Review of Literature on Root Planing Flashcards by John Fixari

What are commonly found in both true and pseudo pockets?

Bacterial Biofilm
Calculus
Chronically inflamed pocket wall (soft tissue)
Destructive host response

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What are commonly found in true pockets and not pseudo pockets?

Altered (diseased) root cementum
Apical migration of attachment apparatus
Bone loss

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What about calculus makes it an etiological factor?

It is plaque retentive

it is NOT a chemical irritant or a mechanical irritant

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What are the methods (for this class) to alter the subgingival microenvironment?

Subgingival instrumentation

Surgical correction of gingival deformities

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What is the rationale for subgingival instrumentation?

Mechanically alter the subgingival ecosystem:
-remove plaque
-remove plaque retentive factors
-remove diseased surfaces
Promote health associated host-response
-adjunctive treatment alternatives

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What are the different types of subgingival instrumentation?

Scaling

Root Planing

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T/F - instrumentation defines technique

False - Treatment rationale defines the technique

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Why don’t we use scalers subgingivally? What do we use instead?

Because scalers have 2 cutting edges, they would tear the soft tissue
Curete - has 1 cutting edge

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Root planing

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

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Subgingival scaling

Instrumentation of the crown and or root surfaces of the teeth to remove plaque, calculus, and stains from these surfaces

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What are the differences in the goal of scaling v root planing

Scaling: Remove deposits
RP: Modify root surface

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What are the differences in the location of scaling v root planing?

Scaling: Super and/or sub-gingival
RP: Subgingival

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What are the differences in stroke of scaling v root planing?

Scaling: Wedging
RP: Shaving stroke

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What are the the differences in instruments of scaling v root planing?

Scaling: Scalers, rotaries, ultrasoncis, curettes
RP: Rotaries, ultrasonics, curettes

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What is the differences in disease(s) treated of scaling v root planing?

Scaling: Gingivitis and/or periodontitis
RP: Periodontitis

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What are the steps of Periodontal Healing?

Repair
Reattachment
New attachment
Regeneration

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What are the different types of ‘New attachment’

True new attachment

Long junctional epithelium (epithelial attachment)

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What types of tissue are forming in True new attachment?

-New bone, new cementum, new PDL

It rarely happens

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What type of new attachment is most common? What is occuring?

Long junctional epithelium

Only epithelium is attaching

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What are the objectives of root planing?

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Restore gingival health by completely removing tooth surface factors that promote gingival inflammation
Make the root surface biologically acceptable to the soft tissues

What are the keys to effective root planing?

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Sharp instruments
Access cemental surface
Correct angulation of the instrument face

What are the challenges to subgingival instrumentation?

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Blind procedure
Lack of access
Subgingival calculus is tenacious
Calculus morphology variations
Complex root morphology
Variation in pocket anatomy
Root concavities and furcations

What are the ideal conditions for root planing?

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Moderately inflamed (better access, more resolution)
Moderate pocket depth
Slight to moderate periodontitis
Obvious deposits

When can we expect less than ideal conditions for root planing?

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Slight periodontitis (responds to scaling alone)
Fibrotic tissues
Defective restorations
Very deep pockets and/or furcations

Hoe does experience effect root planing?

More experienced operators produce a significantly greater number of calculus-free root surfaces than the less experienced operators in periodontal pockets with moderate (4-6mm) and deep (>6mm) probing depths

How long should you spend on one tooth while root planing?

6-8 minutes

What areas are missed the most when root planing?

CEJ Furcation areas Line angles Deeper parts of the pocket

T/F - We can completely remove calculus from a periodontally diseased root

False - curettes can't reach the bottom and we may have to do surgery

Do ultrasonics or hand instruments remove calculus better?

They are equally effective according to most literature | Modified ultrasonic inserts can reduce operator fatigue

Are ultrasonics or hand instruments better at removing cementum/doing root planing?

Hand instruments + Ultrasonics in combination are better than either alone Hand instruments = remove more cementum Ultrasonics = make cementum smoother

What are the effects of rough roots following root planing?

- If roots are intentionally grooved, they have just as good of response as smooth roots - If roots are left rough, there is more bacterial binding and plaque retention

What is used to determine the end point in instrumentation?

When the roots are smooth, we're done

How does LPS (endotoxin) effected with scaling and/or root planing?

Scaling only partly reduces endotoxin Root planing renders roots endotoxin free Endotoxin is a potent inflammatory stimulator in diseased cementum

Do hand instruments or ultrasonics remove LPS better?

Hand instruments | Ultrasonics still can remove it

Why don't we want to remove all cementum?

It would expose dentin - leading to sensitivity and root caries

What is the cementum thickness at the cervical portion of the root?

20-50 um

What is the cementum thickness at the apical portion of the root?

150-250 um

Do ultrasonics or hand instruments remove more tooth structure (after 40 strokes)

``` Ultrasoinics = remove 11.6 um Curettes = remove 108.9 um ```

T/F - It is more beneficial to do more sessions of root planing

False - there is no advantage to multiple sessions v a single session

Critical probing depth

The pocket depth below which there is attachment loss and above which there is attachment gain for a procedure 2.9mm - shallow/healthy sites shouldn't be instrumented

Calculus dissolving gel

No more effective than instrumentation alone

Carbide use subgingivally

They're more effective than gracey curettes, but they're aggressive and can cause hypersensitivity

Piezo-electric ultrasonic instruments and the use of an EDTA agent

Both together removed the smear layer and exposed collagen fibrils

Root instrumentation with a Laser

Give a smoother root surface Remove less cementum than hand instruments Not as effective as conventional scaling and root planing

Antimicrobial photodynamic therapy (ATP) and perio treatment

May promote perio healing - via bacterial killing, inactivates virulence factors and host cytokines Currently accepted as adjunctive therapy to SRP

Gingival curettage

The process of debriding the soft tissue wall of a perio pocket Involves the removal of ulcerated epithelium and inflamed CT (granulation tissue) Difficult to accomplish in very deep pockets Not justified in chronic periodontitis - may have some applications in other forms

Why is gingival curettage not removed from root planing?

Inadverent curettage occurs during root planing | When intentional curettage is performed, the root is always planed, therefor it is impossible to separate the procedures

How do antimicrobial rinses effect root planing?

Can significantly reduce the microbial content of aerosols generated during ultrasonic scaling

How do local applications effect root planing?

They are currently used as adjunctive therapy to SRP | They can help control host response

Review of Literature on Root Planing Flashcards

(49 cards)