Efficiency of the VectorTM-system compared with conventional subgingival debridement in vitro and in...

Efficiency of the VectorTM-systemcompared with conventionalsubgingival debridement in vitroand in vivoBraun A, Krause F, Hartschen V, Falk W, Jepsen S. Efficiency of the Vectort-systemcompared with conventional subgingival debridement in vitro and in vivo. J ClinPeriodontol 2006; 33: 568–514. doi: 10.1111/j.1600-051X.2006.00960.x.

AbstractObjective: To assess the efficacy of the novel ultrasonic Vectort-system system forsubgingival debridement and to compare the results with conventional periodontalinstrumentation in vitro and in vivo.

Material and Methods: Forty extracted human teeth were treated in vitro: Vectort-system with polishing (VP) and abrasive fluid (VA), conventional ultrasonic system(U) and hand instrument (H). At intervals of 40 s, calculus removal was assessed usinga 3D laser scanning device. Eight single-rooted teeth were treated in vivo with theVectort-system or hand instruments. Subgingival plaque samples were obtained formicrobiological evaluation. After extraction, residual calculus was assessed by meansof digitized planimetry.

Results: In vitro efficiency of hand instruments was statistically higher comparedwith the conventional ultrasonic system ( po0.05) and the Vectort-system with nodifference between U and VA ( p40.05) and VA and VP ( p40.05). Residual calculusfollowing in vivo instrumentation was not different in the Vectort and the handinstrument group ( p40.05) but treatment time with the Vectort-system wasstatistically higher ( po0.05). A similar reduction of periopathogenic bacteria could beobserved in both groups.

Conclusions: Using the Vectort-system, root surfaces can be debrided as thoroughlyas with conventional instruments. However, treatment is more time consuming thanconventional debridement.

Key words: 3D laser scanning; calculusremoval; planimetry; subgingival plaque;ultrasonic instrumentation

Accepted for publication 15 May 2006

During the initial treatment of perio-dontitis, most time is spent for mecha-nical debridement. Firmly adheringsubgingival calculus has to be removed,containing a variety of microorganismsand endotoxins capable of producingperiodontal disease (Schenkein 1999).Thus, treatment of periodontitis is direc-ted primarily towards the reduction ofpathogens embedded in subgingivaladhering mineralized deposits and theremoval of the periopathogenic biofilm.Completion of calculus removal coin-cides with endotoxin levels associatedwith clinically healthy teeth (Cadosch

et al. 2003). Calculus can be removed byusing hand scalers, ultrasonic instruments,air-powder abrasive scalers, diamond bursand lasers. Sonic and ultrasonic scalerswere originally designed for removal ofsupragingival calculus (Johnson & Wil-son 1957). Modifying the instrument’stips to obtain smaller diameters and long-er working lengths, better access to deep-probing sites and more efficient instru-mentation could be achieved (Holbrook& Low 1994). No difference concerningclinical outcome between ultrasonic andmanual debridement in the treatment ofchronic periodontitis was found (Drisko

et al. 2000, Tunkel et al. 2002). A pri-mary mechanism for calculus removal isthe mechanical chipping action of thescaler tip. Additionally, hydrodynamicforces such as high-energy shock wavesproduced by cavitation within the cool-ing water supply (Walmsley et al. 1990)and acoustic microstreaming patternsformed close to the surface of the scalertip are supposed to contribute to calculusremoval (Khambay & Walmsley 1999).

A recently introduced novel ultrasonicdevice is the Vectort-system (DuerrDental, Bietigheim-Bissingen, Germany).Ultrasonic vibrations are generated at a

Andreas Braun, Felix Krause, VeraHartschen, Wolfgang Falk and SørenJepsen

Department of Periodontology, Operative and

Preventitive Dentistry, University of Bonn,

Germany

J Clin Periodontol 2006; 33: 568–574 doi: 10.1111/j.1600-051X.2006.00960.x

568 r 2006 The Authors. Journal compilation r 2006 Blackwell Munksgaard

frequency of 25 kHz and then convertedby a resonating ring, deflecting a hor-izontal oscillation vertically (Hahn2000). The instrument tip moves paral-lel to the tooth surface and avoidsvibrations applied horizontally on theroot surface. As a result, treatment hasbeen shown to be less painful thantreatment with conventional methodsfor periodontal therapy (Braun et al.2003, Hoffman et al. 2005). However,reducing the power settings of a con-ventional ultrasonic device, comparablepain sensations were recorded for boththe Vectort-system and a conventionaldevice in maintenance therapy (Kocheret al. 2005). Clinical parameters such aspocket depths and bleeding on probingimproved in a similar way, followingthe use of the Vectort-system or handinstruments for periodontal debridement(Klinger et al. 2000, Sculean et al.2004). Using the device for the treat-ment of peri-implantitis, there was noclinical difference between the ultraso-nic system and carbon fibre curettes(Karring et al. 2005).

It is recommended to use the devicein conjunction with either a hydroxyl-apatite-containing polishing fluid or asilicon-carbide-containing abrasive fluid.Using a 3D laser scanning device, itcould be shown that the amount of rootsubstance removal with the Vectort-system was significantly dependent onthe selection of these irrigation fluids(Braun et al. 2005b). It is assumed thatthe efficiency in removal of adheringdeposits may also depend on this para-meter. Evaluating digitized photographsin a two-dimensional study design, thishypothesis could be confirmed (Braun etal. 2005a). Thus, the aim of the presentstudy was to assess calculus removal bythis novel ultrasonic system using a 3Dlaser scanning device in vitro and tocompare the results with conventionaldebridement. Additionally, the amountof residual calculus should be assessedin situ, comparing the Vectort-systemwith the polishing fluid with handinstrumentation. Evaluating subgingivalplaque samples, the impact of these twotreatment methods on periopathogenicbacteria should be assessed.

Materials and Methods

3D laser scanning

Forty extracted human teeth coveredwith subgingival calculus on the rootsurface were collected from different

patients and stored in a physiologicalsaline solution. The time span betweentooth extraction and the following treat-ment of the teeth did not exceed 1 week.According to an experimental set-updescribed previously (Braun et al.2005b), baseline scanning images ofthe root surfaces were captured andsubsequently, incisors, pre-molars andmolars were evenly assigned to fourgroups of 10 teeth with regard to toothtype and the amount of subgingivalcalculus present. These groups werethen assigned to the treatment methodsusing computer-generated random num-bers to avoid personal bias: Vectort-system with hydroxyl-apatite-containingpolishing fluid and metal curette insert(Fig. 1) at 25 kHz (VP), Vectort-systemwith a silicon-carbide-containing abra-sive fluid and metal curette insert at25 kHz (VA), a conventional ultrasonicsystem (EMS, Nyon, Switzerland) (U)turned to the ‘‘high’’ setting with inserttip ‘‘P’’ (Fig. 1) at 31 kHz and a handinstrument (H) (Gracey curette, Hu-Friedy, Leimen, Germany). Accordingto the manufacturer’s instruction, opera-tion of the Vectort-system was set at anamplitude of 30mm for all applications,corresponding to the first seven LEDslighting up on the intensity display.Ultrasonic instruments were used withthe tip parallel to the root surface andwith continuous adaptation to the rootsurface. In the hand instrument group, anew curette was used for each tooth toavoid dulling of the instruments. Theinstrumentation of all teeth was per-formed by one investigator well trainedin periodontal treatment, who used all

instruments with a clinically appropriateforce of application. Before the instru-mentation of the teeth in the experimentalgroups, lateral force measurements hadbeen performed (Braun et al. 2005a).Evaluating a 200 s treatment period atintervals of 10 s, this preliminary surveyshowed that the operator applied a lateralforce of 4.76 � 0.24 N with the handinstrument, and 0.83� 0.11 N (U), 0.68�0.10 N (VP) and 0.69 � 0.09 N (VA)while treating the root surfaces.

Root instrumentation with hand andultrasonic instruments was performedusing an artificial periodontal pocketmodel according to the experimentalset-up described previously (Braun etal. 2005a, b), using glass slides coveredwith a non-transparent rubber dam (Col-tene/Whaledent, Langenau, Germany).At intervals of 40 s, treatment was inter-rupted and volumes of the teeth weremeasured by a second investigator untilthe surfaces were cleaned completely.The endpoint of calculus removal wasvisible cleanliness of the root surface,assessed by the second investigator.Measurement of volumes was perform-ed using a 3D laser scanning device(Willytec, Munich, Germany). Eachsample was prepared for laser scanningwith a dye surface coating (Met-L-Chek, Santa Monica, CA, USA) andscanned from apical to coronal by alaser beam, projected via an optic sys-tem onto the root surface. The reflectionof the beam was observed at an angle of201 by a high-resolution CCD camerawith an accuracy of 28 mm (width),25mm (length) and 2.5mm (height). Tofacilitate a reproducible position of the

Fig. 1. Ultrasonic insert tips used in the present study. Tip ‘‘P’’ of the EMS device (a) andmetal curette insert of the Vectort-system (b).

Calculus removal with the Vectort-system 569

r 2006 The Authors. Journal compilation r 2006 Blackwell Munksgaard

teeth in the scanning device, teeth werefixed by means of a silicone impressionmaterial (Voco, Cuxhaven, Germany).To evaluate calculus removal, scanningimages from the root surfaces weresuperimposed and subtracted using theMatch 3D superimposition software(Willytec) (Fig. 2). A control group of10 teeth was included in the studydesign to assess the impact of the dyesurface coating. Therefore, teeth werecoated with dye and mounted in thescanning device. After laser scanningof the untreated surface, dye was remov-ed, avoiding any kind of debridementprocedure. This protocol was performed10 times each for every tooth.

For statistical analysis, normal distri-bution of the values was analysedwith the Shapiro–Wilk test. Analysis ofvariances (ANOVA) and subsequentcomparison of means (Scheffe) wereused to analyse the amount of calculusremoval depending on the differenttreatment methods, as all values werenormally distributed. Differences wereconsidered as statistically significantat po0.05.

Planimetric evaluation

Eight single-rooted teeth in eight pati-ents with untreated advanced chronicperiodontitis were included in the study.The teeth were designated for extractionand showed radiographically and/orclinically apparent subgingival calculus.

Probing depths both mesial and distalwere at least 4 mm and bone loss of atleast one-third of the root length couldbe observed radiographically. Informedconsent was obtained from each patientafter the nature of the study was explain-ed and before the initiation of treatment.The study was approved by the localethics committee.

Before each treatment procedure,teeth were evaluated using a periodontalprobe (Florida Probes, Florida ProbeCorporation, Gainesville, FL, USA) withcontrolled pressure (15 grams) to mea-sure and electronically record pocketdepths at six sites per tooth: mesio-buccal, mesio-oral, oral, disto-oral, dis-to-buccal and buccal. After local anaes-thesia, a groove was placed around thecircumference of the teeth at the level ofthe gingival margin with a diamond bur.Either the mesial or the distal root sur-face was treated with the Vectort-sys-tem (Duerr Dental) turned to the usual‘‘70%’’ setting with hydroxyl-apatitecontaining polishing fluid and a metalcurette insert at 25 kHz (VS). The oppo-site root surface of the tooth was deb-rided using hand instruments (Graceycurettes, Hu-Friedy). The endpoint ofdebridement was determined by tactilemeans with a dental explorer. Theinstrumentation was performed by twoexperienced periodontists. One operatorperformed either ultrasonic or handinstrumentation on one tooth surface,while the second treatment on the oppo-

site tooth surface was carried out bythe other operator. A third operatormeasured the treatment time withoutrevealing it to the persons performingdebridement procedures. The sequenceof the different treatments was randomlyassigned to the teeth using a computer-generated random number table. Beforeand after debridement, subgingival pla-que samples were harvested for micro-biological evaluation.

After treatment, teeth were extracted,stored in physiological saline solutionand stained with 1% methylene blue for1 min to distinguish attached connectivetissue. In combination with the recordedprobing depths, the apical edge ofinstrumentation could be determined.The area under investigation was deter-mined coronally by the gingival groove.Laterally, the margins were set 1 mmapart from the line angle of the tooth toavoid inaccuracies because of lineardistortions. Standardized photographsof the teeth were taken with a magnifi-cation of 1:1. The digitized photographswere assessed with a surface analysissoftware (MegaCAD 4.8b, MegatechSoftware GmbH, Berlin, Germany),measuring the amount of residual calcu-lus with an accuracy of 0.1 mm2.

For statistical analysis, normal distri-bution of the values was analysed withthe Shapiro–Wilk test. As not all valueswere normally distributed, the amount ofresidual calculus in the different groupswas compared with a non-parametric test(Wilcoxon’s). Treatment times were alsonot normally distributed and thus com-pared non-parametrically (Wilcoxon’s).Differences were considered as statisti-cally significant at po0.05.

Microbiological evaluation

Subgingival plaque samples wereobtained before and immediately aftertreatment of the eight single-rootedteeth intended for planimetric evalua-tion. Before obtaining the samples, theselected sites were cleaned supragingiv-ally to avoid contamination. At eachsite, two sterile paperpoints were insert-ed, kept in place for 30 s and transferredto vials containing transport medium(Cary-Blair-Transport medium, HainDiagnostika, Neheren, Germany). Afterhomogenizing in pre-reduced trypticase-soy-boullion (Becton & Dickinson,Heidelberg, Germany), one half of thesolution was used for culturing. Aliquotsof 0.1 ml of serial solutions were platedon supplemented tryticase-soy-agar and

Fig. 2. Scanned root surface before (a) and after (b) calculus removal. Difference computedwith the Match 3D software (c).

570 Braun et al.


incubated for 3 days in air 110% CO2

to select microaerophilic microorgan-isms and for 5 days to select anaerobicmicroorganisms (Gas Pac, Becton &Dickinson).

DNA probe analysis was performedwith the other half of the solution toidentify Porphyromonas gingivalis (P.g.),Bacteroides forsythus (B.f.), Prevotellaintermedia (P.i.) and Treponema denti-cola (T.d.). For this purpose, DNAwas extracted by the High Pure DNAPreparation Kit (Roche, Mannheim,Germany). The bacterial DNA was pro-cessed according to the manufacturer’sinstructions for the identification of spe-cific periopathogens (Mikrodent-Kit,Hain Diagnostika). Internal standardiza-tion enabled the expression of the resultsas colony-forming units (CFU/ml).

Results

3D laser scanning

Superimposed images of teeth reposi-tioned in the laser scanning device with-out debridement revealed an accuracy of0.00001 mm3 (Table 1). Using all meth-ods, complete removal of adhering cal-culus could be achieved within thelimits of clinical inspection of the rootsurface, but the time required for debri-dement differed between the groups.Calculus removal with the Vectort-sys-tem depended on the irrigation fluid(VA: 0.014 mm3/s, VP: 0.008 mm3/s,Table 1). However, the differencebetween these two treatment modalitiesof the Vectort-system was not statisti-cally different (p 5 0.291, Fig. 3). Theefficiency of the hand instrument(0.048 mm3/s) was statistically highercompared with the conventional ultra-sonic system (U: 0.016 mm3/s, po0.05,Table 1) and the Vectort-system usedwith the polishing or the abrasivefluid ( po0.05). No difference could bedemonstrated between conventionalultrasonic debridement and treatmentwith the Vectort-system in conjunctionwith the abrasive fluid (p40.05). Theleast efficiency could be observed whenthe Vectort-system was used with thepolishing fluid, resulting in statisticallysignificantly lower values comparedwith the conventional ultrasonic systemand hand instrumentation.

Planimetric evaluation

Using the Vectort-system, 97% (mini-mum: 86%, maximum: 99%) of the root

surfaces appeared calculus free (Fig. 4).Regarding the hand instrumentationgroup, 96% (minimum: 84%, maximum:99%) of the surfaces appeared free ofmineralized deposits with no differ-ence in the ultrasonic group (p40.05).Treatment with the ultrasonic device

(VS: 9.7 s/mm2 (minimum: 3.6 s/mm2,maximum: 17.3 s/mm2)) took signifi-cantly longer than debridement with thehand instruments (HI: 4.8 s/mm2 (mini-mum: 3.6 s/mm2, maximum: 7.9 s/mm2),p 5 0.025, Fig. 4). Representative speci-mens for both groups are given in Fig. 5.

Table 1. Removal of calculus (mm3/s) employing the artificial periodontal pocket

H U VP VA Control

Mean 0.048 0.016 0.008 0.014 0.000006Standard deviation 0.010 0.004 0.003 0.005 0.000004Median 0.046 0.017 0.008 0.013 0.000006Maximum 0.063 0.024 0.011 0.023 0.000013Minimum 0.035 0.008 0.003 0.008 0.000001Number of teeth 10 10 10 10 10

U, conventional ultrasonic instrument; H, hand instrument; VP, Vectort-system with metal curette

insert and polishing fluid; VA, Vectort-system with metal curette insert and abrasive fluid and

control group without treatment.

Vector™

0

5

10

15

Tre

atm

ent

tim

e [s

/mm

²]

p<0.05

Hand instrument

80

85

90

95

100

Cal

culu

s-fr

ee r

oo

t su

rfac

e [%

]

p>0.05

a bVector™ Hand instrument

Fig. 4. In vivo treatment with the Vectort-system and hand instruments. Calculus-free rootsurface related to the overall treated surface was not different in the ultrasonic and the handinstrument group (p40.05) (a). Ultrasonic treatment took statistically longer than handinstrumentation (po0.05) (b).

12p<0.05

p>0.0510

8

6

4

2

00 200 400 600 800

Vector polishing fluid

Vector abrasive fluid

Hand instrument

Conventional ultrasonic instrument

Time (s)

Cal

culu

s re

mov

al (

mm

3 )

1000 1200 1400

Fig. 3. Amount of remaining calculus depending on the duration of treatment. Every groupcalculated from 10 measurements. Fastest calculus removal using hand instrument, andslowest removal using Vectort-system with polishing fluid.



Microbiological evaluation

Using both the ultrasonic device or handinstruments, a similar reduction in the

periopathogenic microorganisms P.g.,B.f., Prevotella intermedia and Trepo-nema denticola could be observed(Table 2). Focusing on P. intermedia, a

quantitative discrepancy between cul-turing and DNA probe analysis becameevident. A similar difference betweenthe outcomes of the analytical toolscould not be found for any other micro-organism in the present study.

Discussion

In the present study, the time requiredfor subgingival calculus removal dif-fered significantly among the methodsinvestigated. As the Vectort-systemavoids a hammering action of the inserttip against the tooth surface and theinsert tips lack a true cutting edge, thismight explain the low efficiency incalculus removal when the device isused with the polishing fluid. Comparedwith the conventional ultrasonic device,the Vectort-system showed the sameefficiency when it was used with theabrasive fluid but less efficiency when itwas used with the polishing fluid. Thus,efficiency seems to be influenced by thechoice of the irrigation fluid, althoughthere was no statistically significant dif-ference between the two treatment mod-alities of the Vectort-system. Theseoutcomes confirm the results of a pre-vious study, using two-dimensional ana-lysis of root surfaces (Braun et al.2005a). Evaluating root substance re-moval with hand instruments, with anincreasing number of strokes the amountof root substance removed per strokecan become less (Zappa et al. 1991).The authors ascribed this effect to thedulling of the curettes. As it is notknown which force has to be appliedto remove firmly adhering deposits, theamount of root substance loss cannot beunreservedly equated with the removedcalculus volume (Kocher et al. 2001).However, in the present study, for alltreatments, new instruments were usedto avoid dulling effects as far as possi-ble. It could be demonstrated that lateralforces and power settings could influ-ence the efficiency of instruments usedfor debridement (Flemmig et al. 1997,1998a, b, Gagnot et al. 2004). To controlfor these effects, in the present study,instruments were used always with thesame power settings. Adjustment ofapplied lateral forces allowed an inter-instrumentation comparison within theexperimental set-up. Values of the pre-liminary survey were comparable withthose published for calculus removalusing sonic scalers (Petersilka et al.2003). The mean debridement force

Table 2. Colony forming units (CFU/ml) of periopathogenic microorganisms before and aftertreatment with the Vectort-system and hand instrumentation

Vectort Hand instrument

Porphyromonas gingivalisculturing

0 0 0 4 5 5 6 6 before 6 6 6 5 5 4 0 00 0 0 0 5 6 6 6 after 6 5 5 4 0 0 0 0

DNA probe0 0 0 5 5 6 6 6 before 6 6 6 6 6 4 0 00 0 0 0 5 6 6 6 after 6 6 5 4 0 0 0 0

Prevotella intermediaculturing

0 0 4 4 4 5 5 6 before 5 5 5 5 4 4 4 40 0 0 0 0 3 3 5 after 4 4 0 0 0 0 0 0


Bacteroides forsythusculturing

0 0 3 4 4 6 6 6 before 5 5 5 0 0 0 0 00 0 0 4 4 4 5 6 after 4 4 0 0 0 0 0 0


Treponema denticolaDNA probe

0 0 0 0 0 4 5 6 before 6 4 0 0 0 0 0 00 0 0 0 0 0 4 5 after 4 0 0 0 0 0 0 0

Numbers indicate the log number of every microorganism. Data are not linked to specific sites. The

darker the shadowing of the boxes, the higher the amount of microorganisms. Data presentation

according to Mombelli et al. (1995) and Bollen et al. (1998).

Fig. 5. Representative specimens for teeth treated with hand instruments and the ultrasonicdevice in vivo. The red lines indicate the area of interest, determined by the coronal groove,lateral margins 1 mm apart from the line angle of the tooth and the border of the connectivetissue attachment.

572 Braun et al.


was 0.87 � 0.27 N for a novel paddle-like scaler tip and 0.79 � 0.22 N fora conventional scaler tip. In the pre-sent study the preliminary survey show-ed a lateral pressure of 0.83 � 0.11 Nfor treatment with the conventionalultrasonic system, 0.68 � 0.10 N forthe Vectort-system with the polish-ing fluid and 0.69 � 0.09 N for theVectort-system with the abrasivefluid.

Comparisons between studies dealingwith calculus removal are difficult, asthere is no consistency between studydesigns and methodologies. Overall,ultrasonic and sonic scalers appear tolead to results similar to hand instru-ments for removing plaque, calculus andendotoxin (Drisko et al. 2000). Evaluat-ing diamond-coated ultrasonic tips onsingle-rooted teeth in vivo, the times forremoving calculus were recorded. Themean time to reach the clinical endpointof treatment was 289 � 193 s for handcurettes, 194 � 67 s for standard smoothultrasonic tips, 167 � 71 s for fine gritand 147 � 92 s for medium grit dia-mond-coated ultrasonic tips (Yuknaet al. 1997). As the amount of calculuspresent before treatment could not berecorded due to the in vivo design of thestudy, these treatment times only showthat diamond-coated inserts tended totake less time for debridement. Compar-ing the ultrasonic Cavitront-system andhand instrumentation, the ultrasonicsystem required 8.2 � 1.9 min, whereasfor hand instrumentation 10.2 � 2.9 minwere needed to achieve visible cleanli-ness of the root surface (Lee et al. 1996).In this study, exact amounts of calculuswere not measured before treatment.Only examination by eye indicated simi-lar amounts of calculus on the rootsurfaces. In the present study, the high-est efficiency of hand instruments maybe due to the in vitro design, measuringexact volumes of removed calculususing laser scanning.

In a previous study, it could bedemonstrated that the amount of rootsubstance removal depended on the irri-gation fluid, used with the Vectort-system (Braun et al. 2005b). The deviceis intended to be used for non-surgicalperiodontal treatment and should there-fore remove a maximum amount ofsubgingival calculus and a minimumamount of root substance. Using theabrasive fluid, a similar degree of effi-ciency in subgingival calculus removalcan be obtained as for conventionalultrasonic systems, but the amount of

root substance removal was similar tothe debridement with hand instruments(Braun et al. 2005b). Using the polish-ing fluid, the amount of root substanceremoval has been shown to be lowerthan with hand instruments or theEnacs-system (Kishida et al. 2004)and similar to the EMS ultrasonic device(Braun et al. 2005b). However, the pre-sent study showed that least efficiencyin calculus removal could be observed,comparing the Vectort-system with aconventional ultrasonic system and handinstrumentation. Hence, the device didnot improve the efficiency of mechan-ical periodontal debridement.

In vivo root debridement resulted inalmost complete removal of subgingivalcalculus. However, due to the non-surgi-cal in vivo study design, it was notpossible to assess the exact amount ofsubgingival calculus before root surfaceinstrumentation. The inclusion criterionwas that the teeth showed radiographi-cally and/or clinically apparent subgingi-val calculus. Using a random allocationfor the sequence of the different treat-ments, major differences between theinitial amounts of calculus should beavoided. The result of the present studyis in agreement with other clinical stu-dies (Sherman et al. 1990, Yukna et al.1997, Eberhard et al. 2003). Some stu-dies showed that the amount of residualcalculus might depend on the pocketdepths (Rabbani et al. 1981, Brayeret al. 1989). The present study includedonly teeth with similar pocket depths atthe mesial and the distal site. Thus, theimpact of different pocket depths didaffect both treatment groups similarly.The results were not analysed dependingon the different tooth types, as theamount of residual calculus was shownnot to be dependent on this parameter(Rabbani et al. 1981, Caffesse et al.1986). Regarding the in vivo treatmenttime, the ultrasonic device took moretime than hand instrumentation to achievea clinically clean root surface. This resultis in contrast to a study evaluating clinicalparameters to assess periodontal healingin vivo (Sculean et al. 2004). In thisstudy, 6 min were required to treatsingle-rooted teeth with the Vectort-system and 8 min with hand instruments.For multi-rooted teeth, ultrasonic treat-ment took 10 min and hand instrumenta-tion was performed for 12 min. However,in this study only non-surgical treatmentprocedures were performed and theamount of residual calculus could not beverified exactly.

In conclusion, the present study indi-cates that the efficiency of the Vectort-system is similar to conventionalultrasonic systems regarding residualcalculus and periopathogenic bacteria.However, treatment is more time con-suming than conventional debridement.The benefit of the device may be thepossibility to adapt the efficiency tothe treatment needs by the selection ofthe irrigation fluid.

Acknowledgements

We acknowledge Duerr Dental for pro-viding the Vectort- system with its diff-erent instrument tips and the irrigationfluids.

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Address:

Priv.-Doz. Dr. Andreas Braun

Welschnonnenstrasse 17

53111 Bonn

Germany

E-mail: [email protected]

Clinical Relevance

Scientific rationale of the study:Ultrasonic devices are used to facil-itate periodontal debridement proce-dures. The novel ultrasonic Vectort-system is supposed to be used withspecific instrument tips and irrigationfluids, but the device’s characteristicsare currently poorly evaluated.

Principal findings: The amount ofresidual calculus and impact on peri-opathogenic bacteria after treatmentwith the novel device is comparableto the findings after conventionaldebridement but treatment is moretime consuming.

Practical implications: One canperform reliable non-surgical perio-

dontal debridement procedures withthe Vectort-system but has to expecta longer treatment time for calculusremoval than with conventionaldevices.

574 Braun et al.


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