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PubMed1984

The effectiveness of hand versus ultrasonic instrumentation in open flap root planing.

The primary purpose of the study was to determine if, with an open flap approach, ultrasonic or hand instrumentation could remove all calculus from previously untreated teeth with moderate to severe loss of attachment. To be included in the study, teeth had to have at least 5 mm of attachment loss, be scheduled for extraction and be graded 2 or 3 on the Calculus Index of the Periodontal Disease Index system. Under local anesthesia, full-thickness, envelope-type flaps were elevated apical to the crest of bone to allow access to the root surfaces which were then treated with hand or ultrasonic instrumentation until the roots felt hard and smooth to a Hartzell explorer. The teeth were then removed, rinsed, and lightly scrubbed to remove debris and a No. 14 wheel bur was used to place a groove along the coronal extent of the connective tissue attachment. A stereomicroscope at magnification X 4.6 was used to quantitate the percentage of residual calculus on 25 teeth treated by each method. Overall, hand-scaled root surfaces demonstrated less residual calculus (5.78%) than ultrasonically treated surfaces (6.17%). Twenty teeth treated by each method were then prepared for histologic evaluation and evaluated under the light microscope at magnification X 100 for residual calculus and relative smoothness. Residual calculus was found on four ultrasonically and 12 hand-treated teeth and was almost evenly distributed between anterior and posterior teeth for both methods. The finding of considerably less calculus on histologic than on stereomicroscopic examination may have been due to the loosening of deposits by instrumentation, especially ultrasonic vibration, and their subsequent release during histologic preparation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

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.

Adult↗
PubMed1989

Clinical observations of the effects of nonsurgical periodontal therapy on human periodontal disease. II. Ultrasonic scaling and root planing for 6 months.

The purpose of this study was to examine and evaluate the short-term (six months) effects of clinical trials of nonsurgical periodontal therapy. The subjects studied included consisted of 34 patients, 24-52 years of age (836 teeth), with various degrees of advanced periodontitis. Following a baseline examination which included assessments of the gingival index (GI), plaque index (PlI), calculus index (CI), probing depth, and attachment level, the patients were subjected to nonsurgical therapy. Differences between various treatment intervals for the pockets initially measuring 1-3 mm, 4-6 mm, and 7 mm or more were analyzed by using the paired Students t-test. Following meticulous debridement of periodontal pockets with ultrasonic instrumentation, routine pocket irrigation with hydrogen peroxide (2.5-3.0%) and chlorhexidine gluconate solutions (0.12%) was performed by the authors as well as by the patients at sites with moderate to deep pockets and furcation involvement. Furthermore, the patients were supervised under a maintenance care program which provided patient motivation, the teaching of oral hygiene procedures, and offered regular recall for six months. The results demonstrated that non-surgical therapy resulted in a prominent reduction of gingival inflammation, dental plaque and calculus formation, and finally increased gingival recession. Also, for sites with an initial probing depth of 1-3 mm, there was a slight loss (0.1 mm) of the attachment level, 3 and 6 months after therapy. For sites with an initial probing depth of 4-6 mm, there was some attachment gain (0.31 mm and 0.69 mm) at 3 and 6 month post-treatment intervals. For pockets 7 mm or more in depth, a pronounced gain (0.49 mm and 1.00 mm) of attachment was noted following 3 and 6 month intervals. Generally, an obvious reduction of probing depth was constantly observed after nonsurgical treatment in each of the three initial pocket groups mentioned above. The changes of probing depths between baseline and at 3 or 6 months after treatment were 0.17 and 0.23, 1.23 and 1.75, and 1.83 and 2.63 mm, respectively. With the exception of attachment loss for the pockets initially measuring 1-3 mm, the difference of GI, PlI, CI, probing depth, and attachment level between baseline and 3 or 6 months after treatment were found statistically significant in each of the three initial pocket groups when analyzed individually by ANOVA.

Adult↗
PubMed2005

Predictive value of clinical and microbiological parameters for the treatment outcome of scaling and root planing.

OBJECTIVES: To compare the clinical and microbiological outcome of non-surgical periodontal therapy after 6 months with data obtained after hygienic phase or 6 weeks after completion of non-surgical therapy, in order to evaluate the value of clinical and microbiological parameters to predict treatment success. MATERIAL AND METHODS: Clinical and microbiological data were available from 271 sites in 10 systemically healthy non-smokers with moderate-to-advanced chronic periodontal disease (24-32 sites per individual). Subgingival plaque samples were tested for the presence of Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, Tannerella forsythensis and Treponema denticola using RNA probes. RESULTS: Stepwise multiple linear regression analysis revealed a significant impact of the number of sites with visible plaque index >1 after hygienic phase on the bleeding tendency of a subject at month 6 (p<0.01). Furthermore, an association could be demonstrated between the number of residual pockets (PD>3 mm) 6 months after therapy and the number of bleeding sites and suppurating sites after hygienic phase (p=0.016). Six weeks after therapy, the mean total bacterial loads had a significant impact on the bleeding tendency of a subject at month 6 (p<0.01). Although the average numbers of sites with persisting P. gingivalis, A. actinomycetemcomitans, T. forsythensis and T. denticola seemed to be very similar 6 weeks and 6 months after therapy, large variations were noted between subjects, and therefore the microbiological status of a subject at week 6 could not predict the status at month 6. CONCLUSIONS: The present study showed a limited potential of microbiological tests, performed after hygienic phase or shortly after non-surgical periodontal therapy, to predict the clinical outcome 6 months later, but confirmed the importance of an establishment of perfect oral hygiene before non-surgical therapy.

Adult↗
PubMed2005

Full-mouth ultrasonic debridement versus quadrant scaling and root planing as an initial approach in the treatment of chronic periodontitis.

AIM: To evaluate the clinical efficacy of (i) a single session of "full-mouth ultrasonic debridement" (Fm-UD) as an initial periodontal treatment approach and (ii) re-instrumentation of periodontal pockets not properly responding to initial subgingival instrumentation. METHODS: Forty-one patients, having on the average 35 periodontal sites with probing pocket depth (PPD) > or =5 mm, were randomly assigned to two different treatment protocols following stratification for smoking: a single session of full-mouth subgingival instrumentation using a piezoceramic ultrasonic device (EMS PiezonMaster 400, A+PerioSlim tips) with water coolant (Fm-UD) or quadrant scaling/root planing (Q-SRP) with hand instruments . At 3 months, all sites with remaining PPD> or =5 mm were subjected to repeated debridement with either the ultrasonic device or hand instruments. Plaque, PPD, relative attachment level (RAL) and bleeding following pocket probing (BoP) were assessed at baseline, 3 and 6 months. Primary efficacy variables were percentage of "closed pockets" (PPD< or =4 mm), and changes in BoP, PPD and RAL. RESULTS: The percentage of "closed pockets" was 58% at 3 months for the Fm-UD approach and 66% for the Q-SRP approach (p>0.05). Both treatment groups showed a mean reduction in PPD of 1.8 mm, while the mean RAL gain amounted to 1.3 mm for Fm-UD and 1.2 mm for Q-SRP (p>0.05). The re-treatment at 3 months resulted in a further mean PPD reduction of 0.4 mm and RAL gain of 0.3 mm at 6 months, independent of the use of ultrasonic or hand instruments. The efficiency of the initial treatment phase (time used for instrumentation/number of pockets closed) was significantly higher for the Fm-UD than the Q-SRP approach: 3.3 versus 8.8 min. per closed pocket (p<0.01). The efficiency of the re-treatment session at 3 months was 11.5 min. for ultrasonic and 12.6 min. for hand instrumentation (p>0.05). CONCLUSION: The results demonstrated that a single session of Fm-UD is a justified initial treatment approach that offers tangible benefits for the chronic periodontitis patient.

Adult↗
PubMed1970

Fern root planes.

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Tooth Abrasion↗