Controle da placa bacteriana supragengival na terapia periodontal não-cirúrgica
Supragingival plaque control on non-surgery periodontal therapy
Faveri, M.; Feres, M.; Gursky, L.C.; Martins, V.N.; Caixeta Neto, L.S.; Figueiredo, L.C.
Rev. odontol. UNESP, vol.35, n4, p.313-318, 2006
Resumo
O tratamento periodontal está relacionado diretamente aos microrganismos envolvidos nos processos de saúde e doença, sendo assim, as terapias devem ser direcionadas para o controle desses microrganismos. A raspagem e o alisamento radicular (RAR) são uma terapia inespecífica que tem capacidade de alterar microbiologicamente o ambiente subgengival e proporcionar resultados clínicos positivos. Todavia, tais resultados não persistem a longo prazo devido à recolonização dos sítios tratados pelas bactérias remanescentes da região subgengival ou por agentes bacterianos provenientes da região supragengival. Nesse contexto, por meio de uma revisão de literatura, este estudo visa a esclarecer a importância da remoção mecânica da placa supragengival e a influência de tal procedimento nos resultados clínicos e microbiológicos da terapia periodontal. Diferentes metodologias clínicas e microbiológicas, tais como métodos de cultura, de microscopia de campo escuro e técnicas mais apuradas de biologia molecular foram utilizadas com o objetivo de avaliar o efeito do controle de placa supragengival associado ou não a RAR. Esses resultados têm demonstrado melhoras adicionais clínicas e microbiológicas quando é realizado um meticuloso controle da placa supragengival associado à RAR. O reconhecimento de novas metodologias microbiológicas faz do controle de placa supragengival um assunto em discussão e novos estudos precisam ser realizados na tentativa de aprimorar o conhecimento sobre a recolonização a longo prazo por periodontopatógenos nos sítios tratados.
Palavras-chave
Doenças periodontais, profilaxia dentária, anti-sépticos bucais
Abstract
The periodontal treatment is relationship directly with the microorganism involved on the health and diseases status, and consequently, the therapies must focus the control of these microorganisms. The scaling and root planning (SRP) is an unspecific therapy that are able not only to change the microbial composition of the subgingival area but also to offer positive clinical results. Nevertheless, these positive results are not longer observed due to re-colonization of the treated periodontal sites by the pathogens remained either in the sub- or in the supragingival area. Therefore, by means of a review of literature this study aims to clarify the importance of both mechanic removal of the subgingival dental plaque and the influence of the SRP on the microbiological and clinical results. Different clinic and microbiologic methodologies such as cultivable techniques, dark-field electron microscopy, and molecular biology were used with the purpose to evaluate the effect of the supragingival plaque control associated or not with the SRP. These results have shown better clinical and microbiological additional results when there is and association between meticulous supragingival plaque control and SRP. The recognize of new microbiological methodologies demonstrate that the control of the supragingival plaque is a field in currently discussion and further investigations must be conducted to try arise the knowledge about the long term re-colonization of treated periodontal sites by periodontal pathogens.
Keywords
Periodontal diseases, dental prophylaxis, antiseptics
References
1. Baderten A, Nilvéus R., Egelberd J. Effect of nonsurgical periodontal therapy. I. Moderately advanced periodontitis. J Clin Periodontol. 1981;8:57-72.
2. Claffey N, Loos B, Gantes B, Martin M. The relative effects of therapy and periodontal disease on loss of probing attachment after root debridement. J Clin Periodontol. 1988;15:163-9.
3. Haffajee AD, Cugini MA, Dibart SS, Kent JR RL, Socransky SS. The effect of SRP on the clinical and microbiological parameters of periodontal diseases. J Clin Periodontol. 1997;24:324-34.
4. Cugini MA, Haffajee AD, Smith C, Kent Jr RL, Socransky SS. The effect of scaling and root planning on the clinical and microbiological parameters of periodontal diseases: 12 mounths results. J Clin Periodontol. 2000;27:30‑6.
5. Cobb CM. Clinical significance of non-surgical periodontal therapy: an evidence based perspective of scaling and root planning. J Clin Periodontol. 2002;29(Suppl2): 6‑16.
6. Carvalho LH, D’Avila GB, Leão A, Haffajee AD, Socransky SS, Feres M. Scaling and root planing, systemic metronidazole and professional plaque removal in the treatment of chronic periodontitis in a Brazilian population. II. Microbiological results. J Clin Periodontol. 2005;32:406‑11.
7. Carvalho LH, D’Avila GB, Leão A, Haffajee AD, Socransky SS, Feres M. Scaling and root planning, systemic metronidazole and professional plaque removal in the treatment of chronic periodontitis in a Brazilian population. I. Clinical results. J Clin Periodontol. 2004;31:1070‑6.
8. Listgarten MA, Lindhe J, Helldén L. Effect of tetracycline and/or scaling on human periodontal disease. Clinical, microbiological and histological observations. J Clin Periodontol. 1978;5:246-71.
9. Helldén L, Listgarten MA, Lindhe J. Effect of tetracycline and/or scaling on human periodontal disease. J Clin Periodontol. 1979;6:222-30.
10. Tabita PV, Bissada NF, Mayburry JE. Effectiveness of supragingival plaque control on the development of subgingival plaque and gingival inflammation in patients with moderate pocket depth. J Periodontol. 1981;52:88‑93.
11. Mousquès T, Listgarten M, Phillips R. The effect of scaling and root planning on the composition of the human subgingival microbial flora. J Periodontal Res. 1980;15:144‑51.
12. Socransky SS, Haffajee AD. Effect of therapy on periodontal infections. J Periodontol. 1993;64:754-9.
13. Axelsson P, Lindhe J. The significance of maintenance care in the treatment of periodontal disease. J Clin Periodontol. 1981;8:281-94.
14. Magnusson I, Lindhe J, Yoneyama T, Liljenberg B. Recolonization of a subgingival microbiota following scaling in deep pockets. J Clin Periodontol. 1984;11:193‑207.15. Stelzel M, Florès-de-Jacoby L. Topical metronidazole application as an adjunct to scaling and root planning. J Clin Periodontol. 2000;27:447-52.
16. Ximénez-Fyvie LA, Haffajee AD, Thompson M, Torresyap G, Socransky SS. The effect of repeated profes sional supragengival plaque removal on the composition of supra and subgingival microbiola. J Clin Periodontol. 2000;27: 637-47.
17. Hughes TP, Caffesse RG. Gingival changes following scaling, root planning and oral hygiene. A biometric evaluation. J Periodontol. 1978;49:245-52.
18. Proye M, Caton J, Polson A. Initial healing of periodontal pockets after a single episode of root planning monitored by controlled probing forces. J Periodontol. 1982;53:296-301.
19. Morrison EC, Ramfjord SP, Hill RW. Short term effects of initial nonsurgical periodontal treatment (Hygiene phase). J Clin Periodontol. 1980;7:199-211.
20. Kaldahl WB, Kalkwarf KL, Patil KD. A Review of longitudinal studies that compared periodontal therapies. J Periodontol. 1993;64:243-53.
21. Kaldahl WB, Kalkwarf KL, Patil KD, Molvar MP, Dyer JK. Evaluation of four modalities of periodontal therapy. Mean probing depth, probing attachment level and recession changes. J Periodontol. 1988;67:93‑102.
22. Hinrichs JE, Wolff LF, Pihlstrom BL, Schaffer EM, Liljemark WF, Bandt CL. Effects of scaling and root planing on subgingival microbial proportions standardized in terms of their naturally occurring distribution. J Periodontol. 1985;56:187-94.
23. Müller HP, Hartmann J, Flores-de-Jacoby L. Clinical alterations in relation to the morphological composition of the subgingival microflora following scaling and root planing. J Clin Periodontol. 1986;13:825-32.
24. Sbordone L, Ramaglia L, Gulletta E, Iacono V. Recolonization of the subgingival microflora after scaling and root planing in human periodontitis. J Periodontol. 1990;61:579-84.
25. Sato K, Yoneyama T, Okamoto H, Dahlen G, LindheJ. The effect of subgingival debridement on periodontal disease parameters and the subgingival microbiota. J Clin Periodontol. 1993;20:359-65.
26. Quirynen M, Mongardini C, De Soete M, Pauwels M, Coucke W, van Eldere J. The role of chlorhexidine in the one-stage full-mouth disinfection treatment of patients with advanced adult periodontitis- long term clinical and microbiological observations. J Clin Periodontol. 2000;27:578‑89.
27. Socransky SS, Haffajee AD, Cugini MA, Smith C, Kent JR RL. Microbial complexes in subgingival plaque. J Clin Periodontol. 1998;25:134-44.
28. Shiloah J, Patters MR. DNA probe analysis of the survival of selected periodontal pathogens following scaling, root planning, and intra pocket irrigation. J Periodontol. 1994;65:568-75.
29. Mombelli A, Schmid B, Rutar A, Lang NP. Persistence patterns of Porphyromonas gingivalis, Prevotella intermedia/ nigrescens, and Actinobacillus actinomycetemcomitans after mechanical therapy of periodontal disease. J Periodontol. 2000;71:14-21.
30. Kho P, Smales FC, Hardie JM. The effect of supragengival plaque control on the subgingival microflora. J Clin Periodontol. 1983;12:676-86.
31. Beltrami M, Bickel M, Baehni PC. The effect of supragengival plaque control on the composition of the subgingival microflora in human periodontitis. J Clin Periodontol. 1987;14:161-4.
32. Loos B, Claffey N, Crigger M. Effect or oral hygiene measures on clinical e microbiological parameters of periodontal disease. J Clin Periodontol. 1988;15:211‑6.
33. McNabb H, Mombelli A, Lang NP. Supragingival cleaning 3 times a week. The microbiological effects in moderately deep pockets. J Clin Periodontol. 1992;9:2348‑56.
34. Dahlén G, Lindhe J, Sato K, Hanamura H, OkamotoH. The effect of supragengival plaque control on the subgingival microbiota in subjects with periodontal disease. J Clin Periodontol. 1992;19:802-9.
35. Hellstrom MK, Ramberg P, Krok L, Lindhe J. The effect of supragengival plaque control on the subgingival microflora in human periodontitis. J Clin Periodontol. 1996;23:934-40.
36. Petersilka GJ, Ehmke B, Flemming TF. Antimicrobial effects of mechanical debridement. Periodontol
2000. 2002;28(2):56-71.
37. Lavanscky D, Bickel M, Baehni P. The effect of plaque control after scaling and root planing on the subgingival microflora in human periodontitis. J Clin Periodontol. 1987;14:295-9.
38. Westfelt ER, Rylander H, Duhlén G, Lindhe J. The effect of supragingival plaque control on the progression of advanced periodontal disease. J Clin Periodontol. 1998;5:536-41.
39. Loomer PM. Microbiological diagnostic testing in the treatment of periodontal diseases. Periodontol
2000. 2004;34:49-56.
40. Al- Yahfoufi Z, Mombelli A, Wicki A, Lang NP. The effect of plaque control in subjects with shallow pockets and high prevalence of periodontal pathogens. J Clin Periodontol. 1995;22:78-84.
41. Lindhe J, Nyman S. The effect of plaque control and surgical pocket elimination on the establishment and maintenance of periodontal health. A longitudinal study of periodontal therapy in cases of advanced disease. J Clin Periodontol. 1975;2:67-79.
42. Nyman S, Rosling B, Lindhe J. Effect of professional tooth cleaning on healing after periodontal surgery. J Clin Periodontol. 1975;2:80-6.
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