Periodontal prophylaxis and periodontal therapies

A. Periodontal prophylaxis

1. Brushing, flossing and rinsing

Regular cleaning your own teeth with toothpaste, toothbrush, floss and rinsing solution daily two times min. 2 minutes.
Bacterial plaque can be removed but tartar (calculus) cannot be removed that way. Colouring agents can help to identify bacterial deposits on teeth.

2. Professional cleaning /supragingival scaling and polishing/

Usually made by a dental hygienist. No need for local anaesthesia.

The objective of gingivitis is the papillary bleeding.
If the brushing and flossing inadequate, bacterial plaque and tartar /calculus/ are covering the tooth surfaces. Manual and ultrasound scalers can remove the tartar from the tooth surface. The scaled and polished smooth tooth surfaces will be cleanable with brushing and flossing.

B. Periodontal therapies

1. Deep scaling and root planing without flap /non-surgical “blind” procedure/

Usually made by a general dentist. Local anaesthesia is needed.

If the sulcus is deeper than 3 mm it is called periodontal pocket. If the plaque and tartar accumulate deeper than 3 mm below the marginal gum in a pocket because of the lost epithelial attachment /junctional epithelia/ but not deeper than 6 mm the lesion can be treated with a “blind” scaling and root planing. It is a non-invasive but time-consuming procedure. After the therapy reattached epithelia will cover the root surface.

2. Deep scaling and root planning with flap surgery. A procedure with visual control.

Usually made by a specialist. Local anaesthesia is needed.
More than 31 years ago has been known that the deep scaling and planning with flap has better results than a flapless procedure if the pocket depth is from 4 to 6 mm.
“Comparison of SO /scaling only/ versus SF /scaling with flap/ at various pocket depths for % of tooth surfaces completely free of calculus showed 1 to 3 mm pockets to be 86% versus 86%, 4 to 6 mm pockets to be 43% versus 76% and greater than 6 mm pockets to be 32% versus 50%. The extent of residual calculus was directly related to pocket depth, was greater following scaling only, and was greatest at the CEJ or in association with grooves, fossae or furcations. No differences were noted between anterior and posterior teeth or between different tooth surfaces. ” J. Clin Periodontol. 1986 Mar;13(3):205 210.Caffesse RG, Sweeney PL, Smith BA: Scaling and root planing with and without periodontal flap surgery.

3. Bone grafting and GBR

These technics help regenerate any bone or gum tissue loss. Own bone or the human bone or animal bone or synthetic bone is placed in the area of the lost bone. These scaffold-like grafted materials promote bone growth. Made by a specialist. Local anaesthesia is needed.
This technique is focused on the development of hard tissues support.
GBR can be described as the regeneration of periodontal attachment and bone.
The periodontal surgical techniques with flap have disadvantages
To minimalise the disadvantages of flap techniques new procedures have been published recently. The so-called minimally invasive surgery.
“New techniques have emerged to achieve periodontal regeneration without the drawbacks associated with conventional flap surgery. Minimally invasive surgery (MIS) is a method of surgical access that minimizes flap reflection and tissue trauma, resulting in maintenance of critical blood supply…” Compend Contin Educ Dent. 2017 Apr;38(4):e13-e16.

“They are promising studies to launch non-surgical technique for alveolar bone regeneration.
Recently published findings indicate that: “A combination of the BMP-2/7 non-viral vector and in vivo electroporation represents a promising non-surgical option for alveolar bone regeneration therapy.”
J Periodontol. 2017 Aug 18:1-18. doi: 10.1902/jop.2017.170328. [Epub ahead of print]

4. Noninvasive new flapless techniques for coverage of root surfaces

Tunnel preparation
“…an undermining split flap preparation of the buccal tissues with newly developed instruments to minimize trauma and ensure a better blood supply for the connective tissue graft. The use of a microsurgical concept, including microsurgical blades and suture material, improves wound healing and establishes a better esthetic result….” Int J Periodontics Restorative Dent. 2007 Oct;27(5):457-63.

Pinhole technique
“Free connective tissue graft techniques are currently considered the most predictable surgical method for root coverage. However, morbidity associated with secondary graft sites has generated interest in other methods. The purpose of this study was to investigate the feasibility of a novel surgical approach to root coverage: the pinhole surgical technique (PST)…(…)…PST holds promise as a minimally invasive, predictable, effective, and time- and cost-effective method for obtaining optimal patient-based outcomes.” Int J Periodontics Restorative Dent. 2012 Oct;32(5):521-31.