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CH. 21: RESPONSE TO NONSURGICAL THERAPY (TERMINOLOGY (Scaling - the…
CH. 21: RESPONSE TO NONSURGICAL THERAPY
TERMINOLOGY
Scaling -
the mechanical removal of supragingival and subgingival dental biofilm, calculus, and stains from the crown and root surfaces
Root planing -
a "definitive tx procedure designed to remove cementum or surface dentin that is rough, impregnated with calculus, or contaminated with toxins or microorganisms"
Periodontal debridement -
the removal of any foreign material, including dental biofilm, its by-products and toxins, calculus, and diseased or dead tissue from the coronal tooth surface, root surfaces, sulcus or pocket, and periodontium
Supragingival debridement -
the mechanical removal of dental biofilm and calculus from tooth surfaces above the margin
Subgingival debridement -
the mechanical removal of dental biofilm and calculus from tooth surfaces below the gingival margin
PERIODONTAL DEBRIDEMENT
establishment of more beneficial microorganisms
reduction in probing depths
reduction in clinical inflammation
gain in attachment
The purpose is to treat and resolve inflammation in the periodontal soft tissues by removing the irritants
DEBRIDEMENT CONT.
Reflection -
the perfect response for when patients ask why they need to go to the dentist
Periodontal debridement has been shown to reduce BOP by 57%.
The ultimate long-term outcome or end point for nonsurgical periodontal debridement is preservation of the form and function of the dentition.
Periodontal Therapy -
the removal of biofilm and calculus below the threshold level capable of initiating inflammation.
It is important to attain a relatively smooth root surface only without excessive removal of cementum and dentin.
HEALING RESPONSE AND THE OUTCOME OF THERAPY
When a periodontal probe is inserted into the pocket of a diseased and inflamed pocket, the probe penetrates the tissue apical to the JE, giving deeper probe readings.
Reflection -
ie: when I had the inflammation due to the popcorn kernel.
Once biofilm and calculus are removed, the pocket epithelium will reform into JE and contact the adjacent tooth surface as it was in health.
Healing after periodontitis will most likely occur by repair rather than regeneration.
Reflection -
the bone cannot regenerate.
LASERS
Indications for lasers include sulcular and/or pocket debridement, reduction of subgingival bacteria, and SRP.
There is much concern about damage to the root surfaces depending on the wavelength.
Lasers are not best for gain in attachment level.
Reflection -
Is it safer to just continue handscaling and using an ultrasonic?
DH APPLICATION
Root smoothness is no longer the main criterion for perio instrumentation
Proper instrument selection is important
Reflection -
we of course want to make sure all deposits are removed