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Local drug delivery
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Periochip
- 2.5 mg (36%) of chlorhexidine gluconate
- Dimensions: 4mm * 5mm* 0.35 mm
- Slow release over 7-10 days
- Indicated for pocket depth >5mm
- Dissolves in 1 week
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Actisite
- Contains 25% w/w tetracycline HCL powder
- Diameter of fibre= 0.5mm with tetracycline 12.7 mg/ 9 inches
- Periodontal plus AB: Bio- resorbable form of fibre, does not need removal; biodegrades within 7 days
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Atridox
- Contains 42.5 mg Doxycycline, available as a 10% doxycycline in syringeable gel
- Biodegradable
- Shows active antibacterial levels in pocket even after 7 days
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Arestin
- Contains 2% minocycline as bio-resorbable microspheres
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Periocol-CG
- 2.5 mg chlorhexidine in collagen membrane
- Bioresorbable : resorbs after 30 days
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Chlo-site
- Contains 1.5% chlorhexidine of xanthan type
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Elyzol 25% gel
- Contains metronidazole 25% (oil based)
- Applied as a viscous consistency to the pocket where it liquefies by body heat & then hardens again on contact with saliva
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Dentamycin & periocline
- Contains 2% minocycline
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Plaque Control Agents
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Classification of chemical plaque control agents
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1st generation
- e.g.: Antibiotics, Phenol, Quaternary ammonium compounds & Sanguinarine, Triclosan
- Show poor retention in mouth
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2nd generation
- e.g. Bisbiguanides ( chlorhexidine)
- Better retained, higher anti- plaque activity than 1st generation
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3rd generation
- e.g.: Delmopinol cause weaker binding of plaque to tooth surface, thus easier plaque removal during brushing
- Block binding of microorganisms to tooth or each other
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Classification of mechanical plaque control
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1. Tooth brushes
- a) Manual tooth brush
- b) Electric tooth brush
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2. Interdental aids
- a) Dental floss
- b) Triangular tooth pics
- c) Interdental brushes
- d) Yarn
- e) Superfloss
- f) Perio-Aid
- g) Pipe cleansers
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3. Aids for gingival stimulation
- a. Rubber tip stimulator
- b) Balsa wood edge
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4. Others
- a) Gauze strips
- b) Pipe cleansers
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5. Aids for edentulous & partially edentulous patients
- a) Denture & partial clasp brushes
- b) Cleansing solutions
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Various Brushing Techniques
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Classification according to pattern of motion while brushing
1. Roll—> Roll method or modified Stillman technique
2. Vibratory—> Stillman, charters or bass techniques
3. Circular—> Fones technique
4. Vertical —> Leonard technique
5. Horizontal—> Scrub technique
- 1) Modified stillmann technique: used in gingival recession
2) Charter’s : Healing wound after surgery or pt who wear RPD or Orthodontic appliance
3) Bass Technique : Routine technique with/ without periodontal disease
4) Fones : In Childrens
- Scrub technique is probably the simplest & most common method of brushing
- Patient with periodontal diseases —> Sulcular technique
- Roll technique—> least effective
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ADA specifications for adult toothbrush
- Length= 1 to 1.25 inches
- Width= 5/16 to 3/8 inches
- Surface area= 2.54 to 3.2 cm
- No. Of rows= 2 to 4 rows of bristles
- No. Of tufts= 5-12 per row
- No. Of bristles= 80 to 85 per tuft
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Brush are classified as follows based on width of these bristles
- Soft : 0.007 inch/ 0.2 mm
- Medium: 0.012 inch/ 0.3 mm
- Hard: 0.014 inch/ 0.4mm
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Sonic & Ultrasonic scalers
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Parameter
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- Magnetostrictive
- Piezoelectric
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Tip action
- Orbital
- Elliptical
- Linear
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Active Tip surfaces
- 4 active surfaces
- 2 active surfaces
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Energy conversion
- Metal rod or stack of metal sheets
- Crystals activated by ceramic handpiece
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Space requirement
- High
- High
- Low
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Heat production
- High
- High
- Low
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Noise level
- Medium
- Medium
- High
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Frequency
- 2000-6500 cycles/ sec
- 20000- 45,000 cyc/sec
- 20,000- 45,000 cyc/sec
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Merins classification
- Used for : patient recall
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Merins classification of patients for recall and maintenance
- Class A patients
Excellent results maintained for 1 yr or more
1. Good oral hygiene, minimal calculus
2. No occlusal problem / complicated prosthesis
3. No remaining pockets & >50% of alveolar bone support for every tooth
- Class B patients
Good results maintained for 1 yr or more, but associated risk factors are there:
1. Poor oral hygiene, calculus deposits
2. Systemic disease/ smoking habit causing periodontal destruction
3. Residual pockets, BOP seen
4. Teeth with <50% bone support
5. Positive family history
- Class C patients
Periodontal therapy has partially been successful with poor results, risk factors same as class B but more severe
1. Poor oral hygiene
2. Many teeth with less than 50% bone support
3. Periodontal surgery indicated but not performed due to medical,psychological, or financial reasons.
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Recall visits advised by Merin
- Class A : 6 months- 1 year
- Class B : 3-4 months
- Class C: 1-3 months
- First year recall ( routine therapy): 3 months
- First year recall ( difficult case with complications): 1-2 months