Join me for Ian’s lecture looking at periodontics and orthodontics from the perspective of the periodontist
o Litigation
o Periodontium is no 1 reason for litigation in dentistry
o Up to 200k payouts
Cases
o Aggressive periodontitis more common in Chinese population
o Adults – majority have some periodontal disease
o BPE easiest method to assess disease – pocket depth and bleeding
Defining stability
Site level
o Closed pocket
o 4mm or less
o No bleeding on probing – bleeding 30% go on to worsen, not completely accurate
Patient level
o Stable
o BOP 10% less
o PPD 4mm less
o No BOP at 4mm sites
Unstable
o PPD 5mm+ or PPD 4mm + BOP
General rule
o Perio stability prior to orthodontic treatment
o Stability sustained 3-6 months – patient able to maintain during orthodontics
o Supportive care – 6-8 week with hygienist when in orthodontic treatment
o Without orthodontic treatment every 3 months, most effective dental intervention
Gingival recession
o Aetilogy
o Toothbrush
o Smoking
o Trauma
o Inflammation
o Frenal pull- very unlikey not active surface
o Anatomical bony dehiscence’s – naturally occuring
§ Common
· Around upper canines
· Crowded cases with anterior teeth – without orthodontics
· Expansion cases – Ian’s experiences
o Phenotype gingiva
o Thin – high scalloped, thin interdental papilla, narrow zone keratinised tissue
o Thick – low scallop, thick interdental papuilla, thick band of keratinised tissue
o Indication for intervention
o Aesthetics – usually self limiting, aesthetics drive intervention
o Worsening of recession
o Persistent inflammation
o Unable to clean due to access
o NOT treatment for sensitivity
Intervention
Free gingival graft
o Most stable surgery
Miller 1 and 2
o Predictable recession correction
Miller 3 and 4
o Unpredictable
Gingival recession
o Orthodontics first, graft later
Retention
o Retainers don’t effect oral hygiene (bonded retainer)
o However adverse tooth movement with torquing in retention
o Consider removal and replacement if movement observed
