Objectives: What s Your Therapeutic Goal?

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Sharon Jennings
5 years ago
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1 Objectives: List differences Magnetorestrictive scalers vs Piezoelectric Understand role of ultrasonic scaling and biofilm management Compare ultrasonic scaling versus hand instrumentation List advantages of air polishing As you are placing the bib on your patient ask them what they are here for? Reframe their thought process by asking what would you like to accomplish today? This will give them time to know the WHY in what you do? What s Your Therapeutic Goal? A. Smooth Root Surfaces B. Pick, Polish & Pay C. Minimize the ability of biofilm to cause chronic damage D. Goals? In the past half-century, we have come to recognize that the mouth is a mirror of the body, it is a sentinel of disease and it is critical to overall health and well-being. David Satcher, M.D., Ph.D. Surgeon General, May 25, 02 Having a standard diagnostic procedure and treatment recommendations are critical steps toward improving a patient's overall oral and systemic Health. Despite the prevalence of periodontal disease among adults, it is still under diagnosed and under treated, putting patients at risk for systemic disease. September 21, 2010 Chicago The prevalence of periodontal disease in the United States may be significantly higher than originally estimated. Research published in the Journal of Dental Research from the Centers for Disease Control and Prevention (CDC) and the American Academy of Periodontology (AAP) suggests that the prevalence of periodontal disease may have been underestimated by as much as 50 percent. The implication is that more American adults may suffer from moderate to severe gum disease than previously thought ADA survey of individuals and reason for last dental visit: Perio TX is less than 1%! We are very subjective in our diagnosis incorporation of a salivary diagnostic test into the dental practice protocols provides the opportunity to increase the objective diagnosis of perio disease: More diagnosis thus more treatment. Doing the right thing for the patient! Systemic Health Problems linked to GUM DISEASE Heart Disease 168% more likely Stroke 250% more likely Diabetes 300% more likely Respiratory 500% more likely

2 Osteoporosis 200% more likely Low birth weight 700% more likely 2-4 hours later- strongly attached micro-colonies Biofilm attach within Minutes Increasingly tolerant to antibiotics, antiseptics, disinfectants 2-4 DAYS FULLY mature Biofilm Now highly resistant to biocides/shedding planktonic bacteria Rapidly recover from mechanical disruption Reform Mature Biofilms within 24 hours CDC states biofilms cause 65% of infections in the body! Use of power scaler in periodontal patient management was first commercially available in 1958 by Dentsply The old periodontal therapy consisted of scaling roots until they were glass like smooth. This created root sensitivity and adverse treatment outcomes. Gracey tips are too large to effectively remove deposits from sub gingival areas without significant tissue displacement. Curette cutting blade adaptation *incidental curettage* Decreased clinical outcomes in furcation! Mechanism of action Instrument tips vibrating at high frequency remove bacterial plaque, calcified deposits and endotoxins Lavage Flushes away debris, blood, bacteria Acoustic Turbulence The fluid pressure streaming is called acoustic turbulence, creating an antimicrobial effect Debriding with mechanical instruments removes higher levels of bacteria than those instrumented manually

Magnetostrictive Hammering Ultrasonics vibrate at much higher frequencies than sonic scalers (25,000 cycles per second or higher). Only the last 1-2 mm of an insert tip is the most active?

3 Magnetostrictive Hammering Ultrasonics vibrate at much higher frequencies than sonic scalers (25,000 cycles per second or higher). Only the last 1-2 mm of an insert tip is the most active? After 1mm of the tip is worn away, 25% of the tip s efficiency is lost. After 2mm of the tip is worn away, 50% of the tip s efficiency is lost. Piezoelectric windshield wiper 25,000 to 50,000 cycles per second. Movement generated by electricity passing over crystals The insert/tip movement is linear. Two sides of the insert/tip are active. High-frequency ultrasonic creates cavitation bubbles Bubbles contact a surface, collapse and release energy Energy created by the collapsing bubbles is sufficient to destroy a spirochete cell membrane. In other words, the ultrasonic spray itself may be lethal to the motile pathogens frequently implicated in periodontal disease. Powered equipment can achieve the same clinical outcomes while reducing time and operator fatigue

* Drisko CL, Cochran DL, Blieden T, et al. Position paper: sonic and ultrasonic scalers in periodontics. Research, Science and Therapy Committee of the American Academy of Periodontology.

4 * Drisko CL, Cochran DL, Blieden T, et al. Position paper: sonic and ultrasonic scalers in periodontics. Research, Science and Therapy Committee of the American Academy of Periodontology. J Periodontol. 2000;71: Over instrumentation of root surface not advocated due to the role of cementum which contains cell activated proteins which stimulate cell attachment. The dentin does not contain these cell activating proteins therefore over instrumentation of the root surface can be detrimental to proper healing. The removal of superficial cementum alone is adequate for tissue healing to occur. Air Polishing Time saving and patient pleasing No heat Removes debris Physically less demanding No negative effect on intact enamel* Ortho patients Prior to sealants Less abrasive

5 Noel Kelsch, RDH, RDHAP presents an hour on INFECTION Control

Principles of Periodontal Instrumentation. Periodontology I - 4th year 23/2/2012 Dr. Murad Shaqman

Principles of Periodontal Instrumentation Periodontology I - 4th year 23/2/2012 Dr. Murad Shaqman Outline Classification of periodontal instruments General principles of instrumentation Principles of scaling