Efficacy versus health risks: An in vitro evaluation of power-driven scalers.

BACKGROUND: Power-driven instrumentation of root surfaces during supportive periodontal therapy is an alternative to hand instrumentation. The purpose of this pilot in vitro study was to investigate the efficacy of sub- and supragingival plaque removal with a sonic (AIR: Synea, W and H, Bürmoos, Austria) and two ultrasonic devices (TIG: Tigon+, W and H, Bürmoos, Austria; VEC: Vector, Dürr, Bietigheim-Bissingen, Germany) as well as the health-risk for dental professionals during treatment. MATERIALS AND METHODS: The power-driven devices were utilized to remove plaque from model teeth in dummy heads. The percentage of residual artificial plaque after 2 min of supra- or subgingival instrumentation was calculated by means of image-processing techniques at four sites (n = 576) of each tooth. The Health-Risk-Index (HRI: spatter/residual plaque quotient) with the different power-driven devices was assessed during treatment. RESULTS: The smallest amounts of residual plaque were found for the sonic device AIR (8.89% ± 10.92%) and the ultrasonic scaler TIG (8.72% ± 12.02%) (P = 0.707). Significantly more plaque was remained after the use of the ultrasonic scaler VEC (18.76% ± 18.07%) (P < 0.001). Irrespectively of the scaler, efficacy was similar sub- (10.7% ± 11.6%) and supragingivally (13.5% ± 17.2%) (P = 0.901). AIR/TIG demonstrated equal residual amounts of plaque sub- (P = 0.831) as well as supragingivally (P = 0.510). However, AIR/VEC and TIG/VEC were significantly in favor of AIR and TIG (P < 0.001). In contrast, the lowest HRI was found after using VEC (0.0043) and differed considerably for AIR (0.2812) and TIG (0.0287). CONCLUSION: Sonic devices are as effective as ultrasonic devices in the removal of biofilm but bear a higher risk to the dental professional's health concerning the formation of spatter.

Retaining or replacing molars with furcation involvement: a cost-effectiveness comparison of different strategies.

AIM: The comparative cost-effectiveness of retaining or replacing molars with furcation involvement (FI) remains unclear. We assessed the cost-effectiveness of retaining FI molars via periodontal treatments versus replacing them via implant-supported crowns (ISCs). METHODS: Using tooth-level Markov models, we followed a molar with FI degree I or II/III in a 50-year-old patient over his lifetime. Tooth-retaining periodontal treatments (scaling and root planing, flap debridement, root resection, guided-tissue regeneration, tunnelling) were compared with tooth replacement using ISCs. We analysed costs, time until first re-treatment and total time of tooth or implant retention. The model adopted a private payer perspective within German health care. Transition probabilities were calculated based on current evidence. Monte-Carlo microsimulations were performed, and robustness of the model and effects of heterogeneity assessed using sensitivity analyses. RESULTS: Despite requiring re-treatment later than other strategies, ISCs were the most costly therapy. Compared with most periodontal treatments, ISCs were retained for shorter time than natural teeth regardless of the degree of FI, the patients' age or risk profile (smoker/non-smoker). CONCLUSIONS: Based on available data and within its limitations, our study indicates that retaining FI molars via periodontal treatments might be more cost-effective than replacing them via ISCs. Changes in the underlying evidence or the setting might alter these results.

Costs and effectiveness of treatment alternatives for proximal caries lesions.

OBJECTIVES: Invasive therapy of proximal caries lesions initiates a cascade of re-treatment cycles with increasing loss of dental hard tissue. Non- and micro-invasive treatment aim at delaying this cascade and may thus reduce both the health and economic burden of such lesions. This study compared the costs and effectiveness of alternative treatments of proximal caries lesions. METHODS: A Markov-process model was used to simulate the events following the treatment of a proximal posterior lesion (E2/D1) in a 20-year-old patient in Germany. We compared three interventions (non-invasive; micro-invasive using resin infiltration; invasive using composite restoration). We calculated the risk of complications of initial and possible follow-up treatments and modelled time-dependent non-linear transition probabilities. Costs were calculated based on item-fee catalogues in Germany. Monte-Carlo-microsimulations were performed to compare cost-effectiveness of non- versus micro-invasive treatment and to analyse lifetime costs of all three treatments. RESULTS: Micro-invasive treatment was both more costly and more effective than non-invasive therapy, with ceiling-value-thresholds for willingness-to-pay between 16.73 € for E2 and 1.57 € for D1 lesions. Invasive treatment was the most costly strategy. Calculated costs and effectiveness were sensitive to lesion stage, patient's age, discounting rate and assumed initial treatment costs. CONCLUSIONS: Non- and micro-invasive treatments have lower long-term costs than invasive therapy of proximal lesions. Micro-invasive therapy had the highest cost-effectiveness for treating D1 lesions in young patients. Decision makers with a willingness-to-pay over 16.73 € and 1.57 € for E2 and D1 lesions, respectively, will find micro-invasive treatment more cost-effective than non-invasive therapy.

Root damage induced by intraosseous anesthesia–An in vitro investigation

Objectives: The principle of the intraosseous anesthesia (IOA) relies on the perforation of the cortical plate of the bone for direct application of the local anesthetic solution into the underlying cancellous structures. During this procedure, IOA needles might accidentally come in contact with the tooth roots. The aim of the current in vitro study was to examine the consequences of this 'worst case scenario' comparing five commercially available IOA systems. Material and Method: Extracted human roots were randomly perforated using five different IOA systems with a drilling time ≤5s. To simulate normal in vivo conditions, the roots were kept humid during the drilling procedure. Data was statistically evaluated using F-test (SPSS16, SPSS Inc., Chicago, USA) and the significance level was set at p ≤ 0.05. Results: All examined systems resulted in root perforation. Drill fractures occurred in either none 0% (Quicksleeper, Anesto, Intraflow, Stabident) or 100% (X-Tip) of the applications. Excessive heat generation, as evident by combustion odor as well as metal and tooth discoloration, appeared in 30% (Quicksleeper), 40% (Anesto), 60% (Intraflow), 90% (Stabident) and 100% (X-Tip) of all perforations. Cconclusions: Within the limits of in-vitro studies, the results show a potential for irreversible root damage that might be inflicted by an improper use of IOA systems (AU)

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Root damage induced by intraosseous anesthesia. An in vitro investigation.

OBJECTIVES: The principle of the intraosseous anesthesia (IOA) relies on the perforation of the cortical plate of the bone for direct application of the local anesthetic solution into the underlying cancellous structures. During this procedure, IOA needles might accidentally come in contact with the tooth roots. The aim of the current in vitro study was to examine the consequences of this 'worst case scenario' comparing five commercially available IOA systems. MATERIAL AND METHOD: Extracted human roots were randomly perforated using five different IOA systems with a drilling time ≤5s. To simulate normal in vivo conditions, the roots were kept humid during the drilling procedure. Data was statistically evaluated using F-test (SPSS16, SPSS Inc., Chicago, USA) and the significance level was set at p ≤ 0.05. RESULTS: All examined systems resulted in root perforation. Drill fractures occurred in either none 0% (Quicksleeper, Anesto, Intraflow, Stabident) or 100% (X-Tip) of the applications. Excessive heat generation, as evident by combustion odor as well as metal and tooth discoloration, appeared in 30% (Quicksleeper), 40% (Anesto), 60% (Intraflow), 90% (Stabident) and 100% (X-Tip) of all perforations. CONCLUSION: Within the limits of in-vitro studies, the results show a potential for irreversible root damage that might be inflicted by an improper use of IOA systems.