The Effect of Mechanical Instrumentation on Dental Hard Tissue In Vitro: A Systematic Review

The aim of this review was to analyse the effects of hand instruments, ultrasonic scalers and air polishing devices on dental hard tissues, focusing on material loss and surface roughness.

Electronic databases MEDLINE, EMBASE, and the Cochrane Library were screened for relevant studies. The review included studies on human cementum and dentine that used at least six human teeth specimens and excluded those using powders other than glycine or erythritol or those examining combined treatments.

Most studies reported higher substance loss with hand curettes compared to ultrasonic scalers. Root substance loss with ultrasonic scalers ranged from 0.28 to 14.73 μm per stroke (mean 4.89 μm) and 0.33 to 8.20 μm per second (mean 2.24 μm). For hand instruments, the loss ranged from 0.86 to 20.60 μm per stroke (mean 6.0 μm). Air polishing with low abrasive powders resulted in a loss of 0.12-23.40 μm (mean 8.65 μm). Surface roughness findings were mixed; air polishing did not increase roughness in one study, while other studies reported both increases and decreases in roughness after using scaling methods.

Due to the heterogeneity of the included studies, comparing the results has certain limitations. Substance loss per second was highest with air polishing devices compared to ultrasonic devices, while substance loss per stroke was greatest with hand instruments compared to ultrasonic scalers.