Characteristics of nonsurgical therapy
- Considered the “gold standard”
- AKA: initial therapy, anti-infective phase, phase I therapy, soft tissue management, hygienic phase
- For most people, effective in controlling disease
What are the broad objectives of nonsurgical therapy?
- Eliminate bacteria in biofilm and calculus
- Eliminate inflammation of the periodontium
- Return the periodontium to a healthy, maintainable state
- Eliminate or reduce etiologic, as well as local and systemic risk factors
Factors influencing therapy outcomes
- Patient compliance- poor comliance –> unfavorable outcomes
- Lifestyle and systemic factors–> may give rise to increasedprevalence, incidence or severity
- Disease factors–> Some cases do not r4espond wel despite well-executed therapy
Goals of nonsurgical therapy
- Minimize bacterial challenge- remove calculus/biofilm
- Eliminate or control local contributing factors- Defective restorations, tooth-related factors etc.
- Minimize impact of systemic risk factors- diabetic control, smoking cessation
- Stabilize attachment level by eliminating inflammation
Nonsurgical therapy procedures
- Customized self-care instructions- mechanical/chemical biofilm control, supra/subgingival irrigation
- Periodontal instrumentation
- Use of antimicrobial agents
- Correction of local contributing factors
- Interdisciplinary care for correction/control of systemic risk factors
- Modulation of host defenses
Indications for nonsurgical therapy
What is the main goal of nonsurgical therapy when it comes to cementum?
- Removal of supra and sub-gingival biofilm and calculus while preserving root cementum
- Conservation is necessary for optimal periodontal health as well as for periodontal regeneration
Describe healing following nonsurgical therapy
- Healing occurs primarily through the formation of long junctional epithelium
- Following instrumentation, there is normally no formation of new AB, cementum or PDL
What is the soft tissue response of nonsurgical therapy?
- Complete resolution of the inflammation resulting in shrinkage of the tissue (recession) and a shallow probing depth
- Readaptation of the tissues to the root surface w/ a long JE resulting in a shallow probing depth
- Little change in the level of the soft tissues resulting in residual pocket depth
Describe the base of the pocket before and after nonsurgical therapy
- Before- tip of the probe penetrates inflamed soft tissue at the base of the pocket
- After- more resilient to deeper penetration of the probe, and there has been a reduction of edema
How many types of embrasure spaces are there?
What is contained within dentinal tubules that is involved in dentinal, hypersensitivity?
Odontoblastic process surrounded by dentinal fluid
What are the three theories of dentinal hypersensitivity?
- Direct stimulation- nerve extends through length of tubule (false)
- Odontoblastic transducer- odontoblasts act as receptors relaying signals (no synapses)
- Hydrodynamic- Stimulation causes dentinal fluid movement that excited nerve endings
How is dentinal hypersensitivity managed?
Meticulous plaque control
Tubule occlusion- At Home: TP, potassium nitrate, strontium chloride, sodium citrate, fluorides
Tubule occlusion- In-Office: potassium oxalate, ferric oxalate, fluoride solution/varnish
- Restorative materials
- Laser
- Soft tissue root coverage
Occluding agents
When do we do reevaluation after nonsurgical therapy and what is included?
- Typically 4-6 weeks
- Update medical history
- Perform perio clinical assessment
- Compare initial assessment w/ reevaluation data
- Decision regarding the next steps in therapy
What are the steps in nonsurgical therapy?
- Clinical assessment to establish perio diagnosis
- Nonsurgical perio therapy
- Reevaluation of nonsurgical perio therapy
- Additional nonsurgical therapy or perio surgery where needed
- Establish a program of perio maintenance
Indications for nonsurgical and surgical therapy
Indications for co-treatment by a periodontist
- Unresolved inflammation or continued attachment loss after nonsurgical therapy
- Managing stage III or IV perio
- Intensive management of grade B or C perio
- Non-plaque-induced conditions (recession)
- Surgical procedures: tissue augmentation, regeneration, mucogingival problems, infrabony defects, furcation invasion
- Pts requiring surgery involving bone reshaping (crown lengthening)
- Implant placement
- Complex med history: radiation, biphosphonate therapy, bleeding disorders
- Pts who general dentist does not feel comfortable treating
