Outcomes of Non-Surgical Therapy Flashcards
What are the outcomes of non-surgical therapy at the histological level?
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
What are the changes in the microflora after non-surgical therapy?
Reduced load and less pathogens (orange and red complex and more friendly bacteria (yellow complex))
What is the histological healing within a few hours after non-surgical therapy?
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
What is the histological healing 5 days after non-surgical therapy?
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
What is the histological healing 3 weeks after non-surgical therapy?
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
What continues to be a potential site of weakness?
Long JE
What could happen should patients supragingival oral hygiene lapse?
Epithelium could ‘unzip’ and a pocket reform
What is repair in healing in periodontal wounds?
Restoration of a normal gingival sulcus at same level as base of previous pathologic periodontal pocket (typically by long epithelial JE)
What is reattachment in healing in periodontal wounds?
Reattachment of gingivae
What is new attachment in healing in periodontal wounds?
Newly generated fibres are embedded in new cementum on a portion of tooth that was uncovered by disease
What is resorption in healing in periodontal wounds?
Loss/blunting of some proportion of a root
What is ankylosis in healing in periodontal wounds?
Fusion of tooth to alveolar bone
What is regeneration in healing in periodontal wounds?
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
What is the clot/vascular phase?
Coagulation, fibrin clot to dental surface, vasoconstriction, and vasodilation
What is the inflammatory/granulation phase?
PMN migration, macrophages lining the, connective tissue attachment > fibroblasts, and contraction
What is the periodontal regeneration?
Angiogenesis, ECM synthesis, epithelialisation, bone mineralisation, cementum deposition, and PDL fibre attachment and orientation
What is the periodontal remodelling and stability
Maturation and remodelling
When does the clot/vascular phase take place?
Minutes after non-surgical therapy
When does the inflammatory and granulation phase take place?
Days after non-surgical therapy
What does the periodontal regeneration take place?
Days/weeks after non-surgical therapy
When does the periodontal remodelling and stability take place?
Months after non-surgical therapy
What is the clinical healing following RSD?
Bacterial remnants continue to be washed out of pocket by blood and crevicular fluid
What is the clinical healing 14 days after non-surgical therapy?
A new gingival sulcus will be formed near to crest of gingiva and some shrinkage of gingiva will occur due to resolution of oedema
How long does it take for collagen repair to mature fully?
12 weeks
Why should you not re-probe an instrumented pocket for 3 months post-RSD?
Collagen repair ultimately takes about 12 weeks to mature fully
What is there little/no connective tissue re-attachment between?
Treated pocket lining and root surface
What does close adaptation between gingivae and instrumented root surface rely on instead of connective tissue attachment?
A long JE and tissue tone in gingivae
What are the clinical outcomes of non-surgical therapy
Improvement of OH, pocket depth reduction, absence of bleeding on probing, and clinical attachment level gain (0.5-1mm)
What are the patient outcomes of non-surgical therapy?
No bleeding on brushing, accessible OH, gingival recession, more sensitivity to temperature, and improved oral health related quality of life
What should you do with a stable periodontitis patient?
Supportive periodontal therapy
What should you do with a remission periodontitis patient?
Supportive periodontal therapy with emphasis on controlling BoP
What should you with with an unstable engaging periodontitis patient?
Further active periodontal therapy
What should you with with a stable engaging periodontitis patient?
Palliative care
