Hartzell TB. The operative and post-operative treatment of pyorrhea. Dent Cosmos. 1913; 55:1094-1101
Claffey N, Polyzois I., 5th edn. In: Lang NP, Lindhe J, Karring T (eds). Oxford: Blackwell Munksgaard; 2008
Nakib NM, Bissada NF, Simmelink JW, Goldstine SN. Endotoxin penetration into root cementum of periodontally healthy and diseased teeth. J Periodontol. 1982; 53:368-378
Ito K, Hindman RE, O'Leary TJ, Kafrawy AH. Determination of the presence of root-bound endotoxin using the local Shwartzman phenomenon (LSP). J Periodontol. 1985; 56:8-17
Heitz-Mayfield LJ. How effective is surgical therapy compared with non-surgical debridement?. Periodontology 2000. 2005; 37:72-87
Hujoel PP, Cunha-Cruz J, Loesche W, Robertson PB. Personal oral hygiene and chronic periodontitis: a systematic review. Periodontology 2000. 2005; 37:29-34
Sanz M, Teughels W. Innovations in non-surgical periodontal therapy: Consensus Report of the Sixth European Workshop on Periodontology. J Clin Periodontol. 2008; 35:3-7
Jepsen S, Deschner J, Braun A, Schwarz F, Eberhard J. Calculus removal and the prevention of its formation. Periodontology 2000. 2011; 55:167-188
Chapple ILC. Periodontal diagnosis and treatment – where does the future lie?. Periodontology 2000. 2009; 51:9-24
Guentsch A, Preshaw PM. The use of a linear oscillating device in periodontal treatment: a review. J Clin Periodontol. 2008; 35:514-524
Kocher T, Konig J, Hansen P, Ruhling A. Subgingival polishing compared to scaling with steel curettes: a clinical pilot study. J Clin Periodontol. 2001; 28:194-199
Eaton KA, Kieser JB, Davies RM. The removal of root surface deposits. J Clin Periodontol. 1985; 12:141-152
Caffesse RG, Sweeney PL, Smith BA. Scaling and root planing with and without periodontal flap surgery. J Clin Periodontol. 1986; 13:205-210
Buchanan SA, Robertson PB. Calculus removal by scaling/root planing with and without surgical access. J Periodontol. 1987; 58:159-163
Kepic TJ, O'Leary TJ, Kafrawy AH. Total calculus removal: an attainable objective?. J Periodontol. 1990; 61:16-20
Robertson PB. The residual calculus paradox. J Periodontol. 1990; 61:65-66
Stillman PR. The management of pyorrhea. Dent Cosmos. 1917; 59:405-414
Aleo JJ, De Renzis FA, Farber PA, Varboncoeur AP. The presence and biologic activity of cementum-bound endotoxin. J Periodontol. 1974; 45:672-675
Aleo JJ, De Renzis FA, Farber PA. In vitro attachment of human gingival fibroblasts to root surfaces. J Periodontol. 1975; 46:639-645
Jones WA, O'Leary TJ. The effectiveness of in vivo root planing in removing bacterial endotoxin from the roots of periodontally involved teeth. J Periodontol. 1978; 49
Nishimine D, O'Leary TJ. Hand instrumentation versus ultrasonics in the removal of endotoxins from root surfaces. J Periodontol. 1979; 50:345-349
Fine DH, Morris ML, Tabak L, Cole JD. Preliminary characterization of material eluded from the roots of periodontally involved teeth. J Periodontal Res. 1980; 15:10-19
Hughes FJ, Smales FC. Immunohistochemical investigation of the presence and distribution of cementum-associated lipopolysaccharides in periodontal disease. J Periodontal Res. 1986; 21:660-667
Moore J, Wilson M, Kieser JB. The distribution of bacterial lipopolysaccharide (endotoxin) in relation to periodontally involved root surfaces. J Clin Periodontol. 1986; 13:748-751
Nyman S, Westfelt E, Sarhed G, Karring T. Role of “diseased” root cementum in healing following treatment of periodontal disease. J Clin Periodontol. 1986; 13:464-468
Hughes FJ, Smales FC. The distribution and quantitation of cementum-bound lipopolysaccharide on periodontally diseased root surfaces of human teeth. Arch Oral Biol. 1990; 35:295-299
Cheetham WA, Wilson M, Kieser JB. Root surface debridement – an in vitro assessment. J Clin Periodontol. 1988; 15:288-292
Smart GJ, Wilson M, Kieser JB. The assessment of ultrasonic root surface debridement by determination of residual endotoxin levels. J Clin Periodontol. 1990; 17:174-178
Cobb CM. Clinical significance of non-surgical periodontal therapy: an evidence-based perspective of scaling and root planing. J Clin Periodontol. 2002; 29:22-32
Tunkel J, Heinecke A, Flemmig TF. A systematic review of efficacy of machine-driven and manual subgingival debridement in the treatment of chronic periodontitis. J Clin Periodontol. 2002; 13:72-81
Ioannu I, Dimitriadis N, Papadimitriou K, Sakellari D, Vouros I, Konstantinidis A. Hand instrumentation versus ultrasonic debridement in the treatment of chronic periodontitis: a randomized clinical and microbiological trial. J Clin Periodontol. 2009; 36:132-141
Bollen CML, Mongardini C, Papaioannou W, van Steenberghe D, Quirynen M. The effect of a one-stage full-mouth disinfection on different intra-oral niches. Clinical and microbiological observations. J Clin Periodontol. 1998; 25:56-66
Mongardini C, van Steenberghe D, Dekeyser C, Quirynen M. One stage full-versus partial-mouth disinfection in the treatment of chronic adult or generalized early-onset periodontitis. 1. Long-term clinical observations. J Periodontol. 1999; 70:632-645
Quirynen M, Mongardini C, Pauwels M, Bollen CML, Van Eldere J, van Steenberghe D. One stage full-versus partial-mouth disinfection in the treatment of chronic adult or generalized early-onset periodontitis. 2. Long-term impact on microbial load. J Periodontol. 1999; 70:646-656
Koshy G, Kawashima Y, Kiji M, Nitta H, Umeda M, Nagasawa T, Ishikawa I. Effects of single-visit full-mouth ultrasonic debridement versus quadrant-wise ultrasonic debridement. J Clin Periodontol. 2005; 32:734-743
Eberhard J, Jervøe-Storm P-M, Needleman I, Worthington H, Jepsen S. Full-mouth treatment concepts for chronic periodontitis: a systematic review. J Clin Periodontol. 2008; 35:591-604
Wennström JL, Tomasi C, Bertelle A, Dellasega E. Full-mouth ultrasonic debridement versus quadrant scaling and root planing as an initial approach in the treatment of chronic periodontitis. J Clin Periodontol. 2005; 32:851-859
Zanatta GM, Bittencourt S, Nociti FH, Sallum EA, Sallum AW, Casati MZ. Periodontal debridement with povidone-iodine in periodontal treatment: short-term clinical and biochemical observations. J Periodontol. 2006; 77:498-505
Del Peloso Ribeiro É, Bittencourt S, Sallum EA, Nociti FH, Goncalves RB, Casati MZ. Periodontal debridement as a therapeutic approach for severe chronic periodontitis: a clinical, microbiological and immunological study. J Clin Periodontol. 2008; 35:789-798
Eley BM, Soory M, Manson JD., 6th edn. London: Churchill Livingstone: Elsevier; 2010
van der Weijden F, Slot DE. Oral hygiene in the prevention of periodontal diseases: the evidence. Periodontology 2000. 2011; 55:104-123
Schwarz F, Aoki A, Sculean A, Becker J. The impact of laser application on periodontal and peri-implant wound healing. Periodontology 2000. 2009; 51:79-108
Soukos NS, Goodson M. Photodynamic therapy in the control of oral biofilms. Periodontology 2000. 2011; 55:143-166
Petersilka GJ. Subgingival air-polishing in the treatment of periodontal biofilm infections. Periodontology 2000. 2011; 55:124-142
Periodontitis is a complex disease that has both oral and systemic consequences. The treatment of periodontitis may be both surgical and non-surgical but, in recent years, there has been a shift towards managing disease non-surgically in preference to surgery. Fundamental to all types of therapy is the patient's role in disease control, in the form of self-performed plaque control, and it is important that the patient understands this. Non-surgical periodontal therapy has a long history and has traditionally been carried out using a variety of hand and powered instruments, the objective being root surface disinfection by the removal of plaque, calculus and contaminated root cementum. However, over the last 30 years or so, it has become apparent that calculus does not cause disease, cementum does not become significantly infected and bacteria and their toxins are only loosely adherent to the diseased root surface. This has led to the development of less invasive instrumentation principles which may be better for patients, more cost-effective and more easily applied in different clinical settings.
Clinical Relevance: This paper aims to describe and justify a minimally-invasive approach to the management of the diseased root surface in periodontitis, to clarify the terminology used and to suggest how these principles may be applied in general practice.
Article
A paper (Wedges and Ledges?), in the first issue of Dental Update, discussed the role of food packing in periodontal disease. In the 40 years since then our understanding of the aetiology of periodontitis has increased enormously, and periodontitis is now recognized as one of the most complex of human diseases. In addition, there is also mounting evidence that periodontitis may play a significant role in general health, so that the effective treatment of periodontitis may be even more important than was once thought. Treatment of periodontitis may be non-surgical or surgical but, since the first issue of Dental Update, there has been a shift away from surgical treatment towards non-surgical management of disease. It is the aim of this paper to explore changing trends in non-surgical therapy and to make a case for the use of conservative, non-tooth destructive treatment techniques.
Many of the methods commonly used today to treat periodontal diseases have remained largely unchanged for decades. For example, in non-surgical periodontal therapy the process of root planing is still widely practised but it was described, and named, in the dental literature a century ago.1 Root planing involves the deliberate removal of tooth structure during periodontal instrumentation2 to render the root surface ‘hard’ and ‘smooth’ and is an invasive procedure since it involves the removal of tooth structure. Studies from the early 1980s, however, suggested that the intentional removal of cementum during root planing was not justified,3,4 and so the concept of less invasive non-surgical management of the diseased root surface was developed. The use of minimally-invasive techniques in restorative dentistry is now recognized as of increasing importance, and is often in the better interests of patients.
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