Outcomes of Non-Surgical Therapy

Question 1

What are the outcomes of non-surgical therapy at the histological level?

Answer 1

Microbial biofilm disruption, eliminate calcified biofilm microorganisms from tooth surface and adjacent soft tissues, changes in microflora, produce a smooth root surface less likely to harbour residual bacteria and that is conducive to healing, and reduction of inflammatory cascade

Question 2

What are the changes in the microflora after non-surgical therapy?

Answer 2

Reduced load and less pathogens (orange and red complex and more friendly bacteria (yellow complex))

Question 3

What is the histological healing within a few hours after non-surgical therapy?

Answer 3

An acute inflammatory reaction occurs in soft tissue pocket wall and remnants of pocket epithelium will proliferate and pocket wall will be fully epithelialized after 2 days

Question 4

What is the histological healing 5 days after non-surgical therapy?

Answer 4

Epithelial reattachment will commence at apical extremity of pocket and progress coronally and involution of pocket epithelium will occur, giving rise to a new long JE

Question 5

What is the histological healing 3 weeks after non-surgical therapy?

Answer 5

Formation of functional orientated collagen, to replace granulation tissue, tends to lag behind healing of dento-epithelial junction, immature collagen not appearing until after 3 weeks

Question 6

What continues to be a potential site of weakness?

Answer 6

Long JE

Question 7

What could happen should patients supragingival oral hygiene lapse?

Answer 7

Epithelium could ‘unzip’ and a pocket reform

Question 8

What is repair in healing in periodontal wounds?

Answer 8

Restoration of a normal gingival sulcus at same level as base of previous pathologic periodontal pocket (typically by long epithelial JE)

Question 9

What is reattachment in healing in periodontal wounds?

Answer 9

Reattachment of gingivae

Question 10

What is new attachment in healing in periodontal wounds?

Answer 10

Newly generated fibres are embedded in new cementum on a portion of tooth that was uncovered by disease

Question 11

What is resorption in healing in periodontal wounds?

Answer 11

Loss/blunting of some proportion of a root

Question 12

What is ankylosis in healing in periodontal wounds?

Answer 12

Fusion of tooth to alveolar bone

Question 13

What is regeneration in healing in periodontal wounds?

Answer 13

Reproduction/reconstruction of a lost/injured part in such a way that architecture and function are completely restored by growing precursor cells replacing lost tissue

Question 14

What is the clot/vascular phase?

Answer 14

Coagulation, fibrin clot to dental surface, vasoconstriction, and vasodilation

Question 15

What is the inflammatory/granulation phase?

Answer 15

PMN migration, macrophages lining the, connective tissue attachment > fibroblasts, and contraction

Question 16

What is the periodontal regeneration?

Answer 16

Angiogenesis, ECM synthesis, epithelialisation, bone mineralisation, cementum deposition, and PDL fibre attachment and orientation

Question 17

What is the periodontal remodelling and stability

Answer 17

Maturation and remodelling

Question 18

When does the clot/vascular phase take place?

Answer 18

Minutes after non-surgical therapy

Question 19

When does the inflammatory and granulation phase take place?

Answer 19

Days after non-surgical therapy

Question 20

What does the periodontal regeneration take place?

Answer 20

Days/weeks after non-surgical therapy

Question 21

When does the periodontal remodelling and stability take place?

Answer 21

Months after non-surgical therapy

Question 22

What is the clinical healing following RSD?

Answer 22

Bacterial remnants continue to be washed out of pocket by blood and crevicular fluid

Question 23

What is the clinical healing 14 days after non-surgical therapy?

Answer 23

A new gingival sulcus will be formed near to crest of gingiva and some shrinkage of gingiva will occur due to resolution of oedema

Question 24

How long does it take for collagen repair to mature fully?

Answer 24

12 weeks

Question 25

Why should you not re-probe an instrumented pocket for 3 months post-RSD?

Answer 25

Collagen repair ultimately takes about 12 weeks to mature fully

Question 26

What is there little/no connective tissue re-attachment between?

Answer 26

Treated pocket lining and root surface

Question 27

What does close adaptation between gingivae and instrumented root surface rely on instead of connective tissue attachment?

Answer 27

A long JE and tissue tone in gingivae

Question 28

What are the clinical outcomes of non-surgical therapy

Answer 28

Improvement of OH, pocket depth reduction, absence of bleeding on probing, and clinical attachment level gain (0.5-1mm)

Question 29

What are the patient outcomes of non-surgical therapy?

Answer 29

No bleeding on brushing, accessible OH, gingival recession, more sensitivity to temperature, and improved oral health related quality of life

Question 30

What should you do with a stable periodontitis patient?

Answer 30

Supportive periodontal therapy

Question 31

What should you do with a remission periodontitis patient?

Answer 31

Supportive periodontal therapy with emphasis on controlling BoP

Question 32

What should you with with an unstable engaging periodontitis patient?

Answer 32

Further active periodontal therapy

Question 33

What should you with with a stable engaging periodontitis patient?

Answer 33

Palliative care