Tuesday, December 18, 2012

Comprehensive Periodontal Examination

Evaluation of patient's periodontal status requires obtaining a relevant medical and dental history and conducting a thorough clinical and radiographic evaluation.

1. A medical history should be evaluated to identify predisposing conditions that may affect treatment, patient management and outcomes. Such conditions include diabetes, hypertension, pregnancy, smoking, substance abuse and medications and other existing conditions that impact traditional dental therapy.

2 A dental history including the reason for the visit and information about past dental and periodontal care and records will be useful.

3.TMJ and other extra oral structures must also be evaluated.

4. Intra oral tissues and structures including oral mucosa, muscles of mastication, lips, floor of mouth, tongue, salivary glands, palate and the oro pharynx should be examined.

5.  Examination of teeth and their replacements should include observation of missing teeth, condition of restorations, caries, tooth mobility, tooth position, occlusal and interdental relationships, signs of para functional habits and pulpal status.

6 Current radiographs  for evaluating status of periodontium and dental implants.

7.Determination of plaque and calculus distribution.

8. Periodontal soft tissue and peri implant tissue examination.

9. Probing depths, clinical attachment levels and bleeding on probing is evaluated.

10. Muco gingival relationships including abnormal frenulum attachments, gingival recession and deficiencies of keratinized tissue.

11. Presence, location and extent of furcation invasions.

Additional diagnostic aids like diagnostic casts, microbial and other assessments add value  to a thorough examination..

Based on the results of the examination, a diagnosis and proposed treatment plan should be presented to the patient. Patients should be informed of the disease process, therapeutic alternatives, potential complications, the expected results and the patient's responsibilities in treatment. Consequences of no treatment should be explained to the patient.

Tuesday, December 11, 2012

Classification of Periodontal Diseases

Classifications systems are necessary in order to provide  a framework to study the cause, pathogenesis and treatment of diseases in an orderly fashion. The current classification  includes a section on gingival diseases.


A Dental Plaque induced Gingival Diseases

1. Gingivitis associated with plaque only
2. Gingival diseases modified by systemic factors
3.Gingival disease modified by medicatons
4 Gingival disease modified by malnutrition

B Non plaque induced gingival lesions

1. Gingival diseases of bacterial origin
2. Gingival diseases of Viral origin
3.Gingival diseases of fungal origin
4. Gingival lesions of genetic origin
5 Gingival manifestations of systemic conditions and allergic reactions
6.Traumatic lesions
7. foreign body reactions
8. Non specified

II. CHRONIC PERIODONTITIS (replacement of adult periodontitis)
A Localized
B Generalized

A Localized
B Generalized

A Associated with hematological disorders
B Associated with genetic disorders
C Non specific


A Gingival abscess
B Periodontal abscess
C Pericoronal abscess


A.Tooth related deformities
B Mucogingival deformities around teeth
C Mucogingival deformities on edentulous ridges
D Occlusal trauma

Carefully adhering to this classification in assessing a periodontal condition  makes it easy to develop effective treatments for this complex group of infections says Dr. Cherukuri


Thursday, December 6, 2012

Dental Bone Grafting

Bone Grafting is the replacement or augmentation of the portion of the jaw bone that anchors the teeth. It's a surgical procedure that's often done to reverse the loss or resorption of bone that may have occurred due to tooth loss, trauma, disease or ill-fitting dentures, and to rebuild the bone structure beneath the gums in preparation for the placement of dental implants or other tooth replacements.

When bone graft is implanted in the jaw, it doesn't just simply fill a void in the bone; it may also help promote new bone growth in that location. When successful, bone grafting can restore both the height and width of your jaw bone
There are several bone graft options, and they differ in how they help promote bone formation. They include:
Autogenous Bone Grafts. Also called autografts, these types of grafts are made from the patient's own bone, harvested from elsewhere in the body. Typical harvest sites include the chin, jaw, bone of the lower leg (tibia), hip (iliac crest) or the skull (cranium).
Autogenous bone graft has traditionally been considered the "gold standard" as a graft material because it is "live bone" complete with the living cellular elements that enhance bone growth.
A potential downside of autogenous bone grafting, however, is that it involves a second procedure to harvest the bone, which may be painful and not in some patients' best interest, depending on their condition. It also may not be a viable option in instances where the patient's overall bone quality and/or density is poor, or when a large volume of graft material is required.

Allogeneic Bone. Allogeneic bone, also called allograft, is bone derived from a genetically unrelated member of the same species. It's typically non-vital (dead) bone harvested from a cadaver, then processed using a freeze-drying method that extracts all the water via a vacuum.
Allogeneic bone cannot produce new bone on its own – Its primary mechanism of action is that it is osteoconductive, and serves as a framework or scaffold over which bone from the surrounding bony walls can grow to fill the defect or void.

Xenogenic Bone. Similar to allogeneic bone, xenogenic bone is non-vital bone derived from another species, usually a cow. Because the potential for immune rejection and contamination by viral proteins is higher in bovine bone than in human cadaver bone, xenograft material is processed at very high temperatures (600-1,000 degrees Celsius). Xenograft's mechanism of action is similar to that of allograft – it serves as an osteoconductive framework on which bone from the surrounding area can grow to fill the void.
These grafting options are preferred by many patients and dental professionals alike because they eliminate the potentially painful second harvesting procedure. However, because allograft and xenograft lack autograft's bone forming properties, bone regeneration may take somewhat longer than it does when using the patient's own bone and the outcome may be less predictable.

Bone Graft Substitutes

Bone graft substitutes are commercially produced synthetic products that have many of the same bone forming properties as human bone, and are a safe and proven alternative to autograft and allograft.
One of the advantages of using a bone graft substitute instead of autogenous bone is that it eliminates the need to harvest the patient's own bone, thus potentially reducing the risk and pain associated with the harvest procedure.

Contact Dr Cherukuri for more information on dental bone grafting or visit www.chinosmiles.com  for more information.