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Objective The aim of this in vitro study was to evaluate the ability of optical coherence tomography (OCT) to display calculus on root surfaces. Material and methods Ten teeth with calculus on the root surface were embedded in resin, omitting the root surface. A region of interest (ROI) was marked by small drill holes coronally and apically of the calculus and imaged by spectral-domain optical coherence tomography ([SD OCT], Telesto SP5, centre wavelength 1310 nm) and light microscopy (LM). To evaluate the impact of different fluids on calculus visualisation, using OCT, root surfaces were covered by a layer of NaCl and blood and displayed by OCT. Subsequently, teeth were completely covered with resin and sectioned for histological evaluation. Within the ROI, lengths of root surface and calculus were measured by LM and OCT, and the ratio [%] was calculated. In addition, at three sites of each ROI, agreement of presence and length of calculus was evaluated. Both methods were compared using Pearson’s correlation. Results Regarding the presence of calculus, agreement between LM and OCT was strong (κi = 0.783, p = 0.033), and measurements regarding the length of the calculus were strongly correlated (ri >0.906; pi Conclusion Calculus on the root surface can be displayed by SD-OCT, which therefore may be suited as imaging technology for subgingival calculus in periodontal pockets.

Background Previous in vitro studies have proven laser fluorescence measurement using a 655-nm Indium Gallium Arsenide Phosphide (InGaAsP) based diode laser radiation to be a useful tool to detect subgingival calculus. The aim of this prospective study was to evaluate the 655-nm InGaAsP diode laser in detecting subgingival calculus in patients with periodontal disease compared with photographic assessment during periodontal surgery. Methods Twelve patients (six women, six men) aged between 21 and 75 years with periodontitis scheduled for periodontal surgery were included in this prospective study. All laser fluorescence measurements were made before periodontal surgery. Intraoperatively a mucoperiostal flap was performed, subgingival calculus was visualized, and photographic images were taken. The presence of calculus was recorded for each evaluated site. Results A total of 115 tooth surface sites of 32 teeth from the 12 patients were evaluated before (laser) and during surgery (image). Compared with image evaluation the laser assessment showed a sensitivity of 0.70 (CI0 .025 0.53 to CI0.975 0.83) and a specificity of 0.97 (CI0.025 0.85 to CI0.975 0.99). The overall probability to correctly detect subgingival calculus with the laser (accuracy) was 0.82 (CI0.025 0.74 to CI0.975 0.88). Conclusions The 655-nm diode laser was able to detect subgingival calculus. Hence, the 655 nm diode laser may be used as an additional tool for calculus detection in non-surgical periodontal therapy.

Objectives A solution based on hypochlorite and amino acids was introduced to improve cleaning efficacy on the root surfaces. The purpose of this in vitro pilot study was to evaluate the time reduction and number of strokes required to clean untreated root surfaces in vitro. Methods Sixty extracted human teeth displaying areas with subgingival calculus were assigned equally to one of three treatment groups (n = 20) according to the size of occupied areas, estimated by the number of pixels. The groups were assigned to either 30 s penetration time (I) or 300 s (II) or no pretreatment application (III). The weight for instrumentation was calibrated for a M25A curette (Deppeler/Switzerland) with 500 g. A new set of tools was used for each group, and each instrument was sharpened after single use by an EasySharp Device (Deppeler/Switzerland). Results The time (in seconds) for instrumentation was recorded as follows: Group I: 32/23.5/50 (median/first quartile/third quartile); group II: 33/20/52.5; group III: 46.5/35.5/52.3. The results for the numbers of strokes were: Group I: 18/14.3/28; group II: 18.5/13/30.5; group III: 17.5/15/25. No statistically significant differences (P < 0.05) were found between the three groups for the variables ‘time’ and ‘number of strokes’. Conclusions Within the limits of this in vitro pilot study, preconditioning of the calculus on root surfaces with an alkaline solution failed to reduce the number of strokes and time of instrumentation significantly.

Deposits of subgingival calculus on the root surfaces of the teeth are difficult to detect with conventional methods such as tactile probing. This study compared the performance of a 655-nm wavelength laser fluorescence (LF) system (DIAGNOdent Classic with a periodontal tip) with conventional periodontal probing under defined conditions in a laboratory simulation, using an experienced examiner. Models with a total of 30 extracted teeth with varying levels of subgingival deposits scattered on their root surfaces were prepared, and silicone impression material applied to replicate periodontal soft tissues. The models were located in a phantom head, and the presence of subgingival calculus recorded at 8 points per tooth (240 sites), then the entire scoring process repeated after 1 and 2 weeks. The optimal LF threshold was determined as a fluorescence score of 7 using Receiver Operating Characteristic curves. When compared the gold standard of direct microscopic examination of roots, LF was more sensitive, specific, and accurate than tactile probing (68.3 vs. 51.7 %; 92.1 vs. 67.8; and 80.2 vs. 59.8 %, respectively), and was also more reproducible (Cohen kappa 0.60 vs. 0.39). These data support the concept of using LF as an adjunct to clinical diagnosis.

This study compared the performance of three laser fluorescence (LF) devices (DIAGNOdent Classic, DIAGNOdent Pen and KEY3 laser) under standardized laboratory conditions for detecting subgingival deposits of calculus on root surfaces of extracted teeth in typodonts. While some studies show the efficacy of LF devices for calculus detection compared with conventional periodontal probes, little is known regarding the differential performance of different LF devices. In this laboratory study, extracted teeth were set in an anatomical configuration in stone typodont models in a phantom head and impression material used to replicate periodontal soft tissues. A total of 240 sites were assessed on three occasions using the three different LF devices and results compared to direct microscopic examination of the roots of the extracted teeth under magnification. The KEY3 showed greater accuracy (86.4 %) than the DIAGNOdent Pen (84 %) and DIAGNOdent Classic (80.2 %). The intra-examiner reproducibility was also higher for the KEY3 (mean Cohen kappa 0.74) than the DIAGNOdent Pen (0.66) and DIAGNOdent Classic (0.6). Of the three LF devices, the KEY3 has greater accuracy and reproducibility.

Objective : Despite promising results of Er:YAG laser in periodontal debridement, to date there is no consensus about the ideal settings for clinical use. This experimental clinical trial aimed to determine the effects of debridement using Er:YAG laser and to compare with ultrasonic treatment. Materials and Methods : 64 teeth, were divided into two in vivo and in vitro subgroups. Each tooth received ultrasonic treatment on one side and Er:YAG laser debridement at either 60 , 100, 160 or 250mJ/pulse and at 10Hz on the other side on a random basis. All samples were morphologically analyzed afterwards under scanning electron microscope for surface changes and dentinal tubules exposure. Treatment duration(d) was also recorded. Results : Laser debridement produced an irregular, rough and flaky surface free of carbonization or meltdown while ultrasound produced a relatively smoother surface. The number of exposed dentinal tubules (n) followed an energy-dependent trend. The number of exposed tubules among the in vivo laser groups was: n60mJ=n100mJd100mJ>dUltrasound=d160mJ>d250mJ (p≤0.046), while for the in vitro groups it was: d60mJ>d100mJ=dUltrasound=d160mJ>d250mJ (p≤0.046). Conclusions : Due to excessive treatment duration and surface damage, Er:YAG laser debridement at 60 and 250mJ/pulse, respectively, is not appropriate for clinical use. Although laser debridement at 100 and 160 mJ/pulse seems more suitable for clinical application, compared to ultrasound the former is more time-consuming and the latter is more aggressive. Using a feedback device or lower pulse energies are recommended when using laser in closed field.

Laser fluorescence (LF) and differential reflectometry (DR) are two new optical methods which have been used to help diagnose subgingival deposits of dental calculus. This study compared the performance of LF using the KEY3 laser system versus DR using the DetecTar system under controlled laboratory conditions designed to simulate clinical conditions as much as possible. A total of 30 extracted human posterior teeth were set in an anatomical configuration in stone typodonts with impression material replicating the periodontal soft tissues. LF was more accurate than DR (76.2% vs. 68.2%) and gave higher reproducibility (Bangdiwala’s B statistic 0.71 vs. 0.54). The better performance of LF makes it the preferred option of the two methods for detection of subgingival dental calculus.

The VistaCam® intra‐oral camera system (Dürr Dental, Bietigheim‐Bissingen, Germany) is a fluorescence system using light emitting diodes that produce a 405‐nm violet light. This wavelength has potential application for detection of dental calculus based on red emissions from porphyrin molecules. This study assessed the digital scores obtained for both supragingival and subgingival calculus on 60 extracted teeth and compared these with lesions of dental caries. It has also examined the effect of saliva and blood on the fluorescence readings for dental calculus. VistaCam fluorescence scores for both supragingival (1.7–3.3) and subgingival calculus (1.3–2.4) were higher than those for sound root surfaces (0.9–1.1) and dental caries (0.9–2.2) (p

To review the data available on the laser-induced calculus fluorescence phenomenon and the calculus detection devices as well as to determine the clinical relevance of using commercialized calculus detection devices in periodontal treatment.In vitro or in vivo English publications found on Medline.In vitro and in vivo studies showed that the devices on the market had a satisfactory detection capacity. Very few studies demonstrated that the erbium:yttrium-aluminium-garnet (Er:YAG) laser debridement, when performed with automatic calculus detection, could lead to improvements at the clinical level, and the outcome was similar to that obtained with conventional treatments.Although preliminary data were encouraging, there was a lack of scientific data concerning the calculus detection devices. Therefore, future studies are crucial for determining the clinical relevance of such equipment.

Objectives: The aim of the present study was to evaluate the effectiveness of a novel optical calculus detection system under in vivo conditions. Methods: One hundred and seventy-six tooth surfaces from 44 adult teeth that were indicated for extraction were selected for the present study. The patients were randomly assigned to one of the two experimental groups. In group A (n = 96), clinical presence or absence of subgingival calculus deposits was determined using the light-emitting diode-based optical probe (OP). In group B (n = 80), the subgingival deposits were first recorded with the OP followed by root surface debridement until no subgingival deposits could be detected by the device. Teeth were then extracted and examined under a stereomicroscope by two trained dentists (DENT 1, DENT 2) and a dental student. Results were compared with the measurements of the OP and direct visual control. Results: In group A, post-extraction results revealed 89% and 90% agreement with the positive and negative OPs detection. In group B, 17% of the surfaces demonstrated even after subgingival debridement and control with the detecting device still calcified deposits in the microscopic evaluation. The highest inter-examiner agreements were observed between DENT 1 and DENT 2. Conclusion: It was shown that the optical detection system identifies subgingival calculus with a high efficacy and therefore, may be a support for the operator to determine the endpoint of root surface instrumentation.

Aim: We recently introduced an experimental surface detection system based on a conventional dental ultrasonic scaler. This device automatically discriminates cementum and dental calculus, which is the prerequisite for complete and thorough calculus removal. In the present study, the detection limits of this device were tested in vitro. Material and Methods: From 50 extracted teeth, subgingival calculus was gradually removed using a Gracey curette. During this stepwise procedure, detection properties of the surface detection system were continuously monitored and systematically verified until the system stopped discriminating calculus from the root surface. By measuring the diameter, circumference and area of the smallest, yet recognizable deposit, and of the no longer recognizable deposit, the cut-off point of the discriminative capability of the detection device was determined. Results: The cut-off points for the correct classification of residual deposits averaged on a diameter of 219 μm, an area of 21,600 μm2, and a circumference of 748 μm. This means a sensitivity of 73% and a specificity of 80% in this critical area. Conclusions: This calculus detection system was able to detect small deposits. In clinical practice, this device may support dentists in deciding whether to stop or to continue the debridement.

The aim of this study was to evaluate the effects of Nd:YAG laser treatment on subgingival calculus, cementum and dentine, in vitro at different power settings and durations. The study included 2 experiments. In the 1st experiment, 32 extracted teeth with calculus were divided into 8 laser treatment groups. Each tooth was treated on 2, 3 or 4 sites. In the 2nd experiment, 3 extracted cementum covered teeth and 3 extracted root planed teeth with exposed dentine were selected. 1 surface of each tooth was subjected to 8 different laser treatments. In both experiments, all specimens were assessed using scanning electron microscopy. Micrographs were taken from each treated site at x 100 and x 750 magnifications. An arbitrary scale (from 0 to 3) was used to score the degree of damage caused by the laser. Generally, the laser caused greater damage on calculus than either cementum or dentine. Linear regression analysis showed that higher total energy input caused a greater mean damage score on calculus (R2 = 66%, p < 0.001). 3-way analysis of variance showed that for calculus, the power setting, number of pulses per second and the duration of exposure contributed independently to the mean damage score in an additive way. Cementum specimens were not affected by treatment 1 (50 mJ, 10 pps, 1 s), treatment 2 (50 mJ, 10 pps, 5 s), and treatment 5 (50 mJ, 20 pps, 1 s). Dentine specimens were not affected by treatment 1 (50 mJ, 10 pps, 1 s).(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical studies using locally applied doxycycline hyclate (DHV) have demonstrated significant probing depth reduction and gain in clinical attachment as a monotherapy without scaling and root planing. The mechanism for this attachment level gain to the non-root planed tooth is not understood. The purpose of this study was to investigate the effect of locally applied doxycycline hyclate on human gingival fibroblast attachment to subgingival calculus on contaminated root surfaces.Two separate experiments were performed, both on subgingival calculus. In experiment 1, teeth with subgingival calculus were treated with either doxcycycline hyclate in bioabsorbable vehicle (DHV) or with vehicle control (VC) in vivo. In experiment 2, teeth with subgingival calculus were treated with DHV, VC, scaling and root planing (SRP), or no treatment in vitro. The amount of cell attachment to calculus-covered root surfaces was quantitatively compared using a fluorescent dye assay and epifluorescence microscope. Values for cell attachment are presented as the mean standard deviation of the mean. The data were evaluated using Student t test.In both experiments, there was no statistically significant difference in fibroblast attachment in the DHV, VC, or no treatment groups (P0.05). The SRP group showed significantly more cellular attachment to tooth surfaces formerly covered by subgingival calculus than all other groups (P0.001). In general, more cells attached to cementum than to calculus. Root chips that showed no attachment to the subgingival calculus also had no cells attached to the adjacent cemental root surface.The addition of doxycycline hyclate in a bioabsorbable vehicle used as a locally delivered drug did not enhance the initial cellular attachment of human gingival fibroblasts to subgingival calculus or contaminated root surfaces.

Introduction: Though dental calculus is generally recognised as comprising mineralised bacteria, areas of non-mineralised bacteria may be present. Aim: To investigate the ultrastructure of non-decalcified young and mature supragingival calculus and subgingival calculus, and the possible presence of internal viable bacteria. Materials and methods: Supragingival calculus was harvested from five patients, 9–10 weeks after scaling and root debridement. Five samples of mature supragingival and subgingival calculus were taken from patients presenting with adult periodontitis. Specimens were fixed and embedded for transmission electron microscopy. Results: The ultrastructure of young and mature supragingival calculus was similar with various large and small crystal types. Non-mineralised channels were observed extending into the calculus, often joining extensive lacunae, both containing intact non-mineralised coccoid and rod-shaped microorganisms. Subgingival calculus possessed more uniform mineralisation without non-mineralised channels and lacunae. Conclusion: Supragingival calculus contains non-mineralised areas which contain bacteria and other debris. The viability of the bacteria, and their identification could not be determined in this preliminary investigation. As viable bacteria within these lacunae may provide a source of re-infection, further work needs to be done to identify the bacteria in the lacunae, and to determine their viability.

The aim of the present study was to investigate laser-fluorescence effects on the root surface. The possibility of detecting subgingival calculus should be evaluated to control complete calculus removal after scaling and root planing. Twenty freshly extracted human teeth, partially covered with calculus on the root surface, were fixed on a translation stage. The specimens were irradiated by light from a laser source (diode laser,1 mW) with a wavelength of 655 nm using the Diagnodent trade mark -system. To simulate the conditions in a periodontal pocket during the measurement procedure, the teeth were covered by a layer of physiological saline solution or blood in order to determine the influence of different inflammatory fluids. The root surface was scanned on a line of about 1 cm in steps of 0.5 mm. The start and end was marked by a notch. The results of the laser-fluorescence detection were compared to clinical and histological findings. Clinically apparent calculus on the root surface was always accompanied with a statistically significant increase of laser-fluorescence values ( p0.05). These values were not influenced by the different fluids ( p0.05). The laser-fluorescence values were reproducible ( p0.05). After scaling, when no debris remained at the root surface, laser-fluorescence values decreased significantly ( p0.05). The histological findings supported the clinical results. In conclusion, the present study indicates that laser-fluorescence values on the root surface are strongly correlated to the presence of calculus. This fluorescence effect can basically be used to develop a new detecting system for subgingival calculus in periodontal pockets.

The aim of the present study was to compare the morphology and elemental composition of subgingival calculus between Indo-Pakistani and Caucasian patient groups.Extracted teeth from 14 Indo-Pakistani and 19 Caucasian subjects were collected. Of these, 12 Indo-Pakistani and 10 Caucasian teeth had sufficient subgingival calculus for analysis. Subgingival calculus present on the 22 teeth was classified into six morphological types: 1) crusty/spiny/nodular; 2) ledge/ ring; 3) thin, smooth veneers; 4) finger/fern-like; 5) individual islands/spots; or 6) supramarginal on submarginal. Subgingival calculus was zoned: coronal, mid, and apical. A sample obtained from each zone was subdivided to allow 3 separate analyses: transmission electron microscopic (TEM) x-ray microanalysis for elemental composition, fluoride analysis, and carbonate analysis.Crusty/spiny/nodular, ledge/ring, and thin, smooth veneers were more commonly found in the Indo-Pakistani group; individual islands were more prevalent in the Caucasian subjects. Supramarginal on submarginal calculus was found only in the Indo-Pakistani group. No finger/fern-like deposits were found. No differences within or between the two ethnic groups were found with regard to calcium:phosphate ratios, fluoride, or carbonate content. However, the Indo-Pakistani group showed significantly lower levels of sodium in apical samples than in coronal samples (ANOVA, F1,16 = 5.98, P= 0.03), and significantly lower levels of sodium (ANOVA, F1,12 = 4.75, P= 0.05) and magnesium (ANOVA, F1,12 = 5.16, P= 0.04) in apical samples than in those from Caucasians. After adjusting for smoking, the magnesium results remained significant (ANOVA, F2,11 = 4.64, P= 0.05).Subgingival calculus demonstrated differences in morphology between these two ethnic groups and differences in elemental composition, which may influence its overall solubility and contribute to its greater accretion in the Indo-Pakistani subjects.

The aim of this study was to determine the association between the quantity of subgingival calculus and the following factors: type and severity of periodontal disease, age, gender and tobacco consumption. A sample of 622 periodontal patients was studied. The radiographically detectable subgingival calculus in proximal root surfaces was recorded in periapical radiographs, considering the number of surfaces without calculus and the number of surfaces exhibiting deposits equal or greater than I mm. The association between the subgingival calculus and the factors under study was analyzed by distinct non-parametric tests. A statistically significant association was found between the absence/presence of subgingival calculus and the type and severity of periodontal disease (p

The aim of this study was to assess the effectiveness of a dentifrice containing 0.3% triclosan, 2.0% copolymer and 0.243% sodium fluoride (Colgate Total) in the prevention of periodontal attachment loss in adolescents. A 3-year, double-blind, randomised, controlled, clinical trial was conducted on 641 adolescents, initially aged 11-13 years. The participants were enrolled from schools in economically deprived areas of Manchester, England, which had a high % of Asian pupils originating from India, Pakistan and Bangladesh. After the baseline examination, which included assessments of pocket depth, attachment loss and subgingival calculus, the adolescents were randomly allocated to use either a triclosan/copolymer or control dentifrice. The control was identical to the test dentifrice with the exception that it did not contain triclosan/copolymer. Participants were re-examined after 18 and 36 months. After 3 years, a total of 239 adolescents remained in the test and 241 in the control group. The prevalence of attachment loss increased from 2% at baseline to 24% after 3 years. The mean increment of attachment loss during the study was 0.025 mm per site in the control group and 0.018 mm per site in the test group. A linear regression model showed a statistically significant difference in attachment loss between the test and control group, in adolescents with high mean pocket depths at baseline. No adverse effects attributable to the test or control dentifrices were observed during the study. This study has demonstrated that unsupervised use of a triclosan/copolymer dentifrice can significantly reduce periodontal attachment loss, particularly in adolescents with high mean pocket depths.

Whether the fluoride concentrations and profiles differ in human dental calculus obtained from different countries was investigated. A total of 203 dental calculus deposits on 203 permanent teeth from residents (mean age, 52.1 years) of Nagoya (Japan), Shanghai (China), Leeds (Great Britain) and the Wuhan mountainous area (China, fluoridated area) were analysed. An abrasive microsampling procedure was used to examine fluoride distribution. There were five types of fluoride profiles in dental calculus in each area/country (designated types L, J, U, T, W). In supragingival calculus, type L (highest in the outermost layers) and type J (highest in the innermost layers) both had significantly higher values than type U (high in the surface and innermost layers) but were relatively identical. In subgingival calculus, type W (high in the outermost, mid and innermost layers) was characteristic. Calculus from the Wuhan mountainous area (fluoridated) had the highest fluoride concentration, followed by Leeds (non-fluoridated), and Nagoya and Shanghai (non-fluoridated) calculus had the lowest. Fluoride concentrations in supragingival calculus were higher in teeth extracted because of periodontal diseases than dental caries. It is concluded that fluoride concentrations and distribution in dental calculus differ from country to country, probably due to different fluoride environments.

Objectives: The aims of this study were to assess the validity of the WHO 621 probe for the detection of subgingival calculus and to assess the effect of subgingival calculus on the measurement of probing pocket depths and clinical attachment levels. Methods: Teeth used in the study were designated for extraction under local analgesia. Prior to extraction the clinical detection of subgingival calculus was made with a WHO 621 probe. Probing pocket depths and clinical attachment levels were measured. The location and direction of the gingival margin and probing measurements were marked on the teeth with a fine, sterile pencil and following extraction, permanent reference grooves were cut with a fine, tapered diamond bur. The extracted teeth were stained with Gomori's stain and examined for the presence of calculus, and the pocket depths and attachment levels were measured using a stereomicroscope. Results: There was an 80% agreement between the clinical and laboratory detection of subgingival calculus. There was no systematic difference between clinical and histopathological measurements when calculus was present or absent (P > 0.05). Analysis of variance indicated a random error effect due to the presence of subgingival calculus. Conclusion: This study has demonstrated the validity of the WHO 621 probe in detecting subgingival calculus and has shown that subgingival calculus could be a source of error in the measurement of probing depths and clinical attachment levels.

A prescale gel product, designed to facilitate the removal of calculus, has recently been introduced and marketed to the dental profession. The purpose of this study was to evaluate the effectiveness of this gel on the removal of subgingival calculus. 10 patients, each with 5 periodontally diseased teeth scheduled for extraction, participated in this in vivo/in vitro study. 4 teeth per patient were randomly assigned using a 2-by-2 block design and treated in vivo with either active or placebo gel, with or without scaling, prior to extraction. To assess possible overexposure to the product, 10 selected teeth from the sample were treated with active gel for an extended exposure time. Standardized scaling was performed on a 4x4 mm treated root area in vitro on groups as assigned. Quantification of residual calculus was determined by one examiner blind to treatment group assignment using SEM photomicrograph montages and the Java image analysis computer system. Repeated measures ANOVA showed no statistically significant treatment effect for gel (p > 0.05) in the scaled and no-scaled groups. The 5th group exposed to the prescale gel for an extended time was evaluated descriptively for root surface morphological changes with no noticeable effect. Based on the results of this investigation, treatment of subgingival calculus with prescale gel offers no advantage for calculus removal over scaling alone. The findings suggest no significant clinical impact of product use.

We examined the site specificity of fluoride (F) distribution in human dental calculus. Teeth with supra- and subgingival calculus were obtained from patients who resided in non-fluoridated areas in Japan and China. Sequential layers of the dental calculus (30 microns thick) were abraded by an abrasive micro-sampling technique and fluoride and phosphorus in the powdered samples were analyzed. Fluoride concentrations were highest in the outer, lowest in the middle and intermediate in the inner layers of dental calculus in general. In the outermost layers fluoride concentrations were highest in calculus found near the tooth cervix both in supra- and subgingival calculus. Fluoride concentrations decreased markedly toward the apical region in subgingival calculus, while it did not change toward the incisal or occlusal region in supragingival calculus. In the inner layers, fluoride concentrations in both supra- and subgingival calculus were not affected by position on the teeth. Fluoride concentrations in subgingival calculus near the apex were lower than in supragingival calculus near the incisal or occlusal region. It was concluded that the fluoride concentrations differ in different regions of dental calculus, probably due to their different mechanisms of formation.

Visible red (655 nm) laser fluorescence (LF) devices are currently used for identifying deposits of subgingival calculus on the root surfaces of teeth during dental examination and treatment; however, it is not known how the fluorescence readings produced by commercially available LF systems correlate to the nature of the deposits. This laboratory study explored the correlation between LF digital readings and the surface area and volume of subgingival calculus deposits on teeth. A collection of 30 extracted human posterior teeth with various levels of subgingival deposits of calculus across 240 sites were used in a clinical simulation, with silicone impression material used to replicate periodontal soft tissues. The teeth were scored by two examiners by using three commercial LF systems (DIAGNOdent, DIAGNOdent Pen and KEY3). The silicone was removed, and the teeth were removed for photography at × 20 magnification under white or ultraviolet light. The surface area, thickness, and volume were calculated, and both linear least squares regression and nonlinear (Spearman's rank method) correlation coefficients were determined. Visible red LF digital readings showed better correlation to calculus volume than to surface area. Overall, the best performance was found for the KEY3 system (Spearman coefficient 0.59), compared to the Classic DIAGNOdent (0.56) and the DIAGNOdent Pen (0.49). These results indicate that while visible red LF systems vary somewhat in performance, their LF readings provide a useful estimation of the volume of subgingival calculus deposits present on teeth.

Periodontal disease is one of the main chronic infectious diseases of oral cavity and the principal cause of tooth loss in humans. The main cause of periodontal disease is the bacteria in calculus or plaque to cause the gum inflamed. Therefore detection and removal of subgingival calculus remains important to all periodontal therapy. However, subgingival calculus within the periodontal pocket remains a complicated and potentially delicate structure to be detected and treated with current dental armamentaria, namely dental x-rays and the dental probe. In this study, an innovative subgingival calculus detection system employing autofluorescence imaging has been developed. Feasibility of such a system on the detection of subgingival calculus is investigated in vitro. Autofluorescence imaging is based on two-photon time correlated fluorescence technique by a femtosecond pulsed Ti-sapphire laser.

This study compared the relative amounts of Actinobacillus actinomycetemcomitans (Aa), Eikenella corrodens (Ec), and black-pigmented anaerobic rods, and the proportions of coccoid forms, nonmotile rods, motile rods, spirochetes, and total motile organisms in subgingival plaque samples from 2 groups of young adults with generalized moderate to severe periodontitis. Two groups of 12 untreated patients were selected based on the relative amounts of subgingival calculus detected. Subgingival plaque samples (2 sites/patient) were taken with a sterile curet, dispersed, and plated under anaerobic conditions on ETSA, ETSA-kanamycin, ETSA-clindamycin, and TSBV agar. Appropriate biochemical tests were performed to confirm suspected microorganisms. Phase-contrast microscopy also was used to count the relative numbers of coccoid forms, nonmotile rods, motile rods, and spirochetes in each of the samples. Patients with no clinically detectable subgingival calculus harbored significantly greater proportions (%) of coccoid forms and Aa and greater amounts (CFU/mg) of Aa than did patients with obvious amounts of subgingival calculus. Subjects with clearly detectable subgingival calculus possessed greater proportions of motile rods, total motile organisms, and black-pigmented anaerobic rods than did subjects with little or no subgingival calculus. Young adult patients with generalized moderate to severe disease and little or no detectable subgingival calculus may possess a subgingival microbiota with relatively higher numbers of Aa and coccoid forms, and a lower percentage of BPB, motile rods, and total motile organisms as compared to similar patients with greater amounts of subgingival calculus.

The dental endoscope was developed to facilitate visualization of the subgingival environment as an aid in diagnosis and non-surgical root debridement. The purpose of this study was to determine whether endoscopy-aided scaling and root planing (SRP) resulted in a greater reduction of residual calculus compared to SRP alone in multirooted teeth.Twenty-four patients were enrolled and contributed 35 tooth pairs (70 teeth in total). Each tooth per pair was randomly assigned to receive endoscopy-aided SRP (test) or SRP alone (control). Both teeth were extracted immediately after treatment, washed with water, and stained with methylene blue. The percentage of residual calculus was determined via stereomicroscopy and digital image software by a single masked examiner.Overall, there was 1.16% (P = 0.097) less residual calculus at test versus control sites. At interproximal surfaces, test roots had 2.63% less residual calculus than control roots (P = 0.003), whereas test roots had slightly more residual calculus than controls at buccal/lingual surfaces (0.36%; P = 0.652). There were no statistically significant differences in residual calculus between groups at deeper probing depths or at sites with deep furcation invasions. Only at shallower interproximal sites with probing depthsor =6 mm was significantly less residual calculus seen in roots treated with endoscopy (P = 0.020). Treatment time decreased significantly as operator experience increased; however, no significant improvement in residual calculus levels was noted with greater experience.Within the confines of this study, the use of the endoscope as an adjunct to traditional SRP provided no significant improvement in calculus removal in multirooted molar teeth.

The purpose of this study was to evaluate the effectiveness of subgingival application of Carisolv™ gel as an adjunctive therapy to scaling and root planing (SRP) on calculus removal compared to conventional instrumentation. Forty-five teeth requiring extraction due to severe periodontal disease were randomized to the following treatments: 1) SRP alone; 2) placebo gel + SRP; 3) Carisolv™ gel + SRP. Either test or placebo gel was applied subgingivally for 1 min and then the root were instrumented until a smooth and calculus-free surface was achieved. Instrumentation time and the number of strokes required were recorded. After extraction, the efficacy of root surface instrumentation was measured by percentage of remaining calculus. There was no statistically significant difference (p>0.05) between the treatment groups regarding either time required for instrumentation or the percentage of residual calculus. The subgingival application of Carisolv™ gel prior to SRP did not provide any additional benefit to root instrumentation compared to scaling and root planing alone. O objetivo deste estudo foi avaliar a efetividade da aplicação subgengival do gel Carisolv™ em associação aos procedimentos de raspagem e alisamento radicular (RAR) na remoção do cálculo dental aderido à superfície radicular, quando comparado à terapia periodontal mecânica convencional. Foram utilizados 45 dentes indicados para a exodontia devido à doença periodontal avançada, os quais foram divididos em três grupos de tratamento: 1) RAR apenas; 2) placebo + RAR; 3) Carisolv™ + RAR. O tempo despendido e o número de movimentos realizados para a instrumentação das superfícies radiculares foram avaliados durante o tratamento. Em seguida, os dentes foram extraídos e avaliados quanto ao percentual de cálculo residual, por meio de um sistema computadorizado de análise de imagens. Não houve diferença estatisticamente significante (p>0,05) entre os grupos com relação ao tempo requerido para os diferentes tratamentos, assim como quanto ao percentual de cálculo residual. Os resultados indicaram que a aplicação do Carisolv™ não promoveu benefícios adicionais àqueles obtidos com a terapia mecânica convencional na remoção do cálculo subgengival.

Objective: A radiographic investigation into the relationship between tobacco smoking and subgingival dental calculus was conducted in an adult population, including 48 current smokers, 57 former smokers, and 125 non-smokers. Material and Methods: Assessment of subgingival calculus was based on a full set of radiographs. Mesial and distal root surfaces were assessed as to presence or absence of radiopaque deposits apical to the cemento-enamel junction. The severity of subgingival calculus deposition, labeled subgingival calculus load, was estimated from both the total number and the proportion of proximal sites affected. Results: The overall prevalence of individuals exhibiting at least one subgingival calculus positive site was 43%, ranging from 15% in age stratum 20–34 years to 72% in age stratum 50–69 years. The prevalence among current smokers, former smokers, and non-smokers was 71%, 53%, and 28%, respectively. The differences between smoking groups were statistically significant (p

The aim of the present study was to compare the ability of the diode laser to detect residual calculus with that of an explorer.The root surface of 40 extracted human teeth, each partially covered with subgingival calculus, was instrumented with curets under simulated clinical conditions in a manikin. The samples were randomly assigned to two study groups. In group A, the root surface was treated with an explorer until it appeared free of mineralized deposits upon examination. The samples in group B were instrumented until the relative intensity of fluorescence as induced with diode laser radiation was below a threshold value of 5. The root surface of each sample was then examined for residual calculus using standardized digital images. The statistical analysis was performed with a non-paired t test at a level of significance of 5% (P0.05).The root surface of single-rooted teeth showed residual calculus on 0.19 +/- 0.37 x 10(7) microm2 in the laser group and on 0.11 +/- 0.26 x 10(7) microm2 in the explorer group (P = 0.19). For multirooted teeth, the mean calculus-covered area was 0.50 +/- 0.48 x 10(7) microm2 for the teeth evaluated with an explorer and 0.27 +/- 0.43 x 10(7) microm2 for the diode laser group (P = 0.02).The present findings indicate that the detection of subgingival calculus is significantly improved using 655 nm diode laser radiation compared to an explorer for molars but not for single-rooted teeth.

Aims: To identify the prevalence and different degrees of periodontal disease in an isolated community (Isla Grande, Colombia) with no dental services and low educational level with the use of CPITN, and to establish periodontal treatment needs in different age groups. Results: Of 116 people examined, 0.9% were in periodontal health (CPITN value 0), 18.1% had gingival bleeding (CPITN value 1), 51.7% had supra or subgingival calculus (CPITN value 2), 18.1% presented pockets 3.5–5.0mm deep (CPITN value 3), and 11.2% had pathological pockets of 5.5mm or deeper (CPITN value 4). No clear differences were observed between sexes. Conclusions: This study shows that 81% of the sample has some type of periodontal treatment need, with 69.8% of them requiring periodontal treatment that may be supplied by a hygienist and 11.2% requiring specialised treatment. Implementation of oral health education and oral prevention programmes was recommended to the authorities for this community.

Objective: To critically analyse the formation, composition, ethnic variations and pathogenic potential of subgingival calculus in comparison with supragingival calculus. Data sources: Using CD-ROM and index medicus, scientific papers relating to subgingival calculus or subgingival and supragingival calculus written in the English language since 1960 were considered, with the emphasis on more recent articles. Study selection: Studies were selected for their relevance and contemporary nature re:composition and formation of dental calculus and comparisons of ethnic groups with regard to dental calculus, especially subgingival calculus. Some similar studies were not included. Data extraction: Abstracts of studies were kept brief unless particularly important to the review. Population, methodology, statistics and accurate conclusions were used as important guides to the quality and validity of studies. Data synthesis: Similarities and differences between supragingival and subgingival calculus in composition and formation were shown. Different morphological types of subgingival calculus were demonstrated. There was evidence for an association between calculus formation and ethnicity with regard to supragingival and subgingival calculus, and an association between subgingival calculus composition and ethnicity was indicated. Conclusions: An association between ethnicity and subgingival calculus formation and composition was found. Further research into the reasons for these ethnic differences in dental calculus and the role of the mineral constituents especially of subgingival calculus would be valuable.

The aims of the present study on 40 patients were to quantitate by the Volpe-Manhold method, the amount of supragingival (SPR) calculus, to determine qualitatively the amount of subgingival calculus (SBG), and to determine the association between supragingival and subgingival calculus on vestibular and lingual surfaces of all the teeth except third molars. Kappa values for intraexaminer reproducibility varied between 0.863 and 0.738. There was marked site-specificity of SPR calculus scores, with the highest values by far on the lingual aspects of the lower anterior teeth: central incisor, lateral incisor, and canine, respectively. Although the grades for SBG calculus were higher on the lingual surfaces than on the vestibular surfaces of 25 of the 28 teeth, there was much less site-specificity than for SPR calculus. For the teeth as a whole, there were significant associations (P0.001), as tested by chi-square or Fisher's exact test, between SPR and SBG grades on both vestibular and lingual surfaces, between SPR grades on vestibular and lingual surfaces, and between SBG grades on vestibular and lingual surfaces. However, for individual teeth, or groups of similar teeth, only a few of the above associations were statistically significant.

Several studies have found incomplete calculus removal during periodontal treatment with traditional hand curets, sonic, and ultrasonic instruments. This study evaluated the speed and effectiveness of subgingival calculus removal with new diamond-coated ultrasonic tips on single-rooted teeth. Single session subgingival scaling and root planing was performed on 80 teeth with 5 to 12 mm probing depths in 15 patients. Each patient provided groups of 4 teeth that were randomly treated with either hand curets (HAND); standard smooth ultrasonic tip (US); or fine grit (FINDIAM) or medium grit (MEDDIAM) diamond-coated ultrasonic tips. The time taken to reach the therapeutic endpoint of a clean, smooth root surface in a defined region on each tooth with each instrument by the 3 therapists with differing experience levels was recorded. The teeth were then atraumatically extracted, stored in a surfactant, photographed at 10X, and the percent of calculus present in the area of the pocket or on a comparable control surface calculated by histometric point counting. ANOVA and paired t tests showed that mean percent remaining calculus on treated versus control surfaces was HAND 4.6 +/- 5.3 versus 57.5 +/- 28.2, US 4.7 +/- 6.4 versus 54.4 +/- 25.9, FINDIAM 4.3 +/- 5.2 versus 37.5 +/- 22.1, and MEDDIAM 3.4 +/- 4.2 versus 50.7 +/- 20.1, respectively (all P < 0.01). The mean time in seconds to reach the clinical endpoint ranged from HAND 289 +/- 193, US 194 +/- 67, FINDIAM 167 +/- 71, to MEDDIAM 147 +/- 92. All powered instruments were significantly faster than HAND (P < 0.05), but did not differ from each other. On a 0 = "smooth" to 3 = "rough" scale, most often HAND resulted in "smooth" surfaces (10/20), the powered tips of all types "slight" surface roughness (10/20 each), and US the most "moderate" roughness (7/20). There were no differences in percent calculus remaining, surface roughness, or time spent among the 3 treating clinicians despite their varying experience levels. The results of this study showed that percent calculus remaining was

Compared to studies with conventional maintenance, relatively few studies have been conducted that have tested pharmacologic intervention as a means for supportive periodontal care. Despite the scarcity of data, several principles have begun to emerge. First, it is clear that removal of subgingival calculus is necessary for the highest level of a long-term effectiveness. Hence, pharmacologic intervention appears best suited as an adjunctive therapy directed toward "problem sites"; sites that fail to respond adequately to conventional maintenance procedures. Intrapocket drug delivery systems appear to offer particular promise since therapy can be directed to selected sites that appear to be failing. Additional effectiveness may also be obtained by use of chlorhexidine mouth rinses for short periods of time during healing to control re-infection. Eradication of reservoirs of infection throughout the mouth also appears to be an important principle related to long-term stabilization. Studies to date suggest that superior clinical response can be obtained by intrapocket delivery systems. Furthermore, up to 2 years of periodontal stabilization can be achieved by these means and longer disease-free maintenance intervals can be established. Additional clinical trials will be necessary to fully optimize and understand this therapeutic approach, but initial studies have reported promising results.

The aims of this study were (1) to monitor the progression and patterns of progression of loss of attachment > or = 1 mm on a site basis over a 5-year period in adolescents, and (2) to relate the presence of oral deposits and inflammation to the subsequent development and progression of loss of attachment on a site basis. 167 subjects were examined at ages 14, 16 and 19 years. Loss of attachment > or = 1 mm, plaque, subgingival calculus, gingival bleeding and gingival colour change were assessed on the mesio-buccal sites of the 1st molars, 1st premolars and central incisors. Each site was treated separately in the analysis to avoid the problem of within-subject site dependence. Sites were classed as progressing, non-progressing or fluctuating according to the probing attachment level measurements at each of the 3 examinations. During the 5 years of this study, a total of 542 sites in 128 subjects progressed; 1136 sites in 162 subjects did not progress; 43 sites in 30 subjects had fluctuating attachment level measurements. Sites which subsequently progressed had significantly more plaque, subgingival calculus and gingival inflammation than non-progressing sites at the baseline examination and throughout the study (p < 0.001). Between 55-57% of the maxillary 1st molars and 46-49% of the mandibular incisors progressed. In contrast, there was no progression of loss of attachment on over 80% of the maxillary central incisors and mandibular 1st premolars.

The effectiveness of a newly-developed Er:YAG laser with a fiber delivery system to remove subgingival calculus was examined in vitro. Fifty-three (53) periodontally-involved human extracted teeth with a band of subgingival calculus were used. Two experiments were conducted: in experiment 1, laser scaling was performed with water irrigation on a straight line and on a broad area, against the subgingival calculus at the energy levels of 10 to 120 mJ/pulse (3.5 to 42.4 J/cm2/pulse) and the pulse repetition rate of 10 pps. The morphological changes of the laser-scaled site were observed by SEM, and the efficiency of laser scaling was determined. In experiment 2, laser scaling was performed with and without water irrigation at 30 mJ/pulse and 10 pps. The morphological changes, the efficiencies, and temperature changes with and without water irrigation were compared. The pulsed Er:YAG laser used with water irrigation was able to remove the subgingival calculus from the tooth root effectively at the energy level of about 30 mJ/pulse (energy density: 10.6 J/cm2/pulse) and 10 pps, under in vitro conditions. Ablation of the tooth substance on laser scaling was generally observed within the cementum. There was little increase in temperature on the root surface during laser scaling. This study suggests the potential for the clinical application of the Er:YAG laser in subgingival scaling.

Service mix studies conducted in Australia have indicated a low provision of periodontal services. The service mix in Australian general dental practices employing dental hygienists has not been studied. This study compares the service mix between 18 practices employing hygienists and 29 practices not employing hygienists in Adelaide. Practices employing hygienists tended to be larger group practices, with younger dentists seeing a younger set of patients. Practices employing dental hygienists provided a mean of 97.9 services to 57.2 patients over 2 days, significantly higher than the mean of 68.8 procedures to 39.1 patients in practices not employing dental hygienists. Comparing the % of procedures provided in treatment categories as a ratio of total procedures, practices employing dental hygienists provided significantly more periodontal procedures and less oral surgery, prosthetic and restorative procedures. Periodontally-related services accounted for an average of 37.7% of procedures in practices employing dental hygienists compared with 18.9% in practices not employing dental hygienists (p(0.05). Periodontal and preventive treatment of 50.7%) of patients in practices employing hygienists was delegated to a hygienist, and the level of delegation of periodontally-related procedures was 77.2%. Over 90% of procedures performed by hygienists were periodontally-related, with the removal of subgingival calculus accounting for 57.7% of all procedures provided by dental hygienists. In conclusion, practices employing hygienists had a more periodontally-orientated service mix, with hygienists acting to complement the services of dentists in the provision of periodontal services, rather than as a substitute for the dentist.

The aims of this study were twofold: firstly, to evaluate the relationship of supra- or subgingival calculus and bleeding on probing (BOP) in sextants coded 2 in the Community Periodontal Index of Treatment Needs (CPITN); and secondly, to compare the differences in four investigations in Taiwan, Hong Kong, Japan and Norway. In a national survey, a total of 2658 Chinese dentate adults were examined by using modified CPITN in the Taiwan area from 1985 to 1987. Sextants given Code 2 were divided into four subclassifications: supragingival calculus with bleeding (I+), supragingival calculus without bleeding (I-), subgingival calculus with bleeding (II+) and subgingival calculus without bleeding (II-). The results showed that of the 9394 sextants given Code 2, the highest percentage (70%) were characterized by the presence of subgingival calculus with bleeding and the lowest percentage (4%) by supragingival calculus with bleeding. The ratio of sextants coded 2 with only supragingival calculus versus subgingival was 1:6.2. The bleeding to nonbleeding ratio of sextants coded 2 in this study was similar to the Hong Kong study. However, differences among Taiwan, Japan and Norway were found. The results indicated that sextants with subgingival calculus had a higher tendency to BOP, with a ratio of 4:1. Those with supragingival calculus had a ratio of 3:7. We conclude therefore, that it is essential to scale teeth to remove subgingival calculus for determination of the necessity of periodontal treatment.

This 5-year longitudinal study monitored 167 subjects at ages 14.3, 16.0 and 19.6 years. The aims were (1) to determine loss of attachment greater than or equal to 1 mm in the study group over the 5-year period; (2) to relate baseline levels of oral deposits and gingivitis to the 5-year increment of loss of attachment; (3) to determine whether subjects who had developed loss of attachment greater than or equal to 1 mm by age 16 years were more susceptible to further development of loss of attachment; (4) to evaluate loss of attachment indices. Loss of attachment, plaque, subgingival calculus, gingival bleeding and gingival colour change were measured. At baseline, 3% of subjects had loss of attachment greater than or equal to 1 mm and less than 1% of sites were involved. By age 19 years, 77% had loss of attachment greater than or equal to 1 mm, and 31% of sites were affected. There was a significant correlation between the presence of subgingival calculus at baseline and the 5-year increment of loss of attachment (Pearson's r = 0.26 p less than 0.001). Subjects who had developed loss of attachment by age 16 years still had significantly more sites affected at the more severe 2 mm level 3 years later than their peers (p less than 0.05). The results suggest that a flexible approach is needed in selecting indices of loss of attachment for epidemiological investigations.

This study evaluated clinically the effectiveness of hand versus sonic subgingival scaling and root planing in the removal of calculus by visually examining the root surface at the time of periodontal flap surgery. Consideration was given to the method of instrumentation, probing depth, number of roots, and type of tooth surface. Eleven patients with moderate to advanced periodontal disease were evaluated. Four subjects were scaled and root planed with the Titan-S only, four with curettes only, and three with the Titan-S + curettes. At reevaluation 3 to 6 weeks after scaling and root planing, the decision to perform periodontal flap surgery was made based upon probing depth, bleeding upon probing, previous access to the root surface, furcation involvement, and the patient's level of oral hygiene. A full thickness mucoperiosteal flap was elevated to gain access to the root surface and measure the distance from the cementoenamel junction to the residual calculus. A total of 690 surfaces were evaluated surgically. The percentage of surfaces with residual calculus for each method of instrumentation was: Titan-S only (31.9%), curettes only (26.8%), and Titan-S + curettes (16.9%). Overall, 15.7% of the surfaces probing 0 to 3 mm, 29.3% of the surfaces probing 4 to 5 mm, and 44.4% of the surfaces probing 6 to 12 mm had residual calculus.(ABSTRACT TRUNCATED AT 250 WORDS)

The Cu concentration as well as the Ca, Mg, Fe, Pb, Zn, and F concentrations were determined in subgingival calculus and the relation of Cu to Zn, Ca, Mg and Fe described. Samples of human subgingival calculus of 60 pieces from 60 subjects were ashed in an acid solution and the cation concentrations were determined with atomic absorption spectrophotometry. The F content was analyzed with an ion-selective electrode. The data was analyzed using the multiple linear regression analysis. The mean +/-SD of the Cu concentration in the subgingival calculus was 48.4+/-59.0 micrograms/g. Four elements, Zn, Ca, Fe and Mg, explained 41.1% of the Cu content. Zn explained 25.5% and the correlation was positive, whereas Ca (10.4%) had a negative correlation with the Cu content. The results showed such a high Cu content that it could affect the mineralization of calculus.

This study investigated the effects of retained subgingival calculus on healing of the periodontium at ten, 30 and 120 days. Eight beagle dogs between eight and ten years old with naturally occurring periodontal disease were used. One dog that died before any procedures were done provided information on the extent of gingival inflammation prior to surgery. Quadrants from seven dogs meeting the criteria for inclusion were selected, and each quadrant was randomly designated as either an instrumented or noninstrumented, surgical site. The gingival index for the selected sites was recorded along with clinical probing measurements. Instrumented sites were treated by reflection of a facial mucoperiosteal flap followed by thorough root planing. Non instrumented sites were treated by a facial mucoperiosteal flap alone. All flaps were returned to their preoperative position and secured with interrupted sutures. No antibiotics were given. Meticulous daily plaque control was begun the day after surgery and continued until sacrifice. There was a statistically significant reduction in gingival index scores for the 30- and 120-day instrumented sites and for the 120-day noninstrumented sites. Mean probing depths for the instrumented group showed a significant reduction at 30 and 120 days and for the noninstrumented group at 120 days after surgery. Forty percent of the noninstrumented roots and 10% of the instrumented roots displayed subgingival calculus. At all evaluation periods and in both instrumented and noninstrumented roots, inflammation was more intense when calculus was present; the difference was significant at ten days with the instrumented and at ten and 30 days with the noninstrumented specimens.(ABSTRACT TRUNCATED AT 250 WORDS)

Significant positive correlations between protease activities in saliva and supragingival/subgingival calculus indices, periodontal pocket depth, or P-M-A index were confirmed. When the partial correlation was calculated, the subgingival calculus index correlated well with the sediment protease at pH 8.5, and the supragingival calculus index showed a significant correlation with the supernate protease at pH 4.5.