Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Root Planing”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 55 records · Page 3Linked to original sources
PubMed2002

Meta-analysis of the effect of scaling and root planing, surgical treatment and antibiotic therapies on periodontal probing depth and attachment loss.

OBJECTIVE: This paper reports a meta-analysis of studies that have investigated the effect of scaling and root planing on periodontal probing depth and attachment loss. MATERIAL AND METHODS: The criteria used for inclusion of studies were as follows: root planing and scaling alone was one of the primary treatment arms; patients or quadrants of each patient were randomly assigned to study groups; 80% of patients enrolled were included in first year follow-up examinations; periodontal probing depth and attachment loss were reported in mm; the sample size of each study and substudy was reported. Sample size was used to weight the relative contribution of each study since standard errors were not reported by many studies and sample size is highly correlated with standard error and therefore statistically able to explain a substantial portion of the standard error on studies that use similar measures. RESULTS: The meta-analysis results show that periodontal probing depth and gain of attachment level do not improve significantly following root planing and scaling for patients with shallow initial periodontal probing depths. However, there was about a 1-mm reduction for medium initial periodontal probing depths and a 2-mm reduction for deep initial periodontal probing depths. Similarly, there was about a 0.50-mm gain in attachment for medium initial periodontal probing depth measurements and slightly more than a l-mm gain in attachment for deep initial periodontal probing depth measurements. Surgical therapy for patients with deep initial probing depths showed better results than scaling and root planing in reducing probing depths. When patients were followed up over 3 years or more, these differences were reduced to less than 0.4 mm. Antibiotic therapy showed similar results to scaling and root planing. However, a consistent improvement in periodontal probing depth and gain of attachment is demonstrated when local antibiotic therapy is combined with root planing and scaling.

Anti-Bacterial Agents↗
PubMed1993

Effects of Nd:YAG laser radiation on removal of a root surface smear layer after root planing: a scanning electron microscopic study.

A scanning electron microscopy (SEM) study was conducted to evaluate the effects of Nd:YAG laser radiation on removal of a root surface smear layer after root planing in comparison with citric acid treatment. The experimental materials were 15 human teeth affected by severe periodontal disease, which were extracted because of a hopeless prognosis. The teeth had at least 5 mm of attachment loss on the proximal surface tested. After removing all visible calculus using an ultrasonic scaler, each proximal surface was vigorously scaled and root planed with a Gracey curet. Thirty specimens were cut from the root-planed proximal surfaces and assigned randomly to one of two groups: Group A (25 specimens) was divided into 5 subgroups and irradiated with a Nd:YAG laser, using non-contact delivery (3 mm beam diameter, distance from the tip to the specimen 5 cm), at a measured power of 20 W for 0.3, 0.5, 1.0, 2.0, or 3.0 seconds corresponding to energy densities of 84.93, 141.54, 283.09, 566.17, or 849.26 J/cm2; Group B (5 specimens) was not irradiated, but treated for 3 minutes with saturated citric acid (pH 1). The center of each specimen in Group A was used as the experimental area (Exp A) treated by laser irradiation and the peripheral area of the specimen served as a control (Cont A). In Group B, one half of the specimen was used as the experimental area (Exp B) treated by citric acid and the other half served as a control (Cont B). The specimens were then fixed and examined by SEM. The surface of the root-planed specimens (Cont A and B) was irregular, corresponding to the presence of a smear layer, and had an amorphous appearance. Both root surfaces of Exp A and B exhibited clear orifices of dentinal tubules and intertubular dentin without a smear layer. Although the root surface of Exp A showed clear orifices of dentinal tubules with a flat morphology, the root surface of Exp B showed widened funnel-shaped dentinal tubule orifices with a fibrillar, mat-like morphology. The present results indicate that Nd:YAG radiation effectively removes the smear layer, uncovers dentinal tubules, and exposes collagen fibers on the root surface without widening the orifices of dentinal tubules after root planing.

Aluminum Silicates↗
PubMed2002

A systematic review on the effect of systemic antimicrobials as an adjunct to scaling and root planing in periodontitis patients.

BACKGROUND: Scaling and root planing (SRP) are the bases of non-surgical therapy in the treatment of periodontitis. However, results from this therapy are often unpredictable and dependable from many different factors. OBJECTIVES: The aim of this systematic review was to evaluate the effectiveness of the adjunctive use of systemic antimicrobials with scaling and root planing (SRP) vs. SRP alone in the treatment of chronic (CP) or aggressive periodontitis (AgP). SEARCH STRATEGY: Use of computerized databases, namely MEDLINE, the Cochrane Oral Health Group Specialty Trials Register and EMBASE; reference lists from relevant articles were hand-searched; and a hand-search of selected journals until April 2001. SELECTION CRITERIA: Studies were selected if they were designed as controlled clinical trials in which systemically healthy patients with either AgP or CP were treated with SRP plus systemic antimicrobials in comparison with SRP alone or with placebo, for a minimum of 6 months. Main outcome measures were clinical attachment level (CAL) change and probing pocket depth (PPD) change. DATA COLLECTION AND ANALYSIS: Two reviewers extracted independently information regarding quality and study characteristics, in duplicate. Kappa scores determined their agreement. Main results were collected and grouped by drug, disease and PPD category. For the quantitative data synthesis, the data was pooled (when mean differences and standard errors were available), and either a Fixed Effects or Random Effects meta-analysis was used for the analysis. RESULTS: After an initial selection, 158 papers were identified by the manual and electronic searches; 25 papers were eligible for inclusion. Their quality assessment showed that randomization and allocation concealment methods were seldom reported and blindness was usually not defined clearly. In general, selected studies showed high variability and lack of relevant information for an adequate assessment. Overall, SRP plus systemic antimicrobial groups demonstrated better results in CAL and PPD change than SRP alone or with placebo groups. Only limited meta-analyses could be performed, due to the difficulties in pooling the studies and the lack of appropriate data. This analysis showed a statistically significant additional benefit for spiramycin (PPD change) and amoxicillin/metronidazole (CAL change) in deep pockets. CONCLUSION: Systemic antimicrobials in conjunction with SRP, can offer an additional benefit over SRP alone in the treatment of periodontitis, in terms of CAL and PPD change, and reduced risk of additional CAL loss. However, differences in study methodology and lack of data precluded an adequate and complete pooling of data for a more comprehensive analyses. It was difficult to establish definitive conclusions, although patients with deep pockets, progressive or 'active' disease, or specific microbiological profile, can benefit more from this adjunctive therapy.

Acute Disease↗
PubMed1991

Scaling and root planing: removal of calculus and subgingival organisms.

Scaling and root planing studies have shown that despite the best efforts of skilled clinicians, it is almost impossible to achieve calculus-free roots. Flap access nearly doubles the operator's ability to remove calculus. Furcation areas, however, continue to harbor significant amounts of calculus after scaling and root planing with or without the benefit of a flap. While thorough root debridement and planing are desirable treatment goals, not all would agree that complete cementum removal is either possible or desirable, or that the removal of calculus is more important than plaque or endotoxin removal in achieving clinical success.

Dental Calculus↗
PubMed1991

The effect of a single episode of chlorhexidine irrigation on the gingival response to scaling and root planing.

The adjunctive effects of subgingival chlorhexidine irrigation on gingival response following scaling and root planing were investigated. Changes in clinical parameters, and microbial composition of subgingival plaque as monitored by dark-field microscopy were assessed in 12 patients over a period of 12 weeks. Two test sites and two matched control sites with probing depth ranging from 4 mm to 7 mm were selected in each patient. Oral hygiene instruction and a single episode of scaling and root planing were carried out. In addition test sites were irrigated with one mL of 0.2% chlorhexidine solution by the operator, while control sites were either irrigated with an equal volume of physiological saline or not irrigated. There were significant improvements in the clinical parameters with little difference between test and control sites. Between the beginning and the end of the study there was a marked reduction in the proportion of spirochaetes with a concomitant increase in coccoid organisms with, again, only minor differences between the test and the control sites. It was concluded that subgingival irrigation with a single application of 0.2% chlorhexidine did not enhance gingival healing, or delay recolonization of pockets by certain micro-organisms (as monitored by dark-field microscopy), when scaling and root planing had been thoroughly carried out immediately prior to irrigation.

Bacteria↗
PubMed1996

Tetracycline fiber used alone or with scaling and root planing in periodontal maintenance patients: clinical results.

This study evaluated the 6-month clinical response to sustained-release tetracycline fibers used alone or with scaling and root planing in 25 adult periodontal maintenance patients. All subjects had at least one pocket > or = 4.0 mm that bled on probing and required therapy. Thirty-six teeth were treated with tetracycline fibers for 7 to 12 days; twelve of the 36 teeth also received scaling and root planing. The selection of teeth for scaling and root planing was based on the condition of the teeth. Therapeutic results were evaluated by changes in probing depth and frequency of bleeding on probing. Use of tetracycline fibers and fibers with scaling produced 1.8- and 1.7-mm reductions in probing depth, respectively, 1 month after treatment; reductions declined to 1.3 and 0.8 mm at 3 months, but rebounded to 1.5 and 1.3 mm at 6 months. The percentage of teeth exhibiting bleeding on probing decreased from 100% at baseline to 68% and 50% in the fiber and fiber plus scaling groups, respectively, at 6 months. None of the differences was statistically significant. Tetracycline fibers clearly decreased clinical signs of periodontal inflammation. Addition of scaling and root planing at the time of fiber placement further decreased, although not significantly, the degree of inflammation.

Adult↗
PubMed1986

The impact of research on scaling and root planing.

The research expanding our knowledge of the periodontally involved root surface and its treatment is reviewed. To improve communication in the clinic and classroom, definitions are suggested for the terms "scaling" and "root planing." The objective and limitations of root planing procedures are discussed.

Citrates↗
PubMed1984

The effect of root planing as compared to that of surgical treatment.

This study was undertaken in order to evaluate the effect of root planing as compared to that of surgical periodontal treatment in patients with advanced periodontal disease. 17 patients with advanced periodontal disease participated in the study. After the initial examination, the teeth were scaled and the patients were given instruction in performing proper oral hygiene. The hygienic phase for the individual patient was continued until less than 20% of the tooth surfaces demonstrated plaque at 2 succeeding appointments. After re-assessment of the periodontal status, 1 side in both the maxilla and mandible was treated with modified Widman flap surgery. In 1 of the remaining quadrants, in the maxilla or mandible, reverse bevel flap surgery was used. Bone contouring was not performed in any of the surgical procedures. The last quadrant was subjected to meticulous root planing under local anesthesia. Subsequently, the patients were recalled every second week for professional tooth cleaning. The periodontal status of each patient was assessed 3 and 6 months following treatment. Root planing resulted in considerable reduction in pocket depth, although more shallow pockets were obtained following modified Widman flap and reverse bevel flap surgery. Clinical gain of attachment was obtained following all 3 modalities, but root planing resulted in slightly more gain of attachment than the 2 surgical procedures.

Adult↗
PubMed1989

[Investigation into the effect of citric and phosphoric acids on planed root surfaces using S.E.M].

The aim of the present study was to evaluate the effect of citric and phosphoric acid conditioning the diseased root surface on periodontally extracted teeth. Citric acid pH1 and 50 per cent phosphoric acid were topically applied to thoroughly scaled and planed root surfaces for one to three minutes. The specimens were then processed for scanning electron microscopy (S.E.M.) Root surfaces that had received acid treatment after root planing exhibited no smear layer and the overall surface appeared to have an undulating morphology. Whereas, examination of nonacid-treated specimens showed the presence of a smear layer. Furthermore, phosphoric acid treated surfaces demonstrated more irregularity with increasing application time.

Acid Etching, Dental↗
PubMed1999

Pain after periodontal scaling and root planing.

BACKGROUND: Although periodontal scaling and root planing, or SRP, is one of the most common procedures used in dental practice, there is little information available about the degree of postprocedural pain associated with it. The authors undertook this study to document the intensity and duration of pain after SRP with a view toward helping practitioners and their patients manage postprocedural discomfort. METHODS: Using the Heft-Parker self-assessment pain scale, 52 adults with moderate periodontitis evaluated their pain before and after SRP conducted with local anesthetic. RESULTS: After SRP, 28 percent of all patients reported faint-to-weak pain, 18 percent experienced weak-to-mild pain, 28 percent experienced mild-to-moderate pain, 8 percent had moderate-to-strong pain and 8 percent reported strong-to-intense pain. The average time to onset of maximum pain was approximately three hours after SRP, and the average duration of mild or greater pain was about six hours. Upon awakening the morning after SRP, subjects found that pain had returned to pre-SRP levels. Overall, 23 percent of all patients reported self-medicating with analgesics to relieve postprocedural pain. Women self-medicated earlier (P < .05) and more often than men (43 percent vs. 10 percent; P < .05). CONCLUSIONS: Patients experienced significant duration and magnitude of pain after SRP. This pain peaked between two and eight hours after SRP, lasted about six hours, and returned to pre-SRP levels by the morning after the procedure. Almost 25 percent of all patients self-medicated to relieve pain after SRP, and women took analgesic medication earlier and more often than men. CLINICAL IMPLICATIONS: Practitioners should consider using appropriate analgesic drugs to alleviate mild-to-moderate pain after SRP. On the basis of this study, it would appear that an analgesic that has a peak effect two to eight hours after the completion of SRP would be the most appropriate medication. Moreover, it is unlikely that analgesic medication would be needed by most patients beyond the day on which SRP was performed.

Adolescent↗
PubMed1999

[A comparative evaluation of the efficacy of the excisional new attachment procedure (ENAP) relative to root planing in the etiological phase of periodontal therapy].

BACKGROUND: In the present study, the effectiveness of root planing has been compared to the excisional new attachment procedure (ENAP) during the etiological phase of periodontal therapy, after the supragingival scaling, in order to establish if a technique offering an easy access to the subgingival areas could reduce the need for a surgical phase in the periodontal treatment. METHODS: Twenty-seven patients, affected by moderate periodontitis, participated in this study; in each of them root planing was performed in a half of the oral cavity (control site) and the ENAP in the other half (test site). The main clinical parameters of periodontal health (probing depth--PD-, attachment loss--AL-, plaque index--PlI- and gingival index--GI-) were evaluated before and 1, 2 and 6 months after the periodontal treatment. RESULTS: The results of the study showed that the parameters related with the amount of plaque and with the conditions of the marginal gingival tissue were not influenced by the different treatments used. Better improvements were found in PD and AL values in teeth treated by ENAP compared to those treated by root planing; this result is explained by a better access to the roots offered by the ENAP. CONCLUSIONS: We can conclude that, within the limits of the present study, the ENAP can reduce the need for a further surgical treatment of the periodontal patient.

Adult↗
PubMed1996

Effectiveness of subgingival scaling and root planing: single versus multiple episodes of instrumentation.

This study evaluates the effectiveness of subgingival scaling and root planing comparing the effect of a single instrumentation to the effect of three instrumentations. A total of 35 teeth in 15 patients were selected; 15 were scaled once (Group A), 15 were scaled three times (Group B), and 5 were used as controls (Group C), representing teeth that were not instrumented. The Group A and B teeth were chosen in the same patient based on random selection. All the teeth were scored by the calculus index of the periodontal disease index. Six surface locations were probed to determine probing depth. The level of the gingival margin was marked on the teeth to locate supra- and subgingival calculus after extraction. The Group A and B teeth received the initial episode of scaling and root planing for not more than 10 minutes, then only the Group B teeth received two additional instrumentations of not more than 5 minutes each. The additional instrumentations were performed 24 hours after the initial scaling. The scaled and control teeth were extracted immediately after the third instrumentation period. The teeth were washed with water and stained with methylene blue. They were viewed under a stereomicroscope which had a tenth grid on its eyepiece. Assessments were made involving the total counts and percents of the surfaces covered with calculus on the scaled and unscaled teeth. The results demonstrated no significant difference in the effectiveness of calculus removal between single and multiple episodes of scaling and root planing. Similar results were found for the total amount of calculus removed, the calculus removed from individual surfaces, and the calculus removed from various probing depth levels.

Adult↗
PubMed1991

Clinical effects of closed root planing compared to papilla reflection and fiber optic augmentation.

Mini-surgical approaches in 4 to 7 mm probing depths have been shown to facilitate improved deposit removal as compared to closed instrumentation. At the same time this treatment is less traumatic than more extensive flap reflection for root planing. The purpose of this study was to compare the clinical effects of closed root planing (C/SCRP) to those of root planing augmented by papilla reflection and fiber optic illumination (PR/SCRP) over a 6-month period. Fourteen patients with moderate/advanced adult periodontitis received each therapy in 2 experimental periodontitis sites (PS = greater than or equal to 5 mm probing depth and greater than 5 mm attachment loss) and one non-periodontitis site (NPS = less than or equal to 3 mm probing depth and no recession). Presence of supragingival plaque, bleeding on probing, probing depths, and clinical attachment levels were measured before treatment and 6, 12, and 24 weeks posttreatment. Mean supragingival plaque levels were high and did not vary significantly over the course of the study, but bleeding on probing was significantly reduced in PS following both C/SCRP and PR/SCRP (P less than or equal to 0.0001). Mean probing depths were significantly reduced after 6 months (P less than or equal to 0.01) in NPS-PR/SCRP from 2.8 +/- 0.1 to 2.0 +/- 0.2 mm, in PS-C/SCRP from 5.5 +/- 0.2 to 4.5 +/- 0.4 mm, and in PS-PR/SCRP from 5.8 +/- 0.2 to 3.2 +/- 0.1 mm. In periodontitis sites, PR/SCRP demonstrated greater probing depth reductions than C/SCRP at all time periods (P less than or equal to 0.004). PS attachment levels also improved following C/SCRP and PR/SCRP at all postoperative times (P less than or equal to 0.01). PR/SCRP appears to provide better short-term mean probing depth reduction (2.6 mm) than C/SCRP (1.0 mm), presumably due to apical positioning of the papillae and periodontal repair following improved access for root planing.

Adult↗
PubMed1991

A morphological comparison of radicular dentin following root planing and treatment with citric acid or tetracycline HCl.

The conditioning of root surfaces with saturated solutions of citric acid or tetracycline is unpredictable in facilitating new attachment, perhaps due to the low pH of these solutions which may be denaturing the organic matrix of the root as well as demineralizing the surface. The purpose of the present study was to compare the effects of a saturated solution of citric acid (pH = 1) with that of a 0.5% solution of tetracycline HCl (pH = 3.2) on radicular dentin with regard to the removal of the smear layer, exposure of dentinal tubule openings, and demineralization of the peritubular dentin. 10 bovine incisors were used in this study. The crowns and apical 1/3 of the root were resected and the resulting root segments were then frozen in icy freon. The cementum was fractured off of the root to produce a fracture-exposed, non-instrumented dentin surface. This fracture-exposed dentin surface was divided into 4 specimens, the 1st being a fracture-exposed, non-instrumented dentin control specimen (FE). After removal of the (FE) specimen from the root segment, the remainder of the fracture-exposed dentin surface was thoroughly root planed and then subdivided into the 3 remaining specimens. One of these specimens served as the root planed dentin surface (RP); another specimen (CA) was immersed in saturated citric acid (pH = 1) for 5 min and then washed in water for 5 min; the final specimen (T) was immersed in a 0.5 mg/ml solution of tetracycline HCl for 5 min and rinsed in water for 5 min.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2005

Effectiveness of scaling and root planing versus modified Widman flap on nitric oxide synthase and arginase activity in patients with chronic periodontitis.

BACKGROUND: Nitric oxide (NO) is synthesized from the conversion of L-arginine to L-citrulline by NO synthase (NOS). Arginase, which is an arginine-depleting enzyme, can compete with NOS for the common substrate L-arginine and thus inhibit NO production. OBJECTIVES: In the present study, we aimed to examine the correlation between the arginase and NOS activity in patients with chronic periodontitis and to compare the effects of scaling and root planing and modified Widman flap procedures on enzyme activity. MATERIAL AND METHODS: The study included 13 patients diagnosed with chronic periodontitis. Using a split-mouth design, the defects showing>or=7 mm of attachment loss were treated either with scaling and root planing or with modified Widman flap. Gingival biopsies from both sites were obtained at baseline and 2 months after periodontal treatment. Immunohistochemical staining was performed for evaluating NOS expression and specific arginase activity was determined spectrophotometrically. RESULTS: Although inflamed periodontal tissues demonstrated a strong inducible NOS (iNOS) expression at baseline, immunostaining decreased after periodontal treatment. iNOS expression intensity and the number of inflammatory cells showing iNOS expression were found to be higher in the scaling and root planing group compared to the modified Widman flap group. The specific activity of arginase was measured as 0.18+/-0.07 IU/mg protein in the modified Widman flap group and 0.25+/-0.11 IU/mg protein in the scaling and root planing group at baseline. After periodontal therapy, the enzyme level was increased to 0.68+/-0.14 IU/mg protein in the modified Widman flap and to 1.10+/-0.23 IU/mg protein in the scaling and root planing group. CONCLUSION: This study was the first report of evaluating the involvement of the arginine-NO pathway in chronic periodontitis and this might be considered to be of value in understanding the periodontal disease mechanisms.

Adult↗
PubMed1999

Effects of smoking on local delivery of controlled-release doxycycline as compared to scaling and root planing.

This paper examines the effects of smoking on the treatment outcomes of two nonsurgical therapies: (1) scaling and root planing alone (SRP) or (2) controlled-release of subgingivally delivered doxycycline hyclate in a polylactic acid based polymer gel. Subjects from 2 9-month multicenter studies were classified as nonsmokers (never smoked: 100 subjects), former smokers (137 subjects), and current smokers (> or = 10 cigarettes/day: 121 subjects). Clinical parameters were analyzed for treated sites with baseline probing depths > or = 5 mm and for a subset of treated sites with baseline probing depths of > or = 7 mm. Clinical parameters (plaque levels, clinical attachment levels, pocket depths, and bleeding on probing) were analyzed at baseline, 4, 6, and 9 months. In the doxycycline treated group in general, there were neither marked significant differences in clinical attachment gain nor differences in probing depth reduction among the 3 smoking groups. On the other hand, in the scaling and root planing treated group in general, there were significant differences in clinical attachment gain and pocket depth reduction, with non-smokers responding better than former smokers and current smokers at 6 and 9 months. These differences in clinical response between scaling and root planing alone versus controlled-release of locally-delivered doxycycline hyclate among these 3 smoking groups are discussed in relation to treatment implications for smokers.

Administration, Topical↗
PubMed1982

Initial healing of periodontal pockets after a single episode of root planing monitored by controlled probing forces.

THE PURPOSE OF the present study was to evaluate, using controlled probing forces, the response of periodontal pockets to a single episode of root planing. The clinical characteristics of 128 pockets (3-7 mm depth) distributed in ten subjects, were monitored immediately before and 1, 2, 3, and 4 weeks after a single episode of subgingival root planing. The clinical parameters measured were: pocket depth and bleeding after probing with 15 gm, 25 gm, 50 gm of controlled probing force and manual probing, gingival margin location, loss of attachment, gingival and plaque indices. Oral hygiene instruction and supragingival prophylaxis were given at each time point. An average aggregated score for each subject for each parameter was calculated at each time point. A repeated measure all-within analysis of variance was done, and the Tukey multiple range test was used to assess the significance of differences among and between the means. Plaque and gingival indices decreased significantly after 1 week. Significant pocket depth reduction (initial) occurred 1 week after root planing, and reduced further (secondary) at 3 weeks. Initial pocket reduction was associated with significant gingival recession, whereas secondary pocket reduction was associated with significant gain of clinical attachment. Bleeding upon probing was virtually absent after 3 weeks. All probing changes were detected more consistently using controlled insertion pressures. It was concluded that substantial reduction in pocket depth occurs within 3 weeks after a single episode of root planing owing to initial gingival recession and secondary gain in clinical attachment.

Adult↗
PubMed1997

Smear layer formed by different root planing modalities and its removal by an ethylenediaminetetraacetic acid gel preparation.

The purpose of the present study was (1) to examine smear layer formation following different root planing modalities, and (2) to evaluate its removal and the exposure of collagen using an ethylenediaminetetraacetic acid gel preparation. Twenty-four periodontitis-affected human teeth were mechanically root planed. Twelve teeth were etched with an ethylenediaminetetraacetic acid gel preparation. The surfaces were examined by a scanning electron microscope. The results showed that root planing resulted in a smear layer covering the root surfaces, irrespective of treatment modality. The smear layer could be efficiently removed with the ethylenediaminetetraacetic acid gel preparation. During this process, collagen fibers were exposed to varying degrees.

Acid Etching, Dental↗