TP5OR1+-+Clinical+Periodontology+and+Implant+Dentistry+-+Kap+38+-+Sammanfattning


 * Sammanfattning – Clinical Periodontology  and Implant Dentistry  (Jan Lindhe)  – Kapitel 38 – Icke-kirurgisk parodontal  behandling  **

> **Mål med behandlingen  ** > > > > **Depuration  ** > > > > > > > **Instrument som används (se kompendium för mer info)  ** > > > > > > > > <span style="background-color: #ffffff; display: block; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 8px;"> > > > > **<span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">Subgingival depuration <span class="EOP SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;"> ** > > > > **<span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">Kliniska resultat <span class="EOP SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;"> ** > > > **<span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">Mikrobiologiska resultat <span class="EOP SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;"> ** > > > > > **<span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">Val av instrument <span class="EOP SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;"> ** > > > > <span style="background-color: #ffffff; display: block; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 8px;"> > > > > **<span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">Val av behandlingsstrategi <span class="EOP SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;"> ** > > > >
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">Depuration <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;"> och <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">supragingival <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;"> plackkontroll motverkar parodontit genom att störa biofilmen, minska antalet bakterier och undantrycka inflammationen.
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">Det optimala är att få roten helt fri från bakterier och tandsten. Är dock väldigt svårt.
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">Bättre att försöka få ner bakterienivåer på en nivå som inte orsakar patologi för pat.
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">Stängda fickor (PPD ≤ 4mm) och ingen blödning vid sondering <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;"> ( <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">BoP <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">) <span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">.
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">Debridering <span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;"> – tar bort biofilm. Minskar därmed bakterieantalet.
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">Scaling <span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;"> – tar bort tandsten. Tar därmed bort en retentionsplats för bakterier.
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">Root <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;"> planing – jämnar till <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">rotytan <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;"> (tar bort ”kontaminerat” rotcement och <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">dentin <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">)
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">Man trodde att <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">endotoxiner <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;"> fr <span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">ån bakterier gick in i rotcementet.
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">Så var det dock inte alls, utan <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">endotoxinerna <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;"> fäste bara löst på <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">rotytan <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">.
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">Inget man eftersträvar idag i första hand. Förutom vid ev. <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">redepuration <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">.
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">Handinstrument <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;"> – ger mer taktil känslighet. Kräver mer tid och instrumentskärpning. <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">Curetter <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">, sicklar <span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">.
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">Känn med en ficksond på <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">rotytan <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;"> för att bestämma fickdjup, anatomin på roten (ojämnheter, <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">furkationer <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">) och vart tandstenen finns.
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">Ultraljud – elektromagnetisk och piezoelektrisk.
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">Laser – elektromagnetisk strålning.
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">Liten mekanisk påverkan på tanden.
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">Strålningen absorberas av vatten och organiskt material i tandstenen och leder till att vattenånga produceras.
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">Detta höjer trycket inuti tandstenen och leder till att tandstenen därför expanderar och lossnar <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;"> från <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">rotyta <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;"> (tänk hårt åtskruvad kork som lossnar från en flaska under rinnande varmt vatten) <span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">.
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">Strålning som träffar skinande material, såsom amalgam, kan skada ögonen.
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">D <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">ärför måste både behandlare och <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">pat <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;"> ha på sig skyddsglasögon.
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">Initial behandling genom kvadrantvis <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">scaling <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;"> med handinstrument (QRSP) eller <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">scaling <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;"> på hela munnen med ultraljud (Full- <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">mouth <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">).
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">Antimikrobiellt komplement: tunga, slemhinna, saliv och tonsiller kan ha många GR- bakterier på sig som är associerade med parodontit.
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">Kan därför också borsta tungan med <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">klorhexidin <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">, skölja med <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">klorhexidin <span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;"> och <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;"> spraya <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">klorhexidin <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;"> på tonsiller <span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">.
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">Supragingival plackkontroll tillsammans med <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">depuration <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;"> minskar fickdjupet (PPD) och förbättrar kliniska fästenivån (CAL).
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">Ingen skillnad mellan handinstrument och ultraljud.
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">Supragingival plackkontroll och borttagning av <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">subgingivalt <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;"> plack och tandsten resulterar i att mikrofloran förändras, fickdjupet minskar och att inflammationen lägger sig. <span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">Patogena bakterier (såsom röda och orangea komplexet) trivs mindre bra i denna miljö.
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">GR+ aeroba kocker och stavar ökar i antal och är associerade med en frisk munflora.
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">Magnusson et al., 1984 - <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">Den <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">subgingivala <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;"> mikrofloran etablerar sig igen om <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">supragingival <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;"> plackkontroll <span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">inte är tillräckligt bra utförd.
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">Ingen skillnad mellan handinstrument, ultraljud eller antimikrobiellt komplement.
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">Handinstrument och ultraljud likvärdiga på att minska fickdjup (PPD), blödning vid sondering <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">( <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">BoP <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">) <span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">och förbättra klinisk fästenivå (CAL).
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">Ultraljud tar däremot bort mindre rotsubstans än handinstrument.
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">Ultraljud kan <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">ibland komma ner djupare i fickor och <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">furkationer <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;"> (smalare instrument).
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">Kaviteringen <span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">vid ultraljud sköljer dessutom bort bakterier och skräp från fickan.
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">Sämre taktil känslighet vid ultraljud jämfört med handinstrument.
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">Aerosol kontaminerad med blod och annat bildas vid ultraljud.
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">Laser likvärdiga resultat som handinstrument och ultraljud. Däremot dyrare och inte kostnadseffektivt (SoS NR).
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">Ingen skillnad mellan konventionell <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">scaling <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;"> och <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">scaling <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;"> + antiseptika.
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">Wennström et al. (2005):
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">Initial behandling med ultraljud vid 1 sittning mer kostnadseffektivt än handinstrument vid 4 sittningar (QRSP).
 * <span style="color: #ff0000; font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">Ultraljud kräver initialt mindre tid per stängd ficka.

**<span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">Behandlingsutvärdering efter icke-kirurgisk behandling <span class="EOP SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;"> ** > > > > > > **<span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">Effekten av <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">redepuration <span class="EOP SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;"> ** > > > > >
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">Kliniska mål (”end- <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">points <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">”) för en lyckad behandling:
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">Ingen blödning vid sondering ( <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">BoP <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">)
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">Stängda fickor (”pocket <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">closure <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">”) – PPD ≤ 4mm.
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">Rökning försämrar behandlingsresultatet – färre fickor stängs.
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">Fickor som är PPD ≥ 5mm och med blödning vid sondering ( <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">BoP <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">) borde <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">redepureras <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">.
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">Dessa fickor kan man då också utföra <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">root <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;"> planing på.
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">Redep <span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">ger inte lika bra <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">resultat om man jämför med den initiala <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">depurationen <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">.
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="TextRun SCX47302477" style="font-family: Calibri,sans-serif; font-size: 12pt;">Wennström et al. (2005) <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;"> – bara 11-16% av de fickor som svarar dåligt på den initiala <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">depurationen <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;"> stängs efter <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">redepuration <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">. 50% av fickorna med PPD ≥ 7mm förblir <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">ostängda <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">.
 * <span style="font-family: Calibri,sans-serif; font-family: verdana; font-size: 12pt; vertical-align: baseline;"><span style="background-color: transparent; color: windowtext; font-family: 'Segoe UI',Tahoma,Verdana,sans-serif; font-size: 6pt; vertical-align: baseline;"><span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">Fickor vid molarer, <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">furkationsområden <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;"> och <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">angulära <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;"> bendefekter svarar sämre på <span class="SpellingError SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">redepuration <span class="NormalTextRun SCX47302477" style="background-color: inherit; font-family: Calibri,sans-serif; font-size: 12pt;">.