The effectiveness of scaling and root planing with curets designed for deep pockets

Clinical Benefits of Minimally Invasive Non-Surgical Periodontal Therapy as an Alternative of Conventional Non-Surgical Periodontal Therapy-A Pilot Study

Minimally invasive procedures were introduced in periodontics, which could enhance clinical outcomes and reduce post-operative discomfort. However, minimally invasive non-surgical periodontal therapy (MINST) as an alternative modality of conventional non-surgical root surface debridement has not been clearly evaluated by randomized controlled clinical trial. The present study aimed to investigate clinical outcomes and patients’ comfort feedback of MINST compared to conventional non-surgical periodontal therapy (CNST). Patients with moderate to severe periodontitis were included. Nine out of ten patients were recruited and completed the post-treatment re-evaluation in this study. Randomized split-mouth design, CNST and MINST on each side, was performed. Clinical parameters, including periodontal probing depth (PD), gingival recession (REC), clinical attachment level (CAL), and gingival bleeding on probing (BOP), were recorded on baseline, 1 month and 3 months post-treatment. Non-parametric statistics were used for analysis. PD, REC, CAL, and BOP were improved after treatment in both CNST and MINST groups. Comfort feedback and gingival recession showed better outcomes in the MINST group than in the CNST group. No statistical significance of parameters was found between CNST and MINST. Within the limitations, minimally invasive non-surgical periodontal therapy could be an alternative modality of conventional non-surgical periodontal therapy. Further studies are required to establish clinical protocol and evidence of MINST.

Analysing root roughness and smear layer relationship by comparing contemporary dental curettes with conventional dental curettes: a randomised controlled trial

Background

Root debridement procedures for the treatment of periodontal diseases, produces root surface irregularities and smear layer on the root surface that can adversely affect the healing of periodontal tissues. The objective of the present study was to evaluate the surface texture of root after hand instrumentation with Gracey curette, After Five curette, and Mini Five curette.

Methods

A randomised, controlled clinical trial was conducted with 120 participants clinically diagnosed with chronic periodontitis. Participants were equally randomised into four groups, with parallel treatment assignment of scaling and root planning using Gracey Curettes, After five and Mini five curette, and a control group with no instrumentation. Mobile teeth of these patients were then extracted atraumatically and analysed under a Scanning Electron Microscope and graded for "Roughness and Loss of Tooth substance index" and "Smear layer index." Cross Tabulation was made between the test groups (Control, Gracey Curette, After five, and Mini Five) versus "Roughness and Loss of Tooth substance Index" and "Smear Layer Index." A Chi-square test with Bonferroni correction was used to determine the graded distribution among the groups.

Results

In the control group, 73.3% of the teeth showed grade 1 roughness. In the Gracey group, 56.7% showed grade 2 roughness; in the After 5 group, 70% showed grade 3 roughness; in the Mini 5 group, 76.7% showed grade 3 roughness. A significant association was found between roughness scores and the use of individual instruments. Regarding smear layer formation, 46.7% of teeth showed a grade 4 smear layer in the control group. 50% of teeth showed grade 2 smear layer thickness in the Gracey group. In the After 5 group, 73.3% of teeth showed a grade 1 smear layer, while in the Mini 5 group, 80.0% showed a grade 1 smear layer. The use of individual instruments was significantly associated with the smear layer scores.

Conclusion

Gracey curettes produced relatively smoother root surfaces with less smear layer formation than After Five and Mini Five curettes, which produced relatively more roughened root surfaces with thicker smear layer formation.

Trial registration

ID: ClinicalTrials.gov Identifier: NCT04216966 Date of Registration: January 3, 2020.

Analysis of the characteristics of periodontal curettes used for scaling the roof of the furcation by manual versus digital method

Abstract Introduction The treatment of periodontal disease in multiradicular teeth with furcation involvement is a challenge for dentists, with unpredictable results. Objective To evaluate the characteristics of the active tip of periodontal curettes used for scaling the furcation roof, comparing the manual versus digital method. Material and method Forty-two Pádua Lima (PL) curettes of the Millennium® brand (n = 6 for each model) were evaluated: PL 1-2, PL 3-4, PL 5-6, PLW 1-2, PLW 3-4, PLW 5 -6, and PLF. The following were measured: total length of the coronary face (CTc, millimeters, mm), total length of the lateral face (CTl, mm), width of the coronary face (Lc, mm), and width of the lateral face (Ll, mm). The measurements were performed in duplicate. Result The results showed that weight varied among the curettes (p <0.05), however the handle diameter was similar for all instruments (p> 0.05). Considering that seven different types of curettes were evaluated, the parameters of CTl and Ll showed a statistical difference for all evaluated curettes (7: 7 ratio), with higher values for the caliper method compared to the software (p <0.05). There was a statistically significant difference between assessment methods for CTc and Lc measurements (p <0.05), showing that there was a coincidence of values in the proportion of 4:7 for measurements of CTc and 5:7 for Lc. Conclusion The comparison between methods generally resulted in lower values and greater variation for the digital method, thus favoring the use of the manual method to measure the active tip of periodontal curettes.

Periodontal Regeneration - Intrabony Defects: Practical Applications From the AAP Regeneration Workshop

Focused Clinical Question: What are important considerations for selecting a predictable regenerative surgical approach for intrabony defects? Summary: The predictable regeneration of intrabony defects remains an important goal in the management of periodontitis. Clinical and histologic evidence of periodontal regeneration has been shown for multiple regenerative therapies, including bone replacement grafts, guided tissue regeneration, and biologics, when used alone or in combination. Regenerative therapies improve periodontal health, as evidenced by gains in clinical attachment level, reductions in probing depth, and gains in radiographic bone fill. Important patient-related factors (e.g., smoking) and defect/site-related factors (e.g., defect morphology and gingival biotype) can influence the potential to achieve periodontal regeneration. The regeneration of intrabony defects generally becomes more challenging with increasing loss of height, proximity, and number of bony walls. Therefore, combination therapies may be necessary to achieve predictable regeneration. Clinical improvements after regenerative therapy can be maintained over extended periods (≥10 years) with professional maintenance at appropriate intervals and adequate home care. Conclusions: Periodontal regeneration of intrabony defects is possible using a variety of regenerative strategies. Management should be coupled with an effective oral hygiene and supportive periodontal maintenance program for long-term success.

Citation classics in periodontology: a controlled study

AIM

The aims of this study were to identify the most cited articles in Periodontology published from January 1990 to March 2005; and to analyse the differences between citation Classics and less cited articles.

MATERIAL AND METHODS

The search was carried out in four international periodontal journals: Journal of Periodontology, Journal of Clinical Periodontology, International Journal of Periodontics and Restorative Dentistry and Journal of Periodontal Research. The Classics, that are articles cited at least 100 times, were identified using the Science Citation Index database. From every issue of the journals that contained a Classic, another article was randomly selected and used as a Control.

RESULTS

Fifty-five Classics and 55 Controls were identified. Classic articles were longer, used more images, had more authors, and contained more self-references than Controls. Moreover Classics had on the average a bigger sample size, often dealt with etiopathogenesis and prognosis, but were rarely controlled or randomized studies.

CONCLUSIONS

Classic articles play an instructive role, but are often non-Controlled studies.

The effects of a single course of a calculus-softening scaling and root planing gel. A scanning electron microscopic study

The effect of a calculus scaling gel was evaluated as an adjunct to instrumentation in a double blind, split-mouth, clinical study. Fifteen comparable periodontally involved teeth from 5 patients were instrumented on the mesio-buccal root surface with the aid of either the test gel, placebo gel, or no gel until smoothness was achieved. Test or placebo gel was applied subgingivally for 10 minutes. Instrumentation time, ease, number of strokes, and gingival/tooth surfaces changes were recorded. Scanning electronic microscopic (SEM) evaluation of root surface topography was evaluated. The results demonstrated effective calculus removal in all treatment groups with no differences found between them. Instrumentation time, ease, and number of strokes were similar for all treatment groups. There were no harmful effects to soft or hard tissues. The results of this study do not support the use of calculus scaling gel as an adjunct to root instrumentation.

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.

Dental calculus: recent insights into occurrence, formation, prevention, removal and oral health effects of supragingival and subgingival deposits

Dental calculus, both supra- and subgingival occurs in the majority of adults worldwide. Dental calculus is calcified dental plaque, composed primarily of calcium phosphate mineral salts deposited between and within remnants of formerly viable microorganisms. A viable dental plaque covers mineralized calculus deposits. Levels of calculus and location of formation are population specific and are affected by oral hygiene habits, access to professional care, diet, age, ethnic origin, time since last dental cleaning, systemic disease and the use of prescription medications. In populations that practice regular oral hygiene and with access to regular professional care, supragingival dental calculus formation is restricted to tooth surfaces adjacent to the salivary ducts. Levels of supragingival calculus in these populations is minor and the calculus has little if any impact on oral-health. Subgingival calculus formation in these populations occurs coincident with periodontal disease (although the calculus itself appears to have little impact on attachment loss), the latter being correlated with dental plaque. In populations that do not practice regular hygiene and that do not have access to professional care, supragingival calculus occurs throughout the dentition and the extent of calculus formation can be extreme. In these populations, supragingival calculus is associated with the promotion of gingival recession. Subgingival calculus, in "low hygiene" populations, is extensive and is directly correlated with enhanced periodontal attachment loss. Despite extensive research, a complete understanding of the etiologic significance of subgingival calculus to periodontal disease remains elusive, due to inability to clearly differentiate effects of calculus versus "plaque on calculus". As a result, we are not entirely sure whether subgingival calculus is the cause or result of periodontal inflammation. Research suggests that subgingival calculus, at a minimum, may expand the radius of plaque induced periodontal injury. Removal of subgingival plaque and calculus remains the cornerstone of periodontal therapy. Calculus formation is the result of petrification of dental plaque biofilm, with mineral ions provided by bathing saliva or crevicular fluids. Supragingival calculus formation can be controlled by chemical mineralization inhibitors, applied in toothpastes or mouthrinses. These agents act to delay plaque calcification, keeping deposits in an amorphous non-hardened state to facilitate removal with regular hygiene. Clinical efficacy for these agents is typically assessed as the reduction in tartar area coverage on the teeth between dental cleaning. Research shows that topically applied mineralization inhibitors can also influence adhesion and hardness of calculus deposits on the tooth surface, facilitating removal. Future research in calculus may include the development of improved supragingival tartar control formulations, the development of treatments for the prevention of subgingival calculus formation, the development of improved methods for root detoxification and debridement and the development and application of sensitive diagnostic methods to assess subgingival debridement efficacy.

Clinical evaluation of the speed and effectiveness of subgingival calculus removal on single-rooted teeth with diamond-coated ultrasonic tips

Several studies have found incomplete calculus removal during periodontal treatment with traditional hand curets, sonic, and ultrasonic instruments. This study evaluated the speed and effectiveness of subgingival calculus removal with new diamond-coated ultrasonic tips on single-rooted teeth. Single session subgingival scaling and root planing was performed on 80 teeth with 5 to 12 mm probing depths in 15 patients. Each patient provided groups of 4 teeth that were randomly treated with either hand curets (HAND); standard smooth ultrasonic tip (US); or fine grit (FINDIAM) or medium grit (MEDDIAM) diamond-coated ultrasonic tips. The time taken to reach the therapeutic endpoint of a clean, smooth root surface in a defined region on each tooth with each instrument by the 3 therapists with differing experience levels was recorded. The teeth were then atraumatically extracted, stored in a surfactant, photographed at 10X, and the percent of calculus present in the area of the pocket or on a comparable control surface calculated by histometric point counting. ANOVA and paired t tests showed that mean percent remaining calculus on treated versus control surfaces was HAND 4.6 +/- 5.3 versus 57.5 +/- 28.2, US 4.7 +/- 6.4 versus 54.4 +/- 25.9, FINDIAM 4.3 +/- 5.2 versus 37.5 +/- 22.1, and MEDDIAM 3.4 +/- 4.2 versus 50.7 +/- 20.1, respectively (all P < 0.01). The mean time in seconds to reach the clinical endpoint ranged from HAND 289 +/- 193, US 194 +/- 67, FINDIAM 167 +/- 71, to MEDDIAM 147 +/- 92. All powered instruments were significantly faster than HAND (P < 0.05), but did not differ from each other. On a 0 = "smooth" to 3 = "rough" scale, most often HAND resulted in "smooth" surfaces (10/20), the powered tips of all types "slight" surface roughness (10/20 each), and US the most "moderate" roughness (7/20). There were no differences in percent calculus remaining, surface roughness, or time spent among the 3 treating clinicians despite their varying experience levels. The results of this study showed that percent calculus remaining was <5% with all the instruments given time ad libitum on a given root surface. Root roughness was generally slightly greater with all 3 powered tips. All of the powered instruments took significantly less time than the HAND. Both DIAM tips took less time than US. Diamond-coated ultrasonic tips appeared to be much more efficient than HAND or US in removing calculus in moderate-deep probing depths on single-rooted teeth in vivo.