Periodontal Instrumentation Research Articles

Impact of the modified curricula on periodontal instrumentation skills development during the COVID-19 pandemic from 2020 to 2023.

This study aimed to evaluate the impact of curriculum modifications on periodontal instrumentation skills development among classes of 2021, 2022, and 2023 during the COVID-19 pandemic. The pandemic began and affected the three classes at different stages of their studies. Onsite simulation-based learning (SBL) was employed for the classes of 2021 and 2022; remote SBL was adopted for the class of 2023. Modified clinical education, due to social distancing guidelines, impacted the class of 2021 significantly and the class of 2022 to a lesser extent. A multiple linear regression model was built to examine the association between the fourth-year patient-based scaling competency examination scores and selected predictors. The classes of 2021 and 2023 showed consistent performances over time, while the class of 2022 exhibited significant variation exhibiting the lowest performance at the second-year practical examination. While the clinical experience of the class of 2021 was significantly less than that of the classes of 2022 and 2023, the fourth-year competency examination scores did not differ across the three classes. The clinic points (p=0.014) significantly affected the fourth-year competency examination score while student gender (p=0.18), the first-year (p=0.736), and second-year (p=0.198) practical examination scores showed no correlations. Based on student performance in the fourth-year scaling competency examination, the curriculum modifications due to the COVID pandemic did not affect student learning outcomes. Clinical experience was the most influential determinant of skill development in periodontal instrumentation.

Instrument fracture in periodontal therapy: ethical disclosure and clinical management - a case report

Periodontal instrument fractures are rare events in dentistry, with limited literature available on their occurrence and management. This case report highlights an incident involving the fracture of a periodontal sickle scaler blade during manual instrumentation for the removal of calculus. The fracture occurred during instrumentation on the mesial surface of the maxillary right second molar, and the separated blade was subsequently pushed into the sulcus. A radiographic assessment was performed to verify the precise location of the fractured segment. Following confirmation, the broken blade was subsequently retrieved using curved artery forceps. The case report highlights factors contributing to instrument fractures, emphasizing the importance of instrument maintenance, sterilization cycles, and operator technique. Ethical considerations regarding patient disclosure, informed consent, and instrument retrieval methods are well discussed. This case underscores the importance of truthful communication, the proper use of instruments, equipment maintenance in dentistry, and the significance of ongoing professional development to enhance treatment safety, proficiency, and ethical standards in dental care.

Evaluating the Ergonomic Performance of a Novel Periodontal Curette with Adaptive Handle Design

(1) Background: Periodontal instrumentation with dental curettes is associated with discomfort, fatigue, and musculoskeletal diseases. The goal of this study was to compare comfort, fatigue, and muscle work using three different curettes. (2) Methods: Eight hygienists each scaled three typodonts using the three different curettes. Curette A was a prototype with a novel adaptive design, Curette B had a conventional stainless-steel design, and Curette C featured a conventional silicon-covered handle. Time-based work in four muscles, comfort, fatigue, tactile feedback, grip and blade position, and pinch and grasp strength were recorded. Statistical analysis was performed using a General Linear Model (GLIM) and Tukey’s post hoc test. The level of significance was set at p < 0.05. (3) Results: Comfort, correct grasp, fingertip placement, and blade-to-tooth adaptation were significantly better with Curette A (p < 0.05). While pinch and grasp strength were significantly reduced post-instrumentation for Curettes B and C (p < 0.05), they remained unchanged for Curette A. Curette A required significantly less total muscle work and work in individual muscles, resulting in significantly less post-instrumentation fatigue than for Curettes B and C, but similar levels of tactile feedback (p < 0.05). (4) Conclusions: The ergonomic performance of a prototype adaptive periodontal curette was significantly better than that of two conventional instruments with rigid handle designs.

Root surface roughness evaluation following application of different periodontal instruments and Er:YAG laser: A profilometry and SEM study.

The aim of the present study was to evaluate the efficacy of 30°-angled Er:YAG laser tip and different periodontal instruments on root surface roughness and morphology in vitro. Eighteen bovine teeth root without carious lesion were decoronated from the cementoenamel junction and seperated longitidunally. A total of 36 obtained blocks were mounted in resin blocks and polished with silicon carbide papers under water irrigation. These blocks were randomly assigned into 3 treatment groups. In Group 1,30°-angled Er:YAG laser (2.94μm) tip was applied onto the blocks with a 20Hz, 120mJ energy output under water irrigation for 20s. In Groups 2 and 3, the same treatment was applied to the blocks with new generation ultrasonic tip and conventional curette apico-coronally for 20s with a sweeping motion. Surface roughness and morphology were evaluated before and after instrumentation with a profilometer and SEM, respectively. After instrumentation, profilometric analysis revealed significantly higher roughness values compared to baseline in all treatment groups(p < 0.05). Laser group revealed the roughest surface morphology followed by conventional curette and new generation ultrasonic tip treatment groups (p < 0.05). In SEM analysis, irregular surfaces and crater defects were seen more frequently in the laser group. Results of the study showed that the use of new generation ultrasonic tip was associated with smoother surface morphology compared to 30°-angled Er-YAG laser tip and conventional curette. Further in vitro and in vivo studies with an increased sample size are necessary to support the present study findings.

블렌디드 러닝에 기반한 치주기구조작 수업 모형 개발

Objectives: Blended learning in a untact lecture is recognized as one of the teaching and learning methods that can provide a meaningful learning experience. Therefore, we have developed the instructional model for periodontal instrumentation education based on the blended learning. Methods: It was developed based on the education structure of the pre-class, in-class, and post-class of the PARTNER instructional learning model. Results: The draft of the developed model was validated by 2 experts. The blended learning model consisted of seven steps(‘learning online lecture contents’, ‘assessment of pre-class learning and learning level analysis’, ‘instrument operation and guidance’, ‘team based and individual practice’, ‘lesson summary’, ‘assessment of online instructional’, ‘online instructional reflection’) was developed. Conclusions: Strategic implications for the effective operation of the post COVID-19 era for periodontal instrumentation curriculum based were suggested.

An In Vivo Investigation of Non-Metallic vs. Metallic Hand Scalers on Zirconia Implant-Supported Crowns: A Year-Long Analysis of Peri-Implant Maintenance.

This study examined whether the degree of abutment surface modification that may occur with regular periodontal instrumentation has a clinical impact in terms of increased plaque accumulation and increased peri-implant tissue inflammation on zirconia implant abutments. Thirteen patients who had zirconia implant crowns were recruited in this randomized clinical trial. Each patient acted as their control and had either the buccal or lingual surface of their screw-retained implant restoration scaled with a metallic scaler and the other surface with a non-metallic scaler at 3, 6, 9, and 12 months. Cytokine testing of the peri-implant crevicular fluid was completed at 0, 3, and 12 months for IL-2, IL-4, IL-6, IL-8, IL-10, TNF-α, or IFNγ. Implant crowns were removed at 12 months and evaluated under an atomic force microscope for the average roughness (Ra). The implant crowns were polished and re-inserted. The results were analyzed using the Kruskal-Wallis test, and post hoc tests were conducted with a significance level of α = 0.05. Significant differences in surface roughness (Ra) were observed between the metallic and non-metallic scalers. The median Ra values were 274.0 nm for metallic scalers and 147.1 nm for non-metallic scalers. However, there were no significant differences between the type of scaler used and the amount of clinical inflammation or cytokine production. Metallic scalers produced deeper, more aggressive surface alterations to the abutment/crown zirconia surface, but there was no statistically significant difference between the degree of surface alterations, amount of BOP, and the amplitude of cytokine inflammation produced.

A Novel Ergonomic Curette Design Reduces Dental Prophylaxis-Induced Muscle Work and Fatigue.

To compare fatigue, comfort, and muscle work associated with the use of two periodontal curettes during scaling: one with a novel adaptive design, the other with a conventional non-adaptive design. Twelve hygienists scaled a typodont using two Universal Barnhart 5/6 curettes: (1) a prototype featuring an adaptive silicone-covered handle (Curette A), and (2) a stainless-steel curette (Curette B). Surface Electromyography (sEMG) traced muscle work. Hand positions, fatigue, comfort, pinch, and grasp strength were recorded. Paired t-tests and a repeated measures ANOVA with covariates were tested for differences. The significance level was set at p < 0.05. Curette A performed significantly better in all categories. Pinch and grasp strength and fatigue were significantly reduced post-instrumentation for Curette B. Curette A required significantly less (i) total muscle work and (ii) work in individual muscles. Comfort, correct grasp, and blade adaptation were significantly better using Curette A. A curette featuring a novel adaptive handle design demonstrated significantly improved ergonomic performance. Additional clinical studies are needed to solidify our understanding of the potential short- and long-term benefits of the novel curette handle design. A novel adaptive curette handle design that enables the clinician to adapt the instrument across the index finger may reduce musculoskeletal burden and fatigue, as well as improve comfort during periodontal instrumentation.

The Effect of Web-based Pre-learning Applied to Class on Periodontal Instrumentation

Objectives: This study aimed to apply web-based pre-learning and evaluate the self-directed learning ability, confidence in manual periodontal instrumentation skills, and learning satisfaction of dental hygiene students after being provided with a class using this technique. Methods: A survey was conducted among 62 dental hygiene students at ‘B’ university in the Chungnam taking periodontal care practice classes. All subjects were evaluated with a selfdirected learning questionnaire. Data was analyzed using a t-test, ANOVA, and Pearson’s correlation coefficient. Results: The results of this study showed that the self-directed learning ability was 3.44, confidence in manual periodontal instrumentation skills was 6.82, learning satisfaction was 4.17. The analysis of correlations among the variables showed that selfdirected learning ability has a positive correlation with confidence in manual periodontal instrumentation skills (r=0.32, p&lt;0.05) and learning satisfaction (r=0.34, p&lt;0.01), and confidence in manual periodontal instrumentation skills has a positive correlation with learning satisfaction (r=0.45, p&lt;0.01). Conclusions: It was identified that self-directed learning ability, confidence in manual periodontal instrumentation skills, and learning satisfaction were improved in the event that a good amount of web-based pre-learning was applied to the periodontal care practice classes. Therefore, web-based pre-learning is recommended to improve the manual periodontal instrumentation skills of students because it can be provided without any time or locations.

In Vitro Evaluation of the Different Supragingival Prophylaxis Tips on Enamel Surfaces

Objective: Periodontal instrumentation during supragingival prophylaxis may increase enamel surface roughness, which may lead to increased dental biofilm accumulation and demineralization of the enamel. The aim of this study was to evaluate the changes of the enamel surface profilometrically after the application of different scaler tips used for the professional supragingival prophylaxis. Materials and methods: Forty-eight enamel block samples obtained from extracted human maxillary premolar teeth were prepared and randomly assigned to four different treatment groups. Each treatment group was instrumented by the same clinician with different tools as Group 1: Er:YAG laser chisel tip, Group 2: scaler, Group 3: new generation universal curette; and Group 4: ultrasonic device. Sample surfaces were evaluated with a profilometer before and after instrumentations and after the polishing process. Results: Baseline roughness of the prepared enamel samples was similar between the groups. After instrumentation and polishing, the Er:YAG laser chisel tip revealed the most irregular surface morphology, whereas the new generation curette induced the smoothest surface. Conclusions: New generation universal curette is a promising tool, which can be used safely for supragingival calculus removal without the need for polishing on enamel surfaces.

Periodontal instrumentation technique: an exploratory analysis of clinical outcomes and financial aspects.

Objective This exploratory post hoc analysis sought to investigate clinical outcomes comparing non-surgical treatment for periodontal disease using exclusively hand instruments, exclusively ultrasonic instruments or a combination approach. Differences in time efficiency and equipment use with each treatment method were evaluated.Methods In total, 55 patients with periodontitis were treated across two studies (randomised controlled trial and cohort study) with non-surgical periodontal therapy using hand instruments (HI), ultrasonic instruments (UI) or a combination approach (CI). All patients were re-evaluated 90 days after treatment. Clinical parameters, time taken and financial implications of non-surgical periodontal therapy were explored with a descriptive analysis within this post hoc analysis.Results There were no clinically relevant differences in clinical parameters across all groups at day 90. Inter-group comparisons showed no clinically relevant differences in treatment outcome between groups. UI required less time on average to complete treatment compared to HI. UI provided using a half mouth approach had fewest overall episodes of expenditure and lowest maintenance costs.Conclusions Comparison of clinical outcomes between HI, UI and CI yielded no clinically relevant differences. When comparing HI and UI, UI had a shorter treatment time on average. Full mouth treatment was associated with the least patient visits. UI was least costly on a recurring basis.

일부 치위생학과 학생의 학습행동스타일에 따른 플립러닝 수업 효과에 관한 연구

Objectives: This study was conducted to confirm the difference in learning effect according to the learning behavior style of students in the flipped learning class. Methods: A Self-reported survey was conducted on 50 students of the dental hygiene department in the 3rd year of university located in Cheonan. Data analysis was performed using SAS 9.4 program. Results: The students belonging to the leader type classification showed higher self-direction than the assistant type(p=0.016), and the presenter type showed higher learner confidence and instrument performance confidence than the assistant type(Learning Confidence p=0.027; Periodontal instrumentation Confidence p=0.007). Conclusions: In order to provide effective education for all students during the flipped learning, it is necessary to grasp the learning behavior style in advance and active professor feedback.

일개 치위생학과 임상치위생학 치주기구조작 수업에서의 블렌디드 러닝 운영 효과에 관한 연구

Objectives: This study aimed to apply blended learning and evaluate its effectiveness in the periodontal instrument class for dental hygiene clinic theory and practice. Methods: Thirteen students were subjected to the traditional mode of instruction and 12 students were subjected to blended learning. The students’ instrument ability was evaluated before and after class. Non-parametric tests were employed in all analyses. Results: After completing the class, the students’ overall comprehension increased (p&lt;0.05). Moreover, those who participated in blended learning had a higher periodontal instrument operation ability (p&lt;0.05). Conclusions: Blended learning may be applied in periodontal instrument class for dental hygiene clinic theory and practice, and it may be established as an effective educational method for on-offline classes.

Instrumentation during the second stage of periodontal therapy: a European survey.

To gather practice-based information about instrumentation during the second stage of periodontal therapy among the members of the European Federation of Periodontology. This survey was conducted to investigate periodontal instrumentation (e.g., frequency, instruments, their maintenance) during the second stage of periodontal therapy. Questionnaires from 2008 responders actively involved in periodontal therapy (general dental practitioners, periodontists, and dental hygienists) were analyzed. The frequency of use of hand and mechanical instruments was similar during the second stage of periodontal therapy and 94.4% of the participants combined both. The most popular hand instruments were Gracey curettes, and the preferred mechanical devices were ultrasonic scalers. For the latter, mostly the combination of standard and micro/slim inserts was preferred (42.4%) over solely standard inserts (32.1%) or micro/slim inserts (25.5%). The wear of hand instruments was sytematically checked by 46.1% of the respondents and the wear of the inserts by 41.3%. The more experienced the dental professional, the more frequent the wear of the instruments and inserts was checked. The most popular periodontal instrumentation technique in clinical practice during the second stage of periodontal therapy is a combination of hand and mechanical instruments. Clinicians should check the wear of their instruments systematically to have the most performant instruments possible for periodontal instrumentation. Scientists should see the results of this questionnaire as an incentive to set up studies investigating whether the combination of hand and mechanical instruments, the preferred treatment method of clinicians, is better than either of these instruments alone.

Blood and saliva contamination on protective eyewear during dental treatment.

ObjectivesDental treatments are inherently associated with the appearance of potentially infective aerosols, blood and saliva splashes. The aim of the present study was to investigate the quantitative contamination of protective eyewear during different dental treatments and the efficacy of the subsequent disinfection.Materials and methodsFifty-three standardized protective eyewear shields worn by students, dentists and dental assistants during different aerosol-producing dental treatment modalities (supragingival cleaning, subgingival periodontal instrumentation, trepanation and root canal treatment and carious cavity preparation; within all treatments, dental evacuation systems were used) were analysed, using common forensic techniques. For detection of blood contamination, luminol solution was applied onto the surface of safety shields. A special forensic test paper was used to visualize saliva contamination. Further analysis was conducted after standardized disinfection using the same techniques. Statistical analysis was performed using SPSS.ResultsMacroscopically detectable contamination was found on 60.4% of protective eyewear surfaces. A contamination with blood (median 330 pixels, equivalent to 0.3% of the total surface) was detected on all shields after dental treatment. Between various dental treatments, the contamination with blood tend to be statistically significant (p = 0.054). Highest amount of blood was observed after professional tooth cleaning (median 1,087 pixels). Significant differences of saliva contamination were detected between the different measurements (p < 0.001) with contamination only after dental treatment. Due to the low variance and right-skewed distribution for saliva contamination, no statistical analysis between different treatments could be performed. After disinfection, 0.02% blood contamination and no saliva contamination were detected.ConclusionsDisinfection is effective against blood and saliva contamination. Macroscopically, clean protective eyewear contains up to 12% surface contamination with blood. Based on the results, it may be concluded that protective eyewear is essential for each dental practitioner.Clinical relevanceAs standard for infection prevention in the dental practice, disinfection of protective eyewear after each patient is necessary.

In Vitro Effect of Instrumentation Using Ultrasonication with and without Hydrogen Peroxide on the Removal of Biofilms and Spread of Viable Microorganisms in Aerosols.

To evaluate the use of hydrogen peroxide as an adjunct to ultrasonication (US) in biofilm removal and whether it can limit the spread of viable microorganisms in the aerosol. Multi-species biofilms were formed on dentin disks and titanium disks fixed on a plastic surface. After placing the specimens in a periodontal pocket model, an ultrasonic scaler was applied for 30 s, in part combined with 0.25% or 0.5% H2O2. After treatment, the remaining biofilm was analysed for bacterial counts (colony forming units [CFU]), biofilm quantity and metabolic activity. Further, the cytotoxic effect of hydrogen peroxide on periodontal ligament fibroblasts was assessed and the spread of bacteria in aerosol was quantified. Ultrasonication reduced bacterial counts in biofilm, biofilm mass and metabolic activity on both dentin and titanium disks. Adjunctive use of 0.25% and 0.5% H2O2 more effectively reduced the viable bacteria in biofilm than ultrasonication alone; this was also found on both dentin and titanium. The different concentrations of H2O2 did not lead to corresponding differences in bacterial mass and metabolic activity. The spread of bacteria through aerosols was statistically significantly reduced when adjunctive H2O2 was used. However, a certain cytotoxic effect on periodontal ligament fibroblasts by H2O2 could not be ruled out. Irrigating with H2O2 during periodontal instrumentation with an ultrasonic scaler increases the reduction of viable bacteria within biofilms. It might limit bacterial spreading via aerosols.

Effect of self-learning media based on 360° virtual reality for learning periodontal instrument skills.

Of 360° Virtual Reality (VR)is possibly produced and sufficiently effective as a consumer-friendly VR learning medium. Therefore, it is also expected to be useful in the dental practice field, as a self-learning medium for non-face-to-face skill training during the ongoing pandemic (COVID-19). Accordingly, this study was conducted to assess 360° VR self-learning media for a periodontal instrument operation. We recruited 30 participants who had never experienced instrument training. We offered basic education and initial assessment (IA), then divided them into three groups: 1) PAPER: trained only with paper handouts; 2) 2D: trained with 2D video; 3) VR: trained with 360° VR. Each group performed self-learning and mid-term assessment (MA). Subjects then implemented home self-learning with the same media for one week, which was then followed by a final assessment (FA). Analysis of IA-to-FA improvement scores showed that VR and 2D video were significantly higher than the PAPER groups. Meanwhile, analysis of MA-to-FA improvement scores showed that only VR was substantially higher than the PAPER group. Although VR and 2D video groups were not considerably different, VR scores were numerically higher than 2D video in all improvement score analyses. Both 2D video and 360° VR training were helpful to participants for an effective self-learning and also had good portability and accessibility as online-based learning methods. 360° VR showed higher learning efficiency than regular 2D video, possibly due to its autonomy, 360° visual information and physical and immersive characteristics, which positively affected self-training. Our findings showed the potential of 360° VR learning media and, further, suggest its usefulness as a novel self-learning method in future dental education.

Effects of Periodontal Endoscopy-Assisted Nonsurgical Treatment of Periodontitis: Four-Month Results of a Randomized Controlled Split-Mouth Pilot Study.

Objective Although the therapeutic effects of nonsurgical periodontal therapy (NSPT) are well established, the clinical benefits of the additional use of periodontal endoscopy (PE) remain controversial. Therefore, this randomized controlled split-mouth pilot study evaluated the effect of NSPT using PE versus NSPT without nPE on bleeding on probing (BOP) in sites with probing depth (PD)≥4 mm (primary outcome), PD, clinical attachment level (CAL), number of hard deposits (HDs), and treatment time per tooth (TrT). Methods Two calibrated operators performed NSPT in twenty periodontitis patients, randomized into two quadrants for PE or nPE treatment. BOP, PD, and CAL were recorded at the first visit for NSPT (T0) and during reevaluation (T1: mean (SD) 119.7 (24.6) days after T0). The average TrT and the number of sites with HDs were documented at T0. Results For BOP, no significant differences were found at the patient's level (10/10 (male/female); aged 54.3 (10.9) years) neither within or between the groups. At tooth surface level, a lower number of surfaces with BOP (p=0.026) was observed in nPE. CAL and PD improved significantly during NSPT in both groups (p ≤ 0.001), with higher PD reduction (p < 0.001) and CAL gain (p < 0.001) in nPE. There are significantly longer TrT (p < 0.001) and more surfaces with subgingival HDs evident in PE at T0 (p=0.001). Conclusion Whereas subgingival HDs can be visually detected with PE during NSPT, no additional clinical benefits regarding BOP, PD, or CAL were notable compared to conventional systematic periodontal instrumentation. Additionally, PE-assisted NSPT required a longer treatment time.

Enhanced Periodontal Debridement with Periodontal Endoscopy (Perioscopy) for Diagnosis and Treatment in Periodontal Therapy

The perioscope, which was only recently introduced, has greatly improved the removal of subgingval calculus during periodontal therapy. A fibre-optic periodontal endoscope was created to aid in the imaging of subgingival tissues and to improve periodontal disease diagnosis and treatment. Scaling and root planing have the goal of completely removing plaque and calculus from root surfaces. While this is unachievable, the agreed end-point during periodontal instrumentation is a smooth, glassy root surface. This has frequently led in over instrumentation and excessive cementum removal. Cement removal has been judged unnecessary in most cases. The removal of plaque, calculus, and endotoxin adhered to the root surface is critical. The easiest way to clean root surfaces is to use powered instruments sparingly. Due to a lack of visibility, excessive cementum removal occurs during hand instrumentation. The ability to visibly debride roots using endoscopic technology can improve success rates in a more conservative and minimally invasive manner. The perioscopy device was created to visualise the subgingival region for diagnosis, but it has since been altered to help with periodontitis therapy. The perioscope is a small camera that is encased in a sleeve and inserted under the gingival sulcus or pocket for subgingivally visualisation and instrumentation. This technique gives the greatest conservative approach to non surgical and surgical periodontal care because it enables superb magnified visualisation of the root surface and ensures the total or near complete elimination of the bacterial infection. The aim of this brief review was to provide knowledge about periodontal endoscopy, its implementation in day today practice.

Effectiveness of remote simulation-based learning for periodontal instrumentation: A non-inferiority study.

While numerous virtual/remote simulation-based learning (SBL) modules were implemented due to the COVID-19 pandemic, limited data on their effectiveness are available. This study aimed to investigate the effectiveness of a remote SBL module for periodontal instrumentation compared to traditional onsite SBL modules. Calibrated faculty members have instructed in all modules. Synchronous remote SBL activities using a secure videoconferencing application, which replaced onsite practices, were conducted in a small group setting in the remote SBL module for the class of 2023. After the class took the onsite second-year practical examination, a set of multiple and logistic regression analyses (N=389) were conducted to test if the second-year practical examination scores and the passing rates were significantly different between the remote SBL (class of 2023) and onsite SBL I and II (class of 2019 and 2022) groups. Both mean practical examination score and passing rate from the remote SBL group (class of 2023) were significantly higher than those from the onsite SBL II group (class of 2022) when their first-year practical examination scores were not considered (p<0.05). Once the first-year practical examination scores were considered, the remote SBL group was not significantly different from the onsite SBL I and II groups with respect to the mean second-year practical examination score and the passing rate. The proposed remote SBL module achieved the comparable student learning outcomes compared to the onsite SBL modules while it utilized less staff, time, and material expenditure.

Remote simulation-based learning for periodontal instrumentation in preclinical education.

Remote simulation-based learning for periodontal instrumentation in preclinical education.