By Massimiliano Ricci, DDS, PhD(C)
Nowadays scientific literature indicates that full mouth therapy is the best choice for patients suffering from moderate or advanced forms of periodontitis; however, a lot of aspects of full mouth approach are still under debate. For instance, the use of chlorexidine was considered essential for such a protocol, but some authors reveal that improvements in attachment levels or probing depth were similar when chlorexidine was used or not. Regarding instrumentation, currently the reduction of damages should be carefully considered by dental hygienists. In fact, it is well known that complete removal of the cementum may cause the entrance of bacteria in dental tubules. This fact, as a consequence, may bring about the proliferation of the same bacteria and, in conclusion, the reactivation of periodontitis after years. Therefore, fundamental requisites of periodontal therapy are the creation of a smooth surface and the preservation of cementum which can prevent bacteria from invasion of tubules. Several studies showed that manual curettes provoke a lot of damage to the root surface, inducing an increase of roughness of the treated area and favoring the adhesion of bacteria. On the other hand, piezoelectric and magnetostrictive instruments are able to remove high percentages of bacteria preserving the integrity of the root. However, there are a large number of differences between these two instruments which a dental hygienist should be aware of. The greater vibration of the magnetostrictive tips and the direction of the movements (circle movement vs. lateral movement of piezoelectric ones) are responsible for a reduction of damage and better removal of calculus. Yet, it should be emphasized that if the magnetostrictive instrument is used at the highest power, the percentage of damage will be significantly higher than piezoelectric instruments. Moreover, under this condition, the discomfort of the patient will be great. Therefore, most studies recommend the use of magnetostrictive instruments at low power levels, indicating this type of instrument as the best choice for good therapy of the periodontal patient.
Nowadays scientific literature indicates that full mouth therapy is the best choice for patients suffering from moderate or advanced forms of periodontitis; however, a lot of aspects of full mouth approach are still under debate. For instance, the use of chlorexidine was considered essential for such a protocol, but some authors reveal that improvements in attachment levels or probing depth were similar when chlorexidine was used or not. Regarding instrumentation, currently the reduction of damages should be carefully considered by dental hygienists. In fact, it is well known that complete removal of the cementum may cause the entrance of bacteria in dental tubules. This fact, as a consequence, may bring about the proliferation of the same bacteria and, in conclusion, the reactivation of periodontitis after years. Therefore, fundamental requisites of periodontal therapy are the creation of a smooth surface and the preservation of cementum which can prevent bacteria from invasion of tubules. Several studies showed that manual curettes provoke a lot of damage to the root surface, inducing an increase of roughness of the treated area and favoring the adhesion of bacteria. On the other hand, piezoelectric and magnetostrictive instruments are able to remove high percentages of bacteria preserving the integrity of the root. However, there are a large number of differences between these two instruments which a dental hygienist should be aware of. The greater vibration of the magnetostrictive tips and the direction of the movements (circle movement vs. lateral movement of piezoelectric ones) are responsible for a reduction of damage and better removal of calculus. Yet, it should be emphasized that if the magnetostrictive instrument is used at the highest power, the percentage of damage will be significantly higher than piezoelectric instruments. Moreover, under this condition, the discomfort of the patient will be great. Therefore, most studies recommend the use of magnetostrictive instruments at low power levels, indicating this type of instrument as the best choice for good therapy of the periodontal patient.
Massimiliano Ricci, DDS, PhD(C), was born March 22, 1983, in Massa, Tuscany. He received his dental degree at Pisa University with the maximum score. He works as a general dentist in his office in Sarzana, La Spezia, Liguria. Dr. Ricci is concluding his PhD at Genoa University, focusing his research on implant bone reconstructive surgery. He is an author of several articles in international journals. He is also a speaker at many congresses.
