Root cleaning or root smoothing. An in vivo study.

The goal of the present study was to determine whether the clinical treatment results in terms of pocket probing depth reduction and attachment gain would be different following conventional periodontal flap surgery if, on the one hand, root surfaces were smoothed after plaque and calculus removal or, on the other hand, root surfaces were first thoroughly cleaned but then intentionally roughened. 13 adult patients with moderate periodontitis participated; the same patients acted as a unit of control. Evaluations were performed on a total of 224 sites on 81 anterior and premolar teeth. On the 41 test teeth (111 sites), a coarse diamond stone was used following traditional root planing to roughen the root surfaces. The 40 control teeth (113 sites) were cleaned and planed using Gracey curettes. Measurements performed 3 and 6 months post-surgery revealed significant reductions in probing depths at both "rough" and "smooth" sites. However, no differences between the 2 methods were detected. This was true also with regard to attachment gain. We conclude that striving for root surface smoothness during periodontal surgery appears unnecessary.

[Subgingival plaque due to gingivitis and inactive periodontitis sites in the adult periodontitis patient]. / Subgingivale Plaque aus Gingivitis- und inaktiven Parodontitisstellen beim erwachsenen Parodontitispatienten.

There are several discrepancies with respect to the composition of subgingival plaque in gingivitis and in inactive adult periodontitis (AP). In this study we compared subgingival plaque samples taken from gingivitis sites to those from inactive periodontitis sites of the same patients. Of 44 patients plaque samples from 86 gingivitis sites and 92 periodontitis sites were analysed. Darkfield microscopy showed a higher proportion of spirochetes and mobile rods in the periodontitis sites. Analysis of cultures revealed a higher and statistically significant number of anaerobes in the periodontitis sites (1.7 x 10(7) vs 3 x 10(6), p = 0.006). The following bacterial species were isolated more frequently from periodontitis sites than from gingivitis sites: Actinobacillus actinomycetemcomitans (18% vs 10%), as well as the black-pigmented Prevotella intermedia (68% vs 48%) and Porphyromonas gingivalis (48% vs 28%). On the one hand, these small differences in the bacteriological parameters can be explained by the fact that both gingivitis and periodontitis plaque samples were taken from the same periodontitis patients. An infection of the gingivitis sites from the parodontitis sites within the same patient could not be excluded. On the other hand, the mean probing depth of the gingivitis sites was relatively high, 3.6 mm (measuring point interdental plus pseudo-pocket) which may favor the growth of anaerobic bacteria.

Sonic and ultrasonic scalers in a clinical comparison. A study in non-instructed patients with gingivitis or slight adult periodontitis.

In the present study, the Cavitron 2002 ultrasonic scaler was compared with the Titan-S air scaler in 20 subjects with gingivitis or slight periodontitis, whereby the majority of the patients suffered from gingivitis. A split mouth experimental design was used. However, patients did not receive any oral hygiene instructions during the study in order to allow the observation of the true effect of instrumentation. The outcome of a one-time treatment was assessed after 4, 14, 28, and 56 days. Gingival crevicular fluid (GCF), papilla bleeding index (PBI), plaque index (Pl-I), probing depth (PD), and relative attachment level (AL) were measured. Both treatments resulted in a statistically significant decrease of clinical signs of inflammation (PBI: p < 0.001). Probing depths decreased (p < 0.001) and a small gain of attachment of 0.11 mm +/- 0.05 mm (p < 0.001) was observed. Following treatment, a statistically significant (p < 0.001) decrease in GCF and Pl-I was observed between baseline and day 4. No statistically significant difference between the instruments' influences on the evaluated clinical parameters could be found. Thus it can be concluded indirectly that the Cavitron 2002 and the Titan-S are both useful instruments for scaling of tooth and root surfaces.

Failure of periodontal treatment.

Treatment failures appear to occur more frequently in periodontology than in other dental disciplines. Inappropriate patient selection, incomplete diagnostic procedures, errors in diagnosis or prognosis, treatment difficulties, unsupervised healing, and the absence of maintenance therapy may be causes of such failures. A regular recall program can largely prevent such failures.

[Comparative probing with an electronic and a manual periodontal probe]. / Vergleichende Sondierung mit einer elektronischen und einer manuellen Parodontalsonde.

The goal of this study was to compare a new electronic probe (Peri-Probe) which uses a defined probing force and allows measurement of probing depth in 0.1 mm increments, with a standard manual probe. 24 sites were probed in each of 12 subjects (6 treated for periodontal disease and 6 untreated). Duplicate measurements with the electronic probe were made with the probe tip remaining in contact with gingival tissue. Similarly executed measurements using the manual probe followed during the same appointment. One week later, measurements were repeated in reversed sequence. Duplicate measurements (within appointments) resulted in measurement errors of +/- 0.18 mm for the manual probe. 98.6% of the electronic measurements and 99.3% of the manual measurements differed by < 1 mm. Replicated duplicated measurements (between appointments) resulted in measurements errors of +/- 0.86 mm for the electronic probe and +/- 0.65 mm for the manual probe. A difference of < 1 mm was found in 89.2% and 95.5% of the measurement repetitions with the electronic probe and the manual probe, respectively. The electronic probe exhibited greater variation of measurements than the manual probe. In addition, probing using the electronic instrument was more arduous than using the manual instrument, resulting in less reliable measurements.

Effectiveness of open flap root debridement with rubber cups, interdental plastic tips and prophy paste. An SEM study.

This study was designed to ascertain whether conservative cleaning of surgically-exposed root surfaces can achieve complete plaque removal. 10 single-rooted teeth (40 surfaces) from 4 patients with advanced periodontitis were included in the study. After flap reflection, the root surfaces were cleaned using only rubber cups, EVA plastic tips and prophy paste. No attempt was made to remove calculus. Immediately after treatment, the teeth were extracted. Then root surfaces were systematically examined in the scanning electron microscope to detect any residual bacteria (plaque). 27 of the 40 treated root surfaces were plaque-free. On the other 13 root surfaces, only a few isolated small islands of plaque were detected. On the other hand, relatively extensive areas of the root surfaces exhibited calculus. Bacterial plaque accumulation was routinely observed on the rough calculus surfaces and at the periphery of the hard deposits. These results demonstrate that the instruments used in this study can successfully remove plaque from exposed root surfaces. However, subgingival calculus that is firmly attached to root surfaces virtually always harbors plaque bacteria; such deposits require more aggressive instrumentation (scalers, curettes) for removal.

Non-surgical periodontal treatment: where are the limits? An SEM study.

In the present scanning electron microscopic study, the possibilities and limitations of non-surgical root planing were investigated. 10 single-rooted teeth from 4 patients with advanced periodontitis were studied. The root surfaces were cleaned and planed without flap reflection, using fine curettes. The teeth were then extracted and the root surfaces were systematically examined by scanning electron microscopy (SEM) for the presence of residual bacteria and calculus. 29 of 40 curetted root surfaces were free of residues, if they were reached by the curette. On the remaining 11 surfaces, only small amounts of plaque and minute islands of calculus were detected, primarily at the line angles and also in grooves and depressions in the root surfaces. Instrumentation to the base of the pocket was not achieved completely on 75% of the treated root surfaces, however. The primary reason for this was the extremely tortous pocket morphology on the teeth selected for study. In conclusion, it may be stated that during non-surgical root planing in cases of advanced periodontitis, surfaces that can be reached by curettes are usually free of plaque and calculus. However, in many cases the base of the pocket will not be reached. It is for this reason that deep periodontal pockets should be treated with direct vision, i.e., after the reflection of conservative flaps.

An in vitro investigation on the loss of root substance in scaling with various instruments.

There are differing opinions as to the extent to which root cementum has to be removed during root surface instrumentation over and above that of the debridement of plaque and calculus. Similarly, the amount of tooth material removed by individual instruments is also unclear, but a trend towards less damaging methods of root surface debridement has evolved in recent years. The purpose of this in vitro study was to determine the amounts of root substance removed by 4 different methods of instrumentation, hand curette, ultrasonic scaler, airscaler and fine grit diamond bur. Measurement of tooth substance loss was carried out with a specially constructed measuring device at 360 sites on 90 mandibular incisors following 12 working strokes with a clinically appropriate force of application. Only a thin layer of root substance (11.6 microns) was removed by the ultrasonic scaler, compared to the much greater losses sustained with the airscaler (93.5 microns), the curette (108.9 microns) and the diamond bur (118.7 microns).

[Periodontal treatment failure]. / Misserfolge nach Parodontaltherapie.

Therapeutic failure appears to be more frequent in periodontology than in other fields of dentistry. Such failure may be caused by errors in patient selection, incomplete diagnostic procedures, diagnostic or prognostic errors, treatment difficulties and obstacles, non-controlled healing, or the absence of maintenance therapy. Most failures can be avoided by instituting a regular recall system.

[The Perioplaner/Periopolisher. The loss of substance on the root surface and the initial clinical experiences]. / Perioplaner/Periopolisher. Substanzverlust auf der Wurzeloberfläche und erste klinische Erfahrungen.

A new system for the removal of supragingival and subgingival plaque and calculus was studied. The system involves two motor driven handpieces. One handpiece works with curettes and hoes (Perioplaner) and the other works with diamond-layered instruments (Periopolisher). In the first part of this study the loss of root substance was measured as a consequence of treatment by these motor-driven instruments. These results were compared with those using classical hand curettes and rotating diamonds (Perio-Set). In the literature there is still debate over whether it is necessary to remove not only plaque and calculus but also cementum which may contain endotoxin or may even be infected. Whatever opinion one may have, it must be known how much root substance is lost by using a particular scaling instrument. This study has shown that the use of the Perioplaner and Periopolisher results in about the same loss of root substance as the use of hand instruments. In the second part of this study, first clinical experiences with these instruments are reported.

[The border seal in restorations of class-V lesions with glass ionomer cement and composite (the sandwich filling)]. / Randschluss bei Restaurationen von Klasse-V-Läsionen mit Glasionomerzement und Komposit (Sandwich-Füllung).

In 9 patients, 60 class V restorations were evaluated clinically and by scanning electron microscopy. All lesions were treated with glass-ionomer combined with composite resin. In 27 fillings (group A) the glass-ionomer lining cement was etched, whereas in 33 fillings (group B) the composite material was applied directly on the unetched glass-ionomer liner. Clinically, the retention of the fillings after one year was 100%. The margins of the fillings were checked with different explorers and found to be acceptable. Scanning electron microscopy of the margins of the fillings showed disappointing results. One week after placement of the fillings, only 16.2% (group A) and 7.4% (group B) of the cervical margins in dentin were rated perfect. After one year, even more cervical bond failures were observed. 9.7% perfect margins were found in group A, 3.2% in group B. Etching of the glass-ionomer liner had no influence on the cervical bond failure of the class V fillings.

The effectiveness of root debridement in open flap procedures by means of a comparison between hand instruments and diamond burs. A SEM study.

The goal of the present in vivo study was to evaluate human roots by means of scanning electron microscopy (SEM), after treating the root surfaces either with conventional hand instruments or with newly developed diamond burs. Peculiar root anatomy often makes perfect instrumentation with hand instruments difficult or impossible. On 20 teeth destined for extraction because of severe periodontitis, the root surfaces were exposed by mucoperiosteal flap procedures. Ten roots were then planed using fine curettes, and 10 were instrumented using diamond burs. Following extraction, the root surfaces were stained and photographed. Stained areas were examined by SEM. On the 20 test teeth, 79 surfaces were evaluated. From these, 381 stained zones were checked by SEM for the presence of bacteria. A total of 216 stained areas from teeth treated by hand instruments was evaluated; 15 of these (6.9%) contained bacteria. Of roots treated by diamond burs, 165 stained areas were evaluated; 9 (5.5%) exhibited bacteria. Thus, both methods resulted in root surfaces that were essentially bacteria-free.