超声龈下刮治对根面影响的扫描电镜研究

目的 研究不同功率超声龈下刮治对根面的影响。方法 选择因重度牙周炎需拔除的患牙12颗，随机分成小功率超声刮治组、大功率超声刮治组、手工刮治组及病变对照组四个组，每组3颗。记录刮治时间，扫描电镜观察各组标本的菌斑、牙石残留及损伤情况。结果 大功率超声刮治效率最高、最省时，小功率次之，手工刮治最慢；大功率超声刮治对根面损伤最大，小功率超声刮治损伤轻微，手工刮治损伤最小。结论 超声龈下刮治能有效地去除根面的菌斑、牙石，且省时、省力，但功率不宜过大。     

Total calculus removal: an attainable objective?

The primary purpose of this study was to determine if two sessions of scaling and root planing, one using a "closed" approach and the other using an "open" approach, would remove all calculus from teeth with severe periodontal disease. Fourteen teeth (8 single-rooted, 6 multi-rooted) were treated by closed scaling and root planing with an ultrasonic instrument, and 17 others (10 single-rooted, 7 multi-rooted) were treated with hand instruments. After a healing period of 4 to 8 weeks, anesthesia was secured, periodontal flaps were raised, and the teeth were treated a second time using the same instrumentation as before. The teeth were then extracted and prepared for light microscopic evaluation. Twelve of the 14 teeth treated by ultrasonics and 12 of the 17 treated by hand instruments retained calculus. The two types of instruments had similar scores in the treatment of proximal root surfaces, furcal walls, and furcal summits. Hand instrumentation appeared to be more effective than ultrasonics in removing cementum from proximal surfaces, although this is not based on a formal statistical comparison of the two methods. Neither instrument was effective in removing cementum from the furcal walls or summits. Five randomly selected blocks containing remaining root structure were deparaffinized and prepared for scanning electron microscopy. One hand-instrumented specimen, which had not shown calculus with light microscopy, displayed calculus at the SEM level. All five specimens displayed residual calculus at either the light microscope, the SEM level, or both. The results of this study indicate that complete removal of calculus from a periodontally diseases root surfaces is rare.     

In vitro evaluation of Er:YAG laser scaling of subgingival calculus in comparison with ultrasonic scaling

The purpose of the present study was to evaluate the effectiveness of Er:YAG laser scaling and the morphological and histological changes of the laser-scaled root surface in comparison with the effectiveness and root surface changes produced by conventional ultrasonic scaling. Fifty-three periodontally involved human extracted teeth with a band of subgingival calculus were used. The teeth were divided randomly into 2 groups for laser scaling and ultrasonic scaling. Laser irradiation was performed at an energy output of 40 mJ/pulse and 10 pulses/s under water spray, with the probe tip contacted obliquely to the root surface. Ultrasonic scaling was performed at a clinically standard power setting. The time required for scaling, the scaled area and the temperature changes were determined using both methods of treatment. The features of the scaled surfaces were examined by histological and scanning electron microscope (s.e.m.) observations. The Er:YAG laser provided subgingival calculus removal on a level equivalent to that provided by the ultrasonic scaler, without major thermal elevation. Macroscopically, the laser-treated root surface was somewhat rougher than or similar to the ultrasonically scaled root. However, the efficiency of the laser scaling was lower than that of the ultrasonic scaling. In addition, histological examination revealed a thin deeply stained zone on the lased root surface, and s.e.m. analysis revealed a characteristic microroughness on the lased surface. The laser scaling provided a level of calculus removal that was similar to that provided by the ultrasonic scaling. However, the Er:YAG laser produced superficial, structural and thermal microchanges on the root cementum.     

The effect of a single scaling with or without oral hygiene instruction on gingival bleeding and calculus formation

Abstract. 136 students of both sexes aged 14–18 years who were deprived of regular dental care participated in a 22-month longitudinal study. All students underwent scaling of the assigned teeth in 2 quadrants according to a randomized split-mouth design on contralateral quadrants. 2 groups of students were formed, one group received oral hygiene instruction (OHI). Follow-up-examinations on gingival bleeding and calculus were carried out 6, 12, and 22 months after the scaling session. The prevalence of calculus on assigned teeth at baseline was high with a mean score of 1.10. At the end of the study, new calculus formation on scaled teeth reached a mean score of 0.58. Formation of calculus still continued on non-scaled teeth, but at a lower rate than on scaled teeth. Scaling resulted in an approximately 20% reduction of the gingival bleeding score which remained during the 22 months follow-up period, OHI had no significant effect on the calculus and bleeding scores. Since the effect of scaling alone on the gingival condition was small and the effect of a single OHI negligible, the practice of occasional scaling without repeated OHI, which is commonly employed in developing countries, should be considered as clinically irrelevant and of little use in improving the standard of periodontal health.     

Scaling and root planing with and without periodontal flap surgery

Complete removal of calculus is a primary part of achieving a "biologically acceptable" tooth surface in the treatment of periodontitis. Rabbani et al. reported that a single episode of scaling did not completely remove subgingival calculus and that the deeper the periodontal pocket, the less complete the calculus removal. The purpose of the present study was to evaluate the effectiveness of scaling relative to calculus removal following reflection of a periodontal flap. Each of 21 patients who required multiple extractions had 2 teeth scaled, 2 teeth scaled following the reflection of a periodontal flap, and 2 teeth serve as controls. Local anesthesia was used. Following extraction, the % of subgingival tooth surfaces free of calculus was determined using the method described by Rabbani with a stereomicroscope. Results showed that while scaling only (SO) and scaling with a flap (SF) increased the % of root surface without calculus, scaling following the reflection of a flap aided calculus removal in pockets 4mm and deeper. Comparison of SO versus SF at various pocket depths for % of tooth surfaces completely free of calculus showed 1 to 3 mm pockets to be 86% versus 86%, 4 to 6 mm pockets to be 43% versus 76% and greater than 6 mm pockets to be 32% versus 50%. The extent of residual calculus was directly related to pocket depth, was greater following scaling only, and was greatest at the CEJ or in association with grooves, fossae or furcations. No differences were noted between anterior and posterior teeth or between different tooth surfaces.     

An evaluation of a pre-scaling gel (SofScale™) on the ease of supragingival calculus removal

Abstract SofScale? is a pre-scaling gel, containing disodium EDTA and sodium lauryl sulphate, which is claimed to soften calculus and therefore facilitate its removal. 31 subjects were treated in a double blind randomised placebo controlled split mouth study to evaluate this product. Test or placebo gels were applied to the lingual surfaces of the mandibular teeth for 4 min and the time taken to complete the removal of supragingival calculus recorded. The operator recorded on which side the calculus was considered easier to remove and the patient indicated how comfortable the scaling had been. The mean calculus index was 1.99 for the SofScale? group and 1.97 for the placebo. The mean time taken to complete scaling was 5.31 min for both groups. Using the Student Mest, there were no statistically significant differences (p>0.7) between either the calculus index or time taken to complete the scaling between the groups. The operator did not consider SofScale? to facilitate calculus removal and patients did not find calculus removal more comfortable when SofScale? had been used. There was no increased sensitivity in the SofScale? group following scaling. The results of this study do not support the use of SofScale? as an adjunct to scaling.     

Comparative in vitro studies of sonic, ultrasonic and reciprocating scaling instruments

Flat root surface areas of formalin-stored mandibular incisors with plaque and calculus were scaled by sonic (PHATELUS SONIC SCALER, SONIC FLEX 2000, TITAN-S SONIC SCALER) or ultrasonic instruments (HYGIENIST ULTRASONIC SCALER, CAVITRON) or by a new reciprocating scaling insert for the EVA/PROFIN system. The test areas were photographed by SEM and coded micrographs were independently graded by three examiners using the RCI (Remaining Calculus Index) and the RLTSI (Roughness Loss of Tooth Substance Index). The findings revealed that the sonic scalers as a group removed calculus more completely but also left significantly more roughness and loss of tooth substance than the other instruments tested. No difference was seen between the two ultrasonic scalers. The reciprocating insert gave results similar to those of the ultrasonic except for the scaling time which was significantly longer for the new "cleansing principle".     

The effectiveness of in vivo root planing in removing bacterial endotoxin from the roots of periodontally involved teeth.

In this study, scaling alone resulted in endotoxin values considerably greater than the values for healthy root surfaces. However, the root-planed Samples contained only about 1 ng more of endotoxin than did the healthy root surfaces. This small difference can be accounted for by the presence of small flecks of calculus left after root planing. Considering that out of a total sample size of 48 surfaces there was only 1 ng difference in the amount of endotoxin between planed teeth and uninvolved teeth, the basic conclusion must be that root planing, as performed in this study, was able to render diseased root surfaces approximately as free of detectable endotoxin as were uninvolved, healthy root surfaces of unerupted teeth.     

In vitro calculus detection with a moved smart ultrasonic device

STUDY OBJECTIVE: The objective of subgingival instrumentation of periodontally diseased root surfaces is to remove the adhering microbial biofilm and calcified deposits. Recently, we have described an automated calculus detection system under static conditions. Clinically however, the tip of the system has to be moved over tooth surfaces. It was thus necessary to study the entire system in motion. METHODS: The detection device is based on a conventional dental piezoelectric ultrasonic handpiece with a conventional scaler insert. The impulse response of the mechanical oscillation system is analysed by a fuzzy logic-based computerized algorithm, which classifies various surfaces. The present study investigates dental surface recognition properties of the new system with the tip being moved over teeth surfaces in vitro. Following a training set of 7977 measurements (3960 calculus, 4017 cement) on 200 extracted teeth, 1363 measurements were conducted on 34 teeth unknown to the system. RESULTS: The surfaces cementum and calculus were correctly classified in 78% within the training set and in 81% within the set unknown, with a kappa value of 0.68. CONCLUSION: It was shown that this method of automatic recognition of tooth surfaces is able to distinguish between different tooth surfaces in vitro independently from tip movements.     

Root surface debridement and endotoxin removal

OBJECTIVE: This study assessed associations between the number of standardized scaling strokes and the reduction of endotoxin on the root surface. BACKGROUND: Therapy of periodontally involved teeth attempts removal of accretions by scaling and root planing. The amount of mechanical therapy required to free the root surface from etiologic factors remains unknown. METHODS: Twenty-four extracted human caries-free single rooted teeth with at least 5 mm attachment loss were used. A region of interest (ROI) which contained subgingival calculus was defined on the root surface of each tooth. Standardized force instrumentation was applied using a force-measuring curet. Fifty working strokes were applied to every ROI. Forces applied were recorded. The force recordings were converted from Millivolts into Newtons (N). After every unit of 5 strokes, presence of calculus was evaluated and scaling debris was collected. Endotoxin concentration was determined in the debris samples. RESULTS: The endotoxin values for strokes 1-5 were statistically significantly greater than the values from all other stroke intervals. Complete calculus removal occurred after a mean of 9.3 strokes. The endotoxin concentration reached a minimal level with concentrations of 0.03-0.306 EU/ml after calculus removal was complete. CONCLUSION: These findings suggest that completion of calculus removal coincides with endotoxin levels associated with clinically healthy teeth.     

牙周内窥镜下刮治与传统刮治对龈下牙石清除效果的比较

目的比较内窥镜下龈下刮治与传统龈下刮治清除龈下牙石的效果。方法收集16例患者26颗无保留价值的重度慢性牙周炎患牙,随机分为两组,每组8例13颗患牙,分别行牙周内窥镜下龈下刮治(A组)及传统龈下刮治(B组),每颗患牙均刮治10min后拔除,亚甲基蓝染色后,蓝色显示残留牙石,对每颗牙颊、舌、近中及远中面拍照并用Image Pro Plus图像分析软件检测、计算各牙面的牙石残留率。比较两组患牙治疗后的牙石残留率以及吸烟、牙周探诊出血位点数和牙周探诊深度对牙石清除效果的影响。结果 A组患牙平均牙石残留率为(8.34±1.70)%,B组患牙平均牙石残留率为(13.02±3.36)%,差异有统计学意义(P<0.05)。吸烟、探诊出血位点数、牙周探诊深度对治疗后的牙石残留率均有影响(P<0.05)。结论在牙周内窥镜下行龈下刮治,清除牙石的效果明显优于传统龈下刮治。吸烟、探诊出血、探诊深度对牙石残留率均有影响。     

Er:YAG laser scaling of diseased root surfaces

BACKGROUND: The removal of calculus and plaque is an essential component of a therapeutic approach to control periodontal disease. Er:YAG laser scaling was recently introduced as an alternative to conventional scaling procedures. In this histological study, the effects of laser instrumentation of diseased root surfaces are compared to mechanical removal of plaque and calculus with ultrasonic instruments and scalers. METHODS: Areas of subgingival calculus were identified on 40 freshly extracted human teeth. Each of these areas was randomly divided into 2 equal parts. The control site was treated either with scaling and root planing or with an ultrasonic instrument. The test site was cleaned using an Er:YAG laser according to the manufacturer's instructions. The end point of debridement was the inability to mechanically or visibly detect any remaining calculus. After pre- and postsurgical photographs and impressions for scanning electronic microscopic investigation, a plastic embedding technique was used to cut the undecalcified roots into 15 microm thick sections. RESULTS: Clinically and histologically, scaling resulted in complete debridement at all samples, producing a smooth root surface. At the test sites, laser scaling was accompanied by an increased removal of tissue and roughened surfaces. CONCLUSIONS: Laser scaling results in an increased loss of cementum and dentin, which should be taken into account in clinical situations.     

A comparative in vitro study of a magnetostrictive and a piezoelectric ultrasonic scaling instrument

BACKGROUND: The effects of magnetostrictive ultrasonic instruments and piezoelectric ultrasonic instruments on tooth surfaces seem to differ with regards to root debridement. AIM: The purpose of this study was to compare a magnetostrictive ultrasonic scaling instrument with a piezoelectric ultrasonic scaling instrument and a hand curette regarding time taken, calculus removal, tooth surface roughness (Ra), and SEM examination before and after instrumentation. METHODS: 30 extracted human teeth with subgingival calculus were assigned to one of three treatment groups (n=10). The working force was standardised for both ultrasonic instruments at 200 g and for the curette at 500 g. RESULTS: The results revealed that the time needed for instrumentation was 126.1+/-38.2 s for the curette, significantly more than for the piezoelectric ultrasonic instrument (74.1+/-27.6 s; p<0.05) and 104.9+/-25.4 s for the magnetostrictive ultrasonic instrument. Remaining calculus was similar for all three groups. The end Ra values were significantly worse for the piezoelectric instrument (2.02+/-0.41; p<0.05) compared to 1.42+/-0.48 for the curette and 1.36+/-0.41 for the magnetostrictive instrument. The SEM examination revealed the smoothest surfaces but, subjectively, the most tooth substance loss after the curette, followed by the magnetostrictive instrument, with the least substance loss, and then the piezoelectric instrument, with medium substance loss. CONCLUSION: The piezoelectric ultrasonic scaler was more efficient than the magnetostrictive ultrasonic scaler in removing calculus but left the instrumented tooth surface rougher.     

牙周内窥镜辅助治疗对牙根表面影响的初步研究

目的:评价牙周内窥镜辅助超声龈下刮治及根面平整术(SRP)对比传统SRP后根面形态的改变和粗糙度的影响.方法:纳入12颗因牙周炎拔除的患牙,分为3组(n =4):(1)内窥镜辅助超声SRP;(2)传统SRP,超声刮治后用Gracey刮治器根面平整;(3)不做处理.另取4颗健康牙作对照.处理后用扫描电镜观察牙根表面微观结...     

Effect of locally delivered doxycycline hyclate on human fibroblast attachment to subgingival calculus

BACKGROUND: Clinical studies using locally applied doxycycline hyclate (DHV) have demonstrated significant probing depth reduction and gain in clinical attachment as a monotherapy without scaling and root planing. The mechanism for this attachment level gain to the non-root planed tooth is not understood. The purpose of this study was to investigate the effect of locally applied doxycycline hyclate on human gingival fibroblast attachment to subgingival calculus on contaminated root surfaces. METHODS: Two separate experiments were performed, both on subgingival calculus. In experiment 1, teeth with subgingival calculus were treated with either doxcycycline hyclate in bioabsorbable vehicle (DHV) or with vehicle control (VC) in vivo. In experiment 2, teeth with subgingival calculus were treated with DHV, VC, scaling and root planing (SRP), or no treatment in vitro. The amount of cell attachment to calculus-covered root surfaces was quantitatively compared using a fluorescent dye assay and epifluorescence microscope. Values for cell attachment are presented as the mean standard deviation of the mean. The data were evaluated using Student t test. RESULTS: In both experiments, there was no statistically significant difference in fibroblast attachment in the DHV, VC, or no treatment groups (P >0.05). The SRP group showed significantly more cellular attachment to tooth surfaces formerly covered by subgingival calculus than all other groups (P <0.001). In general, more cells attached to cementum than to calculus. Root chips that showed no attachment to the subgingival calculus also had no cells attached to the adjacent cemental root surface. CONCLUSION: The addition of doxycycline hyclate in a bioabsorbable vehicle used as a locally delivered drug did not enhance the initial cellular attachment of human gingival fibroblasts to subgingival calculus or contaminated root surfaces.     

Nd:YAG激光照射对牙周病患牙根面的影响

目的 :研究Nd :YAG激光照射对未处理过的和用超声波或手工器械刮治过的牙周病患牙根面的影响。方法 :选择因严重牙周病而须拔除的单根牙 18颗 ,随机平均分为 6组 ,在临床麻醉下分别先后作如下治疗 :超声波刮治 +激光照射 ;激光照射 +超声波刮治 ;手工器械刮治 +激光照射 ;激光照射 +手工器械刮治 ;超声波刮治 ;手工器械刮治。然后拔除患牙作扫描电镜观察。结果 :单纯用超声波或手工器械刮治过的牙根表面均有明显的涂层 ,而用激光 (2 0pps、2 .0W、3min)照射 ,无论是在刮治前还是刮治后 ,均有助于根面涂层的去除 ,但激光对牙根表面结构有不同程度的影响。结论 :先用Nd :YAG激光照射、再行龈下刮治 ,牙根表面的涂层被清除 ,而结构改变最小。     

Clinical subgingival calculus detection with a smart ultrasonic device: a pilot study

Aim: We have recently tested a surface detection system based on a conventional dental ultrasonic scaler in vitro. The aim of the present study was to investigate sensitivity and the specificity of the detection device in vivo. Material and Methods: Subgingival buccal surfaces of 63 arbitrarily selected periodontally compromised teeth were scanned intra‐orally, while the supragingival positions of the insert, along with the corresponding signals of the detection system, were saved as separate files. After extraction, the surface detection results were evaluated by re‐positioning the inserts' position on the tooth in vitro and comparing the detection results with visual findings. Results: On the scanned tooth surfaces, there were 44 calculus spots, which covered 22.3% of all scanned surfaces (prevalence). The calculus‐free surface was divided into “spots” mathematically. The device correctly classified 40 calculus and 125 cementum spots, whereas four calculus and 28 cementum spots were classified incorrectly. Calculus and cementum were discriminated with a sensitivity of 91% and a specificity of 82%. The positive and negative predictive values were 0.59 and 0.97. Conclusion: The surface detection device was able to clinically differentiate cementum and calculus in vivo. Therefore, this method may support the decision of whether continued subgingival scaling could damage the cementum.     

超声和手用器械龈下洁治后牙根面的扫描电镜观察

目的：通过超声和手用器械对牙周炎患牙根面处理的比较，来评价超声龈下洁治在牙周治疗中的作用。方法：选择１０个新鲜拔除的牙周炎患牙，随机分别用手用器械（第１组）和超声（第２组）洁治；选择４个临床诊断需拔除的牙周炎患牙分别行手用器械（第３组）和超声（第４组）龈下洁治，然后将患牙拔除。所有牙齿均在扫描电镜下观察。结果：超声龈下洁治能有效去除龈下菌斑及牙石，使根面较光滑平整，与手用器械洁治相比，无明显差异。结论：超声龈下洁治器是一种进行龈下洁治和根面平整的有效工具。     

Effect of experimentally induced marginal periodontitis and periodontal scaling on the dental pulp

Experimental breakdown of the periodontal attachment apparatus was produced in six young adult monkeys to study the effect on the tissue of the dental pulp by (1) periodontitis, (2) scaling and plaque accumulation on exposed root dentin. Periodontal tissue breakdown was induced by the placement of ligatures around the neck of 92 permanent teeth. Subsequent plaque formation caused marked loss of periodontal tissue support, which after a period of 5--7 months amounted to 30--40% of the root length. One group of teeth received no further treatment. Other teeth were subjected to scaling and root planing. Following treatment, plaque was allowed to accumulate for 2, 10, and 30 days on the freshly planed root dentin surfaces. Histologic examination revealed that in comparison to teeth with normal periodontal conditions, 57% of the teeth exposed to periodontitis exhibited pathologic pulp tissue alterations. Secondary dentin formation and/or inflammatory cell infiltrates were observed within localized areas of the pulp subjacent to root surfaces exposed to periodontal tissue destruction. The changes within the pulp were of "mild" nature and only one tooth displayed signs of total pulp necrosis. Lateral canals communicating with both the pulp cavity and the exposed root surface were never detected. Teeth subjected to scaling and subsequent plaque accumulation in comparison with teeth with periodontitis alone exhibited no obvious aggravation or increased incidence of pathologic pulp reactions. The findings show that in the monkey (1) periodontal destruction limited to the cervical half of the root and (2) plaque accumulation on exposed root dentin does not cause severe alteration in the pulp of the roots involved.