Effectiveness of open flap root debridement with rubber cups, interdental plastic tips and prophy paste. An SEM study

This study was designed to ascertain whether conservative cleaning of surgically-exposed root surfaces can achieve complete plaque removal. 10 single-rooted teeth (40 surfaces) from 4 patients with advanced periodontitis were included in the study. After flap reflection, the root surfaces were cleaned using only rubber cups, EVA plastic tips and prophy paste. No attempt was made to remove calculus. Immediately after treatment, the teeth were extracted. Then root surfaces were systematically examined in the scanning electron microscope to detect any residual bacteria (plaque). 27 of the 40 treated root surfaces were plaque-free. On the other 13 root surfaces, only a few isolated small islands of plaque were detected. On the other hand, relatively extensive areas of the root surfaces exhibited calculus. Bacterial plaque accumulation was routinely observed on the rough calculus surfaces and at the periphery of the hard deposits. These results demonstrate that the instruments used in this study can successfully remove plaque from exposed root surfaces. However, subgingival calculus that is firmly attached to root surfaces virtually always harbors plaque bacteria; such deposits require more aggressive instrumentation (scalers, curettes) for removal.