In-Vitro Measurement of Forces During Debridement with a Piezoelectric Ultrasonic Periodontal Scaler.

PURPOSE: This study investigated the magnitude, direction, and temporal aspects of the force applied during instrumentation with a piezoelectric ultrasonic periodontal scaler, compared this force with recommendations in the literature, and assessed the influence of the profession (dentist or dental hygienist) and calculus hardness. MATERIALS AND METHODS: The force applied by ten dental hygienists and six dentists during debridement of comparatively soft and hard artificial dental calculus with a piezoelectric ultrasonic scaler was recorded in-vitro. The total force and its components in three axes were statistically analysed. RESULTS: During debridement of soft artificial dental calculus, the mean total force applied by dental hygienists was 0.34 N (± 0.18 N, range: 0.13 N to 0.59 N) and by dentists 0.28 N (± 0.33 N, range: 0.06 N to 0.95 N), and the total force exceeded 0.5 N approximately 23% and 14% of the time for dental hygienists and dentists, respectively. During debridement of hard artificial dental calculus, the mean total force applied by dental hygienists was 0.63 N (± 0.40 N, range: 0.28 N to 1.64 N) and by dentists 0.57 N (± 0.17 N, range: 0.34 N to 0.76 N); the total force exceeded 0.5 N more than half of the time for both professions. On average, dental hygienists applied 1.85x (p = 0.04) and dentists 2.04x (p = 0.06) higher force on hard than on soft artificial calculus. However, dental hygienists and dentists used similar forces during the debridement of both hard (p = 1.00) and soft (p = 0.26) calculus. CONCLUSION: The force applied during the debridement of hard artificial dental calculus was statistically significantly higher than during the debridement of soft artificial dental calculus. No statistically significant difference between dentists and dental hygienists was found. The force applied by both groups on soft and hard artificial dental calculus frequently exceeded recommended values.

Efeito da terapia fotodinâmica antimicrobiana como adjuvante no tratamento não cirúrgico da periodontite estádio III ou IV grau C / Effect of antimicrobial photodynamic therapy as an adjuvant in the non-surgical treatment of stage III or IV grade C periodontitis

A Periodontite estádio III e IV grau C em pacientes jovens tem um caráter mais destrutivo dos tecidos periodontais de suporte e tem impacto em perdas dentárias, função mastigatória e pior resposta ao tratamento. E a Terapia Fotodinâmica Antimicrobiana (TFD) tem surgido como uma alternativa promissora adjuvante à Terapia Periodontal não Cirúrgica (TPNC) desta doença. OBJETIVO: avaliar os efeitos da TFD como adjuvante no TPNC da Periodontite estádio III ou IV grau C, através dos parâmetros clínicos periodontais (Índice de Placa Visível (IPV), Índice de Sangramento Gengival (ISG), Sangramento à Sondagem (SS), Profundidade de Sondagem (PS), Recessão Gengival (RG), Nível de Inserção Clínica (NIC) e Mobilidade Dentária (MOB)) bem como avaliar seu impacto na qualidade de vida dos pacientes por meio do Oral healthrelated quality of life (OHRQoL). METODOLOGIA: Vinte e um indivíduos participaram desse ensaio clínico controlado randomizado, duplo cego, em um desenho de boca dividida por quadrantes. Todos os pacientes foram tratados com orientação de higiene bucal, raspagem e alisamento radicular por meio do Full Mouth Disinfection (FMD) e antibioticoterapia sistêmica. Os quatro quadrantes foram randomizados de acordo com os seguintes grupos: grupo 1 (FMD + AB), grupo 2 (FMD + AB + TFD em sessão única), grupo 3 (FMD + AB + TFD em quatro sessões) e grupo 4 (FMD + AB + laserterapia com luz infravermelha em quatro sessões). As avaliações foram feitas no baseline e com média de 6 meses após o tratamento. RESULTADOS: Obteve-se uma melhora dos parâmetros clínicos com redução significativa da PS, NIC e SS para todos grupos e da MOB para os grupos FMD + AB, FMD + AB + TFD sessão única e FMD + AB + TFD em 4 sessões após o tratamento, apresentou redução expressivamente maior do NIC no grupo FMD + AB + TFD 4 sessões (ΔMédia = 3,04 mm) em relação ao grupo FMD + AB (Δmédia =2,18 mm), ou seja, com diferença de 0,86 mm. A estratificação das PS no baseline em PS = 5mm e PS ≥ 6mm mostrou que para PS ≥ 6mm, o grupo FMD + AB + TFD em 4 sessões apresentou maior redução da PS (p = 0,005) e NIC (p = 0,001) em relação ao grupo FMD + AB. Em relação à QV, houve aumento significativo dos valores OHRQoL (p = 0,001) e dos domínios físico (p < 0,001), social (p = 0,027) e psicológico (p = 0,005) após o tratamento. CONCLUSÃO: A terapia periodontal do FMD associada a antibioticoterapia, com acréscimo ou não da TFD apresenta resultados significativos na melhora dos parâmetros clínicos periodontais e, em bolsas mais profundas, a TFD em 4 sessões apresentou resultados superiores. Ademais, a Periodontite estádio III ou IV grau C reflete negativamente na percepção da QV, porém, a TPNC apresentou impacto positivo sobre a mesma (AU).

Stage III ­ IV grade C periodontitis in young patients has a more destructive character of periodontal support tissues and has impact on loss of teeth, masticatory function and worse response to treatment. The Antimicrobial Photodynamic Therapy (PDT) has become as a promising alternative, adjuvant to Non-Surgical Periodontal Therapy (NSPT) of this disease. OBJECTIVE: To evaluate the effect of adjunctive PDT on the non-surgical treatment of stage III ­ IV, grade C Periodontitis, through the analysis of periodontal clinical parameters (Visible Plaque Index (VPI), Gingival Bleeding Index (GBI), Bleeding on Probing (BP), Pocket Probing Depth (PPD), Gingival Recession (GR), Clinical Attachment Level (CAL) and Tooth Mobility (Mob)) as well as to assess their impact on quality of life (QoL) of the patients through Oral health-related quality of life (OHRQoL) questionnaire. METHODOLOGY: Twenty-one subjects particpated in this controlled randomized, double-blind trial, in a split-mouth design divided into quadrants. All the patients were treated with oral hygiene guidance, scaling and root planing through Full Mouth Disinfection (FMD) and systemic anbiotics. The four quadrants were randomly assigned to the following treatment groups: group (FMD + AB), group 2 (FMD + AB + PDT in a single session), group 3 (FMD + AB + PDT in four sessions), and group 4 (FMD + AB + laser therapy with infrared light in four sessions). Assessments were made at baseline and an average of 6 months after treatment. RESULTS: There was an improvement in clinical parameters with significant reduction of PPD, CAL and BoP for all therapies as well as Mob for FMD + AB, FMD + AB + PDT in a sihgle session and FMD + AB + PDT in 4 sessions groups, however there was a significantly greater reduction in CIN in the FMD + AB + PDT group 4 sessions (ΔAverage = 3.04 mm) in relation to the FMD + AB group (ΔAverage = 2.18 mm), that is, with a difference of 0.86 mm. Stratification of the baseline pockets in PPD = 5mm and PPD ≥ 6mm showed that, for PPD ≥ 6mm, FMD + PDT in 4 sessions had a greater reduction of PPD (p = 0.005) and CAL (p = 0.001) in relation to FMD group). Regarding QoL analysis, there was a significant increase in the OHRQoL (p = 0.001) and in the physical (p < 0,001), social (p = 0.027) and psychological (p = 0.005) domains after treatment. CONCLUSION: FMD therapy associated with systemic antibiotic therapy, with or without addition of PDT, showed significant improvement of the clinical periodontal parameters and, in deeper pockets, PDT in 4 sessions showed better results. Furthermore, stage III - IV grade C Periodontitis reflected negatively on the QoL perception, however, NSPT had a positive impact on it (AU).

Efeito da terapia probiótica (Lactobacillus reuteri) coadjuvante no tratamento da periodontite associada ao Diabetes Mellitus: estudo clínico, controlado e randomizado / Effect of adjuvant probiotic therapy (Lactobacillus reuteri) in the treatment of periodontitis associated with Diabetes Mellitus: clinical, controlled and randomized study

A associação de probióticos ao debridamento mecânico pode ser uma proposta de tratamento das doenças periodontais, em especial para pacientes portadores de Diabetes Mellitus tipo 2 (DM2). Avaliou-se os efeitos da administração do probiótico Lactobacillus reuteri como terapia coadjuvante no tratamento da Periodontite (P) associada ao DM2. Um total de 40 participantes diabéticos e diagnosticados com P foram randomizados em Grupo RAR+Placebo (n=20): receberam debridamento mecânico associado ao probiótico e Grupo RAR+Probi (n=20): tratados com debridamento mecânico associado a um placebo. Foram realizadas avaliações de profundidade de sondagem (P.S.), recessão gengival (RG), nível de inserção clínica (NIC), índice de placa (IP), índice de sangramento gengival (IG) e índice PISA no baseline, 30, 90 e 180 dias. Foi realizada dosagem da concentração de citocinas (INF-γ, IL-10, IL-12, IL-13, IL1ß, IL-4, IL-6, IL-8, TNF-α) do fluido crevicular gengival (FCG), no baseline e 180 dias após o tratamento. Informações sobre efeitos adversos do uso de medicamentos e sobre qualidade de vida foram coletadas. Os dados foram obtidos em média e desvio padrão, e analisados pelos testes Fridman/Tukey e MannWhiteny. Considerado a metodologia do presente estudo, os resultados obtidos apontam que o debridamento periodontal promoveu melhora significativa (p<0.05) nos parâmetros clínicos periodontais em ambos os grupos, mas o uso do probiótico não foi eficiente para resultados adicionais quando comparado com o placebo. A terapia periodontal interferiu nos níveis de citocinas do FCG, porém não se pode afirmar que o uso de probiótico apresenta o mesmo efeito(AU)

The association of probiotics with mechanical debridement may be a proposal for the treatment of periodontal diseases, especially for patients with type 2 Diabetes Mellitus (DM2). The effects of the administration of the probiotic Lactobacillus reuteri as an adjunctive therapy in the treatment of Periodontitis (P) associated with DM2 were evaluated. A total of 40 diabetic participants and diagnosed with P were randomized into Group RAR + Placebo (n = 20): received mechanical debridement associated with the probiotic and Group RAR + Probi (n = 20): treated with mechanical debridement associated with a placebo. Probing depth (P.S.), gingival recession (RG), clinical insertion level (NIC), plaque index (IP), gingival bleeding index (IG) and PISA index were performed at baseline, 30, 90 and 180 days. Measurement of the concentration of cytokines (INF-γ, IL-10, IL-12, IL-13, IL-1ß, IL-4, IL-6, IL-8, TNF-α) of the gingival crevicular fluid (FCG), at baseline and 180 days after treatment. Information on adverse effects of medication use and on quality of life was collected. The data were obtained in mean and standard deviation, and analyzed by the Fridman / Tukey and MannWhiteny tests. Considering the methodology of the present study, the results obtained point out that periodontal debridement promoted a significant improvement (p <0.05) in periodontal clinical parameters in both groups, but the use of probiotic was not efficient for additional results when compared with placebo. Periodontal therapy interfered with FCG cytokine levels, but it cannot be said that the use of probiotics has the same effect. Cytokines(AU)

Subgingival glycine powder air-polishing as an additional approach to nonsurgical periodontal therapy in subjects with untreated chronic periodontitis.

BACKGROUND AND OBJECTIVE: Glycine powder air-polishing (GPAP) is an alternative approach to removing subgingival plaque biofilms for effective periodontal therapy. This study aimed to investigate the effect of subgingival GPAP as an additional approach to nonsurgical periodontal treatment in subjects with chronic periodontitis. MATERIAL AND METHODS: Twenty-seven nonsmoking subjects were recruited. Two quadrants in each subject were randomly assigned, according to a split-mouth design, to receive scaling and root planing (SRP) and GPAP (Test group) or SRP and air flushing with water (Control group) at sites with probing depth ≥5 mm. Clinical parameters, gingival crevicular fluid volumes and the concentrations of interleukin-1ß and interleukin-1ra in gingival crevicular fluid were measured at baseline and 1, 3 and 6 months after the treatments. RESULTS: At baseline, no statistically significant difference in periodontal and gingival crevicular fluid parameters was found between the Test and Control groups. Overall, the periodontal conditions of all subjects showed significant improvement after the treatments. Notably, the Test group showed greater reduction in gingival crevicular fluid volume (0.37 ± 0.26 µL) than the Control group (0.23 ± 0.30 µL) at 3 months (P < .05). The gingival crevicular fluid levels of interleukin-1ß and interleukin-1ra showed a significant decrease in both groups at 6 months, and no significant difference was found between the groups. CONCLUSION: These preliminary results suggest that GPAP, as an additional approach to nonsurgical periodontal treatment, may be beneficial for the short-term improvement of subclinical inflammation when measured by gingival crevicular fluid volume. Further longitudinal studies with larger sample sizes are required to clarify the exact benefits of GPAP treatment for controlling inflammation and maintaining long-term periodontal health.

Effectiveness of supplementary irrigant agitation with the Finisher GF Brush on the debridement of oval root canals instrumented with the Gentlefile or nickel titanium rotary instruments.

AIM: To examine the efficacy of a novel supplementary irrigant agitating brush (Finisher GF Brush, MedicNRG, Kibbutz Afikim, Israel) on the debridement of root canals prepared with a novel stainless steel rotary instrumentation system (Gentlefile; MedicNRG), or nickel titanium rotary instruments in oval root canals. METHODOLOGY: Mandibular premolars (n = 72) were selected and divided randomly into three experimental groups (n = 24) after microCT scanning: group 1, canal preparation to rotary NiTi size 20, .04 taper (R20); group 2, rotary NiTi to size 25, .04 taper (R25) and group 3, Gentlefile size 23, .04 taper (GF). Specimens were subdivided into two subgroups: subgroup A, syringe-and-needle irrigation (SNI); subgroup B, Finisher GF Brush (GB). Ten untreated canals served as controls. Specimens were processed for histological evaluation, and the remaining pulp tissue (RPT) was measured. Data were analysed using Mann-Whitney and Kruskal-Wallis tests (P = 0.05). RESULTS: All experimental groups had significantly less RPT than the control (P < 0.05). Group 3B (GF-GB) had significantly less RPT than groups 1B (R20-GB) and 2B (R25-GF; P < 0.05). When irrigated with SNI, there was no significant difference in the RPT between the three groups (P > 0.05). When instrumented with R20, there was no significant difference between SNI and GF (P < 0.05) whilst GB had significantly less RPT than SNI for R25 (P < 0.05). CONCLUSIONS: Supplementary irrigant agitation with the Finisher GF Brush improved the debridement of canals prepared with Gentlefile and size 25, .04 taper rotary NiTi. Root canal debridement did not significantly differ between the instruments when syringe irrigation was used.

Evaluation of ex vivo restoration of carious equine maxillary cheek teeth infundibulae following debridement with dental drills and Hedstrom files.

An ex-vivo study was performed on vertically mounted equine maxillary cheek teeth that had caries of 30 infundibulae, using high and low speed contra-angle dental drills and Hedstrom files to debride infundibular food debris and carious dental tissues. This technique effectively debrided 27/30 infundibulae with a mean depth of 19mm (range 9.4-34.3mm) as assessed by computed tomographic (CT) imaging. The debrided infundibulae were treated with sodium hypochlorite, EDTA and a bonding agent, and then then filled in layers with endodontic restoration materials. Further CT imaging and direct examination of sectioned restored teeth showed 6/30 infundibulae, including three that were incompletely debrided, to have defects between the restoration and the infundibular wall/apex. Twenty-one of the remaining 24 infundibulae contained air bubbles, largely within restorations. It is concluded that the use of drills and Hedstrom files is effective in debriding carious infundibulae but improved techniques and materials are required to more effectively fill infundibulae with restorative material.

Patient-Based Comparison of Traditional Instruments and Piezoelectric Bone Surgery in Osseous Resective Surgery.

Osseous resective surgery has been widely advocated in the treatment of periodontitis. The treatment traditionally has been done with rotary and manual instruments, but piezoelectric devices recently have also been used. A total of 20 adult patients diagnosed with moderate to severe chronic periodontitis were selected. A split-mouth study design was conducted such that one sextant was operated using piezoelectric bone surgery (test) and one with traditional instruments (control) in two separate sessions. Patients were asked to evaluate their perception of cold sensitivity, spontaneous pain, bleeding, swelling, and chewing discomfort. Piezoelectric bone surgery seems to be tolerated slightly better than conventional rotary instruments.

Effect of application of a PVP-iodine solution before and during subgingival ultrasonic instrumentation on post-treatment bacteraemia: a randomized single-centre placebo-controlled clinical trial.

BACKGROUND: To assess the effect of concomitant subgingival rinsing with 10% PVP-iodine during subgingival instrumentation on the prevalence and magnitude of bacteraemia of oral origin. MATERIALS AND METHODS: Subgingival instrumentation was performed with water or PVP-iodine rinse in patients with periodontitis. Prior to instrumentation, subjects gargled for 1 min with the allocated liquid. Pockets were then rinsed for 1 min and subgingivally instrumented with liquid-cooled (water/PVP-iodine) ultrasonic scalers (1 min). Two minutes later, a blood sample from the arm vein was drawn using a lysis centrifugation blood culture system for quantitative microbiological analysis. Non-parametric statistical tests were performed to assess differences in the prevalence and extent of bacteraemia between groups. RESULTS: Of the 19 samples in each group, oral-borne bacteraemia was detected in 10 of the control and 2 of the test samples. With an average of 3.0 [1; 5] colony forming units, significantly less bacteria and bacteraemia were found in the test group compared to the controls (12.2 [1; 46]) (p = 0.003). Anaerobic bacteria were not found in the test group. CONCLUSIONS: Bacteraemia after subgingival instrumentation with concomitant PVP-iodine rinsing is reduced but not eliminated. Therefore, it might be recommended for patients at a high risk of endocarditis or infection of endoprostheses. However, preventive antibiotic treatment should not be omitted.

Cost-effectiveness of non-surgical peri-implantitis treatments.

AIM: The purpose of the present study was to assess the cost-effectiveness of various alternatives of non-surgical peri-implantitis treatment. MATERIALS AND METHODS: A decision analytical model was constructed and populated with parameter estimates from recent literature for reduction in pocket probing depth (PPD) in response to eight different treatment alternatives. A micro-costing approach combined with an online expert survey was applied to simulate a decision-making scenario taking place in Germany. The treatment alternatives providing the most advantageous cost/outcome combinations were identified according to the net benefit criterion. Uncertainties regarding model input parameters were incorporated via simple and probabilistic sensitivity analysis based on Monte Carlo simulation. RESULTS: In the base case scenario, debridement alone, Air-Flow, debridement combined with PerioChip, and debridement combined with local antibiotics were identified as treatment strategies with comparably better value for money than Er:YAG laser monotherapy, Vector System, debridement combined with CHX, and photodynamic therapy. Sensitivity analysis revealed considerable decision uncertainty corresponding to limited evidence about different treatment alternatives for peri-implantitis treatment. CONCLUSIONS: Derivation of robust treatment recommendations for peri-implantitis requires more comprehensive and patient-centred evidence on peri-implantitis treatments.

The utilization of a diode laser in the surgical treatment of peri-implantitis. A randomized clinical trial.

OBJECTIVES: A comparison of different treatment modalities of peri-implantitis can lead to the development and application of more effective and efficient methods of therapy in clinical practice. This study compares the effectiveness of open flap debridement used alone, with an approach employing the additional use of a diode laser for the treatment of peri-implantitis. MATERIALS AND METHODS: Nineteen patients were divided into two groups and treated for peri-implantitis. In the control group (C group), the therapy utilized access flaps, plastic curettes, and sterilized gauzes soaked in saline. The test group (L group) was treated similarly but with additional irradiation using a diode laser. The parameters studied were pocket depth (PD) as the primary outcome variable, clinical attachment level (CAL), bleeding on probing (BOP), and plaque index (PI) as secondary variables. Measurements were performed at three different time points, baseline (BSL), 3 months, and 6 months after treatment. Three months after treatment, a mean PD reduction of 1.19 mm for the control group and 1.38 mm for the laser group was recorded. The corresponding BOP changes were 72.9 and 66.7%, respectively. These changes were significant and remained at the same levels at the 6-month examination (p < 0.05). CAL was reduced significantly only in group L from 5.25 mm at baseline to 4.54 mm at 3 months, remaining at this level at 6 months (p < 0.05). PI was reduced significantly in group C at 3 months from 37.5 to 6.3%. The 6-month data showed no statistically significant difference (p < 0.05) from the 3-month measurements. RESULTS: The two methods of therapy for peri-implantitis examined seemed to be equally efficient in the reduction of the PD and BOP 3 months after surgery, with the results sustained at the same levels after 6 months. CAL significantly improved only in the test group after 3 months. PI was reduced and maintained at low levels in both groups. CONCLUSIONS: Surgical treatment of peri-implantitis by access flaps leads to improvement of all clinical parameters studied while the additional use of diode laser does not seem to have an extra beneficiary effect. CLINICAL RELEVANCE: The additional use of a diode laser in the surgical treatment of peri-implantitis offers a limited clinical benefit.

Pilot study on the clinical and microbiological effect of subgingival glycine powder air polishing using a cannula-like jet.

OBJECTIVES: To assess the efficacy of subgingival glycine powder air polishing (GPAP) during supportive periodontal therapy (SPT). METHODS: Each quadrant of 25 subjects was randomly assigned to the following treatments: subgingival scaling with hand instruments (SRP), GPAP, subgingival ultrasonic debridement (UD) and no subgingival treatment (NT). Clinical recordings included the following: probing pocket depth (PPD), gingival recession (RE), clinical attachment level (CAL), Gingival and Plaque Index. Subgingival plaque samples were taken from two sites >4 mm per quadrant. Therapy, recordings and microbial sampling were performed at baseline, 3 and 6 months, while at 1 month only clinical recordings and sampling were performed. Subgingival samples were analysed using 'checkerboard' DNA-DNA hybridization for Porphyromonas gingivalis, Tannerrella forsythia and Treponema denticola. RESULTS: All groups were homogeneous at baseline for the clinical parameters assessed. The GPAP group displayed statistically significant higher PPD compared to SRP and UD at 1, 3 and 6 months and no statistical differences with the 'no treatment' group at all time points. At 1 month, the GPAP group displayed statistically significantly higher levels of CAL compared to SRP, while at 3 and 6 months statistically significant differences were observed with groups assigned to SRP and UD. No differences were observed among groups for RE, PI, GI and numbers of the investigated bacteria at any time point. CONCLUSIONS: On the basis of clinical and microbiological data, this study does not support the superiority of GPAP as sole treatment over SRP or subgingival ultrasonic scaling.

Trauma from instrumentation after non-surgical periodontal treatment with ultrasonic scalers and Nd:YAG laser.

OBJECTIVE: Periodontal therapies aimed at altering the progression of periodontal diseases must include meticulous mechanical debridement during both the non-surgical and the surgical phases of periodontal treatment. The aim of this study was to evaluate and compare the immediate effect of trauma from instrumentation on clinical attachment level after non-surgical periodontal treatment with ultrasonic scalers and a Nd:YAG laser. MATERIALS AND METHODS: Twenty-four patients with untreated chronic periodontitis, presenting probing depths of 4-6 mm on anterior teeth, upper and lower, were entered into the study. The selected teeth were probed with a pressure-controlled probe, guided by stents. Each quadrant was randomly allocated in a split-mouth design either to treatment with Nd:YAG laser using an energy of 1W, 100mj, 1064nm (test group) or to periodontal treatment using ultrasonic scalers (control group). Clinical parameters, including plaque index (PI), bleeding on probing (BOP), probing pocket depth (PPD) and probing attachment level (PAL) were acquired prior to and immediately after treatment. RESULTS: Statistical analysis demonstrated no differences between groups at baseline for all parameters (p > 0.05). Immediately after treatment, the control group showed a greater PAL loss than the test group (p < 0.05). For the control group, there were statistically significant differences between PAL immediately before and after treatment (p < 0.05), but not test group (p > 0.05). CONCLUSIONS: Within the limits of the present study, it may be concluded that non-surgical periodontal treatment with ultrasonic scalers causes a mean immediate attachment loss of 0.68 mm and that a Nd:YAG laser seems to reduce significantly the trauma the instrumentation produced.

Effects of titanium brush on machined and sand-blasted/acid-etched titanium disc using confocal microscopy and contact profilometry.

OBJECTIVE: Mechanical techniques, including scaling with metal, plastic, or ultrasonic instruments, rubber cup polishing, air-powder abrasive system and brushing with a conventional or a rotating brush, have been used for the debridement of dental implants. Recently, rotating brushes with titanium bristles (titanium brush) have been introduced for the debridement of implant surface when peri-implant osseous defects occur. The purpose of this study was to evaluate the effects of a titanium brush on machined (MA) and sand-blasted and acid-etched (SA) titanium surfaces using scanning electron microscopy, confocal microscopy and profilometry. Moreover, correlations between the two quantitative evaluation methods (confocal microscopy and contact profilometry) were assessed. MATERIALS AND METHODS: Both MA and SA discs were treated with rotating titanium brush at 300 rpm under irrigation for a total of 40 s. Roughness measurements were taken with confocal microscopy and surface profilometry. Then, the MA and SA surfaces were evaluated using scanning electron microscopy to determine the changes of the surface properties. RESULTS: Untreated MA surface demonstrated uniform roughness with circumferential machining marks, and scratch lines over the original surfaces were observed after treatment with the titanium brush. Similarly, the titanium brush produced noticeable changes on the SA titanium surfaces. However, this treatment with titanium brush did not significantly change the roughness parameters, including the arithmetic mean height of the surface (Sa) and the maximum height of the surface (Sz), in both MA and SA surfaces. Correlations between two evaluation methods showed a Pearson correlation coefficient of 0.98 with linear regression R(2) of 0.96. CONCLUSION: This study showed that the treatment with the titanium brush did not significantly change the roughness parameters, including Sa and Sz, in both MA and SA surfaces. Correlations between confocal microscopy and surface profilometry showed high correlation with a Pearson correlation coefficient of 0.98.

Analysis of laser transmission and thermal effects on the inner root surface during periodontal treatment with a 940-nm diode laser in an in vitro pocket model.

The purpose of this study was to analyze thermal effects during laser-assisted periodontal treatment. An in vitro model for temperature measurements was developed to investigate different laser settings regarding pulp safety. Additionally, the influence of transmission on pulp temperature elevation was evaluated. Longitudinal root sections were irradiated with a 940-nm diode laser with 1.0 and 1.5 W in continuous wave mode. According to wall thicknesses, irradiation times were adjusted to 20 s for upper and 10 s for lower incisors, respectively. Transmission was relatively low in both upper (4.8% to 8.3% of incident power) and lower incisors (10.2% to 15.0%). Samples were embedded in a polyurethane model and six thermocouples were affixed. Regardless of dentine thickness, the middle third of the root was identified to be the area with the most heat load, where a temperature rise of 7.5°C (1.0 W) and 10.5°C (1.5 W) was registered in upper incisors. A difference of 1.5°C to 3°C was detected in lower incisors compared with uppers. All settings were safe except for 1.5 W, 20 s. Transmission affected heat generation remarkably. The proposed model provides advantages regarding heat transfer and enables for spatially resolved temperature measurements.

Intrabony defects and non-surgical treatment.

Periodontitis can lead to vertical bone loss with the creation of 'intrabony defects', associated with higher risk of progression if left untreated. Intrabony defects are considered candidates for periodontal surgical procedures, in order to arrest disease progression and achieve bone regeneration. This paper brings forward anecdotal and scientific evidence from the literature to describe how even non-surgical periodontal treatment can result in clinical and radiographic resolution of periodontal intrabony defects.

Supportive periodontal treatment and full-mouth ultrasonic debridement: a randomised controlled clinical trial.

PURPOSE: To evaluate the effect of different maintenance recall intervals in patients with chronic periodontitis treated by full-mouth ultrasonic debridement. MATERIALS AND METHODS: Twenty-eight patients participated in the study and were divided into two groups: group 1 (n = 14) underwent full-mouth ultrasonic debridement followed by monthly supportive periodontal therapy; group 2 (n = 14) underwent full-mouth ultrasonic debridement followed by supportive periodontal therapy delivered at 3-month intervals. Plaque index (PI), bleeding on probing (BOP), pocket probing depth (PD), gingival recession (GR) and clinical attachment level (CAL) were evaluated at baseline and after 3 and 6 months. RESULTS: Subjects in group 1 had statistically significantly lower PI scores than did subjects in group 2 at six months. However, no differences in BOP, PPD, GR and CAL were observed between groups at any of the time points evaluated. Nonetheless, while full-mouth BOP and PPD scores progressively decreased over time in group 1, the same parameters were significantly reduced at 3 months in group 2, but remained stable thereafter. The proportion of moderate and deep pockets decreased progressively over time in the group of monthly recalls, while the proportion of moderate to deep sites decreased significantly in group 2 only at 3 months; no additional reductions were seen at 6 months. CONCLUSION: Supportive periodontal therapy both at one- and three-month intervals promotes short-term stability of clinical improvements obtained after full-mouth ultrasonic debridement in patients with chronic periodontitis.