Full-mouth Scaling And Root Planing Research Articles

Impact of combined non-surgical and surgical periodontal treatment in patients with type 2 diabetes mellitus-a preliminary report randomized clinical study

Background/objectives: Scientific evidence regarding the effects of chronic periodontitis on Type 2 Diabetes Mellitus (T2M) is fragmentary and not definitive. This intervention study was designed to evaluate the effects of a Non-Surgical Procedure (NSP) in addition to a surgical procedure on systemic inflammation and glycaemic control in patients with T2M and periodontitis and Non-Diabetic (ND) patients with periodontitis. Material and Methods: A total of 100 patients with diabetes were randomly allocated to a treatment group and a control group. At least one tooth was extracted from each patient. After extraction, the control group (n=50) did not receive any other treatment until the 3-month follow-up. Patients in the treatment group (n=50) received Full-Mouth Scaling and Root Planing (FM-SRP).The Mean Probing Depth (MPD), Mean Attachment Level (MAL), Plaque Index (PI), Bleeding on Probing (BOP), fasting blood samples for the measurement of high-sensitivity C-Reactive Protein (hs-CRP), and glycated hemoglobin (HbA1c) were measured or taken at baseline and 3 months after treatment. To investigate the effect of diabetes on the therapeutic procedure’s outcome, ND patients with periodontitis (n=60) were divided into two equal groups and subjected to the same procedures and analysis. Results: HbA1c and hs-CRP decreased significantly in the diabetic groups and decreased more markedly when FM-SRP was added to tooth extraction (P<0.001). For ND patients, all of the examined periodontal parameters were in favor of the combination therapy (P<0.001). Conclusion: Non-surgical periodontal treatment can help improve the outcome of surgical periodontal procedures by reducing systemic inflammatory status and improve glucose metabolism.

Effect of 0.8% Hyaluronic Acid in Conventional Treatment of Moderate to Severe Chronic Periodontitis

The aim of this study is to evaluate the effect of the subgingival application of 0.8% hyaluronic acid (HA) gel (GENGIGEL®) as an adjunct to scaling and root planing (SRP) on clinical parameters and expression of human beta defensin-2 (hBD-2) in patients with moderate to severe chronic periodontitis. In this randomized, split mouth design study, 24 participants with moderate to severe chronic periodontitis were evaluated after full mouth SRP. In the test sites 1 mL of 0.8% hyaluronan gel was applied subgingivally after SRP at baseline and 1 week post therapy. Plaque index (PI), gingival index (GI), papillary bleeding index (PBI), periodontal probing depth (PPD), and clinical attachment loss (CAL) were recorded and gingival crevicular fluid (GCF) samples were collected at baseline, after 6 and 12 weeks. Expression of human beta defensin-2 (hBD-2) was analyzed by enzyme-linked immunosorbent assay. At baseline, there were no statistical differences between test and control sites in all clinical parameters and hBD-2 expression. An improvement of PI, GI, PBI, PPD, and CAL was observed at 6 and 12 weeks (p < 0.05) in both groups. Clinically, it was noticed that all indices except CAL had more statistically significant reduction in test sites than control sites at 6 and 12 weeks. The hBD-2 levels were significantly higher in the test sites than in the control sites at 6 and 12 weeks. The local application of 0.8% hyaluronan gel with SRP have a positive effect on periodontal health of moderate to severe chronic periodontitis patients after 6 and 12 weeks. Subgingival application of 0.8% HA gel following SRP has shown anti-inflammatory effect and has a beneficial effect on clinical parameters in moderate to severe chronic periodontitis patients.

Adjunctive subantimicrobial dose doxycycline in the treatment of chronic periodontitis in type 2 diabetic patients: A unique combination therapy

Background/Aim: To evaluate the effectiveness of combination therapy including subantimicrobial dose doxycycline (SDD) and locally delivered doxycycline (LD) as adjuncts to scaling and root planing (SRP) in the treatment of chronic periodontitis in patients with type 2 diabetes mellitus (T2DM). Material and Methods: Forty patients with controlled T2DM (HbA1c ≤7%) and chronic periodontitis were selected. They were randomly divided into two groups, twenty patients each: Test group (TG, n=20) patients was treated with combination therapy of full mouth SRP, LD gel 10% and SDD 20 mg twice daily for 6 months. Control group (CG, n=20) patients was treated with full mouth SRP only. The periodontal parameters were recorded at baseline, 3, 6 and 9 months and included periodontal probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP). Gingival crevicular fluid (GCF) samples were collected and a quantitative measurement of matrix metalloproteinase-8 (MMP-8) was carried out by using Enzyme-Linked Immunosorbent Assay (ELIZA) at baseline, 3, 6 and 9 months. Results: Statistically significant reduction in all clinical parameters (PPD, CAL, and BOP) was observed at TG over CG at 3, 6, and 9 months (p&lt;0.05). Moreover, combination therapy provided significant reductions in the amount of GCF MMP-8 for the TG compared to CG at 3, 6, and 9 months evaluation period (p&lt;0.05). Conclusions: Combination therapy including SRP, SDD, and LD, provided significantly greater clinical benefits than SRP alone in the treatment of chronic periodontitis in patients with controlled T2DM.

EVALUATION OF THE EFFECTS OF LACTOBACILLI CONTAINING PROBIOTICS IN NON-SURGICAL TREATMENT OF CHRONIC PERIODONTITIS: A CLINICAL AND MICROBIOLOGICAL STUDY

Background & Objectives: There is limited information on the effects of beneficial bacteria (probiotics) on management of periodontal disease. The purpose of the present study was to investigate the clinical and microbiological effects of Lactobacilli containing probiotic sachets as an adjunct to non-surgical periodontal therapy.Methods: Thirty chronic periodontitis patients, who satisfied the inclusion and ex­clusion criteria, were randomly assigned to: (1) scaling and root planing (SRP) (control group, 15 patients) or (2) SRP plus Lactobacilli containing sachets (test group, 15 patients). Full mouth SRP was performed on day 0. On the same day, Lactobacilli containing sachets were given to the patients to be taken for 1 month. Periodontal clinical parameters and the proportion of black pigmented anaerobic rods (BPARs) and Lactobacilli levels were recorded on day 0, at 1 month and at 6 months post therapy. Results: Both treatment modalities resulted in a statistically significant improvement in clinical parameters (p 0.05). Microbiological analysis showed a statistically significant reduction of BPARs proportion for both groups, at 1 and 6 months, when compared with baseline values (p<0.01). A statistically significant intergroup difference in proportion of BPARs were found at 1 month in favor of the probiotic group (p<0.05), however, the intergroup difference was not significant at 6 months evaluation period. A statistically significant negative correlation between clinical parameters (FMBI: p =0.032, PPD: p =0.040) and Lactobacilli count was observed. This inverse correlation was also seen with subgingival colonization of BPARs (p = 0.018).Conclusion: Both treatment modalities provided comparable clinical results, however microbiological changes were more evident in the probiotic group. Oral probiotics can repopulate the beneficial microflora and reduce the pathogenic bacteria, however, repeated application is required.

The clinical and systemic effects of periodontal treatment in diabetic and non-diabetic obese patients.

The purpose of the present study was to evaluate the response to periodontal management in obese individuals with poorly controlled diabetes mellitus (DM) and obese individuals without DM. Changes in clinical and biochemical parameters were also investigated. Seventeen obese patients with poorly controlled DM and 14 obese non-DM patients with generalized chronic periodontitis were enrolled. The anthropometric measurements, periodontal parameters, and serum levels of lipid (triglyceride, high-density lipoprotein cholesterol, total cholesterol, low-density lipoprotein cholesterol) and glucose (fasting plasma glucose [FPG], insulin, insulin resistance [IR], hemoglobin [Hb]A1c) metabolism, pro-inflammatory mediators (high-sensitivity C-reactive protein, tumor necrosis factor-α [TNF-α] and Pentraxim-3), and interleukin-6 were measured before and at 3 months, and 6 months after full-mouth scaling and root planing (FM-SRP) together with full-mouth disinfection (FMD). A significant reduction in TNF-α (P < 0.001) values was observed in both groups following periodontal healing. However, significant changes in FPG (P < 0.05), HbA1C (P < 0.05), and the homeostasis model assessment of IR (HOMA-IR; P < 0.05) were only observed after 3 months in the DM group. Our findings suggest that obesity with or without DM does not seem to be a modifying factor for the clinical outcome of FM-SRP and FMD.(J Oral Sci 58, 523-531, 2016).

To compare the effect of the local delivery of hyaluronan as an adjunct to scaling and root planing versus scaling and root planing alone in the treatment of chronic periodontitis.

Background:Hyaluronan is a critical component of the extracellular matrix and contributes significantly to tissue hydrodynamics and cell migration and proliferation. Studies have demonstrated its anti-inflammatory, antibacterial, and regenerative effects. The present study aimed to assess the clinical effects of the subgingival application of 0.8% hyaluronic acid gel as an adjunct to scaling and root planing (SRP) in the treatment of generalized chronic periodontitis.Materials and Methods:Patients with chronic periodontitis were recruited to participate in a study with a split-mouth design and provided informed consent. One hundred sites were included in the study and divided into fifty test sites and fifty control sites. These were assessed for plaque index (PI), gingival index (GI), pocket probing depths, and relative attachment level (RAL) at-pretreatment (baseline), 4, and 12 weeks posttreatment. The patients received full-mouth SRP. A 0.8% hyaluronan gel was administered subgingivally in the test sites at baseline and after 1 week. Significant differences between test and control were evaluated using the t-test, analysis of variance (test) followed by Bonferroni post hoc test.Results:A significant reduction in PI and GI was observed in both groups at 12 weeks (P < 0.05). Significant reduction in the pocket probing depths and gain RAL was observed in both the groups as compared to baseline (P < 0.05). The hyaluronan group compared to control at 12 weeks showed statistically significant reduction in the probing pocket depth and gain in RAL (P < 0.05).Conclusion:The subgingival application of 0.8% hyaluronan gel in conjunction with SRP may have a beneficial effect on periodontal health in patients with chronic periodontitis.

Nonsurgical therapy of chronic periodontitis with adjunctive systemic azithromycin or amoxicillin/metronidazole

The objective of the present study is to compare the effect of systemic adjunctive use of azithromycin with amoxicillin/metronidazole to scaling and root planing (SRP) in a clinical study. Data from 60 individuals with chronic periodontitis were evaluated after full-mouth SRP. Antibiotics were given from the first day of SRP, in the test group (n = 29), azithromycin for 3days and, in the control group (n = 31), amoxicillin/metronidazole for7days. Probing depth (PD), attachment level (AL), and bleeding on probing (BOP) were recorded at baseline and after 3 and 12months. Gingival crevicular fluid was analyzed for matrix metalloprotease (MMP)-8 and interleukin (IL)-1beta levels. Subgingival plaque was taken for assessment of the major bacteria associated with periodontitis. In both groups, PD, AL, and BOP were significantly reduced (p < 0.001). A few significant differences between the groups were found; AL and BOP were significantly better in the test than in the control group at the end of the study (p = 0.020 and 0.009). Periodontopathogens were reduced most in the test group. A noninferiority of the treatment with azithromycin in comparison with amoxicillin/metronidazole can be stated. The administration of azithromycin could be an alternative to the use of amoxicillin/metronidazole adjunctive to SRP in patients with moderate or severe chronic periodontitis; however, a randomized placebo-controlled multicenter study is needed. Application of azithromycin as a single antibiotic for 3days might be considered as an additional adjunctive antibiotic to SRP in selected patients.

Platelet-rich Plasma with Scaling and Root Planing: A Double-blind Split-mouth Randomized Study

Background and aims. Along with conventional periodontal therapy, subginigval application of platelet-rich plasma (PRP) may provide more effective improvements in clinical parameters due to the presence of multiple growth factors. The aim of this double-blind, split-mouth, randomized study was to evaluate the adjunctive use of PRP with scaling and root planing (SRP) in the treatment of chronic periodontitis. Materials and methods. A total of 87 non-smokers suffering from moderate to severe chronic periodontitis were selected. Parameters were probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI) and modified bleeding index (mBI). After full-mouth SRP the sites were randomly divided into experimental sites receiving subgingival application of autologous PRP and controls treated with placebo gel. Measurements were recorded at baseline, 3 months and 6 months. Paired t-test was used to compare response to treatment between the two sites. Results. Statistically significant changes in parameters were seen in both groups from baseline to 6 months. Inter-group comparison revealed significantly more clinical attachment gain for the experimental group (P&gt;0.05). The mean CAL gain was 2.40±0.4 mm for control sites and 2.68±0.5 mm for experimental sites. Conclusion. This study supports the use of PRP during nonsurgical debridement of periodontal pockets measured 6 months after SRP.

Hyaluronic Acid as an adjunct to scaling and root planing in chronic periodontitis. A randomized clinical trail.

AIM of the present study was to evaluate the adjunctive effect of local application of hyaluronon gel following scaling and root planing (SRP) in chronic periodontitis patients. In this randomized split mouth study 33 subjects with chronic periodontitis were evaluated after full mouth SRP. In the test sites hyaluronon gel was applied immediately after SRP and one week post therapy, the control sites were treated with SRP alone. Bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL) were recorded at baseline, 4 wk and 12 wk. Significant reduction in BOP scores was observed in both the groups at 12weeks (p<0.001). The hyaluronon group showed a greater reduction in BOP (p<0.001). In the hyaluronon group the mean PPD at baseline was 6.33±0.09 which reduced to 2.49±0.51 at 12 weeks which was statistically significant (p<0.001). In the control group the mean PPD at baseline was 6.09±1.26 which reduced to 4.36±1.29 at 12 weeks which was statistically significant (p<0.001). The CAL measurements showed a significant difference between the groups (p<0.001) at 12 wk post therapy. Hyaluronic Acid (HA) has a beneficial effect on periodontal health in patients with chronic Periodontitis. HA appears to be a suitable candidate as an adjunct to SRP in chronic periodontitis patients.

Effects of adjunctive daily phototherapy on chronic periodontitis: a randomized single-blind controlled trial.

The purpose of this randomized single-blind controlled trial was to elucidate the clinical and antimicrobial effects of daily phototherapy (PT) as an adjunct to scaling and root planing (SRP) in patients with chronic periodontitis. The study was conducted from December 2013 to May 2014 at Ewha Womans University Mokdong Hospital, Seoul, Korea. Forty-one patients with mild to moderate chronic periodontitis were randomly divided into two therapeutic groups in a 1:1 ratio: SRP+PT and SRP (control) groups. All participants underwent full-mouth SRP. PT was performed thrice a day for a month by using electric toothbrushes with embedded light-emitting diodes. Plaque index, gingival index, probing pocket depth (PPD), clinical attachment level (CAL), and bleeding on probing were assessed before (baseline) and four weeks after (follow-up) the treatment. Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Prevotella intermedia, Fusobacterium nucleatum, Parvimonas micra, Campylobacter rectus, Eikenella corrodens, Streptococcus mutans, and Streptococcus sobrinus levels were detected by a real-time polymerase chain reaction at the same points in time. The clinical parameters improved in both the groups. At the follow-up assessment, PPD was significantly decreased in the SRP+PT group (P=0.00). Further, PPD and CAL showed significantly greater changes in the SRP+PT group than in the SRP group (PPD, P=0.03; CAL, P=0.04). P. gingivalis and T. forsythia levels decreased in this group, but no significant intergroup differences were noted. Adjunctive PT seems to have clinical benefits, but evidence of its antimicrobial effects is not sufficient. Long-term studies are necessary to develop the most effective PT protocol and compare the effectiveness of PT with and without exogenous photosensitizers.

Comparative evaluation of amoxicillin plus metronidazole and doxycycline alone in the nonsurgical treatment of localized aggressive periodontitis

Aim and Objective: To evaluate the effects of a combination of amoxicillin plus metronidazole and doxycycline alone in the nonsurgical treatment of localized aggressive periodontitis (LAP) and compare their effects on clinical and microbiological parameters during 90 days followup in patients with LAP. Materials and Methods: A total of 20 patients with LAP were included in the study. Collection of subgingival plaque samples and recordings of clinical parameters, that is, plaque index (PI), gingival index (GI), probing pocket depth (PPD), and clinical attachment loss (CAL) was done at baseline. The subjects were randomly divided into two groups. Group I subjects were given a combination of amoxicillin plus metronidazole and Group II subjects were given doxycycline. Full-mouth scaling and root planing (SRP) was performed at day 10. Collection of subgingival plaque samples and recording of clinical parameters was repeated at days 10, 30, and 90. Results: There was a statistically highly significant difference ( P P P Conclusion: Systemic administration of doxycycline with full mouth SRP resulted in a better improvement of periodontal parameters and elimination/suppression of putative periodontal pathogens such as Aa, Pg, and Tf, than amoxicillin plus metronidazole in patients with LAP.

Hyaluronic Acid as an Adjunct After Scaling and Root Planing: A Prospective Randomized Clinical Trial

The study is designed to determine the effect on clinical variables, subgingival bacteria, and local immune response brought about by application of hyaluronan-containing gels in early wound healing after scaling and root planing (SRP). In this randomized clinical study, data from 34 individuals with chronic periodontitis were evaluated after full-mouth SRP. In the test group (n = 17), hyaluronan gels in two molecular weights were additionally applied during the first 2 weeks after SRP. The control group (n = 17) was treated with SRP only. Probing depth (PD) and clinical attachment level (CAL) were recorded at baseline and after 3 and 6 months, and subgingival plaque and sulcus fluid samples were taken for microbiologic and biochemical analysis. In both groups, PD and CAL were significantly reduced (P <0.001). The changes in PD and the reduction of the number of pockets with PD ≥5 mm were significantly higher in the test group after 3 (P = 0.014 and 0.021) and 6 (P = 0.046 and 0.045) months. Six months after SRP, the counts of Treponema denticola were significantly reduced in both groups (both P = 0.043), as were those of Campylobacter rectus in the test group only (P = 0.028). Prevotella intermedia and Porphyromonas gingivalis increased in the control group. The adjunctive application of hyaluronan may have positive effects on PD reduction and may prevent recolonization by periodontopathogens.

Effect of Hydrosoluble Chlorine–Mediated Antimicrobial Photodynamic Therapy on Clinical Parameters and Cytokine Profile in Ligature‐Induced Periodontitis in Dogs

Recently, a hydrosoluble chlorine composed of sodium salts chlorine e6, chlorine p6, and purpurine-5 has been shown to be a promising photosensitizer in antimicrobial photodynamic therapy (aPDT). The aim of this study is to evaluate the effects of adjunctive application of hydrosoluble chlorine-mediated aPDT compared with scaling and root planing (SRP) alone on clinical parameters and cytokine levels in gingival crevicular fluid of dogs with experimental periodontitis. Periodontal disease was induced by placing silk ligatures around both maxillary and mandibular teeth. After establishment of attachment loss, full-mouth SRP was performed in all dogs. One day after SRP, each quadrant randomly received one of the following treatment modalities: hydrosoluble chlorine plus diode laser (wavelength 662 nm, power 100 mW, continuous mode, time of irradiation 20 seconds), hydrosoluble chlorine alone, laser alone, or no adjunctive treatment. The same adjunctive procedure was repeated 1 week later. Clinical parameters including periodontal probing depth, clinical attachment level, and bleeding on probing, as well as crevicular levels of interleukin-1β and tumor necrosis factor-α, were evaluated at baseline, at 3 weeks, and at 3 months after treatment. After both 3 weeks and 3 months, all treatment groups showed significant improvement in all clinical and immunologic parameters (P <0.001). No significant differences were found between the four groups with regard to the measured parameters (P >0.05). Based on the results of this study, adjunctive use of hydrosoluble chlorine-mediated aPDT with the current setting has no additional effect on the clinical parameters or proinflammatory cytokine levels in ligature-induced periodontitis.

Short-term microbiological effects of scaling and root planing and essential-oils mouthwash in Chinese adults

To assess the short-term effect of scaling and root planing (SRP) and essential-oils mouthwash on the levels of specific bacteria in Chinese adults. Fifty Chinese adults with chronic periodontitis were randomly assigned to full-mouth SRP or a 7-d essential-oils mouthwash regimen. In addition, 22 periodontally healthy adults used essential-oils mouthwash for 7 d. Clinical examination and plaque/saliva sampling were performed at baseline and on Day 7. Quantitative real-time polymerase chain reaction (PCR) was used to measure Aggregatibacter actinomycetemcomitans (Aa), Fusobacterium nucleatum (Fn), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), and total bacterial loads in saliva, supra- and sub-gingival plaque samples. The detection frequencies of four tested species remained unchanged after either treatment. However, the bacterial loads of Fn, Pg, and Pi were significantly reduced by SRP; the mean reduction of bacterial counts in saliva ranged from 52.2% to 62.5% (p<0.01), in supragingival plaque from 68.2% to 81.0% (p<0.05), and in subgingival plaque from 67.9% to 93.0% (p<0.01). Total bacterial loads were reduced after SRP in supra- and sub-gingival plaque (p<0.05). Essential-oils mouthwash reduced Fn levels in supragingival plaque by a mean of 53.2%, and reduced total bacterial loads in supra- and sub-gingival plaque (p<0.01). In subgingival plaque from periodontal patients, Pg and Pi reductions were high after SRP compared to essential-oils mouthwash (93.0% vs. 37.7% and 87.0% vs. 21.0%, p<0.05). No significant bacterial reduction was observed in periodontally healthy subjects using essential-oils mouthwash. SRP and essential-oils mouthwash both have an impact on saliva and gingival plaque flora in Chinese periodontitis patients in 7 d, with greater microbiological improvement by SRP.

Full‐mouth disinfection as a therapeutic protocol for type‐2 diabetic subjects with chronic periodontitis: Twelve‐month clinical outcomes. A randomized controlled clinical trial

The aim of this randomized controlled clinical trial was to evaluate the clinical effects of chlorhexidine (CHX) application in a full-mouth disinfection (FMD) protocol in poorly controlled type-2 diabetic subjects with generalized chronic periodontitis. Thirty-eight subjects were randomly assigned into FMD group (n=19): full-mouth scaling and root planing (FMSRP) within 24h + local application of CHX gel + CHX rinses for 60days or Control group (n=19): FMSRP within 24h + local application of placebo gel + placebo rinses for 60days. Clinical parameters, glycated haemoglobin and fasting plasma glucose were assessed at baseline, 3, 6 and 12months post-therapies. All clinical parameters improved significantly at 3, 6 and 12months post-therapies for both groups (p<0.05). There were no significant differences between groups for any clinical parameters, and glycemic condition at any time-point (p>0.05). The treatments did not differ with respect to clinical parameters, including the primary outcome variable (i.e. changes in clinical attachment level in deep pockets), for up to 12months post-treatments.

Systemic Ornidazole as an Adjunct to Non‐Surgical Periodontal Therapy in the Treatment of Chronic Periodontitis: A Randomized, Double‐Masked, Placebo‐Controlled Clinical Trial

The purpose of this clinical trial is to evaluate the adjunctive clinical effects of the systemic administration of ornidazole (ORN) in the full-mouth scaling and root planing (SRP) of individuals with moderate-to-advanced chronic periodontitis. Fifty-eight individuals presenting ≥12 teeth with probing depth (PD) ≥4 mm were selected. All participants were instructed on strict oral hygiene measures and were advised to use 0.2% chlorhexidine mouthwash for 1 week before being allocated to two groups. Thirty participants were randomly assigned to full-mouth SRP + placebo (control group), and 28 participants were assigned to full-mouth SRP + ORN (test group). The clinical outcomes evaluated were plaque index, gingival index, clinical attachment level (CAL), and PD. Fifty participants could be evaluated by ≤6 months. At 6 months, the test group had greater mean reduction (2.84 mm) in PD compared to the control group (0.84 mm) (P <0.05), and there was also a greater mean CAL reduction (2.92 mm) in the test group compared to the control group (0.92 mm) (P <0.05). The systemic use of ORN, when used in conjunction with initial periodontal treatment consisting of SRP in adults with periodontitis, achieves significantly better clinical results than initial periodontal treatment alone.

Effectiveness of Systemic Amoxicillin/Metronidazole as an Adjunctive Therapy to Full‐Mouth Scaling and Root Planing in the Treatment of Aggressive Periodontitis: A Systematic Review and Meta‐Analysis

The systemic use of combined amoxicillin and metronidazole (AMX/MET) as an adjunctive treatment to full-mouth scaling and root planing (FMSRP) has been proposed for the treatment of generalized aggressive periodontitis; however, its effectiveness and clinical safety remain to be defined. The purpose of the present meta-analysis is to assess the effectiveness of FMSRP + AMX/MET compared to FMSRP alone. An electronic search of eight databases and a hand-search of 10 international dental journals were conducted through September 11, 2011. Gain in clinical attachment level (CAL), reduction in probing depth (PD), secondary outcomes, and adverse events were analyzed. A random-effect model was used to pool the extracted data. The weighted mean difference (MD) with 95% confidence interval (CI) was calculated for continuous outcomes, whereas risk difference (RD) with 95% CI was used for dichotomous data; heterogeneity was assessed with the χ(2)-based Cochran Q test and I(2) statistic. The level of significance was set at P <0.05. After the selection process, six randomized clinical trials were included. Results of the meta-analysis showed significant CAL gain (MD, 0.42; 95% CI, 0.23 to 0.61; P <0.05) and PD reduction (MD, 0.58; 95% CI, 0.39 to 0.77; P <0.05) in favor of FMSRP + AMX/MET; moreover, no significant RD was found in the occurrence of adverse events (RD, 0.01; 95% CI, -0.02 to 0.04; P >0.05). The findings of the meta-analysis seem to support the effectiveness and the clinical safety of FMSRP + AMX/MET; however, future studies are needed to confirm these results.

Clinical and Microbiologic Results 12 Months After Scaling and Root Planing With Different Irrigation Solutions in Patients With Moderate Chronic Periodontitis: A Pilot Randomized Trial

The aim of this study is to determine in a randomized trial the impact on treatment outcome after 12 months of different subgingival irrigation solutions during scaling and root planing (SRP). Fifty-one adult volunteers with generalized chronic periodontitis were treated by full-mouth SRP using 0.9% sodium chloride, 0.12% chlorhexidine digluconate, or 7.5% povidone-iodine for subgingival irrigation during SRP. Before SRP and after 3 and 12 months, probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) were recorded. Subgingival plaque samples were analyzed for Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola. PD, CAL, and BOP were significantly improved in all groups after 12 months (P <0.001 to P = 0.044). No significant differences were seen among the groups for all sites and sites with 4 to 6 mm PD at baseline. The povidone-iodine group had the highest clinical improvements. The counts of A. actinomycetemcomitans and P. gingivalis were significantly reduced after 12 months (P = 0.045 and P = 0.002) using povidone-iodine. Significant differences between the groups were seen after 3 months for A. actinomycetemcomitans and P. gingivalis, and after 12 months for T. forsythia. No differences were seen among the groups in the clinical results after 12 months. Regarding the microbiologic results, a slight benefit seemed to derive from the use of povidone-iodine.

Partial‐ and full‐mouth scaling and root planing in type 2 diabetic subjects: a 12‐mo follow‐up of clinical parameters and levels of cytokines and osteoclastogenesis‐related factors

The aim of this study was to evaluate the effects of full-mouth scaling and root planing (FMSRP) and partial-mouth scaling and root planing (PMSRP), up to 12 mo after treatment, on clinical parameters, and levels of cytokines and osteoclastogenesis-related factors in type 2 diabetic subjects with chronic periodontitis. Thirty-four subjects received FMSRP (n = 17) or PMSRP (n = 17) within 24 h or in multiple sessions, respectively. Clinical parameters and local levels of tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), interleukin (IL)-17, IL-23, IL-4, receptor activator of NF-β ligand and osteoprotegerin were assessed at baseline, and 3, 6 and 12 mo after therapies. Clinical parameters improved after both therapies (p < 0.05), and no between-group differences were observed at any time-point (p > 0.05). Overall, there were no considerable differences in the local levels of the biomarkers studied between groups (p > 0.05). The IL-23 concentration and total amount of IFN-γ increased in the FMSRP group and decreased in the PMSRP group from baseline to 3 mo and from baseline to 6 mo, respectively (p < 0.05). Both PMSRP and FMSRP promoted benefits in clinical parameters and showed a similar modulation of cytokines and osteoclastogenesis-related factors at 12 mo in type 2 diabetic subjects.

The recolonization hypothesis in a full‐mouth or multiple‐session treatment protocol: a blinded, randomized clinical trial

To test recolonization of periodontal lesions after full-mouth scaling and root planing (FM-SRP) or multiple session-SRP (MS-SRP) in a randomized clinical trial and whether FM-SRP and MS-SRP result in different clinical outcomes. Thirty-nine subjects were randomly assigned to FM-SRP or MS-SRP groups. At baseline and after 3 months, probing pocket depth (PPD), plaque index (PlI) and bleeding on probing (BoP) were recorded. At baseline, immediately after treatment, after 1, 2, 7, 14 and 90 days, paper point samples from a single site from the maxillary right quadrant were collected for microbiological analysis of five putative pathogens by polymerase chain reaction. FM-SRP and MS-SRP resulted in significant reductions in PPD, BoP and PlI and the overall detection frequencies of the five species after 3 months without significant differences between treatments. Compared with MS-SRP, FM-SRP resulted in less recolonization of the five species, significantly for Treponema denticola, in the tested sites. FM-SRP and MS-SRP result in overall clinically and microbiologically comparable outcomes where recolonization of periodontal lesions may be better prevented by FM-SRP.