Received: 3 June 2021 Revised: 9 July 2021
DOI: 10.1002/JPER.21-0343
ORIGINAL ARTICLE
In vitro comparison of root surface roughness and
bacterial adhesion following treatment with three
different instruments
Farah Haroon1 Richard L. Gregory2
Yusuke Hamada4
1 Department of Periodontology,
Roudebush VA Medical Center,
Indianapolis, IN
2 Department of Biomedical Sciences and
Comprehensive Care, Indiana University
School of Dentistry, Indianapolis, IN
3Oral Health Research Institute, Indiana
University School of Dentistry,
Indianapolis, IN
4 Department of Periodontology, Indiana
University School of Dentistry,
Indianapolis, IN
Correspondence
Yusuke Hamada, Department of Peri-
odontology, Indiana University School of
Dentistry, 1121 W. Michigan St., Rm. 425,
Indianapolis, IN 46202.
Email: yuhamada@iupui.edu
J Periodontol. 2021;1–9.
Accepted: 12 July 2021
Anderson Hara3 Steven B. Blanchard4
Abstract
Background: A novel device, piezoelectric 11 Gracey curet tip, reportedly com-
bines benefits of a piezoelectric device and manual curet. The primary objec-
tive of this study was to compare root surface roughness outcomes between tra-
ditional manual curets and piezoelectric devices, as compared with this novel
device. The secondary aim was to assess the level of adhesion of Streptococcus
mutans on the root surface after instrumentation.
Methods: The groups consisted of the following: 1) Gracey curet; 2) piezoelec-
tric scaler; 3) piezoelectric 11 Gracey curet tip; and 4) untreated control. Root
specimens were obtained from extracted human teeth and randomly assigned
to each group. Surface roughness measurements (Ra and Rz) were taken with a
profilometer before and after instrumentation. After instrumentation, root spec-
imens were inoculated with S. mutans and biofilm was dislodged. Various dilu-
tions of resuspended biofilm were incubated on blood agar plates and colony
forming units (CFU) values were measured.
Results: The experimental device resulted in significantly lower Ra and Rz com-
pared with other groups (P < 0.01), and the Gracey curet was significantly lower
than the piezoelectric tip and untreated control (P < 0.05). The Gracey curet and
experimental device tip had significantly lower CFU values compared with the
control (P < 0.05). There were no significant CFU value differences between the
Gracey curet and both the piezoelectric and experimental device tips. There were
no significant CFU differences between piezoelectric tip and both experimental
device and control. There was no correlation between Ra and CFU values for
Gracey curet, piezoelectric tip, or the control. However, correlation between Ra
values and CFU approached significance for the experimental device (correla-
tion = 0.66, P = 0.05).
Conclusions: Piezoelectric 11 Gracey curet tip is effective at resulting in a sig-
nificantly smoother surface compared with traditional piezoelectric and hand
instruments. CFU values with piezoelectric 11 Gracey curet tip were significantly
wileyonlinelibrary.com/journal/jper © 2021 American Academy of Periodontology 1
2 HAROON et al.
lower than non-instrumented surfaces, but there were no significant differences
compared with conventional methods.
KEYWORDS
bacterial adhesion, periodontitis, Streptococcus mutans, surface properties
1 INTRODUCTION
Plaque and calculus have been established as playing an
integral role in the development of periodontitis.1,2 A vital
aspect of treating periodontitis is scaling and root planing
(SRP). The goal of SRP is to recreate a biologically accept-
able root surface that is compatible with the health of adja-
cent periodontal tissues.3 A biologically acceptable root
surface can induce a long junctional epithelial new attach-
ment and reduce bacterial attachment.4
There are several instruments which can be used for
root surface debridement. Manual curets have been the
traditional means with which to accomplish root debride-
ment and SRP. While being effective at achieving treat-
ment goals, some of the disadvantages of curets include
difficulty accessing complex root anatomy,5 increased loss
of cementum,6 postoperative hypersensitivity and risk of
pulp damage.7 Ultrasonic instruments are commonly used
to remove plaque and calculus from root surfaces without
some of these disadvantages.8 While ultrasonic scalers are
desired for their increased efficiency, multiple studies have
demonstrated that root surfaces are left relatively rougher
and more damaged when compared with root surfaces
instrumented with manual curets.9–11 One study compared
mean roughness values obtained for teeth treated in vivo
with either a manual curet, magnetostrictive scaler, or no
treatment.9 The findings revealed that the magnetostric-
tive tip left a significantly rougher surface as compared
with the manual scaler. A prominent finding of this report
was that there was no statistically significant difference
between the magnetostrictive scaler and the control teeth,
implying that though the magnetostrictive scaler removed
surface deposits, it left the root surfaces with a roughness
value approximating that of untreated surfaces. Another
similar study comparing untreated teeth, manual curets,
and two different piezoelectric devices found that all three
treatment methods resulted in a smoother root surface
as compared with the control teeth, implying that piezo-
electric devices represent a valid alternative to manual
instruments.7 Given the varying benefits and limitations
of all of the available treatment options, many clinicians
elect to use both manual and ultrasonic instrumentation
in combination.12
While removal of plaque and calculus is critical, it is
just as vital to minimize further bacterial adherence to root
surfaces. It has been shown that as early as within min-
utes after cleaning and polishing, Gram-positive bacteria
begin to colonize the tooth surfaces, eventually followed by
Gram-negative bacteria.13 The clinical parameters of peri-
odontal disease have been linked with the Gram-negative
bacteria.14 Furthermore, increased surface roughness has
been shown to promote formation and development of this
biofilm.15 These findings further establish the importance
of the objectives of non-surgical periodontal therapy, in
addition to obtaining a smooth root surface.
A novel device, piezoelectric 11 Gracey curet tip,* has
recently been created which reportedly combines the ben-
efits of both a piezoelectric device and a manual curet into
a single piezoelectric tip attachment (Fig. 1); this device
has multiple tips, including FK-11, FK-12, FK-13, and FK-
14. The FK-11 and FK-12 are modeled off of a Gracey curet
#11 and #12 tip while the FK-13 and FK-14 are modeled
off of a Gracey curet #13 and #14. The company claims
that this device will shorten treatment time, increase effi-
ciency, and cause less trauma to the tissues. However, no
study has been conducted to assess the effects of the piezo-
electric 11 Gracey curet tip on root surface roughness, as
well as the subsequent effect on bacterial adherence to
instrumented surfaces. Therefore, the primary purpose of
this study was to compare the effects of: 1) manual Gracey
curet, 2) piezoelectric device, and 3) combined piezoelec-
tric/manual curet—the piezoelectric 11 Gracey curet tip.
F I G U R E 1 Piezoelectric 11 Gracey curet tip attachments.
Pictured from top to bottom: FK-11, FK-12, FK-13, FK-14
* Ultrasonic Gracey Tip,
R
Hakusui Boueki, Tokyo, Japan.
HAROON et al.
The secondary purpose of this study was to assess whether
the resulting surface roughness would affect the ability of
bacteria to adhere to the instrumented root surfaces.
2 MATERIALS AND METHODS
Extracted human teeth stored in 0.1% thymol were used for
this study. The crowns of the teeth were sectioned from the
roots and every effort was made to select roots with rel-
atively flat surfaces, devoid of any exaggerated curvature.
Because of this reason, all included teeth were maxillary
and mandibular incisors, canines, and premolars. Molars
were not included in this study. A 10 mm (height) x 5 mm
(width) area was sectioned from each selected root. No sur-
face pretreatment or adjustment was completed on the Sur-
face planned for instrumentation. A reference notch was
placed in a set reference location to allow for consistent
future orientation of the samples. Specimens were stored
in saline throughout the duration of the data collection.
2.1 Surface roughness measurement
Surface roughness was evaluated both before and after
instrumentation using mean Ra and Rz values, which
were obtained with an optical profilometer† (S5/03 sen-
sor, 0.3 mm measuring range). Ra and Rz are widely used
to characterize the topography of a surface. Ra is a mea-
sure of the arithmetic mean of the valleys and peaks in
a roughness profile,7 while Rz is the average value of the
height of the five highest peaks and five deepest valleys in
the line profile being measured.16 A software surface fil-
ter was used to remove any gross surface curvature. Three
separate measurements were taken at three different loca-
tions on each specimen, both before and after instrumen-
tation. These locations were selected at the time of baseline
measurements and the same locations were used for post-
instrumentation measurements. A 1 mm x 1 mm area was
scanned for each of the three sites on each specimen (100
steps in the x and y direction, with both 0.01 mm step size
for each), and Ra and Rz values were calculated based on
the average of x and y measurements. To locate a specific
portion of the root surface to scan, the profilometer started
in the upper left corner of each specimen before each read-
ing. For the first area of measurement, the machine moved
2 mm in the x-axis and 2 mm in the y-axis. For the second
area of measurement, the machine moved 4 mm in the x-
axis and 2 mm in the y-axis. For the third area of measure-
ment, the machine moved 6 mm in the x-axis and 2 mm in
† Proscan 2000, Scantron, Venture Way, Tauton, UK.
3
the y-axis. Mean baseline Ra and Rz values were obtained
for each specimen and used for balanced randomization
into the treatment groups:
A. Gracey curet group: 50 vertical strokes with a new
Gracey curet #11 and #12.‡ The instrument was sharp-
ened at the beginning of instrumentation for each spec-
imen.
B. Piezoelectric scaler group: Instrumentation with a
Piezoelectric scaler Perio-tip § set at 40% power for 1
minute with water irrigation on the surface of each
specimen.
C. Piezoelectric 11 Gracey curet tip group: Instrumenta-
tion with the novel test device piezoelectric 11 Gracey
curet tip; a new FK11 tip at 40% power for 1 minute with
irrigation. The instrument was sharpened at the begin-
ning of instrumentation for each specimen.
D. Control group: No instrumentation.
An India stone was used to sharpen both the Gracey
11/12 and the test device. The cutting edge of each instru-
ment was placed at a 90◦ angle to the stone and passed
along the surface in one direction repeatedly until the oper-
ator visually felt that the instrument was sharpened. A pro-
filometer was not used to assess the curet tip before instru-
mentation.
2.2 Instrumentation
All instrumentation was performed by board-certified
periodontist (YH). After instrumentation, all specimens
were re-scanned by the profilometer in the same manner
as before instrumentation. Mean Ra and Rz values were
obtained and compared with the initial values. One spec-
imen from each group was randomly selected to obtain
SEM images for visual assessment of the surface appear-
ance.
2.3 Bacterial adherence evaluation
Ethyl acetate was applied to the non-instrumented sur-
faces of each specimen to prevent bacterial adherence on
non-instrumented surfaces. The root specimens were dis-
infected in 70% ethanol for 30 minutes. Specimens were
placed into sterile 24-well tissue culture plates with the
instrumented surfaces facing upward, using sterile forceps.
Two milliliter of bacterial medium [tryptic soy broth (TSB)
containing 1% sucrose (TSBS)] was added to each well. The
‡ Hu-Friedy, Chicago, IL.
§ Acteon Satelec SP Newtron Scaler, Mount Laurel, NJ.
4 HAROON et al.
specimens were inoculated with 25 µL of a 16-hour culture
of S. mutans strain UA159 (ATCC 700610) grown in TSB
at 37◦ C in 5% CO2 and were incubated for 24 hours. The
specimens were removed with sterile forceps and placed
into 5-mL plastic sterile tubes containing 1 mL of sterile
saline. Each specimen was sonicated in the saline for 10
seconds, followed by vigorous vortexing for another 10 sec-
onds to dislodge attached biofilm. One milliliter of resus-
pended biofilm bacterial cells in saline was used to initi-
ate a 1:10 serial dilution series in saline. Serial dilutions
were made up to 1:100,000 for each specimen. The 1:1,000
and 1:100,000 dilutions were plated. Hundred microliters
of each of the 1:1,000 and 1:100,000 dilutions were pipetted
onto blood agar plates and spread evenly over the entire
surface. These plates were incubated for 24 hours and
colonies were counted using an automated colony counter.
With this information, the colony forming units (CFU)/mL
of sonicated biofilm bacteria were obtained for each speci-
men.
One specimen from each group was rinsed with saline
and air-dried for 12 hours, after which they were placed in a
dehydrator. Specimens were mounted on aluminum stubs,
placed in a sputter coater, and coated with gold before SEM
examination. SEM images were taken with x500, x1000,
x2000, and x10,000 magnification.
2.4 Statistical analysis
Surface roughness (Ra and Rz) pre-instrumentation and
post-instrumentation and roughness change were com-
pared using one-way ANOVA followed by pairwise group
comparisons using Fisher Protected Least Significant Dif-
ferences. Bacteria colony counts were compared using
ANOVA on the ranks of the data, followed by pair-
wise group comparisons using Fisher Protected Least Sig-
nificant Differences. A Spearman correlation coefficient
between the post-treatment surface roughness and bacte-
ria colony counts was calculated. A 5% significance level
was used.
2.4.1 Sample size justification
For the surface roughness portion of the study, with a sam-
ple size of nine specimens per group, the study would have
80% power to detect a difference of 0.075 µm for Ra. For the
bacterial adherence portion of the study, with a sample size
of three per group with three experimental replications, the
study would have 80% power to detect a ratio of means of
1.14 for CFU/mL (a 14% increase for one group compared
with another group). Calculations assumed two-sided tests
conducted at a 5% significance level and a within-group
standard deviation of 0.05 µm for Ra and a coefficient of
variation of 0.09 for colony counts.
3 RESULTS
A total of nine root specimens were included in each group,
for a total of 36 specimens. All the specimens were free
of any visible calculus or plaque deposits; thus, none of
the root surfaces were altered before instrumentation and
profilometric assessment. Three separate bacterial serial
dilutions were performed, each round of which included
three root specimens per group. Two control specimens
were excluded from the first serial dilution as the CFU val-
ues were unusually low compared with the other seven
control CFU values. These two control specimens were
entirely excluded from the study, resulting in 34 root spec-
imens being included in the surface roughness and bacte-
rial adherence statistical analyses. Baseline Ra and Rz val-
ues showed no significant differences between any of the
groups. All value descriptors are mean ± SE.
Following instrumentation, the piezoelectric scaler had
higher Ra values than the Gracey curet, 1.90 ± 0.13 and 1.36
± 0.11, respectively (P < 0.05). The piezoelectric scaler also
had higher Ra values compared with the novel test device
(1.90 ± 0.13 versus 0.67 ± 0.12; P < 0.01). Control speci-
mens had an average Ra value of 2.19 ± 0.25 (Table 1). There
were no significant differences between the piezoelectric
scaler and control specimens. Instrumentation with the
novel test device resulted in significantly lower Ra values
compared with control specimens (P < 0.01) and Gracey
curet (P < 0.01). The Gracey curet use resulted in lower
Ra values (P < 0.01) compared with the control. When
comparing the changes in Ra values pre-instrumentation
to post-instrumentation, there was no significant differ-
ence between the Gracey curet and the piezoelectric scaler
(P = 0.07). There was a significant difference between the
novel test device and the Gracey curet, with the test device
producing a more significant reduction in Ra and Rz than
the Gracey curet (P < 0.01). The novel test device produced
a significant reduction from pre-instrumentation Ra val-
ues when compared with the piezoelectric scaler (P < 0.01)
(Table 2).
Regarding Rz values following instrumentation, the
piezoelectric scaler had higher values (8.03 ± 0.66) com-
pared with the Gracey curet (5.58 ± 0.44), which was sta-
tistically significant (P value, 0.02). The Gracey curet had
a significantly higher (P < 0.01) Rz value compared with
the novel test device (2.69 ± 0.45). The piezoelectric scaler
also had a significantly higher (P < 0.01) Rz value com-
pared with the novel test device. There were no signifi-
cant differences in Rz values when comparing the control
group (9.55 ± 1.31) with the piezoelectric scaler (P = 0.16).
HAROON et al. 5

TA B L E 1 Post-treatment surface roughness values (mean ± SE) on 34 surfaces

Pairwise comparisons (P value)
Group C Group D
Group A Group B (Gracey- (no
(Gracey) (Piezo) Piezo) treatment) Groups Groups Groups Groups Groups Groups
Variables (n = 9) (n = 9) (n = 9) (n = 7) A and B A and C A and D B and C B and D C and D
Ra (µm) 1.36 ± 0.11 1.90 ± 0.67 ± 0.12 2.19 ± 0.25 0.01 <0.01 <0.01 <0.01 0.19 <0.01
0.13
Rz (µm) 5.58 ± 0.44 8.03 ± 2.69 ± 0.45 9.55 ± 1.31 0.02 0.01 <0.01 <0.01 0.16 <0.01
0.66
There were no significant differences in Ra or Rz for all groups at baseline. Piezoelectric 11 Gracey curet tip (test group/Group C) resulted in significantly lower
Ra and Rz values compared with all other groups.

TA B L E 2 Mean surface roughness (Ra and Rz) reduction

Group C
Group A Group B (Piezo) (Gracey-Piezo)
Ra (µm) (Gracey) (n = 9) (n = 9) (n = 9)
Mean 0.69 0.22 1.48
SE 0.15 0.2 0.16
Minimum 0.12 -0.65 0.77
Maximum 1.34 1.02 2.35
Group C
Group A Group B (Piezo) (Gracey-Piezo)
Rz (µm) (Gracey) (n = 9) (n = 9) (n = 9)
Mean 3.14 0.96 6.9
SE 0.76 0.76 0.9
Minimum 1.03 -2.26 4.73
Maximum 7.28 6.06 13.58
Both piezoelectric 11 Gracey curet tip (Group C/test group) and Gracey curet resulted in an overall greater mean reduction of both Ra and Rz when compared
with the traditional piezoelectric device, though this reduction was more pronounced with the test device. The piezoelectric device resulted in rougher surfaces
in select specimens.

The control group had significantly greater Rz values com-
pared with the Gracey curet (P value < 0.01) as well as the
novel test device (P value < 0.01). When comparing the
pre-instrumentation and post-instrumentation Rz values,
there were no significant differences between the Gracey
curet and the piezoelectric scaler (P value, 0.07). There
were significant differences between the novel test device
and the Gracey curet, with the novel test device producing
a more significant reduction in Rz values than the Gracey
curet (P < 0.01). The novel test device produced a signifi-
cant reduction from pre-instrumentation Rz values when
compared with the piezoelectric scaler (P < 0.01) (Fig. 2).
Regarding CFU values, there was no significant dif-
ference (P = 0.34) between the Gracey curet (1.6 × 107
± 3.3 × 106 ) and the piezoelectric scaler (2.7 × 107 ±
7.4 × 106 ). Similarly, there was no significant difference
(P = 0.60) between the Gracey curet and the novel test
device (1.5 × 107 ± 3.9 × 106 ). There was no significant
difference (P = 0.14) between the piezoelectric scaler and
the novel test device. Also, there was no significant differ-
ence (P = 0.07) between the piezoelectric scaler and con-
trol group (5.9 × 107 ± 1.3 × 107 ). The control group had sig-
nificantly higher CFU values compared with Gracey curet
(P < 0.05) and the novel test device (P < 0.01). There was no
correlation between Ra and CFU values for Gracey curet
(P = 0.86), piezoelectric scaler (P = 0.54), or the control
group (P = 0.65). Correlation between Ra values and CFU
of the novel test device approached significance (correla-
tion = 0.66, P = 0.05). There was no correlation between
Rz and CFU values for Gracey curet (P = 0.73), piezo-
electric scaler (P = 0.70), piezoelectric 11 Gracey curet tip
(P = 0.07), or the control group (P = 0.43) (Fig. 3).
When evaluating the SEM images, it was apparent that
the novel test device had an overall smoother surface
appearance when compared with the other three groups
(Fig. 4). The control group had a significant amount of
visual surface roughness, while larger bumps could be
visualized on the surfaces that were instrumented with
6 HAROON et al.

F I G U R E 2 Mean ± SE Ra and Rz values for each group. The control and piezoelectric had higher Ra and Rz values than the Gracey
curet and piezoelectric 11 Gracey curet tip. The piezoelectric and control had similar Ra and Rz outcomes, signifying that the piezoelectric
device resulted in a surface comparable to a non-treated surface. *P value < 0.05

if surface roughness values had a correlation with bacterial

F I G U R E 3 Mean ± SE CFU/mL values for each group.
Traditional Gracey curet and piezoelectric 11 Gracey curet tip had
significantly lower CFU values compared with the control group. *P
value < 0.05
the traditional piezoelectric device. These visual micro-
scopic findings generally were in agreement with the sur-
face roughness findings.
4 DISCUSSION
This study was designed to compare the effect on root sur-
face roughness of a novel combined Gracey-piezoelectric
device (piezoelectric 11 Gracey curet tip), as compared with
a traditional manual curet, piezoelectric device, and no
treatment (control). A secondary objective was to evaluate
adherence of S. mutans.
Following instrumentation, both the Gracey curet and
novel test device achieved lower Ra and Rz values. When
comparing the Ra and Rz values of the traditional piezo-
electric and control groups, there were no significant dif-
ferences. Some specimens from the piezoelectric group
had an increase in Ra and Rz values following instrumen-
tation. The most significant finding here is that the novel
test device had significantly lower Ra and Rz values com-
pared with all groups, including the Gracey curet. Though
these findings were statistically significant, it is impor-
tant to note that even the smoothest root surface does not
approach the smoothness of a polished metal implant col-
lar, which are known to harbor plaque, and accompanying
inflammation, despite their surface characteristics. Thus,
further clinical studies are needed to explore the potential
clinical outcomes related to our findings.
Regarding CFU values, the control group had signifi-
cantly higher values compared with both the traditional
Gracey curet and the novel test device; however, there was
no significant difference between the control and piezo-
electric groups. Also, there were no significant differences
among the three experimental groups. There was no sig-
nificant correlation between mean Ra and CFU values for
the Gracey curet, piezoelectric scaler, or the control group.
The correlation between mean Ra and CFU values of the
novel test device approached significance and there was no
correlation between Rz and CFU values for any of the four
groups.
Based on findings from the present study, the Gracey
curet and novel test device were significantly effective
compared with no treatment. This verifies that ultrasonic
HAROON et al.
FIGURE 4 Post-instrumentation SEM images. Ten micrometer reference bar (x500, x1,000, x2,000). One micrometer reference bar
(x10,000)
and hand instruments are effective for root planing; there-
fore, achieving improvements in clinical parameters such
as reduction in probing depth and gain in clinical attach-
ment level. Despite the overall effectiveness of these two
types of instruments, it is important to note that different
instruments may result in different variations of surface
roughness. In the present study, the piezoelectric group
consistently had higher Ra and Rz values and the novel
test device consistently had lower Ra and Rz values. The
latter outcomes may be attributed to the curet-like tip of
the novel device. The overall effect may be that of ultra-
sonic instrumentation followed by manual instrumenta-
tion, which has been shown to be the most effective. In
a study by Kerry, root surfaces were instrumented with
either manual curet alone, ultrasonic alone, manual curet
followed by ultrasonic, or ultrasonic followed by man-
ual curet.17 The findings revealed that the groups ending
in instrumentation with manual curet had significantly
smoother mean surface roughness outcomes as compared
with groups ending in ultrasonic instrumentation. The
study found that a surface roughened by ultrasonic instru-
mentation can be brought back to ideal smoothness when
followed with a hand instrument. This may explain why
the novel test device in the present study resulted in signif-
icantly lower Ra and Rz values as compared with all other
groups.
7
Bacterial adhesion is initiated when bacteria are trans-
ported to the surface. Initial adhesion occurs through
Van der Waals and electrostatic forces. Subsequently a
firm attachment forms (i.e., direct contact or chemical
bonding). Finally, colonization results in the formation of
biofilms.18 This process allows the adherence of initial col-
onizers, including S. mutans, which affects the ability of
bridging colonizers to provide an attachment mechanism
for late colonizers. Therefore, the adherence of the initial
colonizers is critical for the establishment of pathogenic
periodontal pathogens. Furthermore, it has been shown
that abraded, rough subgingival enamel surfaces, without
effective removal, will result in increased plaque and cal-
culus deposition.19
In an in vitro study by Eick et al., Ra and Rz values were
obtained from dentin specimens sectioned from extracted
human teeth and instrumented with either a Gracey curet
or Gracey curet followed by a diamond-coated curet.20 The
findings revealed that the Gracey curet alone resulted in
statistically significant lower Ra and Rz values in com-
parison with the untreated control and Gracey curet fol-
lowed by diamond-coated curet. The specimens treated
with the Gracey curet followed by diamond-coated curets
had lower Ra and Rz values when compared with the
untreated controls, but there were no significant differ-
ences between the two groups. In this study, bacterial
8 HAROON et al.
adherence of S. gordonii was found to be significantly
lower in the specimens instrumented with Gracey curet
followed by diamond-coated curet, when compared with
those instrumented with Gracey curet alone; however,
there were no significant differences between either exper-
imental group when compared with untreated controls.
This finding is slightly different than the findings in the
present study, as the present study found significant differ-
ences between the novel test device and Gracey curet as
compared with untreated controls in regards to S. mutans
adherence. The authors of the aforementioned study did
mention that the specimens were covered in serum before
inoculation with S. gordonii to simulate in-vivo conditions.
Therefore, it may be speculated that this may have poten-
tially weakened surface irregularities and affected bacterial
adherence.
In an in vitro study by Ota-Tsuzuki et al., flattened
bovine roots were instrumented with either ultrasonic
device, Er:YAG laser, or manual curet and compared
with untreated controls in regards to Ra and S. sangui-
nis adherence.21 Surprisingly, the findings revealed that
all treatments increased Ra compared with untreated con-
trols, with the greatest increase seen with the manual
curet and the lowest increase seen with the ultrasonic. The
authors attributed these outcomes potentially to exposed
dentin tubules which they claimed to contribute to sur-
face irregularities. They also found that bacterial adher-
ence was greater in the manual curet group, which was sur-
mised to be due to exposed dentin tubules acting as bacte-
rial reservoirs. This study had notable limitations, includ-
ing the use of bovine roots which present larger dentin
tubules as compared with human roots.
In the present study, mean Ra and Rz decreased signif-
icantly for both the Gracey and novel test device. These
findings were statistically significant when comparing the
control group to both the Gracey curet and test device. The
test device achieved a statistically significant smoother sur-
face when compared with the Gracey curet as well. Bacte-
rial adherence, represented by mean CFU values, for both
the Gracey curet and test device was significantly lower
than non-instrumented controls; however, there were no
significant differences when compared with each other.
When evaluating if there was a correlation between sur-
face roughness and bacterial adherence outcomes, Ra/Rz
and CFU values for the novel test device approached signif-
icance based on the correlation coefficients and represen-
tative P-values, especially when compared with the other
groups.
A strength of this study is that instrumentation was con-
ducted on cementum-containing root surfaces of human
teeth. Though this was an in vitro study, the use of these
types of specimens reflects the clinical situation as closely
as possible without using live subjects. Some limitations
include that teeth with furcation involvement or exagger-
ated root curvature were excluded. This was done to stan-
dardize the pre-instrumentation surface of the root speci-
mens as much as possible, which unfortunately does not
reflect an accurate clinical scenario. Another limitation of
this study is that the effectiveness of calculus removal was
not assessed. Also, SEM imaging was only completed on
one small section of one specimen per treatment and con-
trol groups. Further in vivo studies are recommended.
5 CONCLUSIONS
Piezoelectric 11 Gracey curet tip resulted in a significantly
smoother surface when compared with instrumentation
with traditional instruments. This is an advantage the
novel device has over other traditional ultrasonic devices.
This device did demonstrate reduced bacterial adherence
compared with untreated root surfaces but was compara-
ble with conventional methods. There were no statistically
significant correlations between post-instrumentation sur-
face roughness and CFU values, though the piezoelectric 11
Gracey curet tip did approach significance. Further clinical
studies are needed to verify clinical and patient-centered
outcomes.
AC K N OW L E D G M E N T S
The authors wish to acknowledge the efforts of Adam
Benjamin Kelly (Indiana University), Daniel Eugene Min-
ner (Indiana University), Tianli Zhu (Indiana University),
George Eckert (Indiana University), Surya Sruthi Bhamidi-
palli (Indiana University), and Kohei Fujimoto (private
practitioner, Tokyo, Japan) in addition to academic support
from Dr. Leslie Brooks (Roudebush VA Medical Center)
and Dr. Clark T. Barco (Roudebush VA Medical Center).
This study was partially funded by Indiana Univer-
sity’s Graduate Student Research Committee. This mate-
rial is the result of work supported with non-monetary
resources at the Roudebush VA Medical Center (Indi-
anapolis, IN). The data that support the findings of this
study are available from the corresponding author upon
reasonable request. The authors report no conflicts of
interest related to this study.
The authors do not have any financial interests in any of
the products mentioned in this article.
AU T H O R CO N T R I B U T I O N S
Farah Haroon provided substantial contributions to acqui-
sition, analysis, and interpretation of data; and drafting the
article. Richard L. Gregory provided substantial contribu-
tions to the study design; acquisition, analysis, and inter-
pretation of data; critical revision of the article; and final
approval of the version to be published. Anderson Hara
HAROON et al.
provided substantial contributions to the study design;
acquisition, analysis, and interpretation of data; critical
revision of the article; and final approval of the version
to be published. Steven Blanchard provided substantial
contributions to the study design; critical revision of the
article; and final approval of the version to be published.
Yusuke Hamada provided substantial contributions to the
study conception and design; acquisition, analysis, and
interpretation of data; drafting and revising the article; and
final approval of the version to be published.
ORCID
Farah Haroon https://orcid.org/0000-0002-9108-008X
Anderson Hara https://orcid.org/0000-0001-9822-6064
Yusuke Hamada https://orcid.org/0000-0001-8544-8418
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How to cite this article: Haroon F, Gregory RL,
Hara A, Blanchard S, Hamada Y In vitro
comparison of root surface roughness and bacterial
adhesion following treatment with three different
instruments. J Periodontol. 2021;1-9.
https://doi.org/10.1002/JPER.21-0343