Comprehensive Evaluation Of The Different Basic Periodontal Treatment Techniques

Periodontal disease is chronic infection of periodontal supporting tissues disease caused by dental plaque microorganisms, the chronic periodontitis which caused great harm has become the main cause of adult tooth loss.As a chronic disease, the treatment of periodontitis also requires a long process of gradual implementation, we should develop an individually and orderly treatment plan for every patient. But, periodontal non-surgical treatment is all first stage of periodontal treatment, which is also the critical stage and the most basic treatment of each patient. Supragingival scaling, sub gingival scaling and root planning using instruments to remove plaque and calculus from tooth surfaces, to achieve the object of elimination of risk factors and enhancement of connective tissue reattachment, is the most important and fundamental content of periodontal treatment. Currently, commonly used equipment in clinic is ultrasonic scaler and Gracey curette. Gracey curette is region-specific scaling device, it features a unique curved blade and long neck, A variety of complex curved shape designed to root for the scaling of the operation make the scaling becomes relatively easy. However, because the root surface morphology and parts of complex, there are many drawbacks during deep points and posterior parts of area operations for hand instruments. Such as operational difficulties, low efficiency, patient discomfort, postoperative root surface sensitive, doctors fatigue and susceptibility to carpal tunnel syndrome. With the development of ultrasonic technology, ultrasonic treatment has become the mainstream of periodontal treatment. However, the current treatment are still located in two types of ultrasonic devices (piezoelectric ceramic or magnetostriction). The movements of the tip are easy to produce root vibration which cause patient discomfort and may even damage the root surface. In addition, the work produced cavitation, water and local self-generated aerosol in the effusion contains a large number of pathogens, making the possibility of cross-infection. In the course of treatment, the working principle, efficiency and correct selection of different treatment devices will greatly influence the efficacy and patient response. In addition, patients with pain and discomfort caused by a variety of different levels of fear, will seriously affect patient compliance of periodontal treatment, lead to delay or avoid treatment, missed the best time for treatment, then easily aggravated periodontal tissue destruction. Therefore, based on the quality of scaling, how to reduce the pain of patients and improve the comfort of the treatment to stabilize patients with mental state, is an important aspect of periodontal treatment improving.Vector is the latest development of dental ultrasonic treatment system for periodontal treatment. Vector system is different from the traditional methods of periodontal therapy, it can reduce the pain as well as ease the fear of patients. However, currently there is little domestic in vitro and in vivo experiments dedicated to comprehensive comparison and evaluation of Vector system and conventional periodontal treatments efficacy as well as advantages and disadvantages. It brings certain difficulties for reasonable choice of clinical application. Our experiment was assessing efficacy of Vector system, Gracey instruments and ultrasonic scaler for chronic periodontitis therapy from the in vitro and in vivo experiments, and provided some guidance for clinical treatment method.Objective:The aim of in vitro experiment was to evaluate the influence of root surface roughness and periodontal ligament cell adhesion and proliferation of teeth affected by periodontal disease. The aim of in vivo experiment was to compare the clinical application characteristics and the level of fear of vector system and manual instruments in treating of chronic periodontitis patients. To evaluate the effect of periodontal non-surgical treatment with Vector Systems, Gracey instruments and ultrasonic scaler.Method:1. 24 extracted teeth which were affected by periodontal disease were sorted into 3 groups in random: Gracey treatment group, ultrasonic treatment group and Vector treatment group. In each treatment group, 2 root specimens were chosen to observe surface roughness by AFM; 2 root specimens were chosen to observe root surface morphology change by scanning electron microscope. Other 12 root specimens were incubated with periodontal ligament cell. 1,3,5 days after incubating, cell's adhesion was observed by SEM and DAPI dyeing was used for cell counting.2. 30 patients with chronic periodontitis were randomly divided into two groups: Gracey scaling control group and Vector Systems group,15 cases each, filling the dental fear scale and detecting the clinical parameters (BOP, GI and PD) before the treatment; filling the DFS again 1 month after treatment, and detecting the clinical parameters 1,3,6 month after treatment.Result:1. The roughness of Vector treatment group were lower than Gracey treatment group slightly, but significantly lower than ultrasonic treatment group; The cell's attachment situation of Vector treatment group were similar to Gracey treatment group 1 day after incubation, With the inocubation time extend, the cell's Number of Vector treatment group and Gracey treatment group were significantly higher than ultrasonic treatment group.2. Vector system and Gracey group both can reduce the mean BOP, GI and PD obviously. Most patients fell Vector more comfortable than Gracey scaling, Vector system can achieve painless or slightly painful, can be tolerated.3. DFS subjective scale: The mean DFS of Gracey group increased, but the mean DFS of Vector group decreased significantly. There were significant differences of DFS score between two groups.Conclusion:1. Vector treatment group can get smooth root surface morphology and the relatively less loss. This will be a reasonable choice for the treatment of moderate periodontal.2. Vector system apply with polish liquor can promoting fibroblast attachment and proliferation after root scaling.3. Root scaling with Vector system can get the similar effect as Gracey instruments.4. Compare with Gracey instruments, the Vector system can reduce the psychological fear level and stimulation for treatment of anxiety, it can maintain better mental state as well as improve patient compliance.