Instrumentation of furcation with modified sonic sealer inserts: study on manikins, Part I

Abstract. The purpose of this study was to determine the suitability of different scaling instruments for the debridement of furcations. 12 upper and 12 lower replicated molars with through-and-through furcutions were instrumented 3 × with 5 different types of instruments: (i) hand instruments; (ii) hand instruments in conjunction with diamond burrs: (iii) a conventional ultrasonic sealer insert: (iv) a conventional sonic sealer insert; (v) a set of 2 modified diamond coated sonic sealer inserts with different angulated shafts. The plastic replicas were fixed in a manikin head without replicated soft tissues. Following debridement, weight loss and % of instrumented furcation area were assessed. In the ease of lower molars, it made little difference whether they were treated with hand instruments, hand instruments combined with diamond burrs, or diamond-coated sonic sealer inserts. On upper molars, however, significantly more area was instrumented with the diamond-coated inserts than with the other instruments. Substance removal was greater with diamond-coated inserts than with the other devices. In conclusion, an effective debridement of the furcation seems possible only with an odontoplasty, in which a furcation is fitted to the instrument by means of intensive instrumentation, thus leading to substance loss. To improve results with these instruments, further research is necessary.     

Instrumentation of furcation with modified sonic sealer inserts A study on manikins (II)

Abstract. We developed a sonic sealer tip with an ellipsoid diamond-coated bud and contra-angulated shafts to overcome problems resulting from furcation anatomy. In this study, extracted molars were instrumented in a dummy model without any replicated soft tissues using 3 different instrumentation methods (i) curettes, (ii) diamond-coated sonic sealer tips with normal handle and (iii) diamond-coated sonic sealer tips in 2 handles with varying power levels. 15 extracted upper and lower molars were instrumented using each of the 3 instrumentation types. Following debridement, loss of substanee and % of furcation area instrumented were assessed. In both upper and lower molars, significantly more surface area was instrumented in one instrumentation run with diamond-coated tips than with curettes. Substance loss was greater with diamond-coated lips than with hand instruments. In conclusion, an effective debridement of the furcation roof seems only possible with odontoplasty. Clinical evaluation of this approach to root debridement is needed.     

Diamond-coated sonic tips are more efficient for open debridement of molar furcations. A comparative manikin study

BACKGROUND/AIMS: The aim of this study was to compare the efficacy of open debridement of class II and III furcations by a new diamond-coated sonic instrument tip (Sonicparo) with a conventional sonic insert (Sonicrecall) and hand instruments (Gracey curettes). METHOD: Open debridement was simulated using a manikin head and standardised plastic teeth. The efficacy of debridement was examined by 3 parameters: residual root surface marker, 'tooth' weight loss and time taken for debridement. The teeth used were 1st and 2nd upper and lower molars. Upper left and lower right molars were chosen to represent class II furcation involvements and upper right and lower left molars class III furcation involvements. Each tooth was debrided 4 times with each instrument for both class of furcations. RESULTS: The results of this study showed significantly less residual marker area comparing Sonicparo with Gracey curettes (mean difference 2.52 mm2, p<0.001). However, no significant differences in marker removal were observed between Sonicrecall inserts and the other instruments. Sonicparo inserts also took significantly less time to debride the furcation than Gracey curettes (mean difference 98.3 s, p<0.001) or Sonicrecall instruments (mean difference 74.3 s, p<0.001). However no significant differences were found between instruments concerning weight loss of the plastic teeth. CONCLUSIONS: It was concluded from this in-vitro study that the Sonicparo insert was a more efficient instrument for open molar furcation debridement than Sonicrecall and hand instruments (Gracey curettes) when considering both marker removal and debridement time.     

Root debridement of molars with furcation involvement using diamond-coated sonic scaler inserts during flap surgery – a pilot study

In our laboratory, we modified sonic scaler inserts to increase effectivity of root surface instrumentation of molars with furcation involvement during flap surgery. The working end of conventional sonic scaler inserts was thickened ellipsoidally and diamond coated. Inserts with variously angled shafts were designed in order to facilitate insertion into the furcation. A clinical, split-mouth study examined the debridement of molars with furcation involvement during flap surgery using either hand instruments or diamond-coated sonic scaler inserts with 15 patients. Average treatment time was cut by ca. 50%, using diamond-coated inserts as compared to hand instruments for root surface debridement during surgery. 2 years after surgery, the clinical parameters had not been influenced by type of instrument used.     

Substance loss caused by scaling with different sonic scaler inserts--an in vitro study

BACKGROUND, AIMS: Depending on the phase of periodontal treatment, power-driven inserts with different power levels are necessary: during initial treatment and flap operations, it must be possible to remove calculus which firmly adheres to the root surface with great efficiency; in contrast, gentle root-surface instrumentation has a high priority during maintenance treatment. Recently, modified sonic scaler inserts have been introduced: diamond-coated inserts for open flap operations and slim probe-shaped sonic scaler inserts for deplaqueing during maintenance. METHOD: We compared the substance removal by these inserts to that of a conventional insert. In a bench system which allows application force, stroke height, and width and frequency of instrumentation to be monitored and also permits assessment of the topography before and after instrumentation (yielding depth removal and removed volume), we instrumented aluminum rods in triplicate and bovine roots in a 5-fold repetition. RESULTS: With high application forces (1.0 N), the diamond-coated inserts removed 30 to 50% more substance than the conventional one. Except for the slim inserts, there was a significant linear relationship between increasing force and removed volume. Probe-shaped inserts do not remove considerable substance even with increasing pressures. CONCLUSIONS: Diamond-coated inserts remove tooth substance very effectively and must thus be handled with care: more pressure effects more removal. Probe-shaped inserts can be used without risk during maintenance visits.     

Effectiveness of subgingival instrumentation with power-driven instruments in the hands of experienced and inexperienced operators

Abstract Power instrumentation of periodontally-diseased root surfaces is gaining in significance as an alternative to conventional curette methods. In an experimental study employing manikins with simulated bone loss, we investigated whether inexperienced and experienced operators were able to achieve greater therapeutic success with power-driven devices than with hand instruments in subgingival scaling. 10 dentists experienced in periodontal treatment and 10 inexperienced dentists instrumented 7 teeth in the upper jaw, which had been covered with artificial deposits. Hand instruments, the Perioplaner system, a sonic and an ultrasonic sealer were used. The time required for treatment was measured and the % of residual deposits was calculated by means of image-processing techniques. Weight loss was also determined for the teeth that were scaled with the hand instruments and the Perioplaner system. Experienced operators left significantly less % of residual deposits on the teeth (18±7.6%) than the inexperienced (27±8.4%), regardless of the type of instrument selected. Both experienced and inexperienced operators left the smallest amounts of residual deposits with hand instruments (13±9.8%/24±9.5%). Both treatment groups removed more hard tooth structure with hand instruments than with the Perioplaner system (53±48mg versus 47±25.9 mg). Experienced operators needed somewhat more time for debridement than unexperienced. Use of the sonic/ultrasonic device required somewhat less time than hand instrumentation. Inexperienced operators are however, unable to improve their treatment results by using the power-driven instruments included in the study.     

Molar furcation entrance and its relation to the width of curette blades used in periodontal mechanical therapy

Abstract: Aim:  The purpose of this research was to evaluate molar furcation entrances and the width of periodontal curette blades used in periodontal instrumentation.
Materials and methods:  One hundred extracted molars (50 upper and 50 lower) were analysed. The furcation entrances were measured using orthodontic wires of different predetermined diameters: 0.4, 0.5, 0.6, 0.7, 0.8 and 0.9 mm. McCall 17–18, Gracey 5–6 and Gracey 5–6 mini-five curette blades were measured at their anterior (AT), middle (MT) and posterior (PT) thirds by a single trained investigator, through the use of a digital caliper.
Results:  The results showed significant differences ( P  < 0.0001) in relation to furcation entrances. The buccal upper molar furcations showed the narrowest dimensions. In relation to the blade diameter, significant differences among the instruments were found for their MT and PT ( P  < 0.0001), but not for the AT ( P  = 0.183). Significant differences were found among curette manufacturers. Nineteen per cent of evaluated furcations presented entrances <0.60 mm and 75% of the blades at their AT presented width >0.60 mm.
Conclusions:  These findings demonstrated that some molar furcation entrances could not be adequately instrumented with the tested curettes. The use of other hand instruments, such as periodontal files, rotating instruments and ultrasonic devices should be taken into consideration during periodontal therapy.     

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 p0.05. 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.     

Position paper: sonic and ultrasonic scalers in periodontics. Research, Science and Therapy Committee of the American Academy of Periodontology

Ultrasonic and sonic scalers appear to attain similar results as hand instruments for removing plaque, calculus, and endotoxin. Ultrasonic scalers used at medium power seem to produce less root surface damage than hand or sonic scalers. Due to instrument width, furcations may be more accessible using ultrasonic or sonic scalers than manual scalers. It is not clear whether root surface roughness is more or less pronounced following power-driven scalers or manual scalers. It is also unclear if root surface roughness affects long-term wound healing. Periodontal scaling and root planing includes thorough calculus removal, but complete cementum removal should not be a goal of periodontal therapy. Studies have established that endotoxin is weakly adsorbed to the root surface, and can be easily removed with light, overlapping strokes with an ultrasonic scaler. A significant disadvantage of power-driven scalers is the production of contaminated aerosols. Because ultrasonics and sonics produce aerosols, additional care is required to achieve and maintain good infection control when incorporating these instrumentation techniques into dental practice. Preliminary evidence suggests that the addition of certain antimicrobials to the lavage during ultrasonic instrumentation may be of minimal clinical benefit. However, more randomized controlled clinical trials need to be conducted over longer periods of time to better understand the long-term benefits of ultrasonic and sonic debridement.     

Accessibility of an ultrasonic furcation tip to furcation areas of mandibular first and second molars

The purpose of this study was to compare an ultrasonic furcation tip with an ultrasonic conventional tip and a hand scaler on accessibility to furcation areas of mandibular first and second molars. The study was conducted on 360 artificial molars that were replicated from 30 mandibular first molars and 30 second molars with silicone impression material and resin. The furcation areas of each molar were coated with red nail colour for artificial calculus. The root areas from the cement-enamel junction apically were covered with silicone rubber simulating gingival tissue. Then the models were instrumented on the buccal or lingual aspects by an experienced operator with each of the following instruments: an ultrasonic furcation tip, an ultrasonic conventional tip and a hand scaler. After instrumentation the percentage of the furcation area with residual artificial calculus was assessed using a computerised imaging system. Results showed that when the horizontal pocket depth was less than 2mm, all three instruments showed good accessibility. When the horizontal pocket depth was more than 2mm, the ultrasonic conventional tip and the hand scaler showed less removal of artificial calculus than the ultrasonic furcation tip (P < 0.01). Efficiency of the ultrasonic furcation tip was fairly satisfactory for the horizontal pocket up to the ridge of the furcation roof.     

The effectiveness of two sonic and two ultrasonic scaler tips in furcations

This study compared the effectiveness of two sonic and two ultrasonic scaler tips on artificial calculus removal from the furcations of mandibular first and second molars. Twenty-four extracted mandibular molars were cleaned and randomly assigned to one of four treatment groups. Teeth were split buccal lingually, artificial calculus was placed in the furcation areas, and the teeth were photographed with a stereo camera. Teeth were reconnected with bonding material and mounted in a typodont with simulated gingiva and attached to a dental chair. Teeth were instrumented with either a Cavitron TFI10 tip, Cavitron EWPP tip, Titan-S Universal tip, or Titan-S Sickle tip by a licensed dental hygienist until each tooth was judged calculus free to the touch with a CH3 explorer. Time for each instrumentation period was recorded. Following instrumentation, the teeth were again split and photographed. Stereophotogrammetry was used to produce tracings of the teeth with initial calculus and remaining calculus. Pre-instrumentation and post-instrumentation amounts of calculus on the surface area were computed using the Bioquant system. A two factor analysis of variance was conducted followed with a Newman-Keuls Multiple Comparison Technique to test for within and between differences. Significant differences (P less than or equal to 0.01) were found between pre- and post-amounts of calculus for all tips. No significant differences (P less than or equal to 0.05) were found between the four instrument tips with respect to percentage of furcation surface with calculus remaining. No differences were found between tips with regard to the time required to clean the test surfaces.     

Microscopic analysis of the effects of ultrasonic instrumentation on the root surface of molar furcations

Twenty molars, 10 from the maxilla and 10 from the mandible with furcation areas type II (Staffileno) were instrumented in their inter-radicular area with P10 instrument of Cavitron. It was established that the furcations of easier access instrumentation were the lingual o lower teeth and the buccal of the upper, and the most difficult accessibility were the distal of upper molars. The instrumentation can leave grooves or deformations, depending on the instrument to the area. It was concluded that ultrasonic instrument are useful removing supragingival calculus and bacterial plaque, and it must be limited to perform such procedures.     

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

AIMS: 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. METHOD: 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. 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.     

Root surface texture after different scaling modalities

Root surface texture after scaling with hand instruments, ultrasonic scalers (Amdent 830 and Cavi-Med 2000), and a sonic sealer (Titan-S) was assessed in vitro. The experimental material consisted of 48 extracted human teeth divided into six groups. Root surface texture was assessed with scanning electron microscopy (SEM). Hand and sonic instrumentation produced large grooves and removed cementum evident at a magnification of ×70. while the root surface alterations after ultrasonic instrumentation were not detectable below a magnification of ×500. The working principle of each scaling instrument in relation to its effect on the root surface was discussed.     

Root debridement of single-rooted teeth with a diamond-coated sonic scaler insert during flap surgery. A pilot study

In our laboratory, we modified inserts of a sonic scaler to increase effectivity of root surface instrumentation during flap surgery. The present clinical study investigates whether use of this diamond-coated, thickened insert facilitates more rapid root debridement compared to hand instruments and whether clinical wound healing is influenced by the type of instrument used. In 13 patients with moderate to advanced periodontal destructions, flap surgery was carried out on single rooted teeth with probing depth of > or =6 mm. The mean amount of time saved by root debridement with the diamond-coated insert was 60% over curets. Regardless of the used instrumentation method probing depths and attachment level changes were altered and remained unchanged for 2 years after surgery. In conclusion the newly-developed, diamond-coated sonic scaler insert facilitates more rapid root debridement during flap surgery than hand instruments without disadvantageously affecting clinical healing.     

Histological evaluation of ultrasonic and sonic instrumentation of curved root canals

Fifty extracted human mandibular first and second molars with mesial canal curvatures of 18 to 35 degrees were randomly divided into five groups. After routine endodontic access and canal length determination, one of the mesial root canals was instrumented using tap water and one of the following instrumentation methods: (a) hand instrumentation; (b) ultrasonic instrumentation with the Cavi-Endo unit; (c) ultrasonic instrumentation with the Enac unit; (d) sonic instrumentation with the Medidenta unit; and (e) sonic instrumentation with the Endostar 5 unit. The other mesial canal was used as a control. The mesial roots were decalcified, serially sectioned, stained with hematoxylin and eosin, and blindly evaluated using the light microscope. The mean canal wall planing and soft tissue debridement scores were compared by analysis of variance. There was no statistically significant difference among the groups for wall planing or soft tissue debridement.     

Clinical comparison of bioactive glass bone replacement graft material and expanded polytetrafluoroethylene barrier membrane in treating human mandibular molar class II furcations

BACKGROUND: Class II furcations present difficult treatment problems and historically several treatment approaches to obtain furcation fill have been used. METHODS: The response of mandibular Class II facial furcations to treatment with either bioactive glass (PG) bone replacement graft material or expanded polytetrafluoroethylene (ePTFE) barrier membrane was evaluated in 27 pairs of mandibular molars in 27 patients with moderate to advanced periodontitis. Following initial preparation, full thickness flaps were raised in the area being treated, the bone and furcation defects debrided of granulomatous tissue, and the involved root surfaces mechanically prepared and chemically conditioned. By random allocation, PG or ePTFE was placed into or fitted over the furcations, packed or secured in place, and the host flap replaced or coronally positioned with sutures. Postsurgical deplaquing was performed every 10 days leading up to ePTFE removal at about 6 weeks. Continuing periodontal maintenance therapy was provided until surgical reentry at 6 months for documentation and any further necessary treatment. RESULTS: Direct clinical measurements demonstrated essentially similar clinical results with both treatments for bone and soft tissue changes. There were no statistically or clinically significant differences (e.g., mean horizontal furcation fill 1.4 mm PG, 1.3 mm ePTFE; mean percent horizontal furcation fill 31.6% PG, 31.1% ePTFE, both P>0.85). Seventeen of the PG treated and 18 of the ePTFE furcations became Class I clinically and 1 furcation completely closed clinically with each treatment. Intrapatient comparisons showed similar horizontal furcation responses with both treatments. CONCLUSION: The findings of this study suggest essentially equal clinical results with PG bone replacement graft material and e-PTFE barriers in mandibular molar Class II furcations. PG use was associated with simpler application and required no additional material removal procedures.     

声波、超声波、手用根管器械预备弯曲根管的效果比较

目的：比较声波、超声波和手用根管器械预备弯曲根管的效果。方法：采用3种根管器械预备树脂块模拟根管并进行比较。结果：30个树脂块模拟根管预备效果显示：声波、超声波和手用器械根管预备效果无显著性差异。结论：声波根管器械具有临床应用价值。     

Effectiveness and safety of a sonic vibratory endodontic instrument

Abstract An air-driven sonic vibratory handpiece to which specially designed K-type files are attached has been developed. When activated, the root canal instruments will vibrate in a whirling motion, and when moved up and down, will abrade the root canal wall. The sonic system was tested in simulated root canals in plastic blocks and in usage tests in dogs' teeth. Forty-nine roots in 3 dogs were divided into 3 groups. Two of the groups were instrumented with the sonic device under continuous irrigation with 2.5% NaOCl or 15% EDTA. The 3rd group was treated with conventional chemomechanical instrumentation and 2.5% NaOGl. The teeth were then extracted, fixed and split in a longitudinal direction and the root canals examined in the scanning electron microscope. After hand instrumentation and sonic instrumentation using NaOCl for irrigation, the canal wall was covered by a smear layer and dentin chips and occasional tissue remnants were seen. An extraoral fine mist of NaOCl was seen during continuous irrigation with this medicament, causing eye soreness in the operator. Continuous irrigation with EDTA during sonic instrumentation removed the smear layer and gave clean canal walls. The vibratory files appeared safe and size 20 followed curved canals well. The effectiveness of the sonic device was similar to hand instrumentation. It considerably improved the ease and, to some extent, the speed of root canal instrumentation.     

Stereomicroscopic evaluation of canal shape following hand, sonic, and ultrasonic instrumentation

This study evaluated the root canal shape after using sonic, ultrasonic, and hand instrumentation on the mesial canals of extracted human mandibular first and second molars. One-hundred and five mesial roots were randomly divided into six experimental groups and one untreated control group of 15 roots each. The following instrumentation techniques were evaluated in the experimental groups: hand instrumentation with K-Flex files, sonic instrumentation with the Endostar 5, sonic instrumentation with the Sonic Air MM 3000, and ultrasonic instrumentation with the Cavi-Endo unit. Each technique was directly compared with each other. The mesial roots were instrumented alternating the techniques between the buccal and lingual canals in each group so that a direct comparison could be made. All canals were instrumented to a size corresponding to a #30 K-Flex file 1 mm from the anatomical apex. The roots were then sectioned perpendicular to the long axis so the apical and middle thirds could be evaluated with the stereomicroscope for canal shape. The control group was sectioned and examined without instrumentation. A significantly more regular shape was obtained at both levels with hand instrumentation than was obtained with either sonic or ultrasonic techniques. The comparisons between the sonic and ultrasonic techniques showed significantly better shapes were obtained with the Sonic Air MM 3000 instrument.