Periodontal Therapy Evaluation

Periodontal Therapy EvaluationChapter One Introduction The objectives of periodontic therapy as stated by the Ameri weed Academy of Periodontology official guidelines are natural dentition preservation periodontal health sustenance and improvement, comfort, esthetics, and function and replacements provision where indicated. (Guidelines for periodontal therapy .J Periodontol 1998)Therefore, the reduction of bacterial deposits and calculus on tooth fold is iodine of the objectives of periodontal therapy. (Axelsson et al, 1991) This objective can be touchd with overturn scalers and curets or ultrasonic scaling instruments. (Drisko, 1998) Many clinical studies showed no difference between ultrasonic/sonic and manual procedures when treating chronic periodontitis. (Tunkel et al, 2002)Total removal of subgingival calculus with hand or ultrasonic instruments or even periodontal surgery is not possible even with periodontal surgery. (Buchanan et al., 1987 Kepic et al., 1990).While Al eo et al. (1974) telld the armorial bearing of bacterial endotoxins on diseased lines Hatfield Baumhammers (1971) first described the cytotoxic effect of diseased root go forths in cell cultures. The former workers also detected that human gingival fibroblasts did not adhere in vitro to a root grow contaminated with LPS in 1975. Therefore, it was determined that the removal of the affected cement was critical to the success of periodontal therapy.Nakib et al. (1982), however, in another in vitro study failed to demonstrate penetration of endotoxins into root cement of either periodontally healthy or diseased teeth. As a result, they considered think excessive removal of cementum was not acceptable in treatment, which was reinforced by other workers findings. also Eide et al. (1983, 1984) found that the thin cuticle seen on diseased root surfaces that was most likely stemmed from the instigative exudate and could mineralize so these cytotoxic cognitive contents can be incorp orated.Hughes Smales (1986) and Hughes et al. (1988) also did not approve the removal of real(a) amounts of cementum, as LPS was detected by immunohistochemical techniques only on the cementum surface. Interestingly, Moore et al. (1986) demonstrated that virtually all the LPS associated with periodontally affect root surfaces could be removed just by rinsing and brushing.The root cementum has been canvass for the presence of endotoxins as well as bacteria themselves. Hence for example Daly et al. (1982) observed in a histological study stainable bacteria in the cementum. They have showed that for a root surface to be surrender of contamination, cementum must be removed. Bacteria were also detected by Adriaens et al. (1988) in both the cementum and within the dentinal tubules. These authors as a result suggested the administration of chemotherapeutics to mechanical therapy in the treatment of periodontitis was required. Schroeder Rateitschak-Pliiss (1983) approve the findings of Daly et al. (1982) of resorption lacimae in the cementum showing defects of 30-80 /im in depth. Likewise they found that extensive root planing was natural to remove bacterial accumulation niches.From a clinical point of view the motive for the extensive removal of root surface material has been questioned recently. Nyman et al. (1986) disclosed in beagle dogs that for an effective treatment of periodontitis the removal of so-called diseased cementum was not needed. The roots, following flap elevation, were instrumented with curettes and a diamond bur on one side of the jaw and on the contralateral side were only cleaned with interdental rubber tips and rubber cups by mode of a low abrasive polishing paste. The mend, which was assessed histometrically, was alike with both treatments and was distinguished by a junctional epithelial tissue with subjacent non-inflamed connective tissue.Nyman et al. (1988) in a subsequent study in humans, compared results in which the root surfac e polishing was accompanied by calculus removal but not cementum and similar healing was again seen. Blomlof et al. (1987), in another investigation on monkeys, found new attachment to the teeth hard-boiled with detergents rather than scaling.The effects of root scaling in an in vitro model system (Lie Meyer 1977) have been studied using SEM methods and limited to semi-quantitative assessments with the Loss of Tooth Substance Index (LTSI) score. Others have tried to determine the loss of substance from the micrometer screw recordings in the light microscope, after focusing twice (Allen Rhoads 1963).The ultrasonic instrument, in a corresponding in vitro model, caexercisingd loss of tooth substance of about 250 pm and of about 50 /im after the curette use. Berkstein et al. (1987) measured the diameter of the dental root with a micrometer caliper before and after mavin treatment with the curette, detecting a loss of substance of about 27 pxn.The effectiveness of the procedures of r oot planing can be studied in two different ways. The first one, In vivo studies, by evaluating healing of tissues close to the treated teeth, and the other one, in vitro studies, directly following descent of teeth after SRP in array to observe the characteristics and cleanliness of the root planed surfaces (Kepic et al, 1990).The stereomicroscope has been used by many authors to assess the residual calculus after extraction of the root planed teeth. However, to achieve a precise study to accurately evaluate root planed surfaces, scanning electron microscope (SEM) is a prerequisite (Rateitschak-Plss et al, 1992).Many studies, concerning both microbiological and clinical aspects, have reported beneficial results from mechanical therapy (O Leary et al 1986 Ash et al, 1964 Sbordone, 1990).The hand instruments, ever since, were the first choice of clinicians. These instruments believed to produce a smooth root surface yet, considerable manual dexterity is essential for their effecti ve operation. Also, they are so time consuming and do not have the capability of reaching qabalisticer root surface where pockets are more than 4 mm deep (Waerhaug, 1978 Rabbani et al, 1981 ).Ultrasonic tips were formerly designed for gross scaling and supragingival calculus and stains removal. Currently, modifications have been made to these might driven instruments to have longer working lengths and smaller diameter tips, thus providing better access to deep probing sites and more effective subgingival instrumentation. Ultrasonic instruments are easy to use yet, it is often challenging to achieve a smooth and calculus free root surface (Moskow, 1972 Jones, 1972).Studies assessing variations in the magnitude of root surface changes created by hand, sonic, and ultrasonic instruments are lacking (Walmsley et al, 2008 Oda et al, 2004 Kocher et al, 2002). Bearing in mind manual and ultrasonic scalers, whatever reports show that manual scalers remove more root substance (Jacobson et al, 1994), while others showed that ultrasonic scalers do so (Oda et al, 2004). Concurrently, roughness of root surface after instrumentation is one of the most described changes in the literature. The kindred between the design of the tip, applied force, angulations and ultrasonic scaler type has been reviewed and all of these variables appear to explain the roughness of instrumented root surfaces (Flemmig et al, 1998).Ribeiro et al (2006) revealed that scaling with universal ultrasonic tips and diamond-coated sonic produced similar root surface roughness, which was more than that produced by hand curettes. Furthermore, another study by (Casarin et al, 2006) showed a positive influence of the ultrasonic scaler power settings on the roughness of the surface after instrumentation. As reported by those authors, more increased roughness was celebrated with greater settings of power. Lie and Leknes (1985) assessed the variations produced at different power settings by means of a subje ctive and debatable method, the Roughness Loss of Tooth Substance Index (RLTSI). The RLTSI assesses roughness and substance loss concurrently. Nevertheless, the loss of tooth substance with the use of a specific instrument cannot be straightway correlated with the root surface roughness (Kocher, 2002 Schmidlin et al, 2001), requiring a separate evaluation (Schmidlin et al, 2001).