This document compares surgical and non-surgical periodontal treatments. Non-surgical treatments include scaling, root planing, and maintaining good oral hygiene, while surgical treatments are needed for more advanced cases and include procedures like gum grafts and bone reconstruction. Both approaches aim to reduce bacteria and treat gum disease, but surgery provides better access for deep cleaning and repair of damaged tissue. The choice depends on the severity of the condition, with mild cases treated non-surgically and more advanced cases involving surgery. Overall, both approaches can be effective if followed by good oral hygiene, but surgery may be needed for inaccessible areas of the mouth.
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A simple discussion regarding the differences of Surgical and Non-surgical Periodontics in yielding healthier gums
This document compares surgical and non-surgical periodontal treatments. Non-surgical treatments include scaling, root planing, and maintaining good oral hygiene, while surgical treatments are needed for more advanced cases and include procedures like gum grafts and bone reconstruction. Both approaches aim to reduce bacteria and treat gum disease, but surgery provides better access for deep cleaning and repair of damaged tissue. The choice depends on the severity of the condition, with mild cases treated non-surgically and more advanced cases involving surgery. Overall, both approaches can be effective if followed by good oral hygiene, but surgery may be needed for inaccessible areas of the mouth.
This document compares surgical and non-surgical periodontal treatments. Non-surgical treatments include scaling, root planing, and maintaining good oral hygiene, while surgical treatments are needed for more advanced cases and include procedures like gum grafts and bone reconstruction. Both approaches aim to reduce bacteria and treat gum disease, but surgery provides better access for deep cleaning and repair of damaged tissue. The choice depends on the severity of the condition, with mild cases treated non-surgically and more advanced cases involving surgery. Overall, both approaches can be effective if followed by good oral hygiene, but surgery may be needed for inaccessible areas of the mouth.
Dominguez, Isabel Beatrice Buela, John Christian Dianati, Maryam Esteban, Royce Albert Guarin, Francis James Mashalian, Dara Pastores, Reginald Dwight Pauco, Allen Posada, Reagan Shiroudeskandari, Fatemeh
Dr. Yvonne Vanessa Chua
Introduction
Periodontal treatment, as we all know, constitutes an array of procedures that are needed for the betterment of the surrounding structures of the tooth. Procedures are grouped into two ways in which a dental practitioner may control periodontal disease; the Non-Surgical and the Surgical modes of treatments In this brief report, we will discuss the numerous procedures and treatment modalities done in both groups and compare the advantages and disadvantages of each.
Non-Surgical Periodontal Treatment Non-Surgical Periodontal Treatment is considered as a non-invasive way to handle periodontal disease which deals with less damage to surrounding tooth structure. Treatment methods depend upon the type of disease and how far the condition has progressed. Many times, the early stages of periodontal disease are best treated with non- surgical periodontal therapy. AAP treatment guidelines stress that periodontal health should be achieved in the least invasive and most cost-effective manner. This is often accomplished through non- surgical periodontal treatment. Non-surgical periodontal treatment does have its limitations. When it does not achieve periodontal health, surgery may be indicated to restore periodontal health. The following are treatment protocols classified under Non-Surgical Periodontal treatment
Plaque Control Mechanical plaque control, as measured by the oral hygiene effort of the individual patient, is the most important predictive factor in determining the overall prognosis of the treatment therapy. It is very critical in every phase of therapy that plaque control must be maintained and preferrably with plaque free result. It is an effective way of treating and preventing gingivitis, periodontitis, and perhaps any microbial etiology disease as related to oral health. (Bui, D; 2001) Supra/Subgingival Scaling (SRP) Scaling and root planing is a careful cleaning of the root surfaces to remove plaque and calculus [tartar] from deep periodontal pockets and to smooth the tooth root to remove bacterial toxins. Scaling and root planing is often followed by adjunctive therapy such as local delivery antimicrobials and host modulation, as needed on a case-by-case basis. Most periodontists would agree that after scaling and root planing, many patients do not require any further active treatment. However, the majority of patients will require ongoing maintenance therapy to sustain health. Exodontia the removal of a tooth from themouth. Extractions are performed for a wide variety of reasons, including tooth decay that has destroyed enough tooth structure to render the tooth non-restorable. Endodontics The dental specialtyconcerned with the study and treatment of the dental pulp. Endodontists perform a variety of procedures including endodontic therapy (commonly known as "root canal therapy"),endodontic retreatment, surgery, treating cracked teeth, and treating dental trauma. Root canal therapy is one of the most common procedures. If the dental pulp (containingnerves, arterioles, venules, lymphatic tissue, and fibrous tissue) becomes diseased or injured, endodontic treatment is required to save the tooth. Occlussal Adjustments Occlusal adjustment is the scientific grinding and/or reshaping of the occluding surfaces of teeth to develop and improve upon their harmonious relationships between each other, their supporting structures, muscles of mastication, and temporomandibular joints. Temporizations Minor Tooth Movement Re-Evaluation Re-evaluation is done as a routine check-up to schedule patients according to the need of recall and the severity of the disease. Some patients may need more routine check-ups than most. Advantages and Disadvantages Mainly non-invasive, technique sensitive with a more hectic recall schedule and monitoring. When nonsurgical therapy has been insufficient in controlling inflammation and disease progression in periodontal patients, it is time to call in the specialist for periodontal surgery. An indication for immediate referral is when the extent, severity, and progression of the disease are so severe the general dentist knows scaling and root planing alone will not combat the disease process and the treatment modalities will far exceed what can be achieved through nonsurgical periodontal therapy. (Illyes, K; 2000)
Examples
Scaling and Root Planing
Surgical Periodontal Treatment In advanced cases of periodontal disease, the first line of treatment, scaling and root planing, combined with excellent home care to keep new bacterial deposits from forming, is sometimes not enough to bring the disease under control. In some cases, periodontal surgery is necessary. Surgery is only rarely needed to control periodontal diseaseHowever, when there is periodontal disease, and the gum has unzipped so far down the root of the tooth that dental instruments are no longer effective (about 5-6 millimeters), periodontal surgery may be necessary. If not done, the bacterial deposits will remain on the tooth and cause further bone destruction; ultimately causing the teeth to develop painful abscesses or simply to loosen and fall out. The following procedures are classified as Surgical periodontal procedures Orthodontic Treatment Periodontal Surgery o Periodontal Flap Surgery o Mucogingival Surgery o Regenerative Surgery o Implant Surgery Continuation of Endodontic Therapy Reevaluation of Teeth and Periodontium Implant Surgery and Final Restoration Advantages and Disadvantages General consideration for periodontal surgery comprise patient age and status of the dentition including importance of the tooth, amount of attachment/bone present, probing depth, and long term prognosis. Three advantages for periodontal surgery consist of access to enhance root debridement, particularly in multi-rooted teeth, improved access for plaque control by the patient during home care, and esthetic improvement for certain types of procedures (root coverage grafting). Periodontal surgeries are not indicated for all patients even with advanced periodontal disease. Contraindications include uncontrolled medical conditions such as unstable angina, uncontrolled hypertension, uncontrolled diabetes, myocardial infarction or stroke within 6 months; poor plaque control; high caries rate; and unrealistic patient expectations or desires. (Illyes, K; 2000) Examples Gingivectomy Osseous Surgery Guided Tissue Regeneration
Crown Lengthening Procedure
Indications for Surgical Procedures Periodontal Flap surgery For management of periodontitis Mucogingival surgery For correcting periodontal defects Regenerative surgery For regenerating periodontal structures
Factors that influence the response to surgery - Medical Conditions - Psychological Conditions - Smoking - Poor oral health - Morphology - Aggressive Periodontitis
Detailed Comparison A study according to Al-Shammari, K et. al was able to tabulate and compare both procedures according to different studies across the globe
In this table the different surgical techniques sited were compared in years as to the outcome of the treatment in 1 to 5 years time as indicated. The author collected data from both Sweden and Denmark. The results show that, Apically Positioned Flap, Modified Windman Flap alongside Scaling and Root Planing with or without Osseous Recontouring results in an overall gain in Clinical Attachment Level and better Oral Health as well as reduction of Pocket Depths within the span of 2-5 years.
This table mentions the significant comparison of surgical and non surgical, which basically share almost the same results and product of therapy.
Indications and Contraindications Indications for Surgical Technique Age: < 40 (The younger generation) Pockets: > 7 mm Fibrous gingiva/ Deep Pockets Hyperplastic gingiva Furcations > Class II Restricted access to root anatomy Failure of previous SRP Calculus: Diffuse/Embedded Hypercementosis Contraindications for Surgical Technique Age: > 70 (The older generation) Poor Oral Hygeine Smoking: > 2 Packs Pockets < 6 mm Refractory disease Indications for Non-Surgical Technique Poor Oral Hygeine Smoking: > - 2 Packs Significant Systemic Disease Pockets: < 6 mm Significant systemic disease Inflammed edematous gingiva Contraindications for Non-Surgical Technique Fibrous gingiva/deep pockets Hyperplastic gingiva Hypercementosis Hard to reach calcular infiltration Difficult tooth morphology
Conclusions: Is periodontal surgery better than non-periodontal surgery? In molar furcations, premolar grooves and inaccessible anterior sites which may not respond well to conservative scaling, however; with good oral hygiene, good oral debridement may be able to make the conservative approach more successful. Surgery results in greater short-term probing depth compared to non-surgery, however, the probing depth advantage is lost over time. In shallow pockets, surgery creates greater loss of attachment compared to non-surgery.
References Al-Shammari, K et. al (2002). Surgical and Non-surgical Treatment of Chronic Periodontal Disease. International Chinese Journal of Dentistry . Retrieved February 6, 2014 Illyes, K., (2000). Non-Surgical Periodontal Therapy. to: University of Tennessee Health Science Center Caranza, Newman. Textbook of clincal periodontology. Eighth edition. WB Saunders, 1996. Grant, Stern, Listgarten. Textbook of Periodontics. Sixth Edition. The C.V. Mosby Company, 1988. Genco, R., Goldman, H., Cohen, W. Contemporary Periodontics. The C.V. Mosby Company , 1990.
Endodontic Topics Volume 31 Issue 1 2014 (Doi 10.1111/etp.12066) Baba, Nadim Z. Goodacre, Charles J. - Restoration of Endodontically Treated Teeth - Contemporary Concepts and