“Quite a few periodontal surgical interventions could be avoided”

Over 20 years of the Vector method: since 1999, this technique has been used to treat periodontal diseases with the aid of ultrasound – using a low-pain therapy that focuses on the cause of the disease. In our interview, Univ.-Prof. Dr. Andreas Braun and Dr. Johannes- Simon Wenzler from the Clinic of Restorative Dentistry, Periodontology and Preventive Dentistry at RWTH Aachen University tell us about their experiences and offer advice for application of the techniques in practice.

1. Professor Braun, when did you first become aware of the Vector method?

Prof. Dr. Andreas Braun: To start with, it was Prof. Nolden from the University of Bonn who drew my attention to it. That was around 2000, just after market launch. Prof. Nolden told me in particular about how the Vector can be used for low-pain periodontal treatment. Because I had written my thesis on the objectification of sensory perceptions, I was very aware of the topic and quickly became fascinated with this new technique.

2. Dr. Wenzler, what brought you to the Vector method?

Dr. Johannes-Simon Wenzler: During my time studying in Marburg, I had learned about conventional scaling and root planing, and I asked myself which options could be readily translated into a systematic treatment concept. This matter is particularly important for patients who are more sensitive to pain, as – based on my experience – they are are not really well cared for either with manual curettage or with machine instruments, regardless of whether we are talking about acoustic scalers, magnetorestrictive ultrasonic scalers, piezoelectric ultrasonic scalers or jet powder devices. After consulting with Prof. Braun, I started treating patients who are more sensitive to pain with the Vector system. Coincidentally, this fitted in really well with my scientific endeavours at the time in the project area TransMIT, which was all about in applications in dentistry involving energy transfer.

3. How did you start using the Vector method, and how do you use the system today?

Prof. Dr. Andreas Braun: Well, I started out pretty much as a pilot user, so I embarked on using the new system without any real prior knowledge. I quickly realised that I could use it very effectively, and that the process of using the instrument in the periodontal pockets involved noticeably less pain for the patient than with the other alternatives that were available. However, some of my practising colleagues were irritated because they had hoped for a faster procedure. This is why I also felt it was my duty to promote correct understanding of the Vector method among dental practitioners – that it was primarily not about speed, but about a low-pain and gentle alternative to conventional therapies. The manufacturer, Durr Dental, subsequently developed and refined the system to the point where we now use a combination of two different piezoelectric handpieces to achieve much faster results than we did back in the early days.

Dr. Johannes-Simon Wenzler: I was impressed right away. With the Scaler handpiece and the slim Scaler instruments, my supragingival cleaning work is much faster. For subgingival instrument work, I then switch to the Vector Paro and apply the Vector Fluid polish suspension directly from the handpiece for treatment thatisaseffectiveasitisgentleintheremovalofbiofilm. I was first introduced to the system in 2015 and basically grew up with this combined approach.

4. What exactly is it about the Vector system that makes it so successful for you personally?

Dr. Johannes-Simon Wenzler: I examine the classic periodontological parameters such as BOP, changes to the gingiva involving inflammation, periodontal attachment gain. Normally, initial success starts to show after just a few days. In addition, I always ask my patients to what extent they felt pain sensations during treatment with the instrument or afterwards.

Prof. Dr. Andreas Braun: Changes to the individual bacterial spectrum are generally not a sole indication of success. I will only perform special microbiological investigations if I suspect the presence of a specific pathogenic bacterial spectrum that I would need to tackle with targeted antimicrobial therapy. However, it is generally much more likely that a bacterial spectrum will shift in response to systematic periodontological treatment. When it comes to regular checks, it is primarily the clinically verifiable parameters that we look at.

5. Question: What is your assessment of the scientific evidence?

Dr. Johannes-Simon Wenzler: Based on my experience, the Vector method is almost always superior to other ultrasonic and powder jet treatments in terms of reduced pain and discomfort during treatment. Prof. Braun has also confirmed this in studies.

Prof. Dr. Andreas Braun: Yes, together with Priv.-Doz. Dr. Krause I was able to document this early on already. Initially, we asked the patients to gauge their pain sensitivity on a visual scale after treatment. Because, empirically speaking, the most recent perception tends to dominate, we also asked them to assess their sensitivity during the overall procedure. We gave the patients a pressure recorder they could hold in their hand and asked them to squeeze it according to the level of pain they were experiencing so that we could measure it – the more pressure they exerted, the stronger the pain. This allowed us to record updated pain sensations once a second. In the process, the Vector method achieved significantly better results than both manual scaling and root planing and one other ultrasonic method. SRP and the second ultrasonic technique performed equally well as each other during this investigation.

6. Which practising colleagues would you recommend Vector to, and how should they approach the system?

Prof. Dr. Andreas Braun: Based on my assessment, actually I think the method is suitable for any practice that offers periodontology treatments. A vast store of knowledge has now been built up, so for anyone who is new to the technique I can recommend that they get training on the Vector method from an experienced colleague.

In terms of patients with the highest sensitivity to pain, I would also perhaps recommend use of a topical anaesthetic, which can often help. Patients often welcome the fact that they are not being given an injection. However, if a “Vector session” does ever need to be stopped, then I think it is acceptable for the patient to come back in one to two weeks’ time so that the quadrants that have not yet been treated can then be worked on with the instruments.

7. Where are we at with the Vector method today, and how do you think things might evolve over the next twenty years?

Prof. Dr. Andreas Braun: The Vector method is currently a cost- effective, low-pain method for periodontal therapy. It is not particularly fast, but it is very gentle on the surfaces of the tooth. Particularly in the root areas, I can use this method for selective removal of concrement without excessive abrasion of hard tooth substance and without leaving unwanted traces of my work. The fact that the process is slightly slower actually turns out to be an advantage. But, in particular, the Vector method can help to prevent quite a few periodontal surgical interventions. I believe that this particular aspect is not yet adequately recognised by the German health insurance providers in their assessments.

Dr. Johannes-Simon Wenzler: In the future, in addition to periodontal therapy, peri-implantitis treatments will also be increasingly in demand. I could imagine that the Vector system will also be able to demonstrate its strengths in this area as well – perhaps even with dedicated new working approaches specially developed for this application.

Prof. Dr. Andreas Braun: As part of the research work we have carried out, we have also looked at first experiments in endodontic applications. Subject to targeted further development in this direction, I believe that – under certain conditions – in the future it will be possible to establish the Vector method alongside periodontal therapy and peri- implantatis treatments in the field of endodontics as well.