Scanning electron microscopy in vitro study on the effect of Carisolv application on periodontally diseased root surfaces.

The purpose of this study was to evaluate the characteristics of diseased root surfaces treated by the association of scaling and the application of Carisolv. Twenty-four uniradicular periodontally involved teeth were used in this study. The teeth were divided randomly into three groups: eight teeth were scaled and root planed until there was a complete visible removal of calculus (group 1), Carisolv was applied on the root surfaces of eight teeth twice for 30 seconds before scaling with a sharp curette (group 2), and eight teeth received the same treatment as in group 2 but with a blunt curette (group 3). Specimens were examined using scanning electron microscopy. The superficial aspect of the roots from group 1 presented scratches that mirrored the curette cutting edge, and the smear layer completely covered the surface. Root surfaces from groups 2 and 3 also presented a smear layer that covered the surface completely, but it was somewhat smoother than group 1. The use of Carisolv as an adjunct to scaling and root planing presented no advantage for smear layer removal over scaling alone, suggesting that no benefit is obtained by the use of Carisolv during periodontal mechanical treatment.

A comparative SEM study between hand instrument and Er:YAG laser scaling and root planing.

Scaling and root planing are one of the most commonly used procedures for the treatment of periodontal diseases. Removal of calculus using conventional hand instruments is incomplete and rather time-consuming. In search for more efficient and less difficult instrumentation, investigators have proposed lasers as alternatives or adjuncts for scaling and root planing. The aim of the present study was to compare the effectiveness of subgingival scaling and root planing with erbium: yttrium, aluminium, garnet (Er:YAG) laser and hand instrumentation in vitro. The mesial and distal surfaces of 15 periodontal loosed extracted teeth were treated randomly either by hand instrumentation or by Er:YAG laser irradiation. After choosing the "very long pulse mode" (pulse duration of about 700 micros), the output energy of 160 mJ with 920-microm beam diameter (RO7 Perio tip, Fidelis, Fotona, Slovenia) and frequency of 12 Hz were selected, both according to the best results of past studies. In addition, air water spray was used during the procedures. The morphology of the root surface was evaluated by three observers with a scanning electron microscopy in magnifications of 50x and 400x. The result of this setting showed that the rate of remained roughness on treated root surfaces in two groups of hand instruments and Er:YAG laser had a meaningful difference: The surface roughness in Er:YAG laser group was more than in hand instruments group. The present study could demonstrate the in vitro capability of the Er:YAG laser for scaling and root planing in periodontitis, although the effectiveness of this setting did not reach that achieved by hand instrumentation. It could be concluded that lower frequency and long pulse duration maybe more suitable for the micro-morphology of root surface after treatment. This theory is going to be tested with the same laser instrument in the next study.

Er:YAG laser in defocused mode for scaling of periodontally involved root surfaces: an in vitro pilot study.

BACKGROUND: The Er:YAG laser may be used on periodontally involved teeth in combination with conventional periodontal therapy in order to improve the efficacy of root instrumentation. The aim of this study was to compare the effect of hand instrumentation on root surfaces of periodontally involved teeth with Er:YAG laser application. METHODS: Thirty freshly extracted, non-carious, single-rooted, periodontally diseased human teeth from adult humans with advanced periodontal disease were used in this study. The teeth were divided into three groups of 10 specimens each. Group A was treated with scaling and root planing (SRP) with curets only (control). In group B, the root surfaces were scaled with curets and then lased with an Er:YAG laser (wavelength 2.94 microm). A handpiece with a water spray was used in non-contact mode (defocused) at a distance of 1 cm from root surface. Laser parameters were set at energy of 100 to 200 mJ/pulse, with 10 Hz of frequency. In group C, the root surfaces were lased only with power settings 250 to 300 mJ/pulse and 10 Hz frequency. An epon-araldite plastic embedding technique was used for light microscopic investigation. RESULTS: Histologic findings showed significant differences between the test and control sites. In control sites, after hand instrumentation, the surface was smooth, without a cementum layer, and the dentin layer presented opened tubules. Defects on the dentin layer were also present along root surfaces. In the test sites (B, C) root surfaces revealed no thermal damage; no cracking or tissue carbonization were observed. The superficial layers of lased surfaces appeared smooth and melted without alterations. CONCLUSION: Based on these findings, it appears that it may be feasible to use the Er:YAG laser for root instrumentation without prior root planing if the proper parameters are followed.

The effectiveness of InGaAsP diode laser radiation to detect subgingival calculus as compared to an explorer.

BACKGROUND: The aim of the present study was to compare the ability of the diode laser to detect residual calculus with that of an explorer. METHODS: The root surface of 40 extracted human teeth, each partially covered with subgingival calculus, was instrumented with curets under simulated clinical conditions in a manikin. The samples were randomly assigned to two study groups. In group A, the root surface was treated with an explorer until it appeared free of mineralized deposits upon examination. The samples in group B were instrumented until the relative intensity of fluorescence as induced with diode laser radiation was below a threshold value of 5. The root surface of each sample was then examined for residual calculus using standardized digital images. The statistical analysis was performed with a non-paired t test at a level of significance of 5% (P < 0.05). RESULTS: The root surface of single-rooted teeth showed residual calculus on 0.19 +/- 0.37 x 10(7) microm2 in the laser group and on 0.11 +/- 0.26 x 10(7) microm2 in the explorer group (P = 0.19). For multirooted teeth, the mean calculus-covered area was 0.50 +/- 0.48 x 10(7) microm2 for the teeth evaluated with an explorer and 0.27 +/- 0.43 x 10(7) microm2 for the diode laser group (P = 0.02). CONCLUSION: The present findings indicate that the detection of subgingival calculus is significantly improved using 655 nm diode laser radiation compared to an explorer for molars but not for single-rooted teeth.

A clinical study to assess the ability of a powered toothbrush to remove chlorhexidine/tea dental stain.

AIM: A single-center, single-blind, two-way crossover study was performed to compare the effects of an electric powered toothbrush with a conventional manual toothbrush at removing chlorhexidine/tea tooth staining. METHODS: This study used 24 subjects. During the week before the study, the subjects received a prophylaxis to remove all staining, plaque and calculus deposits. On the Monday of the following week, subjects returned to the clinic to receive a further prophylaxis. Under direct supervision, they then rinsed with a 0.2% chlorhexidine mouthrinse, immediately followed by a rinse with a warm black tea solution. This cycle was repeated hourly eight times throughout the day and on the following days until the Friday. Throughout this period, volunteers omitted all other forms of oral hygiene except rinsing with the chlorhexidine mouthwash. On the Friday, the level of stain was assessed both prior to and immediately after brushing with the allocated brush with toothpaste for 1 min. This was done in an adjoining room (out of sight of the clinical scorer). Subjects were then instructed to use the toothbrush at home according to their normal oral hygiene practices. On the following Friday, subjects returned to the clinic when the stain present was re-assessed. Each subject received a thorough prophylaxis to remove all plaque calculus and staining before starting the second period of the study and again on completion of the study. RESULTS: The study showed relatively little difference between the ability of the two brushes to remove stain at a single test brushing. However, there was some evidence that the powered brush was more effective than the manual brush in minimising stain level during the home use period, overall and in particular for gingival crescent sites. CONCLUSIONS: This study has suggested that the powered brush may become more effective at reducing dental stain, the longer the brush is used under normal home conditions.

The effects of EDTA gel conditioning exposure time on periodontitis-affected human root surfaces: surface topography and PDL cell adhesion.

OBJECTIVE: The purpose of this investigation was to study the surface topography of periodontally-affected human roots following EDTA gel application at different time periods with and without scaling and root planing. In addition, to assess any correlations between root surface changes following EDTA gel conditioning and periodontal ligament fibroblast adhesion. METHODS: Forty-eight teeth that had a labial probing depth and clinical attachment loss of more than 7mm were used in this study. Periodontally-affected teeth were randomly divided into 4 groups of 12 teeth in each. Furthermore, a sample group of 6 teeth, which had a healthy periodontium, were used to serve as the healthy control (G1). The second group (G2) served as a diseased treated control in which sample teeth were only scaled and root planed prior to immediate extraction. Teeth in the third group (G3) were conditioned with a pH neutral, 24% Ethylenediaminetetraacetic acid (EDTA gel), for 2 minutes without any scaling or root planing and immediately extracted. The teeth in the fourth group (G4) were scaled, root planed, and then conditioned with the EDTA gel preparation for 2 minutes before immediate extraction. Finally the teeth in the fifth group (G5) were conditioned with EDTA gel for 4 minutes following scaling and root planing and immediately extracted. Half the samples in each group were randomly selected and processed for SEM evaluation of the surface topography. The other half were prepared to assess PDL cell adhesion with PDL fibroblasts being cultured and seeded on the root surface for 24 hours then processed for SEM evaluation of the adherent cells. RESULTS: SEM evaluation of the root planed surfaces in G2 revealed the typical appearance of a smear layer. The root surfaces of all samples in G3 exhibited a uniform coating of calculus that was covered by a considerable amount of loosely attached material including residual plaque and debris. In G4 EDTA gel exposure for 2-minutes following scaling and root planing resulted in removal of the smear layer and a marked exposure of round to oval dentinal tubule orifices. Areas of bacterial accumulation were observed in 4 out of the 6 samples examined in this group. The root surfaces after the 4-minute EDTA gel application (G5) had a fibrillar texture associated with a marked decrease in the number and an increased diameter of the exposed dentinal tubule openings. With regard to PDL cell adhesion, the majority of the 2-minute EDTA gel conditioning on the non-instrumented samples in G3, showed a failure of cells to adhere to the diseased root surface. The examined samples in G4 showed a significant increase in the number of flat and round adherent cells when compared to the diseased control samples (G2) (P > or = 0.01). The G5 samples showed a significant increase in the number of flat cells when compared to G4 (P > or = 0.01). CONCLUSION: The present study confirms the capability of EDTA gel to remove a root surface associated smear layer and to expose a collagen matrix when it was applied after scaling and root planing. In addition, a positive correlation was found between time of EDTA gel conditioning and the degree of PDL cell adhesion. It appears from the present investigation that EDTA gel conditioning for 4 minutes provides the most desirable root surface to which maximum PDL cells can adhere and on which they can grow.

Comprehensive treatment concept in a young adult patient with severe periodontal disease: a case report.

This case report describes the comprehensive treatment of generalized, advanced periodontal disease in a young patient. In view of the necessary reconstruction, the extensive destruction of the periodontal tissues required a systematic approach to determine the possibilities and the expectations of the patient. The subsequent oral rehabilitation was accomplished with fixed prosthodontics. In the mandible, strategically important anchor teeth were replaced with implants, allowing smaller units to be inserted. The long-term treatment result, however, can only be ensured with the full cooperation of the patient and consistent periodontal maintenance care.

Laboratory stain removal and abrasion characteristics of a dentifrice based upon a novel silica technology.

These laboratory studies examined the stain removal efficacy and hard tissue abrasivity of a new dentifrice formulation--Crest Extra Whitening--based on the incorporation of elevated concentrations of a proprietary silica. Cleaning power assessments were made using a modification of the laboratory test method developed by Stookey and associates at Indiana University Oral Health Research Institute. Abrasion assessments were made using Radioactive Enamel and Radioactive Dentin Abrasivity (REA and RDA) measures. Results show that Crest Extra Whitening dentifrice produced statistically significantly improved stain removal when compared to a number of conventional dentifrices, including Crest Cavity Protection and Crest Tartar Protection, and a number of recently marketed cleaning and whitening dentifrices. Laboratory studies further demonstrated that the Crest Extra Whitening dentifrice produces dentin and enamel abrasivity similar to conventional silica dentifrices.

Suggestion can help.

One cannot practise dentistry without realising that for the patient, the control of pain and fear is extremely important. Modern technical advances have made painless dentistry a reality and yet research has shown that more people avoid dental treatment through fear of pain than all other factors combined. Dental surgeons and psychologists agree that patients frequently magnify their unpleasant dental experiences. There are deep-seated psychological reasons for this exaggerated fear; the mouth being a highly charged erotogenic region, is a primary zone of interaction with the environment and can have important far-reaching emotional significance. To many people the anticipation of dental treatment is sufficient to arouse extreme anxiety. Dental schools lay great emphasis on basic medical sciences and the technical excellence of students, the psychosomatic approach to the alleviation of apprehension, fear and pain is meanwhile often sadly neglected. The use of controlled suggestion and hypnosis can be shown to play a very important role in clinical dentistry.

[Effectiveness of 4microA electroanalgesia during scaling]. / Efficacite de l'electro-analgesie a 4 microA lors du detartrage.

What comfort can be brought by electro-analgesia in scaling? A clinical experimentation including 54 cases evidenced that scaling is not sufficiently regular. The fear of pain is a major cause. Electro-analgesia at 4 microA, provides a valuable solution to this problem, with a recognized in 59% of patients.

The effects of a single course of a calculus-softening scaling and root planing gel. A scanning electron microscopic study.

The effect of a calculus scaling gel was evaluated as an adjunct to instrumentation in a double blind, split-mouth, clinical study. Fifteen comparable periodontally involved teeth from 5 patients were instrumented on the mesio-buccal root surface with the aid of either the test gel, placebo gel, or no gel until smoothness was achieved. Test or placebo gel was applied subgingivally for 10 minutes. Instrumentation time, ease, number of strokes, and gingival/tooth surfaces changes were recorded. Scanning electronic microscopic (SEM) evaluation of root surface topography was evaluated. The results demonstrated effective calculus removal in all treatment groups with no differences found between them. Instrumentation time, ease, and number of strokes were similar for all treatment groups. There were no harmful effects to soft or hard tissues. The results of this study do not support the use of calculus scaling gel as an adjunct to root instrumentation.

Periodontal status of a subject sample of Yemen.

From August to October 1991, the periodontal status of 1001 Yemenis representing the age groups 12-14, 15-19, 20-24 and 35-44 years was recorded and evaluated with reference to the CPITN, the calculus index and clinical attachment levels. The impact of chewing khat, the leaves of a cultivated, alkaloid shrub, and of using the traditional miswak chewing stick for oral hygiene purposes were investigated. The results show that 6.9% of the juvenile probands (15-19 years) had healthy periodontal tissue (CPITN 0), whereas bleeding on probing and calculus (CPITN 1 + 2) were registered in 86.2%. In the 35-44 year age group, 1.7% were periodontally healthy, whereas 84.5% displayed plaque retention or shallow pocketing (CPITN 2 + 3) and 12.5% deep pocketing (CPITN 4). The treatment needs in all age groups are confined primarily to calculus removal and instruction in oral hygiene. The clinical attachment level and the calculus index revealed age-related attachment loss and calculus formation, primarily among male probands. The higher khat consumption among the male population is reflected in its detrimental effect on the periodontal tissue, especially among younger probands. Oral hygiene aids have also an influence on periodontal status, with a toothbrush proving more efficient than the miswak. WHO efforts directed towards prophylactic programs need to be intensified but can be staffed by dental hygienists.

Effectiveness of a prescale gel on subgingival calculus.

A prescale gel product, designed to facilitate the removal of calculus, has recently been introduced and marketed to the dental profession. The purpose of this study was to evaluate the effectiveness of this gel on the removal of subgingival calculus. 10 patients, each with 5 periodontally diseased teeth scheduled for extraction, participated in this in vivo/in vitro study. 4 teeth per patient were randomly assigned using a 2-by-2 block design and treated in vivo with either active or placebo gel, with or without scaling, prior to extraction. To assess possible overexposure to the product, 10 selected teeth from the sample were treated with active gel for an extended exposure time. Standardized scaling was performed on a 4x4 mm treated root area in vitro on groups as assigned. Quantification of residual calculus was determined by one examiner blind to treatment group assignment using SEM photomicrograph montages and the Java image analysis computer system. Repeated measures ANOVA showed no statistically significant treatment effect for gel (p > 0.05) in the scaled and no-scaled groups. The 5th group exposed to the prescale gel for an extended time was evaluated descriptively for root surface morphological changes with no noticeable effect. Based on the results of this investigation, treatment of subgingival calculus with prescale gel offers no advantage for calculus removal over scaling alone. The findings suggest no significant clinical impact of product use.

An evaluation of a pre-scaling gel (SofScale) on the ease of supragingival calculus removal.

SofScale is a pre-scaling gel, containing disodium EDTA and sodium lauryl sulphate, which is claimed to soften calculus and therefore facilitate its removal. 31 subjects were treated in a double blind randomised placebo controlled split mouth study to evaluate this product. Test or placebo gels were applied to the lingual surfaces of the mandibular teeth for 4 min and the time taken to complete the removal of supragingival calculus recorded. The operator recorded on which side the calculus was considered easier to remove and the patient indicated how comfortable the scaling had been. The mean calculus index was 1.99 for the SofScale group and 1.97 for the placebo. The mean time taken to complete scaling was 5.31 min for both groups. Using the Student t-test, there were no statistically significant differences (p > 0.7) between either the calculus index or time taken to complete the scaling between the groups. The operator did not consider SofScale to facilitate calculus removal and patients did not find calculus removal more comfortable when SofScale had been used. There was no increased sensitivity in the SofScale group following scaling. The results of this study do not support the use of SofScale as an adjunct to scaling.

The antimicrobial effectiveness of clindamycin in diseases of the oral cavity.

Veterinary dental ultrasonic equipment can cause bacteria to be aerosolized during prophy procedures. Preoperative treatment with clindamycin prior to removal of calculus using an ultrasonic scaler can reduce aerosolized bacteria. Reduction of plaque bacteria was assessed and was statistically significant in those patients receiving clindamycin. This article describes the evaluation and results of clindamycin application when given prior to dental prophy.

The effect of oral irrigation with a magnetic water treatment device on plaque and calculus.

Calculus formation on tooth surfaces is analogous to the formation of lime and scale deposits in plumbing. Magnetic water devices have been shown to significantly reduce scale deposits in industry; therefore an oral irrigator with a magnetic water device may have a similar effect on calculus. To test this hypothesis, a double-blind clinical study was established using 64 irrigators, 30 of which had their magnetic devices removed. 54 patients with heavy supragingival calculus were given irrigators at random after prophylaxis. Instructions were given to irrigate twice a day, particularly the lower 6 anterior teeth. The patients were also told not to floss these 6 teeth which were to be the study teeth. They were examined after 3 months and measurements were taken of the accretions adhering to the study teeth. No attempt was made to determine whether the adhering material was hard or soft so it must be assumed that at least some of the measured material was also plaque. The measurements of the group using an irrigator with a magnetic device showed a 44% greater reduction in calculus volume (p < 0.0005) and a 42% greater reduction in area (p < 0.0001) over the group using an unmagnetized irrigator. There appears to be a statistically significant difference in supragingival accretion volumes between conventional irrigation and using an irrigator with a magnetic water treatment device.