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.     

Subgingival polishing compared to scaling with steel curettes: a clinical pilot study

BACKGROUND: Recently, we have developed teflon-coated sonic scaler inserts which remove plaque without removing tooth substance; they polish subgingivally. In a preclinical test, we showed that these modified inserts remove plaque nearly as effectively as do conventional sonic scaler inserts. The present investigation was intended as a proof-of-principle of subgingival polishing. The aim was to study the effect of subgingival polishing on the resolution of gingival inflammation in comparison to conventional scaling. MATERIAL AND METHODS: In 10 patients with moderate to advanced periodontal disease, who had at least 2 single-rooted teeth with a probing depth of >6 mm in each quadrant, all single-rooted teeth were subjected to one treatment regimen consisting of 2 instrumentation episodes (1st/2nd treatment): curette/curette, curette/teflon-coated sonic scaler, teflon-coated sonic scaler/teflon-coated sonic scaler, and an untreated control. The second treatment session was performed 3 months after the first instrumentation, and the final registration 3 months after the second instrumentation. Clinical measurements included probing depth, change of clinical attachment level, bleeding upon probing, and plaque scores. RESULTS: Probing depth, attachment level, and bleeding scores were reduced in the 3 instrumentation groups versus the control group in the 1st period; in the 2nd period, no further change occurred. Subgingival polishing with teflon-coated sonic scaler inserts was slightly less effective than conventional scaling. CONCLUSION: Subgingival polishing with teflon-coated sonic scaler inserts seems to be nearly as effective as conventional scaling. Thus, it may be the instrumentation of choice for maintenance treatment of residual pockets.     

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.     

Subgingival debridement with a teflon-coated sonic scaler insert in comparison to conventional instruments and assessment of substance removal on extracted teeth.

OBJECTIVE: Previous studies have shown that endotoxins are located on the periodontally diseased root cementum and not within it. To what extent a Teflon-tubed sonic scaler was capable of removing bacterial deposits in comparison to conventional scaling instruments, and the resulting root surface roughness and root surface topography, were recently assessed. The objective of the present study was to evaluate how much root cementum is removed with these instruments. METHODS AND MATERIALS: Eighty-two teeth were treated subgingivally on one approximal site either with a Teflon-coated sonic scaler insert (tSS), a Gracey curette, a conventional sonic scaler (SS), a piezoelectric ultrasonic scaler insert (US), or an oscillating Periotor insert (PT) before extraction. The untreated site served as control. The width and length of cementum removal were compared histomorphometrically. Nonparametric analyses were carried out for statistical comparison. RESULTS: The US, PT, and tSS inserts removed less substance than the curettes or SS inserts. The cementum removed was 40 microm for root surfaces treated with the curette or SS, 30 microm for those treated with US, 20 microm for PT, and 17 microm for tSS. CONCLUSION: The Teflon-coated sonic scaler inserts can be a reasonable choice for gentle maintenance treatment of compliant patients with good plaque control, and little or no subgingival deposits.     

Safety and efficiency of novel sonic scaler tips in vitro

BACKGROUND: The aim of the study was to evaluate a novel sonic scaler tip for subgingival root surface instrumentation combining high efficiency in calculus removal with minimized risk of root damage through subgingival debridement. METHODS: A metal sonic scaler tip with a paddle-like working end covered with spheroid convexities of 0.8 mm diameter and 0.3 mm height was designed from the aspect of optimized adaptation to the root anatomy (tip-end dimension: 3.0 x 1.5 x 0.6 mm). Using a customary sonic scaler tip as control, instrument efficiency was quantified by measuring the time needed to completely remove calculus on extracted teeth (n=52) under standardized conditions. To quantify the amount of calculus removed, the mean calculus area per tooth was measured on photographs taken before instrumentation. The tips safety was evaluated instrumenting calculus-free root surfaces in vitro (n=18, lateral forces 0.5, 1, 2 N, 20 s instrumentation time, tip angulation 0 degrees ) with subsequent laser-optical determination of resulting root substance loss. RESULTS: Debridement efficiency was significantly higher for the novel tip (0.78+/-0.81 mm2/s completely debrided) than for the conventional tip (0.42+/-0.33 mm2) (Mann-Whitney test, p<0.05). Concerning instrument safety, the novel tip caused significantly less root substance loss than the conventional tip. CONCLUSION: The novel scaler tip appears to be significantly more efficient in calculus removal and less damaging to the root surface than the assessed conventional tip.     

Proof of efficacy of different modified sonic sealer inserts used for debridement in furcations – a dummy head trial

Abstract The purpose of this study was to determine the suitability of different scaling instruments for surgical removal of hard and soft bacterial deposits and for the removal of soft accretions only for maintenance treatment within furcations. 12 upper and 12 lower plastic replicated molars, with through-and-through furcations, were instrumented 3× with 4 different types of instruments: (1) hand instruments: (2) a conventional sonic sealer insert: (3) a set of 3 modified sonic sealer inserts with budded tips and different angulated shafts; (4) a set of 3 sonic sealer inserts with a plastic- coating and different angulated shafts. The plastic replicas were fixed in a dummy head without any replicated soft tissues. In the furcation area, an easily removable surface coating material was applied to the teeth to represent the “plaque” and a second, more stubborn lacquer layer representing “calculus/cementum”. Following instrumentation, the following parameters were recorded to assess efficacy: time required for instrumentation, loss of weight, depth of substance removal at the furcation entrance, % of furcation area instrumented, whereby removal of these 2 layers was judged separately. Only minor differences were observed between hand instruments, conventional and budded sonic sealer inserts as to loss of weight, depth of substance loss and area instrumented. The plastic-coated sonic sealer inserts were just as effective in surface layer removal representing “plaque” as the 3 other instruments, but resulted in less loss of weight and less depth of substance removal. In conclusion, the more aggressive hand instruments, the conventional and budded sonic sealer insert, are preferably used for the surgical phase to increased ease of entry into the furcation dome. An effective debridement of the furcation roof seems only possible with an odontoplastic, for which a furcation is fitted to the instrument by means of an intensive instrumentation, thus leading to weight loss and pronounced substance removal. The plastic-coated sonic sealer inserts seems to be a reasonable choice for maintenance treatment within furcation, since this treatment phase is usually restricted to removal of soft bacterial deposits.     

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.     

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.     

Subgingival polishing with a teflon-coated sonic scaler insert in comparison to conventional instruments as assessed on extracted teeth. (I) Residual deposits

BACKGROUND: Recent studies have shown that endotoxins are located on the periodontally diseased root cementum and not within it. These studies led to the suggestion that the root surface could be treated less aggressively during periodontal therapy. Thus, we designed a teflon-tubed sonic scaler insert for subgingival polishing. It was our objective to assess to which extent this new instrument is capable of removing bacterial deposits in deep pockets in comparison with conventional scaling instruments. METHOD: We compared the extent to which plaque and calculus could be removed with a curette, a conventional sonic and ultrasonic scaler insert, a Per-io-tor insert, and a teflon-tubed sonic scaler insert. 84 teeth requiring extraction had been treated with one of these instruments. After extraction, the teeth were stained with Malachite green, and the following areas were assessed: area lacking plaque and calculus, calculus, and area only covered with plaque. For statistical comparison, nonparametric analyses were carried out. RESULTS: Curettes and conventional ultrasonic and sonic-scaler inserts had more area lacking plaque and calculus (97.5%, 92.2%, 92.1%) than did the Per-io-tor (80.1%) or the teflon-coated sonic scaler insert (84.4%). A similar effectivity sequence was observed for residual soft deposits (curette: 1.9%, ultrasonic scaler: 6.1%, sonic scaler: 5.4%, teflon-coated sonic scaler: 5.1% and Per-io-tor: 9.5%). CONCLUSIONS: The Per-io-tor and the teflon-coated sonic scaler insert seem to be suitable for the removal of soft deposits on the root surface, but not for the removal of calculus.     

Pain during prophylaxis treatment elicited by two power-driven instruments

BACKGROUND: Sonic scalers have an elliptical and piezoceramic ultrasonic scalers a linear oscillation pattern. Thus, a sonic scaler "hammers" the tooth surface, irrespective of its alignment to the tooth, whereas a piezoceramic ultrasonic scaler may oscillate parallel to the tooth surface and gently remove calculus if the alignment is correct. The aim of this study was to measure pain on a visual analogue scale (VAS) during removal of supragingival calculus on mandibular incisors with a sonic or an ultrasonic scaler. MATERIAL AND METHODS: Seventy-four periodontally healthy subjects with supragingival calculus on the mandibular incisors were treated with both a sonic and a piezoceramic ultrasonic scaler in a split-mouth design. The sequence of instrument application and allocation of instruments to jaw side were randomized. Patient comfort was assessed with a VAS after treatment. RESULTS: The VAS results did not show any difference between the two instrumentation modalities. CONCLUSION: For calculus removal during prophylaxis the type of power-driven instrument does not seem to have an impact on perceived pain. This means that the oscillation pattern does not influence the pain experience.     

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).     

The effect of hygiene instruments on dentin surfaces: scanning electron microscopic observations.

The present study consists of two separate parts. The first section is an in vitro evaluation of the relative abrasiveness of some hygiene instrumentations commonly used during maintenance therapy. In the second section, one of the instruments, a recently developed plastic tip for use on a sonic scaler, was examined for its ability to remove dental plaque from root surface specimens instead for 5 weeks in the oral cavities of dogs. The in vitro study was performed on recently obtained dentin specimens where a ridge had been machined parallel to the long axis of the tooth. The sonic scaler fitted with the plastic tip gave considerably less removal of dentin and a smoother dentin surface than the curet, the rubber cup with polishing paste, or the sonic scaler with an ordinary metal tip. These findings further demonstrated that the plastic tip was able to efficiently remove 5-week old dental plaque from experimental root surface areas within a time frame of 5 seconds. The new plastic tip may be valuable in maintenance therapy giving less risks for iatrogenic effects on the root surfaces than other debridement methods.     

Significant influence of scaler tip design on root substance loss resulting from ultrasonic scaling: a laserprofilometric in vitro study

OBJECTIVES: Ultrasonic scalers have become increasingly popular for subgingival debridement. The aim of the present study was to investigate the influence of different working tip designs (narrow versus wide) on root substance loss caused by either magnetostrictive or piezoelectric ultrasonic devices. METHODS: In this in vitro study, a magnetostrictive ultrasonic system with either Slimline or TFI-10 inserts and a piezoelectric ultrasonic system with either Perioprobe or Type-A inserts were compared at different application forces. Loss of root dentin was determined by defect width, defect depth and defect volume resulting from standardized instrumentation using laser profilometry. RESULTS: There were consistent and statistically significant differences between all groups. The mean observed dentin alterations for the magnetostrictive ultrasonic device operating a Slimline insert at a lateral force of 0.3 N were 254.4 microm, 6.3 microm and 22.5 microm3 and for the TFI-10 tip 759.0 microm, 23.5 microm and 160.2 microm3 for the parameters defect width, depth and volume, respectively. For the piezoelectric ultrasonic system operating a Perioprobe insert, the corresponding mean values were 352.0 microm/12.1 microm/56.4 microm3 and for the universal Type-A insert they were 402.4 microm/14.0 microm/133.4 microm3. With application forces of 0.7 N, root substance removal increased up to twofold. CONCLUSION: The present investigation could demonstrate that the aggressiveness of magnetostrictive and piezoelectric ultrasonic devices to root substance was significantly influenced by the scaler tip designs, increasing for wider scaler tips as compared with narrow, probe-shaped inserts.     

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.     

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.     

Working parameters of a sonic scaler influencing root substance removal in vitro

This study assessed defect depth and volume resulting from root instrumentation using a KaVo Sonicflex Lux 2000 L sonic scaler with a slim scaling tip (Perio-Tip no. 8) in vitro. Combinations of the following working parameters were analyzed: lateral forces of 0.5 N, 1 N, and 2 N; tip angulations of 0°, 45°, and 90°; and instrumentation time of 10 s, 20 s, 40 s, and 80 s. Defects were quantified using a three-dimensional optical laser scanner. Instrumentation time had an almost linear impact on defect depth and volume. Although lateral force (β-weight 0.55±0.062) had a greater influence on defect volume than tip angulation (β-weight 0.29±0.062), their effects on defect depth were similar (β-weight 0.43±0.052 and 0.50±0.052, respectively). The combination of force and angulation showed synergistic effects resulting in a wide range of defect depths (21.9±0.96 μm to 174±28.8 μm, at 40 s) and volumes (0.056±0.019 mm³ to 0.68±0.10 mm³ at 40 s). Severe root damage (>50 μm/40 s) did not occur at any combination of 0.5 N lateral force and/or 0° tip angulation. By adjusting lateral force and tip angulation, the efficacy of the assessed sonic scaler may be adapted to various clinical needs.     

The comparative effect of ultrasonic scalers on titanium surfaces: an in vitro study

BACKGROUND: Professional maintenance is as important for patients with dental implants as it is for patients with natural teeth. However, no proper maintenance instruments have been available for implant patients. The purpose of this in vitro study was to compare the effects of a new ultrasonic scaler (VR), a conventional ultrasonic scaler (SP), and a plastic scaler (PS) on titanium surfaces. METHODS: To simulate subgingival conditions, the implant healing abutments were connected to acrylic resin blocks with artificial gingiva using silicon impression material. The abutments were painted with ink as an artificial form of debris. The ink was removed with the VR, SP, or PS scaler for 60 seconds under standardized conditions, and the removal rate was calculated. The roughness of the abutment surface was measured with a profilometer and observed by scanning electron microscopy (SEM). RESULTS: The removal rate using the VR and SP scalers was higher than that using the PS scaler. No significant differences in the surface roughness or SEM observations were found among the VR, SP, or PS scalers. CONCLUSIONS: In this preliminary study, the new ultrasonic scaler and conventional ultrasonic scaler were shown to be useful for removing artificial debris and produced no significant damage to titanium surfaces compared to plastic scalers. We concluded that new and conventional ultrasonic scalers with a non-metal tip would be suitable for implant maintenance.     

An in vitro assessment of the dentine lost during instrumentation using the Periosonic system

This study investigated the ability of a new instrument designed for root debridement, the Periosonic, to remove dentine compared to a hand curette and an ultrasonic scaler. The Periosonic system is a modification of the Micro-Megax endodontic system and uses modified files to remove plaque, calculus and tooth substance. The Periosonic has 2 file types; the Periosonic 1 is a more aggressive file for the removal of gross supra- and subgingival deposits, while the Periosonic 2 is a thinner more flexible file used for the removal of subgingival deposits. 40 human dentine specimens were ground flat and baseline measurements were made using a surfometer. The specimens were divided into 4 experimental groups and each group was treated with a hand curette, ultrasonic scaler, Periosonic 1 or 2 using 12, 1-s strokes. The specimens were remeasured blind in the surfometer. The curette removed 23.6 microm of dentine, the ultrasonic 6.8 microm, the Periosonic 1 18.8 microm and the Periosonic 2 12.5 microm. A qualitative assessment of the samples following mechanical preparation was also made. In conclusion, the Periosonic instrument does not remove more tooth substance than a conventional curette and may be a useful addition for the debridement of root surfaces.     

A comparison of root surface instrumentation using two piezoelectric ultrasonic scalers and a hand scaler in vivo

BACKGROUND AND OBJECTIVE: This study compared the effectiveness of two piezoelectric ultrasonic scalers and a hand scaler for subgingival scaling and root planing in vivo. MATERIAL AND METHODS: Fifteen patients with advanced periodontal disease and with teeth scheduled for extraction were selected for this study. Three experimental groups of 10 teeth each were treated with one of two piezoelectric ultrasonic scalers [Vector scaler and Enac scaler] or with a hand scaler. Instrumentation was continued until the root surface felt hard and smooth to an explorer tip. The root surface characteristics after instrumentation were examined using scanning electron microscopy, and the amount of remaining calculus, roughness and loss of tooth substance were estimated using the remaining calculus index and roughness loss of tooth substance index. RESULTS: The remaining calculus index did not differ significantly among the three groups. The roughness loss of tooth substance index was significantly lower for the Vector scaler and Enac scaler groups than for the hand scaler group and also differed significantly between the Vector scaler and Enac scaler groups. CONCLUSION: This study suggests that the Vector scaler produces a smooth root surface with minimal loss of tooth substance. It is a reasonable choice for gentle periodontal maintenance treatment.     

Subgingival polishing with a teflon-coated sonic scaler insert in comparison to conventional instruments as assessed on extracted teeth

AIM: To assess the root surface roughness and topography on extracted teeth using different instruments. MATERIAL AND METHODS: In the present study, laser profilometry was used to examine the 3-D roughness values Ra and Rz and topography of root surfaces of periodontally-involved teeth instrumented in vivo with curette, conventional ultrasonic device, conventional or teflon-coated sonic scaler insert, or the Periotor instrument (12 teeth per instrument type), and compare these with uninstrumented cementum surfaces. RESULTS: The roughness values Ra and Rz of the roots treated with the different instruments showed a similar pattern: curettes and the Periotor instrument produced the smoothest surfaces (Ra about 1.5 microm, Rz 30 microm); the 4 other instruments created similar Ra values of approximately 2-3 microm and Rz roughness of about 50-70 microm, which equals the untreated root surface. For Ra, the difference between the curette or the Periotor instrument and the teflon-coated sonic insert or ultrasonic insert was significant, and for Rz, a significant difference was found between the curette or the Periotor instrument and ultrasonic insert. As opposed to surfaces debrided with the Periotor and teflon-coated sonic scaler, it appears that hand instruments markedly reconfigure surfaces. CONCLUSION: The lowest root-surface roughness values were obtained with hand instruments. The teflon tubing on the sonic scaler insert effected no change of topography or roughness as compared to uninstrumented, control surfaces. However, it must be pointed out that hard-tissue removal was not investigated.