Periodontal debridement is most important procedure in periodontal treatment, because periodontal disease is the biofilm infection. The use of ultrasonic instrument has many clinical advantages compared to classical hand instrument. The introduction of newly developed ultrasonic scaler tips made the use of ultrasonic scaler popular. However the study of tooth substance removal according to the working parameters of ultrasonic scaler with newly developed tips is not sufficient. The purpose of this study is to evaluate the effects of working parameters of piezoelectric ultrasonic scaler with curette tip on casting gold removal. The working parameters was standardized by the sledge device which controls lateral force(0.5 N, 1.0 N, 2.0 N) and power setting was adjusted 2, 4, 8 in P mode and S mode and instrumentation time was 5 seconds. The defect depth and width were measured with profile meter and defect surface was examined by SME. The depth of defect was significantly large in S mode(39.58 +/-19.35micrometer) compared to P mode(8.37 +/-6.98micrometer). There was significant decrease of depth of defect between 1.0N(32.87 +/-27.18micrometer) and 2.0N(14.86 +/-15.04micrometer). The area of defect was also significantly large in S mode(4482.42 +/-3551.71micrometer2) compared to P mode (922.06 +/-960.32 micrometer2). There was significant decrease of area of defect between 1.0N(3889.12 +/-3936.00micrometer) and 2.0N(974.66 +/-986.01micrometer). The change of mode did not effect on the width of the defect. The change of power setting did not effect on the depth, width, and area of defect. In spite of limitation of this study it could be concluded that the use of piezoelectric ultrasonic scaler with curette tip on S mode could make significant tooth substance loss.
Biofilms ; Dental Instruments ; Periodontal Debridement ; Periodontal Diseases ; Tooth ; Ultrasonics*

Periodontal debridement is most important procedure in periodontal treatment, because periodontal disease is the biofilm infection. The use of ultrasonic instrument has many clinical advantages compared to classical hand instrument. The introduction of newly developed ultrasonic scaler tips made the use of ultrasonic scaler popular. However the study of tooth substance removal according to the working parameters of ultrasonic scaler with newly developed tips is not sufficient. The purpose of this study is to evaluate the effects of working parameters of piezoelectric ultrasonic scaler with curette tip on casting gold removal. The working parameters was standardized by the sledge device which controls lateral force(0.5 N, 1.0 N, 2.0 N) and power setting was adjusted 2, 4, 8 in P mode and S mode and instrumentation time was 5 seconds. The defect depth and width were measured with profile meter and defect surface was examined by SME. The depth of defect was significantly large in S mode(39.58 +/-19.35micrometer) compared to P mode(8.37 +/-6.98micrometer). There was significant decrease of depth of defect between 1.0N(32.87 +/-27.18micrometer) and 2.0N(14.86 +/-15.04micrometer). The area of defect was also significantly large in S mode(4482.42 +/-3551.71micrometer2) compared to P mode (922.06 +/-960.32 micrometer2). There was significant decrease of area of defect between 1.0N(3889.12 +/-3936.00micrometer) and 2.0N(974.66 +/-986.01micrometer). The change of mode did not effect on the width of the defect. The change of power setting did not effect on the depth, width, and area of defect. In spite of limitation of this study it could be concluded that the use of piezoelectric ultrasonic scaler with curette tip on S mode could make significant tooth substance loss.
Biofilms ; Dental Instruments ; Periodontal Debridement ; Periodontal Diseases ; Tooth ; Ultrasonics*

The efficacy of air-polishing on subgingival debridement, as compared to scaling and root planning (SRP), was evaluated clinically and microbiologically. Fifteen patients diagnosed as chronic periodontitis, and having single-root tooth over 5 mm of pocket depth symmetrically in the left and right quadrant, were investigated. Subgingival debridement was performed by SRP and air-polishing. The results were evaluated and compared clinically and microbiologically. Probing pocket depth (PPD), bleeding on probing (BOP), relative attachment level (RAL) and change of gingival crevicular fluid (GCF) were assessed before treatment, and at 14 and 60 days after treatment. Microbial analysis was done pre-treatment, post-treatment, and at 14 and 60 days after treatment. Results of air polishing showed that post treatment, the PPD and BOP decreased, and attachment gain was observed. There was no clinical difference when compared to SRP. The volume of GCF decreased at 14 days, and increased again at 60 days. Compared to SRP, there was a statistical significance of the volume of GCF at 60 days in air-polishing. In the microbial analysis, high-risk bacteria that cause periodontal disease were remarkably reduced. They decreased immediately after treatment, but increased again with the passage of time. Thus, our results show that subgingival debridement by air-polishing was effective for decrease of pocket depth, attachment gain, decrease of GCF and inhibition of pathogens. Further studies are required to compare air-polishing and SRP, considering factors such as degree of pocket depth and calculus existence.
Bacteria ; Calculi ; Chronic Periodontitis ; Debridement ; Gingival Crevicular Fluid ; Hemorrhage ; Humans ; Periodontal Debridement ; Periodontal Diseases ; Root Planing ; Tooth

BACKGROUND: Profound anesthesia with adequate duration is required in periodontal flap surgery, which involves the manipulation of both hard and soft tissues. The anterior middle superior alveolar (AMSA) injection may be an alternative to multiple injections required for this purpose in the maxilla. The present study aimed to assess the effectiveness of AMSA injection using computer-controlled local anesthetic delivery (CCLAD) system to anesthetize buccal hard tissue (BHT), buccal soft tissue (BST), palatal hard tissue (PHT), and palatal soft tissue (PST) around the maxillary teeth. METHODS: Thirty-five patients who were indicated for open flap debridement in a whole maxillary quadrant were given AMSA injection using the CCLAD. The effectiveness of anesthesia was evaluated using subjective and objective parameters around each tooth. Supraperiosteal infiltrations were administered to complete the surgery wherever the AMSA injection was ineffective. RESULTS: The AMSA injection was more effective on the palatal tissues than on the buccal tissues, as 94.14% of PST and 87.89% of PHT sites were anesthetized compared to 49.22% and 43.75% of BHT and BST sites, respectively. There was no significant difference in the frequency of anesthesia around the anterior and posterior teeth. The PHT was significantly more anesthetized (P = 0.003) in males than in females. CONCLUSIONS: The AMSA injection using CCLAD is highly effective on palatal tissues and could be used as a first-line anesthesia for periodontal flap surgery. However, its effect on buccal tissues is less predictable, with supraperiosteal infiltration often required to supplement the AMSA injection.
Amsacrine ; Anesthesia ; Anesthetics, Local ; Butylated Hydroxytoluene ; Debridement ; Female ; Humans ; Male ; Maxilla ; Palate ; Periodontal Debridement ; Tooth

The purpose of this study was to evaluate the clinical and microbiological effects of metronidazole 25% dental gel that was applied to periodontal pockets who have moderate to advanced chronic adult periodontitis were selected for this study. The quadrants that had 2 or 3 teeth with 5-8mm probing pocket depth were selected and divided into test side and control side according to the split-mouth design. The metronidazole 25% dental gel applied on test side and 0.12% chlorhexidine solution applicated on positive control side, normal saline irrigation into periodontal pocket was applicated to negative control side respectively. Above procedures followed scaling and root planing at baseline(0week). The subgingival sterile saline irrigation and chlorhexidine irrigation were done for about 30seconds respectively. The metronidazole 25% dental gel was applied to periodontal pocket at 0,1 week in the test side. The clinical and microbiological analysis carried out at baseline(0week) and 4,8 weeks. The results of this study were as follows; 1. The sulcular bleeding index, probing pocket depth were significantly reduced in the test group. The relative proportions of spirochetes and motile rods were significantly reduced to negative control group and the proportion of cocci was correspondingly increased in the test group. 2. The sulcular bleeding index, probing pocket depth were significantly reduced in metronidazole group. and, there was a significant differences between 2 groups. Also, the relative proportions of spirochetes and motile rods were reduced in both group. And, there was a significant differences between 2 groups. In conclusion, application of metronidazole 25% dental gel as an adjunct to mechanical debridement of root surfaces may improved the clinical and microbiological status of periodontal disease sites.
Adult* ; Chlorhexidine ; Chronic Periodontitis* ; Debridement ; Hemorrhage ; Humans ; Metronidazole* ; Periodontal Diseases ; Periodontal Pocket ; Root Planing* ; Spirochaetales ; Tooth

PURPOSE: Diabetes and periodontal disease are two common diseases with high prevalence rates. Recent evidence has shown a bidirectional relationship between diabetes and periodontitis. The aim of this study was to investigate the effects of nonsurgical periodontal therapy on glycemic control in type 2 diabetes mellitus patients. METHODS: Sixty subjects aged 35-45 years with blood sugar controlled by oral hypoglycaemic agents were randomly divided equally among 3 groups: group A (scaling, mouthwash, and brushing), group B (mouthwash and brushing), and group C (brushing only). Glycated haemoglobin (HbA1c), fasting blood sugar (FBS), probing pocket depth (PPD), gingival index (GI), plaque index (PI), and the relevant drug history were recorded at baseline and after 3 months of intervention. Comparison of the mean difference among the variables was performed by parametric and nonparametric tests, which were further evaluated using multiple regression analysis. RESULTS: The mean differences between the PPD, FBS, HbA1c, GI, and PI in groups A and B were found to be statistically significant (P<0.001). Multiple regression analysis in group A showed that out of all the independent variables, GI and frequency of drug administration independently (b=0.3761 and b=0.598) showed a significantly greater impact on HbA1c (R2=0.832, P<0.05). CONCLUSIONS: Nonsurgical periodontal therapy can effectively decrease HbA1c levels in type 2 diabetes mellitus patients on medication.
Aged ; Blood Glucose ; Diabetes Mellitus, Type 2 ; Fasting ; Hemoglobin A, Glycosylated ; Humans ; Periodontal Debridement ; Periodontal Diseases ; Periodontal Index ; Periodontitis ; Prevalence ; Tuberculin

Although intentional replantation is frequently used as a treatment modality for endodontic problems, severe periodontal involvement has usually been regarded as a contraindication. However, there are some studies suggesting that intentional replantation could be a successful treatment alternative for periodontally involved teeth. This paper reports the treatment of a tooth with severe periodontal involvement using intentional replantation. The tooth, which had had root canal therapy due to endodontic-periodontal combined lesion but showed extensive bone loss, was gently extracted and replanted after thorough debridement of the root surface. By intentional replantation, a tooth with severe periodontal involvement in this case could be preserved, without extraction, over the course of a 3-year follow-up period.
Alveolar Bone Loss ; Debridement ; Follow-Up Studies ; Periodontal Attachment Loss ; Periodontal Diseases ; Replantation ; Root Canal Therapy ; Tooth Replantation ; Tooth

PURPOSE: Aggressive periodontitis, especially in its severe form, was traditionally considered to have an unfavourable prognosis. It required a complex treatment and its stabilization was often achieved by surgical therapy. The aim of this study was to investigate the results of nonsurgical periodontal treatment in severe generalized forms of aggressive periodontitis. METHODS: Patients with advanced generalized aggressive periodontitis were included in the study. Probing depth (PD) of pockets > or =7 mm and clinical attachment level (CAL) of sites with attachment loss > or =5 mm were measured at baseline before nonsurgical periodontal treatment, at re-evaluation, and after treatment. The following other parameters were recorded: resolution of inflammation and bone fill. We compared the baseline values with re-evaluation and posttreatment values using the Friedman test. The Wilcoxon test with the Bonferroni correction was used for both re-evaluation and posttreatment values. RESULTS: Seven patients with 266 periodontal sites were examined. A significant difference was found between values, reported as medians with interquartile ranges, for PD at baseline (7.94 [7.33-8.19] mm) and both re-evaluation (4.33 [3.63-5.08] mm) and posttreatment (3.54 [3.33-4.11] mm) values (P=0.002). A significant difference was also found between values for CAL at baseline (9.02 [7.5-9.2] mm) and both re-evaluation (6.55 [6.30-6.87] mm) and posttreatment (6.45 [5.70-6.61] mm) (P=0.002). Inflammation was resolved and angular bone defects were repaired in all cases. CONCLUSIONS: These therapeutic results suggest that this form of periodontitis could have positive outcomes after nonsurgical periodontal treatment. The reparative potential of tissue affected by severe aggressive periodontitis should encourage clinicians to save apparently hopeless teeth in cases of this form of periodontitis.
Aggressive Periodontitis* ; Humans ; Inflammation ; Periodontal Debridement ; Periodontitis ; Prognosis ; Tooth ; Treatment Outcome

PURPOSE: The goal of periodontal regenerative therapy is to replace bone, cementum, and periodontal ligament on a previously diseased root surface, which has suffered the loss of these supporting structures. To accomplish the regeneration, a number of surgical procedures have been advocated throughout the years. There seems to be a potential for some spontaneous periodontal tissue regeneration in the bottom of periodontal defect following open flap debridement alone. The aim of this study was to analyse the radiographic bone changes over 2-year after flap operation. MATERIAL AND METHODS: Patients attending the department of periodontics of Kyungpook National University Hospital were studied. Patients had clinical and radiographic evidence of infrabony defect(s). forty two sites of 33 patients aged 26 to 65 (mean age 45.5) were treated by flap operation with or without osseous surgery. Baseline and over 2-year follow-up radiographs were collected and evaluated for this study. Radiographic assessment includes a bone fill, bone crest change, defect resolution, and % of defect resolution. Pre- and post-treatment differences between variables (maxilla and mandible, gender, defect depth, defect angle) using the paired t-test were examined. RESULT: We observed 0.74 mm of bone fill, 0.66 mm of crestal resorption, 1.40 mm of defect resolution, and 27% of percentage of defect resolution. Mandible, women, deeper initial defect depth, narrower initial defect angle showed greater bone fill, defect resolution, and % of defect resolution. CONCLUSION: The results of this study suggest that the use of flap operation did enhance the outcome in terms of radiographically detectable bone fill. Both treatment resulted in some loss of crestal bone height.
Aged ; Debridement ; Dental Cementum ; Female ; Follow-Up Studies ; Humans ; Mandible ; Periodontal Ligament ; Periodontics ; Periodontitis ; Regeneration

Periodontal procedures require adequate anesthesia not only to ensure the patient's comfort but also to enhance the operator's performance and minimize chair time. In the maxilla, anesthesia is often achieved using highly traumatic nerve blocks, apart from multiple local infiltrations through the buccal vestibule. In recent years, anterior middle superior alveolar (AMSA) field block has been claimed to be a less traumatic alternative to several of these conventional injections, and it has many other advantages. This critical review of the existing literature aimed to discuss the rationale, mechanism, effectiveness, extent, and duration of AMSA injections for periodontal surgical and non-surgical procedures in the maxilla. It also focused on future prospects, particularly in relation to computer-controlled local anesthetic delivery systems, which aim to achieve the goal of pain-free anesthesia. A literature search of different databases was performed to retrieve relevant articles related to AMSA injections. After analyzing the existing data, it can be concluded that this anesthetic technique may be used as a predictable method of effective palatal anesthesia with adequate duration for different periodontal procedures. It has additional advantages of being less traumatic, requiring lesser amounts of local anesthetics and vasoconstrictors, as well as achieving good hemostasis. However, its effect on the buccal periodontium appears highly unpredictable.
Amsacrine ; Anesthesia ; Anesthetics, Local ; Hemostasis ; Maxilla ; Methods ; Nerve Block ; Palate ; Periodontal Debridement ; Periodontium ; Vasoconstrictor Agents