CURRENT CONCEPTS IN SCALING, ROOT PLANING AND POLISHING: A REVIEW

Öz

Dental scaling and root planing (SRP) is the one of the most common treatment modality for periodontal diseases which was indicated well known in the literature. In SRP procedure, not only the dental calculus eliminated but also the microbial endotoxins which infiltrated into the cementum subside together. Nowadays, it was indicated that the gingival curettage of the pocket wall is not necessary in the classical sense as a treatment modality. During SRP, manual and ultrasonic instruments and lasers are used. The effectiveness of conventional mechanical debridement with curettes depends on the dentist's individual skills and access to some areas (i.e. furcation, concavities, grooves and distal sites of molars) is limited. Ultrasonic devices allow less time consuming and they are easy to use, but they create noise and vibration which can be uncomfortable to the patient. Lasers can achieve excellent tissue ablation, bactericidal and detoxification effects or help with an alternative to the traditional methods of SRP began to stand out as. However, the non-surgical laser treatment there is no sufficient evidence that it is technically superior. Lasers can achieve excellent tissue ablation with bactericidal and detoxification effects and laser was assested as monotherapy and as an adjunct to SRP. However, no evidence exists that the laser is superior to traditional modalities of periodontal therapy Polishing is the following step after the SRP which eliminates most of the scratch to result the plaque retention after SRP procedure. During procedure, if polishing can perform into the subgingival area, the biofilm after SRP can also be eliminated from and has a positive impact on the healing. However, it should be noted that the rubber cup cannot able to enter this area inept which leads to be a disadvantage for the procedure. After starting to use the air polishing device in this area, this negative effect was eliminated. After comparison of pros and cons of air polishing; glycine in subgingival area, and sodium bicarbonate in supra demineralized enamel tissue was widely accepted to use for the procedure which the effect and reliability of the material were evaluated by many studies in the literature

Anahtar Kelimeler

• Scaling and root planing,ultrasonic,laser,air abrasives,nonsurgical periodontal therapy

DİŞTAŞLARI TEMİZLİĞİ, KÖK YÜZEYİ DÜZLEŞTİRMESİ VE POLİSAJDA GÜNCEL KAVRAMLAR: DERLEME

Öz

Periodontal hastalıkların tedavisinin en önemli kısmını İngilizce literatürde scaling ve root planing (SRP) olarak adlandırılan diş taşları temizliği ve polisaj oluşturmaktadır. SRP sırasında diş taşının yanı sıra sement yüzeyine penetre olmuş bakteriyel endotoksinler de uzaklaştırılmaktadır. Klasik anlamda cebin yumuşak duvarına yönelik gingival küretaja günümüzde pek fazla gereksinim duyulmamaktadır.

SRP işlemi sırasında; manuel ve ultrasonik aletler ile laser kullanılmaktadır. Küretlerin kullanıldığı geleneksel mekanik debridmanın etkinliği dişhekiminin bireysel becerilerine bağlıdır ve bazı alanlara (örneğin; furkasyon, konkavite, oluk ve üçüncü molarların distali) erişimi sınırlıdır. Ultrasonik aygıtlar daha az zaman alıcı ve kullanımı kolay araçlardır ama oluşturdukları gürültü ve titreşim hastayı rahatsız edebilir. Laserler mükemmel doku ablasyonu, bakterisidal ve detoksifikasyon etkileri ile SRP de geleneksel yöntemlere alternatif veya yardımcı yöntemler olarak öne çıkmaya başlamışlardır. Ancak, cerrahi olmayan periodontal tedavide laserin daha üstün bir teknik olduğuna dair elimizde yeterli kanıt yoktur.

SRP’den sonra uygulanan polisaj ile dişin sert yüzeylerinde plak retansiyonuna neden olabilecek çiziklerin büyük bir bölümü düzeltilebilir. Bir miktar da subgingival alana girilebilirse SRP sırasında kalmış olabilecek mikrobiyal biyofilm kalıntıları elimine edilerek iyileşmeye önemli ölçüde katkı sağlanmış olunur.  Ancak klasik polisajla biyofilm uzaklaştırılması işleminde cep içine fazla girilememesi büyük bir dezavantaj oluşturmaktadır.  Air polishing cihazlarının subgingival alanda da kullanılmaya başlanması ile bu olumsuz etkiyi ortadan kaldırmıştır.

Air polishing cihazında kullanılan tozların avantaj ve dezavantajları kıyaslandığında; subgingival alanda glisin, supragingival alanlardaki demineralize olmamış mine dokusunda ise sodyum bikarbonat kullanımı tercih edilmektedir. Bu tozlarla ilgili yapılan çalışmalar etkinliklerini ve güvenliliklerini belirlemiştir.

Anahtar Kelimeler

• Diştaşları temizliği,kök yüzeyi düzleştirmesi,ultrasonik,hava püskürtmeli polisaj,cerrahi olmayan periodontal tedavi

Kaynakça

1. Matuliene G, Pjetursson BE, Salvi GE, Schmidlin K, Brägger U, Zwahlen M, Lang NPl. Influence of residual pockets on progression of periodontitis and tooth loss: Results after 11 years of maintenance. J Clin Periodontol 2008; 35:685-695.
2. Socransky SS, Haffajee AD .The bacterial etiology of destructive periodontal disease: current concepts. J Periodontol 1992; 63:322-31.
3. Schenk G, Flemmig TF, Lob S, Ruckdeschel G, Hickel R. Lack of antimicrobial effect on periodontopathic bacteria by ultrasonic and sonic scalers in vitro. J Clin Periodontol 2000; 27:116-9.
4. Stelzel M, Flores-de-Jacoby L. Topical metroni- dazole application as an adjunct to scaling and root planing. J Clin Periodontol 2000; 27: 447-52.
5. Academy Report. Treatment of plaque-ınduced gingivitis, chronic periodontitis, and other clinical conditions. J Clin Periodontol 2001; 72: 1790-800.
6. Cobb CM. Clinical significance of non-surgical periodontal therapy: an evidance- based perspective of scaling and root planing. J Clin Periodontol 2002; 29: 6-16. AM, Caton 7. Polson J. Periodontal Repair and Regeneration. J Periodontol Factors Influencing
7. Jepsen S, Deschner J, Braun A, Schwarz F, Eberhard J. Calculus removal and the prevention of its formation. Periodontol 2000 2011; 55: 167-88.
8. Newman MG, Takei HH, Klokkvold PR, Carranza FA. Carranza's Clinical Periodontology. 11th Ed. Saunders St. Louis; Missouri. 2012. 909.

9. Cleland WP. Nonsurgical periodontal therapy. Clin Tech Small Anim Pract 2000; 15: 221-5.
10. Knöfler GU, Purschwitz RE, Jentsch HFR. Clinical evaluation of partial and full-mouth scaling in the treatment of chronic periodontitis. J Periodontol 2007; 78: 2135-42.
11. Arabaci T, Çiçek Y, Çanakçi CF. Sonic and ultrasonic scalers in periodontal treatment: a review. Int J Dent Hyg 2006; 5: 2-12.
12. Suvarna H, Anita K, Savita AM, Thanawala D. Comparative evaluation of root surface changes by three modes of instrumentation–A scanning electron microscopic study. World Journal of Science and Technology 2012; 2: 53-7.
13. Wennström JL, Tomasi C, Bertelle A, Dellasega E. Full-mouth ultrasonic debridement versus quadrant scaling and root laning as an initial approach in the treatment of chronic periodontitis. J Clin Periodontol 2005; 32: 851-9.
14. Fedi Peter F.Jr. The Periodontic Syllabus 3rd ed., Philadelphia Lippincott Williams & Wilkins 1995. P 74-84.
15. Çağlayan ve ark. Periodontoloji, 1. Bsm Ankara; Hacettepe Üniversitesi 2010. s 304, 301.
16. Walmsley AD, Lea SC, Felver B, King DC, Price GJ. Mapping cavitation activity around dental ultrasonic tips. Clin Oral Investig 2013; 17: 1227- 34.
17. Aslund M, Suvan J, Moles DR, Aiuto FD, Tonetti MS. Effect of two different methods of nonsurgical periodontal therapy on patient perception of pain and quality of life: A randomized controlled trial. J Periodontol 2008; 79: 1031-40.
18. Cobb CM, Mc Cawley TK, Killoy WJ. Apreliminary study on the effects of Nd:YAG laser on root surfaces and subgingival microflora in vitro. J Periodontol 1992; 63:701-7.
19. Ando Y, Aoki, A, Watanabe H, Ishikawa I. of periodontopatic bacteria, Lasers Surg Med 1996; 19: 190-200. Er:YAG laser on
20. Chwarz F, Sculean A, Berakdar M, Georg T, Reich E, Becker. Clinical evaluation of an Er:YAG laser combined with scaling and root planing for non- surgical periodontal treatment. J Clin Periodontol 2003; 30: 26-34.
21. Aoki A, Sasaki KM, Watanabe H, Ishikawa I. Lasers in nonsurgical periodontal therapy. Periodontol 2000 2004; 36: 59-97
22. Aoki A, Miura M, Akiyama F, Nakagawa N, Tanaka J, Oda S, et al. In vitro evaluation of Er:YAG laser scaling of subgingival calculus in comparison with ultrasonic scaling. J Periodontal Res 2000; 35: 266-77.
23. Ting C, Fukuda M, Watanabe T, Aoki T, Sanaoka A, Noguchi T. Effects of Er,Cr:YSGG laser ırradiation on the root surface: Morphologic analysis and efficiency of calculus removal. J Periodontol 2007; 78: 2156- 64.
24. Oliveira GJPL, Theodoro LH, Marcantonio Junior E, Sampaio JEC, Marcantonio RAC. Effect of Er,Cr:YSGG and Er:YAG laser irradiation on the adhesion of blood components on the root surface and on root morphology. Braz Oral Res 2012; 26: 256-62.
25. Amid R, Kadkhodazadeh M, Fekrazad R, Hajizadeh F, Ghafoori A. Comparison of the effect of hand instruments, an ultrasonic scaler, and an erbium- doped yttrium aluminium garnet laser on root surface roughness of teeth with periodontitis: a profilometer study. J Periodontal Implant Sci 2013; 43: 101-5
26. Gupta M, Lamba AK, Verma M, Faraz F, Tandon S, Chawla K, Koli DK. Comparison of periodontal open flap debridement versus closed debridement with Er,Cr:YSGG laser. Aust Dent J 2013; 58: 41-9
27. Kelbauskiene S, Baseviciene N, Goharkhay K, Moritz A, Machiulskiene V. One-year clinical results of Er,Cr:YSGG laser application in addition to scaling and root planing in patients with early to moderate periodontitis. Lasers Med Sci 2011; 264: 445-52.
28. Hakki SS, Korkusuz P, Berk G, Dundar N, Saglam M, Bozkurt B, Purali N. Comparison of Er,Cr:YSGG laser and hand instrumentation on the attachment of periodontal ligament fibroblasts to periodontally diseased root surfaces: an in vitro study. J Periodontol 2010; 81: 1216-25.
29. Miller RJ. Treatment of the contaminated implant surface using the Er,Cr:YSGG laser. Implant Dent 31. Taniguchi Y, Aoki A, Mizutani K, Takeuchi Y, Ichinose S, Takasaki AA, Schwarz F, Izumi Y. Optimal Er:YAG laser irradiation parameters for debridement of microstructured fixture surfaces of titanium dental implants. Lasers Med Sci 2013; 28: 1057-68
30. Berberoğlu A. Scaling and root planing ders notları. Yakındoğu Üniversitesi Diş Hekimliği Fakültesi, Periodontoloji Anabilim Dalı 2013. 4.
31. Greenstein G. Non surgical periodontal therapy in 2000: a literature review. J Am Dent Assoc 2000; 131:1580-92.
32. Eratalay K, Şengün D, Berberoğlu A, Tan C. Airpolishing aygıtının mine, sement, ve serbest dişeti üzerindeki etkileri. H Ü Dişhek Fak Dergi 1987; 11: 1-6.
33. Petersilka GJ, Tunkel J, Barakos K, Heinecke A, Haberlein I, Flemming T. Subgingival plaque removal at interdental sites using a low abrasive air polishing J Periodontol 2003; 74: 307-11.
34. Banerjee A, Hajatdoost-Sani M, Farrell S, Thompson I. A clinical evaluation and comparison of bioactive glass and sodyum bicarbonate air- polishing powders. J Dent 2010; 38: 475-9.
35. Petersilka GJ. Subgingival air-polishing in the treatment of periodontal biofilm infections. Periodontol 2000 2011; 55: 124-42.
36. Petersilka GJ, Faggion Jr CM, Stratmann U, Gerss J, Ehmke B, Haeberlein I, Flemming TF. Effect of glycine powder air-polishing on the gingiva. J Clin Periodontol 2008; 35: 324-32.
37. Flemming TF, Arushanov D, Daubert D, Rothen M, Mueller G, Leroux BG. Randomized controlled trial assessing efficacy and safety of glycine powder air polishing in moderate-to-deep periodontal pockets. J Periodontol 2012; 83: 444-52.
38. Petersilka GJ, Bell M, Mehl A, Hickel R, Flemming TF.Subgingival plaque removal in buccal and lingual sites using a novel low abrasive air- polishing powder. J Clin Periodontol 2003; 30: 328- 33.
39. Kozlovsky A, Artzi Z, Nemcovsky CE, Hirshberg A. Effect of air-polishing devices on the gingiva: histologic study in the canine. J Clin Periodontol 2005; 32: 329-34.
40. Rocha IP, Borges AB, Rodrigues JA, Arrais GAC, Giannini M. Effect of dentinal surface preparation on bond strenght of self etching adhesive systemes. Pesqui Odontol Bras 2006; 20: 8-52.
41. Nishimura K, Nikaido T, Foxton RM, Tagami J. Effect of air-powder polishing on dentin adhesion of a self-etching primer bonding system. Dent mater 2005; 24: 59-65.
42. Brinkmann JGP. The influence of air polishers on tooth enamel. J Orofac Orthop 1998; 59: 1-16.
43. Schwarz F, Ferrari D, Popovski K, Hartig B, Becker J. Influece of different air-abrasive powders on cell viability at biologically contaminated titanium dental implants surfaces. J Biomed Mater Res B Appl Biomater 2009; 88: 83-91.
44. Muthukuru M, Zainvi A, Esplugues EO, Flemmig TF. Non-surgical therapy for the management of peri- implantitis: a systematic review. Clin Oral Impl Res 2012; 23: 77-83.
45. Li YL, Tang ZH, Wang R, Cao J, Cao CF, Jin LJ. Effect of glycine powder air-polishing as an adjunct in the treatment of peri–implant mucositis: a pilot clinical trial. Clin Oral Impl Res 2012; 10: 1-7.
46. Cochis A, Fini M, Carrassi A, Migliario M, Visai L, Rimondini L. Effect of air polishing with glycine powder on titanium abutment surfaces. Clin Oral Impl Res 2012; 24: 904-9.
47. Suzuki Y, Matsuzaka K, Ishizaki K, Tazaki M, Sato T, Inoue T. Characterization of peri-implantitis epithelium in hamster palatine mucosa: behavior of merkel cells and nerve ending. Biomed Res 2005; 26: 257-69.
48. Wennström H, Dahlen G, Ramberg P. Subgingival debridement of periodontal pockets by air polishing in comparison with ultrasonic instrumentation during maintenance therapy. J Clin Periodontol 20011; 38: 820-7.
49. Moene R, Decaillet F, Andresan E, Mombelli A. Subgingival plaque removal using new air-polishing device. J Periodontol 2010; 81: 79-88.
50. Josephson GD, Wambach BA, Noordzji JP. Subcutaneous cervicofacial and mediastinal emphysema Otolaryngol Head Neck Surg 2001; 124: 170-1.
51. Liebenberg WH, Crawford BJ. Subcutaneous, orbital and mediastinal emphysema secondery to the use of an air-abrasive device. Quintessence Int 1997; 28: 31-8.
52. Flemming TF, Hetzel M, Topoll H, Gerss J, Petersilka debridement efficacy of glycine powder air polishing. J Periodontol 2007; 78: 1002-10.
53. Pikdoken ML, Ozcelik C. Severe enamel abrasion due to misuse of air polishing device. Int J Dent Hyg 2006; 4: 209-12.