Proof of efficacy of different modified sonic scaler inserts used for debridement in furcations--a dummy head trial

Impact of Air and Manual Scaling on Dental Anxiety and Blood Glucose Level among Diabetic Patients

Aims:

The current study aimed at describing the short-term effect of nonsurgical periodontal treatment on dental anxiety and blood glucose level change among diabetic patients.

Materials and Methods:

One hundred and fifty patients with diabetes participated in a cross-sectional study design. All of them were divided into two groups, with 75 patients in each group. The first group was treated with air scaling, whereas the second group was treated with manual scaling. The determination of treatment needs and the evaluation of periodontal health status were achieved by using Community Periodontal Index for Treatment Need (CPITN). The level of dental anxiety was assessed by using Visual Analogue Scale (VAS). The glucose change was calculated by subtracting the glucose level before treatment from the glucose level straight after treatment.

Results:

No significant difference in glucose level was observed between manual scaling and air scaling after treatment (P = 0.076), and the level of glucose was significantly lower after scaling treatment within the treatment groups (P = 0.000). The level of glucose change between the groups was significantly lower for the manual scaling treatment group (P = 0.013), and it was significantly correlated with VAS (P = 0.000). Multiple regression analysis showed a significant association between the treatment groups (P = 0.007).

Conclusions:

Scaling reduced blood glucose and dental anxiety levels in patients with diabetes. Manual scaling was associated with reduced glucose level change less than air scaling after treatment.

Results of an experimental study of subgingival cleaning effectiveness in the furcation area

BACKGROUND

Sufficient biofilm removal in the furcation area (FA) is a major challenge in the clinical practice of supportive periodontal therapy. The aim of the present experimental study was to simulate subgingival cleaning of the FA using a powered scaler (sonic scaler (AIR), ultrasonic scaler (US)) for conventional mechanical debridement versus two air polishing with nonabrasive powder (LAPA-1: glycine powder, LAPA-2: erythritol powder) and different nozzles for supra-/subgingival cleaning for each device.

METHODS

Seven trained and calibrated operators with ≥ 2 years each of professional experience in treating periodontitis used the instruments to clean 3D-printed replicas of six molars with through-and-through FA (four 3-rooted and two 2-rooted teeth) in a manikin head. AIR and US were used in the control group; air polishing instruments were used in the test group. For reproducible evaluation, the test teeth were separated vertically into two or three parts, illuminated with ultraviolet light, photographed and evaluated planimetrically. Treatment time (TrT, in s) and relative cleaning efficacy (RCE, in %) were measured.

RESULTS

Overall, 3-rooted molars (RCE in the entire FA, 23.19 ± 20.98%) could be cleaned significantly less effectively than 2-rooted molars (53.04 ± 28.45%, p < 0.001), regardless of the instrument used. In the cleaning of the entire FA, significantly higher RCE values were achieved with conventional mechanical debridement (AIR/US: 46.04 ± 25.96%/39.63 ± 22.02%; AIR vs. US: p > 0.05) than with air polishing (LAPA-1/LAPA-2: 34.06 ± 29.48%/17.09 ± 18.85%; LAPA-1 vs. LAPA-2: p < 0.001) regardless of whether a supra- or subgingival cleaning nozzle used (p < 0.001). Only LAPA-1 with a subgingival nozzle showed RCE values comparable to those of US (41.07 ± 28.95% vs. 39.63 ± 22.02%, p > 0.05). TrT was longest for US (299.40 ± 120.69 s) and shortest for LAPA-1 with a supragingival nozzle (129.67 ± 60.92 s, p < 0.001).

CONCLUSIONS

All of the examined instruments were effective to some degree in removing the simulated biofilm from the FA, but they differed substantially in cleaning efficacy. Only one air polishing device (LAPA-1) with a rigid subgingival nozzle was able to achieve RCE values similar to those of US. The current investigation confirmed that conventional mechanical debridement with powered scalers were most effective, but treatment took longer with these devices than air polishing.

Removal of simulated biofilm: an evaluation of the effect on root surfaces roughness after scaling

BACKGROUND

Despite the development of less invasive devices, a debate exists about the benefits and risks of hand versus powered root surface instrumentation used in supportive periodontal therapy (SPT). The aim of the in vitro study was to differentially compare plaque removal efficacy and root surface roughening of newly developed sonic, ultrasonic scaler, and curettes in the hands of experienced versus less experienced operators.

MATERIALS AND METHODS

Sonic (AIR), ultrasonic devices (TIG), and double-gracey curettes (GRA) were utilized by seven experienced (EO) and four less experienced operators (LO) for root surface instrumentation of standardized plastic teeth on manikins' heads in a randomized sequence. The proportion of residual simulated plaque (RSP area in %) was planimetrically assessed, and the average root surface roughness produced (Ra and ∆Ra in μm) was measured by a precision profilometer.

RESULTS

The uninstrumented root surfaces showed a Ra of (median (Q25/Q75)) 1.00 μm (0.83/1.16). Following instrumentation, EO left significantly less RSP than LO regardless of the used instruments (20.00 % (10.00/34.00) vs. 26.00 % (12.00/44.00) p < 0.001), whereas the ∆Ra values (0.29 μm (-0.04/0.96) vs. 0.35 μm (-0.04/1.01), p = 0.237) failed to show significant differences. The surface roughness was higher with GRA followed by AIR then TIG regardless of operators' experience (p < 0.001).

CONCLUSION

Within the limits of the present study, the sonic device was most efficient in plaque removal, while the ultrasonic device produced the least surface roughness.

CLINICAL RELEVANCE

All three tested instruments seem effective in the mechanical root debridement during SPT, whereat the ultrasonic device show the smoothest root surface of all.

Efficacy versus health risks: An in vitro evaluation of power-driven scalers

Background:

Power-driven instrumentation of root surfaces during supportive periodontal therapy is an alternative to hand instrumentation. The purpose of this pilot in vitro study was to investigate the efficacy of sub- and supragingival plaque removal with a sonic (AIR: Synea, W and H, Bürmoos, Austria) and two ultrasonic devices (TIG: Tigon+, W and H, Bürmoos, Austria; VEC: Vector, Dürr, Bietigheim-Bissingen, Germany) as well as the health-risk for dental professionals during treatment.

Materials and Methods:

The power-driven devices were utilized to remove plaque from model teeth in dummy heads. The percentage of residual artificial plaque after 2 min of supra- or subgingival instrumentation was calculated by means of image-processing techniques at four sites (n = 576) of each tooth. The Health-Risk-Index (HRI: spatter/residual plaque quotient) with the different power-driven devices was assessed during treatment.

Results:

The smallest amounts of residual plaque were found for the sonic device AIR (8.89% ± 10.92%) and the ultrasonic scaler TIG (8.72% ± 12.02%) (P = 0.707). Significantly more plaque was remained after the use of the ultrasonic scaler VEC (18.76% ± 18.07%) (P < 0.001). Irrespectively of the scaler, efficacy was similar sub- (10.7% ± 11.6%) and supragingivally (13.5% ± 17.2%) (P = 0.901). AIR/TIG demonstrated equal residual amounts of plaque sub- (P = 0.831) as well as supragingivally (P = 0.510). However, AIR/VEC and TIG/VEC were significantly in favor of AIR and TIG (P < 0.001). In contrast, the lowest HRI was found after using VEC (0.0043) and differed considerably for AIR (0.2812) and TIG (0.0287).

Conclusion:

Sonic devices are as effective as ultrasonic devices in the removal of biofilm but bear a higher risk to the dental professional's health concerning the formation of spatter.

The effect of the Vector scaler system on human teeth: a systematic review

AIM

To review the available literature, considering the effect of instrumentation with the Vector ultrasonic scaler on human teeth in vitro and in vivo compared to conventional ultrasonic instruments and/or hand instrumentation. The assessed effects are calculus removal, time of instrumentation, root surface aspects, cell attachment, patients' perception, bleeding upon probing, pocket depth, clinical attachment loss and microbiological effects.

MATERIALS AND METHODS

MEDLINE-PubMed and the Cochrane Central register of controlled trials (CENTRAL) were searched up through January 2008 to identify appropriate studies.

RESULTS

Independent screening of the titles and abstracts of 270 MEDLINE-PubMed and 15 Cochrane papers resulted in 15 suitable publications. The studies differed in design and outcome, so this review summarizes the outcomes in a descriptive manner. Comparisons are presented against conventional ultrasonic system and scaling and root planing.

CONCLUSION

The Vector ultrasonic scaler provided comparable clinical and microbiological periodontal healing results as scaling and root planing and conventional ultrasonic system in moderately deep pockets. The Vector ultrasonic scaler may be used as a gentle root debridement device for supportive periodontal therapy, as an alternative to other conventional ultrasonic system. The operator should however consider the extra time needed for instrumentation.

Clinical effects after subgingival polishing with a non-aggressive ultrasonic device in initial therapy

OBJECTIVES

The Vector ultrasonic system provides root debridement supported by different abrasive irrigation fluids. The aim of this study was to investigate the clinical outcome of initial therapy with subgingival low-abrasive debridement.

MATERIAL AND METHODS

Twenty patients, who had at least two teeth with pocket depths >5 mm in each quadrant, took part in this prospective randomized clinical study. Patients were treated in a split-mouth design as one test quadrant (1) subgingivally with Vector fluid polish (VU-H) and as three control quadrants, (2) with only supragingival polishing (PO-H), (3) with hand instruments (HI-H) performed by a hygienist and (4) with hand instruments (HI-D) performed by a dentist. At baseline, 3 and 6 months after treatment, pocket depths and attachment levels (ALs) were measured and bleeding on probing (BOP) was recorded.

RESULTS

At 6-month evaluation, all groups showed an improvement in clinical parameters. No statistically significant differences in any of the investigated parameters could be observed between the Vector group and the hand scaling groups, or when comparing the results of the two different operators.

CONCLUSION

This study demonstrates that Vector treatment with polishing fluid was able to reduce pocket depths and the prevalence of BOP and improve clinical AL in a similar way as scaling with curettes.

In Vitro, Clinical, and Microbiological Evaluation of a Linear Oscillating Device for Scaling and Root Planing

BACKGROUND

The purpose of this study was to conduct an in vitro and short-term clinical and microbiological evaluation of a linear oscillating device for scaling and root planing (SRP). A comparison was made between conventional ultrasonic scaling (US) and hand scaling (HS) with and without chlorhexidine.

METHODS

In vitro, SRP was carried out on human teeth with calculus. Roots and cross-sections thereof were microscopically examined for the efficacy of calculus removal, hard tissue loss, and surface smoothness. In vivo, 11 patients with chronic periodontitis and single-rooted teeth in all quadrants with probing depths of > or =5 mm were selected. One quadrant was treated with linear oscillation and compared to US with chlorhexidine irrigation in the contralateral site. The other arch was treated with HS and compared to HS followed by laser disinfection. One hundred twenty teeth were assessed for clinical attachment level, probing depth, bleeding on probing, and suppuration at baseline and 7, 28, 90, and 180 days. Microbiologically, total numbers of bacteria and six specific periodontal pathogens were determined by quantitative polymerase chain reaction prior to and 1 and 28 days after SRP. Clinical and microbiological data were analyzed statistically with respect to the SRP method, patient specificity, and time effect.

RESULTS

In vitro, linear oscillation preserved more root tissues but left more calculus (P <0.05). Significant improvements of all clinical and microbiological parameters were observed for all groups. However, 21 out of 24 tests demonstrated that the clinical microbiological correlations between linear oscillation and control groups did not differ (P <0.05).

CONCLUSION

Linear oscillation scaling was clinically acceptable and microbiologically comparable to the control groups despite microscopic remnants of calculus observed in vitro.

Tooth substance loss resulting from mechanical, sonic and ultrasonic root instrumentation assessed by liquid scintillation

AIMS

This study investigated the loss of tooth substance (microg) by means of liquid scintillation in combination with profilometric and SEM analyses in order to evaluate the roughness and morphological changes of the root surface before and after instrumentation.

METHOD

40 polished and irradiated bovine root surfaces were scaled in vitro while covered with 50 ml distilled water using a sonic prototype (Periosonic 1/2), a magnetostrictive ultrasonic (Cavitron with Slimline inserts) scaler and a hand curette. Pressures were applied for the Periosonic, Cavitron and hand curette at 500, 500 and 30 g respectively, for 30-s intervals, up to 120 s. Loss of apatite (microg) was determined from the decays/min (32P) of the water samples using the radiochemical method of liquid scintillation. Replicas were made of the specimens for SEM and profilometric analyses.

RESULTS

The least substance loss was noted significantly (p<0.01) at all time intervals after Slimline, followed by the fine sonic prototype Periosonic 2, then the Periosonic 1 and finally the hand curette. In contrast, profilometric and SEM analyses revealed the smoothest root surfaces after the hand curette, whereas Cavitron produced a less smooth surface.

CONCLUSION

It can be concluded that this method can reveal very precisely small quantities of substance lost and, in combination with SEM analysis and microroughness measurements, be of considerable value in evaluating the aggressiveness and efficacy of periodontal instruments.

Subgingival polishing compared to scaling with steel curettes: a clinical pilot study

BACKGROUND

Recently, we have developed teflon-coated sonic scaler inserts which remove plaque without removing tooth substance; they polish subgingivally. In a preclinical test, we showed that these modified inserts remove plaque nearly as effectively as do conventional sonic scaler inserts. The present investigation was intended as a proof-of-principle of subgingival polishing. The aim was to study the effect of subgingival polishing on the resolution of gingival inflammation in comparison to conventional scaling.

MATERIAL AND METHODS

In 10 patients with moderate to advanced periodontal disease, who had at least 2 single-rooted teeth with a probing depth of >6 mm in each quadrant, all single-rooted teeth were subjected to one treatment regimen consisting of 2 instrumentation episodes (1st/2nd treatment): curette/curette, curette/teflon-coated sonic scaler, teflon-coated sonic scaler/teflon-coated sonic scaler, and an untreated control. The second treatment session was performed 3 months after the first instrumentation, and the final registration 3 months after the second instrumentation. Clinical measurements included probing depth, change of clinical attachment level, bleeding upon probing, and plaque scores.

RESULTS

Probing depth, attachment level, and bleeding scores were reduced in the 3 instrumentation groups versus the control group in the 1st period; in the 2nd period, no further change occurred. Subgingival polishing with teflon-coated sonic scaler inserts was slightly less effective than conventional scaling.

CONCLUSION

Subgingival polishing with teflon-coated sonic scaler inserts seems to be nearly as effective as conventional scaling. Thus, it may be the instrumentation of choice for maintenance treatment of residual pockets.

Instrumentation of furcation with modified sonic scaler inserts: a study on manikins (II)

We developed a sonic scaler tip with an ellipsoid diamond-coated bud and contra-angulated shafts to overcome problems resulting from furcation anatomy. In this study, extracted molars were instrumented in a dummy model without any replicated soft tissues using 3 different instrumentation methods (i) curettes, (ii) diamond-coated sonic scaler tips with normal handle and (iii) diamond-coated sonic scaler tips in 2 handles with varying power levels. 15 extracted upper and lower molars were instrumented using each of the 3 instrumentation types. Following debridement, loss of substance and % of furcation area instrumented were assessed. In both upper and lower molars, significantly more surface area was instrumented in one instrumentation run with diamond-coated tips than with curettes. Substance loss was greater with diamond-coated tips than with hand instruments. In conclusion, an effective debridement of the furcation roof seems only possible with odontoplasty. Clinical evaluation of this approach to root debridement is needed.

Instrumentation of furcation with modified sonic scaler inserts: study on manikins, part I

The purpose of this study was to determine the suitability of different scaling instruments for the debridement of furcations. 12 upper and 12 lower replicated molars with through-and-through furcations were instrumented 3x with 5 different types of instruments: (i) hand instruments; (ii) hand instruments in conjunction with diamond burrs; (iii) a conventional ultrasonic scaler insert; (iv) a conventional sonic scaler insert; (v) a set of 2 modified diamond coated sonic scaler inserts with different angulated shafts. The plastic replicas were fixed in a manikin head without replicated soft tissues. Following debridement, weight loss and % of instrumented furcation area were assessed. In the case of lower molars, it made little difference whether they were treated with hand instruments, hand instruments combined with diamond burrs, or diamond-coated sonic scaler inserts. On upper molars, however, significantly more area was instrumented with the diamond-coated inserts than with the other instruments. Substance removal was greater with diamond-coated inserts than with the other devices. In conclusion, an effective debridement of the furcation seems possible only with an odontoplasty, in which a furcation is fitted to the instrument by means of intensive instrumentation, thus leading to substance loss. To improve results with these instruments, further research is necessary.