Root surface removal with diamond-coated ultrasonic instruments: an in vitro and SEM study.

Adequate root preparation in periodontal procedures includes the removal of plaque, calculus, and perhaps contaminated cementum and dentin. The purpose of this study was to evaluate and compare the amount of root surface removal and residual surface texture using similarly shaped regular (US) and both fine (FINDIAM) and medium (MEDDIAM) grit diamond-coated ultrasonic inserts. Forty-five (45) premolars extracted for orthodontic reasons were randomly divided into 3 groups of 15 teeth each. They were individually mounted in a jig and instrumented with a standardized 500 gram force while they were moved a precise horizontal distance of 12 mm over a 1.2 second period using specially designed and computer controlled instrumentation. Three measurements were made to the nearest 0.0005" at 3 points along the test area before instrumentation and after 10 and 20 strokes. The mean depth of root structure removed was US 5.8 +/- 6.6 microns, FINDIAM 50.1 +/- 14.2 microns, MEDDIAM 30.8 +/- 12.1 microns, after 10 strokes, and US 12.7 +/- 10.9 microns, FINDIAM 83.3 +/- 20.1 microns, MEDDIAM 58.7 +/- 17.9 microns after 20 strokes, respectively. All 3 instruments were different from each other (P < 0.001) in the 10 stroke group, while in the 20 stroke group FINDIAM and MEDDIAM were different from US (P < 0.001), but not from each other. Only FINDIAM showed a significant difference between 10 and 20 stroke values for depth of root removal. Modified loss of tooth substance index SEM scores indicated increasingly greater root surface roughness from US to FINDIAM to MEDDIAM. Substantially greater root surface removal and greater residual root surface roughness occurred with diamond-coated ultrasonic inserts under standardized in vitro conditions. These results suggest that caution should be used with diamond-coated ultrasonic instruments during periodontal root planing procedures.