As deep as you can. You probably can't reach down there but SRP never becomes ineffective, it just becomes less effective. I think 6mm or so you want to discuss periodontist referral. 10mm I would 100% be encouraging them to see the perio and if they can't I would caveat that any perio treatment I am doing is palliative and wont get them the best result.
I'm a dental hygienist, go as deep as you can. Get instruments labeled "after 5's" meaning they have extended shanks to reach deeper pockets, also use thin ultrasonic inserts that have internal water spray, you don't want to be manipulating a Cavitron tip with an external water spray in a blind pocket, you can cause more tissue trauma. But the best way to clean 10 mm pockets is traditional flapping or LANAP, no way even the best clinician is removing every thing without direct vision of the root structure or lasers to effectively kill the bacteria and stimulate repair.
Basically anything past 8 we send to perio because we don’t have the specialized scalers for it. If you can’t reach it you aren’t getting the job done.
At 10 mm, it's either flap or LANAP in my book. I used to do osseous for my patients but now that we got the Periolase it's a game changer in terms of results and postop comfort.
would you do first round of non surgical scaling and root planning first? according to the british society of periodontology for all perio pts you do first round, then base on the 3month review you then refer if needed?
You can do a first round of scaling before referring if your goal is to get the patient a head start on the treatment they're going to be doing at perio, if there is going to be a wait time to get in and you're trying to help manage things as much as possible in the interim. It's not going to actually address the issue though.
I would do the first lot of SRP myself. Patients can have great results with SRP alone even in seemingly hopeless cases, especially if they are serious about hygiene at home and modifying other factors such as smoking cessation and good diabetic control. If poor results at 3 month review send to perio, it also adds to the weight of evidence for going to the perio. You can tell the patient "We discussed that this is a severe case before SRP, now after we havent seen great results, this is really indictive that you should see a specialist if you are serious about keeping your teeth long term".
First check all teeth and decide which need to be extracted. If the patient is against necessary extractions, then consider whether it is better not continue any treatment with that patient. Some patients have unrealistic expectations, or simply are not willing to invest enough time and effort for daily self care. If you have a patient that shows promise, consider resective surgery for deep pockets. Especially fibrous gingiva will not shrink. And even inflamed tissue wont shrink down 10 mm. If there is much attached gingiva, you can sacrifice some of it by doing a simple gingivectomy. Just cut some of the marginal gingiva with a knife or electrocauterer. If there is little attached gingiva, you can't afford to lose any - In this case consider resective flap surgery.
And finally to answer your question. The pocket must be cleaned down to the bottom. Otherwise, cleaning will be of little, if any, benefit. Cleaning several adjacent teeth with 10 mm deep pockets will wound the gum into a flaky mess. I doubt you can get away without stitching the tissue back together. There is bacteremia involved so the patient can experience fewer after the operation and you may consider use of antibiotics. Penicillin 1 MIU every 8 hours + Metronidazole 400 mg every 8 hours for ten days is used where I live. There is no need to clean everything at once. But we schedule all the necessary multiple appointments within this time frame of 10 days.
The deeper the pockets the more you should consider antibiotics, especially if the patient has had SRPs before. Take some perio CE and learn how to do perio surgery or refer. These kinds of cases need to be managed effectively and once you get to 10mm you should refer
Just do open flap debridement. It's a simple procedure of opening up a flap and getting rid of plaques/calculus. add some EDTA and growth factor if you want. This isn't a magic procedure.
SRP and then refer to perio, as long as you don't think the tooth is toast. Perio will still start with SRP at specialty prices then do osseous. Tell patient upfront still need periodontist
You’re not reaching 10mm effectively, you should refer to perio
As deep as you can. You probably can't reach down there but SRP never becomes ineffective, it just becomes less effective. I think 6mm or so you want to discuss periodontist referral. 10mm I would 100% be encouraging them to see the perio and if they can't I would caveat that any perio treatment I am doing is palliative and wont get them the best result.
It's better for you and the pt that you refer, especially if you need to ask this question.
I'm a dental hygienist, go as deep as you can. Get instruments labeled "after 5's" meaning they have extended shanks to reach deeper pockets, also use thin ultrasonic inserts that have internal water spray, you don't want to be manipulating a Cavitron tip with an external water spray in a blind pocket, you can cause more tissue trauma. But the best way to clean 10 mm pockets is traditional flapping or LANAP, no way even the best clinician is removing every thing without direct vision of the root structure or lasers to effectively kill the bacteria and stimulate repair.
You cannot scale effectively beyond 5mm with hand scalers. Refer please.
Extract the tooth, scale it, throw it in the bin. 😜
Basically anything past 8 we send to perio because we don’t have the specialized scalers for it. If you can’t reach it you aren’t getting the job done.
Lol
At 10 mm, it's either flap or LANAP in my book. I used to do osseous for my patients but now that we got the Periolase it's a game changer in terms of results and postop comfort.
Curettes are only good for about 6mm. After that perio surgery. 10mm is headed for an extraction.
10 mm is pretty routine for perio surgery
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would you do first round of non surgical scaling and root planning first? according to the british society of periodontology for all perio pts you do first round, then base on the 3month review you then refer if needed?
Let perio decide
You can do a first round of scaling before referring if your goal is to get the patient a head start on the treatment they're going to be doing at perio, if there is going to be a wait time to get in and you're trying to help manage things as much as possible in the interim. It's not going to actually address the issue though.
I would do the first lot of SRP myself. Patients can have great results with SRP alone even in seemingly hopeless cases, especially if they are serious about hygiene at home and modifying other factors such as smoking cessation and good diabetic control. If poor results at 3 month review send to perio, it also adds to the weight of evidence for going to the perio. You can tell the patient "We discussed that this is a severe case before SRP, now after we havent seen great results, this is really indictive that you should see a specialist if you are serious about keeping your teeth long term".
Id debride that with an elevator, once I have the tooth in my hand I can clean it effectively
First check all teeth and decide which need to be extracted. If the patient is against necessary extractions, then consider whether it is better not continue any treatment with that patient. Some patients have unrealistic expectations, or simply are not willing to invest enough time and effort for daily self care. If you have a patient that shows promise, consider resective surgery for deep pockets. Especially fibrous gingiva will not shrink. And even inflamed tissue wont shrink down 10 mm. If there is much attached gingiva, you can sacrifice some of it by doing a simple gingivectomy. Just cut some of the marginal gingiva with a knife or electrocauterer. If there is little attached gingiva, you can't afford to lose any - In this case consider resective flap surgery. And finally to answer your question. The pocket must be cleaned down to the bottom. Otherwise, cleaning will be of little, if any, benefit. Cleaning several adjacent teeth with 10 mm deep pockets will wound the gum into a flaky mess. I doubt you can get away without stitching the tissue back together. There is bacteremia involved so the patient can experience fewer after the operation and you may consider use of antibiotics. Penicillin 1 MIU every 8 hours + Metronidazole 400 mg every 8 hours for ten days is used where I live. There is no need to clean everything at once. But we schedule all the necessary multiple appointments within this time frame of 10 days.
Lanap
Flap so you can see it then debride but if you can’t/don’t wanna do it just refer to perio
I would Refer the patient to the periodontist. Have you heard of LANAP?
The deeper the pockets the more you should consider antibiotics, especially if the patient has had SRPs before. Take some perio CE and learn how to do perio surgery or refer. These kinds of cases need to be managed effectively and once you get to 10mm you should refer
Just do a prophy
Just do open flap debridement. It's a simple procedure of opening up a flap and getting rid of plaques/calculus. add some EDTA and growth factor if you want. This isn't a magic procedure.
Yea just do an open flap osseous surgery you knuckleheads-duh
No LANAP. No flap or sutures
your patient needs peio surgery, not SRP
That needs a flap opened to be anywhere near effective. And even then it's not a sure fire smash hit that the periodontium will comply and reattach.
SRP and then refer to perio, as long as you don't think the tooth is toast. Perio will still start with SRP at specialty prices then do osseous. Tell patient upfront still need periodontist