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Abrasiveness of an Air-Powder Polishing System on Root Surfaces in Vitro

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Abrasiveness of an Air-Powder Polishing System on Root Surfaces in Vitro Abrasiveness of an air-powder polishing system on root surfaces in vitro Mette S. Agger, DDSVPreben Hörsted-Bindslev, DDSTOle Hovgaard, Objective: The purpose oí Ihis study was tc evaluate the abrasiveness of a new air polisher on roof surfaces. Method and materials: Fifty extracted human teeth were air polished for 5 seconds. Results: Ali root surfaces showed a circular defect visible wifh fhe naked eye. Scanning elecfron microscope examination showed smooth crater wails and a few open denfin fubules, but most seemed fc be obliterated. Laser profilomefry of the exposed areas revealed defecfs wifh an average depth of 484 ym, whereas fhe unexposed root surfaces showed irreguiarifies wifh an average depth of 323 gm. The depths of fhe abraded areas were evaluafed in relafion fo the values for the unexposed surfaces, and an average depth of 161 |jm was found.The difference befween the exposed and unexposed surfaces was statisticaliy significanf. Conclusion: The presenf sfudy indicates that the air polisher has a strong abrading effect on exposed roof surfaces and should therefore be used with caution on patients with gingival retractions. (Quintessence Int 2001:32:407-411 ) Key words: abrasiveness, air polishing, exposed roof surfaces Sound, mature enamel has been shown to be resis- CLINICAL RELEVANCE: Air polishing should be per- tant to air polishing and polishing with pumice with- formed wifh caufion on exposed root surfaces. out significant signs of abrasion lesions,^^ whereas air polishing on white spot lesions and enamel (where the prisms have been cut or ground) left an eroded he most common method used for tooth polishing surface.* Tis a rotating rubber cup and pumice. This method Several studies have demonstrated that the air pol- is often disappointing when attempting to remove very ishing device removes significant amounts of calculus, adherent stains and can be time-consuming and sound dentin, and cement,^'"'^ and furthermore, surface fatiguing for the dentist. To meet the demands for changes have been observed in restorative materials.'^•'•' more efficient and time-saving tooth polishing, alter- The abrading effect on root surfaces was shown in a native instruments have heen developed. Among study by Atkinson et al,' who found that the air pol- these, the air polisher operates hy directing a slurry of isher removed an average of 636.6 |im of root struc- high-pressure water, air, and sodium bicarbonate ture after exposure for 30 seconds. The 30 seconds against the tooth surface. would be the total amount of exposure time if the In vitro and in vivo studies comparing rubber cup patient was maintained on a 3-month recall for 15 and pumice with air polishing have found air polish- years with a 0.5-second blast from the device at each ing to be the most efficient and time-saving method visit. The abrading effect on root structure has been for removal of tooth stain and dental plaque.'-" confirmed in later studies.^.«'» and Kontturi-Narhi et al" found that cement covered with plaque showed greater abrasive changes after air pohshing than air- 'Research Associate, Department of Dental Pathology, Operative Dentistry, polished surfaces free of plaque. and EndodontJcs, Royal Dental College, Faculty ot Heallh Sciences, Gingival traumas have been recorded as a side University of Aartijs, Denmark. effect when the air poiisher is used.''=" Due to the 'Associate Professor, Departmenl of Dental Pathology, Operative Deniislry, cervical location of stain and piaque accumulation, and Endodonlics, Royal Dental College, Faculty of Health Sciences, soft tissue trauma is dift'icult to avoid. University oí Aartijs, Denmark, Kontturi-Narhi et al" found that the most erosive ^Assistant Clinical Professor, Department of Dental Pathology. Operative changes were seen in inftamed gingiva, and that the Demistry and Endodontics, Royal Dental College, Faculty of Health Sciences, University of Aarhus, Denrrark. severity of the changes was related to the periodontal Reprint requests: Dr Preben Horsted-Bindsiev, Department of Dental health status. In vivo studies showed no lasting differ- Pathology Operative Dentistry, and Endodontics, Royal Dental College, ence in gingival trauma between air polishing and University of Aarhus, Vennelyst Boulevard 9, DK 8O0O Aarhus C, Denmark. rubber cup treatment, but immediate post-treatment E-mail: [email protected] 407 Quintessence International • Agger et al The powder used for air polishing was supplied by the manufacturer. Tbe basic ingredient of the powder was sodium hydrogen carbonate, with addition of an orange flavor. A standard setting was used: The hand- piece was secured by a clamp to a metal stand, and eacb tooth was fixed with wax to a plastic cube and secured by a clamp. Tbe distance between tbe hand- piece nozzle and the tootb surface was 4 mm, with a preparation angle of 90 degrees. Tbe root surface was exposed for 5 seconds. After treatment, the teeth were removed from the plastic cube and rinsed with water to remove any excess sodium bicarbonate powder. All teeth were Fig 1 PR0PHYfie>!2, ttie air poiisher. profilometcr-scanned directly on the root surface with an optical profilometer (Micro focus 1080, UBM Messtecbnik).'" Next to the air-polisbed area, ati untreated root surface area of the same size as the air- polished area was profilomcter-scanned as a control. By random selection, 10 teeth were rinsed, dehydrated in alcohol, critical point dried, coated with carbon fol- evaluation sbowed an increase in gingival irritation lowed by a coating with 10 nm of platin, and exam- after air polishing.'-'^ ined in SEM. Recently, a modification of the previous air polisber Spray pressure of the air-ahrasive device without was introduced (PROPHYflex2, KaVo Dental) [Fig 1). powder and of the dental unit air-water syringe (A- The new instrument bas a Multiflex connection that dec) was measured hy a manometer (EMPEO) with a enables the practitioner to use it on all units, and com- custom-fit adaptor made hy tbe Technical Department pared to older air-abrasive instruments, the new at the Royal Dental College in Aarhus, Denmark. A device is easy to operate. The manufacturer describes computer statistical package (SPSS 8.0, SPSS) was the device as an efficient instrument for stain and used for statistical analysis. Means, standard deviation, plaque removal. Furtbermore, tbe device is recom- and ranges were calculated, and the data were ana- mended for polishing after calculus removal, cleaning lyzed using Student's paired i-test. enamel surfaces prior to fissure sealing, and preparing enamel cavities for befter bonding of restorative mate- rials to enamel. RESULTS The purpose of the present study, by use of scan- ning electron microscope (SEiVI) and laser profilome- Tbe exposed area of all teeth showed a circular defect try directly on the root surface, was to evaluate the of approximately 2 mm in diameter (Fig 2). SEM abrasiveness of a new air polisher on exposed root revealed smeared crater walls where most dentin surfaces. tubules seemed to be obliterated (Fig 3). The pro- filometer scan showed a crater-like penetration with the deepest point centrally located (Fig 4) and an METHOD AND MATERIALS average depth of 484 pm, witb a range of 191,3 to 917 ym (SD = 196). The unexposed root surfaces showed Fifty fully developed buman teeth were chosen from a irregularities from 109.6 to 592 pm (SD = 153), with collection of extracted teeth and stored in 1% an average deptb of 323 pm. The depths of the cblorhexidine; all tooth types were represented. The abraded areas were evaluated in relation to the unex- teeth were examined under a macroscope (Wild posed root surfaces, and an average deptb of 161 pm M420) at x80 magnification and met the following was found (SD = 126). Tbe difference in depth mea- criteria: (1) the root surface showed a clinically sound surements ranged from -48 to 494 pm. surface without caries or fillings, although some root The values of eacb tooth were found by subtracting surfaces were abraded; (2) the surface was intact and tbe surface measurements on the unexposed root sur- showed no marks from the extraction forceps; (3) face from the surface measurements of the exposed there was no visible calculus, but variable degrees of area. One negative value was seen, meaning that one discoioration; and (4) the chosen area on tbe root sur- tooth showed surface irregularities deeper than the face was witbout fiber-inserted cementum. exposed irregularities. The difference between exposed 408 Volume 32, Number 5. 2001 Agger et ai Fig 2 Scanning electron microscope stiowing a circular detect Fig 3 Scanning electron microscope of ttie surface of ttie after air polistiing tor 5 seconds (Original magnilicalion x4S). smeared crater wali. (Original magnification x1850). 155 [j Fig 4 Prcfiiometerscan of ttie ai>potished area showing a circuiar defeot witii the deepest pcint centraliy iocated. and unexposed surfaces was statistically significant studies of surface alterations have used different meth- (P< 0.00001). ods to describe the abrading effect of air-abrasive Input pressure of air and water into the air polisher devices. Repiicas have heen weighed to find the amount and syringe was 4.1 and 2.0 ban, respectively. Output of lost root structure/" replicas of the tooth surface spray pressure at the nozzle ranged from 3.10 to 3.15 before and after treatment have been compared in ban-(mean = 3.11; SD = 0.02) for the air polisher and SEM," radioactive teeth have been treated to estimate from 3.40 to 3.50 barr (mean = 3.46; SD = 0.05) for the amount of lost root structure/'^" or the heights of the air-wat er syringe. rephcas have been measured.^ When laser-profilometry is used, a more precise abrasion depth may be found, because the measurements are done directly on the DISCUSSION tooth surface.
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