Non-Surgical Therapy Flashcards
Magnusson et al 1984
scaling
Subginval scaling, coupled with supervised oral hygiene, significantly improved periodontal condition
Becker et al 1979
perio tooth loss per year without treatment
0.36 teeth lost per year
Loe et al 1986
Sri Lankan perio progression
8% rapid progression
81% moderate progression
11% no progression
Cobb et al 1996
Tooth loss with and without treatment
With treatment: 0.08 teeth/year
Without treatment: 0.28 teeth per year
Lidnhe et al 1982
15 subjects; critical probing depth for modified widman flap
Attachment loss critical depth: 2.9 mm
MWP critical depth: 4.2 mm
Aljateeli et al 2014
Cohort study, 24 patients; half SRP, half SRP (6-8 weeks) then MWP
combined treatment had greater PD reduction. 3.5 mm at 3 and 6 month follow ups, only 2mm for SRP group
Universal curette
two cutting edges
angled at 90 degrees to terminal shank
Gracey curette
Single cutting edge
70 degrees to terminal shank
Reaches challenging areas, like distal aspects of posterior teeth
Ultrasonic scalers
Invented in 1957 by Dr. Black
Magnetostrictive (cavitron)
* stroke patterns
* entire surface active
Piezoelectric (Hu-Friedy Symmetry IQ)
* linear motion
* lateral aspects active
Ultrasonic scaler safety concerns
Old pacemakers, due to magnetic field generated
Nie et al (2020) systematic review:
* most instrumentation is safe distance from heart; no real concern
* cardiologist consult prudent
Muller et al 2014
Air polishing vs ultrasonic
- 50 patients split mouth
- sites cleaned with air polishing or US scaler every 3 months for 1 year
- No significant differences in clinical parameters
- Air polishing less painful
- study sponsored by air polishing device
Sculean et al 2004
Ultrasonic vs hand scaling efficacy
38 patients RCT
No SSD between groups
Sculean et al 2004
Ultrasonic vs laser
- 20 patients split mouth
- Er:YAG vs US
- No sig differences
Leon and Vogel 1987
Hand vs Ultrasonic scaling efficacy
GCF flow and microbial samples taken
Equally effective at class I furcations
UItrasonic scalers more effective fore class II and III furcations
Aleo et al 1975
Cytotoxic cementum
Three groups:
1. Treated with phenol to remove LPS
2. Cementum removal
3. Control
Results:
* Gingival fibroblasts did not attach to control teeth
* Phenol and scaling group had fibroblast attachment
Moore et al 1986
LPS
- 39% of LPS was removed by gentle washing with water
- 60% LPS removal from brushing for one minute
- 99% can be removed by gentle methods
- DO NOT need to compromise root surface
Root surface smoothness
Waerhaug 1956
* glass like smoothness needed
Rosenberg and Ash 1974
* smoothness not requierd
* no difference in plaque and inflammation in cavitron vs scaling, even with cavitron roughness
Oberholzer and Rateitschak 1996
* intentional roughness vs smooth, no differences in the groups for pocket reduction and attachment gain.
Quiryen et al 2000
Full-mouth disinfection vs SRP
Three groups:
1. SRP + full-mouth disinfection (FMD))
2. SRP with adjunctive use of chlorhexidine (FMD with chlorhexidine (Fdis))
3. Standard treatment with consecutive root planings quadrant per quadrant (control)
Results:
* SSD in clinical parameters for groups 1 and 2 vs control
Quiryen et al 1995
Full mouth disinfection
- SSD reduction in A.A. P. gingivalis and F. nucleatum at one month post FMD and increase in beneficial bacteria at 2 months
Full mouth disinfection
Systematic reviews
Eberhard et al 2008, Lang et al 2008
Minimal superiority of FMD over conventional quadrant scaling
FMD has not gained widespread traction
Wearhaug 1978a
SRP efficiency
SRP immediately before extraction of hopeless teeth
Sites presenting with:
* 3mm PD before exo were plaque free 83% of time
* PD 3-5mm were plaque free 39% of time
* >5mm were plaque free only 11% of time
Stambaugh (1981)
Scaling efficiency based on PD
- 3.73mm was deepest that could achieve complete smoothness
- 5.5 mm was max depth that could be effectively instrumented
- Inflated values as md molars were instrumented for 25 minutes per tooth; 39 minutes for max molar
Sherman et al 1990
Skill at subg calc detection following SRP
- High false negatives (77.4%)
- Low false positives (11.8%)
Bower 1979
Furcation size vs currete size
- 81% of furcations were <1mm
- 58% less than 0.75mm
- Min size of curette is 0.75 mm
Ghishan et al 2023
* similar findings as Bower study
* Digital analysis allowed for determination that furcation widths were as narrow as 0.24 mm
* Mini gracey curettes are as smallas 0.5mm
Fleischer et al 1989
Operator limitations of SRP.
Operators of >10 years experience
* SRP + OFD achieved calculus-free surface 78% of time; only 36% of time without flap access
Residents:
* flap access: 45% free
* non-surgical: 18% free
Formation of long junctional epithelium (studies)
Caton and Zander 1979
Waerhaug 1978b
Magnusson et al 1983
Long junctional epithelium showed similar resistance to inflammatory infiltrate as normal epithelium
Ramfjord et al 1980
restrospective study (8 years), 78 patients; compare SRP efficacy per tooth type
Shallow pockets (1-3mm), anterior teeth had better reduction and stability
Mid pockets (4-6mm): reduction similar, but anterior had better attachment outcomes
Deep pockets (>7mm): max molars showed better outcomes than anterior teeth
Cobb 1996 (AAPWW)
Attachment gain based on pocket depth
Segelnick and Weinberg 2006
re-evaluation key points
- JE re-establishes 1-2 weeks after SRP
- CT repair continues for 4-8 weeks
- Subg microflora repopulates within 2 months
- After 2 months pathogenic bacteria return
- Ideal period for re-eval is 4-8 weeks
- pt OH tends to relapse without maintenance
- anterior teeth (without furcations) show better improvement
- re-eval of mobility after occlusal adjustment should be after 6-12 months
