Hand Curettes Research Articles

The effect of enhanced Nd:YAG laser fiber tip for periodontal treatment

An activated Nd:YAG fiber tip using fiber-tip enhanced device (FTED) makes an activated and scattered irradiation beam. The enhanced (activated) fiber tip could be irradiated parallel to the target surface. The purpose of this study was to determine the effect of the activated laser fiber tip for calculus removal compared with other techniques. Specimens of extracted teeth with or without calculus were prepared. Nd:YAG laser power pulse 1 (SLT Japan, Tokyo, Japan) was used. The diameter of the optimal fiber was 400 μm. The enhanced condition was firstly examined using irradiation power from 100 to 900 mJ, 1 to 10 pps, in order to verify which is the best condition for calculus removal with scattering irradiation beam. Four types of calculus removal methods were compared: (1) hand curette; (2) ultrasonic scaler; (3) laser irradiation through a normal optimal fiber tip at 900 mJ, 10 pps, using a perpendicular irradiation mode with water coolant; (4) laser irradiation through the active fiber tip at 900 mJ, 10 pps, using a parallel irradiation mode with water coolant. After the roughness of the surfaces was clinically measured, the specimens were then prepared for scanning electron microscopy (SEM) observation. These results indicated that the best enhanced condition of the FTED for calculus removal with scattering irradiation beam was 800 mJ, 10 pps. The FTED was more useful for calculus removal than the normal fiber tip. However, it was less effective than hand and ultrasonic scaling considering the treatment time.

Enchondromas of the hand: treatment with curettage and cemented internal fixation.

Removal by means of curettage is the mainstay of surgical treatment of enchondromas of the hand. Reconstruction traditionally entails filling the tumor cavity with a bone graft, or it may be decided not to perform a reconstruction. In either case a period of protected activity is needed until the tumor cavity has healed. The current study describes the use of cemented internal fixation for the purpose of reconstruction of these cavities. This technique provides immediate mechanical stability and allows early mobilization. Between 1986 and 1999, we treated 13 patients who were diagnosed as having enchondroma of the hand. Surgery included tumor removal with hand curettes and high-speed burr drilling. The remaining tumor cavity was reconstructed by using bone cement and intramedullary hardware. All patients were followed-up for more than 2 years. There were no postoperative infections or fractures, and all patients returned to their presurgical functional capability within 4 weeks. At the most recent follow-up evaluation, none of the patients had local tumor recurrence. Although 7 patients had a decrease in flexion of the metacarpophalangeal or interphalangeal joints, none reported a functional limitation. Reconstruction of the tumor cavity with cemented hardware provides immediate mechanical stability, allows early mobilization, and is associated with good functional outcome.

Clinical comparison of the effectiveness of novel sonic instruments and curettes for periodontal debridement after 2 months

AbstractAim: The aim of this study was to evaluate in vivo the effectiveness of scaling and root planing of new oscillating instruments (Periosonic®) using a sonic handpiece compared to hand curettes with a split mouth design after 2 months.Methods: 11 patients with adult periodontitis participated in this study. Plaque index (PII) (O’Leary), bleeding on probing (BOP), probing pocket depth (PPD), recession (REC) and clinical attachment level (CAL) were recorded at baseline and 2 months after treatment. After oral hygiene instruction, 2 randomly assigned quadrants per patient were scaled and root planed with curettes (control side) and the remaining 2 quadrants with the Periosonic® instruments 1 and 2 (test side). The student t‐test for paired data was used to test the significance of difference between test and control sides.Results: There was no statistical difference (p>0.05) between the 2 sides for the improvement of the clinical parameters excepted for the group with initial PPD of 4–6 mm (test: 1.3±0.4 mm PPD reduction, control: 1.6±0.4 mm). For PPD 7 mm, the test side had better clinical improvement in attachment levels (2.2±0.9 mm), less recession (−0.4±0.5 mm) with lower PPD reduction (2.4±0.6 mm) than the control side (AL: 1.6±1.8 mm; REC: −1.3±0.7 mm, PPD reduction: 3.0±1.4 mm).Conclusion: This clinical study demonstrated that Periosonic® instruments are clinically at least as effective as curettes in PPD reduction when initial PPD is 6 mm and show better clinical attachment level improvement with less recession for initial PPD of 7 mm.

Tooth substance loss resulting from mechanical, sonic and ultrasonic root instrumentation assessed by liquid scintillation

AbstractAims: This study investigated the loss of tooth substance (μg) by means of liquid scintillation in combination with profilometric and SEM analyses in order to evaluate the roughness and morphological changes of the root surface before and after instrumentation.Method: 40 polished and irradiated bovine root surfaces were scaled in vitro while covered with 50 ml destilled water using a sonic prototype (Periosonic® 1/2), a magnetostrictive ultrasonic (Cavitron® with Slimline® inserts) scaler and a hand curette. Pressures were applied for the Periosonic, Cavitron and hand curette at 500, 500 and 30 g respectively, for 30‐s intervals, up to 120 s. Loss of apatite (μg) was determined from the decays/min (32P) of the water samples using the radiochemical method of liquid scintilation. Replicas were made of the specimens for SEM and profilometric analyses.Results: The least substance loss was noted significantly (p<0.01) at all time intervals after Slimline, followed by the fine sonic prototype Periosonic 2, then the Periosonic 1 and finally the hand curette. In contrast, profilometric and SEM analyses revealed the smoothest root surfaces after the hand curette, whereas Cavitron produced a less smooth surface.Conclusion: It can be concluded that this method can reveal very precisely small quantities of substance lost and, in combination with SEM analysis and microroughness measurements, be of considerable value in evaluating the aggressiveness and efficacy of periodontal instruments.

Tooth substance loss resulting from mechanical, sonic and ultrasonic root instrumentation assessed by liquid scintillation.

This study investigated the loss of tooth substance (microg) by means of liquid scintillation in combination with profilometric and SEM analyses in order to evaluate the roughness and morphological changes of the root surface before and after instrumentation. 40 polished and irradiated bovine root surfaces were scaled in vitro while covered with 50 ml distilled water using a sonic prototype (Periosonic 1/2), a magnetostrictive ultrasonic (Cavitron with Slimline inserts) scaler and a hand curette. Pressures were applied for the Periosonic, Cavitron and hand curette at 500, 500 and 30 g respectively, for 30-s intervals, up to 120 s. Loss of apatite (microg) was determined from the decays/min (32P) of the water samples using the radiochemical method of liquid scintillation. Replicas were made of the specimens for SEM and profilometric analyses. The least substance loss was noted significantly (p<0.01) at all time intervals after Slimline, followed by the fine sonic prototype Periosonic 2, then the Periosonic 1 and finally the hand curette. In contrast, profilometric and SEM analyses revealed the smoothest root surfaces after the hand curette, whereas Cavitron produced a less smooth surface. It can be concluded that this method can reveal very precisely small quantities of substance lost and, in combination with SEM analysis and microroughness measurements, be of considerable value in evaluating the aggressiveness and efficacy of periodontal instruments.

An in vitro investigation on the loss of root substance in scaling with various instruments

There are differing opinions as to the extent to which root cementum has to be removed during root surface instrumentation over and above that of the debridement of plaque and calculus. Similarly, the amount of tooth material removed by individual instruments is also unclear, but a trend towards less damaging methods of root surface debridement has evolved in recent years. The purpose of this in vitro study was to determine the amounts of root substance removed by 4 different methods of instrumentation, hand curette, ultrasonic scaler, airscaler and fine grit diamond bur. Measurement of tooth substance loss was carried out with a specially constructed measuring device at 360 sites on 90 mandibular incisors following 12 working strokes with a clinically appropriate force of application. Only a thin layer of root substance (11.6 microns) was removed by the ultrasonic scaler, compared to the much greater losses sustained with the airscaler (93.5 microns), the curette (108.9 microns) and the diamond bur (118.7 microns).

A Quantitative Study of Cementum Removal With Hand Curettes

An in vitro study was conducted to quantitatively measure the depth of root surface removal using curettes of standardized sharpness and with definite stroke number. Extracted periodontally healthy teeth from patients 10 to 15, 16 to 25, and 26 to 40 years old had periodontal ligament remnants removed with dry gauze before being secured in a vertical position during root planing. The force applied to the root surface was measured with a tension load cell. The "bright line" test was used to assess curette sharpness. After histologic processing, the thickness of cementum adjacent to the root defect, the cementum (if any) in the root defect, total amount of cementum removed, and depth of root defect were measured by a microscopic ocular grid. Teeth from each age range were evenly distributed into 6 groups of 10 teeth each. In the majority of teeth from the 20 stroke group through the 70 stroke group, complete cementum removal was observed at the site of planing. However, in some sections from each group, fragments of cementum remained on the root surface. A positive relationship (r/s = 1) was found between the number of strokes and the force applied to the root surface and the mean depth of defect (P less than 0.05). However, an inverse relationship existed between mean force per stroke and mean defect depth (r/s = -.99) such that as mean force per stroke increased, the mean defect depth decreased. As the root surface became smoother with an increasing number of strokes, the forces increased and were more consistent.(ABSTRACT TRUNCATED AT 250 WORDS)

In vivo study of bacterial invasion in root planed and citric acid treated radicular surfaces of periodontally involved human teeth

The purpose of this study was to investigate whether plaque bacteria invade the exposed radicular dentin after root planing or chemical root treatment in vivo. Eighteen caries-free human periodontally involved teeth with hopeless prognoses were studied. Fourteen teeth were scaled and root planed with hand curette type scalers. The proximal surface of each treated tooth was designated as the RP surface. The remaining half of the proximal surface was treated with citric acid (pH 1.0) for 3 minutes and was designated as the CA surface. Four untreated teeth served as controls. After 4 weeks, the teeth were extracted, and were processed for light microscopy and for scanning electron microscopy concerning bacterial invasion into the supragingival radicular dentin. The following results were obtained. 1. Radicular cementum was present on most untreated tooth surfaces. However, bacteria were never seen in the dentinal tubules. 2. Bacterial invasion into the dentinal tubules was observed in five of the 10 proximal surfaces (50% of the RP surfaces) and in nine of the 10 proximal surfaces (90% of the CA surfaces). 3. The depth (9.5 +/- 24.1 microns vs 84.6 +/- 136.3 microns) and percentage (0.8 +/- 2.1% vs 20.3 +/- 17.3%) of bacterial invasion in the dentinal tubules of the RP surfaces was lower than that of the CA surfaces. 4. Cocci and short rods were present in the supragingival dentinal tubules. 5. Since CA surfaces may accelerate bacterial invasion the citric acid treatment might be harmful in patients with inadequate plaque control.

Application of an air-powder abrasive system in periodontal therapy and its effect on root surfaces

An air-powder abrasive device used to remove stain and debris adherent to tooth surface is now available for use by dentist. Air Flow was evaluated for its effectiveness in removing stains and debris from teeth. Split design in anterior was used, and half was treated with the device and the contralateral side with a brush cone and tooth polishing paste. Time required by each method to remove stain and debris completely was recorded and compared. A gingival trauma index was assessed according to the method of Weaks L.M. et al. (1984). Air-powder abrasive system removed stain and debris in less time than brush cone technique (P less than 0.001). The system was also most effective in removing stains in pit, fissure and contact areas. The device caused a significant increase (P less than 0.01) in gingival irritation immediately posttreatment, but there was no statistically and clinically significance in the effect on the gingiva at 7 days posttreatment between two techniques. In vitro study, the effect of the device on root surfaces was also assessed. 5, 10, 20, 40 and 60 seconds exposure of a fixed point on root surfaces to the device produced defects 137, 245, 308, 945 and 1,394 microns in depth, respectively. The resulting surface was smooth and all cementum was removed. And the average loss of root structure as a function of the exposure time was also assessed. The average losses were 0.2, 0.6, 1.7, 1.8, 2.0, 2.1, 2.3 and 2.4 mg by 5, 10, 15, 20, 30, 40, 50 and 60 seconds exposures, respectively. Root surface roughness, resulting from hand curette, ultrasonic curette and air-powder abrasive system was examined histologically. The hand curette produced smooth root surface. The ultrasonic instrument produced a surface characterized by irregular ridges. The air powder abrasive system was found to produce a root surface favorably comparable to manual root planing and remove cementum from areas of difficult treatment, such as furcations.

Postsurgical bone loss following root planing by ultrasonic and hard instruments.

The ultrasonic scaler is currently used to plane the roots in periodontal surgery. The purpose of this study was to provide experimental evidence in support of, or against, the use of the ultrasonic scaler for root planning in periodontal surgical procedures. A notch was made through the enamel of each canine of nine adult cats. Full thickness mucoperiosteal flaps were elevated on each canine. Using hand curettes, soft tissue tags were removed from each tooth. At the maxillary right canines and mandibular left canines the roots were planed using the ultrasonic scaler, while at the maxillary left canines and mandibular right canines the roots were planed using hand curettes. A caliper was used to measure the distance from the notch to the crest of the alveolar process at each tooth. The mucoperiosteal flaps were repositioned and secured with cyanoacrylate cement. Three months postoperatively all 36 sites were reoperated and the distance from the notch of each canine to the crest of its alveolar process was measured using the caliper. The same caliper was used for all sites and the same investigator made all the measurements. Analysis of the results showed that all canines lost alveolar bone as a result of the surgical procedure, however, there was no statistical significance between the amount of bone lost on the canines where root planing was carried out by the ultrasonic scaler and the canines where the roots were planed with hand curettes. These findings support the use of the ultrasonic scaler for the planing of roots following elevation of mucoperisteal flaps and confirm its value in the practice of periodontal surgical procedures.

Calculus removal and loss of tooth substance in response to different periodontal instruments

The efficiency of calculus removal and the amount of lost tooth substance resulting from the use of hand curette, ultrasonic curette and rotating diamond and Roto-Pro points were examined by scanning electron microscopy (SEM). Root surfaces of mandibular incisors placed in a jaw model were cleaned of adhering deposits, photographed by SEM and evaluated at a standard magnification by three examiners. Scores were given for remaining calculus (RCI) and loss of tooth substance (LTSI) according to defined index criteria. The results revealed that calculus removal was most complete following diamond instrumentation, whereas the ultrasonic curette was least efficient in this respect. Hand curette, ultrasonic curette and Roto-Pro removed about the same amount of tooth substance whereas the diamond removed considerably more than the others. The diamond regularly removed all the cementum and left deep instrumental marks in the dentin; it seems advisable to avoid the use of such instruments in periodontal depuration.

Root surface roughness in response to periodontal instrumentation studied by combined use of microroughness measurements and scanning electron microscopy

Root surface roughness, resulting from calculus removal by hand curette, ultrasonic curette and rotating diamond or Roto-Pro points, was examined by combined use of microroughness measurements and scanning electron microscopy (SEM). Mandibular incisors were placed in a jaw model with a rubber "gingiva" in an attempt to simulate a clinical situation. After cleaning with the various instruments, the surface roughness was measured by an industrial profilometer followed by SEM evaluation. A microroughness index (MRI) was developed and showed that the instruments could be separated into three groups, where the hand curette produced least roughness, followed by the Roto-Pro instrument, while the ultrasonic curette and the diamond left the most uneven surfaces. A SEM roughness index (SRI) based on defined criteria, corresponded well with the results from the profilometer measurements, except that using this index the diamond scored higher than the ultrasonic curette. This was probably due to considerable calculus remnants remaining in the ultrasonic specimens. Characteristic features of the root surface morphology of the cleaned teeth are described. It is concluded that the combined use of microroughness measurements and SEM is of considerable value in this type of studies since more information may be obtained than by any of these methods used separately.