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SP 16 - Perio Exam 1 > Review of Literature on Root Planing > Flashcards

Review of Literature on Root Planing Flashcards

1
Q

What are commonly found in both true and pseudo pockets?

A

Bacterial Biofilm
Calculus
Chronically inflamed pocket wall (soft tissue)
Destructive host response

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2
Q

What are commonly found in true pockets and not pseudo pockets?

A

Altered (diseased) root cementum
Apical migration of attachment apparatus
Bone loss

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3
Q

What about calculus makes it an etiological factor?

A

It is plaque retentive

it is NOT a chemical irritant or a mechanical irritant

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4
Q

What are the methods (for this class) to alter the subgingival microenvironment?

A

Subgingival instrumentation

Surgical correction of gingival deformities

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5
Q

What is the rationale for subgingival instrumentation?

A 
Mechanically alter the subgingival ecosystem:
-remove plaque
-remove plaque retentive factors
-remove diseased surfaces
Promote health associated host-response
-adjunctive treatment alternatives
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6
Q

What are the different types of subgingival instrumentation?

A

Scaling

Root Planing

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7
Q

T/F - instrumentation defines technique

A

False - Treatment rationale defines the technique

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8
Q

Why don’t we use scalers subgingivally? What do we use instead?

A

Because scalers have 2 cutting edges, they would tear the soft tissue
Curete - has 1 cutting edge

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9
Q

Root planing

A

A treatment procedure designed to remove cementum or surface dentin that is rough, impregnated with calculus, or contaminated with toxins or microorganisms

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10
Q

Subgingival scaling

A

Instrumentation of the crown and or root surfaces of the teeth to remove plaque, calculus, and stains from these surfaces

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11
Q

What are the differences in the goal of scaling v root planing

A

Scaling: Remove deposits
RP: Modify root surface

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12
Q

What are the differences in the location of scaling v root planing?

A

Scaling: Super and/or sub-gingival
RP: Subgingival

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13
Q

What are the differences in stroke of scaling v root planing?

A

Scaling: Wedging
RP: Shaving stroke

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14
Q

What are the the differences in instruments of scaling v root planing?

A

Scaling: Scalers, rotaries, ultrasoncis, curettes
RP: Rotaries, ultrasonics, curettes

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15
Q

What is the differences in disease(s) treated of scaling v root planing?

A

Scaling: Gingivitis and/or periodontitis
RP: Periodontitis

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16
Q

What are the steps of Periodontal Healing?

A

Repair
Reattachment
New attachment
Regeneration

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17
Q

What are the different types of ‘New attachment’

A

True new attachment

Long junctional epithelium (epithelial attachment)

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18
Q

What types of tissue are forming in True new attachment?

A

-New bone, new cementum, new PDL

It rarely happens

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19
Q

What type of new attachment is most common? What is occuring?

A

Long junctional epithelium

Only epithelium is attaching

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20
Q

What are the objectives of root planing?

A

Restore gingival health by completely removing tooth surface factors that promote gingival inflammation
Make the root surface biologically acceptable to the soft tissues

21
Q

What are the keys to effective root planing?

A

Sharp instruments
Access cemental surface
Correct angulation of the instrument face

22
Q

What are the challenges to subgingival instrumentation?

A 
Blind procedure
Lack of access
Subgingival calculus is tenacious
Calculus morphology variations
Complex root morphology
Variation in pocket anatomy
Root concavities and furcations
23
Q

What are the ideal conditions for root planing?

A

Moderately inflamed (better access, more resolution)
Moderate pocket depth
Slight to moderate periodontitis
Obvious deposits

24
Q

When can we expect less than ideal conditions for root planing?

A

Slight periodontitis (responds to scaling alone)
Fibrotic tissues
Defective restorations
Very deep pockets and/or furcations

25
Q

Hoe does experience effect root planing?

A

More experienced operators produce a significantly greater number of calculus-free root surfaces than the less experienced operators in periodontal pockets with moderate (4-6mm) and deep (>6mm) probing depths

26
Q

How long should you spend on one tooth while root planing?

A

6-8 minutes

27
Q

What areas are missed the most when root planing?

A

CEJ
Furcation areas
Line angles
Deeper parts of the pocket

28
Q

T/F - We can completely remove calculus from a periodontally diseased root

A

False - curettes can’t reach the bottom and we may have to do surgery

29
Q

Do ultrasonics or hand instruments remove calculus better?

A

They are equally effective according to most literature

Modified ultrasonic inserts can reduce operator fatigue

30
Q

Are ultrasonics or hand instruments better at removing cementum/doing root planing?

A

Hand instruments + Ultrasonics in combination are better than either alone
Hand instruments = remove more cementum
Ultrasonics = make cementum smoother

31
Q

What are the effects of rough roots following root planing?

A
  • If roots are intentionally grooved, they have just as good of response as smooth roots
  • If roots are left rough, there is more bacterial binding and plaque retention
32
Q

What is used to determine the end point in instrumentation?

A

When the roots are smooth, we’re done

33
Q

How does LPS (endotoxin) effected with scaling and/or root planing?

A

Scaling only partly reduces endotoxin
Root planing renders roots endotoxin free
Endotoxin is a potent inflammatory stimulator in diseased cementum

34
Q

Do hand instruments or ultrasonics remove LPS better?

A

Hand instruments

Ultrasonics still can remove it

35
Q

Why don’t we want to remove all cementum?

A

It would expose dentin - leading to sensitivity and root caries

36
Q

What is the cementum thickness at the cervical portion of the root?

A

20-50 um

37
Q

What is the cementum thickness at the apical portion of the root?

A

150-250 um

38
Q

Do ultrasonics or hand instruments remove more tooth structure (after 40 strokes)

A 
Ultrasoinics = remove 11.6 um
Curettes = remove 108.9 um
39
Q

T/F - It is more beneficial to do more sessions of root planing

A

False - there is no advantage to multiple sessions v a single session

40
Q

Critical probing depth

A

The pocket depth below which there is attachment loss and above which there is attachment gain for a procedure
2.9mm - shallow/healthy sites shouldn’t be instrumented

41
Q

Calculus dissolving gel

A

No more effective than instrumentation alone

42
Q

Carbide use subgingivally

A

They’re more effective than gracey curettes, but they’re aggressive and can cause hypersensitivity

43
Q

Piezo-electric ultrasonic instruments and the use of an EDTA agent

A

Both together removed the smear layer and exposed collagen fibrils

44
Q

Root instrumentation with a Laser

A

Give a smoother root surface
Remove less cementum than hand instruments
Not as effective as conventional scaling and root planing

45
Q

Antimicrobial photodynamic therapy (ATP) and perio treatment

A

May promote perio healing - via bacterial killing, inactivates virulence factors and host cytokines
Currently accepted as adjunctive therapy to SRP

46
Q

Gingival curettage

A

The process of debriding the soft tissue wall of a perio pocket
Involves the removal of ulcerated epithelium and inflamed CT (granulation tissue)
Difficult to accomplish in very deep pockets
Not justified in chronic periodontitis - may have some applications in other forms

47
Q

Why is gingival curettage not removed from root planing?

A

Inadverent curettage occurs during root planing

When intentional curettage is performed, the root is always planed, therefor it is impossible to separate the procedures

48
Q

How do antimicrobial rinses effect root planing?

A

Can significantly reduce the microbial content of aerosols generated during ultrasonic scaling

49
Q

How do local applications effect root planing?

A

They are currently used as adjunctive therapy to SRP

They can help control host response

SP 16 - Perio Exam 1 (8 decks)

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