Root planing review Flashcards
why go subg on cleaning
PD = 6 pockets with subg calculus + attachment loss
if we clean it out and get a smooth root it will improve PD and gingival health
PD = 6mm, no attachment loss, gingival inflammation. supra and subg calculus and plaque
how do we treat
it’s a pseudo pocket - gingival inflammation
only subg scaling, no root planing because no attachment loss
the subg microenvironment common to pseudo and true pockets
in true pockets only?
bacterial biofilm
calculus
chronically inflamed pocket wall(soft tissue)
destructive host response
in true pockets only;
altered (diseased) root cementum
apical migration of attachment apparatus
bone loss
in true pocket we remove cementum
plaque, calculus, and diseased cementum in etiology/pathogenesis
periodontal disease = +
bacterial plaque + susceptible host
calculus is not a _ or _ irritant
it is _ retentive
calculus is not a mechanical or chemical irritant
it is plaque retentive
diseased cementum
barrier to _
perpetuates tissue _
host response
barrier to repair
perpetuates tissue destruction
host response
methods to alter the subg microenvironment
first we _
Nonsurgical treatment first
Then surgical
Every patient have to go to nonsurgical treatment first even if we know that from the beginning
We do this because - with inflammation or fluid filled tissue we can’t control our incision and surgical procedures
Smoking is a risk factor
All of this is controlling subgingival microenvironment
- caries control
- replacing defective restorations
- subg instrumentation
- local chemother
- surgical correction of gingival deformities
- strategic extractions
- smoking cessation
- orthodontics
subg instrumentation rationale
mechanically alter the subg ecosystem by removing ,,_
promote health associated host-response- adjunctive treatment alternatives
remove plaque remove plaque and retentive factors remove diseased surfaces (soft tissue- currettage) (hard tissue - root planing)
curettage is soft or hard tissue
soft tissue removal
not a code anymore - it happens by itself if you are root planning
root planing is soft or hard tissue
hard tissue
removing cementum
what defines the technique for subg instrumentation
treatment rationale does
NOT instrument
a treatment procedure designed to remove cementum or surface dentin that is rough, impregnated with calculus, or contaminated with toxins or microorganisms
root planing
instrumentation of the crown and root surfaces of the teeth to remove plaque, calculus and stains from these surfaces
subgingival scaling
scaling vs root planing
goal - remove deposits
scaling
need to use curettes(rounded tip of blade) not regular scalers (will tear soft tissue)
scaling vs root planing
goal - modify root surface
root planning
scaling vs root planing
supra/subg
wedging stroke
scalers,rotaries, ultrasonics and curettes
may be performed in gingivitis and periodontitis
scaling
scaling vs root planing
subgingival
shaving stroke
curettes, rotaries and ultrasonics
performed in periodontitis only patients
root planing
healing after SRP steps
repair
reattachment
new attachment
regeneration
repair - some healing, tissue will heal not exactly what it was before but healthy
reattachment -
New attachment = on clean root planned surface
True new attachment - 3 different types of tissue forming PDL, cementum, bone
If you don’t nonsurgical treatment (scallign and root planning)- not true new We usually get just long junctional epi (long JE is Tx outcome)
regeneration - everything from scratch
at least 4 week to re-eval and SRP again
objectives in root planing
restore gingival health by _ that promote gingival inflammation
by completely removing tooth surface factors that promote gingival inflammation
make the root surface biologically acceptable to the soft tissues
keys to effective root planing
_ instruments
more efficient
make root planing possible
prevents burnished calculus
access cemental surface
correct angulation of the instrument face
sharp instruments
ideal conditions for root planing
_inflammed (better access, more resolution)
_pocket depth
_ rated periodontitis
obvious deposits
moderately inflammed - better access, more resolution
moderate pocket depth
slight to moderate periodontitis
when to expect less than ideal results from root planing
_ periodontitis
_ tissues
_ restorations
_ probing depths
slight periodontitis - responds to scaling alone
fibrotic tissues
defective restorations
very deep pockets and/or furcations
both mandibular and maxillary teeth have concavities at or within _mm apical to their CEJ
5mm
as much as _ minutes are required for a comprehensive subg treatment of one single tooth when hand instruments are used
6-8minutes
where do we miss most while root planing
4 places
CEJ
furcation areas
line angles
deeper parts of the pocket
complete removal of calculus from periodontally diseased root is common or rare
rare
curettes can or cannot reach the bottom of deep pockets ?
curettes can’t reach bottom of deep pockets
ultrasonics vs hand instruments on calculus removal
most literature shows _ is more effective
literature shows both are equally effective
modified ultrasonic inserts remove calculus and plaque without operator fatigue
combo of both is better - start with ultrasonic and move to more efficient site specific instrument
ultrasonic or hand instruments remove more cementum
both can gouge a root if used incorrectly
hand instruments
may be better in smoothening a rough root
rough vs. smooth roots
_ created smoothest surface
_ roughen the root surface
curettes and fine rotating diamonds created smoothest surface
vibrating instruments (ultrasonics nd sonic scalers) roughen the root surface
effects of rough roots?
roots that are intentionally grooved during surgery have as good a response to surgery as roots that have been _
lead to more bacteria binding and plaque retention
as good as roots that have been planed to be smooth
how to know if oyu are finished SRP
smooth roots are a method of clinically determining the end point in instrumentation
endotoxin is potent inflammatory stimulator
_ only partly reduces endotoxin
_ rendered roots endotoxin free
scaling - reduces endotoxin
root planing rendered roots endotoxin free
IN VIVO which is better, hand instruments or ultrasonics, in removing endotoxin
hand instruments better in vivo at removing endotoxin - but ultrasonics can do it too
it is clinically sound to remove some but not all cementum
removal of tooth structure
_11.6um
108.9um - most
average 40 strokes at low forces
cementum thickness in cervical port of the root and apical portion of root
ultrasonic scaler - 11.6um
curets - 108.9um - the most
cementum thickness cervical root - 20-50um - CEJ, coronal - acellular cememtum - doesn’t repair much
apical part of root - 150-250um
Apical cementum - thicker - cellular cementum
single vs. multiple episodes of instrumentation based on evidence
no advantage to multiple sessions of root planing
repeated SRP won’t help
critical probing depth is the pocket depth below which there is attachment loss and above which there is attachment gain for a procedure
for root planing, critical probing depth is _mm
Critical probing depth - 3mm or shallower
Do not root plane - because we will be the one causing the attachment loss
shallow healthy sites should not be instrumented
the use of piezo-electric ultrasonic instruments and the use of an EDTA (calcium chelation agent) both together removed the smear layer and exposed collagen fibrils
used during surgery
we don’t use it during non-surgical
root instrumentation with laser
surface smoothness?
amount removed?
effective?
smoother surface with YAG laser
removed less cementum
not as effective at removing calculus
After SRP - laser into pocket to get rid of bacterial byproducts
by bacterial killing
inactivating bacterial virulence factors
inactivating host cytokines that impair healing
currently accepted as adjunctive therapy to SRP
antimicrobial photodynamic therapy - APT
low level diode laser
the process of debriding the soft tissue wall of a periodontal epithelium
involves removal of _ and _
we don’t do intentionally - it will tear soft tissue, it happens by itself in advanced perio cases
gingival Curettage
removal of
- ulcerated epithelium
- inflamed connective tissue (granulation tissue)
reasons curettage is not separated from root planing?
inadvertent curettage occurs during root planing
when intentional curettage is performed, the root is always planed, therefore it is impossible to separate the procedures
gingival curettage is difficult to accomplish effectively in deep pockets
conclusion?
gingival curettage not justified in periodontitis
may have some application in some forms of periodontitis
preprocedural rinsing can significantly reduce the microbial content of _ generated during ultrasonic scaling
aerosols
no signif difference in mean combined totaly colony-forming units - CFU for various ultrasonic scaling
local antimicrobial therapy is or isnt accepted at adjunctive therapy to SRP
it is accepted
re-evaluation
of treatment outcome following root planing how soon?
evaluation of gingival health
eval of local and systemic risk factors and short and longterm prognosis
decision making for surgical phase
4-12 weeks is ideal time or re eval of nonsurgical
if longer than biofilm restarts and is big again
