These reasons are8 as follows: • Smooth surfaces retard plaque formation. Various antibiotics have been used in the past with some degree of success. Nonsurgical Periodontal Therapy Appointment Procedures, This chapter defines the technical procedures applied by dental hygienists and the instruments used for treatment. Abrasives used during polishing can scratch amalgam, composite resin, and gold restorative materials. different types of lasers are used in the dental. 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. • Describe the short- and long-term goals 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. It describes scaling procedures, both hand instrumentation and powered instrumentation, root planing, gingival curettage, and polishing. Once successfully completed, the scaling and root planing procedure should leave patients feeling little or no discomfort. Describe the process of healing after periodontal debridement procedures, scaling, and root planing. Periodontal maintenance. Smooth surfaces promote gingival healing. The initial approach for treating gingival and periodontal diseases is debridement of plaque biofilm and calculus through nonsurgical therapeutic techniques. 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. It is now known that the presence of plaque biofilms does not interfere with the uptake of fluoride by tooth structures. Much has been learned about the penetration and removal of lipopolysaccharide endotoxins. After instrumentation, some roots feel smooth, whereas others have varying degrees of granular roughness. It is now known that the presence of plaque biofilms does not interfere with the uptake of fluoride by tooth structures. It commonly occurs during nonsurgical periodontal therapy. 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. Blood samples were collected at various time-points after treatment. These local factors are described in Chapter 5. Cortney Annese, RDH, says attention to detail, patient compliance, and proper selection of adjunctive antimicrobial agents for sustained plaque control are important elements in achieving successful long-term results. setting. This indicated that roughness itself had no effect on wound healing. The bacterial plaque shifts from predominantly gram-negative microbiota to one that is gram-positive, with many fewer motile forms, especially spirochetes. Controlling Systemic Risk Factors.Several risk factors have well established associations with both periodontal and systemic diseases, such as diabetes, smoking, stress, immunodeficiency, medications, obesity, hormones, and nutrition. 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. This chapter defines the technical procedures applied by dental hygienists and the instruments used for treatment. This practice supports the old notion of “necrotic” root surfaces. Scaling and Root Planing. With simple scaling and ultrasonic cleaning, and some home care instructions, the gum disease will be a thing of the past. Both were effective in removing approximately 67% of the plaque in, Calculus is little more than calcified plaque biofilm. Calculus adheres to tooth surfaces through pellicular attachment, mechanical locking, and intercrystalline forces. The dental hygienist has many patient treatment options available for nonsurgical periodontal therapy, including the use of injected local anesthetics for pain control. Duration: 55:30. Scaling and root planing is a nonsurgical periodontal treatment that removes built up plaque and tartar from the gum … Animal studies provide strong evidence that these destructive diseases occur in the presence of microbes, but not in animals raised in germ-free environments. In 1976 Wilkins, in her fourth edition of. Connective tissue fibers are disrupted and lysed beneath the epithelium. 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. It is most commonly performed by rubber-cup application of polishing agents with a slow-speed handpiece. If the non-surgical therapy effectively eliminates the gum disease, the only further requirement will be periodic maintenance every 3-4 months. Definitions of Nonsurgical Periodontal Therapy, This chapter discusses the biologic basis and rationale for nonsurgical therapeutic procedures performed in the dental office. 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. 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. 3. Thus, the rationale for root planing to remove root roughness and achieve glassy, smooth root surfaces is no longer valid. Explain the benefits and indications of antimicrobial adjuncts to nonsurgical therapy. 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. 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 … Periodontal diseases present similar symptoms, but they likely have different bacterial origins that are not yet fully defined. that smooth surfaces had less plaque biofilm formation; however, root texture was not measured. 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. Nonsurgical therapy remains the cornerstone of periodontal treatment. Plaque biofilm must also be dislodged from all accessible surfaces. For optimal treatment results, systemic risk factors must be modified or eliminated. For this reason, every patient must participate in treatment by adopting a regular and effective biofilm removal regimen. Stains on the teeth are generally considered harmless, so their removal is secondary to the therapeutic and preventive goals of the dental hygienist. The dental hygienist must develop a tactile sense that permits detection of obvious calculus on the teeth. Calculus, although not an etiologic agent in itself, is virtually always associated with plaque biofilm, and its removal is associated with improved periodontal health. Thus, the rationale for root planing to remove root roughness and achieve glassy, smooth root surfaces is no longer valid. Periodontal “gum” 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. The use of both ultrasonic instrumentation and magnification to improve vision are important components of dental hygiene practice. Unfortunately at the current time, and according to our doctors, there is inadequate research available to recommend laser therapy for the treatment of periodontitis. Much has been learned about the penetration and removal of lipopolysaccharide endotoxins. The power and powder-to-water ratio is controlled with a foot pedal and can be increased or decreased as needed. The cornerstone of management of chronic periodontitis is the non-surgical periodontal treatment. Repopulation of Microorganisms After Therapy, Scaling and periodontal debridement are effective in reducing the volume of plaque biofilm bacteria in treated sites. The definitions of procedures must be clear and consistent. 5. After 6 weeks, the dentist will schedule an appointment to examine the patient’s response to the treatment. When treating gum disease, it is often best to begin with a non-surgical approach consisting of one or more of the following: Scaling and Root Planing. periodontally healthy sites. 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. Other terms used to describe nonsurgical periodontal therapy include initial therapy,1 Phase I therapy,2,3 etiotropic phase,2 and periodontal debridement. Convincing experimental evidence that plaque microorganisms cause human gingival disease was presented by Löe and colleagues in 1965. 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. An excellent example of the application of the specific plaque hypothesis is the treatment of aggressive periodontitis in its juvenile form. Scaling – This is a process where the plaque is scarped off of the surface of the teeth. Prophylaxis is a preventive procedure to remove local gingival irritants and includes complete calculus removal followed by root planing. However, the minerals in saliva remineralize the tooth surfaces, so surface alterations are only temporary. Synopsis. The power and powder-to-water ratio is controlled with a foot pedal and can be increased or decreased as needed. are provided for commonly used terminology found in publications and other communications. 1981, Serino et al. A comprehensive explanation of periodontal maintenance is found in Chapter 17. Scaling and root planing is the standard of care for nonsurgical and nonpharmacologic treatment of chronic periodontal diseases. Chronic periodontitis is the most common form of periodontitis, and aggressive periodontitis causes rapid destruction of the supporting structures of the teeth. It works by mechanical abrasion using a slurry of sodium bicarbonate and water. Early studies that used visual appraisal of deposits or colony counts on surfaces showed that smooth surfaces had less plaque biofilm formation; however, root texture was not measured. Experience suggests that the roots in an individual patient’s mouth will feel equally smooth after thorough instrumentation. Removal of endotoxins would require the planing away of diseased cementum. This practice supports the old notion of “necrotic” root surfaces. 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. Capnocytophaga species and spirochetes are the last to grow back. However, the roughness associated with calculus and poor restorations is far greater than the slightly granular texture of calculus-free 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). In the early stages it may not even be noticeable to you. Figure 1: Pre-treatment radiographs. 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. These reasons are. This is why regular visits to your periodontist are important especially if other health problems are present, like heart problems or diabetes. 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. Soft Tissue Healing After Scaling and Periodontal Debridement. Describe how the. 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. Describe the contributions of magnification with use of loupes, endoscopy, and microscopes to nonsurgical therapy. Standard cleanings and polishes only deal with the plaque above the gum line, and these procedures aren’t effective on their own to truly treat gum disease. Collectively, these methods represent the fundamentals of non-surgical periodontal therapy. A specific plaque bacterium, Actinobacillus actinomycetemcomitans, was identified in these lesions. As plaque biofilm ages, the organic matrix and bacterial cells calcify. However, the roughness associated with calculus and poor restorations is far greater than the slightly granular texture of calculus-free root surfaces. 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. 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. Minimally-Invasive Non-Surgical Periodontal Therapy – Philip Ower, May 2013. The numbers of organisms are reduced dramatically and grow back in different proportions. Unfortunately, the use of lasers for periodontal therapy is often used as a marketing ploy by uninformed, undiscerning, or unscrupulous dentists, including periodontists. • Discuss the use of lasers in nonsurgical therapy. J Clin Periodontol. Curettage had been defined by the AAP as scraping or cleaning the walls of a cavity or surface by means of a curette.12 It is a commonly misused term, often applied to a variety of procedures from removal of the pocket lining, termed closed curettage, to a surgical flap procedure called open curettage. Discuss the use of lasers in nonsurgical therapy. 4. 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 … 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. 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. Connective tissue fibers are disrupted and lysed beneath the epithelium. Cleaning agents are available for polishing the teeth and are preferable to those that contain abrasives. 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. Very often, early stages of periodontal disease are effectively treated with non-surgical periodontal therapy. Kepic and colleagues, Achieving root smoothness is important for evaluating short-term goals during treatment appointments. Damage to the gums and bone support around the upper front teeth following the use of a laser. Other studies have demonstrated no significant effect of periodontal therapy on metabolic control [9, 16, 17]. 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. 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. Patient plaque biofilm control is a cornerstone of long-term successful therapy. Phone: 949-830-1322 • Fax: 949-830-1383 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. Several issues surround the application of nonsurgical periodontal therapy. 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. 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. • Explain the limitations of calculus removal and the expectations for clinician proficiency. Polishing should be performed selectively. 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. ... to help treat their periodontal disease. including the communities of Newport Beach, 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. 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. 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. Your dentist will first start with nonsurgical … 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. Extensive root instrumentation is not required beyond the removal of calculus and plaque. 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. These procedures are demanding technical activities that require a large share of each therapeutic treatment appointment. To do so, the patient uses oral hygiene procedures and the dental hygienist performs coronal polishing. 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.