Non-Surgical Periodontal Therapy Comprehensive Periodontics for the Dental Hygienist, Chapters 9,...
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Transcript of Non-Surgical Periodontal Therapy Comprehensive Periodontics for the Dental Hygienist, Chapters 9,...
Non-Surgical Periodontal Therapy
Comprehensive Periodontics for the Dental Hygienist, Chapters 9, 12
Learning Objectives
1. Understand the differences between periodontal debridement, scaling, root planing & de-plaquing
2. Discuss the goals & rationale for non-surgical therapy
3. Discuss the process of wound healing following successful intervention
4. Select appropriate instruments for periodontal debridement
Non-Surgical Periodontal TherapyHealthy tissues = good plaque control + complete periodontal debridement + healing
Immediate Treatment Goals educate client instrument tooth
surfaces remove plaque &
calculus explore to evaluate
root surfaces are root surfaces
smooth & plaque free
Long-term Goals of Therapy compliance with
home care/PMP gingival health
restored periodontal health
controlled
Goals of Debridement
Success of treatment depends on: Immune response
to treatment Disease severity Appropriate use of
chemotherapeutic agents
Complete treatmentRemoval of
supra/subgingival plaque
Removal of calculus (due to its plaque retentive nature)
Professional expertiseUse of appropriate
instrumentsIntraoral constraints
Non-Surgical Periodontal Therapy
Rationale promote tissue healing decrease probing depths increase CAL decrease bleeding remove deposits iatrogenic & anatomic factors considered
(e.g. overhangs, malposed teeth)
Non-Surgical Periodontal Therapy - Definitions
Scaling removal of sub/supra deposits instrumentation of tooth & root surfaces
Root Planing treatment of root surfaces removal of deposits, by-products
Deplaquing removal of all plaque (supragingival &
within sulcus or pockets) re-evaluation & maintenance
appointments
Non-Surgical Periodontal Therapy - Definitions
Periodontal Debridement conserves cementum plaque control instrumental to good
healing response removal of deposits, diseased or dead
tissue from root surfaces, within pocket includes pocket space, pocket wall
Bacterial products within non-adherent plaque most detrimental to soft tissue
Non-Surgical Periodontal Therapy
Periodontal Debridement Indications
gingival inflammation – where periodontal pockets exist
presence of bacterial pathogensprogressive attachment loss, bone loss
Contraindicationssites that do not have true pocketing
Non-Surgical Periodontal Therapy
Periodontal Debridement Outcomes
assess clinical parameters• probing depths• clinical attachment levels• alveolar bone height• visual signs of gingival inflammation• changes in subgingival pathogens• bleeding on probing
Non-Surgical Periodontal Therapy
Healing occurs as repair as opposed to regeneration Predictable outcomes include:
Healing of epitheliumResolution of inflammationFormation of long junctional epithelial
attachmentRecession Repopulation of pockets by less pathogenic
forms of bacteria
Non-Surgical Periodontal Therapy
Less predictable outcomes include: Regeneration of new bone New connective tissue attachment New cementum on root surfaces
Non-Surgical Periodontal Therapy
Gingivitis: Healing following intervention Decrease of inflammatory cells Reduced edema New collagen formation Pocket epithelium heals – reduced rete pegs,
lateral attachment of junctional epithelium Reduction of bleeding Return of gingival colour Tissue shrinkage – recession becomes obvious Reduced probing depths
Non-Surgical Periodontal Therapy
Periodontitis: Healing Response Injury to or separation of junctional epithelium
occurs following debridement Healing takes approx. 1 week
Hemidesmosomes begin to reattach from apical end of JEIntact after approx.7 days
Connective tissue healing takes considerably longer
Up to several monthsNew connective tissue fiber attachment not an expected
outcomeDevelopment of an elongated junctional epithelium – this
may result in reduced probing depths
Non-Surgical Periodontal Therapy
Periodontitis: Clinical Healing Response Reduced pocket depths Changes in attachment levels Recession Fewer bleeding sites, reduced redness Improvement in tissue tone & colour
Non-Surgical Periodontal Therapy
Periodontitis: Reduced Pocket Depths Greater reduction of pocket depths occurs in
deeper pockets Pocket depths measuring 4-6 mm
Pocket reduction approximates 1 mmRecession & minimal attachment gain ( 0.5 mm)
Pocket depths measuring > 7 mmPocket reduction approximates 1.5-3.0 mmCombination of recession & attachment gain (
1.0mm)
Non-Surgical Periodontal Therapy
Gain in attachment level May represent more accurate reading of
pocket probing depth Inflamed tissues easily penetrated when
probed Inflates true pocket readings Probe less likely to penetrate when:
Junctional epithelium & CT has healed & fibers are intact
Assessment Following Therapy
Assess response of tissuesAssess plaque & calculus deposits
Residual calculus?No improvement:
Evaluate health history Plaque culture
Recommendations: Antibiotics/antimicrobials Repeat periodontal debridement Periodontal surgery
Repopulation of Pockets
Periodontal debridement reduces bacterial population in pockets
Shift from primarily Gram-negative flora to one that is Gram-positive Fewer motile forms
Repopulation occurs in a specific orderMay take as long as 6 months & may depend
on Completeness of initial therapy Client’s compliance & ability to remove plaque Presence of invasive bacteria
Repopulation of Pockets
Specific order of repopulation: Streptococcus & Actinobacillus species Viellonella Bacteroides Porphyromonas Prevotella Fusobacterium Capnocytophaga sp & spirochetes
Limitations of Non-Surgical Therapy
Pocket depths Residual calculus likely in deeper
pockets Average pocket depth for adequate
removal approx. 3.73 mm Clinical approach: curettes with longer
shanks
Limitations of Non-Surgical Therapy
Furcations Access difficult – residual calculus likely Opening to furcation often smaller than
diameter of periodontal instrument Clinical approach: use of slimline inserts
Root anatomy Depressions on proximal surfaces Clinical approach: knowledge of root anatomy
Limitations of Non-Surgical Therapy
Clinical skill & time spent Debridement technique & skill sensitive Debridement of one periodontally
involved molar (moderate involvement) takes approx. 10 minutes
Attention to technique, proper selection of instruments important to success