Periodontal Therapy – The Hub for Interdisciplinary Care

Teeth with both endodontic and periodontal diseases have often been considered to have a very poor prognosis. However, this is largely due to a poor understanding of the disease processes which in turn is a result of confusing classifications of these diseases. A further compounding problem in most journal articles and textbook chapters on this topic has been the inclusion of all possible conditions that can affect both the periodontium and the pulp or root canal system at the same time even though these conditions are conditions in their own right – for example, a root perforation, root fracture, invasive resorption, etc. In this lecture, an alternate classification will be presented. This classification is based on the individual diseases that are present, rather than attempting to combine them, with the concept that there are two separate diseases occurring on the same tooth at the same time. This classification can then be used to determine the best way to manage the tooth. A particular sequence and approach to treatment will be outlined to help improve the prognosis of teeth with concurrent endodontic and periodontal diseases.

Placement of restorations and dental prostheses are necessary to rebuild missing teeth and to rehabilitate occlusal functions. However, design and fabrication of prostheses for the purpose in periodontally compromised dentitions should be carefully adopted in order to protect the limited periodontium from further deterioration. It highlights the need for well-balanced occlusal loading, adequate assessment of plaque control, and motivation of periodontal maintenance. Through case presentation, factors could affect periodontal prognosis, such as tooth morphology and alignment, periodontal severity, prosthetic considerations and therapeutic modalities, will be discussed.

The treatment of teeth with furcations affected by periodontal disease is one of the most challenging situations for the dental community. When the periodontal disease affects the furcation area, tooth loss chance increases considerably.

Exposed root surface, anatomical peculiarities, and irregularities of the furcation surface all favour the growth of bacteria accompanied by limited access to treatment for the operator and limitations on the performance of oral hygiene for the patient. No ideal procedure or protocol for treating such lesions exists, so this presentation will aim to elaborate on different treatment concepts from the past till the present and some future perspectives when it comes to treatment of teeth with furcation involvement. This presentation aims to help clinicians, understand and consider the importance of case selection, the use of advanced diagnostics, the pros and cons of the current evidence, the importance of multidisciplinary approach and the perspective of their clinical understanding and experience when it comes to the treatment of advanced periodontal disease in furcation areas. Its fundamental and every dental professional should seek consultation with a specialist when in doubt regarding the prognosis and treatment of those teeth.

It is crucial for dental professionals to acknowledge the interrelationship between periodontics and orthodontics and the potential of integrating both therapies to achieve optimal oral health and esthetics for our patients requiring complex interdisciplinary care. This presentation will delve into the synergistic relationship between periodontics and orthodontics, highlighting the importance of a strong periodontal foundation for successful orthodontic treatment. The discussion will include the various periodontal considerations in orthodontic interdisciplinary treatment planning, specifically for the severe stage III/IV periodontitis patients, intra-treatment phase strategies for monitoring and managing treatment progress, and post treatment phase maintenance and retention. Further, the presentation will also discuss the differing perspectives on periodontal-orthodontic treatment sequence and modalities. Through a blended series of clinical cases, we aim to provide a unique perspective based on our experiences in Hong Kong.