What are the various treatment methods involved in periodontitis?

Treatment Modalities: Estimates of prognosis and treatment predictability must be based on the evidence available from the literature and the clinical own experience.

The First step in the treatment of refractory periodontitis with antimicrobial therapy must be microbial diagnostic and susceptibility tests.

These microbiologic test include culture analysis, microscopic assessment, nucleic acid probe analysis, restriction endonuclease analysis, detection of bacterial antigens and enzymes, and analysis using polymerase chain reaction.

The result of these tests provide information about the presence and relative percentages of suspected periodontal pathogens and more importantly determines the organism sensitivity to specific antimicrobials.

This information enables the clinician to make the most informed and appropriate decision about antibiotic selection.A combination of thorough root debridement and systemic antibiotic

Treatment can reduce bleeding on probing, suppuration, pocket depth, and incidence of active lesions and can suppress or eliminated periodontal pathogens in patients who present with refractory periodontitis.

Mechanical debridement with scaling and root planning can reduce total supra and subgingival bacterial masses, but major pathogens such as Actinobacillus actinomycetemcomitans may escape.

The effect of treatment due to their ability to invade periodontal tissues or to reside in furcations or other tooth structures outside the reach of hand instrument or due to poor host defense mechanisms.

Surgical treatment may also eliminate the marginal tissues that might be invaded by bacteria. In addition, the morphology of the gingival tissues should be modified to facilities daily plaque removal by the patient.

Systemic antibiotic therapy aims to reinforce mechanical periodontal treatment and support the host defense system in overcoming the infection by killing subgingival pathogens that remain after conventional mechanical periodontal therapy.

Many efforts have been made to establish the most appropriate regimen of antibiotic therapy for these patients. Similar antimicrobials, consisting of 250 mg amoxicillin and 125 mg potassium clavulanate, have been administered three times daily for 14 days along with scaling and root planning and produced a reduction in attachment loss for at least 12 months.

A regimen of one capsule containing the same amount of drug every 6 months for 2 weeks, with intrasulcular full month lavage with a 10% povidone iodine solution and chlorhexidine mouthwash rinses twice daily, showed a reduction in attachment loss that persisted at approximately three daily, showed a reduction in attachment loss that persisted at approximately 34 months.

A regimen of 500 mg metronidazole three times daily for 7 days was shown to be effective in treating refractory periodontitis in patients who were culture positive for Bacteroides forsythus in the absence of A. actinomycetemcomitans

Clindamycin is a potent antibiotic that penetrates well in to gingival fluid, although it is not usually effective fluid, although it is not usually effective against A. actinomycetemcomitans and Eikenella corrodens.

However it has been demonstrated to be effective in controlling the extent and rate to disease progression in factory cases in patients who have a micro flora susceptible to this antibiotic.

A regimen of Clindamycin hydrochloride 150mg four times daily for 7 days combined with scaling and root planning produced a decrease in the incidence of disease activity from an annual rate of 8% to 0.5% of sites per patient.

Clindamycin should be prescribed with caution due to the potential for pseudomembranous colitis from super infection with clostridium difficile. Azithromycin may be effective in refractory periodontitis in patients infected with porphyromonas gingivalis.

Combination of antibiotic therapy may offer greater promise as adjunctive treatment for the management of refractory periodontitis. The rationale is based on the diversity of putative pathogens and the fact that no single antibiotic is bactericidal for all known pathogens.

Combination antibiotic therapy may help broaden the antimicrobial range of the therapeutic regimen beyond that attained by any single antibiotic other advantages include lowering the dose of individual drugs against targeted organisms.

In addition, combination therapy may prevent or forestall the emergence of bacterial resistance. The following treatment for localized aggressive periodontitis nave been attempted in the past with various degrees of success

1. Extraction. After the involved teeth, usually the first molars have been extracted uneventful healing ensues. The enlargement of the maxillary sinus has been mentioned as an unfavorable sequela that would make future treatment of neighboring teeth difficult. Transplantation of developing third molars to the sockets of previously extracted first has also been attempted.

2. Standard Periodontal therapy. Such therapy has included scaling and root planning, curettage, flap surgery with out bone graft root amputations, hemisections, occlusal adjustment and strict plaque control. However response has been unpredictable, Frequent maintenance visits appear to be most important .



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