by Michael Haas, Martin Koller, Behrouz Arefnia
The objective of this pilot study was to investigate the roughness and loss of substance of tooth surfaces after instrumentation with AirFlow, ultrasound, hand instruments and polishing methods or their combinations.
In addition to the possible differences between the technologies, the extent to which polishing of enamel and cementum surfaces is possible was to be clarified. Instrumentation of tooth surfaces with the objective of biofilm
removal is always inevitably accompanied by a loss of substance in the areas to be cleaned. Ideally speaking, only the 3–7 μm layer of endotoxin invasion should be removed in addition to the biofilm from the cementum. (Fig. 1). Overinstrumentation quickly leads to the complete loss of the cement and the resulting healing of the defect.
The substance removal of cementum with conventional technologies has been quoted for ultrasonic scalers as being 6.3–55.9 μm, for acoustic scalers as 93 μm and for curettes or rotary instruments as being over 100 μm.[1, 2, 3] The development of new powders based on glycine, erythritol+CHX and trehalose has led to a renaissance of the Air-Flow system.[4-6] The effectiveness is comparable to that of ultrasound at an exposure time of only 5 seconds, and no significant loss of substance was found even at longer processing times. In addition to damage to the root surface, the roughness achieved plays a central role in periodontal healing, with values of 7 μm maximum being quoted which are comparable to untreated surfaces. A systematic review with 17 publications also confirms these results in clinical application.
Perfect cleaning without defects is also observed on enamel with erythritol+CHX, whereby the necessity of additional polishing is being discussed here. The objective of our study is to determine how the various surface treatment methods (Air-Flow, ultrasound, hand instrument, polishing) behave in comparison on enamel and cementum, and whether it is even technically possible to polish a hard enamel surface.