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PubMed1991

Root substance removal by scaling and root planing.

The amount of root substance removed by scaling and root planing is largely unknown. The present study evaluated in vitro the root substance loss caused by a defined number of working strokes at known forces. Forty extracted teeth with loss of connective tissue attachment into the middle third of the roots were washed and embedded in plaster, leaving one entire corono-apical tooth aspect exposed. The teeth were reproducibly repositioned in a bench-vise, where a profilometer repeatedly measured root surface levels at the same location. In a standard area of the roots a total of 40 working strokes were applied. Low forces were used in 30 teeth and high forces in 10 teeth. The forces were recorded using a piezo-electric receiver built into the upper shank of the curet. Root substance loss was measured after 5, 10, 20, and 40 working strokes. The results showed that the mean low force used per working stroke across all 40 strokes was 3.04 Newtons for the low forces, and 8.48 Newtons for the high forces. Mean cumulative loss of root substance across 40 strokes was 148.7 microns at low forces, and 343.3 microns at high forces. The mean force per stroke increased slightly across the 40 strokes, while substance removal per stroke decreased. Substance removal per stroke during strokes 1 to 5 was 6.8 microns using low forces and 20.6 microns using high forces. During strokes 21 to 40 mean removal per stroke was 2.3 microns at low forces, and 5.6 microns at high forces. These results suggest that high forces remove more root substance, and loss per stroke becomes less with increasing numbers of strokes.

Dental Scaling↗
PubMed2006

Clinical benefits of subgingival chlorhexidine varnish application as an adjunct to same-day full-mouth root planing: a pilot study.

BACKGROUND: Although scaling and root planing are considered the therapeutic standard for periodontitis, weakly responding sites often occur. To improve treatment outcome, several chemomechanical treatment concepts have been developed. Recently, the clinical surplus value of a highly concentrated chlorhexidine varnish has been shown when used as an adjunct to sequential scaling and root planing. The aim of this study was to explore the clinical effects of a treatment strategy for chronic periodontitis based on a combination of same-day full-mouth root planing and subgingival chlorhexidine varnish administration. METHODS: A randomized, controlled, single-blind, parallel trial was conducted on 12 chronic periodontitis patients. The control group received oral hygiene instructions and same-day full-mouth root planing. The test group received the same instructions and treatment; however, all pockets were additionally disinfected using a chlorhexidine varnish. Clinical response parameters were recorded at baseline and subsequently after 1 and 3 months. RESULTS: Both treatment strategies showed significant reductions in probing depth at both follow-up visits in comparison with baseline levels (P or=7 mm) was found favoring the test group. CONCLUSION: These preliminary findings suggest that the outcome of same-day full-mouth root planing may benefit from the subgingival administration of a highly concentrated chlorhexidine varnish.

Adult↗
PubMed1992

The effectiveness of the air-powder abrasive device for root planing during periodontal surgery.

The efficacy of the air-powder abrasive device (APAD) in root planing during flap surgery was assessed in vitro and in vivo. Two teeth on which full-thickness flaps were raised underwent root planing by hand-scaling alone and hand-scaling combined with APAD. One tooth extracted prior to surgery underwent unrestricted hand-scaling under a binocular microscope (control). The two teeth root planed in situ and the tooth root planed in vitro were observed by scanning electron microscopy (SEM). Then, 10 patients with periodontitis requiring flap surgery were selected for a clinical study. After raising full-thickness flaps, 29 sites from five patients underwent root planing using hand-scaling combined with APAD, whereas 22 sites from six patients underwent root planing by hand scalers only. SEM revealed that root surfaces planed in situ by hand-scaling combined with APAD were smoother than those root-planed using hand scalers alone. The control tooth surface was as smooth as those submitted to combined root planing. The clinical study showed that sites submitted to combined root planing displayed enhanced attachment level gain and pocket reduction. These results, associated with the shortened instrumentation time, suggest APAD as a useful instrument for root planing during flap surgery.

Air↗
PubMed1991

In vivo scaling and root planing forces.

The purpose of the present study was to assess the scaling and root planing forces exerted in vivo. Ten dentists and 10 dental hygienists scaled and root planed one aspect of an incisor in an adult patient with untreated advanced periodontitis. During scaling and root planing forces were recorded using a piezo-electric receiver, an electronic transducer, and an analogous writer. The forces were recorded in mA and converted into Newtons (N). The results showed that the mean scaling force applied by dentists was 5.70 N and ranged between 1.01 to 10.35 N. The corresponding values for dental hygienists were a mean of 5.38 N, and a range of 1.52 to 15.73 N. The root planing forces in dentists reached a mean of 4.62 N, and ranged between 0.86 to 8.88 N. For hygienists, these values were 4.58 N with a range of 1.56 to 10.59 N. Negative forces impacting on the periodontal soft tissues were also recorded. They were not present in all therapists, but consistently at work within specific therapists. During scaling these forces reached a mean of -0.40 N in dentists and -0.47 N in dental hygienists. During root planing, these forces were mean -0.59 N in dentists, and -0.81 N in hygienists. There were no statistically significant differences between scaling forces and root planing forces, nor between forces used by dentists and hygienists (P greater than 0.05). However, there were significant differences between the force levels of the individual therapists for all positive forces (P = 0.0001), and for negative forces during root planing (P = 0.0001). The technology and information provided by this investigation may enable studies evaluating clinical effectiveness of scaling and root planing doses.

Adult↗
PubMed2004

Efficacy of full-mouth disinfection vs quadrant root planing.

This article addresses the capability of full-mouth disinfection, full-mouth root planing, and partial-mouth disinfection to improve periodontal health. A basic premise of full-mouth therapy (full-mouth disinfection or full-mouth root planing) is to eradicate or diminish bacterial reservoirs in the mouth that could impede optimal healing or initiate periodontal disease or disease progression. Several investigations conducted at one university indicated that full-mouth disinfection and full-mouth root planing achieved greater therapeutic improvements compared with partial-mouth disinfection regarding decreased probing depths, gained clinical attachment, diminished bleeding from probing, and reduced subgingival microflora. In contrast, other studies from 2 treatment centers demonstrated that there were no statistically significant differences when the effectiveness of quadrant-by-quadrant root planing was compared with full-mouth root planing and full-mouth disinfection regarding probing depth reduction, gains of clinical attachment, and impact on the magnitude and quality of the immune response. Theoretically, full-mouth therapy could decrease the number of patent visits and allow more efficient use of treatment time. Furthermore, no major adverse reactions to full-mouth root planing with or without adjunctive chemotherapy are evident. Nevertheless, small study populations and noncorroborating data from different treatment centers indicate that more clinical trials are required to determine whether full-mouth therapy provides clinically relevant improvements compared with partial-mouth disinfection.

Anti-Infective Agents, Local↗
PubMed2003

In vivo effects of an Er:YAG laser, an ultrasonic system and scaling and root planing on the biocompatibility of periodontally diseased root surfaces in cultures of human PDL fibroblasts.

BACKGROUND AND OBJECTIVES: The aim of the present study was to investigate the in vivo effects of an Er:YAG laser (ERL), an ultrasonic system and scaling and root planing (SRP) on the biocompatibility of periodontally diseased root surfaces in cultures of human periodontal ligament fibroblasts (PDL). STUDY DESIGN/MATERIALS AND METHODS: Forty single rooted teeth, considered for extraction due to severe periodontal destruction, have been randomly assigned to the following groups: (1) ERL at 160 mJ/pulse and 10 Hz, or (2) Vector ultrasonic system (VUS), or (3) SRP using hand instruments, or (4) untreated control (C). Immediately after instrumentation, all test and control teeth were extracted and root specimens (4 mm2) were prepared from all mesial and distal surfaces (n=80). Following the prescribed treatments, the root specimens were incubated with human PDL fibroblast cultures. Adherent cells were stained with methylene blue and counted using a reflected light microscope and the cell density per mm2 was calculated. Additionally, the cell morphology was investigated using SEM (n=8 teeth). RESULTS: Cell counts within each group yielded the following means and standard deviations (cells/mm2): ERL, 111+/-27; VUS, 75+/-25; SRP, 41+/-17; control, 25+/-11. Analysis of variance (ANOVA) revealed significant differences in the number of attached cells between the test and control groups (P<0.001, P<0.001, P<0.01, respectively). ERL and VUS treated specimens showed significantly higher numbers of cells/mm2 than the SRP group (P<0.001, respectively). The difference between the ERL and VUS group was statistically significant (P<0.001). CONCLUSIONS: The results of the present study indicate that (i) ERL, VUS, and SRP promote the attachment of PDL fibroblasts on previously diseased root surfaces, (ii) periodontally diseased root surfaces inhibit the adherence of PDL fibroblasts, and (iii) the surface structure of ERL and VUS instrumented roots seem to offer better conditions for the adherence of PDL fibroblasts than SRP.

Aged↗
PubMed1997

Root planing following short-term pocket distention.

This study evaluated the effectiveness of root planing following short-term pocket distention. Seventy-five single-rooted teeth with probing depths > or = 5 mm and < or = 10 mm were selected. The teeth were randomly divided into three treatment groups. In groups 1 and 2 a gingival retraction cord (aluminum sulfate-impregnated in group 1 and non-impregnated cord in group 2) was packed subgingivally for 30 minutes. Following removal of the cord, the teeth were scaled and root planed. In group 3 the teeth were root planed only. Following instrumentation, the teeth were extracted and examined under a stereomicroscope. The residual calculus on the root surface of each tooth was measured using a computerized image analysis system. The quantities were compared using a two-way ANOVA and Chi-square test. The results showed that 46.3% of all root surfaces had detectable residual calculus and that the mean percentage of residual calculus per root surface was 4.41% following root planing. Forty percent of the root surfaces in group 1 had residual calculus, 38.0% in group 2, and 61.0% in group 3. There was a statistically significant difference (P < 0.01) between groups 1 and 2 compared to group 3. The mean calculus per root surface for groups 1, 2, and 3 was 3.03%, 3.04%, and 7.15%, respectively. Significant differences (P < 0.005) were found between groups 1 and 2 compared to group 3. These results indicate that subgingival calculus removal in deep pockets is enhanced with short-term pocket distention, and that there is no added benefit to having aluminum sulfate present in the retraction cord.

Administration, Topical↗
PubMed1987

The concentration of lipopolysaccharide on individual root surfaces at varying times following in vivo root planing.

Material with endotoxin activity has been detected in extracts prepared from pooled, periodontally involved teeth, and it has been shown that root planing in vivo reduces the level of such material. However, questions concerning the concentration of endotoxin on the diseased surfaces of individual teeth and questions concerning how rapidly individual root planed tooth surfaces retoxify in vivo have not been addressed previously. Citric acid extracts were prepared from individual, periodontally diseased teeth that had been extracted either from the oral cavity without prior root planing or at varying times up to 12 weeks following root planing. Using a chromogenic Limulus Amebocyte Lysate (LAL) assay, we were able to quantitate the amount of endotoxin associated with diseased root surfaces of individual teeth. We concluded that the extracted material contained endotoxin since it activated LAL and since the LAL-activation was heat-stable, acid-stable and neutralizeable by polymyxin B. The levels of endotoxin found on the root surfaces of these individual, periodontally involved teeth at varying times following in vivo root planing support the following conclusions: the concentration of endotoxin present on diseased root surfaces is markedly reduced, but not eliminated, by in vivo root planing, significant retoxification of root planed surfaces occurs within a relatively short time period after root planing and biological responses to such toxification conceivably may lead to subsequent phases having reduced levels of endotoxin.

Adult↗
PubMed1993

Effect of periodontal root planing on dentin permeability.

The purpose of this study was to quantitate the effects of root planing on the permeability of human root dentin in vitro. Unerupted 3rd molars were used. The crowns were removed and longitudinal slices made of the root. The hydraulic conductance of the root dentin was measured before and after root planing, acid etching and potassium oxalate application using a fluid filtration method. The results showed that root planing creates a smear layer that reduces the permeability of the underlying dentin. However, this smear layer is acid labile. Thus, root planing may ultimately cause increased dentin permeability and the associated sequelae of sensitive dentin, bacterial invasion of tubules, reduced periodontal reattachment and pulpal irritation.

Acid Etching, Dental↗
PubMed1992

The effect of Nd:YAG laser exposure on root surfaces when used as an adjunct to root planing: an in vitro study.

The purpose of this study was to evaluate the effects of Nd:YAG laser treatment on root surfaces in vitro when used alone or in combination with conventional scaling and root planing. The study population consisted of 18 unerupted third molars, each with a 3 mm diameter treatment site outlined on the root surface. Three specimens were randomly assigned to each of 6 different treatment groups: 1) untreated control; 2) root planed only; 3) laser treated only using 1.25 W of energy; 4) laser treated only using 1.50 W of energy; 5) laser treated with 1.25 W of energy followed by root planing; and 6) laser treated with 1.50 W of energy followed by root planing. Following their respective treatment, all specimens were prepared for evaluation by scanning electron microscopy. Specimens from Group 2, root planed only, exhibited a smear layer of scale-like texture with parallel instrument tracks resulting from curet use. Specimens treated by laser only, Groups 3 and 4, featured various surface changes not observed in controls such as charring and carbonization of the cementum surface, randomly distributed pitting and crater formation, and melting of the root mineral phase with subsequent resolidification as porous globules. Those specimens treated by laser followed by root planing, Groups 5 and 6, exhibited surface characteristics similar to those noted in Group 2 specimens. Further, there were areas of exposed dentinal tubules resulting from a "peeling" of the cementum layer. The results of this in vitro study suggest that laser use during root preparation, even at relatively low energy levels, will result in physical changes to the root surface.(ABSTRACT TRUNCATED AT 250 WORDS)

Aluminum Silicates↗
PubMed1985

Healing after treatment of periodontal intraosseous defects. V. Effect of root planing versus flap surgery.

The present study compared surgical therapy to root planing alone in the treatment of periodontal intraosseous defects. 25 defects in 14 patients were subjected to root planing only and another 25 defects in the same patients were surgically exposed and citric acid treated. The healing response was evaluated 6 months after treatment. The mean gain of probing attachment level was 0.8 mm in the root-planed defects as compared to 1.3 mm for the surgically exposed and acid-treated defects. The probing bone level improved an average of 0.2 mm for the root-planed areas as compared to 0.6 mm for the acid-treated defects. The mean preoperative probing pocket depths of 6.7 mm and 6.8 mm for the 2 groups were reduced to 5.2 mm and 4.1 mm, respectively. The differences in these parameters were statistically significant between the 2 groups. However, both groups demonstrated limited regeneration.

Adult↗
PubMed1993

In vivo scaling and root planing forces in molars.

The purpose of the present study was to assess in vivo scaling and root planing forces in molars of periodontitis patients. Ten dentists and 10 dental hygienists scaled and root planed the mesial and distal aspect of one first molar, using Gracey curets 11/12 and 13/14. Scaling and root planing forces were recorded using a piezo-electric receiver, an electronic transducer, and an analogous writer. The forces were recorded in mV and converted into Newtons (N). Three different types of forces were recorded: positive forces during working strokes and positive and negative forces during preparation of working strokes. Multivariate repeated measures analysis of variance was used to assess differences in force between curet types. The mean positive scaling forces exerted with curet 11/12 were statistically significantly (P = 0.0005) greater than the corresponding forces exerted with curet 13/14 in all therapists. The mean positive root planing forces applied with the curet 11/12 were significantly (P = 0.0008) greater than the forces exerted with curet 13/14. The mean positive interstroke forces did not differ between curet 11/12 and 13/14. The mean negative interstroke forces impacting on the soft tissues exerted with curet 11/12 did not significantly differ from curet 13/14 during scaling and during root planing. Therapists differed significantly among themselves for each type of positive and negative force (P < 0.001 in all cases). These results suggest that the extent of instrumentation given to root surfaces in molars depends more on the therapist and on the molar aspect being treated than on the needs of a specific site.

Adult↗
PubMed2005

Enhanced root planing and systemic metronidazole administration improve clinical and microbiological outcomes in a two-step treatment procedure.

BACKGROUND: Recently we described a non-surgical two-step treatment concept, in which we distinguished between a first scaling and root planing step (SRP) and an additional second enhanced root planing step (ERP). Until now it is difficult to determine how often a root surface should be instrumented during ERP. METHODS: The aim of the present study was to investigate the outcomes after different root planing intensities during ERP in 37 patients with aggressive periodontitis after SRP. During ERP a full-mouth root planing was performed. The patients were randomly assigned to one of two root planing regimens (group 1, N = 12 and group 2, N = 11), based on number of curet strokes per root surface (instrumentation frequency, IF) and probing depth. Group 1: PD 1 to 3.5 mm, 4 IF (for group 2, 8 IF); PD 4 to 6 mm, 8 IF (group 2, 14 IF); PD 6.5 to 9 mm, 12 IF (group 2, 20 IF); and PD >9 mm, 16 IF (group 2, 24 IF). Group 3 patients (controls; N = 14) received only the initial SRP. All three groups received the same adjunctive systemic antibiotic treatment. RESULTS: In all groups, the results showed statistically significant differences in PD and clinical attachment level (CAL) after 6 and 24 months compared to baseline data. Compared with the controls, a significant reduction in PD was observed in groups 1 and 2. The reduction in mean PD was distinctly greater in group 2 (higher IF). Furthermore, Porphyromonas gingivalis (Pg) and Actinobacillus actinomycetemcomitans (Aa) were completely suppressed in group 2 after 24 months. CONCLUSIONS: The present results show that the extent of root planing has a distinct influence on treatment outcomes. Patients treated with the highest instrumentation frequency showed the best long-term results.

Adult↗
PubMed1998

Clinical response of localized recurrent periodontitis treated with scaling, root planing, and tetracycline fiber.

The purpose of this study was to compare the clinical efficacy of scaling and root planing alone versus tetracycline fiber therapy used adjunctively with scaling and root planing in the treatment of nonresponsive active periodontitis in patients under supportive periodontal therapy. Thirty patients who were receiving supportive treatment and had at least two nonadjacent periodontitis sites with a probing depth of between 4 and 8 mm and bleeding on probing, or had aspartate aminotransferase (AST) levels above 800 microIU in the gingival crevicular fluid in separate quadrants participated in this study. For each patient, the test sites were treated with scaling and root planing plus tetracycline fibers while the control site was treated with scaling and root planing only. Probing depths, clinical attachment levels, gingival recession, AST levels, and bleeding on probing were recorded and subgingival plaque samples were collected at baseline and 1, 3, and 6 months following treatment. At 3 months after treatment, there was a reduction of bleeding on probing and probing depth, and a gain of clinical attachment in both test and control sites. The mean reduction in probing depth of the test sites was 1.38 mm and the attachment gain was 0.8 mm after 6 months. The clinical response obtained at 3 months following therapy was maintained throughout the 6-month follow-up period. However, there were no statistically significant differences between sites treated with scaling and root planing alone and those treated with combined tetracycline therapy. Most of the reductions of probing depths in the fiber group were attributed to gingival recession. The present study did not confirm the efficacy of adjunctive tetracycline fibers in treating nonresponsive sites in maintenance subjects with regard to probing depth reduction or clinical attachment gain. Reinfection of the pockets from untreated sites and extra-crevicular regions may explain the insignificant response to local tetracycline therapy.

Adult↗
PubMed2004

Diode laser (980 nm) as adjunct to scaling and root planing.

OBJECTIVE: The aim of this study was to evaluate clinical efficacy of InGaAsP diode laser as adjunct to traditional scaling and root planing. BACKGROUND DATA: The use of laser is one of the most recent methods in nonsurgical periodontal treatment. Efficacy and side effects of each type of laser treatment have yet to be determined. METHODS: Thirty patients suffering from moderate periodontal disease have been considered. They were randomly selected to undergo either scaling and root planing with curets, or scaling and root planing combined with InGaAsP laser (980 nm and 2 W). The papilla bleeding index (PBI), bleeding on probing (BOP), and clinical attachment level (CAL) were registered at the beginning and end of treatment. RESULTS: At the end of treatment, PBI average in the group treated with laser was 0.24 versus 0.43 in the group under conventional treatment (p = 0.014). In the group undergoing scaling and root planing, BOP decrease is 19.55% less (p < 0.0001) than in the group also treated with laser. Nevertheless, CAL differences cannot be considered significant between both groups (p = 0.67). CONCLUSIONS: Scaling and root planing in combination with laser produce moderate clinical improvement over traditional treatment.

Dental Scaling↗
PubMed1992

[The limits of root planing in the furcation area. A mathematical comparison of the radii of curvature on the root surfaces and on the curettes].

In order to draw some conclusions about the furcation region accessibility for periodontal instruments and their cleaning effect, the curvature radii of the root faces of 31 lower molars were mathematically determined and compared with the curvature radii of the working end of normally available curettes. From the results of this work it can be seen, that the Gracey curettes have an essential greater curvature radius as the curvature radius of the root faces. On the other site the special curettes for root planing in the furcation region have a smaller curvature radius as that of the root faces. Using the instruments included in this study, it is not possible to achieve an optimal root planing.

Humans↗
PubMed1992

Clinical effects of a 0.12% chlorhexidine rinse as an adjunct to scaling and root planing.

This trial tested the adjunctive effects of a 0.12% chlorhexidine rinse (Peridex) upon gingival healing following scaling and root planing. Assessments were made on reduction in plaque (Pl), gingivitis (GI), pocket depth and gingival bleeding as measures of treatment benefit. All subjects had Class II, III or IV periodontal conditions. Following baseline examinations, subjects received a gross supragingival scaling and polishing. Subjects were separated by sex and periodontal classification, arrayed by GI scores, and randomly assigned to either the chlorhexidine rinse or a placebo rinse. Subjects were instructed to rinse with 1/2 ounce of their assigned products for 30 seconds twice daily. Following two weeks of product use, the clinical examinations were repeated and two randomly selected, opposing contralateral quadrants were scaled and root planed. After two more weeks of product use (week 4), clinical examinations were repeated and the remaining quadrants were scaled and root planed. At week 6, final clinical examinations were conducted. Since half-mouths were treated at different times and exposed to the treatment rinses for different periods, the data were analyzed for the half-mouths independently 2 and 4 weeks after gross scaling, and 2 and 4 weeks after root planing. A total of 94 subjects (47 in each treatment group) completed all phases of the trial. Gingival healing following scaling and root planing in subjects using a chlorhexidine rinse (0.12%) was significantly better than subjects using the placebo rinse as evidenced by less gingivitis (29%), fewer GI bleeding sites (48%) and less plaque (54%).

Analysis of Variance↗
PubMed1985

Root planing with interdental papilla reflection and fiber optic illumination.

The complete removal of accretions during closed scaling and root planing in moderate-deep pockets is difficult, presumably due to inadequate mechanical and visual access. The purpose of this study was to evaluate the effect of minimal papilla reflection and illumination with a prototype fiber optic unit on root planing efficiency. Nonmolar teeth with moderate-deep interproximal pockets (greater than 3 mm) in four patients scheduled to receive immediate complete dentures were randomly divided into groups for treatment: Group I--interproximal root planing augmented by papilla reflection and fiber optic illumination (n = 26 surfaces); Group II--interproximal root planing with papilla reflection only (n = 24); Group III--untreated controls (n = 23). Immediately after treatment, the experimental teeth were extracted, stained with toluidine blue and interproximal areas were evaluated for remaining accretions with a microscope-digitizing pad-computer system. Significantly less (P less than 0.01) root surface was covered by deposits in Group I than Group II (0.57 +/- 0.29% vs. 2.42 +/- 0.63%), and both treatment groups had fewer (P less than 0.0005) accretions than untreated controls (57.72 +/- 3.40%). These results suggest that root planing with papilla reflection produces an interproximal surface with few remaining deposits, and fiber optic illumination and transillumination further enhance this effect.

Dental Calculus↗