Various Nonsurgical Procedures For The Pocket Eradication

Various Nonsurgical Procedures For The Pocket Eradication

• Scaling and root planning
• Use of chemotherapeutic agents
• Laser therapy
• Hyperbaric oxygen therapy
• Photodynamic therapy

Scaling and Root Planing

• Primary objective of scaling and root planning is to regain gingival health by completely removing elements that are responsible for the gingival inflammation (i.e., plaque, calculus, and endotoxins) in the oral environment.
• Both hand instruments and ultrasonic instruments are capable of dramatically reducing the numbers of subgingival microorganisms.
• Scaling and root planning procedure resolve the inflammatory process and gingiva shrinks which reduces the pocket depth.
• After scaling and root planning, maintenance and recall visits are necessary.

Uses of Chemotherapeutic Agents

• Effects of mechanical therapy might be augmented using antimicrobial agents which further suppress the remaining pathogens.
• Many chemotherapeutic agents are now available treating periodontal diseases. Systemic anti-infective therapy (oral antibiotics) and local anti-infective therapy (placing anti infective agents directly into the periodontal pocket) can reduce the bacterial challenge to the periodontium.

Four generations of antiseptics that includes:

• 1 generation: Antibiotics, phenols, quaternary ammonium compounds, and sanguinarine
• 2 generation: Bisbiguanides, bipyridines, quaternary ammonium compounds, phenolic compounds, metalions, halogens, enzymes, surfactants, oxygenating agents, natural products, urea, amino alcohols, salifuor, and agents that increases the redox potentials
• 3 generation: Effective against specific periodontogenic organisms
• 4 generation: Probiotics are incorporated in mouthwashes.
  • Combination of metronidazole and amoxicillin has been found to produce more pocket depth reduction than control medication.
  • Most commonly used antibiotics for periodontal organisms are metronidazole, amoxicillin, tetracycline, clindamycin, azithromycin, ciprofloxacin, and augmentin.
  • Two daily rinses with 10 mL of 0.2% aqueous solution of chlorhexidine digluconate almost completely inhibit the development of dental plaque, calculus and gingivitis. This helps in elimination of periodontal pocket.

Laser Therapy

• Laser irradiation has been reported to exhibit bactericidal, and detoxification effects without producing a smear layer and root surface treated with laser may, therefore, provide favorable conditions for the attachment of periodontal tissue.
• Although there is no clear evidence to date that laser applications improve clinical outcome due to the action of curettge, laser treatment has a potential advantage of accomplishing soft tissue wall treatment effectively along with root surface debridement, and should be further investigated.

Hyperbaric Oxygen Therapy

• This method of administering pure oxygen at greater than atmospheric pressure to a patient to improve or correct conditions.
• Hyperbaric oxygen therapy should be used to compliment conventional therapies and treatments.
• It is showed that hyperbaric oxygen therapy combined with supragingival and subgingival scaling therapy had synergistic action on periodontitis.
• Hyperbaric oxygen therapy had good therapeutic effects on human severe periodontitis, the effects can keep more than 1 year.

Photodynamic Therapy

Photodynamic Therapy is found that scaling and root planning combined with photodisinfection leads to signifiant improvements of the investigated parameters over the use of scaling and root planning alone and this helps in elimination of periodontal pockets.

Question 8. Write differences between suprabony and infrabony periodontal pocket.
Answer.