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AIM The World Health Organization (WHO) periodontal probe is recommended for epidemiologic surveys and periodontal screening, but its ability to identify subgingival dental calculus (DC) relative to a #11/12 explorer is not known. This study compared in vitro the ability of the WHO probe and a #11/12 explorer to detect subgingival DC. MATERIALS AND METHODS Three typodont models with randomly distributed artificial DC on mandibular molar and premolar root surfaces were assessed with a WHO periodontal probe and a #11/12 explorer by two periodontists. The diagnostic performance of the two instruments for subgingival DC detection was compared using 2 × 2 contingency table analysis. RESULTS A #11/12 explorer provided better reproducibility, a higher level of sensitivity, higher positive predictive values, higher negative predictive values, and greater overall accuracy (diagnostic effectiveness) (76.9% vs. 68.5% for the first periodontist; 87.0% vs. 75.0% for the second periodontist) for detection of subgingival DC than the WHO probe. CONCLUSION The in vitro diagnostic performance of a #11/12 explorer was superior to the WHO periodontal probe for identification of subgingival DC. CLINICAL SIGNIFICANCE A #11/12 explorer, rather than the WHO probe, is recommended for identification of subgingival DC.

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.

This study evaluated the effectiveness of swept-source optical coherence tomography (ss-OCT) for detecting calculus and root cementum during periodontal therapy. Optical coherence tomography (OCT) images were taken before and after removal of subgingival calculus from extracted teeth and compared with non-decalcified histological sections. Porcine gingival sheets of various thicknesses were applied to the root surfaces of extracted teeth with calculus and OCT images were taken. OCT images were also taken before and after scaling and root planing (SRP) in human patients. In vitro, calculus was clearly detected as a white-gray amorphous structure on the root surface, which disappeared after removal. Cementum was identified as a thin, dark-gray layer. The calculus could not be clearly observed when soft tissues were present on the root surface. Clinically, supragingival calculus and cementum could be detected clearly with OCT, and subgingival calculus in the buccal cervical area of the anterior and premolar teeth was identified, which disappeared after SRP. Digital processing of the original OCT images was useful for clarifying the calculus. In conclusion, ss-OCT showed potential as a periodontal diagnostic tool for detecting cementum and subgingival calculus, although the practical applications of subgingival imaging remain limited.

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.

The objective of this study is to compare the performance of the DIAGNOdent laser fluorescence (LF) Pen to conventional periodontal probing for detection of subgingival calculus under defined laboratory conditions. Extracted teeth with various levels of subgingival deposits of calculus were mounted anatomically in stone casts, and an impression material was used to replicate periodontal soft tissues. The casts were examined for the presence of subgingival calculus at eight surfaces per tooth (240 sites) using LF and a periodontal probe. Sites were rescored after 1 and 3 weeks. Direct imaging of the root surfaces under magnification was the gold standard. As a result, for an experienced operator, LF was more accurate than tactile assessment (across all sites, 84.0% vs. 59.8%). The performance difference was greater for multi‐rooted teeth (85.8% vs. 56.9%) than single‐rooted teeth (77.2% vs. 66.7%). The performance of LF in this laboratory trial was influenced strongly by clinician skill and experience. When used by an experienced operator, LF was more sensitive (75.1% vs. 69.2%), specific (92.6% vs. 86.3%), and accurate (84% vs. 77.9%) than for an inexperienced operator. In conclusion, under the defined laboratory conditions used, LF had better performance than tactile examination, particularly for multi‐rooted teeth. This method may have value clinically as an adjunct for detecting subgingival deposits of calculus in clinical practice. The usefulness of the method improves with operator experience.

Subgingival debridement is the part of nonsurgical therapy which aims to remove the biofilm without intentionally removing the cementum or subgingival calculus. The objective of this review was to describe the end point of this therapy, the different methods used and how often it should be carried out. The literature shows that several methods are currently available for subgingival debridement, namely hand instrumentation, (ultra)sonic instrumentation, laser, photodynamic therapy and air-polishing. None of these methods seems superior to any other regarding clinical benefits or microbiological differences. However, less treatment discomfort is reported using laser, photodynamic therapy or air-polishing compared with hand- and/or (ultra)sonic instrumentation. Subgingival debridement can be carried out when, during supportive periodontal therapy, pockets of 5 mm or deeper are detected. ispartof: Periodontology 2000 vol:75 issue:1 pages:189-204 ispartof: location:Denmark status: published

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.

The aim of the study was to overview the gingival and periodontal disease in children and adolescents aged 12 to 15 years in Belgaum city. Visible plaque, gingival bleeding, supragingival and subgingival calculus and periodontal pockets were measured. Examination of buccal, lingual and mesial areas of each tooth was recorded sequentially in both arches using Gingivitis and Periodontitis Site Prevalence Index (WHO, 1978). The prevalence of gingival and periodontal disease was more in males than females and in Hindu population compared to others. The sites affected by gingivitis and periodontitis increased with the age. Periodontal problems were significantly more prevalent in patients with betel nut chewing habit. Visible plaque was most common while periodontal pockets were least common in the adolescents. Age, socioeconomic status, brushing habits and brushing frequency did not affect much to the prevalence of sites of gingivitis and periodontal disease. It was concluded that early diagnosis and preventive measures would surely reduce the growing problem of gingival and periodontal diseases among the children and adolescents.

Among commonly used lasers in dentistry viz CO2, Nd:YAG, Ho:YAG, Er: YAG, Er, Cr:YSGG, Nd:YAP, GaAs (diode) and argon, Er:YAG laser, at appropriate settings, possesses the best property for selective subgingival calculus removal without a thermal change of the root surface, soft tissue surgical procedures, root surface alterations, degranulation and implant surface decontamination alongwith proposed application in osseous surgery. Epithelial exclusion using CO2 laser has been suggested to retard its downward growth. Waterlase® and PeriowaveTM systems are recent devices that have further revolutionised the laser techonology for its favourable clinical applications; however, the procedural cost with the laser device still constitutes an obstacle for its routine application.

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.

Orthodontic therapy is not contraindicated for patients with advanced periodontal destruction, provided that factors such as inflammation, plaque, subgingival calculus, and occlusal trauma are well controlled both before and during the orthodontic treatment. The application of extremely light continuous forces might have a better effect on the cell biology of tooth movements. By minimizing necrosis, and the subsequent hyalinization and indirect resorption, it might be possible to achieve continuous progress in tooth movement, avoiding the repeated interruptions occurring when the blood vessels are occluded, and reducing the great risk for further bone loss when treatment is rendered for individuals with decreased osseous support. A new generation of low friction, passive self-ligating brackets, in combination with newer wire and coil materials and longer activation spans, seems to be capable of exerting lower force levels providing more favorable periodontal reactions in patients with previous bone loss. A patient treated following these principles and using these newer technologies is presented. (Semin Orthod 2008;14:36-45.) © 2008 Elsevier Inc. All rights reserved.

Aim:We have recently tested a surface detection system based on a conventional dental ultrasonic scaler in vitro. The aim of the present study was to investigate sensitivity and the specificity of the detection device in vivo. Material and Methods:Subgingival buccal surfaces of 63 arbitrarily selected periodontally compromised teeth were scanned intra-orally, while the supragingival positions of the insert, along with the corresponding signals of the detection system, were saved as separate files. After extraction, the surface detection results were evaluated by re-positioning the inserts’ position on the tooth in vitro and comparing the detection results with visual findings. Results:On the scanned tooth surfaces, there were 44 calculus spots, which covered 22.3% of all scanned surfaces (prevalence). The calculus-free surface was divided into ‘‘spots’’ mathematically. The device correctly classified 40 calculus and 125 cementum spots, whereas four calculus and 28 cementum spots were classified incorrectly. Calculus and cementum were discriminated with a sensitivity of 91% and a specificity of 82%. The positive and negative predictive values were 0.59 and 0.97. Conclusion:The surface detection device was able to clinically differentiate cementum and calculus in vivo. Therefore, this method may support the decision of whether continued subgingival scaling could damage the cementum.

Objective: To identify risk factors, risk predictors and risk determinants for onset and progression of periodontitis.Material and Methods: For this longitudinal, prospective study all subjects in the age range 15-25 years living in a village of approximately 2000 inhabitants at a tea estate on Western Java, Indonesia, were selected. Baseline examination was carried out in 1987 and follow-up examinations in 1994 and 2002. In 2002, 128 subjects could be retrieved from the original group of 255. Baseline examination included evaluation of plaque, bleeding on probing, calculus, pocket depth, attachment loss and presence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, spirochetes and motile microorganisms.Results: The mean attachment loss increased from 0.33 mm in 1987 to 0.72 mm in 1994 and 1.97 mm in 2002. Analysis identified the amount of subgingival calculus and subgingival presence of A. actinomycetemcomitans as risk factors, and age as a risk determinant, for the onset of disease. Regarding disease progression, the number of sites with a probing depth >= 5 mm and the number of sites with recession were identified as risk predictors and male gender as a risk determinant.Conclusion: Screening of these parameters early in life could be helpful in the prevention of onset and progression of periodontal diseases.

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.

This aim of this study was to evaluate the clinical effectiveness of Er:YAG laser at a high pulse rate (ER-D1: HOYA continuum, Japan) for scaling of subgingival calculus and root planning. Sixty-one patients with calculus deposition were treated with the Er:YAG laser (panel setting 30–108 mJ/pulse, 30 Hz) using contact tips and the results were then subjected to clinical analysis. Clinical assessments of calculus index, pain, redness, swelling, discomfort, roughness of root surface, efficiency of scaling, PlI, PD, BOP and mobility were made prior to and at 1, 4 weeks and 3 months after treatment. Fifteen of the sixty-one patients were treated during the flap operation. The Er:YAG laser high-pulse-rate irradiation was capable of ablating the calculus on the root surface precisely and effectively. The roughness of root surface after debridement was evaluated to be adequately plane for 41 cases and still rough for 20 cases. BOP and PD were significantly improved throughout the 3-month examination of this study. No negative side effects or influences were observed on the healing of periodontal tissue following Er:YAG laser irradiation during this clinical study. In conclusion, the Er:YAG laser high-pulse-rate irradiation would be a safe and effective, alternative method for root surface treatment in both nonsurgical and surgical periodontal therapy.

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.

Les effets du tartre sous-gingival sur les comportements cliniques de l'application locale de doxycycline a liberation controlee par comparaison avec le detartrage/surfacage radiculaire Origine, but: Les effets du tartre sous-gingival sur les comportements cliniques de l'application locale d'antimicrobiens sont inconnus. Cette etude examine le comportement clinique de traitement consistant en l'application locale de doxycycline a liberation lente (DH) ou en un detartrage/surfacage radiculaire seul (SRP) dans des groupes de patients atteints de parodontite de l'adulte avec des niveaux initiaux de tartre sous-gingival connus. Methodes: Les donnees examinees sont obtenus chez 393 patients qui participerent a 2 essais multi-centriques. Chez tous les patients, les niveaux de tartre sousgingivaux initiaux furent evalues et ils furent traites a 0 et a 4 mois avec soit DH, soit SRP. Les niveaux d'attache clinique (CAL), les profondeurs de poche (PD) et le saignement au sondage (BOP) furent evalues initialement et a 1, 2, 4, 5, 6, 8 et 9 mois. Resultats: Le traitement avec les 2 methodes apportait des ameliorations statistiquement significatives pour CAL, PD et BOP. Ces comportements cliniques etaient equivalents quel que fut l'importance du tartre sous-gingival initialement. Conclusions: Les resultats indiquent que les effets cliniques primaires de ces traitements sont le resultat de la reduction et de la desorganisation de la plaque sous-gingivale et non pas l'effet de l'elimination du tartre sous-gingival et du cement contamine.

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.