describe the various types of nonsurgical periodontal therapy
Bacteria-specific tests and treatments have been developed and will be more widely used as the understanding of periodontal disease increases.7, It is possible to remove all supragingival plaque effectively. Afterwards, you return to your general dentist, who will place a crown or other restoration on the tooth to protect it … 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. South County Periodontics & Implant Dentistry. 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. Patient plaque biofilm control is a cornerstone of long-term successful therapy. 2. It is possible to remove all supragingival plaque effectively. The initial approach for treating gingival and periodontal diseases is debridement of plaque biofilm and calculus through nonsurgical therapeutic techniques. Several issues surround the application of nonsurgical periodontal therapy. • Identify the techniques and applications for nonsurgical periodontal therapy procedures. However, in periodontology, the term surgery is reserved for more invasive cutting procedures. Other more subtle systemic and environmental issues may … 3. A study published in the 1980s compared the performance of hand instruments with that of ultrasonic tips in the removal of plaque in pockets. No clinical studies have shown greater pocket reduction, more rapid healing, or more new attachment after gingival curettage has been performed compared with scaling and root planing alone. Describe the contributions of magnification with use of loupes, endoscopy, and microscopes to nonsurgical therapy. This end point is best evaluated by explorer detection of smooth surfaces.3 Calculus removal may be considered a subgoal rather than the primary focus.3 The goal at the treatment visit is not to render the roots glassy and hard through extensive planing away of tooth structure. This webinar will discuss the diagnosis and treatment planning of periodontal disease. The power and powder-to-water ratio is controlled with a foot pedal and can be increased or decreased as needed. Nonsurgical therapy includes the procedures listed in Table 13-1. Air powder polishing removes most extrinsic stains and soft deposits from the exposed surfaces of the teeth. This tactile sense is used to determine the amount of calculus present in the untreated patient, the existence of irritating factors such as overhangs, and the point at which thorough instrumentation (periodontal debridement) is finished at each appointment. The formation of new bone to replace bone that is lost, new connective tissue attachment to the root surface, and new cementum on the root are not predictable outcomes. Start studying Perio - Chapter 24 - Nonsurgical Periodontal Therapy. Curettage had been defined by the AAP as scraping or cleaning the walls of a cavity or surface by means of a curette. 3. Polishing is the use of polishing agents to remove stains and supragingival plaque biofilm from the teeth. Non-Surgical Treatment. Patient plaque biofilm control is a cornerstone of long-term successful nonsurgical therapy. including the communities of Newport Beach, For some patients, systemic antibiotics or antimicrobials may be prescribed to be taken orally, to help treat their periodontal disease. Nyman and colleagues, These data indicate that toxins are superficially located on root surfaces and easily removed. 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.16, Although more specific gingival and periodontal diseases are recognized, nonsurgical periodontal therapy focuses on total plaque biofilm removal. This rationale has been questioned for many years and the procedure is no longer considered standard treatment. Enter your mobile number or email address below and we'll send you a link to download the free Kindle App. The goals of nonsurgical periodontal therapy must be considered in terms of the immediate treatment goals at the time of the appointment and the long-term goals for the patient. Specific definitions accepted in the dental hygiene community, The American Academy of Periodontology (AAP) defines scaling as “instrumentation of the crown and root surfaces of the teeth to remove plaque, calculus, and stains from these surfaces.”, Scaling may be accomplished with sharp hand instruments or with, Root planing is defined by the AAP as “a treatment procedure designed to remove cementum or surface dentin that is rough, impregnated with calculus, or contaminated with toxins or microorganisms.”. The power and powder-to-water ratio is controlled with a foot pedal and can be increased or decreased as needed. Inflammation and tissue destruction in conventionally raised animals with oral biota are vastly more widespread and severe. The term nonsurgical therapy is often considered a misnomer because the procedures performed require the application of sharp blades to cut tissues, which is a form of surgery. These products are not effective as standalone treatment and are also not effective for long term control of advanced periodontal disease or with patients who have chronically deep gum pockets. Although NSPT is effective, it does have its limitations. The initial approach for treating gingival and periodontal diseases is debridement of plaque biofilm and calculus through nonsurgical therapeutic techniques. Scaling and root planing are a basic approach to effectively treating the disease and allowing the gums and surrounding bone to heal properly. Nonsurgical therapy remains the cornerstone of periodontal treatment. Calculus is little more than calcified plaque biofilm. The American Academy of Periodontology (AAP) defines scaling as “instrumentation of the crown and root surfaces of the teeth to remove plaque, calculus, and stains from these surfaces.”4 However, subgingival scaling is also referred to as simply the removal of subgingival calculus3 or the more general term, subgingival deposits.5 Scaling is most commonly thought of as the removal of identifiable deposits of calculus, but associated plaque biofilm deposits are also removed during the procedure. Used to probe the depth of a periodontal pocket, allowing the operator to measure the pocket depth by reading the markings Working end is marked in millimetres to measure periodontal pockets around teeth (can probe depths as small as 0.4 mm) Varieties. In 1976 Wilkins, in her fourth edition of. Studies evaluating plaque biofilm formation on rough root surfaces are equivocal. True or false: nonsurgical therapy is typically done prior to surgical therapy? 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. Although there are adjunct procedures that improve periodontal health, there is no substitute for scaling and root planing to remove local irritants to the tissues. diagnosis and treatment of periodontal diseases. Within 10 to 21 days, every subject had gingivitis, which resolved in about 1 week when oral hygiene practices were resumed. These new microbiota are similar to those found in, 17: Periodontal Maintenance and Prevention, 5: Calculus and Other Disease-Associated Factors, 10: Treatment Planning for the Periodontal Patient, 18: Prognosis and Results After Periodontal Therapy, Periodontology for the Dental Hygienist 4e, Oral hygiene instruction for daily plaque biofilm control, Significant component of periodontal debridement biofilm, Supragingival and subgingival plaque biofilm removal, Instrumentation techniques to remove or disrupt subgingival biofilm, Identification of plaque-retentive factors, Referral for treatment of plaque-retentive conditions such as poorly fitting restorations and malpositioned teeth, Instrumentation techniques to alter the environment of the pocket wall, if necessary, Identification of occlusion-related factors affecting the periodontium, Selective procedure for supragingival plaque and stain removal, Locally or systemically delivered antimicrobial, antiseptic and antiinflammatory medications, CALCULUS AND BIOFILM REMOVAL (PERIODONTAL DEBRIDEMENT), Provide technique instruction and reinforcement, Ensure adoption of adequate daily oral hygiene procedures, Regular removal of new deposits at subsequent visits. Categories: Target Audience: Dental Assistants, Dental Students, Dentists. Periodontal diseases present similar symptoms, but they likely have different bacterial origins that are not yet fully defined. Bacteria repopulate in a specific order, starting with Streptococcus and Actinobacillus species, followed by Veillonella, Bacteroides, Porphyromonas, Prevotella, and Fusobacterium species. The exact treatments that your dentist or surgeon will choose depends on the severity of the periodontal disease. The epithelial lining of the pocket wall is also often disrupted and partially removed through inadvertent curettage. In its broadest sense, nonsurgical therapy defines all of the procedures performed to treat gingival and periodontal diseases up to the time of reevaluation, which is when patients begin maintenance care and the need for periodontal surgery to enhance results is determined. Schwarz A, Aoki A, Sculean A, Becker J. zt THE INFLUENCE OF NON-SURGICAL PERIODONTAL THERAPY ON SALIVARY MELATONIN LEVELS: A PILOT STUDY Kristina Bertl1, Angelika Schoiber1, Hady Haririan1, Markus Laky1,2, Oleh Andrukhov1, Irene Womastek3, Michael Matejka1, and Xiaohui Rausch-Fan1 1 Department of Periodontology, Bernhard Gottlieb School of Dentistry, Medical University of Vienna, Austria 2 Department of Dental … Connective tissue fibers are disrupted and lysed beneath the epithelium. Both were effective in removing approximately 67% of the plaque in, Calculus is little more than calcified plaque biofilm. Inflamed pocket lining is composed of thin ulcerated strands of epithelium, with rete pegs extending into the underlying connective tissue and granulation tissue containing disorganized masses of cells. In particular, it shows the most promise for root surface treatment and is safe and efficient for use in periodontal bone surgery when used with concomitant water irrigation. As plaque biofilm ages, the organic matrix and bacterial cells calcify. It is defined as the removal of the inflamed soft tissue lateral to the pocket wall. Duration: 55:30. These reasons are8 as follows: • Smooth surfaces retard plaque formation. Bacteria-specific tests and treatments have been developed and will be more widely used as the understanding of periodontal disease increases. The dental hygienist cannot focus solely on the technical aspects of calculus removal. Quantifiable research has not shown this roughness to be harmful. Step 1. 2013) resulting in periodontal attachment loss (Armitage 1999).Chronic periodontitis can be effectively treated by means of mechanical non-surgical and surgical therapy (Badersten et al. J Clin Periodontol. In the 1960s, this disease was recognized as different from typical periodontitis because the conventional therapy, which consisted of scaling and root planing in the localized affected areas of the anterior teeth and first molars, could only slow the loss of these teeth. nonsurgical coverage of recession-type defects, treatment of suprabony defects and papilla reconstruction techniques. The thoroughness of calculus removal by instrumentation has been studied and shows surprising results. Nonsurgical periodontal treatment has been shown to control periodontal infection and to arrest progression of the disease in a significant number of cases. Other concerns include the possibility of creating bacteremia in the patient and possibly damaging the tooth pulps by heat generated from the power-driven prophylaxis angle. Identify the techniques and applications for nonsurgical periodontal therapy procedures. The restoration of gingival health is the sum of good plaque control, complete scaling and periodontal debridement, and sufficient time for healing to occur—several months for complete healing of both the epithelium and connective tissue. The purpose of prophylaxis is to assist the patient in maintaining and preserving periodontal health. 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.13 There are also secondary influences on periodontal health that must be considered. Learning Outcomes • Define nonsurgical periodontal therapy. Specifically, curettage performed by the dental hygienist (legally permitted in some states), properly termed gingival curettage, is limited to closed curettage. For this reason, every patient must participate in treatment by adopting a regular and effective biofilm removal regimen. Some are under the patient’s control, and may, therefore, require lifestyle changes to achieve significant modification. Kepic and colleagues, Achieving root smoothness is important for evaluating short-term goals during treatment appointments. Because the bacteria can firmly attach to the tooth roots under the gum line, regular dental cleanings may be inadequate to resolve the infection. Once successfully completed, the scaling and root planing procedure should leave patients feeling little or no discomfort. Positive, long-term effects of periodontal therapy are reliably achieved with patient compliance, effective plaque biofilm control, and excellent dental hygiene treatment.3 These are all aspects of dental hygiene care and are essential in the application of nonsurgical periodontal therapy. A number of dental hygiene programs in the United States teach gingival curettage because it is a legally sanctioned duty in many states and may be performed by practitioners in the community.24 In this era of increased emphasis on nonsurgical therapies, removal of disorganized granulation tissue and ulcerated epithelium from pocket linings remains appealing to many clinicians, even if data do not show improved healing. Periodontists are also experts in replacing missing teeth with dental implants. In fact, in some studies, gingivae next to root surfaces that were notched for orientation of researchers after tooth extraction healed uneventfully in the mouth. Stains on the teeth are generally considered harmless, so their removal is secondary to the therapeutic and preventive goals of the dental hygienist. Subgingival plaque biofilm removal is essential in nonsurgical therapy to disrupt the established colonies of bacteria and let a younger plaque develop that is less associated with pathologic conditions. Phone: 949-830-1322 â¢ Fax: 949-830-1383 periodontal disease treatment to Southern California and South County, Orange County It takes considerably longer than healing of epithelium—up to several months. Appearance of the teeth is of great importance to patients, and the polishing procedure can be an excellent way to motivate them to remove plaque biofilm for health as well as appearance. Much has been learned about the penetration and removal of lipopolysaccharide endotoxins. A periodontal infection that can’t be fixed through ordinary periodontal therapy techniques may require surgery and will likely fall into 1 of 4 categories. Studies evaluating plaque biofilm formation on rough root surfaces are equivocal. Within subcrestal periodontal therapy, it is of paramount importance to preserve both marginal tissues and connective ﬁbers inserted in the root cementum at the apical part of the bony defects. In the early stages it may not even be noticeable to you. Peri-implantitis: Nonsurgical therapeutic approach 6. Research has made a drug available called Periostatâ¢ which can be used to help treat periodontal disease but only when combined with conventional non-surgical therapy. However, the minerals in saliva remineralize the tooth surfaces, so surface alterations are only temporary. NONSURGICAL PERIODONTAL THERAPY Instructed by Kelli R. Illyes, R.D.H, M.D.H. It is usually accomplished during one appointment and has many facets. This indicated that roughness itself had no effect on wound healing. Although more specific gingival and periodontal diseases are recognized, nonsurgical periodontal therapy focuses on total plaque biofilm removal. • Describe the contributions of magnification with use of loupes, endoscopy, and microscopes to nonsurgical therapy. Plaque biofilm must also be dislodged from all accessible surfaces. The nonsurgical endodontic therapy or root canal removes the inflamed or infected pulp, carefully cleans and shapes the inside of the tooth, then fills and seals the space. Supragingival oral hygiene procedures have limited effects on symptoms associated with deeper pockets, such as bleeding on probing. However, subgingival plaque is not effectively altered by supragingival oral hygiene procedures, especially in deeper pockets of 5 mm or more. Armitage presented the following information regarding root surface roughness8: 1. The term selective polishing has been clarified to mean that the clinician selects the appropriate agent based on the presenting needs of the patient. The definitions of procedures must be clear and consistent. The concept of selective polishing emerged when research on enamel and root surfaces after polishing revealed changes in the hard tissues. The alternatives to non-surgical periodontal therapy are: Surgical periodontal therapy; No treatment It is important to understand that periodontal disease is not curable. Therefore, treatment emphasis changed to include both conventional therapy and the use of appropriate antibiotics and resulted in successful restoration of periodontal health with less tooth loss. This practice supports the old notion of “necrotic” root surfaces. 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. With non-surgical periodontal therapy, many patients can be treated and maintained without the need for surgical intervention. 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. Convincing experimental evidence that plaque microorganisms cause human gingival disease was presented by Löe and colleagues in 1965.14 The researchers initiated extensive plaque control in a small group of dental students and brought them to a level of excellent periodontal health; then the subjects refrained from oral hygiene procedures for 3 weeks. This rationale has been questioned for many years and the procedure is no longer considered standard treatment.21,22. Even when teeth were instrumented for as long as 39 minutes each, residual calculus was noted regularly in deeper pockets, and totally clean surfaces were achieved only in the 3- to 4-mm range.19,20 Even the best instrumentation techniques leave some residual deposits on the teeth; however, these very small deposits were also present in the subjects of long-term studies used to verify the effectiveness of nonsurgical periodontal treatment, and they did not appear to cause the treatment to fail.2,3. This practice supports the old notion of “necrotic” root surfaces. 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). This indicated that roughness itself had no effect on wound healing. 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.25, Inflammatory activity occurs in the underlying connective tissue during the disease process and is also a result of treatment. 2008;35(Suppl 8):29-44. 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. Removal of this tissue was assumed to enhance pocket reduction beyond the results achieved by scaling and root planing alone, providing faster healing and the formation of new connective tissue attachments to the root surfaces. The emphasis of our practice is conservative periodontal therapy. Rough surfaces mechanically irritate gingival tissues. Both were effective in removing approximately 67% of the plaque in pockets deeper than 5 mm and the ultrasonic instruments performed as well as the hand instruments.16,17 The AAP consensus report on nonsurgical periodontal therapy suggested that 11% plaque remaining on root surfaces after thorough instrumentation was more likely an accurate figure.17. This uniform smoothness should be identified. Cleaning agents are available for polishing the teeth and are preferable to those that contain abrasives. Standard cleanings and polishes only deal with the plaque above the gum line, and these procedures arenât effective on their own to truly treat gum disease. After instrumentation, some roots feel smooth, whereas others have varying degrees of granular roughness. This end point is best evaluated by explorer detection of smooth surfaces. Although calculus is an inert substance, its role appears to be that of plaque biofilm retention, and its removal is associated with a return to periodontal health, as seen in Figure 13-4. In fact, in some studies, gingivae next to root surfaces that were notched for orientation of researchers after tooth extraction healed uneventfully in the mouth. Other terms used to describe nonsurgical periodontal therapy include initial therapy,1 Phase I therapy,2,3 etiotropic phase,2 and periodontal debridement. If the non-surgical therapy effectively eliminates the gum disease, the only further requirement will be periodic maintenance every 3-4 months. If the non-surgical therapy effectively eliminates the gum disease, the only further requirement will be periodic maintenance every 3-4 months. Root planing is defined by the AAP as “a treatment procedure designed to remove cementum or surface dentin that is rough, impregnated with calculus, or contaminated with toxins or microorganisms.”6 This procedure focuses not on identifiable deposits of calculus but on the entire root surface associated with the periodontal pocket. The concept of selective polishing emerged when research on enamel and root surfaces after polishing revealed changes in the hard tissues. Describe how the. The primary ... among different types of … The dental hygienist must develop a tactile sense that permits detection of obvious calculus on the teeth. The thoroughness of calculus removal by instrumentation has been studied and shows surprising results. Periodontal disease is a common gum inflammation that affects 3 out of 4 adults, but it can be prevented or treated with regular periodontal exams. Plaque biofilm must also be dislodged from all accessible surfaces. Synopsis. The contents of any material used for patient care should be read carefully; this is especially warranted when dealing with the myriad choices available for stain removal. This chapter defines the technical procedures applied by dental hygienists and the instruments used for treatment. Calculus adheres to tooth surfaces through pellicular attachment, mechanical locking, and intercrystalline forces. Healing of inflamed connective tissue is complex, requiring many cells and mediators. 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. A number of clinical trials have confirmed that gingival curettage provides no additional benefit to healing compared with scaling and root planing alone in terms of probing depth reduction, attachment gain, or inflammation reduction. It may also contain dislodged calculus and plaque bacteria. The cornerstone of management of chronic periodontitis is the non-surgical periodontal treatment. Several other concerns about polishing exist. âScalingâ is a necessary first step in the treatment process, and it clears the way for a deeper clean. The technical skill of the dental hygienist is the critical element in successful nonsurgical periodontal therapy. Because this system produces an extensive aerosol, it is contraindicated in patients with infectious diseases, respiratory illnesses, hypertension, or those who are on hemodialysis. Much has been learned about the penetration and removal of lipopolysaccharide endotoxins. 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. pockets deeper than 5 mm and the ultrasonic instruments performed as well as the hand instruments. • Describe the process of healing after periodontal debridement procedures, scaling, and root planing. • Explain the limitations of calculus removal and the expectations for clinician proficiency. All plaques are no longer considered intrinsically bad. Stains on the teeth are generally considered harmless, so their removal is secondary to the therapeutic and preventive goals of the dental hygienist. Capnocytophaga species and spirochetes are the last to grow back. 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. The restoration of gingival health is the sum of good plaque control, complete scaling and periodontal debridement, and sufficient time for healing to occur. These data indicate that toxins are superficially located on root surfaces and easily removed. It works by mechanical abrasion using a slurry of sodium bicarbonate and water. 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. The long-term goal of treatment is to restore gingival health. For periodontal patients, this goal often requires multiple appointments with the dental hygienist. Scaling and Root Planing. Abrasives used during polishing can scratch amalgam, composite resin, and gold restorative materials. Laser periodontal therapy is one of the latest and most exciting techniques being developed for the treatment of periodontal disease. This is why regular visits to your periodontist are important especially if other health problems are present, like heart problems or diabetes. Can be single-ended or double-ended Many different types of periodontal probes available Scaling and root planing is the standard of care for nonsurgical and nonpharmacologic treatment of chronic periodontal diseases. Hydrodynamic theory of dentinal sensitivity. 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. 1981, Serino et al. 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. Animal studies, the landmark study on human experimental gingivitis, and much additional evidence prove that plaque biofilm removal is a major part of nonsurgical periodontal therapy.
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