Aimetti Mario
Int J Esthet Dent. 2014 Summer;9(2):251-67.
The primary goal of nonsurgical periodontal therapy is to control microbial periodontal infection by removing bacterial biofilm, calculus, and toxins from periodontally involved root surfaces. A review of the scientific literature indicates that mechanical nonsurgical periodontal treatment predictably reduces the levels of inflammation and probing pocket depths, increases the clinical attachment level and results in an apical shift of the gingival margin. Another parameter to be considered, in spite of the lack of scientific evidence, is the reduction in the degree of tooth mobility, as clinically experienced. It is important to point out that nonsurgical periodontal treatment presents limitations such as the long-term maintainability of deep periodontal pockets, the risk of disease recurrence, and the skill of the operator. A high number of posttreatment residual pockets exhibiting bleeding on probing and > 5 mm deep are related to lower clinical stability. The successful treatment of plaque-induced periodontitis will restore periodontal health, but with reduced periodontium. In such cases, anatomical damage from previous periodontal disease will persist and inverse architecture of soft tissue may impair home plaque removal. The clinician can select one of the following therapeutic options according to the individual patient's needs: - Quadrant/sextant wise instrumentation (conventional staged debridement, CSD). - Instrumentation of all pockets within a 24-hour period with (full mouth disinfection [FMD]) or without (full mouth scaling and root planing [FMSRP]) local antiseptics. Both procedures can be associated with systemic antimicrobials. -CSD or FMD in combination with laser or photodynamic therapy. Patients with aggressive periodontitis constitute a challenge to the clinician. To date there are no established protocols for controlling the disease. However, data from the literature on the application of the FMD protocol combined with amoxicillin-metronidazole systemic administration are promising. A new classification in supra- and subcrestal nonsurgical periodontal therapy will be proposed. The supracrestal therapy includes the treatment of gingivitis, nonsurgical coverage of recession-type defects, treatment of suprabony defects and papilla reconstruction techniques. Within subcrestal periodontal therapy, it is of paramount importance to preserve both marginal tissues and connective fibers inserted in the root cementum at the apical part of the bony defects.
非手术牙周治疗的主要目标是通过清除牙周受累根面上的细菌生物膜、牙石和毒素来控制微生物性牙周感染。对科学文献的回顾表明，机械性非手术牙周治疗可预期地降低炎症水平和探诊深度，增加临床附着水平，并使牙龈边缘向根尖移位。尽管缺乏科学证据，但另一个需要考虑的参数是临床上所观察到的牙齿松动度的降低。需要指出的是，非手术牙周治疗存在局限性，如深牙周袋的长期维持性、疾病复发风险以及操作者的技术水平。大量治疗后探诊出血且深度大于5毫米的残留袋与较低的临床稳定性相关。菌斑性牙周炎的成功治疗将恢复牙周健康，但牙周组织会减少。在这种情况下，先前牙周疾病造成的解剖学损害将持续存在，软组织的逆向结构可能会妨碍牙菌斑的自我清除。临床医生可根据个体患者的需求选择以下治疗方案之一：- 按象限/牙弓分区进行器械操作（传统分期清创术，CSD）。- 在24小时内对所有牙周袋进行器械操作，可使用（全口消毒 [FMD]）或不使用（全口洁治和根面平整 [FMSRP]）局部抗菌剂。这两种操作均可联合全身使用抗菌药物。- CSD或FMD联合激光或光动力疗法。侵袭性牙周炎患者给临床医生带来了挑战。迄今为止，尚无控制该疾病的确立方案。然而，文献中关于FMD方案联合阿莫西林 - 甲硝唑全身给药应用的数据很有前景。将提出一种关于龈上和龈下非手术牙周治疗的新分类。龈上治疗包括牙龈炎的治疗、退缩型缺损的非手术覆盖、骨上袋缺损的治疗以及乳头重建技术。在龈下牙周治疗中，至关重要的是保留边缘组织以及插入骨缺损根尖部牙根牙骨质中的结缔组织纤维。
