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Medical Forum / General / Dentistry / August 2005periodontal surgery
I've had periodontal surgery recommend What s the 5 year outcome of such surgery What is the repeat rate for such surgeries TIA Are you going to quit smoking? Have you changed your oral hygiene habits? How many teeth are being treated? How deep are the pockets? How many three walled defects in the osseous tissue? What is your immuniologic status? Diabetes? HIV? etc. Family history? Amount of vertical loss of tooth support (recession plus pocket depth? What is the URL link to a scanned copy of your full mouth radiographs?  Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > > I've had periodontal surgery recommend [quoted text clipped - 4 lines] > > TIA >Are you going to quit smoking? >Have you changed your oral hygiene habits? [quoted text clipped - 5 lines] >Amount of vertical loss of tooth support (recession plus pocket depth? >What is the URL link to a scanned copy of your full mouth radiographs? I get your point, medicine is personal, but you (I suspect deliberately) misunderstood the question., I'm trying to a.ses the value of the surgery. I'm not asking for a diagnosis. Other branches of medicine have measures 5 year outcomes. I'm looking for the same for periodontal surgery. I want to know the probability that the proceedure will have to be repeated It's done for cancer treatments, I'm sure it's done for periodontal surgery, I m looking for a reference. The reason whiy i'm looking is that the proceedure has little value in preventing tooth loss. I wonder if it has any value in treating the disease itself. As regards to tooth loss, one reference indicates periodontal surgery is no value at all (1). I'd like to know if it has any value whatsoever in the ailment it treats TIA --G [1]Tooth Loss in Periodontal Patients Debora C. Matthews, B.Sc., DDS, Dip. Perio., M.Sc. Craig G. Smith, B.Sc., DDS Stacy L. Hanscom, B.S http://www.cda-adc.ca/jcda/vol-67/issue-4/207.html [2]Periodic health examination, 1993 update: 3. Periodontal diseases: classification, diagnosis, risk factors and prevention Amid I. Ismail, BDS, MPH, DrPH; Donald W. Lewis, DDS, DDPH, MScD, FRCDC; with the Canadian Task Force on the Periodic Health Examination Canadian Medical Association Journal 1993; 149: 1409-1422 'examiners can reach 95% agreement only within a wide range (2 mm) in their measurements of pocket depth." Nope, you are missing the point. Too many variables involved. This is not a simple condition. Each of the variables I listed could effect the prognosis plus or minus 2-8 years. Or, make the prognosis so poor that you would not attempt the procedure. Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > >>Are you going to quit smoking? [quoted text clipped - 42 lines] > 'examiners can reach 95% agreement only within a wide range (2 mm) in > their measurements of pocket depth." > Nope, you are missing the point. Too many variables involved. This is not > a simple condition. Each of the variables I listed could effect the > prognosis plus or minus 2-8 years. Or, make the prognosis so poor that you > would not attempt the procedure. Since the OP noted outcomes for "cancer surgery" I might point out that 5-year "success" rates for papillary ca of the thyroid is of little importance if you've got pancreatic cancer. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > Since the OP noted outcomes for "cancer surgery" I might point out that >5-year "success" rates for papillary ca of the thyroid is of little >importance if you've got pancreatic cancer. Ok, good point. I suspect you exaggerate for effect, presuming, of course, the differences between various periodontal disease(s) treated by surgery are smaller than the difference between thyroid and pancreatic cancer. Last time I checked the function of the thyroid and pancreas could be characterized as a bit greater than differences between one part of the gum to the other, though,of courcse, I defer to your experience I'll try to be more specific What are the categories of periodontal disease? What are the 5 year outcome for each fo these categories? Where are the statistics available? >> Since the OP noted outcomes for "cancer surgery" I might point out that >>5-year "success" rates for papillary ca of the thyroid is of little [quoted text clipped - 13 lines] > What are the 5 year outcome for each fo these categories? > Where are the statistics available? There are some studies purporting to show (as you noted) that history of periodontal surgery did not improve tooth retention in periodontal patients. But the studies I've seen are seriously flawed; there is no practical way to do a double-blind study of this. Besides, years of experience have taught me unequivocally that patients who have regular periodontal treatment fare better than those who don't. (On a personal note, there is a message on my answering machine from a patient of long standing with aggressive periodontal disease; he has over a period of years told me that he really, really intends to go see a periodontist. I last saw him almost 2 years ago. Turns out one of his front teeth just fell out. Guess who can't wait to come in now?) There are some markers for aggressive periodontal disease. The most telling to me is age of onset; if you are a 55 year old male with a couple of scattered 5 mm pockets in your upper molars, I am not nearly so concerned as I would be with an 18 year old female with 4 mm pockets in the upper incisors and first molars. The idea of the perio surgery is (at last) to allow you to retain your teeth. But there are no guarantees. What the surgery usually is designed to accomplish is to reduce the size and number of periodontal pockets, and secondarily to reduce inflammation. Reducing the depth of pockets allows for far more effective oral hygiene, so pushing surgery in the absence of meticulous oral hygiene and regular recalls is very much putting the cart before the horse IMO. If you are determined to be meticulous in your oral hygiene and regular in your recalls, it is highly likely that the surgery will contribute to the long-term retention of your teeth. If not, it will only contribute to your periodontist's boat. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Thanks ... > Besides, years of >experience have taught me unequivocally that patients who have regular >periodontal treatment fare better than those who don't. What do you consider regulare perio treatment... the 3/ 6 month cleaning done by a dental technician, the SRP UL (scaling and root planing) done by quadrant ( insurance code 4341) or the more agressive osseous surgery ( insurance code 4260). I'll seek out the 3/6 mo cleaning withought a second thougfht. I'll even go for the SRP with minor pause. But If extensive surgery is required I want to consider why ( and where) Speaking of SRP.. how often is thios procedure recommended > There are some markers for aggressive periodontal disease. The most >telling to me is age of onset; if you are a 55 year old male with a >couple of scattered 5 mm pockets in your upper molars, I am not nearly >so concerned Well you nailed me , age 55 with a couple of 4-6 mm pockets in the back molars. My hope is that modest treatment ( SRP) with improved oral hygene will be sufficient. But as you point out... I don't know. It would seem prudent to me to try that path for 3/6 months and see if the disease progression was halted, or even reversed. >If you are determined to be meticulous in your oral hygiene and regular >in your recalls, it is highly likely that the surgery will contribute to >the long-term retention of your teeth. If not, it will only contribute >to your periodontist's boat. I don't think he has a boat, but the question of agresive, and perhapss ineffective, treatment goes to the heart of the question. If surgery is necessary I want to know what co factors need to be considered to make sure it is effective. This is not a tirade against the practitioneer, it is just normal prudence in the face of elective surgery I've had SRP, become meticulous in my oral hygene, and a review of pocket depth after 3 weeks showed litttle improvement in depth. Is three weeks suffiucient?. Why not 3 months? Is tissue recovery that fast that 3 weeks is sufficient? ( I know only your dentist knows for sure, but I'd like to know tha AAP recommnedation if one exists) If the patient is reluctent fto engage in surgery are medical treatments appropriate as an interim measure I suspect , in the end, I'll get a second opinion from a periodontist at harvard or tufts dental school faculty, and seek treatment there if the recommencdation coinciedes with teh original. >I've had SRP, become meticulous in my oral hygiene, and a review of > pocket depth after 3 weeks showed little improvement in depth. Is > three weeks sufficient?. Why not 3 months? Is tissue recovery that > fast that 3 weeks is sufficient? ( I know only your dentist knows for > sure, but I'd like to know that AAP recommendation if one exists) I always suggest starting with SRP then advancing from there if tissues do not improve. At 3 weeks, you would see little change in attachment height, but could see big changes in tissue texture and quality. I think tissue health is a better indicator of treatment progress than immediate pocket depth. Pocket depth by itself is not enough to base treatment on. I, personally, often will have patients wait 3 months, re-evaluate the tissue health, then make my recommendations. > If the patient is reluctant to engage in surgery are medical > treatments appropriate as an interim measure If surgery is needed to make the tissues easier to maintain, get rid of granulation tissue, remove accretions, removed diseased tissue, etc, then nothing short of physical therapy is going to work. Antibiotics are an adjunct to this type of therapy, not a replacement for it. > I suspect , in the end, I'll get a second opinion from a periodontist > at Harvard or tufts dental school faculty, and seek treatment there if > the recommendation coincides with the original. A second opinion is often wise. I think it is rude to have one specialist invest tons of work and effort into creating a treatment plan, then have the patient get a second opinion that agrees with the first, and let the second office do the work. If the second office does a better job of instilling confidence and competence, that is a different story. Assuming all things are equal, courtesy would imply the patient return to the first office for actual therapy. Signature/ Amatus / > > Thanks [quoted text clipped - 49 lines] > at harvard or tufts dental school faculty, and seek treatment there if > the recommencdation coinciedes with teh original. >I always suggest starting with SRP then advancing from there... > Pocket depth by itself is not enough to base treatment on. I, >personally, often will have patients wait 3 months, re-evaluate the tissue >health, then make my recommendations. Thank you In my all too brief discussion, all that was indicated was little change in pocket depth. My perusal of the literature suggests other factors should be considered. In tha absensce of any pain bleeding or tooth mobility, I see no harm in waiting 3 months to see if better oral hygene helps >> I suspect , in the end, I'll get a second opinion >A second opinion is often wise. I think it is rude to have one specialist >invest tons of work and effort into creating a treatment plan, then have the >patient get a second opinion that agrees with the first, and let the second >office do the work. The work involved the SRP, and the single post inspection. I had to press to get an idea of what the treatment plan was As to second opinion, I'd always get that before surgery I don't mean to be rude. In the absence of specific detailed knowledge of the practitioner, I'm more comfortable getting surgery in a teaching hospital. > I don't mean to be rude. In the absence of specific detailed knowledge > of the practitioner, I'm more comfortable getting surgery in a > teaching hospital That sounds reasonable. Signature/ Amatus / > >>I always suggest starting with SRP then advancing from there... [quoted text clipped - 27 lines] > of the practitioner, I'm more comfortable getting surgery in a > teaching hospital. >I don't mean to be rude. In the absence of specific detailed knowledge >of the practitioner, I'm more comfortable getting surgery in a >teaching hospital. Then your surgery will usually be done by a resident. (post doctoral *student*) -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >>I don't mean to be rude. In the absence of specific detailed knowledge >>of the practitioner, I'm more comfortable getting surgery in a >>teaching hospital. > >Then your surgery will usually be done by a resident. (post doctoral *student*) Thanks for the tip... but I checked this out ( though not specifically for periodontic services) Harvard has two practices; one for teaching(where the students do the work) , and one by the faculty (run like an ordinary practice) . I was going for the teaching faculty practice. > Harvard has two practices; one for teaching(where the students do the > work) , and one by the faculty (run like an ordinary practice) . I was > going for the teaching faculty practice. I would avoid a faculty practice. Often the reason they practice at the school is that they could not survive ITRW. Some are excellent clinicians, many are excellent teachers. They might not be excellent at both teaching and "doing". Treatment by the "students" would ensure more specialist consultation and more input from many different instructors. JMHO. Signature/ Amatus / > >>>I don't mean to be rude. In the absence of specific detailed knowledge [quoted text clipped - 10 lines] > work) , and one by the faculty (run like an ordinary practice) . I was > going for the teaching faculty practice. >>Harvard has two practices; one for teaching(where the students do the >>work) , and one by the faculty (run like an ordinary practice) . I was >>going for the teaching faculty practice. > > I would avoid a faculty practice. Often the reason they practice at the > school is that they could not survive ITRW. Wow--that's an awful sweeping statement. I'd doubt very highly that Harvard has losers practicing there. Steve Some are excellent clinicians, > many are excellent teachers. They might not be excellent at both teaching > and "doing". Treatment by the "students" would ensure more specialist > consultation and more input from many different instructors. JMHO. SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > Wow--that's an awful sweeping statement. I'd doubt very highly that > Harvard has losers practicing there. You may be right about Harvard, but in general, I have found faculty clinics to be staffed by instructors who lack "something". Signature/ Amatus / > >>>Harvard has two practices; one for teaching(where the students do the [quoted text clipped - 14 lines] >> specialist consultation and more input from many different instructors. >> JMHO. >>>I don't mean to be rude. In the absence of specific detailed knowledge >>>of the practitioner, I'm more comfortable getting surgery in a [quoted text clipped - 8 lines] >work) , and one by the faculty (run like an ordinary practice) . I was >going for the teaching faculty practice. I see, thanks for the info. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > Thanks > ... [quoted text clipped - 7 lines] > planing) done by quadrant ( insurance code 4341) or the more > agressive osseous surgery ( insurance code 4260). I actually was referring to regular maintenance visits, scheduled as needed after active treatment is completed. This active treatment will include a full evaluation including pocket depths, noting tooth mobility, mucogingival problems, inflammation, and deposits, scaling and root planing of inflamed areas, re-evaluation, and pocket-reduction surgery as needed after the initial therapy. > I'll seek out the 3/6 mo cleaning withought a second thougfht. I'll > even go for the SRP with minor pause. But If extensive surgery is > required I want to consider why ( and where) > > Speaking of SRP.. how often is thios procedure recommended In the absence of significant pocketing, inflammation and the presence of optimal oral hygiene, never. If there is backsliding after definitive treatment, it may be necessary in selected areas. >> There are some markers for aggressive periodontal disease. The most >>telling to me is age of onset; if you are a 55 year old male with a [quoted text clipped - 6 lines] > It would seem prudent to me to try that path for 3/6 months and see if > the disease progression was halted, or even reversed. Without seeing you, this sounds reasonable to me--esp. if you agree to return in a reasonable length of time for re-evaluation. Steve >>If you are determined to be meticulous in your oral hygiene and regular >>in your recalls, it is highly likely that the surgery will contribute to [quoted text clipped - 20 lines] > at harvard or tufts dental school faculty, and seek treatment there if > the recommencdation coinciedes with teh original. SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 (snip) > I've had SRP, become meticulous in my oral hygene, and a review of > pocket depth after 3 weeks showed litttle improvement in depth. Is > three weeks suffiucient?. Why not 3 months? Is tissue recovery that > fast that 3 weeks is sufficient? ( I know only your dentist knows for > sure, but I'd like to know tha AAP recommnedation if one exists) One more thing--Dr. Amatus was alluding to the fact that pocket depth alone is not a reliable marker of current disease activity. This is true. I also would not assume that all patients are incapable of maintaining a 5 or even a 5 mm pocket in all areas of the mouth. For this reason I think that as long as your teeth appear clean and there is no significant periodontal inflammation on recall I would feel comfortable in continuing you on regular recall and defer any pocket reduction surgery until such time that it appears things are deteriorating. Steve > If the patient is reluctent fto engage in surgery are medical > treatments appropriate as an interim measure > > I suspect , in the end, I'll get a second opinion from a periodontist > at harvard or tufts dental school faculty, and seek treatment there if > the recommencdation coinciedes with teh original. SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >> Since the OP noted outcomes for "cancer surgery" I might point out that >>5-year "success" rates for papillary ca of the thyroid is of little [quoted text clipped - 13 lines] >2) What are the 5 year outcome for each fo these categories? >3) Where are the statistics available? 1) Class I, II, III, IV Juvenile Periodontitis, Gingivitis, etc. 2) Depends on hundreds of modifying factors a) Class I and II and Gingivitis respond best to treatment since they are less drastic 3) In thousands of peer reviewed research articles over the past 50 years Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... >>1) What are the categories of periodontal disease? >>2) What are the 5 year outcome for each fo these categories? >>3) Where are the statistics available? >1) Class I, II, III, IV Juvenile Periodontitis, Gingivitis, etc. >2) Depends on hundreds of modifying factors > a) Class I and II and Gingivitis respond best to treatment since >they are less drastic >3) In thousands of peer reviewed research articles over the past 50 years Thanks.. 1) can you tell me the distinctions between Class I, II, III, IV. is it soley a matter of pocket depth, or are there other markers equally important in the clinical assessment 3) Can you point me to good review/textbook that you consider good. As you note there are thousands of articles, and some guide is needed >Nope, you are missing the point. Too many variables involved. This is not >a simple condition. Each of the variables I listed could effect the >prognosis plus or minus 2-8 years. Or, make the prognosis so poor that you >would not attempt the procedure. OK., I'll answer the ones I can and see if that will help you narrow it down. I'll ask the periodontist for the answers to missing ones (5,8,9) 1)Are you going to quit smoking? Never smoked 2)Have you changed your oral hygiene habits? Yes , I brush more frequently (3x/day), brush longer (2minutes/sessieon) , floss daily , and rinse with listerine 3)How many teeth are being treated? 4 quadrants recommended, # of teeth was unspeciied 4)How deep are the pockets? Most 2-4, some 4-6mm. no bleeding,no bleeding on probing 5)How many three walled defects in the osseous tissue? not specified, diagnosis was based on pocket depth 6)What is your immuniologic status? Diabetes? HIV? etc. just fine, no HIV, no diabetes 7)Family history? none for periodontal disease 8)Amount of vertical loss of tooth support (recession plus pocket depth? not specified, diagnosis was based on pocket depth 9)What is the URL link to a scanned copy of your full mouth radiographs? not available,I'll try to get them TIA G These are just some of the factors involved in trying to answer your question. Impossible to be specific for your case over the internet. Only a dentist who sees you in person can do that. In general,,,,,,,,,,,,,, if recession is less than 2 mm and pocket depths are less than 6mm and the patient does not smoke, does not have *ANY* health problems, has fantastic oral hygiene, sticks to a strict 3 month re-treatment schedule for professional cleanings, does not clench during sleep, has no dental decay, no tooth mobility, good quality and quantity of saliva, good immunologic response to the various pathogens which cause periodontitis, does not have any dental furcation exposed through the attachment loss, etc....... the case will do fantastic and last for 30-50 years. Any alteration in those factors will reduce the prognosis. The amount of possible variation is infinite. Modify the above factors enough and you may have a 6 month prognosis for the case. Do you understand the point I was trying to make? You are asking for something which cannot be answered through this forum for your particular case. Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > >>Nope, you are missing the point. Too many variables involved. This is [quoted text clipped - 40 lines] > TIA > G >These are just some of the factors involved in trying to answer your >question. Impossible to be specific for your case over the internet. Only [quoted text clipped - 15 lines] >something which cannot be answered through this forum for your particular >case. Thanks for the help Yes I do get the point.. the prognosis depends on the details of the disease/patient history,. That said, I do want a better understanding of the problem then provided in the all to brief recommendation given to me Is there any clinical measure of "good immunologic response to the various pathogens which cause periodontitis" How does one a.ses this >>Are you going to quit smoking? >>Have you changed your oral hygiene habits? [quoted text clipped - 24 lines] > > TIA Yes. Steve > --G > [quoted text clipped - 13 lines] > 'examiners can reach 95% agreement only within a wide range (2 mm) in > their measurements of pocket depth." SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >I've had periodontal surgery recommend Thank you all for your help... I have a better understanding of the problem ( despite the rough start;) --G |
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