title: Influence of immediate attachment loss during instrumentation employing thin ultrasonic tips on clinical response to nonsurgical periodontal therapy.
abstract: OBJECTIVE
  Mechanical instrumentation is fundamental to periodontal treatment. However, independent of the instrument used in scaling, an immediate attachment loss occurs at the bottom of the periodontal pocket. This study aimed to determine the influence of tip diameter on attachment loss and the influence of attachment loss on the periodontal response to nonsurgical treatment.
  
  
  METHODS
  Fifteen patients presenting periodontal pockets with a probing depth of 3.5 mm or more in bilateral teeth were divided into two groups: test group-instrumented with a thin tip, and control group-instrumented with a traditional tip. Probing depth, relative gingival position, and relative attachment level were evaluated immediately before and after and at 1 and 3 months after treatment using an electronic computerized probe. The data were analyzed using ANOVA and Tukey tests (P = .05).
  
  
  RESULTS
  Both groups presented attachment loss immediately after instrumentation; however, the thin tip resulted in statistically higher immediate clinical attachment loss than the traditional tip (0.85 and 0.15 mm, respectively; P < .0001). However, both groups showed a similar healing after the ultrasonic therapy, at all parameters evaluated (P > .05).
  
  
  CONCLUSIONS
  In spite of the higher immediate clinical attachment loss inflicted by thin ultrasonic tips during instrumentation, this did not affect the clinical response to the nonsurgical treatment.
authors.affiliation: Department of Prosthodontics and Periodontics, School of Dentistry at Piracicaba, Campinas State University, São Paulo, Brazil.
authors.forename: Renato Corrêa Viana
authors.initials: RC
authors.lastname: Casarin
authors.forename: Sandro
authors.initials: S
authors.lastname: Bittencourt
authors.forename: Erica Del Peloso
authors.initials: Edel P
authors.lastname: Ribeiro
authors.forename: Francisco Humberto
authors.initials: FH
authors.lastname: Nociti
authors.forename: Antonio Wilson
authors.initials: AW
authors.lastname: Sallum
authors.forename: Enilson Antônio
authors.initials: EA
authors.lastname: Sallum
authors.forename: Márcio Zafallon
authors.initials: MZ
authors.lastname: Casati
mesh_terms: D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003762:Dental Instruments; D012534:Dental Scaling / Q000009:adverse effects* / Q000295:instrumentation*; D003936:Diagnosis, Computer-Assisted; D004311:Double-Blind Method; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017622:Periodontal Attachment Loss / Q000209:etiology*; D010514:Periodontal Pocket / Q000175:diagnosis / Q000628:therapy*; D010517:Periodontics / Q000295:instrumentation; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000295:instrumentation