Atilla BERBEROĞLU, Ayşe ÇAYGÜR, Muhammed BABA, Hayriye TÜMER, Güney YILMAZ

DİŞTAŞLARI TEMİZLİĞİ, KÖK YÜZEYİ DÜZLEŞTİRMESİ VE POLİSAJDA GÜNCEL KAVRAMLAR: DERLEME

Periodontal hastalıkların tedavisinin en önemli kısmını İngilizce literatürde scaling ve root planing (SRP) olarak adlandırılan diş taşları temizliği ve polisaj oluşturmaktadır. SRP sırasında diş taşının yanı sıra sement yüzeyine penetre olmuş bakteriyel endotoksinler de uzaklaştırılmaktadır. Klasik anlamda cebin yumuşak duvarına yönelik gingival küretaja günümüzde pek fazla gereksinim duyulmamaktadır.SRP işlemi sırasında; manuel ve ultrasonik aletler ile laser kullanılmaktadır. Küretlerin kullanıldığı geleneksel mekanik debridmanın etkinliği dişhekiminin bireysel becerilerine bağlıdır ve bazı alanlara (örneğin; furkasyon, konkavite, oluk ve üçüncü molarların distali) erişimi sınırlıdır. Ultrasonik aygıtlar daha az zaman alıcı ve kullanımı kolay araçlardır ama oluşturdukları gürültü ve titreşim hastayı rahatsız edebilir. Laserler mükemmel doku ablasyonu, bakterisidal ve detoksifikasyon etkileri ile SRP de geleneksel yöntemlere alternatif veya yardımcı yöntemler olarak öne çıkmaya başlamışlardır. Ancak, cerrahi olmayan periodontal tedavide laserin daha üstün bir teknik olduğuna dair elimizde yeterli kanıt yoktur.SRP’den sonra uygulanan polisaj ile dişin sert yüzeylerinde plak retansiyonuna neden olabilecek çiziklerin büyük bir bölümü düzeltilebilir. Bir miktar da subgingival alana girilebilirse SRP sırasında kalmış olabilecek mikrobiyal biyofilm kalıntıları elimine edilerek iyileşmeye önemli ölçüde katkı sağlanmış olunur. Ancak klasik polisajla biyofilm uzaklaştırılması işleminde cep içine fazla girilememesi büyük bir dezavantaj oluşturmaktadır. Air polishing cihazlarının subgingival alanda da kullanılmaya başlanması ile bu olumsuz etkiyi ortadan kaldırmıştır.Air polishing cihazında kullanılan tozların avantaj ve dezavantajları kıyaslandığında; subgingival alanda glisin, supragingival alanlardaki demineralize olmamış mine dokusunda ise sodyum bikarbonat kullanımı tercih edilmektedir. Bu tozlarla ilgili yapılan çalışmalar etkinliklerini ve güvenliliklerini belirlemiştir.

Anahtar Kelimeler:

Diştaşları temizliği, kök yüzeyi düzleştirmesi, ultrasonik, hava püskürtmeli polisaj, cerrahi olmayan periodontal tedavi

CURRENT CONCEPTS IN SCALING, ROOT PLANING AND POLISHING: A REVIEW

Dental scaling and root planing (SRP) is the one of the most common treatment modality for periodontal diseases which was indicated well known in the literature. In SRP procedure, not only the dental calculus eliminated but also the microbial endotoxins which infiltrated into the cementum subside together. Nowadays, it was indicated that the gingival curettage of the pocket wall is not necessary in the classical sense as a treatment modality. During SRP, manual and ultrasonic instruments and lasers are used. The effectiveness of conventional mechanical debridement with curettes depends on the dentist's individual skills and access to some areas (i.e. furcation, concavities, grooves and distal sites of molars) is limited. Ultrasonic devices allow less time consuming and they are easy to use, but they create noise and vibration which can be uncomfortable to the patient. Lasers can achieve excellent tissue ablation, bactericidal and detoxification effects or help with an alternative to the traditional methods of SRP began to stand out as. However, the non-surgical laser treatment there is no sufficient evidence that it is technically superior. Lasers can achieve excellent tissue ablation with bactericidal and detoxification effects and laser was assested as monotherapy and as an adjunct to SRP. However, no evidence exists that the laser is superior to traditional modalities of periodontal therapy Polishing is the following step after the SRP which eliminates most of the scratch to result the plaque retention after SRP procedure. During procedure, if polishing can perform into the subgingival area, the biofilm after SRP can also be eliminated from and has a positive impact on the healing. However, it should be noted that the rubber cup cannot able to enter this area inept which leads to be a disadvantage for the procedure. After starting to use the air polishing device in this area, this negative effect was eliminated. After comparison of pros and cons of air polishing; glycine in subgingival area, and sodium bicarbonate in supra demineralized enamel tissue was widely accepted to use for the procedure which the effect and reliability of the material were evaluated by many studies in the literature

Keywords:

Scaling and root planing, ultrasonic, laser, air abrasives, nonsurgical periodontal therapy,

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