Evaluation of Root Surface of Periodontally Involved Teeth after Manual, Ultrasonic, and Laser Instrumentation

Background : Complete removal of calculus is an integral part of achieving a biologically acceptable tooth surface in the treatment of periodontitis. An ideal instrument should enable the removal of all superfluous substances from the root surface, without causing any iatrogenic effect. This study was conducted to compare the efficacy in calculus removal by hand instrument, ultrasonic scaler and hand instrumentation combined with diode laser on the root surface as well as to compare the iatrogenic effects caused by these instruments. To compare the efficacy of calculus removal as well as to compare the roughness and loss of tooth substance caused after instrumentation with: (1) Hand instrument, (2) Ultrasonic scaler, and (3) Hand instrument + Diode laser application. Materials and Methods : A total of 30 extracted non-carious non-restored human teeth with a history of periodontal disease were randomly divided into three groups of 10 teeth each and subjected to scaling and root planing with the assigned instrument. Scanning electron micrographs were taken and interpreted by a blind investigator, the indices used for this study were: Remaining calculus index, loss of tooth substance index (LTSI), and roughness LTSI. The data obtained were analyzed using Kruskal-Wallis test. Results: No statistically significant differences were found between the three groups with respect to the efficacy of calculus removal and the iatrogenic effects caused by the instruments. However, the efficacy of ultrasonic scaler was marginally better, whereas the roughness caused after laser application was more when compared with the other groups. Conclusion: The results of this study show that all three instruments could be used for routine debridement of the root surfaces. Ultrasonic scalers were found to be more efficient than hand scalers. The result also suggests that the diode laser may be routinely used as an adjunct to scaling and root planing as the surface alterations caused were minimal.