Effect of adjunctive diode laser in the non-surgical periodontal treatment in patients with diabetes mellitus: a systematic review and meta-analysis.

This study aimed to systematically review and analyze the present randomized clinical trials (RCTs) regarding the clinical efficacy of a diode laser (DL) adjuvant to scaling and root planning (SRP) in patients with chronic periodontitis (CP) who have diabetes mellitus (DM). Five databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trails, Web of Science, and Chinese BioMedical Literature Databases) were searched. A meta-analysis was implemented to evaluate periodontal parameters including probing depth (PD) and clinical attachment level (CAL) as primary outcomes. Hemoglobin A1c (HbA1c), plaque index (PI), and the gingival index (GI) were also observed as secondary outcomes. Independent scanning of 239 papers resulted in 9 RCTs. Moderate evidence demonstrated that the test groups showed significant benefits for PD reduction, CAL gain, and HbA1c reduction after 3 and 6 months. Significant differences in PI and GI reduction were not found except for GI reduction within 1 month. The collective evidence suggested that the DL with SRP had significant improvements in clinical results compared to SRP alone. Based on our results, the DL could be a recommended therapy for patients with CP who have DM.

A comparative scanning electron microscopy study between the effect of an ultrasonic scaler, reciprocating handpiece, and combined approach on the root surface topography in subgingival debridement.

OBJECTIVE: This study aimed to analyze the effectiveness of root-shape inserts mounted on a reciprocating handpiece during the procedure of root surface debridement (RSD) on extracted teeth. Three different approaches were compared: ultrasonic scaling, employment of root-shape inserts mounted on a reciprocating handpiece, and a combination of both. MATERIALS AND METHODS: A total of 51 extracted teeth were divided into three groups. The first group was instrumented with an ultrasonic scaler, the second group with flexible root-shape inserts mounted on a reciprocating handpiece (grain size 40, 15, and 4 µm), whereas the final group underwent a combination of both approaches. The time required for the instrumentation was taken. The specimens were subjected to optical and scanning electron microscopy (SEM), and the photographs were evaluated by three examiners who were blinded to the study. The parameters included were: SEM roughness index (SRI) for the roughness calculation, remaining calculus Index (RCI) to evaluate the residual calculus deposits, and loss of tooth substance index (LTSI) to evaluate the loss of tooth substance caused by instrumentation. RESULT: The results revealed that the time taken for the instrumentation was on average longer when the root-shape inserts were employed alone, meanwhile the combined approach did not show significant difference in comparison with the ultrasonic scaling. The lower average RCI was obtained with a combined approach. The use of root-shape inserts seems to cause a moderate increase in LTSI, especially in a combined approach, whereas it resulted in a better average SRI. CONCLUSION: The employment of root-shape inserts seems to be effective in the RSD for its ability to obtain a smooth and calculus-free instrumented surface, especially when used in combination with an ultrasonic scaler, and their use can so represent a valid approach to be tested in further in vivo studies.

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.

Calculus Removal and Root Surface Roughness When Using the Er:YAG or Er,Cr:YSGG Laser Compared with Conventional Instrumentation Method: A Literature Review.

Objective: The purpose of this literature review was to evaluate the effectiveness of using Er:YAG (erbium-doped yttrium/aluminum/garnet) laser or Er,Cr:YSGG (erbium, chromium-doped yttrium/scandium/gallium/garnet) laser on calculus removal and their effect on the topography and roughness of root surface in comparison with the conventional instruments in the nonsurgical periodontal therapy. Background data: One of the most challenging problems in treatment of periodontal disease is the elimination of plaque and calculus, leaving a clean and smooth root surface to decrease plaque and calculus retention, and for good gingival reattachment. Materials and methods: PubMed and Google Scholar were searched for available literature. The electronic search was limited to articles published in the period between January 2007 and April 2017, in the English language. Results: A total of 47 publications fulfilled the inclusion criteria of this systematic review and screened according to the research questions. Calculus removal using the ultrasonic instrument showed remaining calculus compared with the hand instrument, whereas, on the contrary, erbium lasers revealed no remaining calculus or smaller amounts compared with the conventional instruments when used in appropriate settings. The results of this review showed that ultrasonic instrumentation produced effects on the root surface almost similar to that of hand instrumentation. Er:YAG laser and Er,Cr:YSGG laser clarify a little more surface roughness when compared with conventional instruments. Conclusions: The present systematic review indicates that a combination of scaling and root planing (SRP) using the erbium lasers as an adjunctive therapy at certain parameters can be appropriate to remove residual debris from the root surface and at the same time have little or no negative thermal effect on the root surface. The Er:YAG laser also seems to be the most suitable for nonsurgical periodontal therapy. Additional new good-designed studies are needed to evaluate the effectiveness of erbium lasers with SRP in nonsurgical periodontal therapy.

Root surface alterations following manual and mechanical scaling: A comparative study.

OBJECTIVES: The aim of this study was to investigate the morphological and surface roughness changes in dental root samples following periodontal scaling by hand curette, piezoelectric ultrasonic devices or a combination of these. METHODS: Twenty-four monoradicular teeth extracted as a result of periodontal disease were divided into 4 groups: Group A was treated by piezoelectric ultrasonic scaler Piezon® Master 400; Group P by piezoelectric ultrasonic scaler PiezoSmart® ; Group C using Gracey curette 7/8; Group AC by a combined technique of piezoelectric ultrasonic scaler Piezon® Master 400 and Gracey curette 7/8. The treated samples were then analysed using a white light interferometer and scanning electron microscopy (SEM). RESULTS: Roughness analysis revealed major surface alterations in Group C (Sa  = 24.98 µm); the samples treated using the combined technique (Group AC) showed reduced but still significant alteration (Sa  = 14.48 µm), while samples treated with the piezoelectric ultrasonic devices (Group A and Group P) presented the lowest roughness values (Sa  = 8.99 and Sa  = 4.45 µm, respectively). A significant difference was found between groups C and P (P = 0.036). SEM analysis confirmed the roughness analysis revealing non-homogeneous surfaces in Group C, while a less morphological alteration was noted in the other groups. CONCLUSION: All periodontal devices used in this in vitro study produced a certain degree of surface alteration. Hand curettes appear to have a major impact on surface integrity compared with piezoelectric ultrasonic devices.

Diamond burs versus curettes in root planing: a randomized clinical trial.

BACKGROUND: This study compares diamond burs and curettes by clinical, microbiological, biochemical and scanning electron microscopic parameters and treatment time data in the non-surgical periodontal treatment of patients with chronic periodontitis. METHODS: Two quadrants of each of the 12 patients received root planing with diamond burs, whereas the other two quadrants were treated with curettes. Clinical periodontal measurements were recorded at baseline and then 1, 3 and 6 months after completion of non-surgical periodontal treatment. Subgingival plaque and gingival crevicular fluid samples were obtained at baseline and 1-month control. Twenty-one hopeless teeth received root planing with diamond burs or curettes or no treatment and then extracted for microscopic evaluations. RESULTS: Clinical periodontal parameters improved similarly with both treatment modalities. Microbiological analyses revealed similar findings for the bacterial load (16S gene copy numbers) and ratio of each bacterium to the total bacterial count at baseline and 1-month control. Cytokine levels in the gingival crevicular fluid samples exhibited differences between the two treatments. Scanning electron microscopic analyses indicated that diamond burs were better in terms of calculus removal and loss of tooth substance indices but roughness index values were better for curettes. CONCLUSIONS: Diamond burs provide findings comparable with curettes in root planing.

Preservation of root cementum: a comparative evaluation of power-driven versus hand instruments.

OBJECTIVES: The purpose of this study was to evaluate the effects of three distinct periodontal treatment methods in comparison with hand instrumentation on residual cementum of periodontal diseased teeth. Cementum can influence the activities of periodontal cells and may play an important regulatory role in periodontal treatment. The ideal method for periodontal therapy involves removal of biofilm, calculus and endotoxin while preserving root cementum. MATERIAL AND METHODS: Forty-eight caries free, single-rooted teeth in patients diagnosed with severe chronic periodontitis were treated using four different methods prior to extraction. The teeth were instrumented subgingivally at one approximal site either by hand curettes (HC), piezoelectric ultrasonic scalers (U), piezoelectric ultrasonic scalers following air polishing (U + AP) or air polishing (AP) alone. Following extraction of teeth, instrumented and non-instrumented sites were analysed with a dissecting microscope and SEM for measurement of the amount of and surface characteristics of residual cementum. RESULTS: The percentage of coronal cementum remaining following subgingival instrumentation was 84% for U, 80% for U + AP, 94% for AP and 65% for HC. Although subgingival instrumentation of apical portions of the cementum demonstrated 6% less retained cementum in comparison with coronal portions, the amount of retained cementum with AP was still significantly greater than with HC. SEM results found the smoothest root surfaces were produced by the HC followed by the AP, while root surfaces instrumented by U or U + AP presented grooves and scratches. CONCLUSIONS: This study demonstrated that AP was superior to U devices in preserving cementum, whereas HC were the most effective instruments in removing cementum.

The effect of low-level laser therapy as an adjunct to non-surgical periodontal treatment on gingival crevicular fluid levels of transforming growth factor-beta 1, tissue plasminogen activator and plasminogen activator inhibitor 1 in smoking and non-smoking chronic periodontitis patients: A split-mouth, randomized control study.

BACKGROUND AND OBJECTIVE: This study aimed to investigate the effects of low-level laser therapy (LLLT) as an adjunct to scaling and root planing (SRP) on smoking and non-smoking patients with chronic periodontitis. MATERIAL AND METHODS: The study was conducted using a split-mouth design with 30 patients with chronic periodontitis (15 smokers, 15 non-smokers) and 30 healthy individuals matched for age, sex and smoking status as controls. Groups were constituted as follows: Cp+SRP+Sham: non-smokers with chronic periodontitis treated with SRP; Cp+SRP+LLLT: non-smokers with chronic periodontitis treated with SRP+LLLT; SCp+SRP+Sham: smokers with chronic periodontitis treated with SRP; SCp+SRP+LLLT: smokers with chronic periodontitis treated with SRP+LLLT; C: control group comprised of periodontally healthy non-smokers; SC: control group comprised of periodontally healthy smokers. LLLT was first applied on the same day as SRP and again on days 2 and 7 after SRP treatment. Clinical parameters were recorded before non-surgical periodontal treatment (baseline) and on day 30. Gingival crevicular fluid samples were collected before periodontal treatment (baseline) and during follow-up visits on days 7, 14 and 30. Gingival crevicular fluid transforming growth factor (TGF)-ß1, tissue plasminogen activator (tPA) and plasminogen activator inhibitor 1 (PAI-1) levels were measured using enzyme-linked immunosorbent assay. RESULTS: All clinical parameters showed significant reductions between baseline and day 30 following SRP treatment in both the LLLT and sham groups (P<.001). No significant differences were observed between the LLLT and sham groups of either the smokers or non-smokers (P>.05). Gingival crevicular fluid PAI-1 levels decreased significantly in the SCp+SRP+sham and SCp+SRP+LLLT groups (P<.05), and gingival crevicular fluid tPA levels decreased significantly in the Cp+SRP+sham, Cp+SRP+LLLT and SCp+SRP+LLLT groups (P<.05). Gingival crevicular fluid TGF-ß1 levels decreased significantly in all treatment groups (P<.05). Although no significant differences were found between the gingival crevicular fluid PAI-1, tPA and TGF-ß1 levels of the LLLT versus sham groups (P>.05) at any of the time points measured, both LLLT groups showed significant reductions in tPA/PAI-1 ratios over time. CONCLUSION: Within the limits of this study, LLLT may be understood to play a role in the modulation of periodontal tissue tPA and PAI-1 gingival crevicular fluid levels, particularly in smoking patients with chronic periodontitis, and may thus be recommended as an adjunct to non-surgical periodontal treatment.

Combined application of Er:YAG and Nd:YAG lasers in treatment of chronic periodontitis. A split-mouth, single-blind, randomized controlled trial.

BACKGROUND: The aim of the present study was to compare the effectiveness of combined Er:YAG and Nd:YAG laser therapy to that of scaling and root planing with hand instruments in non-surgical treatment of chronic periodontitis. MATERIAL AND METHODS: Twenty-five systemically healthy patients with chronic periodontitis were selected for this study. The quadrants were randomly allocated in a split-mouth design to either combined Er:YAG (160 mJ/pulse, 10 Hz) and Nd:YAG laser (100 mJ/pulse, 20 Hz) therapy (test group) or scaling and root planing alone (control group). At baseline, 1 month and 3 months after treatment, plaque index, gingival index, probing depth, clinical attachment level and bleeding on probing (%), were recorded and gingival crevicular fluid and subgingival plaque samples were taken. The gingival crevicular fluid levels of interleukin-1ß and tumor necrosis factor-α were analyzed by enzyme-linked immunosorbent assay. Quantitative analysis of red complex bacteria was performed using quantitative real-time polymerase chain reaction. RESULTS: The clinical parameters had significantly improved for both groups after treatment. There were statistically significant differences in probing depth and clinical attachment level between the test and control groups only for deep pockets (≥7 mm) (P<.05). No significant differences between the two groups were observed for the biochemical and microbiological parameters at any time points (P>.05). CONCLUSIONS: The present study suggests that a combined course of Er:YAG and Nd:YAG laser therapy may be beneficial particularly in inaccessible areas such as deep pockets on a short-term basis. Further, well-designed studies are required to assess the effectiveness of the combination of these lasers.

The effect of the angle of instrumentation of the Piezoelectric Ultrasonic Scaler on root surfaces.

OBJECTIVES: To evaluate the influence of variations in the working angle of the piezoelectric ultrasonic scaler (PUS) on root surfaces. MATERIAL AND METHODS: Fifty-five uniradicular bovine teeth were used, of which 25 teeth were used for the analysis of the roughness and root wear, while the remaining 30 teeth were used for the analysis of morphology (MRS) and the attachment of blood components (ABC). The teeth were randomly divided into five groups according to the type of treatment (G1-G5: piezoelectric ultrasonic scaler; G6: manual curette) and to the PUS working angle applied (G1: 0°; G2: 30°; G3: 45°; G4: 60°; G5: 90°). For statistical analysis, the data describing the MRS and ABC were analysed by the Kruskal-Wallis and Dunn's tests, and the data describing the roughness and tooth wear were analysed by anova and Tukey's tests at the significance level of 5%. RESULTS: Manual curette (MC) promoted a smoother root surface than the application of the PUS. The PUS used at the angles of 30° and 45° resulted in a high level of ABC that was comparable to that obtained by MC. Additionally, the group in which the PUS was applied at an angle of 45° exhibited less tooth wear than the other groups. CONCLUSIONS: Changes in the working angle of the PUS influenced the characteristics of root surfaces after instrumentation.

Intrapulpal temperature changes during root surface irradiation with dual-wavelength laser (2780 and 940 nm): in vitro study.

This work reports that the ablation volume and rate of porcine skin changed significantly with the change of skin water content. Under the same laser irradiation conditions (532 nm Nd:YAG laser, pulse width = 11.5 ns, pulse energy = 1.54 J, beam radius = 0.54 mm), the ablation volume dropped by a factor of 4 as the skin water content decreased from 40 wt. % (native) to 19 wt. % with a change in the ablation rate below and above around 25 wt. %. Based on the ablation characteristics observed by in situ shadowgraph images and the calculated tissue temperatures, it is considered that an explosive rupture by rapid volumetric vaporization of water is responsible for the ablation of the high water content of skin, whereas thermal disintegration of directly irradiated surface layer is responsible for the low water content of skin.

In vitro evaluation of a novel biofilm remover.

OBJECTIVE: To evaluate a novel device for its efficacy in removing experimental biofilm from root surfaces and its potential for concomitantly removing/roughening the surface substance. METHODS AND MATERIALS: A novel acrylic rotary device (biofilm remover, BR) was tested in vitro in three experiments: surface loss, surface roughness [positive controls: Perioset (PS) and Proxoshape (PR)] and biofilm removal [positive controls: ultrasonic (US) and PS]. Surface loss/surface roughness was evaluated for dentin samples instrumented for three 20 s periods. The calcium removed during instrumentation was analysed after each interval and cumulatively, using atomic absorption spectrophotometry (AAS). Surface roughness was measured using profilometric analysis. Biofilm removal was evaluated on dentin specimens coated with a 64.5 h 6-species in vitro formed biofilm, after one 20 s treatment. Surface loss was analysed using anova with Scheffé post hoc test, and surface roughness/biofilm removal was analysed using Mann-Whitney test (all P ≤ 0.05). RESULTS: Significantly less substance loss [µg (± 1 SD)] was observed with the novel device at all time points, both interval and cumulative (1.0 (± 0.5) versus 9.3 (± 3.2) PS and 9.9 (± 1.9) PR at 60 s). Surface roughness [µm (95% CI)] was significantly lower for BR than for PS and PR [0.00 (-0.01, 0.08) 0.20 (0.16, 0.27) and 0.21 (0.19, 0.24) at 60 s]. Significantly less biofilm bacteria remained after treatment with both BR 4.5 (-0.1, 16.2) and US 1.9 (-0.2, 14.3), compared to PS 52 (27.9, 82.1). CONCLUSIONS: The novel biofilm remover was less damaging to dentin surfaces, while removing biofilm at least as effectively as devices used in this study.

Trauma from instrumentation after non-surgical periodontal treatment with ultrasonic scalers and Nd:YAG laser.

OBJECTIVE: Periodontal therapies aimed at altering the progression of periodontal diseases must include meticulous mechanical debridement during both the non-surgical and the surgical phases of periodontal treatment. The aim of this study was to evaluate and compare the immediate effect of trauma from instrumentation on clinical attachment level after non-surgical periodontal treatment with ultrasonic scalers and a Nd:YAG laser. MATERIALS AND METHODS: Twenty-four patients with untreated chronic periodontitis, presenting probing depths of 4-6 mm on anterior teeth, upper and lower, were entered into the study. The selected teeth were probed with a pressure-controlled probe, guided by stents. Each quadrant was randomly allocated in a split-mouth design either to treatment with Nd:YAG laser using an energy of 1W, 100mj, 1064nm (test group) or to periodontal treatment using ultrasonic scalers (control group). Clinical parameters, including plaque index (PI), bleeding on probing (BOP), probing pocket depth (PPD) and probing attachment level (PAL) were acquired prior to and immediately after treatment. RESULTS: Statistical analysis demonstrated no differences between groups at baseline for all parameters (p > 0.05). Immediately after treatment, the control group showed a greater PAL loss than the test group (p < 0.05). For the control group, there were statistically significant differences between PAL immediately before and after treatment (p < 0.05), but not test group (p > 0.05). CONCLUSIONS: Within the limits of the present study, it may be concluded that non-surgical periodontal treatment with ultrasonic scalers causes a mean immediate attachment loss of 0.68 mm and that a Nd:YAG laser seems to reduce significantly the trauma the instrumentation produced.

Evaluation of three different manual techniques of sharpening curettes through a scanning electron microscope: a randomized controlled experimental study.

OBJECTIVE: The purpose of this study was to compare the effectiveness of three different techniques for manually sharpening of periodontal curettes (PCs) by examining the blades with the aid of scanning electron microscope (SEM). METHODS: Three groups were considered based on three sharpening methods used: group A (moving a PC over a stationary stone); group B (moving a stone over a stationary PC) and group C (moving a PC over a stone fixed, placed on a 'sharpening horse'). After the sharpening, the blades were examined using SEM. The SEM images were assessed independently by five different independent observers. An evaluation board was used to assign a value to each image. A preliminary pilot study was conducted to establish the number of samples. Pearson's correlation test was used to assess the correlations between measurements. anova test with Bonferroni's post hoc test was used to compare the three groups. RESULTS: Sixty PCs (20 PCs per group) were used in this study. Statistically significant differences emerged between the three groups (P-value = 0.001). Bonferroni's test showed that the difference between groups A and B was not statistically significant (P-value = 0.80), while it was significant for the comparisons between groups A and C (P-value = 0.005) and between groups B and C (P-value = 0.001). CONCLUSIONS: The sharpening technique used in group C, which involved the use of the sharpening horse, proved the most effective.

Effect of Nonsurgical Periodontal Therapy on the Glycaemic Control of Nondiabetic Periodontitis Patients: A Clinical Biochemical Study.

PURPOSE: To compare the HbA1c levels in nondiabetic subjects with periodontitis and periodontally healthy controls and to evaluate the effect of nonsurgical periodontal therapy on the glycaemic control in nondiabetic subjects with periodontitis. MATERIALS AND METHODS: A total of 220 nondiabetic subjects between 35 and 60 years old were selected and divided into two groups: group A (case group), comprised of subjects with chronic periodontitis, and group B (control group), comprised of subjects with healthy periodontium. Periodontal clinical parameters (plaque index, modified sulcular bleeding index, probing depth and clinical attachment level) were used to assign the subjects into the respective groups. The HbA1c level was estimated for both groups using a commercially available kit. Subjects in group A underwent nonsurgical periodontal therapy in two to four sessions along with oral hygiene instructions. The periodontal parameters and HbA1c levels were again evaluated in the test group three months following periodontal therapy. RESULTS: The HbA1c levels were higher in the case group (A) than the control group (B). Three months following periodontal therapy in group A, there was improvement in periodontal parameters. The HbA1c levels decreased significantly from baseline to 3 months. CONCLUSION: The results of this study found chronic periodontitis to be associated with a significant increase in glycosylated haemoglobin levels in nondiabetic periodontitis subjects. Furthermore, with improvement of periodontal status, the glycaemic levels return to near normal values.

Effect of root planing on surface topography: an in-vivo randomized experimental trial.

BACKGROUND AND OBJECTIVE: The root surface topography exerts a major influence on clinical attachment and bacterial recolonization after root planing. In-vitro topographic studies have yielded variable results, and clinical studies are necessary to compare root surface topography after planing with current ultrasonic devices and with traditional manual instrumentation. The aim of this study was to compare the topography of untreated single-rooted teeth planed in vivo with a curette, a piezoelectric ultrasonic (PU) scraper or a vertically oscillating ultrasonic (VOU) scraper. MATERIAL AND METHODS: In a randomized experimental trial of 19 patients, 44 single-rooted teeth were randomly assigned to one of four groups for: no treatment; manual root planing with a curette; root planing with a PU scraper; or root planing with a VOU scraper. Post-treatment, the teeth were extracted and their topography was analyzed in 124 observations with white-light confocal microscopy, measuring the roughness parameters arithmetic average height, root-mean-square roughness, maximum height of peaks, maximum depth of valleys, absolute height, skewness and kurtosis. RESULTS: The roughness values arithmetic average height and root-mean-square roughness were similar after each treatment and lower than after no treatment ( p < 0.05). Absolute height was lower in the VOU group than in the untreated ( p = 0.0026) and PU (p = 0.045) groups. Surface morphology was similar after the three treatments and was less irregular than in the untreated group. Values for the remaining roughness parameters were similar among all treatment groups ( p > 0.05). CONCLUSION: Both ultrasonic devices reduce the roughness, producing a similar topography to that observed after manual instrumentation with a curette, to which they appear to represent a valid alternative.

Histological and profilometric evaluation of the root surface after instrumentation with a new piezoelectric device - ex vivo study.

OBJECTIVES: An ex vivo model was designed to profilometrically and histologically assess root changes resulting from scaling with a new ultrasonic device, designed for bone piezoelectric surgery, in comparison with curettes. METHODS: Three groups of 10 periodontal hopeless teeth were each subjected to different root instrumentation: Gracey curettes (CUR); ultrasonic piezoelectric device, Perio 100% setting, level 8 (P100); and ultrasonic piezoelectric device Surg 50% setting, level 1 (S50). After extraction, all teeth were photographed to visually assess the presence of dental calculus. The treated root surfaces were profilometrically evaluated (Ra, Rz, Rmax). Undecalcified histological sections were prepared to assess qualitative changes in cementum thickness. Statistical analysis was carried out using one-way anova test with a significance level of 95%. RESULTS: Both instruments proved to be effective in the complete removal of calculus. The CUR group presented the lowest Ra [2.28 µm (±0.58)] and S50 the highest [3.01 µm (±0.61)]. No statistically significant differences were detected among the three groups, for Ra, Rz and Rmax. Histologically, there was a cementum thickness reduction in all groups, being higher and more irregular in S50 group. CONCLUSIONS: Within the limits of this study, there were no statistically significant differences in roughness parameters analyzed between curettes and the ultrasonic piezoelectric unit. This new instrument removes a smaller amount of cementum, mainly at the Perio 100% power setting, which appears to be the least damaging. The ultrasonic device is effective in calculus removal, proving to be as effective as curettes.

Effect of nonsurgical periodontal therapy verses oral hygiene instructions on type 2 diabetes subjects with chronic periodontitis: a randomised clinical trial.

BACKGROUND: 40 subjects with type 2 diabetes and moderate to severe CP were randomly distributed to groups receiving either NSPT or OHI. Periodontal parameters, glycosylated haemoglobin (HbA1c) and high-sensitivity C-reactive protein (hs-CRP) were evaluated at baseline, 2- and 3-months intervals. METHODS: 40 subjects with type 2 diabetes and moderate to severe CP were randomly distributed to groups receiving either NSPT or OHI. Periodontal parameters, glycosylated haemoglobin (HbA1c) and high-sensitivity C-reactive protein (hs-CRP) were evaluated at baseline, 2- and 3-months intervals. RESULTS: 15 subjects from NSPT group and 17 from OHI group completed the study. The difference in plaque index (PI) between NSPT and OHI groups were significant at 2 months recall (p = 0.013). There was no significant difference between NSPT and OHI group for all other clinical periodontal parameters, HbA1c and CRP levels. At 3 months post-therapy, periodontal parameters improved significantly in both groups with sites with probing pocket depth (PPD) < 4 mm reported as 98 ± 1.8% in NSPT group and 92 ± 14.9% in OHI group. Mean PPD and mean probing attachment loss (PAL) within the NSPT group reduced significantly from baseline (2.56 ± 0.57 mm, 3.35 ± 0.83 mm) to final visit (1.94 ± 0.26 mm, 2.92 ± 0.72 mm) (p = 0.003, p < 0.001). For OHI group, improvements in mean PPD and mean PAL were also seen from baseline (2.29 ± 0.69 mm, 2.79 ± 0.96 mm) to final visit (2.09 ± 0.72 mm, 2.62 ± 0.97 mm) (p < 0.001 for both). Similarly, HbA1c levels decreased in both groups with NSPT group recording statistically significant reduction (p = 0.038). Participants who demonstrated ≥ 50% reduction in PPD showed significant reductions of HbA1c and hs-CRP levels (p = 0.004 and p = 0.012). CONCLUSION: NSPT significantly reduced PI at 2 months post-therapy as compared to OHI. Both NSPT and OHI demonstrated improvements in other clinical parameters as well as HbA1c and CRP levels. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01951547.

Subjective pain perception during calculus detection with use of a periodontal endoscope.

PURPOSE: Periodontal endoscopes are relatively new to the dental field. The purpose of this study was to determine the amount of pain reported by subjects with periodontal disease after experiencing the use of a periodontal endoscope compared with the use of a periodontal probe during calculus detection. METHODS: A total of 30 subjects with at least 4 sites of 5 to 8 mm pocket depths were treated with scaling and root planing therapy in a split-mouth design. The 2 quadrants were randomly assigned to either S/RP with tactile determination of calculus using an 11/12 explorer, or S/RP treatment with endoscopic detection of calculus. Each subject's pain experience was determined by via a Heft-Parker Visual Analogue Scale (VAS), which measured perceived pain level during periodontal probing and during subgingival visualization via endoscopy. Since subjects expressing some level of dental anxiety generally express increased levels of pain, a pre-treatment survey was also given to determine each subject's level of dental anxiety in order to eliminate dental anxiety as a confounding factor in determining the expressed level of pain. RESULTS: The level of perceived pain was significantly lower with the periodontal endoscope versus the probe (mean VAS 33.0 mm versus 60.2 mm, p<0.0001). Subjects who indicated some level of dental anxiety did express increased pain levels, but these levels were not statistically significant. CONCLUSION: Subjects did not find the periodontal endoscope to elicit significant anxiety or pain during subgingival visualization.