Revista de Odontologia da UNESP
https://revodontolunesp.com.br/article/doi/10.1590/1807-2577.20260017
Revista de Odontologia da UNESP
Original Article

Comparative evaluation of Dual Gracey™ curettes and sonic instruments for deposit removal in molar furcations: an in vitro study

Avaliação comparativa de curetas dual Gracey™ e instrumentos sônicos para a remoção de depósitos em furcas molares: um estudo in vitro

Felipe BITTARELLO; Milena de Moura GIRARDELLO; Ana Laura Rosa SANTOS; Maria Cecília ANICIO; Fábio André dos SANTOS

http://dx.doi.org/10.1590/1807-2577.20260017 Rev. odontol. UNESP, vol.55, e20260017, 2026
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Abstract

Introduction: The anatomical complexity of molar furcations challenges root deposit removal and may influence the effectiveness of periodontal instrumentation.

Objective: To evaluate the removal of simulated deposits in molar furcations using Dual Gracey™ curettes and sonic instruments.

Material and method: Sixteen molars (80 tooth surfaces) were divided into maxillary (n=8) and mandibular (n=8) molars based on furcation width. Orthodontic wires were inserted into the furcation entrance and divided into two categories: narrow (wire from 0.4–0.6 mm) and wide (wire ≥0.7 mm) furcations. A composite mixture of cyanoacrylate, plaster, and graphite powder was used to simulate the root surface deposits. The molars were mounted on manikins with rubber artificial gingiva to simulate the clinical conditions of ergonomic work. They were randomized according to the periodontal instrument (Dual Gracey™ curettes or sonic instrument), furcation width, dental arch, and side. Planimetric analysis was performed on the buccal, lingual, mesial, distal, and furcation roof surfaces. Statistical analysis was performed using two-way ANOVA, followed by Tukey’s post-hoc test.

Result: The percentage of residual deposits differed significantly (p = 0.011) between the instruments, being higher for the curettes (44 ± 16) than sonic instrument (34 ± 11). The furcation roof showed a higher percentage (71 ± 20) than the other dental surfaces: buccal (27 ± 15), lingual (37 ± 19), mesial (41 ± 20), and distal (41 ± 24). Furcation width and arch position did not affect the instrumentation effectiveness; however, a significant difference was observed between the sides of the dental arches.

Conclusion: Sonic instruments were more effective in removing root surface deposits from the furcation region. Furthermore, the furcation roof showed the highest percentage of residual deposits.

Keywords

Dental scaling; periodontal debridement; molar; furcation defects; dental instruments; dental models

Resumo

Resumo: Introdução: A complexidade anatômica das furcas dos molares dificulta a remoção de depósitos radiculares e pode influenciar a eficácia da instrumentação periodontal.

Objetivo: Avaliar a remoção de depósitos simulados em furcas de molares utilizando curetas Dual Gracey™ e instrumentos sônicos.

Material e método: Este estudo incluiu 16 molares (80 superfícies), divididos em maxilares (n=8) e mandibulares (n=8). Fios ortodônticos foram inseridos na entrada da furca, sendo divididas em: furcas estreitas (fio de 0,4–0,6 mm) e largas (fio ≥0,7 mm). Uma mistura composta de cianoacrilato, gesso e pó de grafite foi utilizada para simular depósitos radiculares. Os molares foram montados em manequins com gengiva artificial de borracha para simular as condições clínicas de trabalho. Eles foram randomizados de acordo com o instrumento periodontal (cureta dual Gracey™ ou instrumento sônico), largura da furca, arcada dentária e lado. A análise planimétrica foi realizada nas superfícies: vestibular, lingual, mesial, distal e do teto da furca. A análise estatística foi realizada utilizando ANOVA de duas vias e pós-teste de Tukey.

Resultado: A porcentagem de depósitos residuais diferiu significativamente (p = 0,011) entre os instrumentos, sendo maior na cureta (44 ± 16) do que no instrumento sônico (34 ± 11). O teto da furca apresentou uma maior porcentagem (71 ± 20) do que as outras superfícies dentárias: vestitular (27 ± 15), lingual (37 ± 19), mesial (41 ± 20) e distal (41 ± 24). A largura da furca e a posição da arcada não afetaram a eficácia da instrumentação; no entanto, observou-se uma diferença significativa entre os lados da arcada dentária.

Conclusão: Os instrumentos sônicos foram mais eficazes na remoção de depósitos da superfície radicular na região da furca. Além disso, a parte superior da furca apresentou a maior porcentagem de depósitos residuais.
 

Palavras-chave

Raspagem dentária; desbridamento periodontal; molar; defeitos da furca; instrumentos odontológicos; modelos dentários

References

1 Caton JG, Armitage G, Berglundh T, Chapple ILC, Jepsen S, Kornman KS, et al. A new classification scheme for periodontal and peri-implant diseases and conditions – introduction and key changes from the 1999 classification. J Periodontol. 2018 Jun;89(Suppl 1):S1-8. https://doi.org/10.1002/JPER.18-0157. PMid:29926946.

2 Uy SNMR, Deng K, Fok CTC, Fok MR, Pelekos G, Tonetti MS. Food intake, masticatory function, tooth mobility, loss of posterior support, and diminished quality of life are associated with more advanced periodontitis stage diagnosis. J Clin Periodontol. 2022 Mar;49(3):240-50. https://doi.org/10.1111/jcpe.13588. PMid:34935175.

3 Carvalho R, Botelho J, Machado V, Mascarenhas P, Alcoforado G, Mendes JJ, et al. Predictors of tooth loss during long-term periodontal maintenance: an updated systematic review. J Clin Periodontol. 2021 Aug;48(8):1019-36. https://doi.org/10.1111/jcpe.13488. PMid:33998031.

4 Jepsen S, Deschner J, Braun A, Schwarz F, Eberhard J. Calculus removal and the prevention of its formation. Periodontol 2000. 2011 Feb;55(1):167-88. https://doi.org/10.1111/j.1600-0757.2010.00382.x. PMid:21134234.

5 Seidel M, Borenius H, Schorr S, Christofzik D, Graetz C. Results of an experimental study of subgingival cleaning effectiveness in the furcation area. BMC Oral Health. 2021 Aug;21(1):381. https://doi.org/10.1186/s12903-021-01736-4. PMid:34340674.

6 dos Santos KM, Pinto SC, Pochapski MT, Wambier DS, Pilatti GL, Santos FA. Molar furcation entrance and its relation to the width of curette blades used in periodontal mechanical therapy. Int J Dent Hyg. 2009 Nov;7(4):263-9. https://doi.org/10.1111/j.1601-5037.2009.00371.x. PMid:19832913.

7 Kocher T, Rühling A, Herweg M, Plagman HC. Proof of efficacy of different modified sonic scaler inserts used for debridement in furcations--a dummy head trial. J Clin Periodontol. 1996 Jul;23(7):662-9. https://doi.org/10.1111/j.1600-051X.1996.tb00591.x. PMid:8841899.

8 Kocher T, Gutsche C, Plagmann H-C. Instrumentation of furcation with modified sonic sealer inserts: study on manikins, Part I. J Clin Periodontol. 1998;25(5):388-93. https://doi.org/10.1111/j.1600-051X.1998.tb02460.x. PMid:9650875.

9 Heinrich-Heine-Universität Düsseldorf. G*Power: statistical power analyses for Mac and Windows [Internet]. Düsseldorf: Heinrich-Heine-Universität Düsseldorf; 2026 [cited 2026 Jun 9]. Available from: https://www.psychologie.hhu.de/arbeitsgruppen/allgemeine-psychologie-und-arbeitspsychologie/gpower

10 Sirinirund B, Garaicoa-Pazmino C, Wang HL. Effects of mechanical instrumentation with commercially available instruments used in supportive peri-implant therapy: an in vitro study. Int J Oral Maxillofac Implants. 2019 Nov/Dec;34(6):1370-8. https://doi.org/10.11607/jomi.7409. PMid:31711078.

11 Randomizer.org. Randomizer Research Randomizer [Internet]. Baltimore (MD): Randomizer.org; 2026 [cited 2026 Jun 9]. Available from: https://www.randomizer.org

12 Bland JM, Altman DG. Measuring agreement in method comparison studies. Stat Methods Med Res. 1999 Jun;8(2):135-60. https://doi.org/10.1177/096228029900800204. PMid:10501650.

13 JASP Team. JASP: a fresh way to do statistics [Internet]. Amsterdam: University of Amsterdam; 2025 [cited 2026 Jun 9]. Available from: https://jasp-stats.org/

14 Graetz C, Schwendicke F, Plaumann A, Rauschenbach S, Springer C, Kahl M, et al. Subgingival instrumentation to remove simulated plaque in vitro: influence of operators’ experience and type of instrument. Clin Oral Investig. 2015 Jun;19(5):987-95. https://doi.org/10.1007/s00784-014-1319-x. PMid:25231069.

15 Takacs VJ, Lie T, Perala DG, Adams DF. Efficacy of 5 machining instruments in scaling of molar furcations. J Periodontol. 1993 Mar;64(3):228-36. https://doi.org/10.1902/jop.1993.64.3.228. PMid:8463946.

16 Muniz FWMG, Langa GPJ, Pimentel RP, Martins JR, Pereira DH, Rösing CK. Comparison between hand and sonic/ultrasonic instruments for periodontal treatment: systematic review with meta-analysis. J Int Acad Periodontol. 2020 Oct;22(4):187-204. PMid:32980832.

17 Chiu BM, Zee KY, Corbet EF, Holmgren CJ. Periodontal implications of furcation entrance dimensions in Chinese first permanent molars. J Periodontol. 1991 May;62(5):308-11. https://doi.org/10.1902/jop.1991.62.5.308. PMid:2072242.

18 Michaud RM, Schoolfield J, Mellonig JT, Mealey BL. The efficacy of subgingival calculus removal with endoscopy-aided scaling and root planing: a study on multirooted teeth. J Periodontol. 2007 Dec;78(12):2238-45. https://doi.org/10.1902/jop.2007.070251. PMid:18052694.

19 Canakci V, Tan U, Orbak R, Tezel A. Right- and left-handed dentists in periodontal therapy. Int J Neurosci. 2002 Jan;112(1):1-14. PMid:12152401.

20 Wang HL, Burgett FG, Shyr Y, Ramfjord S. The influence of molar furcation involvement and mobility on future clinical periodontal attachment loss. J Periodontol. 1994 Jan;65(1):25-9. https://doi.org/10.1902/jop.1994.65.1.25. PMid:8133412.

21 Cadosch J, Zimmermann U, Ruppert M, Guindy J, Case D, Zappa U. Root surface debridement and endotoxin removal. J Periodontal Res. 2003 Jun;38(3):229-36. https://doi.org/10.1034/j.1600-0765.2003.00376.x. PMid:12753358.

22 Graetz C, Fecke P, Seidel M, Engel AS, Schorr S, Sentker J, et al. Evaluation of a systematic digitized training program on the effectivity of subgingival instrumentation with curettes and sonic scalers in vitro. Clin Oral Investig. 2021 Jan;25(1):219-30. https://doi.org/10.1007/s00784-020-03356-8. PMid:32474807.

23 Liu G, Liu X, Li N, Gao C, Cui T, Luan Q, et al. Wear and fracture of curettes due to sharpening and scaling processes. Int J Dent Hyg. 2022 Aug;20(3):564-70. https://doi.org/10.1111/idh.12573. PMid:34954886.

24 Herzog J, Karacic J, Svellenti L, Sahrmann P. In-vitro simulation methods for mechanical plaque removal: a systematic scoping review of current techniques and future directions. BMC Oral Health. 2025 Feb;25(1):178. https://doi.org/10.1186/s12903-025-05558-6. PMid:39893381.

25 Mukherjee M, Nair V, Phull T, Jain A, Grover V, Ali ABM, et al. Biometric analysis of furcation area of molar teeth and its relationship with instrumentation. BMC Oral Health. 2024 Apr;24(1):436. https://doi.org/10.1186/s12903-024-04164-2. PMid:38600486.
 

Submitted date:
04/17/2026

Accepted date:
05/13/2026

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