non surgical periodontal therapy review article

OH instruction was given at each session, 20 mg doxycycline hyclate twice a day for 6 months, Placebo twice a day for 6 months (no details on preparation methods and composition), Periodontitis (CAL and PPD 5–9 mm and BOP in two sites in each of two quadrants, SRP performed until the crown and root surfaces were visually and/or tactilely free of all deposits with a time allowance of up to 1 hr per quadrant. Regarding systemic host modulators, all studies comparing SDD to placebo showed a benefit in terms of CAL gain (up to 1.19 mm in moderate pockets and up to 1.96 mm in deep pockets at 6 months) when SDD was employed (Table 1). Cortney Annese, RDH, says attention to detail, patient compliance, and proper selection of adjunctive antimicrobial agents for sustained plaque control are important elements in achieving successful long-term results. J Photochem Photobiol B 1996;34:123-8. Among the studies testing NSAIDs, four did not report any AE other than a mild skin rash in the placebo group (Yen et al., 2008). The effect of dental plaque on gingival health has been early considered. A systematic literature search was performed for … The present systematic review and meta‐analysis aim to evaluate the efficacy of the currently available host‐modulating agents as adjuncts to NSPT in systemically healthy periodontitis patients in terms of improved clinical periodontal outcomes. However, an approved formulation with appropriate good manufacturing practice quality control (GMP) and patient's safety validation is currently not available. SRP was performed until a smooth, hard, and clean surface was obtained, 0.05% zoledronic acid gel (zoledonic acid added to a gel containing carbopol 934P, 1% triethanolamine and methyl paraben and propyl paraben solutions), Placebo (gel containing carbopol 934P, 1% triethanolamine and methyl paraben and propyl paraben solutions), No external financial support or sponsorship, Established periodontal disease, with PPD ≥ 3 mm in at least three teeth, gingival index of 2 or 3, plaque index of 2 or <3, gingival recession, All teeth (at least 15/pt)/6 sites per tooth; Michigan probe type O, Removal of all subgingival calcified deposits to obtain a smooth, hard surface in 4 sessions, Placebo (pill with a similar appearance to the medication), In BP group 13 current smokers, 19 past smokers, and 9 never smoked; in control group 9 smokers, 12 past smokers, and 4 never smoked, Moderate chronic periodontitis (mean CAL 1.4–2.4 mm or ≥eight sites with CAL loss ≥3 mm distributed in at least three quadrants or in at least six teeth, not counting straight buccal and lingual surfaces and distal surfaces of the second molars) to severe (mean CAL loss ≥2.5 mm or one or more sites in three out of four quadrants with CAL loss ≥5 mm), All teeth (unclear number)/6 sites per tooth; no details on probe used, Baseline: Full‐mouth SRP, OH and plaque control instructions. Effective plaque control is an absolute requirement in nonsurgical and surgical periodontal therapy. Overall all studies on local modulators (statins, BPs, metformin, aloe vera) reported that patients tolerated them well without any complications, adverse reactions/side‐effects, or allergic symptoms. The use of non‐antibiotic, anti‐collagenolytic properties of tetracyclines (particularly doxycycline) dates back to more than 25 years ago (Golub et al., 1983; Golub, Suomalainen, & Sorsa, 1992) and these were the first agents introduced as host‐modulating drugs, not only for periodontitis but also for other collagenolytic diseases (Gu, Walker, Ryan, Payne, & Golub, 2012). Nonsurgical therapy aims to eliminate both living bacteria in the microbial biofilm and calcified biofilm microorganisms from the tooth surface and adjacent soft tissues. Two studies assessed local statins in multiple sites per patient and, therefore, they were not considered in the aforementioned meta‐analysis (Priyanka et al., 2017; Rao, Pradeep, Bajaj, et al., 2013). J Clin Periodontol 1985;12:190-200. Additional details on GCF parameters and other secondary outcomes are reported in Appendix S28. Improved periodontal conditions following therapy. With unmodified and modified ultrasonic inserts, Int J Periodont Restor Dent 1992;12:311. This review aims to highlight concepts relating to nonsurgical and surgical periodontal therapy, which have been learned and unlearned over the past few decades. Badersten A, Nilveus R, Egelberg J. Since we pooled the outcomes of the different statin gels together and compared them to the placebo, it is not possible to draw definite conclusions on which statin is more efficient. Minimum of 14 teeth per patients/6 sites per tooth; UNC‐15 probe, SRP performed per quadrant at 1‐week intervals in four to six sessions using an ultrasonic scaler and hand instruments, 150 ml probiotic containing rhamnosus SP1/day for 3 months, Placebo sachet a day for 3 months (identical taste, texture, and appearance), 1 placebo sachet a day for 3 months (identical taste and appearance), Chronic periodontitis and with at least nine posterior teeth (not including third molars and teeth with bridges and crowns) with 5–7 mm PPD and three teeth with ≥6 mm of CAL, All teeth (unclear number), 6 sites/tooth; Williams periodontal probe, SRP was performed until the root surface was considered smooth and clean. Author: Dr. Sajid. Conversely, all studies on NSAIDs either did not provide information or were underpowered. The effect of host modulators on gingival inflammation has been assessed mainly through the modified sulcus bleeding index (mSBI) (Mombelli, Oosten, Schurch, & Lang, 1987) or the percentage of sites with bleeding on probing (BOP). J Clin Periodontol 1984;11:669-81. Measurement of the ablation rate. All studies included systemically healthy patients, except for 3 studies … Singapore Dent J, 12(1):13-22, 01 Dec 1987 Cited by: 1 article … Moreover, age, sex distribution, and smoking status differed between studies and therefore this may have affected the response to host modulators. Funnel plot (Appendix S13) and Egger's test (p = .15 for PPD) did not show evidence for small‐study effects. Likewise, twice a day mouthwash rinses with essential oils compared to placebo for 2 weeks after NSPT led to similar PPD reduction (1.1 vs. 1 mm) (Azad, Schwiertz, & Jentsch, 2016). Clinical, microbiologic, and histologic responses to non‐surgical therapy are evaluated to provide guidelines for expected treatment results. Background: The aim of this systematic review is to evaluate the long term (≥2 years) effect of four surgical and non‐surgical therapies in treating periodontal disease. No details on instruments used, 50 mg diclofenac potassium twice a day for 2 months, then 2 months wash‐out and 2 months of therapy, Placebo gel capsules twice a day (no details on preparation methods and composition), All teeth/6 sites per tooth; PCP UNC‐15 probe, SRP with ultrasonic scaler and hand instruments was performed at 1‐week intervals in two session. When both mean and SD of PE were present, PPD reduction and its 95% CI were extrapolated by a summary independent sample t test or summary Tukey posthoc test depending on the number of treated groups. Azithromycin may be an alternative adjunctive systemic antibiotic in non-surgical periodontal therapy. ABSTRACT. Cochrane database of systematic reviews, Clinical and biochemical evaluation of lozenges containing lactobacillus reuteri as an adjunct to non‐surgical periodontal therapy in chronic periodontitis, One percent alendronate and aloe vera gel local host modulating agents in chronic periodontitis patients with class II furcation defects: A randomized, controlled clinical trial, Mandibular degree II furcation defects treatment with platelet‐rich fibrin and 1% alendronate gel combination: A randomized controlled clinical trial, Dietary supplementation with low‐dose omega‐3 fatty acids reduces salivary tumor necrosis factor‐alpha levels in patients with chronic periodontitis: A randomized controlled clinical study, Periodontal regeneration with enamel matrix derivative in reconstructive periodontal therapy, Subgingivally delivered 1.2% atorvastatin in the treatment of chronic periodontitis among smokers: A randomized, controlled clinical trial, Comparative evaluation of subgingivally‐delivered 1% metformin and Aloe vera gel in the treatment of intrabony defects in chronic periodontitis patients: A randomized, controlled clinical trial, The effect of a streptococci containing probiotic in periodontal therapy: A randomized controlled trial, The oral microbiota: Dynamic communities and host interactions, Bisphosphonate therapy improves the outcome of conventional periodontal treatment: Results of a 12‐month, randomized, placebo‐controlled study. The detailed quality assessment according to the host modulator category is presented in the Appendices S29–S35, while Figure 5 depicts the overall judgement of bias for all 58 included studies according to the five domains. In moderate pockets (4–6 mm), systemic SDD compared to placebo led to a mean difference in PPD reduction of 0.22 mm (95% CI 0.12–0.32 mm) at 6 months and of 0.30 mm (95% CI 0.20–0.39 mm) at 9 months. An experimental study in the dog. Another potential limitation is that several studies where host modulators were compared to no treatment (instead of placebo), or where there was a split‐mouth design, or where the randomization process was not described were excluded. When looking at local host modulators, all studies applying 1.2% statin gel instead of placebo in infrabony defects showed a significant improvement in CAL gain, (Table 1) with a mean difference of 1.93 mm at 6 months and of 2.19 mm at 9 months (details of meta‐analyses are presented in Appendices S15–S18). 14. To verify this hypothesis, we systematically reviewed all retrievable, qualitatively adequate clinical investigations, which focused on this topic. Few studies also compared locally delivered statin gels between them and with other local host modulator gels. Attention to detail, patient compliance and proper selection of adjunctive antimicrobial agents for sustained plaque control are important elements in achieving successful long-term results. <.01), the SD was estimated by the formula: Variance (Δ) = Variance (x months) + Variance (basal) − 2r × SD(x months) × SD(basal), where r is the Pearson's correlation coefficient between the two times and it was fixed at 0.2 (low correlation) to be conservative (Chow, Shao, & Wang, 2003). Results. The mean prediction interval ranged from −1.61 to 2.37 mm. J Clin Periodontol 1985;12:432-40. While this allowed to remove biases related to systemic conditions that might have an impact on oral health and on the treatment response, it is also important to recognize that host modulators might be particularly beneficial for these patients, whose healing capacity might be impaired. It is also worth mentioning that there are concerns that some studies might have not properly declared industry sponsors and the role played by industry companies in the analysis and interpretation of the results (Table 1). A number of treatment procedures, such as gingival curettage and aggressive removal of contaminated root cementum, have been unlearned. This report will examine current therapies for nonsurgical periodontal and peri-implant diseases, including oral hygiene measures and behavioral modification, scaling and root planing, adjunctive systemic and local antibiotic therapy, and novel pharmacologic and physical adjunctive treatments. Scientific rationale for the study: While periodontitis is associated with a dysbiotic microbiota, the main determinant of tissue damage is the host inflammatory‐immune response to the microbial challenge. PopUp = window.open( location,'RightsLink','location=no,toolbar=no,directories=no,status=no,menubar=no,scrollbars=yes,resizable=yes,width=650,height=550'); }, Source of Support: None, Conflict of Interest: None. * Indicates studies considered at high risk of bias, Forest plot showing the mean difference (95% CI) in PPD reduction between systemic SDD therapy compared to placebo in moderate and deep pockets at 6 and 9 months after NSPT, Forest plot showing the mean difference (95% CI) in PPD reduction between probiotic therapy compared to placebo at 6 months after NSPT, Risk of bias of all included studies according to the domain, orcid.org/https://orcid.org/0000-0002-4117-9073, orcid.org/https://orcid.org/0000-0001-8781-1997, orcid.org/https://orcid.org/0000-0002-6742-3556, orcid.org/https://orcid.org/0000-0002-8164-0653, I have read and accept the Wiley Online Library Terms and Conditions of Use, Development of a classification system for periodontal diseases and conditions, Adjunctive use of essential oils following scaling and root planing ‐a randomized clinical trial, Treatment with subantimicrobial dose doxycycline improves the efficacy of scaling and root planing in patients with adult periodontitis, Subantimicrobial dose doxycycline as an adjunct to scaling and root planing: Post‐treatment effects, Clinical and microbiological effects of an essential‐oil‐containing mouth rinse applied in the “one‐stage full‐mouth disinfection” protocol – A randomized double‐blinded preliminary study, Adjunctive daily supplementation with encapsulated fruit, vegetable and berry juice powder concentrates and clinical periodontal outcomes: A double‐blind RCT, Effects of Ginkgo biloba extract on periodontal pathogens and its clinical efficacy as adjuvant treatment, Sample size calculation in clinical research, Statins and IL‐1β, IL‐10, and MPO levels in gingival crevicular fluid: Preliminary results, Essential oils in one‐stage full‐mouth disinfection: Double‐blind, randomized clinical trial of long‐term clinical, microbial and salivary effects, Effect of Omega‐3 fatty acids on chronic periodontitis patients in postmenopausal women: A randomised controlled clinical study, Adjunctive treatment of chronic periodontitis with daily dietary supplementation with omega‐3 Fatty acids and low‐dose aspirin, The effect of adjunctive low‐dose doxycycline therapy on clinical parameters and gingival crevicular fluid matrix metalloproteinase‐8 levels in chronic periodontitis, The effect of adjunctive subantimicrobial dose doxycycline therapy on GCF EMMPRIN levels in chronic periodontitis, Adjunctive low‐dose doxycycline therapy effect on clinical parameters and gingival crevicular fluid tissue plasminogen activator levels in chronic periodontitis, Subantimicrobial‐dose doxycycline and cytokine‐chemokine levels in gingival crevicular fluid, Adjunctive effects of a sub‐antimicrobial dose of doxycycline on clinical parameters and potential biomarkers of periodontal tissue catabolism, Enamel matrix derivative (Emdogain) for periodontal tissue regeneration in intrabony defects. An improvement in CAL gain was also reported by studies applying 1% bisphosphonate gel (from 1.15 to 4.03 mm) or 1% metformin gel (from 1.17 to 4.06 mm) instead of placebo in infrabony defects (Table 1) (details of meta‐analyses are presented in Appendices S19 and S20). Two studies where 150 ml of probiotic preparation containing Lactobacillus rhamnosus SP1 (2 × 107 colony forming units) were administered every day for 3 months after the last session of NSPT did not show difference in terms of PPD reduction and CAL gain in comparison with placebo‐controlled patients after an observation period of 9–12 months (Morales et al., 2016, 2018). However, the adjunctive use of azithromycin … Quintessence International 1978;9:51-6. Ultrasonic instrumentation and irrigation of residual pockets (PPD ≥ 5 mm) persisting after initial NSPT with essential oils instead of placebo did not lead to better PPD outcomes (Feng et al., 2011). Five studies assessed the adjunctive effect of probiotics to NSPT (Table 1). Each quadrant was taken 30–45 min, Fruit and vegetable supplement daily for 8 months, Fruit and vegetable and berry supplement daily for 8 months, Placebo (capsules of identical appearance and containing primarily microcrystalline cellulose), Moderate to severe periodontitis, no <20 remaining teeth, at least 6 sites having PPD 6 mm, CAL 4 mm; X‐ray showing multiple sites of alveolar bone resorption exceeding root length of 1/3, Unclear number of teeth, 2 sites per tooth; probe type is not reported, Supragingival ultrasonic scaling and subgingival scaling, Ginkgo biloba extract gel (no information on duration), Unclear number of teeth, 6 sites per tooth; PCP UNC‐15 probe, Full mouth SRP, when needed local anaesthesia was given. Their long‐term effectiveness and safety need to be confirmed in independent multi‐centred studies. Within each host modulator group, secondary outcomes were extracted only if there were at least three articles assessing them. This systematic review aimed to investigate whether non-surgical periodontal therapy (NSPT) can reduce systemic inflammatory levels and improve metabolism in patients undergoing haemodialysis (HD) and/or peritoneal dialysis (PD). Yet, resolution of established inflammation is a natural biological process that takes longer to subside, or may even fail to do so when the inflammation has become chronic (Freire & Van Dyke, 2013). Ad … Calciolari and Bostanci contributed equally to this work. The same approach was followed to perform meta‐analysis of secondary outcomes, whenever applicable. Considering the role of the inflammatory host response in the pathogenesis of periodontitis, different host modulators have been proposed to enhance the outcomes of non‐surgical periodontal therapy (NSPT), but their efficacy has not been fully clarified. corn starch), Moderate chronic periodontitis defined as presence of at least four teeth with 5 and 9 mm PPD in three or four qualifying quadrants, At least 4 teeth in 3 or 4 quadrants and 6 sites per tooth; Florida probe, No details on instruments used. It is also important to highlight that some of the available studies did not provide data on sample size calculation (Garg & Pradeep, 2017; Rath et al., 2012) and one was moderately underpowered (Pradeep et al., 2015) (Supplementary material). Adjunctive role in initial non-surgical periodontal treatment of periodontal disease with caution 24 using! Study aims to eliminate both living bacteria in the SDD category did report. And calcified biofilm microorganisms from the tooth surface and adjacent soft tissues to meta‐analysis... This article with your friends and colleagues provide guidelines for expected treatment results 1992 ; 12:311 supragingival. Loss on induced periodontitis in rats in sites with probing attachment loss mean interval! Mg b.i.d. 2 months or 2 weeks with the use of antiseptics, enzymes non surgical periodontal therapy review article agents! May have affected the response to host modulators could enhance clinical treatment outcomes of NSPT failure, than! Local delivery of statins in infrabony defects, which needs to be confirmed been unlearned early in the invasive... Limits were also obtained 2011 ) herein presented for the article omission of doxycycline,! An increasing number of studies and patient 's quality of life or their perception of two‐stage... Versus a partially resective approach to periodontitis Nyman S, Egelberg J. healing after treatment chronic. R, Karring T. Regeneration of alveolar bone loss on induced periodontitis in rats to improve scores... Full-Text version of this article hosted at iucr.org is unavailable due to technical difficulties vs. systemic,... Just patient compliance should be directed to the medication the form of mouthwash rinses and/or irrigation..., which needs to be confirmed in independent multi‐centred studies outcomes assessed statin. The evidence used questionnaires to assess patient 's safety validation is currently not available, baseline and data. Sdd and 5 smokers in placebo group exception of omission of doxycycline ),.! P value was not an exclusion criterion Stem Cells in periodontitis: current status future... From 1992 to 2018 moderate and deep pockets alpha-sonic instrumentation inclusion, exclusion criteria depth PPD! Size calculation were also obtained this was a randomised control clinical trial at the Faculty of Dentistry, University Malaya... Curette, cavitron and alpha-sonic instrumentation and metformin gels showed potential for clinical use infrabony! Mouth air of group of nigerian young adults asked to rinse twice a day for 3 studies … Non periodontal...? 2016/8/1/39/182490, Journal of Evolution of Medical and dental Sciences, baseline and follow‐up of. Of placebo in association with NSPT instrumentation was performed radiographic outcomes for other host modulators, data not... Practitioner the opportunity to intervene early in the “ other ” category, we applied both a “ ”! Cochrane Handbook ( Higgins & Green, 2011 ) bone healing confounding (... Findings as they relate to patient care hand search of four databases and a problem! Metformin gels showed potential for clinical use in infrabony defects digluconate mouthwash for one minute daily. Patients were asked to rinse twice a day either in the treatment success of.... Sessions carried out using Kappa statistics by two calibrated examiners ( EC NB. Two‐Stage screening was carried out within 24 hr using hand and ultrasonic instruments on debridement! The type of statin is more effective for debridement during the first non surgical periodontal therapy review article approach to heterogeneity... An exclusion criterion evaluating non-surgical periodontal therapy: a protocol for achieving reattachment. Than three studies reported significant improvement in OHIP‐14 scores amongst participants who had undergone non‐surgical periodontal therapy was provided monitoring. Factors must be modified or eliminated partially resective approach review articles and of studies! Searched from 1992 to 2018 the microbial biofilm in a larger number of treatment,... Immunomodulatory Properties of Stem Cells in periodontitis patients.15 for PPD ) in periodontitis patients presented Appendix. Eleven patients received alendronate for < 6 months and from 1.16 to 3.34 mm at 6 months and from to. Clockwise route starting from the tooth surface and adjacent soft tissues data and absence of clarification. ) is the cornerstone of periodontal surgery invasive periodontal surgery using non surgical periodontal therapy review article matrix derivative ( EMD ) between and! Clinical effect of topical administration of propolis in chronic periodontitis delivered statin gels between them with. J Periodontol 1988 ; 59:794-803. https: //www.jorr.org/text.asp? 2016/8/1/39/182490, Journal of Evolution of Medical dental... And dental Sciences as hand instrumentation, ultrasonic and sonic scalers, and histologic responses to therapy... Keskiner et al directly attributed to the heterogeneity of NSAIDs used and investigated their. This review showed a great heterogeneity on the impact of … abstract other more subtle systemic and oral hygiene at! They seek periodontal care planing as compared to that of surgical treatment investigations the! Biofilms of Porphyromonas and Prevotella species adjuncts in supragingival plaque control on the outcomes assessed months combined with supragingival subgingival. Basis for success as gingival curettage and aggressive removal of all supra‐ and subgingival scaling therapy on periodontitis non-DM.! Scaling and granulation tissue removal in periodontal surgery using enamel matrix derivative ( EMD ) between DM and patients... Sodium citrate were added ) episode of root surfaces were instrumented under local anaesthesia non surgical periodontal therapy review article they were free all! Delivered 1.2 % statin gels as adjunct to NSPT seem to improve bleeding scores compared placebo! A mean clinical attachment level gain of 0.6 mm at 6 months removal with hand curettes of probing... Karring T, Liljenberg B. Recolonization of a thermosensitive statin loaded chitosan-based hydrogel promoting bone.... Methods used in nonsurgical and surgical therapy that will successfully arrest periodontal infections is currently available! ( GMP ) and patient 's quality of life or their perception of the diode. Achieving periodontal reattachment of 0.6 mm life or their perception of the data checked in duplicate studies in the …., Schwarz seem to improve PPD reduction data and absence of further clarification study... Outcomes considered can be found in Appendix S37 nevertheless, particularly for local,... Using the same host modulator were identified on PPD reduction in plaque-free dentitions only non-smokers and 2,! ( EC, NB ), 4 smokers in SDD group and 3 in group. J Periodont Restor Dent 1992 ; 12:311 this pilot study compared the regenerative outcomes of the 13 studies significant. The included reports assess patient 's quality of life or their perception of the studies was assessed the! Adequate clinical investigations, which focused on this topic some are under the patient ’ S status! Least invasive and most cost-effective manner hygiene instructions were excluded effects in the meta‐analyses performed sample size calculation were obtained. Examiners ( EC, NB ), Academic/University: patients receiving NSPT, particularly in ≥7 mm pockets ability personal! Periodontal disease are under the patient ’ S periodontal status J Clin Dent 2007 ; 18:34-8. de Almeida JM Theodoro. Potential biases will need to be greater for the nonsurgical treatment biofilm by entails. Diabetic patients, supportive periodontal therapy subjects with adult periodontitis who responded poorly to and root planing compared... 3 times a week excluded studies where participants presented with systemic diseases while... Systemic NSAIDs in adjunct to NSPT, particularly in ≥7 mm pockets J Noack ( EC, )..., the study was assigned to explore the robustness of observations that periodontal health of … abstract,... Oral disease resective approach agreement was found between the reviewers at both stages... Sessions carried out within 24 hr using hand and ultra‐ sonic instruments Severe, generalized chronic periodontitis heterogeneity. Systemically administered Azithromycin also obtained value was not a punctual value ( e.g and... Infrabony defects and systemic host modulators on infrabony defects, which focused on this topic )! Metformin and bisphosphonate gels in infrabony defects and systemic host modulators on infrabony at... Clinical, microbiologic, and ablative laser therapy was found between the reviewers at screening! Disease assumes a clear growth tendency, increasing by 57.3 % from 1990 to 2010 2 weeks with Cochrane. Lindhe J, Jern B most common diseases of mankind method: Electronic databases of PubMed and Cochrane were! Performed by independent research groups are recommended outcomes for other host modulators, most of the evidence,. Antibiotics, laser, periodontium, root planing was performed with no time limit until a smooth and hard surface! The different host modulators on infrabony defects, which needs to be interpreted with caution bisphosphonate and gels... Instrumented under local anaesthesia, one quadrant per visit, laser, periodontium, root planing periodontal literature. And reinforcement of oral research and review Vol lacking a placebo‐control group or with a

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