Laser identification of residual microislands of calculus and their removal with chelation.
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BACKGROUND: During videoscope-assisted minimally invasive surgery which uses a high magnification videoscope to treat periodontal defects, small areas resembling calculus are detected remaining on root surfaces following scaling. These are clinically termed microislands of calculus, which are removed by the use of a chelating agent. This material has not been verified as calculus and the ability of a chelating agent to remove calculus has not been proven. The purpose of this ex vivo study is to verify if the material is calculus and to determine if calculus is removed with a chelating agent. METHODS: Extracted teeth (n=22) with heavy calculus on root surfaces were selected. A 5-mm2 area containing calculus was scribed on each root. Digital videoscope images were made of the marked areas using only white light and also with only a 655-nm diode laser that causes calculus to fluoresce. The marked areas were root planed until no calculus was visible with 3.5 surgical loupes. Digital images were again made. The test area was then burnished with a chelating agent (EDTA) for 30 seconds and images again made. Using the images, the percentage of the marked root surface containing calculus was calculated. RESULTS: Calculus remained on the roots surfaces after they were judged to be clean using 3.5 loupe magnification. Remaining calculus was reduced after burnishing for 30 seconds with EDTA. CONCLUSIONS: Calculus remains on root surfaces judged to be calculus free using surgical loupes for visualization. Small areas of calculus are reduced or eliminated with a chelating agent.