NON SURGICAL

PERIODONTAL THERAPY
Drg. Ade Ismail A. K., MDSc., Sp.Perio

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Objectives Of Periodontal
Therapy

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Establish
health
Restore
function
Preserve
helath
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Overall Treatment Plan

Preliminary phase
Phase I therapy
Re-evaluation
Phase II therapy (surgical phase)
Phase III therapy (restorative
phase)
Phase IV therapy (supportive
periodontal therapy)
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Periodontal therapy can be divided

into three but frequently
overlapping phases .
The cause related phase (non surgical
periodontal therapy).
The corrective phase ( periodontal surgery).
The maintenance phase (supportive periodontal
therapy).
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Phase I Therapy
(Etiotropic/ Initial Phase)
Plaque control / Oral Hygiene Instruction
Diet control
Scaling and root planing/scale & polish
Caries control
Endodontic therapy
Occlusal therapy
Minor tooth movement
Provisional splinting
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PERIODONTAL THERAPY
NON SURGICAL

SURGICAL
Curettage

Scaling
Root Planing
Splinting
Occlusal therapy
Local Drug Delivery

Gingivectomy
Abscess Drainage
Flap Surgery
Bone Grafts
GTR procedures
Root coverage procedures
Implant

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Aesthetic surgeries

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Nonsurgical Periodontal Therapy

Other terms used to describe this phase of
treatment.
Initial periodontal therapy
Hygienic phase
Anti-infective phase
Cause-related therapy
Soft tissue management
Phase 1 therapy
Etiotropic phase
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Preparatory therapy

Indications

o Chronic Periodontitis

Gingivitis and mild chronic periodontitis may be controlled

with nonsurgical periodontal therapy (NSPT) alone
Moderate Chronic Periodontitis can be controlled with NSPT
alone for may others may require some spot periodontal
surgery after NSPT.

o Severe Chronic Periodontitis control will probably

require through NSPT followed by periodontal surgery.
o Although periodontal surgery is frequently indicated for
patients with more advanced periodontitis, all chronic
periodontitis patients should undergo nonsurgical periodontal
therapy prior to periodontal surgical intervention.
Nonsurgical periodontal therapy is frequently successful in
minimizing the extent of surgery needed.
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Means of (NSPT):
Patient information .
Self performed plaque control methods.
Scaling and root planning.
Adjunctive use of chemical agents.
Post initial therapy re evaluation.

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Goals of NSPT
1. To control the bacterial challenge to the
patient
2. To minimize the impact of systemic
factors
3. To eliminate or control local risk factors

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Control The Bacterial Challenge

To The Patient
Intensive
training
of
the
patient
in
appropriate techniques for self-care and
professional removal of calculus deposits and
bacterial products from tooth surfaces
Removal of calculus deposits and bacterial
products contaminating the tooth surfaces.
Calculus deposits ALWAYS are covered with
living bacterial biofilms that are associated
with continuing inflammation if not removed.
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Personal plaque control

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Toothbrushing
An ideal toothbrush :
The handle size be appropiate to user age and dexterity.
The head size is appropriate to the size of the patients mouth
Use of end-rounded nylon or polyester filaments not larger than 0.009
inches in

diameter
Use of soft bristle configurations
Bristle patterns which enhance plaque removal in the approximal spaces
and along the gum line (Many of the modern toothbrush designs fulfill these
requirements )

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Interdental cleaning
Plaque
accumulation,
gingival
inflammation
and periodontal disease
are more pronounced
interproximally than on
other surfaces

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Chemical plaque control

The
decision
to
use
a
mouthwash is more likely to be
patient choice than clinical.
Mouthwashes could also be
considered in patients who are
medically compromised, have
a handicap that prevents good
oral hygiene, highrisk caries
patients, orthodontic patients,
and for oral malodour

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To minimize the impact of systemic

factors

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Certain systemic diseases or conditions can

increase the risk of periodontitis and the
severity.
Plan must minimized the impact of systemic
risk factors

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To eliminate or control local risk

factors

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Local environmental risk factors can increase

the risk of developing periodontitis in
localized sites.
Plaque retention in a site allow damage over
time to periodontium
Local environmental risk factors should be
eliminated.

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Learning Objectives
Understand
the
differences
between
periodontal debridement, scaling, root planing
& de-plaquing
Discuss the goals & rationale for non-surgical
therapy
Select appropriate instruments for periodontal
debridement
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Instrumentation Terminology
Scaling = instrumentation of the crown and root
surfaces of the teeth to remove plaque, calculus, and
stains
Root Planing = treatment procedure designed to
remove cementum or surface dentin that is rough,
impregnated with calculus, or contaminated with
toxins or microorganisms.
Periodontal debridement = includes instrumentation of
every square millimeter of root surface for removal of
plaque and calculus, but does not include the
deliberate, aggressive removal of cementum
Conservation of cementum while removing all calculus and
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biofilm is the goal of periodontal

Rationale for Periodontal

Debridement
Arrest the progress
of periodontal disease
Induce positive changes in the subgingival bacterial flora
(count and content)
Create an environment that permits the gingival tissue
to heal, therefore eliminating inflammation
Convert the pocket from an area experiencing increased
loss of attachment to one in which the clinical
attachment level remains the same or even gains in
attachment
Eliminate bleeding
Improve the integrity of tissue attachment
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Scaling and Root planing

Scaling

is the process by which

plaque and calculus are removed
from both supragingval
and
subgingival tooth surfaces .

Root planing means :

The process by which residual
embedded calculus and portion of
cementum are removed from the
roots to produce a smooth ,hard
and clean surface.
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Scaling and root planning

The objective of scaling and
root planning:
Restore gingival health
Removal of root surface element
(plaque - calculus - endotoxine)
Arrest the progression of further
periodontal disease destruction.
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 Access to the Root surface.

The root surface are not easy to
access because Limitation of
penetration of instruments.

In subgingival access.
scaling and root planing skills is
needed.

in deep pockets .
open procedure may needed

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 Ultrasonic scaling:
Ultrasonic instrument have been used
as a valuable adjunct to conventional
hand instrumentation .

Uses of Ultrasonic scaling

devices :
1- Scaling and gingival curettage .
2-Removal of stains .
3- Remove overhangs and excess
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cement

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Contraindications of ultrasonic
scaling
Patient with cardiac pacemaker .
Patients with Known communicable diseases .
Chronic pulmonary Disorder .
Porcelain bounded restoration .
Patient with Titanium implant ( plastic-tipped ultrasonic and sonic
insert and Teflon-coated sonic scaler tips are available)

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Evidence-based studies in periodontal

instrumentation
There was no difference between hand and
powered instrumentation in deposit removal and
improved clinical parameters
(Badersten et al.1981,loos et al . 1987,Laurell et al . 1988)

There was no difference between hand and

powered instruments in the treatment of class I
furcation involved areas , while powered
instruments were more effective than hand
instruments in class II and III furcation due to
smaller tip size
( Matia et al .1986 ,Leon &Vogel 1987)

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Limitation of scaling and root planing

Meticulous
and requires
more experienced operator
.
Time
consuming(2the
time needed for surgery)
Less predictable in deep
pockets
,furcations
and
interproximal groove.
Ineffective
as
mono
therapy in the treatment of
aggressive periodontitis .
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 Might cause dentine hypersensitivity .

Increased the risk of
disease transmission
( aerosol of the powered instruments ).
Powered may interfere with pacemakers .
Patient discomfort .
Cost effectiveness .
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Summary
S/RP is an essential part of non-surgical
periodontal therapy ,yet dose not result in
complete removal of calculus .
Patient motivation and cooperation is important
in success treatment outcomes .
Self performed OH should be applied regularly
and modified if needed .
Re-evaluation provides a check for treatment
success and patients level of cooperation .
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Terimakasih

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