Non‐surgical periodontal treatment: where are the limits?

Abstract

In the present scanning electron microscopic study, the possibilities and limitations of non-surgical root planing were investigated. 10 single-rooted teeth from 4 patients with advanced periodontitis were studied. The root surfaces were cleaned and planed without flap reflection, using fine curettes. The teeth were then extracted and the root surfaces were systematically examined by scanning electron microscopy (SEM) for the presence of residual bacteria and calculus. 29 of 40 curetted root surfaces were free of residues, if they were reached by the curette. On the remaining 11 surfaces, only small amounts of plaque and minute islands of calculus were detected, primarily at the line angles and also in grooves and depressions in the root surfaces. Instrumentation to the base of the pocket was not achieved completely on 75% of the treated root surfaces, however. The primary reason for this was the extremely tortous pocket morphology on the teeth selected for study. In conclusion, it may be stated that during non-surgical root planing in cases of advanced periodontitis, surfaces that can be reached by curettes are usually free of plaque and calculus. However, in many cases the base of the pocket will not be reached. It is for this reason that deep periodontal pockets should be treated with direct vision, i.e., after the reflection of conservative flaps.

Enhanced Root Planing and Systemic Metronidazole Administration Improve Clinical and Microbiological Outcomes in a Two‐Step Treatment Procedure

“…Rateitschak-Plüss et al 39,40 report complete instrumentation achieved on 75% of the root surfaces after non-surgical therapy without differentiation between concrement removal and enhanced root planing as two different steps. It is acknowledged that mechanical therapy alone, especially root planing, has an antiinfective influence.…”

Appréciation du préjudice de la malnutrition protéino-énergétique sur la santé bucco-dentaire de l’enfant

“…Par ailleurs, Marshall [13] a montré que l'augmentation du nombre de caries dentaires est associée à un retard de croissance chez les enfants. La mauvaise hygiène bucco-dentaire est due à une accumulation de la plaque bactérienne qui n'est pas éliminée par un brossage dentaire adéquat [10,11] : elle est donc due à la négligence et/ ou à l'ignorance des parents qui ont tendance à penser que les dents lactéales n'exigent pas une hygiène particulière. Une forte proportion des enfants malnutris (90 %) présentait une mauvaise hygiène bucco-dentaire et une gingivite sévère et généralisée (Tableau III) ; la différence était significative (P = 10 -8 ).…”

A double-blind randomized clinical trial of subgingival minocycline for chronic periodontitis

“…It has been shown that scaling and root planing is an effective mechanical approach for reducing bacterial colonization to sub-threshold values and also for controlling the progression of periodontal disease. However, thorough subgingival scaling and root planing is technically demanding, as access to and visibility of the area are required, so that complete subgingival plaque and calculus removal is rarely achieved and sometimes ineffective (6), and may not eradicate species that can reach epithelial cells and subepithelial connective tissues of the periodontium (7).…”