Method and equipment for treatment of periodontal disease

• US 5,188,531 A
• Filed: 04/01/1992
• Issued: 02/23/1993
• Est. Priority Date: 09/12/1986
• Status: Expired due to Term

• Current Assignee: Lloyd Von Sutfin
• Original Assignee: Lloyd Von Sutfin
• Inventors: Von Sutfin, Lloyd
• Primary Examiner(s): Mancene, Gene
• Assistant Examiner(s): Lucchesi, Nicholas D.
• Application Number:
  US07/863,342
• Time in Patent Office: 328 Days
• Field of Search: 433/72, 433/75, 433/51, 433/81, 433/86, 433/118, 433/119, 433/136, 433/141, 433/159, 433/215, 433/229
• US Class Current: 433/118
• CPC Class Codes: A61C 1/07 with vibratory drive, e.g. ultrasonic
• CPC Class Codes: A61C 3/03 Instruments operated by vibration

Abstract

The present method and apparatus are directed to the treatment of periodontal disease. A contoured, calibrated instrument is employed to probe the gum tooth interface to locate periodontal lesions containing bacteria and their by-products such as plaque, calculus, and diseased tissue. After the prove has identified a periodontal lesion, a vibrating instrument having a configuration similar to the probe is inserted into the periodontal pocket in a manner so as to perferentially contact the tooth. The frequency and power used to drive the vibrating instrument is adjusted to a level sufficient to cauese the instrument to fracture the cementum and cause the instrument to fracture the dentin of the tooth leaving the dentinal tubuli exposed. The lesion is irrigated during treatment with a vibrating instrument with solution having preferably a pH between about 5 and 5.5. The lesion is closed by applying pressure for a time sufficient to assure the fibrin network penetrates the dentinal tubuli thus assuring that the periodontal tissue reattaches to the tooth.

Claims

1. In a vibrational dental instrument for the treatment of periodontal disease comprising a prong disposed at an obtuse angle β

with respect to a shank and adapted to provide sufficient energy to fracture and remove disease affected tissue surrounding a tooth, the improvement comprising said prong being substantially conical in shape and tapering into a blunt pointed tip and said prong having at least one longitudinal channel on an exterior surface thereof for conducting coolant along the surface from a coolant tube in the direction of said blunt pointed tip.

2. In a dental instrument according to claim 1 wherein said prong has a working length between 5/16 and 1/2 of a inch.

3. In a dental instrument according to claim 2 wherein said blunt pointed tip has a radius of curvature of between 0.007 and 0.011 inches.

4. In a dental instrument according to claim 3 wherein said prong has a first taper α

at an angle of approximately 2 degrees for a portion of its working length remote from the tip and a second taper φ

of approximately 4 degrees near the blunt pointed tip.

5. In a dental instrument according to claim 4 wherein said angle β

is between 119 and 130 degrees.

6. In an energy-emitting dental instrument for treatment of periodontal disease utilizing the physical effects of vibrating energy comprising a prong disposed at an obtuse angle β

with respect to a shank and adapted to provide sufficient energy to fracture and remove diseased tissue surrounding a tooth, the improvement comprising said prong having a smooth nonabrasive exterior surface without a sharp edge being substantially conical in shape and tapering into a blunt pointed tip, and wherein said prong has a working length of between 5/16 and 1/2 of an inch, thereby enhancing regeneration of periodontal tissues.

7. A dental instrument according to claim 6, wherein said blunt pointed tip has a radius of curvature of between 0.007 and 0.011 inches.

8. A dental instrument according to claim 7, wherein said prong has a first taper α

at an angle of approximately 2 degrees for a portion of its working length remote from the tip and a second taper θ

of approximately 4 degrees near the blunt pointed tip.

9. A dental instrument according to claim 8, wherein the angle β

is between 119 and 130 degrees.

10. A method for treatment and control of periodontal disease and regeneration of periodontal tissues with the gum tissue remaining in place and connected between the teeth, comprising the steps of:

(a) tracing the gum-tooth interface with a contoured probe to locate a periodontal lesion;

(b) inserting a dental instrument having a smooth nonabrasive exterior surface without a sharp edge into said lesion;

(c) applying vibrational energy with said dental instrument to remove plaque and calculus contained in said lesion and contacting the tooth;

(d) contacting diseased cementum and diseased dentin with said dental instrument while applying sufficient vibrational energy to said dental instrument to cause said diseased cementum and said diseased dentin to fracture;

(e) irrigating the lesion during steps (c) and (d) with a fluid to remove fractured and fragmented plaque, calculus and fractured cementum and dentin;

(f) removing said dental instrument;

(g) inserting a sharp curette into said lesion to remove remaining dislodged cementum, calculus and plaque; and

(h) closing the lesion by applying pressure for a time sufficient to promote attachment of the gum to the tooth;

thereby enhancing said regeneration.

11. The method of claim 10 wherein said fluid has a pH of between about 5 and 5.5.

12. The method of claim 10 further comprising reinserting said probe to isolate diseased dentin and calculus before proceeding with step (a), thereafter repeating steps (b) through (f) until reinsertion of said probe confirms all of said diseased cementum and dentin is removed.

13. The method of claim 12 further comprising the step of irrigating the lesion with a fluid containing a blood clotting agent and/or healing promoting agent after step (g).

14. The method of claim 12 wherein after confirmation that all diseased dentin and cementum has been removed a time interval of 2 to 5 minutes is provided before said curette is inserted into said lesion.

15. The method of claim 14 wherein a force is applied to said gum with dental pliers.

16. The method of claim 12 further comprising the step of removing soft tissue from the inside of the lesion with surgical scissors.

17. The method of claim 10 wherein the dental instrument is employed to remove diseased and excess soft tissue from within the lesion.

18. The method of claim 17 wherein said dental instrument is also employed to remove soft tissue from and expose the regenerative bone surfaces in and around the periphery of the lesion.

19. The method of claim 10 wherein an antibiotic is administered to the patient prior to step (a).

20. The method of claim 10 wherein a healing promoting agent is administered.

21. A method for treatment and control of periodontal disease and regeneration of periodontal tissues with the gum tissue remaining in place and connected between the teeth, comprising the steps of:

(a) tracing the gum-tooth interface with a contoured probe to locate a periodontal lesion;

(b) inserting a dental instrument into said lesion;

(c) applying vibrational energy with said dental instrument to remove plaque and calculus contained in said lesion and contacting the tooth;

(d) contacting diseased cementum, diseased dentin, and diseased soft tissue from bone with said dental instrument while applying sufficient vibrational energy with said dental instrument to cause said diseased cementum and said diseased dentin to fracture, and to remove diseased soft tissue from the bone and expose regenerative bone surfaces in and around the periphery of the lesion;

(e) irrigating the lesion during steps (c) and (d) with a fluid to remove fractured and fragmented plaque, calculus, fractured cementum and dentin, and diseased soft tissue;

(f) removing said dental instrument;

(g) inserting a curette into said lesion to remove remaining dislodged cementum, calculus and plaque; and

(h) closing the lesion by applying pressure for a time sufficient to promote attachment of the gum to the tooth; and

(i) placing in the lesion a bio-compatible porous material before the lesion is closed by pressure.

22. A method for treatment and control of periodontal disease and regeneration of periodontal tissues with the gum tissue remaining in place and connected between the teeth, comprising the steps of:

(a) tracing the gum-tooth interface with a contoured probe to locate a periodontal lesion;

(b) inserting a dental instrument into said lesion;

(c) applying vibrational energy with said dental instrument to remove plaque and calculus contained in said lesion and contacting the teeth;

(d) contacting diseased cementum, diseased dentin, and diseased soft tissue proximate to the bone with said dental instrument while applying sufficient vibrational energy with said dental instrument to cause said diseased cementum and said diseased dentin to fracture;

(e) irrigating the lesion during steps (c) and (d) with a fluid to remove fractured and fragmented plaque, calculus and fractured cementum and dentin;

(f) removing said dental instrument;

(g) inserting a curette into said lesion to remove remaining dislodged cementum, calculus and plaque; and

(h) closing the lesion by applying pressure for a time sufficient to promote attachment of the gum to the tooth; and

(i) wherein the contoured probe and the dental instrument have the same included angle of between 128° and

130° and

are used in the treatment of the upper gums.

23. A method for treatment and control of periodontal disease and regeneration of periodontal tissues with the gum tissue remaining in place and connected between the teeth, comprising the steps of:

(a) tracing the gum-tooth interface with a contoured probe to locate a periodontal lesion;

(b) inserting a dental instrument into said lesion;

(c) applying vibrational energy with said dental instrument to remove plaque and calculus contained in said lesion and contacting the tooth;

(d) contacting diseased cementum and diseased dentin with said dental instrument while applying sufficient vibrational energy with said dental instrument to cause said diseased cementum and said diseased dentin to fracture;

(e) irrigating the lesion during steps (c) and (d) with a fluid to remove fractured and fragmented plaque, calculus and fractured cementum and dentin;

(f) removing said dental instrument;

(g) inserting a curette into said lesion to remove remaining dislodged cementum, calculus and plaque; and

(h) closing the lesion by applying pressure for a time sufficient to promote attachment of the gum to the tooth; and

(i) wherein the dental instrument has a prong, and said probe and the instrument prong have the same included angle of between 119°

to 121°

between shank and tip portions thereof and are used in the treatment of the lower gums.

24. A method for treatment and control of periodontal disease and regeneration of periodontal tissues accomplished with the gum tissue remaining in place and connected between the teeth comprising the steps of:

a. tracing the gum-tooth junction with a contoured probe to locate a periodontal lesion;

b. inserting an instrument having a smooth nonabrasive exterior surface without a sharp edge capable of imparting energy to the contents of the lesion and its environs;

c. applying energy with said instrument to dislodge and remove microbes, plaque, and calculus contained in said periodontal lesion;

d. supplying sufficient energy with said instrument to cause disease affected cementum and disease affected dentin to fracture, cleave, and disintegrate from the tooth;

e. supplying sufficient vibrational energy with said instrument to remove sufficient disease affected soft tissue to destroy and detach epithelium within said periodontal lesion and to produce bleeding;

f. supplying sufficient vibrational energy with said instrument to fractionate, disintegrate and destroy microbes within said lesion and its environs;

g. irrigating or flooding said periodontal lesion and environs during steps (c) and (d) with a fluid to enhance transmission of vibrating energy;

h. irrigating or flooding said periodontal lesion and environs during steps (c) and (d) with a fluid to remove fractured and fragmented microbial debris, plaque, calculus, cementum and dentin;

i. removing said instrument;

j. inserting an instrument into said periodontal lesion to remove clotted blood and any remaining dislodged or free fractured and fragmented microbial debris, plaque, calculus, cementum, dentin, and soft tissue;

k. allowing blood to reclot; and

l. applying pressure of sufficient magnitude and duration to conform the gum to underlying hard structures, condense blood clot, and promote attachment of the surrounding tissue to the tooth, thereby enhancing said regeneration.

25. The method of claim 24, further comprising:

reinserting said probe to isolate diseased dentin and cementum before proceeding with step(J), thereafter repeating steps (b) through (i) until reinsertion of the probe confirms all of said diseased cementum and dentin is removed, and

scraping and removing soft tissue from the inside of said lesion with an instrument with sharpened edges.

26. The method of claim 24, wherein an antibiotic is administered in conjunction with step (a).

27. The method of claim 24, wherein a membrane is placed in the treated lesion between soft gum tissue wall and underlying bone and tooth root, and left during a healing stage.

28. A method of treatment of periodontal disease, its effects and regeneration of disease affected periodontal tissues comprising:

leaving the gingival tissues in place and continuous around the teeth and connected to the teeth while detaching said gingival tissues from said teeth and other subjacent structures where access to disease affected tissue is needed for surgical manipulation, inserting a mechanical tool having a smooth nonabrasive exterior surface without a sharp edge into a periodontal lesion and energizing said tool to cause vibrating energy of sufficient intensity to be conducted into and released within the periodontal lesion to destroy, to at least prepare for removal or release of the disease producing agents and unwanted disease affected tissues from appropriate subjacent structures, to create appropriate physiological reactions, and to leave the various tissues forming the boundaries of said lesion in appropriate histological, biochemical, and microbiological condition to enhance regeneration of the periodontium, thereby enhancing regeneration of disease affected periodontal tissues.

29. A method of treatment of periodontal disease, its effects, and regeneration of disease affected periodontal tissues comprising:

leaving the gingival tissues in place and continuous around the teeth and connected to the teeth while detaching said gingival tissues from said teeth and other subjacent structures where access to disease affected tissue is needed for surgical manipulation, inserting a mechanical tool having a smooth nonabrasive exterior surface without a sharp edge into a periodontal lesion and exciting said tool to cause vibrating energy of sufficient intensity to be conducted into and released within the periodontal lesions to destroy, and to at least prepare for removal of microbes associated with the lesion, thereby enhancing regeneration of disease affected periodontal tissues.

30. A method of treatment of periodontal disease, its effects, and regeneration of disease affected periodontal tissues comprising:

leaving the gingival tissues in place and continuous around the teeth and connected to the teeth while detaching said gingival tissues from said teeth and other subjacent structures where access to disease affected tissue is needed for surgical manipulation, inserting a mechanical tool having a smooth nonabrasive exterior surface without a sharp edge into a periodontal lesion and exciting said tool to cause vibrating energy of sufficient intensity to be conducted into and released within the periodontal pocket or periodontal sulcus to destroy, disintegrate, and at least prepare for removal unwanted periodontal soft tissues, thereby enhancing regeneration of disease affected periodontal tissues.

31. A method of preparing a tooth root and adjacent periodontal structures for the generation of attachment of said adjacent periodontal structures to the tooth root surface from within a periodontal pocket or periodontal sulcus leaving the gingival tissues in place and continuous around the teeth and connected to the teeth but detached from the teeth and other subjacent structures where access to tissue is needed for surgical manipulation whereby a mechanical means of suitable proportions with a smooth nonabrasive exterior surface without a sharp edge is inserted into the periodontal lesion and conducting vibrating, energy of sufficient intensity into and released within the periodontal pocket or periodontal sulcus to cleave, fracture, and/or disintegrate from said tooth root surface any distorted tissue comprising said tooth root surface so that undistorted tissue comprises the tooth root surface and to at least prepare for removal of epithelium and immediately subjacent connective tissue from the periodontal structures adjacent to said root surface and also to create appropriate physiological reactions, and to leave the various tissues forming the boundaries of said pocket or sulcus in appropriate histological, biochemical, and microbiological condition to enhance joining and attaching of the adjacent hard and soft tissues related to said pocket or sulcus biologically, thereby enhancing regeneration of undistorted tissue.

32. A method of generating bone in a bone defect existing in the periodontal region of a tooth root and preparing a tooth root and adjacent periodontal structures for said generation of bone from within a periodontal pocket or periodontal sulcus, comprising leaving the gingival tissues in place and continuous around the teeth and connected to the teeth, but detached from the teeth and other subjacent structures where access to tissue is needed for surgical manipulation, inserting a tool having a smooth nonabrasive exterior surface without a sharp edge into the bone defect through a periodontal lesion or sulcus and through said tool applying vibrating energy of sufficient intensity into and released within said bone defect and said periodontal pocket or periodontal sulcus to cleave, fracture, and/or disintegrate from said tooth root surface any distorted tissue comprising said surface tooth root so that undistorted tissue comprises the surface tooth root and at least prepare for removal of soft tissue from the periodontal structures adjacent to said root surface, and at least prepare for removal all soft tissue from within said bone defect, to thereby release all soft tissue and periosteum from a band of suitable width at the periphery of said bone defect, to open intertrabecular spaces and make them continuous with said bone defect, to create appropriate physiological reactions, and to leave the various tissues forming the boundaries of said bone defect and related surgical access site in appropriate histological, biochemical, and microbiological condition to enhance the growth of bone tissue into said bone defect, thereby enhancing periodontal regeneration.

33. A method of stimulating the immune response of a host afflicted with a periodontal infection leaving the gingival tissues in place and continuous around the teeth and connected to the teeth where healthy but detached from the teeth and other subjacent structures where access to disease affected tissue is needed for surgical manipulation comprising:

inserting a tool having a smooth nonabrasive exterior surface without a sharp edge into a periodontal lesion and conducting vibrating energy of sufficient intensity through said tool into and released within the periodontal lesion to destroy, to disintegrate, and to fractionate microbes within said lesion and surrounding tissues into relatively fine particles, to remove soft tissue lining the lesion and expose connective tissue elements, tissue fluids, and circulatory vessels, fluids, and cells to the relatively fine fractionated microbial particles created by the energy released within the lesion, whereby said particles then stimulate a host immune response, and enhancing regeneration of the connective tissue elements.

34. A method for treatment and control of periodontal disease and regeneration of periodontal tissues with the gum tissue remaining in place and connected between the teeth, comprising the steps of:

(a) tracing the gum-tooth interface with a contoured probe to locate a periodontal lesion;

(b) inserting a dental instrument with a smooth nonabrasive exterior surface without a sharp edge into said lesion;

(c) applying vibrational energy with said dental instrument to remove plaque and calculus contained in said lesion and contacting the tooth;

(d) contacting diseased cementum and diseased dentin with said dental instrument while applying sufficient vibrational energy with said dental instrument to cause said diseased cementum and said diseased dentin to fracture;

(e) removing said dental instrument;

(f) inserting a curette into said lesion to remove remaining dislodged cementum, dentin, calculus and plaque; and

(g) closing the lesion by applying pressure for a time sufficient to promote attachment of the gum to the teeth, thereby enhancing regeneration of periodontal tissues.

35. A method for treatment and regeneration of periodontal tissues with the gum tissue remaining in place and connected between the teeth, comprising the steps of:

(a) tracing the gum-tooth interface with a contoured probe to locate a periodontal lesion;

(b) inserting a dental instrument with a smooth nonabrasive exterior surface without a sharp edge into said lesion;

(c) applying vibrational energy to said dental instrument to remove plaque and calculus contained in said lesion;

(d) contacting at least one of cementum, dentin, and bone with said dental instrument while applying sufficient vibrational energy with said dental instrument to cause said one of said cementum and dentin to fracture and soft tissue to disintegrate away from tooth and bone;

thereby creating a surgical flap for management of at least regeneration of periodontal tissue which has an un-interrupted superficial surface subtending a number of teeth, which is dissected from the underlying bone and tooth root as required for surgical access but remains continuous between the teeth and from which at least an appropriate amount of soft tissue is removed from the internal aspect of to provide adequate flexibility through retraction and stretching for access to and assessment of subjacent structures;

(e) irrigating the lesion during steps (c) and (d) with a fluid to remove any fractured and fragmented plaque, calculus and fractured cementum and dentin;

(f) removing said dental instrument;

(g) inserting a curette into said lesion to remove remaining dislodged cementum, calculus, plaque, dentin and soft tissue; and

(h) closing the lesion by applying pressure for a time sufficient to promote attachment of the gum surgical flap to the tooth, thereby enhancing regeneration of periodontal tissues.