Ch. 25: Nonsurgical Periodontal Therapy Flashcards
(23 cards)
Compared to other methods of treatment, nonsurgical perio therapy is the…
GOLD STANDARD
cornerstone of periodontal therapy
Alternate Terms
initial perio therapy, initial therapy, hygienic phase, anti-infective phase, cause-related therapy, phase I treatment, soft-tissue management
Includes
self care education, perio instrumentation, use of chemical agents
Broad Objectives
remove living microorganism in biofilm and nonliving organisms in calculus
Also, eliminate inflammation of periodontium
And, return periodiim to a healthy state :)
Goals
mechanically remove bacteria, eliminate/control local contributing factors, minimize impact of systemic factors, stabilize attachment level
Types of Procedures
patient ed, instrumentation, antimicrobial agent, irrigation, correction of local factors, interprofessional collaboration, modulation of host defenses
Stage III/IV Grade B/C
more advanced perio procedures necessary, such as surgery
Nonsurgical required before surgical intervention for all cases
Often successful at minimizing extent of surgery needed
Grade B or C risk factors often speed disease progression
Preservation of Cementum
key component of tissues, preservation important for healing
Essential to periodontal reattachment or new attachment
Previously believed cementum harbors bacteria, results in removal of all or most for smooth surface free of endotoxins
Current evidence shows removal not necessary as endotoxins not in cementum, cementum is necessary for perio regeneration-limit instrumentation for favorable tissue responses
scaling
instrumentation to remove biofilm and calculus (traditional term)
root planing
removal of diseased cementum (traditional term)
Emerging Instrumentation Terms
periodontal instrumentation/debridements, supragingival and subgingival removal or disruption of plaque biofilm, its byproducts, and calculus deposits
*newer terms not yet adopted by insurance codes published by ADA- still uses prophylaxis, scaling and root planing
Long Junctional Epithelium
adaptation of epithelium to root surface, may result in reduced probing depths!
Must wait at least one month to assess healing
*nonsurgical perio instrumentation does not stimulate regeneration
Dentinal Hypersensitivity
short, sharp, painful reaction to stimulation of exposed dentin
Intact cementum prevent dentinal tubule exposure
Lesion localization
dentin loses protective cementum coating
lesion initiation
exposure of dentinal tubules to oral environment
Direct stimulation theory
external stimulus acts upon exposed tubule, activates pulpal nerve which extend through tubule (later found out that tubules do not extend this way)
Odontoblast transducer mechanism theory
odontoblasts act as receptor cells that stimulate pain fibers, later found that there are no synapses between them
Hydrodynamic theory
most widely accepted!
Movement of dentinal fluid in tubules activates nerve cells to initiate pain response
Precipitating factors to sensitivity
apical displacement of margin, incisal attrition/abrasion/erosion, nonsurgical perio instrumentation
Sensitivity may not occur if…
smear layer of dentin covers root surfaces and blocks tubules
Exceptions to Nonsurgical Treatment
patients w/ disfiguring gingival enlargement (gingivectomy), patient with Stage I grade A perio accompanied by severe gingival recession may need surgery to correct mucogingival deformity
Factors Indicating Comanagement by a Periodontist
unresolved inflammation/continued bone loss, managing stage III/IV perio, intensive management of Grade B or C perio, special gingival conditions, necessary surgical procedures, medical history affecting management, patient team not comfortable treating
Ideal timeline for perio reevaluation
4-6 weeks after nonsurgical treatment
