Supragingival Irrigation

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Supragingival irrigation is usually performed once or twice daily by the patient as an adjunct to toothbrushing and flossing. I he irrigator's nozzle should be positioned at some distance from the gingival margin and Ihe jet stream lined perpendicular to the long axis of the teeth to achieve optimal subgingival penetration of an irrigant dig. 44-.-0. Irrigation pressures of 540 kPa to 620 kPa (80 psi to 90 psi) can be tolerated without adverse effects.*-'' No histologic alteration of the gingiva has been observed after supragingival irrigation at .i pressure of 410 kl'a (60 psi)."

Supragingival Irrigation as a Monotherapy

Supragingival irrigation with water alone does not sufficiently prevent plaque accumulation nor gingivitis. In this respect, supragingival irrigation is clearly inferior to mechanical plaque control such as using conventional oral hygiene measures.4* Fhus supragingival irrigation

Supragingival Irrigation

Supragingival Irrigation
Gingivitis

Periodontitis w :

Periodontitis

WW K

Periodontitis Subgingival Irrigation

Subgingival Irrigation
44% - 68%
Periodontitis

Mouth Rinsing

Periodontitis

Periodontitis

Fig. 44 1 Subgingival penetration of solutions delivered by supragingival or subgingival irrigation and rinsing in percent of pocket depth.

Supragingival And Subgingival Irrigation
Fig. 44 2 Devices lor supra- and subgingival irrigation.

Fig. 44-3 Positioning of various irrigator tips for supragingival (extreme rujht) and subgingival irrigation (others)

cannot replace toothbrushing and should only be used as iin adjunct to toothbrushing and interdental cleaning.

Supragingival Water Irrigation and Toothbrushing

Although earlier studies concerning supragingival water irrigation as an adjunct to toothbrushing yielded controversial results,1* " n recent studies have clearly demon strated that this method in conjunction with toothbrushing can improve the periodontal health in patients with gingivitis and/or periodontitis, particularly for patients with clinical signs of gingival inflammation and/or poor oral hygiene" -"' u 19 (Fig. 44-4). However, patients with low plaque scores (i.e., good oral hygiene) have no additional benefit from supragingival irrigation^ dig. 44-S).

Stifrraxinxiyitl tint! Subgingival Illicit urn ■ (II AIM IK 44 617

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