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Non-Surgical Treatment of Inflammatory Periodontal Disease

Non-Surgical Treatment of Inflammatory Periodontal Disease. Control Local Etiology. The complete removal of soft and hard deposits from the root surfaces is necessary for the successful treatment of periodontal disease. Calculus. Supragingival – salivary Subgingival - serumal.

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Non-Surgical Treatment of Inflammatory Periodontal Disease

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  1. Non-Surgical Treatment of Inflammatory Periodontal Disease

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

  3. Calculus • Supragingival – salivary • Subgingival - serumal

  4. Supragingival Calculus

  5. Subgingival Calculus

  6. Subgingival Calculus

  7. Attachment of Calculus to Root Surfaces • Cuticle • Irregularities in root • Penetrates cemental tears • Into resorption bays in cementum and dentin

  8. Instrumentation

  9. Scaler

  10. Universal Curette

  11. Gracey Curette

  12. Implant Care

  13. Ultrasonic Instrumentation

  14. Perioscopy

  15. 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

  16. 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

  17. Scaling / Root Planing Before After

  18. Scaling / Root Planing Before After

  19. Scaling / Root Planing Before After

  20. Root Planing Studies

  21. Badersten Study (1984) • N = 49 • OHI • Single surpa and subgingival debridement with local anesthesia • 3 month SPT

  22. Probing Depth mm months Badersten, 1984

  23. % Bleeding Sites Initial Probing Depth Badersten, 1984

  24. % Surfaces with Residual Calculus Probing Depth Buchanan & Robertson, J. Perio 1987

  25. Handle • Shank • Blade

  26. Universal Curette

  27. Gracey Curette

  28. Traditional Site-Specific Instrumentation

  29. Anterior Sextant (Gracey Curette) Facial 1/2, 5/6 Lingual 1/2, 5/6, 7/8

  30. Posterior Sextant (Gracey Curette) Mesial 11/12 Distal 13/14 Facial 5/6, 7/8 Lingual 5/6, 7/8

  31. Standard • Rigid • Extra Rigid

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

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

  34. Langer 1/2

  35. Scaling / Root Planing • ADA code D4341 • Patient with gingival inflammation and LOA

  36. Scale / Polish • ADA code D1110 • Patient with gingival inflammation and no LOA

  37. Supportive Periodontal Therapy • ADA code D4910 • Patient with history of LOA now in maintenance phase

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