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MAR Dental Sciences MAR Dental Sciences Review Article Non-Surgical Periodontal Therapy in treatment of Periodontal Disease: A Brief Review Hilal Ahmad Shah*, Abdul Aziz Khalid Al-Qabandi1, Amani Haikal2 1. Team Leader, Dental Services Division, Ahmadi Hospital, Kuwait. 2. Consultant Periodontist, Dental Services Division, Ahmadi Hospital, Kuwait. *Corresponding Author: Hilal Ahmad Shah*, Registered Dental Hygienist, Dental Services Division, Ahmadi Hospital, Kuwait. Email: [email protected]. Received Date: April 05, 2021 Publication Date: April 15, 2021 Abstract Periodontal disease severely affects dentition leading to tooth migration and loss. It is initiated with microbial biofilm or dental plaque. The current paradigm of periodontal disease emphasizes a greater role of host-mediated inflammatory response responsible for tissue destruction of periodontal disease. Initial therapy consists of a manual debridement of the periodontal pocket and oral hygiene instructions to decrease the number of pathogenic bacteria. Repeated re-evaluation and careful monitoring help the practitioner to intervene early in the diseased state and to arrest or reverse the progression of the periodontal disease with non-surgical periodontal therapy. This manuscript reviews the non-surgical periodontal therapy, its indications and contraindications and its role in preventing systemic diseases. Keywords: Microbial Biofilm, Host-mediated Inflammatory Response, Manual Debridement, Non- surgical Periodontal Therapy. Citation: Hilal Ahmad Shah. “Non-Surgical Periodontal Therapy in treatment of Periodontal Disease: A Brief Review” MAR Dental 1 Sciences 2.5 (2021) MAR Dental Sciences Introduction Periodontal diseases are the most common disease affecting dentition that leads to tooth loss. Biofilm acts as the safest habitat for the bacteria. This biofilm leads to gingivitis which if left untreated results in periodontitis. This is responsible for the clinical attachment loss and eventually tooth loss (1). Periodontal treatment mainly consists of mechanical debridement as disruption of the microbial biofilm and restoration of a biologically acceptable root surface is an important factor in periodontal disease progression. Thus, reduction in periodontal probing depth is normally taken as an indicator for treatment success and means a good control over the inflammatory process. Treatment of any periodontal disease has 4 phases (2): 1. Phase 1- Non-Surgical Phase 2. Phase 2- Surgical Phase 3. Phase 3- Restorative Phase 4. Phase 4-Maintenance Phase The main goal of Non-Surgical Periodontal Therapy is to alter or eliminate the microbes and other predisposing factors that contribute in gingivitis and periodontitis. It also halts the progression of the disease thus restoring normal or healthy dentition. Treatment of periodontitis is directly related to the reduction of pathogens embedded in the subgingival biofilm (3). Non-Surgical periodontal therapy has shown improve probing pocket depths and clinical attachment levels in mild to moderate periodontitis cases with probing pocket depths of less than 6mm (4). Indications 1. Gingivitis and mild chronic periodontitis 2. Severe chronic periodontitis control will require non-surgical periodontal therapy. 3. All chronic periodontitis cases should undergo non-surgical periodontal therapy. They reduce the need for surgical procedures. The rationale of Non-Surgical Periodontal Therapy 1. Evaluation of tissue response 2. Evaluation of patient’s attitude toward the periodontal disease 3. Long-term success of the periodontal treatment depends upon maintaining the results achieved with Phase -I therapy. 4. It may be the only treatment required for mild chronic periodontitis or gingivitis. Citation: Hilal Ahmad Shah. “Non-Surgical Periodontal Therapy in treatment of Periodontal Disease: A Brief Review” MAR Dental 2 Sciences 2.5 (2021) MAR Dental Sciences Non-Surgical periodontal therapy includes mechanical as well as chemotherapeutic measures to lower the microbial plaque related to periodontal tissues and oral cavity (5). Mechanical Therapy Mechanical therapy includes both supragingival and subgingival scaling and debridement of the roots by use of scalers to remove local deposits such as plaque, calculus (6). It is considered the first line of treatment. Until the 1980s, scaling and root planing followed by respective surgery were used to achieve zero pocket depth. Later emphasis was made on non-surgical methods for successful periodontal therapy. Over the years evolution in the techniques used to perform scaling and root planing, from manual scalers to power-driven scalers to lasers is a promising tool. Advantages of scaling on the subgingival microflora 1. The shift of microflora from gram-negative to gram-positive 2. Decrease in the number of microorganisms including black pigmented species. 3. Ultrasonic scaling reduces motile rods and spirochetes. Manual vs Ultrasonic scaling The use of hand scalers is considered the gold standard in mechanical periodontal therapy. Manual scalers are less effective in removing biofilm, time-consuming and required more effort. It is tiring for both patients as well as a dentist. Ultrasonic scaling on other hand is more patient compliance. However, ultrasonic instrumentation causes root surface alteration but when used on medium power settings show comparatively lesser root surface alteration and is more effective in furcation areas (7). A recent advancement is a pain-free ultrasonic system (Vector) is a linear oscillating device that results in the parallel movement of the instrument tip to the root surface. But it is more time-consuming and less effective in cases with deep pockets. Mechanical instrumentation only shows less effectiveness in cases with bony defects, deeper pockets. Therefore, chemotherapeutic agents along with mechanical therapy is highly recommended in reducing periodontal therapy. Gingival Curettage It is basically the removal of the inner surface of the soft tissue wall of the tissue by the curette. Scaling and root planing along with curettage has shown positive results within 4 weeks. After 5 weeks improvement in the periodontal health tissue can be observed with a reduction in gingival inflammation. It is performed to increase new attachment and tissue shrinkage leading to a reduction in pocket depth. Citation: Hilal Ahmad Shah. “Non-Surgical Periodontal Therapy in treatment of Periodontal Disease: A Brief Review” MAR Dental 3 Sciences 2.5 (2021) MAR Dental Sciences LASER (Light Amplification by Stimulated Emission of Radiation) Lasers concentrate light energy, targeting tissue at an energy level much lower than natural light. The laser used as an adjunctive or alternate tool for mechanical periodontal therapy for its haemostatic, bacterial characteristics. The most commonly used lasers are argon, Nd: YAG, and Er: YAG (8). They have been successfully used within periodontal pockets for subgingival debridement, reduction of subgingival bacterial loads. The soft tissue laser is very well absorbed by haemoglobin and other chromophores present in periodontal diseased tissue whereas poorly absorbed by hydroxyapatite. The laser energy is transmitted through water. This property of soft tissue makes them an excellent choice to use in periodontal dark inflamed tissue and pigmented bacteria. Photodynamic therapy It is a non-invasive method that involves photosensitizer agents know as (photosensitizers) in the presence of oxygen. Photodynamic therapy is based on the principle that the photosensitizer binds with the target cell and is activated with the light of a suitable wavelength. This leads to the production of free radicals that act on the microbial cell membrane leading to its toxic effects (9). It involves three components: Photosensitizers, Light, and Oxygen. Scaling and root planing combined with photodynamic therapy using methylene blue shows improvement in periodontal disease tissue. This has been successful in lowering redness, bleeding on probing and reducing the number of P. gingival is bacteria. Host Modulatory Therapy Host Modulatory Therapy is a treatment concept that promotes the tissue regeneration of periodontium and reduces the tissue destruction by decreasing the destructive aspects of the host response and uplifting the protective responses. It includes the Inhibition of Matrix metalloproteinases released in the body through the use of Tetracyclines (CMTs), Inhibition of Arachidonic Acid metabolites through NSAIDs. Modulation of Bone metabolism, and Regulation of immune and inflammatory responses by Suppressing proinflammatory cytokines, Nitric Oxide inhibition, and Infusion/ supplementary anti- inflammatory cytokines IL-4 and IL-10 (10). Chemotherapeutic agents These are an antimicrobial agent that decreases the number of bacteria that can be specific targeting to a certain organism or reducing all bacteria. These are a chemical substance that provides a clinical Citation: Hilal Ahmad Shah. “Non-Surgical Periodontal Therapy in treatment of Periodontal Disease: A Brief Review” MAR Dental 4 Sciences 2.5 (2021) MAR Dental Sciences therapeutic benefit. It is a chemical substance that provides a clinical therapeutic benefit. It is an anti- infective agent that works by destroying or inhibiting the growth of selective microorganisms, generally at low concentrations. It can be administrated either orally or locally. Systemic Antibiotic Therapy They are used in the suppression of periodontal pathogens persisting in biofilms in deep pockets, root furcation, and concavities
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