[A fundamental study on root planing--the permeability of the dental root structures to 35S].
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Dental Prophylaxis↗
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The fluoride content of root-planed dentine in pereiodontitis-exposed roots.
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Adult↗
Periodontal treatment with an Er:YAG laser or scaling and root planing. A 2-year follow-up split-mouth study.
BACKGROUND: Non-surgical periodontal treatment with an Er:YAG laser has been shown to result in significant clinical attachment level gain; however, clinical results have not been established on a long-term basis following Er:YAG laser treatment. Therefore, the aim of the present study was to present the 2-year results following non-surgical periodontal treatment with an Er:YAG laser or scaling and root planing. METHODS: Twenty patients with moderate to advanced periodontal destruction were treated under local anesthesia, and the quadrants were randomly allocated in a split-mouth design to either 1) Er:YAG laser (ERL) using an energy level of 160 mJ/pulse and 10 Hz, or 2) scaling and root planing (SRP) using hand instruments. The following clinical parameters were evaluated at baseline and at 1 and 2 years after treatment: plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL). Subgingival plaque samples were taken at each appointment and analyzed using dark-field microscopy for the presence of cocci, non-motile rods, motile rods, and spirochetes. The primary outcome variable was CAL. No statistically significant differences between the groups were found at baseline. Power analysis to determine superiority of ERL treatment showed that the available sample size would yield 99% power to detect a 1 mm difference. RESULTS: The sites treated with ERL demonstrated mean CAL change from 6.3 +/- 1.1 mm to 4.5 +/- 0.4 mm (P < 0.001) and to 4.9 +/- 0.4 mm (P < 0.001) at 1 and 2 years, respectively. No statistically significant differences were found between the CAL mean at 1 and 2 years postoperatively. The sites treated with SRP showed a mean CAL change from 6.5 +/- 1.0 mm to 5.6 +/- 0.4 mm (P < 0.001) and to 5.8 +/- 0.4 mm (P < 0.001) at 1 and 2 years, respectively. The CAL change between 1 and 2 years did not present statistically significant differences. Both groups showed a significant increase of cocci and non-motile rods and a decrease in the amount of spirochetes. However, at the 1- and 2-year examination, the statistical analysis showed a significant difference for the CAL (P < 0.001, respectively) between the 2 treatment groups. CONCLUSION: It was concluded that the CAL gain obtained following non-surgical periodontal treatment with ERL or SRP can be maintained over a 2-year period.
Aluminum Silicates↗
Clinical and microbiological study of local minocycline delivery (Periocline) following scaling and root planing in recurrent periodontal pockets.
This study was designed to evaluate the clinical and microbiological effects of local administration of 2% minocycline-HCl ointment (Periocline) combined with scaling and root planing in recurrent periodontal pockets. Thirty-three sites were selected for this examination. The sites had probing depths greater than 5 mm and loss of attachment greater than 2 mm within the previous 3 months. They were assigned as test (22 sites) or control sites (11 sites). After meticulous scaling (SC) and root planing (RP), Periocline was delivered into the periodontal pockets of test sites: control sites were irrigated with biological saline following SC/RP. Administration of Periocline or irrigation with saline was performed once a week for 4 consecutive weeks. The effects on clinical conditions including probing pocket depth, clinical attachment level, and bleeding on probing were evaluated at baseline, 2, 4, 8, and 12 weeks. Microbiological examinations consisting of darkfield microscopic study and culture were performed at baseline, 4, and 12 weeks. Clinical conditions improved in both groups following treatment; significantly better improvements were obtained in the test group. Microbiological study revealed that Periocline effectively eliminated periodontopathic gram-negative bacteria. These results indicated that a combination of SC/RP with local administration of 2% minocycline for recurrent periodontal pockets brought about more satisfactory results than conventional SC/RP.
Administration, Topical↗
Computer-controlled delivery versus syringe delivery of local anesthetic injections for therapeutic scaling and root planing.
BACKGROUND: The authors conducted a study to compare administration of local anesthetic using a computer-controlled delivery device with an aspirating syringe for therapeutic scaling and root planing. The anterior middle superior alveolar, or AMSA, injection was compared with other maxillary injections. METHODS: Twenty healthy adults with moderate periodontal disease participated in this single-blind crossover study. Subjects were evaluated by a trained examiner and were treated by experienced dental hygienists. Subjects provided written and verbal pain ratings via a visual analog scale, or VAS, and a verbal rating scale, or VRS. AMSA injections were compared with syringe-delivered injections--greater palatine, or GP, and nasopalatine, or NP, blocks, and anterior superior alveolar and middle superior alveolar injections--in maxillary quadrants. Bleeding and changes in attachment were evaluated after one month. RESULTS: VAS and VRS scores for AMSA were significantly lower for computer-controlled delivery when compared with NP injections and combined maxillary injections (VAS scores) and with GP and combined maxillary injections (VRS scores). Mean injection times were similar for both groups. Mean gains in attachment were equal, 0.19 millimeters for quadrants anesthetized using computer-controlled injections and 0.22 mm for syringe injections. CONCLUSIONS: Subjects reported having less pain with GP and NP injections delivered using the computer-controlled device, and total injection time was similar to that required for syringe injections. Both techniques provided adequate anesthesia for therapeutic scaling and root planing. Clinical Implications. The two anesthetic delivery techniques were therapeutically equivalent for mandibular injections, and the AMSA injection has clinically significant advantages for maxillary injections.
Adult↗
Scaling and root planing without overinstrumentation: hand versus power-driven scalers.
This review focuses on select current articles chosen for their unique contribution to the literature in scaling and root planing. New studies suggest that thorough root debridement can be achieved without overinstrumentation using certain sonic and ultrasonic scalers. Evaluation of residual plaque and calculus after instrumentation with hand- and power-driven scalers showed sonic and ultrasonic scalers to be equivalent, and in some cases, superior to hand scaling. When modified ultrasonic inserts were compared with unmodified ultrasonic inserts and hand curets, the modified ultrasonic inserts produced smoother roots with the least amount of damage, better access to the bottom of the pocket, better calculus and plaque removal, less operator time, and less operator fatigue than did hand scaling or ultrasonics equipped with unmodified inserts.
Dental Scaling↗
Subgingival scaling with root planing and curettage: effects upon gingival inflammation: a comparative study.
In a joint clinical and histological research, carried out in humans of both sexes, it was attempted to establish some of the differences between the effects of curettage and root planing as procedures to accomplish remission of gingival inflammation. In 10 patients, 210 teeth were treated (103 curetted and 98 root planed). Sixty useful samples and 2132 histological sections were obtained. Six different staining techniques were used to study the samples. Clinical and histological evaluations were made of the results obtained with both procedures.
Adult↗
The effect of plaque control after scaling and root planing on the subgingival microflora in human periodontitis.
The aim of the present study was to evaluate the effect of a strict supragingival plaque control regimen on bacterial repopulation following scaling and root planing. 7 patients with moderate to severe inflammatory periodontal disease received a full-mouth scaling and subgingival curettage. Using a split-mouth design, 2 sites of opposite quadrants were submitted to professional supragingival plaque control 3 X a week while the contralateral sites served as controls. Clinical and bacterial examination were performed on days 7, 14, 28, 49, 56, 63 and 70 following therapy. All clinical parameters (P1I, GI, probing depth, attachment levels) showed significant improvement after scaling and root planing. Shifts in the subgingival bacterial population observed by dark field were also noticed following curettage: there was a decrease in the proportions of spirochetes and motile rods and an increase in that of coccoid cells. However, bacterial distribution tended to return to base line values towards the end of the observation period. No difference in the pattern of bacterial recolonization of the subgingival area could be detected between the sites under strict supragingival plaque control and the control sites.
Adult↗
Clinical and microbiological effects of topical subgingival application of hyaluronic acid gel adjunctive to scaling and root planing in the treatment of chronic periodontitis.
BACKGROUND: Hyaluronic acid (HA) has shown anti-inflammatory effects in gingivitis therapy. The potential benefits of local subgingival application of HA adjunctive to scaling and root planing (SRP) were evaluated in this study. METHODS: Twenty patients with chronic periodontitis were included in this split-mouth study. Sulcus fluid flow rate (SFFR) and sulcus bleeding index were monitored at baseline and after 1, 2, 3, 4, 5, 6, and 12 weeks; probing depth and clinical attachment level were monitored at baseline and 6 and 12 weeks. Subgingival plaque samples were also taken at these same three appointments to determine the presence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythensis, and Treponema denticola. All patients were treated with full-mouth scaling and root planing (SRP); in addition, an HA gel was administered subgingivally in the test sites every week for 6 weeks. RESULTS: An improvement of all clinical variables was observed (P < 0.05) in both groups. Clinically, no difference between test and control sites could be found. No difference between test and control sites was seen in the tested microorganisms. CONCLUSIONS: No clinical or microbiological improvement was achieved by the adjunctive use of HA gel compared to SRP alone. Only SFFR was affected by the use of HA in terms of a more rapid reduction of SFFR in the test sites.
Administration, Topical↗
Clinical alterations in relation to the morphological composition of the subgingival microflora following scaling and root planing.
The aim of the present study was to relate shifts in the composition of subgingival plaque in periodontal pockets to alterations of the clinical periodontal conditions following a single course of subgingival scaling and root planing during a period of professional supragingival plaque control. For this purpose, 36 pairs of contralateral periodontal pockets in 10 subjects with moderately advanced periodontitis were assessed for the degree of gingival inflammation, probing pocket depths, bleeding on probing, attachment levels and the amount of supragingival plaque. In addition, samples of subgingival plaque were analyzed morphologically by dark-field microscopy. All patients received detailed information about proper oral hygiene and every 1-2 weeks, professional removal of supragingivally located deposits. When the oral hygiene standard had been sufficiently improved, 1 course of subgingival scaling on 1 side of each jaw only (test side) was carried out. Clinical and microbiological examinations were repeated after the scaling as well as after 2 and 6 months, while patients were recalled for supragingival prophylaxis every 2nd to 4th week. Our data showed that a single course of subgingival scaling and root planing resulted in reduced probing depths, a gain in clinical attachment and a shift in the composition of the subgingival microflora to a composition found in relatively healthy periodontal conditions. In relatively shallow pockets, however, a possible influence of repeated sampling on the subgingival microflora could not be ruled out. Bleeding on gentle probing was a reliable parameter for predicting a subgingival microflora where motile bacteria hold an increased portion.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Periodontal healing after scaling and root planing with the Kavo Sonicflex and Titan-S sonic scalers.
Several types of air turbine scalers have recently been introduced as alternatives to hand instruments and ultrasonic devices in periodontal therapy. Whereas differences in scaling and root planing efficiencies have been demonstrated in vitro between different types of sonic scalers (Lie & Leknes 1985), periodontal healing after instrumentation with the Titan-S sonic scaler, Cavitron ultra sonic scalers and hand instruments has shown to be similar (Gellini et al. 1986, Loos et al. 1987, Laurell & Pettersson 1988). This split mouth designed study compared periodontal healing expressed as reduction in number of sites with probing depths of 4 mm or deeper and bleeding on probing following scaling and root planing with the Sonicflex and the Titan-S sonic scalers. Fifteen patients with moderately advanced periodontitis participated in the study. In each patient one side of the dentition was treated with the Sonicflex and the other with the Titan-S sonic scalers. Reexaminations performed three and seven months after treatment showed significant and similar reductions in number of sites with probing depths of greater than or equal to 4 mm and bleeding scores for the two sides.
Adult↗
Pulpal and periodontal temperature rise during KTP laser use as a root planing complement in vitro.
OBJECTIVE: The purpose of this study was to define the optimal irradiation conditions of a KTP laser during root planing treatment. METHODS: The surfaces of 60 single-root human teeth were scaled with conventional instruments before lasing. The pulpal temperature increase was measured by means of one thermocouple placed in the pulp chamber and a second one placed on the root surface at 1 mm from the irradiation site. The influence of variables of coloration by Acid Red 52 (photosensitizer), scanning speed, dentin thickness, and probe position was analyzed for a constant exposure time of 15 sec and 500 mw (spot size diameter, 0.5 mm). The pulpal temperature was below 3 degrees C for the adjustments. RESULTS: The irradiation on one point of root surface had the following results: The application of photosensitizer on the root surface before lasing produced a 50% higher temperature rise within the pulp than in the case without the application of the photosensitizer. The temperature rise in the pulp chamber was below 3 degrees C with the following settings of 500 mw: PW = 10 msec and PRR < 35; or PW= 20 msec and PRR < 20 Hz. On the other hand, for the same irradiation conditions, the temperature rise on the surface of the root was always below 7 degrees C. However, the temperature increase became higher than 7 degrees C (on the surface of the root) in the case of P > 500 mw, PW > 50 msec and PRR > 10 Hz of root surface or a scanning speed of irradiation of 1 mm/sec for a linear irradiation of 4 mm. CONCLUSION: The KTP laser may be used safely without thermal damage to pulp and periodontal tissue with respect to the biologically acceptable previously described parameters.
Body Temperature↗
Clinical effects of scaling and root planing on untreated teeth.
OBJECTIVE: The aim of this report is to examine whether scaling and root planing (SRP) in one area of the mouth may affect periodontal improvement in untreated areas in the same patient, possibly through systemic effects of treatment. MATERIAL AND METHODS: Twenty patients diagnosed with generalized aggressive periodontitis were randomized into treatment (n=11) and no treatment (n=9) groups. Within the treatment group, three quadrants were treated by SRP at week 0, 3, 12, and 24, while a single experimental quadrant remained untreated throughout the study. The outcome for all teeth was assessed using clinical parameters, subtraction radiography, and pathogenic bacteria levels in the subgingival flora over the 24-week study period. RESULTS: Compared with sites in no treatment patients, the treated sites in the treated patients showed a 1 mm decrease in probing depth (PD) (p<0.01) and a 0.5 mm increase in bone height (p<0.01) by 24 weeks. In untreated sites within treated subjects, however, PDs tended to improve (p=0.09) but at a reduced rate compared with treated sites. The levels of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Tannerella forsythensis (Bacteroides forsythus) remained unchanged in untreated sites while levels of Prevetolla intermedia and Treponema denticola tended to decrease as compared with controls but did not reach significance. CONCLUSIONS: This study indicates that untreated sites in treated periodontitis patients show a trend towards clinical improvement and exhibit reductions in some but not all periodontopathic bacterial species tested.
Adolescent↗
Morphologic analysis, by means of scanning electron microscopy, of the effect of Er: YAG laser on root surfaces submitted to scaling and root planing.
The purpose of this study was to morphologically evaluate, by means of scanning electron microscopy, the effects of Er:YAG laser on the treatment of root surfaces submitted to scaling and root planing with conventional periodontal instruments. Eighteen root surfaces (n = 18), which had been previously scaled and planed, were assigned to 3 groups (n = 6). The control Group (G1) received no further treatment; Group 2 (G2) was irradiated with Er:YAG laser (2.94 mum), with 47 mJ/10 Hz, in a focused mode with air/water spray during 15 s and with 0.57 J/cm of fluency per pulse; Group 3 (G 3) was irradiated with Er:YAG laser (2.94 mum), with 83 mJ/10 Hz, in a focused mode with air/water spray during 15 s and with 1.03 J/cm2 of fluency per pulse. We concluded that the parameters adopted for Group 3 removed the smear layer from the root surface, exposing the dentinal tubules. Although no fissures, cracks or carbonized areas were observed, an irregular surface was produced by Er:YAG laser irradiation. Thus, the biocompatibility of the irradiated root surface, within the periodontal healing process, must be assessed.
Bicuspid↗
Removal of hard tooth structure by ROOTSHAPE root planing files used with a modified EVA contra-angle.
The results of numerous recent investigations indicate that root contamination with bacteria and endotoxins is limited to the root surface only. Therefore, methods on root surfaces instrumentation that preserve root substance should be focused on. Newly available instruments or treatment systems should be evaluated for their root substance-removing potential. The devices for root planing presented here comprised specific files (Rootshape) (with diamond-coating on their convex working surfaces used in conjunction with a water-spray-cooled contra-angle head transforming rotational movements into translatory oscillations. The substance-removal potential of rigid and flexible files with diamond coatings of 2-4, 15, 25 and 40 microns compared with that of regular hand curettes, was evaluated under various working forces. The results demonstrated, that depending on the grit size of the diamond coating, the Rootshape files removed less and in no instance greater amounts of root surface substance than did hand instruments.
Analysis of Variance↗
Clinical significance of non-surgical periodontal therapy: an evidence-based perspective of scaling and root planing.
Analysis of Egyptian hieroglyphics and medical papyri indicate that non-surgical periodontal treatment was common 3000-4000 years ago. Even today, scaling and root planing (SRP) remains an essential part of successful periodontal therapy. The collective evidence from numerous clinical trials reveals a consistency of clinical response in the treatment of chronic periodontitis by SRP using manual, sonic, or ultrasonic instrumentation. Thus, SRP remains the 'gold standard' to which more recently developed therapeutic modalities must be compared. Inherent to the clinical evaluation of SRP are such concerns as manual versus sonic and ultrasonic instrumentation, control of sub-gingival bacterial populations, removal of calculus, root smoothness and changes in various clinical parameters, e.g. probing depth, attachment levels, bleeding on probing and gingival inflammation. Lastly, an abbreviated discussion is presented on a relatively new paradigm of complete mouth 'disinfection' in a compressed time-frame that includes SRP as a significant component of the treatment regimen.
Chronic Disease↗
Clinical evaluation and comparison of 2 topical anesthetics for pain caused by needle sticks and scaling and root planing.
BACKGROUND: Pain generated by needle sticks (Ns) for the delivery of local anesthetic and/or scaling and root planing (SRP) instrumentation is commonly addressed by the use of topical anesthetics, such as a benzocaine-gel preparation (BGP). Pain suppression following such use has been highly variable. Development of medicine-containing patches and adhesives for intraoral use have led to a new approach for topical anesthesia in the form of a transoral lidocaine delivery system (LDS). The purpose of this double-blind study was to evaluate the efficacy of the LDS and also to compare LDS with BGP for pain suppression to Ns and SRP. METHODS: One group of 20 subjects randomly received in both maxillary and mandibular molar-bicuspid areas LDS or BGP on one side and non-anesthetic control on the other side. A second group of 20 subjects compared the effectiveness of LDS directly with BGP in molar-bicuspid areas of both arches. Random order determined the selection for each anesthetic tested between the arches and bilateral. Pain perception was separately scored to a pain-inducing Ns simulation without anesthetic injection at each area and subsequently also to SRP using both a verbal pain scale (VPS) and a visual analog scale (VAS). RESULTS: VPS and VAS results analyzed by Bonferroni-adjusted Wilcoxon matched-pairs signed-rank tests found pain suppression scores significantly (P < 0.005) reduced for Ns by LDS to controls and to BGP. Comparing LDS directly with BGP, LDS was significantly (P < 0.05) more effective in reducing pain to Ns in both arches, to SRP in the maxillary arch, and equally effective as BGP in the mandibular arch. CONCLUSIONS: LDS is more effective than BGP for topical pain suppression to Ns and SRP in both arches.
Administration, Topical↗
Scaling and root-planing treatment with adjunctive subgingival minocycline. A clinical pilot study over six months, of sites adjacent to and remote from the antibiotic application.
AIM: A clinical trial was performed to determine if a single dose of subgingival minocycline has (i) a clinical spillover effect at adjacent and remote sites and (ii) an adjunctive effect to scaling and root-planing. MATERIALS AND METHODS: Each of the 15 adult subjects included in the study had to present with at least two pairs of adjacent 6-9 mm pockets each pair located on adjacent teeth in an interproximal space, on opposite sides of the mouth. Each study site was required to have at least 3 mm loss of attachment. Following a baseline examination including assessments of plaque, pocket depth (PD), clinical attachment levels (CAL) and bleeding on probing (BOP), instruction in oral hygiene was given. Each subject was treated with a single episode of scaling and root-planing (SRP), of approximately 90 minutes duration using ultrasonic and hand instrumentation under local anaesthetic, if indicated. This was followed by a single application of 1 mg of minocycline in the form of Minocycline Periodontal Therapeutic System (MPTS) into one of the four sites selected at random by another clinician, who also randomly selected one of the two sites on the opposite side of the mouth to be designated the Remote site. Clinical re-examinations were performed at 3- and 6-months. RESULTS: At six months the CAL gains at the MPTS sites were statistically significantly different when compared with the Adjacent sites (P=0.04). The proportion of sites demonstrating a CAL gain (> or = 2 mm) was higher in the MPTS group (73%) compared with the Adjacent (40%) and Remote sites (53%). Periodontal therapy, (MPTS+SRP) and (SRP alone) resulted in a statistically significant reduction in mean pocket depths (P<0.01). However no statistically significant differences in pocket depths were found between treatment groups over the six months of the study. The proportion of sites demonstrating a clinically significant reduction in PD (> or = 2 mm) was higher in the MPTS sites (80%) compared with the Adjacent sites (53%) and Remote sites (53%). BOP was significantly reduced at all sites over the duration of the study except at the Adjacent sites at three months (P<0.05). CONCLUSION: No apparent clinical spillover effect of minocycline was demonstrated over the six months of the study. There was a trend for greater improvement in all clinical parameters at the MPTS sites compared with the Adjacent and Remote sites except for plaque scores. This trend needs to be examined in a study with a sufficient number of subjects to allow statistical significance.
Adult↗