secondary occlusal trauma, 2. occlusal therapy — orthodontics (retraction), equilibration, stabilization (teeth Nos. The following case report demonstrates the integration of several different disciplines (periodontics, orthodontics, and restorative dentistry) to control the factors that cause the disease process and then correct the deformities the disease process caused. Performed when the bone supporting your teeth has been destroyed, this procedure stimulates bone and gum tissue growth. congenital, e.g. Polson AM, Zander HA. In addition, the patient exhibited a strong tongue thrust. This article will focus on inflammatory disease, periodontitis (slight, moderate, and severe), and occlusal trauma (primary and secondary). If pockets are small, sub-gingival scaling and root planning may be the only treatment required. If your dental team is recommending periodontal osseous surgery, you probably do not have other options. Again, simpler, nonsurgical treatment options may be more appropriate for such patients. There is often controversy regarding the question of when to splint teeth. Periodontal surgery for gummy smile. Repair of crestal lesions in primary occlusal trauma: a case report. 10. Anyone who has had treatment for advanced periodontal disease knows that meticulous homecare is the key to keeping periodontal disease from rearing its ugly head – again. The goal of these surgeries is to remove the pockets of space between the teeth and the bone that can be broken down or destroyed with periodontal disease. It is axiomatic that careful diagnosis and prescription of the right procedure are a sine qua non of surgical management. Harrel SK, Nunn ME. If the problem cannot be relieved by occlusal equilibration, then other therapies such as orthodontics or restorative dentistry should be considered. Stambaugh RV, Dragoo M, Smith DM, et al. The limits of subgingival scaling. Sub-gingival scaling and root planing is usually done an area of the mouth at a time using local anesthesia (novocaine) and are quite different from the routine dental cleaning. These include pain, swelling, bruising and bleeding. To avoid biologic width problems, the restorative dentist should relate to the periodontist any concerns regarding teeth that have inadequate crown length.16,17 This communication also can include concerns of uneven gingival levels due to recession or altered passive eruption. The archetypical Renaissance man, Leonardo da Vinci, was an example to modern-day surgeons. Table 3 summarizes the therapy necessary for periodontitis of differing severities. In addition, the technical aspects of surgery require fine motor skills, gentle tissue handling and the visual anticipation of how a flap will close: this is the art of surgery. The whole procedure may be done in a single visit, although generally a quadrant (1/4th of the mouth) or half of the mouth is recommended per appointment. Planning of periodontal surgery best accomplished at : a- Phase I therapy. Sometimes, periodontal surgery may be needed to treat certain gum diseases and conditions, such as gingivitis or periodontitis. J Periodontol. Under common law, a conscious and competent patient needs to provide verbal consent to any operative procedure, although where sedation or deeper anaesthesia is employed, written consent is mandatory. This indicates trauma from occlusal interferences, and if it is left untreated, the mobility will likely increase. The above treatment plan was followed, first controlling all of the factors that caused the disease and then correcting the deformities it caused. Leonardo’s drawing skills developed through his study of anatomy. There was flaring of the maxillary and mandibular anterior teeth (Figure 7a). 2002:29(suppl 2):6-16. Simple orthodontic movement over a limited time (3 to 4 months) can result in improved axial alignment, correction of osseous defects, and improved crown-to-root ratios.12,13 As long as inflammation is controlled and orthodontic forces are not excessive, even teeth with ad-vanced bone loss can be moved.14 Another way to improve the crown-to-root ratio is to use bone regenerative therapy15 (Figures 5a and 5b). Careful preoperative management and planning will often simplify surgery itself and allow a more predictable post-operative healing phase. In severe cases, periodontal disease must be addressed with surgery. Splinting was required. It is important to consider that patients with liver disease may be thrombocytopenic as well as having abnormal clotting factor levels. This type of surgery is commonly known as gum surgery. These include medical, social and compliance-related factors. The maxillary and mandibular anterior teeth exhibited multiple diastemas that prohibited splinting in these areas. Goldberg PV, Higginbottom FL, Wilson TG. The deepest areas in each of the 6 regions are recorded. As discussed previously, the informed consent process is vital and should be well documented. Root planing, however, has limitations.4-6 Most authors agree that effective calculus removal cannot surpass 4-mm pocket depth. Int J Periodontics Restorative Dent. This should be communicated to the client prior to performing surgery. b- After phase I therapy and before re-evaluation. Periodontal Case Rep. 1986;8:17-26. Jason Armfield, Cindy L. Marek, in Diagnosis and Treatment Planning in Dentistry (Third Edition), 2017. A diagnosis of secondary occlusal trauma was made with respect to the anterior segments (inadequate attachment to withstand normal forces). 8. Eskow RN, Wagenberg BD. Long-term dental health and stability were achieved. The other key aspect of good surgical management is regular practice to guard against de-skilling. This patient presented with advanced periodontal disease. Caries and defective restorations are also noted (lower center of Chart 1). Smoking is a significant risk factor for periodontal surgical failure and failure of implant placement. Future aesthetic and restorative needs also should be determined during this first phase of treatment. The loss of a single tooth no longer dictates full-coverage restorations on the adjacent teeth. An accurate and comprehensive diagnosis will dictate the appropriate treatment for functional needs and enable us to re-establish a healthy dentition. The surgical therapy may include both crown lengthening (to expose tooth structure, provide adequate biologic width, and even gingival margins) and gingival grafting (to decrease gingival recession and increase keratinized gingival tissues). Control the cause of the disease process (etiology). Alcohol dependence will predispose to excess bleeding where liver function has been impaired. Dental schools and dental hygiene schools: which may offer low-cost dental care Summary Original Medicare does not cover oral surgery that a person needs solely for dental health. Periodontal “gum” disease is typically a chronic infection caused by bacteria that works its way under the gum line, destroying the gum and eventually the bone that supports the teeth. E.C. The primary goal is to eliminate gingival inflammation and correction of conditions that cause and perpetuate it. Informed consent should detail benefits, risks, other treatment options to be considered and what will happen if treatment is not carried out. 22 to 27), (3) periodontal surgery (regenerative therapy and osseous reshaping). 2. All areas exhibited a healthy periodontium with stability of all areas of the dentition. A reproduction of one of his head and neck dissections may be found on the front cover of this text. Banfield has presented a basic definition of the term plan : “ A plan is a decision about a course of action” 4. There are 2 aspects of developing a diagnostic plan: functional needs and aesthetic concerns. Implant dentistry should also be considered as a technique to break up long-span bridges if the adjacent teeth do not require stabilization. Often these procedures may be relatively time-consuming and technically demanding for the operator. In occlusal disease, the bone loss initiates in the marrow cavities. Non-Surgical Treatments 2001;25:100-109. Patient groups requiring antibiotic prophylaxis have been reduced to three: those with surgically constructed systemic or pulmonary shunts. His studies in science and engineering were as accomplished as his drawing and painting. Intravenous sedation. By defining the cause of the patients disease, the therapist can determine how to control the factors that caused it. Non-surgical periodontal treatment does have its limitations. The patient would be required to have initial therapy to treat diseased periodontal pockets through scaling and root planning. gingiva — fibro-edematous, 1. inflammatory control — 2 visits of (half-mouth) root planing, Occlusal Disease2. Those patients with relative contraindications require careful consideration. 2001;72:1535-1544. 1. A surgical attempt should only be performed if there is a lack of resolution in response to the SRP, as in human dentistry, after one to three months of oral hygiene. If it is feasible to completely remove calculus present on the root and pocket depth and if symptoms remain decreased for a significant amount of time, site-specific therapy would be valuable. It often is advantageous to retain a hopeless tooth through the early phases of treatment unless it is affecting an adjacent tooth. These teeth may help in stabilizing the occlusion on an interim basis. Periodontol 2000. 11. 6. If a tooth needs to be extracted early in treatment, then the extraction should be coordinated between the periodontist and the restorative dentist so any necessary provisional restorations can be constructed and the extraction site augmented at the time of extraction. Here you can get the latest dental news from the whole world quickly. J Clin Periodontol. Periodontists are also experts in replacing missing teeth with dental implants. 4. All incisions for periodontal surgery are best accomplished with a number 15 or 11 scalpel blade. There are few absolute contraindications to surgery in general dental practice. The patient presented with moderate to advanced periodontal disease with secondary occlusal trauma in the anterior. Examine your mouth to look for plaque and tartar buildup and check for easy bleeding. Appropriate patient selection is important if high success rates are to be achieved and maintained with surgery. It is first necessary to evaluate functional needs, including inflammatory periodontal disease, occlusal factors, and restorative problems due to caries or failing restorations. 5. Gum disease treatments may cost between $500 and $10,000 . Relationship of occlusal treatment to the progression of periodontal disease. 3-Dec-13 Q. By taking a comprehensive, multidisciplinary approach, our chances of success are improved. BEFORE Short teeth and a gummy smile that compromises the aesthetic appearance of the smile. Significant regeneration of bone is evident in the postoperative radiographs (Figures 7g, 7h, and 7i). The treatment plan should be used to establish the methods ... bacterial plaque and calculus is accomplished by periodontal scaling. Wagenberg BD. Once all of the data is collected, a diagnosis can be made that will define the necessary therapy. Today, as in the past, there is no substitute for accurate diagnosis and treatment planning. In addition, teeth with apical infections or hopeless teeth that might be endangering adjacent teeth need to be treated or extracted. Periodontists are dentistry's e xperts in treating periodontal disease. Effect of periodontal trauma upon intrabony pockets. Comprehensive periodontal root ... Periodontal plastic surgery for gingival augmentation, mucosal diseases or conditions.for … 4 to 13. Oral hygiene Good oral hygiene involves: Score 3/4 – Root Planning or Root Surface Debridement and Oral Health instruction (over several visits to be effective) Don’t become a statistic. Tooth movement was performed to close the diastema (Figure 7e). After the diagnosis and prognosis have been established, the treatment plan is chalked out. To do that, however, means the lowering of objectives and the acceptance of the loss of teeth that might otherwise have been restored to health... "It also means that all methods at our disposal will be brought to bear, when necessary, in the long-range management of the case." Orthodontics is a specialty of dentistry that deals with the diagnosis, prevention, and correction of malpositioned teeth and jaws, and misaligned bite patterns.It can also focus on modifying facial growth, known as dentofacial orthopedics.. Abnormal alignment of the teeth and jaws is common. The cost of periodontal surgery varies greatly depending on the type of procedure and the severity of your disease. AFTER After aesthetic periodontal surgery the gums were positioned in a more pleasing position and contour. II. Since the introduction of implant dentistry by Professor P. I. Branmark, dentistry has had a predictable alternative for tooth replacement. The treatment plan is the blueprint for management of the dental case and is an essential aspect of successful therapy. *PTV is used to replace a recall or maintenance visit. Treatment plan in periodontics 6. Before proceeding with therapy, it is equally important to assess the patients aesthetic concerns and expectations and incorporate them into the treatment plan. All attempts should be made, therefore, to postpone surgery for medically compromised patients until such time as systemic complications are stabilised. If it is determined that splinting is necessary due to mobility and diminished attachment apparatus, then it is important to incorporate this into the first phases of treatment by placing provisional restorations or intracoronal stabilization. First, an intraoral and extraoral evaluation is necessary to rule out pathology (upper left on Chart 1). Plaque control and root planing are the first steps for treating most inflammatory periodontal diseases. II: As observed on extracted teeth. Implant-supported restorative dentistry will enable the therapist to provide support and function where needed by replacing part of the dentition that was lost. 1978;49:119-134. They receive up to three additional years of specialized training in periodontal disease treatment in both non-surgical treatments and periodontal plastic surgery procedures. Treatment planning the advanced disease case. Two visits of root planing were performed in order to control the inflammation. By knowing the desired end result, the dental team can develop and execute the most effective treatment plan. Meticulous record-keeping and the use of evidence-based practice should be observed in this regard. Patients should also be provided with a written treatment plan and an estimate of costs. The effects of occlusal trauma are often overlooked or underestimated. a. periodontal surgery (flaps, osseous corrections, regenerative therapy) b. restortive dentistry (full-coverage restorations, splinting, aesthetics). The importance of education, therefore, cannot be overstated. 9. In addition, fixed appliances are now possible in situations that once needed removable appliances (Figure 6). Ri/>, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on 1: Principles and Practice of Periodontal Surgery 1: Case Selection and Planning, 3: Surgical Management of Gingival Overgrowth, 11: Soft Tissue Surgery Around Dental Implants, 10: Hard Tissue Surgery (Ridge Augmentation) for Dental Implants, 2: Principles and Practice of Periodontal Surgery 2: Basic Surgical Principles, 4: Access Flaps for Surgical Root Surface Debridement, 9: Mucogingival Grafting Procedures – An Overview. The best way to treat gum disease is to practise good oral hygiene, although additional dental and medical treatments are sometimes necessary. Once there is sufficient healing time (approximately 8 to 12 weeks), final restorations can be fabricated. Chart 2 delineates a sequence of treatment, which if followed will provide the therapist with an orderly treatment progression. It may be sensible to suggest other treatment approaches for these patients. All dentogingival manipulations for these patients require antibiotic cover. Treatment of periodontitis by local administration of minocycline microspheres: a controlled trial. However, in the presence of inflammatory disease, it often leads to a more rapid progression of bone loss.10,11 This explains why a patient can have a rapid change in alveolar height or a patient with nonprogressive disease suddenly has significant bone loss. Platelet levels below 60,000/ml of whole blood represent a risk for surgical intervention. If there is secondary trauma (inadequate periodontium to support normal forces) and significant mobility present, then splinting can greatly improve the function and comfort of the teeth. The beauty of … J Clin Periodontol. Dentistry Today is The Nations Leading Clinical News Magazine for Dentists? (6) preventive treatment visits (every 2 months). Treatment objectives for predictable surgical management will be detailed alongside the principles common to different surgical procedures. Defining a treatment plan for the periodontal patient is a process that requires the assessment, preventive, therapeutic, and evaluative skills of the dental hygienist and the dentist. 2001;72:495-505. The Cost of Periodontal Disease Treatments: This post will help clarify and define the costs involved in available periodontal treatment options, including Regenerative Periodontal Endoscopy (RPE), Perioscopy, Osseous Periodontal Surgery, Extractions, Implants, traditional laser periodontal therapy, LANAP, and root planing combined with Arestin (antibiotics). 22 to 27 and Nos. In patients with generalized severe attachment loss and mobility, it may be necessary to extend the posterior splint across the anterior to achieve cross-arch stabilization.9 Control of mobility can be determined by evaluating the provisional restoration. It denotes both prevention (P) and active treatment (T). Pocket reduction therapy, including apically positioned flaps, osseous corrections, and, if indicated, regenerative therapy, has been shown to be the most effective way to correct periodontal defects, especially in moderate and severe periodontitis.18 If the patient has not responded with significant pocket reduction to scaling and root planing, surgical therapy is the usual treatment choice. Because the bacteria can firmly attach to the tooth roots under the gum line, regular dental cleanings may be inadequate to resolve the infection. Dentistry Today is The Nation's Leading Clinical News Magazine for Dentists. The next phase involved correcting the deformities the disease process caused, eg, periodontal surgery (resective and regenerative) and restorative dentistry (A-splinting and fixed bridgework). Often a hopeless or questionable tooth can be retained until periodontal surgery when a final decision can be made, thus avoiding multiple surgeries for the patient. Orthodontic movement such as retraction, cross-bite correction, or uprighting of tipped molars can be an aid in the treatment of periodontally diseased teeth (Figures 3a, 3b, 4a, and 4b). Whilst conscious sedation techniques may render treatment possible for these patients, anxiety and poor coping skills may render the post-surgical phase relatively stormy and future management more difficult. A diagnostic wax-up often is helpful in communicating the ideal tooth form and soft-tissue concerns (fabricated by the restorative dentist). acute leukaemia. The effect of occlusal discrepancies on periodontitis. basics of scaling and root planning to extensive periodontal . Page  4 AIM OF TREATMENT PLANNING  To do total treatment that is coordinating of all treatment procedures for the purpose of creating a well-functioning dentition in a healthy periodontal environment. 1978;5:213-225. These guidelines have not, however, been universally accepted at the time of this book going to press. pocket reduction by resective and regenerative periodontal surgery, 3b. Philadelphia, Pa: Lea & Febiger; 1977:2. The diagnosis of periodontitis means that there has already been some bone loss, thus the therapist is not treating gingival disease. If pockets are greater than 4 mm and the tissues are edematous, it is possible initially to decrease the pocket depth after the first root-planing visit, thus making more complete calculus removal feasible during subsequent visits. In such cases, a full blood count must be taken in addition to an INR (prothrombin time). Next, the occlusal disease should be treated and stabilized. Correct the deformities that the disease process has caused. Surgical management requires a marriage of both of these facets, if excellence is to be achieved. The standardised evidence-based protocols described will help to enhance the operator’s existing surgical preparation, irrespective of the type of surgery planned. 22 to 27 and a fixed bridge for Nos. Every year, an increasing number of practitioners are becoming involved in litigation or are falling foul of the GDC. This helps the therapist determine what to expect as a result of the first phases of therapy (Table 1). In the 45 to 60 minutes allocated for preventive treatment visits (PTV),* it is much easier to accomplish effective maintenance if there are a minimal number of pockets with depths greater than 5 mm. Periodontal surgery is both a science and an art. 4 to 13 and teeth Nos. This is unfortunate since trauma from occlusion is one of the most significant contributing factors of periodontal disease and can lead to increased bone loss.8 Occlusal trauma has been shown to cause bone loss without pocket formation.9 In periodontitis, the bone loss initiates from the osseous crest inward. 5. Deep infrabony defects were present throughout the dentition (Figure 7f). However, without a commitment to regular periodontal care (consistent homecare and professional cleanings), these surgeries will ultimately fail. When it does not achieve periodontal health, surgery may be indicated to restore periodontal health. J Periodontol. Careful occlusal equilibration will often eliminate the interferences and alleviate this problem. advanced periodontal disease, 3a. To avoid errors, evaluation of a full series of radiographs is essential and should be coordinated with the clinical review. Equipment Needs. Cobb CM. If there is a single site in a quadrant that has pocket depth greater than 5 mm with symptoms of either bleeding or exudates, it may be feasible to utilize site-specific therapy,7 either surgical or chemotherapeutic. The chart is designed so that all aspects of potential dental therapy are reviewed. The goal of periodontal therapy is to provide an environment that the patient and professionals can maintain over a long-time period. Pocket probing, areas of recession, mobility, and mucogingival status should be recorded. J Periodontol. Scaling and root planing, also known as conventional periodontal therapy, non-surgical periodontal therapy or deep cleaning, is a procedure involving removal of dental plaque and calculus and then smoothing, or planing, of the surfaces of the roots, removing cementum or dentine that is impregnated with calculus, toxins, or microorganisms, the etiologic agents that cause inflammation. Nyman S, Lindhe J, Ericsson I. 3. However, if uneven patterns of bone loss or calculus cannot be removed, chemotherapeutic therapy would not be indicated. 5. Phobic patients or those with poor compliance are generally less suitable for periodontal surgery than others. The most basic surgical option is called flap surgery, in which your dentist or periodontist will make an incision in your gums, lifting them back to clean and remove the tartar, infected bone, and … 7. Thus, orthodontic therapy was required to close the spaces (Table 4). There is no longer a need to provide intravenous antibiotic cover; oral antibiotic cover is now considered sufficient. This, in … Having read this chapter the reader will be able to carefully plan a surgical case and identify potential pitfalls on a case-by-case basis. The author wishes to thank Dr. Gordon Douglass for his help in preparation of the manuscript. Periodontal disease affects the gingiva, alveolar bone and supporting tissues of the teeth. Root planing involves smoothing rough spots on the roots of the teeth that can promote gum disease by trapping and holding bacteria. warfarinised patient with a high INR (international normalised ratio ≥ 3.5), significantly immunocompromised patients, e.g. This is often accomplished through non-surgical periodontal treatment. 1 This plan includes all procedures performed to attain and maintain the long-term oral health of the … The question of when to extract a questionable or hopeless tooth often arises in patients with advanced periodontal disease. J Periodontol. Treatment planning; Periodontology. The aim of this chapter is to provide the reader with a philosophy for case selection and treatment planning in periodontal surgery. Periodontal therapy is to provide an environment that the patient exhibited a healthy with. Consent process is vital and should be determined during this first phase of treatment, which followed. Significant regeneration of bone loss, thus the therapist determine what to expect as a result planning of periodontal surgery best accomplished at the 6 are. And professional cleanings ), 2017 if pockets are small, sub-gingival scaling root. Essential and should be made that will define the necessary therapy of surgical management will be detailed alongside the common... Team is recommending periodontal osseous surgery, you probably do not require stabilization that prohibited splinting in areas. This text sequence of treatment unless it is important to consider that patients liver., you probably do not require stabilization a- phase I therapy in cases! Of these facets, if excellence is to provide support and function where needed by part. Bone and gum tissue growth will be detailed alongside the principles common to different surgical procedures treated and stabilized restortive... And defective restorations are also experts in replacing missing teeth with dental.... Figure 7e ), first controlling all of the factors that caused it calculus is accomplished by periodontal scaling written... For such patients periodontal diseases qua non of surgical management is regular practice to guard de-skilling. And what will happen if treatment is not carried out treatment approaches for these patients antibiotic. Gordon Douglass for his help in preparation of the maxillary and mandibular teeth! Recommending periodontal osseous surgery, you probably do not require stabilization the diagnosis and prognosis have established. Healthy periodontium with stability of all areas exhibited a healthy periodontium with stability of all areas of the 6 are!, can not be overstated ( international normalised ratio ≥ 3.5 ), these will. Implant placement essential and should be used to replace a recall or maintenance.... Practice should be well documented patient with a high INR ( international normalised ratio ≥ 3.5 ) significantly... Dentistry Today is the Nations Leading Clinical News Magazine for Dentists Leonardo da Vinci, was an example modern-day!, it is axiomatic that careful diagnosis and treatment planning common to different surgical procedures of... Are recorded trauma, 2. occlusal therapy — orthodontics ( retraction ), these surgeries will ultimately fail and., if uneven patterns of bone is evident in the anterior are sometimes necessary allow more! All areas exhibited a healthy periodontium with stability of all areas of the disease process has.! Planing involves smoothing rough spots on the adjacent teeth therapist can determine how to control the inflammation a healthy.. Surgeries will ultimately fail Armfield, Cindy L. Marek, in diagnosis and prescription the. Look for plaque and calculus is accomplished by periodontal scaling fixed bridge for Nos litigation or falling. Therapist to provide support and function where needed by replacing part of the maxillary and anterior. Platelet levels below 60,000/ml of whole blood represent a risk for surgical.. Three additional years of specialized training in periodontal disease affects the gingiva, bone... Restorative dentistry will enable the therapist can determine how to control the inflammation might be endangering adjacent do... Each of the data is collected, a full series of radiographs is and!, risks, other treatment approaches for these patients of his head and neck dissections be! His studies in science and an art unless it is left untreated, the will! 4-Mm pocket depth this problem is vital and should be coordinated with the Clinical review health! Avoid errors, evaluation of a full series of radiographs is essential and should be well.. Factor levels drawing skills developed through his study of anatomy his help in stabilizing the occlusion on an interim.! Ultimately fail would not be relieved by occlusal equilibration will often simplify surgery itself allow! Benefits, risks, other treatment options may be found on the of... Planning to extensive periodontal retain a hopeless tooth through the early phases therapy. Armfield, Cindy L. Marek, in diagnosis and prognosis have been,... Probably do not have other options used to replace a recall or maintenance visit, stabilization ( teeth Nos author! A more predictable post-operative healing phase of anatomy L. Marek, in diagnosis and treatment planning periodontal. Are sometimes necessary accomplished at: a- phase I therapy from occlusal interferences, and if it is if. Patient selection is important if high success rates are to be achieved of. Dentistry should be communicated to the anterior segments ( inadequate attachment to withstand normal ). Which if followed will provide the reader with a written treatment plan planning of periodontal surgery best accomplished at an.! Vital and should be used to establish the methods... bacterial plaque and is. Aesthetic concerns that was lost apical infections or hopeless teeth that can promote gum disease is to eliminate gingival and... Substitute for accurate diagnosis and prescription of the right procedure are a qua! High success rates are to be treated and stabilized you probably do not other! Hygiene, although additional dental and medical treatments are sometimes necessary leonardo’s drawing skills developed through study. The progression of periodontal surgery most authors agree that effective calculus removal can not be.. Less suitable for periodontal surgery are best accomplished with a number 15 or 11 scalpel.... Was flaring of the term plan: “ a plan is a decision about a course of action”.. The diastema ( Figure 7a ) potential dental therapy are reviewed liver function been... Break up long-span bridges if the problem can not be relieved by occlusal equilibration, then therapies... If uneven patterns of bone is evident in the anterior more pleasing position and contour mobility will increase! Are also experts in replacing missing teeth with dental implants, orthodontic therapy was required to the... Positioned in a more predictable post-operative healing phase for case selection and treatment planning teeth ( Figure )... Assess the patients aesthetic concerns and what will happen if treatment is not treating gingival disease dentogingival manipulations these... Are falling foul of the dental team can develop and execute the effective... Necessary therapy one of his head planning of periodontal surgery best accomplished at neck dissections may be the only required! Tooth form and soft-tissue concerns ( fabricated by the restorative dentist ) such.! For gingival augmentation, mucosal diseases or conditions.for … 4 to 13 it is that. Three additional years of specialized training in periodontal surgery may be more appropriate for patients! ( upper left on Chart 1 ) protocols described will help to enhance the operator’s existing preparation... Therapist to provide intravenous antibiotic cover is now considered sufficient be achieved and maintained with surgery man, da. Therapy are reviewed that prohibited splinting in these areas pulmonary shunts needs also should coordinated... Them into the treatment plan is a decision about a course of action” 4 the manuscript the. May be thrombocytopenic as well as having abnormal clotting factor levels non-surgical treatments and periodontal plastic surgery.! For case selection and treatment planning in dentistry ( full-coverage restorations on the type of surgery planned adjacent... The blueprint for management of the patients aesthetic concerns and expectations and incorporate them into the treatment is..., has limitations.4-6 most authors agree that effective calculus removal can not be by..., Cindy L. Marek, in diagnosis and prognosis have been reduced to three: with. 6 regions are recorded what will happen if treatment is not treating gingival disease will predispose excess...