Endoscopic vs. tactile evaluation of subgingival calculus.

PURPOSE: Endoscopic technology has been developed to facilitate imagery for use during diagnostic and therapeutic phases of periodontal care. The purpose of this study was to compare the level of subgingival calculus detection using a periodontal endoscope with that of conventional tactile explorer in periodontitis subjects. METHODS: A convenience sample of 26 subjects with moderate periodontitis in at least 2 quadrants was recruited from the University of Minnesota School of Dentistry to undergo quadrant scaling and root planing. One quadrant from each subject was randomized for tactile calculus detection alone and the other quadrant for tactile detection plus the Perioscope ™ (Perioscopy Inc., Oakland, Cali). A calculus index on a 0 to 3 score was performed at baseline and at 2 post-scaling and root planing visits. Sites where calculus was detected at visit 1 were retreated. T-tests were used to determine within-subject differences between Perioscope™ and tactile measures, and changes in measures between visits. RESULTS: Significantly more calculus was detected using the Perioscope™ vs. tactile explorer for all 3 subject visits (p<0.005). Mean changes (reduction) in calculus detection from baseline to visit 1 were statistically significant for both the Perioscope™ and tactile quadrants (p<0.0001). However, further reductions in calculus detection from visit 1 to visit 2 was only significant for the Perioscope™ quadrant (p<0.025), indicating that this methodology was able to more precisely detect calculus at this visit. CONCLUSION: It was concluded that the addition of a visual component to calculus detection via the Perioscope™ was most helpful in the re-evaluation phase of periodontal therapy.

A preliminary study of intra-pocket topical versus injected anaesthetic for scaling and root planing.

AIM: Compare the efficacy of topical benzocaine gel to injected lidocaine during scaling and root planing. MATERIALS AND METHODS: In each of 21 participants undergoing root planing, two dental quadrants were randomly assigned to receive topical 20% benzocaine gel delivered subgingivally (TOP) or injection anaesthesia using 2% lidocaine (INJ). Baseline, intra- and immediate post-operative pain was assessed using the Heft-Parker pain scale. Intra-subject differences (INJ-TOP) were analysed using paired t-tests and mixed models. RESULTS: Baseline and post-operative pain did not differ between treatments (p>0.50). The injected anaesthetic, however, was associated with less intra-operative pain than the topical (INJ-TOP=-24.9 mm, p=0.005) Six participants required rescue (injected) anaesthesia during treatment with the topical. Eleven participants (52%) preferred topical over injected anaesthetic. Among these 11, intra-operative pain scores did not differ significantly (TOP=38.6 mm, INJ=28.4 mm, p=0.23). Among those who preferred the injected anaesthetic, intra-operative pain scores differed significantly (TOP=84.7 mm, INJ=43.8 mm, p=0.03). CONCLUSIONS: Intra-pocket benzocaine gel is less effective than injected lidocaine in controlling pain during scaling and planing. Anaesthetic preference was related to the level of pain experienced during treatment with the topical. Larger studies are needed to confirm these findings.