Comparing the Efficacy of Five Mechanical Scalers

on the Removal of Supragingival and Subgingival

Calculus in vitro.

LISA HOANG
MASTER OF SCIENCE DENTAL HYGIENE CANDIDATE
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
JUNE 7TH,2017

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 Acknowledgement
George Taylor, DMD, MPH, DrPH
Mark Ryder, DMD
Peter Rechmann, DMD, PhD
Beate Rechmann, SRA

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 Key Terms
Non-surgical periodontal therapy
Scaling and root planing
Mechanical scalers
Sonic scalers
Ultrasonic scalers
Piezoelectric scaler
Magnetostrictive scaler

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 The Research Problem
According to our knowledge, there are no comparative studies
published to date which evaluate the efficacy of only mechanical
instrumentation in the removal of calculus during non-surgical
periodontal therapy.

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 Background
Non-surgical periodontal therapy, also known as scaling and
root planing, is a common treatment for periodontal disease.2
It aims to eliminate periodontal infection by the removal of
supragingival and subgingival calculus using hand and
mechanical instrumentation.2
Without the removal of subgingival calculus, inflammation will
persist.2

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 Background (cont.)
Mechanical instruments such as sonic scalers and ultrasonic
scalers are known to assist in non-surgical periodontal therapy.2-3
Studies have shown that use of mechanical instruments can be
effective in calculus removal, but can also result in residual
calculus after non-surgical periodontal therapy. 2-3

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 Study Purpose
To compare the efficacy of five mechanical instruments,
including three sonic scalers, one piezoelectric scaler and one
magnetostrictive scaler for the removal of supragingival and
subgingival calculus in vitro.

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 Micron Super SS

StarDental

KaVo SONICflex 2003

Nakanishi International

Dentsply Cavitron

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 Research Aims
To Compare:
The efficacy of the five mechanical scalers on calculus removal by
measuring the amount of calculus present before and after
instrumentation using a digital camera with a standard grid ruler.
The time required for the operators determined completion with
each of the five mechanical instruments.

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 Hypotheses
The null hypothesis is there are no significant differences in the
amount of calculus removed among the five mechanical scalers.
The null hypothesis is there are no significant differences in the
time required for the clinicians to remove the calculus with the
five mechanical scalers

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 Methods
A quantitative, in vitro, randomized trial
The study sample was 81 human extracted teeth that were selected
based on tooth type and similar amounts of supragingival and
subgingival calculus.
27 blocks; consisted of three teeth, each
Blocks were randomly assigned and instrumented by 3 licensed
Registered Dental Hygienists (clinicians)

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 Methods
Each clinician instrumented 6 surfaces on 27 teeth in 9 blocks: 9
anteriors, 9 premolars, 9 molars
324 surfaces of the 81 teeth were analyzed in this trial.
Inclusion criteria - Teeth selected included those extracted teeth
with moderate to heavy calculus on the roots
Exclusion criteria - Evidence of root caries on the surfaces examined
& minimal calculus on the root surface

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13
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 Methods (Cont.)
The clinicians instrumented and scaled the randomly assigned blocks
to the level at which they feel confident that the calculus is removed.
Time was recorded in minutes from the time instrumentation begins
for each tooth instrumented to the time all calculus was removed to
the clinicians satisfaction.
Power setting and water flow for the five mechanical scalers were
standardized

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BEFORE AFTER

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17
 Methods (Cont.)
Inter-examiner reliability calculated between the 2 clinicians
measurements for the presence and absence of calculus after
image processing

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 Methods of Analysis
Quantitative
The generalized linear model (GLM) for comparison of differences in
calculus removal among the five mechanical scalers, as well as
operators, and tooth types.
The Student-Newman-Keuls procedure for pairwise comparisons
among operators and tooth types and to contrast each scaler to the
four other scalers.

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 Figure I: Mean Percentage of Calculus Removed by Mechanical Scalers,
Among All Clinicians and All Surfaces
120

100
CALCULUS AMOUNT [%] MEAN

80

60

40

20

0
StarDental Micron SSS KaVo SONICflex 2003 Dentsply Cavitron Nakanishi International

MECHANICAL SCALERS

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 Figure II: Mean Percentage of Calculus Removed by Tooth Type Among All
Mechanical Scalers, All Clinicians on All Surfaces
120

100
CALCULUS AMOUNT [%] MEAN

80

60

40

20

0
Molar Anterior Premolar

TOOTH TYPE

* P= 0.0067 - significantly different

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 Figure III: Mean Percentage of Calculus Removed by Clinicians on All
Surfaces
120

100
*
CALCULUS AMOUNT [%[ MEAN

80

60

40

20

0
Clinician 3 Clinician 1 Clinician 2
CLINICANS

*P = 0.0245 - significantly different

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 Figure IV: Mean Time for Calculus Removal by All Mechanical Scalers
on All Surfaces
40

35

30

25
TIME [MINUTES]
MEAN

20

15

10

0
StarDental Dentsply Cavitron Nakanishi International KaVo SONICflex 2003 Micron SSS

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 Figure V: Mean Time Required for Completed Calculus Removal Among
the Three Clinicians on All Surfaces
40

35
*
30
TIME [MINUTES]

25

20

15

10

0
Clinician 2 Clinician 3 Clinician 1

CLINICIANS

* P = 0.0005 - significantly different

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 Figure VI: Mean Percentage of Calculus Removed for Consolidated
Buccal and Lingual Surfaces by All Mechanical Scalers
100

90
CALCULUS AMOUNT [%] MEAN

80

70

60

50

40

30

20

10

0
Dentsply Cavitron StarDental Micron SSS KaVo SONICflex 2003 Nakanishi International

Above Gingival Margin Below Gingival Margin Between Gingival Margin

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 Figure VII: Mean Percentage of Calculus Removed for Consolidated
Buccal and Lingual Surfaces by All Mechanical Scalers
120

100
CALCULUS AMOUNT [%] MEAN

80

60

40

20

0
StarDental Micron SSS Dentsply Cavitron KaVo SONICflex 2003 Nakanishi International

MECHANICAL SCALERS

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 Figure VIII: Mean Percentage of Calculus Removed for Consolidated
Interproximal Surfaces by All Mechanical Scalers
120

100
CALCULUS AMOUNT [%]

80
MEAN

60

40

20

0
KaVo SONICflex 2003 Nakanishi International Micron SSS StarDental Dentsply Cavitron

MECHANICAL SCALERS

*The interproximal surfaces alone these would be just the consolidated distal of anteriors, mesial & distals of premolars, and mesials of the
molars. These were the less accessible areas which had higher residual calculus retention

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Student-Newman-Keuls test - comparison of
each scaler with the rest of scalers
Percent of difference in calculus removal
No significant difference between each scaler and the rest of scalers
Time difference for calculus removal
Micron SSS vs the rest of scalers
P value: 0.0029 = Statistically significant
StarDental vs the rest of scalers
P value: 0.0274 = Statistically significant

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Student-Newman-Keuls test - comparison for
pairwise comparison between tooth type
Percent of difference in calculus removal
Molar vs Anterior
P value: 0.0451 = Statistically significant
Molar vs Premolar
P value: 0.0017 = Statistically significant

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Student-Newman-Keuls test - comparison for
pairwise comparison between clinicians
Percent of difference in calculus removal
Clinician 2 vs Clinician 3
P value: 0.0086 = Statistically significant

Time difference for calculus removal

Clinician 2 vs Clinician 1
P value: <.0001 = Statistically significant
Clinician 2 vs Clinician 3
P value: 0.0002 = Statistically significant

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 Strengths
Large sample size
Comparing five different mechanical scalers
Consistent operators
Standard working conditions

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 Limitations
Clinicians experience
Power setting
Water flow
Different tips
In vitro study

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Conclusion
There are no significant differences on the amount of calculus
removed among the five mechanical scalers
There are no significant differences in the time required for the
clinicians to remove the calculus with the five mechanical scalers
There were significant differences in clinicians (for calculus removal
& time) & tooth type (for calculus removal)

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Implications
Improve study design
Calibration among clinicians on mechanical scalers
Time limit for calculus removal
Larger sample size for time

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QUESTIONS

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