These data indicate that toxins are superficially located on root surfaces and easily removed. Polishing is the use of polishing agents to remove stains and supragingival plaque biofilm from the teeth. The limitations of non-surgical periodontal therapy lie within the operator's skill at gaining access to all root surfaces in furcations and deep periodontal pockets. Non - surgica pl eriodontal therapy incul d es localized or generalized scaling and root planing, the use of For this reason, limited flap surgery in order to gain access to root surfaces, which would otherwise be too time-consuming to treat with scaling and root planing alone, might still be valuable.link_to_subscribed_fulltex The laser periodontal disease treatment is a simple and non-surgical procedure. Caution must be exercised with this device to prevent damage to exposed root surfaces; thus, its application for periodontal patients is limited. Areas in the periodontium that do not respond to therapy, even after retreatment and evaluation, may benefit from long-term subgingival antimicrobial treatment or surgical intervention. Much has been learned about the penetration and removal of lipopolysaccharide endotoxins. 6.3 Practical implications. Inflamed pocket lining is composed of thin ulcerated strands of epithelium, with rete pegs extending into the underlying connective tissue and granulation tissue containing disorganized masses of cells. Rationale for Non-Surgical Periodontal Therapy remove the etiologic agent of disease (plaque) and it's associated factors Research has proven that SRP = 1) ↓ gingival inflammation Clearly, this requires clinical experience and judgment on the part of the dental hygienist. Abstract Non-surgical periodontal therapy remains the gold standard for resolution of dental plaque biofilm induced oral disease. One size fits all grit paste ignores the science of abrasion, can cause sensitivity, and damage aesthetic restorations.5. Nonsurgical therapy includes the procedures listed in Table 13-1. The focus of the application of the instruments is to remove calculus and biofilms; success of treatment at the time of the therapy is assessed by explorer evaluation of root smoothness after scaling procedures to ensure calculus removal. Positive, long-term effects of periodontal therapy are reliably achieved with patient compliance, effective plaque biofilm control, and excellent dental hygiene treatment. Scaling and root planing causes some removal and disruption of the epithelial attachment to the tooth, junctional epithelium, and deeper connective tissue. PMID: 3334536 [PubMed - indexed for MEDLINE] Although some periodontal destruction has been observed in germ-free (gnotobiotic) animal experiments, it tends to be localized and related to the impaction of foreign objects, such as hairs. The non-surgical periodontal therapies include plaque control, supra, and subgingival scaling and root planing and use of chemotherapeutic and host modulation agents. Rough surfaces mechanically irritate gingival tissues. Research is still needed on the clinical benefit of the granulation tissue removal that is a feature of periodontal surgical therapy and, to a lesser extent, occurs through indirect trauma in nonsurgical therapy. • Identify the techniques and applications for nonsurgical periodontal therapy procedures. The quality of the plaque is more important than the quantity, but plaque biofilm is still the causative agent in disease. start with non‐surgical periodontal treatment), search was limited to articles published between January 1998 and December 2018. Explain the limitations of calculus removal and the expectations for clinician proficiency. Inflammatory activity occurs in the underlying connective tissue during the disease process and is also a result of treatment. In the late 60’s and continuing into the 70’s and 80’s, … Studies evaluating plaque biofilm formation on rough root surfaces are equivocal. Comparative in vitro study of root roughness after instrumentation with ultrasonic and diamond tip sonic scaler. Kepic and colleagues18 demonstrated residual calculus on most teeth after 45 to 60 minutes of treatment time per quadrant. This tactile sense is used to determine the amount of calculus present in the untreated patient, the existence of irritating factors such as overhangs, and the point at which thorough instrumentation (periodontal debridement) is finished at each appointment. J Appl Oral Sci. Specific definitions accepted in the dental hygiene community are provided for commonly used terminology found in publications and other communications. Plaque biofilm is the primary causative agent in gingival and periodontal diseases. USA.gov. KEY TAKEAWAYS. Studies indicate that endotoxins do not penetrate deeply into cemental surfaces and that retained toxins are associated with missed calculus and plaque rather than diseased cementum. In fact, in some studies, gingivae next to root surfaces that were notched for orientation of researchers after tooth extraction healed uneventfully in the mouth. Non-surgical pocket therapy: mechanical. Nyman and colleagues20 compared these treatment strategies by testing the healing of quadrants after periodontal surgery. Air powder polishing removes most extrinsic stains and soft deposits from the exposed surfaces of the teeth. Normal turnover of cells in the junctional epithelium, which migrate from the apical end to the coronal end, takes about 5 days. Active non‐surgical periodontal therapy in patients with adult periodontitis resulted in approximately one third of the cases in “success” (PPD ≤ 5 mm). The following information is a summary of evidence supporting the provision of nonsurgical periodontal treatment: plaque biofilm and calculus removal, hand instruments and powered instruments, the relative merit of smooth roots, healing after nonsurgical treatment, laser use, and antimicrobial adjuncts. The definitions of procedures must be clear and consistent. American Academy of Periodontology, Ad Hoc committee on the parameters of care: Phase I therapy, J Periodontal 2000;71(suppl):856. Non-surgical periodontal therapy may have to extend over long time periods. However, in periodontology, the term surgery is reserved for more invasive cutting procedures. This rationale has been questioned for many years and the procedure is no longer considered standard treatment.21,22. Dramatically thinned root surfaces are shown in, Conscientious removal of calculus and plaque biofilm with minimum destruction of cementum, termed. Caution must be exercised with this device to prevent damage to exposed root surfaces; thus, its application for periodontal patients is limited. Replacement restorations or orthodontic movement of the teeth can simplify plaque biofilm control and help the patient achieve periodontal health. Anatomic and iatrogenic plaque traps, such as overhanging restorations and malposed teeth, must be considered during nonsurgical therapy. • Smooth surfaces promote gingival healing. Supragingival oral hygiene procedures have limited effects on symptoms associated with deeper pockets, such as bleeding on probing.17, Subgingival plaque biofilm removal is essential in nonsurgical therapy to disrupt the established colonies of bacteria and let a younger plaque develop that is less associated with pathologic conditions. This end point is best evaluated by explorer detection of smooth surfaces. ... •Prevalence of periodontal disease •Update on periodontal diagnosis •To save or extract teeth •Non surgical management •Surgical management •Functional crown lengthening ... Photodynamic therapy Needs to be an adjunct No evidence SRP. It is usually accomplished during one appointment and has many facets. Abrasives used during polishing can scratch amalgam, composite resin, and gold restorative materials. This chapter discusses the biologic basis and rationale for nonsurgical therapeutic procedures performed in the dental office. Bacteria-specific tests and treatments have been developed and will be more widely used as the understanding of periodontal disease increases.7, It is possible to remove all supragingival plaque effectively. It describes. If this is not removed, then in time the tooth will be lost through the ongoing destructive process of periodontal disease. Rationale for Comprehensive Nonsurgical Periodontal Therapy: A Review of the Clinical Evidence and Practice Protocol • Microbes, Inflammation, Scaling and Root Planing, and the Periodontal Condition • Locally Delivered Antimicrobials: Clinical Evidence and Relevance • Periodontal Treatment Protocol (PTP) for the General Dental Practice This uniform smoothness should be identified. Cleaning agents are available for polishing the teeth and are preferable to those that contain abrasives. Nonsurgical therapy remains the cornerstone of periodontal treatment. Root planing is defined by the AAP as “a treatment procedure designed to remove cementum or surface dentin that is rough, impregnated with calculus, or contaminated with toxins or microorganisms.”6 This procedure focuses not on identifiable deposits of calculus but on the entire root surface associated with the periodontal pocket. The purpose of prophylaxis is to assist the patient in maintaining and preserving periodontal health. The term is commonly used and has several variations: oral prophylaxis, dental prophylaxis or, simply, prophy. The dental hygienist cannot focus solely on the technical aspects of calculus removal. The specific plaque hypothesis was proposed by Loesche in the 1970s.15 This classic study has increased the understanding of periodontal disease and the use of appropriate antimicrobial agents to improve treatment results. Checchi L, Montevecchi M, Marucci G, Checchi V. Int J Dent. Dental hygiene procedures with hand instruments or powered scalers adequately accomplish subgingival plaque biofilm removal. This practice supports the old notion of “necrotic” root surfaces. 2016 Jul 18;17(1):19. doi: 10.1186/s12903-016-0244-6. Armitage reviewed the reasons dental hygienists and dentists attempt to smooth roots to a glassy, hard texture through root planing. There was no difference in the healing of the differently treated areas; cementum removal through root planing did not improve healing beyond that achieved by calculus removal and polishing. ... still the treatment of choice New technologies Comparison to SRP Modified ultrasonic ... Surgical decision tree Kao et al, Periodontal regeneration- Intrabony defects: A systematic review from the AAP. Start studying Non-Surgical and Surgical Periodontal Therapy Concepts (T2-2). View Week 1 (Handout) Non-Surgical Periodontal Therapy & Healing.pdf from PSYC MISC at Georgia State University. Repair after disruption of the junctional epithelium during scaling procedures (not removal, which occurs with surgical excision) is similar to the normal course of events in tissue turnover. Periodontal diseases present similar symptoms, but they likely have different bacterial origins that are not yet fully defined. It takes considerably longer than healing of epithelium—up to several months. Periodontal therapy can restore chronically inflamed gingiva so that, from a clinical and structural point of view, it is almost identical with gingiva that has never been exposed to excessive plaque accumulation 1 (see Part 8). With REP, the periodontist places a very small fiber optic camera (a periodontal endoscope or PerioScope) into the periodontal pocket. An excellent example of the application of the specific plaque hypothesis is the treatment of aggressive periodontitis in its juvenile form. Rationale and techniques of non-surgical pocket management in periodontal therapy. Understand the differences between periodontal debridement, scaling, root planing de-plaquing ; Discuss the goals rationale for non-surgical therapy Once successfully completed, the scaling and root planing procedure should leave patients feeling little or no discomfort. Prophylaxis is a preventive procedure to remove local gingival irritants and includes complete calculus removal followed by root planing. This thinning is an example of overinstrumentation or root planing without rationale. Non-surgical periodontal therapy for AIDS patient with periodontal involvement. Yusof WZ. Scaling and periodontal debridement are effective in reducing the volume of plaque biofilm bacteria in treated sites. Gartenmann SJ, Dörig I, Sahrmann P, Held U, Walter C, Schmidlin PR. Patient plaque biofilm control is a cornerstone of long-term successful nonsurgical therapy. Eventually, they will be much better understood so that therapies directed toward the specific plaque bacteria in each individual can be used, including the use of more antimicrobial and antiseptic agents.16, Although more specific gingival and periodontal diseases are recognized, nonsurgical periodontal therapy focuses on total plaque biofilm removal. Several other concerns about polishing exist. Dental hygiene procedures with hand instruments or powered scalers adequately accomplish subgingival plaque biofilm removal. 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