Penetration of fluids into periodontal pockets using a powered toothbrush/irrigator device (original) (raw)
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Journal of Periodontal & Implant Science
The aim of this randomized clinical trial was to assess whether chemical cleansing using a sulfonic/sulfuric acid gel solution (HBX) as an adjunct to scaling and root planing (SRP) resulted in a decrease in residual plaque and calculus in deep periodontal pockets compared to SRP alone. Methods: Fifty-six patients with 56 hopeless posterior teeth, scheduled for extraction due to severe periodontitis, were enrolled in this study. Each tooth was randomly assigned to 1 of the 2 experimental procedures. The test teeth were subjected to the irrigation of the subgingival area with HBX for 2 minutes, followed by SRP with hand and ultrasonic instruments for 14 minutes, and then extracted. The control teeth received only mechanical instrumentation before extraction. Residual biofilm was evaluated on photographs and measured as total area and percentage of root surface covered by remaining plaque (RP) or calculus (RC) after treatment. Results: The initial pocket depth (PD) and total subgingival root surface area were similar between the 2 treatment groups. After treatment, the total subgingival root area covered by RP and RC was statistically significantly larger (P<0.001) in the control group than in the test group. The test teeth showed a lower percentage of RP, but a higher percentage of RC than the control teeth (both P<0.001). Complete calculus removal was achieved in 42% of the control teeth surfaces and in 25% of the test teeth surfaces for a PD of 4 mm. Conclusions: The additional chemical cleansing with HBX resulted in a statistically significant improvement in bacterial plaque removal during SRP of deep pockets, but it was not effective in reducing calculus deposits.
A systematic review of powered vs. manual toothbrushes in periodontal cause-related therapy
Journal of Clinical Periodontology, 2002
To compare the effect of power-driven toothbrushes with manual toothbrushes on gingival bleeding and inflammation in patients with gingivitis and chronic peridontitis. Searching MEDLINE and the Cochrane Oral Health Group's Trials Register were searched to June 2001 for reports published in the English language; the search terms were stated. The Journal of Clinical Periodontology, Journal of Periodontal Research and Journal of Periodontology were handsearched to June 2001, and editors of these journals were asked for details of any in press reports or reports that had been accepted for publication. Reviews and letters were excluded. Reference lists in reviews, texts and workshops were also checked. Study selection Study designs of evaluations included in the review Randomised controlled trials (RCTs) were eligible for inclusion. The included RCTs allocated patients into parallel treatment groups, or allocated sides or quadrants of mouths to treatments. Specific interventions included in the review Studies that compared electric toothbrushes with conventional manual toothbrushes were eligible for inclusion. The included studies were grouped into four models of care according to the intensity of the intervention: the over-the-counter (OTC) model, in which toothbrushes were used with standard instructions, but without any professional input into change to oral hygiene; the oral hygiene instruction (OHI) model, which included professional input into education, motivation and change to oral hygiene habits, with or without encouragement using telephone calls or cards; the prophylaxis and oral hygiene instruction (POHI) model, which included instruction in oral hygiene and administration of a prophylaxis after the first examination, with or without encouragement to comply; and the supportive periodontal treatment (SPT) model, in which long-term studies included treatment for periodontal disease with prophylaxis and scaling every 3 months. The included studies used oscillating-rotating, counter-rotational, sonic, ultrasonic and other types of electric toothbrushes. The duration of treatment in long-term studies ranged from 6 to 24 months. Participants included in the review Studies of adult patients (older than 15 years old at enrolment) with gingivitis or periodontitis, who had no handicap, implants, extensive prosthetic restoration, or orthodontic treatment, were eligible for inclusion. Most of the participants in the included studies were from the general population, enrolled in periodontal treatment programmes, or were nondental university students. Outcomes assessed in the review Studies that assessed gingival bleeding or inflammation were eligible for inclusion. The review also assessed plaque, gingival recessions and abrasions. The included studies used a variety of indices (at least 23 different indices) to assess the outcomes. The most commonly used plaque index was the Turesky, while the most common gingival bleeding index was bleeding on probing.
Assessment of the half-life of cationic periodontal pocket irrigation
BMC Oral Health, 2020
Background: The concentration and persisting time of antimicrobial agents in the periodontal pockets are important factors for their antimicrobial efficacy. Increased clearance time in the periodontal pocket is a significant criterion for the selection of intrapocket irrigants. The aim of this study was to estimate the clearance time of a cationic agent from the periodontal pocket. Methods: Thallium-201(Tl-201) was chosen as a tracer to simulate the clearance of cationic substance because of its electrical activity. Twenty patients with periodontitis and probing depths 6 to 9 mm were included in this study. In each patient, 3 Mega Becquerel (MBq) of Tl-201 were inserted into the periodontal pocket. Dynamic imaging was performed and clearance of radioactivity was measured.
Journal of Periodontology, 2007
Background: Studies evaluating the efficacy of oral hygiene procedures typically focus on prevention or maintenance after periodontal therapy. Little is known about the specific benefit of a power toothbrush during therapy. The objective of this study was to evaluate the clinical efficacy of power toothbrushing compared to manual toothbrushing in patients undergoing the initial phase of periodontal therapy. Methods: This was an examiner-masked, randomized, twoarm parallel study involving 70 adults (range, 23 to 81 years) with untreated periodontitis. After an initial supragingival debridement, subjects were assigned to toothbrushing with a manual (group M) or power (group P) toothbrush. Subjects returned for evaluation after 7, 14, and 28 days. Results: At day 28, the mean plaque index (PI) was significantly lower for subjects in group P than for those in group M (P = 0.006). The mean number of sites with PI >1 at days 14 and 28 and the mean number of sites with bleeding on probing at days 14 and 28 also were significantly lower in these subjects (P = 0.018 and P = 0.005, respectively, and P = 0.017 and P = 0.034, respectively). Differences in the mean gingival index, the number of sites with a gingival index >1, mean recession, mean probing depth, and the number of pockets >4 mm were not significant. Conclusion: Subjects using a power toothbrush during initial treatment reduced supragingival plaque to lower levels and showed significantly less bleeding on probing than subjects using a manual brush.
Efficacy of an ionic toothbrush on gingival crevicular fluid--a pilot study
2008
The aim of this study was to compare the efficacy of an ionic and a conventional toothbrush in reducing gingival inflammation measured by gingival crevicular fluid (GCF) volume. Twenty dental students participated in this randomized crossover clinical trial. Quigley-Hein (QH) Plaque Index was assessed in six sites per tooth. GCF was measured in 3 teeth. Two experimental periods of 28 days with a 14-day washout were set. Mean values of GCF were calculated and tested by paired sample t-test. Correlations between % QH = O and alterations in GCF were performed. No significant differences were observed between conventional and ionic toothbrushes respectively neither at baseline (.62 +/- .19 vs. .55 +/- .18) nor at 28 days (.44 +/- .12 vs. .47). A negative correlation (-.33) was detected between the increase in % of QH = O and GCF for both brushes. It may be concluded that the performance of an ionic toothbrush does not differ from that of a conventional brush.
Journal of Periodontology, 1999
Background: The purpose of this 30-day blinded, parallel-design study was to compare the effect of 2 powered toothbrushes, the Rowenta MH700 and the Braun Plak Control Ultra, on reducing plaque accumulation, gingivitis, and gingival bleeding in a cohort of 60 healthy adults. Methods: After baseline evaluation of plaque, gingivitis, and gingival bleeding, subjects were randomly assigned to one of the experimental groups, provided written and verbal toothbrushing instructions, and had their teeth polished. At 2 weeks (follow-up 1) and 4 weeks (follow-up 2) all clinical parameters were again evaluated. Results: The Braun group demonstrated a nearly significant reduction in gingival index (Gl) and a significant reduction in GI at follow-up 2. The Rowenta group demonstrated significant reductions in GI, plaque index (PI), and bleeding index (GBI) at both follow-up 1 and 2 examinations. At follow-up 1, the Braun group demonstrated a nearly significant reduction in GI, a significant reduction in PI, and a non-significant reduction in GBI. At follow-up 2, the Braun group demonstrated a significant reduction in GBI, but not a significant reduction in PI. The reduction in GI for the Rowenta group was significantly greater (P values of 0.0001 and 0.0001, respectively) than that demonstrated in the Braun group. However, the Rowenta group did not demonstrate a significantly greater reduction in PI (P values of 0.7135 and 0.3184 for follow-up 1 and follow-up 2, respectively) or GBI than the Braun group at either examination (P values of 0.0663 and 0.3397 for followup 1 and 2, respectively). Conclusions: The results of this study support the findings of numerous other studies that powered toothbrushes have great potential to remove plaque and improve gingival health and that the improvement can be demonstrated in a relatively short period of time.
Non-surgical periodontal treatment: clinical and microscopic evaluation
Rio de Janeiro Dental Journal (Revista Científica do CRO-RJ), 2018
To compare the effectiveness of two combined non-surgical periodontal therapies from an analysis of the treated tooth surface using optical microscopy (OM) and scanning electron microscopy (SEM). Methods: Thirty patients were selected with moderate to severe periodontal disease and indicating at least one piece for extraction due to poor prognosis. A clinical study with a split-mouth, randomized, double-blind design was performed. Two combined treatment modalities were compared: Cavitron Bobcat ™ + completion with Gracey Curettes (G1); EMS™ + completion with Gracey curettes (G2). The treatment was performed until a smooth surface was obtained and no residual calculus was present, which was verified by a periodontal probe. The extracted pieces were analyzed by OM and SEM. Periodontal variables were: plaque index (PI), bleeding on probing (BP), probing pocket depth (PPD), clinical insertion level (CIL), gingival recession (GR) were observed before treatment, 3 and 6 months later. The operative time (OT) for each method was also analyzed. The results were compared by ANOVA followed by the Tukey test, setting the significance value at p<0.
Subgingival Instrumentation for Treatment of Periodontitis. A Systematic Review
Journal of Clinical Periodontology
Objectives: To evaluate the efficacy of subgingival instrumentation (PICOS-1), sonic/ultrasonic/hand instruments (PICOS-2) and different subgingival instrumentation delivery protocols (PICOS-3) to treat periodontitis. Methods: Systematic electronic search (CENTRAL/MEDLINE/EMBASE/SCOPUS/LILACS) to March 2019 was conducted to identify randomized controlled trials (RCT) reporting on subgingival instrumentation. Duplicate screening and data extraction were performed to formulate evidence tables and meta-analysis as appropriate. Results: As only one RCT addressed the efficacy of subgingival instrumentation compared to supragingival cleaning alone (PICOS-1), baseline and final measures from 11 studies were considered. The weighted pocket depth (PD) reduction was 1.7 mm (95%CI: 1.3-2.1) at 6/8 months and the proportion of pocket closure was estimated at 74% (95%CI: 64-85). Six RCTs compared hand and sonic/ultrasonic instruments for subgingival instrumentation (PICOS-2). No significant differences were observed between groups by follow-up time point or category of initial PD. Thirteen RCTs evaluated quadrant-wise vs full-mouth approaches (PICOS-3). No significant differences were observed between groups irrespective of time-points or initial PD. Five studies reported patient-reported outcomes, reporting no differences between groups. Conclusions: Nonsurgical periodontal therapy by mechanical subgingival instrumentation is an efficacious means to achieve infection control in periodontitis patients irrespective of the type of instrument or mode of delivery. Prospero ID:CRD42019124887 Accepted Article This article is protected by copyright. All rights reserved Reported for: All sites Pico 1: clinical benefit of subgingival instrumentation Pico 2: no difference between hand and ultrasonic instruments Pico 3: n/a Reported for: All sites ≥5 mm Shallow sites 5-6 mm Deep sites ≥7 mm Other Outcomes: Not reported Timepoints: 3 and 6 months Pico 1: clinical benefit of subgingival instrumentation Pico 2: n/a Pico 3: no difference between full mouth and quadrant approach Reported for: All sites Shallow sites 4-6 mm Deep sites >6 mm Other Outcomes: Not reported Timepoints: 3 and 6 months Pico 1: clinical benefit of subgingival instrumentation Pico 2: no difference between hand instruments and ultrasonic according to authors Pico 3: n/a Author, year, country, title Population of study Treatment Groups Treatment Outcomes Study Findings Reported for: All sites Shallow sites 4-5 mm Deep sites ≥6 mm Other Outcomes: Not reported Timepoints: 3 and 6 months Pico 1: clinical benefit of subgingival instrumentation Pico 2: n/a Pico 3: no difference between full mouth and quadrant approach Pico 1: clinical benefit of subgingival instrumentation Pico 2: no difference between hand and ultrasonic instruments Pico 3: n/a
Non-surgical periodontal treatment: where are the limits?. An SEM study
Journal of Clinical Periodontology, 1992
where are the limits? An SEM study. J Clin Periodontol 1992; 19: 240-244. Abstract. In the present scanning electron microscopic study, the possibilities and timitations of non-surgical root planing were investigated. iO singie-rooted teeth from 4 patients with advanced periodontitis were studied. The root surfaces were cleaned and planed without flap reflection, using fine curettes. The teeth were then extracted and the root surfaces were systematically exatnined by scanning electron tnicroscopy (SEM) for the presetice of residual bacteria and caicuius, 29 of 40 curetted root surfaces were free of residues, if they were reached by the curette. On the remaining 11 surfaces, only small amounts of plaque and minute islands of calculus were detected, primarily at the line angles and aiso in grooves and depressions in the root surfaces. Instrumentation to the base of the pocket was not achieved compieteiy on 75% of the treated root surfaces, however. The primary reason for this was the extremely tortous pocket morphology on the teeth selected for study. In conclusion, it may be stated that during non-surgical root planing in cases of advanced periodontitis, surfaces that can be reached by curettes are usually free of plaque and calculus. However, in many cases the base of the pocket will not be reached. It is for this reason that deep periodontal pockets should be treated with direct vision, i.e., after the refieetion of conservative flaps.