Page 369 - WSAVA2018
P. 369

This author is a big believer in minimally invasive surgery. Use small, sharp luxating elevators, minimal bone removal, and envelope flaps for extractions.
BONE REGENERATION
Regenerating bone lost via periodontal disease is another weapon in the fight against periodontal disease. This is combined with periodontal flap surgery to clean and regenerate the lost bone. The technique of guided tissue regeneration (GTR) has been around for decades, but recent advances in barriers and bone grafting has markedly improved the success rates. Regardless, there are only a handful of conditions which carry a good prognosis for bone regeneration. The best prognosis is seen with 3-walled periodontal pockets (typically seen on the palatal aspect of the maxillary canine and distal aspect of the distal root of the mandibular first molar) and class II furcation lesions. Since these are quite common in small breed dogs, there are a large number of patients who would benefit from these procedures.
The theory of GTR is that the down growth of faster healing soft tissue must be prevented to allow the slower growing bone and periodontal ligament to repopulate the periodontally induced bony defect. GTR involves creating a periodontal flap and performing open root planning to create a clean root surface for healing.
After this is accomplished, the defect is filled with bone augmentation and a barrier membrane placed. There
are numerous products currently utilized on the human side, however currently the products of choice for
most veterinary dentists are cancellous freeze-dried demineralized bone for the graft and demineralized laminar bone sheets[ as the membrane.
HOST MODULATION
This is an exciting new area of periodontal therapy. It is the use of products to decrease the inflammatory response to bacterial plaque. In this way it can lessen gingivitis and in some cases decrease the amount of alveolar bone loss. Some products are drugs, but there are and increasing number of nutraceuticals in this segment.
Probiotics have been shown to be very effective at improving oral health. They can be administered orally, bit are more effective when rubbed on the gums. Additionally, they have been shown to decrease pocket depths when injected into a periodontal pocket.
Fatty acids are well known for their anti-inflammatory effect on skin and joints. They have also been shown to be effective against periodontal disease. In particular, a veterinary labelled product can be topically applied for maximum local effect, but when swallowed also provides joint support.
Other agents in this category are CoQ10, antioxidants, and proper overall nutrition.
CONCLUSIONS
Periodontal disease is by far the most common disease process in small animal veterinary patients. It is particularly common in small and toy breed dogs. Not only does it create local infection and can lead to tooth loss, there are numerous negative local and systemic effects of untreated periodontal disease. In fact, on the human side periodontal disease is known as the “silent killer”. Proper care of periodontal disease is critical for the overall health of the patient.
The basis for therapy of periodontal disease is plaque control. This is achieved by a combination of professional cleanings, periodontal surgery, extractions, and most critically homecare. It is critical to select therapies (particularly homecare) which are effective at and below the gumline. Recently, guided tissue regeneration and host modulation have emerged as additional options for combatting periodontal disease.
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