Use of the Vectortm scaling unit in supportive periodontal therapy: a subjective patient evaluation

Clinical efficacy and pain control of diode laser-assisted flap surgery in the treatment of chronic periodontitis:A systematic review and meta-analysis

Objective

To assess the diode laser-assisted periodontal flap surgery's clinical effectiveness and postoperative pain management in treating chronic periodontitis, and to offer evidence-based medical justification for the procedure's clinical use.

Data sources and study selection

In this study, a computer combined with manual search was used to search for articles on diode laser-assisted periodontal flap surgery for the treatment of chronic periodontitis published from the establishment of the database to September 2023. The databases searched included China Academic Journal Full Text Database (CNKI), China Biomedical Literature Database (CBM), Chinese Science and Technology Journal Database (VIP), Wanfang Database, PubMed, Web of science, Cochrane Library, Embase, and Scopus. Two researchers independently performed the screening and study selection, following the inclusion and exclusion standards to extract basic information and required data. Meta-analysis of the included literature was performed using Revman V5.4 software.

Result

Thirteen articles were analyzed. Meta-analysis showed that the use of the diode laser was effective in reducing patients' probing pocket depth (PPD) at 3 and 6 months postoperatively (3 months: MD = -0.46, 95 % CI = [-0.89, -0.03], P = 0.04; 6 months: MD = -0.35, 95 % CI = [-0.63, -0.06], P = 0.02), was able to effectively improve 3 month clinical attachment level (CAL) (MD = -0.36, 95 % CI = [-0.66, -0.06], P = 0.02), and was able to promote wound healing and reduce patients' early postoperative pain (MD = 0.67, 95 % CI = [0.01, 1.32], P = 0.05; MD = -1.67, 95 % CI = [-2.23, -1.00], and P < 0. 001), while for gingival index (GI), the use of diode laser did not have a significant effect.

Conclusions

The available evidence suggests that the use of a diode laser adjunct is effective in reducing PPD, improving CAL, promoting wound healing, and reducing early postoperative pain in patients compared with flap application alone; however, for GI, diode lasers did not show any improvements.

Clinical significance

Periodontal flap surgery fails to eliminate microorganisms from the soft tissue wall, potentially leading to recolonization, reinfection, and accompanying side effects such as pain and swelling. The use of a diode laser reduces PPD, improves CAL, and relieves early postoperative pain.

[Ultrasound subgingival scaling combined with manual root planing for treatment of chronic periodontitis in elderly patients]

OBJECTIVE

To evaluate the clinical efficacy of ultrasound subgingival scaling combined with manual root planing for treatment of chronic periodontitis in elderly patients.

METHODS

Forty elderly patients with chronic periodontitis were randomly divided into test group for treatment with ultrasound and Gracey subgingival curette for subgingival scaling combined with manual root planing and control group treated with ultrasound subgingival curette scaling (n=20). We compared plaque index (PLI), bleeding index (BI), probing depth (PD), and attachment loss (AL) between the two groups before and at 6 weeks and 12 weeks after the treatment.

RESULTS

After periodontal treatment, PLI, BI, PD and AL all decreased significantly in both groups compared with the levels before the treatment (P < 0.05). The patients in the test group showed significantly more obvious decrease of PD and AL than those in the control group (P < 0.05), but the reduction of PLI and BI was comparable between the two groups (P>0.05).

CONCLUSIONS

Ultrasound subgingival scaling combined with manual root planing produces better therapeutic effect than ultrasonic subgingival scaling alone for treatment of chronic periodontitis in elderly patients.

Routine scale and polish for periodontal health in adults

BACKGROUND

Many dentists or hygienists provide scaling and polishing for patients at regular intervals, even for those at low risk of developing periodontal disease. There is debate over the clinical and cost effectiveness of 'routine scaling and polishing' and the optimal frequency at which it should be provided for healthy adults.A 'routine scale and polish' treatment is defined as scaling or polishing, or both, of the crown and root surfaces of teeth to remove local irritational factors (plaque, calculus, debris and staining), which does not involve periodontal surgery or any form of adjunctive periodontal therapy such as the use of chemotherapeutic agents or root planing. Routine scale and polish treatments are typically provided in general dental practice settings. The technique may also be referred to as prophylaxis, professional mechanical plaque removal or periodontal instrumentation.This review updates a version published in 2013.

OBJECTIVES

1. To determine the beneficial and harmful effects of routine scaling and polishing for periodontal health.2. To determine the beneficial and harmful effects of routine scaling and polishing at different recall intervals for periodontal health.3. To determine the beneficial and harmful effects of routine scaling and polishing for periodontal health when the treatment is provided by dentists compared with dental care professionals (dental therapists or dental hygienists).

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 10 January 2018), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 12), MEDLINE Ovid (1946 to 10 January 2018), and Embase Ovid (1980 to 10 January 2018). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

Randomised controlled trials of routine scale and polish treatments, with or without oral hygiene instruction, in healthy dentate adults without severe periodontitis. We excluded split-mouth trials.

DATA COLLECTION AND ANALYSIS

Two review authors screened the results of the searches against inclusion criteria, extracted data and assessed risk of bias independently and in duplicate. We calculated mean differences (MDs) (or standardised mean differences (SMDs) when different scales were reported) and 95% confidence intervals (CIs) for continuous data. We calculated risk ratios (RR) and 95% CIs for dichotomous data. We used a fixed-effect model for meta-analyses. We contacted study authors when necessary to obtain missing information. We rated the certainty of the evidence using the GRADE approach.

MAIN RESULTS

We included two studies with 1711 participants in the analyses. Both studies were conducted in UK general dental practices and involved adults without severe periodontitis who were regular attenders at dental appointments. One study measured outcomes at 24 months and the other at 36 months. Neither study measured adverse effects, changes in attachment level, tooth loss or halitosis.Comparison 1: routine scaling and polishing versus no scheduled scaling and polishingTwo studies compared planned, regular interval (six- and 12-monthly) scale and polish treatments versus no scheduled treatment. We found little or no difference between groups over a two- to three-year period for gingivitis, probing depths, oral health-related quality of life (all high-certainty evidence) and plaque (low-certainty evidence). The SMD for gingivitis when comparing six-monthly scale and polish treatment versus no scheduled treatment was -0.01 (95% CI -0.13 to 0.11; two trials, 1087 participants), and for 12-monthly scale and polish versus no scheduled treatment was -0.04 (95% CI -0.16 to 0.08; two trials, 1091 participants).Regular planned scale and polish treatments produced a small reduction in calculus levels over two to three years when compared with no scheduled scale and polish treatments (high-certainty evidence). The SMD for six-monthly scale and polish versus no scheduled treatment was -0.32 (95% CI -0.44 to -0.20; two trials, 1088 participants) and for 12-monthly scale and polish versus no scheduled treatment was -0.19 (95% CI -0.31 to -0.07; two trials, 1088 participants). The clinical importance of these small reductions is unclear.Participants' self-reported levels of oral cleanliness were higher when receiving six- and 12-monthly scale and polish treatments compared to no scheduled treatment, but the certainty of the evidence is low.Comparison 2: routine scaling and polishing at different recall intervalsTwo studies compared routine six-monthly scale and polish treatments versus 12-monthly treatments. We found little or no difference between groups over two to three years for the outcomes of gingivitis, probing depths, oral health-related quality of life (all high-certainty evidence) and plaque (low-certainty evidence). The SMD for gingivitis was 0.03 (95% CI -0.09 to 0.15; two trials, 1090 participants; I² = 0%). Six- monthly scale and polish treatments produced a small reduction in calculus levels over a two- to three-year period when compared with 12-monthly treatments (SMD -0.13 (95% CI -0.25 to -0.01; 2 trials, 1086 participants; high-certainty evidence). The clinical importance of this small reduction is unclear.The comparative effects of six- and 12-monthly scale and polish treatments on patients' self-reported levels of oral cleanliness were uncertain (very low-certainty evidence).Comparison 3: routine scaling and polishing provided by dentists compared with dental care professionals (dental therapists or hygienists)No studies evaluated this comparison.The review findings in relation to costs were uncertain (very low-certainty evidence).

AUTHORS' CONCLUSIONS

For adults without severe periodontitis who regularly access routine dental care, routine scale and polish treatment makes little or no difference to gingivitis, probing depths and oral health-related quality of life over two to three years follow-up when compared with no scheduled scale and polish treatments (high-certainty evidence). There may also be little or no difference in plaque levels over two years (low-certainty evidence). Routine scaling and polishing reduces calculus levels compared with no routine scaling and polishing, with six-monthly treatments reducing calculus more than 12-monthly treatments over two to three years follow-up (high-certainty evidence), although the clinical importance of these small reductions is uncertain. Available evidence on the costs of the treatments is uncertain. The studies did not assess adverse effects.

Relief of Injection Pain During Delivery of Local Anesthesia by Computer-Controlled Anesthetic Delivery System for Periodontal Surgery: Randomized Clinical Controlled Trial

BACKGROUND

Pain from local anesthetic injection makes patients anxious when visiting a dental clinic. This study aims to determine differences in pain according to types of local anesthetizing methods and to identify the possible contributing factors (e.g., dental anxiety, stress, and sex).

METHODS

Thirty-one patients who underwent open-flap debridement in maxillary premolar and molar areas during treatment for chronic periodontitis were evaluated for this study. A randomized, split-mouth, single-masked clinical trial was implemented. The dental anxiety scale (DAS) and perceived stress scale (PSS) were administered before surgery. Two lidocaine ampules for each patient were used for local infiltration anesthesia (supraperiosteal injection). Injection pain was measured immediately after local infiltration anesthesia using the visual analog pain scale (VAS) questionnaire. Results from the questionnaire were used to assess degree of pain patients feel when a conventional local anesthetic technique (CNV) is used compared with a computer-controlled anesthetic delivery system (CNR).

RESULTS

DAS and PSS did not correlate to injection pain. VAS scores were lower for CNR than for CNV regardless of the order in which anesthetic procedures were applied. VAS score did not differ significantly with sex. Pearson coefficient for correlation between VAS scores for the two procedures was 0.80, also indicating a strong correlation.

CONCLUSION

Within the limitations of the present study, relief from injection pain is observed using CNR.

Removal of simulated biofilm: a preclinical ergonomic comparison of instruments and operators

BACKGROUND

Periodontal scaling might cause musculoskeletal disorders, and scaling instruments might not only have different effectiveness and efficiency but also differ in their ergonomic properties. The present study assessed ergonomic working patterns of experienced (EO) and less experienced operators (LO) when using hand and powered devices for periodontal scaling and root planning.

METHODS

In an experimental study using periodontally affected manikins, sonic (AIR), ultrasonic (TIG) and hand instruments (GRA) were used by 11 operators (7 EO/4 LO) during simulated supportive periodontal therapy. Using an electronic motion monitoring system, we objectively assessed the working frequency and positioning of hand, neck and head. Operators' subjective evaluation of the instruments was recorded using a questionnaire.

RESULTS

Hand instruments were used with the lowest frequency (2.57 ± 1.08 s(-1)) but greatest wrist deviation (59.57 ± 53.94°). EO used instruments more specifically than LO, and generally worked more ergonomically, with less inclination of head and neck in both the frontal and sagittal planes, especially when using hand instruments. All groups found hand instruments more tiring and difficult to use than powered instruments.

CONCLUSION

Regardless of operators' experience, powered instruments were used more ergonomically and were subjectively preferred compared to hand instruments.

CLINICAL RELEVANCE

The use of hand instruments has potential ergonomic disadvantages. However, with increasing experience, operators are able to recognise and mitigate possible risks.

Routine scale and polish for periodontal health in adults

BACKGROUND

Many dentists or hygienists provide scaling and polishing for patients at regular intervals, even if those patients are considered to be at low risk of developing periodontal disease. There is debate over the clinical effectiveness and cost effectiveness of 'routine scaling and polishing' and the 'optimal' frequency at which it should be provided for healthy adults.A 'routine scale and polish' treatment is defined as scaling or polishing or both of the crown and root surfaces of teeth to remove local irritational factors (plaque, calculus, debris and staining), that does not involve periodontal surgery or any form of adjunctive periodontal therapy such as the use of chemotherapeutic agents or root planing.

OBJECTIVES

The objectives were: 1) to determine the beneficial and harmful effects of routine scaling and polishing for periodontal health; 2) to determine the beneficial and harmful effects of providing routine scaling and polishing at different time intervals on periodontal health; 3) to compare the effects of routine scaling and polishing with or without oral hygiene instruction (OHI) on periodontal health; and 4) to compare the effects of routine scaling and polishing provided by a dentist or dental care professional (dental therapist or dental hygienist) on periodontal health.

SEARCH METHODS

We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 15 July 2013), CENTRAL (The Cochrane Library 2013, Issue 6), MEDLINE via OVID (1946 to 15 July 2013) and EMBASE via OVID (1980 to 15 July 2013). We searched the metaRegister of Controlled Trials and the US National Institutes of Health Clinical Trials Register (clinicaltrials.gov) for ongoing and completed studies to July 2013. There were no restrictions regarding language or date of publication.

SELECTION CRITERIA

Randomised controlled trials of routine scale and polish treatments (excluding split-mouth trials) with and without OHI in healthy dentate adults, without severe periodontitis.

DATA COLLECTION AND ANALYSIS

Two review authors screened the results of the searches against inclusion criteria, extracted data and assessed risk of bias independently and in duplicate. We calculated mean differences (MDs) (standardised mean differences (SMDs) when different scales were reported) and 95% confidence intervals (CIs) for continuous data and, where results were meta-analysed, we used a fixed-effect model as there were fewer than four studies. Study authors were contacted where possible and where deemed necessary for missing information.

MAIN RESULTS

Three studies were included in this review with 836 participants included in the analyses. All three studies are assessed as at unclear risk of bias. The numerical results are only presented here for the primary outcome gingivitis. There were no useable data presented in the studies for the outcomes of attachment change and tooth loss. No studies reported any adverse effects.- Objective 1: Scale and polish versus no scale and polish Only one trial provided data for the comparison between scale and polish versus no scale and polish. This study was conducted in general practice and compared both six-monthly and 12-monthly scale and polish treatments with no treatment. This study showed no evidence to claim or refute benefit for scale and polish treatments for the outcomes of gingivitis, calculus and plaque. The MD for six-monthly scale and polish, for the percentage of index teeth with bleeding at 24 months was -2% (95% CI -10% to 6%; P value = 0.65), with 40% of the sites in the control group with bleeding. The MD for 12-monthly scale and polish was -1% (95% CI -9% to 7%; P value = 0.82). The body of evidence was assessed as of low quality.- Objective 2: Scale and polish at different time intervals Two studies, both at unclear risk of bias, compared routine scale and polish provided at different time intervals. When comparing six with 12 months there was insufficient evidence to determine a difference for gingivitis at 24 months SMD -0.08 (95% CI -0.27 to 0.10). There were some statistically significant differences in favour of scaling and polishing provided at more frequent intervals, in particular between three and 12 months for the outcome of gingivitis at 24 months, with OHI, MD -0.14 (95% CI -0.23 to -0.05; P value = 0.003) and without OHI MD -0.21 (95% CI -0.30 to -0.12; P value < 0.001) (mean per patient measured on 0-3 scale), based on one study. There was some evidence of a reduction in calculus. This body of evidence was assessed as of low quality.- Objective 3: Scale and polish with and without OHIOne study provided data for the comparison of scale and polish treatment with and without OHI. There was a reduction in gingivitis for the 12-month scale and polish treatment when assessed at 24 months MD -0.14 (95% CI -0.22 to -0.06) in favour of including OHI. There were also significant reductions in plaque for both three and 12-month scale and polish treatments when OHI was included. The body of evidence was once again assessed as of low quality.- Objective 4: Scale and polish provided by a dentist compared with a dental care professionalNo studies were found which compared the effects of routine scaling and polishing provided by a dentist or dental care professional (dental therapist or dental hygienist) on periodontal health.

AUTHORS' CONCLUSIONS

There is insufficient evidence to determine the effects of routine scale and polish treatments. High quality trials conducted in general dental practice settings with sufficiently long follow-up periods (five years or more) are required to address the objectives of this review.

Subjective intensity of pain during supportive periodontal treatment using a sonic scaler or an Er:YAG laser

OBJECTIVE

To assess the subjective intensities of pain during supportive periodontal treatment using a sonic scaler or an Er:YAG laser.

MATERIAL AND METHODS

Forty patients with two residual periodontal pockets following conventional periodontal therapy were treated using a sonic scaler and an Er:YAG laser in a split-mouth design. A visual analogue scale was used for pain assessment directly after each treatment procedure. Additionally, pain was recorded during the treatment of 11 patients at intervals of 0.5 s using an inter-modal intensity comparison.

RESULTS

Pain assessment during treatment showed that laser treatment (median pain score: 0.71 U, maximum: 9.94 U, minimum: 0 U) caused less pain than the sonic device (median pain score: 2.17 U, maximum: 11.26 U, minimum: 0 U) (p<0.05) with no difference in the treatment time (p>0.05). These results could be confirmed by the visual analogue scale: pain scores assessed after laser treatment (median: 1 U, maximum: 7 U, minimum: 0 U) were lower than those after sonic instrumentation (median: 3.5 U, maximum: 7.5 U, minimum: 0 U) (p<0.05).

CONCLUSIONS

Using an Er:YAG laser during supportive periodontal treatment, painful sensations can be reduced compared with sonic scaler instrumentation.

The evaluation of the vector system in removal of carious tissue

The aim of this study was to evaluate the Vector system in comparison to the conventional technique in cavity preparation. Four extracted primary teeth with no restorations and similar fissure carious lesions and four permanent teeth extracted for orthodontic reasons were used. Class I preparations were made provided that the caries depth remained within the dentin limits. Two teeth were treated with an aerator, the other two had carious tissue removed with the Vector system. Prepared cavities were evaluated with scanning electron microscopy for the surface roughness of the dentine and enamel and for the carious tissue removal efficiency. This pilot study determined that it is possible to remove carious tissue and perform cavity preparation with the Vector system. According to this preliminary evaluation of surface quality, a cavity prepared with the Vector treatment system, allows for a slicker floor, and a more regular enamel-dentine line than that prepared with an aerator. However, the Vector system requires a longer treatment time which we believe may be a negative point, especially for young patients.

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.

Microbiological findings after periodontal therapy using curettes, Er:YAG laser, sonic, and ultrasonic scalers

AIM

To evaluate and compare the microbiological effects of hand instruments, Er:YAG-laser, sonic, and ultrasonic scalers in patients with chronic periodontitis. Patient perception of each treatment was documented.

MATERIAL AND METHODS

From 72 patients, bacterial samples were collected from the deepest pocket in each quadrant (total: 288 sites). A polymerase chain reaction kit estimated the amount of Aggregatibacter (Actinobacillus) actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Tannerella forsythensis (Tf), and Treponema denticola (Td) at baseline as well as 3 and 6 months after therapy. One quadrant in each patient was randomly assigned to curettes (H-group), Er:YAG laser (L-group), sonic device (S-group), or ultrasonic device (U-group).

RESULTS

Three months post-operatively, the amounts of Pg, Pi, Tf, and Td were significantly reduced in all groups. Laser and sonic instrumentation failed to reduce Aa. Six months after therapy, significant differences were still detected for Pg (L- and U-group), for Pi and Tf (S-group), and for Td (L-, S- and U-group). Patients rated ultrasonic treatment as more preferable than hand and laser instrumentation.

CONCLUSION

The various treatment methods resulted in a comparable reduction of the evaluated periodontal pathogens, and bacterial increase was only partially different 6 months post-operatively. Ultrasonic instrumentation caused less discomfort.

Subjective intensity of pain during ultrasonic supragingival calculus removal

OBJECTIVE

To assess subjective intensities of pain during supragingival calculus removal employing ultrasonic scaler tips of two different shapes.

MATERIAL AND METHODS

Twenty patients were treated using a piezoelectric ultrasonic device (Sirosonic L) and two different scaler tips representing a conventional (Instrument No. 3) and a slim-line style (Perio Pro Line Instrument SI-11) in a split-mouth design. Pain was recorded during calculus removal at intervals of 0.5 s employing an inter-modal intensity comparison. Additionally, a visual analogue scale was used for evaluation directly after the treatment procedure. Treatment time was recorded to assess the efficiency of calculus removal.

RESULTS

Pain assessment during treatment showed that the slim-line scaler tip (median pain score: 1.4 [U], maximum: 3.5 [U], minimum: 0 [U]) caused less pain than the conventional device (median pain score: 7.8 [U], maximum: 14.7 [U], minimum: 0 [U]) (p<0.05). These results could be confirmed by the visual analogue scale. Treatment with the slim-line tip took significantly longer than treatment with the conventional tip (p<0.05).

CONCLUSIONS

Using slim-line-styled ultrasonic scaler tips for supragingival calculus removal, painful sensations can be reduced compared with conventional ultrasonic devices. Thus, it might be possible to increase the patient's compliance during dental treatment with oscillating instruments.

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.

Periodontal healing after non-surgical therapy with a new ultrasonic device: a randomized controlled clinical trial

AIM

The aim of this study was to compare the clinical and microbiological healing outcomes following non-surgical periodontal therapy using the new Vector ultrasonic system versus scaling and root planing (S/RP) with Gracey curettes.

MATERIAL AND METHODS

The study comprised 20 chronic periodontitis patients. Using a split-mouth design, both treatment modalities were randomly applied to one quadrant of the upper and the lower jaws each. Clinical and microbiological parameters were assessed at baseline, 4 weeks, and 6 months after treatment. Furthermore, post-operative hypersensitivity was assessed. The Wilcoxon signed rank test (alpha=0.05) was used for statistical analysis.

RESULTS

Both therapies provided statistically significant clinical and microbiological improvements of periodontal conditions after 4 weeks and 6 months. Hypersensitive teeth were found only 4 weeks after S/RP. Besides a significantly better bleeding on probing reduction in deep S/RP sites, no other clinical and microbiological parameters revealed significant differences between the sites treated with the Vector system or S/RP.

CONCLUSION

Both the Vector system and S/RP provided favourable periodontal healing results, although in deep pockets S/RP appeared to achieve a better resolution of inflammation.

Sonic and ultrasonic scalers in periodontal treatment: a review

Periodontal therapy aims at arresting periodontal infection and maintaining a healthy periodontium. The periodic mechanical removal of subgingival microbial biofilms is essential for controlling inflammatory periodontal disease. Mechanical periodontal therapy consists of scaling, root planing and gingival curettage. The sonic and ultrasonic scalers are valuable tools in the prevention of periodontal disease. The vibration of scaler tips is the main effect to remove the deposits from the dental surface, such as bacterial plaque, calculus and endotoxin. However, constant flushing activity of the lavage used to cool the tips and cavitational activity result in disruption of the weak and unattached subgingival plaque. The aim of the study was to review the safety, efficacy, role and deleterious side-effects of sonic and ultrasonic scalers in mechanical periodontal therapy.

Efficiency of the VectorTM-system compared with conventional subgingival debridement in vitro and in vivo

OBJECTIVE

To assess the efficacy of the novel ultrasonic Vector -system system for subgingival debridement and to compare the results with conventional periodontal instrumentation in vitro and in vivo.

MATERIAL AND METHODS

Forty extracted human teeth were treated in vitro: Vector -system with polishing (VP) and abrasive fluid (VA), conventional ultrasonic system (U) and hand instrument (H). At intervals of 40 s, calculus removal was assessed using a 3D laser scanning device. Eight single-rooted teeth were treated in vivo with the Vector -system or hand instruments. Subgingival plaque samples were obtained for microbiological evaluation. After extraction, residual calculus was assessed by means of digitized planimetry.

RESULTS

In vitro efficiency of hand instruments was statistically higher compared with the conventional ultrasonic system (p < 0.05) and the Vector -system with no difference between U and VA (p > 0.05) and VA and VP (p > 0.05). Residual calculus following in vivo instrumentation was not different in the Vector and the hand instrument group (p > 0.05) but treatment time with the Vector -system was statistically higher (p < 0.05). A similar reduction of periopathogenic bacteria could be observed in both groups.

CONCLUSION

Using the Vector -system, root surfaces can be debrided as thoroughly as with conventional instruments. However, treatment is more time consuming than conventional debridement.

Ibuprofen arginine for pain control during scaling and root planing: a randomized, triple-blind trial

OBJECTIVES

The aim of this controlled clinical trial was to investigate the analgesic efficacy and tolerability of ibuprofen arginine in patients with mild-to-moderate periodontitis during and after non-surgical periodontal treatment.

METHODS

This randomized, triple-blind, placebo-controlled, parallel-group trial assessed the analgesic efficacy of ibuprofen arginine (Spedifen) in patients undergoing routine periodontal scaling and root planing. 64 patients with chronic periodontitis received either 800 mg ibuprofen arginine or placebo 30 min. before treatment. Numeric pain and electronic visual analogue scales ranging from 0 to 100 were used.

RESULTS

The average pain levels during treatment were lower following ibuprofen arginine (quartiles: 0.5, 4.5, 11) compared with placebo (4, 16, 26), corresponding to a percentage reduction in median pain of 72% (p=0.023). The median maximum pain was 28 (inter-quartile range 10-50) following placebo and 10 (4-31) following ibuprofen arginine (p=0.065).

CONCLUSIONS

In patients with mild-to-moderate chronic periodontitis, ibuprofen arginine was safe and superior to placebo for alleviating pain during non-surgical periodontal treatment. Its painless administration and rapid onset of action make it well suitable for pain management in a general dental office.

Influence of fluorescence-controlled Er:YAG laser radiation, the Vectortm system and hand instruments on periodontally diseased root surfaces in vivo

OBJECTIVES

The aim of the present study was to evaluate the effects of fluorescence-controlled Er:YAG laser radiation, an ultrasonic device or hand instruments on periodontally diseased root surfaces in vivo.

MATERIAL AND METHODS

Seventy-two single-rooted teeth (n=12 patients) were randomly treated in vivo by a single course of subgingival instrumentation using (1-3) an Er:YAG laser (ERL1: 100 mJ; ERL2: 120 mJ; ERL3: 140 mJ; 10 Hz), or (4) the Vector ultrasonic system (VUS) or (5) hand instruments (SRP). Untreated teeth served as control (UC). Areas of residual subgingival calculus (RSC) and depth of root surface alterations were assessed histo-/morphometrically.

RESULTS

Highest values of RSC areas (%) were observed in the SRP group (12.5+/-6.9). ERL(1-3) (7.8+/-5.8, 8.6+/-4.5, 6.2+/-3.9, respectively) revealed significantly lower RSC areas than SRP. VUS (2.4+/-1.8) exhibited significantly lower RSC areas than SRP and ERL(1, 2). Specimens treated with SRP revealed conspicuous root surface damage, while specimens treated with ERL(1-3) and VUS exhibited a homogeneous and smooth appearance.

CONCLUSION

Within the limits of the present study, it may be concluded that ERL and VUS enabled (i) a more effective removal of subgingival calculus and (ii) a predictable root surface preservation in comparison with SRP.