Abstract
The aim of this study was to evaluate the clinical and microbiological effects of subgingival instrumentation (SI) alone or combined with either local drug delivery (LDD) or photodynamic therapy (PDT) in persistent/recurrent pockets in patients enrolled in supportive periodontal therapy (SPT). A total of 105 patients enrolled in SPT were randomly treated as follows: group A (n = 35): SI +PDT and 7 days later 2nd PDT; group B (n = 35): SI+LDD; group C (n = 35): SI (control). Prior intervention, at 3 and 6 months after therapy, probing pocket depths, clinical attachment level, number of treated sites with bleeding on probing (n BOP), full mouth plaque and bleeding scores (gingival bleeding index, %BOP) were recorded. At the same time points, 8 periodontopathogens were quantitatively determined. All three treatments resulted in statistically significant improvements (p < 0.05) of all clinical parameters without statistically significant intergroup differences (p > 0.05). Several bacterial species were reduced in both test groups, with statistically significantly higher reductions for LDD compared to PDT and the control group. In conclusion, the present data indicate that: (a) In periodontal patients enrolled in SPT, treatment of persistent/recurrent pockets with SI alone or combined with either PDT or LDD may lead to comparable clinical improvements and (b) the adjunctive use of LDD appears to provide better microbiological improvements for some periodontal pathogens than SI alone or combined with PDT.
Highlights
Supportive/maintenance periodontal therapy (SPT) aims at preventing or at least minimizing the recurrence of disease and its progression in previously treated periodontitis patients and is currently referred to as step 4 of therapy in the EFP S3 (EuropeanFederation of Periodontology) clinical practice guideline [1,2]
The aim of this study was to evaluate the clinical and microbiological effects of subgingival instrumentation (SI) alone or combined with either photodynamic therapy (PDT) or antibiotic local drug delivery (LDD) in persistent/recurrent pockets of periodontal patients enrolled in supportive periodontal therapy (SPT)
A total of 105 patients diagnosed with stages I–IV, grades A, B, C periodontitis (n = 35 per treatment group) were included in the present study
Summary
Supportive/maintenance periodontal therapy (SPT) aims at preventing or at least minimizing the recurrence of disease and its progression in previously treated periodontitis patients and is currently referred to as step 4 of therapy in the EFP S3 (EuropeanFederation of Periodontology) clinical practice guideline [1,2]. SPT consists of predefined recall sessions, with re-examination of the periodontal status, re-instrumentation of sites with clinical signs of disease activity, re-enforcement of the self-performed oral hygiene, and polishing of the teeth. The adjunctive use of antimicrobials or of different types of lasers, especially the photodynamic therapy (PDT), has been investigated for the treatment of recurrent sites in SPT patients [5,6,7,8,9]. The use of local antimicrobials in SPT patients has been investigated in numerous controlled clinical studies and systematic reviews, reporting on greater clinical improvements in terms of PD reduction and clinical attachment level (CAL) gain for the adjunctive use of locally applied antimicrobials to subgingival instrumentation (SI) as compared to SI alone [10]. Positive short-term effects of topically applied doxycycline were reported in furcation-involved teeth in SPT [8]
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