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BOARDS PREP > NON SURGICAL THERAPY > Flashcards

NON SURGICAL THERAPY Flashcards

1
Q

Define non surgical therapy

A
  1. Plaque control
  2. Supra and sub gingival scaling, root planing
  3. Adjunctive use of chemical agents
  4. Re-evaluation
  5. Periodontal maintenance
  6. Re-treatment
    ** non surgical therapy may be definitive but often you need to perform surgical therapy
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2
Q

Non surgical therapy-Effects on single rooted teeth

A

1.SRP< PD reduction and slightly greater CAL compared to surgical therapy
2. No correlation between OH and recurrence, suggesting subgingival scaling at frequent recalls important
3. Deeper site >BoP
4. Single session of SPT as effective as multiple sessions.
5. Not necessary that deeper sites are harder to maintain..?
6.Most of the effect is from SPT and not OH
7. Surgery is better at reducing PDs than SRP and eliminating pockets, more patients in SRP group showed advanced disease progression
8. Single rooted teeth respond better to non surgical than multi rooted teeth

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3
Q

Non surgical therapy -Effects on multi-rooted teeth

A
  1. Molar furcation sits-poorer response than non molar and molar flat sites
  2. Lost teeth: Mx 2nd molars, Mnd 2nd molars, Mx 1st molars
    3.Deeper pockets better managed with surgery
  3. At 8years no difference in PD reduction and increase CAL for any single therapy (sub g curettage, PE, MWF)
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4
Q

Long term effect of 4 surgical therapies and non surgical therapy ( Mailoa et al 2015 J PERIO)

A
  1. Shallow (1-3mmPD) - Surgery- significantly higher CAL loss than SRP
  2. Moderate (4-6mm)- MWF- significantly higher PD reduction than SRP
  3. Deep (>or = 7mmPD)- Osseous surgery, significantly higher PD reduction than SRP
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5
Q

Does plaque control matter in those receiving NSPT?

A

Patients with imperfect plaque control fare just as well as those with high plaque scores. Sub-gingival instrumentation is absolutely essential at maintenance visits.

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6
Q

What are the clinical characteristics of sites with continued probing attachment loss?

A
  1. high BoP
  2. 20-30x less AL in well maintained pts than untreated patients
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7
Q

What is the frequency and localization of sites with continued increased probing attachment loss?
Non surgical treatment- influential factors

A

PD decreases and BI decrease mainly influences by baseline PD, AL and mobility, tooth type and maintenance frequency

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8
Q

Endpoints of Root planing?

A
  1. Excellent OH (supra and sub g)
  2. Pink and firm gingiva
  3. PD<5mm
  4. No BoP
  5. Calculus not detectable on exploration/ probing
  6. Reduced mobility
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9
Q

Root planing effectiveness?

A
  1. PD reduction and CAL gain related to the initial level of disease severity
  2. You can expect to have residual pockets with 7mm PDs
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10
Q

Critical Probing Depths (Lindhe 1982)

A

<2.9= AL
2.9-4.2= SRP; surgery will cause AL
4.2-5.5= both SRP and surgery work
>5.5 =benefit from surgery

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11
Q

Basic Treatment Planning for PDs

A

1-3mm= supragingival scaling
4-6mm= SRP /surgery
> than or =7mm = surgery

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12
Q

Full mouth debridement vs quadrant wise, difference?

A

No significant difference
(Cochrane Database- modest favouring of full mouth disinfection) other systematic reviews show no difference

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13
Q

What are limitations of SRP?

A
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14
Q

Calculus

A

Mineralized plaque permeated with calcium phosphate crystals supplied by saliva and GCF
Subgingival calculus indicates chronic inflammation.

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15
Q

Common sites for residual calculus?

A
  1. CEJ
  2. Flutes
  3. Line angles
  4. Resorption bays, carious defect, interradicular areas, deep PD, below contact areas
    *sig correlation between amount of residual calculus and increased PDs
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16
Q

Instrument efficiency

A

Removal of all subgingival calculus average depth of 3.73mm

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17
Q

Residual calculus and PD

A

Amount of residual calculus after instrumentation correlated to increasing PDs

18
Q

Residual PD: Scaling vs Scaling +Flap

A

1-3mm (86% vs 86%)
4-6mm (43% vs 76%)
>6mm (32% vs 50%)

19
Q

Experience and calculus removal

A

Experienced operators were able to remove more calculus in both closed and open flaps.
Furcations most difficult; but even with flaps, 68% residual calculus

20
Q

Ultrasonic vs hand instruments

A

Both equally effective; combination of both was superior for subg calculus removal

21
Q

Evidence for using subgingival irrigation during scaling and root planing?

A

Chlx, saline, H2O2, povidone iodine, TCN, metronidazole= Insufficient evidence

22
Q

What is the beneficial effect of adjunctive systemic antibiotics with SRP

A

Amox+metro in non surgical phase resolved disease quicker and reduced need for additional surgical intervention- use clinical judgement (side effects, abx resistance, perio benefits)
Insufficient evidence to use systemic abx as a monotherapy

23
Q

What is the beneficial effect of using subgingival locally delivered abx?

A

-limited benefit; not recommended to use routinely, use when conventional treatment has not been ideal.
- use with SRP showed decrease in PD, and increase in CAL

24
Q

Local and systemic abx and non surgical treatment of smokers

A

additional decrease in PD and gain in CAL

25
Q

Adjunctive use of host modulators in non surgical periodontal treatment

A
  1. Statin gels 1.2%- sig decrease PD (infrabony defects)
  2. Systemic LDD- improved PPD decrease
    3.Probiotics-limited clinical benefits
  3. Bisphosphonates and Metformin gels- potential, but needs confirmation
26
Q

When to re-evaluate your therapy?

A

4-8 weeks = ideal time (adequate time for improved OH, decrease in BoP, edema, redness)
Too soon= over treatment
Too long= disease progression and return of pathogenic flora

27
Q

What is the value in re-evaluation

A
  1. assess improvements following initial therapy
  2. OHI compliance
  3. Assess tissue condition prior to surgery (not too friable)
  4. identify progression of disease in a timely manner
  5. identify need for possible re-treatment
28
Q

Maintenance goals

A
  1. Minimize recurrence and progression of periodontal disease in patients
  2. Prevent tooth loss by monitoring dentition
29
Q

Recall intervals

A

3-4months= successful
Prophy bi-weekly for 2-3month after active treatment (surgery)
**tailor to pt needs
spirochete, motile rods repopulate pockets in 4-8 weeks.

30
Q

Maintenance and tooth retention

A

87-92% tooth retention
Maxillary molars most often lost, and mandibular canines often retained.
Furcation involved teeth lost 3-5x often as other teeth

31
Q

Maintenance compliance

A

complete compliance 16-32%
erratic compliers required more surgical interventions
non compliers= male, <40yo, non sx patients

**compliant pts lose fewer teeth than non compliant pts

32
Q

Tooth retention with maintenance

A

Treated and maintained patients lost teeth 0.11 tooth/yr/pt (years to lose 1 tooth =9.1)
Treated but NO maintenance lost 0.22 teeth/yr/pt (years to lose 1 tooth= 4.5 years)
Diagnosed, untreated pts lost 0.36 teeth/yr/pt (years to lose 1 tooth =2.8 years)

33
Q

Causes of treatment failure

A

cannot maintain adequate home care
inappropriate patient selection
incomplete diagnostic procedures
treatment difficulties
unsupervised healing
absence of maintenance therapy

34
Q

When do you decide to retreat?

A

not before adequate history and trial of conservative therapy

35
Q

Signs of disease recurrence

A
  1. BoP
  2. Increasing PDs
  3. Radiographic Bone loss
  4. Progressing mobility
36
Q

SPT interval of 2months

A

Stage III or IV
Poor OH
Uncontrolled or recurrent disease

37
Q

SPT interval of 3months

A

Adult orthodontic patients
Pregnant women
Diabetic patients
Smokers
>50yo with active perio
High stress
Early to mod perio
Moderate perio who do not see periodontist

38
Q

SPT intervals of 4 months

A

Teens/young adults
Mod disease with excellent OH
Non bleeding 4-5mm periodontal pockets and good OH

39
Q

SPT intervals of 6 months

A

Healthy patients with 1-4mm non bleeding PDs
Pediatric pts
Gingivitis patients with improving OH and high motivation

40
Q

Brushing techniques

A

Bass- brush head parallel to occlusal plane, bristles at GM apically at 45deg to long axis, vibratory motion
Modified bass- same as above + sweep towards occlusal
Charters- brush at right angles to long axis, slight rotary movements
Stillmans- bristles partially on cervical aspect, partially on gingiva oblique to long axis, lateral pressure. Slight rotary motion, but not displacing bristles
Modified Stillman - same as above, except short back and forth strokes + coronal movement. Recommended in areas of progressive recession

41
Q

Brushing Frequency

A

Plaque removal every 24 for health

42
Q

Interdental brushes

A

wide interdental spaces better cleaned with interdental brushes vs floss, plaque can be removed 2-2/5cm subg.

BOARDS PREP (10 decks)

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