Scaling and root plan , also known as conventional periodontal therapy , non-surgical periodontal therapy , or in cleaning , is a procedure involving removal of dental plaque and calculus (scaling or debridement) and then smoothing, or plotting, from the open surface of the root, removing cementum or dentine impregnated with calculus, toxin, or microorganism, the etiologic agent causing inflammation. It helps to form periodontsium that eases periodontal disease. Periodontal scalars and periodontal curettes are some of the tools involved.
Video Scaling and root planing
Plakat
Plaque is a soft grayish yellow substance attached to the tooth surface including removable and fixed restorations. This is an organized biofilm that mainly consists of bacteria in glycoprotein matrix and extracellular polysaccharide. This matrix makes it impossible to remove the plaque by rinsing or using a spray. Materia alba is similar to plaque but does not have a regular plaque structure and is therefore easily removed with rinses and sprays.
Although everyone has a tendency to develop plaque and materia alba, through regular brushing and flossing organized colonies of these bacteria are disrupted and removed from the oral cavity. In general, the more effective one brushing, flossing, and other oral homecare practices, the less plaque that accumulates in the teeth.
However, if, after 24 hours in the oral environment, the biofilm remains undisturbed by brushing or flossing, it begins to absorb the mineral saliva content. Through the absorption of calcium and phosphorus from saliva, oral biofilms are converted from soft forms easily transferred to hard substances known as calculus. Generally known as 'tartar', calculus provides the basis for a new layer of biofilm plaque to settle and build over time. Calculus can not be removed by brushing or flossing.
Maps Scaling and root planing
Plaque buildup and bone loss
The accumulation of plaque tends to be the thickest along the gum line. Due to the proximity of this area to the gum tissue, bacterial plaque begins to irritate and infect the gums. These gum infections cause gum disease known as gingivitis, which literally means gingival inflammation, or gums. Gingivitis is characterized by swelling, redness and bleeding gums. This is the first step in the decline of periodontal health, and the only step that can be completely reversed to restore a person's oral health.
When the gingival tissue swells, it no longer provides an effective seal between the tooth and the external environment. The vertical space is created between the teeth and gums, allowing biofilm of new bacterial plaque to begin migrating into the sulcus, or the space between the gums and the teeth. In healthy individuals, sulcus is not more than 3 mm when measured with a periodontal probe. As the gingivitis stage continues, the capillaries inside the sulcus begin to dilate, producing more bleeding when brushing, flossing, or on the promise of a tooth. It is the body's attempt to clear the infection from the tissues. Thus, bleeding is generally accepted as a sign of active mouth infection. Swelling of the tissue can also produce deeper readings on periodontal probes, up to 4 mm. At a depth of 4 mm or more, the vertical space between the teeth and the surrounding sweets is known as a periodontal pouch. Because toothbrushes and floss can not reach the bottom of gum pockets in 4-5 mm, bacteria are stagnant in these places and have the opportunity to reproduce into colonies that cause periodontal disease.
Once the bacterial plaque has infiltrated into the pocket, the transformation of the biofilm into calculus continues. This results in ulceration in the tissue lining, which begins to break the gum bonds to the teeth. The gingival attachment begins to loosen up further because the bacterial plaque continues to invade the space created by the swelling it causes. This plaque eventually turns into calculus, and the process continues, resulting in sediment under the chewing gum, and increasing pocket depth. Because the depth of vertical space between the teeth and gum reaches 5mm, there is a change. Bacterial morphology, or makeup, of a biofilm change from a gram-positive aerobic bacteria found in the biofilm lies supragingiva, or above the gum line. Replacing these gram-positive bacteria from common oral flora is a mandatory anaerobic gram-negative bacteria. These bacteria are much more damaging than their aerobic cousins. Gram negative cell wall cells contain endotoxins, which allow these organisms to destroy gingival tissue and bone much more quickly. Periodontitis officially begins when the bacteria begin to act, resulting in bone loss. This bone loss marks the transition from gingivitis to the actual periodontal disease. In other words, term periodontal disease may be synonymous with bone loss.
The first evidence of periodontal disease damage becomes apparent in radiography when the jaw crestal bone begins to become dull, oblique, or outward in appearance. This damage occurs as a result of the bacterial endotoxin effect on bone tissue. Because the bone is alive, it contains the bone-building cells in it, known as osteoblasts, and bone-breaking cells, called osteoclasts. Usually this works with the same speed and maintain balance with each other. However, in periodontitis, chemical mediators, or byproducts, chronic inflammation stimulates osteoclasts, causing them to work faster than bone-building cells. The end result is the missing bone, and loss of bone and attachment tissue called periodontal disease.
This process will continue, causing greater damage, until bacterial infectious agents (plaque) and local irritating factors (calculus) are removed. To effectively eliminate this at this stage in the disease process, brushing and flossing is no longer enough. This is due to several factors, the most important to note is the depth of the periodontal pocket. Brushing and flossing are only effective for removal of alba and biofilm soft materials in the supragingival area, and in pockets up to 3 mm deep. Even the best brushing and flossing are ineffective for cleaning deeper pockets, and are never effective in removing calculus. Therefore, to eliminate the causal factors that cause periodontal disease, the scale of pocket depth and root planning procedures are often recommended.
Once the bacteria and calculus are removed from the periodontal pouch, the tissue can begin to heal. Inflammation disappears when the infection decreases, allowing a decreased swelling which causes the gums to once again form an effective seal between the tooth root and the outer environment. However, the damage caused by periodontal disease never cured completely. Bone loss due to disease process can not be changed. The gingival tissue of the gums also tends to experience a permanent effect after the disease reaches a certain point. Because gum tissue requires bone to support it, if bone loss is widespread, a patient will have a permanent gum recession, and therefore exposure to the root of the tooth in the area involved. If the bone loss is large enough, the tooth can begin to move, or loose, and without intervention to catch the disease process, will be lost.
Contrary to the old belief, it is not a normal part of aging teeth loss. Conversely, it is a periodontal disease that is a major cause of tooth loss in the adult population.
Periodontal Intervention
Treatment of periodontitis may include several steps, the first often requiring the removal of local causal factors to create a biologically compatible environment between the tooth and surrounding periodontal tissues, gums and bone underneath. If left untreated, chronic inflammation of the gums and support tissues may increase a person's risk of developing heart disease.
Before starting this procedure, the patient is generally numb in an area intended for instrumentation. Due to the deeper nature of periodontal scaling and root planing, one half or a quarter of the mouth is generally cleaned during a one-time appointment. This allows the patient to completely numb in the area required during the treatment. It is usually not advisable to have all scaly mouths on an appointment because of the potential for discomfort and numbing complications of the whole mouth, inability to eat or drink, the possibility of self-injury by biting, etc.
Generally, the first step is to remove dental plaque, microbial biofilm, from the tooth, a procedure called scaling. Root planning involves smoothing the tooth roots. This procedure can be referred to as scaling and root planing, periodontal cleaning, or deep cleaning. All of these names refer to the same procedure. The term "deep cleaning" comes from the fact that sacs in patients with periodontal disease are literally deeper than those found in individuals with healthy periodontia. Such scaling and root planing can be performed using a number of gears, including ultrasonic instruments and hand instruments, such as scalers and periodontal curettes.
The goal for periodontal scaling and root planing is to remove dental plaque and calculus (tartar), in which bacteria release toxins that cause inflammation of the surrounding gum tissue and bone. Planning often eliminates some cementum or dentin from the teeth.
Removal of plaque and calculus with hand instruments can also be performed in patients without periodontal disease. A prophylactic refers to scaling and polishing of teeth to prevent oral diseases. Poles do not remove the calculus, but only some plaque and stain, and therefore should be done only along with scaling.
Often, an electrical device, known as an ultrasonic scaler, a sonic scaler, or a power scaler can be used during scaling and root planing. Ultrasonic scalers vibrate at high frequencies to help remove stains, plaque and calculus. In addition, ultrasonic scalers create tiny air bubbles through a process known as cavitation. These bubbles are important for periodontal cleansing. Because the bacteria that live in the sacs involved periodically are anaerobic, meaning they can not survive in the presence of oxygen, these bubbles help to destroy them. Oxygen helps break down bacterial cell membranes and cause them to melisis, or explode.
Because it is important to remove the entire savings in each of the periodontal pockets, attention to detail during this procedure is essential. Therefore, depending on the depth of the bag and the amount of deposit calculus versus the soft biofilm deposit, the hand instrument can be used to complete a fine-grained scale that removes anything left by the ultrasonic scaler. In addition, scalar energy can be used after hand scaling to remove deposition that has been removed from the tooth or root structure, but remains in the periodontal pouch.
The sonic and ultrasonic scalars are supported by systems that cause the ends to vibrate. The sonic scaler is powered by an air-driven turbine. The ultrasonic scaler uses a magnetostrictive or piezoelectric system to create vibrations. The magnetostrictive scaler uses a pile of metal plates bound to the end of the tool. The stack is induced to vibrate by an external coil connected to the AC source. The ultrasonic scaler also includes fluid or lavage output, which helps in cooling the appliance while in use, as well as rinsing all unwanted substances from the teeth and gum line. Lavage can also be used to send antimicrobial agents.
Although ultrasonic scalar end results can be produced using hand scalars, ultrasonic scalers are sometimes faster and less irritating to clients. Ultrasonic scalers do create aerosols that can spread pathogens when clients carry infectious diseases. Research differs on whether there is a difference in effectiveness between ultrasonic scalers and hand instruments. Most important for dentists themselves is that the use of ultrasonic scalers can reduce the risk of recurrent stress injuries, because ultrasonic scalars require less pressure and repeatability compared to hand scalars.
A new addition to the tool used to treat periodontal disease is the dental laser. Lasers of different strength are used for many procedures in modern dentistry, including patches. In periodontal settings, lasers can be used following scaling and root planing to promote tissue healing.
After scaling
After scaling, additional steps may be taken to disinfect periodontal tissue. Oral irrigation of the periodontal tissue can be performed by using a chlorhexidine gluconate solution, which has a high substantivity in the mouth tissue. This means that unlike other mouthwashes, whose benefits terminate with expectorant, the active antibacterial agent in chlorhexidine gluconate infiltrates the tissue and stays active for a period of time. However effective, chlorhexidine gluconate is not intended for long-term use. A recent European study showed a link between the use of mouthwash and long-term blood pressure, which can lead to higher incidence of cardiovascular events. In the United States, it is available only through prescription, and in small doses, has rarely been shown to help tissue healing after surgery.
Location-specific antibiotics can also be placed in the periodontal pocket after scaling and root planing to provide additional healing of the infected tissue. Unlike antibiotics taken orally to achieve systemic effects, site-specific antibiotics are specifically placed in the area of ​​infection. These antibiotics are placed directly into the periodontal pouch and released slowly over a period of time. This allows the drug to seep into the tissues and destroy the bacteria that may live in the gingiva, providing disinfection and facilitation of further healing. Specific site-specific antibiotics not only provide these benefits, but also boast the added benefit of pocket depth reduction. Arestin, a popular minocycline antibiotic special brand, is claimed to be able to restore at least 1 mm of high gingival reattachment.
In the case of severe periodontitis, scaling and root planing can be considered as an initial therapy before future surgical needs. Additional procedures such as bone grafting, tissue transplantation and/or gingival flap surgery performed by periodontists (dentists specializing in periodontal treatment) may be necessary for severe cases or for patients with refractory periodontitis (recurrent).
Patients who come with severe periodontal disease or necrosis may have further steps involved in their care. These patients often have genetic or systemic factors that contribute to the development and severity of their periodontitis. Common examples include type I and type II diabetes, family history of periodontal disease, and individuals with the immune system. For such patients, practitioners can take samples from the pouch to allow culture and identification and treatment more specifically than the causative organism. Interventions may also include discontinuation of drugs that contribute to a patient's vulnerability or referral to a physician to address existing but previously untreated conditions if they play a role in the process of periodontal disease.
Full mouth care
The "traditional" debridement procedure involves four sessions spaced two weeks apart, doing one quadrant (quarter of the mouth) each session. In 1995, a group in Leuven proposed to do whole mouth in about 24 hours (two sessions). When finished using this ultrasonic instrument it is called full mouth ultrasonic debridement (FMUD). The rationale for full mouth debridement is that cleared quadrants will not be re-infected with bacteria from unopened quadrants. Other advantages of full mouth ultrasonic debridement include reduced speed/time of care, and reduced need for anesthesia, with results equivalent to scale and planning. One study found that the average time to handle each pocket with full-mouth ultrasonic debridement was 3.3 minutes, whereas it took 8.8 minutes per pocket for quadratic and root planing (SRP) scales. Differences in improvement are not statistically significant. Studies by the Leuven group, using somewhat different protocols, found that one-stage treatment (ie within 24 hours) gave better results than the quadrant-by-quadrant approach (taking six weeks). They also asked patients to use chlorhexidine for two months after treatment.
Depth of planning
Another question in dental cleansing is how much cementum or dentin should be removed from the roots. Bacterial contamination from the root surface is limited in depth, so extensive plans far from cementum - as recommended by traditional scaling and root planing - are not necessary to allow for periodontal healing and the formation of new attachments. In contrast to traditional scale and root planing, the purpose of some FMUD procedures is to disrupt bacterial biofilms in the periodontal pouch, without removing cementum. Typically, root planing will require the use of hand instruments such as special dental curettes instead of the tip scaler used in the FMUD to negate root surfaces and periodontal pockets.
Evidence-based dentistry
Several systematic reviews have been made about the effectiveness of scaling and root planing as evidence-based dentistry. Cochrane Reviews by Worthington et al. in 2013 is considered only scaling and polishing gear, but not root planing. After examining 88 papers, they found only three studies that met all their requirements, commenting that "the quality of evidence is generally low." They reported mixed results: one study "did not show any benefit or danger to a regular six or 12 month scale and polish treatment when compared with no scaling and polishing", but previous research found that care every three months produced better results in terms gingivitis, plaque and calculus from an annual treatment (with an evaluation after two years in each case). Oral hygiene instructions are found to be helpful as well. Another unconvincing review of scaling and polishing (without planning) was published by the British Dental Association in 2015.
Extensive reviews involving root planing are published by the Canadian Agency for Drug and Technology in Health in 2016. This makes a number of findings, including (1) In five randomized, scale and root planing controlled trials "is associated with a decrease in plaque from baseline on one month, three months, or six months; "and (2) Four studies analyzed changes in the gingiva index (GI) from the baseline and" found a significant increase of baseline in the scale and root planing groups at three months and six months. " The study also discusses evidence-based guidelines for frequency scaling with and without a root plan for patients with and without chronic periodontitis. The group that produced one of the major systematic reviews used in the Canadian review of 2016 has published guidelines based on its findings. They recommend that scaling and root planing (SRP) should be considered as an initial treatment for patients with chronic periodontitis. They note that "the strength of recommendation is limited because the SRP is considered a reference standard and is thus used as an active control for periodontal testing and there are several studies in which researchers compare SRP without treatment." They added that "root planing... carries the risk of damaging the root surface and potentially causing tooth or root sensitivity." Generally the expected post-SRP procedural side effects include discomfort. "
The enamel cracks, early caries and resin restorations can be damaged during scaling. A study conducted in 2018 recommended that dental and restorative conditions be identified before undergoing ultrasonic scaling procedures.
Effectiveness of procedure
Scaling and root planing procedures will be considered effective if patients can further maintain their periodontal health without bone loss or further adherence and if preventing recurrent infections with periodontal pathogens.
The long-term effectiveness of scaling and root planing depends on a number of factors. These factors include patient compliance, progression of the disease at intervention, probing depth, and anatomical factors such as grooves in tooth roots, concave, and furcation involvement that may limit the visibility of internal calculus and underlying debris.
First and foremost, periodontal scaling and root planing are procedures that must be done thoroughly and with attention to detail to ensure complete removal of all calculus and plaque from the sites involved. If the agent of this cause is not removed, the disease will continue to develop and further damage will occur. In the case of mild to moderate periodontitis, scaling and root planing can achieve excellent results if the procedure is thorough. As the severity of periodontitis increases, the larger amount of bone support is destroyed by infection. This is illustrated clinically by deepening the periodontal pouch targeted for cleaning and disinfection during the procedure. After the periodontal pouch exceeds 6 mm, the effectiveness of the removal of the deposit begins to decrease, and the chances of complete healing after one procedure begin to decline as well. The more severe the infection before the intervention, the greater the effort it takes to halt its progress and return the patient to health. Diseased sacs greater than 6 mm can be treated by a periodontal flap surgery, performed by a dental specialist known as a Periodontist.
Although soft tissue healing will begin soon after the removal of microbial biofilms and the calculus that causes disease, scaling and root planing is only the first step in capturing disease processes. After the initial cleaning and disinfection of all affected sites, it is necessary to prevent recurrent infections. Therefore, patient compliance, by far, the most important factor, has the greatest influence on the success or failure of periodontal intervention. Immediately after the treatment, the patient needs excellent oral care at home. With the right homecare, which includes but is not limited to brushing twice daily for 2-3 minutes, daily flossing and use of mouthwash, effective healing potential after scaling and root planing increases. Commitment and perseverance in completing daily oral hygiene practices are essential to this success. If the patient fails to change the factors that allow the disease to be regulated in - for example, not flossing or brushing just once a day - the infection is likely to recur.
The process that allows for the formation of deep periodontal pockets does not occur overnight. Therefore, it is unrealistic to expect the network to heal completely within the same short period of time. Benefits in gingival attachments can occur slowly over time, and ongoing periodontal maintenance visits are usually recommended every three to four months to maintain health. The frequency of these subsequent promises is key to sustaining the results of initial scaling and root planing, especially in the first year immediately after treatment.
Because patients may still have pockets that exceed the effective cleaning ability of the brush or dental floss, for long-term treatment success they should return every 90 days to ensure that the bag remains free of deposit. It should be pointed out that 90 days is not an arbitrary interval. At 90 days, the healing made possible by scaling and root planing will be completed. This will allow practitioners to re-measure the depth of the pocket to determine whether the intervention is successful. At this appointment, progress will be discussed, as well as refractory periodontitis. At 90 days of original scaling and root planing, periodontal bacteria, if any residual, will reach their full strength again. Therefore, if there is any remaining area of ​​the disease, the practitioner will clean it again, and may place more site-specific antibiotics. In addition, this designation allows to review the homecare, or addition or education required.
See also
- Tooth cleaning
- Tooth polish
- Debridement (teeth)
- Periodontal disease
References
External links
Source of the article : Wikipedia
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