perio seminar 2

NON-SURGICAL TREATMENT OF PERIODONTAL DISEASE

Overview of Non-Surgical Treatment

  • Non-surgical treatment can often lead to

    • Permanent remission of the disease process.

    • Complete elimination of periodopathogens from pockets is not feasible but significantly reducing their quantities aids in control through anti-infectious defense mechanisms.

Methods of Non-Surgical Treatment

  • Mechanical instrumentation using:

    • Hand tools

    • Power scalers

  • Objectives:

    • Removal of bacterial biofilm.

    • Elimination of mineralized deposits.

    • Smoothing of the surface of the root cement.

    • Achieving this without surgical access to the pockets.

  • Gold Standard: These methods represent the gold standard in periodontology and are often combined with pharmacological agents or laser treatments.

Reservoirs of Perio-pathogens

  • The main reservoirs of periodopathogens include:

    • Subgingival biofilm

    • Subgingival calculus

    • Gingival fluid

    • Outer layer of root cement

  • The ultimate goal of non-surgical treatment is to remove as many reservoirs of periodopathogens as possible.

Root Planing

  • Definition: Smoothing the surface of the cement involves cleaning the outermost layer infiltrated with bacterial lipopolysaccharide (endotoxin).

  • Key points:

    • The cement is not removed.

    • Bacterial endotoxins (LPS) are loosely attached to the cement.

Effectiveness of Non-Surgical Instrumentation

  • Insufficient effectiveness in instrumentation can lead to

    • Rapid recolonization of the root surface with periodopathogens, causing persistent inflammation symptoms.

  • A mechanical preparation of the root surface must aim for:

    • A smooth and hard root surface that can connect with exposed connective tissue and the gingival epithelium for effective pocket healing.

Instrumentation Techniques

  • Manual Instrumentation:

    • Involves using hand instruments for periodontal treatment.

Hand Instrument Construction

  • All hand instruments consist of:

    1. Handles

    2. Lower shank

    3. Working end

Gracey Curettes

  • Specific names and functions include:

    • Gracey 1/2, 3/4, 5/6: For incisors and premolars (models LM 201-206).

    • Gracey 7/8, 9/10, 11/12: For molars (models LM 207-212).

  • Proper angulation:

    • The blade's face and the root surface should have an angle of about 70-80 degrees.

    • Incorrect angles may damage the cement surface or only polish subgingival calculus.

Pocket Considerations

  • Pockets deeper than 6 mm

    • Use instruments like Mini Five (MF) and Mini (M) that have elongated intermediate parts and shortened working parts to access deeper pockets.

Subgingival Instrumentation Techniques

  • Modified Pen's Grip for better control during subgingival procedures.

  • Different types of supports:

    • Direct internal support

    • Direct external support

    • Indirect external support

Working Technique for Instrumentation

  • Guidelines:

    • Instruments are guided laterally and should not exceed a maximum angle of 15° against the tooth surface.

    • Avoid contacting the enamel or cement surface with the pointed tip to prevent damage and tool dulling.

Polishing Techniques After Treatment

  • Important to polish the cleaned surface to reduce plaque accumulation:

    • Use devices like erasers, brushes with polishing paste, or sandblasters with fine-grained polishing powders.

Complications from Non-Surgical Procedures

  • Potential issues arising from improper technique include:

    • Leaving rough surfaces above and below the gum, leading to plaque accumulation.

    • Mechanical damage to dental tissue and potential need for specialized instruments for cleaning implants or around recently treated areas.

Microbiological Changes After Treatment

  • Changes observed post-treatment include:

    • New colonization of cementum and root dentin predominantly by aerobic bacteria.

    • Total microorganism count in pockets decreases.

    • Shifts from gram-negative to gram-positive bacterial dominance in subgingival spaces.

    • Percentage of P. gingivalis decreases by 66-70%, and T. forsythia by 37-55%.

Additional Considerations

  • Treatment protocols for periodontitis should combine mechanical and antiseptic methods, particularly for severe cases.

  • Recommended antibiotic regimens for bacterial control immediately before instrumentation involve combinations like:

    • Amoxicillin and Metronidazole

    • Ciprofloxacin and Metronidazole

Conclusion

  • Healing typically spans 6 weeks to 3 months, improving conditions by reducing pocket depth and promoting epithelial regeneration.

  • The depth of periodontal pockets is significantly reduced, correlating with enhanced healing and a long epithelial attachment.

Key Takeaways

  • Non-surgical interventions are crucial for managing periodontal disease effectively and are supported by consistent polishing and careful instrumentation to maintain dental health.