*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)
