Longitudinal - Practical knowledge Flashcards
Summarize the studies by Ramfjord from 1968-1975
Initially investigated SRP followed by Curretage vs Pocket Elimination (PE) and found the initial SRP had better CAL gain in deep pockets, and PE results in CALoss (1968)
Seperate study in 1975 with 5yrs follow up found:
SRP: most CAL gain/Least PD reduction
PE: Most PD reduction, CALoss
MWF: In between
Concluded that PE was an unnecessarily aggressive treatment
Summarize Knowles 1979
First to stratify based on pocket depth
Shallow: 1-3
Mod: 4-6
Deep: 7-12
PD: PE and MWF best for Mod-Deep
CAL: SRP best for Mod, MWF best for Deep
PE: NOT JUSTIFIED
Why 3mo maintenance?
Ramfjord 1928 stratified patients based on FMPS best and worst 25% and found NSSD in recurrence over 7years with STRICT 3mo recall
Any clinical studies that support SRP not being effective for deep pockets?
Pihlstrom 1983
SRP in deep pockets = greater recurrence
MWF = more effective in deep (>7mm) pockets
7mm+ PD: SRP more PD recurrence vs MWF (PD reduction sustained 6.5yrs in MWF vs 3yrs in SRP)
How do molars respond vs non-molars
Molars tend to have less PD reduction and less CAL gain
Pihlstrom 1984 found this in Mod PDs, but NSSD in deep
Why do we perform APF + OSS and not MWF?
Kaldahl 1988
APF/OSS had most CAL gain in 7mm PDs
Kaldahl 1996 5yr follow up found APF/OSS had sustained PD reduction for 5mm+
How does smoking impact improvement after perio treatment?
Kaldahl 1996 first to show negative impact of smoking
non-smokers and past smokers had 2x the CAL gain and PD reduction vs current smokers
How does ultrasonic compare to hand instruments? and repeated SRP?
Badersten found them to be equally effective - but this was single rooted teeth
What are the issues with PE/Gingivectomy?
Residual infrabony defects (Rosling 1976)
CALoss (Ramfjord 1975)
When do you do surgery?
Lindhe 1982
2.9+ - SRP CAL Gain
4.2+ - MWF CAL Gain
Heitz-Mayfield & Lang 2013
5.4+ - MWF > SRP
