New research is demonstrating that a person’s total health is indeed related to his or her oral health. Elimination of all oral infections, including gingivitis and periodontitis, is important to overall health.
. Here are some trends in nonsurgical and surgical therapy that will successfully arrest periodontal infections. Opportunities for early diagnosis and prevention will play an increasing role in dental practice in the future as patients understand the importance of oral health to overall health A prospective approach of prevention and early intervention in treating the disease is more important than ever before.
Nonsurgical Therapy: Emerging Trends
Ultrasonics and sonics and topical antimicrobial therapy.
Extensive reviews of the literature have been conducted regarding the use of power driven scalers or manual scalers for root debridement. Results confirmed that calculus and plaque removal can be performed equally well with either manual or power-driven scalers Attachment gains, as well as reductions in probing depths and bleeding on probing have been accomplished with both manual and ultrasonic and sonic scaling.
Topical antimicrobials have emerged as important adjuncts to nonsurgical therapy and are easily delivered in the ultrasonic lavage during instrumentation. Povidone iodine, or PVP-I, and chlorhexidine, or CHX, are both effective topical antiseptics that could potentially be used to enhance results in initial therapy or maintenance patients. Although not yet a strong trend, recent data suggest that antimicrobial toothpastes may be useful in the long-term maintenance of oral health in periodontitis-susceptible patients
Sustained-release local drug delivery. Doxycycline gel and tetracycline fibers, both are types of tetracycline antibiotics used to treat periodontal infections locally. Tetracycline fibers are nonresorbable, whereas the doxycycline gel is resorbable within a short period
In general, all of these delivery systems have reported statistically significant effects on clinical parameters, showing attachment gains, and reduction of bleeding on probing and probing depths. These local antimicrobials are primarily used for treating recurrent isolated pockets of 5 mm or more that bleed upon probing in patients with moderate-to severe adult periodontitis. Trends in nonsurgical therapy include incorporating more anti-infective types of drugs into treatment protocols, which fits the concept of periodontitis as an infection. It should be mentioned that in advanced and early-onset–type periodontitis, these topical and sustained local drug delivery approaches are usually not sufficient to stop or eradicate infection, particularly if some of the more invasive organisms such as P. gingivalis and A. actinomycetemcomitans are present. In the case of infections with these invasive organisms, systemic antibiotics are often needed in combination with surgical débridement to completely eliminate the infection.
Surgical Interventions: Emerging Trends
Periodontal plastic surgery. Trends in surgical periodontics are continuing to expand into the “periodontal plastic surgery” area. Many new techniques have been incorporated into daily practice that are focused on root coverage and pre prosthetic procedures such as ridge preservation or ridge augmentation prior to implant placement or restorations.
Regeneration techniques: new materials.
Regeneration techniques continue to expand the ability of the surgeon to restore lost hard and soft tissues to a much healthier and more functional and esthetic state. Guided tissue regeneration can be accomplished with many different types of materials and techniques.. The techniques most commonly used to correct bony defects consist of placing an autogenous or bone replacement graft into the defect. For smaller three-walled defects, no other material may be needed. For furcation defects or larger defects, clinicians will often choose to add a resorbable or non resorbable membrane to contain the graft material and exclude the epithelial down growth into the defect.
Dentistry has always been a leader in the health care community in prevention, and has already addressed one of the most prevalent chronic infections worldwide—dental caries. Now we must focus our attention on all infectious oral diseases, which include not only caries, but gingivitis and periodontitis as well.