Aim: To assess the roughness and loss of substance of tooth surfaces after instrumentation with AirFlow, ultrasonics, hand instruments and polishing methods or their different combinations. This was a pilot study.
Materials and methods
Post extraction, impacted 3rd molars were marked and stored teeth were then divided and subjected to the following treatments:
- 1A – Airflow EMS PLUS powder at 2mm distance for 5 sec with a pressure of 1.8 bar at an angle of 45° with a wiping movement
- 1B – Airflow EMS PLUS powder +conventional polishing with rubber cup and polishing paste of varying RDA 170>120>40>7
- 2A – Ultrasonic EMS with PS instrument for 60 sec/ surface, brushstroke movements, pressure ~ 30p
- 2B – Ultrasonic + Airflow EMS PLUS powder used as above
- 2C – Ultrasonic + conventional polishing used as above
- 3A – Hand scaler/ curette. On enamel scaler curved. On root Gracey curette from Deppeler blue, scaling movement per position one stroke
- 3B – scaler/ curette + Airflow EMS PLUS powder as above
- 3C – scaler + Airflow EMS PLUS powder +Conventional polishing as above
- 3D – scaler + conventional polishing as above
- Substance loss and roughness were assessed 2 control groups: enamel untreated, cementum untreated
Results
On enamel: Group 1: Airflow
• There are no additional benefits in conventional polishing and Airflow in comparison to using AIRFLOW alone
Group 2: Ultrasonic
• In comparison to Air-Flow, all other instrumentations produced small roughness values. Additional conventional polishing does not alter the overall results.
Group 3: Hand instrument
• Hand instrument scaler also causes a loss of substance in the enamel. No additional improvement by additional instrumentation with Air-Flow, conventional polishing or a combination of both.
On cementum: Group 1: AirFlow
Slight roughness due to additional conventional polishing.
Group 2: Ultrasonic
Ultrasonic produces a smooth cementum surfaces with low roughness values, which are not significantly altered by combinations with Air-Flow or conventional polishing.
Group 3: Hand instrument
Gracey curette: A smooth surface is produced of the processed cementum, addition of Air-Flow worsens the result, polishing measures as already described above lead to an apparently smoother surface.
Conclusions
- Air-Flow with PLUS powder produces the highest level of cleaning on enamel and cementum in comparison to ultrasonics or hand instrumentation.
- Repeated instrumentation, too high pressure and too long exposure times lead to high substance loss with all systems.
- Use of conventional instrumentation leads of unnecessary over instrumentation especially in use on ceramics or restorations
- Airflow is the most efficient solution providing maximum tooth preservation
- Ultrasound and hand instruments enable a stripe-shaped cleaning pattern through punctiform contact with the tooth surface. A planar pattern is achieved with Air-Flow. This makes it easier to achieve a homogeneous result on large surfaces. This is much more difficult with ultrasound and hand instruments and quickly leads to grooves and furrows.
Recommended treatment approach is:
- Assessment followed by disclosure for motivation
- Deep cleaning with Air-Flow followed by ultrasonic if necessary
- Quality check for remaining stains, biofilm or calculus
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