Treatment options in periodontics: non-surgical therapy
21716 Views - Apr 2017Download PDF
In Periodontics, the fundamental goal is to assess the correct diagnosis in order to plan a custom treatment schedule. Different treatment plans can be drawn according to the final result to be achieved: the non-surgical therapeutic option can achieve extraordinary results and guarantee maintenance of natural dentition in the long term.
A 55 years old male patient presented with class 1 occlusion, tooth mobility, horizontal and angular bone defects with furcation involvement and signs of gingival inflammation.
Img. 3 Radiographic examination was carried out at the beginning of therapy and followed-up for 16 years. At time zero, the patient had intact dentition, meaning no caries, BOP at many sites, considerable mobility of all dental elements, deep pockets, angular and horizontal bone defects and furcation involvement. In images 1, 2 and 3 we can see the evolution through the follow-up time for the different oral sextants.
Img. 4 - Frontal picture. Clinical pictures show how in non-surgical therapy dedication, recalls can make a difference in the patient’s health while preserving dentition. After 16 years of nonsurgical therapy and periodontal maintenance alone, the patient has an intact dental arrangement, no caries, and has gained stability of the teeth despite furcation involvement and considerable bone resorption.
Img. 5 - Posterior areas. Clinical pictures after 16 years of non-surgical therapy show gingival recessions, loss of papillae, abrasions, chipping and discoloration of the tooth surfaces, and presence of diastemata. Slight bleeding of the gingival margin is due to the fact that the photograph was taken right after a session with the dental hygienist. The patient is satisfied with the treatment and has no esthetic concerns. Health and function have been restored and maintained over the course of the years while the esthetic appearance remained practically unchanged.
ConclusionsThough the non-surgical treatment is apparently the simplest therapeutic modality, it requires the greatest dedication, meaning time, focus and specific skills of the operator and the whole dental team.
- Chambrone L, Chambrone D, Lima LA, Chambrone LA. Predictors of tooth loss during long-term periodontal maintenance: a systematic review of observational studies. J Clin Periodontol. 2010 Jul;37(7):675-84. Epub 2010 May 26. Review.
- Berglundh T, Krock B, Liljenberg E, Westfelt E, Serino G, Lindhe J. The use of metronidazole and amoxicillin in the treatment of advanced disease. A Prospective, controlled, clinical trial. J Clin Periodontol 1998 May; 25(5):354-62.
- Nyman S, Lindhe J, Ericsson I. The effect of progressive
- Tooth mobility on destructive periodontitis in the dog. J Clin Periodontol. 1978 Aug;5(3):213-25.
- Waerhaug J. The angular bone defect and its relationship to trauma from occlusion and downgrowth of subgingival plaque. J Clin Periodontol. 1979 Apr;6(2):61-82.
- Waerhaug J. The infrabony pocket and its relationship to trauma from occlusion and subgingival plaque. J Periodontol. 1979 Jul;50(7):355-65.
- Badersten A, Nilveus R, Egelberg J. Effect of nonsurgical periodontal therapy. II. Severely advanced periodontitis. J Clin periodont. 1984 Jan; 11(1):63-76.
- Badersten A, Nilveus R, Egelberg J. Effect of nonsurgical periodontal therapy. III. Single versus repeated instrumentation. J Clin Periodontology 1984 Feb;11(2): 114-24.
- Isidor F, Karring T, Attstrom R. The effect of root planing as compared to that of surgical treatment. J Clin Periodiotol. 1984 Nov;11(10):669-81.