Influence of scaler tip design on root surface roughness, tooth substance loss and patients' pain perception: an in vitro and a randomised clinical trial

Abstract

Background: The influence of scaler tip design on root surface roughness, tooth substance loss and patients' pain perception is investigated.

Methods: This article was divided into the following parts: Part 1 Surface roughness and substance loss: an in vitro study, which involves intact extracted teeth sectioned and treated using a piezoelectric ultrasonic device (PM200 EMS Piezon, Switzerland) with a conventional scaler tip (FS-407) and a Perio Slim (PS) scaler tip (Perio Slim DS-016A). All sectioned samples for tooth surface roughness (n = 20) and tooth substance loss (n = 46) analyses were measured and compared using a 3D surface texture analyser and scanning electron microscope (SEM) respectively, at baseline and following scaling. Part 2 Pain Perception: a clinical study, which was a split mouth study design including 30 participants with gingivitis and/or mild chronic periodontitis; treated with supra-gingival scaling from teeth #13 to #23. Subjects were randomised to group A or group B. Group A was treated first with PS scaler tips, whereas group B was treated first with conventional scaler tips. Pain perception was recorded using the visual analogue scale (VAS).

Results: In vitro study: both scaler tips caused significant reduction in root substance roughness after scaling (p < 0.05), but no significant difference between the two scaler tips (p > 0.05) was observed. The PS scaler tip caused statistically significantly less root substance loss (p < 0.05) when the initial thickness of the tooth was < 1000 µm. Clinical study: the participants reported significantly lesser pain score during scaling using the PS scaler tip (median: 3) than when using the conventional scaler tip (median: 5) (p < 0.05).

Conclusions: In the in vitro study, using a slim scaler tip design causes less tooth substance loss compared to a wider scaler tip design. In the clinical study, less pain was observed compared than a wide (conventional) scaler tip design.

Trial registration: ClinicalTrials.gov NCT04623723.

Keywords: Pain perception; Scaler tip design; Tooth substance loss; Tooth surface roughness; Ultrasonic scaler.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1

Diagram showing tooth preparation. a The mesial view of an incisor sectioned indicated by dotted line. An area of 3 mm × 5 mm area was marked apical to CEJ for roughness assessment, as indicated by R. Scaling was performed at R. b The cross-sectional view of the incisor tooth showing two reference points marked using a scaler tip

Fig. 2

Portable ultrasonic scaler unit (PM200, EMS Switzerland)

Fig. 3

Lateral view of conventional (C) and Perio Slim (PS) scaler tips (EMS Piezon, Switzerland)

Fig. 4

Frontal view of conventional (C) and Perio Slim (PS) scaler tips (EMS Piezon, Switzerland)

Fig. 5

Visual Analogue Scale (VAS)

Fig. 6

Consort 2010 flow chart of the clinical study

Fig. 7

Scanning electron micrograph showing a cross-section of the tooth before scaling at × 50 magnification. Two reference points shown: upper reference point (UR) and lower reference point (LR). Tooth thickness (D) is measured from the outer tooth surface (T) (dotted lines) to the reference points, UR and LR. c is cementum, d is dentine and p is pulp

Fig. 8

Frequency distribution of VAS scores for Perio Slim (PS) and conventional scaler tips