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PubMed2001

Subantimicrobial dose doxycycline as an adjunct to scaling and root planing: post-treatment effects.

BACKGROUND/OBJECTIVE: Subantimicrobial dose doxycycline (SDD 20 mg bid) plus scaling and root planing (SRP) significantly improved clinical attachment level (CAL) and reduced probing depth (PD) compared with placebo plus SRP in a double-blind, placebo-controlled, multicenter study of patients with adult periodontitis (AP). In a study conducted as a follow-up, the post-treatment effects of SDD were assessed in patients who completed the SRP study. METHODS: The SRP study was a 9-month, active-treatment study and the follow-up was a 3-month, no-treatment study. In the SRP study, tooth sites in qualifying quadrants were scaled and root planed and patients were randomized to receive twice daily SDD 20 mg or placebo. In the follow-up, patients received no study drug; investigators and patients remained blinded to the previous treatment group assignments. Efficacy measures included the change in CAL and PD from baseline values determined at the start of the SRP study in tooth sites stratified by baseline PD (i.e., 0-3 mm, 4-6 mm, > or =7 mm). Safety was evaluated using adverse event data and the results of clinical laboratory tests, oral pathology examinations, and microbiological assessments. RESULTS: Within each disease stratum, the incremental improvements in PD and CAL demonstrated in the SDD group over 9 months of active treatment were maintained through 3 additional months of no treatment. Treatment cessation did not result in an accelerated regression of periodontal health. No differences in the incidence of adverse events (including those related to infection) or laboratory or microbiological parameters were noted between the SDD group and the placebo group. CONCLUSIONS: The administration of SDD 20 mg bid for a period of up to 9 months is not associated with rebound effects or delayed or negative after-effects for a 3-month period after cessation of therapy.

Adult↗
PubMed2002

Comparison of conventional periodontal maintenance versus scaling and root planing with subgingival minocycline.

BACKGROUND: Alternative regimens using subgingival antimicrobials compared to conventional periodontal maintenance (PM) may lead to more efficient protocols. The purpose of this study was to evaluate treatment time and clinical and radiographic outcomes in 2 periodontitis cohorts, one receiving conventional PM and the other receiving scaling and root planing (SRP) and multiple doses of subgingival minocycline. METHODS: Moderate to advanced chronic periodontitis patients were concurrently treated with either: 1) scaling and root planing and 4 subgingival doses of minocycline microspheres in all > or = 5 mm pockets over a 6-month period (RP/M; n = 24 patients); or 2) conventional 3-month periodontal maintenance (PM; n = 24 patients). Clinical and radiographic measurements, including probing depth (PD), clinical attachment level (CAL), and interproximal bone height (BH), were analyzed in 2 premolar/molar interproximal > or = 5 mm pockets at baseline and 1 year using paired t tests, analysis of variance, chi-square analysis, and correlation coefficients. RESULTS: Baseline clinical and radiographic data were similar between RP/M and PM patients. Probing depths showed greater mean improvement in RP/M (0.9 +/- 0.1 versus 0.4 +/- 0.1 mm, P = 0.02), with 25% of subjects in RP/M gaining > or = 2 mm compared to 4.2% in PM (differences were statistically significant). The mean loss in bone height and percent subjects losing bone height were less in RP/M (0.05 +/- 0.05 mm; 12.5%) than PM (0.09 +/- 0.08 mm; 16.7%), but bone height differences were not statistically significant. A subset of RP/M molar furcation sites responded with similar PD reduction and no BH loss over 1 year. While cross-sectional RP/M data between CAL and BH, or PD and CAL were highly correlated, changes over 1 year were not correlated among any of these parameters. CONCLUSIONS: Scaling and root planing and subgingival minocycline in experimental sites took little time (<5 minutes/appointment), but resulted in more probing depth reduction and less frequent bone height loss than conventional periodontal maintenance.

Administration, Topical↗
PubMed2006

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.

Adult↗
PubMed1990

Recolonization of the subgingival microflora after scaling and root planing in human periodontitis.

The purpose of this study was to evaluate the recolonization patterns of the subgingival microflora of adult periodontitis patients after a single session of scaling and root planing. In each of eight patients, three clinically diseased sites were investigated microbiologically by darkfield microscopy and cultural analysis. After initial clinical and microbiological parameters were determined, each subject received a single session of scaling and root planing but no oral hygiene instructions. Clinical indices were measured and microbial parameters were reassessed 7, 21, and 60 days after treatment in a manner such that each of the test sites was sampled only once after treatment. Recolonization was evaluated by matching any single site with its own preoperative site. A significant improvement in probing depth was noted for up to 60 days after treatment, while the gingival index did not change markedly during the course of the study. The microbial composition of treated sites 7 days after scaling and root planing, as determined by both cultural and darkfield data, was similar to that of periodontally healthy sites. Differences between cultural and darkfield data became apparent at the 21 day sampling point. The darkfield data showed that the sites consisted of cocci with few spirochetes. Cultural data demonstrated that the majority of the cocci were anaerobic, namely Streptococcus intermedius, Veillonella parvula, and Peptostreptococcus micros. At 60 days, there was no significant variation in any of the parameters from pretreatment levels. The most prevalent anaerobic rods prior to and 60 days after therapy were Fusobacterium nucleatum, Bacteroides gingivalis, and B. intermedius.(ABSTRACT TRUNCATED AT 250 WORDS)

Actinobacillus↗
PubMed2006

Orthodontic extrusion with or without circumferential supracrestal fiberotomy and root planing.

The aim of this randomized clinical trial was to carry out a biometric comparison between the orthodontic extrusion (OE, group B) technique and OE combined with fiberotomy and root planing (OEFRP, group A). Twenty single-root teeth were extruded and assigned to two different groups. In both groups, fixed orthodontic appliances were activated weekly during the course of 3 weeks. After activation, the extruded teeth were maintained in retention for a period of 8 weeks. In group A, along with weekly activation, fiberotomy and root planing were carried out on the top of the alveolar bone crest. Statistical analysis revealed that the amount of dental structure exposed was greater in group A, where the gingival margin and bone tissue remained stable (P < .05). Group B presented coronal migration of the gingival tissue and bone tissue of 2 mm and 1.5 mm, respectively.

Adult↗
PubMed1990

5-year follow up of periodontal intraosseous defects treated by root planing or flap surgery.

Intraosseous, periodontal defects in 12 subjects initially treated by root planing alone (21 defects) or by flap surgery (21 defects) were monitored during a 5-year postoperative interval. Maintenance therapy during this interval was limited to reinforcement of oral hygiene and tooth polishing every 6 months. No subgingival instrumentation was performed at the defect sites. Longitudinal clinical measurements demonstrated that surgically-treated lesions responded with somewhat more reduction of probing depth and more gain of probing bone level than root-planed lesions. Mean gains of probing attachment level were similar for the 2 treatments. Some relapse of the clinical conditions could be observed towards the end of the 5-year observation interval compared to the results at year 1 and year 2. However, the majority of defects subjected to either treatment showed 60-month recordings of probing attachment and probing bone levels equal to or slightly improved compared to those at baseline. Counts from cultures of subgingival, microbial samples were obtained at 42, 48 and 60 months. No significant difference between the 2 therapies was observed for the investigated groups of micro-organisms.

Adult↗
PubMed2001

Intrapocket anesthesia for scaling and root planing: results of a double-blind multicenter trial using lidocaine prilocaine dental gel.

BACKGROUND: The efficacy of a novel anesthetic gel (lidocaine 25 mg/g plus prilocaine 25 mg/g in thermosetting agents) for non-invasive periodontal pocket anesthesia was evaluated. METHODS: One hundred twenty-two (122) patients in 8 centers with moderate to severe periodontitis requiring scaling and root planing (SRP) were enrolled in this multicenter, randomized, double-blind, controlled clinical trial. The active dental gel or a matching placebo gel was applied into the periodontal pocket using a blunt applicator. Following a waiting period of 30 seconds to 2 minutes, scaling and root planing were performed. If the patient had any discomfort, a second application of the gel was applied. If the patient continued to experience discomfort, conventional anesthesia was offered. After all teeth in the test quadrant had received SRP, the overall pain was assessed by the patient using a 100 mm horizontal, ungraded visual analog scale in which the left side was marked "no pain" and the right side marked "worst pain imaginable." Patients also assessed pain by using a 5-point verbal rating scale, from "no pain" to "very severe pain." RESULTS: The visual analog scale showed significant reductions in reported pain, favoring the active gel over the placebo (mean reduction, 8 mm; P <0.0005). The verbal rating scale revealed that 90% of patients treated with active gel reported no pain or mild pain compared to 64% of placebo-treated patients (P<0.001). CONCLUSIONS: Intrapocket administration of lidocaine 25 mg/g plus prilocaine 25 mg/g and thermosetting agents may be effective for pain control for scaling and root planing and may offer an alternative to infiltration anesthesia.

Administration, Topical↗
PubMed2006

A systematic review on the effects of the chlorhexidine chip when used as an adjunct to scaling and root planing in the treatment of chronic periodontitis.

BACKGROUND: Several local antimicrobial agents, such as a bioabsorbable chlorhexidine chip, have been developed to enhance the outcome of non-surgical periodontal therapy. METHODS: Electronic (MEDLINE and Cochrane Oral Health Group Specialized Trials Register) and manual searches were performed to detect studies concerning the use of the chlorhexidine chip as an adjunct to scaling and root planing in the treatment of chronic periodontitis. Only full-text randomized controlled trials published in English up to June 2005 were included. RESULTS: Five studies were finally selected following independent screening by two reviewers. Due to considerable heterogeneity in study design, a qualitative data analysis was performed. Multicenter studies have indicated significantly higher pocket reductions and clinical attachment gains following a combination of mechanical debridement and repeated chlorhexidine chip administration in comparison to scaling and root planing alone. However, some recent studies failed to confirm the additional value of the chlorhexidine chip. A number of interstudy disparities with respect to methodological quality and study design may account for this lack of accordance. CONCLUSIONS: The clinical and microbiological data currently available on the chlorhexidine chip are limited and conflicting. More research is needed to elucidate the additional value of the chlorhexidine chip when used as an adjunct to scaling and root planing.

Absorbable Implants↗
PubMed1986

Clinical and microbiologic effects of single-dose metronidazole or scaling and root planing in treatment of adult periodontitis.

Sites affected with adult periodontitis were observed for 3 months to compare their clinical and microbiologic responses to a single 2 g dose of metronidazole, scaling and root planing, or no treatment. 2 sites with probing depths greater than or equal to 5 mm in each of 18 female subjects (6 in each treatment group) were evaluated clinically (plaque and bleeding indices, probing depth, attachment loss) and microbiologically (%s of cocci, motile rods, non-motile rods and spirochetes, and of obligate anaerobic colony-forming units, black-pigmented Bacteroides, Fusobacterium and Actinobacillus actinomycetemcomitans in subgingival plaque). No significant differences in these variables existed between the 3 groups at baseline. The no-treatment (control) group showed no substantial clinical or microbiologic changes during the study. After 1 month, scaling and root planing had effected significant clinical improvement and significant shifts in the subgingival flora to a pattern more consistent with periodontal health; these changes were still evident at 3 months. In contrast, 1 month after metronidazole, there was some clinical improvement and a significant increase in cocci and a decrease in motile rods, but at 3 months these changes were no longer evident. The results show that the benefits of scaling and root planing are sustained for at least 3 months. However, the benefits of a single 2 g dose of metronidazole are both few and transient, indicating that this regimen, while effective against anaerobic infections in other organ systems, is not clinically or microbiologically effective in the treatment of adult periodontitis.

Adult↗
PubMed1994

Effectiveness of oral hygiene with and without root planing in treating subjects with chronic periodontitis.

The extent to which patients with chronic periodontitis could improve their condition by oral hygiene without instrumentation was investigated. Ten subjects were assessed, instructed in a subgingivally-directed oral hygiene technique (OH) twice a week until plaque was present at less than 20% of sites on two occasions and reassessed after 6 weeks when half the mouth was root planed. A final assessment took place after a further 6 weeks. At six weeks the mean number of sites with bleeding on probing (BOP) was significantly reduced (P < 0.001), the percentage of sites with BOP falling from 59% to 34%. In addition, an increase in gingival recession (P < 0.001) was accompanied by a reduction in mean probing depths (PD) (P < 0.05). The mean percentage reduction in sites with BOP was greatest for sites with probing depths less than 4 mm at baseline but even at sites with PD of 6 mm or more the mean BOP reduced from 81% to 57% of sites. Root planing at 6 weeks resulted in further significant reductions at 12 weeks in both BOP (to 10% of all sites) and in PD (P < 0.001), but there was little further change for the sites receiving OH alone. There was some evidence that this adjunctive effect of root planing was also present at sites with a PD less than 4 mm at baseline and at sites without retention factors at or below the gingival margin. The results indicate that patients with chronic periodontitis can improve their periodontal condition by OH alone even in deep pockets.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Attachment of human gingival fibroblasts to planed root surfaces exposed to human plasma in vitro.

We studied the effect of exposing planed dentin surfaces (DS) to human plasma on the attachment of human gingival fibroblasts (HGF) in vitro as compared with their attachment to citric-acid-demineralized DS. Sixty-six DS were prepared from root-planed roots of surgically extracted human third molars. In a pilot experiment 30 DS were demineralized in citric acid (pH 1.0 for 3 min), and each of 3 DS were placed in a culture dish and incubated with fresh plasma for 0, 10, or 30 sec, 1, 10, or 30 min, or 1, 1.5, 2, or 4h. In a second experiment, three culture dishes containing three DS each were assigned to each of four groups. These were untreated (control), incubated with plasma for 2h, acid-demineralized only, or acid-demineralized and then incubated with plasma for 2h. To each dish was added 0.2 X 10(6) HGF, and these were incubated for 2, 6, or 24 h. The unattached cells were then removed, and the DS fixed and processed for SEM. The results showed that exposing demineralized dentin surfaces to plasma causes the absorption of a coating layer, presumably of organic nature, as early as 30 sec after exposure. Acid-demineralized DS alone or together with plasma treatment enhanced both the attachment and the growth of HGF. However, treatment with plasma alone seemed to enhance the HGF attachment less than did acid demineralization alone.

Cell Adhesion↗
PubMed1998

Scaling and root planing: hand versus power-driven instruments.

Scaling and root planing (S&RP) are regarded as the main modalities for treating periodontal disease. The goal of these treatments is to arrest the disease process, maintain a healthy periodontium and preserve the dentition. As prevention becomes a larger component of everyday dental practice, dentists are performing S&RP more often as part of their periodontal maintenance programs. Therefore, it is essential for dentists to know the latest S&RP techniques and methods. This paper reviews the current knowledge and experiences related to mechanical non-surgical periodontal therapy and focuses on the types of S&RP instruments that are available, their advantages and disadvantages, their efficacy in debridement, and their effects on the hard tissues of the oral cavity.

Dental Cementum↗
PubMed1991

A nonclinical model for predicting scaling and root planing case difficulty.

As students progress through their clinical education, the integration of patient types challenging the development of scaling and root planing skills is necessary. A clinical screening to determine case type is ideal; however, some programs do not have the time or resources for a clinical screening, and some patients do not want to take the time for the additional screening appointment. The intent of the screening process is to determine case type and/or treatment needs. In some cases, this information is used to match student educational requirements with patient needs. Even though an institution or program may have a clinical screening process, patient assignment can still be haphazard, resulting in an inequitable distribution of patient case types to students. It seems the problem is due, in part, to the absence of a mechanism for early identification and distribution of case types. The purpose of this study was to develop a model for initially predicting patient scaling and root planing case difficulty from nonclinical, patient variables obtained during a telephone interview. Dental hygiene student evaluation forms (n = 1,356) at the University of North Carolina at Chapel Hill School of Dentistry were gathered and categorized by patient case difficulty. A sample of charts was selected from each scaling classification. The scaling classifications were then subdivided into two samples for developing and testing the model. Variables selected from the patient charts as possible predictors were smoking status, race, age, gender, date of last prophylaxis, periodontal classification, and oral hygiene habits (brushing and flossing).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2004

Subantimicrobial dose doxycycline enhances the efficacy of scaling and root planing in chronic periodontitis: a multicenter trial.

BACKGROUND: Previous studies have shown that subantimicrobial dose doxycycline (SDD) is of clinical benefit in the treatment of chronic periodontitis (CP). The aim of this study was to further assess the role of SDD as an adjunct to scaling and root planing (SRP) in the treatment of CP. METHODS: A double-blind, randomized, placebo-controlled, multicenter clinical study was conducted to test the efficacy of SDD (20 mg doxycycline B.I.D.) in combination with SRP in subjects with moderate to severe CP. Two-hundred ten subjects were treated with a standardized episode of SRP and randomized to receive either adjunctive SDD or placebo for 9 months. Efficacy parameters included per-subject mean changes in clinical attachment level (CAL) and probing depth (PD) from baseline, and the total number of sites with attachment gains and probing depth reductions > or = 2 mm and > or = 3 mm from baseline. RESULTS: In periodontal sites with PD 4 to 6 mm and > or = 7 mm (N = 209, intent-to-treat population), mean improvements in CAL and PD were greater following SRP with adjunctive SDD than SRP with placebo, achieving statistical significance in all baseline disease categories at month 9 (P < 0.05). At month 9, 42.3% of sites in the SDD group demonstrated CAL gain > or = 2 mm compared to 32.0% of sites in the placebo group (P < 0.01). CAL gain > or = 3 mm was seen in 15.4% of sites in the SDD group compared to 10.6% of sites in the placebo group (P < 0.05). When considering the same thresholds of change in PD, 42.9% of sites in the SDD group compared to 31.1% of sites in the placebo group demonstrated PD reduction > or = 2 mm (P < 0.01), and 15.4% of sites in the SDD group compared to 9.1% of sites in the placebo group demonstrated PD reduction > or = 3 mm (P < 0.01). CONCLUSION: Adjunctive subantimicrobial dose doxycycline enhances scaling and root planing. It results in statistically significant attachment gains and probing depth reductions over and above those achieved by scaling and root planing with placebo.

Adult↗
PubMed2004

Attachment loss after scaling and root planing with different instruments. A clinical study.

OBJECTIVES: The aim of this study was to evaluate clinically the immediate effect of trauma from instrumentation after scaling and root planing with different instruments. MATERIAL AND METHODS: Ten subjects with moderate chronic periodontitis, presenting probing depths ranging from 3.5 to 6.5 mm on anterior teeth, upper and/or lower, were selected. Teeth were randomly assigned to one of the following groups: MC group--scaled and planed with Gracey mini-curettes (MiniFive); CC group--scaled and planed with Gracey conventional curettes. The selected teeth were probed with a computerized electronic probe, guided by an occlusal stent, and then subjected to scaling and root planing. Immediately following instrumentation, teeth were probed again. The difference between relative attachment level (RAL) immediately before and after instrumentation was considered as trauma from instrumentation. RESULTS: Intra-group analysis revealed statistically significant differences between RAL immediately before and after instrumentation in both groups (0.68 +/- 0.32 for MC group; and 0.83 +/- 0.41 for CC group--p < 0.05). However, inter-group analysis did not show a statistically significant difference in trauma from instrumentation caused by the different instruments. CONCLUSIONS: Within the limits of this study, it was concluded that root instrumentation causes an average trauma from instrumentation of 0.76 mm with no differences between the tested instruments.

Adult↗
PubMed1984

The effect of root planing and citric acid applications on flap healing in humans. A histologic evaluation.

Four human teeth and their facial gingival attachment were removed en block 3 months after periodontal flap therapy and citric acid root conditioning and then prepared for histologic evaluation. At the time of periodontal surgery, and prior to citric acid application, the facial root surface was grooved at midline and citric acid was applied only to one-half of each root surface. Tissues were decalcified and histologically prepared as horizontally oriented, step serial sections from the level of the gingival margin to the level of the facial crest. The gingival margins demonstrated reformation of a crevice. The corium at this level showed a mild inflammatory infiltrate. Apical to this level, junctional epithelium adhered to both sides of the root surface and to the central groove. Further apically, supracrestal fiber groups were encountered. No new cementum was noted in these areas. Fiber attachment was present apical to this level. Since no new cementum was seen at this area of attachment, it may represent collagen attachment present prior to periodontal surgery. In the four specimens examined, no differences were seen in the soft tissue closures between the root-planed citric acid-treated root surfaces and root surfaces which received root planing alone.

Administration, Topical↗
PubMed1982

Maintenance of healed periodontal pockets after a single episode of root planing.

The present study evaluated the clinical stability of healed periodontal pockets over a 3 month time period to determine whether this time interval is appropriate for periodontal maintenance therapy. The clinical characteristics of 128 pockets (3-7 mm depth) distributed in 10 patients, were monitored immediately before and 4, 8 and 16 weeks after a single episode of subgingival root planing. The clinical parameters measured were: pocket depth and bleeding after probing with 15, 25 and 50 gm and manual probing, gingival margin location, clinical attachment level, and gingival and plaque indices. Oral hygiene instruction and supragingival cleaning were given at each time point. An average aggregated score for each subject and for each parameter was calculated at each time point. A repeated measure all within analysis of variance was done, and the Tukey multiple range test was used to assess the significance of differences among and between the means. The significant decreases in plaque, gingival and bleeding indices, and pocket depth as well as the significant gingival recession and gain of clinical attachment which were present at the 4 week point were maintained at 8 and 16 weeks after root planing. It was concluded that the favorable clinical changes which occur in periodontal pockets within 1 month after a single episode of subgingival root planing combined with improved oral hygiene can be maintained for an additional 3 month time period.

Dental Plaque↗
PubMed1981

The effectiveness of subgingival scaling and root planing in calculus removal.

The study presents an evaluation of the effectiveness of subgingival scaling and root planing related to depth of pocket and type of teeth. A total of 199 teeth in 25 patients were selected; 62 were scaled and 57 were used as controls. All teeth were initially scored using the calculus index of the P.D.I. (Ramfjord). Six surface locations were probed to determine pocket depth. The levels of the gingival margin were marked on the teeth to locate supra and subgingival calculus after extraction. The experimental teeth then were scaled. Both scaled and unscaled teeth were extracted immediately after the experimental procedures. The teeth were washed with water and stained with methylene blue. They were viewed under a stereomicroscope which had a tenth grid on its eyepiece. Percent of surface covered by calculus was assessed on both scaled and unscaled teeth. The results demonstrated a high correlation between percent of residual calculus and pocket depth. It was shown that pockets less than 3 mm were the easiest sites for scaling and root planing. Pocket depths between 3 to 5 mm were more difficult to scale and pockets deeper than 5 mm were the most difficult. Tooth type did not influence the results.

Dental Calculus↗