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Evaluation of adjunctive tetracycline fiber therapy with scaling and root planing: short-term clinical results.

The purpose of this single-blind, randomized study was to evaluate the clinical efficacy of slow-release tetracycline fibers as an adjunct to initial periodontal therapy in moderate to advanced periodontitis patients who had no periodontal treatment before. A group of 17 patients with at least two sites in each quadrant with probing pocket depths > 5 mm that bled on probing were included in the study. After scaling and root planing, each selected site was randomly assigned to one of two treatment groups: tetracycline fiber therapy and control group. Plaque index, gingival index, bleeding on probing, probing pocket depth, and clinical attachment level were measured at baseline and at 1, 3, and 7 weeks. The change from the baseline of each measurement was studied using analysis of variance with subject and treatment effects and a baseline covariate. Results of this investigation demonstrated that tetracycline fiber treatment as adjunct to scaling and root planing is effective in regard to probing pocket depth reduction and bleeding on probing. On the other hand, fiber application seems to have no beneficial effect on gain of clinical attachment level within limits of this study.

Adult↗

A 6-month multi-center evaluation of adjunctive tetracycline fiber therapy used in conjunction with scaling and root planing in maintenance patients: clinical results.

The purpose of this study was to compare the efficacy of scaling and root planing (S and RP) alone versus tetracycline fiber therapy used adjunctively with S and RP in the treatment of localized recurrent periodontitis sites in maintenance patients. A total of 113 patients receiving regular supportive periodontal therapy (SPT) were treated with whole mouth S and RP. Two non-adjacent sites in separate quadrants were selected in each patient for monitoring based on criteria that the sites were 5 to 8 mm deep and had a history of bleeding on probing. The chosen sites were randomly assigned to one of the two treatment groups. Probing depth (PD), bleeding on probing (BOP), and clinical attachment level (CAL) were measured at baseline and 1, 3, and 6 months. At 1, 3 and 6 months, adjunctive fiber therapy was significantly better in reducing PD (P < 0.05) and reducing BOP (P < 0.05) than S and RP alone. At 6 months, fiber therapy was significantly better in promoting clinical attachment gain (P < 0.05) than S and RP alone. Overall, these results indicate that fiber therapy significantly enhanced the effectiveness of S and RP in the management of localized recurrent periodontitis sites, in patients receiving regular supportive periodontal treatment.

Arizona↗

Clinical and microbiological effect of scaling and root planing in smoker and non-smoker chronic and aggressive periodontitis patients.

OBJECTIVES: To compare the effects of scaling and root planing (SRP) on clinical and microbiological parameters at selected sites in smoker and non-smoker chronic and generalized aggressive periodontitis patients. MATERIALS AND METHODS: Clinical parameters including probing depth (PD), relative attachment level (RAL), and bleeding upon probing (BOP), and subgingival plaque samples were taken from four sites in 28 chronic periodontitis (CP) and 17 generalized aggressive periodontitis (GAgP) patients before and after SRP. Polymerase chain reaction assays were used to determine the presence of A. actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythensis, Prevotella intermedia and Treponema denticola. RESULTS: Both CP and GAgP non-smokers had significantly greater reduction in pocket depth (1.0+/-1.3 mm in CP smokers versus 1.7+/-1.4 mm in non-smokers, p=0.007 and 1.3+/-1.0 in GAgP smokers versus 2.4+/-1.2 mm in GAgP non-smokers, p<0.001) than respective non-smokers, with a significant decrease in Tannerella forsythensis in CP sites (smokers 25% increase and non-smokers 36.3% decrease, p<0.001) and Prevotella intermedia at GAgP sites (smokers 25% reduction versus 46.9% in non-smokers, p=0.028). CONCLUSION: SRP was effective in reducing clinical parameters in both groups. The inferior improvement in PD following therapy for smokers may reflect the systemic effects of smoking on the host response and the healing process. The lesser reduction in microflora and greater post-therapy prevalence of organisms may reflect the deeper pockets seen in smokers and poorer clearance of the organisms. These detrimental consequences for smokers appear consistent in both aggressive and CP.

Adult↗

A comparative study of a surgical method and scaling and root planing using the Odontoson.

This investigation compared a traditional periodontal surgical method with a non-surgical treatment of scaling and root planing by an ultrasonic device (Odontoson M) using irrigation with an iodised solution. 8 adult patients with periodontal disease were each treated at 2 randomly chosen quadrants by a Widman flap type surgical technique, and the remaining non-surgically. The patients then attended bi-monthly oral hygiene sessions over a period of 1 year. At that stage, clinical evaluation revealed that the Odontoson M plus an ionized irrigant solution achieved a statistically comparable outcome to that of surgical treatment, even in the pockets initially up to 7 mm in depth.

Adult↗

Scaling and root planing efficacy in multirooted teeth.

The effect of operator experience level and root surface access on instrumentation of multirooted teeth was investigated. Fifty molars designated for extraction were randomly distributed among four operators of two different experience levels for scaling and root planing with or without surgical access. Following treatment the teeth were extracted and scored in a blind manner for residual calculus. Teeth were sectioned to allow assessment of the furcal aspects. Results show that operators of both experience levels obtained calculus-free root surfaces significantly more often with flap access than with a non-surgical approach. Additionally, operators with more experience achieved calculus-free root surfaces significantly more often than operators of lesser experience with both an open and closed procedure. However, when furcation aspects alone were assessed, it was found that the more experienced operators obtained a calculus-free surface only 68% of the time with an open approach. Results suggest that, although both surgical access and a more experienced operator significantly enhance calculus removal in molars with furcation invasion, total calculus removal in furcations utilizing conventional instrumentation may be limited.

Adult↗

Effect of subantimicrobial dose doxycycline as an effective adjunct to scaling and root planing.

BACKGROUND: This study evaluated the efficacy and safety of a subantimicrobial dose of doxycycline (SDD) in conjunction with scaling and root planing (SRP). METHODS: The study was a 9-month, double masked, randomized, placebo-controlled, parallel-group trial. A total of 41 patients with moderate chronic periodontitis who received SRP were randomly allocated to receive either a doxycycline hyclate or a placebo 2 weeks after SRP. Clinical attachment level (CAL), the probing depth (PD), gingival crevicular fluid (GCF) levels, and matrix metalloproteinase (MMP)-8 and -13 levels were measured throughout the study. The effect of SDD in conjunction with SRP on the dynamics of the periodontal microflora was also assessed using dark-field microscopic and culture analysis. Information on adverse events was collected throughout the study. RESULTS: During the treatment period, per-patient reductions in PD and CAL were demonstrated for both treatment groups, with a significantly greater reduction for the SDD group. The mean value of per-patient change in the GCF was much greater for the SDD group. Microbial analysis showed there were a general tendency for cocci, non-motile rods, and aerobes to increase with increasing treatment duration and a general decreasing tendency for spirochetes, motile rods, and anaerobes and black pigmented bacteria in both treatment groups, but no significant difference between the groups. The MMP-8 and -13 levels of the SDD group gradually reduced with time, and the mean perpatient average was significantly higher than in the placebo group. The adverse events in the SDD group were similar to those in the placebo group. CONCLUSION: This study suggests that a submicrobial dose of doxycycline as an adjunct therapy with SRP might be safe and effective in the long-term management of chronic periodontitis.

Adult↗

[Ultrastructural aspects of root planing: scanning electron microscopy (S.E.M.)].

The basis of Periodontal treatment is represented by scaling and root planing. The aim of this study was to compare root morphology after the use of three currets: a new Hu Friedy Gracey 7/8, a semi-new Hu Friedy Gracey 7/8, a worn Hu Friedy Gracey 7/8. The research indicates that manual treatment with the new curette is effective in removing tartar but can cause excoriations on the enamel of the tooth. In contrast, the use of the semi-new curette is less damaging and obtains the same results removing tartar without injuring the enamel surface.

Dental Prophylaxis↗

Periodontal therapy in humans. I. Microbiological and clinical effects of a single course of periodontal scaling and root planing, and of adjunctive tetracycline therapy.

The present results showed that maarked and long-lasting changes in the subgingival microflora associated with periodontal disease could be achieved by a single course of periodontal treatment. Immediately following therapy, the total number of subgingival organisms decreased 10- to 100-fold and the proportions of cultivable Gram negative organisms and anaerobic organisms generally decreased 3- to 4-fold or more. After treatment, most periodontal pockets were populated by a scant microflora predominated by facultative Actinomyces and Streptococcus species. The kinetics of the subgingival bacterial recolonization revealed that the total cell counts and the proportions of spirochetes and Capnocytophaga species did not reach their pretreatment levels even after 6 months. Other Gram negative anaerobic species returned to pretreatment proportions after 3 to 6 months. Several Gram positive species exhibited higher posttreatment than pretreatment proportions throughout the 6 months study. The microbiological shifts paralleled significant changes in the clinical status of the periodontal tissues. Following therapy, the periodontal pocket depths decreased generally 1 to 4 mm, the gingival inflammatory index, the gingival fluid flow, and the suppurative index were generally lower, and nine of 33 test pockets examined showed apposition of alveolar bone. The microbiological and clinical changes described were exhibited by two patients treated with periodontal scaling and root planing alone and by two patients treated with the adjunctive use of systemic tetracycline therapy. In two other patients, mechanical periodontal therapy only slightly reduced the total number of subgingival organisms and the proportions of spirochetes and other Gram negative anaerobic rods. A shift in the subgingival microbial composition was achieved in these two patients after tetracycline therapy. The following model for treatment of periodontal disease is proposed: (1) Conventional therapy including thorough periodontal scaling and root planing; (2) Monitoring the subgingival flora and the clinical course; and (3) Use of antimicrobial therapy in refractory cases. Further studies are needed to develop means for rapid identification of refractory patients, and to determine the optimal antimicrobial agent, the optimal route of administration, and the optimal dosage regime.

Actinomyces↗

[Clinical and microbiological study concerning effects of scaling and root planing. 2. The effects of mechanical debridement until one year and of minocycline application topically].

This study was performed to assess the effect of scaling and root planing clinically and microbiologically during one year. Nine patients with moderate to severe periodontitis were studied. After the process of plaque control, the selected single rooted teeth with 5mm probing depth were debrided mechanically under non-local anesthesia four times biweekly. Observing the results of the treated teeth until three months, the experimental teeth were divided into two groups. The standard of division was whether they showed good response to the mechanical debridement or not. Observation was continued until one year after the debridement according to the following criteria: 1. The sites which showed good responses at three months were continued to be observed biweekly. 2. The sites which showed no improvement at three months were applied the gel of minocycline (Periocline) four times biweekly. 3. The untreated sites used as control until three months received mechanical debridement four times biweekly. The following results were obtained: The sites that showed good responses to the mechanical debridement at three months were maintained in good condition continuously during one year. The topical application of Periocline was effective in reducing the inflammation and probing depth clinically and microbiologically until three months.

Administration, Topical↗

Repeated local metronidazole-therapy as adjunct to scaling and root planing in maintenance patients.

The purpose of this investigation was to evaluate the effect of local antibiotic therapy with metronidazole adjunctively to scaling and root planing (SRP) versus mechanical treatment alone. 30 maintenance-patients were included in this single-blind study. The subjects had to comply with the following criteria: 2 non-adjacent sites with a probing depth > or =6 mm with bleeding on probing in separate quadrants, no periodontal therapy within the last 3 months, and no antibiotic therapy within the last 6 months. After randomization, the study sites were assigned to one of the following 2 treatments: SRP plus subgingival application of metronidazole 25% dental gel (Elyzol) 5x during 10 days (test site) or SRP alone (control site). Subgingival microbiological samples were taken prior to, and 21 days and 3 months after scaling. The samples were analyzed with a commercial chair-side ELISA (Evalusite) for Porphyromonas gingivalis, Prevotella intermedia and Actinobacillus actinomycetemcomitans. Probing pocket depth (PPD), attachment level (AL) and bleeding on probing (BOP) were recorded at baseline and 3 months later. PPD reduction and AL-gain were statistically significant (p<0.001) after both treatments. However, there were no statistically significant differences between them. The same observation was made for BOP. P. gingivalis was reduced significantly after both treatments without statistically significant differences. P. intermedia was reduced significantly only after SRP. A. actinomycetemcomitans was not reduced significantly after either treatment. In conclusion, the repeated local application of metronidazole as an adjunct to SRP and the mechanical treatment alone showed similar clinical and microbiological effects without statistically significant differences with the exception of P. intermedia.

Administration, Topical↗

In vitro, clinical, and microbiological evaluation of a linear oscillating device for scaling and root planing.

BACKGROUND: The purpose of this study was to conduct an in vitro and short-term clinical and microbiological evaluation of a linear oscillating device for scaling and root planing (SRP). A comparison was made between conventional ultrasonic scaling (US) and hand scaling (HS) with and without chlorhexidine. METHODS: In vitro, SRP was carried out on human teeth with calculus. Roots and cross-sections thereof were microscopically examined for the efficacy of calculus removal, hard tissue loss, and surface smoothness. In vivo, 11 patients with chronic periodontitis and single-rooted teeth in all quadrants with probing depths of > or =5 mm were selected. One quadrant was treated with linear oscillation and compared to US with chlorhexidine irrigation in the contralateral site. The other arch was treated with HS and compared to HS followed by laser disinfection. One hundred twenty teeth were assessed for clinical attachment level, probing depth, bleeding on probing, and suppuration at baseline and 7, 28, 90, and 180 days. Microbiologically, total numbers of bacteria and six specific periodontal pathogens were determined by quantitative polymerase chain reaction prior to and 1 and 28 days after SRP. Clinical and microbiological data were analyzed statistically with respect to the SRP method, patient specificity, and time effect. RESULTS: In vitro, linear oscillation preserved more root tissues but left more calculus (P <0.05). Significant improvements of all clinical and microbiological parameters were observed for all groups. However, 21 out of 24 tests demonstrated that the clinical microbiological correlations between linear oscillation and control groups did not differ (P <0.05). CONCLUSION: Linear oscillation scaling was clinically acceptable and microbiologically comparable to the control groups despite microscopic remnants of calculus observed in vitro.

Adult↗

The effect of locally delivered controlled-release doxycycline or scaling and root planing on periodontal maintenance patients over 9 months.

BACKGROUND: This research report evaluates clinical changes resulting from local delivery of doxycycline hyclate (DH) or traditional scaling and root planing (SRP) in a group of patients undergoing supportive periodontal therapy (SPT). METHODS: In all, 141 patients received either DH (67) or SRP (74) treatment in sites > or =5 mm on one-half of their dentition at baseline and month 4. RESULTS: Clinical results were determined at month 9. Baseline mean probing depth recordings were similar between the two groups (DH = 5.9 mm; SRP = 5.9 mm). Mean month 9 results showed similar clinical results for attachment level gain (DH 0.7 mm; SRP 0.8 mm) and probing depth reduction (DH 1.3 mm; SRP 1.1 mm). Percentage of sites showing > or =2 mm attachment level gain at month 9 was 24.7% in the DH group and 21.2% in the SRP group. Thirty-nine percent (39%) of DH sites and 38% of SRP sites showed > or =2 mm probing depth reduction. When treated sides of the dentition were compared to untreated sides, DH showed a difference in disease activity (> or =2 mm attachment loss) from 19.3% (untreated) to 7.2% (treated); and SRP from 14.3% (untreated) to 8.1% (treated). CONCLUSIONS: Results show that both DH without concomitant mechanical instrumentation and SRP were equally effective as SPT in this patient group over the 9-month study period.

Administration, Topical↗

Scaling and root planing and chlorhexidine mouthrinses in the treatment of chronic periodontitis: a randomized, placebo-controlled clinical trial.

OBJECTIVE: Evaluation of the clinical and microbiological effects of scaling and root planing (SRP) alone or in combination with 0.12% chlorhexidine (CHX) rinsing. METHODS: A blind, placebo-controlled, parallel-design, randomized clinical trial was conducted in 29 subjects with chronic periodontitis. Subjects were assigned to two therapeutic groups: control (SRP+placebo) and test (SRP+CHX during and up to 42 days post-therapy). Clinical and microbiological [N-benzoyl-dl-arginine-2-naphthylamide (BANA test)] examinations were performed at baseline, 42 and 63 days post-therapy. RESULTS: Initially, intermediate sites (4-6 mm) in the test group showed less plaque accumulation, gingival bleeding, bleeding on probing and a greater reduction in attachment level and probing depth (PD) at 63 days after treatment. The initially deep sites (>6 mm) in the CHX group also showed a better reduction in plaque accumulation and in PD compared with the control group. Both therapies led to a microbiological improvement; however, the test subjects showed a higher frequency of BANA-negative sites after treatment, which was sustained over time (p<0.001). At 63 days, the control group presented 25 BANA-negative sites and 65 positive sites, and the test group 58 and 26, respectively. CONCLUSION: The combination of CHX rinses and SRP leads to clinical benefits and to a better reduction in BANA-positive species.

Adult↗

Scaling and root planing, systemic metronidazole and professional plaque removal in the treatment of chronic periodontitis in a Brazilian population. I. clinical results.

OBJECTIVE: The current investigation evaluated the clinical effects of scaling and root planing (SRP) alone or in combination with systemic metronidazole and/or repeated professional removal of supragingival plaque in subjects with chronic periodontitis. METHODS: Fourty-four adult subjects (mean age: 45+/-6 years) with periodontitis were randomly assigned to four treatment groups; a control (C, n=10) that received SRP and placebo and three test groups treated as follows: Test 1 (T1) (n=12) received SRP and metronidazole (400 mg t.i.d., M) for 10 days; Test 2 (T2) (n=12) received SRP, weekly professional supragingival plaque removal for three months (professional cleaning (PC)) and placebo; and Test 3 (T3) (n=10) received SRP, M and PC. Pocket depth (PD), attachment level (AL), bleeding on probing (BOP) and presence of visible plaque and suppuration were measured at six sites per tooth at baseline and at 90 days post-therapy. Significance of differences over time was determined using the Wilcoxon test, and among groups using ancova. RESULTS: A reduction in full-mouth mean clinical parameters was observed at 90 days after all therapies. Sites with baseline PD<4 mm showed an increase in mean PD in the control group and in mean AL in all treatment groups. Sites with baseline PD of 4-6 mm in subjects who received PC as part of therapy (T2, T3) showed a marked reduction in PD, AL and in the % of sites with BOP. Subjects who received metronidazole (T1 and T3) showed the best clinical response at sites with an initial PD of >6 mm. The major clinical benefit occurred when the combination of SRP, M and PC was used. Group T3 showed the least attachment loss in initially shallow pockets. This group also exhibited the greatest reduction in the % of sites with BOP and suppuration as well as in mean PD and AL at sites with baseline PD>4 mm. CONCLUSION: The data suggest a significant clinical benefit in combining SRP, systemic metronidazole and weekly professional supragingival plaque removal for the treatment of chronic periodontitis.

Adult↗

[The role of chlorhexidine irrigation combined with ultrasonic root planing in treatment of periodontal disease. Preliminary study].

The beneficial effects of chlorhexidine on plaque formation have been well documented. This study was undertaken to evaluate the dual effects of chlorhexidine irrigation and root planing with an ultrasonic scaler. The parameters measured were plaque and gingival indices and bleeding on probing. A statistically significant decrease in all indices measured was demonstrated when compared with the test group of patients who received ultrasonic scaling and irrigation with sterile water.

Chlorhexidine↗

A 14-year follow-up study of localized juvenile periodontitis treated by scaling and root planing, systemic metronidazole, and subgingival curettage: a case report.

This 14-year longitudinal case study involved the treatment of localized juvenile periodontitis in a male patient commencing at 15 years of age, by scaling and root planing, systemic metronidazole, and subgingival curettage along with supervised maintenance. No other surgery was required. All symptoms disappeared by the end of the active treatment phase, and radiographic evaluation and reduced probing pocket depth measurements showed adequate bone fill to have occurred and be preserved over this period.

Adolescent↗

Bacteremia following subgingival irrigation and scaling and root planing.

The purpose of this study was to determine the incidence of bacteremia after a single professional subgingival irrigation with a 0.12% chlorhexidine gluconate mouthrinse (CHX) as well as after a subsequent scaling and root planing (S/RP) during the same visit. Thirty subjects each with at least 1 site that probed 4 mm or more and bled on probing were randomly assigned to the following groups: 1) irrigation with 0.12% CHX; 2) irrigation with sterile water; and 3) non-irrigated controls. To begin the study blood was drawn just before and 2 minutes after irrigation. Thirty minutes later, blood was drawn again just before and 2 minutes after S/RP at the same site. Specimens were cultured for anaerobic and aerobic microorganisms using standard cultural techniques. Eighteen blood cultures from 15 subjects yielded positive cultures resulting in 23 isolates. Gram-positive rods comprised 34.8% of the total isolates; Gram-positive cocci 34.8%, Gram-negative rods 21.7%, and Gram-negative cocci 8.7%. In the CHX group, bacteremia was detected in 5 subjects after irrigation and in 2 other subjects after S/RP. In the water group, bacteremia was detected in one subject after irrigation and in 4 subjects after S/RP. The control group had 3 bacteremias after S/RP. There was no significant difference between the incidence of bacteremia associated with irrigation by CHX or sterile water (P = 0.141). There was also no significant difference in the incidence of bacteremia after S/RP between the CHX and sterile water irrigation groups and in patients who did not receive irrigation (control group) (P = 0.88).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗