The Impact of Periodontal Instrumentation on Enamel and Cementum: A Narrative Review

Objectives: Achieving a smooth tooth surface following periodontal instrumentation is critical for maintaining periodontal health and minimizing plaque and calculus reaccumulation. This narrative review aimed to synthesize preclinical laboratory-based evidence regarding the effects of periodontal instrumentation techniques on enamel and cementum surface roughness and hard-tissue loss. Methods: A focused literature search was conducted using the PubMed database to identify relevant in vitro and in vitro/in vivo hybrid studies published within the last 15 years. This review focused on ultrasonic scaling, hand instrumentation, and air polishing of human teeth during periodontal treatment. Results: Periodontal instrumentation was associated with surface alterations of enamel and cementum, with the extent of these changes depending on instrumentation parameters. Manual instrumentation was generally associated with greater surface irregularities and increased cementum removal, whereas ultrasonic scaling tended to produce more uniform surface characteristics. However, outcomes varied depending on instrumentation parameters. Air-polishing systems were described as less abrasive, particularly in biofilm management. Conclusions: Within the limitations of predominantly in vitro evidence, periodontal instrumentation appears to alter dental hard tissues to varying degrees depending on the technique and application. The clinical relevance of these findings remains uncertain, as the evidence was primarily laboratory-based and may not fully reflect clinical conditions or predict long-term outcomes.