Surgical solutions to periodontal complications of orthodontic therapy

Collaboration of various specialists has become essential in pediatric dental practice. In orthodontics, this collaboration is completely necessary when the patient presents periodontal problems. Even in healthy patients, who do not suffer from periodontal disease, periodontal complications may occur during treatment with fixed appliances. Two cases of young patients, in which periodontal procedures were used to complement the results of orthodontic treatment are presented.     

Surgical and nonsurgical periodontal therapy. Learned and unlearned concepts

This review aims to highlight concepts relating to nonsurgical and surgical periodontal therapy, which have been learned and unlearned over the past few decades. A number of treatment procedures, such as gingival curettage and aggressive removal of contaminated root cementum, have been unlearned. Advances in technology have resulted in the introduction of a range of new methods for use in nonsurgical periodontal therapy, including machine‐driven instruments, lasers, antimicrobial photodynamic therapy and local antimicrobial‐delivery devices. However, these methods have not been shown to offer significant benefits over and above nonsurgical debridement using hand instruments. The method of debridement is therefore largely dependent on the preferences of the operator and the patient. Recent evidence indicates that specific systemic antimicrobials may be indicated for use as adjuncts to nonsurgical debridement in patients with advanced disease. Full‐mouth disinfection protocols have been proven to be a relevant treatment option. We have learned that while nonsurgical and surgical methods result in similar long‐term treatment outcomes, surgical therapy results in greater probing‐depth reduction and clinical attachment gain in initially deep pockets. The surgical technique chosen seems to have limited influence upon changes in clinical attachment gain. What has not changed is the importance of thorough mechanical debridement and optimal plaque control for successful nonsurgical and surgical periodontal therapy.     

Low-cost periodontal therapy

Periodontitis is a complex infectious disease that affects low‐income individuals disproportionately. Periodontitis is associated with specific bacterial species and herpesviruses, and successful prevention and treatment of the disease is contingent upon effective control of these pathogens. This article presents an efficacious, highly safe, minimally invasive, practical and low‐cost periodontal therapy that involves professional and patient‐administered mechanical therapy and antimicrobial agents. The major components are scaling for calculus removal, periodontal pocket irrigation with potent antiseptics, and treatment with systemic antibiotics for advanced disease. Povidone‐iodine and sodium hypochlorite have all the characteristics for becoming the first‐choice antiseptics in the management of periodontal diseases. Both agents show excellent antibacterial and antiviral properties, are readily available throughout the world, have been safely used in periodontal therapy for decades, offer significant benefits for individuals with very limited financial resources, and are well accepted by most dental professionals and patients. Four per cent chlorhexidine applied with a toothbrush to the most posterior part to the tongue dorsum can markedly reduce or eliminate halitosis in most individuals. Systemic antibiotics are used to treat periodontopathic bacteria that are not readily reached by topical therapy, such as pathogens within gingival tissue, within furcation defects, at the base of periodontal pockets, and on the tongue, tonsils and buccal mucosae. Valuable antibiotic therapies are amoxicillin‐metronidazole (250 mg of amoxicillin and 250 mg of metronidazole, three times daily for 8 days) for young and middle‐aged patients, and ciprofloxacin‐metronidazole (500 mg of each, twice daily for 8 days) for elderly patients and for patients in developing countries who frequently harbor enteric rods subgingivally. Scaling to remove dental calculus and the prudent use of inexpensive antimicrobial agents can significantly retard or arrest progressive periodontitis in the great majority of patients.     

Regenerative periodontal therapy

Regenerative periodontal therapy comprises procedures which are specially designed to restore parts of the tooth supporting apparatus which have been lost due to periodontitis. A procedure must fulfill certain criteria to be considered a therapy which encourages regeneration. This paper discusses a variety of surgical approaches including root surface conditioning, the placement of bone garfts or bone substitute implants and the use of organic or synthetic barrier membranes (GTR). Evidence is presented that regenerative surgery utilising the GTR principle fulfills all the criteria required of a surgical procedure to be considered a procedure leading to periodontal regeneration.     

Supportive periodontal therapy after reconstructive periodontal surgery

Clinical practice and research have established the value of supportive periodontal treatment after reconstructive periodontal surgery. The clinical procedures and the rationale for developing individualized treatments are discussed in general and for specific types of reconstructive procedures. The application of adjunctive diagnostics and chemotherapeutic agents to supplement traditional methods is described.     

Lasers in periodontal therapy

About 50 years ago, lasers started to be used in periodontal treatment following evidence that wounds produced in animals healed more quickly after being irradiated with low‐intensity lasers. Increased production of growth factors, stimulated mainly by red and infrared lasers, may participate in this process by influencing the behavior of various types of cells. High‐intensity lasers have been used as an alternative to nonsurgical periodontal therapy in root biomodification and to reduce dentin hypersensivity; low‐intensity lasers are frequently employed to improve tissue repair in regenerative procedures and in antimicrobial photodynamic therapy. Despite the abundance of promising data on the advantages of their use, there is still controversy regarding the real benefits of lasers and antimicrobial photodynamic therapy in periodontal and peri‐implant treatment. A huge variation in the parameters of laser application among studies makes comparisons very difficult. An overview of the current concepts and findings on lasers in periodontal therapy is presented with emphasis on data collected from Latin‐American researchers.     

激光与牙周治疗

本文就激光概况、强、弱激光在牙周治疗中的应用作一综述，发现强、弱激光均广泛用于牙周治疗。强激光如CO2激光及Nd：YAG激光可切除增生的牙龈、去除牙周袋内的炎性上皮、杀灭细菌及提高牙周附着的形成。弱激光如He—Ne激光可消除炎症、促进创口愈合、促进牙周膜成纤维细胞增殖以期提高牙周新附着的形成等。牙周治疗中设置合适的激光能量将是获得预期效果的保障。