non-surgical therapy Flashcards
How much PD reduction and CAL gain can you get from SRP
Cobb
-4-6mm PD: reduced 1.29mm, gain 0.55mm
->7mm PD: reduced 2.16mm, gain 1.79mm
How effective is SRP
-Stambaugh: effective instrumentation limit is 6.21mm
-Waerhaug: 90% had plaque and calculus remaining in pockets >5mm
what factors affect the efficacy of SRP
-Quality of root debridement
-host response to therapy
-PD: surgical is more effective for PD>4mm (Brayer)
Is it more effective to do SRP or FMD?
-Quirynen: FMD had greater PD reduction of 1.5mm and a gain of 2mm (for pockets >7mm) and a greater reduction in spirochetes. No difference between the use of chlorhexidine though.
-Santuchi: No significant difference
What is more effective - scalers or ultrasonic?
-Dahiya 2011 (using scanning electron microscope): Manual = ultrasonic
-Hallmon and Rees 2003: systematic review; Manual = mechanical for perio parameters and instrumentation time
What is more effective for cleaning FURCATIONS - scalers or ultrasonic?
-Bower: furcation is 1mm 81% of the time and <0.7mm 58% of the time so the ultrasonic would fit better in grade 2/3 furcation than Gracey curette
-Parashis 1993: ultrasonic>manual
-Leon and Vogel 1987:
-Grade 1: scalers=ultrasonic
-Grade 2/3: ultrasonic > scalers
Cavitron versus piezo
-Both are ultrasonic
-Cavitron has fewer cycles/second and tip moves elliptical
-Piezo is linear movement
Does contaminated cementum need to be removed?
-Mombelli 1995:
No
-similar results after 1 year
-reduction of microbes was more important
Is irrigation recommended/required?
-position paper by AAP: insufficient evidence; controversial
-Hallmon and Rees: systematic review; similar outcomes to just manual instrumentation
What about lasers? AAP statement
-controversial and minimal evidence
What about lasers? -Slot et al:
effect was comparable with SRP
What about lasers? -Zhao et al:
Er:YAG led to sig greater short term decrease in PD, but was clinically effective to SRP after 3 months
What about systemic antibiotics?
Haffaje:
-systematic review
-adjunct use leads to greater CAL gain
-Esp with aggressive periodontitis
What about locally delivered antibiotics?
-Hanes and Purvis: systematic review; greater CAL gain and reduction in PD with minocycline gel, chlorhexidine chips, and doxycycline gel in conjunction with SRP compared to SRP alone.
What about powders?
-Wennström: split-mouth study (SRP alone versus SRP and air polishing with glycine powder). Both improved BOP, PD, and CAL, but there were NO additional benefits from air polishing at 2 months
-Flemming: subgingival adjunctive use of glycine powder air polish led to significantly lower total bacterial counts at 10 days and lower total P gingivalis count at 90 days compared with SRP alone.
What about SRP by quadrant (1 every week for 4 weeks) or FMD (full SRP in 24h)?
-Eberhard: Cochrane review; no additional benefit for FMS or FMD over SRP
- Santuchi 2016 – no sig difference
- Lang 2008 – systematic review; sig reduction in PD (0.2mm) but was not clinically relevant
-no clear superiority at clinical level and a bit controversial, but if systemic antibiotics are needed then FMD may be treatment of choice and if pt has time limitations
How effective is NSPT?
-more remaining plaque and calculus in: deeper pockets and teeth with furcations
Waerhaug:
-PD<3mm = 83% of surfaces were plaque-free
-PD>3mm = 44% of surfaces free of plaque-free
-PD3-5mm: high chance of leaving calculus
-PD>5mm: 90% chance; only 11% of surfaces were plaque-free
Stambaugh:
Plaque remained on teeth with mean PD of 7.69mm
Curette efficiency was 3.73mm
Curette limit was (average) 5.52mm, with a max of 6.21mm
If you have a residual deep pocket, will you try to keep scaling or go surgical?
Badersten
-repeated SRP q3m did not lead to any clinical improvements after the first 3 cycles
König
-2nd round of NSPT 5m later lead to even more CAL gain and reduced need for surgical intervention
Non-surgical versus surgical therapy?
Becker
-after 5 years, no sig difference in SRP, osseous, and MWF
Heitz-Mayfield 2002:
-meta analysis
-PD 4-6mm: NSPT => less PD reduction and more gain in CAL
-PD >6mm: Surgical => higher PD reduction and more gain in CAL
Caffesse 1986:
-clinical study
-more calculus and plaque if non surgical and also if there are grooves, fossae, or furcations
PD 1-3: 86% calculus free for both
PD 4-6: 43% (non surg) versus 76% (surg)
PD >6: 32% versus 50%
Critical probing depth:
-Lindhe 1982:
-PD <2.9mm – SRP leads to CAL loss
PD <4.2mm – surgical SRP leads to CAL loss
Heitz-Mayfield 2013:
PD>5.4mm – surgical has more CAL gain
Therefore, from 2.9-5.4mm you should do SRP. For PD >5.4mm you should do surgical.
How effective is SRP in furcations?
-Fleischer: experienced operators had calculus-free surface only 68% of the time
When would you use a surgical modality vs a non-surgical modality?
- Level of BOP
- PI
how does the tissues heal after SRP
- Waerhaug
-some of the remaining pocket epithelium will give rise to the reformation of the junctional epithelium (takes 2 weeks)
The initial pocket depth reduction following SRP (about 1 week) is related to increased gingival recession, while the secondary pocket reduction (after 3 weeks) is due to clinical attachment gain.
-Caton and Zander: formation of a long junctional epithelium (LJE) rather than new connective tissue (CT) attachment. However, this LJE was demonstrated to be no different in resistance to plaque or disease progression.
