A comparative scanning electron microscopy study between the effect of an ultrasonic scaler, reciprocating handpiece, and combined approach on the root surface topography in subgingival debridement

Abstract

Objective This study aimed to analyze the effectiveness of root‐shape inserts mounted on a reciprocating handpiece during the procedure of root surface debridement (RSD) on extracted teeth. Three different approaches were compared: ultrasonic scaling, employment of root‐shape inserts mounted on a reciprocating handpiece, and a combination of both. Materials and Methods A total of 51 extracted teeth were divided into three groups. The first group was instrumented with an ultrasonic scaler, the second group with flexible root‐shape inserts mounted on a reciprocating handpiece (grain size 40, 15, and 4 μm), whereas the final group underwent a combination of both approaches. The time required for the instrumentation was taken. The specimens were subjected to optical and scanning electron microscopy (SEM), and the photographs were evaluated by three examiners who were blinded to the study. The parameters included were: SEM roughness index (SRI) for the roughness calculation, remaining calculus Index (RCI) to evaluate the residual calculus deposits, and loss of tooth substance index (LTSI) to evaluate the loss of tooth substance caused by instrumentation. Result The results revealed that the time taken for the instrumentation was on average longer when the root‐shape inserts were employed alone, meanwhile the combined approach did not show significant difference in comparison with the ultrasonic scaling. The lower average RCI was obtained with a combined approach. The use of root‐shape inserts seems to cause a moderate increase in LTSI, especially in a combined approach, whereas it resulted in a better average SRI. Conclusion The employment of root‐shape inserts seems to be effective in the RSD for its ability to obtain a smooth and calculus‐free instrumented surface, especially when used in combination with an ultrasonic scaler, and their use can so represent a valid approach to be tested in further in vivo studies.

PRP and PRF—Subgroups and Divisions When Used in Dentistry

“…Shukla et al [59] claimed that the gold standard in treatment using graft materials is autografting; however, it can lead to complications, such as ankylosis and root resorption. It was investigated that graft materials provide adequate conditions for the ingrowth of osteogenic elements [54,65]. They act osteoconductively, creating a mechanical scaffold to create a new bone [45,65].…”

“…It was investigated that graft materials provide adequate conditions for the ingrowth of osteogenic elements [54,65]. They act osteoconductively, creating a mechanical scaffold to create a new bone [45,65].…”

“…In recent years, interest has focused on the field of biological mediators that can improve wound healing and enhance the benefits of bone grafts [58,66,67]. The use of biological mediators can selectively increase the cellular renewal of periodontal wounds [65,67,68]. Thus, the combination of scaffold materials and biologically active agents can have a positive effect on the treatment of intrabony defects by promoting periodontal regeneration because this combination can give synergistic effects [54,65].…”

“…The use of biological mediators can selectively increase the cellular renewal of periodontal wounds [65,67,68]. Thus, the combination of scaffold materials and biologically active agents can have a positive effect on the treatment of intrabony defects by promoting periodontal regeneration because this combination can give synergistic effects [54,65]. Graft materials may act as an osteoconductive scaffold, while bioactive materials can induce the formation of periodontal ligaments, root cement and bones [54,65,66].…”

“…One of the biomaterials is an autologous platelet concentrate that aims to provide high levels of polypeptide growth factor in periodontal wounds. PRF acts as a fibrin glue due to its mechanical adhesive properties and biological functions [65,68]. Compressed PRF can be placed in a defect or used to cover a defect like a guided tissue regeneration (GTR) membrane, facilitating the development of vascularization and directing the migration of epithelial cells to its surface [54,65,69].…”