Assessment of ultrasonic debridement of calculus–associated periodontally-involved root surfaces by the limulus amoebocyte lysate assay

This investigation assessed the effectiveness of an in vitro ultrasonic debridement regime on periodontally involved teeth with visually-detectable calculus deposits, using the LAL assay for lipopolysaccharides (LPS) as a marker of bacterial products. 34 single rooted teeth with extensive amounts of calcified accretions were selected, of which 10 served as uninstrumented controls for the estimation of existing LPS levels. The periodontally involved roots of the 24 experimental teeth were debrided with a Cavitron TF-10 tip for a limited time using light pressure and overlapping strokes which ensured complete surface instrumentation without reference to the presence of calculus. Marked reductions in root surface area coverage by calculus were nevertheless achieved as assessed planimetrically from photographic records of the teeth before and after debridement. The root surfaces of each tooth were then stripped away and the harvested material subjected to 'Westphal' extraction and LAL assay for LPS. The resulting LPS yields from the experimental teeth ranged from less than 0.08 to 22.387 ng compared to 1,900 to 29,200 ng from the uninstrumented controls. The extremely small residual LPS yields from the experimental teeth not only confirm the efficacy of ultrasonic debridement but, when coupled with the lack of a relationship with the widely varying amounts of the remaining calculus, support the contention that bacterial plaque rather than calculus has the greater pathogenic potential. These results reinforce the growing impression of the superficial location of bacterial toxic products associated with periodontally involved root surfaces.     

Root surface debridement – an in vitro assessment

Root planing has been advocated to render periodontally involved root surfaces 'biologically compatible' with the surrounding soft tissues and thus promote healing. However, recent work has shown that only small amounts of cytotoxic material are likely to be incorporated within the root surfaces, thereby questioning the rationale for the traditional emphasis that is placed upon the removal of 'diseased cementum'. This investigation assessed by limulus amoebocyte lysate (LAL) assay and Polymyxin B affinity chromatography the extent of residual lipopolysaccharide (LPS) following root surface instrumentation in vitro. A conservative regime was carried out, consisting of 15 instrument strokes per surface designed to ensure complete overlapping of the strokes. This harvested varying amounts of LPS from 18 single-rooted teeth while leaving behind less than 0.24 ng of LPS per tooth in the majority (72%) of cases. This finding endorses the growing belief that extensive root planing may not be warranted.     

The distribution of bacterial lipopolysaccharide (endotoxin) in relation to periodontally involved root surfaces

The distribution of lipopolysaccharide (LPS) in periodontally involved root surface associated materials has been investigated using improved methods of identification and quantification. 39% of the LPS could be removed by gently washing in water for 1 min and 60% by brushing for 1 min with a slowly rotating bristle brush. The finding that 99% of the LPS can be removed by comparatively gentle procedures suggests that effective root surface debridement may be achieved by methods other than traditional hand instrumentation.     

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.     

The effect of subgingival debridement with hand and ultrasonic instruments on the subgingival microflora

The effect of hand or ultrasonic instrumentation on the subgingival microflora of periodontal pockets was investigated. Pockets with probing depths of 6-9 mm were selected in 12 patients and were randomly assigned per patient to the experimental and control groups. After oral hygiene instruction, instrumentation of the experimental pockets was carried out either by ultrasonic or by hand instruments in a split-mouth design. The treatment effect on the subgingival microbiota was evaluated by microscopic and culture studies of subgingival plaque samples, while in addition, supragingival plaque, bleeding after probing and probing pocket depth were scored. Examinations were carried out before and 7, 21 and 49 days after treatment. The hand and ultrasonic treatments were equally effective in reducing probing pocket depths and bleeding scores. At the end of the experimental period, the probing depths of 54% of the hand-treated pockets and 43% of the ultrasonic-treated pockets were reduced to 4 mm or less while the bleeding scores were reduced to 29% and 22%, respectively. The analysis of microscopical and cultural data did not show any differences between hand and ultrasonic debridement. Both treatments reduced the microscopical counts of rods, spirochetes and motiles and reduced the total colony-forming units and number of black-pigmented Bacteroides and Capnocytophaga, resulting in a subgingival microbiota consistent with periodontal health.     

全口超声龈下刮治两次法对轻中度慢性牙周炎老年患者的近期疗效观察

目的:观察全口超声龈下刮治两次法对轻中度牙周炎的治疗效果。方法:按病例纳入标准选择年龄60岁以上、轻中度牙周炎患者42例,经口腔卫生宣教、超声龈上洁治术后,进行基线检查:牙龈出血指数(GBI),探针出血(BOP)阳性位点,牙周探诊深度(PD)及附着水平(AL),然后进行两次全口超声龈下刮治。术后1个月、3个月复查。所得数据进行配对t检验,统计学分析各临床指标治疗前后的变化。结果:术后1个月的PD由治疗前平均3.18 mm减少至平均2.45 mm(P<0.05),附着水平由平均4.51 mm提高至平均3.34mm(P<0.05),术后3个月的PD及AL分别为2.37 mm(P<0.05)及3.27 mm(P<0.05)。GBI术前平均为3.17,术后一个月及三个月分别减少至1.67(P<0.05)及1.82(P<0.05)。BOP阳性率由术前的37.2%,在术后一个月及三个月分别下降至13.2%(P<0.05)和16.8%(P<0.05)。结论:全口超声龈下刮治两次法短期可改善老年轻中度牙周炎患者的牙龈出血及附着水平,牙周袋探诊深度也有减少的趋势,同时相对于传统的分区龈下刮治及根面平整术,可减少患者复诊次数。     

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.     

The periodontally-involved root surface

Abstract Recent years have seen much research on the periodontally-involved root surface. Many of these studies have produced results which suggest that plaque contaminants of the root surface are only superficially placed, and capable of being removed by gentle means. Further research has attested to the difficulties in rendering periodontally-involved root surfaces free of calculus deposits by instrumentation, yet clinical studies show that periodontal disease can be managed by root planing. It is concluded that root surface debridement is best assessed on the basis of the healing response and that it should aim to disrupt plaque on and remove plaque from the periodontally-involved root surface rather than to remove part of the root surface itself.     

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.     

Methodology of three-dimensional determination of root surface roughness

In comparing and evaluating the instruments that are used in root debridement, roughness constitutes a standard variable that is assessed. The purpose of this study was to describe the conditions and requirements for the three-dimensional roughness measurements of tooth roots using a laser profilometer. Impressions were made of 60 instrumented and 12 untreated root surfaces, which were then measured using a dynamically focussing optical profilometer (Mikrofocus, UBM, Karlsruhe, Germany). To separate roughness from the form of the tooth, a low pass filter was applied. This meant that the longer wavelengths - which roughly approximated the root forms - were subtracted from the measured profile. We then used an individualized Fourier transformation to define the threshold at which roughness becomes waviness. Roughness parameters were Ra (average roughness) and Rz (average roughness in the z dimension) for two- and three-dimensional measurements. To describe the requirements for the measurement, we studied the effect of pixel density and the field size on the average roughness value, Ra. We found that Ra increases with pixel density until 400 per mm is reached, after which it does not change meaningfully. Furthermore, Ra is highly dependent upon the area of the field to be scanned, increasing in line with the area, and does not approach one value within the surface available on one tooth. The correlation coefficients between the two-dimensional and three-dimensional Ra and Rz values ranged from 0.7 to 0.8. We conclude that roughness values are strongly dependent on the measurement conditions and the results of one study cannot be directly compared to another. In addition, it was found that two-dimensional measurements are sufficient for characterizing root surfaces.     

Root surface debridement and endotoxin removal

OBJECTIVE: This study assessed associations between the number of standardized scaling strokes and the reduction of endotoxin on the root surface. BACKGROUND: Therapy of periodontally involved teeth attempts removal of accretions by scaling and root planing. The amount of mechanical therapy required to free the root surface from etiologic factors remains unknown. METHODS: Twenty-four extracted human caries-free single rooted teeth with at least 5 mm attachment loss were used. A region of interest (ROI) which contained subgingival calculus was defined on the root surface of each tooth. Standardized force instrumentation was applied using a force-measuring curet. Fifty working strokes were applied to every ROI. Forces applied were recorded. The force recordings were converted from Millivolts into Newtons (N). After every unit of 5 strokes, presence of calculus was evaluated and scaling debris was collected. Endotoxin concentration was determined in the debris samples. RESULTS: The endotoxin values for strokes 1-5 were statistically significantly greater than the values from all other stroke intervals. Complete calculus removal occurred after a mean of 9.3 strokes. The endotoxin concentration reached a minimal level with concentrations of 0.03-0.306 EU/ml after calculus removal was complete. CONCLUSION: These findings suggest that completion of calculus removal coincides with endotoxin levels associated with clinically healthy teeth.     

龈下清创术与根面平整术

自20世纪70年代起,为了清除“病变牙骨质”,需专用手工器械完成的根面平整术成为牙周炎非手术治疗的核心内容。随后部分有关根面内毒素的研究认为没有必要使用根面平整术过度去除牙骨质,主张“龈下清创术”。目前规范化牙周治疗的主流观点仍强调在龈下清创后使用手工器械处理牙根表面作为去除病因的重要程序,从而使根面具有生物相容性。既往有关根面平整术的研究主要是对比单纯超声龈下清创术和单纯手工龈下刮治及根面平整术,缺乏超声龈下清创术与超声龈下清创联合手工根面平整术的对比研究。本文综述以往关于龈下清创术和根面平整术的相关研究,为临床医生治疗方案选择提供指导,同时也为将来开展相关的临床研究提供参考。     

Effects of cavitational activity on the root surface of teeth during ultrasonic scaling

It is recognised that roughness of the root surface will occur during ultrasonic scaling and this has been attributed to the vibrating scaling tip. Although the presence of cavitational activity and acoustic microstreaming forces have been described their effects on the root surface have not been fully evaluated. Utilising an in vitro system of polished gold, it was possible to demonstrate an indentation produced by the scaling tip. However cavitational activity around the tip within the water supply appeared to produce an area of erosion (0.66 +/- 0.3 mm2, 1 SD, n = 10), and the surface appeared pitted. A scanning electron microscope study (SEM) of root surfaces following ultrasonic scaling showed similar areas of erosion. A replica technique was utilised so that control and experimental root surfaces could be observed. Cavitational activity and acoustic microstreaming resulted in a superficial removal of root surface constituents, and this area of removal was measured as 0.7 +/- 0.3 mm2 (1 SD, n = 10), which was not significantly different from that area observed with the gold surface system (p greater than 0.1). It may be concluded that cavitational activity within the cooling water supply of the ultrasonic scaler results in a superficial removal of root surface constituents.     

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 effect of plaque control and root debridement in molar teeth

The healing response of non-molar sites, molar flat surface sites, and molar furcation sites was investigated in 19 adult periodontitis patients following a periodontal therapy of plaque control and root debridement. A total of 2472 sites were monitored by recordings of dental plaque, bleeding on probing, probing depth, and probing attachment levels every 3rd month for 24 months. The results demonstrated that in sites with initial probing depth of 4.0 mm or greater, molar furcation sites responded less favorably to the therapy as compared to molar flat surface sites or non-molar sites. This was demonstrated by higher mean scores for bleeding on probing, less reduction in probing depth, and a mean loss of probing attachment of 0.5 mm over 24 months. Site analyses using linear regression showed a higher % of deeper sites with probing attachment loss for the molar furcations than either molar flat surface or non-molar sites. Among sites initially 7.0 mm or deeper, 21% of molar furcations were identified as showing probing attachment loss as compared to 7% of the molar flat surface sites and 11% of the non-molar sites.     

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.     

Clinical effects of root debridement in molar and non-molar teeth A 2-year follow-up

12 patients were studied longitudinally to monitor the effects of basic periodontal therapy in molar and non-molar teeth. Periodontal sites were grouped into molar furcation sites, molar flat-surface sites and non-molar sites. Clinical measurements were taken at baseline and directly followed by full mouth root debridement. Subsequently, measurements were taken every 3rd month until 24 months. At each of these appointments, the patients were monitored for their oral hygiene performance and given supragingival prophylaxis. The mean results indicated that initially moderately deep and deep molar furcation sites responded less favorably to therapy compared to non-molar sites and molar flat-surface sites of similar probing depth. Initial improvements in probing measurements for moderately deep and deep molar furcation sites were limited and also tended to revert during the observation interval. Identification of individual sites with probing attachment loss disclosed that 25% of molar furcation sites lost probing attachment as compared to 7% for non-molar sites and 10% for molar flat-surface sites. These results corroborate previous findings and call for additional or alternative treatment regimens for periodontal furcation pockets.     

Subgingival debridement of root surfaces with a micro-brush: macroscopic and ultrastructural assessment

AIM: The aim of this study was to assess the use of a micro-brush to remove plaque deposits from subgingival, periodontally involved root surfaces in vivo. METHODS: 30 periodontally involved teeth requiring extraction for periodontal or prosthetic reasons in 26 adult patients were utilised. For inclusion, teeth had to display at least 30% bone loss radiographically. Following the establishment of local anaesthesia, grooves were cut on the proximal root surface adjacent to the gingival margin at the line angles. For each tooth, 1 proximal root surface was rubbed with the micro-brush for 2 min to the depth of the pocket whilst the other root surface acted as an undebrided control. The teeth were then extracted, rinsed in 0.85% NaCl, stained with 2% erythrosine solution and photographed. The amount of erythrosine staining on each subgingival, periodontally involved root surface was assessed by tracing the areas of stain on a colour photograph and scanning the tracings into a computerised image tracing program. RESULTS: Results were expressed as the % of the periodontally involved root-surface area that exhibited staining. Stained areas were further examined with the scanning electron microscope (SEM). The undebrided root surfaces each displayed 100% staining. The debrided surfaces (with probing pocket depths of 4-10 mm) displayed mean staining of 16.1% (SD +/-7.1%) of the proximal surface area. SEM assessment showed that undebrided root surfaces were covered with thick deposits of bacteria. On debrided surfaces, stain-free areas were free of plaque whilst areas of faint staining exhibited either no plaque, calculus deposits or scanty, isolated islands of bacteria. Bacteria had been partially removed from the surface of calculus in some areas. CONCLUSIONS: The findings indicate that subgingival debridement with a micro-brush is effective in removing plaque deposits from periodontally involved root surfaces.     

The combination of amoxicillin and metronidazole improves clinical and microbiologic results of one-stage, full-mouth, ultrasonic debridement in aggressive periodontitis treatment

Background: The aim of the present study is to assess clinical, microbiologic, and immunologic benefits of amoxicillin/metronidazole (AM) when performing full‐mouth ultrasonic debridement (FMUD) in generalized aggressive periodontitis (GAgP) treatment. Methods: Twenty‐four GAgP patients were divided into two groups: the FMUD group (n = 12), which received FMUD plus placebo, and the FMUD+AM group (n = 12), which received FMUD and 375 mg amoxicillin plus 250 mg metronidazole for 7 days. The following clinical outcomes were tested: plaque and bleeding on probing indices, pocket probing depth (PD), relative gingival margin position (GMP), and relative clinical attachment level (CAL). Total amount of Porphyromonas gingivalis (Pg), Aggregatibacter actinomycetemcomitans (Aa), Tannerella forsythia (Tf), and gingival crevicular fluid (GCF) concentration of interleukin (IL)‐10 and IL‐1β were also determined. All clinical, microbiologic, and immunologic parameters were assessed at baseline and at 3 and 6 months post‐therapy. The ANOVA/Tukey test was used for statistical analysis (α = 5%). Results: Amoxicillin/metronidazole used as an adjunct to the FMUD protocol added clinical and microbiologic benefits to GAgP treatment (P <0.05). FMUD+AM groups presented an additional PD reduction in initially deep PDs at the 3‐month follow‐up (3.99 ± 1.16 mm and 3.09 ± 0.78 mm for FMUD+AM and FMUD, respectively; P <0.05), a lower number of residual pockets at the 3‐ and 6‐month follow‐ups, and a statistical reduction in amounts of Aa (P <0.05). Analysis of Tf and Pg amounts, as well as IL‐10 and IL‐1β GCF concentrations failed to demonstrate a difference between the groups (P >0.05). Conclusion: It may be concluded that amoxicillin/metronidazole improves clinical and microbiologic results of FMUD in GAgP treatment.     

Clinical effects of an essential oil solution used as a coolant during ultrasonic root debridement

To cite this article: Int J Dent HygieneDOI: 10.1111/j.1601‐5037.2012.00554.x
Cosyn J, Miremadi SR, Sabzevar MM, De Bruyn H. Clinical effects of an essential oil solution used as a coolant during ultrasonic root debridement. Abstract: Aim: The use of chlorhexidine and povidone iodine solutions applied as a coolant during ultrasonic root debridement for the treatment of chronic periodontitis has been described. Hitherto, this application has not yet been extensively investigated for essential oil solutions. The goal was to clinically explore this and to compare to water irrigation. Materials and methods: Thirty‐five chronic periodontitis patients participated in a single‐blind randomized controlled clinical study. Patients were randomly allocated to the control group (n = 18) or test group (n = 17) receiving oral hygiene instructions and ultrasonic root debridement using water as a coolant, respectively, a pure essential oil solution. Oral hygiene was reinforced if necessary at each occasion, and clinical parameters were collected at baseline and after 1 and 3 months. Results: Significant pocket reduction (control, 1.02 mm; test, 0.89 mm) and clinical attachment gain (control and test, 0.48 mm) were shown in both groups. However, there were no significant differences between the groups at any point in time for any of the parameters. Conclusion: Essential oil solutions do not offer a clinical benefit over water when used as a coolant during ultrasonic root debridement for the treatment of chronic periodontitis.