Root planing review Flashcards by Luke Lloyd

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

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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

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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

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plaque, calculus, and diseased cementum in etiology/pathogenesis

periodontal disease = +

bacterial plaque + susceptible host

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calculus is not a _ or _ irritant

it is _ retentive

calculus is not a mechanical or chemical irritant

it is plaque retentive

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diseased cementum

barrier to _
perpetuates tissue _
host response

barrier to repair

perpetuates tissue destruction

host response

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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

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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)

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curettage is soft or hard tissue

soft tissue removal

not a code anymore - it happens by itself if you are root planning

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root planing is soft or hard tissue

hard tissue

removing cementum

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what defines the technique for subg instrumentation

treatment rationale does

NOT instrument

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

root planing

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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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scaling vs root planing

goal - remove deposits

scaling

need to use curettes(rounded tip of blade) not regular scalers (will tear soft tissue)

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scaling vs root planing

goal - modify root surface

root planning

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scaling vs root planing

supra/subg
wedging stroke
scalers,rotaries, ultrasonics and curettes

may be performed in gingivitis and periodontitis

scaling

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scaling vs root planing

subgingival
shaving stroke
curettes, rotaries and ultrasonics

performed in periodontitis only patients

root planing

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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

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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