Efficacy+of+Manual+Root+Planing

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 * Efficacy of Manual Root Planning vs. Ultrasonic Scaling **

//The history of scaling and root plaining has changed and evolved throughout time. In the past, ultrasonic scaling was seen as a "lazy" way of performing a dental cleaning and it was preferred or recommended to only use manual root plainning and scaling with hand instruments. Throughout time we have identified benefits associated with ultrasonic scaling such as flushing out and irrigation of the periodontal pocket aside from removal of calculus deposits. To prevent burnishing of calculus it is recommended to utilize the correct ultrasonic tip and the correct power setting, an example would be a thicker tip at a higher power setting with a light consistent and slow speed in conjunction with sharp hand instruments. While it is one day hoped that ultrasonic scaling will replace hand scaling altogether, is recommended to follow ultrasonic scaling with manual hand scaling to achieve the highest benefit possible.// By: Ferris Prado Diem: Efficacy of Manual Root Planning There are many hand instruments available for dental hygienists to choose. Hand instruments are best to use on mild to moderate periodontal patients because there are limitation to access to the hard to reach areas to provide care if periodontal tissue is too involved and the pocket depths are too deep. According to Greenstein, manual root planning cannot eliminate A. a. which cause invasive tissue and the clinicians have to take all assessment in consideration during scaling. For instance, how osseous and tissue around a tooth and what instrument can access to this specific areas. Every non-surgical periodontal treatment should be re-evaluated as the four to six weeks. Researchers also show that manual root planning leaves a smoother root surface compared to ultrasonic scaling microscopically, but there are no significant effects on periodontal tissue. Greenstein, G. (2000). Nonsurgical periodontal therapy in 2000: A literature review. //The Journal of American Dental Association, 131//(11), 1580-1592. Takei, N. & Carranza, K. (2006). Scaling and root planning. In J. Dolan, J. Pendill & J. Dedeke (Eds.), //Carranza's Clinical Periodontalogy// (pp.749-760). Elsevier Inc. Lia: The research that I read indicated that a combination of the two methods was most effective. However there have been no long term studies on either. Reference C.H., Drisko. (1998, April). Root instrumentation. Power-driven versus manual scalers, which one? Dent Clin North America. 42,2, p.229-44. Reina: Scaling and root planning procedures are technically demanding and time-consuming. The beneficial effects of scaling and root planning combined with personal plaque control in the treatment of chronic periodontitis have been validated with reduction in clinical inflammation, microbial shifts to a less pathogenic subgingival flora, decreased probing depth, gain of clinical attachment, and less diseases progression. Re-evaluation should be conducted to determine the treatment response, and if there are sites that continue to exhibit signs of disease, several factors, e.g. additional instruction and motivation as well as anatomical factors, must be considered. Greenstein, G. (2000, November). Nonsurgical periodontal therapy in 2000: A literature review. //Journal of the American Dental Association//, //131//(11), 1580-1592. Research, Science and Therapy Committee of the American Academy of Periodontology. (2001, December). Treatment of plaque-induced gingivitis, chronic periodontitis, and other clinical conditions. //Journal of Periodontology//, //74//(10), 1790-1800. Ultrasonic scaler verse hand scaling -Marcia There are many advantages of using ultrasonic scalers however there are also many disadvantages such as the risk of aerosols that can be harmful to the clinician when the patient is immune compromised, there are also the risk of delivering biofilm to this patients who are already medically compromised since not all ultrasonic units contain a container for the delivery of sterile water, Flushing the water lines does not eliminate the biofilm completely. SO when treating these patients it may be best to treat them without the ultrasonic since there is no evidence to indicate that the patient will get better results than hand scaling Merjohn, G. K., (2001). The biofilm problem and a few simple solutions. Journal of the California Dental Association Received on April 10, 2009 from http://www.cda.org/library/cda_member/pubs/journal/jour0901/comment.html Kwan, J. Y., (2005). Enhanced periodontal debridement with the use of micro ultrasonic periodontal endoscopy. Journal of the California Dental Association 33:3 241- 248. Received on April 10, 2009 from http://www.cda.org/library/cda_member/pubs/journal/jour0305/kwan.pdf Tawnya As dental hygienists one of our goals is to prevent periodontal disease and progression with our patients. We must be aware of the best possible treatment we can provide to our patients and what research indicates the most appropriate treatment options are. Through the research I evaluated I have learned hand scaling and ultrasonic scaling are equally effective but the combination of the two is most favorable. Damage can result with either method if the clinician is not practicing the correct techniques so it is critical that the clinician is properly trained in the use. For patients with periodontal disease the use of the slimmer ultrasonic tips can provide the clinician better access to CII and III furcations when providing non surgical treatment. Arabaci, T., Cicek, Y., & Canakci, C. (2007). Sonic and ultrasonic scalers in periodontal treatment: a review. International Journal of Dental Hygiene. 5(1):2-12. Bonner, B., Young, L., Smith, P., McCombes, W., and Clarkson, J. (2005). A randomized controlled trial to explore attitudes to routine scale and polish and compare manual versus ultrasonic scaling in the general dental service in Scotland. BioMed Central Oral Health. (5): 1186/1472-6831-5-3. Chapper, A., Catao, V., and Oppermann, R. (2005). Hand and ultrasonic instrumentation in the treatment of chronic periodontitis after supragingival plaque control. Brazilian Oral Research. 19 (1): 41-6. Jennifer After our class discussed ultrasonic vs. hand scaling, we found that there are a growing number of advancements in the ultra sonic technology. The new tips coming out are allowing better access to areas which may not be accessed through hand instruments, although there are an increasing amount of advances in the shanks of hand instruments. We were excited about the new tips and found that some tips work for some people and other tips not so much. Besides the tips we found that the most important aspect of using an ultra sonic is to use the correct technique to protect tooth surfaces from gouging and correct angulation to prevent burnishing calculus. However the research gathered in the classroom revealed manual scaling had better long term out comes, therefore the ultrasonic should be used as an adjunct manual scaling and root planning and not in place of. Natalie: Through my research I have discovered that the clinical results of hand scaling and ultrasonic scaling on periodontal disease are similar. A combined approach seems to be most effective in removing deposits and allowing for an environment where healing can occur. Non-surgical therapy has its limitations for severe periodontal disease with pocket depths over 6mm. Sometimes surgical intervention is necessary if non-surgical therapy is unsuccessful in localized areas. Systemic conditions and the use of tobacco also affect periodontal disease and their response to non-surgical therapy. Utilizing both power and hand scaling provides the best clinical results. One study with 20 individuals who had moderate to severe periodontal disease compared manual and power scaling. Their quads were randomly assigned into hand scaling and ultrasonic scaling groups, and also a combination group. Assessments were gathered including probing depths, BOP, and PI at 3 and 6 mos. All of the groups experienced an improvement in their periodontal disease in comparison with their original findings; however, there was not a statistical difference between the quads that were scaled. Both techniques were effective. The operator technique and systemic factors also influence the outcome and healing response. It is important that the dental hygienist is competent with hand scaling and ultrasonic scaling so that we can provide the best non-surgical treatment for our patients. Arabaci, T., Cicek, Y., & Canakci, C. (2007). Sonic and ultrasonic scalers in periodontal treatment: a review. International Journal of Dental Hygiene. 5(1):2-12.  Dental Ultrasonic Scaling. Retrieved on April 24, 2009 from http://www.softdental.com/houston_dentist/Dental_Ultrasonic_Scaling.html Obeid, P., D’Hoore, W., & Bercy, P. (2004). Comparative clinical responses related to the use of various periodontal instrumentation. Journal of Clinical Periodontology. 31(3):193-199.  Dorinda- Manual scaling can be just as effective as ultrasonic scaling. Research has shown that both are effective at removing calculus. Us as students have seen that the ultrasonic helps with our time management and can help us be more time effective than manual scaling alone, this will be very effective when we are in a private practice and have one hour or less patient apts. Noo: Based on the researches, it strongly recommend the use of an ultrasonic scaler in conjunction with hand instrumentation. The sequence of instrumentation for scaling and root planning includes starting with a standard size ultrasonic insert for gross debridement. This removes the supragingival and gross subgingival deposits and provides water lavage. The water lavage provides improved vision and less bleeding. After a thorough debridement with the standard size tips, area specific curettes should be used to explore the root surface and gain access to deep, tortuous pocket anatomy. Hand instrumentation produces a smear layer. The debris is moved over the subgingival root surface so after the curette is used, the ultrasonic should be used on a low setting with a thinner insert. This will provide a final smoothing stroke and remove the smear layer. A study by Kwan demonstrated the advantages of the modified ultrasonic insert, including removing the most calculus, leaving the smoothest root surface, and reaching deepest into the pocket. The study compared ultrasonic standard tip size, ultrasonic modified tip size, and hand instruments. Croft LK, Nunn ME, Crawford LC, Holbrook TE, McGuire MK, Kerger MM, Zacek GA. Patient preference for ultrasonic or hand instruments in periodontal maintenance. Int J Periodontics Restorative Dent. 2003;23:567-573.  Kwan JY. Enhanced periodontal debridement with the use of micro ultrasonic, periodontal endoscopy. J Calif Dent Assoc. 2005;33:241-248.  Ceri: There is much to the history of manual scaling and power scaling. Power scaling was introduced in the 1950's and has been changing since that time. New tips and ways to scale have been introduced for all types of mouths and patients. Power scaling can be very effective and time saving if done properly. There is a learning curve when it comes to power scaling, as well as manual scaling. There really is no cost difference for the patient if they are being treated with a power scaler or manual scaler. Combining power scaling with manual scaling is best for the patient and clinician. Bonner, B., Young, L., Smith, P., McCombes, W., and Clarkson, J. (2005). A randomized controlled trial to explore attitudes to routine scale and polish and compare manual versus ultrasonic scaling in the general dental service in Scotland. BioMed Central Oral Health. (5): 1186/1472-6831-5-3. Kwan JY. Enhanced periodontal debridement with the use of micro ultrasonic, periodontal endoscopy. J Calif Dent Assoc. 2005;33:241-248. Obeid, P. R., D’Hoore, W., & Bercy, P. (2004, March). Comparative clinical responses related to the use of various periodontal instrumentation. Journal of Clinical Periodontology, 31(3), 193-199. Melody: From the research I gathered the most effective approach to treating periodontitis is the blended approach. Using the ultrasonic for debridement, manually scaling and then if needed or desired you can use the thinner inserts for hard to reach, deep pockets and furcations. The blended approach is the most popular. Years ago the ultrasonic was considered a short cut that was not as effective as using the hand instruments but with the newer research and innovations in ultrasonic inserts it allows for better subgingival debridement without root surface damage. As with any instrument it is only as good as the clinician using it, so both techniques are effective in treating periodontitis as long as the clinician is using it effectively. So ultimately the best method for treating periodontitis is the integration of several techniques, which may include manual, manual and ultrasonic, ultrasonic, or surgery, manual and ultrasonic. The answer to which technique is best for what type of periodontitis is based on each individual case. And as a good clinician we need to use our best clinical judgment when deciding on what's best for our patient. A Blended Approach (2006) Dimensions of Dental Hygiene 4(4):26-27 Greenstein, G.(2000) Nonsurgical periodontal Therapy in 2000. The Journal of the American Dental Association 131(11):1580-1592 Last edited on: April 28, 2009 6:38 PM Jackie What are the contraindications for the use of power driven scalers? Communicable disease: pt.’s with tuberculosis. Patients susceptible to infections are those with compromised heath examples are: uncontrolled diabetes, debilitation, and kidney disease, and organ transplant, immunosuppression from disease or chemotherapy. Patients with respiratory problems: COPD, cystic gibrosis, cardiovascular disease with secondary pulmonary disease or breathing problems. Swallonwing Difficulty: patients with gagging problems or swallowing problems. Example: amyotrophic lateral sclerosis, muscular distrophy, paralysis, multiple sclerosis. Cardiac pacemaker: Some newer devices have protective coverings. Dematerialized areas: dematerialized enamel cam be recommended. Exposed Dentinal Surfaces: May removed smear layer and increase sensitivity. Children: Developing tissue is sensitive to ultrasonic scaler. Heat from the ultranoc may damage the pulp chamber with is big. What are the recommendations to reduce dental aerosols infections? 1. PPE use.: mask, gloves, and safety glasses, 2. Routine use of a pre-procedural antiseptic rinse. 3. Use of a high speed evacuation device be a dental assistant or attached to the instrument being used. Carranza, F., Klokkevold, P., Takei, H., & Newman, M. (200). Sonic and ultrasonic instrumentation (828‑833). Carranza's Clinical Periodontology ( 10th edition).San Loius, MI: Daunders elseview. Wilkins, E. (2005). Nonsurgical periodontal instrumentation (645‑676). Clinical Practice of the Dental Hygienist (9th edition). Boston, MA: Lippincott Williams & Wilkins. Drina: Both ultrasonic scaling and manual root planning are beneficial in treating periodontal disease. There are both advantages and disadvantages to them both. The advantage of manual root planning is that it makes the root surface smoother than the power scaler. The disadvantage of manual root planning is that it causes operator fatigue and can’t remove all the calculus as effectively in between furcations areas like power scaling can. Power scaling on the other hand causes less fatigue on the clinician but does produce aerosols and roughen the tooth surface. They both help to reduce probing depths and help with attachment gain.

References: Greenstein, G. (2000, November). Nonsurgical periodontal therapy in 2000: A literature review. The Journal of the American Dental Association, 131: 1580-1592. Low, S. (2004, September). The evolution of ultrasonic therapy. Dimensions of Dental Hygiene, 2(9): 18, 20, 22-23.