Periodontal Therapy Research Articles

Step 2 for the treatment of periodontal diseases

This article discusses the modalities of treatment involved in step 2 of periodontal therapy, including exploring looking at the evidence-based recommendations produced by the S3 stages I–III periodontal treatment guideline. CPD/Clinical Relevance: Step 2 of periodontal therapy is essential for removal of the subgingival biofilm and reduction in the bacterial load.

Effects of minimally invasive non-surgical therapy on C-reactive protein, lipoprotein-associated phospholipase A2, and clinical outcomes in periodontitis patients: A 1-year randomized, controlled clinical trial.

Growing evidence suggests the type of periodontal treatment could differentially influence the reduction of key cardiovascular risk mediators in periodontitis patients. This randomized, controlled clinical trial compared the impact of minimally invasive non-surgical therapy (MINST) with quadrant-wise subgingival instrumentation (Q-SI) on C-reactive protein (CRP) together with lipoprotein-associated phospholipase A2 (Lp-PLA2) levels, and clinical periodontal outcomes in patients with periodontitis. Moreover, it was evaluated if baseline CRP levels impacted the efficacy of non-surgical periodontal therapy protocols. Forty-two periodontitis patients were enrolled and randomly treated by means of MINST (n=21) or Q-SI (n=21). The outcomes assessed were serum CRP and Lp-PLA2, and periodontal parameters (probing depth [PD], clinical attachment level [CAL], full-mouth bleeding score [FMBS]), at baseline and at follow-ups at 1, 3, and 6 months and at 1 year after treatment. At 1 year, MINST significantly reduced, among others, mean PD (p=0.007), mean CAL (p=0.007), the number of pockets>4mm (p=0.011) and ≥6mm (p=0.005), and FMBS (p=0.048) compared to Q-SI. Generalized multivariate analysis evidenced that high baseline CRP (p=0.039) and FMBS (p=0.046) levels, together with MINST treatment (p=0.007) were significant predictors of PD reduction at 1-year follow-up. Moreover, the Jonckheere-Terpstra test showed that patients with high baseline CRP levels gained more benefits from MINST treatment at 1-year follow-up than they did from Q-SI. Patients receiving MINST showed a greater reduction in CRP levels than patients with Q-SI after 1 year of follow-up. Moreover, patients with high baseline levels of CRP and Lp-PLA2 gained more benefits from the MINST approach at 1-year follow-up.

Demystifying the S3 guidelines: what do they actually mean?

Recent guidelines have been developed by the European Federation of Periodontology (EFP) and adoloped by the British Society of Periodontology to provide evidence-based guidance for clinicians in the UK to deliver periodontal therapy. To ensure the guidelines are as robust as possible the process of development is carefully structured. This article explores the background behind S3-level guidance for the treatment of periodontitis. CPD/Clinical Relevance: Understanding the process behind guideline formulation allows clinicians to apply them appropriately and confidently within their clinical practice.

Step 3 for the treatment of periodontal diseases: surgical regeneration of the periodontium

Surgical regeneration can offer significant benefits in the management of teeth affected by severe periodontitis that continue to demonstrate pocketing following steps 1 and 2 of periodontal therapy. To gain the maximum benefit from this treatment modality, an understanding of the biological principles of regeneration, appropriate case selection and the latest surgical techniques are required. The most recent S3-level guideline released by the European Federation of Periodontology (EFP) and adoloped by the British Society of Periodontology is evidence based, and can support the clinician in such decision-making. CPD/Clinical Relevance: Surgical regenerative techniques can play an important role in the treatment of complex periodontal defects.

Managing Patient Treatment Through Deming's PDCA Cycle: A Standardized Approach in Phases that Adds Value to Dental Care.

This essay is an expert opinion by 3 clinicians who feel the need for a clear phased approach capable of integrating all dental therapies for the care of patients suffering from multiple pathologies of the oral cavity. At the moment, the only guidelines available when treating interdisciplinary cases, i.e., patients with multiple overlapping pathologies (carious disease, periodontal disease, malocclusion, incongruous restorations, etc.), are those describing the proper sequence of periodontal therapy. The authors take inspiration from a method developed in the manufacturing world, the so called "lean management", and its tools to outline the sequence of therapy phases and the correct placement of the various activities within these phases. In the "lean healthcare', it is the patient at the center of the attention and it is him/her who 'pulls' the process with his/her health as the main value.

Periodontal grading—estimation of responsiveness to therapy and progression of disease

ObjectiveTo investigate the capability of periodontal grading to estimate the progression of periodontal disease and the responsiveness to therapy.Materials and methodsEighty-four patients who underwent non-surgical therapy (NST) were included. Direct and indirect evidence of progression were determined according to the current classification. Responsiveness to therapy was examined using mean pocket probing depths reduction (PPDRed), reduction of bleeding on probing (BOPRed), and the rate of pocket closure (%PC) after six months.ResultsStatistical analysis revealed no agreement between direct and indirect evidence in grading periodontitis (κ = 0.070). The actual rate of progression as determined by longitudinal data was underestimated in 13% (n = 11), overestimated in 51% (n = 43) and correctly estimated in 30% (n = 36) by indirect evidence. No significant differences in responsiveness to therapy were observed in patients graded according to direct evidence. Using indirect evidence, patients assigned grade C showed more PPDRed but less BOPRed and lower %PC compared to grade B.ConclusionThe present data indicate that indirect evidence may lead to inaccuracies compared to direct evidence regarding the estimation of periodontal progression. However, indirect evidence seems to be more suitable in the estimation of responsiveness to therapy than direct evidence, helping to identify cases that are more likely to require additional therapies such as re-instrumentation or periodontal surgery.Clinical relevanceRegarding the estimation of disease progression and responsiveness to periodontal therapy, accuracy and reliability of both direct and indirect evidence are limited when grading periodontitis.

TRI- Immunophasic Therapy: A Future Landscape

The chronic, multifactorial inflammatory disease known as periodontitis is linked to dysbiotic plaque biofilms and is defined by the gradual breakdown of the structure that supports teeth. Its main characteristics are gingival bleeding, periodontal pocketing, radiographically measured alveolar bone loss, and clinical attachment loss (CAL), which indicate a decrease of periodontal tissue support. Owing to its high prevalence, periodontitis is a major public health concern since it can lead to tooth loss and impairment, negatively affect one's look and ability to chew food, exacerbate social inequality, and diminish one's quality of life. Improvements have been made in the diagnosis and treatment of periodontal infections using a variety of contemporary methods that are currently accessible.Controlling the etiological causes and bacteria, reducing inflammation, and replenishing the lost alveolar support are the main goals of periodontal therapy. The main components of periodontal treatment is the surgical and non-surgical therapy. Dissatisfaction with the conventional therapy for protecting oral microbiota and replacing lost alveolar bone support may prompt medical professionals and researchers to investigate the novel and cutting-edge Bone One Session Treatment (BOST). It is an aerobic therapy that supports the alveolar bone and eradicates periodontal disease in the deepest pocket without requiring an intrusive operation. This review paper provides a novel approach, emphasis, and assessment of the important pathway for treating periodontal disease using the Bone One Session Treatment.

Exploring The Potential of Adjunctive Use of Virgin Coconut Oil in Periodontal Therapy: A Narrative Review

Exploring The Potential of Adjunctive Use of Virgin Coconut Oil in Periodontal Therapy: A Narrative Review

Changes in periodontal parameters of splinted versus non-splinted posterior teeth during ten years of supportive periodontal therapy – A retrospective evaluation

ObjectivesTo compare periodontal parameters of splinted posterior teeth versus control teeth over ten years of supportive periodontal therapy (SPT) and to assess the survival rate of splints.Material and methodsRetrospective data of 372 SPT-patients was screened for splints (composite/fiberglass-reinforced composite) in the posterior (molars/premolars) which were inserted at least ten years before due to increased tooth mobility. For each splinted tooth (test), a corresponding control tooth had to be present at the first SPT-session after splint insertion (T1). Data was assessed at T1 and ten years later (T2). Possible influencing covariates for splint survival (mobility degree/Eichner class) were tested by Cox regression. The change in clinical attachment level (ΔCAL), probing pocket depth (ΔPPD) and the testing of possible influencing covariates was analyzed by using mixed linear regression.ResultsTwenty-four patients (32 splints, 58 splinted teeth) were included. Ten test and two control teeth were lost. No differences were observed between ΔCAL and ΔPPD of test teeth compared to control teeth (ΔCAL -0.38 ± 1.90 vs. 0.20 ± 1.27 mm; ΔPPD -0.17 ± 1.18 vs. 0.10 ± 1.05 mm). Twenty-two splints fractured during the observation period (survival-rate: 31%). Mobility degree and Eichner class did not influence time until fracture.ConclusionsSplinting of periodontally compromised and mobile posterior teeth does not have any disadvantage regarding the clinical periodontal situation when regular SPT is applied. However, splint fractures occur very often.Clinical relevanceSplinting of posterior teeth is a treatment option in addition to active periodontal therapy when patients are disturbed by tooth mobility but splints have a high susceptibility to fracture.

Exploring the bi-directional relationship between periodontitis and dyslipidemia: a comprehensive systematic review and meta-analysis.

As periodontitis and dyslipidemia are diseases that occur with high incidence, the relationship between them has attracted much attention. Previous studies on these diseases have tended to focus on lipid parameters and periodontitis, we aimed to investigate the relationship between dyslipidemia and periodontitis. A comprehensive search to identify the studies investigating the relationship between dyslipidemia and periodontitis was performed on PubMed, Web of Science and Cochrane Library before the date of August, 2023. Studies were considered eligible if they contained data on abnormal blood lipid parameters and periodontitis. Studies that reported mean differences and 95% confidence intervals or odds ratios were used. A total of 73 publications were included in the meta-analysis. Hyper total cholesterol (TC), triglycerides (TGs), low-density lipoprotein (LDL), very low-density lipoprotein (VLDL) and lower high-density lipoprotein (HDL) levels are risk factors for periodontitis. Periodontal disease is a risk factor for high TG and low HDL levels. Three months after periodontal treatment, the levels of TC, TG and HDL were significantly improved, and statin treatment only improved gingival index (GI) levels compared to that of the dietary control. The findings reported here suggest that the mutual promotion of periodontitis and dyslipidemia can be confirmed. Non-surgical periodontal therapy may improve lipid abnormalities. It can't be demonstrated whether systematic application of statins have a better effect on the improvement in periodontal status in patients with dyslipidemia compared to that of the control.

Probing the salivary proteome for prognostic biomarkers in response to non-surgical periodontal therapy.

This prospective study investigated the salivary proteome before and after periodontal therapy. Ten systemically healthy, non-smoking, stage III, grade C periodontitis patients underwent non-surgical periodontal treatment. Full-mouth periodontal parameters were measured, and saliva (n = 30) collected pre- (T0), and one (T1) and six (T6) months post-treatment. The proteome was investigated by label-free quantitative proteomics. Protein expression changes were modelled over time, with significant protein regulation considered at false discovery rate <0.05. Treatment significantly reduced bleeding scores, percentages of sites with pocket depth ≥5 mm, plaque and gingival indexes. One thousand seven hundred and thirteen proteins were identified and 838 proteins (human = 757, bacterial = 81) quantified (≥2 peptides). At T1, 80 (T1 vs. T0: 60↑:20↓), and at T6, 118 human proteins (T6 vs. T0: 67↑:51↓) were regulated. The salivary proteome at T6 versus T1 remained stable. Highest protein activity post- versus pre-treatment was observed for cellular movement and inflammatory response. The small proline-rich protein 3 (T1 vs. T0: 5.4-fold↑) and lymphocyte-specific protein 1 (T6 vs. T0: 4.6-fold↓) were the top regulated human proteins. Proteins from Neisseria mucosa and Treponema socranskii (T1 vs. T0: 8.0-fold↓, 4.9-fold↓) were down-regulated. Periodontal treatment reduced clinical disease parameters and these changes were reflected in the salivary proteome. This underscores the potential of utilizing saliva biomarkers as prognostic tools for monitoring treatment outcomes.

Exploring the Potential of Micro-Immunotherapy in the Treatment of Periodontitis.

Periodontitis, characterized by the progressive destruction of dental support tissues due to altered immune responses, poses a significant concern for public health. This condition involves intricate interactions between the immune response and oral microbiome, where innate and adaptive immune responses, with their diverse cell populations and inflammatory mediators, play crucial roles in this immunopathology. Indeed, cytokines, chemokines, growth factors, and immune cells perform key functions in tissue remodeling. Focusing on periodontal therapies, our attention turns to micro-immunotherapy (MI), employing low doses (LDs) and ultra-low doses (ULDs) of immunological signaling molecules like cytokines, growth factors, and hormones. Existing studies across various fields lay the groundwork for the application of MI in periodontitis, highlighting its anti-inflammatory and regenerative potential in soft tissue models based on in vitro research. In summary, this review underscores the versatility and potential of MI in managing periodontal health, urging further investigations to solidify its clinical integration. MI supports an innovative approach by modulating immune responses at low doses to address periodontitis.

A retrospective analysis of the role of age and sex in outcomes of non-surgical periodontal therapy at a single academic dental center

The present study examined the role of age and sex in the outcomes of non-surgical periodontal therapy (NSPT). De-identified demographic and periodontal characteristics of patients who presented for baseline periodontal evaluation, NSPT, and periodontal re-evaluation were abstracted from electronic health records. Independent associations of age and sex with severe periodontitis defined as ≥ 5 mm clinical attachment loss (CAL) and ≥ 6 mm probing depth (PD) were determined using multinomial logistic regression. The null hypothesis was rejected at α < 0.05. A total of 2866 eligible subjects were included in the analysis. Significantly lower odds of CAL ≤ 4 mm than CAL ≥ 5 mm (reference) were observed in adults aged 35–64 (odds ratio, OR, 0.19; 95% confidence interval, CI 0.13, 0.29) and ≥ 65 years (OR 0.13; 95% CI 0.07, 0.25) compared to those aged 18–34 years. Odds of PD < 4 mm versus PD ≥ 6 mm (reference) were lower in adults aged 35–64 years than those aged 18–34 years (OR 0.71; 95% CI 0.55, 0.90) and higher in females compared to males (OR 1.67; 95% CI 1.14, 2.44). These results suggest more compromised post-NSPT outcomes in older adults and males compared to the respective populations and highlight the need for personalized therapeutic strategies in these populations.

Xanthan-based chlorhexidine gel effects in non-surgical periodontal therapy? A meta-analysis.

To carry out a systematic review and meta-analysis of randomized controlled clinical trials (RCTs) and controlled clinical trials (CCTs) comparing scaling and root planing (SRP) or placebo with subgingival application of xanthan-based CHX (chlorhexidine) gel as adjunct to SRP. The literature search was carried out in PubMed/MEDLINE, EMBASE, and SCOPUS; primary outcomes were probing pocket depth (PPD) reduction and gain in clinical attachment level (CAL). Overall, 15 studies were included. Three studies were judged to be at moderate risk of bias while the remaining 12 were rated at high risk of bias. A significant improvement in PPD reduction (standardized mean difference, SMD, 0.87, 95% CI, 0.41-1.34) and CAL gain (SMD = 0.84, 95% CI, 0.36-1.33) emerged for the SRP + CXH gel compared to the SRP alone group, in the presence of significant high heterogeneity among the studies. Our systematic review and meta-analysis showed that xanthan-based chlorhexidine gel as adjunct to non-surgical periodontal therapy gives benefit in terms of PPD reduction and CAL gain as compared to non-surgical periodontal therapy only. Since there was high heterogeneity among studies and the quality of the evidence is low, further studies characterized by a better methodology, adequate sample size and longer follow-up are warranted in the next future. The protocol of this scoping review was registered in the International Prospective Register of Systematic Reviews (https://www.crd.york.ac.uk/PROSPERO) with ID: CRD42023391589.

Comparison of the clinical efficacy of bone grafting and bone grafting combined with guided tissue regeneration in periodontal regenerative therapy: a meta-analysis.

This study aims to compare the clinical efficacy of simple bone grafting and bone grafting combined with guided tissue regeneration (GTR) in periodontal regenerative therapy. The authors systematically searched PubMed, the Web of Science, The National Library of Medicine, the China National Knowledge Infrastructure database and the Wanfang database and collected randomized controlled trials relating to bone graft co-guided tissue regeneration. The retrieval was conducted between January 1990 and December 2022. This study included relevant literature about the clinical efficacy of bone grafting combined with GTR according to the population, intervention, control and outcomes principle and excluded studies using other materials in addition to bone graft and membrane materials. After independently screening the literature, extracting the data and evaluating the risk of bias in the included studies, data analysis was performed using RevMan 5.3 software. Results: Eighteen studies met the inclusion criteria, and, after further evaluation, a total of 327 teeth that were featured in 15 articles were finally included for meta-analysis. The meta-analysis showed that there was no significant statistical difference in clinical attachment level, probing depth and bone gain between the test group (bone grafting with GTR) and the control group (bone grafting only) at 6 months after the operation (p > 0.05). In terms of gingival recession (GR), the use of non-resorbable membranes produced more recession in the test group compared with the control group (p < 0.05), whereas the use of resorbable membranes produced less recession (p < 0.05). Both simple bone grafting and bone grafting combined with membrane materials have good clinical efficacy in periodontal regenerative therapy, and no significant difference in clinical efficacy is indicated between the two, with the exception of GR.

Effectiveness of Surgical Periodontal Therapy in Oral Health-Related Quality of Life.

Background and objective The objective of this study is to evaluate and compare the surrogate and true end points following surgical periodontal therapy using the Oral Health Impact Profile-14 (OHIP-14) questionnaire. Materials and methods The study included a total of 30 participants, comprising 15 males and 15 females aged between 25 and 50 years. All individuals who had undergone periodontal flap surgery for generalized chronic periodontitis at the Department of Periodontology, Saveetha Dental College and Hospitals were included in the study. The OHIP-14 questionnaire was used to assess the patient-centered outcomes (true end points) pre- and post-flap surgery at baseline and six months. Surrogate end points such as the clinical attachment level (CAL), probing pocket depth (PPD), and gingival index (GI) were recorded at baseline and six months pre- and post-flap surgery. Results Clinical parameters such as the GI (p=0.03*), CAL (p=0.03), and PPD (p=0.02*) showed a statistically significant improvement after surgery. Patient-centered outcomes showed statistically significant differences in terms of taste perception, reduction in pain sensation, improvement in self-consciousness and reduction in anxiety levels, diminution of the feeling of embarrassment and enhancement in the ability to relax due to problems associated with gums, and improvement in the workplace (p<0.05) post-operatively. Conclusion Surgical periodontal therapy plays a pivotal role in improving oral health-related quality of life (OHRQoL) among patients with chronic periodontal disease. Utilizing OHIP-14 as an assessment tool enables a comprehensive evaluation of treatment outcomes, encompassing various dimensions of oral health impact. Patient-centered outcomes such as psychological discomfortand functional limitations can be achieved only by an interdisciplinary approach.

THE EFFECTIVENESS OF METRONIDAZOLE GELS IN THE MANAGEMENT OF PERIODONTAL DISEASE

Introduction : Metronidazole is one of the antimicrobial and antimicrobial that has been widely used as antibacterial and antiprotozoal agent for treatment. Metronidazole is antimicrobial have been used as an adjuvant to mechanical plaque removal. Periodontal disease is a chronic inflammatory disease that develops from dental plaque that affects periodontal supporting tissues. Many chemical agents that have been evaluated to determine their effect on plaque, gingivitis and periodontitis, one of which is metronidazole, has been successfully introduced and studied extensively. This literature review explains effectiveness of metronidazole gels in the management of periodontal disease. Review : Metronidazole (MTZ) is frequently used in the treatment for periodontal diseases since it can be against several Gram-negative anaerobic rods, the pathogenesis of periodontitis. It can be administered via oral and topical routes. However, the systemic adverse effects may in the oral cavity if used peroral. Hence, topical administration is preferable. The bacterial reservoirs not eliminated by conventional periodontal therapy can be further suppressed with the use of chemotherapeutic agents. Localized antimicrobial therapy, in particular, has evoked growing interest because of the site‑specific nature of periodontal infections, the higher concentration of anti‑microbial agent subgingivally and reduced side‑effects of systemic antibiotic use. Among the various locally delivered chemotherapeutic agents metronidazole, a has bactericidal action against anaerobes, such as Prevotela intermedia, Porphyromonas gingivalis, Tannerella forsythia, Fusobacterium species and spirochetes like Treponema denticola, Treponema vincentii, which are generally believed to be the main pathogens associated with periodontitis. Conclusion : Treatment of periodontal pockets with metronidazole gel in addition to scaling and root planning, provides a significant increase in reducing pocket depth and microbial count and effective in the treatment of periodontal disease.

Enhanced control of periodontitis by an artificial intelligence-enabled multimodal-sensing toothbrush and targeted mHealth micromessages: A randomized trial.

Treatment of periodontitis, a chronic inflammatory disease driven by biofilm dysbiosis, remains challenging due to patients' poor performance and adherence to the necessary oral hygiene procedures. Novel, artificial intelligence-enabled multimodal-sensing toothbrushes (AI-MST) can guide patients' oral hygiene practices in real-time and transmit valuable data to clinicians, thus enabling effective remote monitoring and guidance. The aim of this trial was to assess the effect of such a system as an adjunct to clinical practice guideline-conform treatment. This was a single-centre, double-blind, standard-of-care controlled, randomized, parallel-group, superiority trial. Male and female adults with generalized Stage II/III periodontitis were recruited at the Shanghai Ninth People's Hospital, China. Subjects received a standard-of-care oral hygiene regimen or a technology-enabled, theory-based digital intervention consisting of an AI-MST and targeted doctor's guidance by remote micromessaging. Additionally, both groups received guideline-conform periodontal treatment. The primary outcome was the resolution of inflamed periodontal pockets (≥4 mm with bleeding on probing) at 6 months. The intention-to-treat (ITT) analysis included all subjects who received the allocated treatment and at least one follow-up. One hundred patients were randomized and treated (50 tests/controls) between 1 February and 30 November 2022. Forty-eight tests (19 females) and 47 controls (16 females) were analysed in the ITT population. At 6 months, the proportion of inflamed periodontal pockets decreased from 80.7% (95% confidence interval [CI] 76.5-84.8) to 52.3% (47.7-57.0) in the control group, and from 81.4% (77.1-85.6) to 44.4% (39.9-48.9) in the test group. The inter-group difference was 7.9% (1.6-14.6, p < .05). Test subjects achieved better levels of oral hygiene (p < .001). No significant adverse events were observed. The tested digital health intervention significantly improved the outcome of periodontal therapy by enhancing the adherence and performance of self-performed oral hygiene. The model breaks the traditional model of oral health care and has the potential to improve efficiency and reduce costs (NCT05137392).

Serum biomarker levels in smokers and non-smokers following periodontal therapy. A prospective cohort study

BackgroundTo compare presence and levels of serum cytokines in smokers and non-smokers with periodontitis following periodontal therapy.MethodsThirty heavy smokers and 30 non-smokers with stage III or IV periodontitis were included in this prospective cohort study. Clinical data and blood serum were collected at baseline (T0), after step I-III (T1), and after 12 months step IV periodontal therapy (T2). Cytokine IL-1β, IL-6, IL-8, TNF-α, IL-10, and IP-10 levels were measured using multiplex kit Bio-Plex Human Pro™ Assay. Linear regression models with cluster robust variance estimates to adjust for repeated observations were used to test intra- and intergroup levels for each marker, IL-6 and IL-8 defined as primary outcomes.ResultsClinical outcomes improved in both groups following therapy (p < 0.05). IL-6 levels increased with 75.0% from T0-T2 among smokers (p = 0.004). No significant intra- or intergroup differences were observed for IL-8. Higher levels of TNF-α (44.1%) and IL-10 (50.6%) were detected in smokers compared with non-smokers at T1 (p = 0.007 and p = 0.037, respectively). From T1-T2, differences in mean change over time for levels of TNF-α and IL-10 were observed in smokers compared with non-smokers (p = 0.005 and p = 0.008, respectively).ConclusionUpregulated levels of serum cytokines in smokers indicate a systemic effect of smoking following periodontal therapy. Differences in cytokine levels between smokers and non-smokers demonstrate a smoking induced modulation of specific systemic immunological responses in patients with severe periodontitis.

Systemic Impact of Subgingival Infection Control in Periodontitis Patients with Cardiovascular Disease: A Narrative Review.

Periodontitis, an infectious inflammatory condition, is a key contributor to sustained systemic inflammation, intricately linked to atherosclerotic cardiovascular disease (CVD), the leading cause of death in developed nations. Treating periodontitis with subgingival mechanical instrumentation with or without adjunctive antimicrobials reduces the microbial burden and local inflammation, while also potentially bringing systemic benefits for patients with both periodontitis and CVD. This review examines systemic effects of subgingival instrumentation with or without antimicrobial products in individuals with periodontitis and CVD, and explores intricate pathogenetic interactions between periodontitis and CVD. English-language databases (PubMed MEDLINE and Cochrane Library) were searched for studies assessing the effects of nonsurgical periodontal therapies in periodontitis patients with or without CVD. While the ability of periodontal therapy to reduce mortality- and morbidity-related outcomes in CVD patients with periodontitis remains uncertain, some studies indicate a decrease in inflammatory markers and blood cell counts. Subgingival mechanical instrumentation delivered over multiple short sessions carries lower risks of adverse effects, particularly systemic inflammation, compared to the full-mouth delivery, making it a preferable option for CVD patients. Subgingival mechanical instrumentation, ideally conducted in a quadrant-based therapeutic approach, to decontaminate periodontal pockets has the potential to reduce both local and systemic inflammation with minimal adverse effects in patients suffering from periodontitis and concurrent CVD.