Stephen K. Harrel D.D.S

Harrel, S.K., Cobb, C.M., Sottosanti, J.S., Sheldon, L.N. and Rethman, M.P. (2022). “Clinical Decisions Based on the 2018 Classification of Periodontal Diseases.” Compend Contin Educ Dent 43(1): 52-56.

Full text of this article.

The absence of widely accepted treatment decision points for the management of periodontitis can be problematic for the dental profession and patients. After conducting a thorough review of published peer-reviewed studies, the authors developed basic therapeutic decision points for the management of periodontitis based on the 2018 classification of periodontal diseases. These decision points were utilized to outline appropriate treatments, which include: patient commitment to a thorough daily self-care regimen, the definitive elimination of etiological factors, professional treatment that includes the complete removal of residual bacterial biofilm (plaque), the definitive removal of both supragingival and subgingival calculus, and, in advanced disease, possible tissue augmentation and regenerative surgery. Advanced therapies to accomplish an acceptable therapeutic end point are indicated in stage III and stage IV periodontitis. The presented decision points for the treatment of periodontitis offer a basis for the ethical care and management of patients in all stages of periodontitis.

Harrel, S. K., T. G. Wilson, Jr., J. C. Tunnell and W. V. Stenberg (2020). “Laser identification of residual microislands of calculus and their removal with chelation.” J Periodontol Apr 13. [Epub ahead of print].

Full text of this article.

BACKGROUND: During videoscope assisted minimally invasive surgery (VMIS) which utilizes 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 mm(2) 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 X 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. Utilizing the images, the percent 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 X 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.

Al Shaikhly, B., Harrel, S. K., Umorin, M., Augsburger, R. A. and Jalali, P. (2020). “Comparison of a Dental Operating Microscope and High-resolution Videoscope for Endodontic Procedures.” J Endod Mar 2. pii: S0099-2399(20)30039-X. [Epub ahead of print].

Full text of this article.

INTRODUCTION: The purpose of this study was to compare a dental operating microscope (DOM) with a high-resolution videoscope (VS) in terms of depth of field (DOF), resolution, and effect on fine motor skills. METHODS: Two observers used test targets to measure the resolution and DOF of the DOM and the VS. In addition, 18 participants (12 dental students and 6 endodontic residents) performed an accuracy test on a manikin head using DOM, VS, or loupes. Each participant completed a posttest survey. RESULTS: The 3 magnifications of the DOM had higher resolutions and DOF (resolution: 32, 40.3, and 50.8 line pairs/mm; DOF: 15, 10, and 6 mm) than the VS (resolution: 20.1 line pairs/mm; DOF: 5 mm). Accuracy testing showed the DOM produced better results than the VS for both resident and student groups (P < .001); however, the VS was not significantly different than loupes. The residents performed better than the students using the DOM and the VS (P < .001). The students in general took 1.3 times longer than the residents to perform the accuracy test, irrespective of the magnification device used. The DOM and the VS required on average 1.9 and 2.8 times longer compared with loupes, respectively. Most participants reported a preference for the DOM with regard to visualization and ease of use. Comments also suggested that the VS has value in diagnosis and magnification in endodontics. CONCLUSIONS: Considering the findings from this study, the DOM stands out as the leading magnification tool in endodontics. However, the VS has potential in endodontic procedures and might be used as an adjunct to other visualization aids.