TREATMENT OF PERIODONTAL DISEASES. Popovich Ivan Yurevich Ph. D, assistant of department

Transcription

1 TREATMENT OF PERIODONTAL DISEASES Popovich Ivan Yurevich Ph. D, assistant of department

2 Main principles of treatment of periodontitis and periodontosis General Комплексное Complex Local Therapeutic Surgical Somatic diseases Type of disease Acute Associated Differentiated Individual Prosthetic Physiotherapy Severity level Immunobiological status Chronic Stabilization Course, periodically repeated

3 LOCAL TREATMENT OF PERIODONTAL DISEASES Orthopedic Surgical Orthodontic

4 Scheme of local therapeutic treatment of periodontal diseases 1. Professional hygiene of oral cavity. 2. Elimination of local etiologic factors: restoration of old bad fillings; filling of carious cavities; renewing of contact points between the teeth. 3. Medicinal treatment (using medicines for elimination of symptomatic gingivitis).

5 Main stages of professional hygiene Performing conversation with patient about required professional hygiene of oral cavity Teaching the patient for oral hygiene rules Performing the procedure of professional oral hygiene Removing of all dental deposits and performing of curettage Finishing and polishing of crown and root surfaces

6 Methods of plaque and calculus removing Physical (device) method MANUAL APPARATUS Chemical method Combined method

7 Instruments for removing of calculus and curettage of periodontal pockets: Spoon excavators; Gingival trimmers; Spoon curettes and curettes

8 Stages of instrumentation removing of dental calculus Local using of antiseptic solutions ; Local anesthesia (if need) Removing of dental calculus from different teeth surfaces with different types of scales and curettes; Polishing of hard teeth tissues with brushes, rubber cups, wood polishers, polishing cups and special abrasive pastes Application preparation for prevention of development caries and decrease caries

9 Instrumentation removing of dental calculus Polishing of hard teeth tissues with brushes, rubber cups, wood polishers, polishing cups and special abrasive pastes ( Detartine Septodont, Cleanicdent Hawe Neos Dental, Nupro Dentsplay), Polident VladMiVa and other)

10 Instrumentation removing of dental calculus Application preparation for prevention of development caries and decrease caries

11 Advantages of manual methods Absent special contraindication to use Wide range of instrument for different areas The formation of a smooth surface

12 Disadvantages of manual methods Hard use of instruments, dependence of the quality of the treatment manual skills Low efficiency in areas with complex anatomic relief Surface damage restorations, prosthetic The need for constant sharpening and rapid wear Long time of work Agressive of work

13 Physical apparatus method of removing of dental deposits: Air abrasive (powder-flow) devices; Low-frequency sonic scalers (pneumoscalers); Magnetostrictious ultrasonic scalers; Piezo-electric (piezo-ceramic) scalers; System Vector

14 Removing of dental plaque with air- abrasive (powder-flow ) device

15 Low-frequency sonic scalers (pneumoscalers) DIAPASON OF FREQUENCY 2-8 KHz CREATE ELIPSOID OSCILLATORY MOVEMENTS CAN BE CONNECTED TO THE PLACE OF HANDPIECE

16 Magnetostrictious ultrasonic scalers; DIAPASON OF FREQUENCY KHz ELIPSOID MOVEMENT

17 PEZOELLECTRIC SCALLERS Ultrasonic device Mini-Piezon (EMS, Swiss) for removing of dental calculus RECIPROCATION MOVEMENT Ultrasonic device Piezon Master 600 (EMS, Swiss) for removing of dental calculus DIAPASON OF FREQUENCY KHz

18 Main benefits for removing of dental deposits with sonic and ultrasonic devices: Reduction of dentist s working time; Maximum cleaning of periodontal pockets; Reduction of microflora in periodontal pockets for 25%; Relative painless procedures; Comfort for the patient

19 Main disadvantages of removing of dental deposits with sonic and ultrasonic devices: Appearance of aerosol cloud, containing the big amount of microorganisms; Risk of dentist and assistant infection; Risk of injury of hard teeth tissues and pulp, also soft tissues with wrong using of devices; Required frequent changing of dental mask; Presence of contra-indication for using of sonic and ultrasonic scalers:

20 Contraindications for using of sonic and ultrasonic scalers: Implanted cardio-stimulator (pace makers); Localized ostheomyelitis; Malignant tumors; In case of prescripted immune-depression and cortico-steroid therapy; Acute infection diseases; Severe level of diabetes mellitus; Injuries of oral mucosa

21 Working guide for using of sonic and ultrasonic scalers: Do not use device without water supply; Perform procedures without excessive pressure; Do not put sharp end of tip athwart the tooth axis; Necessary to use protection glasses, mask, gloves

22 Vector system Removed of dental plaque and non surgical method of treatment periodontal diseases

23 Chemical method of removing of soft and mineralized dental deposits Perform application of 50% organic acids for min. with the aim of softening of dental calculus; Gargling of oral cavity with 2% sodium bicarbonate sol. (feeding soda); Perform remineralizing therapy

24 Medical drug treatment Ways of local using of medicines: Gargling; Mouth washes; Irrigation; Applications; Instillations; Injections; Medical bandages; physiotherapeutic methods (electrophoresis, phonophoresis, magnetophoresis, etc.)

25 Medical drug treatment Local using of antiseptic solutions 4-5 TIME IN DAY DAYS Mouth washes

26 Medical drug treatment Local anesthesia (application on the gum)

27 Medical drug treatment Local anesthesia (infiltration)

28 Medical drug treatment Antinflammatory drug APPLICATION ON THE GUM 2-3 TIMES DAILY DAYS

29 Medical drug treatment ENZIME PREPARATION APPLICATION ON EROSION SURFACE WITH PLAQUE TO HELP THE REMOVED OF PLAQUE

30 Medical drug treatment PREPARATION FOR SCLEROTIC THERAPY FOR TREATMENT HYPERTROPHIC GINGIVITIS 20% solution of resorcini 3% solution of chlorhexidine Entrance in periodontal pockets On 20 min. day about Mixture with novocaini 1:2

31 Medical drug treatment STIMULATIVE LOCAL IMMUNITY PREPARATIONS 6-8 TAB. IN DAY 6-12 DAYS (Sublingual)

32 Medical drug treatment KERATOPLASTIC PREPARATIONS AFTER ACUTE PERIOD APPLICATION ON THE GUM 4-5 TIME IN DAY 5-7 DAYS

33 Medical drug treatment KERATOPLASTIC PREPARATIONS APPLICATION ON THE GUM 4-5 TIME IN DAY 5-7 DAYS

34 Types of local surgical interventions at periodontitis: Curettage of periodontal pockets: - closed; - opened; - cryocurettage; - vacuum-curettage; Gingivotomy; Gingivectomy; Flap operations; Incisions of periodontal abscesses; Extraction of teeth

35 Local surgical treatment of periodontitis Indications Methods of treatment Severity level Depths of periodontal pockets Features of clinical current Curettage Closed І,ІІ Until 3-4 mm Gums are dense, no bone pockets Opened ІІ Until 4-5 mm Hypertrophy of gums Cryocurettage ІІІ 5-7 mm Expressed hypertrophy of gums, growth of granulations in periodontal pocket Vacuum-curettage ІІІ More than 7 mm Appearance of periodontal abscesses Gingivotomy ІІ, ІІІ, More than 4-5 mm Appearance of deep periodontal pockets Gingivectomy ІІ, ІІІ More than 4-5 mm Expressed hypertrophy of gums Flap operations ІІ, ІІІ More than 5 mm Teeth mobility of ІІ-ІІІ level, resorbtion of interalveolar laminas more than 1/2 of root length

36 Local prosthetic treatment of periodontitis and periodontosis Methods of treatment Selective smoothing of teeth Indications Traumatic occlusion Aims of treatment Distribution of masticatory pressure for all occlusal line Splinting: -temporary; -Semi-permanent armatured -permanent Pathological teeth mobility - Elimination of pathological mobility of teeth; - Prevention of teeth displacement Rational prosthetic measures Bad quality prosthetic appliances Elimination of local (extrinsic) factors

37 Main principles of selective preparation of teeth at traumatic occlusion Traumatic occlusion is defined with carbon paper of wax strip; Preparation (finishing) of hard tissues has to be done in the measures of enamel layer; After each finishing it is required to make additional polishing of hard teeth tissues with further prescription of remineralizing therapy; Finishing of occlusal surface is not recommended to perform at the teeth, that hold interalveolar height; Teeth-antagonists in central occlusion must save the contact points

38 Splinting association of a few or all the teeth with pathological mobility in one block with the aim of its immobilization Type of splinting Terms of duration Aim of splinting Temporary 1 day 1 month Establishing the conditions for normal functioning of Semi-permanent 1 month 1 year periodontium for the period of therapeutic or surgical treatment Permanent More than 1 year Longtime immobilization of mobile teeth

39 Main requirements for splints: Splinting must fix all the mobile teeth firmly; Equally distribute the masticatory pressure onto abutments; Do not make hard therapeutic and surgical procedures; Do not traumatize Oral mucosa; Must have good esthetic properties; Must be simple in performing; Do not decrease the hygienic rate

40 Main types of temporary and permanent splintings Plastic splinting of composites; Ligature splintings, covered with composite; Parapulpal and pulpal П type splints (staples); Glass-fiber splints, fixed with light-cured composite material (armature-adhesive technology): - on the base of non-organic matrix ( Glass Span, USA, Fiber Splint, Swiss); - on the base organic matrix ( Ribond, Connect USA)

41 PHYSIOTHERAPY Branch of medicine that studies the effects on the body of natural and artificially created physical agents used to treat patients, disease prevention and medical rehabilitation

42 PHYSIOTHERAPY ADVANTAGES UNIVERSAL ACTION USE FOR DIFFERENT DISEASES PHYSIOLOGICAL CAUSES MILD COMPENSATORY-ADAPTIVE REACTIONS ABSENCE TOXIC, ALLERGIC EFFECT, SIDE EFFECTS NONINVASIVE ACTION GOOD COMBINE WITH MEDICAL DRUG INCREASE ACTION OF MEDICAL DRUG ACCESS AND NON EXPENCIVE

43 Physiotherapy of periodontal diseases Hydrotherapy; Balneotherapy (using of mineral water); Paraffin therapy; Ozokerit therapy; Massage (auto-massage, vibration massage, vacuum-massage, hydro-massage); Reflex-therapy; Illumination therapy (infrared, laser, ultraviolet illumination); Electrotherapy (electrophoresis, diadynamotherapy, fluctuorization, d Arsonvalization, UHF therapy), etc.

44 PHYSIOTHERAPY TUMORS CONTRAINDICATIONS SYSTEM BLOOD DISEASES AND, BLEEDING IN THE BODY DECOMPENSATION OF CARDIOVASCULARY AND RESPARATORY SYSTEM INTOLERANCE FOR PHYSICAL FACTORS CACHEXIA ATEROSCLEROSIS OF BRAIN VESSELS ACUTE INFECTION PROCESS PREGNANCY

45 GENERAL TREATMENT OF PERIODONTAL DISEASES ANTIBIOTICS PRINCIPlES USE OF - Determining sensitivity to the drug - Use drugs in bactericidal antibiotic doses - use full course of treatment

46 GENERAL TREATMENT OF PERIODONTAL DISEASES ANTIBIOTICS GROUP OF TETRACYCLINE HAVE ANTIBACTERIOAL ACTION AND INHIBITORY ACTION ON KOLAGENAZA - BASIC FACTOR WHICH DESTROYED PERIODONTAL TISSUES

47 GENERAL TREATMENT OF PERIODONTAL DISEASES ANTIBIOTICS GROUP OF TETRACYCLINE DOSAGE 100 MG IN DAY 14 DAYS Effective in Juvenile Periodontitis

48 GENERAL TREATMENT OF PERIODONTAL DISEASES ANTIBIOTICS GROUP OF TETRACYCLINE DOSAGE MG 2-3 TIME IN DAY 7-12 DAYS It has the MOST wide spectrum of action

49 GENERAL TREATMENT OF PERIODONTAL DISEASES ANTIBIOTICS GROUP OF LINCOSAMIDES - ACCUMULATES IN BONE - VERY ACTIVE FOR ANAEROBIC AND AEROBIC MICROFLORA DOSAGE MG 3-4 TIMES DAILY 5-10 DAYS

50 GENERAL TREATMENT OF PERIODONTAL DISEASES ANTIBIOTICS GROUP OF LINCOSAMIDES - ACCUMULATES IN GINGIVAL FLUID - HAVE SMALL TOXIC EFFECT AND HIGH EFFECTIVE DOSAGE 200 ML 4 TIMES DAILY 5-10 DAYS

51 GENERAL TREATMENT OF PERIODONTAL DISEASES ANTIBIOTICS GROUP OF CEPHALOSPORINE RESERVE DRUG - VERY EFFECTIVE FOR PERIODONTITIS, - WHICH HAVE HIGH PROGRESSIVE COURSE DOSAGE 1000 MG 1 TIMES DAILY 5 DAYS

52 GENERAL TREATMENT OF PERIODONTAL DISEASES ANTIBIOTICS AUGMENTIN COMBINE AMOXICILIN AND CLAVULANIC ACID - MODERN PREPARTION - VERY EFFECTIVE FOR PERIODONTITIS, DOSAGE 625 MG 2 TIMES DAILY 7-14 DAYS

53 GENERAL TREATMENT OF PERIODONTAL DISEASES ANTIPROTOZOAL METRONIDAZOL VERY EFFECTIVE FOR ANAEROBIC MICROFLIRA DOSAGE 500 MG 2-3 TIMES DAILY 8 DAYS

54 GENERAL TREATMENT OF PERIODONTAL DISEASES ANTIFUNGAL PREPARATIONS

55 GENERAL TREATMENT OF PERIODONTAL DISEASES PREPARATIONS WHICH NORMALIZATION OF MICROBIOCENOSIS EUBIOTICS PREBIOTICS Bificol, Lactobacterin, Linex Lactuloza, Inulin PROBIOTICS SYNBIOTICS Enterol, Biosporun Bactulin, Probiovit

56 GENERAL TREATMENT OF PERIODONTAL DISEASES ANTIINFLAMMATORY PREPARATIONS EFFECTS - Antiinflammatory ( after 3-4 days of use) - Analgesic ( 0,5-2 hours after use) - Antipyretic (0,5-2 hours after use) - Anticoagulative - Hyposensebilizative DOSAGES 1 tab. 3-4 time in day

57 GENERAL TREATMENT OF PERIODONTAL DISEASES INDICATIONS ANTIINFLAMMATORY PREPARATIONS - ALL FORMNS OF GINGIVITIS AND PERIODONTITIS CONTRAINDICATIONS - Idiosyncrasy - Pregnancy, lactation - Ulcer of stomach - Diseases of liver and kidney - Decompensation of cardiovascular system - Glaucoma

58 GENERAL TREATMENT OF PERIODONTAL DISEASES HYPOSENSIBILIZING (ANTIHISTAMINE) I GENERATION - HAVE SEDATIVE EFFECT

59 GENERAL TREATMENT OF PERIODONTAL DISEASES NDICATIONS - exacerbation of periodontitis, periodontitis with allergic component of change body reactivity - Hyperergic way of acute periodontal diseases HYPOSENSIBILIZING (ANTIHISTAMINE) II-III GENERATION

60 GENERAL TREATMENT OF PERIODONTAL DISEASES NDICATIONS - Decrease nonspecific protective factors - Initial stages of diseases - Pathological process in young age - In remission (after removed of acute inflammatory picture) IMUNOMODULATION DRUG

61 GENERAL TREATMENT OF PERIODONTAL DISEASES IMUNOMODULATION DRUG CONTRAINDICATIONS GENERAL LOCAL - High reactivity of the body - Tumors - Hormonal dischange - Pregnancy, menstruation, climax - Hard general diseases - Allergic reactions - Active process in periodontal tissues - Presence granulations in periodontal pockets - After curretage

62 GENERAL TREATMENT OF PERIODONTAL DISEASES IMUNOMODULATION DRUG HERBAL ORIGIN 20 drops 3 times daily 10 days 1 tea spoon in day 5-6 days 1 caps in morning 1-3 month 1 tab. in day 2 month

63 GENERAL TREATMENT OF PERIODONTAL DISEASES IMUNOMODULATION DRUG BEEKEEPING PRODUCTS 1 tab. 3 times daily, 15 days 2 dr. 2-3 times daily 2-3 weeks

64 GENERAL TREATMENT OF PERIODONTAL DISEASES IMUNOMODULATION DRUG ANIMAL ORIGIN 1-2 ml 10 injections 1 ml 5 injections

65 GENERAL TREATMENT OF PERIODONTAL DISEASES IMUNOMODULATION DRUG 1 ml in day each 2-3 days, 3-10 injections 500 mg 3-4 times daily 1 month

66 GENERAL TREATMENT OF PERIODONTAL DISEASES VITAMIN-MINERAL COMPLEX

67 GENERAL TREATMENT OF PERIODONTAL DISEASES PREPARATION OF CALCIUM 1 tab. 2 times in day 1 month 1 tab, in day 2-4 week 1-2 tab. In day 3-6 month

68 DIET THERAPY - Active chewing - Sufficient consumption hard food - Balanced diet - Eating at the same time

69