The effect of miniaturized manual versus mechanical instruments on calculus removal and root surface characteristics: An in vitro light microscopic study.

Objectives: The aim of this study was to evaluate by light microscopy analysis the effect of the use of miniaturised piezoelectric tips versus mini-five area specific curets on calculus removal and postoperative root surface alterations. Methods: A total of 20 extracted teeth were used. Two square surfaces (5×5 mm) were marked on each root surface with a diamond bur mounted on a high-speed handpiece. Before and after instrumentation, a series of magnified images (4.2×) of each experimental surface were taken with a standardized approach. According to a randomization list, the two surfaces on each sample were instrumented in a standardised fashion either with a mine-five curet or a slim piezoelectric tip. The images were processed using an imaging software. Data were summarised as means and standard deviations for the two outcomes (calculus and alterations.) at each time (pre and post) for both of the groups (manual and mechanical). Results: Both manual and mechanical instrumentation significantly reduced the calculus deposits (p < .001) without significant differences between the two groups. Both manual and mechanical treatments significantly increased alterations (p < .01). There was a statistically significant evidence of a greater increase in alterations from mechanical treatment. Conclusions: Slim mechanical piezoelectric tips and manual mini-five area-specific curets have similar effects on calculus removal. Manual instrumentation results in a more homogeneous postoperative root surface with less root alterations.

Videoscope-assisted minimally invasive periodontal surgery (V-MIS).

AIM: Small incision surgery has become routine in many areas of medicine but has not been widely accepted in periodontal therapy. A videoscope to assist minimally invasive surgery (MIS) has been developed. The clinical outcomes from MIS performed using this videoscope (V-MIS) are reported. MATERIALS AND METHODS: Patients were evaluated for residual defects following non-surgical therapy consisting of root planing with local anaesthetic. Thirty patients having 110 sites with residual pocket probing depth (PPD) of at least 5 mm, 2 mm loss of clinical attachment level (CAL), and radiographic evidence of bone loss were surgically treated. V-MIS was performed utilizing the videoscope for surgical visualization. RESULTS: At re-evaluation 6 months post surgery, there was a statistically significant improvement (p < .001) in mean PPD and CAL (PPD 3.88 ± 1.02 mm, CAL 4.04 ± 1.38 mm) in 1, 2, and 3 wall defects. All PPD at re-evaluation were 3 mm or less. There was a mean post-surgical increase in soft tissue height (0.13 ± 0.61 mm, p = 0.168) with a decrease in recession. CONCLUSIONS: The improvement in PPD and CAL from V-MIS, in the authors' opinion, appears to be favourable when compared to previously reported results of periodontal regenerative surgery. The lack of post-surgical recession following V-MIS has not been reported with traditional regenerative surgery.

[Impact of Er, Cr: YSGG-laser on the tooth root cement in the treatment of chronic periodontal disease (the results of electron microscopic studies)].

Ten teeth removed because of periodontal disease were irradiated by Er, Cr: YSGG laser (power 1W and 1,5W). Scanning electron microscopy showed the 10-second exposure of the laser beam to remove the tartar from the surface of the tooth root, as well as "smear" layer and infected cement, exposing the dentine tubules and influencing the collagen fibers, forming a rough surface of the tooth root. These data suggest the effectiveness of Er, Cr: YSGG-laser in the treatment of tooth root cement surface by periodontal disease. Er, Cr: YSGG-laser with a power of 1 and 1,5 W can be used as an adjunctive treatment mode by periodontal therapy.

Near-ultraviolet removal rates for subgingival dental calculus at different irradiation angles.

The laser ablation rate of subgingival dental calculus irradiated at a 400-nm-wavelength, 7.4-mJ pulse energy, and 85- and 20-deg irradiation angles is measured using laser triangulation. Three-dimensional images taken before and after irradiation create a removal map with 6-µm axial resolution. Fifteen human teeth with subgingival calculus are irradiated in vitro under a cooling water spray with an ∼300-µm-diam, tenth-order super-gaussian beam. The average subgingival calculus removal rates for irradiation at 85 and 20 deg are 11.1±3.6 and 11.5±5.9 µm∕pulse, respectively, for depth removal and 4.5±1.7×10(5) and 4.8±2.3×10(5) µm(3)∕pulse, respectively, for volume removal. The ablation rate is constant at each irradiation site but varies between sites because of the large differences in the physical and optical properties of calculus. Comparison of the average depth- and volume-removal rates does not reveal any dependence on the irradiation angle and is likely due to the surface topology of subgingival calculus samples that overshadows any expected angular dependence.

Relato de caso com análise de cálculos dentários supragengivais humanos através das técnicas de difração de raios X e espectroscopia Raman / Analyse of human supragingival dental calculus by x-ray diffraction and spectroscopy Raman techniques - case report

A composição química dos cálculos dentários já tem sido discutida na literatura, bem como seu processo de deposição mineral ao longo do tempo. Entretanto, diante de um caso de grandes proporções, tem-se o objetivo de relatar o caso clínico e aprofundar a discussão da análise química do material coletado. 0 paciente, sexo masculino, 42 anos, apresentava cinco elementos dentários com acúmulo de cálculos com dimensões macroscópicas acima da média. 0 tratamento estabelecido foi a remoção cirúrgica dos dentes associados aos cálculos e posterior investigação da composição e da cristalinidade segundo análise das técnicas através de espectroscopia Raman e difração de raios X. Os resultados mostraram diferenças obscuras na espectroscopia Raman devido à fluorescência natural dos compostos e através da difração de raios X foi possível observar a presença da hidroxiapatita principalmente na superfície interna, o p fosfato tricálcio com maior concentração externa e a baixa concentração de bruxita em ambos os casos. Os resultados descritos corroboram com a descrição da literatura e podem ser explicados devido ao diferente tempo de envelhecimento do cálculo, nas regiões internas e externas. 0 uso das técnicas de caracterização químicas são ferramentas que têm se mostrado úteis em várias áreas de pesquisa, inclusive e cada vez mais, enriquecendo diagnósticos clínicos.

The chemical composition of dental calculus has already been discussed in the literature, as well as the process of mineral deposition over time. However, based on an high dimensions case, has the objective of describing the clinical case, and deepen the discussion of the chemical analysis of material collected. The male patient, 42 years old, presents five dental elements with accumulation of calculations with macroscopic dimensions above average. The surgical extraction of the teeth associated with the calculations was established, and further investigation of the composition and crystallinity second analysis techniques Raman spectroscopy and by X-ray diffraction. The results showed obscure differences by the Raman spectroscopy due to fluorescence and X-ray diffraction was possible to observe mainly of hydroxyapatite on the inner surface, the whitlockite with the highest concentration outside, and the low concentration of brushite in both cases. The results described corroborate the description of the literature and can be explained due to different aging time of the calculation in the regions internal and external. The use of characterization techniques have been showed fuseful in different research areas, and may enrich the clinical diagnosis.

Investigation into the optimum beam shape and fluence for selective ablation of dental calculus at lambda = 400 nm.

BACKGROUND AND OBJECTIVES: A frequency-doubled Ti:sapphire laser is shown to selectively ablate dental calculus. The optimal transverse shape of the laser beam, including its variability under water-cooling, is determined for selective ablation of dental calculus. STUDY DESIGN/MATERIALS AND METHODS: Intensity profiles under various water-cooling conditions were optically observed. The 400-nm laser was coupled into a multimode optical fiber using an f = 2.5-cm lens and light-shaping diffuser. Water-cooling was supplied coaxially around the fiber. Five human tooth samples (four with calculus and one pristine) were irradiated perpendicular to the tooth surface while the tooth was moved back and forth at 0.3 mm/second, varying between 20 and 180 iterations. The teeth were imaged before and after irradiation using light microscopy with a flashing blue light-emitting diode (LED). An environmental scanning electron microscope imaged each tooth after irradiation. RESULTS: High-order super-Gaussian intensity profiles are observed at the output of a fiber coiled around a 4-in. diameter drum. Super-Gaussian beams have a more-homogenous fluence distribution than Gaussian beams and have a higher energy efficiency for selective ablation. Coaxial water-cooling does not noticeably distort the intensity distribution within 1 mm from the optical fiber. In contrast, lasers focused to a Gaussian cross section (< or =50-microm diameter) without fiber propagation and cooled by a water spray are heavily distorted and may lead to variable ablation. Calculus is preferentially ablated at high fluences (> or =2 J/cm(2)); below this fluence, stalling occurs because of photo-bleaching of the calculus. Healthy dental hard tissue is not removed at fluences < or =3 J/cm(2). CONCLUSION: Supplying laser light to a tooth using an optical fiber with coaxial water-cooling is determined to be the most appropriate method when selectively removing calculus with a frequency-doubled Ti:sapphire laser. Fluences over 2 J/cm(2) are required to remove calculus efficiently since photo-bleaching stalls calculus removal below that value.

Effects of root planing procedures with hand instrument or erbium, chromium:yttrium-scandium-gallium-garnet laser irradiation on the root surfaces: a comparative scanning electron microscopy study.

The purpose of this study was to investigate the efficiency of hand instrumentation and laser irradiation on calculus removal from the root surfaces, in vitro. Thirty-two human teeth, extracted for periodontal reasons, were used in this study. Root surfaces of single-rooted teeth were treated by different methods including (1) conventional hand instruments; (2) hand instruments and tetracycline-hydrochloride (Tet-HCl); (3) erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser irradiation, setting I (short pulse); (4) Er,Cr:YSGG laser irradiation, setting II (long pulse). Three premolar teeth, extracted for orthodontic reasons, served as control. The morphology of the root surfaces was evaluated by light and scanning electron microscopy. Energy dispersive X-ray (EDX) analysis was performed to compare the mineral content of root surfaces treated with hand instrumentation and lasing procedures. The results of this study demonstrated that all treatments were efficient in calculus removal from the root surfaces. Thermal changes, including melting and carbonization, were not observed in either lasing procedure. The surface was rougher in the laser groups than in the groups treated with hand instruments. Moreover, roughness was greater in the long-pulse laser setting than in the short-pulse setting. While increased calcium (Ca) and decreased phosphate (P) (weight concentration percent) were observed in all treatments when compared with the control, laser procedures resulted in a more similar mineral content than in the groups treated with hand instruments. Based on these findings, laser procedures, when used in appropriate settings, are capable of performing scaling and root planing in the treatment of periodontitis. It may be concluded that short pulse laser may be more suitable for the micro-morphology of the root surface. However, additional in vitro and clinical studies are necessary to clarify the success of laser in periodontal therapy.

Histologic evaluation of an Nd:YAG laser-assisted new attachment procedure in humans.

This report presents histologic results in humans following a laser-assisted new attachment procedure (LANAP) for the treatment of periodontal pockets. Six pairs of single-rooted teeth with moderate to advanced chronic periodontitis associated with subgingival calculus deposits were treated. A bur notch was placed within the pocket at the clinically and radiographically measured apical extent of calculus. All teeth were scaled and root planed with ultrasonic and hand scalers. One of each pair of teeth received treatment of the inner pocket wall with a free-running pulsed neodymium:yttrium-aluminum-garnet (Nd:YAG) laser to remove the pocket epithelium, and the test pockets were lased a second time to seal the pocket. After 3 months, all treated teeth were removed en bloc for histologic processing. LANAP-treated teeth exhibited greater probing depth reductions and clinical probing attachment level gains than the control teeth. All LANAP-treated specimens showed new cementum and new connective tissue attachment in and occasionally coronal to the notch, whereas five of the six control teeth had a long junctional epithelium with no evidence of new attachment or regeneration. There was no evidence of any adverse histologic changes around the LANAP specimens. These cases support the concept that LANAP can be associated with cementum-mediated new connective tissue attachment and apparent periodontal regeneration of diseased root surfaces in humans.

Dental laser research: selective ablation of caries, calculus, and microbial plaque: from the idea to the first in vivo investigation.

One of the current dental laser research tracks is selective ablation, which is the removal of disease while not harming adjacent healthy structures. This article describes the scientific path from the first basic laboratory study of the absorption characteristics of caries to selective ablation of bacteria, microbial plaque, and calculus with a blue laser and the first in vivo safety studies in dogs. This article is an example of a typical research path for future studies of the uses of lasers in dentistry.

In vivo and in vitro effects of an Er:YAG laser, a GaAlAs diode laser, and scaling and root planing on periodontally diseased root surfaces: a comparative histologic study.

BACKGROUND AND OBJECTIVES: The aim of the present histologic study was to compare the in vivo and in vitro effects of an erbium: yttrium, aluminum, and garnet (Er:YAG) laser (ERL), combined with a fluorescent calculus detection system, a diode laser (DL) and scaling and root planing (SRP) on periodontally diseased root surfaces. STUDY DESIGN/MATERIALS AND METHODS: Twenty-four single rooted teeth, considered for extraction due to severe periodontal destruction, were included in the study. Prior to extraction all mesial root surfaces were randomly assigned to the following treatment groups: (1) ERL combined with a calculus detection system with fluorescence induced by 655 nm InGaAsP DL radiation (160 mJ/pulse and 10 pulses/second under water irrigation) (ERL), or (2) GaAlAs DL (1.8 W, pulse/pause relation 1:10), or (3) SRP using hand instruments. Immediately after extraction, all distal root surfaces were treated with the same instruments under standardized conditions. For light microscopic investigation, a plastic embedding technique was used to cut the undecalcified roots into 30 microm thick crossections. The following parameters were recorded by on blind examiner: remaining debris, root surface morphology, and thermal side effects. RESULTS: Root surfaces instrumented with both, ERL in vivo and DL in vitro exhibited no detectable surface alterations. In contrast, ERL scaling in vitro and SRP in vivo/in vitro produced superficial microchanges in root cementum. However, irradiation with DL in vivo caused severe damages to the root surface (i.e., crater formation). There were no signs of thermal side effects in all laser treated groups. ERL provided subgingival calculus removal on a level equivalent to that provided by SRP. DL was unsuitable for calculus removal, since macroscopic inspection revealed the presence of large amounts of subgingival calculus. CONCLUSIONS: The present in vivo results showed that (i) ERL, combined with a fluorescent calculus detection system, provided a selective subgingival calculus removal on a level equivalent to that provided by SRP, and (ii) DL, using this power output, was unsuitable for calculus removal and altered the root surface in an undesirable manner.

Effects of Er:YAG laser on periodontal therapy.

The use of the laser in dentistry has been widening due to its increasing use in surgery and medicine. In the field of periodontology, the most commonly used lasers have been CO2 and Nd:YAG lasers. According to the last reviews reporting the use of lasers in periodontal therapy, these lasers were considered unsuitable for dental treatment, due to various shortcomings, such as the carbonization and severe thermal damages caused on the target and surrounding tissues, and therefore their use has been confined to soft tissue procedures. Technological advances and improvements have increased the choices of the available laser systems. Among them, Er:YAG lasers seem to be of promising use. The Er:YAG laser is a solid-state crystal laser operating in the infrared wavelength (2,940 nm). Due to its high absorbability in water and hydroxyapatite, several studies have shown the effectiveness of this laser for both hard and soft tissue ablation, and its bactericidal effects with less or even no pain under clinical applications. The variety of the potential applications for this laser has been studied and the interest about its use in dental practice has increased among practitioners. This review includes studies regarding the use of Er:YAG laser on hard tissue procedures, such as calculus removal and osseous surgery as well as soft tissue management, like gingivectomy, gingival curettage and melanin removal.

[Lasers in dentistry. 5. The use of lasers in periodontology]. / Lasers in de tandheelkunde. 5. Het gebruik van lasers in de parodontologie.

This literature review shows that the Nd:YAG laser and the Er:YAG laser can be beneficially used in periodontology for subgingival curettage and gingivectomy. Studies demonstrated that subgingival laser treatment can result in significant reduction of the initial levels of periodontal pathogens. It is beneficial to perform laser curettage under water irrigation prior to scaling in order to destroy of the structure of the calculus and its attachment to the root surface. During laser curettage sufficient haemostasis is obtained, which improves detection of subgingival calculus. Nd:YAG laser gingivectomy results in similar improvement of deep periodontal pocket as conventional flap surgery, with the advantages such as minimal bleeding and post-operative pain, no swelling, and neither sutures nor post-surgical dressing are needed. Both non-surgical and surgical laser treatments are often performed without local anaesthesia, making full-mouth treatment in one session possible. Treatments are well accepted by the patients and require about 50% less time than the conventional therapies. Laser-de-epithelialization for periodontal regeneration has been experimentally attempted, but more controlled studies are needed to establish its usefulness in the clinic. Laser treatment of peri-implantitis is not recommended.

Safety of the ArF193 excimer laser for the removal of dental plaque and calculi: an in vitro histological study.

OBJECTIVE: To assay the safety of the ArF excimer laser in the integrity of human pulp elements. BACKGROUND DATA: The use of lasers in dentistry remains controversial, in spite of their increasing application in medical practice. The main reason for this discrepancy is the frequent report of damage to surrounding tissues and the dental pulp, due to the energy transfer, from the site of laser impact. The progress made on laser technology during the last 10 years, could overcome this obstacle and allow the use of lasers in dentistry. METHODS AND RESULTS: The present study reports the use of the ArF 193 excimer laser, under conditions of strict control of frequency and fluency, for the ablation of dental carries, plaque, and calculi, by the use of a new, articulated arm. We have tested 10 teeth, extracted for prosthetic reasons, immediately after extraction. Our in vitro results show that the ArF193 excimer laser does not produce any harm to the dental pulp (at least at the photo- or electronic microscopy level), whereas in a matter of seconds, it can be effective in removing all dental deposits. In addition, the use of the flexible articulated arm, makes this treatment comfortable and easier for both the dentist and patient. CONCLUSION: Under a strict control of laser technology, and the use of the new articulated arm presented, the use of the ArF excimer laser in dentistry is safe and comfortable.

Calculus-like deposit at apex of tooth with refractory apical periodontitis.

It is generally accepted that bacteria in or outside the root canal are the reason for apical periodontitis and endodontic failures. This case report presents a 60-year-old woman with a periapical lesion and a fistulous tract which did not respond to conventional root canal treatment. During periapical surgery, granulomatous tissue was removed and a calculus-like deposit was observed on the root surface. A radicular cyst was diagnosed. Nine months after this calculus-like deposit had been removed and the cyst enucleated, complete recovery of the bone had occurred. It is suggested that the presence of the calculus-like deposit at the apex of the tooth or its effects may in part have delayed the healing of the periapical inflammation in spite of apparently adequate endodontic treatment.

Calculus removal from multirooted teeth with and without surgical access. II. Comparison between external and furcation surfaces and effect of furcation entrance width.

The purpose of this study was to evaluate the effect of furcation entrance width on the efficacy of calculus removal from furcation areas as well as to compare this efficacy between external and furcation surfaces after closed root planing, open root planing and use of a rotary diamond for the furcation area. 30 first and second lower molars scheduled for extraction with a calculus index > or = 2 and a degree II or III furcation involvement were divided into 3 groups: 10 molars were scaled and root planed using a closed approach: 10 molars were scaled and root planed using an open approach; 10 molars were scaled and root planed with an open approach and rotary diamond was used for removal of deposits in the furcation area. After extraction, the width of the furcation entrance was measured buccally and lingually 2 mm apical from the bifurcation and furcations were categorized as wide (width > 2.4 mm) or narrow (width < 2.4 mm). The teeth were assessed in a stereomicroscope and the % of residual calculus on external and furcation surfaces was calculated. The width of the furcation entrance influenced the efficacy in root planning in the open group (p = 0.0015). The use of rotary diamond was the most effective method for removing calculus both for narrow and wide furcations. The effectiveness of open root planning in the mesial root was related to the width of the furcation entrance where the % of residual calculus was significantly higher for narrow furcations (p = 0.008).(ABSTRACT TRUNCATED AT 250 WORDS)

[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.

Total calculus removal: an attainable objective?

The primary purpose of this study was to determine if two sessions of scaling and root planing, one using a "closed" approach and the other using an "open" approach, would remove all calculus from teeth with severe periodontal disease. Fourteen teeth (8 single-rooted, 6 multi-rooted) were treated by closed scaling and root planing with an ultrasonic instrument, and 17 others (10 single-rooted, 7 multi-rooted) were treated with hand instruments. After a healing period of 4 to 8 weeks, anesthesia was secured, periodontal flaps were raised, and the teeth were treated a second time using the same instrumentation as before. The teeth were then extracted and prepared for light microscopic evaluation. Twelve of the 14 teeth treated by ultrasonics and 12 of the 17 treated by hand instruments retained calculus. The two types of instruments had similar scores in the treatment of proximal root surfaces, furcal walls, and furcal summits. Hand instrumentation appeared to be more effective than ultrasonics in removing cementum from proximal surfaces, although this is not based on a formal statistical comparison of the two methods. Neither instrument was effective in removing cementum from the furcal walls or summits. Five randomly selected blocks containing remaining root structure were deparaffinized and prepared for scanning electron microscopy. One hand-instrumented specimen, which had not shown calculus with light microscopy, displayed calculus at the SEM level. All five specimens displayed residual calculus at either the light microscope, the SEM level, or both. The results of this study indicate that complete removal of calculus from a periodontally diseases root surfaces is rare.