Related Articles:

Independent Two Month Study on Oral Irrigation

Special Report: Oral Irrigation

Crimes We Commit Against Our Breath

Bad Breath Curable or Only Preventable

Shocking truth: Commercial tooth pastes bad for you

A healthy smile along the way

Oral Breeze Products - 14 days to healthier gums

The Highway to Health

A New Twist in Prevention

Heart Disease Diagnosis by Dentist?

Whose teeth are these anyway?

Basic Periodontal Pathology


NON-SURGICAL TREATMENT

Basic Periodontal Pathology

  1. 2-8 hours following scaling and rootplaningImmediately following non-surgical treatment, undertaken as recommended under local anaesthesia and using around 5 to 8 minutes on each single-rooted tooth, the pocket epithelium as well as most of the remaining junctional epithelium have been unintentionally removed. Part of the connective tissue lateral to the dentogingival epithelium is also curetted away. These effects are similar for both the hand and machine driven scaling instruments. Strands of epithelium may remain in certain areas of the connective tissue surface. The treatment thus result in that a connective tissue wound is created lateral to the tooth. A surface zone of approximately 0.2 mm necrotize in the healing process. On the surface of the necrotic zone layer of leukocytes accumulate. These cells provide a protection against bacterial attack and also mediated some of the healing events. Soon after wounding the epithelium starts to proliferate to cover the connective tissue. The proliferation takes places from the gingival margin and from surviving strands om epithelium on the wound surface. Current studies have documented that islands of calculus and subgingival plaque may remain on the rootsurface following even careful subgingival scaling and rootplaning. Also bacteria may have invaded dentinal tubuli.The remaining subgingival bacteria are one of the biological reasons for the need of supportive treatment postoperatively. (Click image to enlarge.)

  2. 8-24 hours post scaling and rootplaningBetween 8-24 hours post treatment dramatic changes take place in the connective tissue, in the remaing epithelium and in the blood clot between the tooth surface and the soft tissue. Mediators for inflammation are released, cell proliferation is initiated and the blopd clot start to disintegrate. Current studies indicate that remnants of subgingival calculus invariably are present as well as portions of subgingival plaque. In addition it is likely that living bacteria are still present in dentinal tubules.The presence of living bacteria subgingivally post treatment is probably one of the reasons for the need of supportive treatment in most cases of periodontal disease.

    The leukocyte band forming lateral to the surface necrosis of the connective tissue provide protection against frank invasion of bacteria into the connective tissue in this phase of the healing process. The epithelium proliferation to cover the connective tissue takes place in a zone just below the leukocyte band and the surface necrosis of the connective tissue. The leukocyte band provide the function of a temporarily epithelium during the healing process. (Click image to enlarge.)

  3. 7 days after scaling and rootplaningAfter about 7 days most of the connective tissue is covered with epithelium and a new epithelial attachment has formed against the tooth surface. In uncovered areas the leukocytes constitute the barrier towards the environment of the subgingival space. Studies have shown that it is practically impossible to clean the subgingival space from all bacteria and remove all calculus. Inflammatory process and bacterial proliferations therefore continue but on a level which is difficult to observe clinically. However these processes requires that the self cleaning mechanisms of the dentogingival region are optimal. Clinically one must therefore avoid procedures which might interfere with the drainage from the area. Ill-fitting temporary appliances may be one common cause for complications following treatment which leaves deep probing depths postoperatively. Also the demand for drainage at times requires adjustment of the root anatomy, for example at furcation involved teeth. (Click image to enlarge.)

  4. 14 - 90 days after scaling and rootplaningOver time the healing proceed and the tissue condition gradually normalize. The initial healing is rapid while the maturation of the tissue takes time and remodelling processes have been shown to occur for months after treatment. The attachment level following successful non-surgical periodontal treatment demonstrates a gain i probing attachment level of about 1 to 2 mm. This does not mean that new connective tissue attachment has formed but is a reflection of the increased tonus of the gingival tissues preventing the apical placement of the measuring probe. Probing pocket depths may show decrease of up to 2-4 mm due retraction of the gingival margin. The treatment result following non-surgical periodontal therapy is stable over time in most patients if the patient cooperate and the oral health team provide supportive treatments according to need. Under such conditions the result of non-surgical therapy do not significantly differ from that obtained with surgical methods for gaining access to the root surface. (Click image to enlarge.)

Click for our dental products. Make sure to read our FAQ'S  please.