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Introduction: Periodontal therapy disrupts the biofilm harbouring calculus that triggers inflammation. The explorer is primarily used for calculus detection, and the ultrasonic instrument is primarily used for calculus removal. The efficiency in dental hygiene care may improve if the ultrasonic instrument could be used in both calculus detection and removal., Purpose: The purpose of this study was to validate the effectiveness of calculus detection between the Thinsert® ultrasonic insert and the 11/12 explorer., Methods: Upon IRB approval, this validation study involved three dental hygiene faculty from the Ohio State University Dental Hygiene Program and 30 patient participants from the Ohio State University community. Using both instruments, calculus was evaluated on Ramfjord index teeth and on four possible surfaces per tooth. Data were analysed to evaluate for interrater reliability, intrarater reliability, sensitivity, and specificity., Results: For interrater reliability, the average measure of intraclass coefficient (ICC) value was 0.782 with a 95% confidence interval (CI) of 0.749-0.810 (F (1439, 2878)  = 4.852, P < 0.01). For intrarater reliability, mean Kappa averages were in the full agreement range (κ = 0.726, n = 2160, P < 0.01). When using the Thinsert® for calculus detection, the sensitivity was 75%, specificity was 97%, PPV was 81%, and NPV was 94%., Conclusion: Since calculus evaluation was comparable when using the ODU 11/12 explorer and the Thinsert®, efforts can be focused on developing the tactile sensitivity when using the Thinsert® ultrasonic instrument in the assessment, treatment, and maintenance of periodontal disease and the support of oral health. The efficiency in dental hygiene care may improve by using the Thinsert® ultrasonic instrument in both the detection and removal of calculus., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Purpose: The purpose of this study was to evaluate the efficacy of calculus detection between a thin and curved ultrasonic inserts (UI) as compared to the Old Dominion University (ODU) 11/12 explorer. Methods: Three clinical dental hygiene faculty members were recruited to participate as calibrated raters for the presence of calculus in a group of 60 patient volunteers. Inclusion criteria were: adults aged >18 in good health, and no history of a professional prophylaxis within the past six months. Raters used an ODU 11/12 explorer, thin and curved UIs to evaluate 4 surfaces on Ramfjord index teeth for the presence of subgingival calculus. Data were analyzed for intra- and intrerrater reliability, sensitivity, and specificity. Results: Interrater reliability for calculus detection with an ODU 11/12 explorer and a thin UI was demonstrated with an Intraclass Coefficient (ICC) of .782, confidence interval (CI) 95%. An ICC of .714, CI 95% was demonstrated with the ODU 11/12 explorer and curved UIs. Intra-rater reliability was shown with mean Kappa averages in the full agreement range (Kappa=.726, n=2,160, p <0.01) for use of the ODU 11/12 explorer versus the thin UI as well as versus curved UIs (Kappa=.680, n=2160, p <0.01). Sensitivity was 75%, specificity 97%, PPV 81%, and NPV 94% when the thin UI was used and sensitivity measured 65%, specificity 98%, PPV 81%, and NPV 95% when curved UIs were used. Conclusion: Calculus detection was comparable when using the ODU 11/12 explorer, a thin UI and curved UIs on patients with limited amounts of calculus among the three clinicians. Efforts may be focused on developing tactile sensitivity for calculus detection in addition to calculus removal when using thin and curved ultrasonic instruments. Future studies should investigate calculus evaluation utilizing a variety of ultrasonic insert designs, varying amounts of calculus, and levels of clinical experience., (Copyright © 2018 The American Dental Hygienists’ Association.)

Objectives: The objective of this study is to evaluate the effects of treatment modalities on titanium surface characteristics and surrounding tissues., Materials and Methods: Eighteen participants each had four titanium healing caps (HC) attached to four newly inserted implants. After healing, each HC was randomly assigned to either (1) titanium curettes (TC), (2) stainless steel ultrasonic tip (PS), (3) erythritol air-polishing powder (EP), or (4) only rubber cup polishing (CON). Probing depths (PD), bleeding on probing (BOP), matrix metalloproteinase 8 (MMP-8), and periopathogens were recorded before and 3 months following instrumentation. After final assessments, HCs were removed, cleaned, and subjected to (a) bacterial colonization (Streptococcus gordonii, 24 h; mixed culture, 24 h) and (b) gingival fibroblasts (5 days). HC surfaces were analyzed with a scanning electron microscope (SEM)., Results: No significant differences between the groups were evident before or after instrumentation for PD and BOP (except TC showed a significant decrease in PD; p = 0.049). MMP-8 levels and bacterial loads were always very low. MMP-8 decreased further after instrumentation, while bacteria levels showed no change. No significant differences (p > 0.05) were evident in bacterial colonization or fibroblast attachment. A comparison of the overall mean SEM surface roughness scores showed a significant difference between all groups (p < 0.0001) with the lowest roughness after EP., Conclusions: All treatments performed yielded comparable outcomes and may be implemented safely., Clinical Relevance: Clinicians may fear implant surface damage, but all instrumentation types are safe and non-damaging. They can be implemented as needed upon considering the presence of staining and soft and hard deposits.

Background: This study aims to reveal how air polishing behaves on a titanium surface by evaluating the size and shape of the cleaned area and the influence of different device settings, probing depths, and cleaning movements., Methods: Forty-eight titanium sandblasted large-grit acid-etched surface film-coated disks were treated with an air abrasive system using a subgingival plastic nozzle. Two subgingival models were used: open-ended (step 1) and defined-size (step 2). In step 1, the most effective parameters were investigated by 5-second static applications under different settings. In step 2, the best settings were used for dynamic application to test influence of different movements (up-down, slowly up, rotation). For both steps, powder and water consumption and total cleaned area were calculated., Results: Air pressure was the main factor with the strongest effect on cleaning. Increasing air pressure extended cleaning area. Other factors, such as nozzle depth and excessive powder flow amount, had weak influence. Cleaning effect reached deeper than the nozzle physically reached. Step 2 showed that there was no significant difference between different nozzle movements; however, cleaning efficiency decreased significantly without movement., Conclusions: For the most effective clinical use of air polishing, it should be applied with high pressure, deep insertion of nozzle, and enough water flow. Additionally, the nozzle has to be moved to get the best cleaning effect.

Purpose: The aim of this study was to evaluate the surface characteristics and gingival fibroblast adhesion of disks composed of implant and abutment materials following brief and repeated instrumentation with instruments commonly used in procedures for implant maintenance, stage-two implant surgery, and periimplantitis treatment., Materials and Methods: One hundred twenty disks (40 titanium, 40 titaniumzirconium, 40 zirconia) were grouped into treatment categories of instrumentation by plastic curette, titanium curette, diode microlaser, rotary titanium brush, and no treatment. Twenty strokes were applied to half of the disks in the plastic and titanium curette treatment categories, while half of the disks received 100 strokes each to simulate implant maintenance occurring on a repetitive basis. Following analysis of the disks by optical laser profilometry, disks were cultured with human gingival fibroblasts. Cell counts were conducted from scanning electron microscopy (SEM) images., Results: Differences in surface roughness across all instruments tested for zirconia disks were negligible, while both titanium disks and titaniumzirconium disks showed large differences in surface roughness across the spectrum of instruments tested. The rotary titanium brush and the titanium curette yielded the greatest overall mean surface roughness, while the plastic curette yielded the lowest mean surface roughness. The greatest mean cell counts for each disk type were as follows: titanium disks with plastic curettes, titanium-zirconium disks with titanium curettes, and zirconia disks with the diode microlaser., Conclusion: Repeated instrumentation did not result in cumulative changes in surface roughness of implant materials made of titanium, titanium-zirconium, or zirconia. Instrumentation with plastic implant curettes on titanium and zirconia surfaces appeared to be more favorable than titanium implant curettes in terms of gingival fibroblast attachment on these surfaces.

Background: Following the debonding of orthodontic brackets, the removal of residual adhesive from the enamel surface is required. Published adhesive removal protocols present conflicting advice., Aims: The present study evaluated the surface roughness of enamel after debonding and instrumentation with non-traditional orthodontic polishing systems., Methods: The facial aspects of 35 extracted human incisor teeth were scanned with a surface profilometer for surface roughness prior to the bonding of orthodontic brackets. After debonding, residual adhesive was removed with a 12-fluted titanium carbide bur. The teeth were randomly divided into seven groups (N = 5 per group) and the enamel surface was polished with one of seven products. All samples were re-scanned for surface roughness and subjectively evaluated via SEM., Results: There was no significant difference in enamel surface roughness between the groups when compared using surface profilometry. Visual observations from the SEM evaluations demonstrated differences in the enamel surface at the microscopic level that were not detected by profilometric analysis., Conclusions: The present study found no statistically significant difference in mean enamel smoothness change from pretreatment to post-treatment between the seven polishing methods studied via profilometer surface reading measurements. An SEM analysis showed visual differences in enamel striations viewed at 1000x magnification in a comparison of traditional versus non- traditional polishing methods.

Periodontal probing aims at detecting the presence, type and gravity of periodontal diseases influencing distance between gingival margin and connective ligament. Measurements in vivo are affected by substantial uncertainty, owing, for example, to probe features, anatomic variations and operator's skill. Inadequate reproducibility in periodontal probing may lead to diagnostic mistakes and inappropriate therapeutic decisions. In vitro evaluation of reproducibility of measurements of periodontal pockets was aimed at while developing a Periodontal Calibration Box designed to calibrate periodontal probe operators, catering also for simulating contraction observed in vivo. Probe type and clinical experience of operators were found to affect substantially probing errors., (© IMechE 2015.)

Objective: To assess enamel surface under scanning electron microscopy (SEM) after resin removal and enamel polishing procedures following brackets debonding, as well as compare the time required for these procedures., Methods: A total of 180 deciduous bovine incisors were used. The enamel surface of each tooth was prepared and brackets were bonded with light cured Transbond XT composite resin. Brackets were removed in a testing machine. The samples were randomized and equally distributed into nine groups according to the resin removal and polishing technique: Group 1, 30-blade tungsten carbide bur in high speed; Group 2, 30-blade tungsten carbide bur in high speed followed by a sequence of 4 Sof-lex polishing discs (3M); Group 3, 30-blade tungsten carbide bur in high speed followed by Enhance tips (Dentsply). All groups were subdivided into (a) unpolished; (b) polished with aluminum oxide paste; and (c) polished with water slurry of fine pumice. Subsequently, the enamel surface was assessed and statistical analysis was carried out., Results: There were statistically significant differences in enamel roughness and removal time among all groups. Groups 3a, 3b and 3c appeared to be the most efficient methods of removing resin with low damages to enamel. Groups 2a, 2b and 2c were the most time consuming procedures, and Group 2a caused more damages to enamel., Conclusion: The suggested protocol for resin removal is the 30-blade tungsten carbide bur in high speed followed by Enhance tips and polishing with aluminum oxide paste. This procedure seems to produce less damages and is less time consuming.

Introduction: The aim of this study was to evaluate the surface roughness and morphology of enamel with a surface roughness tester and scanning electron microscopy after the removal of metal brackets and polishing., Methods: Ten orthodontic patients were selected for the study. At the conclusion of orthodontic treatment, their metal brackets were removed. For each patient, teeth on one side of the mouth were randomly chosen for finishing and polishing with aluminum oxide discs (n = 10). Teeth on the other side were finished with multilaminated carbide burs (n = 10). Dental replicas (before and after tooth polishing) were obtained with epoxy resin. Three surface roughness measurements were made in different directions with an angle of 120° among them, and a mean for each dental replica was calculated. The roughness data were statistically evaluated by repeated-measurements analysis of variance. Three specimens from each group were also used for scanning electron microscopy analysis., Results: After resin removal, the average roughness in the carbide bur group (0.31 μm) was significantly greater than that in the aluminum oxide disc group (0.25 μm)., Conclusions: The aluminum oxide disc polishing system resulted in less enamel roughness than did the multilaminated carbide bur system., (Copyright © 2015 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Dental and dental hygiene faculty members often do not provide consistent instruction in the clinical environment, especially in tasks requiring clinical judgment. From previous efforts to calibrate faculty members in calculus detection using typodonts, researchers have suggested using human subjects and emerging technology to improve consistency in clinical instruction. The purpose of this pilot study was to determine if a dental endoscopy-assisted training program would improve intra- and interrater reliability of dental hygiene faculty members in calculus detection. Training included an ODU 11/12 explorer, typodonts, and dental endoscopy. A convenience sample of six participants was recruited from the dental hygiene faculty at a California community college, and a two-group randomized experimental design was utilized. Intra- and interrater reliability was measured before and after calibration training. Pretest and posttest Kappa averages of all participants were compared using repeated measures (split-plot) ANOVA to determine the effectiveness of the calibration training on intra- and interrater reliability. The results showed that both kinds of reliability significantly improved for all participants and the training group improved significantly in interrater reliability from pretest to posttest. Calibration training was beneficial to these dental hygiene faculty members, especially those beginning with less than full agreement. This study suggests that calculus detection calibration training utilizing dental endoscopy can effectively improve interrater reliability of dental and dental hygiene clinical educators. Future studies should include human subjects, involve more participants at multiple locations, and determine whether improved rater reliability can be sustained over time.

Purpose: Dental professionals suffer from a high prevalence of work-related musculoskeletal disorders (MSD). Dental hygienists in particular have a high prevalence of pain in the forearms and hands. The objective of this study was to compare 1 cordless handpiece to 2 corded handpieces during simulated tooth polishing in terms of the muscle loads (recorded as electromyography (EMG) activity), duration of polishing procedure, and dental hygienist opinion about ease of use., Methods: EMG was used to quantify muscle electrical activity of 4 forearm muscles during simulated dental polishing with 2 corded handpieces (HP-A and HP-B) and 1 cordless handpiece (HP-C). A convenience sample of 30 dental hygienists (23 to 57 years of age) with 1 to 20+ years of clinical practice experience completed the study. Each participant spent approximately 5 minutes polishing 3 predetermined teeth in each of the 4 quadrants. The sequence of the handpieces was randomly assigned. At the end of the study, participants completed a subjective end user evaluation of handpiece preference., Results: Muscle activity levels of 10th, 50th and 90th percentiles did not differ significantly between the 3 handpieces tested (p>0.05). However, total muscle workload (integrated EMG) was lowest for the cordless handpiece (HP-C), but this was only significantly less than HP-A (p<0.05). Polishing using the cordless handpiece (HP-C) (M=257 seconds, SD=112 seconds) took significantly less time than either the HP-A corded (M=290 seconds, SD=137 seconds) or HP-B corded handpiece (M=290 seconds, SD=126 seconds) (p<0.05). Overall, 50% of the study participants preferred the cordless handpiece, 37% preferred HP-A and 13% preferred HP-B (p<0.05)., Conclusion: Use of the cordless handpiece reduced the duration of polishing, which in turn led to less total muscle activity, but not muscle intensity. Overall, dental hygienists preferred the cordless handpiece., (Copyright © 2014 The American Dental Hygienists’ Association.)

The aim of this article was to report the clinical case of a male patient of 20 years with hyperpigmented gingiva and moderate fluorosis, whose smile was reestablished by the use of a laser assisted depigmentation procedure, an enamel microabrasion technique, followed by at-home bleaching and subsequent remineralization therapy. The association of these techniques presented excellent results and the patient was satisfied. All techniques are painless, fast and easy to perform, in addition to preserving the hard and soft dental structure. Treatment showed immediate and permanent results; these techniques must be divulged among professionals and their patients.

Introduction: At orthodontic treatment completion, knowledge about the effects of adhesive remnant removal on enamel is paramount., Objective: This study aimed at assessing the effect of different adhesive remnant removal methods on enamel topography (ESI) and surface roughness (Ra) after bracket debonding and polishing., Methods: A total of 50 human premolars were selected and divided into five groups according to the method used for adhesive remnant removal: high speed tungsten carbide bur (TCB), Sof-Lex discs (SL), adhesive removing plier (PL), ultrasound (US) and Fiberglass burs (FB). Metal brackets were bonded with Transbond XT, stored at 37°C for 24 hours before debonding with adhesive removing plier. Subsequently, removal methods were carried out followed by polishing with pumice paste. Qualitative and quantitative analyses were conducted with pre-bonding, post-debonding and post-polishing analyses. Results were submitted to statistical analysis with F test (ANOVA) and Tukey's (Ra) as well as with Kruskal-Wallis and Bonferroni tests (ESI) (P < 0.05)., Results: US Ra and ESI were significantly greater than TCB, SL, PL and FB. Polishing minimized Ra and ESI in the SL and FB groups., Conclusion: Adhesive remnant removal with SL and FB associated with polishing are recommended due to causing little damage to the enamel.

Statement of Problem: Bacterial plaque must be routinely removed from teeth, adjacent structures, and prostheses. However, the removal of this plaque can inadvertently increase the risk of future bacterial adhesion., Purpose: The purpose of this investigation was to assess the change in the surface roughness of 3 different surfaces after dental prophylactic instrumentation and how this influenced bacterial adhesion., Material and Methods: Forty specimens each of Type III gold alloy, lithium disilicate, and zirconia were fabricated in the same dimensions. The specimens were divided into 4 groups: ultrasonic scaler, stainless steel curette, prophylaxis cup, and control. Pretreatment surface roughness measurements were made with a profilometer. Surface treatments in each group were performed with a custom mechanical scaler. Posttreatment surface roughness values were measured. In turn, the specimens were inoculated with Streptococcus mutans, Lactobacillus acidophilus, and Actinomyces viscosus. Bacterial adhesion was assessed by rinsing the specimens with sterile saline to remove unattached cells. The specimens were then placed in sterile tubes with 1 mL of sterile saline. The solution was plated and quantified. Scanning electron microscopy was performed. The statistical analysis of surface roughness was completed by using repeated-measures single-factor ANOVA with a Bonferroni correction., Results: The surface roughness values for gold alloy specimens increased as a result of prophylaxis cup treatment (0.221 to 0.346 Ra) (P<.01) and stainless steel curette treatment (0.264 to 1.835 Ra) (P<.01). The results for bacterial adhesion to gold alloy proved inconclusive. A quantitative comparison indicated no statistically significant differences in pretreatment and posttreatment surface roughness values for lithium disilicate and zirconia specimens. In spite of these similarities, the overall bacterial adherence values for lithium disilicate were significantly greater than those recorded for gold alloy or zirconia (P<.05). Instrumentation of the lithium disilicate and zirconia with the stainless steel curette significantly increased bacterial adhesion compared with the control (P<.05)., Conclusions: The results of this investigation indicate that Type III gold alloy exhibited increased surface roughness values after stainless steel curette and prophylaxis cup treatments. Zirconia was less susceptible to bacterial adhesion than lithium disilicate, and greater bacterial adhesion was found for the stainless steel curette than the other instrumentation methods., (Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Purpose: Endoscopic technology has been developed to facilitate imagery for use during diagnostic and therapeutic phases of periodontal care. The purpose of this study was to compare the level of subgingival calculus detection using a periodontal endoscope with that of conventional tactile explorer in periodontitis subjects., Methods: A convenience sample of 26 subjects with moderate periodontitis in at least 2 quadrants was recruited from the University of Minnesota School of Dentistry to undergo quadrant scaling and root planing. One quadrant from each subject was randomized for tactile calculus detection alone and the other quadrant for tactile detection plus the Perioscope ™ (Perioscopy Inc., Oakland, Cali). A calculus index on a 0 to 3 score was performed at baseline and at 2 post-scaling and root planing visits. Sites where calculus was detected at visit 1 were retreated. T-tests were used to determine within-subject differences between Perioscope™ and tactile measures, and changes in measures between visits., Results: Significantly more calculus was detected using the Perioscope™ vs. tactile explorer for all 3 subject visits (p<0.005). Mean changes (reduction) in calculus detection from baseline to visit 1 were statistically significant for both the Perioscope™ and tactile quadrants (p<0.0001). However, further reductions in calculus detection from visit 1 to visit 2 was only significant for the Perioscope™ quadrant (p<0.025), indicating that this methodology was able to more precisely detect calculus at this visit., Conclusion: It was concluded that the addition of a visual component to calculus detection via the Perioscope™ was most helpful in the re-evaluation phase of periodontal therapy., (Copyright © 2014 The American Dental Hygienists’ Association.)

Background: Root surfaces experience continuous abrasive instrumentation during lifelong periodontal maintenance. Periodontists need both effective and minimally abrasive debridement techniques. Air polishing devices might, therefore, constitute a good alternative to mechanical instrumentation. Because little is known of the three-dimensional shape and volume of the abrasion caused by different powders, it is the aim of the study to investigate the three-dimensional extent of these defects., Methods: Cementum-covered roots of 20 extracted human premolars were coated with resin caps, leaving four areas with identical diameter open for instrumentation using bicarbonate powder and glycine powder. Treatment times were 5 and 10 seconds in a first interval and 10 seconds in a second interval. Maximum settings were chosen for power and lavage. The teeth were scanned using microcomputed tomography initially and after every treatment interval. Differences in volume and defect depths were calculated by superimposition of the scans and tested for significance (Wilcoxon test, P <0.001)., Results: Defect volumes (in mm(3)) presented in medians (interquartile ranges) for the bicarbonate powder after 5, 10, 15, and 20 seconds, respectively, were 0.16 (0.11), 0.28 (0.16), 0.32 (0.18), and 0.41 (0.28), and for glycine powder, 0.00 (0.02), 0.01 (0.05), 0.03 (0.11), and 0.06 (0.1). For each time period, abrasion caused by glycine was significantly lower (five- to 20-fold) compared to defects caused by bicarbonate., Conclusions: In patients with exposed root surfaces, cleaning with bicarbonate powder cannot be recommended. Less abrasive glycine powder, however, demonstrated non-critical substance loss.

Purpose: To evaluate the in vitro and in vivo effects of three treatment regimens on dentin permeability and reduction of dentin hypersensitivity (DH)., Methods: The desensitization treatments were: Gluma Desensitizer PowerGel (GLU), MS Coat One (MSC), and dentin burnishing with fiber-resin burs (STB). A split-chamber device was used to determine the permeability of dentin slices cut from human molars in vitro. Fluid flow through dentin was recorded with a photochemical method after EDTA cleaning, albumin soaking and desensitization treatment (n = 10). 61 study participants with three severely hypersensitive teeth each were enrolled. Sensitivity was determined with an air stimulus before, immediately after treatment, and after 1, 3 and 6 months, using a verbal rating scale., Results: From the 61 study participants enrolled, 52 completed the trial. Permeability at baseline and after albumin soaking was not significantly different. All treatments produced reduced fluid flow through dentin (P > 0.05). All treatments reduced DH significantly (no or moderate sensitivity). Statistical results revealed significant differences among the treatments (P = 0.03). Mann-Whitney comparisons showed GLU, STB < MSC.

Objective: This study aimed at assessing, in vivo, whether the prior use of 0.12% chlorhexidine as mouthwash would decrease air contamination caused by aerosolized sodium bicarbonate during dental prophylaxis. The study was conducted with 23 patients aged between 10 and 40 years old who were randomly selected and undergoing fixed orthodontic treatment., Methods: The study was divided into two phases (T1 and T2) with a 30-day interval in between. In both phases, dental prophylaxis was performed with aerosolized sodium bicarbonate jetted to the upper and lower arches for 4 minutes. In T1, 10 minutes before the prophylaxis procedure, the participants used distilled water as mouthwash for one minute; whereas in T2, mouthwash was performed with 0.12% chlorhexidine. Microbial samples were collected in BHI agar plates for microbiological analysis. Two dishes were positioned on the clinician (10 cm from the mouth) and a third one at 15 cm from the patient's mouth. The samples were incubated for 48 hours at 37°C. Results were expressed in colony-forming units (CFU)., Results: Statistical analysis carried out by means of Student's t test, as well as Wilcoxon and Kruskal-Wallis tests revealed that the prior use of 0.12% chlorhexidine as mouthwash significantly reduced CFU in the three positions studied (P < 0.001)., Conclusion: The prior use of 0.12% chlorhexidine as mouthwash significantly reduced contamination caused by aerosolized sodium bicarbonate during dental prophylaxis in the orthodontic clinic.

The aim of this research was to describe the effects of altering the composition of a modified remineralizing agent (MRA) and the osmotic pressure on tooth color by using spectrophotometric analysis. One hundred and four (104) human premolars and molars were randomly divided into 2 groups of 52 specimens each. Group 1 was treated with the remineralizing agent MRA 55, (remineralizing agent 1), a 50% - 50% by weight mixture of coarse-grain and fine-grain generating minerals, and group 2 was treated with the remineralizing agent MRA 91 (remineralizing agent 2), containing the same minerals in a 90% - 10% proportion. Each group was divided into 2 subgroups with 26 specimens each, which were stored as follows: subgroups A were stored in synthetic saliva with isotonic osmotic pressure (IP), and subgroups B in hypotonic osmotic pressure saliva (HP). The initial and final readings were taken with a Vita Easy Shade spectrophotometer. Color parameters (L*, a*, b*) and whiteness indices (WIC, WIO, W) were calculated from the readings. The color changes (deltaL, deltaA, deltaB, and deltaE) and whiteness indices were compared and analyzed with descriptive analyses. The variables deltaL, deltaA, deltaB, deltaE, and the whiteness index W were analyzed with an analysis of variance (ANOVA), and the indices WIC and WIO were analyzed with a nonparametric Kruskal-Wallis ANOVA. The results indicate that combination A2 (MRA 91 and IP) affected variables deltaB and deltaE, while combination B1 (MRA 55 and HP) affected variables deltaA, deltaB and the whiteness index WIO. Only MRA 91 affected the variable deltaL. The osmotic pressure of saliva and the remineralizing agent used affect the color of dental enamel.

The use of high-level magnification (6-8x loupes magnification, or higher degrees of magnification provided by the surgical operating microscope), combined with head-mounted, coaxial lighting, may improve the ability of a dentist or dental hygienist to perform prophylaxis or scaling and root planing procedures, compared to the performance of these tasks using unaided vision or entry-level (2.5x) magnification, combined with overhead operatory lighting. A magnified view of the supragingival contours of a tooth surface facilitates visualizing the dimensions and curvature of the unseen sub-gingival tooth surfaces, which facilitates detection and removal of calculus that is located on these subgingival surfaces. Improved calculus removal ability may lead to better periodontal disease outcomes.

Purpose: Dental hygiene education continues to move beyond mastery of content material and skill development to learning concepts that promote critical-thinking and problem-solving skills. The purpose of this research was to evaluate the effectiveness of collaborative learning and determine the growth in intellectual development of 54 first-year dental hygiene students., Methods: The control group used traditional pre-clinical teaching and the experimental group used collaborative pedagogy for instrument introduction. All students were subjected to a post-test evaluating their ability to apply the principles of instrumentation. Intellectual development was determined using pre- and post-tests based on the Perry Scheme of Intellectual Development. Student attitudes were assessed using daily Classroom Assessment Activities and an end-of-semester departmental course evaluation., Results: Findings indicated no significant difference between collaborative learning and traditional learning in achieving pre-clinical competence as evidenced by the students' ability to apply the principles of instrumentation. Advancement in intellectual development did not differ significantly between groups. Value added benefits of a collaborative learning environment as identified by the evaluation of student attitudes included decreased student reliance on authority, recognition of peers as legitimate sources of learning and increased self-confidence. A significant difference in student responses to daily classroom assessments was evident on the 5 days a collaborative learning environment was employed., Conclusion: Dental hygiene students involved in a pre-clinical collaborative learning environment are more responsible for their own learning and tend to have a more positive attitude toward the subject matter. Future studies evaluating collaborative learning in clinical dental hygiene education need to investigate the cost/benefit ratio of the value added outcomes of collaborative learning.

Objectives: The objective of the study was to evaluate the efficacy of an additional usage of a diamond-coated curette on surface roughness, adhesion of periodontal ligament (PDL) fibroblasts, and of Streptococcus gordonii in vitro., Materials and Methods: Test specimens were prepared from extracted teeth and exposed to instrumentation with conventional Gracey curettes with or without additional use of diamond-coated curettes. Surface roughness (Ra and Rz) was measured before and following treatment. In addition, the adhesion of PDL fibroblasts for 72 h and adhesion of S. gordonii ATCC 10558 for 2 h have been determined., Results: Instrumentation with conventional Gracey curettes reduced surface roughness (median Ra before: 0.36 μm/after: 0.25 μm; p < 0.001; median Rz before: 2.34 μm/after: 1.61 μm; p < 0.001). The subsequent instrumentation with the diamond-coated curettes resulted in a median Ra of 0.31 μm/Rz of 2.06 μm (no significance in comparison to controls). The number of attached PDL fibroblasts did not change following scaling with Gracey curettes. The additional instrumentation with the diamond-coated curettes resulted in a two-fold increase in the number of attached PDL fibroblasts but not in the numbers of adhered bacteria., Conclusions: Treatment of root surfaces with conventional Gracey curettes followed by subsequent polishing with diamond-coated curettes may result in a root surface which provides favorable conditions for the attachment of PDL fibroblasts without enhancing microbial adhesion., Clinical Relevance: The improved attachment of PDL fibroblasts and the limited microbial adhesion on root surfaces treated with scaling with conventional Gracey curettes followed by subsequent polishing with diamond-coated curettes may favor periodontal wound healing.

Aim: Self-etch bonding systems have been introduced recently and have the advantage of reduced operating time. Because of patient management and isolation difficulties in children, the present study aimed to evaluate microtensile bond strength of two self-etch bonding systems (AdheSE and Xeno® III) on cleaned only, ground and sandblasted enamel., Materials and Methods: Thirty intact primary molars were selected and randomly divided into two groups according to the type of bonding used (Xeno® III and AdheSE). The teeth were divided into three subgroups according to enamel surface conditioning method: prophylaxis with pumice, grinding with coarse finishing and polishing disc, and sandblasting with aluminum oxide particles. Tetric Ceram composite then was applied. Samples were sectioned coronally and axially. The interface area of dental sticks was measured and specimens were subjected to a tensile force of 0.5 mm/min until failure., Results: Microtensile bond strength of Xeno® III-sandblasting, AdheSE-sandblasting, AdheSE-grinding, and AdheSE- cleaned only were 25.5±7.7, 21.2±2.3, 12.9±2.2, and 9.1±1.1, respectively. During sectioning, all specimens of Xeno® III-cleaned only and Xeno® III-grinding groups were fractured., Conclusions: Two step AdheSE yields higher mTBS in comparison to one step Xeno ® III. In regard to surface conditioning, sandblasting increases the mTBS relative to grinding with finishing and polishing disc, and the cleaned-only enamel has the lowest mTBS.

Aim: The purpose of this study was to evaluate the ultramorphology and surface roughness of permanent tooth enamel after various post-stripping polishing methods., Methods: Sixty extracted, permanent lower incisors were randomly assigned to two groups (Group A and Group B). Group A was morphologically assessed by a scanning electron microscopy (SEM) and Group B was assessed by a stylus profilometer which applied a surface roughness test. Each group was divided into five subgroups of six incisors. Four of the subgroups were subjected to interpoximal enamel reduction, followed by various polishing methods; the fifth subgroup served as a control. The polishing methods comprised; Subgroup 1, diamond disk followed by a fine Sof-lex disc; Subgroup 2, diamond disk and fine diamond bur; Subgroup 3, diamond disk and fine tungsten carbide bur; Subgroup 4, diamond disk and chemical stripping using 37% orthophosphoric acid in conjunction with a fine 3M finishing strip and Subgroup 5 (control), no stripping nor polishing. Qualitative (scanning electron microscopy) and quantitative (surface roughness test) assessments were performed. Surface roughness values (Ra) for permanent enamel were evaluated using the Welch analysis of variance (ANOVA)., Results: Subgroup 1 (diamond disk and fine Sof-lex disc) produced the smoothest enamel surface and Subgroup 4 (chemical stripping) produced the roughest enamel surface., Conclusions: All proximal stripping and polishing methods significantly roughened the enamel surfaces. The best results were obtained when the stripped enamel surfaces were polished and finished with fine Sof-lex discs.

Purpose: To evaluate the best method for decontaminating tooth enamel contaminated by contact with blood before bonding orthodontic buttons., Materials and Methods: The labial surfaces of 195 bovine incisors initially received prophylaxis, followed by 37% phosphoric acid etching, adhesive application, and light polymerization. After this, the labial surfaces of all teeth were contaminated with blood. The teeth were then randomly divided into 13 groups (n = 15), comprising the control group (treated according to the manufacturer's recommendations) and 12 experimental groups treated by the following decontamination methods: group 1, no decontamination; group 2, washing with distilled water; group 3, washing with physiologic solution; group 4, jets of air; group 5, gauze; group 6, cotton wool; group 7, distilled water plus jets of air; group 8, distilled water plus gauze; group 9, distilled water plus cotton wool; group 10, physiologic solution plus jets of air; group 11, physiologic solution plus gauze; and group 12, physiologic solution plus cotton wool., Results: No statistical differences were shown between the control group and groups 4, 7, 10, and 11 (P > .05). The lowest bond strength values were shown in group 1, in which no decontamination was performed, and groups 6 and 12, which were decontaminated with cotton wool and physiologic solution plus cotton wool, respectively., Conclusions: The best method of decontaminating enamel contaminated with blood is washing with physiologic solution, followed by drying with jets of air and gauze or drying with jets of air only., (Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Aim: The aim of this study was to evaluate and compare the shear bond strength of hydrophilic materials like Transbond MIP with Assure-fluoride releasing light cure sealant paste system (Reliance orthodontic product), Enhance Lc-adhesion booster (Reliance Orthodontics) Prime and Bond NT-one step adhesive with nanotechnology (Dentsply Product India) with Transbond XT as the control group., Materials and Methods: The study was conducted on 180 extracted human premolar teeth which were divided into five main groups. Each group contained 36 teeth, which were further subdivided into three subgroups containing 12 teeth. The teeth were bonded in three different surface environments namely dry, contaminated with artificial saliva and reprimed after contamination with artificial salvia. The brackets were bonded and cured. The shear bond strength was tested using Instron universal testing machine (4501)., Results: The results were subjected to statistical analysis like 3 factorial ANOVA and compared to post-hoc using the Student Newman levels test. The residual resin on the tooth surface after debonding was evaluated with adhesive remnant index., Clinical Significance: The results revealed that in situations in which moisture contamination is critical there is distinct advantage in using hydrophilic primers.

Aim: To find an alternative to popular orthodontic bonding agent composite resin and elimination of acid etching. To assess GC Fuji Ortho as an orthodontic bonding agent under different enamel conditions and evaluate the shear bond strength. Enamel surfaces intentionally contaminated with saliva, conditioned enamel using Fuji dentin conditioner and conventional 37% phosphoric acid/60 seconds. To evaluate and compare shear bond strength to a 'gold standard' composite bonding agent--Rely-a-Bond., Materials and Methods: The sample consisted of 50 human premolar teeth collected and stored in formalin. Out of 50 samples, 38 were upper premolars and 12 were lower second premolars. The total sample divide into 10 each. Stainless steel contour bracket with bondable mesh measured about 3.42 mm in length and 3.31 mm in width. Each tooth sample was embedded in a cylindrical acrylic block of polymethyl methacrylate (PMMN). The buccal surfaces of all the samples were polished with fluoride-free pumice and rinsed thoroughly. Group 1 bonded with GC Fuji Ortho after getting etched with 37% phosphoric acid/60 seconds. Group 2 was contaminated with saliva. Group 3 was conditioned with Fuji dentin condition. Group 4 unetched, uncontaminated, and Group 5 was treated with rely bond composite resin after getting etched with 37% phosphoric acid. The shear bond strength was tested using Instron universal testing machine. The force at which bond failed was recorded on XY recorder as shear/peel bond strength of the material used for bonding. The reading obtained were statistically analyzed., Result: Rely bond showed highest bond strength of 64.70 N (Newtons). The next highest value was that of Group 1. The lowest bond strength in the Group 4., Conclusion: GC Fuji Ortho can be used as a bonding agent on etched enamel. Unetched, uncontaminated enamel surfaces were inadequate for bracket bonding., Clinical Significance: Potential benefits of glass ionomer cements can be utilized in orthodontic bonding.

Objectives: There are controversial reports regarding the effect of repeated bonding on shear bond strength (SBS) of orthodontic attachments. The aim of this study was to evaluate the SBS of brackets following early and delayed rebonding, and after employing different methods of composite removal., Materials and Methods: Sixty eight premolars were randomly assigned into 4 groups. After initial debonding and recording the SBS, the adhesive remnants in the first group were removed by a round bur, in the second group by a green rubber wheel, and in the third and fourth groups by 12-fluted tungsten carbide burs, all of them connecting to a low speed handpiece. In the fourth group following adhesive removal, the teeth were kept in a simulated oral environment for one month. Then, rebonding was performed and the second SBS was measured. Two representative samples from each group were examined under a scanning electron microscope following adhesive removal. The data were analyzed by ANOVA, Paired sample t-test and Chi-Square test., Results: In the first group, the rebonding strength was decreased significantly (p<0.05), while composite removal with a tungsten carbide bur or a green rubber wheel did not affect SBS significantly (p>0.05). Late rebonding of brackets had no effect on the SBS (p>0.05)., Conclusions: Postponing rebonding to the next visit does not improve the SBS significantly. It is recommended to use a tungsten carbide bur or a green rubber wheel, and not a round bur for removing adhesive remnants following debonding of orthodontic brackets., (Copyright © 2011 Società Italiana di Ortodonzia SIDO. Published by Elsevier Srl. All rights reserved.)

The aim of this study was to evaluate the use of fluoride varnish as a prophylaxis method with self etching primer (SEP) and its comparison with pumice before orthodontic bonding. Thirty seven orthodontic patients participated in a prospective clinical trial. A split mouth technique was used in each patient, one quadrant was assigned to fluoride varnish and the contralateral quadrant to pumice prophylaxis. A total of 684 teeth were bonded with SEP (Transbond plus; 3M Unitek) and monitored for 6 months for bond failures. A total of 42 (6.1%) failures were recorded, 9 (2.6%) in the pumice group and 33 (9.6%) in the fluoride varnish group. Chi-square analysis was used to compare the number of bracket failures between the pumice and fluoride varnish groups and the number of patients in each group experiencing at least one bond failure. Statistically significant differences were found both in total number of bond failures (P < 0.001) and in the number of patients with bond failures (P < 0.05) between both groups. A significantly lower and clinically acceptable bond failure rate was observed with Transbond Plus self etching primer after pumice prophylaxis.

Work-related musculoskeletal disorders of upper limbs are very common among dental hygienists. To minimize the risk of their occurrence, it is essential that attention be paid to proper ergonomics in the workplace, including the selection of instrumentation. At present there are no specific guidelines but only some indications for the selection of the different hand tools. The main purpose of this study was to make a comparative analysis of different types of handles of hand tools used for root planing (Gracey curettes). Nine dental hygienists were interviewed with a questionnaire aimed to assess three different types of curette handle. The results showed that lightness, being of solid steel, having a cylindrical non-uniform shape with full enlarged cross-section, and being silicon coated with non-slip ends are the preferred characteristics for a curette handle. These considerations may assist both manufacturers in designing new hand instruments and clinicians in selecting the most ergonomic ones to buy.

Purpose: The aim of this study was to evaluate the effects of a variety of implant cleaning instruments on different implant surfaces, specifically surface roughness and cleaning efficacy., Materials and Methods: Biofilm layers of Streptococcus mutans were cultivated on titanium disks with four different surface structures (polished, grit-blasted, acid-etched, and acid-etched/grit-blasted). Five disks each were cleaned using nine mechanical implant cleaning instruments or an erbium:yttrium-aluminum-garnet laser. Surface roughness (average, Ra; maximum, Rz) and waviness (Lr) were evaluated by two-dimensional laser profilometry. Surface structure damage and cleaning scores were assessed by scanning electron microscopy. Statistical analyses of the results were performed with one- and two-way analyses of variance and Bonferroni-Dunn multiple-comparison post hoc analysis (α = .05)., Results: Ra and Rz values for the acid-etched surfaces and Ra, Rz, and Lr values for the polished and the grit-blasted surfaces showed no significant differences between the different cleaning methods or cleaning instruments compared to the control (not cultured, not cleaned) groups. Significantly lower Ra and Rz values on grit-blasted/acid-etched implant surfaces were found following use of the Sonic-Flex clean with prophylaxis brush and the plastic curette compared to Satelec ProphyMax with Periosoft curette. Ra and Rz values of the different implant structure surfaces before cleaning were significantly different between all implant surfaces except for the polished compared to the acid-etched surfaces., Conclusions: Cleaning effect and alterations of the implant surfaces were strongly dependent on the implant cleaning method used.

Purpose: This pilot study compared the clinical endpoints of the magnetostrictive and piezoelectric ultrasonic instruments on calculus removal. The null hypothesis stated that there is no statistically significant difference in calculus removal between the 2 instruments., Methods: A quasi-experimental pre- and post-test design was used. Eighteen participants were included. The magnetostrictive and piezoelectric ultrasonic instruments were used in 2 assigned contra-lateral quadrants on each participant. A data collector, blind to treatment assignment, assessed the calculus on 6 predetermined tooth sites before and after ultrasonic instrumentation. Calculus size was evaluated using ordinal measurements on a 4 point scale (0, 1, 2, 3). Subjects were required to have size 2 or 3 calculus deposit on the 6 predetermined sites. One clinician instrumented the pre-assigned quadrants. A maximum time of 20 minutes of instrumentation was allowed with each technology. Immediately after instrumentation, the data collector then conducted the post-test calculus evaluation., Results: The repeated analysis of variance (ANOVA) was used to analyze the pre- and post-test calculus data (p≤0.05). The null hypothesis was accepted indicating that there is no statistically significant difference in calculus removal when comparing technologies (p≤0.05). Therefore, under similar conditions, both technologies removed the same amount of calculus., Conclusion: This research design could be used as a foundation for continued research in this field. Future studies include implementing this study design with a larger sample size and/or modifying the study design to include multiple clinicians who are data collectors. Also, deposit removal with periodontal maintenance patients could be explored.

This study evaluated the enamel loss and composite remnants after debonding and clean-up. The tested null hypothesis is that there are no differences between different polishing systems regarding removing composite remnants without damaging the tooth surface. Brackets were bonded to 75 extracted human molars and removed after a storage period of 100 hours. The adhesive remnant index (ARI) was evaluated. The clean-up was carried out with five different procedures: 1. carbide bur; 2. carbide bur and Brownie and Greenie silicone polishers; 3. carbide bur and Astropol polishers; 4. carbide bur and Renew polishers; and 5. carbide bur, Brownie, Greenie and PoGo polishers. Silicone impressions were made at baseline (T0) and after debonding (T1) and polishing (T2) to produce plaster replicas. The replicas were analysed with a three-dimensional laser scanner and measured with analytical software. Statistical analysis was performed with the Kruskal-Wallis test and pairwise Wilcoxon tests with Bonferroni-Holm adjustment (α = 0.05). Enamel breakouts after debonding were detectable in 27 per cent of all cases, with a mean volume loss of 0.02 mm(3) (±0.03 mm(3)) and depth of 44.9 μm (±48.3 μm). The overall ARI scores was 3 with a few scores of 1 and 2. The composite remnants after debonding had a mean volume of 2.48 mm(3) (±0.92 mm(3)). Mean volume loss due to polishing was 0.05 mm(3) (±0.26 mm(3)) and the composite remnants had a mean volume of 0.22 mm(3) (±0.32 mm(3)). There were no statistically significant differences in volumetric changes after polishing (P = 0.054) between the different clean-up methods. However, sufficient clean-up without enamel loss was difficult to achieve.

Objective: The purpose of this laboratory study was to evaluate extrinsic stain removal from teeth by a specially engineered sonic powered toothbrush with unique sensing and control technologies, using the Triple Clean and the Sensitive refill brush heads, in comparison to a manual flat-trim toothbrush., Methods: Twelve (12) artificially stained bovine teeth were tested with each product. The percentage of stain removed by each product was calculated by taking the ratio of the amount of stain removed by brushing for 800 strokes to the total amount of stain removed by subsequent application of a dental prophylaxis. The stain was quantified by measuring the light reflected by the stained teeth with a spectrophotometer. Data were reported as L*, lightness of the stain, and as W*, a whiteness index comprising the lightness, hue, and chroma of reflected light. Statistical analyses were performed separately for the AL* and AW* scores. Comparisons of the toothbrushes with respect to baseline-adjusted deltaL* and deltaW* scores were performed using an analysis of covariance (ANCOVA). Post-ANCOVA pair-wise comparisons of the study toothbrushes were performed using Tukey's test for multiple comparisons. All statistical tests of hypotheses were two-sided, and employed a minimum level of significance of 0.05., Results: The percentage of stain removed by the sonic powered toothbrush, using either the Triple Clean brush head or the Sensitive brush head under laboratory test conditions, is superior (p < 0.05) to the percentage of stain removed by the manual flat-trim toothbrush when analyzed for both the deltaL* and deltaW* scores. The mean percentage of stain removed was 62.10 for the power toothbrush with the Triple Clean brush head, 49.01 for the power toothbrush with the Sensitive brush head, and 30.56 for the manual flat-trim toothbrush when calculated using deltaL* scores. The mean percentage of stain removed was 59.89 for the power toothbrush with the Triple Clean brush head, 46.83 for the power toothbrush with the Sensitive brush head, and 29.25 for the manual flat-trim toothbrush when calculated using deltaW* scores., Conclusions: This new specially engineered sonic powered toothbrush with unique sensing and control technologies effectively removes extrinsic stains from the surface of teeth under laboratory test conditions with both the Triple Clean and the Sensitive brush heads. The effectiveness of stain removal with either brush head is significantly greater than the effectiveness of stain removal of a manual flat-trim toothbrush under these conditions.

Aim & Objectives: The purpose of this in vitro study was to evaluate and compare the microleakage of pit and fissure sealants after using six different preparation techniques: (a) brush, (b) pumice slurry application, (c) bur, (d) air polishing, (e) air abrasion, and (f) longer etching time., Material & Method: The study was conducted on 60 caries-free first premolars extracted for orthodontic purpose. These teeth were randomly assigned to six groups of 10 teeth each. Teeth were prepared using one of six occlusal surface treatments prior to placement of Clinpro" 3M ESPE light-cured sealant. The teeth were thermocycled for 500 cycles and stored in 0.9% normal saline. Teeth were sealed apically and coated with nail varnish 1 mm from the margin and stained in 1% methylene blue for 24 hours. Each tooth was divided buccolingually parallel to the long axis of the tooth, yielding two sections per tooth for analysis. The surfaces were scored from 0 to 2 for the extent of microleakage., Statistical Analysis: Results obtained for microleakage were analyzed by using t-tests at sectional level and chi-square test and analysis of variance (ANOVA) at the group level., Results: The results of round bur group were significantly superior when compared to all other groups. The application of air polishing and air abrasion showed better results than pumice slurry, bristle brush, and longer etching time. Round bur group was the most successful cleaning and preparing technique. Air polishing and air abrasion produced significantly less microleakage than traditional pumice slurry, bristle brush, and longer etching time.

The application of cleaning and polishing agents to a patient's dentition is a routine part of many dental practices. This study measured the surface roughness and surface gloss of tooth enamel, composite resin, and dental porcelain restorative materials when exposed to a paste-free prophylaxis polishing cup as well as a conventional prophylaxis polishing paste. Samples of human tooth enamel, a composite resin restorative material, and dental porcelain were prepared by a series of polishing papers to produce a flat smooth surface. The baseline average surface roughness (Ra) was measured using a contact stylus profilometer, and the surface gloss was measured with a glossmeter. The test samples were subjected to a standardized polishing routine using a paste-free prophylaxis polishing cup and a fine- or coarse-particle prophylaxis paste. Post-treatment surface roughness and gloss measurements were compared using a paired t statistical test. The conventional prophylaxis pastes increased surface roughness and decreased the gloss of the composite resin and tooth enamel test groups. The paste-free cups did not significantly affect the surface roughness of the enamel or the restorative materials. Dental porcelain surface roughness essentially was not affected by the application of paste-free cups and the fine and coarse pastes.

This in vivo study evaluated the effects of topical fluoride application on enamel by repeated scanning electron microscopy analysis of replicas. Baseline fluid droplets were employed as qualitative indication of enamel permeability. CaF(2)-like globules were detected in vivo after fluoride application and were not found after professional brushing, ultrasound action, or chemical extraction. Absence of water permeability of enamel was demonstrated even after removal of CaF(2)-like globules. Droplets reappeared within 1 h in sodium fluoride-treated teeth, but they did not reappear even after 1 week following topical enamel treatment with acidulated phosphate fluoride. Teeth treated with an acidulate fluoride-free solution showed lack of CaF(2)-like globules and no droplets for at least 1 week as detected in acidulate phosphate fluoride-treated teeth. The caries-preventing action of fluoride may be due to its ability to decrease permeability and diffusion pathways. CaF(2)-like globules seem to be indirectly involved in enamel protection over time maintaining an impermeable barrier, and phosphoric acid seemed to play an unexpected fluoride-independent preventive role.

The aim of this study was to evaluate the plaque removal efficacy of four toothbrushes: the Philips Sonicare Elite with medium and mini brush heads, the Elmex Sensitive, and the American Dental Association (ADA) reference toothbrush. This study was a randomized, controlled, investigator-blinded, four-brush crossover design study, which examined plaque removal following a consecutive repeated use. All brushes were used on each participant in a randomly assigned quadrant of the mouth. A total of 90 subjects participated in the study. Prior to the experiment, they received a professional prophylaxis and were requested to refrain from toothbrushing for 48 h. Teeth were professionally brushed consecutively for 10 to 90 s per quadrant. A Turesky-modified Quigley Hein Index score was assessed at baseline and after each brushing interval by one blinded investigator. Results showed reduction of mean plaque scores for all brushes with time from 10 to 90 s. After 30 s (2-min whole mouth equivalent) of brushing, the Sonicare brushes cleaned 19, the ADA brush 16, and the Elmex Sensitive 10 of in average 28 tooth surfaces. With time, the number of additional cleaned surfaces decreased. Time is an important variable in the evaluation of plaque-removing efficacy since absolute efficacy increases with time and differs per toothbrush. No differences could be found between the two brush heads of the Sonicare.

Purpose: The aim of this study was to compare the effect of polishing after scaling and root planing on supragingival plaque, calculus formation, and gingival bleeding., Materials and Methods: The study was designed as a split-mouth randomised clinical trial. Seventy-six patients were submitted to supragingival scaling on the six mandibular anterior teeth with manual curettes until a smooth surface was achieved. Subsequently, quadrants were randomly selected to be polished (test) or not (control) with a rubber cup and pumice. One, two and three weeks following treatment, a blinded examiner evaluated the visible plaque index, gingival bleeding index and the presence of supragingival calculus on the lingual tooth surfaces., Results: The results showed that unpolished surfaces exhibited higher mean percentages of visible plaque in the third week. No statistically significant differences were observed between unpolished and polished sites related to gingival bleeding. Calculus formation was higher on unpolished sites than on polished sites at 2 and 3 weeks. Dental polishing after supragingival scaling contributed to reducing plaque and calculus formation., Conclusions: Polishing exerts an inhibitory effect on plaque and calculus formation.

Esthetic alterations (such as fluorosis) that result from intrinsic dental staining in enamel and dentin can be controlled or softened by noninvasive methods such as dental bleaching or enamel microabrasion. Part of the enamel is removed during microabrasion; however, this wear is clinically insignificant and does not harm the dental structure. This article presents a case in which the microabrasion technique was used to remove fluorosis staining. Based on the results of this case report, it can be concluded that this technique is efficient and can be considered a minimally invasive procedure.