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Periodontal Medicine Practice Model Mini Me Periodontal Medicine Practice Model Mini Me © 2017 KOIS CENTER, LLC MINI ME Periodontal Medicine Practice Model 1. Documentation ................................................................................................................................................................4 Marginal Plaque Index ................................................................................................................................................................4 Soft Tissue Management ...............................................................................................................................................................5 Probing Depth Measurement.......................................................................................................................................................6 Pathogen Profile .............................................................................................................................................................................7 Clinical Case: Pathogen Profile ...........................................................................................................................................9 Summary Key ...............................................................................................................................................................................10 Radiographs ..................................................................................................................................................................................14 2. Diagnosis and Risk Assessment ....................................................................................................................17 Attachment Loss ..........................................................................................................................................................................17 Innate Risk ....................................................................................................................................................................................17 Race ............................................................................................................................................................................................17 Genetic Factors .........................................................................................................................................................................18 Systemic Testing .......................................................................................................................................................................19 Systemic Relationships ............................................................................................................................................................26 Diabetes .................................................................................................................................................................................26 Cardiovascular Disease ........................................................................................................................................................33 Preterm Low Birth Weight ..................................................................................................................................................37 Acquired and Environmental Risk ............................................................................................................................................44 Age .............................................................................................................................................................................................44 Tobacco / Smoking ...................................................................................................................................................................45 Additional Material: PerioSciences ...................................................................................................................................50 Cocaine and Other Illicit Drugs .............................................................................................................................................53 Obstructive Sleep Apnea .........................................................................................................................................................54 Psychological Stress .................................................................................................................................................................55 Depression.................................................................................................................................................................................56 Sarcoidosis .................................................................................................................................................................................56 Rheumatoid Arthritis ..............................................................................................................................................................57 Sexual Behavior ........................................................................................................................................................................61 Kidney Disease .........................................................................................................................................................................62 Alzheimer's Disease .................................................................................................................................................................63 Cytome Systemic Medication .................................................................................................................................................64 Nutrition ....................................................................................................................................................................................65 Lifestyle Factors ........................................................................................................................................................................72 3. Gingival Management .............................................................................................................................................73 Oral Malodor ................................................................................................................................................................................73 © Kois Center, LLC 2 MINI ME Periodontal Medicine Practice Model | 3 of 78 L1 Override ALWAYS Periodontal Medicine Practice Model 1 of 1 L2 Override • Marginal Plaque Index (MPI) L3 Override • Probing Depth Measurements (PD) – 6 Sites Per Tooth • Line Bleeding on Probing (BOP) • Clinical Attachment Loss (CAL) Documentation • Assess Bone Levels – Panorex – Periapical Radiograph – Bitewing – CBCT Scan • Pathogen Profi le • Risk Prediction Diagnosis and (Innate vs. Acquired and Environmental) Risk Assessment • Genetic Testing – Biomarkers • Scaling and Root Planing (SRP) – Mechanical Debridement Gingival Management – Ultrasonic Instrumentation (Controlling Local Factors) • Oral Hygiene Instruction • Home Care Management (i.e., toothbrush, fl oss, adjunctive protocols) • Laser • Photodynamic Therapy • Antimicrobial Attachment Loss – Local Delivery Management – Systemic Delivery • Antiviral Medication • Host Modulation Therapy • Root Coverage • Pocket Elimination (Horizontal Bone Loss) Surgical Management • Regenerative Therapy (Site Specifi c Defects; Infrabony) • Selective Extraction (Site Specifi c Defects) • 6 Months – Low Risk Continuous Care • 4 Months – Moderate Risk Frequency • 3 Months – High Risk © 2018KOIS KoisCENTER Center,, LLC LLC 3 MINI ME Periodontal Medicine Practice Model | 1. Documentation | Marginal Plaque Index 4 of 78 1. Documentation Marginal Plaque Index Establishment of a New Marginal Plaque Index with High Sensitivity for Changes in Oral Hygiene Deinzer R, Jahns S, Harnacke D. J Periodontol. 2014 Dec;85(12):1730-8. Materials and Methods TABLE 1.1 Although several plaque indices exist, they Description of Different PIs rarely assess in detail the plaque adjacent to the gingival margin, an area most important for Index Level of Measurement Characteristics periodontal health. This study aims to develop a TQHI Ordinal Rating of plaque extension new marginal plaque index (MPI) and to assess considering the whole tooth; its validity and treatment sensitivity compared values from 0 to 5 to the internationally accepted Turesky Silness and Löe PI Ordinal Rating of plaque extension modification of the Quigley and Hein Index considering the whole tooth; (TQHI). values from 0 to 3 Modified navy PI, Dichotomous Presence or absence of Results O’Leary plaque plaque is assessed for 1. Convergent validity with TQHI is very good. control record/plaque prespecified areas. assessment scoring Concurrent and predictive validity parameters system of the MPI are similar to the TQHI. Axial and the proximal Cardinal Plaque height is measured by 2. The treatment sensitivity of MPI exceeds TQHI plaque extension means of a periodontal probe. by far. This results in a reduction by >70% of index the sample size needed to discover significant Image analysis Cardinal Pictures of disclosed plaque treatment effects. are taken; plaque extension is
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