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SRP patients: not seeing pocket reduction

I really am Having a problem with this. I feel like I’m not getting sufficient pocket reduction after SRPs which is really …among other things…heartbreaking. I always use 11/12 explorer and obviously piezo and handscale until its smooth. WTH!! I’m going to start having the dr check srp pts from now on. This is driving me nuts! am I alone? :'(



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6 Answers

How are your patients doing with their homecare?

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I would take post-SRP radiographs (a bitewing on each side) before I had the doctor check my work. I’m not trying to put another professional down, I’m just going from personal experience. For the most part my patients’ condition does improve, but like Sue Halverson said, it’s all about their homecare. You can lead a horse to water but you can’t make them drink. If it was every single patient, I’d be a little more concerned, however it seems you are being thorough and doing your best! Keep doing the best you can and stay confident in your skills!

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What about the patients’ after SRP care? When do you have them back for their follow up appt? Then do you see them every 3 months under perio maintenance?

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With S/RP we are not trying to make the roots glassy smooth anymore. It’s more of a debridement of all the biofilm, endotoxins etc…. You should only expect a 1.5mm decrease in pocket depths. The sharpey’s fibers no longer attach the gingiva to the tooth to the bone, it is now a LJE long junctional epithelial attachment which acts as a suction cup for the tissue to attach to the tooth. Sharpey’s fibers are not present after periodontal destruction. Now…..I have had a 9mm go to a 3mm then to a 6mm and back to 9mm over several 3 month Perio maintenance appts. We want to watch numbers closely and we never want to see the number increase past what we originally treated. Example: pocket was a 6mm at initial S/RP and went to a 4mm for over a year and now presents with 8mm. Something is not right and you may need to refer to periodontist.

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Also bleeding is an indication of infection so if pocket is remaining the same only in a few sites and there is no presence of exudate or hemo then I wouldn’t worry unless the pocket is deeper than when originally diagnosed the disease. Depending on Health history, diabetes, smoking etc…..you never said if there are underlying medical conditions that would or could compromise S/RP outcome.

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Homecare is a major part for sure. A pocket may not always reduce if there is a boney defect in that area. Vertical BW or PA and a referral may be the best option, especially if this a maxillary molars and the pocket is at/near furcations.

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