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

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

The effect of a one-stage full-mouth disinfection on different intra-oral niches Clinical and microbiological observations

Abstract. A treatment for periodontal infections often consists of consecutive rootplanings (per quadrani, at a 1-to 2-week interval), without a proper disinfection of the remaining intra-oral niches (untreated pockets, tongue, saliva, mucosa and tonsils). Such an approach, could theoretically lead to a reinfection of previously-treated pockets. The present study aims to examine the effect of a full-mouth disinfection on the microbiota in the above-mentioned niches. Moreover, the clinical benefit of such an approach was investigated. 16 patients with severe periodontitis were randomly allocated to a test and a control group. The patients from the control group were scaled and rootplaned, per quadrant, at 2-week intervals and obtained oral hygiene instructions. The patients from the test group received a full-mouth disinfection consisting of: scaling and rootplaning of all pockets in 2 visits within 24 h, in combination with tongue brushing with 1% chlorhexidine gel for 1 min, mouth rinsing with a 0.2% chlorhexidine solution for 2 min and subgingival irrigation of all pockets (3× in 10 min) with 1%, chlorhexidine gel. Besides oral hygiene, the test group rinsed 2× daily with 0.2% chlorhexidine and sprayed the tonsils with a 0.2% chlorhexidine for 2 months. Plaque samples (pockets, tongue, mucosa and saliva) were taken at baseline and after 2 and 4 months, and changes in probing depth, attachment level and bleeding on probing were reported. The full-mouth disinfection resulted in a statistically significant additional reduction/elimination of periodonlopathogens, especially in the subgingival pockets, but also in the other niches. These microhiological improvements were reflected in a statistically-significant higher probing depth reduction and attachment gain in the test patients. These findings suggest that a disinfection of all intra-oral niches within a short time span leads to significant clinical and microbiological improvements for up to 4 months.     

Subgingival chlorhexidine varnish administration as an adjunct to same-day full-mouth root planing. I. Clinical observations

BACKGROUND: Chemo-mechanical treatment concepts have been developed to improve the outcome of non-surgical periodontal therapy. Recently, the clinical additive value of a supersaturated chlorhexidine varnish was shown when used as an adjunct to staged scaling and root planing. The aim of this study was to investigate the clinical effects of a treatment strategy for chronic periodontitis based on a combination of same-day full-mouth root planing and subgingival chlorhexidine varnish administration. METHODS: A randomized, controlled, single-blind, parallel trial was conducted on 33 non-smoking chronic periodontitis patients. The control group received oral hygiene instructions and same-day full-mouth root planing. The test group received the same instructions and treatment; however, all pockets were disinfected using a chlorhexidine varnish. Clinical response parameters were recorded at baseline and after 1, 3, and 6 months. RESULTS: Both groups showed significant reductions in probing depth following therapy (P <0.001). There was no significant difference in full-mouth probing depth between the groups at any examination point. However, when a site-specific comparison was made, additive effects were found in the test group; an extra pocket reduction of 0.93 mm (P = 0.044) for initially deep pockets (>or=7 mm) was found at study termination. Additive clinical attachment gains seemed to be temporary. Impermanent extra pocket reductions and clinical attachment gains were found for initially medium-deep pockets (4 to 6 mm). CONCLUSION: The outcome of same-day full-mouth root planing may benefit from the subgingival administration of a highly concentrated chlorhexidine varnish, at least in terms of pocket reduction in initially deep sites (>or=7 mm).     

Full mouth disinfection versus quadrant debridement: the clinician's choice

Traditional periodontal therapy is subgingival debridement with maintenance of good oral hygiene. This approach is either definitive or the initial phase before surgical therapy in severe cases of periodontitis. Mechanical therapy, either hand instrumentation or ultrasonic debridement, is the most common therapy for periodontitis and its success is well documented (Badersten et al. 1984). This non-surgical therapy involves considerable amounts of time, a high level of operator skill and dedication, and some unavoidable discomfort for the patient. It has often been remarked that the time taken for periodontal therapy of severe periodontitis cases exceeds that needed for cardiac arterial bypass surgery. Quirynen et al. (1995) re-introduced the one-stage full-mouth disinfection and compared the clinical and microbiological effects of this treatment strategy (FMRP) with the widespread practice of quadrant scaling and root planing at 2-week intervals (QRP). The rationale behind their treatment strategy was to prevent re-infection of the treated sites from the remaining untreated pockets and intra-oral niches. The results revealed a significant reduction in pocket depth for the FMRP over QRP group for deep pockets. Quirynen et al. (2000) concluded that the elimination of the periodontopathogens in addition to the possible host response benefits after the one-stage full-mouth therapy is the effective aspect of this therapy rather than oral chlorhexidine disinfection. Recently, Kinane's group in Glasgow failed to demonstrate differences in the clinical, microbiological or immunological outcome between QRP and FMRP. FMRP was well tolerated by patients and these authors concluded that the clinician should select the treatment modality based on practical considerations related to patient preference and clinical workload. Koshy et al. (2005) re-analysed the effects of FMRP and QRP using ultrasonics and concluded that either full-mouth or quadrant ultrasonic debridement are just as effective.     

Full mouth one stage disinfection of the oropharynx. A new treatment strategy for periodontitis

Most periodontal pathogens colonise different niches such as the oral mucosa, tongue, saliva, periodontal pockets, all hard intra-oral surfaces and the tonsils. Since intra-oral translocation of these pathogens between these niches is possible, a 'one stage' disinfection of the whole mouth in one or two consecutive days as treatment strategy for periodontal infections must be considered. A one stage full-mouth disinfection is achieved by a scaling and root planing of all periodontal pockets within 24 hours, in combination with a chlorhexidine application in all niches (subgingival irrigation, mouth wash, brushing of the tongue, and spray for the pharynx). As such, reinfection by bacteria of recently instrumented sites is inhibited. This approach results in significant additional clinical and microbiological results compared to the classical approach (scaling and rootplaning per quadrant with several days or weeks between each session).     

One-stage full-mouth disinfection. Long-term microbiological results analyzed by checkerboard DNA-DNA hybridization

BACKGROUND: Recent studies reported significant, additional clinical and microbiological improvements when severe adult periodontitis was treated via the one-stage full-mouth (OSFM) disinfection approach, instead of a standard treatment scheme with staged instrumentation per quadrant. The OSFM disinfection involves dealing with the remaining oropharyngeal niches such as tonsils, saliva, tongue, and mucosa. The OSFM disinfection procedure involves scaling and root planing of all pockets within 24 hours in combination with chlorhexidine application to all oropharyngeal niches (chairside and at home for 2 months). This study aimed to compare the microbiological shifts with the OSFM approach versus standard therapy. METHODS: Nineteen patients with advanced chronic periodontitis (AP) and 12 patients with early-onset periodontitis (EOP) were randomly assigned to the test and control groups. The control group (9 AP patients, 6 EOP patients) was scaled and root planed, per quadrant, with 2-week intervals. The test group (10 AP patients and 6 EOP patients) underwent OSFM disinfection treatment. At baseline and after 2, 4, and 8 months, pooled subgingival plaque samples were taken from single- and multi-rooted teeth. The presence and levels of 30 subgingival taxa were determined using whole genomic DNA probes and checkerboard DNA-DNA hybridization. RESULTS: Both treatments resulted in important reductions of the pathogenic species up to 8 months after therapy, both for their detection level and frequency. The OSFM disinfection resulted in an additional improvement, especially in the AP group. P. gingivalis and B. forsythus were reduced below detection level. The number of beneficial species remained nearly unchanged. CONCLUSIONS: The OSFM disinfection results in supplementary reductions of periodontal pathogens even after 8 months in the treatment of patients with advanced or early-onset periodontitis.     

Clinical benefits of subgingival chlorhexidine varnish application as an adjunct to same-day full-mouth root planing: a pilot study

BACKGROUND: Although scaling and root planing are considered the therapeutic standard for periodontitis, weakly responding sites often occur. To improve treatment outcome, several chemomechanical treatment concepts have been developed. Recently, the clinical surplus value of a highly concentrated chlorhexidine varnish has been shown when used as an adjunct to sequential scaling and root planing. The aim of this study was to explore the clinical effects of a treatment strategy for chronic periodontitis based on a combination of same-day full-mouth root planing and subgingival chlorhexidine varnish administration. METHODS: A randomized, controlled, single-blind, parallel trial was conducted on 12 chronic periodontitis patients. The control group received oral hygiene instructions and same-day full-mouth root planing. The test group received the same instructions and treatment; however, all pockets were additionally disinfected using a chlorhexidine varnish. Clinical response parameters were recorded at baseline and subsequently after 1 and 3 months. RESULTS: Both treatment strategies showed significant reductions in probing depth at both follow-up visits in comparison with baseline levels (P or=7 mm) was found favoring the test group. CONCLUSION: These preliminary findings suggest that the outcome of same-day full-mouth root planing may benefit from the subgingival administration of a highly concentrated chlorhexidine varnish.     

Benefit of "one-stage full-mouth disinfection" is explained by disinfection and root planing within 24 hours: a randomized controlled trial

OBJECTIVES: The beneficial effects of the one-stage, full-mouth disinfection remain controversial in the scientific literature. This might be due to the fact that an entire mouth disinfection with the use of antiseptics has been confused with a full-mouth scaling and root planing. This parallel, single blind RCT study aimed to compare several full-mouth treatment strategies with each other. MATERIAL AND METHODS: Seventy-one patients with moderate periodontitis were randomly allocated to one of the following treatment strategies: scaling and root planing, quadrant by quadrant, at two-week intervals (negative control, NC), full-mouth scaling and root planing within 2 consecutive days (FRP), or three one-stage, full-mouth disinfection (FM) protocols within 2 consecutive days applying antiseptics to all intra-oral niches for periopathogens using as antiseptics: chlorhexidine (FMCHX) for 2 months, amine fluoride/stannous fluoride for 2 months (FMF), or chlorhexidine for 2 months followed by amine fluoride/stannous fluoride for another 6 months (FMCHX+F). At baseline and after 2, 4, and 8 a series of periodontal parameters were recorded. RESULTS: All treatment strategies resulted in significant (p<0.05) improvements of all clinical parameters over the entire duration of the study. Inter-treatment differences were often encountered. The NC group nearly always showed significant smaller improvements than the two CHX groups. The differences between the FRP or FM groups, and the two CHX groups only sporadically reached a statistical significance. CONCLUSION: These observations indicate that the benefits of the "OSFMD" protocol are partially due to the use of the antiseptics and partially to the completion of the therapy in a short time.     

Clinical outcomes of quadrant root planing versus full-mouth root planing

OBJECTIVES: To determine the clinical effects of full mouth compared with quadrant wise scaling and root planing. METHOD: Twenty patients with chronic periodontitis (> or = 2 teeth per quadrant with probing pocket depths (PPD) > or = 5 mm and bleeding on probing (BOP) were randomized into a test group treated in two sessions with subgingival scaling and root planing within 24 h (full-mouth root planing (FMRP)) and a control group treated quadrant by quadrant in four sessions in intervals of 1 week (quadrant root planing (QRP)). PPD, relative attachment level (RAL) and BOP were recorded at baseline, 3 and 6 months. RESULTS: Analysing first quadrant data, in moderately deep pockets (5 mm < or = PPD < 7 mm) there was no evidence for a difference (FMRP-QRP) between both groups for PPD reduction (mean: -0.128 mm; CI: [-0.949, 0.693]; p=0.747), RAL gain (mean: 0.118 mm; CI: [-0.763, 1.000]; p=0.781), and BOP reduction (mean: -20.1%; CI: [-44.3, 4.2]; p=0.099). Likewise, no significant differences between treatments were found for initially deep pockets (PPD > or = 7 mm), neither for first quadrant nor for whole mouth data. CONCLUSION: The results of the present study demonstrated equally favourable clinical results following both treatment modalities.     

One stage full- versus partial-mouth disinfection in the treatment of chronic adult or generalized early-onset periodontitis. II. Long-term impact on microbial load.

BACKGROUND: Recent studies showed the clinical benefits of a one stage full-mouth disinfection, when compared to the worldwide standard treatment strategy of consecutive root planings per quadrant without proper disinfection of the remaining intraoral niches. The purpose of this study was to investigate the microbiological benefits of such a one stage full-mouth disinfection with special attention to all intraoral niches for periodontopathogens and to evaluate the perception by the patients of the new treatment strategy. METHODS: Sixteen patients with early-onset periodontitis and 24 patients with severe adult periodontitis were randomly assigned to test and control groups. The control group was scaled and root planed, per quadrant, at 2-week intervals and given oral hygiene instructions. The test group received the one stage full-mouth disinfection treatment. At baseline and after 1, 2, 4, and 8 months, microbiological samples were taken from all niches (tongue, mucosa, saliva, and pooled samples from single- and multi-rooted teeth). The samples were cultured on selective and non-selective media. Patient perception of the treatment was evaluated using a questionnaire. RESULTS: In comparison to the standard therapy, the one stage full-mouth disinfection resulted in significant additional microbial improvements. The test group showed larger reductions in the proportions of spirochetes and motile organisms in the subgingival flora, and more significant reductions in the density of key pathogens, with even the eradication of P. gingivalis. The beneficial effects in the other niches were primarily restricted to the number of colony-forming units/ml of black-pigmented bacteria, especially on the mucosa and in the saliva and to a lesser extent on the tongue. Both treatments were well tolerated by the patients and the overall severity rating for both therapies was comparable, although 4 quadrants were treated within 24 hours in the test group versus only 1 in the control group. The full-mouth disinfection approach resulted more frequently in a slight increase of body temperature, especially after the second day. CONCLUSIONS: These findings support the benefit of a one stage full-mouth disinfection in the treatment of patients with either chronic adult or early-onset periodontitis.     

The effect of 2% chlorhexidine digluconate irrigation on clinical parameters and the level of Bacteroides gingivalis in periodontal pockets

Eight patients with moderate periodontitis volunteered to participate in a study to assess the effect of subgingival 2% chlorhexidine irrigation, with and without scaling and root planing, on clinical parameters and the level of Bacteroides gingivalis in periodontal pockets. Each quadrant was required to have at least one site with a probing depth of 6 mm or greater and bleeding on probing. The patients were treated following a randomized four quadrant design: one quadrant received no treatment; a second quadrant received scaling and root planing only; a third quadrant received chlorhexidine irrigation only; the fourth quadrant received scaling and root planing, plus chlorhexidine irrigation. Sites to receive chlorhexidine were irrigated at 0, 1, 2, and 3 weeks. Clinical and microbiological indices were measured and recorded at 0, 5, 7, 11, and 15 weeks. The clinical parameters measured included; Plaque Index (PI), Gingival Index (GI), probing depth (PD), Bleeding Tendency (BT), and attachment level (AL). The attachment level was measured using an occlusal stint as a fixed reference point. The level of Bacteroides gingivalis was measured by labeling the plaque sample with a polyclonal fluorescent antibody. The plaque smear was then read using a fluorescent microscope at 1000 magnification. The Spearman Rank-Order Correlation was used to determine the relationship between parameters at baseline. The effects of the treatment groups were compared using the Neuman-Keuls Multiple Comparison Technique. The results showed that a positive correlation existed between B. gingivalis (rs = 0.68) and Bleeding Tendency and between P1I (rs = 0.77) and GI.(ABSTRACT TRUNCATED AT 250 WORDS)     

Increase in cariogenic bacteria after initial periodontal therapy

This study examined the hypothesis of an intra-oral shift, during initial periodontal therapy, from a periopathogenic to a cariogenic flora. Seventy-one patients with periodontitis were randomly allocated to one of the following treatment strategies: (1) scaling and root planing, quadrant by quadrant, at two-week intervals (NC); (2) full-mouth scaling and root planing within 24 hrs (FRP); or (3) full-mouth disinfection within 24 hrs, including antiseptics [chlorhexidine (CHX) or amine fluoride/stannous fluoride (F) for 2 mos, or CHX for 2 mos followed by F for 6 mos (CHX+F)]. At baseline and after 2, 4, and 8 mos, bacterial samples were taken from supra- and subgingival plaque, saliva, and tongue. The detection frequencies and relative proportions of Streptococcus mutans increased in the NC and FRP groups, but decreased in the F group. In the CHX group, these species disappeared temporarily, but they disappeared for the entire 8 mos in the CHX+F group. These observations were similar for all sample locations. The periopathogens decreased in all groups. This finding confirms the abovementioned hypothesis and indicates a need for caries prophylactic regimens.     

Local delivery of chlorhexidine gluconate in patients with aggressive periodontitis

The aim of this randomized, controlled, single-blinded trial was to evaluate the effectiveness of a biodegradable chlorhexidine chip as an adjunctive therapy to scaling and root planing. Eleven consecutive patients with aggressive periodontitis were recruited for this study. Each volunteer provided four sites with probing depth > or = 5 mm. Two sites received scaling and root planing (SRP) and placement of the chlorhexidine chip (PC), and the other two sites received scaling and root planing only. The clinical outcomes were measured at baseline, 6 weeks and 3 months after treatment. All patients completed the trial. None of the volunteers reported any adverse effect. Both groups showed a significant reduction in periodontal pocket depth (PPD) and gain in clinical attachment level (CAL) after treatment. However, there were no significant differences in the clinical parameters between the groups after 6 weeks and after 3 months. Sites presenting probing depths > or = 8 mm at baseline treated with SRP + PC demonstrated greater reduction in PPD and a greater CAL gain than sites treated with SRP alone after 6 weeks and after 3 months. The authors concluded that the adjunctive use of the biodegradable chlorhexidine chip resulted in greater reduction of PPD and additional gain in CAL in deep pockets (PPD > or = 8 mm) in patients with aggressive periodontitis when compared to scaling and root.     

Evaluation of the effect of subgingival placement of chlorhexidine chips as an adjunct to scaling and root planing

BACKGROUND: The purpose of this 9-month study was to compare the effect of scaling and root planing alone (control) to that of scaling and root planing plus application of chlorhexidine chips (test). METHODS: Twenty-six subjects having two non-adjacent sites in non-molar teeth with probing depth > or =5 mm and bleeding on probing participated in this split-mouth trial. At baseline, the patients received full-mouth scaling and root planing followed by placement of chlorhexidine chips secured by cyanoacrylate at test sites and placement of cyanoacrylate alone at control sites. Test sites still > or =5 mm deep at 3 and 6 months were retreated with renewed chlorhexidine chip application. Recordings of bleeding on probing, probing depths, and clinical attachment levels were performed at baseline, after 6 weeks, and after 3, 6, and 9 months. RESULTS: Improvements of bleeding scores, probing depths and clinical attachment levels were observed for both test and control sites at 6 weeks compared to baseline. Subsequently, all three measurements remained comparatively stable throughout the study. No differences in improvements were found comparing test and control sites. CONCLUSION: This study failed to observe any adjunctive effect of subgingival placement of chlorhexidine chips after scaling and root planing.     

The intra-oral translocation of periodontopathogens jeopardises the outcome of periodontal therapy. A review of the literature

BACKGROUND: Although periodontitis has a multi-factorial aetiology, the success of its therapy mainly focuses on the eradication/reduction of the exogenous/endogenous periodontopathogens. Most of the species colonise several niches within the oral cavity (e.g. the mucosae, the tongue, the saliva, the periodontal pockets and all intra-oral hard surfaces) and even in the oro-pharyngeal area (e.g., the sinus and the tonsils). METHODS: This review article discusses the intra-oral transmission of periodontopathogens between these niches and analyses clinical studies that support the idea and importance of such an intra-oral translocation. RESULTS AND CONCLUSIONS: Based on the literature, the oro-pharyngeal area should indeed be considered as a microbiological entity. Because untreated pockets jeopardise the healing of recently instrumented sites, the treatment of periodontitis should involve "a one stage approach" of all pathologic pockets (1-stage full-mouth disinfection) or should at least consider the use of antiseptics during the intervals between consecutive instrumentations, in order to prevent a microbial translocation of periodontopathogens during the healing period. For the same reason, regeneration procedures or the local application of antibiotics should be postponed until a maximal improvement has been obtained in the remaining dentition. This more global approach offers significant additional clinical and microbiological benefits.     

Full-mouth therapy versus individual quadrant root planning: a critical commentary

BACKGROUND: This commentary compares the abilities of full-mouth disinfection (FDIS), full-mouth root planing (FRP), and partial-mouth disinfection (PDIS) to improve periodontal health. FDIS consists of 4 quadrants of root planing completed within 24 hours with adjunctive chlorhexidine therapies (e.g., rinsing, subgingival irrigation, tongue brushing). FRP denotes 4 quadrants of root planing performed within 24 hours, and PDIS refers to root planing individual quadrants of the dentition, spaced 2 weeks apart. A basic premise of administering full-mouth therapy (FDIS or FRP) is to eliminate or reduce bacterial reservoirs within the oral cavity that could inhibit optimal healing of treated sites or cause periodontal disease initiation or progression. METHODS: Controlled clinical trials that compared the abilities of PDIS and full-mouth root planing with and without adjunctive chlorhexidine chemotherapy to alter periodontal status were reviewed. RESULTS: Several studies conducted at one treatment center indicated that FDIS and FRP attained greater therapeutic improvements than PDIS with respect to decreasing probing depths (PD), gaining clinical attachment (CAL), diminishing bleeding upon probing, and reducing the subgingival microflora. However, the magnitude of PD reductions and gains of clinical attachment must be carefully interpreted, because initial PD measurements were usually determined after scaling and root planing, which may have caused the results to be overstated. Furthermore, in studies that addressed the utility of FDIS, it was not possible to determine if benefits induced beyond PDIS were due to FRP or administration of multifaceted intraoral chlorhexidine treatments ora combination of both therapies. One investigation that had protocol limitations indicated that similar results were attained by FRP with and without adjunctive chemotherapy. In contrast, recent studies from 2 other treatment centers indicated that there were no significant differences when the efficacy of quadrant-by-quadrant root planing was compared to FRP or FDIS with regard to PD reduction, gains of clinical attachment, and impact on the magnitude and quality of the immune response. POSSIBLE CLINICAL IMPLICATIONS: Conceptually, full-mouth therapy (FRP or FDIS) could reduce the number of patient visits and facilitate more efficient use of treatment time. In addition, there appears to be no major adverse reactions to full-mouth root planing with or without adjunctive chemotherapy. However, small study populations and non-corroborating data from different treatment centers indicate that additional randomized clinical trials are needed to determine if full-mouth therapy provides clinically relevant improvements beyond PDIS.     

Quadrant root planing versus same-day full-mouth root planing. I. Clinical findings

OBJECTIVES: The aim of this study was to test the hypothesis that same-day full-mouth scaling and root planing (FM-SRP) resulted in greater clinical improvement compared to quadrant scaling and root planing (Q-SRP) in chronic periodontitis patients over a period of 6 months. MATERIAL AND METHODS: Forty patients were recruited into this study. Subjects were randomised into two groups. The FM-SRP group received full-mouth scaling and root planing completed within the same day, while the Q-SRP group received quadrant root planing at 2-weekly intervals over four consecutive sessions. Whole-mouth clinical measurements were recorded with a manual periodontal probe at baseline (BAS) and at reassessment 1 (R1) (approximately 6 weeks after the completion of therapy), and at reassessment 2 (R2) (6 months after the initiation of therapy). Selected site analyses were performed on the deepest site in each quadrant before and after therapy (R1 and R2) and clinical indices were recorded with an electronic pressure sensitive probe. In addition, during the active phase of treatment clinical data were collected at 2-weekly intervals from the remaining untreated quadrants in the Q-SRP group only. RESULTS: Both therapies resulted in significant improvements in all clinical indices both at R1 and R2. A continuous clinical improvement was seen for both treatment groups during the experimental period, which reached peak levels at 6 months (DeltaPD=1.8 mm, DeltaCAL=1.1 mm, p<0.001; PD: pocket depth; CAL: clinical attachment level). The selected-site analysis revealed no significant differences in any clinical index between the two treatment groups at R2 (DeltaPD=2.8 mm, DeltaRAL=1.1 mm; RAL: relative attachment level). At the selected sites, the analysis of the deep pockets (>7 mm) showed a significantly greater gain in RAL for the FM-SRP group compared to the Q-SRP group at R2 (p<0.05). The results of this analysis however, should be interpreted with care due to the small number of deep pockets. Data from the Q-SRP group provided an insight into how treated and untreated quadrants responded during the initiation of plaque control measures. There were significant reductions in PD, suppuration (SUP), modified gingival index (MGI) and plaque index (PI) in the remaining untreated quadrants in the Q-SRP group during the initial phase of treatment (p<0.05), while minimum changes in RALs and bleeding on probing (BOP) occurred. Nevertheless, the improvement in PD was clearly inferior to that seen after scaling and root planing. CONCLUSION: Following both therapeutic modalities, there were marked clinical improvements at both R1 and R2 (6 months) from baseline. The current study, in contrast to previous findings, failed to show that FM-SRP is a more efficacious periodontal treatment modality compared to Q-SRP. However, both modalities are efficacious and the clinician should select the treatment modality based on practical considerations related to patient preference and clinical workload.     

A clinical and microbiological comparison of the effects of water and 0.02% chlorhexidine as coolants during ultrasonic scaling and root planing

The maxillary teeth of 10 patients with moderately advanced chronic periodontitis were treated in a split-mouth design study. The baseline examination included plaque and bleeding scores, probing depths and probing attachment levels. 2 sites in each quadrant were selected for dark-field microscopic analysis. Each quadrant was randomly assigned to test or control and instrumented with an ultrasonic scaler using either 0.02% chlorhexidine or water as the coolant. Measurements were repeated 2, 6 and 10 weeks later, together with additional plaque sampling. Ultrasonic instrumentation with either chlorhexidine or water was equally effective in reducing bleeding scores and improving probing attachment levels. 42% of chlorhexidine- and 38.7% of water-treated sites showed gains of 1 mm or more in clinical attachment. Mean reductions in probing depth were similar (0.9 mm chlorhexidine, and 0.8 mm water). At the final examination, the chlorhexidine-treated quadrants had significantly more sites with probing depths in the 1-3 mm category and less in the greater than 3 mm category than the control quadrants (P less than 0.05). Both treatments reduced the microscopic counts of motiles and spirochaetes, resulting in a subgingival microbiota consistent with periodontal health. The results indicate that chlorhexidine has a slight adjunctive effect in the reduction of pocket depth when used as a coolant during ultrasonic root planing for the treatment of chronic periodontitis.     

Long-term clinical effects of a chlorhexidine varnish implemented treatment strategy for chronic periodontitis

BACKGROUND: Scaling and root planing in combination with oral hygiene monitoring are still considered the therapeutic standards for periodontitis. Although this treatment concept customarily results in satisfactory clinical improvements, treatment outcome may become less favorable predominantly when full access to periodontal defects is compromised, thereby leaving accretions behind. The purpose of this study was to investigate, over a 9-month period, the clinical benefits of a treatment strategy for chronic periodontitis based on a combination of sequential scaling and root planing and subgingival chlorhexidine varnish administration. METHODS: This randomized controlled, single blind, parallel trial included 26 volunteers with chronic periodontitis. The control group received oral hygiene instructions and was scaled and root planed in two sessions. The test group received the same instructions and treatment; however, all pockets were additionally disinfected using a highly concentrated chlorhexidine varnish. Clinical response parameters were recorded at baseline and at 1, 3, 6, and 9 months. The impact of the initial strategy on the decision-making process for supplementary therapy at 9 months was investigated based on treatment decisions made by five independent clinicians. RESULTS: Both treatment strategies showed significant reductions in probing depth and gains in clinical attachment at study termination in comparison with baseline (P<0.001). However, combination therapy resulted in a significant additional pocket reduction of 0.62 mm (P<0.001). Initially deep pockets (>or=7 mm) around multirooted teeth seemed to benefit most from the combination strategy, resulting in an additive pocket reduction of 1.06 mm (P=0.009) and a clinical attachment gain of 0.54 mm (P=0.048) in comparison to scaling and root planing alone. A trend toward a reduction of surgical treatment needs following the varnish-implemented strategy was found (P=0.076). CONCLUSION: These findings suggest that the outcome of initial periodontal therapy may benefit from the adjunctive subgingival administration of a highly concentrated chlorhexidine varnish.     

A chlorhexidine varnish implemented treatment strategy for chronic periodontitis: short-term clinical observations

OBJECTIVES: The aim of this study was to investigate the clinical outcome of a subgingivally applied chlorhexidine varnish when used as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis. MATERIAL AND METHODS: A randomized controlled, single blind, parallel trial was conducted on the basis of 16 volunteers suffering from chronic periodontitis. The control group received oral hygiene instructions and was scaled and root planed in two sessions. The test group received the same instructions and treatment, however, all pockets were additionally disinfected using a chlorhexidine varnish. The gingival index, plaque index, bleeding on probing, probing pocket depth (PPD) and clinical attachment level (CAL) were recorded at baseline and subsequently after 1 and 3 months. RESULTS: Both treatment strategies showed significant reductions in PPD and CAL at both follow-up visits by comparison with baseline levels (p<0.001). Yet, at study termination, combination therapy resulted in additional pocket reductions between 0.73 and 1.23 mm (p<0.02), and clinical attachment gains between 0.63 and 1.09 mm (p<0.02). CONCLUSIONS: These findings suggest that a varnish-implemented strategy may improve the clinical outcome for the treatment of chronic periodontitis in comparison with SRP alone.