Clinical and Microbiologic Evaluation of Scaling and Root Planing per Quadrant and One‐Stage Full‐Mouth Disinfection Associated With Azithromycin or Chlorhexidine: A Clinical Randomized Controlled Trial

Background: Conflicting data about the protocol of choice for non‐surgical periodontal therapy with adjuvant use are still reported. This study aims to evaluate, through clinical and microbiologic parameters, the systemic use of azithromycin (AZ) and chlorhexidine (CHX) as adjuvants to non‐surgical periodontal treatment performed by one‐stage full‐mouth disinfection (FMD) within 24 hours or conventional quadrant scaling (QS) in four weekly sections. Methods: In this randomized controlled trial, 85 patients diagnosed with chronic periodontitis underwent different treatment protocols, in six groups: three FMD groups and three QS groups, each with no adjuvants, with CHX, and with AZ. Clinical periodontal parameters were recorded, and total and quantitative bacterial counts of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, and Streptococcus oralis were measured with real‐time polymerase chain reaction at baseline and 90 and 180 days after treatment. Results: In all groups, a significant reduction was observed in the percentage of periodontal diseased sites, gingival index, plaque index, and clinical attachment level gain at 90 days, demonstrating effectiveness of the treatment, independently of the adjuvant. The FMD with CHX group showed higher reduction in probing depth and percentage of periodontal diseases sites, as well as lower total bacterial count, than all the other groups at 180 days. Conclusions: The adjuvant use of AZ did not provide any significant benefit, independently of the treatment protocol. The adjuvant use of CHX showed a more expressive and significant improvement in clinical and microbiologic parameters, especially in the FMD protocol, followed by QS.     

One‐stage full‐mouth disinfection versus quadrant and full‐mouth root planing

Objective: The aim of this study was to test the hypothesis that the one‐stage full‐mouth disinfection (FMD) provides greater clinical and microbiological improvement compared with full‐mouth scaling and root planing (FM‐SRP) within 24 h and quadrant scaling and root planing (Q‐SRP) in patients with generalized chronic periodontitis. Material & Methods: Twenty‐eight patients were randomized into three groups. 25 patients completed the study and were the basis for analysis. The Q‐SRP group was scaled quadrant‐wise at 1‐week intervals. The other groups received a one‐stage full‐mouth scaling with (FMD) and without (FM‐SRP) chlorhexidine. At baseline, after 1, 2, 4 and 8 months clinical parameters were recorded and microbiological analysis was performed. Results: All three treatment modalities resulted in significant clinical improvement at any time. There were only group differences after 1 and 2 months: in the FM‐SRP group was a significantly higher reduction of probing depth and bleeding on probing compared with the other two groups. The bacteria could be reduced in every group although this reduction was only significant for Prevotella intermedia in the FMD group 8 months after treatment. Conclusion: All three treatment modalities lead to an improvement of the clinical and microbiological parameters, however, without significant group differences after 8 months.     

Long‐Term Effect of Four Surgical Periodontal Therapies and One Non‐Surgical Therapy: A Systematic Review and Meta‐Analysis

Background: The aim of this systematic review is to evaluate the long term (≥2 years) effect of four surgical and non‐surgical therapies in treating periodontal disease. Methods: An electronic search of four databases and a hand search of peer‐reviewed journals for relevant articles were conducted. Prospective human controlled clinical trials were included that compared surgical therapy to non‐surgical therapy in ≥10 patients diagnosed with chronic periodontitis with a follow‐up period of ≥2 years and that reported change in probing depth (PD) and clinical attachment level (CAL) after the therapy. Random effect meta‐analysis was performed to compare the outcome of surgical and non‐surgical therapy in shallow, moderate, and deep PD. Results: Eight human prospective clinical trials were included. In 1‐ to 3‐mm PD, scaling and root planing (SRP), modified Widman flap (MWF), and osseous surgery (OS) resulted in 23.2%, 39.4%, and 61.39% CAL loss, respectively; SRP, MWF, and OS resulted in increased mean PD of 2.5%, 3.3%, and 6.3%, respectively. In 4‐ to 6‐mm PD, SRP, MWF, and OS resulted in 8.4%, 6.5%, and 5.22% CAL gain, respectively; SRP, MWF, and OS resulted in 18.7%, 25.4%, and 30.8% PD reduction, respectively. In PD ≥7 mm, SRP, MWF, and OS resulted in 9.8%, 14.2%, and 9.38% CAL gain, respectively; SRP, MWF, and OS resulted in mean PD reduction of 21.6%, 33.1%, and 42.8%, respectively. Conclusions: Surgical therapy had significantly more CAL loss than non‐surgical therapy in shallow PD. In moderate PD, MWF had significantly more PD reduction than SRP, and there was significantly less CAL gain with surgical therapy. In deep PD, OS had significantly higher PD reduction than SRP.     

Effect of Non‐Surgical Periodontal Treatment on Clinical and Biochemical Risk Markers of Cardiovascular Disease: A Randomized Trial

Background: Various studies have shown periodontal disease is one of the risk factors for coronary heart disease (CHD), and periodontal treatment of patients with CHD has also been correlated with reduction in systemic markers of CHD. The aim of this study is to evaluate the effect of non‐surgical periodontal treatment (NSPT) on the cardiovascular clinical and biochemical status of patients with CHD. Methods: Seventy known patients with CHD were allocated randomly to either a control group (C; no periodontal therapy) (n = 35) or an experimental group (E; NSPT in the form of scaling and root planing [SRP]) (n = 35). Cardiovascular status was assessed using clinical parameters such as pulse, respiratory rate, blood pressure (BP), and biochemical parameters, such as high‐sensitivity C‐reactive protein (hsCRP), lipid profile, and white blood cell (WBC) count, at baseline and 1, 3, and 6 months. Intergroup and intragroup comparisons were performed using Student t test, and P <0.05 was considered statistically significant. Results: The complete data at the end of the study were provided by only 55 patients (group C, n = 25; group E, n = 30). Highly statistically significant reduction was observed in systolic BP (7.1 mm Hg) and very‐low‐density lipoproteins (VLDLs; 5.16 mg/dL) in group E. Changes were also observed in other cardiovascular biochemical and clinical parameters but were not statistically significant. Conclusions: NSPT (in the form of SRP) positively affects limited cardiovascular (clinical and biochemical) status of patients with CHD. Reduction in triglyceride, VLDL, total WBC, lymphocyte, and neutrophil counts and increase in hsCRP, total cholesterol, high‐density lipoprotein, and low‐density lipoprotein levels were observed. Highly significant reduction in VLDL cholesterol levels and systolic BP was observed among the various parameters measured.     

Effect of Non‐Surgical Periodontal Treatment on Visfatin Concentrations in Serum and Gingival Crevicular Fluid of Patients With Chronic Periodontitis and Type 2 Diabetes Mellitus

Background : This study aims to assess visfatin concentrations in serum and gingival crevicular fluid (GCF) and investigate this relationship in patients with type 2 diabetes mellitus (T2DM) and chronic periodontitis (CP) before and after non‐surgical periodontal treatment. Methods: Fifty‐four patients with T2DM and CP were recruited. The patients were randomly divided into two groups: treatment and control. Serum and GCF visfatin concentrations and glycated hemoglobin (HbA1c) levels were measured by enzyme‐linked immunosorbent assay at different time points (at baseline and 3 and 6 months after non‐surgical periodontal treatment). Results: Serum and GCF visfatin concentrations showed no significant differences between the groups at baseline (t test, P >0.05). A significant decline of visfatin in the treatment group was found in serum and GCF 3 months after non‐surgical periodontal treatment (t test, P <0.01). Baseline and 3‐month HbA1c levels were not significantly different, but at 6 months, a statistically significant difference was detected (t test, P >0.05). Conclusions: The data suggest that non‐surgical periodontal treatment is helpful for glucose control, an effect that may be associated with reduced visfatin in patients with T2DM and periodontitis. Furthermore, the data suggest that visfatin may be considered an inflammatory marker for periodontal diseases.     

Short‐term effects of periodontal therapy as an adjunct to anti‐lipemic treatment

Oral Diseases (2010) 16 , 648–654 Objective: This study was conducted to assess the effect of improved periodontal health following periodontal treatment on metabolic lipid control of patients on anti‐lipemic treatment. Materials and Methods: The study population consisted of 20 patients aged 34–62 years with diagnoses of hyperlipidemia and chronic periodontitis. All patients used statin to treat their elevated levels of low‐density lipoprotein cholesterol. Blood samples were obtained for measurement of serum lipids, fasting plasma glucose, and high sensitive C‐reactive protein. Periodontal parameters, including plaque index, gingival index, probing pocket depth, clinical attachment level, and percentage of bleeding on probing, were evaluated. All parameters were assessed in each subject at baseline, after 3 months as a control (at the time of periodontal treatment), and 3 months after the non‐surgical periodontal treatment that included scaling and root planning. Results: All lipid parameters decreased after the periodontal treatment, but only the decreases in total cholesterol and low‐density lipoprotein cholesterol levels reached statistical significance compared to baseline (P = 0.002 and P = 0.003, respectively). Conclusion: Improved periodontal health may influence metabolic control of hyperlipidemia and could be considered as an adjunct to the standard measures of hyperlipidemic patient care.     

Clinical Effects of Lactobacillus rhamnosus in Non‐Surgical Treatment of Chronic Periodontitis: A Randomized Placebo‐Controlled Trial With 1‐Year Follow‐Up

Background: Probiotics are living microorganisms that provide beneficial effects for the host when administered in proper quantities. The aim of this double‐masked placebo‐controlled parallel‐arm randomized clinical trial is to evaluate the clinical effects of a Lactobacillus rhamnosus SP1‐containing probiotic sachet as an adjunct to non‐surgical therapy. Methods: Twenty‐eight systemically healthy volunteers with chronic periodontitis were recruited and monitored clinically at baseline and 3, 6, 9, and 12 months after therapy. Clinical parameters measured included plaque accumulation, bleeding on probing, probing depths (PDs), and clinical attachment loss. Patients received non‐surgical therapy, including scaling and root planing (SRP), and were assigned randomly to a test (SRP + probiotic, n = 14) or control (SRP + placebo, n = 14) group. The intake, once a day for 3 months, of an L. rhamnosus SP1 probiotic sachet commenced after the last session of SRP. Results: Both test and control groups showed improvements in clinical parameters at all time points evaluated. However, the test group showed greater reductions in PD than the control. Also, at initial visits and after 1‐year follow‐up, the test group showed a statistically significant reduction in the number of participants with PD ≥6 mm, indicating a reduced need for surgery, in contrast to the placebo group. Conclusion: The results of this trial indicate that oral administration of L. rhamnosus SP1 resulted in similar clinical improvements compared with SRP alone.     

Clinical Effectiveness of Diode Laser Therapy as an Adjunct to Non‐Surgical Periodontal Treatment: A Randomized Clinical Study

Background: The aim of this randomized clinical study is to evaluate the effect of a 980‐nm diode laser as an adjunct to scaling and root planing (SRP) treatment. Methods: Thirty‐five patients with chronic periodontitis were selected for the split‐mouth clinical study. SRP was performed using a sonic device and hand instruments. Quadrants were equally divided between the right and left sides. Teeth were treated with SRP in two control quadrants (control groups [CG]), and the diode laser was used adjunctively with SRP in contralateral quadrants (laser groups [LG]). Diode laser therapy was applied to periodontal pockets on days 1, 3, and 7 after SRP. Baseline data, including approximal plaque index (API), bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL), were recorded before the treatment and 6 and 18 weeks after treatment. Changes in PD and CAL were analyzed separately for initially moderate (4 to 6 mm) and deep (7 to 10 mm) pockets. Results: The results were similar for both groups in terms of API, BOP, PD in deep pockets, and CAL. The laser group showed only significant PD gain in moderate pockets during the baseline to 18‐week (P <0.05) and 6‐ to 18‐ week (P <0.05) periods, whereas no difference was found between LG and CG in the remaining clinical parameters (P >0.05). Conclusion: The present study indicates that, compared to SRP alone, multiple adjunctive applications of a 980‐nm diode laser with SRP showed PD improvements only in moderate periodontal pockets (4 to 6 mm).     

Preliminary Results of Non‐Surgical Periodontal Treatment in Patients With Breast Cancer Undergoing Chemotherapy

Background: Although priority is often given to treat the cancer itself, focus should also be directed to prevention and improvement of oral complications that may occur as a result of cancer and/or its treatment. This study compares periodontal treatment results in healthy patients and patients with breast cancer undergoing chemotherapy by monitoring clinical conditions and C‐reactive‐protein (CRP) levels. Methods: Thirty‐five participants were allocated to one of two groups: patients with periodontitis (P) (n = 18) and patients with breast cancer and periodontitis (CAN/P) (n = 17). The following clinical parameters were assessed at baseline and 45, 90, and 180 days after non‐surgical periodontal treatment (NSPT): 1) probing depth (PD); 2) clinical attachment level (CAL); 3) plaque index (PI); 4) gingival index (GI); 5) CRP; and 6) complete blood count. Clinical parameters and CRP levels were statistically analyzed. Results: P and CAN/P groups presented a statistically significant decrease in PD after NSPT at 45, 90, and 180 days compared with baseline (P <0.05). There was a CAL gain in the P group and a significant reduction in PI and GI at 45, 90, and 180 days for both groups (P <0.05). At 180 days after NSPT treatment, the CAN/P group showed a higher number of residual pockets (P <0.05) compared with the P group (46.48 ± 26.80 and 7.58 ± 7.40, respectively). The P group demonstrated a significant reduction in CRP levels at 45 and 180 days after NSPT compared with baseline (P <0.05), whereas this reduction was not observed in the CAN/P group. Conclusion: Patients with breast cancer who were undergoing chemotherapy responded to periodontal non‐surgical therapy, although with less favorable results than patients with periodontitis without cancer, and may require additional or adjunctive periodontal treatments.     

Quality of life and psychological well‐being among endodontic patients: a case‐control study

Background: Much is already known about the consequences of endodontic disease from clinicians’ perspectives; a significant omission is an understanding from patients’ perspectives. This study aimed to determine oral health‐related quality of life (OHQoL) and psychological distress among subjects referred for endodontic care compared to patients in periodontal maintenance. Methods: This was a case‐control study involving 200 patients; 100 patients requiring endodontic treatment and 100 control subjects (periodontal maintenance patients). OHQoL was assessed using the short form Oral Health Impact Profile measure (OHIP‐14) and psychological well‐being using the short form of the General Health Questionnaire (GHQ‐12). Variations in OHIP‐14 and GHQ‐12 scores between the ‘case’ and ‘control’ group were determined, and the magnitude of such differences through effect size (ES) calculations. Results: There were significant differences in OHIP‐14 summary scores between the case and control groups (p < 0.001) and significant differences across all seven domain scores (p < 0.05). The ES was moderate (0.63) with respect to summary OHIP‐14 scores. There were also significant differences in GHQ‐12 scores between the case and control groups (p < 0.05), but the ES was small (0.36). Conclusions: OHQoL and psychological well‐being is compromised among patients seeking endodontic treatment, and to a greater magnitude than patients in periodontal maintenance.     

Effect of Non‐Surgical Periodontal Therapy Along With Myo‐Inositol on High‐Sensitivity C‐Reactive Protein and Insulin Resistance in Women With Polycystic Ovary Syndrome and Chronic Periodontitis: A Randomized Controlled Trial

Background: The purpose of this study is to evaluate the effect of non‐surgical periodontal therapy and medical treatment on the level of a serologic marker of inflammation (high‐sensitivity C‐reactive protein [hsCRP]) and insulin resistance (homeostatic model assessment [HOMA]) in women with polycystic ovary syndrome (PCOS) and chronic periodontitis (CP). Methods: Women with PCOS and CP (n = 60) were randomly divided into two groups. The test group was treated with scaling and root planing (SRP) and myo‐inositol (MI). The control group was treated with MI and given oral hygiene instructions. Anthropometric, metabolic, and periodontal parameters were assessed at baseline and re‐evaluated at 3 and 6 months. All parameters of both groups at 6 months were compared with 25 systemically and periodontally healthy females (group A). Results: Periodontal parameters were significantly improved in the test group compared with the control group at 3‐ and 6‐month follow‐up (P <0.001). A statistically significant reduction was observed in hsCRP and HOMA in both groups at 3‐ and 6‐month follow‐up (P <0.05). However, significantly more improvement in hsCRP (P <0.05) and a statistically comparable reduction in HOMA (P >0.05) was observed in the test group compared with the control group at 3 and 6 months. Both the test and control group showed significant consistent improvement in metabolic parameters at 3‐ and 6‐month follow‐up, which was further comparable to group A. Conclusion: SRP together with medical treatment results in a greater reduction of systemic inflammatory burden compared with medical treatment alone in management of women with PCOS and CP.     

Antimicrobial Photodynamic Therapy as an Adjunct to Non‐Surgical Treatment of Aggressive Periodontitis: A Split‐Mouth Randomized Controlled Trial

Background: The management of aggressive periodontitis (AgP) represents a challenge for clinicians because there are no standardized protocols for an efficient control of the disease. This randomized controlled clinical trial evaluated the effects of repeated applications of antimicrobial photodynamic therapy (aPDT) adjunctive to scaling and root planing (SRP) in patients with AgP. Methods: Using a split‐mouth design, 20 patients with generalized AgP were treated with aPDT + SRP (test group) or SRP only (control group). aPDT was applied at four periods. All patients were monitored for 90 days. Clinical, microbiologic, and immunologic parameters were statistically analyzed. Results: In deep periodontal pocket analysis (probing depth [PD] ≥7 mm at baseline), the test group presented a decrease in PD and a clinical attachment gain significantly higher than the control group at 90 days (P <0.05). The test group also demonstrated significantly less periodontal pathogens of red and orange complexes and a lower interleukin‐1β/interleukin‐10 ratio than the control group (P <0.05). Conclusion: The application of four sessions of aPDT, adjunctive to SRP, promotes additional clinical, microbiologic, and immunologic benefits in the treatment of deep periodontal pockets in single‐rooted teeth in patients with AgP.     

Systemic Inflammatory Biomarkers and Their Association With Periodontal and Diabetes‐Related Factors in the Diabetes and Periodontal Therapy Trial,A Randomized Controlled Trial

Background: The present study evaluates effects of non‐surgical periodontal treatment on serum biomarkers in patients with type 2 diabetes mellitus (t2DM) and chronic periodontitis who participated in the Diabetes and Periodontal Therapy Trial (DPTT); and associations among diabetes markers, serum biomarkers, and periodontal measures in these patients. Methods: DPTT participants randomized to receive immediate or delayed non‐surgical periodontal therapy were evaluated at baseline and 6 months. Serum samples from 475 participants with 6‐month data were analyzed for the following biomarkers: 1) high sensitivity C‐reactive protein; 2) E‐selectin; 3) tumor necrosis factor (TNF)‐α; 4) vascular cell adhesion molecule (VCAM); 5) interleukin (IL)‐6; 6) IL‐8; 7) intercellular adhesion molecule; and 8) IL‐10. Changes in biomarker levels from baseline and correlations among biomarker levels and clinical findings were analyzed. Results: No differences between treatment and control groups were observed for any biomarkers at baseline or 6 months (P >0.05 for all variables). VCAM levels increased by an average (standard deviation) of 17.9 (99.5); ng/mL (P = 0.006) and E‐selectin decreased by 2.33 (16.08) ng/mL (P = 0.03) in the treatment group after 6 months. E‐selectin levels were significantly correlated with DM‐related variables (hemoglobin A1c [HbA1c] and fasting glucose) at baseline and with 6‐month change in both groups; no significant correlations were found among periodontal clinical parameters and serum biomarkers or DM‐related variables. Neither HbA1c or body mass index varied during the study period in either study group. Conclusions: Non‐surgical periodontal therapy and periodontal disease severity were not associated with significant changes in serum biomarkers in DPTT participants during the 6‐month follow‐up. Correlations among changes in E‐selectin, IL‐6, and DM‐related variables suggest that t2DM may be the primary driver of systemic inflammation in these patients.     

Efficacy of Local Antimicrobials in the Non‐Surgical Treatment of Patients With Periodontitis and Diabetes: A Systematic Review

Background: Patients with diabetes present a worse response to periodontal treatment. Local antimicrobials as an adjunct to scaling and root planing (SRP) provide additional benefits in the treatment of periodontitis in healthy patients. This review aims to evaluate the effects of local antimicrobials as an adjunct to SRP, compared with SRP alone, on periodontal clinical parameters of patients with chronic periodontitis (CP) and diabetes mellitus (DM). Methods: Only randomized controlled trials with: 1) at least 6 months of follow‐up; 2) SRP, in combination with local antimicrobials; and 3) patients with periodontitis and DM were considered eligible. MEDLINE, EMBASE, and LILACS databases were searched for articles published up to January 2016. Random‐effects meta‐analyses were conducted for clinical attachment level (CAL), probing depth (PD), bleeding on probing, and gingival index change after treatment. Results: Of 153 papers potentially relevant to this review, six were included. The majority of trials showed a significant PD reduction and CAL gain associated with use of local antimicrobials in patients with type 1 and type 2 DM. Only studies that included well‐controlled patients and applied antimicrobials at the deepest sites or sites with baseline PD ≥5 mm presented significant PD reduction and CAL gain. Conclusion: In patients with DM and CP, use of local antimicrobials as an adjunct to SRP may result in additional benefits compared with SRP alone in PD reduction and CAL gain, especially in well‐controlled individuals and deep sites.     

Non‐Surgical Periodontal Therapy Improves Serum Levels of C‐Reactive Protein and Edematous States in Female Patients With Idiopathic Edema

Background: The relationship between periodontal disease and systemic disease is revealing new and exciting associations. Idiopathic edema presents a clinical syndrome with obscure pathophysiology. The present study investigates whether non‐surgical periodontal therapy is beneficial in patients who are not responding to conventional treatment of idiopathic edema. Methods: Thirty patients with idiopathic edema were allocated to intervention and control groups. All the subjects were assessed for systemic (body weight, body mass index, visual scale of edema, serum C‐reactive protein, and serum albumin) and periodontal (plaque index, calculus index, and gingival index) parameters. Non‐surgical periodontal therapy, including oral hygiene instructions, scaling and root planing, and systemic antibiotic therapy, was provided in the intervention group. Both groups were reevaluated after 4 weeks. Results: Both groups were comparable at baseline. All parameters, except serum albumin, showed significant improvement after periodontal therapy. The control group showed further worsening of these parameters. Conclusions: This study shows that sources for systemic inflammation, such as periodontal disease, could affect the pathogenesis of idiopathic edema. Successful elimination of such covert sources of inflammation leads to a clinical benefit in patients who are distressed by this condition.     

Psychosocial impact of periodontal disease and its treatment with 24-h root surface debridement

Aim: To assess the impact of periodontal disease and treatment with 24-h root surface debridement on the oral health-related quality of life of patients (OHQoL).
Methods: Two cohorts were recruited: 20 patients with moderate to advanced periodontal disease and 16 dentally healthy patients. Patients with periodontal disease were treated with 24-h root surface debridement. OHQoL was assessed, using Oral Health Impact Profile-14, during the initial assessment and by a telephonic interview daily for 7 days for both groups. OHQoL was also assessed at review for the treated cohort. The number of impacts each patient experienced "occasionally" or more often was analysed by non-parametric tests.
Results: Patients with periodontal disease reported significantly more impacts on their quality of life than dentally healthy patients ( p <0.05). After root surface debridement the impact was significantly reduced ( p <0.05) and sustained at review ( p <0.05); however, the impact on quality of life was still greater than that experienced by the dentally healthy cohort ( p <0.05).
Conclusions: Patients with periodontal disease have worse OHQoL than healthy patients, but this impact can be partly ameliorated by periodontal treatment. This implies that periodontal disease is not "silent" and that conventional non-surgical treatment provided in a secondary referral centre can be effective from patients' perspectives.     

Periodontal dressing may influence the clinical outcome of non-surgical periodontal treatment: a split-mouth study

To cite this article:
Int J Dent Hygiene 10 , 2012; 284–289
DOI: 10.1111/j.1601‐5037.2010.00493.x Genovesi AM, Ricci M, Marchisio O, Covani U.Periodontal dressing may influence the clinical outcome of non surgical periodontal treatment: a split‐mouth study. Abstract: Introduction: After scaling and root planning (SRP), healing induces the formation of a junctional long epithelium rather than a new connective attachment. We hypothesize that the placement of a periodontal dressing will be able to prevent detachment of coagulum inducing proper healing and improving periodontal parameters. Materials and methods: This split‐mouth study included 30 patients with periodontitis with ages ranging from 35 to 70 years. Probing pocket depth (PD), probing attachment level (PAL), bleeding on probing index (BoP) and plaque index (PI) were assessed before and after therapy. The group of patients received SRP in a span of 24 h. Then, a periodontal dressing was applied on the test side and it was removed after 1 week. Results: Control group: The difference between PD values at baseline and after therapy was 1.6 ± 0.6 mm. The difference in PAL (ΔPAL) measurement was 1.4 ± 0.4. Test group: there was a greater PD reduction, this being 2.4 ± 0.6 mm on average. The difference in PAL was 2.5 ± 0.4 mm. Conclusions: Our results clearly suggest that the use of a periodontal dressing improves the periodontal parameters after an SRP procedure. This is probably due to clot stabilization and prevention of bacterial colonization during wound healing.     

A Randomized Double‐Masked Clinical Trial Comparing Four Periodontitis Treatment Strategies: 5‐Year Tooth Loss Results

Background: Tooth loss is the ultimate negative consequence of periodontitis, and reports of the extent to which different treatment strategies may influence long‐term tooth loss are hard to find. This study aims to test the hypothesis that there is no difference in 5‐year clinical outcome of therapy in terms of tooth mortality between groups of patients treated with conventional scaling and root planing (SRP) over weeks or same‐day full‐mouth disinfection (FDIS), with or without adjunctive metronidazole (MET). Methods: One hundred eighty‐four patients with moderate‐to‐severe periodontitis were randomly allocated to one of four treatment groups: 1) FDIS+MET; 2) FDIS+placebo; 3) SRP+MET; and 4) SRP+placebo. Total 161 patients (88%) completed the 5‐year follow‐up examination, and data on number and timing of tooth extractions as well as pre‐extraction diagnoses and reasons for extractions were analyzed. Results: No differences were observed between groups with regard to number of, reasons for, or time of extractions in the four groups at baseline and 1, 3, and 5 years after treatment. Conclusion: If extraction or retention of teeth is regarded as a measure of failure or success 5 years after completion of periodontal therapy, none of the four strategies produced an end result better than the other.     

Adjunctive Non‐Surgical Therapy of Inflamed Periodontal Pockets During Maintenance Therapy Using Diode Laser: A Randomized Clinical Trial

Background: Numerous studies have documented the clinical outcomes of laser therapy for untreated periodontitis, but very few have reported on lasers treating inflamed pockets during maintenance therapy. The aim of this study is to compare the effectiveness of scaling and root planing (SRP) plus the adjunctive use of diode laser therapy to SRP alone on changes in the clinical parameters of disease and on the gingival crevicular fluid (GCF) inflammatory mediator interleukin‐1β (IL‐1β) in patients receiving regular periodontal maintenance therapy. Methods: This single‐masked and randomized, controlled, prospective study includes 22 patients receiving regular periodontal maintenance therapy who had one or more periodontal sites with a probing depth (PD) ≥5 mm with bleeding on probing (BOP). Fifty‐six sites were treated with SRP and adjunctive laser therapy (SRP + L). Fifty‐eight sites were treated with SRP alone. Clinical parameters, including PD, clinical attachment level (CAL), and BOP, and GCF IL‐1β levels were measured immediately before treatment (baseline) and 3 months after treatment. Results: Sites treated with SRP + L and SRP alone resulted in statistically significant reductions in PD and BOP and gains in CAL. These changes were not significantly different between the two therapies. Similarly, differences in GCF IL‐1β levels between SRP + L and SRP alone were not statistically significant. Conclusion: In periodontal maintenance patients, SRP + L did not enhance clinical outcomes compared to SRP alone in the treatment of inflamed sites with ≥5 mm PD.     

Clinical Effects of Potassium–Titanyl–Phosphate Laser and Photodynamic Therapy on Outcomes of Treatment of Chronic Periodontitis: A Randomized Controlled Clinical Trial

Background: The main objective of periodontal treatment is to control infection and thereby curb disease progression. Recent studies have demonstrated that adjunctive treatment procedures, such as laser irradiation or photodynamic therapy (PDT), may provide some additional benefit in the treatment of chronic periodontitis (CP). The aim of this randomized controlled trial is to clinically evaluate and compare the clinical effects of potassium–titanyl–phosphate (KTP) laser and PDT on outcomes of CP treatment. Methods: Twenty‐four patients with untreated CP were treated using a split‐mouth study design in which the teeth in each quadrant were randomly treated by scaling and root planing (SRP) alone (group A), PDT followed by SRP (group B), or KTP laser followed by SRP (group C). The periodontal pockets were exposed to a KTP laser with the following parameters: 0.8 W output power, 50 milliseconds time on/50 milliseconds time off, 30 seconds per irradiation at 532 nm and 11.7 J/cm² fluence, with a flexible fiberoptic tip with a diameter of 200 µm. The selected pockets were probed with a pressure‐controlled probe, guided by stents. Clinical periodontal parameters assessed included plaque index, gingival index, bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL), which were recorded at baseline and at 6 months after therapy. Results: Statistical analysis demonstrated no differences between groups at baseline for all parameters (P >0.05). All treatments yielded significant improvements in terms of BOP and PD decrease and CAL gain compared to baseline values (P <0.05). Group C showed a greater reduction in PD compared to the other groups (P <0.05). In addition, group C showed a greater CAL gain compared to the other groups (P <0.05). Conclusion: In patients with CP, clinical outcomes from conventional periodontal treatment of deeper pockets can be improved by using adjunctive KTP laser.