Abstract
Aims: To systematically review the literature addressing the following focused questions: “What is the efficacy of either (#1) alternative or (#2) additional methods to professional mechanical plaque removal (PMPR) on progression of attachment loss during supportive periodontal therapy (SPT) in periodontitis patients?”.
Methods: A systematic search for randomized clinical trials was performed. Change in clinical attachment level (CAL) from baseline was the primary outcome.
Results: Routine PMPR performed with either a combination of ultrasonic/hand instruments or Er:Yag laser showed similarly effective in preventing CAL loss. Moreover, a routine SPT regimen based on PMPR led to stability of CAL irrespective of a daily sub-antimicrobial doxycycline dose (SDD). Finally, an adjunctive photodynamic therapy (PDT) did not enhance the magnitude of CAL gain when sites with probing depth≥ 4 mm were repeatedly treated. After pooling all data, the results of the meta-analysis showed no statistical differences in CAL change from baseline: mean overall CAL change was -0.233 mm (95% confidence interval: -1.065, 0.598; p=0.351).
Conclusions: Weak evidence indicate that in treated periodontitis patients enrolled in a 3-4 month SPT based on PMPR, Er:Yag laser (as alternative), SDD and PDT (as additional) do not produce a greater clinical effect on periodontal conditions compared to PMPR.
CLINICAL RELEVANCE
Scientific background: When managing maintenance of treated periodontitis patients, limited information exists on the efficacy of alternative or adjunctive treatments for conventional professional mechanical plaque removal (PMPR).
Principal findings: Within the context of a 3-4 month SPT recall program, (i) daily supplementation with subantimicrobial dose of doxycycline and routine photodynamic therapy have limited to no adjunctive effect over PMPR; (ii) Er:Yag laser may maintain stable attachment levels at deep bleeding and/or suppurating pockets similarly to ultrasonic/hand instrumentation.
Practical implications: Limited evidence indicates that adjunctive treatments may not provide any additional benefit compared with mechanical PMPR in supportive periodontal therapy.
Methods: A systematic search for randomized clinical trials was performed. Change in clinical attachment level (CAL) from baseline was the primary outcome.
Results: Routine PMPR performed with either a combination of ultrasonic/hand instruments or Er:Yag laser showed similarly effective in preventing CAL loss. Moreover, a routine SPT regimen based on PMPR led to stability of CAL irrespective of a daily sub-antimicrobial doxycycline dose (SDD). Finally, an adjunctive photodynamic therapy (PDT) did not enhance the magnitude of CAL gain when sites with probing depth≥ 4 mm were repeatedly treated. After pooling all data, the results of the meta-analysis showed no statistical differences in CAL change from baseline: mean overall CAL change was -0.233 mm (95% confidence interval: -1.065, 0.598; p=0.351).
Conclusions: Weak evidence indicate that in treated periodontitis patients enrolled in a 3-4 month SPT based on PMPR, Er:Yag laser (as alternative), SDD and PDT (as additional) do not produce a greater clinical effect on periodontal conditions compared to PMPR.
CLINICAL RELEVANCE
Scientific background: When managing maintenance of treated periodontitis patients, limited information exists on the efficacy of alternative or adjunctive treatments for conventional professional mechanical plaque removal (PMPR).
Principal findings: Within the context of a 3-4 month SPT recall program, (i) daily supplementation with subantimicrobial dose of doxycycline and routine photodynamic therapy have limited to no adjunctive effect over PMPR; (ii) Er:Yag laser may maintain stable attachment levels at deep bleeding and/or suppurating pockets similarly to ultrasonic/hand instrumentation.
Practical implications: Limited evidence indicates that adjunctive treatments may not provide any additional benefit compared with mechanical PMPR in supportive periodontal therapy.
| Original language | English |
|---|---|
| Journal | Journal of Clinical Periodontology |
| Early online date | 14 Feb 2020 |
| DOIs | |
| Publication status | E-pub ahead of print - 14 Feb 2020 |
Keywords
- periodontitis
- periodontal diseases
- secondary prevention
- Disease progression
