title: Potential of shock waves to remove calculus and biofilm.
abstract: Effective calculus and biofilm removal is essential to treat periodontitis. Sonic and ultrasonic technologies are used in several scaler applications. This was the first feasibility study to assess the potential of a shock wave device to remove calculus and biofilms and to kill bacteria. Ten extracted teeth with visible subgingival calculus were treated with either shock waves for 1 min at an energy output of 0.4 mJ/mm(2) at 3 Hz or a magnetostrictive ultrasonic scaler at medium power setting for 1 min, which served as a control. Calculus was determined before and after treatment planimetrically using a custom-made software using a grey scale threshold. In a second experiment, multispecies biofilms were formed on saliva-preconditioned bovine enamel discs during 64.5 h. They were subsequently treated with shock waves or the ultrasonic scaler (N = 6/group) using identical settings. Biofilm detachment and bactericidal effects were then assessed. Limited efficiency of the shock wave therapy in terms of calculus removal was observed: only 5% of the calculus was removed as compared to 100% when ultrasound was used (P ≤ 0.0001). However, shock waves were able to significantly reduce adherent bacteria by three orders of magnitude (P ≤ 0.0001). The extent of biofilm removal by the ultrasonic device was statistically similar. Only limited bactericidal effects were observed using both methods. Within the limitations of this preliminary study, the shock wave device was not able to reliably remove calculus but had the potential to remove biofilms by three log steps. To increase the efficacy, technical improvements are still required. This novel noninvasive intervention, however, merits further investigation.
authors.affiliation: Clinic for Preventive Dentistry, Periodontology and Cariology, Center for Dental and Oral Medicine and Maxillofacial Surgery, Plattenstrasse 11, 8032 Zurich, Switzerland.
authors.forename: Philipp
authors.initials: P
authors.lastname: Müller
authors.forename: Bernhard
authors.initials: B
authors.lastname: Guggenheim
authors.forename: Thomas
authors.initials: T
authors.lastname: Attin
authors.forename: Ernst
authors.initials: E
authors.lastname: Marlinghaus
authors.forename: Patrick R
authors.initials: PR
authors.lastname: Schmidlin
mesh_terms: D000190:Actinomyces / Q000528:radiation effects; D000818:Animals; D058491:Bacterial Load / Q000528:radiation effects; D018441:Biofilms / Q000528:radiation effects; D002176:Candida albicans / Q000528:radiation effects; D002417:Cattle; D003728:Dental Calculus / Q000382:microbiology / Q000628:therapy*; D044622:Dental Pellicle / Q000382:microbiology; D012534:Dental Scaling / Q000295:instrumentation; D005240:Feasibility Studies; D016967:Fusobacterium nucleatum / Q000528:radiation effects; D019220:High-Energy Shock Waves / Q000627:therapeutic use*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D023861:Photography, Dental / Q000379:methods; D011829:Radiation Dosage; D013295:Streptococcus mutans / Q000528:radiation effects; D019533:Streptococcus oralis / Q000528:radiation effects; D013997:Time Factors; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000295:instrumentation; D014678:Veillonella / Q000528:radiation effects
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