In Table V, dental hygienists most commonly reported that they perform both supragingival and subgingival instrumentation
around dental implants (n=164, 77%).
4 mm--Gingival Attachment Level
The clinician was evaluated on specific criteria developed for subgingival instrumentation
with both technologies prior to data collection.
In order to perform maximally effective subgingival instrumentation
, the current standard is to use local anesthetic for patient comfort and clinician effectiveness.
The flora may consist of residual microorganisms following incomplete subgingival instrumentation
, or may be a result of the colonization and maturation of supragingival plaque.
Dufour LA, Bissell HS: Periodontal attachment loss induced by mechanical subgingival instrumentation
in shallow sulci.
(8) When supra- and subgingival instrumentation are included as part of the dental hygiene therapy, the goal is to create an environment that is conducive to periodontal health, by producing crown and root surfaces that are biologically acceptable to the periodontal tissues.
In light of these NIDR workshop conclusions, the purpose of this paper is to examine more recent studies related to the periodontal outcome of mechanical subgingival instrumentation in shallow sulci.
Thirteen clinical studies--1 animal and 12 human--were reviewed for the effects of subgingival instrumentation on the level of probing attachment in shallow sulci.
Subjects in both trials received "professional tooth cleanings" (as described by Axelsson and Lindhe) (22) throughout the duration of the study, but received no further subgingival instrumentation. The results of these singular episodes of mechanical sub gingival instrumentation ranged from "minor apical shift" of the probing attachment level in sulci measuring <4.0 mm, (9) to >2.0 mm loss in 20% of sulci initially categorized as shallow ([less than or equal to] 3.0 mm).
An actual prophy appointment has long been a hybrid of supra and subgingival instrumentation
. Within the context of informed consent, often the reality of what actually occurs at the hygiene appointment is based on the time allotted for the appointment, the price patients are willing to pay, and the extent to which patients can be convinced it is in their best interest.