Periodontal disease treatment
Gingivitis: Inflammation of the soft tissues with no bone loss
- Place OptraGate (Ivoclar Vivadent), a latex-free retraction device for visibility and protection of lips. Pull apart, place in corners of mouth, position in vestibular regions (figure 1).
- Use low-abrasion powder-streaming technology with erythritol or glycine powder to remove biofilm, or polish with silica paste containing xylitol (e.g., Proxyt fine, Ivoclar Vivadent) to interrupt the bacterial metabolism.
- Debride any calculus present with ultrasonic and curette instruments.
- Apply antimicrobial varnish (e.g., Cervitec Plus) to the root surface at the cervical margin in the disease sulcus pockets to prevent biofilm formation.
- For home care, instruct the patient to brush, floss or water floss, and use an antimicrobial rinse twice daily.
- Reevaluate in six weeks, and set recare at least every three to four months.
Periodontitis: Inflammatory disease or condition affecting the periodontal supporting tissues and bone
Periodontitis stages I–II treatment: Nonsurgical SRP
- Place OptraGate (Ivoclar Vivadent), a latex-free retraction device for visibility and protection of lips. Pull apart, place in corners of mouth, position in vestibular regions (figure 1).
- Use low-abrasion powder-streaming technology with erythritol or glycine powder to remove biofilm, and anesthesia as needed.
- SRP with ultrasonic technology and hand instruments; pick three curette instruments plus Queen of Hearts curette (Paradise Dental Technologies) to debride any calculus present.
- Complete with ultrasonic technology on low power and lavage to remove remaining sulcus debris.
- Apply antimicrobial varnish (e.g., Cervitec Plus) subgingivally into affected periodontal pockets after SRP to prevent biofilm formation as adjunctive therapy.2
- Re-evaluate and set recare at least every three to four months for periodontal maintenance.
Peri-implant disease treatment
Peri-implant mucositis: Inflammation of the soft tissues with no bone loss > 2 mm/early peri-implantitis
- Place OptraGate (Ivoclar Vivadent), a latex-free retraction device for visibility and protection of lips. Pull apart, place in corners of mouth, position in vestibular regions (figure 1).
- Use low-abrasion powder-streaming technology with erythritol or glycine powder subgingivally to treat inflammation of mucositis.
- Debride with proper titanium scalers (e.g., Wingrove Go-To Set, Paradise Dental Technologies; figure 2) and titanium ultrasonic tips.
- Polish restoration with silica prophy paste (e.g., Proxyt fine).
- Apply antimicrobial varnish (e.g., Cervitec Plus) into the permucosal seal of the implant. Instruct patient to wait one hour to eat or drink.
- For home care, instruct the patient to brush, floss or water floss, and use an antimicrobial rinse twice daily.
- Re-evaluate in three to six weeks and refer for peri-implantitis evaluation if cement, residue, or inflammation is present.
Peri-implantitis: Inflammatory reaction that affects both soft tissue and bone loss > 2 mm3
- Early: PD ≥ 4 mm, bleeding on probing and/or exudate on two or more aspects of the implant, bone loss < 25% compared to length of the implant
- Moderate: PD ≥ 6 mm, bleeding on probing and/or exudate on two or more aspects of the implant, bone loss 25% to 50% compared to length of implant; see specialist for treatment
- Advanced: PD ≥ 8 mm, bleeding on probing and/or exudate on two or more aspects of the implant, bone loss > 50% of implant length (measure on radiographs taken at time of definitive prothesis loading to current or earliest radiograph
Editor's note: View Susan Wingrove's companion article to this treatment sheet here.
Based on the Ivoclar Vivadent Protect Teeth/Implants All Around Protocol Sheet by Susan Wingrove. © Susan Wingrove/Wingrove Dynamics 2019.
References
1. Caton JG, Armitage G, Berglundh T, et al. A new classification scheme for periodontal and peri-implant diseases and conditions - Introduction and key changes from the 1999 classification. J Clin Periodontol. 2018;45 Suppl 20:S1-S8. doi:10.1111/jcpe.12935.
2. Anand V, Govila V, Gulati M, Anand B, Jhingaran R, Rastogi P. Chlorhexidine-thymol varnish as an adjunct to scaling and root planing: A clinical observation. J Oral Biol Craniofac Res. 2012;2(2):83-89. doi:10.1016/j.jobcr.2012.05.006.
3. Froum SJ, Rosen PS. A proposed classification for peri-implantitis. Int J Periodontics Restorative Dent. 2012;32(5):533–540.
Susan Wingrove, BS, RDH, is an international speaker, author, researcher, instrument designer, and a 2016 Sunstar/RDH Award of Distinction recipient. She is a member of the American Dental Hygienists’ Association, the International Federation of Dental Hygienists, the Oral-B Global Implant Board, and the Western Society of Periodontology. She is an author of multiple journal articles and the textbook Peri-Implant Therapy for the Dental Hygienist: Clinical Guide to Maintenance and Disease Complications, and a scientific panel member for the American College of Prosthodontists Clinical Practice Guidelines. Contact her at [email protected] and wingrovedynamics.com.
