23 - Nonsurgical Therapy Mike COPY Flashcards
Bacteremia and SRP
Lafaurie 2007
BL: SRP induced anaerobic bacteremia in patients w/ severe ChP
- 81% w/ bacteremia after SRP
- P. gingivalis, Actinomcyces, M. micros
Endoscopy and SRP
Michaud 2007
BL: Endoscopy does not provide a statistically significant (SS) benefit to traditional SRP
-No difference between test and controls in total % residual calculus
Endotoxin and SRP
Jones & O’Leary 1978
BL: SRP renders root surfaces generally free of endotoxin. Scaling alone does not remove endotoxin.
Endotoxin and Curette/Ultrasonic
Nishmine 1979
BL: Root planing resulted in 8X less endotoxin compared to ultrasonic scaling
Full mouth disinfection: systematic review
Eberhard 2008
Compare: 1) Full mouth scaling in 24 hours + antiseptic 2) Full mouth scaling in 24 hours 3) Quadrant scaling
BL: All treatment modalities offer benefits w/ minor differences between them (~0.5mm difference)
Most important name for full mouth disinfection
Quirynen
Are periodontal parameters useful for detecting residual calculus?
Sherman 1990
BL: NO! BOP/PD/CAL not useful for predicting residual calculus after SRP
- <50% sensitivity
- Still have improvement in periodontal parameters after SRP even w/ residual calculus
Root roughness relation to plaque accumulation and gingival inflammation
Rosenberg 1974
BL: Root surface roughness is not SS related to supragingival plaque accumulation or gingival inflammation
-Curette produces smoother surface than ultrasonic
Diamond bur for root planing
Leknes 1994
BL: Diamond bur causes roughness that promotes subgingival bacterial colonization
-Beagle dog study
Pathological pocket and SRP
Waerhaug 1978
BL: Pathological pocket is reversible with SRP/MWF
-Dento-epithelial junction reforms where subgingival calculus is removed
How often do we miss subgingival plaque?
***Know these numbers
Waerhaug 1978
90% of the time we miss subgingival plaque
<3mm PD: 89% plaque free
3-5mm PD: 63% plaque free
5mm+ PD: 11% plaque free
Do we need to remove infected cementum?
Nyman 1988
BL: Removal of infected cementum not necessary
- Experimental group = remove cementum w/ bur
- No difference in periodontal parameters compared to calculus removal alone
SRP effects on specific bacteria
Cugini 2000
BL: PG/TF/TD decreased w/ SRP
-Majority of changes during first 3 months
SRP in smokers
Renvert 1998
BL: SRP successful in smokers but they have a less favorable response at 6 months
- BOP 37% S vs 23% Non-S
- PD reduction 1.9mm S vs 2.5mm Non-S
How far down the root surface do we clean with curettes?
***Know these numbers
Stambaugh 1981
- 73 + 0.97mm = greatest pocket depth at which root surface hard/smooth/calculus free
- 52 + 1.94mm = maximum mean pocket depth in which evidence of instrumentation observed
- 21mm = absolute maximum PD curette cleans
What is the problem with the Stambaugh article?
“Most famous 7 teeth in all of perio”
- 7 teeth only
- 25-39 minutes SRP per tooth
2 studies that looked at multiple rounds of SRP?
How was it performed?
Anderson 1996 - SRP 1X versus 3X (24 hours apart)
Badersten 1984 - Ultrasonic SRP 1X versus 3X (at baseline, 3, and 6 months)
Multiple rounds of SRP study results
Anderson - no SS difference for single or multiple SRP
Badersten - full effect of treatment realized 6-9 months following instrumentation. Single episode of SRP is as effective as SRP q3months in patients w/ good hygiene
How good are we at detecting residual calculus?
***Know these numbers
Sherman 1990
2 clinicians say calculus is present, we are 72% correct
2 clinicians say no calculus is present, we are 50% correct
Site/tooth/patient level factors accounting for variance in PD reduction
D’Aiuto 2005
Site level: 80% -M/D greater response than B/L -Deeper sites greater PD reduction Tooth level: 12% -Mobile teeth decreased PD reduction Anterior teeth greatest PD reduction Patient level: 8% -Bad for IL-6, smokers
Curettes vs ultrasonics in moderate periodontitis
Badersten 1981
BL: 4-7.5mm PD in non-molars w/ excellent hygiene successfully treated w/ curettes OR ultrasonic
-SRP at 1/3/7 months
SRP for severe periodontitis
Badersten 1984
BL: Wait longer for severe sites, repeated instrumentation is effective
SRP in molar furcations compared to flat surfaces
Nordland 1987
BL: molar furcations w/ PD 4mm+ have poorer response to SRP compared to molar flat surfaces and non-molars
-Loss of attachment furcations (21%), molar flat surfaces (7%), non-molars (11%)
Is there any difference in the amount of inflammation histologically after SRP?
***Rationale for NST for case presentation
Caton 1989
BL: OH + SRP more effective for reducing interproximal inflammation compared to OH alone
-Repair occurs within 4 weeks
What are reliable predictors for CAL loss?
Claffey 1990
BL: Increased PD and BOP predictive for CAL loss over time
- 1mm+ PD increase = PPV 68% and 87% when combined with BOP 75%+
- 7mm+ residual PD = PPV 50% and 67% when combined with BOP 75%+
SRP in a healthy periodontium
animal
Lindhe 1982
BL: Repeated SRP in a healthy periodontium leads to SS loss of CT of 0.39mm and alveolar bone
-2 rhesus monkeys, SRP q2weeks
SRP in a healthy periodontium (human)
Claffey 1986
BL: Loss of attachment w/ thin healthy gingiva
- No loss of attachment for thick and thin bleeding sites
- No loss of attachment for thick non-bleeding sites
Rationale for OFD in non-molar teeth
Brayer 1989
BL: In PD >4mm, OFD more effective than closed and is related to operator experience
-Compared resident to board certified periodontitis
Where is residual calculus found?
Brayer 1989
CEJ
Root concavity
Line angle
Distal surfaces
Rationale for OFD in all teeth
***Know numbers for residual calculus by pocket depth
Caffesse 1986
BL: OFD SS more effective for pockets >3mm.
-% residual calculus dependent on severity of PD
Numbers for residual calculus by pocket depth for flapless/OFD
Caffesse 1986
1-3mm pockets, 86% calculus free surfaces for flapless AND OFD
4-6mm pockets, 76% calculus free surface w/ OFD
> 6mm pockets, 50% calculus free surface w/ OFD
Rationale for OFD in molars
Fleischer 1989
BL: OFD and operator experience enhances calculus removal in molars w/ furcation invasion
-68% calculus free surfaces in 4mm+ sites with board certified periodontist
Rationale for OFD in furcations
Most common site for residual calculus in this study?
Matia 1986
BL: OFD and ultrasonic indicated for debridement of furcations
-Residual calculus = furcal dome
Matia 1986 - distinguish between wide and narrow furcations
Wide >2.3mm - most often calculus free
Narrow <2.3mm - ultrasonic better than curettes, but not perfect
Diamond burs + OFD in molars
Parashis 1993
BL: OFD + diamond rotary burs for furcations
-5% residual calculus in furcation flutes and roof
