Ultrasonic sanitation — mechanical removal of root deposits of teeth by vibration
Numerous studies prove that the effectiveness of ultrasound use is comparable to the effectiveness of dentition removal by curettes by an experienced clinician. For example, with an initial sounding depth of more than 4 mm, the average decrease in pockets achieved with SRP curettes is 1.2 to 2.3 mm, the result of SRP ultrasound is from 1.7 to 1.9 mm.
At the same time, ultrasound sanation allows to avoid excessive removal of root cement in comparison with using a curette, which can cause hypersensitivity of the teeth during the healing phase. Moreover, the use of ultrasonic devices reduces the time of visit. On the other hand, SRP curettes leave a smoother surface at the micro level, however, according to studies, this difference is not clinically relevant. Studies also show a higher efficiency of ultrasonic devices compared to curettes in the context of the removal of deposits in deep pockets (> 6 mm) and in the treatment of molar fouling, which is explained by the relatively large size of the working part of the curette (the size of the nozzles of ultrasonic devices is usually smaller, penetration into the furcation and to the «bottom» of the pockets).
The results of the studies, in which the effectiveness of using medicines in ultrasound instruments instead of water was evaluated, were contradictory. Most studies show the lack of any benefit from the use of chlorhexidine as an irrigation agent for the cavitron / piezon. According to some studies, at a great depth (more than 7 mm), the result of treatment can be improved with povidone-iodine (PVP-I). A 0.25% concentration of iodine allows the bacteria Porphyromonas gingivalis to be killed in five minutes. Dilute the drug with water to such a concentration (but no more) follows due to unpleasant taste sensations.
One of the problems associated with the use of ultrasound instruments is the formation of aerosols from particles of blood and bacteria within a radius of a couple of meters from the chair. The average time of presence of such aerosols in the air is 30 minutes. Accordingly, the doctor should work in a mask, use a high-speed saliva ejector and ask the patient to rinse the mouth with chlorhexidine before the procedure, which significantly reduces the amount of bacteria in the air. In general, the use of ultrasonic instruments is justified and effective.
In conclusion, we can say that the best results are achieved by periodontists with good manual skills when using a curette in combination with ultrasound devices.
«Local delivery» of antibiotics in the pocket
A variety of drugs have been tested by researchers and clinicians to deliver drugs directly to the pocket: tetracycline fibers, doxycycline in the polymer, chlorhexidine in gelatin matrix, etc. The idea is of interest, since local delivery allows maintaining in the pocket such concentration of the antibiotic, which is several times higher than the concentration , provided by the use of systemic antibiotics. Thus, all the side effects of the latter are excluded.
The most common drug on the local delivery market is Arestin from OraPharma (approximately 95% of the market for such drugs in the US). According to the research, the depth of sounding in pockets deeper than 5 mm decreases by an additional 0.25-0.5 mm. It is generally believed that the results of less than 1 mm decrease in depth of sounding are not of clinical significance. Given the price of the drug and the need for repeated application, the method of «local delivery» is impractical from the point of view of the author and can be reasonably applied only in cases of isolated (single) pockets of about 5 mm.
Systemic antibiotics
As a justification for the use of antibiotics in periodontal diseases, the fact is usually given that the main etiologic factor is bacteria. However, in the treatment of chronic periodontitis, antibiotics are not at all a panacea. Studies show that in order to achieve an effective concentration in the presence of biofilm and subgingival deposits, the concentration of some antibiotics should be 500-700 times higher than that achieved by taking conventional therapeutic doses. Therefore, in order to maximize the effect of antibiotics, a «rupture» of the biofilm and the removal of sediments through SRP is necessary. Hence the sequence of therapy: first SRP, and only then antibiotics, if the situation justifies their use.
Most systematic reviews show that not all antibiotics are equally effective. Even if they are effective, then «the game is worth the candle» only in case of chronic generalized severe periodontitis (that is, it is possible to reduce the probing depth by about 1 mm in pockets deeper than 6 mm in addition to the results achieved with SRP alone).
Сообщение Removal of subgingival dental deposits by ultrasound появились сначала на Имплантация зубов.