perio non surgery

8/19/2019 Perio Non Surgery

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NON – SURGICALPERIODONTAL THERAP

Drg. Ade Ismail A. K., MDS., S!.Pe

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O#$e%i&es O' Peri"d"(%alT)era!*

Es%a#lis))eal%)

Res%"re'+(%i"(

Preser&e

)ela%)04/01/2016 kulpak blok 17, 2016


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O&erall Trea%me(% Pla(

Prelimi(ar* !)ase

P)ase I %)era!*

Ree&al+a%i"(

P)ase II %)era!* – -s+rgial !)ase

P)ase III %)era!* – -res%"ra%i&e!)ase

P)ase I/ %)era!* – -s+!!"r%i&e!eri"d"(%al %)era!*

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Peri"d"(%al %)era!* a( #e di&i(%" %)ree #+% 're0+e(%l*"&erla!!i(g !)ases . T)e a+se – rela%ed !)ase (non – surgical

periodontal therapy).

T)e "rre%i&e !)ase ( periodontal surger

T)e mai(%e(a(e !)ase (supportive perio– therapy).

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P)ase I T)era!*-E%i"%r"!i1 I(i%ial P)ase

Pla0+e "(%r"l 1 Oral H*gie(e I(s%r+%i"Die% "(%r"l

Sali(g a(d r""% !la(i(g1sale 2 !"lis)

Caries "(%r"l

E(d"d"(%i %)era!*Ol+sal %)era!*

Mi("r %""%) m"&eme(%

Pr"&isi"(al s!li(%i(g

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PERIODONTAL THERAPYNON SURGICAL

Sali(g

R""% Pla(i(g

S!li(%i(g

Ol+sal %)era!*

L"al Dr+g Deli&er*

SURGICAL

C+re%%age

Gi(gi&e%"m*

A#sess Drai(age

3la! S+rger*

4"(e Gra'%s

GTR !r"ed+res

R""% "&erage !r"

Im!la(%

Aes%)e%i s+rgerie04/01/2016 kulpak blok 17, 2016


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Nonsurgical Periodontal Thera

•O%)er %erms +sed %" desri#e %)is !)a%rea%me(%. I(i%ial !eri"d"(%al %)era!*

H*gie(i !)ase

A(%ii('e%i&e !)ase

Ca+serela%ed %)era!*

S"'% %iss+e ma(ageme(%

P)ase 5 %)era!*

E%i"%r"!i !)ase

Pre!ara%"r* %)era!*04/01/2016 kulpak blok 17, 2016


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I(dia%i"(so C)r"(i Peri"d"(%i%is Gi(gi&i%is a(d mild )r"(i !eri"d"(%i%is ma* #e

6i%) ("(s+rgial !eri"d"(%al %)era!* -NSPT al"(e M"dera%e C)r"(i Peri"d"(%i%is a( #e "(%r"lled 6

al"(e '"r ma* "%)ers ma* re0+ire s"me s!"% !es+rger* a'%er NSPT.

o Se&ere C)r"(i Peri"d"(%i%is "(%r"l 6ill !re0+ire %)r"+g) NSPT '"ll"6ed #* !eri"d"(%al

o

!lthough periodontal surger is "re#uentl indicpatients $ith %ore ad&a(ed !eri"d"(%i%is, aperiodontitis patients should undergo nonsurgical petherap prior to periodontal surgical inter&Nonsurgical periodontal therap is "re#uentl succ%ini%i(ing the e)tent o" surger needed'

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Mea(s "' -NSPT7

Pa%ie(% i('"rma%i"( .

Sel' – !er'"rmed !la0+e "(%r"l me%

Scaling and root planning.

Ad$+(%i&e +se "' )emial age(%s.

P"s% – i(i%ial %)era!* re – e&al+a%i"(

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G"als "' NSPT

5. T" "(%r"l %)e #a%erial )alle(ge %"!a%ie(%

8. T" mi(imi9e %)e im!a% "' s*s%emi'a%"rs

:. T" elimi(a%e "r "(%r"l l"al ris; 'a

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C"(%r"l T)e 4a%erial C)alleT" T)e Pa%ie(%

I(%e(si&e %rai(i(g "' %)e !a%iea!!r"!ria%e %e)(i0+es '"r sel'ar!r"'essi"(al rem"&al "' al+l+s de!"s#a%erial !r"d+%s 'r"m %""%) s+r'aes

Rem"&al "' al+l+s de!"si%s a(d #

!r"d+%s "(%ami(a%i(g %)e %""%) s+Cal+l+s de!"si%s AL


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Pers"(al !la0+e "(%r"l

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T""%)#r+s)i(g

•

A( ideal %""%)#r+s) 7• T)e )a(dle si9e #e a!!r"!ia%e %" +ser age a(d de?%eri%*.

• T)e )ead si9e is a!!r"!ria%e %" %)e si9e "' %)e !a%ie(%@s m"+%)

• Use "' e(dr"+(ded (*l"( "r !"l*es%er =lame(%s ("% larger i()es i(

diame%er

•Use "' s"'% #ris%le "(=g+ra%i"(s

• 4ris%le !a%%er(s 6)i) e()a(e !la0+e rem"&al i( %)e a!!r"?ia(d al"(g %)e g+m li(e -Ma(* "' %)e m"der( %""%)#r+s) desig(s re0+ireme(%s

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I(%erde(%al lea(i(g

Pla0+e a+m+la%i"(,gi(gi&al i(>amma%i"(a(d !eri"d"(%al diseaseare m"re !r"("+(edi(%er!r"?imall* %)a( "("%)er s+r'aes

04/01/2016 kulpak blok 17, 2016


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C)emial !la0+e "(%r"

T)e deisi"( %" +se am"+%)6as) is m"re li;el* %" #e!a%ie(% )"ie %)a( li(ial.M"+%)6as)es "+ld als" #e"(sidered i( !a%ie(%s 6)" aremediall* "m!r"mised, )a&e

a )a(dia! %)a% !re&e(%s g""d"ral )*gie(e, )ig)ris; aries!a%ie(%s, "r%)"d"(%i !a%ie(%s,a(d '"r "ral mal"d"+r

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T" mi(imi9e %)e im!a% "' s*s%'a%"rs

•

Cer%ai( s*s%emi diseases "r "(di%i"i(rease %)e ris; "' !eri"d"(%i%is ase&eri%*.

• Pla( m+s% mi(imi9ed %)e im!a% "' s*ris; 'a%"rs

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T" elimi(a%e "r "(%r"l l"al r'a%"rs

•

L"al e(&ir"(me(%al ris; 'a%"rs a( i(%)e ris; "' de&el"!i(g !eri"d"(%l"ali9ed si%es.

• Pla0+e re%e(%i"( i( a si%e all"6 damag%ime %" !eri"d"(%i+m

• L"al e(&ir"(me(%al ris; 'a%"rs s)"elimi(a%ed.

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earning -b.ecti&es

Understand the differences bperiodontal debridement, scaling, root

& de-plaquing

Discuss the goals & rationale for non-s

therapySelect appropriate instruments for peri

debridement

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I(s%r+me(%a%i"( Termi("l"

•

Sali(g i(s%r+me(%a%i"( "' %)e r"6( as+r'aes "' %)e %ee%) %" rem"&e !la0+e, al+s%ai(s

• R""% Pla(i(g %rea%me(% !r"ed+re desirem"&e eme(%+m "r s+r'ae de(%i( %)a% isim!reg(a%ed 6i%) al+l+s, "r "(%ami(a%

%"?i(s "r mir""rga(isms.• Peri"d"(%al de#rideme(% i(l+des i(s%r+me(

e&er* s0+are millime%er "' r""% s+r'ae '"r re!la0+e a(d al+l+s, #+% d"es ("% i(l+deli#era%e, aggressi&e rem"&al "' eme(%+m

• C"(ser&a%i"( "' eme(%+m 6)ile rem"&i(g all al

#i"=lm is %)e g"al "' !eri"d"(%al de#rideme(%.04/01/2016 kulpak blok 17, 2016


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Ra%i"(ale '"r Peri"d"(%aDe#rideme(%

• Arres% %)e !r"gress "' !eri"d"(%al disease

•

I(d+e !"si%i&e )a(ges i( %)e s+#gi(gi&al #a%e-"+(% a(d "(%e(%

• Crea%e a( e(&ir"(me(% %)a% !ermi%s %)e gi(gi&a%" )eal, %)ere'"re elimi(a%i(g i(>amma%i"(

• C"(&er% %)e !";e% 'r"m a( area e?!erie(i(g i(

l"ss "' a%%a)me(% %" "(e i( 6)i) %)e a%%a)me(% le&el remai(s %)e same "r e&e( a%%a)me(%

• Elimi(a%e #leedi(g

• Im!r"&e %)e i(%egri%* "' %iss+e a%%a)me(%

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caling and oot planing

•Scaling is %)e !r"ess #* 6)i)!la0+e a(d al+l+s are rem"&ed'r"m #"%) s+!ragi(g&al a(ds+#gi(gi&al %""%) s+r'aes .

•Root planing means : T)e !r"ess #* 6)i) resid+alem#edded al+l+s a(d !"r%i"( "'eme(%+m are rem"&ed 'r"m %)er""%s %" !r"d+e a sm""%) ,)ard

a(d lea( s+r'ae.04/01/2016 kulpak blok 17, 2016


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T)e "#$e%i&e "' sali(g a(dr""% !la((i(g7

estore gingi&al health

e%o&al o" root sur"ace ele%ent

pla#ue calculus endoto)ine

!rrest the progression o" "urtherperiodontal disease destruction.

caling and root planning

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• Aess %" %)e R""% s+r'ae. The root sur"ace are not eas to

access because i%itation o"penetration o" instru%ents'

I( s+#gi(gi&al aess. scaling and root planing skills is

needed'i( dee! !";e%s 'open procedure %a needed

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• Ul%ras"(i sali(g7

ltrasonic instru%ent ha&e been usedas a &aluable ad.unct to con&entionalhand instru%entation '

•

Uses "' Ul%ras"(i sali(gde&ies 7

1 caling and gingi&al curettage '

2e%o&al o" stains '

3 e%o&e o&erhangs and e)cess

ce%ent04/01/2016 kulpak blok 17, 2016


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C"(%rai(dia%i"(s "' +l%ras"sali(g

Patient $ith cardiac pace%aker '

Patients $ith no$n co%%unicable diseases '

hronic pul%onar isorder '

Porcelain bounded restoration '

Patient $ith Titaniu% i%plant ( plastic-tipped ultrasoniinsert and Tefon-coated sonic scaler tips are available)

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• T)ere 6as (" diere(e #e%6ee( )a(d a

!"6ered i(s%r+me(%a%i"( i( de!"si% rem"&al aim!r"&ed li(ial !arame%ers

(Badersten et al.1981,loos et al . 1987,Laurell et al . 1988)

• T)ere 6as (" diere(e #e%6ee( )a(d a!"6ered i(s%r+me(%s i( %)e %rea%me(% "' lass

'+ra%i"( i(&"l&ed areas , 6)ile !"6eri(s%r+me(%s 6ere m"re ee%i&e %)a( )ai(s%r+me(%s i( lass II a(d III '+ra%i"( d+e smaller %i! si9e

( Matia et al .1986 ,Leon !o"el 1987)

Evidence-based studies in periodoinstrumentation

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• Me%i+l"+s a(d re0+ires

m"re e?!erie(ed "!era%"r.

• Time "(s+mi(g-8%)e%ime (eeded '"r s+rger*

•

Less !redi%a#le i( dee!!";e%s ,'+ra%i"(s a(di(%er!r"?imal gr""&e.

• I(ee%i&e as m"("%)era!* i( %)e %rea%me(% "'aggressi&e !eri"d"(%i%is .

Limitation of scaling and root plan

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• Mig)% a+se de(%i(e )*!erse(si%i&i%* .

•

I(reased %)e ris; "' disease %ra(s- aer"s"l "' %)e !"6ered i(s%r+me(%s .

• P"6ered ma* i(%er'ere 6i%) !aema;ers .

• Pa%ie(% dis"m'"r% .

• C"s% ee%i&e(ess .

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•

S1RP is a( esse(%ial !ar% "' ("(s!eri"d"(%al %)era!* ,*e% d"se ("% re"m!le%e rem"&al "' al+l+s .

• Pa%ie(% m"%i&a%i"( a(d ""!era%i"( is imi( s+ess %rea%me(% "+%"mes .

•

Sel' !er'"rmed OH s)"+ld #e a!!lied rea(d m"di=ed i' (eeded .

• Ree&al+a%i"( !r"&ides a )e; '"r %res+ess a(d !a%ie(%@s le&el "' ""!era%i"(

Summary

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Terima;asi)

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perio non surgery

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