describe the various types of nonsurgical periodontal therapy02/12/2020
• Describe the contributions of magnification with use of loupes, endoscopy, and microscopes to nonsurgical therapy. NONSURGICAL PERIODONTAL THERAPY Instructed by Kelli R. Illyes, R.D.H, M.D.H. ... to help treat their periodontal disease. For periodontal patients, this goal often requires multiple appointments with the dental hygienist. Cleaning agents are available for polishing the teeth and are preferable to those that contain abrasives. This involves the removal of bacterial plaque and tartar which is present at and below the gum line. Air powder polishing removes most extrinsic stains and soft deposits from the exposed surfaces of the teeth. • Describe the process of healing after periodontal debridement procedures, scaling, and root planing. Clearly, this requires clinical experience and judgment on the part of the dental hygienist. 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. 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. Healing of inflamed connective tissue is complex, requiring many cells and mediators. 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. For periodontal patients, this goal often requires multiple appointments with the dental hygienist. Once successfully completed, the scaling and root planing procedure should leave patients feeling little or no discomfort. This chapter discusses the biologic basis and rationale for nonsurgical therapeutic procedures performed in the dental office. Plaque biofilm is the primary causative agent in gingival and periodontal diseases. Thus, the rationale for root planing to remove root roughness and achieve glassy, smooth root surfaces is no longer valid. Describe the contributions of magnification with use of loupes, endoscopy, and microscopes to nonsurgical therapy. Identify the techniques and applications for nonsurgical periodontal therapy procedures. 3. • Discuss the use of lasers in nonsurgical therapy. Periodontal diseases present similar symptoms, but they likely have different bacterial origins that are not yet fully defined. 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, 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. Calculus adheres to tooth surfaces through pellicular attachment, mechanical locking, and intercrystalline forces. Discuss the use of lasers in nonsurgical therapy. 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. A comprehensive explanation of periodontal maintenance is found in Chapter 17. Start studying Perio - Chapter 24 - Nonsurgical Periodontal Therapy. Unfortunately, periodontal infections are usually silent, and can be present for many years, without any significant symptoms like pain. However, the minerals in saliva remineralize the tooth surfaces, so surface alterations are only temporary. Polishing may have some aesthetic value for patients and may help motivate them to maintain a clean mouth, but it has no proven therapeutic value. The numbers of organisms are reduced dramatically and grow back in different proportions. Other terms used to describe nonsurgical periodontal therapy include initial therapy,1 Phase I therapy,2,3 etiotropic phase,2 and periodontal debridement. 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. Nyman and colleagues, These data indicate that toxins are superficially located on root surfaces and easily removed. Nonsurgical therapy remains the cornerstone of periodontal treatment. Armitage presented the following information regarding root surface roughness8: 1. Studies evaluating plaque biofilm formation on rough root surfaces are equivocal. It is now known that the presence of plaque biofilms does not interfere with the uptake of fluoride by tooth structures. The goal of root planing is to remove the surface layer of cementum or dentin that may be impregnated with bacterial lipopolysaccharides (endotoxins) or calculus to create a glassy, hard surface.5 When the root surfaces feel smooth and hard, the dental hygienist can be confident that the treated pockets are free of deposits and contaminants on and embedded in the root surfaces.7 Root planing was thought to render root surfaces less prone to the reestablishment of the cause of disease—bacterial plaque biofilm—than scaling alone, but this theory has not been proven. Inflammation and tissue destruction in conventionally raised animals with oral biota are vastly more widespread and severe.5. The American Dental Association states that the treatment is aimed to prevent further advancement of the disease, and it is a lifelong plan for treatment. Most importantly, no surfaces should feel rough, as if calculus is still present. Smooth surfaces promote gingival healing. ... Schwarz F, Aoki A, Becker J, Sculean A. Laser application in non-surgical periodontal therapy: A systematic review. periodontally healthy sites. Polishing is the use of polishing agents to remove stains and supragingival plaque biofilm from the teeth. A study published in the 1980s compared the performance of hand instruments with that of ultrasonic tips in the removal of plaque in pockets. Phyllis L. Beemsterboer and Dorothy A. Perry. Quantifiable research has not shown this roughness to be harmful. • Explain the benefits and indications of antimicrobial adjuncts to nonsurgical therapy. Due to the contradicting findings in the literature, we wanted to evaluate the influence of nonsurgical periodontal therapy on the metabolic control in type 1 diabetes in Malaysian subjects. Animal studies provide strong evidence that these destructive diseases occur in the presence of microbes, but not in animals raised in germ-free environments. 5. These procedures are demanding technical activities that require a large share of each therapeutic treatment appointment. different types of lasers are used in the dental. 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. 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. 3. 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 … Other studies have demonstrated no significant effect of periodontal therapy on metabolic control [9, 16, 17]. 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. The term selective polishing has been clarified to mean that the clinician selects the appropriate agent based on the presenting needs of the patient. This indicated that roughness itself had no effect on wound healing. 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. Stains on the teeth are generally considered harmless, so their removal is secondary to the therapeutic and preventive goals of the dental hygienist. Patient plaque biofilm control is a cornerstone of long-term successful nonsurgical therapy. 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. 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. 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. 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. South County Periodontics & Implant Dentistry. Very often, early stages of periodontal disease are effectively treated with non-surgical periodontal therapy. 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. 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. The long-term goal of treatment is to restore gingival health. 2. are provided for commonly used terminology found in publications and other communications. least invasive and cost effective manner. The rationale for nonsurgical periodontal therapy is to remove the etiologic agent of disease—bacterial plaque biofilm—and its associated factors. 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. If the long-term goal of restoring periodontal health has not been achieved after conscientious nonsurgical therapy, the dental hygienist must first suspect residual calculus (and plaque biofilm) and re-treat nonresponding areas. Because this system produces an extensive aerosol, it is contraindicated in patients with infectious diseases, respiratory illnesses, hypertension, or those who are on hemodialysis.10 The periodontal patient often has multiple exposed root surfaces and caution with the choice of polishing agent is advised. Root roughness has been equated with incomplete instrumentation because of concerns that endotoxins (e.g., lipopolysaccharides) formed by gram-negative bacteria invade the root structure. that smooth surfaces had less plaque biofilm formation; however, root texture was not measured. Although more specific gingival and periodontal diseases are recognized, nonsurgical periodontal therapy focuses on total plaque biofilm removal. • Describe the process of healing after periodontal debridement procedures, scaling, and root planing. Polishing should be performed selectively. No experimental evidence indicates that rough root surfaces are mechanical irritants and would therefore delay healing. Gingival curettage, also called closed curettage or nonsurgical gingival curettage (truly a misnomer), was traditionally performed to remove inflamed pocket lining for reasons distinct from periodontal debridement. By Judy Carroll, RDH, and Howard M. Notgarnie, RDH, EdD. Here’s a quick look at the different types of dentists and these dental terms. The initial approach for treating gingival and periodontal diseases is debridement of plaque biofilm and calculus through nonsurgical therapeutic techniques. However, the roughness associated with calculus and poor restorations is far greater than the slightly granular texture of calculus-free root surfaces. Experience suggests that the roots in an individual patient’s mouth will feel equally smooth after thorough instrumentation. Nonsurgical therapy includes the procedures listed in Table 13-1. The terms nonsurgical periodontal therapy or periodontal debridement are used along with the traditional terms of scaling and root planing. It is defined as the removal of the inflamed soft tissue lateral to the pocket wall. The dental hygienist cannot focus solely on the technical aspects of calculus removal. 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. Collectively, these methods represent the fundamentals of non-surgical periodontal therapy. 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. 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. Periodontal âgumâ disease is typically a chronic infection caused by bacteria that works its way under the gum line, destroying the gum and eventually the bone that supports the teeth. nonsurgical coverage of recession-type defects, treatment of suprabony defects and papilla reconstruction techniques. Extensive root instrumentation is not required beyond the removal of calculus and plaque. Irvine, San Juan Capistrano, San Clemente, Mission Viejo, & Orange County CA. Periodontics: Home | Meet Our Staff | Patient Information | Periodontal Disease | Dental Implants The purpose of prophylaxis is to assist the patient in maintaining and preserving periodontal health. 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. 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.”. Damage to the gums and bone support around the upper front teeth following the use of a laser. The initial approach for treating gingival and periodontal diseases is debridement of plaque biofilm and calculus through nonsurgical therapeutic techniques. These are the procedures and instruments required to scale, root-plane, and debride the tooth surfaces of bacterial plaque biofilms and calculus and to remove stains by the application of polishing techniques.3. 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. 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. Because of the fragile state of healing connective tissues, probing after treatment should be avoided for 4 weeks.17. Unfortunately at the current time, and according to our doctors, there is inadequate research available to recommend laser therapy for the treatment of periodontitis. 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. The exact treatments that your dentist or surgeon will choose depends on the severity of the periodontal disease. 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. Scaling – This is a process where the plaque is scarped off of the surface of the teeth. It is possible to remove all supragingival plaque effectively. Unfortunately, the use of lasers for periodontal therapy is often used as a marketing ploy by uninformed, undiscerning, or unscrupulous dentists, including periodontists. All plaques are no longer considered intrinsically bad. 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. Mission Viejo, CA 92691 Rough surfaces mechanically irritate gingival tissues. This practice supports the old notion of “necrotic” root surfaces. Glassy, smooth root surfaces are not end points in treatment. It may also contain dislodged calculus and plaque bacteria. 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. It appears that variation in smoothness is acceptable as long as calculus that makes surfaces feel rough and irregular has been removed and plaque biofilm has been disrupted. Kepic and colleagues, Achieving root smoothness is important for evaluating short-term goals during treatment appointments. All plaques are no longer considered intrinsically bad. 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. 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. • Rough surfaces mechanically irritate gingival tissues. True, this will increase the manageability of the tissues during surgery and allows for better healing What term is used when the healing outcome after surgery does not replicate the tissues originally lost, but rather there is formation of a long junctional epithelium? Air powder polishing removes most extrinsic stains and soft deposits from the exposed surfaces of the teeth. Inflammation and tissue destruction in conventionally raised animals with oral biota are vastly more widespread and severe. Can be single-ended or double-ended Many different types of periodontal probes available Duration: 55:30. Normal turnover of cells in the junctional epithelium, which migrate from the apical end to the coronal end, takes about 5 days. Your periodontist is best trained to determine if this treatment approach will help your specific condition. Gingival curettage, also called closed curettage or nonsurgical gingival curettage (truly a misnomer), was traditionally performed to remove inflamed pocket lining for reasons distinct from periodontal debridement. 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. However, in periodontology, the term, 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. Plaque biofilm must also be dislodged from all accessible surfaces. 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. To do so, the patient uses oral hygiene procedures and the dental hygienist performs coronal polishing. • Describe the short- and long-term goals of nonsurgical periodontal therapy. Much has been learned about the penetration and removal of lipopolysaccharide endotoxins. Root roughness has been equated with incomplete instrumentation because of concerns that endotoxins (e.g., lipopolysaccharides) formed by gram-negative bacteria invade the root structure. Because smooth surfaces are clinically associated with the restoration of gingival health, clinicians believe that smooth root surfaces are good. Conscientious removal of calculus and plaque biofilm with minimum destruction of cementum, termed periodontal debridement, is justified. The epithelial lining of the pocket wall is also often disrupted and partially removed through inadvertent curettage. Connective tissue fibers are disrupted and lysed beneath the epithelium. Smooth root surfaces do not appear to promote better or faster healing than rough surfaces. Describe the short- and long-term goals of nonsurgical periodontal therapy. It commonly occurs during nonsurgical periodontal therapy. Plaque biofilm is the primary causative agent in gingival and periodontal diseases. One size fits all grit paste ignores the science of abrasion, can cause sensitivity, and damage aesthetic restorations.5. Animal studies show that hemidesmosomes begin to reattach from the apical end of the junctional epithelium and are intact after 7 days. Although these features are primarily plaque biofilm control problems, the dental hygienist should recognize them, design specific plaque control measures, and refer patients for further treatment. 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. However, the roughness associated with calculus and poor restorations is far greater than the slightly granular texture of calculus-free root surfaces. 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. These data indicate that toxins are superficially located on root surfaces and easily removed. Supragingival oral hygiene procedures have limited effects on symptoms associated with deeper pockets, such as bleeding on probing.17, 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. A thorough review of nonsurgical periodontal therapy by Cobb et al reported mean PPD reductions of 1.29 mm to 2.16 mm and CAL gains of 0.55 mm to 1.19 mm for initial probing depths of 4 mm to 6 mm or more than 6 mm before treatment in chronic periodontitis patients … 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). periodontal disease treatment to Southern California and South County, Orange County âScalingâ is a necessary first step in the treatment process, and it clears the way for a deeper clean. Bacteria live in the mouth and are present around diseased teeth. Supragingival oral hygiene procedures have limited effects on symptoms associated with deeper pockets, such as bleeding on probing. The specific plaque hypothesis was proposed by Loesche in the 1970s.15 This classic study has increased the understanding of periodontal disease and the use of appropriate antimicrobial agents to improve treatment results. It works by mechanical abrasion using a slurry of sodium bicarbonate and water. 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. In the early stages it may not even be noticeable to you. Some residual calculus is likely to remain after dental hygiene treatment, especially in deeper pockets, but patients can probably tolerate some small amount.