We repeat the sequence of treatment of periodontitis.
Periodontal card + diagnosis
Conservative Periodontology (PSA)
Second periodontal card (after 6 weeks), assessment of the results of conservative treatment, decision on the need for surgical treatment / maintenance therapy (paragraph 5).
Surgical treatment: patchwork, removal of hopeless teeth.
Maintenance therapy: sediment removal every 3-6 months (for life), replacement of lost teeth with implants, removable / non-removable dentures.
If we take into account the fact that the cause of periodontitis — subgingival raid, the following patterns become apparent:
the proximal pockets are deeper than the buccal or oral pockets (more plaque accumulates between the teeth);
pockets on molars are usually deeper than pockets on the front teeth, and the pockets of the second molars and wisdom teeth are deeper than the pockets of the first molars, since it is more difficult to clean the distal teeth;
Oral pockets are often deeper than the buccal pockets for the same reason.
Treatment of periodontitis of any severity begins with conservative therapy, namely the removal of supra- and subgingival deposits (SRP — scaling and root planing). Curettes and ultrasonic devices (cavitron, piezon and their analogs) are used to solve this problem. This procedure is performed under local anesthesia, which gives the doctor complete freedom of action: he does not have to worry that he can hurt the patient, which means that he can perform his work more qualitatively. In my clinic PSA is performed by experienced hygienists, if there are none, the parodontologist can also remove the deposits. The specialist performing the PSA should have appropriate training and literally be able to «work with his hands», since the outcome of this procedure depends on the outcome of the entire treatment.
PSA: quadrants
For the convenience of planning treatment, all teeth are divided into quadrants: upper right, upper left, lower right and lower left. Each quadrant has a maximum of 8 teeth. Usually, in order to ensure the proper quality of the PSA and to avoid unnecessary inconvenience to the patient, two quadrants are cleared within one visit: first on the right side (for example, upper right quadrant and lower right), then on the left (upper left and lower left) . This approach avoids the blocking of two lower lunar nerves at once. In addition, the removal of deposits on the sides gives the patient the opportunity to «feel the difference»: after the PSA, many notice a decrease in bleeding gums on the treated side, and this motivates them to continue treatment.
When is anesthesia necessary?
Anesthesia during PSA is required in those cases where the depth of the pockets is 4 + mm, since such situations imply work under the gum. If the pocket depth is 3 mm or less, anesthesia can be avoided.
EWS: process
After applying anesthesia and determining the priority teeth on the periodontal map (teeth with the deepest pockets), you can begin ultrasound treatment with a cavitron / piezon. Particular attention should be paid to furcations of molars and apical areas of root surfaces.
The tip of the piezon / cavitron is parallel to the root and is constantly pressed against its surface. The saliva ejector is located in the patient’s mouth. The presence of an assistant is desirable, but not necessary. The quality of the PSA depends primarily on the manual skills and scrupulousness of the operator, as well as on the time spent on processing each tooth. The dependence is simple: the more time is spent, the more deposits are removed.
If the pocket depth is 3 mm or less, you can limit yourself to supragingival removal. Where pockets are deeper, more time is needed. Special attention should be paid to the proximal surfaces of the roots, where the pockets are the deepest, and also to the areas of furcation of molars. The thinner the tip of the cavitron / piezon, the better the result of processing in the field of furcations and in deep pockets.
A more effective tool is a thin piezo tip with a diamond coating:
Typically, the supragingival stone is yellow, and subgingival — brown, brown (colored with pigmented blood). Very often the subgingival tartar firmly fuses with the root surface and requires certain skills and some effort to remove. Therefore, the second stage is the application of the curette. The working part of the curette is located at an angle of 70 degrees to the surface of the root. Curettes should be sharp and sharpened (recommendations for sharpening the curette see in this clip), otherwise the stone «rubbed» into the surface of the roots, and not cut with the surface layer of cement.
It should be remembered that excessive removal of cement leads to a temporary increase in tooth sensitivity after PSA. In this connection, the adequacy of the efforts of the periodontist / hygienist to the task facing him is of particular importance. After the procedure, it is necessary to warn the patient about possible temporary hypersensitivity of the teeth. It can last for several days and even weeks.
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Removal of deposits by the curette under the gum
A — input of the curette, blade level with the tooth.
B — working angle (from 45 to 90 degrees) is determined at the base of the pocket.
C — pressure (side) and displacement of the blade towards the crown, the result of motion — removal of sediments.
The cracks of Gracie are optimal for such work. They have different versions, each of which is designed for certain surfaces of certain teeth. For example, Gracie 13/14 curets are designed for the distal surfaces of the lateral teeth.
Сообщение Algorithm for the treatment of periodontitis появились сначала на Имплантация зубов.