Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2016-05-04, 10:09:48 | version 1.38.0
hygiene tribune Dental tribune Middle East & Africa Edition | January-February 2016 4D < Page 1D comfort for patients and den- tal staff. Hand instruments that have only limited tissue- preserving properties can be replaced in preservation ther- apy by ultrasonic instruments (Piezon, EMS Electro Medi- cal Systems, Munich) and air polishing (Air-Flow with low abrasive erythritol-based Plus powder, EMS) for the beneit of dental staff and patients. In the following article, the classical method (Axelsson / Lindhe) is compared to the modern meth- od (guided bioilm therapy) based on a patient case. Using the example of a 20-year- old patient with braces, in- creased plaque deposits and a hyperplastic gingiva, the au- thor describes the procedure, the implementation and time management of a structured, professional prophylaxis ses- sion. The upper jaw was treated with the modern method us- ing piezo technology (EMS No Pain) and air-low technology (EMS, Air-Flow with Plus pow- der). The lower jaw was treated according to the classic, con- ventional method (hand instru- ments, ultrasonic technology, polishing cup, brush, polishing paste CCS red and Proxyt ine, Ivoclar Vivadent, Ellwangen). Procedure (work phases) 1. Workplace preparation It is advisable to speciically set up basic tools and products for the respective treatment measures of the patient and to prepare them accordingly (Fig. 1-3). In that way you can save a lot of time during the prophy- laxis treatment and simplify compliance with the hygiene chain. 2. Patient pick-up and repeat anamnesis (2 minutes) A short introductory talk, in which speciic needs and ques- tions can be addressed, gives the patient a sense of having ar- rived, creates trust and conveys interest and professionalism. This is followed by the control and questions on the case his- tory. This vital step has the ob- jective of ascertaining changes in health, new risks, prevention of infection and medicines, and integrating them into the treat- ment process. The information helps to clarify and ensure that the right technical and mate- rial resources are used for the prophylaxis session without exposing the patient or dental staff to any health risk. Only af- ter clariication can the profes- sional cleaning session begin. 3. Disinfection of oral cavity (1-2 minutes) In order to reduce the num- ber of bacteria prior to fur- ther treatment, rinsing with 0.2% chlorhexidine is recom- mended. Another modern way is to clean the entire oral cav- ity (full-mouth treatment ac- cording to Flemmig) includ- ing tongue, cheek, palate and mucolabial fold using air-low technology and Plus powder in a gentle and simple manner (Fig. 4). This seemingly simple step already serves to carry out successful bioilm manage- ment (guided bioilm therapy). 4. Diagnostics (7 minutes) After the visual inspection of the teeth, follows the inspec- tion of the mucous membranes in the oral cavity. This is where tongue surface/underside, the palate, base of the mouth, the mucolabial fold as well as lips and inner surfaces of the cheeks are ac- curately inspected. After that, a re- evaluation of car- ies, periodontitis and erosion diag- nostics is carried out (PSI, measure- ment of probing depths, oral hy- giene indices, etc.). This is where elec- tronic systems that enable a follow-up have proven their worth. In order to ascertain the plaque index, it is helpful to stain the teeth using Mira 2 Ton (miradent, Hager & Werken GmbH & Co. KG, Duisburg). The patient situation can be represented neutrally and made visible (Fig. 5). In order to ensure an accurate reproduc- ibility of the indi- ces, it is advisable for the entire team involved in prophy- laxis to agree on the documentation and evaluation of a particular index and system. 5. Oral hygiene reinstruction and remotivation (5 minutes) The diagnostic indings should be discussed in detail with the patient. They are the basis for successfulreinstructionandre- motivation of oral hygiene mea- sures at home. Only if patients understand their situation, can better compliance be expected. Visual aids such as a magnify- ing mirror and an intraoral camera are very useful for in- struction purposes. Based on the obtained indings, patients should then be individually in- structed on the use of some of the many available tools (man- ual toothbrush, rotating or son- ic toothbrush, toothpastes, in- terdental brushes, dental loss, tongue cleaners, etc.) but not be overwhelmed with too many options and techniques. In summary, it must be stressed that in order to achieve effec- tive oral hygiene, the instruc- tion and motivation of patients is a central and challenging component of professional prophylaxis sessions. The se- lection of the appropriate tools and instruction depends on the individual needs and abilities of the patient. 6. treatment preparation (2 minutes) This includes the use of safety goggles as protection against infections for both the dental staff and the patient. Further- more, lips should be protected by putting crème on them. Pa- tient comfort can likewise be increased by using an Optra- Gate rubber appliance (Ivoclar Vivadent), which allows a clear- er view of the oral cavity. The use of parotis rolls can also be very helpful. 7. Professional tooth cleaning (30 minutes) 7.1. Modern preservation therapy (general) Modern professional dental cleaning involves the removal of hard and soft deposits in a particularly gentle way. Bioilm management today plays an in- creasingly important role. With the air-polishing technology with low abrasive powders, the surfaces are not only cleaned and subjected to bioilm man- agement in supragingival and sulcular regions, but also in subgingival regions even into deep pockets. A classic polish- ing with conventional polish- ing pastes, cups and brushes, which is only possible in supra- gingival regions and always ac- companiedbylossofsubstance, is not necessary. With this new technology, injury to the soft tissue around the tooth and the mucous membranes can be avoided. Another big advan- tage is that all restorations and prosthetics in the oral cavity are cleaned and polished at the same time without roughening or damaging the materials. 7.2. Modern preservation therapy (patient case) In the case at hand, the bioilm and discoloration made vis- ible by staining were removed in the upper jaw using air- low technology and erythritol powder (Plus, EMS) above and below the enamel cement bor- der (Fig. 6, upper jaw). Only by using the new technology is it possible to quickly and eas- ily achieve a perfect polish in Fig. 4: Cleaning the oral cavity with erythritol. Fig. 5: Staining with Mira 2 Ton color before cleaning the upper and lower jaw. Fig. 3: Air-Flow Master Piezon device. dificult-to-reach areas, which are inaccessible with polish- ing cup and brush. In addition, when using this technology, the metal of orthodontic ap- pliances can also be cleaned without running the risk of damaging it. Once the bioilm has been removed, tartar and any subgingival calculus be- come clearly visible and can be selectively removed with a very ine ultrasonic tip (EMS Piezon/PS tip). This develop- ment in ultrasound technol- ogy is referred to as “Piezon No Pain” in the new generation. It is an intelligent technology that enables lightning-fast, con- tinuous power adjustment. The EMS instrument measures the resistance (approximately 125 times per second) provided by hard deposits and feeds the resistance value information back to the built-in module in the EMS device (continuous feedback). The intensity of the instrument tip is thus adjusted to the “dificulty” of the hard deposits that are to be removed. Once the resistance (tartar, cal- culus) has been removed, the device reduces the power au- tomatically. This therefore en- ables gentle as well as eficient work. Exposed, hypersensitive cervical areas and root sur- faces are treated in a painless manner and patient comfort is increased. Only in exceptional cases is re-polishing with air- low technology and erytrithol powder (Plus, EMS) necessary. Since the patient had a hyper- plastic gingiva, sulcular clean- ing and polishing was neces- sary in this case. The aim was to carry out successful bioilm management here, too. It was possible to do this very well with the air-low technology Plus (erytrithol) without trau- matizing the tissue. The patient thought the treatment was very pleasant. 7.3 Classic treatment (patient case) The same initial situation was at hand in the lower jaw, too. Here conventional materials were now used for cleaning (ul- trasonic, hand tool, polishing cup, polishing brush, polish- ing pastes CCS red and Proxyt ine). With the help of mechani- cal and manual instruments, hard and soft deposits were removed in supragingival and sulcular regions. Afterwards, a pre-polishing of all areas fol- lowed using a polishing paste (CCS red) and various soft brushes of any form. The ine polishing was carried out with a soft polishing cup with a ine polishing paste (Proxyt ine) (Fig. 6, lower jaw). The dificul- ty compared to the air-low pol- ishing therapy was that some regions were very hard to reach or not suficiently accessible. Polishing and bioilm manage- ment cannot be carried out as precisely in sulcular regions. Minor injuries to the gingiva were caused quicker. Especial- ly in the region of the brackets, the cleaning was more dificult than using air-low polishing and erytrithol (Plus). Com- pared to the treatment in the upper jaw with Piezon No Pain and air-low technology Plus, more materials, tools and time were needed for the lower jaw. Cleaning with air-low technol- ogy Plus was more precise in terms of cleaning success. 8. Control of the degree of per- fection and chemical plaque control (10 minutes) Control of the cleaning per- fection degree can be carried out very well with a ine probe (here: Hu Friedy EXD 3CH, Frankfurt/Main) and magni- fying glasses. It followed the inspection by the dentist and a chemical plaque control. As a hyperplastic situation was at hand, a 1% chlorhexamed gel was applied. The luoridation with Elmex Fluid was carried out in the next session two days later. 9. recall (2 minutes) Regular professional care is a basic element of prevention. It is important to determine an appropriate time for the follow- up appointment on the basis of the respective indings. This depends on many individual factors. Here one has to differ- entiate according to risk groups (individual, age-speciic, risk- based prophylaxis). Conclusion A paradigm shift is currently taking place when it comes to the procedures and implemen- tation of professional preserva- tion therapy, which makes it necessary to critically re-think old habits. The scientiic and technical conditions are pro- vided. It is time to start using the simpliied, more eficient, effective, comfortable and – above all – substance-conserv- ing treatment method for the good and the health of our pa- tients. Fig. 6: Inspection after cleaning the upper jaw using a modern method and the lower jaw using a classic method. Adina Maurer Dental hygienist Zahnklinik Berlin Gropiuspassagen Johannisthaler-Chaussee 295-327 12351 Berlin www.zahnklinik-berlin.info Instructor/Member of DG Paro e.V. About the Author