Root Planing Flashcards by Courtney Kast

When is it an indication to go subgingival

PD = 6mm
no attachment loss
gingival inflammation
supra and subgingival plaque and calculus

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What four things are common to pseudo and true pockets

bacteria biofilm
calculus
chronically inflamed pocket wall
destructive host response

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What three things occur in true pockets only

altered (diseased) root cementum
apical migration of attachment apparatus
bone loss

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This is not a mechanical or chemical irritant; it is plaque retentive

calculus

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What are some methods to alter the subgingival environment

caries control
replacing defective restorations
subgingival instrumentation
local chemotherapeutics
surgical correction of gingival deformities
strategic extractions
smoking cessation
orthodontics

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What are the three outcomes of mechanically altering the subgingival ecosystem

remove plaque
remove plaque retentive factors
remove diseases surfaces

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What is the removal of soft tissues called

curettage

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What is the removal of hard tissues called

root planing

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True or False

subgingival scaling and root planing are the same thing

False

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

root planning

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This is instrumentation of the crown and root surfaces of the teeth to remove plaque, calculus, and stains from these surfaces

subgingival scaling

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What are the characteristics if the goal is solely to remove deposits

supra/sub gingival
wedging stroke
scalers, rotaries, ultrasonics, and curettes
may be performed in gingivitis and periodontitis

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What are the characteristics if the goal is to modify root surfaces

subgingival
shaving stroke
curettes, rotaries, and ultrasonics
performed in periodontitis only

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This term of periodontal healing is when you treat, and the outcome is healing with a positive outcome, but not exactly the same tissue

repair

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This term describes a less connective tissue attachment and a more epithelial tissue attachment

long junctional epithelium

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This term of periodontal healing is when there is new tissue that is exactly the same

regeneration

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What are the two objectives of root planing

restore gingival health by completely removing tooth surface factors that promote gingival inflammation
make sure the root surface is biologically acceptable to the soft tissue

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What are three keys to effective root planing

sharp instruments
access cemental surface
correct angulation of instrument face

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What are some challenges to subgingival instrumentation

blind procedure
lack of access
tenacious calculus
calculus morphology variations
complex root morphology
variation in pocket anatomy
root concavities and furcations

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What are the four ideal conditions for root planing

moderately inflamed (better access, more resolution)
moderate plaque depth
slight to moderate periodontitis
obvious deposits

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In which conditions should you expect less than ideal results

slight periodontitis - responds to scaling alone
fibrotic tissues
defective restorations
very deep pockets and/or furcations

True or False

there more experiences operators produce a significantly greater number of calculus-free root surfaces

True

How much time is required for comprehensive subgingival treatment of one single tooth when hand instruments are used

6-8 minutes

Which four locations do we miss the most

CEJ
furcation areas
line angles
deeper parts of the pocket

True or False | complete removal of calculus from periodontally diseased root is rare

True

If curettes cannot reach the bottom of deep pockets, what may be required to gain access

periodontal surgery

True or False | most literature shows that ultrasonics are far superior to hand instrumentation

False, is shows that both are equally effective

True or False | Hand instrumentation create a smooth surface while vibrating instruments and sonic scalers can roughen the root surface

True

True or False roots that re intentionally grooved during surgery have as good a response to surgery as roots that have been planed to be smooth

True

What is the method to determine the clinical end point of instrumentation

smooth roots

root planing renders roots free of tis

endotoxin

True or False | Hand instruments are more effective in removing endotoxin in vivo

True

True or False | ultrasonics can remove endotoxin

True

True or False | It is clinically sound to remove all cementum because endotoxin is tenaciously adherent

False, endotoxin is more loosely adherent then though, it is clinically sound to remove some but not all cementum

What is the cementum thickness in the cervical and apical portions of the root

cervical: 20-50µm apical: 150-250µm

What is the average number of strokes at a low force

True or False | There is NO advantage to multiple sessions of root planing

True

This is the pocket depth below which there is attachment loss and above which there is attachment gain for a procedure

critical probing depth

What is the critical probing depth for root planing

2.9mm

True or False | shallow healthy sites should be instrumented

False, they should not

This is currently accepted as adjunctive therapy to SRP

antimicrobial photodynamic therapy (APT) [low level diode laser]

Antimicrobial photodynamic therapy may promote periodontal healing how

bacterial killing inactivating bacterial virulence factors inactivating host cytokines that impair healing

This is the process of deriding the soft tissue wall of the periodontal pocket

gingival curettage

What does gingival curettage involve

the removal of ulcerated epithelium and inflamed connective tissue (granulation tissue)

True or False | Inadvertant curettage occurs during root planing

True

Why are curettage and root planing not separated

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

Which is gingival curettage difficult to effectively accomplish

in deep pockets

When is gingival curettage not justified

in chronic periodontitis

What three local antimicrobial therapies are currently accepted as adjunctive therapy to SRP

slow releasing agents; bioabsorable minocycline loaded microcapsules (Arestin) doxycycline hyclate in a biodegradable polymer (Atridox) chlorhexidine gluconate (PerioChip)

This is a low dose doxycycline prescription for 90 days (possible complications)

Periostat

Why would you wait 4-6 weeks to evaluate treatment

normal flora returns | 4 weeks for attachment