Minimally invasive non-surgical periodontal therapy Flashcards
What is MINIMALLY-INVASIVE PERIODONTOLOGY?
GREATER ATTENTION TO PATIENT’S POINT OF VIEW (morbidity/ quality of life/ treatment time)
What are some tools used in minimally-invasive periodontology?
These are fairly new:
Slimline ultrasonic tips
Micro mini curettes
Microsurgical instruments
Loupes
Microscope
Periodontal endoscope
Videoscope
What was root planing?
This was part of periodontal non-surgical treatment.
Describes the process of smoothing the root surface after scaling to remove bacterial deposits.
It was often done using scalers and curettes or ultrasonic instruments.
This is not commonly done now.
What was Curettage?
This was part of periodontal non-surgical treatment.
Refers to the removal of the soft tissue lining of the periodontal pocket, aiming to eliminate inflamed tissue and promote healing by allowing new, healthy tissue to regenerate.
Removal of necrotic cementum of tooth root
Disruption, removal and management of biofilm
Why was removal of the infected cementum done?
It was thought that diseased cementum, which may harbor bacteria and endotoxins, should be completely removed to ensure a healthy, infection-free root surface.
This is not commonly aimed for nowadays.
What are some newer concepts of MINST?
Use of magnification loupes or microscope
Thorough debridement of the root with piezoelectric devices with slimline thin tips and ‘after five’ and ‘micro mini five’ minicurettes
Avoid smoothing the root surface or performing gingival curettage to minimize trauma and preserve as much healthy tissue as possible.
Attempt to stimulate the formation of a stable blood clot by natural filling of the intrabony defect with blood following debridement
What can MINST do for intrabony defects?
It improves them - an average of 3 mm reduction in radiographic bone loss
Suggest a MINST protocol.
- Magnification loupes
Thorough root debridement with only ultrasonic scalers with specific slimline thin tips on minimum vibration (rpm) setting
Sub-papillary access (minimize soft tissue trauma)
No ‘smoothing’ of the root surface or gingival curettage
Attempt to stimulate the formation of a stable blood clot, by natural filling of the intrabony defect with blood following debridement (no use of subgingival rinses or adjuncts)
OH (oral hygiene) re-enforcements
Review (no probing), OH, scaling, and polishing session 2-3 months after treatment
Re-evaluation 6-9 months after treatment
What are the mechanisms for healing of intrabony defects after non-surgical therapy?
Removal of subgingival biofilm
Formation of a stable blood clot
Reduction of chronic inflammation
Formation of long junctional epithelium
Bone apposition or increased bone mineralization (mainly where supra-crestal fibers are still attached to cementum and bone matrix is present?)
Emphasis needs to be put on what in relation to resolving intra-bony defects?
Emphasis needs to be put on OHI and non-surgical debridement for resolution of intrabony defects
Do you still need surgery after MINST?
In some case, surgical intervention is still needed following MINST to obtain further pocket reduction
