Non-surgical Perio Treatment Flashcards
How can aetiological factors of periodontal disease be controlled?
Supra and subgingival biofilm can be disrupted via mechanical and chemical plaque control
Mechanical biofilm control can be carried out by professional and by patient
How can subgingival biofilm be removed?
Mechnically: Debridement of the subgingival area by a dental professional. This can be done surgically and non-surgically.
Chemical: Antibiotics can be used
What are the steps in patient perio treatment management?
History
Exam
Diagnosis
Provisional prognosis
Treatment plan
What are the phases of the treatment plan?
Emergency phase
Risk management phase
Fundamental phase
What happens during the fundamental phase of perio treatment plan?
Patient education: Inform and motivate the patient, awareness of PDs, modifiable risk factors.
Training in personal oral hygiene
Counselling on control of risk factors and oral hygiene instruction
Removal of defective restorations, overhangs, and/or any predisposing factors
Scaling and root debridement of teeth
What is the role of the professional in maintaining patient oral health?
Oral health education / oral hygiene advice
Professional removal of predisposing factors: Calculus, overhangs, etc
Professional supra and sub-gingival plaque control: Debridement, chemotherapeutics
What is the aim of scaling?
To remove plaque and calculus from the tooth surface and can be supra or sub gingival depending on the location of the deposits.
What is the aim of root planing?
To remove calculus and softened cementum leaving a smooth and hard root surface. (The need for cementum removal has been questioned. making keeping root surface clean the primary aim)
What is root surface debridement?
Term used to describe removing deposits from the root surface to leave the surface clean but without a specific aim of cementum removal
What does the effectiveness of scaling, root planing, and root surface debridement depend on?
Probing depth
Skill of the operator
Root anatomy
Time available
Instrument sharpness
What should be removed in debridement?
Aim to remove plaque, bacterial by-products, and calculus to create an environment compatible to periodontal health
Endotoxins and other bacterial products can be removed with gentle instrumentation
Cementum contributes to periodontal healing and should be preserved
What hand instruments should be used for periodontal treatment?
Curettes
Hoes and files
Ultrasonic and sonic instruments (powered): Tip vibration and spraying/cavitation
Vibrations can be produced by an EMF or crystal transducer (Piezoelectric)
What are the benefits of using ultrasonic instruments?
Effective for calculus removal and deplaque
Flushes out bacteria and by-products via fluid lavage
Anti-bacterial via cavitation
Ergonomic (light strokes only needed)
Less hand fatigue
Increased efficiency especially to remove bulk of heavy calculus deposits
What are the benefits of using hand instruments?
Enhanced tactile sensitivity
Some are designed to be area-specific and are thus more adaptable to the tooth structure
Less tooth sensitivity
Water not required, no aerosols
Should hand or ultrasonic instrumentation be used preferrably?
A combination of both is most effective.
What is calculus?
Mineralized biofilm
Develops above or below the gingival margin (supra and subgingival)
Superficially covered by vital, non-mineralized biofilm
Why should calculus be removed?
They act as plaque/biofilm retaining factors.
When should scaling and debridement be performed?
When there is supra or subgingival calculus
Presence of marginal bleeding (gingivitis)
Probing depth of 4mm and more with signs of bleeding and/or calculus
What are the steps for subgingival debridement?
1) Anaesthesia
2) Pocket mapping to check: Different depths, presence of calculus, concavities, sulci, root anatomy, pre-furcation and furcation involvement
3) Debridement
4) Probing to check
5) Irrigation (saline or chlorhexidine)
6) Haemostasis
7) Recommendations to patients
What are the recommendations to make to patients following debridement?
Controlling plaque in the areas well
Possible pain so to use painkillers
Chewing discomfort
Dentine hypersensitivity - transient
What are the potential complications that can arise from subgingival debridement?
Excessive bleeding
Soft tissue and papilla rupture
Instrument fracture
How should post debridement assessment be done?
Immediate assessment - Resolution of visual signs of inflammation (Volume and edema/suppuration)
Mediate assessment - Subgingival probing, probing depth reduction, absence of BOP
How does wound healing take place?
Through a long Junctional epithelium.
The LJE forms a barrier against biofilm and it is not more susceptible to further disease progression.
What are the types of changes that follow non-surgical periodontal therapy?
Changes in microbiota
Hard and soft tissue clinical changes
What effect does non-surgical periodontal therapy have on microbiota?
Shift in composition
Less gram -ve bacteria
Change in microflora assocaited with gingival health
What are the hard tissue changes that follow non-surgical periodontal therapy?
Very little bone gain at sites with horizontal bone loss
Intrabony/vertical bony defects - some bone fill on x-ray
What are the soft tissue changes that follow non-surgical periodontal therapy?
Amount of Pocket Depth reduction:
For PD 1 - 3mm: 0
For PD 4 - 6mm: 1.3mm
For >=7mm: 2.2mm
THESE ARE AVERAGE VALUES
How long does healing take for reduced pocket depths?
Healing may take 9 - 12 months at deeper sites
When should the re-evaluation phase be done?
6 - 8 weeks following the hygiene phase because that is how long it takes for tissue response and maturation.
What should be observed during the re-evaluation phase?
Colour, form and aspect of the tissue.
Tissue tone (how easy is the tissue to probe)
Bleeding and exudates
Presence of subgingival plaque or calculus
Clinical probing depth and attachment levels and their changes over time.
What are the possible outcomes of the re-evaluation phase?
1) All inflammatory responses have been eliminated as a consequence of successfully completed hygienic phase. Patient should be placed in maintenance and initiating the supportive phase of therapy.
2) Areas of persistent inflammation should be detected but at the same time deposits of residual calculus are found and considered to be accessible through instrumentation. Further selective scaling and root planing are performed.
3) Areas with persistent inflammation require open debridement for accessibility and visibility. In these cases periodontal surgery is indicated.
What indicates resolution of inflammation?
No bleeding on probing.
Healthy gingival appearance; pink colour, firm consistency, regular gingival margins
Reduced probing depths: resolution of gingival oedema, gingival recession, reattachment or repair via formation of long JE
What is the outcome that we ideally want to see?
Reduced Pocket Depths to <4mm
Easier for maintenance since easier access to shallow pockets
Good oral hygiene has more effect on shallow PD
What should be done if some sites are still non-responsive following treatment?
Re-instrument residual sites or refer to a periodontist.
