Non-Surgical Treatment of Inflammatory Periodontal Disease

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Non-Surgical Treatment of Inflammatory
Periodontal Disease
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Control Local Etiology

• The complete removal of soft and hard deposits
  from the root surfaces is necessary for the
  successful treatment of periodontal disease.

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Calculus

• Supragingival salivary
• Subgingival - serumal

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Supragingival Calculus
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Subgingival Calculus
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Subgingival Calculus
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Attachment of Calculus to Root Surfaces

• Cuticle
• Irregularities in root
• Penetrates cemental tears
• Into resorption bays in cementum and dentin

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Instrumentation
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Scaler
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Universal Curette
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Gracey Curette
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Implant Care
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Ultrasonic Instrumentation
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Perioscopy
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Root Planing / Debridement

• Improves tissue quality
• Reduces probing depth
• Gain in clinical attachment
• Expect junctional epithelial attachment
• Expect no bone formation
• Repeat RP may further improve result
• Technically difficult to do well

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Root Planing / Debridement

• Complete removal of subgingival calculus not
  predictable
• Open better than closed
• Shallow better than deep
• Facial / lingual better than interproximal
• Molars more difficult
• Similar effectiveness hand vs. ultrasonic
• Operator experience important

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Scaling / Root Planing
Before
After
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Scaling / Root Planing
Before
After
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Scaling / Root Planing
Before
After
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Root Planing Studies
PD Reduction PD Reduction
(CAL) (CAL)
4-6 mm gt7 mm
Ramfjord et al, 1987 1.08 (-0.32) 2.92 (0.69)
Hill et al, 1981 1.16 (-0.10) 2.76 (0.47)
Hammerle et al, 1991 1.03 (0.69) 2.28 (1.52)
Philstrom et al, 1981 0.71 (0.41) 1.21 (1.07)
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Badersten Study (1984)

• N 49
• OHI
• Single surpa and subgingival debridement with
  local anesthesia
• 3 month SPT

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Probing Depth
mm
months
Badersten, 1984
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Bleeding Sites
Initial Probing Depth
Badersten, 1984
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Surfaces with Residual Calculus
Probing Depth
Buchanan Robertson, J. Perio 1987
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• Handle
• Shank
• Blade

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Universal Curette
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Gracey Curette
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Traditional Site-Specific Instrumentation
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Anterior Sextant (Gracey Curette)
Facial 1/2, 5/6 Lingual 1/2, 5/6, 7/8
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Posterior Sextant (Gracey Curette)
Mesial 11/12 Distal 13/14 Facial 5/6,
7/8 Lingual 5/6, 7/8
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• Standard
• Rigid
• Extra Rigid

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Langer Curettes

• Dr. Burton Langer / 1986
• Universal Blade
• Gracey Shank design
• Less Flexible

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• Langer 1/2 - mandibular posterior
• Langer 3/4 - maxillary posterior
• Langer 5/6 anterior
• Langer 17/18 posterior

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Langer 1/2
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Scaling / Root Planing

• ADA code D4341
• Patient with gingival inflammation and LOA

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Scale / Polish

• ADA code D1110
• Patient with gingival inflammation and no LOA

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Supportive Periodontal Therapy

• ADA code D4910
• Patient with history of LOA now in maintenance
  phase