In complex cases usually the clinical protocol follows the logical sequence:
- patient history, extraoral and intraoral examinations
- paraclinical examinations
- initial diagnosis
- in periodontal patients we use the following treatment approach :
“Progressive – accumulative periodontal therapy” as pre-treatment procedure.
The patient is invited every day for 20-30 minutes for ultrasonic-scaling therapy. The rationale behind this treatment is to reduce the bacterial load every day. Trough this, approx. 80% of the bacterial load is taken out or destroyed. This good result is owed to the high energy disseminated in the pocket by the ultrasonic device. The population of bacteria in the pockets cannot recover until the next 24 hours. During the next day’s treatment again approx. 80% of the (remained or recovered ) population is reduced. This will shift gradually the spectrum of bacteria and usually the bleeding will stop after 2 or 4 days of this treatment. If this treatment is not performed every day, the effect will not be the same.
Should the periodontal pockets around single teeth show bleeding after 4 days of this treatment, the teeth should be removed, e.g. in the appointment when dental implants are placed. Leaving those teeth would carry the risk of getting the callus around basal implants infected.
In most cases one treatment like this is enough to stop the acute periodontal activity, i.e. the spreading of bacteria. (The ultrasonic treatment can be carried out right before the implant placement and it is advisable to use Betadine in addition to have a powerful and otherwise harmless pharmaceutical agent present.)
After a month reassessment of the effect from the therapy and patient motivation should be done. Based on this, the final treatment plan will be implemented and it could contain:
- surgery phase
- therapeutic phase
- prosthetic phase
- therapy of occlusion
The different phases could overlap each other.
Having achieved the Health-Function, the final step is Aesthetics- aesthetic treatment in line with the individual desires and wishes of every patient.