Results

Phase I therapy is a complex and individualized treatment. It requires detailed analysis of each patient's disease and contributing factors and customized therapy. I he treatments common to «ill Phase I therapy are patient plaque control, caries control, and scaling and root planing to remove supragingival calculus, subgingival calculus, and plaque deposits. Plaque control performed by the patient at home is complex and requires c hanging lifelong habits. It is difficult to achieve and varies among individual patients, but strategies tor success exist. Plaque control education and motivation are presented in ( hapter 4C>.

Scaling and root planing therapy has been studied extensively to evaluate its el led.s on periodontal disease. A review of studies evaluating Ihe effects ot scaling and root planing indicate that the treatment is both effective and reliable/ Studies ranging from I month to 2 years in length demonstrate up to 80% reductions in bleeding on probing and mean probing depth reductions in the range of 2 lo i mm. Others have demonstrated that the number ot pockets 4 nun in depth or greater was reduced by S2% to 80%. Several of these studies also compared the relative healing result using hand instrumentation and ultrasonic or sonic instruments for scaling and rool planing. No difference in healing was identified based on the type ot instruments used to provide the treatment.' Additional individual treatment such as caries control and correction of ill-fitting restorations only augment the positive results ol healing gained through good plaque control and scaling and root planing. Fig. 48-1 shows the effects of an overhanging amalgam restoration on the gingiva. Maximal healing from scaling and root planing is not possible with local

Overhang Gingival Margin

Fig. 48 1 Effect of an overhanging amalgam margin on the interproximal gingiva of a maxillary lirst molar A, Clinical appearance of rough, irregular, and overcontoured amalgam. B, Gentle probing of the interproximal pocket. C, Extreme amount of bleeding elicited by gentle probing in the area is indicative of severe inflammation in the area. D, Clinical appearance of recontoured restoration (arrow)

Fig. 48 1 Effect of an overhanging amalgam margin on the interproximal gingiva of a maxillary lirst molar A, Clinical appearance of rough, irregular, and overcontoured amalgam. B, Gentle probing of the interproximal pocket. C, Extreme amount of bleeding elicited by gentle probing in the area is indicative of severe inflammation in the area. D, Clinical appearance of recontoured restoration (arrow)

conditions that retain plaque and provide reservoirs lor repopulation of periodontal pathogens.

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