Cause related therapy: Professional mechanical plaque control Zsuzsanna Papp Prof. István Gera

Transcription

1 Cause related therapy: Professional mechanical plaque control Zsuzsanna Papp Prof. István Gera Periodontal Clinic, Semmelweis University, Budapest

2 Complex periodontal therapy Systemic phase of therapy, including smoking counselling Initial (or hygienic) phase of periodontal therapy, that is cause related therapy (I) Corrective phase of therapy: periodontal surgery and implant surgery (II), restorative,orthodontic, and/or prosthetic treatment (III) Maintenance phase (care), that is supportive periodontal therapy (SPT) (IV)

3 Initial phase Main goal This phase is the major cause related therapy the objective of this phase is the achievement of clean and infection free condition, bringing inflammation under control removal of all soft and hard deposits and their retentive factors Furthermore, this phase should aim at motivating the patient to perform optimal plaque control Clinical periodontology and implant dentistry Fifth edition (2008) Jan Lindhe, Niklaus P. Lang, Thorkild Karring

4 Initial phase Base of treatment plan Phases I. (Initial phase) therapy or hygienic Instruation and motivationof the patient Supragingingival and subgingival scaling and root planing Elimination of other plaque retentive factors Treatment of the teeth with caries Extraction of the hopeless teeth Splinting Systemic and local antibiotic support

5 First instruation and motivation Elimination of etiological factors Dentist, dental hygenist Biofilm, dental plaque - causal relationship with dental biofilms, a positive association between periodontal diease has been documented (Bergstrom 1989) Primery and secondary prevention of periodontitis are based on the achievement of sufficient plaque removal.

6 Forty years of experimental research, clinical trials, and demonstration projects in different geographical and social settings have confirmed that effective removal of dental plaque is essential to dental and periodontal health throughout life European Workshop on Mechanical Plaque Control 1998 Calculus does not in itself induce inflammation, but has a deleterious effect because of its ability to provide an ideal surface for microbial colonization. (Waerhaug 1952).

7 Daily interdental plaque removal is crucial to augment the effect of toothbrushing as most dental and periodontal diseases originate in interproximal area European Workshop on Mechanical Plaque Control 1998

8 First instruation and motivation 1st appointment Modell Clear and understandable (50-50%) Patient s trust

9 Modified Bass technique: cleaning the tooth tissue adjacent to the gingival tissue, the gingival margins and the sulcus

10 First instruation and motivation Sulcus and interproximal area Origin of the bleeding Mirror before&after After Phase I. repeat Maintenece 5As method (Ask, Advise, Assess, Assist, Arrange) may be used (Fiore 2000)

11 Mechanical plaque control Base of treatment plan Phase I. Therapy Instruation and motivationof the patient Supragingingival and subgingival scaling and root planing Elimination of other plaque retentive factors Treatment of the teeth with caries Extraction of the hopeless teeth Splinting Systemic and local antibiotic support

12 Definitions Scaling: Mechanical removal of plaque and calculus Root planing: Cleaning the porous root surface, and removal of the infected cementlayer

13 THE MAIN GOAL OF SCALING TO REMOVE: - Supra and subgingival plaque - Supra and subgingival calculus - Other plaque retentive factors VISUAL CONTROL Chlorhexidin rinsing

14 Effects and goals of supra and subgingival scaling (nonsurgical therapy) Subgingival scaling and root planning are effective - Reduces inflammation even in very deep pockets but provides no definitive results - Reduces pocket depth - Slows down the progression of attachment loss - Sometimes provides clinical attachment gains

15 OVERHANGING SUBGINGIVAL CROWN MARGINS SURFACED SUBGINGIVAL CALCULUS BULKY SUPRAGINGIVAL CALCULUS

16

17 Case drug induced gingiva hyperplasia

18 1 year later after cause related therapy

19 Instrumentation Sonic and ultrasonic devices Ultrasonic Magnetostrictive Piezoelectrical Sonic Laser Other EVA system Hand instruments Scalers Sickle Hoe curettes Universal Specific Gracey Mini Langer Periimplantal

20 Instrumentation Sonic and ultrasonic devices Ultrasonic Magnetostrictive Piezoelectrical Sonic Laser Other EVA system Hand instruments Scalers Sickle Hoe curettes Universal Specific Gracey Mini Langer Periimplantal

21 Ultrasonic instruments the removal of the plaque and calculus is accomplished by the vibration of the instruments tip (cavitation: collapse of the air-bubbles) frequency: Hz use for supra or subgingival scaling, removing of the plaque or the discolouration of the tooth always with water- spraying!!! contra-indication: pacemaker

22 Ultrasonic instruments 2 types: magnetostrictive and piezoelectric The electrical current causes a dimensional change in the handpiece The electrical current produces a magnetic field in the handpiece transmitted to working tip as vibration The insert to expand and contract along its length and in turn causes the insert to vibrate

23 Sonic instrument produce vibration mechanically in the sonic range (frequency: Hz ) effective for calculus removal use with water-spraying (friction) has no contra-indication Air-driven instrument

24 SONIC SCALER

25

26 Strokes in horizontally direction!!!

27 Mechanized instruments compared with manual instruments Advantages - Increased efficiency (time!) - Multiple surfaces of tip are capable of removing deposits - No need to sharpen - Less chance for repetitive stress injuries - Handpieces size large - Reduced lateral pressure - Less tissue distention - Water - Lavage - irrigation Disadvantages - More precautions and limitations - Patient comfort (Water spraying) - Aerosol production - Temporary hearing shifts - Noise - Less tactile sensation - Reduced visibility Michael G. Newman DDS and Henry Takei DDS MS: Carranza s clinical periodontology, 12 th edition

28 Selection of instruments Hand, sonic, and ultra sonic instruments produce similar periodontal healing response with respect to PPD, bleeding on probing, and CAL (Badersten et al. 1981, 1984; Lindhe & Nyman 1985; Kalkwarf et al. 1989; Loos et al. 1987; Copulos et al. 1993; Obeid et al. 2004; Wennstro m et al. 2005; Christgau et al. 2006) the use of sonic and ultrasonic instruments may provide better access to deep pockets and furcation areas (Kocher et al. 1998; Beuchat et al. 2001) Clinical periodontology and implant dentistry Fifth edition (2008) Jan Lindhe, Niklaus P. Lang, Thorkild Karring

29 EVA contra angle handpiece for hard-to-reach intraoral areas. (oscillating instrument) - Allowing reshaping of restaurations - Finishing, polishing and conturing of the dental surfaces - To remove overhangs - Tips: one side is with diamond-coated, the other one is smooth

30 Instrumentation Sonic and ultrasonic devices Ultrasonic Magnetorestrictive Piezoelectrical Sonic Laser Other EVA system Hand instruments Scalers Sickle Hoe curettes Universal Specific Gracey Mini Langer Periimplantal

31 I. HANDLE II. SHANK Terminal shank III. BLADE Facial surface Lateral surface

32

33 Hand instruments I. Sickle scalers: sharp-ended blade triangular cross section two cutting edges for supragingival scaling and debridement

34 CUTTING EDGE SCALERS AND UNIVERSAL CURETTES HAVE TWO WHILE GRACEY HAS ONLY ONE CUTTING EDGE

35 Subgingival adaptation around the root is better with the curette than with the sickle

36 Use of a sickle scaler Supragingival!!!! Subgingival adaptation around the root is better with the curette than with the sickle

37

38

39 Gracey curettes surface specific (!) one working edge (!) working edge looks down (!) curved in two planes (!) double-ended (mirror-turned blades) semicircular cross section Rounded toe

40 Gracey curettes Selection of curettes with varying shank configurations to facilitate debridement of different areas of the dentition. The length and angulation of the shank and the dimensions of the blade differ between different brands of instruments

41 Gripping the hand instruments Modified penholder grip Proper illumination Soft tissue protection Stable position 3 point (grip+ring and little finger) Extra or intraoral supporting (maxilla) Clinical periodontology and implant dentistry Fifth edition (2008) Jan Lindhe, Niklaus P. Lang, Thorkild Karring

42 Subgingival scaling and root planing A diagonal B vertical C horisontal D circular

43 Subgingival scaling with Gracey curettes

44 THE ANGULATION OF THE BLADE TO THE ROOT SURFACE IS ESSENTIAL

45 strokes from the apical to the coronal direction (terminal neck paralell with the axis of the teeth!!!)

46 Effect of different angulations of the cutting edge of the curette to the tooth surface Correct angle of application Angulation too obtuse Angulation too acute Ineffective and the possibility of cratering the surface Ineffective and burnishing of the calculus deposits Clinical periodontology and implant dentistry Fifth edition (2008) Jan Lindhe, Niklaus P. Lang, Thorkild Karring

47 (terminal neck paralell with the axis of the teeth!!!)

48

49

50

51

52 2001 OCTOBER JUNE 22.

53

54 Gracey Curettes

55 Gracey 1-2

56 Gracey 3-4

57

58 Gracey 5-6

59

60 Gracey

61

62

63 Gracey 11-12

64

65

66 Gracey 13-14

67

68

69 REDUCED GRACEY TRAY daily praxis

70

71

72

73

74

75

76

77

78 Initial therapy effects In perio patients, mechanical nonsurgical therapy reduces inflammation, pocket depth, and increases clinical attachment level The magnitude of pocket depth reduction correlates with greater pocket depth before the treatment Nonsurgical mechanical debridement may cause loss of attachment in shallow pockets ( 3 mm)

79 Initial therapy effects Adjunctive therapies have been developed and investigated, but, to date, no therapy exists as a stand alone replacement for mechanical nonsurgical pocket therapy.

80 Maintenance therapy In periodontal maintenance patients, mechanical debridement reduces inflammation and disturbs the bacterial biofilm understood to be key in disease control, including prevention of disease progression. Maintenance of effective plaque control is the cornerstone of any attempt to prevent and control periodontal disease. In fact, without the continuous collaboration of patients, periodontal treatment has little success and results obtained do not last long.

81

82 Generalized aggressive periodontitis

83