surgical vs non-surgical approach in periodontics

8/12/2019 Surgical vs Non-Surgical Approach in Periodontics

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Surgical vs. Non-Surgical Periodontal Treatment

A Comparative Report

DHB

Endo-Perio SS

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


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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 Peri odontal 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 notachieve periodontal health, surgery may be

indicated to restore periodontal health. The

following are treatment protocols classified

under Non-Surgical Periodontal treatment


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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 atooth from themouth.Extractions are performed for a

wide variety of reasons, includingtooth decay that has destroyed enough

tooth structure to render the tooth non-restorable.

Endodontics

Thedental specialtyconcerned with the study and treatment of thedental

pulp.Endodontists perform a variety of procedures includingendodontic

therapy (commonly known as "root canal therapy"),endodontic
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retreatment,surgery, treatingcracked teeth,and treatingdental trauma.

Root canal therapy is one of the most common procedures. If thedental

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 D isadvantages

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)
http://en.wikipedia.org/wiki/Endodontic_retreatmenthttp://en.wikipedia.org/wiki/Cracked_tooth_syndromehttp://en.wikipedia.org/wiki/Dental_traumahttp://en.wikipedia.org/wiki/Dental_pulphttp://en.wikipedia.org/wiki/Dental_pulphttp://en.wikipedia.org/wiki/Nervehttp://en.wikipedia.org/wiki/Arterioleshttp://en.wikipedia.org/wiki/Venuleshttp://en.wikipedia.org/wiki/Lymphatic_tissuehttp://en.wikipedia.org/wiki/Lymphatic_tissuehttp://en.wikipedia.org/wiki/Venuleshttp://en.wikipedia.org/wiki/Arterioleshttp://en.wikipedia.org/wiki/Nervehttp://en.wikipedia.org/wiki/Dental_pulphttp://en.wikipedia.org/wiki/Dental_pulphttp://en.wikipedia.org/wiki/Dental_traumahttp://en.wikipedia.org/wiki/Cracked_tooth_syndromehttp://en.wikipedia.org/wiki/Endodontic_retreatment


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Examples

Scaling and Root Planing

Surgical Per iodontal Tr eatment

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 abscessesor 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


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Advantages and Di sadvantages

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


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Osseous Surgery

Gui ded Tissue Regenerati on


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Crown Lengthening Procedure

Indications for Surgical Procedures

Periodontal Flap surgery For management of periodontitis

Mucogingival surgeryFor correcting periodontal defects

Regenerative surgeryFor regenerating periodontal structures

Factors that influence the response to surgery

- Medical Conditions

- Psychological Conditions

- Smoking

- Poor oral health

- Morphology

- Aggressive Periodontitis


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Detailed Comparison

A study according toAl-Shammari, K et. alwas 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.


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This table mentions the significant comparison of surgical and non surgical, which


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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


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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.

surgical vs non-surgical approach in periodontics

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