Periodontal disease-a primer on recognition and therapy - DVM
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Periodontal disease-a primer on recognition and therapy


DVM360 MAGAZINE



Image 2: Local antibiotic administered.
Upon contact with the gingival crevicular fluid or water, the doxycycline polymer hardens within the periodontal pocket. The application allows sustained release of antibiotic for several weeks at the site of injection. The gel gradually biodegrades to carbon dioxide and water. The antibiotic is not a substitute for scrupulous pocket debridement and other periodontal procedures (Images 1 and 2.)

Antibiotic at a glanceDoxirobe allows direct treatment of localized periodontal disease.

  • Is bacteriostatic against Porphyromonas gingivalis, Prevoltella intermedia, Camphylobacter rectus, and Fusobacterium nucleatum, which are associated with periodontal disease.
  • Inhibits collagenase enzymes, which are destructive to the periodontal attachment apparatus.
  • Directly binds to dentin and cementum for prolonged release.
  • Decreases edema and inflammation, and promotes growth of junctional epithelium resulting in decreased pocket depth.
  • Helps rejuvenate tissues of the periodontium (LAA does not regenerate lost tissue).

Established periodontitis (stage 3) and advanced periodontitis (stage 4) therapies are based on dental findings after the patient and radiographs are evaluated. The practitioner should consider:

Percentage of support loss. Greater than 50 percent support loss carries a guarded-to-poor prognosis; greater than 75 percent support loss carries a poor prognosis for long-term success.

Type and extent of attachment loss. Pockets form secondary to the apical migration of the epithelial attachment from the destruction of supporting periodontal tissues. Absolute pockets are classified as either suprabony or infrabony.

Suprabony pockets are present above the crest of alveolar bone. Suprabony pocket bone loss commonly occurs horizontally at similar rates on the mesial and distal surfaces of the teeth.

When the suprabony pocket is less than 5 mm, treatment includes removal of supra and subgingival plaque and calculus, root planing, and, in the dog, installation of local antibiotics. This initial care provides tissue shrinkage, connective tissue remodeling, and gain of soft tissue attachment reducing pocket depth. Home care is essential for maintenance.

If greater than 50 percent of the gingiva and alveolar bone has receded along the root (gingival recession), or if furcation exposures cannot be cleaned at home, extraction is the treatment of choice unless the owner accepts a guarded to poor prognosis.

For suprabony pockets >5 mm without gingival recession, apical repositioned flap surgery can be performed to visualize and clean the roots so that adequate treatment can be accomplished to help eliminate the pocket.

Infrabony (infra-alveolar vertical bone loss) pockets occur when the pocket floor (epithelial attachment) is apical to the alveolar bone. The infrabony pocket extends into a space between the tooth and the alveolar socket. Radiographically, infrabony pockets appear as vertical loss of bone along the root surface.

Future articles will cover specific gingival surgical procedures, home care products and ways to help your client prevent periodontal disease.


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