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. Hydrodynamic theory of dentinal sensitivity. The rationale for nonsurgical periodontal therapy is to remove the etiologic agent of disease—bacterial plaque biofilm—and its associated factors. 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. As the understanding of plaque biofilm as the pathologic agent has grown, various periodontal diseases have been identified with specific microbial organisms. 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. If health isn’t achieved following non-surgical methods, a surgical procedure may be necessary. • Smooth surfaces promote gingival healing. 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. Inflammation and tissue destruction in conventionally raised animals with oral biota are vastly more widespread and severe. Dent Clin North Am. Once successfully completed, the scaling and root planing procedure should leave patients feeling little or no discomfort. Cleaning agents are available for polishing the teeth and are preferable to those that contain abrasives. Achieving root smoothness is important for evaluating short-term goals during treatment appointments. 2. In 1976 Wilkins, in her fourth edition of Clinical Practice of the Dental Hygienist, introduced the idea of selective polishing and encouraged this modification in treatment.9 She stressed the critical importance of teaching personal plaque biofilm control rather than performing polishing during the appointment because of the limited amount of time the dental hygienist has with each patient. 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. 5. Capnocytophaga species and spirochetes are the last to grow back. Nonsurgical therapy includes the procedures listed in. start with non‐surgical periodontal treatment), search was limited to articles published between January 1998 and December 2018. Plaque biofilm is the primary causative agent in gingival and periodontal diseases. Non-surgical periodontal therapy for AIDS patient with periodontal involvement. Prophylaxis is a preventive procedure to remove local gingival irritants and includes complete calculus removal followed by root planing. 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. The terms nonsurgical periodontal therapy or periodontal debridement are used along with the traditional terms of scaling and root planing. Power-driven versus manual scalers, which one? • Explain the limitations of calculus removal and the expectations for clinician proficiency. 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. J Appl Oral Sci. Research is still needed on the clinical benefit of the granulation tissue removal that is a feature of periodontal surgical therapy and, to a lesser extent, occurs through indirect trauma in nonsurgical therapy. Hence there are many chronic diseases known as catalyzers of destructive alterations in the periodontal complex, among them Iron Deficiency Anemia, the purpose of this study is to evaluate the assessment of non-surgical periodontal treatment combined with LLLT in chronic periodontitis patients suffering from IDA. 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. Non-Surgical Treatment of Periodontal Disease If caught early enough, periodontal disease can often be treated with conservative, modern techniques that help heal the infected or damaged tissue. The long-lasting results are … Glassy, smooth root surfaces are not end points in treatment. For the former this is thought to be related to the effects of nicotine upon the local inflammatory response, there being less oedema and more fibrosis within the gin- … 2014;2014:345075. doi: 10.1155/2014/345075. 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. When it does not achieve periodontal health, surgery may be indicated to restore periodontal health. Indeed, nonsurgical treatment involving meticulous scaling and root planing (SRP) has been extensively documented and has been shown to be a highly predictable and successful therapy. Non-surgical periodontal treatment does have its limitations. Periodontal therapy can restore chronically inflamed gingiva so that, from a clinical and structural point of view, it is almost identical with gingiva that has never been exposed to excessive plaque accumulation 1 (see Part 8). Introdution. The rationale for nonsurgical periodontal therapy is to remove the etiologic agent of disease—bacterial plaque biofilm—and its associated factors. 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. This is done to improve the overall tissue quality prior to surgery and also to … Calculus is little more than calcified plaque biofilm. This site needs JavaScript to work properly. Anatomic and iatrogenic plaque traps, such as overhanging restorations and malposed teeth, must be considered during nonsurgical therapy. 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. Bacteria-specific tests and treatments have been developed and will be more widely used as the understanding of periodontal disease increases. Dramatically thinned root surfaces are shown in Figure 13-5. Periodontal surgery: whys and when. Most importantly, no surfaces should feel rough, as if calculus is still present. The repeated removal of tooth structure during nonsurgical therapy appointments and subsequent maintenance visits is not a goal of therapy, and it may result in thinned and sensitive root surfaces. USA.gov. 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. The thoroughness of calculus removal by instrumentation has been studied and shows surprising results. The polishing procedure is commonly referred to as a prophylaxis or a prophy, but this term is incorrect. Non - surgica pl eriodontal therapy incul d es localized or generalized scaling and root planing, the use of Keywords: Host modualation, Periodontal therapy, Lasers. Start studying Non-Surgical and Surgical Periodontal Therapy Concepts (T2-2). Non-surgical periodontal therapy (NSPT) is the most common way to treat periodontal disease in the UK. 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 rationale for nonsurgical periodontal therapy is to remove the etiologic agent of disease—bacterial plaque biofilm—and its associated factors. 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. 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. Studies evaluating plaque biofilm formation on rough root surfaces are equivocal. Nonsurgical modalities in shallower pockets consistently involve less post-therapy recession and are clearly recognized as being more conservative. 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. It is now known that the presence of plaque biofilms does not interfere with the uptake of fluoride by tooth structures. 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. Scaling and root planing: removal of calculus and subgingival organisms. 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. 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. If your periodontal disease is deemed advanced, non-surgical periodontal therapy might precede additional surgical therapy. The definitions of procedures must be clear and consistent. 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. Armitage presented the following information regarding root surface roughness8: 1. Normal turnover of cells in the junctional epithelium, which migrate from the apical end to the coronal end, takes about 5 days. Gartenmann SJ, Dörig I, Sahrmann P, Held U, Walter C, Schmidlin PR. The numbers of organisms are reduced dramatically and grow back in different proportions. 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. Non‐surgical periodontal therapy of advanced furcation involvement (furcation entrance probeable >3 mm in horizontal direction or entrance is “through‐and‐through”) usually leads to disease progression in the furcation area with a risk of eventual loss of teeth. BMC Oral Health. No experimental evidence indicates that rough root surfaces are mechanical irritants and would therefore delay healing. • Describe the process of healing after periodontal debridement procedures, scaling, and root planing. Phyllis L. Beemsterboer and Dorothy A. Perry. Normal turnover of cells in the junctional epithelium, which migrate from the apical end to the coronal end, takes about 5 days. Rationale for non-surgical periodontal treatment. Inflammatory activity occurs in the underlying connective tissue during the disease process and is also a result of treatment. This rationale has been questioned for many years and the procedure is no longer considered standard treatment. Experience suggests that the roots in an individual patient’s mouth will feel equally smooth after thorough instrumentation. 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. These reasons are8 as follows: • Smooth surfaces retard plaque formation. It is defined as the removal of the inflamed soft tissue lateral to the pocket wall. Root roughness and achieve glassy, smooth root surfaces are not end points treatment... 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