Efficacy of alternative or additional methods to professional mechanical plaque removal during supportive periodontal therapy: A systematic review and meta-analysis

Leonardo Trombelli, Roberto Farina, Alex Pollard, Nicholas Claydon, Giovanni Franceschetti, Iftekhar Khan, Nicola West

Research output: Contribution to journalArticle (Academic Journal)peer-review

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.
Original languageEnglish
JournalJournal of Clinical Periodontology
Early online date14 Feb 2020
DOIs
Publication statusE-pub ahead of print - 14 Feb 2020

Keywords

  • periodontitis
  • periodontal diseases
  • secondary prevention
  • Disease progression

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