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Background: Periodontitis is caused by microorganisms in the plaque tooth supporting tissues of chronic infectious diseases, lead to periodontal tissue inflammation, formation of periodontal pockets and alveolar bone resorption, which may eventually lead to tooth mobility and be removed. Plaque initiating factor of periodontal disease, subgingival plaque periodontal pathogens survival of micro-ecological environment, the gap in the periodontal pocket depths of the root surface and periodontal pocket with teeth peripheral tissue is most closely related. The periodontitis treatment goal is to control plaque and eliminate inflammation after to restore periodontal tissue physiological morphology and function, to prevent recurrence. The core part of periodontal treatment is plaque control. The main way to control the plaque is the mechanical scaling and root planing. Effectively remove subgingival plaque and calculus, improve the periodontal pocket microecological subgingival scaling and root formation is an important step in the treatment of moderate to severe chronic periodontitis. But complete removal of subgingival calculus and plaque, root planing, physician experience of different factors such as calculus residual amount up to 3% -80%. At the same time, in recent years, many studies have shown that, in the the periodontal treatment process, regardless of the use of hand or machine instruments used, will cause root hard tissue loss. Ultrasonic instruments, the greater the power, the longer the time, the greater the trauma to the tooth surface, the more damage to the dental hard tissue. Especially when cementum the exfoliative cause under dentin exposure, prone to dentin hypersensitivity or root caries occurrence. Even the bacteria invade pulp from exposed dentin small tube, causing pulpitis. The root of the surface structure change was rough, irregular fissures, lacunae, for the newly formed plaque, tartar stranded provide convenient conditions not conducive to the clean-up of the self-cleaning effect. And periodontal maintenance on a regular basis, even though every time scaling the loss of only a small amount of cementum, their cumulative effect can also cause serious damage to the root, thus affecting the efficacy of maintaining periodontitis. In this case, how both efficient and thorough removal of subgingival calculus and plaque, while minimizing the damage caused by the root surface and the root surface is smooth, clean, has become a new research direction. Periodontal scaling, tooth polishing can effectively remove plaque, to increase tooth surface finish, slow plaque and pigmentation. The conventional polishing methods, such as a rubber cup polishing can not be polished at the subgingival root surface. Sandblasting technology can enter the periodontal space, but the traditional method using sodium bicarbonate particles the sand powder abrasion resistance is too strong, and easy on the root surface and periodontal soft tissue damage. Many studies have shown that on the exposed root surface or dentine blasting will cause significant tissue damage, and therefore the root surface polishing for periodontal pockets has been a problem. In recent years, with the emergence of new instruments and materials, low wear of the polishing material and a small operating head subgingival root surface polishing it possible. Subgingival root surface polishing, also known as periodontal pockets polishing, the use of new technologies and materials, break past the limitations of the sandblasting polishing, sandblasting polishing the root surface into the periodontal pockets. Subgingival root surface polishing can reduce the residual root plaque dirt, the root surface is more smooth, flat, slow plaque, tartar redeposition, the effect of the consolidation. Glycine (Glycine) particles of a water-soluble low abrasion resistance of materials, using glycine as the main raw material of a new blasting sand particles sleek, small particle size, low abrasion resistance and a water-soluble powder having advantages. EMS company Air-Flow Master sandblasting system in addition to the traditional supragingival sandblasting treatment, you can also use the new sand powder Perio-Flow glycine particles mainly matrix subgingival root surface polishing. Flemmig, TF and Petersilka, GJ et al studies have shown that glycine particles as the main component of the new subgingival polishing material on the root surface damage, histological observation also prove that there is no obvious damage to the soft tissue, deep periodontal pockets root surface polishing. Foreign scholars plaque staining the technical effect of removing plaque, the study results show that the use glycine particles on each tooth surface sandblasting polishing 5s in probing depth less than or equal to 3mm sites showed significant effect. Bacteriology research also proved that regardless of the buccal and lingual or near and far side of the periodontal pocket, the glycine sand powder subgingival polishing techniques are more effective than traditional manual reduction of subgingival plaque. Therefore this subgingival root surface polishing techniques contribute to the treatment of periodontal disease, is expected to become the new secondary periodontal treatment. Foreign scholars study focused on its low wear resistance, less clinical efficacy studies, while domestic research of new materials and technology is still a blank. Objective: To use the new blasting material Perio-Flow subgingival root surface polishing teeth on complete periodontal treatment, morphology was observed by scanning electron microscopy after the root surface, taking pictures, and study the technology it be root surface damage; root surface roughness of the surface brightness detected changes in the use of statistical methods to analyze whether the new technology enables the root surface is more smooth, flat. Check through clinical indicators to analyze whether the new technology will help reduce the inflammation of periodontal tissue, reducing clinical probing depth, and promote tissue healing. The new subgingival polishing material so as to assess the use subgingival root surface polishing treatment of chronic periodontitis, and provide experimental evidence for the clinical application of new technology. After polishing methods: the first part: subgingival root surface roughness comparison sample selection: select necessary to remove a single severe periodontitis front teeth 10, require the patient to the health, age 35-70 years old, diabetes and other systemic system diseases, women not pregnant or breast-feeding, no bad habits such as smoking and alcohol. Selected teeth should meet the following requirements: ① chronic periodontitis, Ⅲ degree loose; ② teeth interproximal probing depth 4-6mm; ③ nearly six months did not undergo periodontal treatment (scaling, scaling, root planing); ④ teeth interproximal caries or fillings, restorations; ⑤ no acute inflammation. Sample processing: teeth meet the requirements of one week after the completion of the supragingival scaling subgingival scaling mesiodistal root surface below the gingival margin, until the probe checks the root surface is smooth, hard and far. The course of treatment using the same ultrasound equipment and power, all operations are done by the same surgeon. 10 teeth after basic treatment will be completed near and far the the 20 CPC root surface were randomly divided into 2 groups. New Perio-Flow sand powder test group teeth with periodontal pockets of scaling subgingival root surface polishing, the control group only spray as a control. Recording whether the patient has pain or other discomfort during treatment. Treatment complete with a small ball drill a shallow trench at the gingival margin at the mill, to record the position of the gingival margin, under local anesthesia, immediately unplug. Unplug the teeth rinse under running water to remove blood, remove the crown sand sheet in the water cooling. Along the long axis of the tooth root is divided into two halves mesiodistal sterile saline rinse placed in formalin fixed, after ethanol gradient dehydration and critical point drying. Data analysis: the dried sample was placed in the optical profiler measurements to the same set of parameters, the analysis of the gingival margin under the center position approximately 3 × 3mm ~ 2 root surface roughness, surface roughness parameters Ra ( averageroughness) value of the input data SPSS13.0 statistical software, paired T-test analysis. Part II: subgingival root surface after polishing observed sample selection: The patient inclusion criteria were the same experiment (a) select six teeth. Sample Preparation: Sample processing with the experiment (a) 3. Data analysis: processing after sample conductive adhesive Taiwan underwent vacuum pure gold coating, field emission scanning electron microscope to observe the root surface, capturing an image. Part III: Subgingival polishing impact on clinical indicators of periodontal case selection: study requires good health, diabetes, cardiovascular disease and other systemic diseases; unhealthy habits such as smoking and alcohol consumption; women in non-pregnant and lactating ; ages 18-60 years old; within 3 months prior to the line to participate in this experiment periodontal treatment and taking antibiotics; oral remaining teeth than or equal to 20, at least four molars (excluding third molars); dental None decayed or filled tooth neck and body, full crown of the tooth is not included in the statistics; moderate or severe chronic periodontitis, each quadrant at least a tooth bits probing depth of 4-6 mm. The experimental method: of selected moderate or severe chronic periodontitis patients to complete the full mouth subgingival scaling one week after full-mouth periodontal probing as a baseline. Per tooth check cheek, tongue side of the near, middle and far 6 CPC sites, records PD, SBI, AL and other clinical indicators and survey, registration of patient data. After line scaling and root planing, subgingival polishing week after basic treatment. In this study, using self-control, randomly selected quadrants 1,3 or 2,4 quadrant of teeth as the experimental group, the remaining two quadrants of teeth for the control group. The experimental group teeth row subgingival polishing treatment, gas control group polishing only sprinkler. 1 month after treatment, 3 months referral, each review only repeated when the check of the PD, SBI, AL and other clinical indicators, without gingival of scaling up and down or subgingival polishing treatment. Data analysis: and periodontal probing results enter SPSS13.0 statistical software, repeated measures analysis of variance. Results: Part I: the roughness of the surface of the sample using the optical profiler measurements processed samples, surface roughness Ra value data for statistical analysis SPSS13.0 software. Paired t-test, was t = 2.546, P = 0.031, P <0.05 (n = 20), showed that subgingival root surface polished, roughness significant difference between the two groups. Subgingival root surface smooth, flat root surface after polishing. Part II: scanning electron microscopy morphology observed in control group: the root surface more parts visible residual smear layer, the presence of plaque, tartar and dirt, it is difficult to distinguish between the calculus and cementum. The rest of the root surface is visible a few scattered in different sizes of tartar and plaque residue, part of the the location visible the cementum pits and scratches, and a small amount of cementum flaky exfoliation. Experimental group: the root surface residual plaque, tartar small handful of sites visible residual smear layer, root surface morphology more clearly, some of the sites can be seen clearly \A small amount of the cementum stripping and scratches, no obvious root surface pits or perforated. Part III: the periodontal clinical indicators research probing pocket depth (PD) baseline value for two independent samples T-test t = 1.676, P = 0.094, P> 0.05, so that the test group and the control group at baseline when there was no significant difference. After periodontal treatment, probing depth alleviate. Data obtained using repeated measures ANOVA, F = 2.190, P = 0.139, P> 0.05, that the change was no significant difference between the two groups probing depth (PD). Baseline data sulcus bleeding index (SBI) for two independent samples T-test t = 0.344, P = 0.731, and that no significant differences in baseline mean. After treatment, the sulcus bleeding is reduced. Repeated measure analysis of variance F = 0.063, P = 0.731, P-values ??greater than 0.05, indicating no significant difference between the experimental group and the control group. Conclusion: 1 new blasting material Perio-Flow of the periodontitis patients subgingival root surface polishing, and found no obvious cause periodontal tissue damage, does not appear in the experimental process of polishing due to pain or tooth sensitivity concurrent disease; subgingival root surface polishing, roughness between the experimental and control groups significant differences. Subgingival root surface root surface polished smooth, smooth; 3. Scanning electron microscopy showed that periodontal treatment after the root surface residual plaque and smear layer can further reduce subgingival root surface polishing, and did not cause root surface significant damage; 4., the current study can not prove yet subgingival root surfaces polished to a significant improvement in periodontal clinical indicators.
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