内窥镜辅助下微创牙周基础治疗的临床疗效评价

目的探讨牙周内窥镜辅助下超声龈下刮治及根面平整(subgingival scaling and root planning,SRP)对重度牙周炎治疗的临床疗效。方法选取2017年6月至2019年1月于南京大学医学院附属口腔医院就诊的Ⅲ?Ⅳ期牙周炎患者19例,随机分为内窥镜组及对照组。内窥镜组在龈上洁治术1周后,牙周内窥镜下行一次SRP;对照组在龈上洁治术1周后,行常规微创下SRP,隔周复查,对探诊出血位点行再次SRP,每个位点SRP最多3次。SRP前、治疗后3个月和6个月,采用Florida探针检查记录牙周状况:探诊深度(probing depth,PD)、探诊出血(bleeding on probing,BOP)阳性率及附着丧失(attachment loss,AL)。结果40.05)。BOP阳性率、AL两组在3个月和6个月时均未见明显差别(P>0.05)。PD>6 mm位点:在基线时,内窥镜组的PD、BOP阳性率及AL均比对照组更严重,差异有统计学意义。两组PD、BOP阳性率、AL在治疗后3个月和6个月时较基线均显著下降。但治疗后3个月和6个月后,内窥镜组PD较对照组变的更浅(P<0.05),BOP阳性率、AL在治疗后3个月和6个月时两组间没有明显统计学差异(P>0.05)。结论与常规微创下SRP相比,内窥镜下SRP有利于改善PD水平和减少更深位点的BOP及AL。     

牙周内窥镜辅助超声龈下刮治对残留牙周袋临床疗效的评价研究

目的 评价牙周内窥镜下超声龈下刮治对牙周基础治疗后残留牙周袋的临床治疗效果.方法 收集20例慢性牙周炎患者259颗经牙周基础治疗后仍残留深牙周袋的患牙,行牙周内窥镜下超声龈下刮治,比较治疗前及治疗后3个月全口牙周探诊出血(BOP)和牙周探诊深度(PD)的变化.结果 内窥镜治疗后3个月全口平均PD值和BOP位点百分比有显著改善(P<0.001).单根牙和多根牙的平均PD均显著降低(P<0.001),PD≥5mm位点百分比显著改善(P<0.05),其中重度牙周袋位点的改善更明显(P<0.05).根分叉病变位点百分比治疗前后无明显变化.结论 残留牙周深袋经牙周内窥镜辅助超声龈下刮治后,单根牙和多根牙都有显著治疗效果,并且单根牙重度牙周袋位点改善更明显,但是多根牙II度及以上根分叉病变位点的改善有限.     

全口一次龈下刮治与分区段龈下刮治的疗效分析

目的：比较一次全口龈下刮治与分区段龈下刮治的临床疗效。方法：选择需进行牙周洁治的慢性牙周炎患者50例,分为实验组25例和对照组25例,实验组一次全口龈下刮治,对照组分四个区段进行龈下刮治,观察3个月内治疗前后PD、BI、PI的变化,并记录患者对治疗的主观感觉和治疗后是否有发热症状。结果：实验组和对照组龈下刮治后3个月,PD、BI均显著降低,两组间无统计学差异（P〈0.05）;与对照组相比,实验组1个月时P（I1.09±0.57）和VAS值（0.37±0.26）显著降低,差异有统计学意义（P〈0.05）。两组患者均无治疗后发热症状。结论：全口一次龈下刮治与分区段龈下刮治都可获得良好的治疗效果,全口一次龈下刮治更利于菌斑控制和短期消除治疗不适。     

一次性全口龈下刮治和根面平整术治疗慢性牙周炎的近期疗效评价

目的：探讨一次性全口龈下刮治和根面平整术（full-mouth scaling and root planning，FM-SRP）治疗慢性牙周炎的效果，并与常规的分象限刮治（quadrant scaling and root planning，Q-SRP）效果进行比较。方法：将60例慢性牙周炎患者随机分为2组：FM-SRP组在1天内完成全口所有象限的刮治和根面平整。而Q-SRP组每周进行1个象限的刮治，连续4周完成全口治疗。分别在基线、3个月和6个月时，检测菌斑指数（plaque index，PI）、牙龈指数（gingival index，GI）、探诊出血（bleeding on probing，BOP）、探诊深度（probing depth。PD）及附着丧失（attachment loss，AL）的变化及患者的术后反应。所得结果分别进行秩和检验（PI、GI）、t检验（PD、AL）和X^2检验（BOP）。结果：与基线时相比，2种治疗方式在3个月和6个月时的所有临床牙周指数均有显著改善（P〈0．01），但2组之间无显著性差异（P〉0．05）。在首次治疗24h，FM-SRP组的术后反应发生率显著高于Q-SRP组（P〈0.05），但患者能够耐受。结论：FM-SRP和Q-SRP两种方法均可达到相同的临床效果，临床医生可根据实际需要，选择合适的治疗方式。     

120例慢性牙周炎临床治疗分析

目的评价不同方法治疗慢性牙周炎的临床效果。方法将120例慢性牙周炎患者随机分成2组:A组采用龈上洁治术 龈下刮治术 抗生素治疗,B组采用龈上洁治术 龈下刮治术治疗。治疗前及治疗后1、3、6个月检查牙周袋探诊深度(PPD)、附着水平(AL)、菌斑指数(PLI)、龈沟出血指数(SBI)。结果各项指数在治疗后与治疗前比较差异有统计学意义(P<0.05),治疗后3个月与1个月比较差异也有统计学意义(P<0.05),治疗后6个月与3个月比较差异无统计学意义(P>0.05)。A组治疗效果较B组好(P<0.05)。结论治疗慢性牙周炎宜采用龈上洁治术、龈下刮治术、局部抗生素联合应用的方法。     

超声和手工龈下刮治对龈下微生物影响的研究

目的 :比较Perioproline超声龈下刮治和手工龈下刮治对龈下微生物的影响 ,评价Periopro line超声龈下刮治系统的临床疗效和工作效率。方法 :选取慢性成人牙周炎患者 7名 ,共 2 0个左右基本对称牙被纳入研究 ,随机分入实验组 (超声组 )和对照组 (手工组 )。记录治疗时间和治疗前、治疗后 0d、7d和 14d的PD ,BOP值 ,及采集龈下菌斑样本培养鉴定 ,观察比较总菌落形成单位 (CFU)和牙周可疑致病菌检出率及检出量的变化。结果 :两组在治疗后PD、BOP值及龈下菌斑总量 (CFU)和牙周可疑致病菌数量及检出率均显著下降 (P <0 .0 5) ;治疗前后各时段组间均无明显差别 ;超声组的治疗时间明显少于手工组 (P <0 .0 5)。结论 :Perioproline超声龈下刮治和手工龈下刮治均可有效减少龈下微生物的量 ,改善患牙的牙周临床状况 ,且两者间无差异 ,但Perioproline超声龈下刮治明显较手工刮治节省时间     

龈下刮治配合补肾固齿丸治疗中、重度牙周炎的短期疗效评价

目的：探讨龈下刮治配合补肾固齿丸对中、重度牙周炎的短期治疗效果。方法：纳入中、重度牙周炎患者共44例,随机分为两组,每位患者选择2颗指数牙。所有患者试验前均进行龈上洁治和龈下刮治,试验组同时给予口服补肾固齿丸4g／次,2次／日,连服3个月。测定治疗前后指数牙的探诊出血（BOP）、探诊深度（PD）、附着丧失（AL）及其牙槽骨平均灰度值（MGVs）。结果：试验组BOP阳性率、PD和AL均较治疗前有明显下降（P〈0．05）,而MGVs升高（尸〈0．05）。对照组治疗后BOP阳性率和PD明显降低（P〈0．05）,但AL及MGVs无明显改善（P〉0．05）。试验组与对照组对中、重度牙周炎的短期疗效有显著差异@〈0．05）。结论：龈下刮治配合口服补肾固齿丸治疗中、重度牙周炎的短期疗效明显优于单纯龈下刮治组,可能与补。肾固齿丸能促进牙槽骨新骨形成、降低AL有关。     

单独龈下超声刮治与结合人工刮治两种方法的临床效果比较

目的 比较单独应用龈下超声刮治与结合人工刮治两种治疗方式的临床效果.方法 选取36例慢性牙周病患者,采用半口对照的方法将患牙分为对照组(左半口)和实验组(右半口),先对所有患牙进行龈上洁治术,一周后对照组实行龈下超声刮治术,实验组实行龈下超声刮治结合人工刮治术.治疗前后1个月、3个月分别检查受试牙,并记录各项临床指标( BOP、PD、CAL).结果 在治疗结束后1个月和3个月,两组各项牙周临床指标均有明显改善(P＜0.05),实验组的改善优于对照组,且有显著性差异(P＜0.05).结论 龈下超声刮治后使用人工刮治,可以获得一个更加平整的根面,取得良好的临床效果.     

一次完成与分次完成龈下刮治的短期疗效观察

目的：比较一次完成和分次完成龈下刮治治疗牙周炎的短期临床疗效。方法：30例中度牙周炎患者，进行洁治和口腔卫生指导后随机分为两组，实验组为一次性完成龈下刮治，洗必泰含漱；对照组为传统的分4次完成龈下刮治，每次间隔1周。记录各组刮治前，治疗后6周的改良龈沟出血指数（SBI）、探诊深度（PD）、附着丧失（AL）等相关指标。结果：一次性和分次完成龈下刮治均使SBI、PD、AL等指标明显改善，但实验组与对照组相比较SBI、PD、AL等指标明无统计学差异。结论：一次和分次完成龈下刮治治疗牙周炎疗效肯定，一次性龈下刮治较传统的分次法治疗周期短，复诊次数少，提高患者的依从性，值得在临床上推广。     

不同龈下冲洗方式对牙周炎治疗效果的对比评价

目的:比较超声龈下刮治结合不同龈下冲洗方式治疗中、重度慢性牙周炎的临床效果,分析、评价不同龈下冲洗方式的临床应用特点和价值。方法:选择中、重度牙周炎患者15例(68颗),随机分为2组,每组34颗:实验组使用超声龈下刮治同步0.2%甲硝唑液冲洗;对照组使用超声龈下刮治后传统冲洗器给予0.2%甲硝唑液冲洗。分别记录治疗前和治疗7天后的菌斑指数(PL)、牙龈出血指数(SBI)、探诊深度(PD)、附着丧失(AL)。分别比较实验组、对照组治疗前后牙周各指数的变化以及两组间治疗前后牙周各指数差值。结果:实验组和对照组在治疗7d后PL、SBI均显著降低;实验组治疗后PL、SBI、PD、AL降低程度大于对照组,差异具有统计学意义。结论:超声龈下刮治同步药物冲洗比传统超声龈下刮治后冲洗器给药冲洗更有效。     

Effects of single-visit full-mouth ultrasonic debridement versus quadrant-wise ultrasonic debridement

BACKGROUND: The aim of this randomized controlled clinical trial was to determine the effects of single-visit full-mouth ultrasonic debridement versus quadrant-wise therapy. MATERIAL AND METHODS: Thirty-six subjects with chronic periodontitis, were randomly allocated to three groups--quadrant-wise ultrasonic debridement, single-visit full-mouth ultrasonic debridement with povidone iodine and single-visit full-mouth ultrasonic debridement with water. Whole-mouth plaque, bleeding on probing (BOP), pocket depth and attachment level were recorded before treatment and 1, 3 and 6 months post-treatment. Plaque and saliva samples were collected for microbiological analysis. RESULTS: After treatment, all groups showed significant improvement in clinical parameters. Full-mouth treatments resulted in similar improvements in full-mouth mean plaque percentage, probing pocket depth and probing attachment level as conventional therapy. When data were analysed based on pocket depth and tooth type, there was no difference between groups in probing depth reduction or attachment gains. The full-mouth groups demonstrated greater reduction in BOP% and number of pockets > or =5 mm and the total treatment time was significantly shorter. The detection frequencies of periodontal pathogens in plaque and saliva showed slight changes with no difference between groups. CONCLUSION: Single-visit full-mouth mechanical debridement may have limited additional benefits over quadrant-wise therapy in the treatment of periodontitis, but can be completed in a shorter time.     

两种刮治方法对老年牙周炎患者的临床疗效及患者疼痛感受的比较

目的:比较两种刮治方法对老年牙周炎患者的临床疗效及患者疼痛感受的差异,以期为临床提供参考.方法:选择老年牙周炎患者30名,随机分为两组,A组接受常规牙周刮治,用Gracey刮治器分四区段手工刮治,B组接受一次性超声全口龈下刮治,用EMS超声龈下工作尖一次性完成全口刮治.治疗结束后即刻用视觉模拟评分法(visual analogue scale,VAS)对患者行疼痛评估,并记录治疗时间.两组分别于刮治开始前和治疗后6周记录全口牙周情况:菌斑指数(plaque index,PLI)、探诊深度(probing depth,PD)、附着丧失(attachment loss,AL)、牙龈出血指数(bleeding index,BI).结果:用两种刮治方法对老年牙周炎患者进行治疗后,患者各项临床指标均较术前明显改善(P<0.05);两者PD、AL和BI的改变差异无统计学意义(P>0.05),与A组相比,B组的PLI改善更明显(P<0.05).手工刮治和超声刮治在牙周基础治疗中患者主观感受疼痛VAS值分别为(37.7±10.5)mm和(27.9±8.4)mm,后者约为前者疼痛值的74%,两者差异有统计学意义(P<0.05).超声刮治所用时间明显少于手工刮治.结论:在老年牙周炎患者的牙周基础治疗过程中,两种刮治方法疗效均确切,超声刮治能明显减轻老年患者在牙周治疗过程中的疼痛感,减少就诊时间.     

Full-mouth ultrasonic debridement and risk of disease recurrence: a 1-year follow-up

AIM: To evaluate the incidence of disease recurrence following a full-mouth pocket/root debridement approach with ultrasonic instrumentation versus that following a traditional approach of quadrant-wise scaling and root planing (Q-SRP) performed with hand instrumentation. METHODS: Thirty-seven patients were re-examined 1 year after the completion of a 6-month clinical trial comparing two different treatment protocols: a 1-h session of full-mouth ultrasonic debridement (UD--19 patients) or four sessions of Q-SRP with hand instruments (Q-SRP--18 patients). At 3 months, re-instrumentation was performed of pockets showing a remaining probing pocket depth (PPD) of > or =5 mm using the same type of instruments as used during the initial treatment phase. The clinical examinations comprised assessments of plaque, bleeding on probing (BoP) and PPD. The primary outcome variable was the incidence of recurrent diseased sites (i.e., sites showing PPD > or =5 mm and BoP+) between the post-treatment and 1-year follow-up examinations. All sites that were healed (PPD < or =4 mm and BoP(-)) at the post-treatment examination were included in the study sample, with a mean number of sites per patient of 23.5. RESULTS: In the UD group, 29 (7%) out of 430 initially healed sites showed disease recurrence at the 1-year follow-up examination compared with 47 (11%) of 440 sites in the Q-SRP group (p>0.05). Twelve patients (63%) in the UD group presented recurrent diseased pockets, compared with 14 patients (78%) in the Q-SRP group. Two or more recurrent, diseased pockets were observed in nine patients in the UD group versus 11 in the Q-SRP group. All but one of the smokers belonged to the group of patients presenting recurrences. A tendency towards a higher mean plaque score was observed for the patients with recurrent sites. CONCLUSION: The study revealed no significant difference in the incidence of recurrence of diseased periodontal pockets between the full-mouth UD approach and the traditional approach of Q-SRP.     

Periodontal disease and diabetes metabolic control: a full-mouth disinfection approach

Some studies demonstrated that local mechanical periodontal treatment and systemic antibiotics might improve the level of metabolic control in patients with diabetes. The aim of this clinical pilot trial was to evaluate if type 1 diabetes patients with periodontitis will experience improvement in periodontal status and glycemic control after a full-mouth disinfection treatment. Ten adult patients with poor metabolic control (mean glycated hemoglobin (HbA1c) = 10.7 %) and periodontitis were included in the study. All patients received a full-mouth disinfection in 24 hours as described by Quirynen et al. (1995) at baseline and 6 months later. The periodontal parameters included plaque index (PI), bleeding on probing, probing depth and clinical attachment loss. Metabolic control was measured by the serum level of HbA1c. All measurements were done at baseline and at 3, 6, 9 and 12 months. The results demonstrated a significantly lower PI, less bleeding on probing, reduction in probing depth and gain of clinical attachment at 3 months and 9 months of the study. Similarly, a significant reduction in the serum level of HbA1c was measured three months after full-mouth disinfection but disappeared 6 months later at the 6- and 12-month check points. We conclude that a full-mouth disinfection approach significantly improves periodontal status and metabolic control in type 1 diabetes patients with periodontitis. However, the results of our study imply that a full-mouth disinfection method has to be applied at least every 3 months to control periodontal status and glycemic control in type 1 diabetes patients. Further studies with greater numbers of diabetes patients are needed to confirm the long-term beneficial effects of a full-mouth disinfection approach on diabetic metabolic control.     

Full-mouth ultrasonic debridement versus quadrant scaling and root planing as an initial approach in the treatment of chronic periodontitis

AIM: To evaluate the clinical efficacy of (i) a single session of "full-mouth ultrasonic debridement" (Fm-UD) as an initial periodontal treatment approach and (ii) re-instrumentation of periodontal pockets not properly responding to initial subgingival instrumentation. Methods: Forty-one patients, having on the average 35 periodontal sites with probing pocket depth (PPD) > or =5 mm, were randomly assigned to two different treatment protocols following stratification for smoking: a single session of full-mouth subgingival instrumentation using a piezoceramic ultrasonic device (EMS PiezonMaster 400, A+PerioSlim tips) with water coolant (Fm-UD) or quadrant scaling/root planing (Q-SRP) with hand instruments . At 3 months, all sites with remaining PPD> or =5 mm were subjected to repeated debridement with either the ultrasonic device or hand instruments. Plaque, PPD, relative attachment level (RAL) and bleeding following pocket probing (BoP) were assessed at baseline, 3 and 6 months. Primary efficacy variables were percentage of "closed pockets" (PPD< or =4 mm), and changes in BoP, PPD and RAL. RESULTS: The percentage of "closed pockets" was 58% at 3 months for the Fm-UD approach and 66% for the Q-SRP approach (p>0.05). Both treatment groups showed a mean reduction in PPD of 1.8 mm, while the mean RAL gain amounted to 1.3 mm for Fm-UD and 1.2 mm for Q-SRP (p>0.05). The re-treatment at 3 months resulted in a further mean PPD reduction of 0.4 mm and RAL gain of 0.3 mm at 6 months, independent of the use of ultrasonic or hand instruments. The efficiency of the initial treatment phase (time used for instrumentation/number of pockets closed) was significantly higher for the Fm-UD than the Q-SRP approach: 3.3 versus 8.8 min. per closed pocket (p<0.01). The efficiency of the re-treatment session at 3 months was 11.5 min. for ultrasonic and 12.6 min. for hand instrumentation (p>0.05). CONCLUSION: The results demonstrated that a single session of Fm-UD is a justified initial treatment approach that offers tangible benefits for the chronic periodontitis patient.     

Utilisation of locally delivered doxycycline in non-surgical treatment of chronic periodontitis

AIM: In the present 6-month multicentre trial, the outcome of 2 different approaches to non-surgical treatment of chronic periodontitis, both involving the use of a locally delivered controlled-release doxycycline, was evaluated. MATERIAL AND METHODS: 105 adult patients with moderately advanced chronic periodontitis from 3 centres participated in the trial. Each patient had to present with at least 8 periodontal sites in 2 jaw quadrants with a probing pocket depth (PPD) of > or =5 mm and bleeding following pocket probing (BoP), out of which at least 2 sites had to be > or =7 mm and a further 2 sites > or =6 mm. Following a baseline examination, including assessments of plaque, PPD, clinical attachment level (CAL) and BoP, careful instruction in oral hygiene was given. The patients were then randomly assigned to one of two treatment groups: scaling/root planing (SRP) with local analgesia or debridement (supra- and subgingival ultrasonic instrumentation without analgesia). The "SRP" group received a single episode of full-mouth supra-/subgingival scaling and root planing under local analgesia. In addition, at a 3-month recall visit, a full-mouth supra-/subgingival debridement using ultrasonic instrumentation was provided. This was followed by subgingival application of an 8.5% w/w doxycycline polymer at sites with a remaining PPD of > or =5 mm. The patients of the "debridement" group were initially subjected to a 45-minute full-mouth debridement with the use of an ultrasonic instrument and without administration of local analgesia, and followed by application of doxycycline in sites with a PPD of > or =5 mm. At month 3, sites with a remaining PPD of > or =5 mm were subjected to scaling and root planing. Clinical re-examinations were performed at 3 and 6 months. RESULTS: At 3 months, the proportion of sites showing PPD of < or =4 mm was significantly higher in the "debridement" group than in the "SRP" group (58% versus 50%; p<0.05). The CAL gain at 3 months amounted to 0.8 mm in the "debridement" group and 0.5 mm in the "SRP" group (p=0.064). The proportion of sites demonstrating a clinically significant CAL gain (> or =2 mm) was higher in the "debridement" group than in the "SRP" group (38% versus 30%; p<0.05). At the 6-month examination, no statistically significant differences in PPD or CAL were found between the two treatment groups. BoP was significantly lower for the "debridement" group than for the "SRP" group (p<0.001) both at 3- and 6 months. The mean total treatment time (baseline and 3-month) for the "SRP" patients was 3:11 h, compared to 2:00 h for the patients in the "debridement" group (p<0.001). CONCLUSION: The results indicate that simplified subgingival instrumentation combined with local application of doxycycline in deep periodontal sites can be considered as a justified approach for non-surgical treatment of chronic periodontitis.     

Effects of full-mouth scaling and root planing in conjunction with systemically administered azithromycin

BACKGROUND: One-stage full-mouth disinfection (FMD), in which full-mouth scaling and root planing (SRP) is performed with adjunctive use of chlorhexidine, was introduced in 1995. There have been several reports on the effectiveness of this treatment protocol. However, FMD was reported to induce pyrexia frequently. We examined the effects of full-mouth SRP in conjunction with azithromycin administered orally before SRP to control the number of bacteria. The purpose of this study was to compare the effects of full-mouth SRP using azithromycin with conventional SRP. METHODS: Thirty-four subjects (17 in the test group and 17 in the control group) with severe chronic periodontitis were selected. The subjects of the test group had azithromycin 3 days before full-mouth SRP. Clinical parameters (probing depth [PD], gingival index [GI], bleeding on probing [BOP], and gingival crevicular fluid [GCF]), total number of bacteria, and number of black pigment-producing rods (BPRs) were evaluated at baseline and 5, 13, and 25 weeks after baseline. RESULTS: All clinical parameters improved in the test group more than in the control group. In the bacteriologic examination, the total number of bacteria did not change during the examination. In the test group, BPRs were not detected until 13 weeks. However, BPRs were detected in the control group by 13 weeks. CONCLUSION: It was shown that full-mouth SRP using systemically administered azithromycin was a clinically and bacteriologically useful basic periodontal treatment for severe chronic periodontitis.     

The rôle of chlorhexidine in the one-stage full-mouth disinfection treatment of patients with advanced adult periodontitis. Long-term clinical and microbiological observations

BACKGROUND/AIMS: Recent studies reported significant additional clinical and microbiological improvements when severe adult periodontitis was treated by means of a "one-stage full-mouth" disinfection instead of a standard treatment strategy with consecutive root planings quadrant per quadrant. The one stage full-mouth disinfection procedure involves scaling and root planing of all pockets within 24 h in combination with an extensive application of chlorhexidine to all intra-oral niches such as periodontal pockets, tongue dorsum, tonsils (chairside, and at home for 2 months). This study aims to examine the relative importance of the use of chlorhexidine in the one stage full-mouth disinfection protocol. METHODS: Therefore, 3 groups of 12 patients each with advanced periodontitis were followed, both from a clinical and microbiological point of view, over a period of 8 months. The patients from the control group were scaled and root planed, quadrant per quadrant. at two-week intervals. The 2 other groups underwent a one stage full-mouth scaling and root planing (all pockets within 24 h) with (Fdis) or without (FRp=full-mouth root planing) the adjunctive use of chlorhexidine. At baseline and after 1, 2, 4 and 8 months, the following clinical parameters were recorded: plaque and gingivitis indices, probing depth, bleeding on probing and clinical attachment level. Microbiological samples were taken from different intra-oral niches (tongue, mucosa, saliva and pooled samples from single- and multi-rooted teeth). The samples were cultured on selective and non-selective media in order to evaluate the number of CFU/ml for the key-periodontopathogens. At baseline, an anonymous questionnaire was given to the patients to record the perception of each treatment (post operative pain, fever, swelling etc.). RESULTS: All 3 treatment strategies resulted in significant improvements for all clinical parameters, but the Fdis and FRp patients reacted always significantly more favourably than the control group, with an additional probing depth reduction of +/- 1.5 mm and an additional gain in attachment of +/- 2 mm (for pockets > or = 7 mm). Also from a microbiological point of view both the FRp and Fdis patients showed additional improvements when compared to the control group, as well in the reduction of spirochetes and motile organisms as in the number of CFU/ml of the key-pathogens, especially when the subgingival plaque samples were considered. The differences between FRp and Fdis patients were negligible. CONCLUSIONS: These findings suggest that the benefits of a "one-stage full-mouth disinfection" in the treatment of patients suffering from severe adult periodontitis probably results from the full-mouth scaling and root planing within 24 h rather than the beneficial effect of chlorhexidine. The raise in body temperature the second day after the full-mouth scaling and root planing seems to indicate a Shwartzman reaction.     

Photodynamic therapy associated with full-mouth ultrasonic debridement in the treatment of severe chronic periodontitis: a randomized-controlled clinical trial

Background:

Photodynamic therapy (PDT) is a method of microbial reduction which can benefit periodontal treatment in areas of difficult access, such as deep pockets and furcations. The aim of this randomized controlled clinical trial was to evaluate the effects of PDT as an adjunct to full-mouth ultrasonic debridement in the treatment of severe chronic periodontitis.

Material and Methods:

Twenty-two patients with at least one pocket with a probing depth (PD) of ≥7 mm and one pocket with a PD of ≥5 mm and bleeding on probing (BOP) on each side of the mouth were included, characterizing a split mouth design. The control group underwent full-mouth ultrasonic debridement and the test group received the same treatment associated with PDT. The PDT was performed on only one side of the mouth and the initial step consisted of subgingival irrigation with 0.005% methylene blue dye. Two minutes after applying the photosensitizer, the low power laser - AsGaAl (Photon Lase III - PL7336, DMC, São Carlos -São Paulo, Brazil) was applied (660 nm, 100 mW, 9 J, 90 seconds per site, 320 J/cm², diameter tip 600 µm).The following clinical parameters were evaluated: plaque index, gingival index, BOP, gingival recession (GR), PD, and clinical attachment level (CAL). All parameters were collected before, 1, 3 and 6 months after treatment.

Results:

An improvement in BOP, PD and CAL was observed after treatment, in both groups, but without any difference between them. After 6 months, the PD decreased from 5.11±0.56 mm to 2.83±0.47 mm in the test group (p<0.05) and from 5.15±0.46 mm to 2.83±0.40 mm in the control group (p<0.05). The CAL changed, after 6 months, from 5.49±0.76 mm to 3.41±0.84 mm in the test group (p<0.05) and from 5.53±0.54 to 3.39±0.51 mm in the control group (p<0.05).

Conclusion:

Both approaches resulted in significant clinical improvements in the treatment of severe chronic periodontits, however, the PDT did not provide any additional benefit to those obtained with full-mouth ultrasonic debridement used alone.     

Antibody response after single-visit full-mouth ultrasonic debridement versus quadrant-wise therapy

INTRODUCTION: The aim of this study was to compare serum antibody responses to periodontal pathogens after single-visit full-mouth ultrasonic debridement and quadrant-wise therapy. MATERIAL AND METHODS: Thirty-six subjects with chronic periodontitis were randomized into three groups: quadrant-wise debridement in four visits, one-visit full-mouth debridement with water and with povidone iodine. Blood samples were collected before and immediately after treatment and 1, 3 and 6 months post-therapy. Serum antibody titres and avidity to Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, Prevotella intermedia and Treponema denticola were determined by enzyme-linked immunosorbent assay (ELISA) and thiocyanate ELISA, respectively. RESULTS: IgG titres to P. gingivalis significantly decreased at 1, 3 and 6 months in full-mouth debridement with water group, while significant reductions were seen only at 3 and 6 months after quadrant-wise debridement. Both full-mouth groups showed significant reduction in IgG titres to A. actinomycetemcomitans at 3 and 6 months. Significant increases in antibody avidity to P. gingivalis and A. actinomycetemcomitans were noted 3 months following full-mouth debridement with povidone. CONCLUSION: Both full-mouth and quadrant treatments generally resulted in a decrease in antibody titres and increase in antibody avidity. Full-mouth debridement induced an earlier reduction of IgG titre to P. gingivalis and A. actinomycetemcomitans, than quadrant-wise therapy.