Breininger D R, O'Leary T J, Blumenshine R V
J Periodontol. 1987 Jan;58(1):9-18. doi: 10.1902/jop.1987.58.1.9.
The purpose of the study was two-fold: to determine the nature of stainable deposits on periodontally diseased root surfaces subsequent to in vivo scaling and root planing procedures, and to quantify the distribution of residual plaque on instrumented root surfaces. Thirty molar and 30 nonmolar teeth which were condemned for periodontal or prosthetic reasons and had proximal probing depths of 4 to 7 mm were treated. Half of these were instrumented with I.U. curettes and the other half with an ultrasonic scaling device. Instrumentation was continued until the root surface felt hard and smooth to an explorer tip. The location of the gingival margin was recorded by notching the treated proximal surface with a No. 1/2 round bur. Twenty control teeth, 10 molar and 10 nonmolar, were extracted without instrumentation. Control and experimental teeth were irrigated with saline and stored in a 2.5% glutaraldehyde fixative solution until the time of assessment. All teeth were stained with a 0.5% solution of toluidine blue, and the amount of residual stained material and calculus was assessed under the stereomicroscope using an eyepiece fitted with a 10 X 10 optical grid. Stained deposits were marked by placing small V-shaped notches in the adjacent root surface as an aid to identification after the specimens were processed for scanning electron microscopic (SEM) examination. The nature of stained deposits on selected teeth was then characterized using the SEM. Treated root surfaces were also surveyed in detail to assess the quantity and extent of residual plaque deposits. The findings showed that although a large percentage of the treated proximal root surface may possess stainable deposits, these surfaces were often unexpectedly free of microbial organisms. In this study, the majority of stained deposits were composed of adherent fibrin and instrumentation debris. When bacterial plaque was present, it was usually found in small "mini-colonies" smaller than 0.5 mm across. Such findings cast doubt on the validity of using histologic and disclosing stains as an indicator for the presence of bacterial plaque immediately after instrumentation. Although only partially effective in removing subgingival calculus, both methods of instrumentation in this study appeared to be remarkably effective in bacterial debridement of subgingival root surfaces.
确定在体内进行龈下刮治和根面平整术后牙周病牙根表面可染色沉积物的性质，并量化器械处理过的牙根表面残留菌斑的分布。选取了30颗磨牙和30颗非磨牙，这些牙齿因牙周或修复原因被判定需要治疗，其近中探诊深度为4至7毫米。其中一半用国际标准刮治器进行器械处理，另一半用超声洁治器。器械处理持续进行，直到用探针尖端探测牙根表面感觉坚硬光滑为止。用1/2号圆钻在处理过的近中表面刻痕来记录牙龈边缘的位置。拔除20颗对照牙，其中10颗磨牙和10颗非磨牙，未进行器械处理。对照牙和实验牙用生理盐水冲洗，然后保存在2.5%的戊二醛固定液中直至评估时。所有牙齿用0.5%的甲苯胺蓝溶液染色，使用配有10×10光学网格的目镜在体视显微镜下评估残留染色物质和牙石的量。在对标本进行扫描电子显微镜（SEM）检查后，通过在相邻牙根表面放置小的V形切口来标记染色沉积物，以便于识别。然后用扫描电子显微镜对选定牙齿上染色沉积物的性质进行表征。还对处理过的牙根表面进行详细检查，以评估残留菌斑沉积物的数量和范围。研究结果表明，尽管处理过的近中牙根表面有很大比例可能存在可染色沉积物，但这些表面常常意外地没有微生物。在本研究中，大多数染色沉积物由附着的纤维蛋白和器械碎屑组成。当存在细菌菌斑时，通常以直径小于0.5毫米的小“微型菌落”形式存在。这些发现对使用组织学染色和显示染色作为器械处理后立即存在细菌菌斑的指标的有效性提出了质疑。尽管在去除龈下牙石方面仅部分有效，但本研究中的两种器械处理方法在龈下牙根表面的细菌清创方面似乎都非常有效。
