Download Chapter 29

Periodontics and Coronal
Polish
Chapter 29
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Periodontal Team
• Periodontist
– Screens patient and
coordinates with
dentist
• Dental assistants
• Dental hygienists
– Cleaning
– Examinations
• Business office staff
– Room preparation
– Chairside assisting
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Dental Assistant’s Role
• Periodontal dressing
placement and
removal
• Sutures removal
• Coronal polish
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Radiographs
Impressions
Fluoride treatments
Patient education
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Periodontal Disease
• Symptoms:
– Bleeding or inflamed gums
– Periodontal pockets
– Malocclusion
– Halitosis
– Tissue recession
– Abnormal contour
– Pain, tenderness, and discoloration
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Causes of Periodontal Disease
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Local irritants
Poor oral hygiene
Improper nutrition
Malocclusion
Stress
• Systemic factors
– Hormonal imbalance
– Diseases
– Medications
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Classification of Periodontal
Disease
• Gingivitis
– Plaque-induced
– Non-plaque-induced
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Classification of Periodontal
Disease
• Periodontitis
– Chronic
• Necrotizing ulcerative gingivitis (NUG)
– Inflamed gingiva, metallic taste, bad breath,
pain, and tissue hemorrhage
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Classifications of Periodontal
Disease
Unhealthy tissue
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Sublingual calculus
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Dental Check
• What is the condition of recession of
periodontal fibers and resulting
inflammation and destruction of bone?
– Periodontitis
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Periodontal Diagnostic
Procedures
• Medical dental history
– Questionnaire should include:
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Chief complaints
Medical history
Oral history
Oral habits
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Extraoral Examination
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Intraoral Examination
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Periodontal Examination
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Plaque
Periodontal probes
Tooth mobility
Furcation involvement
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Periodontal Examination
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Appearance of gingiva
Bleeding/suppuration
Recession
Gingival cleft
Occlusion
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Periodontal Screening and
Recording
• Indicates need for partial or full periodontal
evaluation
– Early detection
– Timely screening
– Patient education
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Radiograph Interpretation
Vertical bone loss
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Horizontal bone loss
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Chemotherapeutic Agents
• To aid patients who do not respond well to
removal of dental deposits or aggressive
form of periodontitis
– Antibiotics
• Penicillin, Tetracycline, Erythromycin, or
Clindamycin
– Anti-inflammatory
• Ibuprofen, Acetylsalicylic acid (aspirin)
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Presentation of Treatment Plan
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Form treatment plan
Schedule appointment
Educate patient
Make financial arrangements
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Periodontal Instruments
• Instrument
sharpening
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– Manual and
mechanical methods
• Periodontal probes
– Calibration needed
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Periodontal Instruments
• Explorers
– Adapt to curves and
tooth surfaces
• Curettes
– Universal
– Gracey
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©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned,
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Periodontal Instruments
• Scalers remove
hard deposits
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Sickle
Jacquette
Chisel
Hoe
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Periodontal Instruments
• Files remove calculus
• Ultrasonic instrument
– High-powered
vibrations with water
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Periodontal Instruments
• Air polishing systems
– Remove extrinsic stain, plaque, and small
debris
– Fine powder abrasive air delivered under
pressure through nozzle
• Fine powdered sodium bicarbonate
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Periodontal Instruments
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Periodontal knives
Interdental knives
Peritomes
Surgical scalpel
Electrosurgery
Courtesy of Hu-Friedy Mfg., Co., Inc.
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Periodontal Instruments
• Pocket marking pliers
• Periosteal elevators
• Periodontal scissors,
rongeurs, and forceps
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Instrumentation Techniques
Supragingival
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Subgingival
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Lasers
• Precise beam of concentrated light energy
• Efficiency based upon absorption rate of
wavelengths
• Dentist must be trained and qualified to
use
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Lasers
• Uses:
– Debridement and curettage
– Gingivectomy
– Gingivoplasty
– Frenectomy
– Tumor and lesion removal
– Implant exposure
– Aphthous ulcer treatment
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Lasers
• Uses:
– Tissue fusion
– Elimination of granulation tissue
– Biopsy
– Crown lengthening
– Control bleeding
– Osseous procedures
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Lasers
• Benefits:
– Bloodless operating
field
• Improves vision
– Minimal to no
anesthesia
– Minimal swelling and
discomfort
– Improved coagulation
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©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned,
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Lasers
• Benefits:
– Minimal healing time
– Reduction of tissue
damage and infection
– Accuracy
– Less time
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copied, duplicated, or posted to a publicly accessible website, in whole or in part.
Dental Check
• For what are periotomes used?
– To sever the peridontal ligament prior to
atraumatic extractions and to prepare tissue
for dental implants
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Nonsurgical Procedures
• Occlusal adjustments
– Teeth occlude evenly
• Scaling and polishing
– Removal of plaque
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Instrument Placement for Scaling
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Nonsurgical Procedures
• Root planing
– Scraping of root surfaces
• Gingival curettage
– Soft-tissue curettage scraping
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Preoperative Instruction
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Confirm patient understands procedure
Explain procedure and answer questions
Confirm patient has prepared as instructed
Instructions if patient is to receive
intravenous (IV) sedation
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Surgical Periodontal Procedures
• Gingivectomy
– Surgical removal of diseased gingival tissue
• Gingivoplasty
– Reshaping of gingival tissues
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copied, duplicated, or posted to a publicly accessible website, in whole or in part.
Gingivectomy Procedure
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©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned,
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Surgical Periodontal Procedures
• Periodontal flap surgery
– Separation of gingiva and underlying tissue
Both images courtesy of Dr. Gary Shellerud
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copied, duplicated, or posted to a publicly accessible website, in whole or in part.
Surgical Periodontal Procedures
• Osseous surgery
– Reshaping of bone
• Mucogingival surgery
– Reconstructive surgery on gingiva and
mucosal tissues
– Covers exposed roots
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Surgical Periodontal Procedures
• Gingival grafting
– Tissue graft from
palate
– Donor site dressed
• Frenectomy
– Complete removal of
frenum
Courtesy of Dr. Gary Shellerud
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copied, duplicated, or posted to a publicly accessible website, in whole or in part.
Surgical Periodontal Procedures
• Guided tissue regeneration
– Uses barrier membranes to maintain space
between gingival flap and root surface
– Prevents interference of cells forming new
structures
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Periodontal Dressing
• Types:
– Zinc oxide eugenol
– Noneugenol
– Light-cured
– Gelatin-base
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Periodontal Maintenance
Procedures
• Patient must be committed to ongoing
therapy
• Maintain plaque control
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Advanced Chairside Functions
• Coronal polish
– Removal of soft deposits and extrinsic stains
• Rubber prophy cup
• Prophy brush
• Abrasives
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Coronal Polish Rationale
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Easier to keep teeth clean
Motivates patient to maintain
Slows accumulation of new deposits
Better absorption of fluoride
Prepares tooth for other procedures
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Contraindications and
Modifications
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Orthodontic appliances
Hypersensitive teeth
Green chromogenic bacterial stain
Minor oral irritations
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Dental Deposits
• Soft deposits
• Calculus
• Stains
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Intrinsic Stains
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Dental fluorosis
Pulp damaged or non-vital tooth stain
Tetracycline stain
Metallic stain
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Extrinsic Stain
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Yellow and brown stains
Tobacco stain
Green stain
Black line stain
Orange stain
Chlorhexidine stain
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Abrasives and Polishing Agents
• Abrasives
– Powders or pastes used to remove soft
deposits on teeth
– Many varieties
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Equipment and Supplies
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Handpiece
Abrasives
Rubber prophy cup
Prophy brush
Dental tape or floss
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Maintaining the Operating Field
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Free of saliva and debris
Maximum light
Maintain patient comfort
Maintain proper positioning
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Auxiliary Polishing Aids
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Bridge threaders
Abrasive polishing strips
Soft wood points
Interproximal brushes
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