Is it really magic? Laser use in scaling and root planing.
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Dental Plaque↗
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Scaling and root planing: effective therapeutic modalities. Interview by Phillip Bonner.
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Dental High-Speed Equipment↗
Clinical evaluation of subgingival debridement with ultrasonic instruments used by trained and untrained operators.
Previous studies have proven the efficacy of modified ultrasonic (EWP-12 R & L) inserts in scaling and root planing (root debridement) procedures performed by skilled periodontists and dental hygienists. This study was undertaken to compare and skilled operators in these tasks. Using a slightly altered testing protocol, untrained operators demonstrated equal ability. A reevaluation of current thinking in the training of professionals in scaling and root planning (root debridement) procedures is suggested. Future studies are needed to determine if a training protocol is possible to prepare inexperienced operators to use ultrasonic instruments for subgingival scaling and root planing.
Clinical Competence↗
In-vivo comparisons of clot formation on titanium and hydroxyapatite-coated titanium.
We investigated in vivo clot formation on the surface of hydroxyapatite (HA)-coated titanium (Ti) implants and on non-coated Ti implants. Immediately after tooth extraction implant samples were inserted into the blood clot, in the same extraction site, for 1, 30, 60, or 120 seconds. Samples were processed for scanning electron microscopy (SEM). Qualitative observations of clotting topography were made by direct SEM viewing. Neither of the implant surfaces appeared to differ markedly in the degree of clotting during the 120 seconds of implantation; they revealed very early clot formation and limited clot attachment. These results were compared to the findings obtained in a previous study using identical methods with an intact periodontal ligament (PDL), root planed roots, and roots planed and treated with pH 1 citric acid. The PDL surface had the most rapid clot formation at all time periods. By 120 seconds, all root surfaces had completed clot formation.
Alloys↗
A clinical evaluation of guided tissue regeneration with a bioabsorbable matrix membrane combined with an allograft bone graft. A series of case reports.
THE PURPOSE OF THIS STUDY was to evaluate the clinical effectiveness of a surgical technique in treating periodontal defects. The technique combined tetracycline treatment of a root planed root, grafting of the osseous defect with a demineralized freeze-dried bone allograft combined with tetracycline and the placement of a bioabsorbable matrix membrane, made of polylactic acid softened with citric acid ester. Thirty defects were treated in 27 patients. Statistically significant changes, as a result of the surgical procedure, were observed in marginal recession (mean: 0.5 mm), probing depth reductions (mean: 5.7 mm), and attachment level gain (mean: 5.2 mm). No statistically significant difference existed between the results in the furcation and non-furcation groups. The defects with probing depths > or = 10 mm had a greater mean probing depth reduction (7.4 mm) and mean attachment level improvement (7.2 mm) than the defects with < 10 mm probing depths (probing depth reduction 4.5 mm and attachment level gain 3.9 mm). The proposed surgical procedure seemed to be an effective method to treat periodontal defects.
Adult↗
A quantitative analysis of the migration, attachment, and orientation of human gingival fibroblasts to human dental root surfaces in vitro.
The purpose of this study was to assess the migration, attachment, and orientation of human gingival fibroblasts to human dental roots over a period of 21 days in vitro. The fibroblasts were incubated with a total of 120 periodontally diseased and non-diseased root slices (200 microns thickness) which had been treated in the following manner: 1) Root planed diseased root (DT); 2) Root planed and citric acid demineralized diseased root (DTD); 3) Non-treated diseased root (DNT); 4) Citric acid demineralized diseased root (DNTD); 5) Non-diseased control (ND); 6) Citric acid demineralized non-diseased root (CA); 7) Citric acid and collagenase digested non-diseased root (CAC); 8) EDTA demineralized non-diseased root (E); and 9) EDTA-demineralized and collagenase-digested non-diseased root (EC). The results showed that that most active phase of cell attachment and orientation occurred during the first 10 days of the experiment. Statistical differences were observed between the variables, and, in terms of cell attachment and orientation to the root slices, it was concluded that: 1) Root planing improves diseased roots; 2) Acid demineralization subsequent to root planing improved diseased roots to such an extent as to render them comparable to non-diseased roots; 3) Citric acid demineralization alone improved diseased roots to the same extent as root planed diseased roots; 4) The exposure of collagen fibrils resulting from acid demineralization of the tools is not the sole reason for the improvement of the root surface, but rather a combination of the exposed collagen fibrils with the creation of a more hospitable environment was found to be responsible.
Cell Adhesion↗
Controlled local delivery of tetracycline with polymer strips in the treatment of periodontitis.
BACKGROUND: Several antibacterial agents have been studied as a means to produce bactericidal or bacteriostatic activity as an adjunct to mechanical treatment of periodontal disease. The primary purpose of this study was to evaluate the efficacy of tetracycline strips administered singly or in multiples in conjunction with root planing, versus root planing alone, or to an untreated control. Secondary purposes were to compare gingival crevicular fluid (GCF) volume and GCF concentrations of tetracycline in pockets treated with strips; to evaluate strip insertion time; and to compare ease of placement for single or multiple strips. METHODS: Using a 4-quadrant design, 4 test teeth in 24 patients were treated with either root planing and single strip application; root planing and multiple strip application; root planing alone; or an untreated control. RESULTS: Single and multiple strip placement resulted in a significant reduction in probing depth (P = 0.033) compared to root planing and untreated groups. The multiple strip group significantly decreased bleeding on probing (P = 0.05) compared to all other treatment groups. There was no treatment effect on GCF; however, there was a significant reduction in the GCF volume over time (P = 0.001). The time required for placement was, on average, 1.9 minutes for single strips and 3.25 minutes for multiple strips. CONCLUSIONS: Our data suggest that multiple strips are superior to a single strip in reducing bleeding on probing, and that local delivery of tetracycline is superior to root planing alone in reducing probing depth.
Adult↗
Calculus removal from multirooted teeth with and without surgical access. (I). Efficacy on external and furcation surfaces in relation to probing depth.
The purpose of this study was to evaluate the efficacy of the calculus removal from multirooted teeth after closed root planing, open root planing and use of a rotary diamond for the furcation area. The effect of pocket depth on the effectiveness of calculus removal was also examined. 30 first and second lower molars scheduled for extraction, with a calculus index > or = 2 and a degree II or III furcation involvement, were divided into 3 groups: 10 molars were scaled and root planed using a closed approach; 10 molars were scaled and root planed using an open approach; 10 molars were scaled and root planed with an open approach and rotary diamond was used for removal of deposits in the furcation area. After extraction, the teeth were assessed in a stereomicroscope and the % of residual calculus was calculated on external and furcation surfaces. The % of residual calculus on the external surfaces was significantly higher after closed than open root planing (p = 0.002). Pocket depth affected the effectiveness of scaling and root planing, with more residual calculus observed for depths > or = 7 mm for both groups. Differences between the 3 groups in the % of residual calculus on furcation surfaces were statistically significant (p < 0.0001 and p < 0.0005). The most effective method was the combination of open root planing and rotary diamond. More calculus was observed in all groups for pocket depths > or = 7 mm but the difference was significant only in the closed group (p = 0.006).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Alteration of root surface morphology by topical application of doxycycline hydrochloride on periodontally diseased human teeth.
The objective of this study was to describe the surface morphology of periodontally involved root cementum and its alteration following topically applied doxycycline hydrochloride to root-planed and non-planed samples. Root surfaces were treated with 100 mg/mL doxycycline hydrochloride solution for three minutes. A control group was treated with sterile saline. Observations made by scanning electron microscopy showed that treating the periodontally diseased cementum surfaces altered the surface topography significantly. Root planed, doxycycline-treated surfaces showed characteristics similar to those reported for citric acid conditioning. An important finding of the study was that the topical application of doxycycline hydrochloride also removed and/or altered the surface integument on non-planed root surfaces.
Dental Cementum↗
Calculus removal from multirooted teeth with and without surgical access. II. Comparison between external and furcation surfaces and effect of furcation entrance width.
The purpose of this study was to evaluate the effect of furcation entrance width on the efficacy of calculus removal from furcation areas as well as to compare this efficacy between external and furcation surfaces after closed root planing, open root planing and use of a rotary diamond for the furcation area. 30 first and second lower molars scheduled for extraction with a calculus index > or = 2 and a degree II or III furcation involvement were divided into 3 groups: 10 molars were scaled and root planed using a closed approach: 10 molars were scaled and root planed using an open approach; 10 molars were scaled and root planed with an open approach and rotary diamond was used for removal of deposits in the furcation area. After extraction, the width of the furcation entrance was measured buccally and lingually 2 mm apical from the bifurcation and furcations were categorized as wide (width > 2.4 mm) or narrow (width < 2.4 mm). The teeth were assessed in a stereomicroscope and the % of residual calculus on external and furcation surfaces was calculated. The width of the furcation entrance influenced the efficacy in root planning in the open group (p = 0.0015). The use of rotary diamond was the most effective method for removing calculus both for narrow and wide furcations. The effectiveness of open root planning in the mesial root was related to the width of the furcation entrance where the % of residual calculus was significantly higher for narrow furcations (p = 0.008).(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
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.
Animals↗
Effect of citric acid and lyophilized autologous plasma on healing following periodontal flap surgery in monkeys.
The purpose of this histologic, histometric, and autoradiographic study was to examine the effect of citric acid conditioning and lyophilized autologous plasma (LAP) application on healing following periodontal flap surgery. Mucoperiosteal flaps were elevated in six rhesus monkeys using the modified Widman flap procedure. A total of 24 quadrants were treated, each included the first and second premolar and first and second molar teeth. Cementum was removed from the exposed root surfaces, and reference notches were inscribed into the roots at the alveolar bone margin. Two treatment modalities were employed: (1) surgery plus citric acid conditioning, to serve as control and (2) surgery plus citric acid followed by LAP application (400 mg/ml saline). Flaps were returned to their preoperative positions and sutured. Animal sacrifices were scheduled to provide observations 3, 7, 14, 21, 28, and 45 days after surgery. Each monkey received an intravenous injection of tritiated thymidine, 1 microCi/gm of body weight, 1 hour before it was killed. Tissue specimens were processed for evaluation following standard procedures. Histologically, tissue sections were examined for: (1) proliferation and attachment of epithelium, (2) organization and maturation of periodontal fibers, (3) inflammatory cell types, (4) presence or absence of new cementum deposition, and (5) degree of vascularity of the tissues. For histometric evaluation, the radicular notches were used as reference points. The distances examined histometrically were: (1) from the root surface notch to the alveolar bone crest, (2) from the root surface notch to the apical extent of the junctional epithelium, and (3) from the free gingival margin to the apical extent of the junctional epithelium. For autoradiographic evaluation labeled cells were counted in five spatial compartments at 400 X magnification: (1) oral epithelium, (2) crevicular area, (3) supracrestal connective tissue, (4) coronal periodontal membrane, and (5) coronal bone marrow. For each the histometric and autoradiographic evaluation involved a total of 36 tissue sections per quadrant (9 sections per tooth). Tooth and quadrant means were obtained for each monkey. The plasma-treated and control quadrants were compared at each time point by the paired t test. N = 2 monkeys were used for each comparison. Histologic results showed that in teeth that were acid-conditioned after root planing, the epithelium often migrated apically reaching the radicular notch. Those teeth that were conditioned and subsequently treated with LAP demonstrated fiber attachment to the planed root surface and little or no epithelial downgrowth.(ABSTRACT TRUNCATED AT 400 WORDS)
Animals↗
A clinical evaluation of an allograft combined with a bioabsorbable membrane versus an alloplast/allograft composite graft combined with a bioabsorbable membrane. 100 consecutively treated cases.
The purpose of this study was to evaluate and compare the clinical effectiveness of 2 surgical techniques in treating periodontal defects. Both techniques involved tetracycline treatment of a root planed root, grafting the osseous defect with a bone graft, and placement of a bioabsorbable membrane. In group A, the bone graft was a mix of demineralized freeze-dried allograft, tetracycline, and porous hydroxyapatite and in group B, the bone graft was a mix of demineralized freeze-dried allograft and tetracycline. There was a statistically significant increase in recession (group A, 0.7 mm; group B, 0.6 mm), decreases in probing depth (group A, 6.1 mm; group B, 5.6 mm), and gains in attachment levels (group A, 5.4 mm; group B, 5.0 mm). There were no statistically significant differences between the results for either group. The defects associated with furcations and those that were not associated with furcations had similar results, except for the percent attachment gain. Smoking and age (> or =60 years old) could not be associated with results. Defects with > or =10 mm probing depths (PD) had greater PD reductions (group A, 7.7 mm; group B, 7.1) and attachment gains (group A, 6.6 mm; group B, 6.4 mm) than the defects with probing depths less than 10 mm (probing reduction group A, 4.8 mm; group B, 4.5 mm; attachment gain group A, 4.4 mm; group B, 4.0 mm). Both surgical procedures improved the clinical situation. However, neither technique seemed to offer a statistical advantage over the other. The inclusion of porous hydroxyapatite did not improve or diminish the results.
Adult↗
Povidone-iodine as a periodontal pocket disinfectant.
OBJECTIVES AND BACKGROUND: Povidone-iodine [polyvinylpyrrolidone-iodine complex (PVP-iodine)] might constitute a valuable adjunct to current periodontal therapy because of its broad-spectrum antimicrobial activity, low potential for developing resistance and adverse reactions, wide availability, ease of use, and low financial cost. This investigation employed a randomized, split-mouth study design to determine the microbiological and clinical effects of 10% PVP-iodine subgingival irrigation in periodontitis lesions showing radiographic evidence of subgingival calculus. METHODS: Sixteen adults having at least one periodontal pocket of 6 mm or more in each quadrant of the dentition and harboring one or more periodontopathic bacteria participated in the study. In each subject, a study site in each quadrant was randomly chosen to receive either subgingival irrigation with 10% PVP-iodine together with scaling and root planing, scaling and root planing alone, subgingival irrigation with 10% PVP-iodine, or subgingival irrigation with sterile saline. Prior to therapy and at 5 weeks post-treatment, microbiological culture was carried out without knowledge of the clinical status or the type of treatment rendered. A blinded clinical examiner determined presence of dental plaque, probing pocket depth, and gingival bleeding on probing. Microbiological and clinical data were analyzed using a repeated measures analysis of variance and Kruskal-Wallis rank test with the Tukey and Mann-Whitney post hoc tests. RESULTS: At 5 weeks post-treatment, subgingival irrigation with PVP-iodine together with scaling and root planing caused a 95% or greater reduction in total pathogen counts in 44% of pockets having >/= 6 mm depth whereas scaling and root planing alone, povidone-iodine irrigation alone and water irrigation alone caused 95% reduction of total pathogens only in 6-13% of similar study sites (P = 0.02). Reduction in mean pocket depth was 1.8 mm for the PVP-iodine/scaling and root planing group, 1.6 mm for the scaling and root planing group, and 0.9 mm for the PVP-iodine and the saline monotherapy groups, with statistical significance reached for the scaling and root planing group vs. the PVP-iodine group (P = 0.04) and for the scaling and root planing group vs. the saline group (P = 0.02). Reduction in visible dental plaque, which ranged from 38% to 62%, showed no significant differences among treatment groups. CONCLUSIONS: The addition of subgingival PVP-iodine irrigation to conventional mechanical therapy may be a cost-effective means of reducing total counts of periodontal pathogens and helping control periodontal disease. However, subgingival irrigation with PVP-iodine without concomitant mechanical debridement might not improve microbiological and clinical variables in comparison with saline irrigation, at least not in sites with radiographic evidence of subgingival calculus.
Adult↗
The effect of citric acid application on periodontally involved root surfaces. 1. An in vitro light microscopic study.
This study investigated the effect of citric acid application on periodontally involved root surfaces. Forty periodontally involved teeth were randomly divided into four groups of ten teeth each: no treatment, citric acid treatment, root planing alone, and root planing in conjunction with citric acid treatment. Ten nondiseased, untreated teeth served as controls. After treatment, each tooth was split along its long axis; half was examined under light microscopy and half under scanning electron microscopy (part II of the paper). Light microscopy revealed that the effects obtained by scaling and root planing were not altered after citric acid application. Moreover, the cementum layer was not entirely removed without careful and thorough planing of the root surface. Citric acid application alone had no effect on the diseased root surface. Citric acid did not penetrate the dentinal tubules, nor did it alter the collagen content of the roots obtained by scaling and root planing.
Analysis of Variance↗
[In vitro study of bacterial invasion in radicular dentin].
The purpose of this study was to investigate whether plaque bacteria invade exposed radicular dentin after root planing or chemical root treatment in vitro. Pieces of dentin were cut out from impacted third molars. The surface of all dentin pieces was treated with sandpaper (#240) so as to make the surface roughness of dentin pieces equal to that of the root surface after root planing (RP surface). Half of the dentin pieces were treated with citric acid (pH 1.0) for 3 minutes (CA surface). After sterilization, each dentin piece was incubated at 37 degrees C in a culture medium inoculated with either S. mutans or S. sanguis. After 1, 3, 7 and 28 days of incubation, the invasion of microorganisms into the dentinal tubules was histologically examined using a light microscope. The following results were obtained. 1. The invasion of S. mutans and S. sanguis into the dentinal tubules was observed at 1, 3, 7 and 28 days. The depth and number of bacterial invasion into the dentinal tubules were positively correlated with incubation time on CA surfaces but not with RP surfaces. 2. The depth and the number of bacterial invasion into the dentinal tubules were higher on the CA surfaces than the RP surfaces. 3. Since the citric acid treatment of scaled and root planed root surfaces may accelerate bacterial invasion from treated root surfaces, the use of citric acid might be harmful in patients with inadequate plaque control.
Dental Plaque↗
The use of antimicrobial acrylic strips in the nonsurgical management of chronic periodontitis.
Evidence to date has demonstrated the potential value of acrylic strips to deliver antimicrobial compounds into periodontal pockets. The present study was designed to evaluate further the therapeutic effect of antimicrobial acrylic strips in the management of chronic periodontitis. A total of 101 pockets in 69 patients were randomly treated with (1) chlorhexidine strips, (2) metronidazole strips, (3) tetracycline strips, (4) root planing, and (5) combined root planing and metronidazole strips. Immediately before and after treatment clinical measurements of disease were recorded over a three-month period. For all treatment groups significant improvements in clinical parameters were seen compared to control untreated sites but the most effective treatment was combined root planing and metronidazole and the least effective chlorhexidine. Although not significant, combined root planing and metronidazole also appeared to produce some adjunctive effects on clinical parameters compared to root planing alone. Antimicrobial acrylic strips appear useful treatments for chronic periodontitis, but should be used primarily as an adjunct to conventional root planing.
Acrylic Resins↗
Root surface characteristics associated with subgingival placement of monolithic tetracycline-impregnated fibers.
The purpose of this investigation was to inspect and characterize the subgingival root surface after a 10-day exposure in vivo to 25% tetracycline hydrochloride by weight in an ethylene vinyl acetate copolymer fiber matrix with and without root planing therapy. The root surfaces were examined by fluorescent-light microscopy (FLM), scanning electron microscopy (SEM), and energy dispersive spectroscopy (EDS). Thirty-two teeth were selected for study, 4 from each of 8 patients. The teeth of each patient were randomly assigned to one of four treatment groups: non-treated control (C), scaling and root planing only (RP), tetracycline-impregnated fiber only (F), and scaling and root planing with tetracycline-impregnated fiber application (RP/F). SEM revealed a visible reduction in the subgingival microbial flora in both the F and RP/F treatment groups in comparison with the C group specimens. Many of the residual bacteria observed in F and RP/F specimens appeared non-viable, exhibiting obvious loss of membrane integrity. In contrast, the RP specimens exhibited randomly distributed areas of residual subgingival plaque and calculus with newly developing plaque fronts; the plaque fronts undoubtedly having formed during the 10 days post-therapy. All RP/F specimens exhibited an incomplete removal of adsorbed root surface pellicle and demineralization of the subsequently exposed root surface. EDS analysis of large crystals adhering to root surfaces of F and RP/F specimens revealed high chloride peaks, suggesting the presence of residual tetracycline. FLM examination of F and RP/F treated specimens showed a superficial penetration of tetracycline into the root surface of about 10 microns. Areas of demineralized root showed slight tetracycline penetration into exposed dentinal tubules.
Adsorption↗