Analysing root roughness and smear layer relationship by comparing contemporary dental curettes with conventional dental curettes: a randomised controlled trial

Abstract

Background Root debridement procedures for the treatment of periodontal diseases, produces root surface irregularities and smear layer on the root surface that can adversely affect the healing of periodontal tissues. The objective of the present study was to evaluate the surface texture of root after hand instrumentation with Gracey curette, After Five curette, and Mini Five curette. Methods A randomised, controlled clinical trial was conducted with 120 participants clinically diagnosed with chronic periodontitis. Participants were equally randomised into four groups, with parallel treatment assignment of scaling and root planning using Gracey Curettes, After five and Mini five curette, and a control group with no instrumentation. Mobile teeth of these patients were then extracted atraumatically and analysed under a Scanning Electron Microscope and graded for "Roughness and Loss of Tooth substance index" and "Smear layer index." Cross Tabulation was made between the test groups (Control, Gracey Curette, After five, and Mini Five) versus "Roughness and Loss of Tooth substance Index" and "Smear Layer Index." A Chi-square test with Bonferroni correction was used to determine the graded distribution among the groups. Results In the control group, 73.3% of the teeth showed grade 1 roughness. In the Gracey group, 56.7% showed grade 2 roughness; in the After 5 group, 70% showed grade 3 roughness; in the Mini 5 group, 76.7% showed grade 3 roughness. A significant association was found between roughness scores and the use of individual instruments. Regarding smear layer formation, 46.7% of teeth showed a grade 4 smear layer in the control group. 50% of teeth showed grade 2 smear layer thickness in the Gracey group. In the After 5 group, 73.3% of teeth showed a grade 1 smear layer, while in the Mini 5 group, 80.0% showed a grade 1 smear layer. The use of individual instruments was significantly associated with the smear layer scores. Conclusion Gracey curettes produced relatively smoother root surfaces with less smear layer formation than After Five and Mini Five curettes, which produced relatively more roughened root surfaces with thicker smear layer formation. Trial registration ID: ClinicalTrials.gov Identifier: NCT04216966 Date of Registration: January 3, 2020.

Efficacy of Non-Surgical Periodontal Therapy with Adjunctive Methylene Blue and Toluidine Blue O Mediated Photodynamic in Treatment of Periodontitis: A Randomized Clinical Trial

“…However, cumulative evidence suggests that ultrasonic-based devices and manual instrumentation are equally effective in treating periodontal pockets [ 18 ]. Additionally, root surfaces demonstrated rougher surfaces, more gouges, and thicker smear layers when curettes were used as compared to ultrasonic scalers [ 27 , 28 ].…”

Evaluation of the relationship between periodontal bone destruction and mesial root concavity of the maxillary first premolar

“…According to our research, the presence of mesial concavity in the upper first premolar teeth could be a factor in the development of periodontitis. In this instance, treatment should focus on these unique anatomical regions with appropriate instruments, such as Mini Five curettes, whose blades are half the size of After Five or regular Gracey curettes [ 21 ]. A shorter blade allows easier insertion and adaptation in deep, narrow pockets; furcation areas; developmental grooves; line angles; and deep, tight facial, lingual, or palatal pockets [ 22 ].…”

Micro‐CT evaluation of the effect of various ScRp instrumentation methods on cement loss, porosity and micro‐crack formation

“…Clean root surfaces have the clinical importance of minimalizing bacterial plaque accumulation, therefore preventing calculus, 3 and easing the reattachment of fibrous tissue of the gingival. 6,22 Some studies on plaque accumulation showed a positive relation between root surface roughness and plaque growth. 23 However, the surface roughness effect of the instruments used is still not clear.…”

“…3,4 Surface qualities are not important for physiological tissue healing but is for regeneration. 5,6 Many clinicians believe that a clean and hard tooth surface is the endpoint of mechanical scaling and root planning (SRP); but this may lead to pulpitis or hypersensitivity after extensive removal of hard tissues. 7 So, it is recommended to remove as little tooth structure as possible to obtain a shapely surface.…”