Effectiveness of ultrasonic instruments in the therapy of severe periodontitis: a comparative clinical-microbiological assessment with curettes

Patients with deep periodontal pockets were treated with either Vector System (TG) or manual instruments (CG). Clinical assessments by supragingival plaque (PL+), gingival index (GI), bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL) and subgingival plaque collection for microbiological analysis were made prior to and after treatment. Multiplex Polymerase Chain Reaction was used to determine the presence of Actinobacillus actinomycetemcomitans, Campylobacter rectus, Eikenella corrodens, Fusobacterium nucleatum, Prevotella intermedia, Porphyromonas gingivalis, Tannerella forsythensis and Treponema denticola. GI, PD, CAL and the number of BOP+ sites underwent a significant reduction over time in both groups. When compared to baseline, the pair-wise analyses showed significantly lower PD and CAL at 6 months in the CG and significant reductions in the GI, PD, CAL and a number of BOP+ sites at 3 and 6 months in the TG. For microbiological results, significant reductions were seen for C. rectus and R. gingivalis in the CG and for T. forsythensis, E. corrodens and T. denticola in the TG. The total bacterial count underwent a reduction in both groups. Both ultrasonic and manual debridement are equally effective in non-surgical periodontal therapy of severe periodontitis in terms of clinical and microbiological effects.

[Clinical evaluation of electronic dental analgesia during ultrasonic scaling]

OBJECTIVE

To evaluate the effect of electronic dental analgesia (EDA) device--Team Up Duo during ultrasonic scaling.

METHODS

The clinical trial was conducted as a randomized double-blind split-mouth design. Eighty-one patients requiring ultrasonic scaling were selected as subjects. Patients received treatment using the EDA device either in an active or an inactive state in paired quadrants. The patients scored their pain/discomfort levels with visual analog scale (VAS) after each procedure and filled a questionnaire.

RESULTS

In questionnaire, 79.0% patients felt EDA could relieve pain/discomfort during ultrasonic scaling. But the double-blind test showed that Team Up Duo was effective in 46.9% patients overall. The effective rate was 55.1% and 34.4% in groups with or without attachment loss, respectively. In CP group, the success rate of EDA was not statistically significantly different between the groups according to sex, age or site.

CONCLUSIONS

When using Team Up Duo during ultrasonic scaling, most patients subjectively believed that it was effective for controlling pain. In fact, this EDA device was effective in partial patients.

Periodontal Debridement With Povidone-Iodine in Periodontal Treatment: Short-Term Clinical and Biochemical Observations

BACKGROUND

The aim of the present study was to evaluate the clinical effects of one-stage periodontal debridement with an ultrasonic instrument, associated with 0.5% povidone (pvp)-iodine irrigation in patients with chronic periodontitis.

METHODS

Forty-five patients were randomly assigned into three groups: the control group (CG) received quadrant root planing at 1-week intervals over four consecutive sessions; the periodontal debridement plus pvp-iodine group (PD-PIG) received a 45-minute full-mouth debridement with an ultrasonic instrument, associated with 0.5% pvp-iodine irrigation; and the periodontal debridement group (PDG) received a 45-minute full-mouth periodontal debridement with an ultrasonic instrument, associated with NaCl irrigation.

RESULTS

At the 3-month evaluation, the mean probing depth (PD) reduction in CG was 2.51+/-0.52 mm, 2.53+/-0.50 mm in PD-PIG, and 2.58+/-0.60 mm in PDG (P<0.05). The clinical attachment level (CAL) analysis showed a statistically significant gain in all groups compared to baseline (1.87+/-0.56 mm [CG], 1.94+/-0.70 mm [PD-PIG], and 1.99+/-0.92 mm [PDG]). Intergroup analysis of PD and CAL at 1 and 3 months showed no differences (P>0.05). The N-benzoyl-L-arginine-p-nitroanilide (BAPNA) test showed a significant reduction in trypsin activity only during the first month (P<0.05); at 3 months there were no differences compared to baseline (P=0.80).

CONCLUSION

This study provides no evidence that pvp-iodine is effective as an adjunct for one-stage periodontal debridement.

Clinical outcomes of quadrant root planing versus full-mouth root planing

OBJECTIVES

To determine the clinical effects of full mouth compared with quadrant wise scaling and root planing.

METHOD

Twenty patients with chronic periodontitis (> or = 2 teeth per quadrant with probing pocket depths (PPD) > or = 5 mm and bleeding on probing (BOP) were randomized into a test group treated in two sessions with subgingival scaling and root planing within 24 h (full-mouth root planing (FMRP)) and a control group treated quadrant by quadrant in four sessions in intervals of 1 week (quadrant root planing (QRP)). PPD, relative attachment level (RAL) and BOP were recorded at baseline, 3 and 6 months.

RESULTS

Analysing first quadrant data, in moderately deep pockets (5 mm < or = PPD < 7 mm) there was no evidence for a difference (FMRP-QRP) between both groups for PPD reduction (mean: -0.128 mm; CI: [-0.949, 0.693]; p=0.747), RAL gain (mean: 0.118 mm; CI: [-0.763, 1.000]; p=0.781), and BOP reduction (mean: -20.1%; CI: [-44.3, 4.2]; p=0.099). Likewise, no significant differences between treatments were found for initially deep pockets (PPD > or = 7 mm), neither for first quadrant nor for whole mouth data.

CONCLUSION

The results of the present study demonstrated equally favourable clinical results following both treatment modalities.

A laboratory study to determine the effects of universal and rotating ultrasonic inserts on wrist movement and scaling time efficiency of dental hygienists

PURPOSE

The purpose of this study was to determine if differences existed in range of wrist movements and scaling time efficiency of dental hygienists using a rotating ultrasonic insert when compared with a standard universal insert.

METHODS

A convenience sample of 32 consenting experienced dental hygienists who met inclusion criteria was invited to participate. Using a cross-over research design, the 32 participants were randomly assigned to one of the two subgroups. Subgroup A (n = 16) used the rotating universal ultrasonic insert on a typodont, rested for 15 min and the standard universal insert on a different typodont. Subgroup B (n = 16) used the standard universal ultrasonic insert on a typodont, rested for 15 min and the rotating universal ultrasonic insert on a different typodont. Each participant used the rotating and standard universal ultrasonic scaling inserts to remove 2 cm3 artificial calculus from two different typodonts for up to 15 min per insert. Scaling time efficiency was determined using a Modified Volpe-Manhold Calculus Index, measuring the amount of artificial calculus remaining after ultrasonic scaling. While scaling, each participant wore the WristSensor goniometry gloves, which determined changes in wrist movements (flexion and extension and ulnar and radial deviations), measured as a deviation from the neutral position.

RESULTS

A paired t-test (P = 0.05) using 30 subjects with useable data, revealed no statistically significant differences between the two different inserts in terms of wrist movements and scaling time efficiency. A multivariate analysis of variance revealed no statistically significant differences in the percentage of time dental hygienists were in high, medium or low-risk posture categories while using the rotating ultrasonic insert compared with the standard universal insert. Based on the results of this laboratory study, dental hygienists using a rotating ultrasonic insert appear to experience no ergonomic advantage in terms of wrist postures or timesavings over a standard insert.

[A quadrant-design trial of four therapeutic modalities in chronic moderate periodontitis]

This randomized clinical study (blind and controlled) compared the effectiveness of an ER:YAG laser (combined with a calculus detection system using fluorescence induced by diode laser radiation for use in non-surgical periodontal therapy) as well as sonic and ultrasonic scalers and scaling and root planning with hand instruments to each other. 72 patients suffering from moderate chronic periodontitis (based on a probing depth of 4 mm or more of at least one tooth in each quadrant) were treated using either an Er:YAG-Laser (KEY 3, KaVo), a piezo-electric ultrasonic system (Piezon Master 400, EMS), a sonic scaler (Sonicflex 2003 L, KaVo), or Gracey Mini-five curettes (Hu Friedy) (control). These four kinds of treatment were randomized and grouped into quadrants. Oral health indicators, probing depths (PD) and clinical attachment levels were examined before commencement of the hygiene phase as well as three months after by a blind, calibrated examination. Within the study period, the mean PD (+/- SE) of the control group fell from 4.40 (0.03) mm to 3.08 (0.03) mm; for the laser group, the reduction was slightly greater, falling from 4.47 (0.04) mm to 3.08 (0.03). In comparison, values for the ultrasonic group were 4.39 (0.04) mm in the pre-study examination and 3.09 (0.04) after treatment; in the sonic group, the values were 4.40 (0.03) mm pre-study and 3.07 (0.03) mm post-study. Within the control group, the mean CAL (+/- SE) decreased from 4.95 (0.07) mm to 3.92 (0.07) mm. Within the laser group, the reduction was more distinct, falling from 5.05 (0.07) mm to 3.88 (0.07) mm. In the ultrasonic group, the median CAL decreased from 5.02 (0.08) mm to 3.88 (0.08) mm and from 4.95 (0.07) mm to 3.84 (0.08) mm within the sonic group. From the date of treatment until the third month thereafter, all of the clinical parameters were shown to be statistically significant (p < 0.0001; GEE). Use of the laser led to a much greater reduction in PD levels (p = 0.0021; GEE) than in the ultrasonic group and demonstrated a higher increase in CAL (p = 0.0010; GEE) relative to the manual methods.

CONCLUSION

All four methods of treatment lead to a clinically comparable outcome.

Efficacy of Carisolv™ as an adjunctive therapy to scaling and root planing on subgingival calculus removal

The purpose of this study was to evaluate the effectiveness of subgingival application of Carisolv™ gel as an adjunctive therapy to scaling and root planing (SRP) on calculus removal compared to conventional instrumentation. Forty-five teeth requiring extraction due to severe periodontal disease were randomized to the following treatments: 1) SRP alone; 2) placebo gel + SRP; 3) Carisolv™ gel + SRP. Either test or placebo gel was applied subgingivally for 1 min and then the root were instrumented until a smooth and calculus-free surface was achieved. Instrumentation time and the number of strokes required were recorded. After extraction, the efficacy of root surface instrumentation was measured by percentage of remaining calculus. There was no statistically significant difference (p>0.05) between the treatment groups regarding either time required for instrumentation or the percentage of residual calculus. The subgingival application of Carisolv™ gel prior to SRP did not provide any additional benefit to root instrumentation compared to scaling and root planing alone.

Characterisation of dentin surfaces processed with KrF excimer laser radiation

In the present work, the surface microtexture and chemical changes induced in human dentin by laser processing with KrF excimer laser radiation using fluences ranging from 0.5 to 20 J/cm2 were studied by SEM, XPS and FTIR. Two distinct behaviours were observed in the evolution of surface topography. In some samples, the laser-treated surface remained flat, independently of the fluence used. It was covered by a layer formed of redeposited ablation particles, which occluded the dentinal apertures. In other samples the surface topography depended on radiation fluence. When the fluence was lower than 1 J/cm2, preferential removal of intertubular dentin occurs, producing a columnar structure in which the columns are essentially formed of peritubular material. If the fluence exceeded 1 J/cm2 the processed surface was flat and covered with resolidified material. Despite these topographic changes, the dentin was not significantly affected by the laser treatment. The observed behaviour can be explained by differences in the constitution of dentin.

Antibiotic prophylaxis in oral health care: administration strategies of general dental practitioners

OBJECTIVE

To examine the strategies that general dental practitioners (GDPs) use to administer antibiotic prophylaxis and to study the agreement between the administration strategies of GDPs and local recommendations.

METHODS

Postal questionnaires in combination with telephone interviews were used. Two hundred GDPs in two Swedish counties, Skåne and Orebro, were asked to participate. The response rate was 51% (n = 101). The GDPs were presented with eight simulated cases of patients with different medical conditions for which antibiotic prophylaxis might be considered necessary when performing dental procedures (scaling, tooth removal, root canal treatment). The administration strategies of the GDPs were compared with local recommendations.

RESULTS

In general, the variation in the administration strategies of the GDPs was large. For two medical conditions, type 1 diabetes that was not well controlled and hip prosthesis, significantly more GDPs in Skåne than in Orebro administered antibiotic prophylaxis for tooth removal. Agreement between the administration strategies of the GDPs and local recommendations was low. Differences between the two counties were non-significant. Furthermore, within Orebro, GDPs who did not have formal access to local recommendations did not differ in their administration strategies from those who did. The choice of substance was seldom in agreement with the substance recommended, while the majority followed the recommended duration of treatment.

CONCLUSION

Although recommendations existed, their impact appeared to be limited. This is significant, since the implementation of recommendations is crucial in making clinical practice more effective and in promoting the health of patients.

Hand and ultrasonic instrumentation in the treatment of chronic periodontitis after supragingival plaque control

This study compared the clinical effects of hand or ultrasonic scaling and root planing on the treatment of chronic periodontitis. After supragingival plaque control, twenty patients were examined by a blinded and calibrated examiner for probing pocket depth (PPD), clinical attachment level (CAL) and bleeding on probing (BOP). Experimental teeth were allocated to the following subgingival treatment groups according to PPD: 1) hand instrumentation; 2) hand instrumentation with irrigation; 3) ultrasonic instrumentation; 4) ultrasonic followed by hand instrumentation. Time used in the procedures was recorded. Follow-up examinations were performed at 30 and 90 days after treatment. Each patient's individual BOP, PPD and CAL means were analyzed with repeated-measures ANOVA. Differences in the instrumentation time were analyzed with 1-way ANOVA. Significance level was established at 5%. All treatments produced significant changes in the clinical parameters. BOP reduced, in proximal surfaces, from 67.21-79.17% at baseline to 45.75-51.54% at 90 days. Significant reductions were also found for PPD and CAL in all groups, both in proximal and free surfaces. Reductions in mean PPD at 90 days ranged from 0.92 to 1.14 mm for the free surfaces and from 1.01 to 1.35 mm for proximal surfaces, whereas reductions in CAL ranged from 0.43 to 0.82 mm and from 0.60 to 0.73 mm for free and proximal surfaces, respectively. Mean instrumentation time ranged from 4.77 to 5.30 minutes. No statistically significant differences were found among the four study groups. It can be concluded that the four methods of subgingival instrumentation were equally efficacious in the improvement of the studied clinical parameters.

Full-mouth ultrasonic debridement versus quadrant scaling and root planing as an initial approach in the treatment of chronic periodontitis

AIM

To evaluate the clinical efficacy of (i) a single session of "full-mouth ultrasonic debridement" (Fm-UD) as an initial periodontal treatment approach and (ii) re-instrumentation of periodontal pockets not properly responding to initial subgingival instrumentation.

METHODS

Forty-one patients, having on the average 35 periodontal sites with probing pocket depth (PPD) > or =5 mm, were randomly assigned to two different treatment protocols following stratification for smoking: a single session of full-mouth subgingival instrumentation using a piezoceramic ultrasonic device (EMS PiezonMaster 400, A+PerioSlim tips) with water coolant (Fm-UD) or quadrant scaling/root planing (Q-SRP) with hand instruments . At 3 months, all sites with remaining PPD> or =5 mm were subjected to repeated debridement with either the ultrasonic device or hand instruments. Plaque, PPD, relative attachment level (RAL) and bleeding following pocket probing (BoP) were assessed at baseline, 3 and 6 months. Primary efficacy variables were percentage of "closed pockets" (PPD< or =4 mm), and changes in BoP, PPD and RAL.

RESULTS

The percentage of "closed pockets" was 58% at 3 months for the Fm-UD approach and 66% for the Q-SRP approach (p>0.05). Both treatment groups showed a mean reduction in PPD of 1.8 mm, while the mean RAL gain amounted to 1.3 mm for Fm-UD and 1.2 mm for Q-SRP (p>0.05). The re-treatment at 3 months resulted in a further mean PPD reduction of 0.4 mm and RAL gain of 0.3 mm at 6 months, independent of the use of ultrasonic or hand instruments. The efficiency of the initial treatment phase (time used for instrumentation/number of pockets closed) was significantly higher for the Fm-UD than the Q-SRP approach: 3.3 versus 8.8 min. per closed pocket (p<0.01). The efficiency of the re-treatment session at 3 months was 11.5 min. for ultrasonic and 12.6 min. for hand instrumentation (p>0.05).

CONCLUSION

The results demonstrated that a single session of Fm-UD is a justified initial treatment approach that offers tangible benefits for the chronic periodontitis patient.

Effects of single-visit full-mouth ultrasonic debridement versus quadrant-wise ultrasonic debridement

BACKGROUND

The aim of this randomized controlled clinical trial was to determine the effects of single-visit full-mouth ultrasonic debridement versus quadrant-wise therapy.

MATERIAL AND METHODS

Thirty-six subjects with chronic periodontitis, were randomly allocated to three groups--quadrant-wise ultrasonic debridement, single-visit full-mouth ultrasonic debridement with povidone iodine and single-visit full-mouth ultrasonic debridement with water. Whole-mouth plaque, bleeding on probing (BOP), pocket depth and attachment level were recorded before treatment and 1, 3 and 6 months post-treatment. Plaque and saliva samples were collected for microbiological analysis.

RESULTS

After treatment, all groups showed significant improvement in clinical parameters. Full-mouth treatments resulted in similar improvements in full-mouth mean plaque percentage, probing pocket depth and probing attachment level as conventional therapy. When data were analysed based on pocket depth and tooth type, there was no difference between groups in probing depth reduction or attachment gains. The full-mouth groups demonstrated greater reduction in BOP% and number of pockets > or =5 mm and the total treatment time was significantly shorter. The detection frequencies of periodontal pathogens in plaque and saliva showed slight changes with no difference between groups.

CONCLUSION

Single-visit full-mouth mechanical debridement may have limited additional benefits over quadrant-wise therapy in the treatment of periodontitis, but can be completed in a shorter time.

Histologic Evaluation of Three Methods of Periodontal Root Surface Treatment in Humans

BACKGROUND

Removing subgingival plaque and calculus is a major goal of periodontal treatment. Few attempts have been made to evaluate the use of lasers for root surface debridement in periodontal therapy. The aim of the present study was to compare, histologically, the effects of hand instrumentation, ultrasonic instrumentation, and CO2 lasers on the root surfaces of teeth treated in situ.

METHODS

A total of 33 teeth scheduled for extraction due to severe periodontal disease were divided into three groups. In the first group, teeth were treated by ultrasonic bactericidal curettage (UBC) with an ultrasonic scaler; in the second group, teeth were treated by hand instrumentation; and in the third group, after hand instrumentation, roots were lased by a CO2 laser. The samples were then processed for histological examination.

RESULTS

In the first and second groups, plaque and calculus were present in interradicular septa, lacunae, and surface concavities. In the third group, surfaces of specimens treated by a low-power defocused CO2 laser showed areas devoid of cementum, with completely sealed dentinal tubules, and no bacterial cell remnants.

CONCLUSIONS

The CO2 laser treatment, used at low power and in the defocused mode, combined with traditional mechanical instrumentation, could improve root surface debridement of periodontally involved teeth. More extensive, long-term studies are needed to confirm this hypothesis.

Enhanced periodontal debridement with the use of micro ultrasonic, periodontal endoscopy

Current literature supports the use of powered instrumentation over traditional hand instrumentation. The objective of scaling and root planing is the complete removal of plaque and calculus from root surfaces. While this is unrealistic, the accepted end-point is a smooth, glassy root surface during periodontal instrumentation. This often has resulted in overinstrumentation and excessive removal of cementum. Cementum removal has been deemed generally unnecessary. What is essential is the removal of plaque, calculus, and the endotoxin adherent to the root surface. This cleaning of root surfaces is best done with judicious use of powered instrumentation. The excessive removal of cementum during hand instrumentation is due to the lack of visualization. Using endoscopic technology, the ability to visually debride roots can improve chances of success in a more conservative and minimally invasive way. This article provides a brief review of micro ultrasonic technologies and periodontal endoscopy, its implementation in our practice, and a limited case series.

Effect of handedness on learning subgingival scaling with curettes: a study on manikins

The aim of the present study was to evaluate the influence of systematic manikin-head training and the effectiveness of subgingival scaling applied with hand instruments (curettes) by right- and left-handed dental students on dental chairs (traditional) designed for right-handers. A questionnaire focusing on handedness was administered to 69 voluntary dental students in the third class at the School of Dentistry during pre-participation examination. Handedness was assessed using the Turkish version of the Edinburgh Handedness Inventory. Then, 18 dental students were specially selected in 2 equal groups according to hand preference: consistent right-handers with Geschwind Scores of +100 (5 female and 4 male) and consistent left-handers with Geschwind Scores of -100 (5 female and 4 male). These two untrained dental student groups received 10 weeks manikin-head training. Subgingival scaling was performed with hand instruments (Gracey curettes) in manikin-head mounted on right-sided dental chairs. At 6 test days each dental student had to instrument 12 test teeth. Effectiveness of subgingival scaling was evaluated by adoption of a grading system. This system had scores from 0 to 3 and was defined by illustrated and described criteria. Statistical analysis was carried out with SPSS. Two groups were statistically compared on all test days. The yet-untrained left-handed dental students begin with a relatively high the mean score of 2.25, compared to the yet-trained right-handed dental students with 1.93, which was statistically significant (p > .05). The right-handed dental students reached the mean score of 0.53, whereas the left-handed dental students reached the mean score of 0.87 on test day 6. Significant differences in the mean scores were found between the two groups for overall surfaces (p < .05), the distal surfaces (p < .01), lingual surfaces (p < .01), and each group of teeth (p < .05). But there was no statistically significant difference between the 2 groups of students on all test day, except for test day 3 in terms of the mean scores for the facial and mesial surfaces (p > .05). Learning success was observed a high level in both groups through systematical training (p < .0001). The present study has documented that the left-handed dental students were less successful than the right-handed dental students in subgingival scaling, except for mesial and facial surfaces. However although training on right-sided chairs, they were quite similar to their right-handed counterparts in terms of learning success.

Removal of root substance with the Vectortm-system compared with conventional debridement in vitro

OBJECTIVE

The aim of the present study was to assess the removal of root substance with the Vector-system depending on different irrigation fluids and to compare the results with conventional methods for root debridement.

MATERIAL AND METHODS

Forty extracted human teeth were treated using four different methods: Vector-system with polishing fluid and metal curette (VP), Vector-system with abrasive fluid and metal curette (VA), conventional ultrasonic system (U) with insert tip "P" and hand instrument. Treatment of the calculus-free root surfaces was carried out for a total of 12 min. using an artificial periodontal pocket. At intervals of 120 s, the removal of dental hard tissues was assessed using a three-dimensional (3D) laser scanning device and the Match 3D software with an accuracy of 0.00001 mm(3).

RESULTS

No difference in the removal of root substance with the hand instrument (0.0055 mm(3)/s) and the Vector-system using the abrasive fluid (0.0044 mm(3)/s) could be observed (p=0.51). Using these two systems, a larger amount of root substance (p<0.05) was removed compared with the other methods (U: 0.0023 mm(3)/s, VP: 0.0022 mm(3)/s), which did not differ from each other (p=0.76).

CONCLUSIONS

The present study indicates that the Vector-system in combination with polishing fluid or conventional ultrasonics might be used for root debridement without extensive root substance removal.

Efficiency of subgingival calculus removal with the Vectortm-system compared to ultrasonic scaling and hand instrumentation in vitro

OBJECTIVE

The recently introduced Vector-system (Duerr Dental, Bietigheim-Bissingen, Germany) is recommended to be used in conjunction with different insert tips and irrigation fluids. The aim of the study was to assess subgingival calculus removal depending on the mode of operation and to compare the results to conventional methods for root debridement.

METHODS

Sixty extracted human teeth with calculus on the root surface were treated in an artificial periodontal pocket model using six methods: Vector-system with metal probe insert (VPP) or metal curette insert (VPC), both used with polishing fluid, Vector-system with metal probe insert (VAP) or metal curette insert (VAC), both used with abrasive fluid, EMS-ultrasonic system (U) and hand instrument (Gracey curette). Photographs of the root surface were taken at intervals of 10 s and calculus removal was assessed using a surface analysis software until the root surfaces were cleaned completely. Analysis of variances (ANOVA) of the ranks with subsequent comparison of mean ranks and calculation of homogeneous groups (Scheffe) were used for statistical analysis.

RESULTS

Employing the hand instrument, highest efficiency could be observed (0.340 mm2/s). Calculus removal with the Vector-system and metal probe insert (VPP: 0.036 mm2/s; VAP: 0.067 mm2/s) was less effective (p < 0.05) than using the system with metal curette inserts (VPC: 0.122 mm2/s; VAC: 0.209 mm2/s). Employing the abrasive fluid, removal of deposits with the metal curette insert was as efficient as with the conventional ultrasonic system (U: 0.199 mm2/s, p > 0.05).

CONCLUSION

The present in vitro study indicates that the efficiency of calculus removal with the Vector-system is significantly dependent on the selection of inserts and irrigation fluids.

Clinical and microbiological effect of scaling and root planing in smoker and non-smoker chronic and aggressive periodontitis patients

OBJECTIVES

To compare the effects of scaling and root planing (SRP) on clinical and microbiological parameters at selected sites in smoker and non-smoker chronic and generalized aggressive periodontitis patients.

MATERIALS AND METHODS

Clinical parameters including probing depth (PD), relative attachment level (RAL), and bleeding upon probing (BOP), and subgingival plaque samples were taken from four sites in 28 chronic periodontitis (CP) and 17 generalized aggressive periodontitis (GAgP) patients before and after SRP. Polymerase chain reaction assays were used to determine the presence of A. actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythensis, Prevotella intermedia and Treponema denticola.

RESULTS

Both CP and GAgP non-smokers had significantly greater reduction in pocket depth (1.0+/-1.3 mm in CP smokers versus 1.7+/-1.4 mm in non-smokers, p=0.007 and 1.3+/-1.0 in GAgP smokers versus 2.4+/-1.2 mm in GAgP non-smokers, p<0.001) than respective non-smokers, with a significant decrease in Tannerella forsythensis in CP sites (smokers 25% increase and non-smokers 36.3% decrease, p<0.001) and Prevotella intermedia at GAgP sites (smokers 25% reduction versus 46.9% in non-smokers, p=0.028).

CONCLUSION

SRP was effective in reducing clinical parameters in both groups. The inferior improvement in PD following therapy for smokers may reflect the systemic effects of smoking on the host response and the healing process. The lesser reduction in microflora and greater post-therapy prevalence of organisms may reflect the deeper pockets seen in smokers and poorer clearance of the organisms. These detrimental consequences for smokers appear consistent in both aggressive and CP.

Effects of ultrasonic scaling and hand-activated scaling on tactile sensitivity in dental hygiene students

PURPOSE

This study was conducted to determine if tactile sensitivity varies in dental hygiene students who use the ultrasonic scaler, as compared to those who scale with hand-activated instruments.

METHODS

A two-group, randomized subjects, pretest-posttest design was carried out mid-semester for five weeks on 40 first-year dental hygiene students who met the inclusion criteria of this study and who agreed to participate. A convenience sample of 40 consenting, first-year dental hygiene students were randomly assigned to one of two groups (experimental or control). After establishing a baseline tactile sensitivity score with the Vibratory Sensory Analyzer (VSA), experimental group subjects used the ultrasonic scaler to remove 4 cc's of artificial calculus from a typodont in a controlled, simulated clinical setting for 45 minutes, while each control subject manually scaled 4 cc's of artificial calculus on a typodont in a controlled, simulated situation for 45 minutes. Immediately following exposure to either the ultrasonic scaler or hand-activated scaling instruments, tactile sensitivity scores were obtained using the VSA. Analysis of variance with one repeated measures factor was used to determine between group and within group differences on the pretest and posttest tactile sensitivity scores.

RESULTS

Results revealed that tactile sensitivity increased after a 45-minute scaling session with the ultrasonic scaler. Pretest to posttest changes in tactile sensitivity for the ultrasonic scaling group exhibited a much larger threshold as compared to those in the hand-activated scaling group, supporting a gain in students' level of sensitivity with stimulus (vibration). Tactile sensitivity decreased in those who used hand-activated scaling instruments. The thumb, index, and middle fingers of students in both groups showed similarities in tactile sensitivity, with the index finger being the most sensitive.

CONCLUSION

Tactile sensitivity decreases with hand-activated scaling and increases with ultrasonic scaling over a 45-minute period. Short-term vibration exposure from the ultrasonic scaler is insufficient to negatively affect tactile sensitivity.

Clinical efficacy of semiconductor laser application as an adjunct to conventional scaling and root planing

BACKGROUND AND OBJECTIVES

The aim of the in vitro study was to examine the clinical efficacy of semiconductor laser periodontal pocket irradiation as an adjunct to conventional scaling and root planing.

MATERIALS AND METHODS

Twenty-two healthy patients with a need of periodontal treatment (15 women, 7 men, mean age 45.0 +/- 10.8 years) with at least four teeth in all quadrants, were included. All of them underwent a conventional periodontal treatment including scaling and root planing. Using a split mouth design, two randomly chosen quadrants (one upper and the corresponding lower one) were subsequently treated with an 809 nm GaAlAs laser operated at a power output of 1.0 Watt using a 0.6 mm optical fiber. The teeth in the control quadrants were rinsed with saline. The clinical outcome was evaluated by means of plaque index (PI), gingival index (GI), bleeding on probing (BOP), sulcus fluid flow rate (SFFR), Periotest (PT), probing pocket depth (PPD), and clinical attachment loss (CAL) at baseline and at 3 months after treatment. A total of 492 teeth in both groups were evaluated and differences between the laser and the control teeth were analyzed using the Wilcoxon test (P < 0.05).

RESULTS

Teeth treated with the laser revealed a significantly higher reduction in tooth mobility, pocket depth, and clinical attachment loss. Twelve percent of the teeth in the laser group showed an attachment gain of 3 mm or more, compared to 7% in the control group. An attachment gain of 2-3 mm was found in 24% of the teeth in the laser group and 18% in the control group. No significant group differences, however, could be detected for the plaque index, gingival index, bleeding on probing, and the sulcus fluid flow rate.

CONCLUSIONS

The higher reduction in tooth mobility and probing depths is probably not predominantly related to bacterial reduction in the periodontal pockets but to the de-epithelization of the periodontal pockets leading to an enhanced connective tissue attachment. The application of the diode laser in the treatment of inflammatory periodontitis at the irradiation parameters described above is a safe clinical procedure and can be recommended as an adjunct to conventional scaling and root planing.

Influence of temporary cement remnant and surface cleaning method on bond strength to dentin of a composite luting system

The aim of the current study was to evaluate the influence of polycarboxylate temporary cement remaining on the dentin surface on the bond strength of a composite luting system. An acrylic resin plate was luted to bovine dentin with a polycarboxylate temporary cement (HY-Bond Temporary Cement Hard, HYB). The temporary cement was not used for the control groups. After removing the temporary cement with an excavator, dentin specimens were divided into five groups; 1) no subsequent treatment, 2) cleaning with a rotational brush (RTB), 3) cleaning with a rotational brush and non-fluoridated flour of pumice, 4) sweeping with an air scaler, and 5) treated with a sonic toothbrush. A silane-treated ceramic disk (IPS Empress) was bonded to each dentin specimen with a composite luting system (Panavia F). Shear testing results showed that the RTB groups exhibited the highest bond strength regardless of the use of temporary cement (P < 0.05). The use of a rotational brush with water coolant is recommended to achieve ideal bond strength between the Panavia F luting system and dentin to which HYB temporary cement was primarily applied.

Clinical effects of scaling and root planing on untreated teeth

OBJECTIVE

The aim of this report is to examine whether scaling and root planing (SRP) in one area of the mouth may affect periodontal improvement in untreated areas in the same patient, possibly through systemic effects of treatment.

MATERIAL AND METHODS

Twenty patients diagnosed with generalized aggressive periodontitis were randomized into treatment (n=11) and no treatment (n=9) groups. Within the treatment group, three quadrants were treated by SRP at week 0, 3, 12, and 24, while a single experimental quadrant remained untreated throughout the study. The outcome for all teeth was assessed using clinical parameters, subtraction radiography, and pathogenic bacteria levels in the subgingival flora over the 24-week study period.

RESULTS

Compared with sites in no treatment patients, the treated sites in the treated patients showed a 1 mm decrease in probing depth (PD) (p<0.01) and a 0.5 mm increase in bone height (p<0.01) by 24 weeks. In untreated sites within treated subjects, however, PDs tended to improve (p=0.09) but at a reduced rate compared with treated sites. The levels of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Tannerella forsythensis (Bacteroides forsythus) remained unchanged in untreated sites while levels of Prevetolla intermedia and Treponema denticola tended to decrease as compared with controls but did not reach significance.

CONCLUSIONS

This study indicates that untreated sites in treated periodontitis patients show a trend towards clinical improvement and exhibit reductions in some but not all periodontopathic bacterial species tested.

Periodontal treatment with an Er:YAG laser compared to ultrasonic instrumentation: a pilot study

BACKGROUND

The aim of the present study was to compare the effectiveness of an Er:YAG laser to that of ultrasonic scaling for non-surgical periodontal treatment.

METHODS

Twenty patients with moderate to advanced periodontal disease were randomly treated in a split-mouth design with a single episode of subgingival debridement using either an Er:YAG laser device (160 mJ/pulse, 10 Hz) combined with a calculus detection system with fluorescence induced by 655 nm InGaAsP diode laser radiation (ERL), or an ultrasonic instrument (UI). Clinical assessments of full-mouth plaque score (FMPS), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL) were made at baseline and at 3 and 6 months following therapy.

RESULTS

No differences in any of the investigated parameters were observed at baseline between the two groups. The mean value of BOP decreased in the ERL group from 40% at baseline to 17% after 6 months (P<0.0001) and in the UI group from 46% at baseline to 15% after 6 months (P<0.0001). The sites treated with ERL demonstrated mean CAL gain of 1.48 +/- 0.73 mm (P<0.001) and of 1.11 +/- 0.59 mm (P<0.001) at 3 and 6 months, respectively. The sites treated with UI demonstrated mean CAL gain of 1.53 +/- 0.67 mm (P<0.001) and of 1.11 +/- 0.46 mm (P<0.001) at 3 and 6 months, respectively. No statistically significant differences were observed between the groups (P>0.05).

CONCLUSION

Within the limits of the present study, it can be concluded that both therapies led to significant improvements of the investigated clinical parameters.