Periodontal Treatment Guide

Transcription

1 Periodontal Treatment Guide

2 Teamwork for treating periodontal disease The treatment of patients with periodontal disease should involve the application of standard procedures based on commonly accepted guidelines. This Periodontal Treatment Guide aims to support local networks of general dentists, hygienists and periodontists by providing evidence-based guidelines for diagnosis, referral and treatment options. The Periodontal Treatment Guide is the result of a consensus established by a group of experienced and highly renowned periodontists who based their recommendations for these guidelines on the systematic assessment of the available literature. The final goal of these activities is to help you to improve periodontal therapies in order to restore oral health and help preserve the teeth of the patient. 2

3 The following authors have significantly contributed to the development of the Periodontal Treatment Guide Prof. Dr. med. dent. Anton Sculean, Dr. h.c., M.S., Chairman of Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland Dr. Christina Tietmann, Certified periodontal specialist of the German Society of Periodontology, Private Practice for Periodontology, Aachen, Germany Dr. David Nisand, Lecturer of periodontics at the University of Paris, Private Practice limited to periodontology and implantology, Paris, France Dr. Frank Bröseler, Certified periodontal specialist of the German Society of Periodontology, Private Practice for Periodontology, Aachen, Germany Dr. Holger Janssen, Specialist for periodontology, implantology and restorative dentistry, Private Practice, Berlin, Germany Dr. Mario Roccuzzo, Lecturer in Periodontics at University of Torino and Siena. Private Practice limited to Periodontics and Implantology, Torino, Italy Dr. Markus Schlee, Lecturer for periodontics and implantology at the Steinbeis University, Berlin and DIU, Dresden, Germany. Private practice limited to periodontology and implantology, Forchheim, Germany Prof. Dr. Nick Donos, DDS, MS, FHEA, FDSRCSEngl, PhD., Head & Chair of Periodontology, Director of Research, UCL-Eastman Dental Institute, Department of Periodontology, London, United Kingdom 3

4 Periodontal treatment BPE Periodontally healthy patient EVALUATION BPE 3 4 Patient with periodontal disease HYGIENE BPE 3 4 Patient with periodontal disease SURGERY Legend BPE Basic Periodontal Examination PPD Probing Pocket Depth FMPS Full Mouth Plaque Score BOP Bleeding on Probing GTR Guided Tissue Regeneration SRP Scaling and Root Planing 4

5 Periodontally healthy patient ORAL CHECK! TO CHECK MAINTENANCE PHASE Oral hygiene Tobacco consumption Periodontal status Furcation involvement X-ray status General health TO DO Oral hygiene motivation Instruction Disinfection EVALUATION PPD 4 mm FMPS 20% BOP 20% Successful Not successful Click here PROPHYLAXIS Preventive long-term care 5

6 Patient with periodontal disease SYSTEMIC PHASE AND PERIODONTAL DIAGNOSIS! TO CHECK Oral hygiene PPD 4 mm FMPS 20% BOP 20% EVALUATION Moderate chronic periodontitis PPD 6 mm without intrabony defect Furcation involvement (class I) Severe chronic periodontitis or aggressive periodontitis PPD > 6 mm with intrabony defect with furcation involvement (class II or class III) Tobacco consumption Periodontal status Furcation involvement X-ray status General health (systemic diseases, e.g. diabetes, circulatory problems, etc.) Stress Pregnancy Consider also the removal of inadequate restorations,optional splinting before surgery, use of microbiologic tests, involvement of general physician and extraction of hopeless teeth. Regarding hopeless teeth the following factors should be considered: bone loss, clinical attachment loss, degree of mobility, endodontic factors, restorative factors, anatomy and tooth position. Necrotizing periodontitis Periodontitis with systemic disease Special case of periodontitis PPD > 6 mm Profuse bleeding or pus PROPHYLAXIS Preventive long-term care Optionally not via specialist TO DO Refer to a specialist Click here 6

7 Patient with periodontal disease TO DO Motivation for oral hygiene Instruction Plaque control TO DO Non-surgical periodontal treatment i.e. supragingival and subgingival SRP RE-EVALUATION Not successful PPD 4 mm FMPS 20% BOP 20%ATION 2 nd Chance RE-EVALUATION (3 Month) PPD 4 mm FMPS 20% BOP 20%ATION Not successful Successful TO DO Successful Second non-surgical periodontal treatment PROPHYLAXIS Preventive long-term care PROPHYLAXIS Preventive long-term care Click here 7

8 PERIODONTAL SURGERY OF MULTI-ROOTED TEETH WITH FURCATION INVOLVEMENT (Class II and III) PERIODONTAL SURGERY OF SINGLE-ROOTED TEETH OR MULTI-ROOTED TEETH WITHOUT FURCATION INVOLVEMENT (PPD > 6 mm) 8

9 Surgery with furcation involvement (Class II and III) MAXILLA¹ MANDIBLE² Class II Class III Class II Class III Buccal: Straumann Emdogain or GTR Mesial: Straumann Emdogain Resective approach or extraction Straumann Emdogain or GTR either alone or in combination with graft (in buccal defects) or resective approach Tunneling, or resective approach or extraction Distal: Root resection or flap surgery with Straumann Emdogain Click here ¹ Limited evidence for regeneration ² Depending on the local soft and hard tissue characteristics 9

10 Surgery without furcation involvement (PPD > 6 mm) HORIZONTAL BONE LOSS ANGULAR BONY DEFECT Conventional periodontal flap surgery Conservative or resective approach according to site characteristics Site mapping for defect localization, e.g. bone sounding Regenerative surgical technique designed to maintain the interdental soft tissue Intrabony component 3mm SELF-CONTAINED DEFECT NON-SELF-CONTAINED DEFECT Straumann Emdogain or GTR either alone or combined with graft Straumann Emdogain or GTR combined with graft Click here 10

11 Re-evaluation RE-EVALUATION (6 Month) TO DO PPD 4 mm FMPS 20% BOP 20% Closure or improvement to furcation class I Filling of the angular bony defect Post-operative care Successful Not successful Click here PROPHYLAXIS Preventive long-term care TO DO Reconsider diagnosis and treatment plan. Further non-surgical therapy, if necessary. 11

12 Post-operative care (after periodontal surgery) Use of antiseptic oral rinse (e.g % chlorhexidine solution) for 3-6 weeks Optional use of systemic antibiotics Removal of sutures when they are no longer necessary for wound stability (usually after days) No brushing in the operated area for at least 2-3 weeks, professional post-operative care once a week (about 30 min) After 3 weeks gentle brushing of the buccal and lingual tooth surface with a wiping technique No sulcus or interproximal tooth cleaning for at least 3-4 weeks post-op/until stable or interproximal conditions are achieved Regular check-up by dentist individual recall program 12

13 The following publications have been consulted by the authors Lang, Lindhe, Clinical Periodontology and Implant Dentistry (5th ed.) 2008(2) Lang et al., Qualitätssicherung in der Parodontologie. Interdisziplinäre Fortbildungswoche IWF zur Qualitätssicherung in der Zahnmedizin der Schweizerischen Zahnärzte-Gesellschaft SSO, 1999 Saxer UP, Muhlemann HR, Motivation and education. SSO Schweiz Monatsschr Zahnheilkd 1975, 85, Lang N, Tan WC, Krähenmann MA, Zwahlen M, A systematic review of the effects of full-mouth debridement with and without antiseptics in patients with chronic periodontitis. 6th European Workshop on Periodontology 2008, Feb, Ittingen, Thurgau, Switzerland. Heitz Mayfield LJA, Trombelli L, Heitz F, Needleman I, Moles D, A systematic review of the effect of surgical debridement vs. non-surgical debridement for the treatment of chronic periodontitis. J Clin Periodontol 2002, 29 (3) Herrera D, Alonso B, Leon R, Roldan S, Sanz M, Antimicrobial therapy in periodontitis: the use of systemic antimicrobials against the subgingival biofilm. 6th European Workshop on Periodontology 2008, Feb, Ittingen, Thurgau, Switzerland. Gaunt F, Devine M, Pennington M, Vernazza C, Gwynett E, Steen N, Heasman P, The cost-effectiveness of supportive periodontal care for patients with chronic periodontitis. 6th European Workshop on Periodontology 2008, Feb, Ittingen, Thurgau, Switzerland. Schwarz F, Aoki A, Becker J, Sculean A, Laser application in non-surgical periodontal therapy: a systematic review. 6th European Workshop on Periodontology 2008, Feb, Ittingen, Thurgau, Switzerland. Claffey N, Nylund K, Kiger R, Garrett S, Egelberg J, Diagnostic predictability of scores of plaque, bleeding, suppuration and probing depth for probing attacment loss. 3.5 years of observation following initial periodontal therapy. J Clin Periodontol 1990, 17 (2) Eberhard J, Jervoe-Storm PM, Needleman I, Worthington H, Jepsen S, Full-mouth treatment concepts for chronic periodontitis: a systematic review, J Clin Periodontol 2008, 35 (7) Lang N et al., A systematic review of the effects of full-mouth debridement with and without antiseptics in patients with chronic periodontitis, J Clin Periodontol 2008, 35 (8) Quirynen M, Mongardini C, de Soete M, The role of chlorhexidine in the one-stage full-mouth disinfection treatment of patients with advanced adult periodontitis. J Clin Periodontol 2000, 27 (8) Swierkot K, Flores de Jacoby L, Mengel R et al., One-stage full-mouth disinfection versus quadrant and full-mouth root planing, J Clin Periodontol 2009, 36, (3) Quirinen M et al., Benefit of one-stage fullmouth disinfection is explained by disinfection and root planing within 24 hours: a randomized controlled trial. J Periodontol, 33, (9) Wang D et al., Antibody response after single-visit full-mouth ultrasonic debridement versus quadrant-wise therapy. J Clin Periodontol 2006, 9, Lindhe J et al., Special issue of the Journal of Clinical Periodontology on Enamel Matrix Proteins. J Clin Periodontol 1997 Sep. 24(9). Bosshardt D et al., Effects of enamel matrix proteins on tissue formation along the roots of human teeth. J Periodontol. Res 2004, 40, 158. Heijl, Heden et al., Enamel matrix derivative (Straumann Emdogain) in the treatment of intrabony periodontal defects. J Clin Periodontology 1997; 24; Pontoriero et al., The use of barrier membranes and enamel matrix proteins in the treatment of angular bone defects. J Clin Periodontol. 1999; 26(12): Heden, Wennström et al., Five-Year Follow-Up of Regenerative Periodontal Therapy with Enamel Matrix Derivative at Sites with Angular Bone Defects. J Periodontol 2006; Sculean et al., Treatment of Intrabony Defects With an Enamel Matrix Protein Derivative or Bioabsorbable Membrane: A 8-Year Follow-Up Split-Mouth Study. J Periodontol 2006; 77(11), McGuire MK, Nunn M, Evaluation of Human recession defect treated with coronally advanced flaps and either Enamel Matrix Derivative or Connective Tissue. J Periodontol 2003; 74: McGuire MK, Cochran DL, Evaluation of Human recession defect treated with coronally advanced flaps and either Enamel Matrix Derivative or Connective Tissue. J Periodontol 2003; 74; Cueva MA, Boltchi FE, Nunn ME, Rivera-Hidalgo F, Rees T, A comparatitive study of coronally advanced flaps with and without the addition of enamel matrix derivative in the treatment of marginal tissue recession. J Periodontol 2004 Jul; 75(7): Castellanos A, de la Rosa M, de la Garza M, Caffesse RG, Enamel matrix derivative and coronal flaps to cover marginal tissue recessions. J Periodontol Jan; 77(1):7-14 Jepsen, Meyle et al., A randomized clinical trial comparing enamel matrix derivative and membrane treatment of buccal Class II furcation involvement in mandibular molars. Part I: Study design and results for primary outcomes. Part II: secondary outcomes. J Periodontol. 2004, Aug; 75(8): Meyle, Jepsen et al., A randomized clinical trial comparing enamel matrix derivative and membrane treatment of buccal Class II furcation involvement in mandibular molars. Part I: Study design and results for primary outcomes. Part II: secondary outcomes. J Periodontol. 2004, Sep; 75(9): Lindhe J et al., Special issue of the Journal of Clinical Periodontology on Enamel Matrix Proteins. J Clin Periodontol 1997 Sep. 24(9). Bosshardt D et al., Effects of enamel matrix proteins on tissue formation along the roots of human teeth. J Periodontol. Res 2004, 40, 158 Cortellini P, Tonetti MS, Microsurgical approach to periodontal regeneration. Initial evaluation in a case cohort. J Periodontol 2001,72, De Sanctis M, Zucchelli G, Clauser C, Bacterial colonization of barrier material and periodontal regeneration. J Clin Periodontol 1996, 23, Esposito M, Grusovin MG, Coulthard P, Worthington HV, Enamel matrix derivative (Emdogain) for periodontal tissue regeneration in intrabony defects. Cochrane Database Syst Rev 2005, CD

14 Exclusion of liability for statements and recommendations of the authors: The statements and recommendations published in this Periodontal Treatment Guide have been systematically assessed and carefully selected by the publisher of the Periodontal Treatment Guide (Institut Straumann AG, Basel). The statements and recommendations in every case reflect the opinion of the authors and therefore do not necessarily coincide with the publisher s opinion. Nor does the publisher guarantee the completeness or accuracy and correctness of the statements and recommendations published in the Periodontal Treatment Guide. The information given in the Periodontal Treatment Guide cannot replace a dental assessment by an appropriately qualified dental specialist in an individual case. Any orientation to statements and recommendations published in the Periodontal Treatment Guide is therefore on the dentist s responsibility. The statements and recommendations published in the Periodontal Treatment Guide are protected by copyright and may not be reused, in full or in part, without the express consent of the publisher. International Headquarters Institut Straumann AG Peter Merian-Weg 12 CH-4002 Basel, Switzerland Phone +41 (0) Fax +41 (0) Institut Straumann AG, All rights reserved. Straumann and/or other trademarks and logos from Straumann mentioned herein are the trademarks or registered trademarks of Straumann Holding AG and/or its affiliates /en/A/00 12/17