Influence of tooth instrumentation roughness on gingival tissue reactions

Diamond burs versus curettes in root planing: a randomized clinical trial

BACKGROUND

This study compares diamond burs and curettes by clinical, microbiological, biochemical and scanning electron microscopic parameters and treatment time data in the non-surgical periodontal treatment of patients with chronic periodontitis.

METHODS

Two quadrants of each of the 12 patients received root planing with diamond burs, whereas the other two quadrants were treated with curettes. Clinical periodontal measurements were recorded at baseline and then 1, 3 and 6 months after completion of non-surgical periodontal treatment. Subgingival plaque and gingival crevicular fluid samples were obtained at baseline and 1-month control. Twenty-one hopeless teeth received root planing with diamond burs or curettes or no treatment and then extracted for microscopic evaluations.

RESULTS

Clinical periodontal parameters improved similarly with both treatment modalities. Microbiological analyses revealed similar findings for the bacterial load (16S gene copy numbers) and ratio of each bacterium to the total bacterial count at baseline and 1-month control. Cytokine levels in the gingival crevicular fluid samples exhibited differences between the two treatments. Scanning electron microscopic analyses indicated that diamond burs were better in terms of calculus removal and loss of tooth substance indices but roughness index values were better for curettes.

CONCLUSIONS

Diamond burs provide findings comparable with curettes in root planing.

Comparative evaluation of manual scaling and root planing with or without magnification loupes using scanning electron microscope: A pilot study

Aim:

The aim of the present study is to compare the amount of remaining calculus, loss of tooth substance, and roughness of root surface after scaling and root planing with or without magnification loupes using scanning electron microscope.

Materials and Methods:

In the study, 30 teeth indicated for extractions due to severe chronic generalized periodontitis were included in the study. In test Group I, scaling and root planing was performed without magnification loupes, and in test Group II, scaling and root planing was performed with magnification loupes before extraction. In control Group III, no procedure was performed. After scaling and root planing, teeth were extracted followed by preparation of specimens. Specimens were then sent for scanning electron microscope study.

Results:

Statistically significant (P ≤ 0.05) differences were found among different test groups. Results showed that test Group II with magnification loupes had less remaining calculus and smoother surface with lesser amount of loss of cementum layer.

Conclusion:

From this, it was concluded that test Group II was more efficient in root debridement than test Group 1, so scaling and root planing done with magnification loupes will cause less damage to the tooth surface.

Effects of Root Debridement With Hand Curettes and Er:YAG Laser on Chemical Properties and Ultrastructure of Periodontally-Diseased Root Surfaces Using Spectroscopy and Scanning Electron Microscopy

Introduction: The efficacy of erbium-doped yttrium aluminum garnet (Er:YAG) laser for root debridement in comparison with curettes has been the subject of many recent investigations. Considering the possibility of chemical and ultra-structural changes in root surfaces following laser irradiation, this study sought to assess the effects of scaling and root planing (SRP) with curettes and Er:YAG laser on chemical properties and ultrastructure of root surfaces using spectroscopy and scanning electron microscopy (SEM). Methods: In this in vitro experimental study, extracted sound human single-rooted teeth (n = 50) were randomly scaled using manual curettes alone or in conjunction with Er:YAG laser at 100 and 150 mJ/pulse output energies. The weight percentages of carbon, oxygen, phosphorous and calcium remaining on the root surfaces were calculated using spectroscopy and the surface morphology of specimens was assessed under SEM. Data were analyzed using one-way analysis of variance (ANOVA). Results: No significant differences (P > 0.05) were noted in the mean carbon, oxygen, phosphorous and calcium weight percentages on root surfaces following SRP using manual curettes with and without laser irradiation at both output energies. Laser irradiation after SRP with curettes yielded rougher surfaces compared to the use of curettes alone. Conclusion: Although laser irradiation yielded rougher surfaces, root surfaces were not significantly different in terms of chemical composition following SRP using manual curettes with and without Er:YAG laser irradiation. Er:YAG laser can be safely used as an adjunct to curettes for SRP.

Atomic force microscopy and scanning electron microscopy evaluation of efficacy of scaling and root planing using magnification: A randomized controlled clinical study

Aim:

A randomized controlled clinical study was undertaken to evaluate the effectiveness of scaling and root planing (SRP) by using Magnifying Loupes (ML) and dental operating microscope (DOM).

Materials and Methods:

A total of 90 human teeth scheduled for extraction from 18 patients aged between 25 and 65 years suffering from generalized chronic severe periodontitis were randomly assigned to three treatment groups. Group 1 consisted SRP performed without using magnification (unaided), Group 2-SRP with ML and Group 3-SRP with DOM. Following extractions, samples were prepared for (i) evaluation of surface topography by atomic force microscopy, (ii) presence of smear layer, debris by scanning electron microscopy (iii) elemental analysis by energy dispersive X-ray analysis. Data was subjected to statistical analysis using analysis of variance, post-hoc (Tukey-HSD) and Chi-square test.

Results:

Statistically significant (P < 0.001) difference was found among the different treatment groups. Group 3 was the best while Group 1 was the least effective technique for SRP. Order of efficacy in terms of the surface was found to be - Palatal < Lingual < Distal ≃ Mesial < Buccal. Efficiency in mandibular to maxillary teeth was found to be significant (P < 0.05), also anterior to posterior teeth (P < 0.05).

Conclusion:

Magnification tools significantly enhance the efficacy of supragingival and subgingival SRP.

Comparative in vitro study of root roughness after instrumentation with ultrasonic and diamond tip sonic scaler

Objective:

The purpose of this study was to evaluate the root surface roughness after instrumentation with hand curette and diamond-coated sonic and universal ultrasonic tips.

Materials and Methods:

Forty root surfaces of human teeth were randomly assigned to four treatment groups: control group (without instrumentation), curette instrumentation, ultrasonic instrumentation with universal tip and sonic instrumentation with diamond-coated tip. Each sample was instrumented with fifteen strokes. Before and after instrumentation, surface roughness was measured. In addition, the root surface topography was examined after treatment under the scanning electron microscope.

Results:

Significant statistical differences (p<0.05) were observed when comparing the control group (0.48±0.07mm) to the treated groups (hand - 1.246±0.279mm, ultrasonic - 1.468±0.177mm and sonic instrumentation - 1.576±0.20mm). The highest roughness was produced by diamond-coated sonic tip and by ultrasonic universal tip (p>0.05).

Conclusion:

The diamond-coated tip with sonic scaler instrumentation and ultrasonic instrumentation produce similar root surface roughness, higher than curette instrumentation.

Root surface removal and resultant surface texture with diamond-coated ultrasonic inserts: an in vitro and SEM study

BACKGROUND

A new diamond-coated ultrasonic insert has been developed for scaling and root planing, and it was evaluated in vitro for the amount of root surface removed and the roughness of the residual root surface as a result of instrumentation.

METHODS

48 extracted single-rooted human teeth were ground flat on one root surface and mounted (flat side up) in PVC rings of standard height and diameter with improved dental stone. Each tooth surface was treated with either a plain ultrasonic insert (PI), an ultrasonic insert with a fine grit diamond coating (DI) or sharp Gracey curettes (HI). The mounted teeth were attached to a stepper motor which drove the teeth in a horizontal, reciprocal motion at a constant rate. The thickness from the flattened bottom of the ring to the flattened tooth surface was measured before and after 10, 20, and 30 instrumentation strokes for each root surface with each of the experimental instruments. A number of treated teeth were randomly selected for examination with SEM and a profilometer. Statistical analysis (analysis of co-variance) was performed to compare the amounts of tooth structure removed among the 3 instruments and t-test was used to compare the roughness of the treated root surfaces.

RESULTS

The mean depth of root structure removed was PI 10.7 microm, HI 15.0 microm, and DI 46.2 microm after 10 strokes; and PI 21.6 microm, HI 33.2 and DI 142.0 microm after 30 strokes, respectively. On average, 0.9 microm, 1.3 microm, and 4.7 microm of root surface was removed with each stroke of PI, HI and DI, respectively. PI and HI were not different from each other for all the stroke cycles, while DI was significantly different from PI and HI for all the stroke cycles (p<0.0001). Analysis with the profilometer showed that the smoothest surface was produced by the PI followed by the HI. The DI produced a surface that was significantly rougher than the surface produced by the PI or HI.

CONCLUSION

These results suggest that diamond-coated ultrasonic instruments will effectively plane roots, and that caution should be used during periodontal root planing procedures. Additionally, the diamond-coated instruments will produce a rougher surface than the plain inserts or the hand curettes.

Tissue reactions to sutures in the presence and absence of anti-infective therapy

BACKGROUND

In the oral cavity, sutures are placed within tissues of high vascularity in a moist environment with infectious potential. The objective of this study was to evaluate tissue reactions at silk and expanded polytetrafluoroethylene (ePTFE) sutures in the presence and absence of anti-infective therapy (AT).

METHODS

Thirty-six sutures were placed within the mandibular keratinized gingiva in six Beagle dogs. Each animal received one braided silk (4-0) and one ePTFE (CV-5) suture in contra-lateral jaw quadrants at 14, 7, and 3 days prior to biopsy. Three animals received daily AT including topical 2% chlorhexidine solution and a systemic broad-spectrum antibiotic. Biopsy specimens allowed histometric analysis of tissue reactions along the central part of the suture loop including the area of perisutural epithelium, ratio inflammatory cells (ICs)/epithelial cells and IC/fibroblasts, and presence/absence of bacterial plaque in the suture track.

RESULTS

A perisutural epithelial sheath was forming within 3 days. The cross-sectional area of the epithelium increased with time for both suture materials (p=0.003) but was particularly pronounced for the silk sutures in the absence of AT. Clusters of IC were present in the perisutural connective tissue and epithelium. Over time, a more prominent increase in IC/fibroblasts was evident for the silk sutures in the absence of AT. The pooled material revealed a significantly higher IC/fibroblast ratio for silk compared with ePTFE sutures (p=0.017). Bacterial plaque influx was detected in 6/9 silk and 0/9 ePTFE suture channels in the presence, and 6/6 and 3/6 suture channels, respectively, in the absence of AT.

CONCLUSIONS

AT may reduce biofilm formation and inflammation along the suture track. Braided silk, however, elicits more severe tissue reactions than ePTFE regardless of infection control.

Influence of Parameters on Root Surface Roughness Following Treatment With a Magnetostrictive Ultrasonic Scaler: An In Vitro Study

BACKGROUND

This in vitro study aimed to evaluate the influence of different parameters, i.e., lateral force, instrument power setting, and the shape of the working tip, on the roughness of root surfaces following treatment with a magnetostrictive ultrasonic scaling device.

METHODS

The study sample comprised a total of 102 extracted human molars, premolars, canines, and incisors. The samples were randomly divided into 10 equal units of 10 each for treatment with the ultrasonic device at a lateral force of 0.5 N and 2.0 N, a low and high instrument power setting, and with a straight and angulated shaped working tip. Twenty samples were treated manually using curets at a lateral force of 0.5 N and 2.0 N. Two samples were left untreated as controls. The mean (Ra) and maximum (Rmax) surface roughness of each sample was recorded. The statistical analysis was performed using analysis of variance (three-way ANOVA) at a level of significance of 5% (P < 0.05).

RESULTS

The mean surface roughness (+/-SD) using different parameters ranged from 0.6 +/- 0.1 microm to 1.8 +/- 0.3 microm. The maximum surface roughness (+/-SD) was between 4.8 +/- 1.3 microm and 17.2 +/- 4.3 microm. The mean surface roughness (+/-SD) for samples treated with curets at a lateral force of 0.5 N was 0.5 +/- 0.0 microm and 0.4 +/- 0.1 microm at 2.0 N. The maximum surface roughness (+/-SD) was 3.7 +/- 0.8 microm at 0.5 N and 3.9 +/- 1.4 microm at 2.0 N.

CONCLUSIONS

The findings of the present study indicate that the shape of the working tip and the lateral force significantly influence the mean and maximum surface roughness of root surfaces treated with a magnetostrictive ultrasonic scaling device. At any specific parameter, the surface roughness was significantly higher for the ultrasonic scaling device as compared to the hand curet.

Surface wear on cervical restorations and adjacent enamel and root cementum caused by simulated long-term maintenance therapy

BACKGROUND

In an in vitro study, the surface wear on cervical restorations and adjacent enamel and root cementum caused by different tooth-cleaning methods in simulated long-term therapy was investigated.

METHODS

Cervical restorations of amalgam (Oralloy), modified composite resin (Dyract), glass-ionomer cement (ChemFill Superior), and composite (Tetric) were instrumented by POL (polishing), CUR+POL (curette and polishing), US+POL (ultrasonic device with polishing) and the polishing agents Cleanic and Proxyt in a computer-controlled test bench. Treatment time corresponding to a real-time period of 5 or 10 years. Substance loss from instrumented surfaces was measured with a digital gauge. A three-way anova was used in the statistical evaluation.

RESULTS

The results showed that POL led to slight substance loss, which was greater using Cleanic (27 microm) than Proxyt (5 microm). CUR+POL produced a significantly greater substance loss than did US+POL, with 186 microm versus 35 microm on glass-ionomer cement, respectively, and 123 microm versus 18 microm, respectively, on root cementum, followed by composite (111 microm versus 27 microm, respectively), polyacid modified composite resin/compomer (89 microm versus 36 microm), amalgam (75 microm versus 19 microm), and enamel (32 microm versus 23 microm).

CONCLUSIONS

As opposed to the use of US+POL or POL, substance loss on cervical restorations and especially root cementum must be expected to result from tooth-cleaning during long-term maintenance treatment using CUR+POL.

Clinical significance of non-surgical periodontal therapy: an evidence-based perspective of scaling and root planing

Analysis of Egyptian hieroglyphics and medical papyri indicate that non-surgical periodontal treatment was common 3000-4000 years ago. Even today, scaling and root planing (SRP) remains an essential part of successful periodontal therapy. The collective evidence from numerous clinical trials reveals a consistency of clinical response in the treatment of chronic periodontitis by SRP using manual, sonic, or ultrasonic instrumentation. Thus, SRP remains the 'gold standard' to which more recently developed therapeutic modalities must be compared. Inherent to the clinical evaluation of SRP are such concerns as manual versus sonic and ultrasonic instrumentation, control of sub-gingival bacterial populations, removal of calculus, root smoothness and changes in various clinical parameters, e.g. probing depth, attachment levels, bleeding on probing and gingival inflammation. Lastly, an abbreviated discussion is presented on a relatively new paradigm of complete mouth 'disinfection' in a compressed time-frame that includes SRP as a significant component of the treatment regimen.

The influence of anatomic and iatrogenic root surface characteristics on bacterial colonization and periodontal destruction: a review

PERIODONTITIS IS A MULTIFACTORIAL infectious disease affecting primarily a subset of subjects and a subset of sites. Recent microbiological data have acknowledged that before disease progression can occur, a susceptible host and site are required, in addition to the presence of pathogenic bacteria. This review discusses factors affecting periodontal disease progression and focuses in particular on the influence of anatomic and iatrogenic root surface characteristics. Retrospective studies clearly suggest a strong association between anatomic aberrations and periodontal attachment loss. Cemental tear seems to have the potential to initiate an aseptic, rapid, site-specific periodontal breakdown in a non-infected environment, illustrating the complexity of the attachment loss process. Recent experimental findings, furthermore, demonstrate a significant influence of root surface instrumentation roughness upon subgingival plaque formation and gingival tissue reactions, as well as a significant and positive relationship between subgingival plaque accumulation and inflammatory cell mobilization. These results indicate that subgingivally located irregularities may form stagnant sites or ecological niches which favor both retention and growth of organisms. Such events in addition to the progressive inflammatory changes may critically influence the subgingival environment by turning a stable site into an unstable or active periodontitis site. Thus, local anatomic and iatrogenic root surface characteristics may have a more profound effect on gingival health than previously assumed, particularly on a site level.

A correlation study of inflammatory cell mobilization in response to subgingival microbial colonization

This study evaluated site-by-site the relations between subgingival microbial colonization and gingival tissue reactions. Experimental, deep periodontal defects were established at buccal surfaces of mandibular and maxillary canine teeth in 5 beagle dogs. The root surfaces were instrumented by a flame-shaped, fine-grained, rotating diamond point, or by a sharp curet. Following a 10-day postsurgical healing period, the dogs were fed a plaque-inducing diet for 70 days. The animals were then sacrificed and tissue blocks of the experimental sites including teeth and periodontal tissues were secured. The buccal gingiva was removed and processed for histomorphometric analysis while the teeth were prepared for scanning electron microscopic evaluation of the extent of subgingival microbial colonization. The results revealed that inflammatory cell density in the junctional epithelium and in the connective tissue were positively correlated to subgingival microbial colonization (P < 0.01). Furthermore, the degree of significance decreased with increasing distance from the plaque. The present study demonstrates that a close relation may exist between the extent of subgingival microbial colonization and inflammatory gingival tissue reactions.