Hand Curettes Research Articles

Effect of Hand and Ultrasonic Scaling-Root Planing Methods on Tooth Surface Topography: An In-Vitro Atomic Force Microscopy Study.

Any instrumentation on the tooth surface for plaque or calculus removal will cause some amount of roughness on the tooth surface. Hence, this study was proposed to investigate the effects of hand and ultrasonic scaling and root planing on enamel and cementum, respectively. Forty tooth samples were prepared from extracted maxillary and mandibular first pre-molars and were divided randomly into four groups of 10 samples each. Group l: received ultrasonic scaling on enamel; Group II: received hand scaling on enamel surface; Group III: root planing with an ultrasonic unit on the cementum samples; and Group IV: root planing using hand curettes on cementum surface. The amount of roughness produced on the surface of each sample of all four groups was evaluated using atomic force microscopy (AFM) and statistically analyzed using Chi-square, ANOVA, and Wilcoxon tests. The results suggested that the surface roughness produced on both crown and root after scaling and root planing (SRP) using a hand instrument is lower than that of an ultrasonic unit. The roughness of the crown was found to be lower than that of the root after SRP using both a hand instrument and an ultrasonic unit and was also statistically significant (P= 0.034). In contrast, there is not enough evidence to conclude a significant difference (P=0.13) between root planing using hand instruments and ultrasonic scaler groups. The combined p-value using the Chi-square test (P=0.026) suggests a statistically significant overall difference between crown and root groups. From the present study, the authors concluded that scaling as well as root planing using an ultrasonic unit cause more tooth (enamel and cementum) surface roughness as compared to hand scaling and root planing. While there is no significant difference in the surface roughness of root-cementum produced due to the root planing in both groups, crown-enamel exhibits a significant difference after scaling in both groups. Clinical significance of the study: Rough, uneven tooth surfaces negatively influence the anticipated healing of the periodontium by providing retention areas for microbial dental plaque.

The Effect of Nonaugmentative Approaches in the Surgical Treatment of Peri-implantitis: A Systematic Review and Network Meta-analysis

This systematic review and Bayesian network meta-analysis (NMA) were performed to compare the clinical effects of nonaugmentative adjunctive approaches in the surgical treatment of peri-implantitis. A systematic search of six electronic databases was performed up to June 20, 2020. Additional relevant literature was identified through gray literature and hand searches. Randomized controlled trials (RCTs) of surgical treatment of periimplantitis with nonaugmentative adjunctive approaches were included. Probing depth (PD) changes, marginal bone level (MBL) changes, and treatment success rates were extracted and assessed. Pairwise meta-analysis and Bayesian NMA were performed. This review was registered at PROSPERO (CRD42020191113). The search yielded 7,419 articles, of which 10 studies with 11 articles were included in the quantitative analysis. In the NMA of mechanical approaches and photodynamic therapy (PDT), compared with hand curettes, implantoplasty provided significant additional PD improvement at the 6-month follow-up evaluation (mean difference [MD]: 1.29; 95% confidence interval [CI]: 0.17, 2.38) and 12-month follow-up evaluation (MD: 1.39; 95% CI: 0.91, 1.74). In the NMA of antiseptics and systemic antibiotics, adjunctive use of antiseptics and/or systemic antibiotics did not provide significant improvement in PD or MBL. In the NMA of all adjunctive approaches, no significant differences were found in PD improvements. Within the limitations of this systematic review and NMA, implantoplasty is more effective than hand curettes in improving PD in the surgical treatment of peri-implantitis. Chemical antiseptics or systemic antibiotics have a limited effect on improving PD and MBL.

A novel in vitro periodontal pocket model to evaluate the effect of root surface instrumentation on biofilm-epithelial cell interactions.

ObjectiveTo develop a novel in vitro periodontal pocket model for evaluating the effect of two different root surface instrumentation modalities on biofilm-epithelial cell interactions.Materials and methodsAn artificial periodontal pocket model was created using an impression material. Dentin discs were prepared and incubated for 3.5 days with a biofilm consisting of 12 bacterial strains. Then, the discs were inserted into the pocket model and instrumented for 10 s or 10 strokes either with ultrasonics (US) or hand instruments (HI). Subsequently, a glass slide coated with epithelial cells was placed in close vicinity to the discs. After incubation of the pocket model in a 5% CO2 atmosphere for 6 h, residual bacteria of the biofilm as well as bacteria adhering to or invaded into epithelial cells were determined using colony-forming unit (cfu) counts and real-time PCR. Further, as a parameter of the pro-inflammatory cell response, interleukin (IL)-8 expression was determined by ELISA.ResultsCompared to untreated control, HI reduced the cfu counts by 0.63 log10 (not significant) and US by 1.78 log10 (p = 0.005) with a significant difference between the treatment modalities favoring US (p = 0.048). By trend, lower detection levels of Tannerella forsythia were detected in the US group compared to HI. Concerning the interaction with epithelial cells, half of the control and the HI samples showed epithelial cells with attaching or invading bacteria, while US displayed bacteria only in two out of eight samples. In addition, US resulted in significantly lower IL-8 secretion by epithelial cells compared to the untreated control. Between HI and controls, no statistically significant difference in IL-8 secretion was found.ConclusionThis newly developed in vitro model revealed in terms of biofilm-epithelial cell interaction after root surface instrumentation that compared to hand curettes, ultrasonic instrumentation appeared to be more effective in removing bacterial biofilm and in decreasing the inflammatory response of epithelium to biofilm.Clinical relevanceUltrasonic instrumentation might be more advantageous to reduce cellular inflammatory response than hand instruments.

Effect of 940 nm Diode Laser as Adjunct Treatment to Mechanical Instrumentation on Root Surface Gingival Fibroblast Adhesion in Periodontally Compromised Extracted Teeth : An in vitro Study

Introduction: Mechanical debridement of diseased root surfaces produces a smear layer that encompass microorganisms and residual cementum which may interfere with periodontal healing and regeneration of connective tissue attachment. Accordingly, this study aimed to determine impact of 940nm diode laser on adhesion of fibroblasts to root surface of extracted teeth from patients with chronic periodontitis. Methods: Twenty extracted single-rooted teeth with hopeless prognosis were collected and debrided with hand curettes. Afterward, two specimens were obtained from each tooth by splitting them with a sterile diamond disk. Samples were submerged in fibroblast suspension and randomly divided into two groups. Group A comprised of 20 specimens subjected to scaling and root planing only and group B included 20 specimens which received SRP and and 940 nm diode laser irradiation. The adhesion of fibroblasts was investigated by MTT and cell morphology was assessed with scanning electron microscopy (SEM). Results: The extent of adhesion was higher in group B compared with group A, though this difference was not statistically significant. In the laser group, fibroblast cells showed more elongated morphology and a smaller number of rounded forms was found. But no significant difference was observed between the two groups. Conclusion: A diode laser with a wavelength of 940 nm has a negligible effect on adhesion of fibroblasts to the root surface of teeth extracted because of chronic periodontitis

Clinical outcomes following periodontal surgery and root surface decontamination by erythritol-based air polishing. A randomized, controlled, clinical pilot study

AimTo evaluate the outcomes following surgical periodontal treatment and root surface decontamination by means of air polishing using an erythritol powder or conventional mechanical root debridement.Material and methodsThirty systemically healthy patients (44.38 ± 8.2 years old, 11 smokers, 19 women) diagnosed with periodontitis stages III–IV were included. Each patient, with one single-rooted tooth, with one probing pocket depth (PD) ≥ 6 mm associated with horizontal bone loss, was treated by means of simplified papilla preservation flap (SPPF) and randomized to either test treatment (careful removal of the calculus with the tip of a blade, air polishing of the root surfaces with erythritol) or to the control group (scaling and root planing with hand curettes, ultrasonic instruments). PD, clinical attachment (CAL), bone sounding (BS), and radiographic bone level (BL) were evaluated at baseline and 12 months postsurgically.ResultsTwenty-seven patients completed the 12-month follow-up (test: n = 14, control: n = 13). In both groups, statistically significant improvements were obtained (p < 0.05, mean CAL gain/PD reduction: test, 2.50 ± 1.60 mm/3.00 ± 0.96 mm; control, 2.85 ± 1.21 mm/3.38 ± 1.12 mm). No statistically significant differences were observed between the groups for any of the investigated parameters (p < 0.05).ConclusionWithin their limits, the present results indicate that the use of air polishing with an erythritol powder during periodontal surgery may represent a valuable minimally invasive adjunct following calculus removal by means of hand and ultrasonic instruments or a valuable alternative to these, for root surfaces without calculus.Clinical relevanceThe use of air polishing with an erythritol powder during periodontal surgery appears to represent a valuable minimally invasive adjunct following calculus removal by means of hand and ultrasonic instruments or a valuable alternative to these, for root surfaces without calculus.

Nano-Hydroxyapatite Airborne-Particle Abrasion System as an Alternative Surface Treatment Method on Intraorally Contaminated Titanium Discs.

The aim of this study was to test the nano-hydroxyapatite powder decontamination method on intraorally contaminated titanium discs and to compare this method with current decontamination methods in the treatment of peri-implantitis. Contaminated discs were assigned to six treatment groups (n = 10 each): titanium hand curette; ultrasonic scaler with a plastic tip (appropriate for titanium); ultrasonic scaler with a plastic tip (appropriate for titanium) + H2O2; short-term airflow system (nano-hydroxyapatite airborne-particle abrasion for 30 seconds); long-term airflow system (nano-hydroxyapatite airborne-particle abrasion for 120 seconds); Er:YAG laser (120 mJ/pulse at 10 Hz). There were also two control groups (n = 10 each): contaminated disc (negative control) and sterile disc (positive control). Scanning electron microscopy, energy-dispersive x-ray spectroscopy, and dynamic contact angle analysis were used to determine the most effective surface-treatment method. The highest percentage of carbon (C) atoms was observed in the negative control group, and the lowest percentage of C atoms was found in the long-term airflow group, followed by the short-term airflow, laser, ultrasonic + H2O2, ultrasonic, and mechanical groups. When the groups were examined for wettability, the lowest contact angle degree was observed in the long-term airflow, short-term airflow, and laser groups. Nano-hydroxyapatite and laser treatments for detoxifying and improving infected titanium surfaces may show the most suitable results for reosseointegration.

Combining various non‐surgical techniques for treating peri‐implantitis – A randomized clinical trial

Background Non-surgical treatment of peri-implantitis is targeted at mechanical and or chemical disinfection of the implant and its suprastructures, to allow inflamed peri-implant tissues to heal. Many different surgical and non-surgical techniques for the treatment of peri-implantitis have been investigated, with varying results. However, a combination of various non-surgical techniques in a single treatment session in a full-mouth disinfection protocol has not been investigated yet. Aim/Hypothesis To determine if a combination of various non-surgical techniques in a single treatment session, comprised of using hand curettes and carbon-tipped ultrasonic, air abrasion, and Er-YAG-laser therapy in a full-mouth disinfection protocol, leads to short-term resolution of peri-implantitis. Material and Methods 27 patients with one or more dental implants with clinical and radiographic signs of peri-implantitis were divided ad random into two groups. The test group (11 patients, 31 implants) received debridement of the affected implants, using hand curettes, carbon-tipped ultrasonics, air-abrasion with glycine powder and Er-YAG-laser irradiation. Additionally, full-mouth disinfection was performed on all teeth with pockets > 4 millimeters. The control group (16 patients, 30 implants) received debridement of the implants only by hand curettes. This group did not undergo a full-mouth disinfection. For both groups, all treatments were performed in a single session. Bleeding on probing (BoP) scores, peri-implant probing depths (PPD), clinical attachment levels (CAL), interproximal bone levels (BL) and full-mouth plaque scores (FMPS) were recorded at intake and at 3 and 6 months after treatment. Results The test group showed statistically significantly more reduction in bleeding on probing scores at the 3 and 6 months of follow-up despite of an increase of scores in the test group in between 3 and 6 months after treatment. Both groups showed a statistically significant decrease in PPD after 3 months (P = 0.009 and P = 0.0008 for the control and test groups respectively). The difference in decrease between both groups was statistically significant in favor of the test group (P = 0.0001). At 6 months an increase in PPD was observed for both groups. The difference at 6 months was no longer statistically significant. Changes in bone level from intake to 3 months and 6 months after treatment were not statistically significant. Neither were differences in bone level changes in between both groups. Conclusion and Clinical Implications A more thorough debridement protocol can result in greater resolution of inflammation in the peri-implant tissues and the effects can be sustained up to 6 months after treatment. Clinically this implicates that a more comprehensive mechanical and or chemical disinfection protocol is beneficial for the treatment of implants affected by peri-Implantitis.

Evaluation of Remaining Cementum Thickness Following the Use of Hand and Ultrasonic Curettes of Periodontally Diseased Root Surface - An in-vitro Study

Background: Scaling and root planing are the most predictable treatment outcomes for periodontal disease. However root planing with hand curettes removes excess of cementum as compared to ultrasonic curettes. Hence the purpose of this study was to evaluate the effectiveness of remaining cementum thickness following the use of ultrasonic and hand curettes. Aim: To evaluate the remaining cemental thickness following the use of hand and ultrasonic curettes on periodontally diseased root surface using a stereomicroscope. Materials and Methods: Thirty single rooted teeth were extracted due to advanced periodontitis and were randomly divided into two groups: Group 1 (SRP with hand curettes) and Group 2 (SRP with ultrasonic curettes). The proximal surfaces of the teeth (mesial and distal) were subjected to root planning. one surface served as a test site where instrumentation was done and no instrumentation was done on the other surface (control site). Following instrumentation, midroot region of instrumented specimen was cross-sectioned and prepared for stereomicroscopic study. The data gathered from stereomicroscopic study was subjected to statistical analysis by Mann Whitney test. Results: The results of our study showed that in both the groups, the mean cemental thickness in scaled group was significantly lower than unscaled group. Clinically, teeth treated with the ultrasonic scaler showed less tooth substance removal than hand curettes but the difference between the two groups were statistically non-significant. Conclusion: Both the therapies i.e. SRP with hand curettes and ultrasonic curettes seemed to be effective in the removal of diseased cementum.

Effects of Root Debridement With Hand Curettes and Er:YAG Laser on Chemical Properties and Ultrastructure of Periodontally-Diseased Root Surfaces Using Spectroscopy and Scanning Electron Microscopy.

Introduction: The efficacy of erbium-doped yttrium aluminum garnet (Er:YAG) laser for root debridement in comparison with curettes has been the subject of many recent investigations. Considering the possibility of chemical and ultra-structural changes in root surfaces following laser irradiation, this study sought to assess the effects of scaling and root planing (SRP) with curettes and Er:YAG laser on chemical properties and ultrastructure of root surfaces using spectroscopy and scanning electron microscopy (SEM). Methods: In this in vitro experimental study, extracted sound human single-rooted teeth (n = 50) were randomly scaled using manual curettes alone or in conjunction with Er:YAG laser at 100 and 150 mJ/pulse output energies. The weight percentages of carbon, oxygen, phosphorous and calcium remaining on the root surfaces were calculated using spectroscopy and the surface morphology of specimens was assessed under SEM. Data were analyzed using one-way analysis of variance (ANOVA). Results: No significant differences (P > 0.05) were noted in the mean carbon, oxygen, phosphorous and calcium weight percentages on root surfaces following SRP using manual curettes with and without laser irradiation at both output energies. Laser irradiation after SRP with curettes yielded rougher surfaces compared to the use of curettes alone. Conclusion: Although laser irradiation yielded rougher surfaces, root surfaces were not significantly different in terms of chemical composition following SRP using manual curettes with and without Er:YAG laser irradiation. Er:YAG laser can be safely used as an adjunct to curettes for SRP.

Use of a trephine bur and curette for minimally invasive harvesting of particulate cancellous bone and marrow from the iliac crest: a case of alveolar ridge reconstruction.

Iliac particulate cancellous bone and marrow (PCBM) is still the most predictable autogenous graft material for vertical ridge reconstruction because of its high cell content as well as osteoinductive and osteoconductive properties. However, postoperative meralgia paresthetica, gait disturbance, pain, and bleeding have been reported following conventional harvesting from the anterior iliac crest. We present a case of minimally invasive harvesting of iliac PCBM. A short incision was made, and the iliac crest was exposed after elevation of the periosteal membrane. Only the iliac cortical bone was removed using a trephine bur to avoid perforation. PCBM was harvested with hand curettes and grafted into the vertical ridge defect. Because of the small surgical field, gait disturbance was resolved within 1 day without other postoperative complications. This technique is potentially useful for harvesting a small amount of iliac PCBM.

Evaluation of root roughness after using diamond tips, ultrasound tips, and hand curettes in human teeth, in vitro study

ABSTRACTObjective: This in vitro study aimed to compare the degree of root roughness in human teeth after using hand curettes, stainless steel, and diamond ultrasound tips. Material and Methods: The scaling was performed on the root surface of 36 human teeth previously standardized and randomly divided into three groups (n = 12). The roughness degree was measured with the aid of a rugosimeter, before and after the scaling, through readings perpendicular and parallel to the scaling direction. The statistical analysis comprised Wilcoxon and Kruskal-Wallis tests (p &lt; 0.05). The qualitative and visual complementation of the results was performed by scanning electronic microscopy. Results: The scaling executed with hand curettes increased root roughness (before - Ra median = 0.1583 µm; after = 0.7783 µm; before - Rz median =1.667 µm; after = 7.350 µm). The degree of root roughness also increased when stainless steel ultrasound (before - Ra median = 0.1483 µm; after = 0.3933 µm; before- Rz median = 1.567 µm; after = 4.333 µm) and diamond tips were used (before - Ra median = 0.1800 µm; after = 2.457 µm; before - Rz median = 1.850 µm; after = 18.58 µm). Conclusion: The superficial roughness significantly increased in all groups. The scaling with diamond tips promoted the greatest root roughness than hand curettes and ultrasound tips. Keywords: Dental biofilm; Dental scaling; Periodontics; Superficial roughness.

EFFECT OF HAND, ULTRASONIC SCALER AND ERBIUM-DOPED YTTRIUM ALUMINUM GARNET (ER: YAG) LASER ON THE MORPHOLOGY OF ROOT SURFACES WITH PERIODONTITIS: A COMPARATIVE IN VITRO SCANNING ELECTRON MICROSCOPY STUDY

Introduction: The main purpose of the present study was to describe the ultra structural changes which happened after treatment of the root surfaces with ultrasonic and hand devices followed by Erbium-Doped Yttrium Aluminum Garnet (Er:YAG) laser irradiation. Methods: Sixty single-rooted maxillary and mandibular teeth which had been extracted due to periodontal problems were collected. Crown and apical parts of the root were cut off using a diamond bur. The specimens were mounted on an acrylic resin in order to make a plain surface of the root accessible. The samples were assigned as following: group1: samples were root planed using conventional hand curette, group2: were prepared by ultrasonic device, group3: roots after scaling by hand instrumentation were treated by Er:YAG laser with 50 mJ/pulse and frequency of 10 Hz, group4: roots were prepared by ultrasonic scaler and consequently were treated by laser. Furthermore, the teeth were dried, sputter-coated with gold, and monitored with scanning electron microscope (SEM). Results: Photomicrographs from ten samples of root surfaces which were taken at magnifications up to 500X revealed that there were not any severe morphologic changes, such as melting and charring, in any group. However, the samples treated by laser irradiation showed more irregularities and distortions. Conclusion: Er:YAG laser setting at 50mj/pulse, as an adjunctive to traditional scaling and root planning, did not induce severe damages to root surfaces, although root surface irregularities were more pronounced in laser treated groups compare to hand instruments.

Er:YAG Lasers Versus Ultrasonic and Hand Instruments in Periodontal Therapy: Clinical Parameters, Intracrevicular Micro-organism and Leukocyte Counts

The aim of this study was to compare the clinical parameters and crevicular cell population, particularly leukocyte counts, changes after initial periodontal therapy with different instruments by a chairside laboratory technique, in severe periodontitis patients. Although scaling and root planing (SRP) with hand curettes or ultrasonic scalers may alter the subgingival microbial composition and improve clinical parameters, it is known that this effect decreases as the pocket depth (PD) increases. Thirty systemically healthy subjects with severe chronic periodontitis were randomly assigned to three groups (n=10), and were treated either with hand curettes, ultrasonic scalers, or Er:YAG laser alone. Clinical measurements were made before and 90 days after treatment. A total of four subgingival plaque samples were collected from pockets with a PD 4-6 and ≥7 mm and were analyzed with a phase-contrast microscopy for microorganism proportions and leukocyte counts at baseline and 7 and 90 days after treatment. From day 0 to day 90, clinical parameters were significantly improved in all groups (p<0.01), but there were no significant differences among groups. Laboratory assessments revealed significant differences in all groups between baseline, day 7, and day 90. However, considering changes from day 7 to day 90, hand curettes were the most successful for maintaining the levels of micro-organisms and leukocytes. Although Er:YAG lasers are promising in treating periodontitis, the results of this study favor finishing SRP with hand curettes. Moreover, as there is a similar tendency between micro-organism and leukocyte count changes, leukocyte counts may be used as chairside marker to evaluate the efficacy of SRP.

Evaluation of root surface microtopography following the use of four instrumentation systems by confocal microscopy and scanning electron microscopy: an in vitro study

The ideal instrument for initial periodontal therapy should enable the removal of all extraneous substances from the root surfaces without any iatrogenic effects. Because of that the objective of this study is to analyse and to compare the root surface roughness after using Gracey curettes, termination diamond burs (40 μm), a piezo-ceramic ultrasonic scaler and a piezosurgery ultrasonic scaler using confocal microscopy and scanning electron microscopy. A 2 mm × 2 mm interproximal root area of 20 teeth (n = 40 surfaces) was evaluated by confocal microscopy (×20 magnification) and scanning electron microscopy (×50 to ×1000 magnification). Teeth were randomly assigned to the following four groups: Gracey curettes with 15 vertical strokes; termination diamond burs (40 μm) at 3000 r.p.m.; a piezo-ceramic ultrasonic scaler with a power of 11; and a piezosurgery ultrasonic scaler in mode ROOT with a power of two. Confocal microscopy revealed that curettes [mean changes in the value of surface roughness average reduced by 0.11 ± 0.3], piezo-ceramic ultrasonic scaler (roughness average reduced by 0.47 ± 0.93) and piezosurgery ultrasonic scaler (roughness average reduced by 0.62 ± 0.93) left a smoother surface than termination diamond burs (roughness average increased by 0.39 ± 0.18). Statistically significant differences were observed in roughness (p = 0.005) between piezosurgery and termination diamond burs (p = 0.005). No statistically significant differences were between piezosurgery and Gracey curettes (p = 0.140) and between piezosurgery and piezo-ceramic ultrasonic scalers (p = 0.745). Confocal microscopy and scanning electron microscopy showed that piezosurgery seems to leave the smoothest surface. Surfaces treated with termination burs appear to show more scratches and pits. Three of the four instruments tested for root planing reduced surface roughness; however, the piezosurgery ultrasonic scaler produced the smoothest surface. The termination diamond burs (40 μm) produced a rougher surface than the ultrasonic instruments and the hand curettes. Further clinical studies are needed.

A comparative evaluation of the efficacy of manual, magnetostrictive and piezoelectric ultrasonic instruments: an in vitro profilometric and SEM study

ObjectivesThe debridement of diseased root surface is usually performed by mechanical scaling and root planing using manual and power driven instruments. Many new designs in ultrasonic powered scaling tips have been developed. However, their effectiveness as compared to manual curettes has always been debatable. Thus, the objective of this in vitro study was to comparatively evaluate the efficacy of manual, magnetostrictive and piezoelectric ultrasonic instrumentation on periodontally involved extracted teeth using profilometer and scanning electron microscope (SEM). Material and Methods30 periodontally involved extracted human teeth were divided into 3 groups. The teeth were instrumented with hand and ultrasonic instruments resembling clinical application. In Group A all teeth were scaled with a new universal hand curette (Hu Friedy Gracey After Five Vision curette; Hu Friedy, Chicago, USA). In Group B CavitronTM FSI - SLITM ultrasonic device with focused spray slimline inserts (Dentsply International Inc., York, PA, USA) were used. In Group C teeth were scaled with an EMS piezoelectric ultrasonic device with prototype modified PS inserts. The surfaces were analyzed by a Precision profilometer to measure the surface roughness (Ra value in µm) consecutively before and after the instrumentation. The samples were examined under SEM at magnifications ranging from 17x to 300x and 600x. ResultsThe mean Ra values (µm) before and after instrumentation in all the three groups A, B and C were tabulated. After statistically analyzing the data, no significant difference was observed in the three experimental groups. Though there was a decrease in the percentage reduction of Ra values consecutively from group A to C. ConclusionWithin the limits of the present study, given that the manual, magnetostrictive and piezoelectric ultrasonic instruments produce the same surface roughness, it can be concluded that their efficacy for creating a biologically compatible surface of periodontally diseased teeth is similar.

A comparison of root surface instrumentation using manual, ultrasonic and rotary instruments: An in vitro study using scanning electron microscopy

The commonly accepted idea concerning root planing is that excessive removal of cementum is not necessary for removal of endotoxins. The ideal instrument should enable the removal of all extraneous substances from the root surfaces, without causing any iatrogenic effects. To compare the remaining calculus, loss of tooth substance, and roughness of root surface after root planing with Gracey curette, ultrasonic instrument (Slimline insert FSI-SLI-10S), and DesmoClean rotary bur. The efficiency of calculus removal, the amount of lost tooth substance, and root surface roughness resulting from the use of hand curette, ultrasonic instrument, and rotary bur on 36 extracted mandibular incisors were examined by SEM. We used three indices to measure the changes: Remaining calculus index (RCI), Loss of tooth substance index (LTSI), and Roughness loss of tooth substance index (RLTSI). Twelve samples were treated with each instrument. The time required for instrumentation was also noted. Kruskal-Wallis ANOVA was used for multiple group comparisons and the Mann-Whitney test for group-wise comparisons. Analysis was carried out with SPSS software (version 13). The RCI and LTSI showed nonsignificant differences between the three groups. RLTSI showed a significant difference between Slimline and hand curette as well as Slimline and Desmo-Clean. Slimline showed the least mean scores for RCI, LTSI, and RLTSI. Thus, even though the difference was not statistically significant, Slimline insert was shown to be better than the other methods as assessed by the indices scores and the instrumentation time.

Comparative evaluation of roughness of titanium surfaces treated by different hygiene instruments

PurposeThe use of appropriate instruments to clean surfaces with minimal change, is critical for the successful maintenance of a dental implant. However, there is no consensus about the type and methodology for such instruments. The aim of this study was to characterize changes in the roughness of titanium surfaces treated by various scaling instruments.MethodsThirty-seven identical disks (5 mm in diameter) were investigated in this study. The specimens were divided into eight groups according to the types of instrumentation and the angle of application. Ultrasonic scaling systems were applied on a titanium disk to simulate standard clinical conditions. The equipment included a piezoelectric ultrasonic scaler with a newly developed metallic tip (NS group), a piezoelectric ultrasonic scaler with a conventional tip (CS group), a piezoelectric root planer ultrasonic scaler with a conventional tip (PR group), and a plastic hand curette (PH group). In addition, the sites treated using piezoelectric ultrasonic scaler systems were divided two sub-groups: 15 and 45 degrees. The treated titanium surfaces were observed by scanning electron microscopy (SEM), and the average surface roughness (Ra) and mean roughness profile depth (Rz) were measured with a profilometer.ResultsSEM no significant changes in the titanium surfaces in the NS group, regardless of the angle of application. The PH group also showed no marked changes to the titanium surface, although some smoothening was observed. All CS and PR sites lost their original texture and showed irregular surfaces in SEM analysis. The profilometer analysis demonstrated that the roughness values (Ra and Rz) of the titanium surfaces increased in all, except the PH and NS groups, which showed roughness decreases relative to the untreated control group. The Ra value differed significantly between the NS and PR groups (P<0.05).ConclusionsThe results of this study indicated that changes in or damage to titanium surfaces might be more affected by the hardness of the scaler tip than by the application method. Within the limitations of this study, the newly developed metallic scaler tip might be especially suitable for peri-implant surface decontamination, due to its limited effects on the titanium surface.

Root surface defect produced by hand instruments and ultrasonic scaler with different power settings: an in vitro study

The aim of this study was to evaluate the root surface defect produced by hand curettes and ultrasonic tips with different power settings. Forty root surfaces were divided into 4 groups according the treatment: Gracey curettes, ultrasonic scaler at 10% power, ultrasonic scaler at 50% power and ultrasonic scaler at 100% power. Each specimen was instrumented with 15 strokes and the and divided in the middle to evaluate: (1) the defect depth produced by the instrumentation and (2) contact area of the instrument tips, which was analyzed by scanning electron microscopy. ANOVA and Tukey's test were used for statistical analysis (alpha =0.05). The results (mean +/- SD) of the contact area showed significantly greater defects (p<0.05) for the hand instrumented groups (2092.9 +/- 482) compared to the ultrasonic groups (606.8 +/- 283.0; 858.6 +/- 422.5; 1212.0 +/- 366.7, respectively), independently of the power setting. The values for the defect depth on root surface showed no statistically significant difference (p<0.05) between hand instrumentation (66.1 +/- 34.0) and ultrasonic scaling at 10%, 50% or 100% power settings (52.4 +/- 22.1; 72.0 +/- 29.9; 77.7 +/- 37.7, respectively). The findings of this study demonstrate that ultrasonic instrumentation produced a similar defect depth to that of hand instrumentation, with a smaller tip contact area, independently of the power setting used for scaling.

Comparative in vitro study of root roughness after instrumentation with ultrasonic and diamond tip sonic scaler

Objective:The purpose of this study was to evaluate the root surface roughness after instrumentation with hand curette and diamond-coated sonic and universal ultrasonic tips.Materials and Methods:Forty root surfaces of human teeth were randomly assigned to four treatment groups: control group (without instrumentation), curette instrumentation, ultrasonic instrumentation with universal tip and sonic instrumentation with diamond-coated tip. Each sample was instrumented with fifteen strokes. Before and after instrumentation, surface roughness was measured. In addition, the root surface topography was examined after treatment under the scanning electron microscope.Results:Significant statistical differences (p<0.05) were observed when comparing the control group (0.48±0.07mm) to the treated groups (hand - 1.246±0.279mm, ultrasonic - 1.468±0.177mm and sonic instrumentation - 1.576±0.20mm). The highest roughness was produced by diamond-coated sonic tip and by ultrasonic universal tip (p>0.05).Conclusion:The diamond-coated tip with sonic scaler instrumentation and ultrasonic instrumentation produce similar root surface roughness, higher than curette instrumentation.

Root surface removal and resultant surface texture with diamond‐coated ultrasonic inserts: an in vitro and SEM study

A new diamond-coated ultrasonic insert has been developed for scaling and root planing, and it was evaluated in vitro for the amount of root surface removed and the roughness of the residual root surface as a result of instrumentation. 48 extracted single-rooted human teeth were ground flat on one root surface and mounted (flat side up) in PVC rings of standard height and diameter with improved dental stone. Each tooth surface was treated with either a plain ultrasonic insert (PI), an ultrasonic insert with a fine grit diamond coating (DI) or sharp Gracey curettes (HI). The mounted teeth were attached to a stepper motor which drove the teeth in a horizontal, reciprocal motion at a constant rate. The thickness from the flattened bottom of the ring to the flattened tooth surface was measured before and after 10, 20, and 30 instrumentation strokes for each root surface with each of the experimental instruments. A number of treated teeth were randomly selected for examination with SEM and a profilometer. Statistical analysis (analysis of co-variance) was performed to compare the amounts of tooth structure removed among the 3 instruments and t-test was used to compare the roughness of the treated root surfaces. The mean depth of root structure removed was PI 10.7 microm, HI 15.0 microm, and DI 46.2 microm after 10 strokes; and PI 21.6 microm, HI 33.2 and DI 142.0 microm after 30 strokes, respectively. On average, 0.9 microm, 1.3 microm, and 4.7 microm of root surface was removed with each stroke of PI, HI and DI, respectively. PI and HI were not different from each other for all the stroke cycles, while DI was significantly different from PI and HI for all the stroke cycles (p<0.0001). Analysis with the profilometer showed that the smoothest surface was produced by the PI followed by the HI. The DI produced a surface that was significantly rougher than the surface produced by the PI or HI. These results suggest that diamond-coated ultrasonic instruments will effectively plane roots, and that caution should be used during periodontal root planing procedures. Additionally, the diamond-coated instruments will produce a rougher surface than the plain inserts or the hand curettes.