ABSTRACT
This laboratory study investigated the efficiency and aggressiveness of metallic and carbonic inserts of a vertically oscillating ultrasonic device (Vector-system) at different power settings. The following parameters concerning periodontal treatment were assessed under standardized conditions: calculus and tooth substance removal, mean surface roughness and micro morphological appearance of the treated roots. Concerning the calculus removal potential, no significant differences were found between the types of insert used. The carbon fibre inserts, however, showed significantly more tooth substance loss than the metallic inserts. These findings were confirmed by micromorphological SEM analysis. In view of these results, the repeated use of these carbon fiber inserts during periodonatal sustaining therapy cannot be recommended.
Subject(s)
Dental Calculus/therapy , Dental Instruments/adverse effects , Dental Scaling/instrumentation , Tooth Root/injuries , Analysis of Variance , Bicuspid , Carbon , Carbon Fiber , Dental High-Speed Technique/adverse effects , Dental Scaling/adverse effects , Equipment Design , Humans , Metals , Microscopy, Electron, Scanning , Statistics, Nonparametric , Tooth Abrasion/etiology , Ultrasonic Therapy/adverse effects , Ultrasonic Therapy/instrumentationABSTRACT
AIM: This prospective multicentre randomized controlled clinical trial was designed to compare the clinical outcomes of papilla preservation flap surgery with or without the application of enamel matrix proteins (EMD). MATERIAL AND METHODS: 172 patients with advanced chronic periodontitis were recruited in 12 centers in 7 countries. All patients had at least one intrabony defect of > or =3mm. Heavy smokers (> or =20 cigarettes/day) were excluded. The surgical procedures included access for root instrumentation using either the simplified or the modified papilla preservation flap in order to obtain optimal tissue adaptation and primary closure. After debridement, roots were conditioned for 2 min with a gel containing 24% EDTA. EMD was applied in the test subjects, and omitted in the controls. Postsurgically, a strict plaque control protocol was followed. At baseline and 1 year following the interventions, clinical attachment levels (CAL), pocket probing depths (PPD), recession (REC), full-mouth plaque scores and full-mouth bleeding scores were assessed. A total of 166 patients were available for the 1-year follow-up. RESULTS: At baseline, 86 test and 86 control patients presented with similar subject and defect characteristics. On average, the test defects gained 3.1+/-1.5 mm of CAL, while the control defects yielded a significantly lower CAL gain of 2.5+/-1.5 mm. Pocket reduction was also significantly higher in the test group (3.9+/-1.7 mm) when compared to the controls (3.3+/-1.7 mm). A multivariate analysis indicated that the treatment, the clinical centers, cigarette smoking, baseline PPD, and defect corticalisation significantly influenced CAL gains. A frequency distribution analysis of the studied outcomes indicated that EMD increased the predictability of clinically significant results (CAL gains > or =4 mm) and decreased the probability of obtaining negligible or no gains in CAL (CAL gains <2 mm). CONCLUSIONS: The results of this trial indicated that regenerative periodontal surgery with EMD offers an additional benefit in terms of CAL gains, PPD reductions and predictability of outcomes with respect to papilla preservation flaps alone.
