Full-mouth treatment concepts for chronic periodontitis: a systematic review

Objectives: To systematically review the effectiveness of full-mouth treatment concepts for chronic periodontitis.
Material and Methods: A search was conducted for randomized, controlled clinical trials including full-mouth scaling with (FMD) or without (FMS) the use of antiseptics and quadrant scaling (control). Data sources included COHG, CENTRAL, MEDLINE and EMBASE. Reviewers independently conducted data abstraction and quality assessment. The primary outcome was tooth loss; secondary outcomes were the reductions of PPD and BOP and a gain of CAL.
Results: Of 216 identified abstracts, seven trials were included. Meta-analysis revealed a weighted mean difference (WMD) for the reduction of PPD between FMD and control of 0.53 mm [95% confidence interval (CI) (0.28, 0.77), p <0.0001] in moderately deep pockets of single-rooted teeth. The WMD for gain in CAL was 0.33 mm [95% CI (0.04, 0.63), p =0.03] in moderately deep pockets of single- and multi-rooted teeth. Comparing FMD and FMS, the WMD for the reduction of CAL amounted to 0.74 mm [95% CI (0.17, 1.31), p =0.01] in deep pockets of multi-rooted teeth in favour of FMS. For BOP a WMD –18.0% [95% CI (−34.30, −1.70), p =0.03] was calculated in deep pockets of single-rooted teeth in favour of FMD.
Conclusions: In adults with chronic periodontitis only minor differences in treatment effects were observed between the treatment strategies.     

Laser application in non-surgical periodontal therapy: a systematic review

Objectives: The primary aim was to address the following focused question: What is the clinical effect of laser application compared with mechanical debridement in non-surgical periodontal therapy in patients with chronic periodontitis? A secondary aim was to survey the relevant literature in relation to safety of laser applications.
Material and Methods: Electronic databases of the PubMed and the Cochrane Library were searched and completed by manual searches up to December 2007.
Results: Following screening, 12 publications (11 studies) were eligible for the review. A meta-analysis could not be performed due to the heterogeneity of the studies. The results from a narrative synthesis indicate that Er:YAG laser monotherapy resulted in similar clinical outcomes, both in the short and the long term (up to 24 months), compared with mechanical debridement. There is insufficient evidence to support the clinical application of either CO₂, Nd:YAG, Nd:YAP, or different diode laser wavelengths.
Conclusions: The Er:YAG laser seems to possess characteristics most suitable for the non-surgical treatment of chronic periodontitis. Research conducted so far has indicated that its safety and effects might be expected to be within the range reported for conventional mechanical debridement. However, the evidence from the evaluated studies is weak.     

牙周炎基础治疗对咬合力和牙周状况影响的观察

目的 探讨牙周基础治疗对慢性牙周炎(CP)牙周状况和最大咬合力的影响。方法 重度CP病例27例,每病例双侧磨牙各选择一患牙(初诊患牙牙周袋≥5mm,牙松动度≤Ⅱ度),随机分为龈上洁治组(S组)和根面平整组(P组)。S组患牙给予龈上洁治、碘氧液冲洗疗法;P组患牙予以龈上洁治、根面平整和碘氧液冲洗疗法。分别在治疗前和治疗后1、3、6个月测定息牙的咬合力值、龈炎指数(GI)、牙周袋深度(PD)。结果 ①P组治疗后1、3、6个月,最大咬合力值较治疗前有显著性提高(P<0.05);S组与治疗前无显著性差异(P>0.10)。②治疗后1个月,两组的咬合力值无显著性差异(P>0.05);治疗后3、6个月,P组的咬合力显著高于S组(P<0.01);③治疗后3、6个月,P组的GI值、PD值显著低于S组(P<0.001)。结论 洁治、根面平整治疗对于CP患牙的最大咬合力、GI、PD的改善是持续性的,较龈上洁治有显著性差异。     

Azithromycin as an adjunct to non‐surgical periodontal therapy: a systematic review

The aim of this study was to investigate the current published work relating to the clinical benefits of the use of systemic azithromycin as an adjunct to non‐surgical periodontal therapy. A published work search of PubMed, EMBASE and Cochrane Register of Controlled Trials up to 27 April 2016 was undertaken. The large degree of heterogeneity in the types of studies, treatment protocols, test subjects, sample size and exclusion criteria indicated that the use of narrative synthesis of all relevant studies was a valid method of review. Of the 194 eligible studies, 15 were found to be of relevance. The majority of studies demonstrated an additional clinical benefit when azithromycin is used as an adjunct to non‐surgical periodontal therapy, particularly in deeper pockets (≥6 mm). In conclusion, the current body of research on the adjunctive use of systemic azithromycin in non‐surgical periodontal therapy suggests there is a clinical benefit and that this benefit is greatest in deeper initial pockets (≥6 mm). The findings also suggest that future studies need to be more careful in subject selection to identify susceptible patients or at risk sites, both the immunoregulatory effects and antibiotic resistance of azithromycin needs to be reported, and that study populations need to be more homogeneous.     

Lack of short-term adjunctive effect of systemic neridronate in non-surgical periodontal therapy of advanced generalized chronic periodontitis: an open label-randomized clinical trial

Aim: To determine if the adjunctive use of intra-muscular neridronate (NE) during non-surgical periodontal treatment (PT) provides, in patients with generalized chronic periodontitis (GCP), adjunctive benefits as compared with PT alone 3 months after the completion of a 3-month NE therapy.
Material and Methods: Sixty GCP healthy patients were randomly assigned to control (CG) or test group (TG). CG patients received PT only. Thirty subjects in TG also received adjunctive NE (12.5 mg in an i.m. injection/week for 3 months). Clinical parameters were evaluated at baseline, at the end of NE treatment (3 months after PT) and 3 months after the completion of NE treatment (6 months after the beginning of PT).
Results: Groups were balanced at baseline and all clinical parameters showed improvement between baseline and follow-ups. At 6 months improvements from baseline at sites with deep pocket depth (7 mm) were 3.2 mm [95% confidence interval (CI): 2.7–3.9] in CG and 3.0 mm (95% CI: 2.3–3.8) in TG with a non-significant difference of 0.2 mm (95% CI: −1.0–0.5; ancova ; p =0.549) between groups. Secondary outcomes did not show significant differences between groups. No major adverse events were reported.
Conclusions: The adjunctive use of NE during PT did not result in additional short-term improvements in periodontal conditions of GCP patients when compared with PT.     

A systematic review of guided tissue regeneration for periodontal infrabony defects

OBJECTIVES: To systematically review the evidence for efficacy of guided tissue regeneration (GTR) for infrabony defects. BACKGROUND: The evidence for the efficacy of GTR has not yet been systematically appraised. METHODS: We searched for randomised controlled trials of at least 12 months' follow-up comparing GTR with open flap debridement (OFD). Data sources included electronic databases, hand-searched journals and contact with experts. Screening, data abstraction and quality assessment were conducted independently by multiple reviewers. The primary outcome measure was gain in clinical attachment. RESULTS: For attachment level change, the weighted mean difference between GTR alone and open flap debridement was 1.11 mm (95% CI: 0.63-1.59), chi-square for heterogeneity 31.4 (9 df ), P < 0.001) and for GTR + bone substitutes was 1.25 mm (95% CI: 0.89-1.61, chi-square for heterogeneity 0.01 (1 df), P = 0.91). The number of sites needed to treat (NNT) for GTR to achieve one extra site gaining 2 mm or more attachment over open flap debridement was 8 (95% CI: 4-33). Heterogeneity between studies was highly statistically significant for all principal comparisons and could not be explained satisfactorily by sensitivity analyses. CONCLUSIONS: Overall, GTR was more effective than OFD in improving attachment levels. However, there was marked variability between studies and general conclusions about the clinical benefit of GTR are limited by this heterogeneity. Future studies should aim to identify factors associated with achieving consistent benefits over open flap debridement. Open flap surgery should remain the control comparison in these studies.     

Periodontal regeneration in aggressive periodontitis patients: A systematic review of the literature

The aim of the present study was to systematically review the existing literature on periodontal regenerative procedures in individuals affected by aggressive periodontitis (AgP). An electronic and manual search was performed using an ad hoc prepared search string. All types of study designs were considered acceptable for inclusion. Data about treated patients, baseline clinical parameters, type of surgery, and outcomes were extracted and recorded. A narrative evaluation of the results was performed. After the article‐selection process, a total of 22 full‐texts were included in the qualitative synthesis. Twelve papers were case reports; one was a retrospective study; six were non‐randomized, comparative studies; and three papers were published on two randomized, controlled trials (RCT). Various biomaterials and surgical techniques were described in the included papers. Based on the existing literature, even considering the relatively low level of evidence, periodontal regenerative surgery could be successfully performed in patients affected by AgP. There is a substantial need of high‐quality RCT to support this.     

重度牙周炎非手术治疗的研究进展

重度牙周炎由于严重的牙槽骨破坏和附着丧失及多种伴发病变,通常需要非手术治疗、牙周手术及多学科联合治疗,但非手术治疗仍是最基础、最有效、最重要的内容。传统机械治疗存在一定局限性,牙周内窥镜、药物治疗、激光等因其具有某些优势,作为机械治疗的辅助手段越来越多的应用于临床。本文拟就重度牙周炎的非手术治疗内容及其研究进展进行综述。     

牙周治疗对心血管疾病危险因素控制效果的系统评价

目的 评价牙周治疗对部分心血管疾病危险因素的控制效果。方法 对Cochrane图书馆临床随机对照试验库、PubMed数据库、荷兰医学文摘（EMBASE）数据库和中国生物医学文献数据库进行检索,检索时间为2011年10月13日;同时对纳入文献的参考文献进行进一步检索。由两位评价者分别对纳入文献进行偏倚风险评价。运用Revman 5.1软件进行Meta分析。结果共纳入6篇随机对照试验,涉及患者682例,偏倚风险评价显示1个研究为低偏倚风险,1个研究为中偏倚风险,4个研究为高偏倚风险。Meta分析的结果显示,牙周治疗并不能明显改善患者血清C-反应蛋白、总胆固醇、低密度脂蛋白、甘油三脂的水平（P>0.05）,但在改善患者血清高密度脂蛋白水平方面效果明显[MD=0.05,95%CI（0.00,0.09）,P=0.04]。结论 牙周治疗对改善患者血清高密度脂蛋白水平有较明显的效果,但还需要更多的临床随机对照试验的支持。     

Healing following surgical and non-surgical treatment of juvenile periodontitis

The patient sample used in the present study comprised 16 young individuals who were referred for treatment of advanced periodontal disease. Based upon the age of the patients and the location of the diseased sites, the patients were divided into 2 groups; a juvenile periodontitis group (JP) and a post-juvenile periodontitis group (post-JP). The patients in the JP group had periodontal lesions only at first molars and incisors. All 16 subjects were in excellent general health and none had been treated with antibiotics during a period of at least 12 months prior to the 1st examination. At a baseline examination and 6, 24 and 60 months after active therapy, the diseased sites were examined regarding plaque, gingivitis, probing pocket depths, probing attachment level, recession of the gingival margin and marginal alveolar bone level. Following a case presentation and instruction in proper oral hygiene measures, the 16 subjects were subjected to periodontal treatment, utilizing a split mouth design. By random selection, the diseased sites in one side of the jaws were treated by scaling and root planing in conjunction with a "modified Widman flap" procedure, while in the contralateral jaw quadrants treatment was restricted to scaling and root planing. During the 1st 6 months following active therapy, the patients were subjected to professional tooth cleaning once every 4 weeks. Subsequently, the interval between the recall appointment was 3 months. 2 years after treatment, this maintenance care program was terminated. A final examination was performed 5 years after therapy. None of the patients involved in the trial received antibiotic treatment during the 5 years of observation. The findings of the present study revealed that the response of the periodontal tissues to therapy, both in the JP and the post-JP group of patients, was almost identical to that found for similar types of treatment in patients with adult periodontitis. The re-examinations performed after 6, 24 and 60 months following active therapy of JP and post-JP lesions revealed that excision of the granulation tissue in conjunction with flap elevation did not enhance the degree of probing pocket depth reduction, probing attachment gain and bone fill that occurred following meticulous root surface instrumentation.     

牙周非手术治疗1例慢性牙周炎伴畸形根面沟病例的6年维护效果评价

追踪1例慢性牙周炎伴右上侧切牙畸形根面沟病变的发生、发展以及对牙周非手术治疗、定期维护治疗反应的转归过程.6年前初诊为轻度慢性牙周炎,给予常规牙周基础治疗并维护1次;2年后复诊时牙周破坏显著加重,上下磨牙区出现深牙周袋同时伴右上侧切牙畸形根面沟周围骨质重度破坏至根尖区,再次对全口牙周袋进行龈下刮治及根面平整,期间完成右...     

The use of PVP-iodine as an adjunct to non-surgical treatment of chronic periodontitis

OBJECTIVE: The present study was performed to assess the effect of topically-applied PVP-iodine, used as an adjunct both during basic non-surgical therapy and at re-treatment during the long-term maintenance of patients with advanced periodontal disease. MATERIAL AND METHODS: 223 patients with advanced destructive periodontitis were recruited. The participants met the following inclusion criteria: (i) a minimum of 8 non-molar teeth, (ii) probing pocket depth of > or = 6 mm at > or = 2 teeth in each dentate quadrant, and radiographic bone loss exceeding 40% at the same teeth. A baseline I examination included assessment of plaque, gingivitis, probing pocket depth (PPD), probing attachment level (PAL) and radiographic bone height (RxBL). Following baseline I, the patients were stratified into 2 treatment groups; 2 subjects out of 3 were included in a control group and 1 in a test group. All participants, on an individual basis, received a case presentation and were instructed in proper self-performed plaque control measures. Non-surgical therapy was performed by the use of an ultrasonic device. The instrumentation in the test group was combined with the administration of 0.1% PVP-iodine. All subjects were recalled for comprehensive examinations 3, 6 and 12 months (baseline II) after baseline I and then after 3, 5 and 13 years of maintenance therapy. PAL determinations were performed annually. Subjects (losers) who at the re-examinations after 1, 2 and 3 years of maintenance demonstrated an annual further loss of PAL > or = 2 mm at > or = 4 teeth were exited from the study and referred for re-treatment. There were 9 losers in the test and 31 in the control group. In addition, 8 subjects in the test and 25 subjects in the control group withdrew from the trial for reasons unrelated to the study. These 73 subjects were not included in the data presentation from the various examinations. RESULTS: It was demonstrated that non-surgical periodontal therapy resulted in (i) improved gingival conditions, (ii) reduced PPD, (iii) gain in PAL. It was also documented that the topical application of 0.1% PVP-iodine in conjunction with the mechanical root debridement established conditions which further improved the outcome of therapy. This was evidenced by the fact that at the 3, 6, and 12 months re-examinations after baseline I, the test group had significantly lower mean PPD values and significantly more gain of PAL than the control group. During the 12 years of SPT, it was possible for most subjects in both groups to maintain shallow pockets and to avoid marked further loss of PAL. There were, however, a larger number of losers in the control than in the test group. CONCLUSION: PVP-iodine, topically applied during subgingival instrumentation, may improve the outcome of non-surgical periodontal therapy.