Clinical evaluation of the use of locally delivered chlorhexidine in periodontal maintenance therapy

BACKGROUND: The objective of this study was to evaluate clinically the effectiveness of a chlorhexidine gluconate chip in sites still showing signs of disease during periodontal maintenance therapy. METHODS: Forty-two maintenance non-smoking patients (previously treated with non-surgical scaling and root planing [SRP]), presenting at least one probing depth (PD) of 5 to 8 mm, and bleeding on probing (BOP) at single-rooted teeth were assigned randomly to two groups: treated with a chlorhexidine gluconate chip (CHIP group) and treated with SRP (SRP group). Patients were assessed for plaque index, gingival index, BOP, PD, clinical attachment level (CAL), and gingival recession at baseline, 6 weeks, and 3 and 6 months. RESULTS: Both treatments resulted in improvements in all parameters evaluated. After 6 months, a reduction in PD of 2.64 +/- 0.02 mm and 2.12 +/- 0.02 mm was observed for CHIP and SRP groups, respectively (P >0.05). The observed gain in CAL was 2.19 +/- 0.87 mm and 2.07 +/- 1.53 mm for CHIP and SRP groups, respectively (P >0.05). In deep pockets, PD reduction was 3.60 +/- 0.70 mm for CHIP group and 2.83 +/- 0.62 mm for SRP group (P = 0.01). CONCLUSIONS: Both treatments were equally effective in periodontal health reestablishment in inflamed single-root sites of maintenance patients. However, for deep pockets, the chlorhexidine gluconate chip was more effective than SRP in reducing PD.     

Clinical and microbiological effects of different antimicrobials on generalized aggressive periodontitis

AIM: To evaluate and compare the effects of adjunctive metronidazole plus amoxicillin, doxycycline and metronidazole on clinical and microbiological parameters in patients with generalized aggressive periodontitis. MATERIAL AND METHODS: Forty-three patients participated in this randomized clinical trial divided into four groups. Six weeks after scaling and root planning (SRP), groups 1-3 received adjunctive metronidazole, plus amoxicillin, doxycycline and metronidazole respectively, and group 4 acted as controls. Clinical recordings concerning probing depth, probing attachment level and bleeding on probing were performed at baseline, 6 weeks after SRP and 6 months from baseline. Subgingival samples were analysed using the 'checkerboard' DNA-DNA hybridization for Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, Tannerella forsythia and Treponema denticola. Results: All treatments resulted in improvement of clinical parameters (ANOVA p > 0.05). Systemic administration of metronidazole plus amoxicillin or metronidazole resulted in statistically significant greater reduction of the proportion of sites > 6 mm than SRP (z-test, p < 0.05). These antimicrobials yielded a significant effect on levels of important periodontal pathogens for 6 months. CONCLUSION: Adjunctive metronidazole plus amoxicillin or metronidazole alone (when A.actinomycetemcomitans is not involved) is effective in deep pockets of aggressive periodontitis patients.     

Effectiveness of systemic amoxicillin/metronidazole as adjunctive therapy to scaling and root planing in the treatment of chronic periodontitis: a systematic review and meta-analysis

Background: The combination of Amoxicillin and metronidazole (AMX/MET) as an adjunctive treatment to scaling root planing (SRP) has been proposed for the treatment of chronic periodontitis; however, its effectiveness and clinical safety remain to be defined. The purpose of the present meta-analysis is to assess the effectiveness of SRP + AMX/MET compared to SRP alone. Methods: An electronic search of eight databases from their earliest records through October 8, 2011 and a hand search of international dental journals for the last 15 years were conducted. Gain in clinical attachment level (CAL), reduction in probing depth (PD), secondary outcomes, and adverse events were analyzed. A random-effect model was used to pool the extracted data. The weighted mean difference (WMD) with 95% confidence interval (CI) was calculated for continuous outcomes; heterogeneity was assessed with the Cochrane χ(2) and I(2) tests. The level of significance was set at P <0.05. Results: After the selection process, four randomized clinical trials were included. Results of the meta-analysis showed significant CAL gain (WMD = 0.21; 95% CI = 0.02 to 0.4; P <0.05) and PD reduction (WMD = 0.43; 95% CI = 0.24 to 0.63; P <0.05) in favor of SRP + AMX/MET. No significant differences were found for bleeding on probing (WMD = 10.77; 95% CI = -3.43 to 24.97; P >0.05) or suppuration (WMD = 1.77; 95% CI = -1.7 to 5.24; P >0.05). Conclusion: The findings of this meta-analysis seem to support the effectiveness of SRP + AMX/MET; however, future studies are needed to confirm these results.     

Clinical and microbiological evaluation of the effectiveness of the Nd:Yap laser for the initial treatment of adult periodontitis. A randomized controlled study

BACKGROUND: Enhancement of the results obtained by scaling and planing is most often sought by using antimicrobial therapies. Laser beams have been shown to be bactericidal and could possibly target pathogens more effectively and with fewer compliance problems than antiseptic solutions. METHODS: Thirty subjects 20-60 years old presenting periodontal pockets at least 5 mm deep in each quadrant received initial periodontal treatment. The study had a split-mouth design. The control side (SRP) only received scaling and planing, and the test side (SRP+laser) was treated by both SRP and Nd:Yap (yttrium aluminum perovskite doped with neodym) laser. Clinical conditions were evaluated at day 0 and day 90 using the plaque index, gingival index, bleeding on probing, pocket probing depth, and clinical attachment level. Microbial sampling was also performed on days 0 and 90, and the presence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythensis, and Treponema denticola was analysed by polymerase chain reaction in a commercial laboratory. Post-operative pain or discomfort was measured by the patient using a linear visual scale. Pearson's chi-squared test was used to compare bacterial presence. RESULTS: There was no statistically significant difference concerning clinical data between test and control groups at baseline. Both treatments enhanced the clinical situation compared to baseline; however, results were not significantly different between the two groups. T. forsythensis was the organism most numerous in both groups. Though initial treatment diminished the numbers of all the pathogens it did not do so statistically significantly. Differences between test and control groups were very small and bore no significance. Evaluation of the post-operative pain did not reveal any differences between the groups. CONCLUSIONS: Scaling and root planing was effective in reducing levels of plaque, inflammation, and bleeding upon probing. No additional advantage was achieved by using the Nd:Yap laser.     

Topical use of a metronidazole gel in the treatment of sites with symptoms of recurring chronic inflammation

BACKGROUND: Bacterial plaque accumulation at the dentogingival junction and in periodontal pockets is the major etiologic factor in all manifestations of periodontal disease. The aim of this study was to evaluate whether a locally delivered 25% metronidazole gel after scaling and root planing (SRP) would enhance the treatment outcome over SRP alone in periodontal pockets with symptoms of recurring chronic inflammation. METHODS: Twenty-one maintenance-care patients, 10 men and 11 women, having at least one pair of contralateral anatomically matching proximal tooth surfaces showing probing depth > or = 5 mm and bleeding on probing (BOP), were included in the study. The sites were randomized to be treated with SRP plus 25% metronidazole gel (test sites) or with SRP alone (control sites) in a split-mouth design. Clinical evaluations were performed immediately pretreatment (baseline) and at 3 and 6 months post-treatment. RESULTS: Both treatments yielded a statistically significant (P = 0.001) reduction in probing depth (1.9 and 1.8 mm), gain of attachment level (1.6 and 1.0 mm), and reduction of BOP (38.1% and 33.3%) for test and control sites, respectively, at 6 months. There was no statistically significant difference between the treatments for any of the clinical parameters. CONCLUSION: This study indicates that a locally applied 25% metronidazole gel does not improve the treatment outcome over SRP alone in sites with recurring chronic inflammation in maintenance-care patients.     

Scaling and root planing and chlorhexidine mouthrinses in the treatment of chronic periodontitis: a randomized, placebo-controlled clinical trial

OBJECTIVE: Evaluation of the clinical and microbiological effects of scaling and root planing (SRP) alone or in combination with 0.12% chlorhexidine (CHX) rinsing. METHODS: A blind, placebo-controlled, parallel-design, randomized clinical trial was conducted in 29 subjects with chronic periodontitis. Subjects were assigned to two therapeutic groups: control (SRP+placebo) and test (SRP+CHX during and up to 42 days post-therapy). Clinical and microbiological [N-benzoyl-dl-arginine-2-naphthylamide (BANA test)] examinations were performed at baseline, 42 and 63 days post-therapy. RESULTS: Initially, intermediate sites (4-6 mm) in the test group showed less plaque accumulation, gingival bleeding, bleeding on probing and a greater reduction in attachment level and probing depth (PD) at 63 days after treatment. The initially deep sites (>6 mm) in the CHX group also showed a better reduction in plaque accumulation and in PD compared with the control group. Both therapies led to a microbiological improvement; however, the test subjects showed a higher frequency of BANA-negative sites after treatment, which was sustained over time (p<0.001). At 63 days, the control group presented 25 BANA-negative sites and 65 positive sites, and the test group 58 and 26, respectively. CONCLUSION: The combination of CHX rinses and SRP leads to clinical benefits and to a better reduction in BANA-positive species.     

Clinical response of azithromycin as an adjunct to non-surgical periodontal therapy in smokers

BACKGROUND: Antibiotic therapy can be used in very specific periodontal treatment situations such as in refractory cases of periodontal disease found to be more prevalent in smokers. This study was designed to determine the efficacy of azithromycin (AZM) when combined with scaling and root planing (SRP) for the treatment of moderate to severe chronic periodontitis in smokers. METHODS: Thirty-one subjects were enrolled into a 6-month randomized, single-masked trial to evaluate clinical, microbial (using benzoyl- DL-arginine naphthylamine [BANA] assay), and gingival crevicular fluid (GCF) pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (ICTP) levels in response to SRP alone or SRP + AZM. At baseline, patients who smoked > or =1 pack per day of cigarettes who presented with at least five sites with probing depths (PD) of > or =5 mm with bleeding on probing (BOP) were randomized into the test or control groups. At baseline and 3 and 6 months, clinical measurements (probing depth [PD], clinical attachment loss [CAL], and bleeding on probing [BOP]) were performed. GCF bone marker assessment (Ctelopeptide [ICTP] as well as BANA test analyses) were performed at baseline, 14 days, and 3 and 6 months. RESULTS: The results demonstrated that both groups displayed clinical improvements in PD and CAL that were sustained for 6 months. Using a subject-based analysis, patients treated with SRP + AZM showed enhanced reductions in PD and gains in CAL at moderate (4 to 6 mm) and deep sites (>6 mm) (P <0.05). Furthermore, SRP + AZM resulted in greater reductions in BANA levels compared to SRP alone (P <0.05) while rebounds in BANA levels were noted in control group at the 6-month evaluation. No statistically significant differences between groups on mean BOP and ICTP levels during the course of the study were noted. CONCLUSIONS: The utilization of AZM in combination with SRP improves the efficacy of non-surgical periodontal therapy in reducing probing depth and improving attachment levels in smokers with moderate to advanced attachment loss.     

Effects of Photodynamic Therapy on Clinical and Gingival Crevicular Fluid Inflammatory Biomarkers in Chronic Periodontitis: A Split‐Mouth Randomized Clinical Trial

Background: There are limited clinical experiments addressing the effects of photodynamic therapy (PDT) as an adjunct to conventional scaling and root planing (SRP) on clinical and biologic features of periodontitis. This trial compares the clinical parameters and cytokine profiles in gingival crevicular fluid of patients with moderate‐to‐severe chronic periodontitis (CP) who have been treated using SRP alone or SRP + PDT. Methods: Twenty‐two patients with two contralateral teeth affected with moderate‐to‐severe CP were selected. After SRP, the participants’ teeth were randomized to receive either no further treatment or a single application of PDT using a 638‐nm laser and toluidine blue. Although the change in probing depth was the primary outcome, bleeding on probing, clinical attachment level, gingival recession, interleukin‐1β, tumor necrosis factor (TNF)‐α, and matrix metalloproteinase 8 and 9 were also evaluated at baseline and 3 months postintervention. An oral rinse assay was also performed to determine the total levels of oral polymorphonuclear cells (PMNs) before and 3 months after the treatments. Results: Within each group, significant improvements (P <0.001) were found for all variables in 3‐month follow‐up compared with baseline. Only TNF‐α was significantly improved in the PDT + SRP versus SRP group. Total levels of PMNs were reduced for all patients compared with baseline levels (P <0.001). Conclusion: In patients with CP, a single application of PDT (using a 638‐nm laser and toluidine blue) did not provide any additional benefit to SRP in terms of clinical parameters or inflammatory markers 3 months following the intervention.     

Debridement and local application of tetracycline-loaded fibres in the management of persistent periodontitis: results after 12 months

BACKGROUNDS, AIMS: The aim of our study was to evaluate the clinical, radiological and microbiological response to the local delivery of tetracycline (TE) of sites with persistent periodontal lesions. MATERIALS AND METHODS: The study was conducted in a split-mouth design. Nineteen patients with at least four bilateral pockets 4-5 mm and bleeding on probing (BOP) were treated with scaling and root planing (SRP) plus TE fibres (test sites) or with SRP alone (control sites). Clinical and radiological measurements were taken at baseline, 6 months and 12 months post-operatively. Subgingival plaque samples were collected at baseline, at fibres removal, 6 and 12 months following treatment and analysed by polymerase chain reaction. RESULTS: Both treatments yielded a statistically significant (p<0.05) reduction of probing depth (2.05 and 1.21 mm), gain of clinical attachment level (1.71 and 0.53 mm) and reduction of BOP scores (23.68% and 57.89%) for TE and SRP groups, respectively, when comparing 12-month data with baseline. The differences between two groups were significant. The prevalence of Treponema denticola and Bacteroides forsythus decreased after therapy in both groups but only in the test sites Actinobacillus actinomycetemcomitans and Prevotella intermedia were not yield detected. The pathogens could be eliminated from five periodontal pockets by SRP alone, while 21 TE sites were not recolonized at 12 months. CONCLUSIONS: SRP plus TE fibres gave the greatest advantage in the treatment of periodontal persistent lesions at least 12 months following treatment.     

Scaling and Root Planing per Quadrant Versus One‐Stage Full‐Mouth Disinfection: Assessment of the Impact of Chronic Periodontitis Treatment on Quality of Life — A Clinical Randomized,Controlled Trial

Background: There are few randomized, controlled clinical trials about the effect of non‐surgical periodontal treatment on oral health–related quality of life (OHRQL). This study aims to compare the effects of two different forms of non‐surgical periodontal therapy, scaling and root planing (SRP) per quadrant and one‐stage full‐mouth disinfection (FMD), on periodontal clinical parameters and OHRQL of patients with chronic periodontitis. Methods: In this randomized, controlled clinical trial, the questionnaires Oral Impacts on Daily Performance (OIDP) and Oral Health and Quality of Life (OHQoL) were given to 90 patients divided into two groups: SRP (n = 45) and FMD (n = 45). Periodontal clinical parameters recorded included probing depth, clinical attachment level, plaque index, and gingival index. For statistical analysis, χ² test, Fisher exact test, Mann‐Whitney U test, and Wilcoxon test were used. Intention‐to‐treat analyses were performed at T0 (baseline) for periodontal clinical parameters, T1 (30 days after treatment) for questionnaires, and T2 (180 days after treatment) for both. Results: No significant differences were identified between the SRP and FMD groups in regard to OHQoL and OIDP scores when comparing the data of T1 and T2. Conclusion: Patients treated by both SRP and FMD showed improvement in all periodontal clinical parameters and OHRQL, with no significant differences between treatment groups.     

Repeated local metronidazole-therapy as adjunct to scaling and root planing in maintenance patients

The purpose of this investigation was to evaluate the effect of local antibiotic therapy with metronidazole adjunctively to scaling and root planing (SRP) versus mechanical treatment alone. 30 maintenance-patients were included in this single-blind study. The subjects had to comply with the following criteria: 2 non-adjacent sites with a probing depth > or =6 mm with bleeding on probing in separate quadrants, no periodontal therapy within the last 3 months, and no antibiotic therapy within the last 6 months. After randomization, the study sites were assigned to one of the following 2 treatments: SRP plus subgingival application of metronidazole 25% dental gel (Elyzol) 5x during 10 days (test site) or SRP alone (control site). Subgingival microbiological samples were taken prior to, and 21 days and 3 months after scaling. The samples were analyzed with a commercial chair-side ELISA (Evalusite) for Porphyromonas gingivalis, Prevotella intermedia and Actinobacillus actinomycetemcomitans. Probing pocket depth (PPD), attachment level (AL) and bleeding on probing (BOP) were recorded at baseline and 3 months later. PPD reduction and AL-gain were statistically significant (p<0.001) after both treatments. However, there were no statistically significant differences between them. The same observation was made for BOP. P. gingivalis was reduced significantly after both treatments without statistically significant differences. P. intermedia was reduced significantly only after SRP. A. actinomycetemcomitans was not reduced significantly after either treatment. In conclusion, the repeated local application of metronidazole as an adjunct to SRP and the mechanical treatment alone showed similar clinical and microbiological effects without statistically significant differences with the exception of P. intermedia.     

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.     

透明质酸在慢性牙周炎治疗中的作用

目的　观察局部应用外源性透明质酸(HA)对慢性牙周炎的临床疗效。方法　采用口内自身对照的研究方法。选择20例慢性牙周炎患者的患牙306颗,其中150颗患牙为对照组,156颗为实验组。对照组患牙仅作洁刮治和根面平整(SRP)。实验组患牙在行SRP后,龈下辅助给予0·2%透明质酸凝胶。观察两组患牙的菌斑指数、龈沟液流速、龈沟出血指数、牙周探诊深度和临床附着水平等临床指标的动态变化。结果　对照组和实验组患牙的各临床指标在治疗后均显著改善,实验组患牙龈沟液流速的下降显著快于对照组(P=0·001),但其余临床指标两组间的差异无显著性。结论　本研究未发现HA结合SRP对治疗慢性牙周炎在牙周组织修复再生中有促进作用; HA能迅速减轻牙周组织的炎症反应。     

牙龈卟啉单胞菌与牙周基础治疗关系的实验研究

目的应用TaqMan实时荧光定量聚合酶链反应法检测慢性牙周炎患者牙周洁刮治术（SRP）治疗前后龈下菌斑中牙龈卟啉单胞菌（P. gingivalis）的变化,分析P. gingivalis与SRP疗效之间的关系,探讨应用实时荧光定量聚合酶链反应监测和评价SRP的可能性。方法选择20例中重度慢性牙周炎患者为研究对象,检查SRP治疗前后的临床指标,包括探诊深度（PD）、临床附着丧失（CAL）和探诊出血（BOP）;采集SRP治疗前后的龈下菌斑共142个样本,应用TaqMan实时荧光定量聚合酶链反应检测样本中的P. gingivalis。构建含有P. gingivalis扩增片段的重组质粒,建立定量标准。结果慢性牙周炎患者SRP治疗后PD、CAL和BOP均明显下降（P<0.001）;治疗前P. gingivalis检出率为80.28%,治疗后下降为54.23%;治疗前P. gingivalis数量与PD相关,Kendall相关系数为0.70（P<0.001）,治疗后牙周袋内细菌数量明显减少（P<0.001）。治疗前牙周袋内P. gingivalis的定植数量与PD、CAL和BOP的改善无相关性（P>0.05）,但治疗后治疗有效位点P. gingivalis数量减少程度明显大于治疗无效位点（P<0.05）,细菌减少量与PD改善弱相关（r=0.25,P=0.04）。结论SRP治疗可以明显改善临床症状,降低P. gingivalis检出率和绝对数量;治疗前P. gingivalis定植水平对临床指标的改善没有影响,治疗后P. gingivalis数量下降程度可以反映治疗效果。TaqMan实时荧光定量聚合酶链反应可以用于牙周炎治疗效果的监测和评价。     

Adjunctive effects to non-surgical periodontal therapy of systemic metronidazole and amoxycillin alone and combined. A placebo controlled study

BACKGROUND AND AIM: Several studies have reported adjunctive benefits to scaling and root planing (SRP) of systemic amoxycillin and metronidazole in the treatment of periodontal diseases. To date no comparisons have been made of these antimicrobials alone or in combination. The aim of this study was to compare the adjunctive benefits to SRP of amoxycillin and metronidazole alone and combined. METHODS: 66 subjects <46 years of age with advanced chronic periodontal disease participated in this randomised, double blind, 4 parallel treatment group designed study. All subjects received quadrant SRP and then were prescribed amoxycillin capsules (250 mg) and metronidazole tablets (200 mg) (AM) or lactate capsules and metronidazole (PM) or amoxycillin and calcium lactate tablets (AP) or lactate and calcium lactate (PP). All medication was 3 of each per day for 7 days. Subgingival plaque samples were obtained and probing depth (PD), loss of attachment (LOA), bleeding on probing (BOP), suppuration (SUPP) and plaque (DEP) were recorded pre-treatment, 1, 3 and 6 months post-treatment. RESULTS: Final group sizes were: AM=15, PM=16, AP=16 and PP=15. PD improved in all groups. Treatment effects were highly significantly different and always greatest in the AM and least in the PP groups. Benefits of PM and AP over PP were also noted. LOA improved in all groups and showed the same highly significant treatment differences, again favouring AM. BOP improved in all groups, particularly in AM compared to the other groups. SUPP improved in all groups and was virtually eradicated in AM with differences among treatments highly significant. DEP changed little in any group and there were no significant differences among groups. Microbiological data showed significant differences in favour of AM compared to PP and PM for total aerobes and anaerobes at 1 month. P. intermedia counts were always lower in active groups compared to PP and reached significance for AM and AP at 1 month and AM and PM at 3 months. CONCLUSION: The significant differences among treatment groups and the overall trend in the data, in line with other studies, support the considerable adjunctive benefits to SRP of amoxycillin and metronidazole combined in the treatment of advanced chronic periodontal disease.     

Hand instrumentation versus ultrasonic debridement in the treatment of chronic periodontitis: a randomized clinical and microbiological trial

Aim: To compare the effectiveness of scaling and root planing (SRP) with the use of hand instruments to that of non-surgical treatment with the use of an ultrasonic device, using clinical and microbiological criteria.
Material and Methods: Thirty-three patients with chronic periodontitis participated in this randomized-controlled clinical trial divided into two groups. Patients in the control group received SRP with hand instruments, whereas patients in the test group received ultrasonic debridement (UD). Clinical recordings concerning probing pocket depth, clinical attachment level, plaque index and gingival bleeding index were performed at baseline, 3 and 6 months after baseline. Subgingival samples were analysed using the "checkerboard" DNA–DNA hybridization technique for Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Tannerella forsythia and Treponema denticola .
Results: Both treatments resulted in a significant improvement in all clinical recordings. Three months after treatment, a numerical decrease was observed for P. gingivalis, T. forsythia and T. denticola in both groups, which was statistically significant only for P. gingivalis ( p <0.05). Inter-group differences were observed at 6 months for T. forsythia and T. denticola ( p <0.05), favouring SRP.
Conclusions: Both treatment modalities provided comparable clinical results in the treatment of chronic periodontitis.     

The efficacy of subgingival calculus removal with endoscopy-aided scaling and root planing: a study on multirooted teeth

BACKGROUND: The dental endoscope was developed to facilitate visualization of the subgingival environment as an aid in diagnosis and non-surgical root debridement. The purpose of this study was to determine whether endoscopy-aided scaling and root planing (SRP) resulted in a greater reduction of residual calculus compared to SRP alone in multirooted teeth. METHODS: Twenty-four patients were enrolled and contributed 35 tooth pairs (70 teeth in total). Each tooth per pair was randomly assigned to receive endoscopy-aided SRP (test) or SRP alone (control). Both teeth were extracted immediately after treatment, washed with water, and stained with methylene blue. The percentage of residual calculus was determined via stereomicroscopy and digital image software by a single masked examiner. RESULTS: Overall, there was 1.16% (P = 0.097) less residual calculus at test versus control sites. At interproximal surfaces, test roots had 2.63% less residual calculus than control roots (P = 0.003), whereas test roots had slightly more residual calculus than controls at buccal/lingual surfaces (0.36%; P = 0.652). There were no statistically significant differences in residual calculus between groups at deeper probing depths or at sites with deep furcation invasions. Only at shallower interproximal sites with probing depths < or =6 mm was significantly less residual calculus seen in roots treated with endoscopy (P = 0.020). Treatment time decreased significantly as operator experience increased; however, no significant improvement in residual calculus levels was noted with greater experience. CONCLUSION: Within the confines of this study, the use of the endoscope as an adjunct to traditional SRP provided no significant improvement in calculus removal in multirooted molar teeth.     

The significance of prior mechanical therapy for changes of periodontal status achieved by local delivery of a doxycyclinehyclate containing gel

AIM: The purpose of this retrospective analysis was to examine what effect, if any, the time elapsed between an individual's last episode of scaling and root planing and subsequent treatment with a sustained-release doxycycline hyclate gel (DH) alone or scaling and root planing alone (SRP) would have upon adult periodontitis. METHODS: A total of 207 subjects were included in the DH group and 210 patients in the SRP group. Periodontitis was defined as those sites which presented with pocket depths > or =5 mm and exhibited bleeding upon probing. In both DH and SRP groups, 3 sub-groups of subjects were identified according to their last episode of scaling and root planing prior to the study baseline: within 2 to 6 months, >6 but < or =12 months, and one or more times in their life but not within the last 12 months. Each study site was treated twice over a 9-month study period, once at baseline and again at 4 months. Data from the study sites at 4, 6, and 9 months were then evaluated for changes in probing depth, clinical attachment level, and bleeding upon probing. RESULTS: At the 9-month evaluation, all sub-groups in the DH and SRP treatment arms presented with improvement in the measured clinical parameters, as compared to baseline. No significant differences were observed in the measured periodontal indices among the study sites between the three sub-groups for either treatment. CONCLUSIONS: It is concluded that the time interval since the last episode of scaling and root planing had no observable effect on the results achieved when treating periodontitis sites with locally delivered doxycycline hyclate alone or scaling and root planing alone. The treatment of periodontitis sites with locally delivered doxycycline hyclate resulted in clinical improvement comparable to scaling and root planing irrespective of the patient's prophylaxis frequency.     

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).