Ultrastructural Examination of Human Periodontal Pockets Following the Use of an Oral Irrigation Device in Vivo

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Abstract
To date, there are no ultrastructural studies that have examined untreated chronic periodontal pockets immediately following dental debridement with an oral irrigation device. This study used both scanning electron microscopic and transmission electron microscopic methodology to examine previously untreated human periodontal pockets after their exposure to a pulsating oral irrigation with saline solution. A comparison of 16 untreated controls with 16 test specimens revealed qualitative differences in microbial morphotypes at various pocket depths. Control specimens at all pocket depths examined (0‐6 mm), exhibited a mixed microbial flora consisting of cocci, short rods, and filamentous organisms. Specifically at 3‐ to 4‐mm and 5‐ to 6‐mm levels in control specimens, spirochetes, fusiforms, and branching organisms were obvious. In contrast, test specimens exhibited a few cocci and short rods at 0‐ to 2‐mm and 3‐ to 4‐mm levels and a mixed flora at the 5‐ to 6‐mm level. There was no observable difference between control and test specimens concerning epithelial topography, cavitations, microulcerations, spatial relationships, and individual cell appearance. Both control and test specimens exhibited a mild spirochete invasion of the epithelial strata. Collectively these observations suggest that pulsating oral irrigation effects a qualitative change on subgingival plaque and is not injurious to the soft tissues.