Results of an experimental study of subgingival cleaning effectiveness in the furcation area

Abstract

Background Sufficient biofilm removal in the furcation area (FA) is a major challenge in the clinical practice of supportive periodontal therapy. The aim of the present experimental study was to simulate subgingival cleaning of the FA using a powered scaler (sonic scaler (AIR), ultrasonic scaler (US)) for conventional mechanical debridement versus two air polishing with nonabrasive powder (LAPA-1: glycine powder, LAPA-2: erythritol powder) and different nozzles for supra-/subgingival cleaning for each device. Methods Seven trained and calibrated operators with ≥ 2 years each of professional experience in treating periodontitis used the instruments to clean 3D-printed replicas of six molars with through-and-through FA (four 3-rooted and two 2-rooted teeth) in a manikin head. AIR and US were used in the control group; air polishing instruments were used in the test group. For reproducible evaluation, the test teeth were separated vertically into two or three parts, illuminated with ultraviolet light, photographed and evaluated planimetrically. Treatment time (TrT, in s) and relative cleaning efficacy (RCE, in %) were measured. Results Overall, 3-rooted molars (RCE in the entire FA, 23.19 ± 20.98%) could be cleaned significantly less effectively than 2-rooted molars (53.04 ± 28.45%, p < 0.001), regardless of the instrument used. In the cleaning of the entire FA, significantly higher RCE values were achieved with conventional mechanical debridement (AIR/US: 46.04 ± 25.96%/39.63 ± 22.02%; AIR vs. US: p > 0.05) than with air polishing (LAPA-1/LAPA-2: 34.06 ± 29.48%/17.09 ± 18.85%; LAPA-1 vs. LAPA-2: p < 0.001) regardless of whether a supra- or subgingival cleaning nozzle used (p < 0.001). Only LAPA-1 with a subgingival nozzle showed RCE values comparable to those of US (41.07 ± 28.95% vs. 39.63 ± 22.02%, p > 0.05). TrT was longest for US (299.40 ± 120.69 s) and shortest for LAPA-1 with a supragingival nozzle (129.67 ± 60.92 s, p < 0.001). Conclusions All of the examined instruments were effective to some degree in removing the simulated biofilm from the FA, but they differed substantially in cleaning efficacy. Only one air polishing device (LAPA-1) with a rigid subgingival nozzle was able to achieve RCE values similar to those of US. The current investigation confirmed that conventional mechanical debridement with powered scalers were most effective, but treatment took longer with these devices than air polishing.

Prevalencia de factores de riesgo de lesiones de furca en pacientes de la clínica de la UCSG semestre B-2022

“…(2021) Para los molares con compromiso de furcación, los autores notaron que estos sitios radiculares no eran tan tratables como otros sitios. Además, notaron una tendencia hacia el deterioro del estado de la furca por la dificultad de la limpieza 10 . Corroborando en el presente estudio que el porcentaje de placa bacteriana sí influye en las lesiones de furca.…”

“…4 En cuanto a la anatomía dentaria, por la posición de las raíces dentales, la acumulación de biofilm es menor en los molares birradiculares, que relación a los molares que poseen 3 raíces, ocasionando una mayor complicación de limpieza completa independientemente del instrumento utilizado. 5 El grado de afectación de la furcación, determina significativamente el pronóstico ya que al finalizar el tratamiento periodontal y durante la terapia de mantenimiento, los molares con furcación Clase I se pueden perder en el 10% de los casos. Mientras que los molares con Clase II y Clase III se pueden perder en el 25% y 40% de los casos, respectivamente.…”

Subgingival Use of Air-Polishing Powders: Status of Knowledge: A Systematic Review

“…According to Lu et al, supragingival glycine air-polishing consistently proves effective in removing dental plaque biofilm during the maintenance phase, suggesting that a threemonth interval may be appropriate for pockets no deeper than 5 mm [50]. Seidel et al found that while powered scalers used in conventional mechanical debridement were the most efficient, air-polishing was faster [51]. The findings from Zhu et al suggest that GPAP may have the potential to replace conventional treatments for gingival inflammation due to its potential for quicker treatment and reduced discomfort [52].…”

Biomechanical behaviour and modelling of periodontally compromised teeth restored with fibreglass restorations

“…Degradation of periodontal tissues most commonly affects multi-rooted, upper posterior teeth with anatomies that are complex and difficult to clean [13,32,33]. As a result, the second and third molars are often removed before the other teeth, and thus the upper first molar teeth may become the most distally located molars in the quadrant, as in the case presented above.…”