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ORIGINAL ARTICLE
Year : 2016  |  Volume : 20  |  Issue : 1  |  Page : 22-27  

Profilometric analysis of root surfaces after using various polishing agents


1 Department of Periodontics, Guru Nanak Institute of Dental Sciences and Research, Panihati, Kolkata, India
2 Central Glass and Ceramic Research Institute, Jadavpur, Kolkata, India

Date of Submission10-Mar-2014
Date of Acceptance07-Sep-2015
Date of Web Publication25-Feb-2016

Correspondence Address:
Anjan Jana
Department of Periodontics, Guru Nanak Institute of Dental Sciences and Research, 34/2/1 BalaiMistry Lane, B.Garden, Howrah - 711 103, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-124X.168485

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   Abstract 

Background: Polishing is an important step in oral prophylaxis procedure which retards further accumulation of plaque on the root surfaces. Though polishing was done with various abrasive particles with different sizes over a long period of time, it was never been highlighted to evaluate the ideal polishing material and the particle size that would produce the ideal surface smoothness (Ra <0.2 μm). Materials and Methods: The present study was carried out on 70 periodontally involved, caries-free extracted human teeth from 42 patients. All the teeth were collected from the region of incisors, canines, and premolars. In vitro scaling and root planing were performed by piezoelectric scaler and Gracey's area specific curettes, respectively. All the teeth were grouped at random into control and experimental. The collections of abrasive materials were done directly from the market, and the different particle sizes were prepared in the laboratory. Experimentation: The polishing was done at a constant speed of 200 rpm with cylindrical nylon bristle brush followed by rubber prophy cup. Each group belonging to control and experimental was subjected to profilometric study for evaluation of surface roughness. Results: Regular polishing abrasives are not able to produce the surface smoothness of our desire level (i.e., Ra <0.2 μm), which can be achieved only by submicron-sized particles. Conclusion: Regular size polishing particles available in the market (>5 μm) are not able to produce the surface smoothness <0.2 μm. Only, submicron sized particles are able to produce the desired smoothness.

Keywords: Polishing, profilometer, surface smoothness


How to cite this article:
Jana A, Chakraborty A, Pal TK, Datta S. Profilometric analysis of root surfaces after using various polishing agents. J Indian Soc Periodontol 2016;20:22-7

How to cite this URL:
Jana A, Chakraborty A, Pal TK, Datta S. Profilometric analysis of root surfaces after using various polishing agents. J Indian Soc Periodontol [serial online] 2016 [cited 2022 Jul 7];20:22-7. Available from: https://www.jisponline.com/text.asp?2016/20/1/22/168485


   Introduction Top


Cleaning of root surfaces is the most important measure in the treatment of periodontitis.[1],[2],[3],[4] Root planing includes both cleaning and smoothening of the root surface. Meticulous mechanical preparation is an important aspect of the surgical technique associated with gingival attachment and regeneration.[5],[6]

The purpose of polishing is to remove bacterial plaque, stain, and pellicle from the root surface and provide the smoothest surface possible. It has been stated that polishing will reduce the surface roughness beyond that which can be achieved by root planing instruments alone.[7],[8] Polishing may be thought of as the final stage of root planing. The studies that have looked at polishing involved various mechanical devices and polishing pastes.[9] The most commonly used polishing device in dental practice today is the rotating rubber cup and the nylon bristle brush, whereas polishing paste containing alumina and zirconia is currently in use. At present, there are no such studies showing the effects of various particle sizes on the efficiency of polishing on root surface.

Therefore, the objective of the present study was to find out at what dimension the various polishing agents would perform its effects on the root surface and to compare calcium hydroxyapatite as a test material.


   Materials and Methods Top


The present study was carried out on 70 periodontally involved human extracted teeth encompassing, incisors, canines, and premolars having attachment loss more than 5 mm and recession from the Outpatient Department of Oral and Maxillofacial Surgery, Guru Nanak Institute of Dental Sciences and Research, Kolkata. The cause for extraction was mobility (Miller Grade III) and hopeless for any further dental therapy.

Grouping of teeth

The teeth were washed properly under running water and stored in the normal saline. The expected area of study was 5 mm apical from cemento-enamel junction (CEJ).In vitro scaling and root planing (SRP) were performed by piezoelectric scaler (P5 Newtron, Satelac) and Gracy's area specific curettes, respectively.

All the teeth were grouped at random into control and experimental. Experimental groups were divided into three groups A, Z, and H, and were polished with alumina, zirconia, and crystalline HA, respectively. A control group consisted of 7 numbers of teeth where no polishing was made whereas 3 experimental groups contained total 63 teeth.

Each of the experimental group was further subdivided into three subgroups - a, b, and c each containing 7 teeth.

All subgroups “a” received polishing with particle size ranging from 10 to 30 µm, “b” with particle size ranging from 3 to 5 µm, and “c” with particle size of sub-micron level (<1 µm). Teeth of the control group received only SRP with no polishing, whereas the teeth of the experimental groups were subjected to SRP followed by polishing with various polishing agents with different particle sizes. The four of the authors conducted the entire work.

Collection and preparation of samples (abrasives)

For the subgroups Aa, Za, and Ha, the requirement of particle size was 10–30 µm. The collection was done directly from the market and used for the present study and named “super fine.”

Preparation of samples (abrasives)

For the rest of the subgroups (Ab, Ac, Zb, Zc, Hb, and Hc), the intended particles were prepared in the laboratory by milling the larger particle (collected from the market) in an automated milling machine [Figure 1] by wet milling process. The materials collected from the market were then divided into two parts:
Figure 1: Automated milling machine

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  1. 1First part: For subgroups Ab, Zb, and Hb, 30 cc of each sample was mixed with 70 cc ethanol in a zirconia pot containing zirconia balls of 10 mm diameter. The total weight of all the zirconia balls was just the double of the weight of the ethanol and powder to be grounded. Spinning was done in the milling machine at 150 rpm spinning speed for 4 h and dried in a hot air oven at 40°C temperature. The dried particles were undergone through the particle size distribution (PSD) method and showed the dimension of 3–5 µm and named as “ultra-fine”
  2. 2nd part: For subgroups Ac, Zc, and Hc, 30 cc of each sample was mixed with 80 cc ethanol (extra 10 cc was taken for the purpose of making the slurry in suitable consistency for higher spinning rate as well as time) in a zirconia pot in similar. Milling time was 30 h under 200 rpm spinning speed [Figure 2]. The samples were then dried and again subjected to PSD method. The particle thus received showed the dimension of 450–800 nm (submicron level) and named as “ultra-super fine.”
Figure 2: rpm and milling time

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Experimental work

Preparation of experimental site

Each proximal surface of a tooth was examined with the help of a magnifying glass to determine the anatomical location of CEJ. A tentative area on the root surface of the proximal side up to 5 mm apically from the CEJ was properly demarcated with the help of an indentation [Figure 3] made of 1.5 mm diameter straight fissure bur. All the proceedings of polishing were conducted in this area of proximal side.
Figure 3: Indentation on the root surface

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Preparation of polishing paste

2 scoops of each sample were taken with the help of a measuring scoop into a smaller concavity of dappen glass and were mixed with 6 drops of glycerin (100% by vol) to make the slurry for polishing [Figure 4].
Figure 4: Preparation of polishing slurry

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Work procedure

Armamentarium

Following instruments were used for the preparation of tooth surfaces and the polishing pastes [Figure 5]. First scaling was done with the help of Piezoelectric scaler (P5 Newtron, Satelac)and no 1 scaler tip followed by root planing with Gracy's area specific curettes (Hu Fridey). Polishing was done with nylon bristle brush and prophy rubber cup mounted in marathon III Micro motor and Contra angle hand piece (NSK). Polishing paste was made in a dappen glass using measuring scoop, dropper and metal mixing spatula.
Figure 5: Armamentarium for scaling, root planing and polishing

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Experimentation

Fixing the tooth on a stone block did the polishing of the specified proximal area. Micro motor (Marathon III) was used for the polishing at a constant speed of 200 rpm. As per [Table 1], for each group (A, Z, and H), there were 3 subgroups namely subgroup “a” (super fine), subgroup “b” (ultra-fine), and subgroup “c” (ultra-super fine). There were 21 teeth in each of the polishing group (A, Z, and H) which were further distributed in 3 of the subgroups at the rate of 7 in each subgroup.
Table 1: Distribution of number of teeth in various categories of experimentation with abrasives

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All the teeth belonging to each subgroup (Aa, Za, and Ha) were first polished with cylindrical nylon bristle brush for 30 s followed by rubber prophy cup for 60 s. For the subgroups Ab, Zb, and Hb, further polishing was done with ultra-fine powder for 90 s with the help of rubber prophy cup only. For the subgroups Ac, Zc, and Hc, further polishing was done for another 90 s with ultra-super fine powder with the rubber prophy cup only.

All the teeth after polishing were washed with water spray with the help of 3-way water syringe and were dried with air from the same. Each tooth was then preserved into a plastic zip pouch.

Profilometric study

To evaluate the surface topography of each group belonging to control and experimental, they were subjected to profilometric study. Each tooth (n = 70) was mounted on a profilometer [Figure 6] (Taylor Hobson, Leicester, England).
Figure 6: Profilometer

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The machine was adjusted and calibrated to move the stylus not more than 5 mm apico-coronally. With the concomitant movement of the stylus, a representative graph appeared on the screen of the computer. The graph was then subsequently recorded and printed [Figure 7].
Figure 7: A specimen of print of a recorded graph

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Statistical analysis

Primary assumption was all the teeth were equally hard and responded equally to a given type of treatment. For statistical analysis, R package (R Foundation for Statistical Computing Vienna, Austria) and SPSSv16, (SPSS Inc., IBM, 2015) were used, and data had been categorized according to a different treatment option. First, F-test was performed for the equality of variance among all three possible combinations of Aa, Ab, and Ac. As the distributions of sample numbers were small, Kruskal–Wallis and one-tailed Mann–Whitney U-test were performed to find out the difference among different groups. From the P values, it was implied that the entire test was significant.


   Results Top


All the teeth under this study belonging to control and experimental groups were polished with different types of abrasives with three different dimensions in the manner described in the materials and methods. The evaluations of the surface topography of all the teeth after such polishing were done by profilometric study with representative photomicrographs. [Table 2] shows the results of F-test for the equality of variance to determine whether particle size has any effect on the roughness value. [Table 3] shows the results of Kruskal–Wallis test among three different abrasive groups. [Table 4] shows the results of Mann–Whitney U-test among different subgroups. [Table 5] shows the results of F- test for the equality of variance to determine whether different polishing agents have any effects on roughness value.
Table 2: The results of F-test for equality of variance to determine particle size has any effect on roughness value

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Table 3: The results of Kruskal-Wallis test between three different abrasive groups

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Table 4: The results of Mann-Whitney U-test between different sub groups

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Table 5: The results of F-test for equality of variance to determine different polishing agents have any effects on roughness value

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Control group

The mean Ra value for the experimental group was calculated and rounded off as 3.18.

Alumina

  1. For the abrasive particle alumina sized 11.91 µm (average), the Ra value was 1.34
  2. For sized 4.08 µm (average), it was 0.97
  3. For sized 755 nm (average), it was 0.16.


Zirconia

  1. For the abrasive particle zirconia sized 15.66 µm (average), the Ra value was 1.42
  2. For sized 4.39 µm (average), it was 0.88
  3. For sized 575 nm (average), it was 0.13.


Crystalline HA

  1. For the abrasive particle crystalline HA sized 29.38 µm (average), the Ra value was 1.16
  2. For the abrasive particle crystalline HA sized 3.83 µm (average), it was 0.1
  3. For the abrasive particle crystalline HA sized 455 nm (average), it was 0.12.



   Discussion Top


The objective of periodontal therapy is the reduction of bacterial deposits and calculus on tooth surfaces.[10],[11],[12],[13] This can be achieved with hand scalers and curettes or ultrasonic instruments. Studies have shown that scalers, curettes, and ultrasonic instruments are effective in removing subgingival plaque and calculus but does not produce smooth surface on the tooth.[14],[15],[16] Root planing makes the root surface smooth and hard by removing all the diseased cementum. This prevents the further accumulation of bacteria on the root surface. The recommended surface smoothness expressed as Ra value has been calculated to be 0.2 µm.[17],[18]

Regular polishing abrasives/agents are not found to produce the surface smoothness of our desire level (i.e., Ra <0.2 µm). Polishing is affected by the hardness, shape, and sizes of the abrasive particles used and speed of the rotary handpiece.[19],[20],[21] Pressure with which polishing is done can also increase the rate of material removal from the surface.

Much information is available in regard to finish and polish the restorative materials on the tooth surface. Attention has so far not been made properly on polishing the root surface which perhaps the best and the prime end part of root planing.

This has given a thrust in undertaking this present study as to how best polishing of the root surface can be achieved. Normally, the polishing is done with agents such as alumina, zirconia, and pumice. However, the size specification of the abrasives in a polishing paste is not delineated and at present it is not known which abrasive material with what dimension is best suited for root polishing.

The abrasives are designated formally as super-fine, ultra-fine, and ultra-superfine from the stand point of dental materials science but not equal weightage of attention has been given from the discipline of periodontology. As per the textbook descriptions, the size range of abrasives (10–20 µm), namely alumina and zirconia, have not been able to produce the desired root surface micro-topography. The super-fine (10–30 µm) and ultra-fine (3–5 µm) abrasives normally exist in the market, which are of no use in terms of inability to produce the desired level of smoothness.

Standardization of experimental conditions is important in studies concerned with the evaluation of instrumentation and their effects on the root surfaces. The abrasives with its proper dimension required for polishing on tooth surface is mainly dictated by material science and recommendations are few abrasives such as alumina, zirconia, and pumice, in the size range of 20 µm. However, according to Ra value, the desired level of the polished surface should be < 0.2 µm. The size range of abrasives in the category of super-fine and ultra-fine employed in the present study could not produce the required smoothness and found that the values are far behind from the desired level of recommendation.

The above results show the necessity of employing even finer particles which in this study fall in the middle group, that is, ultra-fine. This category of abrasives of alumina and zirconia has not been able to produce the desired surface smoothness, but the crystalline HA reached the goal along with Ra value 0.1 µm.

The finest group, that is, the ultra-super fine has been employed for the first time with the objective of polishing the root surface and found to be very effective for the standpoint of Ra value. The goal is achieved with much smoother surface than our desired surface smoothness level. All the materials of this category produce the surface smoothness value, which is much below from 0.2 µm. Crystalline HA could not produce further smoothness. As the submicron sized particles are much smaller than the opening of the dentinal tubules, there is a chance of penetration of those particles into the dentinal tubules during polishing procedure and the particles which are not biocompatible may create harm to the tooth surface.


   Conclusion Top


  1. Super-fine group of abrasives (sized at 10–30 µm range), namely alumina, zirconia, and crystalline HA, could not produce the desired level of smoothness
  2. Ultra-fine group of abrasives (sized at 3–5 µm range), namely alumina and zirconia, did not produce the desired level of smoothness, which crystalline HA produced
  3. Ultra-super fine group of abrasives of sub-micron level (sized at 400–800 nm range) used in this present study first time alumina, zirconia, and crystalline HA produce the desired level of smoothness (Ra value <0.2 µm)
  4. Ultra-fine crystalline HA of 3–5 µm range and ultra-super fine at the sub-micron level of alumina and zirconia can produce smoothness of the desired level as revealed through profilometry.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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