Non-surgical

Question 1

How does pocket reduction effect microbial community?

Answer 1

Mombelli 1995
Pocket reduction resulted in significant and lasting decrease in anaerobic bacteria

Question 2

How does calculus form?

Answer 2

Theilade 1964

By mineralization of dental plaque

Question 3

Does calculus alone prevent attachment?

Answer 3

No

Listgarten and Ellegaard 1973

Sterilized Calc with chlorohexidine allows normal hemidesmosomal attachment (JE)

Allen and Kerr 1965

Steralized calc did not cause marked inflammation or granulation tissue when inserted into tissue of guinea pigs

Question 4

What are the critical probing depths?

Answer 4

Lindhe & Socransky 1982

2.9mm and 4.2mm

Heitz-Mayfield & Lang 2013

5.4mm

Question 5

What is curette efficiency and instrumentation limit?

Answer 5

Stambaugh 1981

3. 7 +/- 0.97mm efficiency
4. 21 Limit

Question 6

How does pocket depth effect % calc removal?

Answer 6

Caffesse 86

Scaling
86% 1-3
43% 4-6
32% >6

OFD
86% 1-3
76% 4-6
50% >6

Question 7

How does manual scaling compare to ultrasonic?

Answer 7

Wennstrom, Tomasi et al.

4Quad
SRP: 66% Calc removed
Ultrasonic: 58%

Time:

3. 3min/closed pocket Ultrasonic
4. 8min/closed pocket curette

Question 8

How hard is it to remove endotoxin?

Answer 8

Moore 1986

39% removed via washing with water for 1min

60% via brushing for 1min w/ rotating brush

Question 9

Do we have to curette extra after removing calculus to remove endotoxin?

Answer 9

NO

Cadosch 2003

9.3 strokes to remove all calc - minimal levels of endotoxin after calc removal

Question 10

How does root irregularity effect perio?

Answer 10

Waerhaug 1956

Does not cause periodontal disease - Normal tissue attachment histologically observed in roughened areas

Querynen

Irregularities can increase plaque accumulation

Question 11

Is healing after SRP sufficient to stop plaque?

Answer 11

Magnusson 1983

JE exhibits similar plaque resistance as regular attachment

Question 12

Why should we not just do another SRP if there are residual pockets?

Answer 12

Badersten 1984

3 consecutive SRPs 3mo apart - no significant benefit over 1 SRP

Question 13

Should you use non surgical for peri-implantitis?

Answer 13

NO

Elena Figuero 2014

Non-surgical shows little efficacy for treating peri-implantitis

Does well for peri-implant mucositis

Cochrane Systematic review says that theres inconclusive evidence though

Question 14

What is endotoxin?

Answer 14

A heat stable lipid polysaccharide in the cell wall of many gram - bacteria. Causes inflammation - part of the etiology of perio

Question 15

Is calculus detection accurate?

Answer 15

Sherman 1990

Periodontists did calc detection

EXT teeth

57. 7% had calc
58. 8% was detected

Question 16

Why did we root plane before?

Answer 16

Theorized that the endotoxin is trapped in the root surface and needs to be removed

Question 17

Why dont we need to root plane?

Answer 17

Moore et al. 1986

Looked at periodontally involved single rooted teeth

Found 39% of endotoxin could be removed by water spray

60% of endotoxin was removed by light brushing

Question 18

How much calculus do we remove in non-surgical and surgical?

Answer 18

Waerhaug NSurg

Shallow: 83%

Mod: 38% (flip 83)

Deep: 11%

Cafesse 1986 NSurg

Shallow: 86%

Mod: 43% (86/2)

Deep: 32% (-11)

Cafesse 1986 Surg

Shallow: 86%

Mod: 75% (-11)

Deep: 50%

Question 19

What challenges are there in cleaning molars?

Answer 19

Bower 1979

Average instrument 0.75mm

81% of furcations are = 1mm

58% are = 0.75mm

85% of Buccal Max 1st are = 0.75mm

Question 20

How can we improve molar furcation debridement?

Answer 20

Matia 1986

Using US will aid in narrow furcation cleaning

Question 21

Which is better, ultrasonic or hand scaling?

Answer 21

Baderstein et al. 1981

RCT split mouth

NSSD between clinical results

Cobb 2002

Ultrasonic was faster

Question 22

What kind of healing occurs after SRP?

Answer 22

Long junctional epithelium

Caton & Zander 1979

Question 23

What kind of healing occurs after OFD?

Answer 23

Long Junctional Epithelium

Caton 1980

Question 24

How much PD reduction can you expect from non-surgical?

Answer 24

Cobb 1996

Review of longitudingal/RCT/Cohorts

1-3mm: 0.03mm

4-6mm: 1.3mm

>6mm: 2.1mm