Scaling And Root Planing Gingivitis Pdf

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Periodontitis is a chronic inflammatory disease of the periodontal tissues periodontium which surround and support the teeth, that results in attachment loss and alveolar bone destruction leads to ultimate tooth loss. It is caused by the bacteria present in dental plaque, which is a tenacious substance that forms on teeth and gingiva just after teeth are brushed. Periodontal treatment is aimed at controlling the infection in order to stop the progression of the disease and to be able to maintain a healthy periodontium.

Causes and treatment of gingivitis

Metrics details. Periodontal diseases are regarded as the most common diseases of mankind. The prevalence rate of periodontal disease assumes a clear growth tendency, increasing by Thereby, effective periodontal therapy is still a long-term task and a difficult problem. The goals of periodontal therapy are to eliminate the infectious and inflammatory processes of periodontal diseases. However, along with the understanding of the effects of endotoxin on the root surface, the necessity of manual root planing has been gradually queried.

Ultrasonic instruments, which are more recent innovations, would not remove the cementum excessively, and are also more time-saving and labor-saving compared to using hand instruments. Hence, an increasing number of dentists prefer to do scaling with ultrasonic instruments only. However, the necessity of root planing remains emphasized in the international mainstream views of periodontal mechanical treatment.

Therefore, this study is devoted to compare the clinical effect of ultrasonic subgingival debridement and ultrasonic subgingival scaling combined with manual root planing, which takes the implementation of root planing as the only variable and is more in line with the current clinical situation, thus hoping to provide some valuable reference to dentists. Forty adult patients who fit the inclusion criteria are being recruited from the Peking University Hospital of Stomatology Beijing, China.

By means of randomization tables, one quadrant of the upper and lower teeth is the test group and the other is the control group. Test group: ultrasonic subgingival scaling combined with manual root planing. Control group: ultrasonic subgingival debridement. In a week follow-up period, plaque index, probing depth, clinical attachment loss, bleeding index, furcation involvement, mobility, and patient-reported outcome Visual Analog Scale for pain and sensitivity will be observed and documented.

The result of the trial should potentially contribute to an advanced treatment strategy for periodontitis with an ideal clinical outcome. Registered on 12 July Peer Review reports. Periodontal diseases are regarded as the most common diseases of mankind [ 1 ]. The prevalence rate of periodontal disease assumes a clear growth tendency worldwide, increasing by The Global Burden of Disease Study [ 6 ] reports that periodontitis is the sixth most prevalent disease worldwide.

The overall prevalence is The prevalence of periodontitis in China is even higher. According to the recently released Fourth Epidemiologic Sampling Survey in China, the prevalence of periodontal disease is Periodontitis is the main cause of tooth loss in the adult population worldwide that affects nutrition, quality of life and self-esteem as well as imposing great socio-economic impacts and healthcare costs [ 7 , 8 , 9 , 10 ].

However, good periodontal therapy is still a long-term task and a difficult problem. Periodontal treatment aims to control gingivitis and periodontitis, avoid disease progression leading to tooth loss, retain a functional dentition for a lifetime, preserve self-esteem and improve quality of life. Subgingival plaque and calculus on the root surface in the periodontal pocket are the most important local factors for the occurrence and development of periodontitis.

In the past, dentists used a variety of manual instruments e. Later, it was found that the vibration of ultrasonic tips, as well as the cavitation effect and microflow of cooling water could effectively remove plaque and calculus, which has made ultrasonic instruments widely used in nonsurgical treatment of periodontitis.

By the s, more studies clarified that endotoxin was only loosely attached to the surface of the cementum [ 14 , 15 ], and most of the endotoxin was related to the bacterial biofilm [ 16 , 17 , 18 ]. Therefore, it was suggested that excessive root planing for endotoxin removal was unreasonable. Ultrasonic instruments will not remove the cementum excessively, and are also more time-saving and labor-saving compared to hand instruments.

However, the necessity of root planing remains emphasized in the international mainstream views of periodontal mechanical treatment; ultrasonic subgingival scaling with manual root planing is recommended after supragingival scaling. The primary objective of scaling and root planing is to restore gingival health by completely removing elements that provoke gingival inflammation i. A large amount of in vivo and in vitro research has been conducted to compare ultrasonic and manual instruments, and it was found that there was not much difference between them in clinical effects, changes in microflora and root surface characteristics [ 20 , 21 , 22 , 23 , 24 , 25 ].

In fact, there is still a lack of research evidence comparing the clinical effects of ultrasonic subgingival scaling with or without manual root planing. On the one hand, it is difficult to distinguish subgingival scaling from root planing in traditional manual operation; on the other hand, there are fewer dentists using manual subgingival scaling and root planing.

Therefore, this study is devoted to comparing the clinical effect of ultrasonic subgingival debridement and ultrasonic subgingival scaling combined with manual root planing in the nonsurgical treatment of periodontitis, which, taking the implementation of root planing as the only variable, is more in line with the clinical situation, hoping to provide some valuable reference for dentists.

The major goals of the current randomized controlled trial are to compare and evaluate the clinical outcomes of ultrasonic subgingival debridement and ultrasonic subgingival scaling combined with manual root planing. The study is a prospective, single-center, split-mouth randomized controlled trial.

Forty patients who have periodontitis and are in need of periodontal treatment will be recruited. The assessments, interventions and follow-ups will be performed at Peking University School and Hospital of Stomatology Beijing, China.

Aggressive periodontitis AgP : according to the AgP diagnostic criteria established by the international symposium on the classification of periodontal diseases in [ 26 ]:. All are confirmed to have alveolar bone resorption on the adjacent surface by examining periapical films. There are at least 20 remaining teeth in the whole mouth except the third molars, and at least one molar in each quadrant. Chronic periodontitis CP : according to the CP diagnostic criteria established by the International Symposium on the Classification of Periodontal Diseases in specifies that [ 26 ]:.

The patient is systematically healthy, has gingival bleeding, swelling, pain, halitosis, teeth mobility and occlusive discomfort. At least one molar exists in each quadrant. Subjects who are looking for periodontal treatment and are willing to join this trial will be recruited from the Periodontology Department, Peking University School and Hospital of Stomatology. Subjects will receive the study information.

Before subjects are included in the present study, the consent form must be signed. An experienced periodontist is going to perform the periodontitis disease diagnostic process according to clinical and radiographic examination. The randomization sequence and allocation concealment placed in sealed envelopes were performed by a professor in the absence of the working investigators; one quadrant of the upper and lower teeth is the test group and the other quadrant is the control group.

All subjects will be treated by one experienced and calibrated therapist who does not partake in the allocation, examination, or statistical analysis. The treatment plan and grouping will be confidential to the examiner and statistical analyst. All enrolled subjects received supragingival scaling using ultrasonic scalers, oral hygiene instruction OHI including tooth brushing with the modified Bass technique and interdental cleaning with interdental brushes or dental floss.

They are submitted to a complete periodontal clinical assessment. Subsequently, the upper and lower teeth of each subject are randomly allocated to the following therapeutic groups: 1 ultrasonic subgingival scaling combined with manual root planing group; 2 ultrasonic subgingival debridement group. The treatment is performed by an experienced periodontist who has been calibrated before the trial. After the subjects have been included, plaque index PLI , probing depth PD , clinical attachment loss CAL , bleeding index BI , furcation involvement FI and mobility are tested before treatment by a calibrated examiner not the therapist who has been trained to adequate levels of accuracy and reproducibility.

All subjects will be recalled for follow-up at weeks 2, 4, 12 and 24 after the treatment. Any complications will be documented. Consequently, this trial will require at least 40 subjects in all. The recruitment began in October , and the intervention period will be ending in June The schedule of enrollment, intervention and assessments.

The data of the patients will be documented on both spreadsheets and databases. The statistical analysis will be performed by two experimenters independently. A Shapiro-Wilk test and Levene variance homogeneity test will be performed to test the normality and variance equality, respectively.

A paired-samples T test or two-related-samples test will be used to identify any differences between groups. Statistical significance difference will be set as P value of less than 0. Data analyses will be performed using SPSS software. Before subjects are officially recruited into this study, they will be given a study information sheet and will be asked to sign a consent form. Subjects will be informed that they have the right to withdraw from this trial at any time without providing a reason.

If the withdrawal occurs, treatment will also be provided to the subject. The results of this trial will be saved at the International Clinical Trials Registry Platform ICTRP and published in an international peer-reviewed journal which will allow anyone access to obtain the results.

Periodontitis is strongly associated with the presence of bacterial biofilms and dental calculus on root surfaces. The success of periodontal treatment depends on the removal of deposits from the root surface [ 27 , 28 , 29 , 30 ]. All kinds of studies performed in different models and under different conditions have indicated that neither manual nor mechanical instruments are superior in removing subgingival deposits [ 31 , 32 , 33 , 34 , 35 , 36 , 37 ].

Previous studies demonstrated that hand instrumentation curettage created the smoothest root surface, whereas mechanical instruments, such as the ultrasonic scaler, tended to roughen the root surface [ 38 ].

Cobb found that manual curettes were more technique-sensitive and time-consuming [ 39 ]. The old concept of infected cementum removal in order to provide the root surface biocompatible for soft tissue healing [ 11 , 12 ] has been questioned by various studies [ 15 , 16 ]. The utilization of ultrasonic devices for subgingival debridement offers a less aggressive and a more comfortable therapeutic method for both the patient and therapist.

But, some research has shown that the comparison between manual instruments and ultrasonic scalers did not show an advantage over machine-driven instruments [ 20 ], and tissue trauma was similar in both instruments [ 40 ]. Therefore, the necessity of manual root planing cannot be completely denied. Hand instrumentation has been recommended to smooth the root surface after ultrasonic debridement as the final finishing procedure in the treatment of periodontitis-affected roots [ 41 ].

At present, root planing is no longer used to emphasize the deliberate removal of cementum, but to contribute to the removal of subgingival plaque. We hope that the results could lead to an advanced treatment strategy of periodontitis with an ideal clinical outcome. The recruitment began in October and will be completed in June Guinness World Records Eds.

Gum disease. In: Guinness World Records. New York: Mint Publishers, Inc. Global burden of oral diseases: emerging concepts, management and interplay with systemic health. Oral Dis. Global burden of severe periodontitis in a systematic review and meta-regression. J Dent Res. Global burden of oral conditions in a systematic analysis. Disability-adjusted life years DALYs for diseases and injuries in 21 regions, a systematic analysis for the Global Burden of Disease Study

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Metrics details. Periodontal diseases are regarded as the most common diseases of mankind. The prevalence rate of periodontal disease assumes a clear growth tendency, increasing by Thereby, effective periodontal therapy is still a long-term task and a difficult problem. The goals of periodontal therapy are to eliminate the infectious and inflammatory processes of periodontal diseases. However, along with the understanding of the effects of endotoxin on the root surface, the necessity of manual root planing has been gradually queried. Ultrasonic instruments, which are more recent innovations, would not remove the cementum excessively, and are also more time-saving and labor-saving compared to using hand instruments.

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DENTAL SCALING AND ROOT PLANING EXPLAINED

If you have a stubborn case of gum disease, your dentist may recommend a dental procedure called dental scaling to keep it from getting worse. Dental scaling is the most common non-surgical way to treat gum disease, which is also known as periodontitis. This will remove plaque and tartar from your teeth and help your gums regain health.

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Gingival enlargement GE is defined as an increase in the size of the gingiva. It is also known as gingival overgrowth. A wide variety of etiological factors play an important role in the development of GE.

Read more. CDA Practice Support is receiving calls from dentists and their staff concerning claim denials for scaling and root planing services by dental benefit plans. It is indicated for patients with periodontal disease and is therapeutic, not prophylactic, in nature. Some soft tissue removal occurs. The ADA in introduced a new code: D scaling in presence of generalized moderate or severe gingival inflammation — full mouth, after oral evaluation.

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It is indicated for patients who have swollen, inflamed gingiva, generalized prophylaxis, scaling and root planing, or debridement procedures.


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Gingival enlargement or overgrowth is a common disease of gingiva. The causative factors may range from inflammation due to local factors to conditioned enlargement and neoplastic enlargements. They commonly present as bulbous interdental gingival, diffuse swelling of gingival. Due to the unaesthetic appearance of the overgrown gingiva, treatment becomes inevitable. This results in excision of overgrowth known as gingivectomy. The first gingivectomy procedure was explained by Robicsek in and later by Zentler

Treatment of Gingival Enlargement

Без воска, Дэвид. Она просияла и прижала записку к груди. Это был Дэвид, кто же. Без воска… Этот шифр она еще не разгадала. Что-то шевельнулось в углу.

1 Comments

  1. Eric B. 10.06.2021 at 02:32

    Deep Cleaning (Scaling and Root Planing). The dentist, periodontist, or dental hygienist removes the plaque through a deep-cleaning method called scaling.