Trattamento della parodontite - KaVo. Dental Excellence.

Effects of two different methods of non-surgical periodontal therapy on patient perception of pain and quality of life: a randomized controlled clinical trial

Aslund M, Suvan J, Moles DR, D'Aiuto F, Tonetti MS
Periodontology Unit, Division of Restorative Dentistry, Eastman Dental Institute and Hospital, University College London, 256 Gray's Inn Road, London, U.K.
J Periodontol. 2008 Jun;79(6):1031-40., 6/1/2008

BACKGROUND: The purpose of this study was to investigate the effect of two modes of delivery of non-surgical periodontal therapy on patient experience of pain and oral health-related quality of life (OHQoL).

Effects of two different methods of non-surgical periodontal therapy on patient perception of pain and quality of life: a randomized controlled clinical trial

Aslund M, Suvan J, Moles DR, D'Aiuto F, Tonetti MS
Periodontology Unit, Division of Restorative Dentistry, Eastman Dental Institute and Hospital, University College London, 256 Gray's Inn Road, London, U.K.
J Periodontol. 2008 Jun;79(6):1031-40., 6/1/2008

BACKGROUND: The purpose of this study was to investigate the effect of two modes of delivery of non-surgical periodontal therapy on patient experience of pain and oral health-related quality of life (OHQoL). METHODS: Fifty-nine patients with mild to moderate periodontitis received non-surgical therapy using a piezo-ceramic device (n = 30) or curets (n = 29). Periodontal examinations were carried out at baseline and 8 weeks following therapy. Subjects completed the short-form McGill pain questionnaire, visual analog scales regarding sensitivity and satisfaction, and the United Kingdom OHQoL questionnaire (OHQoL-UK) at baseline, treatment, and 1, 4, and 8 weeks. RESULTS: Both groups showed improvements in clinical parameters with no significant differences between the groups. Pain scores and OHQoL-UK showed no significant differences between the groups. After treatment, OHQoL-UK scores improved from an initially negative effect on quality of life to a level of no effect. Differences in sensitivity scores between the groups were statistically significant at 1 week (P = 0.011), 4 weeks (P = 0.005), and 8 weeks (P = 0.025), favoring the use of the piezo-ceramic device. CONCLUSIONS: In mild to moderate periodontitis, therapy had a small positive impact on pain and OHQoL-UK scores. These data support the concept that periodontitis may negatively affect a patient's quality of life and that treatment may improve it.

A quadrant-design trial of four therapeutic modalities in chronic moderate periodontitis

Nonhoff J, Derdilopoulou F, Neumann K, Kielbassa AM
Poliklinik für Zahnerhaltungskunde und Parodontologie, Klinik und Polikliniken für Zahn-, Mund- und Kieferheilkunde, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin
Schweiz Monatsschr Zahnmed., 1/1/2006

This randomized clinical study (blind and controlled) compared the effectiveness of an ER:YAG laser (combined with a calculus detection system using fluorescence induced by diode laser radiation for use in non-surgical periodontal therapy) as well as sonic and ultrasonic scalers and scaling and root planning with hand instruments to each other.

A quadrant-design trial of four therapeutic modalities in chronic moderate periodontitis

Nonhoff J, Derdilopoulou F, Neumann K, Kielbassa AM
Poliklinik für Zahnerhaltungskunde und Parodontologie, Klinik und Polikliniken für Zahn-, Mund- und Kieferheilkunde, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin
Schweiz Monatsschr Zahnmed., 1/1/2006

This randomized clinical study (blind and controlled) compared the effectiveness of an ER:YAG laser (combined with a calculus detection system using fluorescence induced by diode laser radiation for use in non-surgical periodontal therapy) as well as sonic and ultrasonic scalers and scaling and root planning with hand instruments to each other. 72 patients suffering from moderate chronic periodontitis (based on a probing depth of 4 mm or more of at least one tooth in each quadrant) were treated using either an Er:YAG-Laser (KEY 3, KaVo), a piezo-electric ultrasonic system (Piezon Master 400, EMS), a sonic scaler (Sonicflex 2003 L, KaVo), or Gracey Mini-five curettes (Hu Friedy) (control). These four kinds of treatment were randomized and grouped into quadrants. Oral health indicators, probing depths (PD) and clinical attachment levels were examined before commencement of the hygiene phase as well as three months after by a blind, calibrated examination. Within the study period, the mean PD (+/- SE) of the control group fell from 4.40 (0.03) mm to 3.08 (0.03) mm; for the laser group, the reduction was slightly greater, falling from 4.47 (0.04) mm to 3.08 (0.03). In comparison, values for the ultrasonic group were 4.39 (0.04) mm in the pre-study examination and 3.09 (0.04) after treatment; in the sonic group, the values were 4.40 (0.03) mm pre-study and 3.07 (0.03) mm post-study. Within the control group, the mean CAL (+/- SE) decreased from 4.95 (0.07) mm to 3.92 (0.07) mm. Within the laser group, the reduction was more distinct, falling from 5.05 (0.07) mm to 3.88 (0.07) mm. In the ultrasonic group, the median CAL decreased from 5.02 (0.08) mm to 3.88 (0.08) mm and from 4.95 (0.07) mm to 3.84 (0.08) mm within the sonic group. From the date of treatment until the third month thereafter, all of the clinical parameters were shown to be statistically significant (p < 0.0001; GEE). Use of the laser led to a much greater reduction in PD levels (p = 0.0021; GEE) than in the ultrasonic group and demonstrated a higher increase in CAL (p = 0.0010; GEE) relative to the manual methods. Conclusion: All four methods of treatment lead to a clinically comparable outcome.

http://www.ncbi.nlm.nih.gov/pubmed/16792053

Heat propagation in dentin during cavity preparation in vitro with oscillating instruments

Zesewitz H, Klaiber B, Hotz P, Hugo B
Universität Bern, Klinik für Zahnerhaltung
Schweiz Monatsschr Zahnmed. , 1/1/2005

The purpose of this work was to study the temperature rise caused by preparation of human dentin using two different types of oscillating instruments. A newly designed tungsten carbide tip (Cariex TC, KaVo) and a diamond-coated tip (Cariex D, KaVo) in combination with an airscaler (Sonicflex 2003L, KaVo) and two different flow rates of two coolants were investigated.

Heat propagation in dentin during cavity preparation in vitro with oscillating instruments

Zesewitz H, Klaiber B, Hotz P, Hugo B
Universität Bern, Klinik für Zahnerhaltung
Schweiz Monatsschr Zahnmed. , 1/1/2005

The purpose of this work was to study the temperature rise caused by preparation of human dentin using two different types of oscillating instruments. A newly designed tungsten carbide tip (Cariex TC, KaVo) and a diamond-coated tip (Cariex D, KaVo) in combination with an airscaler (Sonicflex 2003L, KaVo) and two different flow rates of two coolants were investigated. For both tips significant differences in temperature rise were found between cooling with waterspray or with Plakout Gel (Kerr, HaWe) and using no coolant. A flow of 7.3 ml water/min was found to be sufficient to avoid any critical temperature rise, an excavation of longer duration without coolant cannot be recommended. The use of water-based highly viscous substances over a defined period during the caries excavation process seems to be a viable alternative.

http://www.ncbi.nlm.nih.gov/pubmed/16033018

Primary preparation of class II cavities with oscillating systems

Wicht MJ, Haak R, Fritz UB, Noack MJ
Dept of Operative Dentistry and Periodontology, University of Cologne, Germany
Am J Dent., 2/1/2002

To assess the effectiveness and side effects of three sonoabrasive systems and conventional rotary cavity preparation.

Primary preparation of class II cavities with oscillating systems

Wicht MJ, Haak R, Fritz UB, Noack MJ
Dept of Operative Dentistry and Periodontology, University of Cologne, Germany
Am J Dent., 2/1/2002

PURPOSE: To assess the effectiveness and side effects of three sonoabrasive systems and conventional rotary cavity preparation. MATERIALS AND METHODS: Standardized artificial carious lesions were placed in 48 human premolars at mesial and distal surfaces. Three dentists prepared eight cavities each using (1) diamond burs, (2) Sonicflex 2000 L/N (HS), (3) an experimental air scaler (HS.EXP), and (4) the Piezon Cavity System (PCS). A small hemispherical preparation tip (Sonicsys micro) was utilized with the airscalers in Groups 2 and 3. Loss of substance was determined by weighing. Residual caries and damage to the adjacent tooth were assessed by two calibrated investigators. Each cavity was digitally photographed prior to planimetrical measuring of its circumferential dimension. Quality of the cavities' margins was examined by SEM. RESULTS: Rotary preparation required less time (4 minutes 53 seconds) than oscillating preparation with HS (6 minutes 45 seconds) or PCS (7 minutes 45 seconds), (Scheffé, P< 0.05). Preparation with HS.EXP (5 minutes 52 seconds) was not different from rotary and HS. 64% of all cavities were completely excavated, 28% showed distinct and 8% marked residual caries. However, chi2-tests did not reveal differences in caries removal between the systems. Oscillating preparation with HS as well as the experimental air scaler in combination with the hemisphere resulted in less trauma to adjacent tooth surfaces than rotary preparation and the PCS system, (chi2-tests P< 0.05). HS.EXP caused less loss of substance (Scheffé, P< 0.05). Regarding circumferential extension of the cavities, there were no differences between the groups.

http://www.ncbi.nlm.nih.gov/pubmed/12074224

A comparative in vitro study of a magnetostrictive and a piezoelectric ultrasonic scaling instrument

Busslinger A, Lampe K, Beuchat M, Lehmann B
Clinic for Preventive Dentistry, Periodontology and Cariology, Centre for Dental Medicine, University of Zurich, Zurich, Switzerland
J Clin Periodontol. 2001 Jul;28(7):642-9, 7/1/2001

BACKGROUND: The effects of magnetostrictive ultrasonic instruments and piezoelectric ultrasonic instruments on tooth surfaces seem to differ with regards to root debridement. AIM: The purpose of this study was to compare a magnetostrictive ultrasonic scaling instrument with a piezoelectric ultrasonic scaling instrument and a hand curette regarding time taken, calculus removal, tooth surface roughness (Ra), and SEM examination before and after instrumentation.

A comparative in vitro study of a magnetostrictive and a piezoelectric ultrasonic scaling instrument

Busslinger A, Lampe K, Beuchat M, Lehmann B
Clinic for Preventive Dentistry, Periodontology and Cariology, Centre for Dental Medicine, University of Zurich, Zurich, Switzerland
J Clin Periodontol. 2001 Jul;28(7):642-9, 7/1/2001

BACKGROUND: The effects of magnetostrictive ultrasonic instruments and piezoelectric ultrasonic instruments on tooth surfaces seem to differ with regards to root debridement. AIM: The purpose of this study was to compare a magnetostrictive ultrasonic scaling instrument with a piezoelectric ultrasonic scaling instrument and a hand curette regarding time taken, calculus removal, tooth surface roughness (Ra), and SEM examination before and after instrumentation. METHODS: 30 extracted human teeth with subgingival calculus were assigned to one of three treatment groups (n=10). The working force was standardised for both ultrasonic instruments at 200 g and for the curette at 500 g. RESULTS: The results revealed that the time needed for instrumentation was 126.1+/-38.2 s for the curette, significantly more than for the piezoelectric ultrasonic instrument (74.1+/-27.6 s; p<0.05) and 104.9+/-25.4 s for the magnetostrictive ultrasonic instrument. Remaining calculus was similar for all three groups. The end Ra values were significantly worse for the piezoelectric instrument (2.02+/-0.41; p<0.05) compared to 1.42+/-0.48 for the curette and 1.36+/-0.41 for the magnetostrictive instrument. The SEM examination revealed the smoothest surfaces but, subjectively, the most tooth substance loss after the curette, followed by the magnetostrictive instrument, with the least substance loss, and then the piezoelectric instrument, with medium substance loss. CONCLUSION: The piezoelectric ultrasonic scaler was more efficient than the magnetostrictive ultrasonic scaler in removing calculus but left the instrumented tooth surface rougher.

Root instrumentation. Power-driven versus manual scalers, which one?

Drisko CH.
Department of Periodontics, Endodontics, and Dental Hygiene, University of Louisville School of Dentistry, Kentucky, USA.
Dent Clin North Am. 1998 Apr;42(2):229-44., 4/1/1998

The literature is clear that periodontal therapies aimed at altering the progression of inflammatory periodontal diseases must include meticulous subgingival mechanical débridement during both the nonsurgical and the surgical phases of treatment as the basis of most anti-infective therapy. In the past, infection control was achieved by the mechanical removal of subgingival deposits of plaque, calculus, and endotoxin with curets, files, and hoes.

Root instrumentation. Power-driven versus manual scalers, which one?

Drisko CH.
Department of Periodontics, Endodontics, and Dental Hygiene, University of Louisville School of Dentistry, Kentucky, USA.
Dent Clin North Am. 1998 Apr;42(2):229-44., 4/1/1998

The literature is clear that periodontal therapies aimed at altering the progression of inflammatory periodontal diseases must include meticulous subgingival mechanical débridement during both the nonsurgical and the surgical phases of treatment as the basis of most anti-infective therapy. In the past, infection control was achieved by the mechanical removal of subgingival deposits of plaque, calculus, and endotoxin with curets, files, and hoes. Historically, it was also generally agreed that aggressive scaling and root planing with hand instruments was necessary to remove tenacious calculus deposits to produce roots as smooth as possible for removal of the endotoxins previously thought to be deeply embedded into the root surfaces. Based on current evidence in the literature, it is now known that endotoxin is a weakly adherent surface phenomenon and that sonic and ultrasonic (power-driven) instruments can be used to accomplish definitive root detoxification and maximal wound healing without overinstrumentation of root and without extensive cementum removal. Power-driven scalers may have unique advantages because of the cavitational activity associated with ultrasonics thought to supplement removal of root surface plaques. In addition, the constant flushing activity of the lavage used to cool the tips results in disruption of the unattached and weakly attached subgingival plaques. The ability to flush the pocket during subgingival instrumentation with water or other chemical irrigating solutions is unique to ultrasonic and sonic scalers and has been shown to enhance pocket depth reduction and gain in clinical attachment beyond that achieved with hand scaling. The added benefit of chemical lavage during ultrasonic instrumentation shows great promise and may enhance the overall effect of nonsurgical anti-infective periodontal therapy. Other major advantages of power-driven scalers may include better access to difficult areas, such as deep narrow defects, root grooves, and furcations, using newly designed microultrasonic tips, which are smaller in diameter and able to penetrate the pocket approximately 1 mm farther than hand instruments. Taken together, it appears that use of ultrasonic or sonic scalers for periodontal débridement will result in improvements in clinical and microbial parameters at a level equal to or superior to hand scalers.

http://www.ncbi.nlm.nih.gov/pubmed/9597335

Working parameters of a sonic scaler influencing root substance removal in vitro

Flemmig TF, Petersilka GJ, Mehl A, Rüdiger S, Hickel R, Klaiber B
Department of Periodontology, Julius Maximilian University Würzburg, Germany
Clin Oral Investig. (2):55-60, 6/1/1997

This study assessed defect depth and volume resulting from root instrumentation using a KaVo Sonic-flex Lux 2000 L sonic scaler with a slim scaling tip (Perio-Tip no. 8) in vitro.

Working parameters of a sonic scaler influencing root substance removal in vitro

Flemmig TF, Petersilka GJ, Mehl A, Rüdiger S, Hickel R, Klaiber B
Department of Periodontology, Julius Maximilian University Würzburg, Germany
Clin Oral Investig. (2):55-60, 6/1/1997

This study assessed defect depth and volume resulting from root instrumentation using a KaVo Sonic-flex Lux 2000 L sonic scaler with a slim scaling tip (Perio-Tip no. 8) in vitro. Combinations of the following working parameters were analyzed: lateral forces of 0.5 N, 1 N, and 2 N; tip angulations of 0 degree, 45 degrees, and 90 degrees; and instrumentation time of 10 s, 20 s, 40 s, and 80 s. Defects were quantified using a three-dimensional optical laser scanner. Instrumentation time had an almost linear impact on defect depth and volume. Although lateral force (beta-weight 0.55 +/- 0.062) had a greater influence on defect volume than tip angulation (beta-weight 0.29 +/- 0.062), their effects on defect depth were similar (beta-weight 0.43 +/- 0.052 and 0.50 +/- 0.052, respectively). The combination of force and angulation showed synergistic effects resulting in a wide range of defect depths (21.9 +/- 0.96 microns to 174 +/- 28.8 microns, at 40 s) and volumes (0.056 +/- 0.019 mm3 to 0.68 +/- 0.10 mm3 at 40 s). Severe root damage (> 50 microns/40 s) did not occur at any combination of 0.5 N lateral force and/or 0 degree tip angulation. By adjusting lateral force and tip angulation, the efficacy of the assessed sonic scaler may be adapted to various clinical needs.

http://www.ncbi.nlm.nih.gov/pubmed/9552818

Sonic and ultrasonic scalers in a clinical comparison. A study in non-instructed patients with gingivitis or slight adult periodontitis

Hermann JS, Rieder C, Rateitschak KH, Hefti AF
Department of Periodontology and Cariology, University of Basel, Switzerland
Schweiz Monatsschr Zahnmed. 1995;105(2):165-70, 1/1/1995

In the present study, the Cavitron 2002 ultrasonic scaler was compared with the Titan-S air scaler in 20 subjects with gingivitis or slight periodontitis, whereby the majority of the patients suffered from gingivitis.

Sonic and ultrasonic scalers in a clinical comparison. A study in non-instructed patients with gingivitis or slight adult periodontitis

Hermann JS, Rieder C, Rateitschak KH, Hefti AF
Department of Periodontology and Cariology, University of Basel, Switzerland
Schweiz Monatsschr Zahnmed. 1995;105(2):165-70, 1/1/1995

In the present study, the Cavitron 2002 ultrasonic scaler was compared with the Titan-S air scaler in 20 subjects with gingivitis or slight periodontitis, whereby the majority of the patients suffered from gingivitis. A split mouth experimental design was used. However, patients did not receive any oral hygiene instructions during the study in order to allow the observation of the true effect of instrumentation. The outcome of a one-time treatment was assessed after 4, 14, 28, and 56 days. Gingival crevicular fluid (GCF), papilla bleeding index (PBI), plaque index (Pl-I), probing depth (PD), and relative attachment level (AL) were measured. Both treatments resulted in a statistically significant decrease of clinical signs of inflammation (PBI: p < 0.001). Probing depths decreased (p < 0.001) and a small gain of attachment of 0.11 mm +/- 0.05 mm (p < 0.001) was observed. Following treatment, a statistically significant (p < 0.001) decrease in GCF and Pl-I was observed between baseline and day 4. No statistically significant difference between the instruments' influences on the evaluated clinical parameters could be found. Thus it can be concluded indirectly that the Cavitron 2002 and the Titan-S are both useful instruments for scaling of tooth and root surfaces.

http://www.ncbi.nlm.nih.gov/pubmed/7878417

Effects of ultrasonic and sonic scalers on dental plaque microflora in vitro and in vivo

Baehni P, Thilo B, Chapuis B, Pernet D
Division of Preventive Dentistry, School of Dental Medicine, Medical Faculty, University of Geneva, Switzerland
J Clin Periodontol. 1992 Aug;19(7):455-9., 8/1/1992

The effects of ultrasonic and sonic scalers on the subgingival microflora were investigated in vitro and in vivo. In the in vitro investigation, 27 plaque samples collected from periodontal pockets were submitted to ultrasonic and sonic vibrations for 10, 30 and 60 s. Bacterial suspensions were examined by darkfield microscopy to detect qualitative changes and cultured to evaluate the total number of cultivable bacteria.

Effects of ultrasonic and sonic scalers on dental plaque microflora in vitro and in vivo

Baehni P, Thilo B, Chapuis B, Pernet D
Division of Preventive Dentistry, School of Dental Medicine, Medical Faculty, University of Geneva, Switzerland
J Clin Periodontol. 1992 Aug;19(7):455-9., 8/1/1992

The effects of ultrasonic and sonic scalers on the subgingival microflora were investigated in vitro and in vivo. In the in vitro investigation, 27 plaque samples collected from periodontal pockets were submitted to ultrasonic and sonic vibrations for 10, 30 and 60 s. Bacterial suspensions were examined by darkfield microscopy to detect qualitative changes and cultured to evaluate the total number of cultivable bacteria. Microscopic counts following both instrumentations showed a decrease in the proportions of spirochetes and motile rods and an increase in the % of coccoids and rods. The changes were directly related to the time-period of instrumentation. Comparison between both types of instrumentation showed significant differences and more pronounced changes were observed with the ultrasonic than the sonic scaler. Spirochetes and motile rods were reduced to approximately 0.1% after ultrasonic treatment versus 24.7% after sonic instrumentation. Cultural observations showed a marked increase in total number of colony-forming units following both treatments. The clinical investigation included 66 periodontal pockets which were instrumented subgingivally for 10 and 30 s with ultrasonic or sonic scalers. Qualitative changes were similar to those observed in vitro, i.e., reduction in spirochete and motile rod counts as well as the other morphotypes with an increase in coccoid cells. Total counts of bacteria were reduced following debridement. No difference in the microscopic or cultural data was found between ultrasonic and sonic instrumentation.

http://www.ncbi.nlm.nih.gov/pubmed/1430279