Definitief Paro 2015-als handout · Tand Bot Wortelvlies (parodontaal ligament) [Parodontaal ligament] - wortelvlies. 10‐2‐2015 5 [Parodontaal ligament] - wortelvlies Replantation

10‐2‐2015

1

Fridus van der Weijden,

Paro Praktijk Utrecht,Implantologie Utrecht,

Academisch Centrum Tandheelkunde Amsterdam

Because we have becomeaccustomed to the scientific

terms applied to teeth and gums we loose sight of the fact that teeth are bones protruding through soft

tissues where conditions are extremely unfavorable

to maintainhealth.

T.S. Smith, 1940

[gezond tandvlees]

[gezond tandvlees]

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[aanhechtingsepitheel]

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[neutrofiele granulocyt] [neutrofiele granulocyt]

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[cyclische neutropenie]

♀ 24 jaar

[cyclische neutropenie]

♀ 24 jaar

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Biologic W

idth

± 1 mm

± 1 mm

± 1 mm

[sulcus]

[supra-alveolair bindweefsel]

[aanhechtingsepitheel]. ...…

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..± 1 mm

Meestal constante afstandvan ongeveer 1 mm.

[Aanhechtingsniveau]

[Alveolaire botrand]

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..± 1 mm

Schou et al. Clinical Oral Implants Research 2002,13,113-126

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[Connective Tissue Fibers]

-Circular--Alveolar-Gingiva--Periosto-Gingival--Dento-Gingival--Dento-Periostal-

-Transseptal-

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-Transseptal- . ...…

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-Transseptal-

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-Transseptal-

[Samenvattend]

Epitheliale aanhechting

Supra-alveolaire bindweefselvezels

Creviculaire vloeistofstroom

Locale afweer

Tand Bot

Wortelvlies (parodontaal ligament)

[Parodontaal ligament] - wortelvlies

10‐2‐2015

5

[Parodontaal ligament] - wortelvlies

Replantation of PDL progenitor-seeded tooth roots resulted in the complete formation of a new PDL and stable reattachment of teeth.

Dangaria et al. Stem Cells Dev. 2011, 20, 1659-1668.

Melcher AH. Ann R Coll Surg Engl. 1985, 67, 130-131.

Cells of periodontium: their role in the healing of wounds.

[Parodontaal ligament] - wortelvlies Casus: Dick Barendregt & Manfred Leunisse

[Parodontaal ligament] - wortelvlies Casus: Dick Barendregt & Manfred Leunisse [Parodontaal ligament] - wortelvlies Casus: Dick Barendregt & Manfred Leunisse

-0- -3- -6- -12- wk

10‐2‐2015

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Long‐term effect of surgical/non‐surgicaltreatment of periodontal disease. Lindhe J, Westfelt E, Nyman S, Socransky SS, Haffajee AD. J Clin Periodontol. 1984, 11, 448-458.

Effect of nonsurgical periodontal therapy.II. Severely advanced periodontitis. Badersten A, Nilveus R, Egelberg J. J Clin Periodontol. 1984, 11, 63-76.

The effect of root planingas compared to that of surgical treatment.

Isidor F, Karring T, Attström R. J Clin Periodontol. 1984, 11, 669-681..

Effect of nonsurgical periodontal therapy.III. Single versus repeated instrumentation.

Badersten A, Nilveus R, Egelberg J. J Clin Periodontol. 1984, 11, 114-124.

[Non-surgical]

Studies from the United States and Swedenhave documented that surgical pocket elimination including bone surgery offers no advantage to maintenance of the teeth and their support compared with more conservative modalities of treatment.

Ramfjord SP. J Am Dent Assoc. 1987, 114, 37-40.

Ramfjord SP. Prosthet Dent. 1984, 52, 781-786.

[Non-surgical]

Effect of non‐surgical periodontal therapy

[Severely advanced periodontitis]

Anita Badersten, Rolf Nilveus & Jan EgelbergJournal of Clinical Periodontology 1984, 11, 63‐76.

[Non-surgical]

Badersten et al. Journal of Clinical Periodontology, 1984, 63‐76.

Initial scoresOral hygiene visits 1

3 months 2

3

3‐month scores

.3 monthly maintenance and scores .

.24 months scores

[Non-surgical]

repeated oral hygiene

instrumentation #1 instruction according

3 months to individual needs

6 months scores .instrumentation #2 .

3 months .9 months scores .instrumentation #3 .

[Non-surgical]

% plaque scores% plaque scores

% bleeding scores

0 3 6 9 12 15 18 21 240 3 6 9 12 15 18 21 24

0 3 6 9 12 15 18 21 240 3 6 9 12 15 18 21 24

100%

0%

100%

0%


10‐2‐2015

7

[mondhygiene]

Efficacy of homecare regimens formechanicalplaque removal in managing gingivitis ‐meta‐review. Van der Weijden & Slot. J Clin Periodontol. 2015

Power toothbrushes have a benefit over manual toothbrushes. The greatest body of evidence was available for oscillating/rotatingbrushes.

Efficacy of interdental mechanical plaque control in managing gingivitis ‐meta‐review. Sälzer et al. J Clin Periodontol. 2015

[mondhygiene]

Evidence suggests that inter‐dental cleaning with interdental brushes is the most effective method for inter‐dental plaque removal


[Non-surgical]

S.L. Male, 54 years: PI= 57%, BI= 90%


[Non-surgical]

S.L. Male, 54 years: PI= 5%, BI= 5%


[Non-surgical]12

11

10

9

8

7

6

5

4

3

2

1

0

‐1

‐2

mm

<2.5 3‐3.5 4‐4.5 5‐5.5 6‐6.5 7‐7.5 8‐8.5 9‐9.5 >10 mm


10‐2‐2015

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12

11

10

9

8

7

6

5

4

3

2

1

0

‐1

‐2

mm

mm


<2.5 3‐3.5 4‐4.5 5‐5.5 6‐6.5 7‐7.5 8‐8.5 9‐9.5 >10

1211109876543210‐1‐2

mm

mm


Change Clinical Attachment Level

<2.5 3‐3.5 4‐4.5 5‐5.5 6‐6.5 7‐7.5 8‐8.5 9‐9.5 >10

12

11

10

9

8

7

6

5

4

3

2

1

0

‐1

‐2

mm

mm


hand instrument

ultrasonic scaler

<2.5 3‐3.5 4‐4.5 5‐5.5 6‐6.5 7‐7.5 8‐8.5 9‐9.5 >10


[Non-surgical]

Curette versus Ultrasonics

■ Similar reduction in bleeding on probing,

pocketdepth and changes of

attachment level.

A systematic review of efficacy of

machine‐driven and manual

subgingival debridement in the

treatment of chronic periodontitis

Tunkel et al.

Journal of Clinical Periodontology 2002, 29, 72‐81.

[ultrasonic] [Non-surgical]

Tunkel et al. Journal of Clinical Periodontology 2002, 29, 72‐81.

■ No difference in the efficacy of subingival

debridement in the treatment of chronic

periodontitis.

Curette versus Ultrasonics

■ Subgingival debridement may be completed

in less time with ultrasonic/sonic than with

hand instruments. Take your time!It is faster, but not fast

10‐2‐2015

9

[commercial break]

Zee KY. Aust Dent J. 2009, 54, 44-50.

Risk calculations suggested that 40 %of chronic periodontitis cases may be

attributed to smoking, with an increased odds ratio of 5.4 for chronic periodontitis in smokers.

[roken] [roken]

van der Weijden GA et al. J Clin Periodontol. 2001, 28, 955-960.

43% of the patient population was smokers

35% of the overall Dutch population approximately has reported to be smokers

[roken]

Van Winkelhoff et al. J Clin Periodontol. 1989, 16, 128-131.

Metronidazole plus amoxycillinin the treatment of

Actinobacillus actinomycetemcomitansassociated periodontitis.

[antibiotica]

10‐2‐2015

10

[antibiotica]


[antibiotica]



[antibiotica]

Patients had received periodontal treatment in the past

Clinical improvements were observed in all patients, resulting in reduced pocket probing depths as well as in a significant reduction in bleeding on probing.

[antibiotica]

[SRP + AB]

Zandbergen et al. J Periodontol. 2013, 84, 332-351.

[Initial PPD]

PPD 4‐6 mmReduction ≥ 7 mm

CAL 4‐6 mmgain ≥ 7 mm

‐1.47‐3.72

1.312.66

[antibiotica]

‐1.47‐3.72

1.312.66

‐1.29‐2.16

0.551.19

Cobb CM. J Clin Periodontol. 2002, 29, 6-16.

[SRP + AB] [SRP][Initial PPD]

PPD 4‐6 mmReduction ≥ 7 mm

CAL 4‐6 mmgain ≥ 7 mm

[antibiotica]

Zandbergen et al. J Periodontol. 2013, 84, 332-351.

The authors want to express their concern toward the unprofessional use of, for example, antimicrobial treatment in the absence of thorough subgingival debridement.

10‐2‐2015

11

Clinical and microbiologicalbenefits of

strict supragingival plaque controlas part of the active phase of

periodontal therapy

[chloorhexidine]

Feres et al. J Clin Periodontol. 2009, 36, 857-867.

SRP 6x 1 hour + Placebo rinse 2x day (63 days)

SRP + Prof. Prophylaxis 2x week (63 days) + Placebo rinse 2x day (63 days)

SRP + Chlorhexidine 2x day (63 days)

[chloorhexidine]


SRP+CHX

Baseline 35% 31% 30%

2 Months 16% 12% 7%

6 Months 16% 10% 5%

SRP

% Pockets PPD ≥ 5mm

[chloorhexidine]


SRP+PP

[chloorhexidine & H2O2]

[chloorhexidine & H2O2]

The effect of an oxygenating agent on chlorhexidine‐induced extrinsic tooth staining‐a systematic review‐van Maanen-Schakel et al. Int J Dent Hyg. 2012 Aug;10(3):198-208.

Evidence that a combination of an oxygenating agent with chlorhexidine reduces tooth staining without interfering with plaque growth inhibition.

[lasers]

Slot et al. J Periodontol. 2009, 80, 1041-1056.

Slot et al. J Clin Periodontol. 2014, 41, 681-692.

■ Nd:YAG Laser

■ Diode laser

10‐2‐2015

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[lasers]

Currently, there is minimal evidence to support use of a laser for the purpose of subgingival debridement, either as a monotherapy or adjunctive to scaling and rootplaning.

American Academy of Periodontology. J Periodontol. 2011, 82, 513-514.

There is insufficient evidence to suggest that any specific laser wavelength is superior to the traditional treatment methods of periodontitis.

[parodontale chirurgie]


[Parodontitis is geen appendicitis]

[Doel]

■ Zichtbaarheid en toegang tot het worteloppervlak


• volledige verwijdering van plaque en tandsteen

• zicht op wortelgroeven, furcaties, restauratie‐randen

[Doel]


■ De verdiepte pocket als retentiefactor voor plaque elimineren

[parodontale chirurgie] [parodontale chirurgie]

In the treatment of deep pockets open flap debridement results in greater PPD reduction.

Heitz-Mayfield et al.J Clin Periodontol. 2002, 29, 92-102.

10‐2‐2015

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[Doel]



■ Creëren van een gingiva‐vorm die goede

mondhygiëne bevordert


[parodontale chirurgie] Casus: Hans Rodenburg [parodontale chirurgie] Casus: Hans Rodenburg

[parodontale chirurgie] Casus: Hans Rodenburg

[Doel]



■ Creëren van een gingiva‐vorm die goede

mondhygiëne bevordert

■ Regeneratie: Bevorderen herstel bindweefselaanhechting


10‐2‐2015

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EMD significantly improved CAL levels and PPD reduction when compared to a placebo or control.

However, the high degree of heterogeneity observed among trials suggests that results have to be interpreted with great caution.


Esposito et al. Cochrane Database Syst Rev. 2009, 7, CD003875.

[Samenvattend] [Samenvattend]

Gezond ► Parodontitis

Parodontitis ►Gezond

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Documents

Definitief Paro 2015-als handout · Tand Bot Wortelvlies (parodontaal ligament) [Parodontaal ligament] - wortelvlies. 10‐2‐2015 5 [Parodontaal ligament] - wortelvlies Replantation