Power-driven Instruments Research Articles

A Sex-Specific Evaluation on Dental Students' Ability to Perform Subgingival Debridement: A Randomized Trial.

A successful periodontitis treatment demands good manual skills. A correlation between biological sex and dental students' manual dexterity is currently unknown. This study examines performance differences between male and female students within subgingival debridement. A total of 75 third-year dental students was divided by biological sex (male/female) and randomly assigned to one of two work methods (manual curettes, n=38; power-driven instruments, n=37). Students were trained on periodontitis models for 25 min daily over 10 days using the assigned manual or power-driven instrument. Practical training included subgingival debridement of all tooth types on phantom heads. Practical exams were performed after the training session (T1) and after 6 month (T2) and comprised subgingival debridement of four teeth within 20 min. The percentage of debrided root surface was assessed and statistically analyzed using a linear mixed-effects regression model (P<.05). The analysis is based on 68 students (both groups n=34). The percentage of cleaned surfaces was not significantly different (P=.397) between male (mean 81.6, SD 18.2) and female (mean 76.3, SD 21.1) students, irrespective of the instrument employed. The use of power-driven instruments (mean 81.3, SD 20.5) led to significantly better results than the use of manual curettes (mean 75.4, SD 19.4; P=.023) and the overall performance decreased over time (T1: mean 84.5, SD 17.5; T2: mean 72.3, SD 20.8; P<.001). Female and male students perform equally well in subgingival debridement. Therefore, sex-differentiated teaching methods are not necessary.

Subgingival instrumentation for the treatment of periodontitis

Periodontal disease is the most common chronic inflammatory non-communicable disease in the human population. It is estimated that severe periodontitis affects 11% of the world’s population, with prevalence increasing with age. Subgingival instrumentation refers to all non-surgical procedures, either performed by hand (i.e., curettes) or with power-driven instruments (i.e., sonic/ultrasonic devices).

Evaluation of root surface roughness produced by hand instruments and ultrasonic scalers: An in vivo study.

Background. The aim of periodontal treatment is to remove bacterial plaque and dental calculus by hand and power-driven instruments. However, the comparison of the effectiveness of these instruments has always been controversial. Therefore, this in vivo study investigated and compared the effects of hand and ultrasonic piezoelectric instruments on the roughness of dental surfaces under an atomic force microscope (AFM). Methods. In this study, 35 periodontally hopeless teeth were selected and randomly divided into four groups (n=7). The control group consisted of teeth that had to be extracted for orthodontic or prosthetic treatment (n=7). In group one, scaling and root planing were performed using hand instruments. In other groups, scaling and root planing were performed using piezoelectric ultrasonic instruments with low to high power, respectively. Then the scaled teeth were extracted for analysis under an atomic force microscope. Results. This study showed that root roughness significantly differed between different experimental groups (P<0.027). The root roughness (Rq) in the SRP2 group significantly differed from the control group (P<0.05), while no significant differences were observed between the other groups. Furthermore, the least roughness was observed in the SRP3 group, with the highest roughness in the SRP2 group. Conclusion. Within the limitation of this study, there were no significant differences in surface roughness between different powers of the ultrasonic device.

Efficacy of air polishing in comparison with hand instruments and/or power-driven instruments in supportive periodontal therapy and implant maintenance: a systematic review and meta-analysis

BackgroundSupportive periodontal therapy (SPT) is the key for a stable periodontal health following active treatment. Likewise, implant maintenance is crucial following implant placement. This systematic review aimed to assess clinical outcomes, patients’ perception, and cost-effectiveness of repeated periodontal therapy with air polishing devices (APDs) in comparison with hand instruments and/or power-driven instruments (conventional interventions) in SPT and implant maintenance.MethodsElectronic search for randomised controlled clinical trials with minimum 6 months follow-up for SPT and implant maintenance programme was conducted for data published from 01 January 2000 to 30 April 2020 using multiple databases and hand searching. Risk of bias was assessed using the Revised Cochrane Risk-of-Bias tool (RoB 2).ResultsA total of 823 articles were screened. 4 SPT and 2 implant maintenance studies were eligible for inclusion. For SPT, repeated APDs interventions revealed no statistically significant difference when compared to the conventional interventions (weighted mean difference [WMD] 0.11 mm, p = 0.08). Likewise, no statistical difference was noted in terms of percentage of bleeding on probing (BOP) and clinical attachment level (CAL) gain. APDs were associated with lower pain score (based on Visual Analogue Scale) and higher patient acceptance in SPT studies. For implant maintenance, APDs resulted in reduction in PPD and percentage of BOP. However, CAL gain was comparable between the two groups. In terms of patient reported outcomes, no implant maintenance studies recorded any forms of patient reported outcomes. In addition, no studies reported on economic evaluation of APDs in both SPT and implant maintenance.ConclusionWithin the limitations of this systematic review and meta-analysis, repeated subgingival debridement using APDs in SPT resulted in similar clinical outcomes but better patients’ comfort when compared to the conventional interventions. For implant maintenance, there is limited evidence to show that repeated application of APDs leads to improved clinical outcomes when compared to conventional treatments.

Non-surgical Periodontal Treatment: SRP and Innovative Therapeutic Approaches.

Periodontitis is a major public health problem, that can have local and systemic consequences ranging from tooth loss to the aggravation of other chronic diseases. The consequences of which have an impact on patient's overall general health and quality of life. Periodontal treatments include a large range of techniques and concepts from plaque control to periodontal debridement, surgery and regeneration. Regardless of the treatment proposed, it always begins with the same first essential simple step that is etiological therapy which includes oral hygiene management and the control of periodontal risk factors. The aim of this first step, presented in this chapter, consists mainly in reducing oral bacterial load and inflammation by the means of daily oral hygiene methods and sub-gingival biofilm disruption. Although understanding of the pathogenesis and molecular and cellular mechanisms involved in periodontitis has increased, treatment wise, non-surgical debridement remains the keystone of every periodontal treatment and supportive periodontal therapy. Once risk factors are monitored and plaque control mastered by the patient, root instrumentation can be performed with hand or power-driven instruments. However effective, sub-gingival biofilm disruption has some limits and can be improved with adjunctive therapies such as antiseptics, antibiotics, air polishing or other emerging devices and therapies. Unfortunately, the lack of clear clinical guidelines, concerning these adjunctive therapies, still remains, thus pointing out the necessity of more standardized clinical studies. Also, if some patients can return to a healthy periodontal state, most periodontal patients will remain at periodontal risk for life. Proper assessment of the patient's periodontal risk will help establish correct monitoring of patients successfully treated for their periodontal disease.

Efficacy versus health risks: An in vitro evaluation of power-driven scalers.

Background:Power-driven instrumentation of root surfaces during supportive periodontal therapy is an alternative to hand instrumentation. The purpose of this pilot in vitro study was to investigate the efficacy of sub- and supragingival plaque removal with a sonic (AIR: Synea, W and H, Bürmoos, Austria) and two ultrasonic devices (TIG: Tigon+, W and H, Bürmoos, Austria; VEC: Vector, Dürr, Bietigheim-Bissingen, Germany) as well as the health-risk for dental professionals during treatment.Materials and Methods:The power-driven devices were utilized to remove plaque from model teeth in dummy heads. The percentage of residual artificial plaque after 2 min of supra- or subgingival instrumentation was calculated by means of image-processing techniques at four sites (n = 576) of each tooth. The Health-Risk-Index (HRI: spatter/residual plaque quotient) with the different power-driven devices was assessed during treatment.Results:The smallest amounts of residual plaque were found for the sonic device AIR (8.89% ± 10.92%) and the ultrasonic scaler TIG (8.72% ± 12.02%) (P = 0.707). Significantly more plaque was remained after the use of the ultrasonic scaler VEC (18.76% ± 18.07%) (P < 0.001). Irrespectively of the scaler, efficacy was similar sub- (10.7% ± 11.6%) and supragingivally (13.5% ± 17.2%) (P = 0.901). AIR/TIG demonstrated equal residual amounts of plaque sub- (P = 0.831) as well as supragingivally (P = 0.510). However, AIR/VEC and TIG/VEC were significantly in favor of AIR and TIG (P < 0.001). In contrast, the lowest HRI was found after using VEC (0.0043) and differed considerably for AIR (0.2812) and TIG (0.0287).Conclusion:Sonic devices are as effective as ultrasonic devices in the removal of biofilm but bear a higher risk to the dental professional's health concerning the formation of spatter.

Early Clinical Effectiveness of ER:Yag Laser in Association with the Red Complex of Bacteria in the Initial Treatment of Moderate Chronic Periodontitis

Summary Chronic periodontitis is a result of polymicrobial infection and its treatment aims removal of dental calculus and biofi lm from the periodontal pocket. Many hand and power-driven instruments are created for this purpose. In recent years, lasers are widely discussed tools for periodontal therapy. The aim of the present study is to evaluate the early microbiological and clinical effectiveness of the Er:YAG laser in the treatment of chronic periodontitis. 30 patients with moderate chronic periodontitis were enrolled in the study. Using a split-mouth design they were treated either with Er:YAG laser (chisel tip, 100 mJ, 15 Hz, 5-6 water spray)-test group or with Gracey curettes- control group. Probing pocket depth (PPD), gingival recession (GR), clinical attachment level (CAL), bleeding on probing and plaque presence were evaluated at baseline and one month after the therapy. Microbiological samples were taken from the deepest four pockets of each quadrant from 20 randomly selected patients (n = 80). They were evaluated using real time PCR for periodontal pathogens from the red complex (Porphyromonas gingivalis, Treponema denticola and Tannerella forsythia). One month after therapy in the control group PPD decreased from 4.59 mm to 3.36 mm, the CAL gain was 1.09 mm and the reduction of bleeding and plaque - from 87.9% to 33.7% and from 75.9% to 40.9%, respectively. In the test group PPD decreased from 4.58 mm to 3.15 mm, the CAL gain was 1.37mm and the reduction of bleeding and plaque was from 85.6% to 25.9% one month after the treatment. The results were statistically significant in favour of the laser group (p &lt; 0.05). Microbiological analysis revealed that the pathogens from the red complex decreased 3 times in the control and 6 times in the test group. Therefore, the Er:YAG laser demonstrate pronounced early effectiveness in chronic periodontitis treatment and would be appropriate alternative of the conventional periodontal therapy.

Clinical Uses and Benefits of Ultrasonic Scalers as Compared to Curets: A Review

ABSTRACT Complete cementum removal is no longer a requisite. Many studies have demonstrated that hand and power-driven instruments are equally effective in reducing the probing depth, attaining attachment level gains and reducing inflammation by removal of plaque bacteria, calculus, and endotoxin. Power-driven instruments have many advantages over the manual scalers; however, further studies are needed to improve the performance of currently available instruments. These include the development of a more effective tip and ultrasonic generator unit. Long-term randomized controlled studies are also required to examine the efficacy of the newly designed scalers. These studies would help to provide treatment based on exact information regarding the instrument and technology. Every instrument comes with its own disadvantages and advantages but when proper protocol is followed the instrument can be put to its best use for the comfort of the patient and the operator. The use of Ultrasonic in periodontal surgery definitely has benefits but the choice to use hand instrument or ultrasonic instruments depends solely in the manual skill, expertise and preference of the clinician.

Comparative evaluation of hand and power-driven instruments on root surface characteristics: A scanning electron microscopy study.

Aim:The aim of this study was to compare root surface characteristics following root planing with various hand- and power-driven instruments.Materials and Methods:A total of 20 single, rooted teeth were used in this study; two specimens were used as control (no instrumentation done) and the remaining 18 specimens were equally divided into three groups. Specimens from each group were then subjected to root planing by one of the following instruments: (1) a Gracey curette, (2) ultrasonic tip and (3) a Rotary bur. In each case, the time required for scaling and root planing and surface roughness using the Roughness and Loss of Tooth Substance Index (RLTSI) was measured.Result:The mean RLTSI scores for the Gracey curette, ultrasonic and rotary instrument groups were 2.5, 2.0 and 0.667, respectively. The mean scores of time spent for scaling and root planing by the Gracey curette, ultrasonic and rotary instrument groups in seconds were 42.50, 35.83 and 54.50, respectively.Conclusions:All the three instruments, namely Gracey curette, ultrasonic tip and rotary bur, were effective in mechanical debridement of the root surface. The results favored the use of rotary instruments for root planing to achieve a smooth, clean root surface; however, the use of rotary instrument was more time consuming, which might limit its use in clinical practice.

Advances in power driven pocket/root instrumentation

The primary aim was: "Does power-driven pocket/root instrumentation offer a clinical advantage over hand instrumentation"? Secondary aim was to update knowledge base of power-driven instrumentation post Tunkel et al. (2002). A literature search of power-driven instruments (in vitro, in vivo and controlled clinical trials) was performed from April 2001 using similar criteria to Tunkel et al. (2002). Primary outcome was whether power-driven instruments offered an advantage over hand instrumentation; secondary outcomes were effect on root surface, effectiveness of new instrument designs, and role of biophysical effects such as cavitation. From a total of 41 studies, 14 studies involved comparison of power-driven devices with hand instrumentation for non-surgical therapy. These were subdivided into new designs of power instrumentation, full-mouth debridement and irrigation and patient acceptance. Use of power-driven instrumentation provides similar clinical outcomes compared with hand instrumentation. Difficulty of pooling studies continues to hinder the drawing of definitive conclusions. Newer designs of powered instruments have not shown any benefit when compared with other ultrasonic devices in non-surgical periodontal therapy. New in vitro research shows there is variation in the performance of different tip designs and generators, but its clinical relevance remains unknown.

Sixth European Workshop on Periodontology of the European Academy of Periodontology at the Charterhouse at Ittingen, Thurgau, Switzerland

For the sixth time in 15 years, the European Academy of Periodontology (EAP), a standing committee of the European Federation of Periodontology (EFP) invited teachers and researchers in Periodontology and Implant Dentistry to participate in the 6th European Workshop on Periodontology (6th EWP). Seventy-three colleagues travelled to the Charterhouse at Ittingen in the Canton of Thurgau, Switzerland, to spend 5 days in the seclusion of the monastery and to discuss controversial and pertinent issues of “Contemporary Periodontics”. Such an academic event can only take place if all participants contribute with their full enthusiasm and engagement. It is, therefore, our privilege to acknowledge the enormous work of our colleagues before the workshop and the complete devotion during the sessions. Moreover, the EAP wishes to acknowledge the generous financial support of the 6th EWP by Straumann AG, Basel, Switzerland. Without their spontaneous and no-strings-attached financial support as well as their professional help and interest this Academy could not have convened. Last, but not least, the Swiss Society of Periodontology SSP who continuously supported each of the past six workshops with both financial and moral support deserves a whole-hearted thank you note. In five working sessions, the following major aspects were discussed, debated and consensus reached: Innovations in Periodontal Practice with position papers on “Full mouth disinfection versus conventional staged debridement”, “Advances in power-driven instrumentation”, “Antimicrobial therapy in periodontitis”, “Cost-effectiveness for supportive periodontal care” and “Lasers in non-surgical periodontal therapy”. Periodontal Tissue Engineering and Regeneration with position papers on “Combinations of barrier membranes and grafting materials”, “Growth factors and biological mediators”, “Bioactive agents alone or in combination with grafting or GTR” and “Treatment of gingival recession with coronally advanced flap procedures”. Critical Issues in Bone Regeneration with position papers on “Clinical outcomes of dental implants placed in sites with lateral bone augmentation”, “Potential of growth factors for localized alveolar ridge augmentation”, “Success of sinus floor elevation and survival of implants inserted in combination with sinus floor elevation” and “Vertical bone augmentation to enable dental implant placement”. Peri-implant Infections with position papers on “Definition and prevalence of peri-implant diseases”, “Peri-implant diseases: diagnosis and risk indicators”, “Non-surgical treatment of peri-implant mucositis and peri-implantitis” and “Surgical treatment of peri-implantitis” Periodontal Diseases and Health with position papers on “Has the prevalence of periodontitis changed during the last 30 Years?”, “Prevalence and distribution of principal periodontal pathogens worldwide”, “Cardiovascular disease and periodontitis”, “Effects of diabetes mellitus on periodontal and peri-implant conditions” and “Adverse pregnancy outcomes and periodontal disease”. As a result of this intensive Academy, a total of 15 narrative and nine systematic reviews were discussed and scrutinized. This supplement of the Journal of Clinical Periodontology presents the revised and ammended, peer-reviewed versions of the 24 reviews and the five Consensus Reports of the Sessions A–E. With an extremely efficient review process setting priority for early publication the EAP hopes to contribute with another monograph and putting periodontal practice on a solid scientific foundation. Owing to the generosity of Wiley Blackwell International Publishers, this supplement of the Journal of Clinical Periodontology will reach the interested reader within a few months of the Ittingen Workshop and, hence, the acquired knowledge will disseminate as fast as possible.

Ultrasonic Cement Removal in Revision Arthroplasty

Efficient and safe cement removal is critical in revision arthroplasty. Conventional manual cement removal by hand or power-driven instruments can be time-consuming, require osteotomy, and be associated with complications such as cortical perforation, fracture, or bone loss. Ultrasonic devices offer an alternative method of cement removal by converting mechanical vibrations into thermal energy, liquefying the cement. This facilitates selective cement removal, preserves bone, decreases cortical perforation risk, and eliminates the need for osteotomy. However, potential for thermal injury exists. Ultrasound basic science, mechanism of action, and clinical applications with specific emphasis on methods to limit excessive heat generation are reviewed.

Loss of tooth substance during root planing with various periodontal instruments: an in vitro study

Ultrasonic and power-driven instrumentation is gaining in significance as an acceptable alternative to manual periodontal root treatment. Some question whether they do not remove too much tooth substance. Various ultrasonic scalers, hand instruments and two power-driven systems were compared by assessing the loss of tooth substance due to root instrumentation. Quantitative analysis of this effect of the instruments used was performed on 20 freshly extracted, non-periodontally involved, large human molars. In the first study, 40 specimens were randomly assigned to four groups of treatment: combined use of ultrasonic scaler and Periopolisher diamond-coated inserts (US-POL), hand instruments (MANUAL), Perioplaner-Periopolisher system (PPL-POL) and Periokit ultrasonic-designed scalers (PERIOKIT). The second study involved two treatment groups, ultrasonic scaler alone and hand instruments, each allocated with 20 teeth (small root fragments). An unpaired two-tailed t test was carried out for both studies to compare the average weight loss of root substance with the modes of instrumentation. The level of significance was set at p<or=0.05. The overall results of the first and second experimental trials did not reveal obvious differences in weight loss between the manual, ultrasonic or power-driven root treatments. Based on the results of these two comparative studies, the power-driven inserts or the various ultrasonic scalers tested did not remove more tooth substance than conventional hand instruments. They may thus be a useful alternative for the debridement of root surfaces.

Learning root debridement with curettes and power-driven instruments. Part I: a training program to increase effectivity.

In a dummy-head trial, we assessed how effectively untrained operators were able to learn scaling with curettes and power-driven instruments. Two untrained operator groups (n = 11 each) received six 2-h lessons during a 10-week period following a training program. Subgingival scaling was performed with curettes (GRA) and a power-driven system (PP). At 6 test days each subject had to instrument 10 test teeth. The percentage of debrided area was assessed with an image analysis program. Learning success was measured as a percentage of debrided root area and scaling time. Furthermore, the effectivity was related to difficulty in anatomical situations and access to root surfaces. Statistical analysis was carried out with SPSS. At baseline, effectivity was 63.1% (GRA) vs. 52.3% (PP). Between weeks 9 and 11, operators reached a plateau for group GRA at 84.7% and group PP at 81.3%. Scaling time did not differ between the two groups. Debridement of teeth with complex root shapes that were hard to access was less effective with the power-driven system. Independent of the instrument used, untrained operators were only able to debride root surfaces at low levels of efficacy. With systematical training, effective scaling with the power- driven system was as easy to learn as with hand instruments. On root surfaces with complicated shape and anatomy or difficult accessibility, the power-driven system works significantly less effectively.

Removal of overhanging amalgam: A comparative study of three instruments

This study compared the effects on tooth surface of three power-driven instruments commonly used to remove overhanging amalgam. Comparisons of methods of instrumentation were made on enamel, cementum, and amalgam. Cavitron, Roto Pro, and EVA system instruments were used. Findings showed significantly more abrasion on all surfaces in EVA groups compared with other groups. All surfaces in Roto Pro groups appeared to be smoother than in other groups. There appeared to be little difference between treated surfaces and control surfaces in the Cavitron group.