CAUSE RELATED PERIODONTAL THERAPY
A-INTROUDUCTION
Periodontal therapy can be divided into three but frequently overlapping phases .
1. The cause – related phase (non – surgical periodontal therapy).
2. The corrective phase ( periodontal surgery).
3. The maintenance phase (supportive periodontal – therapy).
? B-Phase one therapy:-
2-Control of diet.
3-Control of breathing malodor.
4-Control of systemic factors.
5-Control of smoking.
? 1-Control of plaque
A- Mechanical plaque control : involve motivation and instruction to your patient , it is the responsibility of the dentist to well motivate the patient since this method of plaque control is the self performed method which means the patient himself practice these method :
-- Tooth brush : the best tooth brush is :
1- straight ,with short head
2- multitufted with medium or soft nylon bristles
3- rounded end to prevent damage of gingival
? The objectives of the tooth brushing are :
1- remove and disturb plaque formation
2- clean teeth from food debris and stains
3- stimulate gingival tissue
4-apply fluoride dentifrice
Tooth brush method :-
- Bass method
-Charter method
-Stillman method
-Horizontal method
-Roll method
? 2-Interdental aids :-
1- dexterity of the patient
2- morphology of the dentition
3- spaces between the teeth
Types of interdental aids :
a – dental floss
b – tooth picks
c – interdental brushes
? The disadvantages of mechanical plaque control
2- need effort
3- time consuming
4- need continuity and follow up
? B- chemical plaque control
Chemicals that influence the dental plaque include :-
1- antiseptic : the most common type of antiseptic used as anti plaque agent is chlorhexidin gluconate (CHX)
2- antibiotic
? 2-CONTROL OF DIET
? More benefit comes from reduction of sucrose in diet so less caries and less plaque minimal effect on gingival inflammation from other dietary modifications
? 3-Control of breath malodor
? Plaque control is most predictable way to reduce oral malodor together with daily tongue scarping to reduce bacterial load of oral cavity.
? 4-Control of systemic factors
- Control of hemostasis.
- Control of bactermia.
- Control of diabetis.
- Control of medication.
? 5-CONTROL OF TOBACCO SMOKING
? Elimination of smoking significantly improves tissue response to initial therapy.
? C-Means of cause related therapy:
? Scaling is the process by which plaque and calculus are removed from both supragingval and subgingival tooth surfaces .
? Whereas root planning means :
The process by which residual embedded calculus and portion of cementum are removed from the roots to produce a smooth ,hard and clean surface.
Scaling &Root planning
? Scaling and Root planning are not separate procedure, however they are different .
? All principles of scaling apply equally to Root planning, the difference between scaling and Root planning is only a matter of degree .
? Access to the Root surface.
The root surface are not easy to access because Limitation of penetration of instruments.
q In subgingival access.
scaling and root planing skills is needed.
q in deep pockets .
open procedure may needed
*) It was shown that pockets less than 3 mm were the easiest sites for scaling and root planing. Pocket depths between 3 to 5 mm were more difficult to scale and pockets deeper than 5 mm were the most difficult.)
? Supra gingival scaling technique:
Sickles ,curettes ,and ultrasonic and sonic instrument are most commonly used for removal of supragingival calculus .
? Sub gingival scaling and Root planning technique:
The curette is preferred by most clinicians because of the advantages afforded by its design.
Instruments used for scaling and root planning are
classified as:
1. Hand instruments
2. Ultrasonic and sonic instruments
3. Rotating instruments
4. Reciprocating instruments
5. Laser instruments
? Curettes
? Are instrument used for both scaling and root planning.
? The working part of curette is spoon shaped blade which has two curved cutting edges.
? The two edges are united by rounded toe.
? Ultrasonic scaling:
Ultrasonic instrument have been used as a valuable adjunct to conventional hand instrumentation .
? Uses of Ultrasonic scaling devices :
1- Scaling and gingival curettage .
2-Removal of satins .
3- Remove overhangs and excess cement
? Contraindications of ultrasonic scaling:
q Patient with cardiac pacemaker .
q Patients with Known communicable diseases .
q Chronic pulmonary Disorder .
q Porcelain bounded restoration .
q Patient with Titanium implant ( plastic-tipped ultrasonic and sonic insert and Teflon-coated sonic scaler tips are available)
? Factors important for the outcome of subgingival instrumentation
? 1-Root anatomy:
? The surface of a single-rooted tooth is often easier to reach by sub gingival instrumentation than the furcation complex of multirooted teeth. However , concavities and tooth furrows exist in booth single and multi rooted teeth. Such root irregularities may contain small deposits of plaque and calculus which are difficult to reach. In such sites ultrasonic instruments with specially designed tips may facilitate local therapy . The technical problems inherent in sub gingival instrumentation increase with increasing probing depth.Specially designed instruments with a long shank may be used in deep pockets.
? 2-Skill of the operator
?
The outcome of the sub gingival instrumentation is "operator sensitive". Thus, the technical skill of the dentist/dental hygienist influences
the result of this procedure demonstrated that experienced dentists were more efficient in sub gingival debridment than more inexperienced operators. The difference between the two categories of therapists was most pronounced in the treatment of deeper (> 6 mm) pocket sites. Also, in surgical therapy the technical skill of the operator remains important for the outcome of the root debridement
? 3-Time allowed
? The time allowed for the instrumentation will also influence the treatment result. In a study by Badersten et al. (1981) it was demonstrated that as much as 6-8 minutes were required for a comprehensive sub gingival treatment of one single tooth when hand instruments were used. When ultrasonic instruments were used 4-6 minutes were required.
المادة المعروضة اعلاه هي مدخل الى المحاضرة المرفوعة بواسطة استاذ(ة) المادة . وقد تبدو لك غير متكاملة . حيث يضع استاذ المادة في بعض الاحيان فقط الجزء الاول من المحاضرة من اجل الاطلاع على ما ستقوم بتحميله لاحقا . في نظام التعليم الالكتروني نوفر هذه الخدمة لكي نبقيك على اطلاع حول محتوى الملف الذي ستقوم بتحميله .