Effects of Periodontal Endoscopy-Assisted Nonsurgical Treatment of Periodontitis: Four-Month Results of a Randomized Controlled Split-Mouth Pilot Study.

Susanne Schorr,Miriam Cyris,Claudia Springer,Sivakumar Nuvvula,Christian Graetz,Johanna Sentker,Karim M. Fawzy El-Sayed

doi:10.1155/2022/9511492

Abstract

Objective Although the therapeutic effects of nonsurgical periodontal therapy (NSPT) are well established, the clinical benefits of the additional use of periodontal endoscopy (PE) remain controversial. Therefore, this randomized controlled split-mouth pilot study evaluated the effect of NSPT using PE versus NSPT without nPE on bleeding on probing (BOP) in sites with probing depth (PD)≥4 mm (primary outcome), PD, clinical attachment level (CAL), number of hard deposits (HDs), and treatment time per tooth (TrT). Methods Two calibrated operators performed NSPT in twenty periodontitis patients, randomized into two quadrants for PE or nPE treatment. BOP, PD, and CAL were recorded at the first visit for NSPT (T0) and during reevaluation (T1: mean (SD) 119.7 (24.6) days after T0). The average TrT and the number of sites with HDs were documented at T0. Results For BOP, no significant differences were found at the patient's level (10/10 (male/female); aged 54.3 (10.9) years) neither within or between the groups. At tooth surface level, a lower number of surfaces with BOP (p=0.026) was observed in nPE. CAL and PD improved significantly during NSPT in both groups (p ≤ 0.001), with higher PD reduction (p < 0.001) and CAL gain (p < 0.001) in nPE. There are significantly longer TrT (p < 0.001) and more surfaces with subgingival HDs evident in PE at T0 (p=0.001). Conclusion Whereas subgingival HDs can be visually detected with PE during NSPT, no additional clinical benefits regarding BOP, PD, or CAL were notable compared to conventional systematic periodontal instrumentation. Additionally, PE-assisted NSPT required a longer treatment time.

Highlights

Advanced periodontitis remains to be one of the primary causes of tooth loss [1]
NPE, on the periodontal clinical parameters bleeding on probing (BOP), clinical attachment level (CAL), and probing depth (PD), on the time per tooth (TrT), and on the number of hard deposit (HD) detected. Both treatments improved periodontal outcomes, including BOP, PD and CAL, in accordance with the current evidence on Nonsurgical periodontal therapy (NSPT) efficacy [18], whereby among other factors, nPE was identified as a significant predictor for the absence of BOP at T1 (B −0.326, p 0.015). is finding is in contrast to a recently published clinical investigation by Naicker, Ngo [8], who observed a reduction in BOP of over 70% in both treatment groups and a significantly lower BOP for periodontal endoscopy treatment (PE)-assisted NSPT on longer-term follow-ups
With a TrT of 4.2 min per tooth, the findings were comparable to our recent in vitro results [11], they still remained in contrast to a previously published clinical investigation [21] that demonstrated a significantly longer mean TrT of 19 min per tooth with PE versus 13 min without PE. e longer TrT reported in the latter study could be based on the fact that all teeth evaluated had been previously deemed untreatable due to prosthetic or periodontal reasons, with higher levels of gingival inflammation, mobility, granulation tissues, and carious lesions, which could have affected the operator’s instrumentation ability [22]

Summary

Introduction

Advanced periodontitis remains to be one of the primary causes of tooth loss [1]. Nonsurgical periodontal therapy (NSPT) relies primarily on mechanical biofilm and calcified hard deposit (HD) removal [2]. E primary component of the periodontal endoscopic system is an imaging system with a fiber optic bundle, allowing for visualization of the submarginal area of the periodontium, the root surfaces, and the soft tissue lining [9, 10]. A systematic review and meta-analysis [7] found no significant improvements in bleeding on probing (BOP), gingival inflammation (GI) or PD with PE-assisted NSPT. Given these inconsistent findings, we designed this pilot study as a randomized controlled clinical split-mouth study to assess whether PE-assisted NSPT (test group: PE) has significant advantages over conventional NSPT without PE (control group: nPE). The study evaluated whether PE-assisted NSPT would remove more HDs than nPE and whether a possible difference in outcomes could be accurately detected, employing either a purely visual inspection (with PE) or a limited visualtactile inspection (in nPE)

Methods

Results

Discussion

Conclusion