ABOUT THE BOOK:

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lmplantology.

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SARANRAJ JPS PUBLICATION DR. SYED WALi PEERAI

Bl. IAITHIIEYAI IAMAL/lliAM
Essentials of
PERIODONTICS &
ORAL IMPLANTOLOGY

DR. SYED WALi PEERAN

DR. KARTHIKEYAN RAMALINGAM
Essentials Of
PERIODONTICS & ORAL IMPLANTOLOGY
Published by Dr. Syed Wali Peeran and Dr. Karthikeyan Ramalingam @
Saranraj JPS Publication,
Tamil Nadu, India

© Dr. Syed Wali Peeran &

Dr. Karthikeyan Ramalingam
1st Edition 2021
ISBN: 978-81-950475-4-3
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
mechanical, including photocopy, recording or any information storage and retrieval system without the permission in writing from the
publisher.
Note: As new information becomes available, changes become necessary. The editors/author/contributors and the publishers have,
as far as it is possible, taken care to ensure that the information given in this book is accurate and up to date. In veiw of the possibility
of human error or advances in medical science neither the editor nor the publisher nor any other party who has been involved in the
preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete. Readers
are strongly advised to conirm. This book is for sale in India only and cannot be exported without the permission of the publisher in
writing. Any disputes and legal matters to be settled under Chennai jurisdiction only.

Published in India
 Dr. Syed Wali Peeran is Professor of Periodontology and Oral lmplantology.
He finished his postgraduation in Periodontology in 2008 and has a doctoral degree.
He has a postgraduate certificate in advanced oral implantology and a
fellowship from international congress of oral implantologists.
He is the Editor in Chief and the founding editor for the journals-
Dentistry & Medical Research and Case Reports in Odontology.
He has over 63 national and international publications to his credit.
He has attended various national and international conferences and workshops.
He has also authored "Perio-Quest- MCQs in Periodontics with Self-Assessment
Picture Test" published by EMMESS publishers. He has been a reviewer for Libyan
Journal of Medicine,Journal of Nature, Biology and Medicine and various other
journals. He is a Life member of Indian Academy of Osseo Integration,
Indian Society of Periodontology, Indian immunological Society,
Indian Society of Oral lmplantologists and Indian Dental association.

Dr. Syed Wali Peeran, B.D.S, M.D.S (Peria), Ph.D. FICO/., PGCOI.
Professor, Department of Periodontics & Oral lmplantology,Faculty of Dentistry, Sebha
University, Sebha, Libya.

Dr. Karthikeyan Ramalingam is a Professor of Oral Pathology and Microbiology.

He finished his graduation and post graduation from Saveetha Dental College,
Chennai. He was the College topper in Part I and Part II postgraduate University
examinations.
He had secured the Gold medal in Pathology & Microbiology and Community
Dentistry in University examinations.He has guided postgraduates in oral pathology for
their seminars, research studies, journal discussions, library dissertations, thesis
preparation and in submitting articles for publication in various national and
international journals. He has also handled lectures and practical demonstrations
for undergraduates in oral histology,dental anatomy, forensic odontology, oral
pathology and microbiology. He has 65 international and national publications to his
credit. He is the Co-author of Textbook of Prosthodontics by Jaypee Brothers Medical
Publishers (P) Ltd. He has also contributed multiple choice questions and clinical
pictures to Perio-Quest- MCQs in Periodontics with Self-Assessment Picture Test by
EMMESS publishers. He is the Editor for Journals - Dentistry and Medical Research &
Case reports in Odontology.He is also the Reviewer for Journal of Oral and
Maxillofacial Pathology and North American Journal of Medical Sciences
(Indexed with PUBMED) and Journal of Cranio-Maxillary diseases.
He is a member of International Association of Oral Pathologists since 2016.
He is a Life member of Tamilnadu Dental Council since 2001, Life member of
Indian Association of Oral and Maxillofacial Pathologists since 2006 and a Life
member of Saveetha Dental College Old Students Association since 2001.
Dr. Karthikeyan Ramalingam, B.D.S, M.D.S
Professor, Department of Oral Pathology & Microbiology,Faculty of Dentistry, Sebha University,
Sebha,Libya
 Dr. ABDULNASIR MAQBOOL AHMED. Dr. MOHAMMAD NAZISH ALAM. Dr. Syed Nahid Basheer.
MSc, FICOI (U.S.A), Private Practice, BOS., MOS. BOS., MOS.
U.A.E. Asst. Prof, Department of Periodontics, Assistant Professor, Department of Restorative
College of Dentistry, Jazan university Dental Science, College of Dentistry, Jazan
Dr. Abhilash. University, Gizan, Kingdom of Saudi Arabia.
P.R. M.D.S Dr. Nagabushan.
(Oral Pathology and Microbiology), B.D.S., M.D.S Dr. Syeda Nikhat Mohammadi.
Reader, Department of Oral Pathology (Oral Medicine and Radiology), BOS., MOS.
and Microbiology, Department of Oral Medicine and Radiology, Senior lecturer, public health dentistry,
Oxford Dental College & Hospitals, India. Pravara institute of dental sciences, Loni.
Bangalore, Karnataka, India. Dr. Neha. Maharashtra.
MOS., Dr. Tazeen.D
Dr. Ahmed Taher El-Hassan. Department Of Periodontics and lmplantology, B.D.S., M.D.S (Peria).
M.Sc (Oral Sciences-Periodontics), Surendera Dental College and Research Institute, Assistant Professor, Department of Periodontics,
Diplomate of American Board of Sriganganagar, Rajasthan. Jazan University, Jazan, KSA.
Periodontics, NOBE, WREB.
Assistant Professor, Benghazi University, Dr. R. Ganesh. Prof. Dr. Abdul Hafeez Khan
B.D.S., M.D.S. (Pedodontics) M.Sc., Ph.D.
Benghazi, Libya.
Reader, Department of Pediatric and Chairman, Department of Parasitology, Faculty
Dr. Aisha Ahmed. Preventive dentistry, SRM University, of Medicine, Sebha University, Sebha, Libya.
MB.ChB Tamil Nadu, India.
ECFMG Certified Physician. Prof. Dr. Abdul Hafeez Khan
Dr. Rashmi Rai.
Department of Medicine, Faculty of M.Sc., Ph.D.
BOS., MOS.
Medicine, Sebha University, Sebha, Chairman, Department of Parasitology, Faculty
Senior lecturer, public health dentistry,lndex
Libya. of Medicine, Sebha University, Sebha, Libya.
institute of dental sciences, Indore
Dr. Bandar M.A. AL-Makramani. Prof. Dr. Madhumala Thiruneervannan
Dr. Santosh Kumar.BB
BOS, HOD, MDSc, Ph.D BOS., M.D.S (Peria),
BOS, MOS (Peria), M.Perio RCSEd (U.K),
Assistant Professor, Fixed Prosthodontics, Head, Department of Periodontics, Vinayaka
MICOI (U.S.A) ), Specialist Periodontist and
Department of Prosthodontics, College Mission's Sankarachariyar Dental College,
lmplantologist, Kuwait.
of Dentistry, Jazan University, Kingdom Salem, India.
of Saudi Arabia. Dr. Salhya Selhuraman.
Prof. Dr. Marei Hamad Al Mugrabi.
B.D.S, M.A, PG0CA,
Dr. Fatma Mojtaba Al Said. B.D.S., M.Dent.Sc. (Periodontics-Dublin),Ph.D.
Surendra Dental College and Research
BOS., MPH (USA), Head, Department of Periodontics, Benghazi
Institute, Sriganganagar, Rajasthan. India.
Faculty of Dentistry, Sebha University, University, Libya.
Sebha, Libya. Dr. Shaesta Begum.
BOS, MOS (Periodontics), Prof. Dr. Nurgul KOMERIK.
Reader, Depatment of Periodontics, Farooqia DDS., Ph.D.
Dr. Franciso AL.
Dental College & Hospital, Mysore, Karnataka. Post Doc. Biruni University, Dental School,
College of Dentistry, Jizan University, Dept. of Oral Surgery, Istanbul, TURKEY
India.
KSA
Dr. Shamimul Hasan. Prof. Dr. P.G. Naveen Kumar.
Dr. Fuad Al Sanabani. BOS, MOS B.D.S., M.D.S., (Community Dentistry),
MSc, PhD Assistant Professor, Department of Oral Head, Department of Community and
Department of Oral and Maxillofacial Medicine and Radiology, Faculty of Dentistry, Preventive dentistry, College of Dental
Prosthodontics, Jazan University, Jazan, Jamia Milia lslamia, New Delhi.India Sciences, Davangere, Karnataka, India.
Kingdom of Saudi Arabia Prof. Dr. PC Anila Namboodiripad.
Dr. Soumya K Nair.
B.D.S., MOS., BDS, MDS., Department of Oral and M axillofacial
Dr. Ismail Abbas Darout. Pathology, India
DDS, Ph.D. (Dr .odont), Private practitioner, Mysore, India.
Postdoc Peria, Associate Professor Prof. Dr. R Thiruneervannan
Dr. Suchelra N. Malleshi. BDS., MDS.
and Head, Department of Preventive
B.D.S., M.D.S (Oral Medicine and Radiology), Principal, Vinayaka Mission's Sankarachariyar Dental
Dental Sciences, College of Dentistry,
Department of Oral Medicine and Radiology, College, Salem, Tamil Nadu, India.
Jazan University, Kingdom of Saudi
J.S.S Dental College, Karnataka, India.
Arabia.
Prof. Dr. Syed Khalid Alla!.
Dr. Supriya Ebenezer. MDS.
Dr. Khaled Awidat Abdalla. BOS., MOS. Associate Fellow AAID, Department of oral
B.D.S., C.E.S., DuODF (France), Reader, Department of Periodontics, mplantology, Vivekenanda dental college,
Assistant Professor, Department of Mathrusri Ramabai Ambedkar Dental TN, India
Oral Biology and Orthodontics, College and Hospital, Bangalore, India.
Sebha University, Sebha, Libya. Prof. Dr. V.Gopinalh.
Dr. Syed Ali Peeran. M.D.S.
M.D.S. (Prostho)., MBA(HA), M.Phil (H.A), Professor, Department of Periodontology and
Dr. Manohar Murugan
Department of Prosthodontics, Assistant lmplantology, Chhattisgarh dental college
M.Sc. (Microbiology), Ph.D.,
Professor, Jazan University, Jazan, KSA. and research institute, Rajnandgaon, India
Assistant Professor, Department of
Medical Microbiology, Faculty Prof. DR.V.HARIKRISHNA.
of Medicine, Sebha University, Sebha, Dr. Syed Kuduruthullah. S.K M.D.S.
Libya. M.0.S.(Oral Path) Department of Orthodontics and Dentofacial
Lecturer, Ajman University, Orthopaedics. Chhattisgarh Dental college
Ajman, U.A.E. and research institute, Rajnandgaon, India.

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Chapter 55 Prosthetic Aspect of Dental Implant
CHAPTER

40 Treatment planning and

rationale of periodontal
treatment
Madhumala Thiruneervannan &
Syed Wali Peeran

Chapter Outline:
• Treatment planning and rationale of periodontal RATIONALE OF PERIODONTAL TREATMENT
treatment • Local therapy:
• TREATMENT PLAN • Systemic therapy.
• Phases of Periodontal treatment HEALING AFTER PERIODONTAL THERAPY
• Review Question Review Question
• Principal references and suggested further reading: Principal references and suggested further reading:

TREATMENT PLAN
A treatment plan is a scheme for case management. It
Treatment plan is the identification and prioritization of includes all procedures required for establishment and
current and potential dental and periodontal needs, maintenance of oral health.
establishment of goals, and determination of intervention Periodontal therapy is started after the establishment of a
and outcome to meet the needs bases on prior treatment plan. In case of emergencies, it may not be the
assessment of findings. case.
Periodontal therapy plan should aim at establishing and
maintaining the overall periodontal health of the
dentition.
The primary goal is to eliminate gingival inflammation and
correction of conditions that cause and perpetuate it.
This includes:
• Elimination of root irritants
• Pocket eradication and reduction
• Establishment of gingival contours and
mucogingival relation to preserve periodontal health
• Restoration of carious areas
• Correction of existing restorations.

Periodontics & Oral Implantology 1

Treatment considerations Section - VI

Table 40-1: General overview of the major steps in a typical periodontal treatment plan: (Sweeting et al.)
Sl no: SEQUENCE OF MAJOR PHASES
1 Address acute periodontal problems and manage pain.
2 Review and update medical and dental histories.
3 Assessment of systemic risk factors and refer for medical consultation as needed.
4 Extraoral examination.
5 Oral pathologies evaluation.
6 Assessment of periodontal risk and modifying factors.
7 Periodontal examination of natural teeth and dental implants.
8 Dental examination to include occlusal relationships and dental implants.
8 Radiographic examination.
10 Establish a definitive diagnosis.
11 Generate a diagnosis-driven periodontal treatment plan and sequence of treatment.
12 Determine required adjunctive restorative, prosthetic, orthodontic and/or orthodontic treatments and
sequence.
13 Execute Phase-I therapy with consideration given to adjunctive use of chemotherapeutic agents.
14 Re-evaluation of Phase I therapy
15 If end-points are not achieved, consider selective retreatment, need for surgical therapy, speciality
referral or use of adjunctive diagnostic aids, e.g., microbial, genetic, medical lab tests, etc
16 Determine interval for periodontal maintenance and continued assessment of periodontal status.

Table 40-2:Treatment options for periodontally involved teeth (Fugazzotto & DePaoli)..

Periodontics & Oral Implantology

Chapter 40

Phases of Periodontal treatment: Phase II therapy (Surgical Phase):

Preliminary Phase: After Scaling and root planning periodontal healing
Treatment of emergencies (relief of pain) continues for up to 4–5 months in moderately advanced
1. Relief of pain: esp pain of endodontic/Periapical and periodontitis and for up to 9 months in severely advanced
periodontal origin. periodontitis. So, adequate time should be allowed for the
2. Treatment of active caries. periodontal healing before periodontal surgery is carried
3. Extraction of hopeless teeth. over.

Phase I therapy (Etiotropic phase/Initial • Periodontal therapy including placement of implants.

therapy/anti-infective/Non-surgical phase): • Endodontic therapy.

It is directed to eliminate the etiologic factors of gingival Phase III therapy (Restorative Phase):
and periodontal disease. If done successfully, this phase
Initial healing occurs within 6 weeks after periodontal
stops the progression of dental and periodontal disease.
surgery, but to assure stability of tissue contours, It may be
It is a definitive treatment for early to moderate
desirable to postpone final restorative care until 5–6 months
periodontitis and an initial therapy for those expected to
after periodontal surgery.
require periodontal surgery.
• Final restoration.
• Plaque:
• Fixed and or removable prosthodontic appliances
 Limited plaque control instructions. The
toothbrush is often the only hygiene aid indicated • Evaluation of response to the restorative
at this stage of therapy. procedures.
 Comprehensive plaque control instruction. e.g., • Periodontal examination.
dental floss, interdental brushes, and wooden tips.
• Scaling and Root Planning. Phase IV therapy (Maintenance phase-periodic
rechecking):
• Temporary or permanent restorations of carious
lesions depending on their prognosis. It is the ongoing care at specified intervals. The ultimate
aim of this phase is to prevent the recurrence of
• Recontouring of defective restorations, e.g., Rough periodontitis and to maintain functionally healthy
over contoured, overhanging restorations, etc. dentition. Regardless of the treatment provided,
• Antimicrobial therapy. periodontal therapy will fail in the absence of periodontal
maintenance. The following are rechecked:
• Occlusal adjustment.
• Minor orthodontic treatment. • Plaque and calculus.
• Provisional splinting and prosthesis. • Gingival condition (pockets, inflammation).
Evaluation of response to Phase-I therapy (rechecking):
Re-assessment of Phase one treatment is mandatory to • Occlusion, tooth mobility.
determine success of phase 1. It also lets us know the • Other pathologic changes.
feasibility of proceeding to phase-2.
• Pocket depth and gingival inflammation. Farooqi et al in a review found that the evidence for a
specific recall (e.g., every 3 months) for all patients
• Plaque and calculus. following periodontal therapy to be weak and that
• Dental caries. optimum frequency of the maintenance phase is unclear.
• Current smoking status.
• Review of mobile teeth.
Periodontics & Oral Implantology 3
 Treatment considerations Section - VIII

Overall plan for treatment of periodontal Review Questions

diseases (Ramfjord)
Systemic therapy: Short notes:
1. Write a short note on periodontal treatment plan.
 Physician consultation for treatment of systemic
diseases if any. Principal references and suggested further
 Physician consultation for altering any medication that reading:
affects the periodontium ♦ Balshi TJ. Sequential treatment planning. Gen Dent. 1981;
 Encoragement if patients to quit tobacco use and 29(2):113-7.
enrollment of patients in tobacco cessation program. ♦ Farooqi OA, Wehler CJ, Gibson G, Jurasic MM, Jones JA.
Appropriate Recall Interval for Periodontal Maintenance:
Hygienic therapy:
A Systematic Review. J Evid Based Dent Pract. 2015
 Patient education and oral hygiene instruction. Dec;15(4):171-81.
 Extraction of hopeless teeth. ♦ Fugazzotto PA, DePaoli S. Examination and diagnosis. In:
 Placement of temporary prostheses Fugazzotto PA, Hains F. Periodontal-Restorative
Interrelationships: Ensuring Clinical Success. John Wiley
 Endodontic therapy. & Sons; 2011:3-29.
 Thorough scaling and root planning. ♦ Newman MG, Takei HH, Klokkevold PR, Carranza FA,
 Use of local or systemic antimicrobial agents. editors. Carranza's Clinical Periodontology. 10 ed. St.
Louis, Missouri: Elsevier Inc; 2006
 Temporary restoration of carious teeth. ♦ Pihlstrom BL. Periodontal risk assessment, diagnosis and
 Correction or replacement of defective restorations treatment planning. Periodontol 2000. 2001; 25:37-58.
that have overhangs. ♦ Ramfjord SP. A rational plan for periodontal therapy. J
 Open margins Periodontol 1953: 24: 75–87.
♦ Sweeting LA, Davis K, Cobb CM. Periodontal Treatment
 Open proximal contacts that result in food impaction. Protocol (PTP) for the general dental practice. J Dent
Corrective therapy: Hyg. 2008; 82 Suppl 3:16-26.
 Occlusal adjustment.
 Fabrication of occlusal guards or biteplanes.
 Orthodontic treatment.
 Implant placement
 Periodontal surgery for debridement, resection or
regeneration.
Periodontal maintenance:
 Update of the medical and dental histories.
 Radiographic review.
 Extraoral and intraoral soft and hard tissue
examination.
 Periodontal evaluation.
 Removal of the bacterial flora from crevicular and
pocket areas.
 Scaling and root planing where indicated.
 Polishing of the teeth.
 A review of the patient's plaque control efficacy

4 Periodontics & Oral Implantology

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Chapter 40

RATIONALE OF PERIODONTAL TREATMENT:

Periodontal treatment if carried out aptly can
• Eliminate pain and discomfort.
• Reduce and eliminate gingival inflammation and its
signs
o Bleeding on probing.
• Reduce and eliminate periodontal disease.
o Decrease and may eliminate periodontal
pockets.
o Stop suppuration/ pus formation.
o Arrest tooth mobility Fig 40-2 : Local factors that affect periodontal
o Arrest the destruction of periodontium healing.
(soft tissue damage and bone loss).
• Prevent recurrence of the disease.
• Establish occlusal function and improve comfort.
• Restore physiologic contours of the tissues and
improve aesthetics.
• Result in regeneration of the lost periodontium.
• Reduce tooth loss.
• Helps in maintaining the function of the dentition.
Local therapy:
It forms the backbone of periodontal treatment. It is
focused on the removal of plaque that initiates the
periodontal inflammation and kicks in the disease. Fig 40-3 : Systemic factors that affect
 Removal of the plaque: Plaque is the prime periodontal healing.
cause of gingivitis and periodontitis that can be
prevented. Hence, the removal of plaque is an
HEALING AFTER PERIODONTAL THERAPY:
integral part of periodontal therapy. PERIODONTAL REGENERATION: Restoration of lost
 Elimination of plaque retentive areas: periodontium. (Glossary of periodontal terms, 2001)
Factors that help in plaque accumulation are to REGENERATION: Reproduction or reconstitution of a lost
or injured part. (http://members.perio.org/libraries/glossary?
be eliminated to help in better plaque control. ssopc=1 assessed on 2nd Feb 2016)}
Calculus, food impaction, overhanging NEW ATTACHMENT: The union of connective tissue or
restorations and anatomic variations are all to be epithelium with a root surface that has been deprived of its
eliminated. original attachment apparatus. This new attachment may be
 Elimination of trauma from occlusion: epithelial adhesion and/or connective adaptation or attachment
Elimination of trauma does not stop the and may include new cementum. (Glossary of periodontal
periodontal disease but helps in periodontal terms, 2001)
REATTACHMENT: To attach again. The reunion of
tissue healing, bone regeneration and gain of epithelial and connective tissue with a root surface following
attachment. separation by incision or physical injury (not by disease). Not to
Systemic therapy: be confused with new attachment. (http://members.perio.org/
libraries/glossary?ssopc=1 assessed on 2nd Feb 2016)
Antibiotic therapy: is used in periodontal treatment REPAIR: Healing of a wound by tissue that does not fully
• To prevent bacteraemia after periodontal therapy. restore the architecture or the function of the part. (Glossary
• In treatment of aggressive periodontitis. of periodontal terms, 2001) Repair is healing with scar tissue
• In treatment of recurrent periodontitis.
Host modulation therapy.
Periodontics & Oral Implantology 5
 Treatment considerations Section - VIII

Review Questions

Short notes:
1. What is the rationale of periodontal treatment?
Principal references and suggested further
reading:
 Caffesse RG, Mota LF, Morrison EC. The rationale for
periodontal therapy. Periodontol 2000. 1995 Oct;
9:7-13.
 Guo S, DiPietro LA. Factors Affecting Wound Healing.
Journal of Dental Research. 2010;89(3):219-229.
 Newman MG, Takei HH, Klokkevold PR, Carranza FA,
Fig 40-4: Common reasons for poor editors. Carranza's Clinical Periodontology. 10 ed. St.
responses to treatment Louis, Missouri: Elsevier Inc; 2006.
 Ramfjord SP. A rational plan for periodontal therapy. J
Periodontol 1953: 24: 75–87.

6 Periodontics & Oral Implantology

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