2008;35(Suppl 8):29-44. Air powder polishing removes most extrinsic stains and soft deposits from the exposed surfaces of the teeth. Polishing is the use of polishing agents to remove stains and supragingival plaque biofilm from the teeth. Scaling and root planing is the standard of care for nonsurgical and nonpharmacologic treatment of chronic periodontal diseases. 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. Dental hygiene procedures with hand instruments or powered scalers adequately accomplish subgingival plaque biofilm removal. 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. 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. 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. Enter your mobile number or email address below and we'll send you a link to download the free Kindle App. Irvine, San Juan Capistrano, San Clemente, Mission Viejo, & Orange County CA. Scaling may be accomplished with sharp hand instruments or with sonic or ultrasonic instrumentation using powered scaling devices. • Define nonsurgical periodontal therapy. 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. Peri-implantitis: Nonsurgical therapeutic approach 6. diagnosis and treatment of periodontal diseases. Periodontal maintenance. 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.2,3 These goals are summarized in Table 13-2. The concept of selective polishing emerged when research on enamel and root surfaces after polishing revealed changes in the hard tissues. 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. Patient plaque biofilm control is a cornerstone of long-term successful therapy. As plaque biofilm ages, the organic matrix and bacterial cells calcify. This removes tartar, plaque and bacteria from the gum surrounding the root, and promotes the healthy regeneration of the gum tissue. Much has been learned about the penetration and removal of lipopolysaccharide endotoxins. One size fits all grit paste ignores the science of abrasion, can cause sensitivity, and damage aesthetic restorations. Periodontists are dentistry's e xperts in treating periodontal disease. 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. • Smooth surfaces promote gingival healing. 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. âScalingâ is a necessary first step in the treatment process, and it clears the way for a deeper clean. Replacement restorations or orthodontic movement of the teeth can simplify plaque biofilm control and help the patient achieve periodontal health. Abrasives used during polishing can scratch amalgam, composite resin, and gold restorative materials. 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. The quality of the plaque is more important than the quantity, but plaque biofilm is still the causative agent in disease. Periodontists are also experts in replacing missing teeth with dental implants. The question remains whether root surfaces need to be glassy smooth. Extensive root instrumentation is not required beyond the removal of calculus and plaque. This involves the removal of bacterial plaque and tartar which is present at and below the gum line. 30200 Agoura Road, Suite 270 Agoura Hills, CA 91301 (818) 889-0400 firstname.lastname@example.org This rationale has been questioned for many years and the procedure is no longer considered standard treatment. NONSURGICAL PERIODONTAL THERAPY Instructed by Kelli R. Illyes, R.D.H, M.D.H. Definitions of Nonsurgical Periodontal Therapy, This chapter discusses the biologic basis and rationale for nonsurgical therapeutic procedures performed in the dental office. nonsurgical coverage of recession-type defects, treatment of suprabony defects and papilla reconstruction techniques. Air powder polishing is especially effective with severe staining, such as that found in cigarette and pipe smokers. The concept of selective polishing emerged when research on enamel and root surfaces after polishing revealed changes in the hard tissues. Specifically, curettage performed by the dental hygienist (legally permitted in some states), properly termed gingival curettage, is limited to closed curettage. A study published in the 1980s compared the performance of hand instruments with that of ultrasonic tips in the removal of plaque in pockets. are provided for commonly used terminology found in publications and other communications. âRoot planingâ involves cleaning plaque from below the gum line that is most often the culprits in periodontal disease. For optimal treatment results, systemic risk factors must be modified or eliminated. 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. Chronic periodontitis is a polymicrobial biofilm infection (Abusleme et al. including the communities of Newport Beach, Learn vocabulary, terms, and more with flashcards, games, and other study tools. 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. Can be single-ended or double-ended Many different types of periodontal probes available Laser periodontal therapy is one of the latest and most exciting techniques being developed for the treatment of periodontal disease. This practice supports the old notion of “necrotic” root surfaces. 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. 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. 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. Armitage presented the following information regarding root surface roughness8: 1. Very often, early stages of periodontal disease are effectively treated with non-surgical periodontal therapy. Hydrodynamic theory of dentinal sensitivity. Treatment options will focus on non-surgical periodontal therapy. Stains on the teeth are generally considered harmless, so their removal is secondary to the therapeutic and preventive goals of the dental hygienist. A comprehensive explanation of periodontal maintenance is found in Chapter 17. If periodontal disease has progressed to the point where gum tissue no longer fits snugly against the teeth, minor gum surgery may be needed. 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. Our practice has made great strides in non-surgical management of periodontal problems. It takes considerably longer than healing of epithelium—up to several months. 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. The term is commonly used and has several variations: oral prophylaxis, dental prophylaxis or, simply, prophy. 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. Describe the contributions of magnification with use of loupes, endoscopy, and microscopes to nonsurgical therapy. For periodontal patients, this goal often requires multiple appointments with the dental hygienist. J Clin Periodontol 2012; 39: 1065–1074. Although more specific gingival and periodontal diseases are recognized, nonsurgical periodontal therapy focuses on total plaque biofilm removal. 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. 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. Duration: 55:30. Healing of inflamed connective tissue is complex, requiring many cells and mediators. Inflammatory activity occurs in the underlying connective tissue during the disease process and is also a result of treatment. 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. It describes scaling procedures, both hand instrumentation and powered instrumentation, root planing, gingival curettage, and polishing. For this reason, every patient must participate in treatment by adopting a regular and effective biofilm removal regimen. 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. One size fits all grit paste ignores the science of abrasion, can cause sensitivity, and damage aesthetic restorations.5. Aim: To describe the kinetics of serum inflammatory markers after a course of treatment comprising surgical and non-surgical treatment of chronic periodontitis (CP). 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. The long-term goal of treatment is to restore gingival health. Smooth surfaces promote gingival healing. 4. After 6 weeks, the dentist will schedule an appointment to examine the patientâs response to the treatment. This practice supports the old notion of “necrotic” root surfaces. If the non-surgical therapy effectively eliminates the gum disease, the only further requirement will be periodic maintenance every 3-4 months. 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. Dental hygienist performing nonsurgical therapy in the contemporary clinical setting. It takes considerably longer than healing of epithelium—up to several months.26 New connective tissue fiber attachment to the tooth surface is not a predictable outcome, but the development of an elongated junctional epithelial attachment may result in reduced probe readings. Scaling and periodontal debridement are effective in reducing the volume of plaque biofilm bacteria in treated sites. The long-term goal of treatment is to restore gingival health. Plaque biofilm is the primary causative agent in gingival and periodontal diseases. Inflammation and tissue destruction in conventionally raised animals with oral biota are vastly more widespread and severe.5. It varies in crystal composition, type of attachment, and degree of difficulty in removal (see Chapter 5). It is now known that the presence of plaque biofilms does not interfere with the uptake of fluoride by tooth structures. This indicated that roughness itself had no effect on wound healing. Mission Viejo, CA 92691 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. Scaling and root planing causes some removal and disruption of the epithelial attachment to the tooth, junctional epithelium, and deeper connective tissue. 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. 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. Nyman and colleagues, These data indicate that toxins are superficially located on root surfaces and easily removed. • Discuss the use of lasers in nonsurgical therapy. 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. The definitions of procedures must be clear and consistent. Nonsurgical Approaches for the Treatment of Periodontal Diseases Maria Emanuel Ryan, DDS, PhD, Dent Clin N Am 49 (2005) 611–636 Step 1. J Clin Periodontol. The use of both ultrasonic instrumentation and magnification to improve vision are important components of dental hygiene practice. Nonsurgical periodontal treatment has been shown to control periodontal infection and to arrest progression of the disease in a significant number of cases. 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. In some cases, it could be non-surgical or surgical. This webinar will discuss the diagnosis and treatment planning of periodontal disease. By Judy Carroll, RDH, and Howard M. Notgarnie, RDH, EdD. 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. The bacterial plaque shifts from predominantly gram-negative microbiota to one that is gram-positive, with many fewer motile forms, especially spirochetes. Collectively, these methods represent the fundamentals of non-surgical periodontal therapy. The effects of nonsurgical periodontal therapy. Achieving root smoothness is important for evaluating short-term goals during treatment appointments. Convincing experimental evidence that plaque microorganisms cause human gingival disease was presented by Löe and colleagues in 1965. Both were effective in removing approximately 67% of the plaque in, Calculus is little more than calcified plaque biofilm. ... that describe … 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, Some residual calculus is likely to remain after dental hygiene treatment, especially in deeper pockets, but patients can probably tolerate some small amount. Conscientious removal of calculus and plaque biofilm with minimum destruction of cementum, termed periodontal debridement, is justified. In the early stages it may not even be noticeable to you. For this reason, every patient must participate in treatment by adopting a regular and effective biofilm removal regimen. 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. 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. 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). 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. The numbers of organisms are reduced dramatically and grow back in different proportions. • Explain the limitations of calculus removal and the expectations for clinician proficiency. The cornerstone of management of chronic periodontitis is the non-surgical periodontal treatment. 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. These local factors are described in. Learning Outcomes • Define nonsurgical periodontal therapy. In these instances, root planing, commonly referred to as âdeep cleaningsâ, becomes necessary. Dramatically thinned root surfaces are shown in Figure 13-5. 4. 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. 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. However, subgingival plaque is not effectively altered by supragingival oral hygiene procedures, especially in deeper pockets of 5 mm or more. These procedures are demanding technical activities that require a large share of each therapeutic treatment appointment. 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. 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. Extensive root instrumentation is not required beyond the removal of calculus and plaque. Some are under the patient’s control, and may, therefore, require lifestyle changes to achieve significant modification. This uniform smoothness should be identified. Material and methods: Fourteen CP cases received full-mouth non-surgical treatment and, after 6 months, at least two surgical sessions. It works by mechanical abrasion using a slurry of sodium bicarbonate and water. Capnocytophaga species and spirochetes are the last to grow back. Calculus is little more than calcified plaque biofilm. 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. Non-Surgical Treatment. • Describe the process of healing after periodontal debridement procedures, scaling, and root planing. 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. Plaque biofilm must also be dislodged from all accessible surfaces. Smooth root surfaces do not appear to promote better or faster healing than rough surfaces. 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. Glassy, smooth root surfaces are not end points in treatment. Afterwards, you return to your general dentist, who will place a crown or other restoration on the tooth to protect it … Removal of endotoxins would require the planing away of diseased cementum. Normal turnover of cells in the junctional epithelium, which migrate from the apical end to the coronal end, takes about 5 days. Bacteria live in the mouth and are present around diseased teeth. 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. The dental hygienist must develop a tactile sense that permits detection of obvious calculus on the teeth. that smooth surfaces had less plaque biofilm formation; however, root texture was not measured. With simple scaling and ultrasonic cleaning, and some home care instructions, the gum disease will be a thing of the past. 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. Kepic and colleagues, Achieving root smoothness is important for evaluating short-term goals during treatment appointments. 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. Clearly, this requires clinical experience and judgment on the part of the dental hygienist. To effectively take care of periodontal disease, the initial treatment is typically scaling and root planing; this treatment exists to remove tartar at or below the gum line. 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. Scaling and root planing is the standard of care for nonsurgical and nonpharmacologic treatment of chronic periodontal diseases. Schedule Your Free Dental Implant Consultation. Minimally-Invasive Non-Surgical Periodontal Therapy – Philip Ower, May 2013. The dental hygienist has many patient treatment options available for nonsurgical periodontal therapy, including the use of injected local anesthetics for pain control.
describe the various types of nonsurgical periodontal therapy