Local anesthetics are also used to numb the area for greater comfort. Smooth root surfaces do not appear to promote better or faster healing than rough surfaces. 2008;35(Suppl 8):29-44. This webinar will discuss the diagnosis and treatment planning of periodontal disease. The bacterial plaque shifts from predominantly gram-negative microbiota to one that is gram-positive, with many fewer motile forms, especially spirochetes. Slightly rough root surfaces, those that are scaled and cleaned but not planed in a systematic way to remove cementum and leave glassy surfaces, do not accumulate plaque more rapidly than smoother surfaces. With the following innovative techniques, we are able to achieve periodontal health for many of our patients in a simple, non- invasive and affordable manner. Experience suggests that the roots in an individual patient’s mouth will feel equally smooth after thorough instrumentation. Much has been learned about the penetration and removal of lipopolysaccharide endotoxins. 1981, Serino et al. It works by mechanical abrasion using a slurry of sodium bicarbonate and water. Non-Surgical Perio Therapy with Adjunctive Agents. • Identify the techniques and applications for nonsurgical periodontal therapy procedures. When the junctional epithelium has been injured or separated from the tooth surfaces, as it would be during periodontal debridement, healing can be expected to take approximately 1 week. Kepic and colleagues18 demonstrated residual calculus on most teeth after 45 to 60 minutes of treatment time per quadrant. It commonly occurs during nonsurgical periodontal therapy. Polishing should be performed selectively.10,11. 2. Conscientious removal of calculus and plaque biofilm with minimum destruction of cementum, termed periodontal debridement, is justified. Smooth surfaces promote gingival healing. The only study that attempted to measure root texture with quantifiable profilometer (Micrometrical Manufacturing, Ann Arbor, MI) readings found that the amount of root roughness did not affect plaque biofilm formation. Bacteria live in the mouth and are present around diseased teeth. The difference between scaling and root planing is a matter of degree; root planing involves a specific effort to instrument every portion of the root surfaces, not simply identifiable calculus deposits. This rationale has been questioned for many years and the procedure is no longer considered standard treatment.21,22. Extensive root instrumentation is not required beyond the removal of calculus and plaque. Dramatically thinned root surfaces are shown in, Conscientious removal of calculus and plaque biofilm with minimum destruction of cementum, termed. The emphasis of our practice is conservative periodontal therapy. After periodontal debridement is performed (unless there are systemic complications) periodontal pockets, alveolar bone, periodontal ligament, and epithelium will heal. Studies indicate that endotoxins do not penetrate deeply into cemental surfaces and that retained toxins are associated with missed calculus and plaque rather than diseased cementum. that smooth surfaces had less plaque biofilm formation; however, root texture was not measured. There are also air devices that polish teeth with a power-driven handpiece that sprays abrasive slurry against the tooth surfaces. The diode laser in nonsurgical cause-related periodontal therapy 5. Scaling and root planing causes some removal and disruption of the epithelial attachment to the tooth, junctional epithelium, and deeper connective tissue. It was once thought that tooth surfaces had to be plaque-free to absorb fluoride during fluoride treatments, so polishing of teeth was performed routinely before office fluoride applications. These reasons are. Removal of endotoxins would require the planing away of diseased cementum. One size fits all grit paste ignores the science of abrasion, can cause sensitivity, and damage aesthetic restorations. Your dentist will first start with nonsurgical … Start studying Perio - Chapter 24 - Nonsurgical Periodontal Therapy. Healing after scaling, root planing, and gingival curettage occurs as a repair of existing tissues rather than regeneration of tissues lost in the periodontal disease process. Curettage had been defined by the AAP as scraping or cleaning the walls of a cavity or surface by means of a curette. A small “flap” may be opened in the gum tissue, enabling infected tissue and bacteria to be removed from an infected “pocket” under the gums; healthier gum tissue can then begin naturally reattaching to bone. This chapter discusses the biologic basis and rationale for nonsurgical therapeutic procedures performed in the dental office. Describe the contributions of magnification with use of loupes, endoscopy, and microscopes to nonsurgical therapy. Subgingival bacterial plaque biofilm will regrow but, at least initially, it will consist of a younger, less pathogenic bacterial biofilm than that associated with untreated periodontal pockets. After instrumentation, some roots feel smooth, whereas others have varying degrees of granular roughness. The thoroughness of calculus removal by instrumentation has been studied and shows surprising results. Periodontal diseases present similar symptoms, but they likely have different bacterial origins that are not yet fully defined. This uniform smoothness should be identified. Areas in the periodontium that do not respond to therapy, even after retreatment and evaluation, may benefit from long-term subgingival antimicrobial treatment or surgical intervention. These procedures are demanding technical activities that require a large share of each therapeutic treatment appointment. This article presents the essential elements of a PTPincluding diagnosis, treatment planning, implementation of therapy, assessment and monitoring of therapy, insur-ance coding, introduction of the patient to periodontal therapy, and enhanced verbal skills. Some are under the patient’s control, and may, therefore, require lifestyle changes to achieve significant modification. A detailed plan for non-surgical periodontal therapy will always include minimizing the impact of local environmental risk factors.. C. goal 3: to minimize exposure of the systemic factors for periodontal disease 1. Calculus is little more than calcified plaque biofilm. periodontally healthy sites. Air powder polishing is especially effective with severe staining, such as that found in cigarette and pipe smokers. It is now known that the presence of plaque biofilms does not interfere with the uptake of fluoride by tooth structures. Eventually, they will be much better understood so that therapies directed toward the specific plaque bacteria in each individual can be used, including the use of more antimicrobial and antiseptic agents. During periodontal debridement procedures, the goal for the dental hygienist is to promote plaque biofilm control and instrument the tooth surfaces until they are clean and smooth, touching all portions of the roots to disrupt plaque biofilm and remove calculus. Email: Implant Dentist Dr. Caplanis your Mission Viejo Periodontist and Orange County Periodontist provides a full range of dental implant & periodontal services including dental implants, Here’s a quick look at the different types of dentists and these dental terms. Because this system produces an extensive aerosol, it is contraindicated in patients with infectious diseases, respiratory illnesses, hypertension, or those who are on hemodialysis. Clinical trials have consistently demonstrated that scaling and root planing reduce gingival inflammation and probing depths and result in gains of clinical attachment in most periodontal patients. If the non-surgical therapy effectively eliminates the gum disease, the only further requirement will be periodic maintenance every 3-4 months. • Describe the process of healing after periodontal debridement procedures, scaling, and root planing. 4. The appealing notion that rough surfaces would present more of a plaque control problem for patients is borne out by experience with obvious calculus or overhanging restorations. As the understanding of plaque biofilm as the pathologic agent has grown, various periodontal diseases have been identified with specific microbial organisms. Armitage presented the following information regarding root surface roughness. Quantifiable research has not shown this roughness to be harmful. Some residual calculus is likely to remain after dental hygiene treatment, especially in deeper pockets, but patients can probably tolerate some small amount. Duration: 55:30. The numbers of organisms are reduced dramatically and grow back in different proportions. Animal studies show that hemidesmosomes begin to reattach from the apical end of the junctional epithelium and are intact after 7 days. Selective polishing is choosing the surfaces to polish on the basis of patient concerns and the presence of plaque biofilm and stains that cannot be removed with normal patient oral hygiene practices. There was no difference in the healing of the differently treated areas; cementum removal through root planing did not improve healing beyond that achieved by calculus removal and polishing. This indicated that roughness itself had no effect on wound healing. Material and methods: Fourteen CP cases received full-mouth non-surgical treatment and, after 6 months, at least two surgical sessions. Cleaning agents are available for polishing the teeth and are preferable to those that contain abrasives. Treatment frequently requires the use of pain control measures. However, subtle signs such as red or swollen gums, gums that bleed when brushed or flossed, chronic bad breath or loose teeth can alert you to the presence of gum disease and the need to see a periodontist. Repair after disruption of the junctional epithelium during scaling procedures (not removal, which occurs with surgical excision) is similar to the normal course of events in tissue turnover. Gingival curettage is thus considered to have little therapeutic value in the treatment of chronic periodontitis and is no longer listed as a method of treatment by the American Dental Association and the AAP.12. Dental hygienists remove the primary etiologic factor of periodontal disease, plaque biofilm, and its associated factors through scaling and root planing, cleaning and smoothing of the roots or, more broadly, periodontal debridement. In a recent review, Ishikawa et al5 stated that the Er:YAG laser seems to provide the most suitable characteristics for various types of periodontal treatment. In 1976 Wilkins, in her fourth edition of. Several issues surround the application of nonsurgical periodontal therapy. Caution must be exercised with this device to prevent damage to exposed root surfaces; thus, its application for periodontal patients is limited. The following information is a summary of evidence supporting the provision of nonsurgical periodontal treatment: plaque biofilm and calculus removal, hand instruments and powered instruments, the relative merit of smooth roots, healing after nonsurgical treatment, laser use, and antimicrobial adjuncts. The alternatives to non-surgical periodontal therapy are: Surgical periodontal therapy; No treatment It is important to understand that periodontal disease is not curable. Bacteria repopulate in a specific order, starting with, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window). The. 26302 La Paz Rd Suite 207 â¢ These new microbiota are similar to those found in periodontally healthy sites. The goal of root planing, leaving the roots clean, has not changed, but the extent to which root tissue is scraped away to create a glassy, hard texture has been under scrutiny. Inadvertent curettage is a term used to describe accidental and incomplete removal of the pocket lining during scaling and root planing or periodontal debridement procedures. Barnes recommended that the least abrasive paste necessary to remove stains was appropriate and if no stain was present a cleaning agent should be employed. • Rough surfaces mechanically irritate gingival tissues. Healing of inflamed connective tissue is complex, requiring many cells and mediators. Unfortunately at the current time, and according to our doctors, there is inadequate research available to recommend laser therapy for the treatment of periodontitis. ... that describe … Although some periodontal destruction has been observed in germ-free (gnotobiotic) animal experiments, it tends to be localized and related to the impaction of foreign objects, such as hairs. 4. South County Periodontics & Implant Dentistry. For some patients, systemic antibiotics or antimicrobials may be prescribed to be taken orally, to help treat their periodontal disease. 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