Clinical Study On Comprehensive Treatment Of Periodontal Disease

Objective The aim of periodontal prothesis is to cure the gingival swelling,bleeding,periodontal abscess,bad breath and other symptoms of periodontal inflammation by the surgical or non-surgical periodontal treatment.Then,the reconstruction of the remaining residual dentition include: ideal architecture of the crowns and gums,symmetrical arch patterns,continuous and correct occlusal plane in sagittal and coronal plane,stable occlusion without occlusal interference.We can use these steps to treat patients with aesthetic、function、phonetic and long term success.Method This study collected 6 periodontal disease patients,the basic data included dental profile,systemic diseases history,past dental history,oral examination,X-ray interpretation,model analysis the past 3 years.Treatment is according to the Dr.Amsterdam’s concepts-periodontal infection control and occlusal treatment – that is strategic treatment: the first stage is initial treatment(including etiological treatment),the purpose is to use basic periodontal treatment,root canal treatment,hopeless teeth removal,temporary prothesis treatment,etc.,reduce inflammation and occlusal trauma to stabilize the oral condition,and avoid residual teeth deterioration.The second stage is surgical treatment,the purpose for the stage is to use periodontal surgery to remove periodontal pockets or increase keratinized periodontal tissue and strengthen periodontal health.The third stage is the prosthesis therapy,the purpose for this treatment is to reconstruct the dentition and restore the occlusion function by using the ridge support and cross linking concepts to redistribute the occlusal force.The fourth stage is the maintenance phase,the purpose is to keep following up.My treatment procedures followed Dr.Amsterdam’s concepts.Result This thesis contained 6 case reports.Besides active motivation and well coordination,patients were taught good oral hygiene control and basic periodontal therapy.After thoroughly basic treatment for 4 weeks,re-evaluating the periodontal condition.The subgingival caries were treated with crown lengthening procedure to expose sound teeth structure(case 2,3,4)in order to keep biological width: 3 mm.Pathologic migration(case 1,2,3,4)inducing teeth crowding、occlusal interference、uneven occlusal table、food impaction and improper space distribution were corrected by orthodontic therapy(case 1,2,3,4).Lacking attached gingiva were organized with connective tissue grafts in order to maintain the periodontal stability then preventing gingival inflammation and gingival recession(case 2).A common consequence of teeth loss for a long–term period was augmented with connective tissue grafts to keep anterior esthetics(case 2).The hopeless teeth due to severe periodontitis were preformed with ridge preservation procedure(cases 5 or 6)to maintain ridge dimension for ideal size of implants placement.Ridge height efficiency was done by sinus lift to increase crown/implant ratio(cases 5)In the aspect of periodontal prosthesis,when poor supporting teeth structure should be treated with inner copping、crown to root ratio reduction、lateral force elimination or preventing secondary trauma from occlusion.The other benefits for double crown restoration(case 1,2,3,4)made the occlusion for one-unit preventing uneven sinking between nature teeth and denture.Edentulous ridge restored by implants(case 5,6)avoided nature teeth preparation、mucosa irritation、alveolar ridge maintenance、denture stability、raising chewing efficiency 、increasing the border of mandibular movement、improving maximal biting force(cases 5 or 6).In addition,as loss of posterior supporting teeth,implant can provide anchorage、posterior support which prevented anterior teeth flaring out、redistributing space、keeping the whole arch integration and stability.This study is based on the principles of Dr.Amsterdam treatment.Six cases were all finished and followed for more than one year.So now,all cases are stable without obvious site effects and keep following up.Conclusion In sum up,periodontal prosthesis is treated in multidisciplinary manner,rather than simply periodontal or prosthetic.Dentist must evaluate the advantage and disadvantage in each prosthetic design to give patients the most appropriate treatment depending on financial consideration、function and beauty for the long-term health.