RSD and Healing

Question 1

What are the aims of non-surgical periodontal debridement?

Answer 1

• removal of supra and subgingival calculus deposits from the tooth surfaces
• disruption of the pathogenic subgingival plaque biofilm
• the root surface should be inert making it biologically compatible for healing

Question 2

If calculus is inert, why is it necessary we remove it?

Answer 2

• acts as a plaque trap which promotes further build up of plaque biofilm
• removal of calculus makes it easier for patients to maintain adequate levels of oral hygiene

Question 3

What can be done to prevent future build up of calculus?

Answer 3

• OHI
• smoking cessation

Question 4

What is the definition of scaling?
Define root surface debridement:

Answer 4

• removal of dental plaque and calculus from the surface of a tooth
  Root surface debridement: the removal/disruption of subgingival biofilm and calculus deposits without the removal of cementum

Question 5

What is the rationale for leaving root cementum?
What is the criteria for RSD?

Answer 5

• increase the likelihood of some regeneration of the periodontium
• true pockets 4mm or more, BOP and/or subgingival calculus and adequate oral hygiene

Question 6

Why is there usually more recession following non-surgical periodontal treatment?

Answer 6

• reduction in inflammatory swelling following periodontal treatment results in more recession

Question 7

What are the 4 cell types that are involved in periodontal pocket healing?
What are the fastest growing cells?

Answer 7

• gingival epithelial cells
• gingival connective tissue cells
• bone cells
• periodontal ligament cells
  Gingival epithelial cells (long junctional epithelium) are the fastest cell type to develop (approx 1mm per day) following perio treatment
• epithelial cells block the growth of other cell types preventing regeneration of periodontal tissues

Question 8

Give 3 reasons for reduced probing depth following successful periodontal treatment:

Answer 8

• reduction in inflammatory swelling
• improved tissue resistance
• formation of the long junctional epithelium

Question 9

What are features of treatment failure?

Answer 9

• patient in discomfort
• persisting pockets not maintainable by home OH measures
• persistent BOP
• persistent suppuration
• increasing attachment loss

Question 10

What are the causes of treatment failure?

Answer 10

• inadequate plaque control
• original assessment/diagnosis incorrect
• inadequate debridement
• patient is a poor responder (possible underlying health condition)
• inadequate maintenance

Question 11

What is periodontal palliative care?

Answer 11

• aims to keep the patient comfortable, functioning and slow the progression of the periodontal disease (disease cannot be stabilised, poor plaque control)

Question 12

When should a patient be referred to a periodontal specialist?

Answer 12

• high susceptibility to periodontitis (stage 3/4 grade C)
• complex medical history e.g. bleeding disorder/immunocompromised
• deep non-responding perio pockets with persistent bleeding/suppuration despite adequate OH and non-surgical therapy
• complex dental management - restorative/ortho treatment required
• localised gingival recession
• complex root/anatomical factors
• peri-implantitis