A comparison of root surface instrumentation using manual, ultrasonic and rotary instruments: An in vitro study using scanning electron microscopy.

Background: The commonly accepted idea concerning root planing is that excessive removal of cementum is not necessary for removal of endotoxins. The ideal instrument should enable the removal of all extraneous substances from the root surfaces, without causing any iatrogenic effects. Aim: To compare the remaining calculus, loss of tooth substance, and roughness of root surface after root planing with Gracey curette, ultrasonic instrument (Slimline® insert FSI-SLI-10S), and DesmoClean® rotary bur. Materials and Methods: The efficiency of calculus removal, the amount of lost tooth substance, and root surface roughness resulting from the use of hand curette, ultrasonic instrument, and rotary bur on 36 extracted mandibular incisors were examined by SEM. We used three indices to measure the changes: Remaining calculus index (RCI), Loss of tooth substance index (LTSI), and Roughness loss of tooth substance index (RLTSI). Twelve samples were treated with each instrument. The time required for instrumentation was also noted. Statistical Analysis: Kruskal-Wallis ANOVA was used for multiple group comparisons and the Mann-Whitney test for group-wise comparisons. Analysis was carried out with SPSS® software (version 13). Results and Conclusion: The RCI and LTSI showed nonsignificant differences between the three groups. RLTSI showed a significant difference between Slimline™ and hand curette as well as Slimline™ and Desmo-Clean™. Slimline™ showed the least mean scores for RCI, LTSI, and RLTSI. Thus, even though the difference was not statistically significant, Slimline™ insert was shown to be better than the other methods as assessed by the indices scores and the instrumentation time.

A comparative evaluation of the efficacy of manual, magnetostrictive and piezoelectric ultrasonic instruments: an in vitro profilometric and SEM study

OBJECTIVES: The debridement of diseased root surface is usually performed by mechanical scaling and root planing using manual and power driven instruments. Many new designs in ultrasonic powered scaling tips have been developed. However, their effectiveness as compared to manual curettes has always been debatable. Thus, the objective of this in vitro study was to comparatively evaluate the efficacy of manual, magnetostrictive and piezoelectric ultrasonic instrumentation on periodontally involved extracted teeth using profilometer and scanning electron microscope (SEM). MATERIAL AND METHODS: 30 periodontally involved extracted human teeth were divided into 3 groups. The teeth were instrumented with hand and ultrasonic instruments resembling clinical application. In Group A all teeth were scaled with a new universal hand curette (Hu Friedy Gracey After Five Vision curette; Hu Friedy, Chicago, USA). In Group B CavitronTM FSI - SLI TM ultrasonic device with focused spray slimline inserts (Dentsply International Inc., York, PA, USA) were used. In Group C teeth were scaled with an EMS piezoelectric ultrasonic device with prototype modified PS inserts. The surfaces were analyzed by a Precision profilometer to measure the surface roughness (Ra value in µm) consecutively before and after the instrumentation. The samples were examined under SEM at magnifications ranging from 17x to 300x and 600x. RESULTS: The mean Ra values (µm) before and after instrumentation in all the three groups A, B and C were tabulated. After statistically analyzing the data, no significant difference was observed in the three experimental groups. Though there was a decrease in the percentage reduction of Ra values consecutively from group A to C. CONCLUSION: Within the limits of the present study, given that the manual, magnetostrictive and piezoelectric ultrasonic instruments produce the same surface roughness, it can be concluded that their efficacy for creating a biologically compatible surface of periodontally diseased teeth is similar.

Ultramorphology of the root surface subsequent to hand-ultrasonic simultaneous instrumentation during non-surgical periodontal treatments: an in vitro study

OBJECTIVE: The purpose of this study was to investigate the ultramorphology of the root surfaces induced by mechanical instrumentation performed using conventional curettes or piezoelectric scalers when used single-handedly or with a combined technique. MATERIAL AND METHODS: Thirty single-rooted teeth were selected and divided into 3 groups: Group A, instrumentation with curettes; Group B instrumentation with titanium nitride coated periodontal tip mounted in a piezoelectric handpiece; Group C, combined technique with curette/ultrasonic piezoelectric instrumentation. The specimens were processed and analyzed using confocal and scanning electron microscopy. Differences between the different groups of instrumentation were determined using Pearson's χ2 with significance predetermined at α=0.001. RESULTS: Periodontal scaling and root planing performed with curettes, ultrasonic or combined instrumentation induced several morphological changes on the root surface. The curettes produced a compact and thick multilayered smear layer, while the morphology of the root surfaces after ultrasonic scaler treatment appeared irregular with few grooves and a thin smear layer. The combination of curette/ultrasonic instrumentation showed exposed root dentin tubules with a surface morphology characterized by the presence of very few grooves and slender remnants of smear layer which only partially covered the root dentin. In some cases, it was also possible to observe areas with exposed collagen fibrils. CONCLUSIONS: The curette-ultrasonic simultaneous instrumentation may combine the beneficial effects of each instrument in a single technique creating a root surface relatively free from the physical barrier of smear layer and dentin tubules orifices partial occlusion.

Effect of instrumentation using curettes, piezoelectric ultrasonic scaler and Er,Cr:YSGG laser on the morphology and adhesion of blood components on root surfaces: a SEM study

This study used scanning electron microscopy (SEM) to evaluate the morphology and adhesion of blood components on root surfaces instrumented by curettes, piezoelectric ultrasonic scaler and Er,Cr:YSGG laser. One hundred samples from 25 teeth were divided into 5 groups: 1) Curettes; 2) Piezoelectric ultrasonic scaler; 3) Curettes plus piezoelectric ultrasonic scaler; 4) Er,Cr:YSGG laser; 5) Curettes plus Er,Cr:YSGG laser. Ten samples from each group were used for analysis of root morphology and the other 10 were used for analysis of adhesion of blood components on root surface. The results were analyzed statistically by the Kruskall-Wallis and Mann-Whitney tests with a significance level of 5 percent. The group treated with curettes showed smoother surfaces when compared to the groups were instrumented with piezoelectric ultrasonic scaler and the Er,Cr:YSGG laser. The surfaces instrumented with piezoelectric ultrasonic scaler and Er,Cr:YSGG laser, alone or in combination with hand scaling and root planing, did not differ significantly (p>0.05) among themselves. No statistically significant differences (p>0.05) among groups were found as to the adhesion of blood components on root surface. Ultrasonic instrumentation and Er,Cr:YSGG irradiation produced rougher root surfaces than the use of curettes, but there were no differences among treatments with respect to the adhesion of blood components.

Esse estudo utilizou microscopia eletrônica de varredura (MEV) para avaliar a morfologia e a adesão de elementos sanguíneos em superfícies radiculares instrumentadas com curetas, ultrassom piezoelétrico e laser de Er,Cr:YSGG. Foram utilizadas no presente estudo 100 amostras provenientes de 25 dentes que foram divididas em 5 grupos: 1) Raspagem manual com curetas; 2) Raspagem com ultrassom; 3) Associação instrumento manual e ultrassom; 4)Irradiação do laser de Er,Cr:YSGG;5)Associação raspagem manual com irradiação com laser de Er,Cr:YSGG. Dez amostras de cada grupo foram utilizadas para análise da morfologia e as outras 10 foram utilizadas para a análise de adesão de elementos sanguíneos. As eletromicrografias foram analisadas através dos escores de adesão de elementos sanguíneos e pelo índice de morfologia radicular e os resultados foram analisados estatisticamente através dos testes de Kruskall-Wallis e de Mann-Whitney com nível de significância de 5 por cento. O grupo que foi tratado com instrumentos manuais apresentou superfície mais lisa em relação aos grupos que foram instrumentados com ultrassom e com o laser de Er,Cr:YSGG. As superfícies instrumentadas com ultrassom e com o laser de Er,Cr:YSGG de forma isolada ou associada a raspagem manual não apresentaram diferenças estatísticas entre si (p>0,05). Não houve diferenças estatísticas entre os grupos em relação a adesão de elementos sanguíneos(p>0,05). A instrumentação ultrassônica e a irradiação com o laser de Er,Cr:YSGG produziram superfícies radiculares mais rugosas em relação a raspagem com curetas, porém não houve diferenças entre os tratamentos com relação à adesão de elementos sanguíneos.

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.

O objetivo deste estudo foi avaliar a efetividade da aplicação subgengival do gel Carisolv™ em associação aos procedimentos de raspagem e alisamento radicular (RAR) na remoção do cálculo dental aderido à superfície radicular, quando comparado à terapia periodontal mecânica convencional. Foram utilizados 45 dentes indicados para a exodontia devido à doença periodontal avançada, os quais foram divididos em três grupos de tratamento: 1) RAR apenas; 2) placebo + RAR; 3) Carisolv™ + RAR. O tempo despendido e o número de movimentos realizados para a instrumentação das superfícies radiculares foram avaliados durante o tratamento. Em seguida, os dentes foram extraídos e avaliados quanto ao percentual de cálculo residual, por meio de um sistema computadorizado de análise de imagens. Não houve diferença estatisticamente significante (p>0,05) entre os grupos com relação ao tempo requerido para os diferentes tratamentos, assim como quanto ao percentual de cálculo residual. Os resultados indicaram que a aplicação do Carisolv™ não promoveu benefícios adicionais àqueles obtidos com a terapia mecânica convencional na remoção do cálculo subgengival.

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

Este estudo comparou, clinicamente, o efeito de raspagem e alisamento radicular por instrumentações manual e ultra-sônica no tratamento da periodontite crônica, após o controle de placa supragengival em 20 pacientes. Os parâmetros clínicos profundidade de sondagem (PS), nível de inserção clínica (NIC) e sangramento à sondagem (SS) foram avaliados por um examinador calibrado e cego. Os dentes experimentais foram alocados para uma das seguintes abordagens subgengivais, de acordo com a profundidade de sondagem: 1) manual, 2) manual associada à irrigação, 3) ultra-sônica, 4) ultra-sônica previamente à manual. O tempo usado nos procedimentos foi registrado. Avaliações foram feitas 30 e 90 dias após os tratamentos. Médias individuais de SS, PS e NIC foram analisadas pelo teste ANOVA de medidas repetidas (p < 0,05). Diferenças no tempo de instrumentação foram analisadas por meio do teste ANOVA para um critério de classificação (p < 0,05). Os resultados revelaram que os tratamentos produziram alterações significativas nos parâmetros clínicos sem diferenças estatisticamente significantes entre os quatro grupos. Observaram-se reduções no SS, que, nas faces proximais, variou de 67,21 a 79,17%, no início, para 45,75 a 51,54% no final. Também foram observadas reduções significativas na PS e no NIC em todos os grupos, tanto para faces livres quanto proximais: as médias da PS aos 90 dias reduziram entre 0,92 e 1,14 mm nas faces livres e entre 1,01 e 1,35 mm nas proximais, enquanto para NIC as reduções foram de 0,43 a 0,82 mm e 0,60 a 0,73 mm, para as faces livres e proximais respectivamente. A média do tempo operatório variou de 4,77 a 5,30 minutos. Pôde-se concluir que as quatro modalidades terapêuticas de instrumentação subgengival foram igualmente eficazes na melhora dos parâmetros clínicos estudados.

Comparative SEM study on the effect of root conditioning with EDTA or tetracycline Hcl on periodontally involved root surfaces.

This study compared the surface characteristics of periodontally diseased single human teeth extracted after treatment with either EDTA or Tetracycline Hcl. The study was comprised of 30 teeth from 20 patients with advanced periodontal disease. Diseased root surfaces were root planed by hand curette or finishing bur. The teeth were sectioned and solutions of EDTA (pH 7.3) or Tetracycline Hcl (pH 1.8) were applied to the surface with cotton pellets for 3 minutes using light pressure. Specimens were processed and examined by Scanning Electron Microscope. The surfaces of both etched treated sets of specimens differed considerably from specimens treated with root planing alone, regardless of the root planing method. The etched specimens exhibited numerous dentinal tubules exposed by the removal of smear layer.