Root Debridement Research Articles

Permanent pacing and conduction recovery in patients undergoing cardiac surgery for active infective endocarditis in an Australian Tertiary Center.

Postoperative heart block is common among patients undergoing surgery for infective endocarditis (IE). Limited data exists allowing cardiologists to predict who will require permanent pacemaker (PPM) implantation postoperatively. We aimed to determine the rate of postoperative PPM insertion, predictors for postoperative PPM, and describe PPM utilization and rates of device-related infection during follow-up. A retrospective analysis was performed of 191 consecutive patients from a single institution who underwent cardiac surgery for IE between 2001 and 2017. Preoperative and operative predictors for postoperative PPM were evaluated using univariate and multivariate logistic regression. The rate of postoperative PPM implantation was 11% (17/154). The PPM group had more preoperative prolonged PR interval alone (33% vs 12%; P = .03), coexistent prolonged PR and QRS durations (13% vs 2%; P = .01), infection beyond the valve leaflets (82% vs 41%; P = .001), aortic root debridement (65% vs 23%; P = <.001), patch repair (47% vs 20%; P = .01), postoperative prolonged PR interval (50% vs 24%; P = .01), and prolonged QRS duration (47% vs 15%; P = .001). On multivariate analysis, infection beyond the valve leaflets emerged as an independent predictor for postoperative PPM (odds ratio, 1.94, 95% confidence interval, 1.14-3.28; P = .014). A reduction in PPM utilization was observed in five patients while eight patients continued to show significant ventricular pacing with no underlying rhythm at 12 months. There were no device-related infections. Postoperative PPM was required in 11% of patients undergoing surgery for IE over a 16-year period. Infection beyond the valve leaflet was an independent predictor for postoperative PPM insertion.

Efficacy of Locally Administered 1.2% Rosuvastatin Gel in Patients with Periodontitis: A Randomized Placebo Controlled Clinical Trial

Objective Periodontitis initiation and progression are a result of host immune inflammatory response to oral pathogens. Several pharmacological agents are being delivered locally, to improve periodontal health. Hence, the present randomized placebo controlled clinical trial is designed to check the clinical and antimicrobial efficacy of locally delivered 1.2% rosuvastatin (RSV) in intrabony defects (IBD) in periodontitis patients. Materials and Methods One-hundred patients were randomly allotted into two treatment groups: group A received 1. 2% RSV gel, scaling and root debridement and group B received placebo gel, scaling and root debridement. Clinical parameters, including modified sulcus bleeding index (mSBI), probing depth (PD), clinical attachment level (CAL), and plaque index (PI), were recorded at baseline before phase 1 and after 6 months. Radiographic assessment of IBD was done by cone beam computed tomography at baseline and after 6 months. Anaerobic colony count was done at baseline and after 180 days. Results On intragroup comparison, there is a significant improvement in periodontal parameters in both the groups. On intergroup comparison, there is significant gain in CAL in group A than group B ( p = 0.04). There is significant decrease in PD in group A, compared to group B. There is significant bone fill in group A ( p = 0.034), compared to group B. With respect to mSBI, PI, and anaerobic colony count, there is no significant difference between the two groups after 6 months. No adverse effect was noticed in any subjects. Conclusion The author concludes that 1.2% RSV gel when delivered locally into IBD improved periodontal clinical parameters such as PD and CAL and showed significant bone fill.

Infrared lasers for the treatment of moderate to severe periodontitis: An American Academy of Periodontology best evidence review.

This systematic review assesses the efficacy of infrared laser therapy used alone or as an adjunct to nonsurgical or surgical periodontal therapy, on clinical and patient-centered outcomes in patients with periodontitis. Randomized clinical trials (RCTs) with a follow-up duration ≥3 months that evaluated root surface debridement (i.e., scaling and root debridement with or without surgical access) to laser therapy alone or laser therapy plus root surface debridement for the treatment of adult patients (≥18 years old) with moderate to severe aggressive or chronic periodontitis were considered eligible for inclusion. The MEDLINE, EMBASE and CENTRAL databases were searched for articles published up to and including March 2016. Random effects meta-analyses were used throughout the review using continuous data (i.e., mean changes from baseline), and pooled estimates were expressed as weighted mean differences (MDs) with their associated 95% confidence intervals (CIs). Additionally, summaries are presented of the included RCTs, critical remarks of the literature and evidence quality rating/strength of recommendation of laser procedures. Of the 475 potentially eligible articles, 28 were included in the review. Individual study outcomes and seven sets of meta-analysis (1 for the nonsurgical treatment of AgP and 9 for nonsurgical and surgical treatment of CP) showed a benefit of laser therapy in improving clinical attachment level (CAL) and probing depth (PD). However, the comparative differences in clinical outcomes were modest (<1mm) and the level of certainty for different therapies was considered low-to-moderate (i.e., more information would be necessary to allow for a reliable and definitive estimation of effect/magnitude of therapies on health outcomes). Overall, most of the Strength of Clinical Recommendations of laser therapies were considered weak or based on expert opinion. In patients with moderate to severe periodontitis, the nonsurgical treatment of AgP and CP by SRP plus infrared diode laser, and the surgical treatment of CP by Er:YAG laser therapy alone may promote statistically significant improvements in PD and CAL. However, these gains are relatively small (<1mm) and provide modest clinical relevance compared with SRP alone.

PR508: The use of a novel bioactive glass in air polishing for root debridement: a pilot study

PR508: The use of a novel bioactive glass in air polishing for root debridement: a pilot study

Comparative evaluation of manual scaling and root planing with or without magnification loupes using scanning electron microscope: A pilot study.

Aim:The aim of the present study is to compare the amount of remaining calculus, loss of tooth substance, and roughness of root surface after scaling and root planing with or without magnification loupes using scanning electron microscope.Materials and Methods:In the study, 30 teeth indicated for extractions due to severe chronic generalized periodontitis were included in the study. In test Group I, scaling and root planing was performed without magnification loupes, and in test Group II, scaling and root planing was performed with magnification loupes before extraction. In control Group III, no procedure was performed. After scaling and root planing, teeth were extracted followed by preparation of specimens. Specimens were then sent for scanning electron microscope study.Results:Statistically significant (P ≤ 0.05) differences were found among different test groups. Results showed that test Group II with magnification loupes had less remaining calculus and smoother surface with lesser amount of loss of cementum layer.Conclusion:From this, it was concluded that test Group II was more efficient in root debridement than test Group 1, so scaling and root planing done with magnification loupes will cause less damage to the tooth surface.

Periodontal treatment modulates gene expression of endothelial progenitor cells in diabetic patients.

Periodontitis is closely linked with type 2 diabetes mellitus (T2DM) and endothelial dysfunction. This study investigated the effects of periodontal treatment on immuno-inflammatory gene expression of endothelial progenitor cells (EPCs) in diabetic patients. Eighteen T2DM patients with moderate to severe chronic periodontitis were randomly assigned to the Treatment group with oral hygiene instruction (OHI), scaling and root debridement (n=11), and Control group (n=7) with OHI alone. Peripheral blood samples were taken for biochemical analysis and culture of EPCs at baseline and 6months after the treatment. PCR array-based profiling of 84 Toll-like receptor signalling-related genes in EPCs was firstly assessed for four randomly selected patients from the Treatment group. The differentially expressed genes were then further validated by qPCR in both groups. All subjects in the Treatment group significantly improved their periodontal conditions. Among the 84 genes tested, IL-6 and IL-8 transcripts were significantly downregulated with over twofold change after the treatment, and this observation was further validated by qPCR in all subjects from both groups (p<.05). This preliminary study suggests that periodontal treatment may contribute to a notable reduction in immuno-inflammatory gene expression measured by IL-6 and IL-8 transcripts in EPCs.

Adjunctive antimicrobial chemotherapy based on hydrogen peroxide photolysis for non-surgical treatment of moderate to severe periodontitis: a randomized controlled trial

Treatment of severe periodontitis with non-surgical therapy remains challenging in dentistry. The present study aimed to evaluate the clinical efficacy of hydrogen peroxide (H2O2) photolysis-based antimicrobial chemotherapy adjunctively performed with root debridement (RD) for moderate to severe periodontitis. A randomized controlled trial was conducted that included 53 patients with 142 test teeth. The test teeth were randomly assigned to one of three treatment groups: Group 1, RD + H2O2 photolysis; Group 2, RD followed by administration of a local drug delivery system (minocycline chloride gel); or Group 3, RD alone. Clinical and microbiological examination were performed for up to 12 weeks following treatment. Probing pocket depth (PPD) and bleeding on probing (BoP) were improved after each treatment session. At 12 weeks, Group 1 had achieved significantly lower PPDs than the other groups, though there were no significant differences in BoP between Group 1 and the other groups. Counts of Porphyromonas gingivalis, a known periodontal pathogen, in Group 1 were significantly lower than those in Group 3, and were comparable to those in Group 2. Therefore, it is suggested that H2O2 photolysis treatment can be used as a novel adjunctive antimicrobial chemotherapy for non-surgical periodontal treatment.

Trigeminocardiac reflex during non-surgical root canal treatment of teeth with irreversible pulpitis.

Trigeminocardiac reflex (TCR) is a unique clinical incident of acute change in hemodynamic balance, which may lead to hypotension, bradycardia, and even clinical crisis. Up to date, no study so far considers the impact of non-surgical root canal treatment (NSRCT) of irreversible pulpitis teeth under either local infiltration or block anesthesia on hemodynamic change possibly related to TCR. This study enrolled 111 patients with 138 irreversible pulpitis teeth that were treated by two sessions of NSRCT. The first session involved mainly the removal of vital pulp tissue with the direct stimulation of the dental branches of the trigeminal nerve, and the second session included the root canal enlargement and debridement with minimal disturbance to the dental branches of the trigeminal nerve. Vital signs mainly the blood pressure were recorded during both NSRCT sessions. The incidences of NSRCT patients with MABP decrease ≧10%, ≧15%, or ≧20% were all significantly higher in the first NSRCT session than in the second NSRCT session (all the P-values<0.001). In the first NSRCT session, the incidence of patients with MABP decrease ≧10% was significantly associated with tooth type. For both upper and lower teeth, the patients with premolars treated by NSRCR had significantly higher incidences of MABP decrease ≧10% than those with either anterior or molar teeth treated by NSRCR (all the P-values<0.05). We conclude that vital pulp extirpation may lead to a substantial drop in patient's blood pressure possibly related to TCR.

Effects of root debridement and adjunctive photodynamic therapy in residual pockets of patients on supportive periodontal therapy: A randomized split-mouth trial

BackgroundThe study aims to compare the effects of adjunctive photodynamic therapy (PDT) with scaling and root debridement alone on periodontal parameters and inflammatory cytokines in residual pockets of patients undergoing maintenance therapy. Methods27 subjects, each with at least 2 residual pockets ≥5mm, were recruited for this randomized, split-mouth controlled trial, providing total of 72 sites. Probing pocket depth (PPD), recession, clinical attachment loss (CAL), plaque and bleeding on probing of all sites were examined at baseline, 3 and 6 months. Gingival crevicular fluids (GCFs) were collected to determine levels of IL-1β, IL-6, IL-8, TNF-α and MMP-8 via enzyme-linked immunosorbent assay. At baseline, all sites received subgingival instrumentation and polishing. In addition, test sites received a single application of PDT using Fotosan® with toluidine blue O solution photosensitizer. At 3 and 6 months, site level analysis was performed for changes in clinical parameters and cytokine level. ResultsBased on mixed model analysis, at 3 months, test sites showed significant reduction in CAL (p=0.016) and PPD (p=0.027) (from 6.14±0.28mm to 5.49±0.20mm and 5.42±0.16mm to 4.65±0.18mm respectively) compared to control sites (from 6.32±0.24mm to 6.08±0.17mm and 5.32±0.13mm to 5.15±0.15mm respectively). At 6 months, these differences were no longer significant (p=0.510). Adjunctive PDT did not offer additional reduction in levels of GCF cytokines. ConclusionsA single application of PDT to residual pockets provided a modest improvement of CAL and PPD over 3 months. Application of adjunctive PDT may lead to faster resolution of residual pockets and may be recommended for periodontal patients with slower healing capacity.

Effects of Root Debridement With Hand Curettes and Er:YAG Laser on Chemical Properties and Ultrastructure of Periodontally-Diseased Root Surfaces Using Spectroscopy and Scanning Electron Microscopy.

Introduction: The efficacy of erbium-doped yttrium aluminum garnet (Er:YAG) laser for root debridement in comparison with curettes has been the subject of many recent investigations. Considering the possibility of chemical and ultra-structural changes in root surfaces following laser irradiation, this study sought to assess the effects of scaling and root planing (SRP) with curettes and Er:YAG laser on chemical properties and ultrastructure of root surfaces using spectroscopy and scanning electron microscopy (SEM). Methods: In this in vitro experimental study, extracted sound human single-rooted teeth (n = 50) were randomly scaled using manual curettes alone or in conjunction with Er:YAG laser at 100 and 150 mJ/pulse output energies. The weight percentages of carbon, oxygen, phosphorous and calcium remaining on the root surfaces were calculated using spectroscopy and the surface morphology of specimens was assessed under SEM. Data were analyzed using one-way analysis of variance (ANOVA). Results: No significant differences (P > 0.05) were noted in the mean carbon, oxygen, phosphorous and calcium weight percentages on root surfaces following SRP using manual curettes with and without laser irradiation at both output energies. Laser irradiation after SRP with curettes yielded rougher surfaces compared to the use of curettes alone. Conclusion: Although laser irradiation yielded rougher surfaces, root surfaces were not significantly different in terms of chemical composition following SRP using manual curettes with and without Er:YAG laser irradiation. Er:YAG laser can be safely used as an adjunct to curettes for SRP.

Effectiveness of photodynamic therapy and probiotics as an adjunct to scaling and root debridement in the treatment of chronic periodontitis

Objective: This study aimed to evaluate the effectiveness of a single application of photodynamic therapy (PDT) and probiotics as an adjunct to scaling and root debridement (SRD) to treat chronic periodontitis. The objectives of the study were to compare the probing pocket depths and clinical attachment loss (CAL) in experimental sites (E-sites) treated with PDT and probiotics with SRD against SRD alone (controls) at the baseline and 3 months post intervention. Materials and Methods: In 22 chronic periodontitis patients aged 25-45 years, 136 sites with pocket depths of 4-6 mm were identified. In each patient, one E-site was randomly selected while one served as control. E-sites were treated with SRD + PDT + probiotics whereas control sites received only SRD. Clinical parameters of pocket depths and CAL were measured at the baseline and at 3 months. Results: In the E-sites, mean pocket depth was 3.62 ± 1.40 mm at the baseline and 3.12 ± 1.48 mm after 3 months. In the control sites, the mean pocket depth was 3.43 ± 1.46 mm at the baseline and 2.99 ± 1.45 after 3 months. In the E-sites, the mean CAL before treatment was 5.31 ± 1.39 mm and 5.10 ± 1.46 mm after treatment. In the control sites, mean CAL before treatment was 5.15 ± 1.41 mm and 4.87 ± 1.55 mm after treatment. There was no significant improvement in pockets depths and CAL between the E-sites and control sites. Conclusion: A single application of PDT + probiotics with SRD did not show any additional clinical benefits when compared with SRD alone. Further studies with multiple applications of PDT and probiotics are needed.

Removal of simulated biofilm: an evaluation of the effect on root surfaces roughness after scaling.

Despite the development of less invasive devices, a debate exists about the benefits and risks of hand versus powered root surface instrumentation used in supportive periodontal therapy (SPT). The aim of the in vitro study was to differentially compare plaque removal efficacy and root surface roughening of newly developed sonic, ultrasonic scaler, and curettes in the hands of experienced versus less experienced operators. Sonic (AIR), ultrasonic devices (TIG), and double-gracey curettes (GRA) were utilized by seven experienced (EO) and four less experienced operators (LO) for root surface instrumentation of standardized plastic teeth on manikins' heads in a randomized sequence. The proportion of residual simulated plaque (RSP area in %) was planimetrically assessed, and the average root surface roughness produced (Ra and ∆Ra in μm) was measured by a precision profilometer. The uninstrumented root surfaces showed a Ra of (median (Q25/Q75)) 1.00μm (0.83/1.16). Following instrumentation, EO left significantly less RSP than LO regardless of the used instruments (20.00% (10.00/34.00) vs. 26.00% (12.00/44.00) p < 0.001), whereas the ∆Ra values (0.29μm (-0.04/0.96) vs. 0.35μm (-0.04/1.01), p = 0.237) failed to show significant differences. The surface roughness was higher with GRA followed by AIR then TIG regardless of operators' experience (p < 0.001). Within the limits of the present study, the sonic device was most efficient in plaque removal, while the ultrasonic device produced the least surface roughness. All three tested instruments seem effective in the mechanical root debridement during SPT, whereat the ultrasonic device show the smoothest root surface of all.

Comparison of nonsurgical periodontal therapy with hand scaler, conventional ultrasonic scaler, and vector™ ultrasonic system in patients with generalized chronic periodontitis

Background: The purpose of the study was to compare clinical efficacy of nonsurgical periodontal therapy with hand scaler, conventional ultrasonic scaler, and Vector™ ultrasonic system in patients with generalized chronic periodontitis. Materials and Methods: Sixty patients with generalized chronic periodontitis fitting the inclusion and exclusion criteria were assigned to one of the three treatment groups (n = 20 in each group). Group I – hand scalers, Group II – conventional ultrasonic scalers, and Group III – Vector™ ultrasonic system. Before oral prophylaxis, clinical parameters (gingival index [GI], plaque index [PI], calculus index [CI], periodontal probing depth [PPD], clinical attachment loss [CAL], and hypersensitivity) were recorded. GI, PI, CI, and hypersensitivity were reevaluated at 1, 3, 6 and 12 weeks. PPD and CAL were reevaluated at 6 and 12 weeks. Results and Conclusion: The results showed that nonsurgical therapy with Vector™ ultrasonic system is clinically comparable in all the parameters, to hand and conventional ultrasonic scalers, suggesting that it can be used as a gentle root debridement device for supportive periodontal therapy, as an alternative to other ultrasonic or sonic scalers.

Detection of CD63+ micro-vesicles, placental alkaline phosphatase and angiogenic markers in gingival crevicular fluid in preeclamptic patients

The study aims to compare the effects of adjunctive photodynamic therapy (PDT) with scaling and root debridement alone on periodontal parameters and inflammatory cytokines in residual pockets of patients undergoing maintenance therapy.27 subjects, each with at least 2 residual pockets ≥5 mm, were recruited for this randomized, split-mouth controlled trial, providing total of 72 sites. Probing pocket depth (PPD), recession, clinical attachment loss (CAL), plaque and bleeding on probing of all sites were examined at baseline, 3 and 6 months. Gingival crevicular fluids (GCFs) were collected to determine levels of IL-1β, IL-6, IL-8, TNF-α and MMP-8 via enzyme-linked immunosorbent assay. At baseline, all sites received subgingival instrumentation and polishing. In addition, test sites received a single application of PDT using Fotosan® with toluidine blue O solution photosensitizer. At 3 and 6 months, site level analysis was performed for changes in clinical parameters and cytokine level.Based on mixed model analysis, at 3 months, test sites showed significant reduction in CAL (p = 0.016) and PPD (p = 0.027) (from 6.14 ± 0.28 mm to 5.49 ± 0.20 mm and 5.42 ± 0.16 mm to 4.65 ± 0.18 mm respectively) compared to control sites (from 6.32 ± 0.24 mm to 6.08 ± 0.17 mm and 5.32 ± 0.13 mm to 5.15 ± 0.15 mm respectively). At 6 months, these differences were no longer significant (p = 0.510). Adjunctive PDT did not offer additional reduction in levels of GCF cytokines.A single application of PDT to residual pockets provided a modest improvement of CAL and PPD over 3 months. Application of adjunctive PDT may lead to faster resolution of residual pockets and may be recommended for periodontal patients with slower healing capacity.

広汎型重度慢性歯周炎患者に根面デブライドメントを行い改善した1症例

広汎型重度慢性歯周炎患者に根面デブライドメントを行い改善した1症例

Clinical Efficacy of Local Delivered Minocycline in the Treatment of Chronic Periodontitis Smoker Patients

Aim: The aim of this study was to evaluate the efficacy of a locally delivered 2% minocycline as an adjunct to scaling and root planing plus oral hygiene measures in treating chronic periodontitis smoker patients. Materials and Methods: This was a randomized controlled trial using a split-mouth study design. Twenty pairs of sites in twenty smoker patients with similar deep probing depths were randomly allocated to test and control groups. The test sites received minocycline after root debridement. The clinical parameters included the plaque index, probing pocket depths, attachment levels, and bleeding upon probing. They were evaluated at the baseline, and after 3 and 6 months. Results: Both the test and control sites showed statistically significant improvements in the clinical periodontal parameters over the baseline measurements during the study period (P<.05). In follow-up, the intervals sites that received minocycline showed more favorable results manifested by probing depth reduction. This improvement was constant at 3 and 6 months and the difference between the two groups was statistically significant (P<.05). Conclusion: The study results show that patient motivation to maintain meticulous oral hygiene self-care with adjunctive professional dental care using local delivery 2% minocycline can significantly enhance treatment outcome of deep periodontal pockets in chronic periodontitis smoker patients.

Large aortic root pseudoaneurysm occurring late after aortic root repair and valve replacement for endocarditis

A 68-year-old male presented with Group B Streptococcus aortic valve (AV) endocarditis with aortic root abscess and refractory sepsis. An emergency cardiac surgery was performed with root abscess drainage, excision and debridement of necrotic tissue, reconstruction of annulus, and AV replacement. Fifteen months later he presented with a huge aortic root pseudoaneurysm (PA). This case illustrates late occurrence of aortic root PA following AV surgery for endocarditis.

Therapeutic management of a case of generalised aggressive periodontitis in an 8-year old child: 18-month results

Generalised aggressive periodontitis (GAP) is a rare condition associated with rapid periodontal destruction, in multiple teeth. The paper aims to present a case of an 8-year old with GAP and discuss his response to treatment. An 8-year old male was referred to the postgraduate clinic of paediatric dentistry of the University of Athens due to increased mobility in his primary dentition. At initial clinical examination, plaque accumulation, gingival inflammation and temporary restorations were noted. Detailed periodontal examination revealed bleeding on probing, pocket depths of up to 9 mm and second degree mobility in primary teeth. Radiographic examination showed advanced bone loss and carious lesions. Microbiological analysis revealed increased percentages of peri-opathogens in pooled subgingival samples. Final diagnosis of GAP was made after ruling out any underlying systemic disorder. Periodontal therapy involved non-surgical subgingival debridement, systemic administration of antibiotics and retention of periodontally involved teeth. This was based on a monthly recall program for the first 6 months and a 3-monthly regime thereafter. At 18-months after initial examination, a substantial improvement in clinical parameters was seen, while levels of periodontal pathogens were sustained at low levels. Non-surgical root debridement along with systemic administration of antibiotics and retention of the periodontally involved teeth, can be successful in achieving improvement and maintenance of periodontal health in the mixed dentition.

Antimicrobial Photodynamic Therapy as an Adjunctive Modality in the Treatment of Chronic Periodontitis

Introduction: Due to penetration of pathogenic bacteria into the periodontal tissues in moderate to severe periodontitis, the mechanical methods are not sufficient in these cases. Therefore, administration of local/systemic antibiotic is recommended following mechanical root debridement. However, side effects of antibiotics such as microbial resistance and patient allergy led to development of alternative methods. One of the suggested methods is the antimicrobial photodynamic therapy (aPDT). aPDT is a local non invasive treatment modality without the side effects caused by antibiotics. The aim of this study was to collect the clinical articles related to the application of aPDT in the treatment of chronic periodontitis. Method: In order to find related clinical articles, a search of PubMed, Google Scholar and Science Direct until 2012 was performed. Results: A total of 11 articles were found. In 7 of the 11 articles, the assessment of aPDT led to a significant improvement in the clinical attachment and probing depth. In 4 studies, there was no difference between the scaling & root planing (SRP) and adjunctive application of aPDT. aPDT in most cases resulted in less gingival bleeding compare to SRP alone. Furthermore, its application in multiple doses was more effective in comparison to a single dose treatment. Conclusion: It appears that aPDT is effective as an adjunctive therapy compared to conventional non_surgical treatment alone, and is recommended in multiple doses in order

Effect of Mechanical Debridement on Distal Periodontal Aspects of Second Molars After the Extraction of Third Molars: A Systematic Review

The risk of periodontal defects after the extraction of third molars continues to challenge clinicians. Intervention trials, including subgingival scaling and/or root planing, were systematically reviewed. Data sources included the Cochrane Oral Health Group Trials Register and MEDLINE. The primary outcome was postoperative change in pocket probing depth (PD). The electronic search yielded 751 abstracts, and manual searching added one study. From them, four trials fulfilled the inclusion criteria and were selected for review. The overall sample size of the studies was small, ranging from 15 to 30 participants. Only one trial was considered to present with low risk for bias in the sequence generation, the concealment of allocation to treatment, and the strategy for masking. The lack of information provided by the authors of the remaining studies resulted in unclear or high risk of bias for the chief dimensions of trial quality. The heterogeneity of the studies did not allow the use of meta-analysis to summarize the results of several studies. Preliminary evidence originating from a small study suggests that ultrasonic root debridement of the second molar and a three-visit plaque control program may have a beneficial effect on PD levels on the second molar. The available intervention trials on this topic have important limitations, and, consequently, there is insufficient evidence to recommend the use of mechanical debridement of second molars after the extraction of third molars.