Case presentation of periodontology
Anamnesis
What is the main
problem of the patient?
(for example: breath
malodor, bleeding by the
toothbrushing, pain…)
How long has he/she had
it?
Basic anamnesis
(important questions during examination)
Have you ever had endocarditis/ rheumatic fever?
Coronary and heart disease?
Allergy?
Haemorrhagic disease?
Hepatitis?
Diabetes?
Tumors?
Medicine taken?
Dental anamnesis
(some questions about the patient’s dental
habits)
How often does he go to the dentist?
Has he had ortodontics/endodontics
treatment?
How old his/her denture?
Has he had bleeding after teeth
extraction?
Last x-ray picture?
Bad oral habit?
Last SRP?
How often does he brush his/her
teeth?
Does he use dental floss?
Clinical examination
Extraoral
See the whole patient
Systemic examination
Inspection, palpation
Describe abnormal lesions
Intraoral examination
Oral epithelium
Color, ulcer, tumor
Examination of the teeth
Missing tooth
Abrasion, carries, filling
Crown, bridge
Tooth sensitivity test
Examination of the gingiva
Clinical sings of gingival
inflammation
Recession/hyperplasia
Bleeding index (%)
Plaque index (%)
Calculus (subjective) + ++
+++
Pocket depths registration
Clinical attachment loss
Assessment of furcation involvement
Degree 1: horisontal bone
destruction not exceeding
1/3 of the width of the
tooth
degree 2: > 1/3 but not total
Degree 3: ”through and
through” destruction
Tooth mobility
Degree 1: 0.2-1mm horizontal
Degree 2: >1mm horizontal
Degree 3: vertical
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Radiographic analysis
Horisontal/vertical
bone loss
Periodontal diagnosis for the single tooth
diagnosis criteria
Periodontitis levis Horisontal loss < 1/3 of Bleeding on probing
the root length
Periodontitis gravis Horisontal loss > 1/3 of Bleeding on probing
the root length
Periodontitis Vertical loss
complicata Interdental craters
Furcation involvement
2/3
Decisions related to treatment
sequencing
The periodontal treatment plan
Primary goal is elimination of gingival and periodontal
inflammation and correction of the conditions that
cause it
Assessment phase: data collection and needed care for
immediate treatment needs (emergency dental care)
Nonsurgical periodontal therapy phase: it includes
dental hygiene care and patient educational measures
(and measures to minimize the impact of local factors)
Surgical therapy phase: it includes may needed
periodontal surgery and placement of dental
implants.
This phase of treatment is not needed for all
patients!
Restorative therapy phase: it includes placement of
dental restorations and replacement of missing
teeth by fixed or removable prostheses.
Periodontal maintenance phase:
by the dental team/by the patient
to keep periodontitis from recurring
The objective of the maintenance phase is to
maintain the teeth functioning throughout life of the
patient
Phases of treatment
”Irrational-to-treat” teeth
Periodontal
Recurrent periodontal abscesses
Periodontic-endodontic lesions
Attachment loss to the apex
Endodontal
Root perforation in the apical half of the root
Periapical pathology in the presence of obturating post
and core
”Irrational-to-treat” teeth II.
dental
Long fracture of the root
Oblique fracture in the middle third of the root
Caries lesions that extend into the root canal
functional
3rd molars without antagonists
Questionable prognosis
Periodontal
Furcation involvement
Angular bone defects
Horisontal bone loss involving> 2/3 of the root
Endodontal
Incomplette root canal therapy
Periapical pathology
Presence of voluminous posts/screws
Dental
Excensive root caries
What we need for the case presentation
X-ray pictures about the teeth
Periodontal chart
Plaque/gingivitis index
Intraoral pictures
Alternatives for treatment
