1. SUPRAGINGIVAL AND SUBGINGIVAL IRRIGATION

2. CONTENTS I NTRODUCTION OBJECTIVES CLASSIFICATION PROCEDURE MECHANISM OF ACTION IRRIGATING SOLUTIONS PERSONALLY APPLIED PROFESSIONALLY APPLIED IMPACT APPLICATIONS MERITS LIMITATIONS CONCLUSION

3. INTRODUCTION Known as HYDROTHERAPY or lavage Targeted application of pulsated or steady stream of water GOAL –forcing pulsating water on the gingival tissues and root surfaces to remove unattached debris, loosely attached biofilm, and reduces concentration of bacteria & byproducts.

4. OBJECTIVE Primary purpose of irrigation-nonspecifically reduce the bacteria & their byproducts that lead to initiation or progression of the periodontal disease SUPRAGINGIVAL IRRIGATION-disruption & dilution of bacteria and byproducts-treats gingivitis. SUBGINGIVAL IRRIGATION-interferes with complex ecosystem and prevents initiation or further destruction of periodontium.

6. RAM AND SLOTS CLASSIFICATION 1.PERSONALLY APPLIED(in patient home selfcare) A. Non-sustained subgingival drug delivery(home oral irrigation) B. Sustained subgingival drug delivery(not developed) 2.PROFESSIONALLY APPLIED(in dental office) A. Non-sustained subgingival drug delivery(professional pocket irrigation) B. Sustained subgingival drug delivery

7. PROCEDURE OF IRRIGATION HYDROKINETICS AND IRRIGATION FORCES Compression and pulsated decompression phase(displacement of debris) Force – 80-90psi TIPS CLASSIFICATION – COMPOSITION - metal, rubber ANGULATION -straight, angulated USE -standard, specialized

8. MECHANISM OF ACTION IMPACT ZONE - irrigant makes an initial contact FLUSHING ZONE - irrigant is deflected from tooth surface LAVAGE – irrigant in subgingival region

9. ZONES

10. IRRIGATING SOLUTIONS WATER CHLORHEXIDINE-2%, 0.2%, 0.12% PEROXIDES FLUORIDES IODINE PHENOLICS SODIUM BICARBONATE ANTIMICROBIALS-tetracycline hcl ANTI-INFLAMMATORIES-Acetylsalicylic acid

11. PERSONALLY APPLIED Mono jet subgingival irrigation system Conventional pulsed oral irrigator –WATERPIK TIPS-standard blunt jet and soft cone tip ANGULATION-45’- 90’ to the tooth gingival margin Mainly employed in supragingival irrigation

12. DELIVERED BY POWER DRIVEN Generates intermittent or pulsating jet of fluid Attached to power supply Adjustable dial for regulation of pressure With tips that can rotate at 360” NON-POWER DRIVEN Uncontrolled water pressure Attached to household water supply Pressure cant be adjusted With interchangable tips

13. ORAL IRRIGATOR Dental water jet- homecare device – stream of pulsating water, removes plaque and food debris bet teeth and gumline thus improves oral health First developed in 1962 by a dentist and engineer from FORT COLLINS,CO.

14. COMMERCIAL IRRIGATORS

16. TIPS

17. PROFESSIONALLY APPLIED MAINLY INDICATED IN – SUBGINGIVAL IRRIGATION DONE BY- SYRINGE JET IRRIGATOR WITH A CANNULA ULTRASONIC UNIT

18. HAND HELD SYRINGE IRRIGATION

19. SUBGINGIVAL IRRIGATION Irrigation with soft site specific tip. Localized irrigation of specific sites such as deep pocket, furcation, implant, crown and bridge. Combined with antimicrobial therapy.

20. IMPACT - study results by Pitcher et al EFFECT ON PLAQUE TOXICITY : Change in plaque composition Flushing out of inflammatory produts Change in tissue integrity PENETRATION : Increased depth of penetration into pocket with hand held syringe, (mean =1.8mm). Compared to oral rinse(m=0.2mm) & toothbrush(m=0.9mm)

21. STUDY BY -STABHOLTZ ET AL ROOT SUBSTANTIVITY- 5% TetracyclineHCL exhibited greater antimicrobial action compared to 0.12%Chlorhexidine 0.12% for 12 days control study - saline irrigation

22. APPLICATION ADJUNCT in oral health care maintenance Orthodontic patient Implant Children Old age patient Diabetic patients

23. MERITS Permits patient to participate in maintaining their oral health Important role in treatment of gingivitis Helps in maintenance of periodontal status ADJUNCT to conventional therapy When rootplanning is difficult due to any anatomic factors.

24. LIMITATIONS Induction of bacteremia Contraindicated in medically compromised patients Quick elimination of subgingivally placed drugs Follows FIRSTORDER KINETICS –High initial concentration and multiple applications to achieve substaintivity.

25. 25 CONCLUSION The greatest shortcoming of irrigation therapy is quick elimination of subgingivally placed drugs. To ameliorate this problem appropriate slow releasing medicaments(e.g. bioadsorbable polymers) can be employed. The future of chemotherapeutic management of subgingival flora is promising and will provide a predictable adjunct in treating and maintaining periodontal status.

26. REFERENCES ADJUNCTIVE ROLE OF SUPRAGINGIVAL AND SUBGINGIVAL THERAPY Role of supragingival and subgingival irrigation-American Academy of Periodontology

27. ANY QUESTIONS????