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Transfer of the patient from active treatment status to a maintenance program is a definitive step in total patient care that requires time and effort on the part of the dentist and staff. Patients must understand the purpose of the maintenance program, and the dentist must emphasize that preservation of the teeth depends on maintenance therapy. Patients who are not maintained in a supervised recall program subsequent to active treatment show obvious signs of recurrent periodontitis (e.g., increased pocket depth, bone loss, or tooth loss).
Maintenance Phase


maintenance & reattachment




maintenance & reattachment




maintenance & reattachment




maintenance & reattachment





maintenance & reattachment




maintenance & reattachment




maintenance & reattachment


maintenance & reattachment

MAINTENANCE PROGRAM

Periodic recall visits form the foundation of a meaningful longterm prevention program. The interval between visits is initially set at 3 months but may be varied according to the patient’s needs. Periodontal care at each recall visit comprises three parts:
The first part involves examination and evaluation of the patient’s current oral health. The second part includes the necessary maintenance treatment and oral hygiene reinforcement. The third part involves scheduling the patient for the next recall appointment, additional periodontal treatment, or restorative dental procedures.
The time required for a recall visit for patients with multiple teeth in both arches is approximately 1 hour, which includes time for greeting the patient, setting up, and cleaning up.



maintenance & reattachment




maintenance & reattachment




maintenance & reattachment




maintenance & reattachment




maintenance & reattachment


maintenance & reattachment




Sequence of maintenance phase


maintenance & reattachment




maintenance & reattachment


maintenance & reattachment




maintenance & reattachment




maintenance & reattachment





maintenance & reattachment




maintenance & reattachment




maintenance & reattachment




maintenance & reattachment




maintenance & reattachment




maintenance & reattachment





maintenance & reattachment




maintenance & reattachment




maintenance & reattachment




maintenance & reattachment




maintenance & reattachment





maintenance & reattachment




maintenance & reattachment


maintenance & reattachment


maintenance & reattachment




maintenance & reattachment




maintenance & reattachment

RECONSTRUCTIVE SURGICAL TECHNIQUES


Reconstructive techniques can be subdivided into two major types: non–bone graft–associated new attachment and bone graft– associated new attachment. Many procedures combine both approaches.
All recommended techniques include careful case selection and complete removal of all irritants on the root surface. Although this can be done in some cases as a closed procedure, in the great majority of cases it should be done after exposure of the area with a flap

Non–Bone Graft–Associated Procedures

Periodontal reconstruction can be attained without the use of bone grafts in meticulously treated three-wall defects (intrabony defects) and in periodontal and endodontic abscesses. New attachment is more likely to occur when the destructive process has occurred rapidly such as after treatment of pockets complicated by acute periodontal abscesses and after treatment of acute necrotizing ulcerative lesions


maintenance & reattachment




maintenance & reattachment




maintenance & reattachment




maintenance & reattachment





maintenance & reattachment




maintenance & reattachment




maintenance & reattachment



Osseous defect mesial to a second premolar. B, Graft material placed in dappen dish before transfer to the graft site. C, Material in place. D, Reentry 6 months later.
maintenance & reattachment


maintenance & reattachment




maintenance & reattachment





maintenance & reattachment




maintenance & reattachment




maintenance & reattachment




maintenance & reattachment


END



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