VACS USLIT 427 REGEN Periodontal Flow Chart - Straumann

Initial evaluation
Includes: initial examination, diagnosis and prognosis, prophylaxis and EVALUATION
Periodontally
healthy patient
PPD ≤ 4mm
No CAL loss
BOP none to slight
No mobility
No mucoginival issues
Patient with gingivitis
Mild to Moderate Peridodontitis
PPD ≤ 6mm
CAL ≤ 4mm
BOP moderate to severe
+/- suppuration
Moderate mobility
Class 1 furcation
Localized: 1 - 3
teeth
Generalized
4+ teeth
Severe
Periodontitis
PPD > 6mm
CAL > 4mm
Increased
mobility
Class II / III
furcation
involvement
CRITERIA FOR
EVALUATION
■ PPD ≤ 4mm
■ No CAL loss
■ BOP none to slight
■ No mobility
■ No mucogingival issues
REPEAT Initial therapY
EVALUATION
Initial therapY
EVALUATION
Initial therapy
■ Instructions for hygiene
■ Plaque control
■ Supragingival and
subgingival SRP
possibly with chemotherapeutics
■ Occlusal therapy
■ Risk factor mediation
Referral for surgery
Surgery - furcation
involvement
EVALUATION
Surgery - no furcation
involvement
Re-evaluate
treatment plan
recall
Periodontal maintenance
Legend
PPD: Pocket Probing Depth
BOP: Bleeding On Probing
CAL: Clinical Attachment Level
GTR: Guided Tissue Regeneration
SRP: Scaling and Root Planing
This is an abbreviated version of the Periodontal Treatment Guide. Please refer to the complete
Guide for more details on evaluation points and further details about surgical choices.

Depending on the extent of the procedure, these are some possible insurance codes that you might use in each step of the treatment
process. This list is simply for reference and may or may not cover all of the codes that you might consider using. Responsibility for
determination of the correct codes remains with the physician.*
Pre-determining insurance coverage
Determining the level to which a patient’s insurance is estimated to cover treatment can help you and your patient in understanding
the estimated out-of-pocket cost. Pre-determining coverage for Emdogain is also an opportunity to discuss the benefits and value
this treatment can bring to the patient. Work with the insurance company for a pre-estimate of coverage and educate your patient
on the financial investment they can’t afford NOT to make.
INITIAL EVALUATION STEP
■ D1110 Prophylaxis for adults in healthy state
■ D0180 Complete Periodontal Examination
■ D0140 Limited oral evaluation – problem focused
■ D1204 Topical application of fluoride – adult
■ D9630 Other drugs and/or medicants by report
■ D0277 Vertical bitewings (7-8 films) OR D0210
Intraoral, complete series (Including bitewings)
■ D0330 Panoramic films
INITIAL THERAPY
■ D4355 Full mouth debridement
■ D4341 Periodontal scaling and root planing – 4+
teeth per quad
■ D4342 Periodontal scaling and root planing – 1-3
teeth per quad
■ D4381 Delivery of localized chemotherapuetic agent
■ D1204 Topical application of fluoride – adult
■ D9630 Other drugs and/or medicants by report
ONGOING EVALUATION STEP
■ D4910 Recall evaluation
Recall (healthy or gingivitis)
■ D1110 Prophylaxis for adults in healthy state
■ D1204 Topical application of fluoride – adult
■ D9630 Other drugs and/or medicants by report
Surgery
■ D4260 osseous surgery (including flap entry and
closure) – 4+ teeth per quad
■ D4261 osseous surgery (including flap entry and
closure) – 1-3 contiguous teeth per quad
■ D4263 bone replacement graft – first site in
quadrant (use this code when graft is used to
replace bone in areas of bone loss due to
periodontal disease)
■ D4265 Biologic material to aid in soft and osseous
tissue regeneration
Code D4265 Biologic material to aid in
soft and osseous tissue regeneration
Biologic materials may be used alone or with other regenerative
substrates such as bone and barrier membranes, depending upon
their formulation and the presentation of the periodontal defect.
This procedure does not include surgical entry and closure, wound
debridement, osseous contouring, or the placement of graft and/
or barrier membranes. Other separate procedures may be required
concurrent to D4265 and should be reported using their
own unique codes.
Periodontal maintenance
■ D4910 Peridontal Maintenance Procedures
(following active therapy)
*Straumann-provided insurance information is not a guarantee of reimbursement. Each insurance carrier varies in terms of limits,
restrictions and coverage.
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