Ultramorphology of the root surface subsequent to hand-ultrasonic simultaneous instrumentation during non-surgical periodontal treatments: an in vitro study

Simone D Aspriello, Matteo Piemontese, Luca Levrini, Salvatore Sauro, Simone D Aspriello, Matteo Piemontese, Luca Levrini, Salvatore Sauro

Abstract

Objective: The purpose of this study was to investigate the ultramorphology of the root surfaces induced by mechanical instrumentation performed using conventional curettes or piezoelectric scalers when used single-handedly or with a combined technique.

Material and methods: Thirty single-rooted teeth were selected and divided into 3 groups: Group A, instrumentation with curettes; Group B instrumentation with titanium nitride coated periodontal tip mounted in a piezoelectric handpiece; Group C, combined technique with curette/ultrasonic piezoelectric instrumentation. The specimens were processed and analyzed using confocal and scanning electron microscopy. Differences between the different groups of instrumentation were determined using Pearson's χ2 with significance predetermined at α=0.001.

Results: Periodontal scaling and root planing performed with curettes, ultrasonic or combined instrumentation induced several morphological changes on the root surface. The curettes produced a compact and thick multilayered smear layer, while the morphology of the root surfaces after ultrasonic scaler treatment appeared irregular with few grooves and a thin smear layer. The combination of curette/ultrasonic instrumentation showed exposed root dentin tubules with a surface morphology characterized by the presence of very few grooves and slender remnants of smear layer which only partially covered the root dentin. In some cases, it was also possible to observe areas with exposed collagen fibrils.

Conclusions: The curette-ultrasonic simultaneous instrumentation may combine the beneficial effects of each instrument in a single technique creating a root surface relatively free from the physical barrier of smear layer and dentin tubules orifices partial occlusion.

Figures

Figure 1
Figure 1
Scanning electron microscopy showing the morphology of the root surfaces treated with hand curettes. A: mechanical periodontal treatment with curettes creates a compact and multilayered smear layer characterized by the presence of superficial furrows; B (×2,000) and C (×5,000): At higher magnification it is possible to clearly observe a distinguished morphology similar to that of “tree-bark” (pointer) induced by the working strokes of the curette. No exposed dentin tubules were observed subsequent to the mechanical periodontal treatment with curettes
Figure 2
Figure 2
Scanning electron microscopy showing the morphology of the root surfaces treated with the piezoelectric scaler. A: non-surgical periodontal treatment performed with this method creates an irregular root surface with few shallow grooves; B: higher magnification (×2,000) showing that the root cementum was not removed by the ultrasonic instrumentation but was only altered and characterized by pits and tips (pointer); C: (×5,000) presence of a porous and thin layer of debris with no exposed dentin tubules (pointer)
Figure 3
Figure 3
Confocal laser scanning microscopy topographical images. A: root surface treated with hand curettes showing a compact smear layer characterized by the presence of superficial furrows. No exposed dentin tubules were observed subsequent to the mechanical periodontal treatment with the curettes; B: root surfaces treated using the piezoelectric scaler, showing an irregular and coarse root surface with few shallow grooves pits and tips (pointer)
Figure 4
Figure 4
Scanning electron microscopy appearance of the morphology of the root surfaces treated with the simultaneous manual and ultrasonic instrumentation. Image A shows the morphology of the root surfaces characterized by very few grooves and slender remnant smear layer which only partially covered the root dentin. Image B: at higher magnification it is possible to observe that the root-cementum was completely removed with the exposure of root dentin and dentin tubules (pointer). Image C shows that the remnant smear layer produced by this combined manual/sonic technique obliterated the dentin tubules (pointer) and many of them had a characteristic conformation similar to the shape of a “flute-mouthpiece”
Figure 5
Figure 5
Scanning electron microscopy (A and B) of the morphology of root surfaces treated with simultaneous manual and ultrasonic instrumentation reveal that some areas with exposed collagen fibrils (pointer)
Figure 6
Figure 6
Confocal laser scanning microscopy topographical (A) and single projection (B) images of the root surfaces treated using the simultaneous curette/ultrasonic instrumentation technique showing the morphology of the root surfaces characterized by slender remnant smear layer that only partially covered the root dentin (B). It is possible to observe that the root cementum was completely removed with the exposure of root dentin and dentin tubules

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