Local Anti-Infective Therapy: Mechanical and Physical Approaches. A Systematic Review

Full-mouth treatment concepts for chronic periodontitis: a systematic review

OBJECTIVES

To systematically review the effectiveness of full-mouth treatment concepts for chronic periodontitis.

MATERIAL AND METHODS

A search was conducted for randomized, controlled clinical trials including full-mouth scaling with (FMD) or without (FMS) the use of antiseptics and quadrant scaling (control). Data sources included COHG, CENTRAL, MEDLINE and EMBASE. Reviewers independently conducted data abstraction and quality assessment. The primary outcome was tooth loss; secondary outcomes were the reductions of PPD and BOP and a gain of CAL.

RESULTS

Of 216 identified abstracts, seven trials were included. Meta-analysis revealed a weighted mean difference (WMD) for the reduction of PPD between FMD and control of 0.53 mm [95% confidence interval (CI) (0.28, 0.77), p<0.0001] in moderately deep pockets of single-rooted teeth. The WMD for gain in CAL was 0.33 mm [95% CI (0.04, 0.63), p=0.03] in moderately deep pockets of single- and multi-rooted teeth. Comparing FMD and FMS, the WMD for the reduction of CAL amounted to 0.74 mm [95% CI (0.17, 1.31), p=0.01] in deep pockets of multi-rooted teeth in favour of FMS. For BOP a WMD -18.0% [95% CI (-34.30, -1.70), p=0.03] was calculated in deep pockets of single-rooted teeth in favour of FMD.

CONCLUSIONS

In adults with chronic periodontitis only minor differences in treatment effects were observed between the treatment strategies.

Factors influencing the outcome of non-surgical periodontal treatment: a multilevel approach

AIM

To investigate, by means of multilevel analysis, factors that may affect the short-term clinical outcome of non-surgical periodontal treatment.

MATERIALS AND METHODS

Forty-one patients randomly assigned to two protocols of non-surgical therapy were included. The impact of different covariates on the probability of "pocket closure" [i.e. probing pocket depth (PPD)

RESULTS

The logistic model revealed a significant impact of smoking (p<0.001), presence of plaque at the site (p<0.001) and location of the pocket at a multi-rooted tooth (p<0.001). The model explained 44% of the total variability. Of the unexplained variance, 19% was attributed to inter-patient variability. The continuous model revealed the same factors to be significant and an additional significant impact of interactions between the covariates. The R(2) was 0.50 and the random slopes model revealed an increase in the variability of the final pocket depth with an increase in the initial PPD.

CONCLUSION

Smoking habits, plaque at site level and tooth type were significant factors in determining the short-term clinical outcome of non-surgical periodontal treatment.

Collapse

Key Words Collapse

MESH Headings

• Debridement/instrumentation
• Debridement/methods
• Dental Plaque/complications
• Epidemiologic Methods
• Female
• Humans
• Male
• Middle Aged
• Periodontal Diseases/etiology
• Periodontal Diseases/therapy
• Periodontal Pocket/therapy
• Smoking/adverse effects
• Treatment Outcome
• Ultrasonic Therapy/instrumentation
• Ultrasonic Therapy/methods

Collapse

Grants

• MC_U130059823 Medical Research Council
• SPHSU2 Chief Scientist Office

Collapse

Affiliation(s)

Cristiano Tomasi Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at Göteborg University, Sweden.
Alastair H Leyland
Jan L Wennström

Collapse

Collaborators Collapse

Periodontal healing after non-surgical therapy with a new ultrasonic device: a randomized controlled clinical trial

AIM

The aim of this study was to compare the clinical and microbiological healing outcomes following non-surgical periodontal therapy using the new Vector ultrasonic system versus scaling and root planing (S/RP) with Gracey curettes.

MATERIAL AND METHODS

The study comprised 20 chronic periodontitis patients. Using a split-mouth design, both treatment modalities were randomly applied to one quadrant of the upper and the lower jaws each. Clinical and microbiological parameters were assessed at baseline, 4 weeks, and 6 months after treatment. Furthermore, post-operative hypersensitivity was assessed. The Wilcoxon signed rank test (alpha=0.05) was used for statistical analysis.

RESULTS

Both therapies provided statistically significant clinical and microbiological improvements of periodontal conditions after 4 weeks and 6 months. Hypersensitive teeth were found only 4 weeks after S/RP. Besides a significantly better bleeding on probing reduction in deep S/RP sites, no other clinical and microbiological parameters revealed significant differences between the sites treated with the Vector system or S/RP.

CONCLUSION

Both the Vector system and S/RP provided favourable periodontal healing results, although in deep pockets S/RP appeared to achieve a better resolution of inflammation.

Periodontal healing after non-surgical therapy with a modified sonic scaler: a controlled clinical trial

AIM

The aim of this study was to compare the clinical and microbiological healing outcomes following non-surgical periodontal therapy using a modified sonic scaler system versus scaling and root planing (S/RP) with hand instruments.

MATERIAL AND METHODS

The study comprised 20 chronic periodontitis patients. Using a split-mouth design, both treatment modalities were randomly applied to one quadrant of the upper and lower jaws. Clinical and microbiological parameters were assessed at baseline, 4 weeks, and 6 months after treatment. Furthermore, post-operative hypersensitivity was investigated. The Wilcoxon signed-rank test (alpha = 0.05) was used for statistical analysis.

RESULTS

With both therapy methods, periodontal conditions showed statistically significant clinical and microbiological improvements after 4 weeks and 6 months. Hypersensitive teeth were found only 4 weeks after S/RP. Besides a significantly better bleeding on probing reduction in deep S/RP sites and less time required for root instrumentation by the sonic scaler, no other clinical and microbiological parameters revealed significant differences between sites treated with the sonic scaler or S/RP.

CONCLUSION

The sonic scaler system and S/RP seem to provide similarly favourable periodontal healing results, although in deep pockets S/RP appeared to achieve a better resolution of inflammation.

Full-mouth ultrasonic debridement and risk of disease recurrence: a 1-year follow-up

AIM

To evaluate the incidence of disease recurrence following a full-mouth pocket/root debridement approach with ultrasonic instrumentation versus that following a traditional approach of quadrant-wise scaling and root planing (Q-SRP) performed with hand instrumentation.

METHODS

Thirty-seven patients were re-examined 1 year after the completion of a 6-month clinical trial comparing two different treatment protocols: a 1-h session of full-mouth ultrasonic debridement (UD--19 patients) or four sessions of Q-SRP with hand instruments (Q-SRP--18 patients). At 3 months, re-instrumentation was performed of pockets showing a remaining probing pocket depth (PPD) of > or =5 mm using the same type of instruments as used during the initial treatment phase. The clinical examinations comprised assessments of plaque, bleeding on probing (BoP) and PPD. The primary outcome variable was the incidence of recurrent diseased sites (i.e., sites showing PPD > or =5 mm and BoP+) between the post-treatment and 1-year follow-up examinations. All sites that were healed (PPD < or =4 mm and BoP(-)) at the post-treatment examination were included in the study sample, with a mean number of sites per patient of 23.5.

RESULTS

In the UD group, 29 (7%) out of 430 initially healed sites showed disease recurrence at the 1-year follow-up examination compared with 47 (11%) of 440 sites in the Q-SRP group (p>0.05). Twelve patients (63%) in the UD group presented recurrent diseased pockets, compared with 14 patients (78%) in the Q-SRP group. Two or more recurrent, diseased pockets were observed in nine patients in the UD group versus 11 in the Q-SRP group. All but one of the smokers belonged to the group of patients presenting recurrences. A tendency towards a higher mean plaque score was observed for the patients with recurrent sites.

CONCLUSION

The study revealed no significant difference in the incidence of recurrence of diseased periodontal pockets between the full-mouth UD approach and the traditional approach of Q-SRP.

Position Paper: The Role of Supra- and Subgingival Irrigation in the Treatment of Periodontal Diseases

This position paper addresses the role of supra- and subgingival irrigation in the treatment of periodontal diseases. It was prepared by the Committee on Research, Science and Therapy of the American Academy of Periodontology. The document is divided into two portions, consisting of supragingival irrigation and subgingival irrigation. In their respective segments, these treatment techniques are assessed as monotherapies and as adjuncts to conventional treatment. The conclusions drawn in this paper represent the position of the American Academy of Periodontology regarding irrigation therapy in the treatment of periodontal diseases.

Full-mouth ultrasonic debridement versus quadrant scaling and root planing as an initial approach in the treatment of chronic periodontitis

AIM

To evaluate the clinical efficacy of (i) a single session of "full-mouth ultrasonic debridement" (Fm-UD) as an initial periodontal treatment approach and (ii) re-instrumentation of periodontal pockets not properly responding to initial subgingival instrumentation.

METHODS

Forty-one patients, having on the average 35 periodontal sites with probing pocket depth (PPD) > or =5 mm, were randomly assigned to two different treatment protocols following stratification for smoking: a single session of full-mouth subgingival instrumentation using a piezoceramic ultrasonic device (EMS PiezonMaster 400, A+PerioSlim tips) with water coolant (Fm-UD) or quadrant scaling/root planing (Q-SRP) with hand instruments . At 3 months, all sites with remaining PPD> or =5 mm were subjected to repeated debridement with either the ultrasonic device or hand instruments. Plaque, PPD, relative attachment level (RAL) and bleeding following pocket probing (BoP) were assessed at baseline, 3 and 6 months. Primary efficacy variables were percentage of "closed pockets" (PPD< or =4 mm), and changes in BoP, PPD and RAL.

RESULTS

The percentage of "closed pockets" was 58% at 3 months for the Fm-UD approach and 66% for the Q-SRP approach (p>0.05). Both treatment groups showed a mean reduction in PPD of 1.8 mm, while the mean RAL gain amounted to 1.3 mm for Fm-UD and 1.2 mm for Q-SRP (p>0.05). The re-treatment at 3 months resulted in a further mean PPD reduction of 0.4 mm and RAL gain of 0.3 mm at 6 months, independent of the use of ultrasonic or hand instruments. The efficiency of the initial treatment phase (time used for instrumentation/number of pockets closed) was significantly higher for the Fm-UD than the Q-SRP approach: 3.3 versus 8.8 min. per closed pocket (p<0.01). The efficiency of the re-treatment session at 3 months was 11.5 min. for ultrasonic and 12.6 min. for hand instrumentation (p>0.05).

CONCLUSION

The results demonstrated that a single session of Fm-UD is a justified initial treatment approach that offers tangible benefits for the chronic periodontitis patient.