Periodontal Debridement Research Articles

Oral prophylaxis and its effects on halitosis‐associated and inflammatory parameters in patients with chronic periodontitis

A controlled clinical trial was conducted to evaluate the effects of oral prophylaxis on halitosis-associated, immunological and microbiological parameters. Thirty subjects were included in this controlled clinical trial (patients with generalized chronic periodontitis and controls without clinical attachment loss; each n = 15). Before oral prophylaxis and 14 days after (including tongue cleaning) volatile sulphur compounds (VSC), organoleptic scores and a tongue coating index were evaluated. The levels of IL-1β, IL-8, IL-10 and MMP-8 were measured in GCF, and also major periodontal pathogens were detected. Data were statistically analysed using anova and paired t-test. Supragingival plaque and calculus removal with combined tongue cleaning was able to reduce significantly (P < 0.05) the VSC values in both groups (no significant differences between both groups). Two weeks after periodontal debridement, the VSC values were observed in the periodontitis group, but not in the control group, similar to the baseline values. The difference between the groups was statistically significant (P < 0.05). Only a repeated prophylaxis session in the periodontitis group was able to reduce VSC values significantly in comparison with baseline (P < 0.05). Organoleptic scores (10 and 30 cm) were significantly different (P < 0.05) between both groups before and after the treatment. Periodontal pathogens and host-derived markers were not significantly affected by a single prophylaxis session. Oral prophylaxis may result in a significant decrease in VSC values. However, in periodontal diseases, a more complex treatment seems to be necessary.

Are There Specific Benefits of Amoxicillin Plus Metronidazole in Aggregatibacter actinomycetemcomitans‐Associated Periodontitis? Double‐Masked, Randomized Clinical Trial of Efficacy and Safety

It has been suggested that prescription of amoxicillin plus metronidazole in the context of periodontal therapy should be limited to patients with specific microbiologic profiles, especially those testing positive for Aggregatibacter actinomycetemcomitans. The main purpose of this analysis is to determine if patients positive for A. actinomycetemcomitans with moderate to advanced periodontitis benefit specifically from amoxicillin plus metronidazole given as an adjunct to full-mouth scaling and root planing. This is a double-masked, placebo-controlled, randomized longitudinal study including 41 participants who were positive for A. actinomycetemcomitans and 41 participants who were negative for A. actinomycetemcomitans. All 82 patients received full-mouth periodontal debridement performed within 48 hours. Patients then received either systemic antibiotics (375 mg amoxicillin and 500 mg metronidazole, three times daily) or placebo for 7 days. The primary outcome variable was persistence of sites with a probing depth (PD) >4 mm and bleeding on probing (BOP) at the 3-month reevaluation. Using multilevel logistic regression, the effect of the antibiotics was analyzed according to the following factors (interaction effect): A. actinomycetemcomitans-positive or -negative at baseline, sex, age, smoking, tooth being a molar, and interdental location. At reevaluation, participants in the test group had significantly fewer sites with a persisting PD >4 mm and BOP than control patients (P <0.01). Being A. actinomycetemcomitans-positive or -negative did not change the effect of the antibiotics. Patients benefited from the antibiotics irrespective of sex, age, or smoking status. Molars benefited significantly more from the antibiotics than non-molars (P for interaction effect = 0.03). Patients who were positive for A. actinomycetemcomitans had no specific benefit from amoxicillin plus metronidazole. Sites on molars benefited significantly more from the antibiotics than non-molar sites.

Debridamento ultrassônico de boca toda no tratamento da periodontite crônica: uma revisão sistematizada

INTRODUÇÃO: O debridamento ultrassônico de boca toda visa a uma instrumentação mais leve e conservadora da superfície radicular, evitando a recolonização da bolsa periodontal. OBJETIVO: Este trabalho verificou os efeitos do debridamento subgengival com o uso de ultrassom sobre os parâmetros clínicos periodontais no tratamento da periodontite crônica por meio de uma revisão na literatura. MATERIAL E MÉTODO: A revisão foi realizada nas bases de busca bibliográfica PubMed, Lilacs, Scielo, Medline e Centro de Registro de Ensaios Clínicos Controlados (Biblioteca Cochrane). Foram incluídas publicações na língua inglesa que abordaram estudos clínicos de intervenção em humanos, randomizados e controlados, e que utilizaram o debridamento ultrassônico para o tratamento não cirúrgico da periodontite crônica. RESULTADO: Inicialmente, foram encontradas 167 referências e, a partir da análise dos títulos e resumos, dez estudos perfizeram as características exigidas e foram considerados válidos para a realização desta revisão. Os estudos mostraram que a abordagem pelo debridamento ultrassônico pode ser terapia favorável ao tratamento da periodontite crônica. CONCLUSÃO: O tratamento da periodontite crônica por meio do debridamento ultrassônico periodontal de boca toda produz resultados clínicos semelhantes aos conseguidos na raspagem e no alisamento radicular convencionais.

Effect of surgical and non-surgical periodontal debridement on vascular thrombotic markers in hypertensives.

Background:Periodontal debridement has an impact on the vascular thrombotic markers in healthy individuals. This study aimed to investigate changes in several vascular thrombotic markers after surgical and non-surgical periodontal debridement in hypertensives with periodontitis.Materials and Methods:40 hypertensives, 27 males and 13 females, 37-68 year old, mean 51.2 years, with moderate to severe periodontitis, were divided into two groups, (n = 20 for each); the first received comprehensive one session non-surgical periodontal debridement, (pockets 4-6 mm), while the second received comprehensive supragingival scaling with surgical debridement at one quadrant, (Pockets > 6 mm). Periodontal parameters included; plaque index (PI), gingival inflammation (GI), bleeding on probing (BOP), pocket probing depth (PPD). Vascular thrombotic tests included; platelets count (Plt), fibrinogen (Fib), Von Willebrand factor antigen activity (vWF:Ag), and D-dimers (DD).Results:PI, GI, BOP, PPD, decreased significantly (P = 0.001) after 6 weeks of periodontal debridement in both groups, while BOP and PPD remained higher in the surgical one (P < 0.05). Thrombotic vascular markers changes through the three-time intervals were significant in each group (P = 0.001), and time-group interception effect was significant for vWF:Ag (P = 0.005), while no significant differences between groups after treatment (P > 0.05).Conclusion:Periodontal debridement, surgical and non-surgical, improved the periodontal status in hypertensives. Periodontal treatment activated the coagulation system in hypertensives and recessed later while the treatment modality did not affect the degree of activation.

Scope of photodynamic therapy in periodontics and other fields of dentistry

The advancement in science and technology in the medical field amends a path for embedding new treatment modalities to the challenges presented by the viable diseases. The increasing use of lasers in dentistry and medicine reflects the great advances in this technology during recent decades. A. The gold standard for the non surgical treatment of periodontal disease remains mechanical periodontal debridement. The mechanical periodontal treatment has to be often sustained with various anti infectious means, such as antiseptics or antibiotics. Antimicrobial agents used systemically or as a local drug delivery further suppress the periodontal pathogens, increasing the benefits of conventional mechanical therapy. The emergence of resistant microorganisms and a shift in the microflora after extended use limit the use of antimicrobials. This created the foundation for our modern use of chemotherapy and emergence of photodynamic therapy. The oral cavity is especially suitable for photodynamic antimicrobial chemotherapy (PACT) because it is relatively accessible to illumination. A search was initiated to locate original research articles, review articles, and case reports pertaining to the key words: photodynamic therapy, periodontal treatment, photosensitizer, wound healing, laser, photodentistry. Electronic database was selected and articles were retrieved from PubMed and Google This article presents an overview of photodynamic therapy as it represents a novel therapeutic approach in the management of oral biofilms.Clinical Relevance to Interdisciplinary Dentistry Photodynamic therapy is a non invasive treatment modality which can be used in all the major specialty treatments in the field of dentistry. Inflammation, soft tissue and bone healing, postoperative pain, and post treatment tooth hypersensitivity can be managed in pedodontia, oral surgery, peroidontics, endodontics, and conservative dentistry. Antimicrobial photodynamic therapy reduces bacterial contamination, especially during the surgical procedures.

Dental diastemata and periodontal disease secondary to axially rotated maxillary cheek teeth in three horses

SummaryMalerupted axially rotated maxillary cheek teeth (CT) were identified as the primary cause of diastemata and severe periodontitis in 3 horses. Diastema widening and periodontal debridement was performed initially in one case but did not resolve clinical signs. Subsequently, all 3 cases underwent extraction of the axially rotated teeth per os without complication. Follow‐up indicated remission of periodontitis and signs of oral pain. In these cases, maxillary CT had erupted in a manner that resulted in axial rotation of CT with undulating buccal and palatal surfaces aligned with the interproximal surfaces of adjacent normally orientated teeth. This resulted in poor interproximal compression and diastemata causing severe periodontitis. Axially rotated maxillary CT and the severe periodontitis that they precipitate, have not been previously described as a discrete dental disease entity.

Microbiologic Testing and Outcomes of Full‐Mouth Scaling and Root Planing With or Without Amoxicillin/Metronidazole in Chronic Periodontitis

It has been suggested that use of systemic antibiotics should be limited to patients with specific microbiologic profiles. The main purpose of the present analysis was to study whether microbiologic testing before therapy was of value in predicting which patients would specifically benefit from adjunctive amoxicillin and metronidazole, given in the context of full-mouth scaling and root planing (SRP) within 48 hours. This was a 6-month, single-center, double-masked, placebo-controlled, randomized longitudinal study. Fifty-one patients received full-mouth periodontal debridement, performed within 48 hours; then, 25 subjects received metronidazole, 500 mg, and amoxicillin, 375 mg, three times a day for 7 days, and 26 received a placebo (control group). Pooled microbiologic samples were taken from the deepest pocket at baseline in each quadrant before and 6 months after treatment. Six periodontal pathogens were quantified by real-time polymerase chain reaction. Forty-seven patients were followed for 6 months. After treatment, test subjects had a substantially lower mean number of persisting sites with probing depth >4 mm and bleeding on probing than did control subjects (0.4 versus 3.0; P = 0.005; month 6). Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans) could not be detected in the antibiotic group after treatment. However, in the placebo group, three of six subjects positive for A. actinomycetemcomitans continued to be positive. Lower frequencies were also noted in the test group for Porphyromonas gingivalis (P = 0.013) and Tannerella forsythia (previously T. forsythensis) (P = 0.007). However, even subjects testing negative for A. actinomycetemcomitans at baseline had a significantly better primary clinical outcome if they received the active drugs. The presence of six putative periodontal pathogens (A. actinomycetemcomitans, Fusobacterium nucleatum spp., P. gingivalis, Prevotella intermedia, Treponema denticola, and T. forsythia) quantified prior to therapy was not correlated with the outcome of full-mouth SRP with or without amoxicillin and metronidazole. Excellent clinical results in the antibiotics group were obtained regardless of the presence or absence of six classic periodontal periopathogens prior to treatment.

Amoxicillin and Metronidazole as an Adjunct to Full‐Mouth Scaling and Root Planing of Chronic Periodontitis

It has been suggested that scaling and root planing of all pockets within a few hours and chlorhexidine treatments (full-mouth disinfection) may reduce the need for supplementary therapies. The aim of this study was to evaluate the clinical benefit of amoxicillin and metronidazole administered immediately after completion of full-mouth periodontal debridement in patients with chronic periodontitis. This was a single-center, double-masked, placebo-controlled, randomized longitudinal study of 6 months' duration. Fifty-one patients received full-mouth periodontal debridement, performed within 48 hours. Twenty-five subjects received metronidazole, 500 mg, and amoxicillin, 375 mg, three times a day for 7 days; 26 subjects received a placebo. Forty-seven patients could be followed up to month 6. No differences in clinical parameters were noted before treatment. The overall mean probing depth decreased from 4.3 +/- 0.4 mm to 3.0 +/- 0.2 mm in the test group and from 4.4 +/- 0.4 mm to 3.1 +/- 0.3 mm in the control group (P = 0.05, difference between groups). More importantly, test subjects had a significantly lower mean number of persisting pockets >4 mm and bleeding on probing that required further treatment (P = 0.005): 6 months after full-mouth debridement plus antibiotics, only 0.4 +/- 0.8 persisting pockets were still present, whereas 3.0 +/- 4.3 persisting pockets were still present in the control group. The protective risk of the antibiotics for having more than one pocket deeper than 4 mm and bleeding on probing per subject after 6 months was 8.85. Systemic metronidazole and amoxicillin significantly improved the 6-month clinical outcomes of full-mouth non-surgical periodontal debridement, thus significantly reducing the need for additional therapy.

Periodontal debridement as a therapeutic approach for severe chronic periodontitis: a clinical, microbiological and immunological study

To clinically, microbiologically and immunologically characterize periodontal debridement as a therapeutic approach for severe chronic periodontitis. Twenty-five patients presenting at least eight teeth with a probing pocket depth (PPD) of >or=5 mm and bleeding on probing (BOP) were selected and randomly assigned to quadrant-wise scaling and root planing or one session of full-mouth periodontal debridement. The following clinical outcomes were assessed: plaque index, BOP, position of gingival margin, relative attachment level (RAL) and PPD. Real-time PCR was used for quantitative analysis of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Tannerella forsythia. The enzyme-linked immunosorbent assay permitted the detection of IL-1beta, prostaglandin E(2), INF-gamma and IL-10 in gingival crevicular fluid (GCF). All the parameters were evaluated at baseline, and at 3 and 6 months after treatment. Both the groups had similar means of PPD reduction and attachment gain over time. Besides a significant reduction in the bacterial level after treatment in both groups, microbiological analysis failed to demonstrate significant differences between them. Finally, no difference was observed between groups with respect to the levels of inflammatory mediators in GCF. Periodontal debridement resulted in a similar clinical, microbiological and immunological outcome when compared with standard scaling and root planing and therefore may be a viable approach to deal with severe chronic periodontitis.

Aggressive periodontitis associated with Papillon‐Lefèvre syndrome: Report of a 14‐year follow‐up

This case report describes the periodontal management, therapeutic approach, and 14-year follow-up of a patient diagnosed with Papillon-Lefevre syndrome (PLS). A female child, diagnosed with PLS-associated periodontitis at the age of 9 years and 11 months, presented with hyperkeratosis of the palms and soles, as well as generalized aggressive periodontitis. The dental treatment comprised standard periodontal debridement, scaling and root planing, instructions on oral hygiene, restorations, extraction of hopelessly affected teeth and a therapeutic use of antibiotics. The concomitant supportive periodontal therapy and antibiotic coverage could not stop the loss of periodontal attachment and destruction of the alveolar bone. Four years after treatment was initiated, the last remaining teeth were extracted and complete dentures were constructed. The dentures have been periodically replaced and the patient continues to return for follow-up once a year. The combination of intensive periodontal treatment and antibiotic regimen only temporarily delayed periodontal disease progression and did not prevent loss of both primary and permanent teeth. The outcome of this long-term follow-up case report shows that management of PLS-associated periodontitis is further complicated when the patient is first seen in the mixed dentition stage or later. In these situations, the chances of controlling the progression of periodontal breakdown and minimizing tooth loss are greatly reduced.

Periodontal Debridement With Povidone‐Iodine in Periodontal Treatment: Short‐Term Clinical and Biochemical Observations

The aim of the present study was to evaluate the clinical effects of one-stage periodontal debridement with an ultrasonic instrument, associated with 0.5% povidone (pvp)-iodine irrigation in patients with chronic periodontitis. Forty-five patients were randomly assigned into three groups: the control group (CG) received quadrant root planing at 1-week intervals over four consecutive sessions; the periodontal debridement plus pvp-iodine group (PD-PIG) received a 45-minute full-mouth debridement with an ultrasonic instrument, associated with 0.5% pvp-iodine irrigation; and the periodontal debridement group (PDG) received a 45-minute full-mouth periodontal debridement with an ultrasonic instrument, associated with NaCl irrigation. At the 3-month evaluation, the mean probing depth (PD) reduction in CG was 2.51+/-0.52 mm, 2.53+/-0.50 mm in PD-PIG, and 2.58+/-0.60 mm in PDG (P<0.05). The clinical attachment level (CAL) analysis showed a statistically significant gain in all groups compared to baseline (1.87+/-0.56 mm [CG], 1.94+/-0.70 mm [PD-PIG], and 1.99+/-0.92 mm [PDG]). Intergroup analysis of PD and CAL at 1 and 3 months showed no differences (P>0.05). The N-benzoyl-L-arginine-p-nitroanilide (BAPNA) test showed a significant reduction in trypsin activity only during the first month (P<0.05); at 3 months there were no differences compared to baseline (P=0.80). This study provides no evidence that pvp-iodine is effective as an adjunct for one-stage periodontal debridement.

Effect of the menstrual cycle on pain experience associated with periodontal therapy

The aim of this pilot cross-over study was to compare preliminarily the pain perception of female patients undergoing periodontal debridement during menstrual or pre-menstrual phases (peri-menstrual period) with that observed during mid-menstrual phase (post-menstrual period). Twenty women with moderate-to-advanced chronic periodontitis and regular menstrual cycles were asked to complete Corah's Dental Anxiety Scale (DAS) during the first debridement visit. Patients were randomly assigned to receive their first debridement visit during either their peri-menstrual or post-menstrual period. Debridement was performed in bilateral quadrants of patients during the periods. Pain levels for each quadrant were assessed with a Visual Analogue Scale (VAS), after each debridement visit. There was no significant correlation of order of treatment in the intensity of perceived pain during the periods (p<0.05). The median VAS scores were 22.0 and 15.2 mm in the peri-menstrual and the post-menstrual period, respectively. Increase in pain perception among females during their peri-menstrual period was significantly greater than their post-menstrual period (p<0.05). No clinical conclusions can be drawn at this stage as this pilot study did not have a sufficiently broad population to generalize these observations to all female periodontal patients. Providing clinicians with information about patients' menstrual cycle during debridement can alter the pain experience.

Adjunctive benefits of systemic amoxicillin and metronidazole in non‐surgical treatment of generalized aggressive periodontitis: a randomized placebo‐controlled clinical trial

The objective of this study was to assess the adjunctive clinical effect of the administration of systemic amoxicillin and metronidazole in the non-surgical treatment of generalized aggressive periodontitis (GAP). Forty-one systemically healthy subjects with GAP were included in this 6-month double-blind, placebo-controlled, randomized clinical trial. Patients received a course of full-mouth non-surgical periodontal treatment delivered over a 24 h period using machine-driven and hand instruments. Test subjects received an adjunctive course of systemic antibiotic consisting of 500 mg amoxicillin and 500 mg metronidazole three times a day for 7 days. Clinical parameters were collected at baseline, and at 2 and 6 months post-treatment. In both the test and the placebo groups, all clinical parameters improved at 2 and 6 months. In deep pockets (> or =7 mm), the test treatment resulted in an additional 1.4 mm (95% confidence interval 0.8, 2.0 mm) in full-mouth probing pocket depth (PPD) reduction and 1 mm (0.7, 1.3 mm) of life cumulative attachment loss (LCAL) gain at 6 months. In moderate pockets (4-6 mm), the adjunctive benefit was smaller in magnitude: PPD reduction was 0.4 mm (0.1, 0.7 mm) and LCAL gain was 0.5 mm (0.2, 0.8 mm). In addition, the 6-month data showed LCAL gains > or =2 mm at 25% of sites in test patients compared with 16% in placebo (p=0.028). Similarly, PPD reductions of 2 mm or more were observed in 30% of sites in test and 21% of sites in placebo patients. Seventy-four percent of pockets with PPD > or =5 mm at baseline were 4 mm or shallower at 6 months in the test group. This compared with 54% in the placebo group (p=0.008). Disease progression at 6 months was observed at 1.5% of test and 3.3% of sites in test and placebo, respectively (p=0.072). These data indicate that a 7-day adjunctive course of systemic metronidazole and amoxicillin significantly improved the short-term clinical outcomes of full-mouth non-surgical periodontal debridement in subjects with GAP.

Enhanced Periodontal Debridement with the Use of Micro Ultrasonic, Periodontal Endoscopy

Current literature supports the use of powered instrumentation over traditional hand instrumentation. The objective of scaling and root planing is the complete removal of plaque and calculus from root surfaces. While this is unrealistic, the accepted end-point is a smooth, glassy root surface during periodontal instrumentation. This often has resulted in overinstrumentation and excessive removal of cementum. Cementum removal has been deemed generally unnecessary. What is essential is the removal of plaque, calculus, and the endotoxin adherent to the root surface. This cleaning of root surfaces is best done with judicious use of powered instrumentation. The excessive removal of cementum during hand instrumentation is due to the lack of visualization. Using endoscopic technology, the ability to visually debride roots can improve chances of success in a more conservative and minimally invasive way. This article provides a brief review of micro ultrasonic technologies and periodontal endoscopy, its implementation in our practice, and a limited case series.

Which reconstructive procedures are effective for treating the periodontal intraosseous defect?

Deep intraosseous defects represent a major challenge for the clinician. Sites with intraosseous lesions have been shown to be at higher risk of disease progression in subjects who had not received systematic periodontal therapy (78). Treatments of intrabony defects include scaling and root planing with or without surgical access flap. When the periodontal debridement is surgically performed, additional osseous resective therapy and ⁄ or reconstructive therapy by means of the application of membranes, biological agents or grafting biomaterials can be used to correct the bone deformities induced by destructive periodontal disease. In this respect, reconstructive procedures have been used with varying success during the past decades to accomplish the restitutio ad integrum of lost attachment apparatus in deep intraosseous defects. Although observations from histologic studies in humans (6, 19, 41, 105, 125) and data from controlled clinical trials have demonstrated that some of the available grafting procedures may result in healing that can be termed periodontal regeneration, complete and predictable reconstruction of periodontal tissues is still difficult to obtain. Despite the widely accepted effectiveness of the reconstructive procedures previously documented (28, 36, 89), there is a substantial variation in clinical response that can only in part be attributed to the biomaterials ⁄ biological agents adopted (54). Several traditional reviews have previously reported the additional effect of the use of different reconstructive procedures in intraosseous defects

Anaesthetic gel to reduce pain during periodontal scaling and root planing

Design The study was a multicentre randomised controlled trial (RCT). Intervention A total of 130 patients received either the active or placebo gel in periodontal pockets in one quadrant of the mouth for 30 s, prior to periodontal debridement (scaling and root planing). Outcome measure Pain was measured using both a 100-mm visual analogue scale (VAS) and a verbal rating scale (VRS). Results The median VAS pain score for people treated with the anaesthetic gel was 5 mm (range, 0–5 mm) as opposed to 13 mm (range, 0–9 mm) in the placebo-treated patients (P=0.015). There was no significant difference in the proportion of patients who reported no pain or mild pain (78% and 76% for the anaesthetic gel and placebo, respectively). Conclusions The VAS pain scores showed that the anaesthetic gel 5% was statistically more effective than the placebo in reducing pain during periodontal debridement. Acknowledgements The study was supported by Astra Zeneca Pain Control Sweden.

Rare lesions of the oral cavity: case report of an actinomycotic lesion limited to the gingiva

Actinomycosis is an infectious disease that frequently has chronic granulomatous and suppurative lesions caused by saprophytic Actinomyces species. Although cervicofacial actinomycosis is known to be the most common type, intraorally and periodontally types occur rarely in a localized fashion. The present case reports on an adult periodontitis patient with a diffuse and atypic actinomycotic lesion which was limited to the gingiva and had an abscess formation, a large desquamation and subsequent exposure of the alveolar bone in the involved region. Diagnosis was based on histopathological examination, the history of the case and clinical nature of the lesion. The patient responded to daily administration of 100 g doxcycycline (first day-bid) for 3 weeks and 0.2% chlorhexidine gluconate irrigation (following tooth brushing) performed with oral hygiene reinforcement and periodontal debridement procedures. Complete improvement of the lesion was observed after 5 weeks. Due to the opportunistic characteristics of the actinomycotic infection, early and adequate differential diagnosis of actinomycosis prior to therapeutic attempts, as well as management steps, are of great importance in the oral cavity to prevent the spread of the disease.

Clinical comparison of the effectiveness of novel sonic instruments and curettes for periodontal debridement after 2 months

AbstractAim: The aim of this study was to evaluate in vivo the effectiveness of scaling and root planing of new oscillating instruments (Periosonic®) using a sonic handpiece compared to hand curettes with a split mouth design after 2 months.Methods: 11 patients with adult periodontitis participated in this study. Plaque index (PII) (O’Leary), bleeding on probing (BOP), probing pocket depth (PPD), recession (REC) and clinical attachment level (CAL) were recorded at baseline and 2 months after treatment. After oral hygiene instruction, 2 randomly assigned quadrants per patient were scaled and root planed with curettes (control side) and the remaining 2 quadrants with the Periosonic® instruments 1 and 2 (test side). The student t‐test for paired data was used to test the significance of difference between test and control sides.Results: There was no statistical difference (p&gt;0.05) between the 2 sides for the improvement of the clinical parameters excepted for the group with initial PPD of 4–6 mm (test: 1.3±0.4 mm PPD reduction, control: 1.6±0.4 mm). For PPD 7 mm, the test side had better clinical improvement in attachment levels (2.2±0.9 mm), less recession (−0.4±0.5 mm) with lower PPD reduction (2.4±0.6 mm) than the control side (AL: 1.6±1.8 mm; REC: −1.3±0.7 mm, PPD reduction: 3.0±1.4 mm).Conclusion: This clinical study demonstrated that Periosonic® instruments are clinically at least as effective as curettes in PPD reduction when initial PPD is 6 mm and show better clinical attachment level improvement with less recession for initial PPD of 7 mm.

Nonsurgical periodontal therapy.

Regular home care by the patient in addition to professional removal of subgingival plaque is generally very effective in controlling most inflammatory periodontal diseases. When disease does recur, despite frequent recall, it can usually be attributed to lack of sufficient supragingival and subgingival plaque control or to other risk factors that influence host response, such as diabetes or smoking. Causative factors contributing to recurrent disease include deep inaccessible pockets, overhangs, poor crown margins and plaque-retentive calculus. In most cases, simply performing a thorough periodontal debridement under local anesthesia will stop disease progression and result in improvement in the clinical signs and symptoms of active disease. If however, clinical signs of disease activity persist following thorough mechanical therapy, such as increased pocket depths, loss of attachment and bleeding on probing, other pharmacotherapeutic therapies should be considered. Augmenting scaling and root planing or maintenance visits with adjunctive chemotherapeutic agents for controlling plaque and gingivitis could be as simple as placing the patient on an antimicrobial mouthrinse and/or toothpaste with agents such as fluorides, chlorhexidine or triclosan, to name a few. Since supragingival plaque reappears within hours or days after its removal, it is important that patients have access to effective alternative chemotherapeutic products that could help them achieve adequate supragingival plaque control. Recent studies, for example, have documented the positive effect of triclosan toothpaste on the long-term maintenance of both gingivitis and periodontitis patients. Daily irrigation with a powered irrigation device, with or without an antimicrobial agent, is also useful for decreasing the inflammation associated with gingivitis and periodontitis. Clinically significant changes in probing depths and attachment levels are not usually expected with irrigation alone. Recent reports, however, would indicate that, when daily irrigation with water was added to a regular oral hygiene home regimen, a significant reduction in probing depth, bleeding on probing and Gingival Index was observed. A significant reduction in cytokine levels (interleukin-1beta and prostaglandin E2, which are associated with destructive changes in inflamed tissues and bone resorption also occurs. If patient-applied antimicrobial therapy is insufficient in preventing, arresting, or reversing the disease progression, then professionally applied antimicrobial agents should be considered including sustained local drug delivery products. Other, more broadly based pharmacotherapeutic agents may be indicated for multiple failing sites. Such agents would include systemic antibiotics or host modulating drugs used in conjunction with periodontal debridement. More aggressive types of juvenile periodontitis or severe rapidly advancing adult periodontitis usually require a combination of surgical intervention in conjunction with systemic antibiotics and generally are not controlled with nonsurgical anti-infective therapy alone. It should be noted, however, that, to date, no home care products or devices currently available can completely control or eliminate the pathogenic plaques associated with periodontal diseases for extended periods of time. Daily home care and frequent recall are still paramount for long-term success. Nonsurgical therapy remains the cornerstone of periodontal treatment. Attention to detail, patient compliance and proper selection of adjunctive antimicrobial agents for sustained plaque control are important elements in achieving successful long-term results. Frequent re-evaluation and careful monitoring allows the practitioner the opportunity to intervene early in the disease state, to reverse or arrest the progression of periodontal disease with meticulous nonsurgical anti-infective therapy.

ROOT INSTRUMENTATION: Power-Driven Versus Manual Scalers, Which One?

The literature is clear that periodontal therapies aimed at altering the progression of inflammatory periodontal diseases must include meticulous subgingival mechanical débridement during both the nonsurgical and the surgical phases of treatment as the basis of most anti-infective therapy. In the past, infection control was achieved by the mechanical removal of subgingival deposits of plaque, calculus, and endotoxin with curets, files, and hoes. Historically, it was also generally agreed that aggressive scaling and root planing with hand instruments was necessary to remove tenacious calculus deposits to produce roots as smooth as possible for removal of the endotoxins previously thought to be deeply embedded into the root surfaces. Based on current evidence in the literature, it is now known that endotoxin is a weakly adherent surface phenomenon and that sonic and ultrasonic (power-driven) instruments can be used to accomplish definitive root detoxification and maximal wound healing without overinstrumentation of root and without extensive cementum removal. Power-driven scalers may have unique advantages because of the cavitational activity associated with ultrasonics thought to supplement removal of root surface plaques. In addition, the constant flushing activity of the lavage used to cool the tips results in disruption of the unattached and weakly attached subgingival plaques. 58, 59 The ability to flush the pocket during subgingival instrumentation with water or other chemical irrigating solutions is unique to ultrasonic and sonic scalers and has been shown to enhance pocket depth reduction and gain in clinical attachment beyond that achieved with hand scaling. 10, 24, 45 The added benefit of chemical lavage during ultrasonic instrumentation shows great promise and may enhance the overall effect of nonsurgical anti-infective periodontal therapy. Other major advantages of power-driven scalers may include better access to difficult areas, such as deep narrow defects, root grooves, and furcations, using newly designed microultrasonic tips, which are smaller in diameter and able to penetrate the pocket approximately 1 mm farther than hand instruments. 16, 53 Taken together, it appears that use of ultrasonic or sonic scalers for periodontal debridement will result in improvements in clinical and microbial parameters at a level equal to or superior to hand scalers.