Periodontal Video-Net
Diagnosis and Treatment of Moderate Periodontitis

This series of video sequences illustrate diagnosis and treatment of moderate periodontitis in a 35 years old female. The registration of gingival inflammation is undertaken by observing form, color, surface and consistency of the gingival margin. If the gingival margin is flabby when hit by a blast of air it is usually an indication of inflammation in the tissue	Probing pocket depth measurements and registrations of bleeding on probing are undertaken around each tooth and registered for at least 4 surfaces mesial, buccal, distal and lingual. In some instances registrations at 6 sites might be advisable. The destruction of the periodontium is generally irregular and it is necessary to move the probe tip in several directions in order to find the deepest site at each surface.	Note also the severely inflamed gingiva and the presence of supragingival plaque on the teeth.. At the buccal site of the lower right second molar there is a deep probing depth and a large chunk of supra and subgingival plaque is forced out of the dentogingival region when the probe is move along the gingival margin.	In the lower right incisor region the gingiva is inflamed and the presence of subgingival calculus can be noted with the probe. The gingiva also bleed easily when probing the pockets.
Mirror image. On the lingual side of the left lower jaw the signs of gingival inflammation is very prominent. The tissue is swollen, red, shiny and bleed very easily upon probing of the pockets	Mirror image. On the lingual side of the right lower jaw the signs of gingival inflammation is very prominent. The gingival margin has an irregular form is swollen and shiny as well as bleed easily following probing	The X-ray of the right side demonstrate moderate periodontal bone loss with a tendency of infrabony pockets at the first premolar in the upper jaw.	The X-ray of the patients left side also demonstrates moderate periodontal bone loss
The periapical radiograph on the right upper quadrant shows that in particular the premolar is damaged with infrabony pockets on both the mesial and the distal sites.	In order for the patient to see dental plaque, the cause of gingival inflammation and periodontal disease, the teeth are stained with a disclosing solution.	The patient demonstrates her cleaning habits and corrections are made for proper oral hygiene procedures. The brush should be placed over the gingival margin and the cleaning undertaken with a soft and short back and forth movement. It is important to use a soft tooth brush.	Cleaning of the teeth from plaque and calculus is carried out using an ultrasonic cleaning devices which is moved over the root surface with a slight pressure. Intensive water cooling as provided continuously. The time needed to clean the root surfaces but a single rooted tooth requires several minutes of active treatment to be cleaned.
It is important to keep the tip of the instrument in a constant move to reduce damage to the tooth surface and tissues.	In areas difficult to reach, handinstruments are used to remove subgingivally located calculus and bacterial deposits. Hand instruments also provide better tactility compared with the ultrasonic device. The effect of the two types of instruments on the result of treatment is the same.	This image shows the condition two weeks following treatment. The gingiva appears pale and has a healthy appearance. The patient has practiced efficient oral hygiene procedures since the treatment.	Here it can be seen that some calculus is remaining. This calculus is removed by an ultrasonic instrument or a hand instrument. Studies have shown that is practically impossible to remove all subgingival calculus. Despite this in most cases the tissues heal clinically satisfactory following careful subgingival debridement.
This region in the lower jaw also has some calculus remaining. The main criteria for finding remaining plaque and calculus is the persistence of gingival pathology. Such sites should be retreated.	This show (mirror) the gingival condition at the lingual side in the lower jaw on the patients left side. It can be noted that the tissue appears healthy. A couple of weeks following treatment.	Also at the lower right lingual side(mirror) the gingiva demonstrates gingival and periodontal health. There is minimal bleeding following probing and the gingiva adopt closely to the teeth.	This is two months following treatment. The gingiva is healthy and the depths of the periodontal pockets are reduced. Few sites shows bleeding following pocket probing.
The lower jaw two month following treatment. The periodontal condition is healthy.	In comparison to the video sequence in sequence 21 this shows the condition before treatment. Aboundance of subgingival plaque is pressed out of the pockets when probing	The patient should following treatment be given supportive treatment consisting of sub- and supragingival cleanings and re-instruction in oral hygiene procedures. This logistics of periodontal treatment prevent in most patients further progression of periodontal disease.	These videos were produced by Rolf Attstrom and Danish Dental Association in collaboration with Goof Video, Denmark. Camera and videoediting Tommy Ols, Videocompiling and Sound Recording Anders Nattestad Link to document with sound

Rolf Attstrom & Anders Nattestad 1999

Designed for a screen resolution of 1024*768
Updated 991112

Centre for Oral Health Sciences, Malmoe University,
Malmoe, Sweden
School of Dentistry, Faculty of Health Sciences, University of Copenhagen,
Copenhagen, Denmark.
Copyright Rolf Attstrom et al Interactive Periodontology, Council for Higher Education, National Agency of Higher Education, Stockholm,Sweden.

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