A new approach to root debridement: millimeter and furcation specific periodontal files

Objectives:Scaling and root planing (SRP) is one of the most commonly used procedures during periodontal treatment. The aim of this study was to evaluate the root surface roughness after SRP with erbium: yttrium aluminum garnet (Er:YAG) laser compared to ultrasonic and hand instruments.Materials and Methods:In this experimental study, 56 extracted sound single-rooted teeth with moderate level of calculus were selected and randomly divided into four groups: SRP was performed with Er:YAG laser (100 mJ pulse, 1W, 10Hz, VSP and contact mode, with 50% water and air) in group one, hand instrument in group two and ultrasonic tool in group three. Group four was considered as the control group. After SRP, all samples were cut by Servocut cutting machine into pieces with 3×3×2mm dimensions. The samples were mounted in acrylic resin. The surface roughness of the samples was evaluated with profilometry, and the data were analyzed using one-way ANOVA and Tukey’s test in SPSS software.Results:Surface roughness was higher in laser and lower in ultrasonic group compared to other groups. There was a significant difference in surface roughness between laser and ultrasonic groups (P=0.043), but there was no significant difference in surface roughness among other groups (P>0.05).Conclusion:The results of this study showed that surface roughness after SRP with Er:YAG laser was not higher than that after manual SRP, but the former value was higher than that after SRP with ultrasonic instrument.

The aim of this randomized clinical study is to evaluate the effect of a 980-nm diode laser as an adjunct to scaling and root planing (SRP) treatment. Thirty-five patients with chronic periodontitis were selected for the split-mouth clinical study. SRP was performed using a sonic device and hand instruments. Quadrants were equally divided between the right and left sides. Teeth were treated with SRP in two control quadrants (control groups [CG]), and the diode laser was used adjunctively with SRP in contralateral quadrants (laser groups [LG]). Diode laser therapy was applied to periodontal pockets on days 1, 3, and 7 after SRP. Baseline data, including approximal plaque index (API), bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL), were recorded before the treatment and 6 and 18 weeks after treatment. Changes in PD and CAL were analyzed separately for initially moderate (4 to 6 mm) and deep (7 to 10 mm) pockets. The results were similar for both groups in terms of API, BOP, PD in deep pockets, and CAL. The laser group showed only significant PD gain in moderate pockets during the baseline to 18-week (P <0.05) and 6- to 18- week (P <0.05) periods, whereas no difference was found between LG and CG in the remaining clinical parameters (P >0.05). The present study indicates that, compared to SRP alone, multiple adjunctive applications of a 980-nm diode laser with SRP showed PD improvements only in moderate periodontal pockets (4 to 6 mm).

The aim of this trial was to investigate changes occurring in the subgingival microbiological composition of subjects with aggressive periodontitis, treated with antimicrobial photodynamic therapy (aPDT), in a single episode, or scaling and root planing (SRP), in a split-mouth design on -7, 0, and +90 days. Ten patients were randomly assigned to either aPDT using a laser source in conjunction with a photosensitizer or SRP with hand instruments. Subgingival plaque samples were collected and the counts of 40 subgingival species were determined using checkerboard DNA-DNA hybridization. The data were analyzed using the method of generalized estimating equations (GEE) to test the associations between treatments, evaluated parameters, and experimental times (α = .05). The results indicated that aPDT and SRP affects different bacterial species, with aPDT being effective in reducing numbers of A. actinomycetemcomitans than SRP. On the other hand, SRP was more efficient than aPDT in reducing the presence of periodontal pathogens of the Red Complex. Additionally, a recolonization in the sites treated by aPDT was observed, especially for T. forsythia and P. gingivalis. Under our experimental conditions, this trial demonstrates that aPDT and SRP affected different groups of bacteria, suggesting that their association may be beneficial for the non-surgical treatment of aggressive periodontitis.

In the present investigation, a scanning electron microscopy analysis was performed to evaluate the effects of the topical application of ethylenediaminetetraacetic acid (EDTA) gel associated with Cetavlon (EDTAC) in removing the smear layer and exposing collagen fibers following root surface instrumentation. Twenty-eight teeth from adult humans, single rooted and scheduled for extraction due to periodontal reasons, were selected. Each tooth was submitted to manual (scaling and root planing) instrumentation alone or combined with ultrasonic instruments, with or without etching using a 24% EDTAC gel. Following extraction, specimens were processed and examined under a scanning electron microscope. A comparative morphological semi-quantitative analysis was performed; the intensity of the smear layer and the decalcification of cementum and dentinal surfaces were graded in 12 sets using an arbitrary scale ranging from 1 (area covered by a smear layer) to 4 (no smear layer). Root debridement with hand instruments alone or combined with ultrasonic instruments resulted in a similar smear layer covering the root surfaces. The smear layer was successfully removed from the surfaces treated with EDTAC, which exhibited numerous exposed dentinal tubules and collagen fibers. This study supports the hypothesis that manual instrumentation alone or instrumentation combined with ultrasonic instrumentation is unable to remove the smear layer, whereas the subsequent topical application of EDTAC gel effectively removes the smear layer, uncovers dentinal openings and exposes collagen fibers.

The aim of the present study was to compare the effectiveness of an Er:YAG laser to that of scaling and root planing for non-surgical periodontal treatment. Twenty patients with moderate to advanced periodontal destruction were treated under local anesthesia and the quadrants were randomly allocated in a split-mouth design to either Er:YAG laser using an energy level of 160 mJ/pulse and 10 Hz or scaling and root planing (SRP) using hand instruments. Clinical assessments of plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL) were made prior to and at 3 and 6 months after treatment. Subgingival plaque samples were taken at each appointment and analyzed using darkfield microscopy for the presence of cocci, non-motile rods, motile rods, and spirochetes. Differences in clinical parameters and prevalence of bacterial species were analyzed using the paired t-test. The PI remained nearly unchanged while a significant reduction of the GI occurred in both groups after 6 months (P < or =0.001, P< or =0.001, respectively). The mean value of BOP decreased in the laser group from 56% at baseline to 13% after 6 months (P < or =0.001) and in the SRP group from 52% at baseline to 23% after 6 months (P < or =0.001). The mean value of the PD decreased in the laser group from 4.9+/-0.7 mm at baseline to 2.9+/-0.6 mm after 6 months (P< or =0.001) and in the SRP group from 5.0+/-0.6 mm at baseline to 3.4+/-0.7 mm after 6 months (P < or =0.001). The mean value of the CAL decreased in the laser group from 6.3+/-1.1 mm at baseline to 4.4+/-1.0 mm after 6 months (P < or =0.001) and in the SRP group from 6.5+/-1.0 mm at baseline to 5.5+/-1.0 after 6 months (P < or =0.001). The reduction of the BOP score and the CAL improvement was significantly higher in the laser group than in the SRP group (P < or =0.05, P < or =0.001, respectively). Both groups showed a significant increase of cocci and non-motile rods and a decrease in the amount of motile rods and spirochetes. An Er:YAG laser may represent a suitable alternative for non-surgical periodontal treatment.

Experimental periodontitis was induced in monkeys by means of elastic orthodontic ligatures. The periodontally-involved teeth were then treated with different methods. At the end of the treatment period, the monkeys were sacrificed. The premolar-molar areas were dissected out and embedded in a low-viscosity embedding medium (Spurr). The results of the treatment procedures were analyzed on ground sections. Formation of new cementum and new bone was determined by means of tetracycline labeling. Root planing with an ultrasonic device or with hand instruments almost completely removed the cementum and a portion of the peripheral dentin. The root surface was more uneven after treatment with the ultrasonic device than after using hand instruments. No new attachment could be found after root planing. Cleaning of the periodontally-involved root surfaces with two detergents (cetylpyrimidinium chloride and sodium-N-lauroyl sarcosine) without root planing resulted in a significant amount of new attachment.

To evaluate the clinical efficacy of (i) a single session of "full-mouth ultrasonic debridement" (Fm-UD) as an initial periodontal treatment approach and (ii) re-instrumentation of periodontal pockets not properly responding to initial subgingival instrumentation. Forty-one patients, having on the average 35 periodontal sites with probing pocket depth (PPD) > or =5 mm, were randomly assigned to two different treatment protocols following stratification for smoking: a single session of full-mouth subgingival instrumentation using a piezoceramic ultrasonic device (EMS PiezonMaster 400, A+PerioSlim tips) with water coolant (Fm-UD) or quadrant scaling/root planing (Q-SRP) with hand instruments . At 3 months, all sites with remaining PPD> or =5 mm were subjected to repeated debridement with either the ultrasonic device or hand instruments. Plaque, PPD, relative attachment level (RAL) and bleeding following pocket probing (BoP) were assessed at baseline, 3 and 6 months. Primary efficacy variables were percentage of "closed pockets" (PPD< or =4 mm), and changes in BoP, PPD and RAL. The percentage of "closed pockets" was 58% at 3 months for the Fm-UD approach and 66% for the Q-SRP approach (p>0.05). Both treatment groups showed a mean reduction in PPD of 1.8 mm, while the mean RAL gain amounted to 1.3 mm for Fm-UD and 1.2 mm for Q-SRP (p>0.05). The re-treatment at 3 months resulted in a further mean PPD reduction of 0.4 mm and RAL gain of 0.3 mm at 6 months, independent of the use of ultrasonic or hand instruments. The efficiency of the initial treatment phase (time used for instrumentation/number of pockets closed) was significantly higher for the Fm-UD than the Q-SRP approach: 3.3 versus 8.8 min. per closed pocket (p<0.01). The efficiency of the re-treatment session at 3 months was 11.5 min. for ultrasonic and 12.6 min. for hand instrumentation (p>0.05). The results demonstrated that a single session of Fm-UD is a justified initial treatment approach that offers tangible benefits for the chronic periodontitis patient.

To investigate changes in periodontal parameters and superoxide dismutase activity after root surface debridement with and without omega-3 fatty acid (omega-3 FA) supplementation in postmenopausal women. Fifty postmenopausal women with chronic periodontitis were divided randomly into two groups. Group 1 (control group, n = 25) patients were provided with periodontal treatment in the form of scaling and root planing (SRP) plus soft gelatinous capsules containing only some olive oil, while group 2 (n = 25) received SRP along with systemic administration of omega-3 FAs in the same soft gelatinous capsules. Clinical parameters and superoxide dismutase (SOD) activity in the gingival crevicular fluid were recorded at baseline, 3 and 6 months after therapy. By the end of the study period, the omega-3-treated group achieved a greater mean probing pocket depth reduction, a mean gain in clinical attachment level especially in deep periodontal pockets, as well as a greater increase in SOD activity (p < 0.01) compared to SRP alone. Adjunctive omega-3 FAs supplements with SRP reduce periodontal inflammation and improve the status of systemic enzymatic antioxidants in postmenopausal women.

Current literature supports the use of powered instrumentation over traditional hand instrumentation. The objective of scaling and root planing is the complete removal of plaque and calculus from root surfaces. While this is unrealistic, the accepted end-point is a smooth, glassy root surface during periodontal instrumentation. This often has resulted in overinstrumentation and excessive removal of cementum. Cementum removal has been deemed generally unnecessary. What is essential is the removal of plaque, calculus, and the endotoxin adherent to the root surface. This cleaning of root surfaces is best done with judicious use of powered instrumentation. The excessive removal of cementum during hand instrumentation is due to the lack of visualization. Using endoscopic technology, the ability to visually debride roots can improve chances of success in a more conservative and minimally invasive way. This article provides a brief review of micro ultrasonic technologies and periodontal endoscopy, its implementation in our practice, and a limited case series.

The objective of this study was to evaluate the microbiological and clinical outcomes following nonsurgical treatment by either scaling and root planing, combination of Nd:YAG and Er:YAG lasers, or by Er:YAG laser treatment alone. The study involved 60 patients with generalized chronic periodontitis, randomly assigned into one of three treatment groups of 20 patients. The first group received scaling and root planing by hand instruments (SRP group), the second group received Er:YAG laser treatment alone (Er group), and the third group received combined treatment with Nd:YAG and Er:YAG lasers (NdErNd group). Microbiological samples, taken from the periodontal pockets at baseline and 6months after treatments, were assessed with PET Plus tests. The combined NdErNd laser (93.0%), followed closely by Er:YAG laser (84.9%), treatment resulted in the highest reduction of all bacteria count after 6months, whereas SRP (46.2%) failed to reduce Treponema denticola, Peptostreptococcus micros, and Capnocytophaga gingivalis. Full-mouth plaque and bleeding on probing scores dropped after 6months and were the lowest in both laser groups. The combination of NdErNd resulted in higher probing pocket depth reduction and gain of clinical attachment level (1.99 ± 0.23mm) compared to SRP (0.86 ± 0.13mm) or Er:YAG laser alone (0.93 ± 0.20mm) in 4-6mm-deep pockets. Within their limits, the present results provide support for the combination of Nd:YAG and Er:YAG lasers to additionally improve the microbiological and clinical outcomes of nonsurgical periodontal therapy in patients with moderate to severe chronic periodontitis.

The purpose of this study was to evaluate the effects of Nd:YAG laser treatment on root surfaces in vitro when used alone or in combination with conventional scaling and root planing. The study population consisted of 18 unerupted third molars, each with a 3 mm diameter treatment site outlined on the root surface. Three specimens were randomly assigned to each of 6 different treatment groups: 1) untreated control; 2) root planed only; 3) laser treated only using 1.25 W of energy; 4) laser treated only using 1.50 W of energy; 5) laser treated with 1.25 W of energy followed by root planing; and 6) laser treated with 1.50 W of energy followed by root planing. Following their respective treatment, all specimens were prepared for evaluation by scanning electron microscopy. Specimens from Group 2, root planed only, exhibited a smear layer of scale-like texture with parallel instrument tracks resulting from curet use. Specimens treated by laser only, Groups 3 and 4, featured various surface changes not observed in controls such as charring and carbonization of the cementum surface, randomly distributed pitting and crater formation, and melting of the root mineral phase with subsequent resolidification as porous globules. Those specimens treated by laser followed by root planing, Groups 5 and 6, exhibited surface characteristics similar to those noted in Group 2 specimens. Further, there were areas of exposed dentinal tubules resulting from a "peeling" of the cementum layer. The results of this in vitro study suggest that laser use during root preparation, even at relatively low energy levels, will result in physical changes to the root surface.(ABSTRACT TRUNCATED AT 250 WORDS)

Instrumentation on tooth surface for debridement of hard and soft debris forms the basis of periodontal therapy. This involves periodic removal of accumulated material using different methods of instrumentation. An ideal instrument should eliminate all the deposits from the root surfaces with no or minimal alteration of the natural morphology. To compare the root surface roughness after root planing performed with gracey curette and by ultrasonic scalers (Satelec P-5 Booster) set at different power modes. The root surface roughness and its surface microtopography resulting from the use of Gracey curette, ultrasonic instrument at low, medium and high power setting on 35 healthy premolars extracted for orthodontic treatment purpose were examined using Optical Profilometer and the surface topography was assessed using Field Emission Microscope. Analysis of variance (ANOVA) test was used to observe the variance in a particular variable is partitioned into components attributable to different sources of variation. Duncan multiple range tests were used to determine whether three or more means differ significantly. The mean roughness was found to be the highest in group where Scaling and Root Planing (SRP) was performed using ultrasonic scaler at low power mode (3.03±1.54 μm) whereas the lowest surface roughness was seen on the samples where SRP was performed using ultrasonic scaler at medium power mode. The surface roughness in group where SRP was performed with ultrasonic scaler at high power mode (2.22±0.74μm) was found to be similar to that of group in which root planing was carried out using curette (2.24±1.71μm).

This was a multicentre randomised controlled trial (RCT). Pregnant women were divided into two groups. Those to whom dental treatment was given had up to four visits of periodontal scaling and root planing using ultrasonic and hand instruments, with local anaesthesia as needed. Treatment recipients were also given instruction in oral hygiene and monthly tooth polishing and re-instruction in oral hygiene, with scaling and planing as needed. Control patients received only a brief oral examination at monthly follow-ups but attended the same number of visits as the treatment group. Patients in the control group were offered the same periodontal therapy after delivery. The primary outcome was gestational age at delivery. Secondary outcomes included birth weight, the proportion of infants who were small for gestational age, Apgar scores, and admissions to a neonatal intensive care unit. Preterm birth (before 37 weeks of gestation) occurred in 49 out of 407 women (12.0%) in the treatment group (resulting in 44 live births) and in 52 out of 405 women (12.8%) in the control group (resulting in 38 live births). Although periodontal treatment improved periodontitis measures (P<0.001), it did not significantly alter the risk of preterm delivery [P 0.70; hazard ratio for treatment group versus control group, 0.93; 95% confidence interval (CI), 0.63-1.37]. There were no significant differences between the treatment and control groups in mean babies' birth weights (3239 g versus 3258 g; P 0.64) or in the rate of delivery of infants who were small for gestational age (12.7% versus 12.3%; odds ratio, 1.04; 95% CI, 0.68-1.58). There were five spontaneous abortions or stillbirths in the treatment group, compared with 14 in the control group (P 0.08). Treatment of periodontitis in pregnant women improves periodontal disease and is safe but does not significantly alter rates of preterm birth, low birth weight or foetal growth restriction.

The aim of this study was to compare the clinical and microbiological healing outcomes following non-surgical periodontal therapy using a modified sonic scaler system versus scaling and root planing (S/RP) with hand instruments. The study comprised 20 chronic periodontitis patients. Using a split-mouth design, both treatment modalities were randomly applied to one quadrant of the upper and lower jaws. Clinical and microbiological parameters were assessed at baseline, 4 weeks, and 6 months after treatment. Furthermore, post-operative hypersensitivity was investigated. The Wilcoxon signed-rank test (alpha = 0.05) was used for statistical analysis. With both therapy methods, periodontal conditions showed statistically significant clinical and microbiological improvements after 4 weeks and 6 months. Hypersensitive teeth were found only 4 weeks after S/RP. Besides a significantly better bleeding on probing reduction in deep S/RP sites and less time required for root instrumentation by the sonic scaler, no other clinical and microbiological parameters revealed significant differences between sites treated with the sonic scaler or S/RP. The sonic scaler system and S/RP seem to provide similarly favourable periodontal healing results, although in deep pockets S/RP appeared to achieve a better resolution of inflammation.

Results of recent studies have suggested an association between periodontitis and several adverse pregnancy outcomes—preeclampsia, preterm birth, and low birth weight. Although the possibility that periodontal treatment during pregnancy may lessen the risk of preterm birth had been suggested by two previous single center clinical trials, a third study found no association between periodontal treatment and reduced preterm birth. This randomized, blinded trial, the Obstetrics and Periodontal Therapy (OPT) Study, randomly assigned women with periodontal disease, first seen at 13–17 weeks’ gestation, to have scaling and root planing either before 21 weeks’ gestation (n = 413) or following delivery (n = 410). Both ultrasonic and hand instruments were used to remove dental plaque and calculus from the tooth enamel and root. Women in the treatment group also had tooth polishing at monthly intervals and were instructed in oral hygiene. Most of the patients had generalized early-to-moderate periodontitis. The women who did and did not receive periodontal treatment did not differ significantly in gestational age at the end of pregnancy. The incidence of birth before 37 weeks’ gestation was 12.0% in the treatment group and 12.8% in the control group. Similar results were obtained after excluding spontaneous abortions and indicated preterm births, and after adjusting for baseline features. On competing-risks analysis, there were no group differences in the risk of live preterm birth, spontaneous abortion, or stillbirth. Serious adverse events, including hospital admission for any reason, were comparably frequent in the two groups. The treatment and control groups did not differ significantly with respect to birth weight or small-for-gestational-age births. Spontaneous abortions and stillbirths totaled 5 in the treatment group and 14 in the control group. Compared to postpartum treatment, treating periodontitis before 21 weeks’ gestation did not significantly increase the risk of preterm delivery in the OPT Study. The periodontal treatment was effective in promoting oral health, and did not produce serious complications or side effects.