Scaling and granulation tissue removal in periodontal therapy*

摘要

AbstractThe present clinical trial was performed 10 study whether subgingival scaling is a method of therapy which is equally effective as “access” Haps in reducing gingivitis and probing depths and in improving probing attachment levels. The study was also designed to assess whether granulation tissue removal is a determining factor for proper healing in the treatment of periodontal disease.15 patients with advanced periodontal disease were included in the study‐ Each patient had at least 4 sites in each quadrant of the jaws with probing depths exceeding 6 mm. A baseline examination was performed to assess the following parameters: the oral hygiene status, the gingival conditions, the probing pocket depths and the probing attachment levels. In addition, in each quadrant, 3 approximal sites were selected for analysis of the subgingival microbiota. All of these sites showed signs of gingivitis. One site had a probing depth of<4 mm, another a probing depth between 4 and 6 mm and the third site had a probing depth exceeding 6 mm. The subgingival bacterial samples were‐ studied by dark‐field microscopy and the of spirochetes and motile rods was assessed.By random selection the 4 jaw quadrants in each patient were treated for periodontal disease by the use of<11 the modified Widman flap procedure, (2) the modified Kirkland flap procedure or by (3) non‐surgical scaling and root planing. In all, 20 quadrants were treated with each of the 3 procedures.After the termination of active periodontal treatment, all patients were recalled for professional tooth cleaning once every 2 weeks during a 12‐week period, Subsequently, they were recalled for prophylaxis every 3 months. The patients were examined 6 and 12 months after treatment using the same parameters as used at baseline.The data from the examinations demonstrated that subgingival scaling is an effective measure in the treatment of periodontal disease. Both in terms of average gingivitis resolution and average probing depth reduction, non‐surgical therapy appeared to be equally effective as a surgical approach to treatment. It was also observed, however, that following non‐surgical treatment, a larger number of sites with pockets exceeding 6 mm remained than following surgical therapy. Most of these deep pockets in non‐surgically treated quadrants bled on probing to the base of the pocket. In addition, the subgingival microbiola of such sites were found to harbor more than 20 spirochetes and motile rods.The present investigation also demonstrated that granulation tissue removal in conjunction with flap surgery is not a critical measure for the establishment of conditions which are conducive for proper healing of the periodontal tissues.No attempts were made in the present study to assess the effect of treatment in furcation areas. This means that conclusions drawn from the results obtained are valid only for tooth surfaces devoid of fur