*01/27 - Review of Literature on Root Planing Flashcards
What is the difference between root planing and scaling?
ROOT PLANING: a treatment procedure designed to remove cementum or surface dentin that is rough, impregnated with calculus, or contaminated with toxins or microorganisms
- GOAL IS TO MODIFY ROOT SURFACE
- shaving stroke
- subgingival
- curettes, rotaries, and ultrasonics
- only performed in periodontitis
SUBGINGIVAL SCALING: instrumentation of the crown and root surfaces of the teeth to remove plaque, calculus, and stains from these surfaces
- GOAL IS TO REMOVE DEPOSITS
- wedging stroke
- supra- and subgingival
- scalers, rotaries, ultrasonics, and curettes
- may be performed in gingivitis and periodontitis
What are the objectives of root planing?
- restore gingival health by completely removing tooth surface factors that promote gingival inflammation
- make the root surface biologically acceptable to the soft tissues
Why do we go subgingival? (AKA what is in a pseudo and true pocket and what is only in a true pocket)
PSEUDO AND TRUE POCKETS:
- bacterial biofilm
- calculus
- chronically inflamed pocket wall (soft tissue)
- destructive host response (tissue breakdown products)
TRUE POCKETS ONLY:
- altered (diseased) root cementum
- apical migration of attachment apparatus
- bone loss
Periodontal disease = ___ + ___
How does calculus and cementum play a role in the etiology of periodontal disease?
- bacterial plaque
- susceptible host
CALCULUS:
- not a mechanical irritant
- not a chemical irritant
- plaque retentive!
DISEASED CEMENTUM:
- barrier to repair
- perpetuates tissue destruction
- host response
What is the rationale behind subgingival instrumentation?
- mechanically alter the subgingival ecosystem (remove plaque and retentive features, remove diseased surfaces)
- promote health associated host-response
What is the difference between curettage and root planing?
- CURETTAGE: soft tissue removal
- ROOT PLANING: hard tissue removal
What are the challenges (limitations) to subgingival instrumentation?
- *blind procedure
- *lack of access
- subgingival calculus tenacious
- calculus morphology variations
- *complex root morphology
- *variations in pocket anatomy
- *root concavities and furcations
- = bolded
What are the 3 keys to effective root planing?
- sharp instruments (more efficient, make root planing possible, prevents burnished calculus)
- access cemental surface
- correct angulation of the instrument face
True or false: The more experienced operators produce a significantly greater number of calculus-free root surfaces than the less experienced operators in periodontal pockets with moderate (4-6 mm) and deep (6+ mm) probing depths.
true
Which are easier to instrument: multi- or single-rooted teeth?
- single-rooted teeth
- root groove, narrow furcation openings or furcation ridges make instrumentation harder, if not impossible
- both mandibular and maxillary teeth have concavities at or within 5 mm apical to their CEJ
Are ultrasonics or hand instruments more effective at removing calculus? Cementum?
- CALCULUS: equally effective
- CEMENTUM: combination of both is better than either alone; forces vary among practitioners so can’t tell which is truly more effective
How many minutes are required for comprehensive subgingival treatment of one single tooth when hand instruments are used?
6-8 minutes
What areas are missed most (lack of access) with initial therapy?
- CEJ
- furcation areas
- line angles
- deeper parts of the pocket
Which is better: surgical or non-surgical therapy?
- complete removal of calculus from periodontally diseased root is rare
- curettes can’t reach the bottom of deep pockets
- periodontal surgery may be required to gain access (but have to do non-surgical therapy first before surgery so that you don’t operate on an infected site)
Which one is better: rough or smooth roots?
- roots that are intentionally grooved during surgery have as good a response to surgery as roots that have been planed smooth
- rough roots lead to more binding of bacteria and plaque retention
- CONCLUSION: smooth roots are method of clinically determining the end-point of instrumentation
- hand instruments remove more cementum and may be better in smoothing a rough root (although both hand instruments and ultrasonics can gouge a tooth if used improperly)
Why do we remove cementum?
to remove endotoxin (LPS)
- scaling only partially reduces endotoxin; root planing rendered roots endotoxin free
- conclusion: it is clinically sound to remove some, but not all, cementum
When is root planing contraindicated?
- the critical probing depth for root planing is 2.9 mm
- shallow healthy sites < 2.9 mm should NOT be instrumented because you will CAUSE permanent attachment loss (*beware of pseudo pockets!)
What is curettage? What does it do? When does it occur? When should we do it?
- the process of debriding the soft tissue wall of a periodontal pocket
- removes ulcerated epithelium and inflamed connective tissue
- occurs whenever root planing occurs
- it is not justified in chronic periodontitis! (may have some application in other forms of periodontitis like NUG)
What is the expected outcome following initial periodontal therapy? Why does each occur?
- POCKET REDUCTION: because the junctional epithelium lengthens
- LESS BLEEDING: because the plaque retentive calculus is removed so there is less of an inflammation response
- LESS PLAQUE/CALCULUS: plaque and calculus are mechanically removed
- GENERALLY MORE GINGIVAL RECESSION: because inflammation is lessened which makes the soft tissue tighter
What are the 4 periodontal healing patterns? Describe each.
- REPAIR: treated and the outcome is positive, but it is not exactly the same tissue that you started from
- REATTACHMENT: attaching back; ex. if you make an incision around the root, it would attach back if you didn’t touch the root surface
- NEW ATTACHMENT:
TRUE NEW ATTACHMENT: after removing cementum, dentin, and soft tissue, brand new cementum, bone, and PDL forms (will never get with SRP, except maybe at bottom of pocket)
LONG JUNCTIONAL EPITHELIUM ATTACHMENT: after treatment, the JE lengthens (will get after SRP!) - REGENERATION: after treatment, expect new tissue that is exactly the same as it was in the beginning (no way to get this with non-surgical techniques)
What healing pattern is mostly seen after SRP?
long junctional epithelium attachment
What are the ideal conditions for root planing?
- moderately inflamed (better access, more resolution)
- moderate pocket depth (5-6 mm)
- slight to moderate periodontitis (chronic)
- obvious deposits
When should you expect less than ideal results after root planing?
- slight periodontitis (responds to scaling alone)
- fibrotic tissues
- defective restorations (overhangs)
- very deep pockets and/or furcations
