This document discusses supragingival and subgingival irrigation. It defines irrigation as using a pulsating stream of water to remove debris and reduce bacteria from the gums and root surfaces. Irrigation can be done personally at home using devices like a Waterpik or professionally in a dental office. Different solutions can be used for irrigation and it helps treat gingivitis as an adjunct to conventional periodontal therapy.
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.
5. 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
6. 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
7. MECHANISM OF ACTION
IMPACT ZONE- irrigant
makes an initial contact
FLUSHING ZONE- irrigant is
deflected from tooth surface
LAVAGE – irrigant in
subgingival region
10. 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
11. 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
12. 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. PROFESSIONALLY APPLIED
MAINLY INDICATED IN – SUBGINGIVAL
IRRIGATION
DONE BY-
SYRINGE
JET IRRIGATOR WITH A CANNULA
ULTRASONIC UNIT
15. 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.
16. IMPACT
EFFECT ON PLAQUE TOXICITY :
Change in plaque composition
Flushing out of inflammatory produts
Change in tissue integrity
PENETRATION :
Increased depth of penetration(mean =1.8mm)
compared to oral rinse(m=0.2mm) &
toothbrush(m=0.9mm)
17. APPLICATION
ADJUNCT in oral health care maintenance
Orthodontic patient
Implant
Children
Old age patient
Diabetic patients
18. 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.
19. 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.
20. 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.