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PubMedDate not supplied

Local chemotherapeutics as an adjunct to scaling and root planing.

Gingival diseases are the most widely held diseases in America. In some patients, periodontal disease appears in a generalized form, but more often it appears in localized areas. Furthermore, after treatment with scaling and root planing (SRP) in generalized cases, the disease is often reduced to a few local areas in the patient's mouth. Since periodontitis is a bacterial infection with known pathogenic microorganisms, the local delivery of antimicrobials has been considered to be a possible solution for treating and controlling localized forms of periodontal disease. Three current local chemotherapeutic agents are reviewed in this paper: doxycycline gel, chlorhexidine chip and minocycline microspheres. With the advancement of local drug delivery systems, clinicians and their patients have new alternatives for treatment of periodontal disease.

Chlorhexidine↗
PubMed1989

[Amount of mineralized tissue removed by root planing].

The Author's aim was to determine the amount of mineralized tissues removed during root planing conducted by means of a curette, using a profilometer. Records were kept at time 0 and after 4 cycles of 5 strokes each. Mean values of final records show that the average of tissue removal, expressed in microns, was greater than the mean thickness of cementum in the instrumented areas.

Dental Cementum↗
PubMed2004

Comparison of the effectiveness of scaling and root planing in vivo using hand vs rotary instruments.

The purpose of the present investigation was to compare the effectiveness of a scaling bur and conventional Gracey curettes in vivo. Ten teeth scheduled for extraction were scaled and root planed thoroughly before extraction. The instrumented areas were observed using SEM. Scaling with a No. 12 fluted carbide bur was more effective in removing debris and plaque than were conventional Gracey curettes. Because of the aggressive nature of the process, a certain learning curve is necessary to get accustomed to bur scaling; otherwise, dentinal hypersensitivity and patient discomfort may be increased.

Adult↗
PubMed2002

The effects of subgingival calculus on the clinical outcomes of locally-delivered controlled-release doxycycline compared to scaling and root planing.

BACKGROUND/AIM: The effect of subgingival calculus on the clinical outcomes of the local delivery of antimicrobials is unknown. This study examines the clinical outcomes of treatment with locally delivered controlled-release doxycycline (DH) or scaling and root planing (SRP) in subsets of adult periodontitis patients with known baseline levels of subgingival calculus. METHODS: The data examined were obtained from 393 patients who participated in 2 multi-center trials. All patients had baseline subgingival calculus levels assessed and were then treated at baseline and month 4 with either DH or SRP. Clinical attachment levels (CAL), pocket depth (PD) and bleeding on probing (BOP) were assessed at baseline and months 1, 2, 4, 5, 6, 8 and 9. RESULTS: Treatment with either DH or SRP resulted in significant statistical and clinical improvements in CAL, PD and BOP. These clinical outcomes were equivalent regardless of the extent of subgingival calculus present at baseline. CONCLUSIONS: The results indicate that the primary clinical effects of these therapies are the result of a disruption and reduction of the subgingival plaque and not the effect of the removal of subgingival calculus and contaminated cementum.

Administration, Topical↗
PubMed2005

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

OBJECTIVE: The current investigation evaluated changes in levels and proportions of 39 bacterial species in subgingival plaque samples after scaling and root planing (SRP) alone or in combination with systemic metronidazole and/or professional cleaning in subjects with chronic periodontitis. METHODS: Forty-four adult subjects (mean age 45+/-6 years) with periodontitis were randomly assigned in four treatment groups, a control (C, n=10) that received SRP and placebo and three test groups treated as follows: T1 (n=12): SRP and metronidazole (M, 400 mg tid) for 10 days; T2 (n=12): SRP, weekly professional supragingival plaque removal for 3 months (PC) and placebo; and T3 (n=10): SRP, M and PC. Subgingival plaque samples were taken from seven sites per subject at baseline and 90 days post-therapy. Counts of 39 subgingival species were determined using checkerboard DNA-DNA hybridization. Significance of differences over time was determined using the Wilcoxon signed ranks test and among groups using ancova. RESULTS: The mean counts of the majority of the species were reduced post-therapy in the 4 treatment groups. Counts (x 10(5)+/-SEM) of Porphyromonas gingivalis, Tannerella forsythensis and Treponema denticola were significantly reduced in groups T2 and T3. Levels of beneficial species, such as some Actinomyces species, Veillonella parvula, Streptococcus sanguis, Streptococcus oralis and Streptococcus gordonii were minimally affected in levels when the combined therapy was applied (T3). Mean proportions of red complex species decreased from 18.4% at baseline to 3% at 90 days post-therapy in group T3 (p<0.01), from 25.8% to 2.3% in group T2 (p<0.01), from 17.7% to 5.6% in group T1 (p<0.05) and from 19.4% to 8.8% in group C (NS). Proportions of the suspected periodontal pathogens from the orange complex were also markedly reduced in groups T2 and T3. CONCLUSIONS: All treatments reduced counts and proportions of red complex species. Adjunctive therapy appeared to have a greater effect and also affected members of the orange complex.

Administration, Oral↗
PubMed2003

Clinical evaluation of an Er:YAG laser combined with scaling and root planing for non-surgical periodontal treatment. A controlled, prospective clinical study.

OBJECTIVES: The purpose of the present controlled clinical trial was to compare the treatment of advanced periodontal disease with a combination of an Er:YAG laser (KEY II, KaVo, Germany) and scaling and root planing with hand instruments (SRP) to laser alone. MATERIAL AND METHODS: Twenty healthy patients with moderate to advanced periodontal destruction were randomly treated in a split-mouth design with a combination of an Er:YAG laser and SRP (test) or with laser (control) alone. The used energy setting for laser treatment was 160 mJ/pulse at a repetition rate of 10 Hz. Prior to treatment and 3, 6 and 12 months later the following parameters were evaluated by a blinded examiner: Plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR) and clinical attachment level (CAL). Subgingival plaque samples were taken at each appointment and analysed using darkfield microscopy for the presence of cocci,-non-motile rods, motile rods and spirochetes. No statistical significant differences in any of the investigated parameters between both groups were observed at baseline. RESULTS: Initially, the plaque index was 1.0 +/- 0.6 in both groups. At the 3-month examination the plaque scores were markedly reduced and remained low throughout the study. A significant reduction of the GI and BOP occurred in both groups after 3, 6 and 12 months (P < 0.05, P < 0.05, respectively). The mean PD decreased in the test group from 5.2 +/- 0.8 mm at baseline to 3.2 +/- 0.8 mm after 12 months (P < 0.05) and in the control group from 5.0 +/- 0.7 mm at baseline to 3.3 +/- 0.7 mm after 12 months (P < 0.05). The mean CAL decreased in the test group from 6.9 +/- 1.0 mm at baseline to 5.3 +/- 1.0 mm after 12 months (P < 0.05) and in the control group from 6.6 +/- 1.1 mm at baseline to 5.0 +/- 0.7 after 12 months (P < 0.05). Both groups showed a significant increase of cocci and-non-motile rods and a decrease in the amount of motile rods and spirochetes. CONCLUSION: In conclusion, the present results have indicated that: (i) non-surgical periodontal therapy with both an Er:YAG laser + SRP and an Er:YAG laser alone may lead to significant improvements in all clinical parameters investigated, and (ii) the combined treatment Er:YAG laser + SRP did not seem to additionally improve the outcome of the therapy compared to Er:YAG laser alone.

Adult↗
PubMed1997

Ultrasonic subgingival root planing and EDTA etching in a one-step procedure.

The purpose of the present study was to investigate if ultrasonic debridement and EDTA etching could be combined in a ore-step procedure. Tap water was exchanged for a 24% EDTA solution as irrigation agent during root planing with a piezo scaler. 24 human teeth extracted due to severe periodontal disease were used and the results were evaluated with scanning electron microscopy. Results indicate that synergistic effects (smear removal and exposure of collagen fibers) were negligible with conventional application of the irrigation fluid to the working area of the scaling tip while a marked effect was evident when the EDTA solution was applied directly to the working area of the piezoelectric scaler through a customized tip.

Acid Etching, Dental↗
PubMed2006

Ibuprofen arginine for pain control during scaling and root planing: a randomized, triple-blind trial.

OBJECTIVES: The aim of this controlled clinical trial was to investigate the analgesic efficacy and tolerability of ibuprofen arginine in patients with mild-to-moderate periodontitis during and after non-surgical periodontal treatment. METHODS: This randomized, triple-blind, placebo-controlled, parallel-group trial assessed the analgesic efficacy of ibuprofen arginine (Spedifen) in patients undergoing routine periodontal scaling and root planing. 64 patients with chronic periodontitis received either 800 mg ibuprofen arginine or placebo 30 min. before treatment. Numeric pain and electronic visual analogue scales ranging from 0 to 100 were used. RESULTS: The average pain levels during treatment were lower following ibuprofen arginine (quartiles: 0.5, 4.5, 11) compared with placebo (4, 16, 26), corresponding to a percentage reduction in median pain of 72% (p=0.023). The median maximum pain was 28 (inter-quartile range 10-50) following placebo and 10 (4-31) following ibuprofen arginine (p=0.065). CONCLUSIONS: In patients with mild-to-moderate chronic periodontitis, ibuprofen arginine was safe and superior to placebo for alleviating pain during non-surgical periodontal treatment. Its painless administration and rapid onset of action make it well suitable for pain management in a general dental office.

Adult↗
PubMed2000

Treatment with subantimicrobial dose doxycycline improves the efficacy of scaling and root planing in patients with adult periodontitis.

BACKGROUND: In a previous study, subantimicrobial dose doxycycline (SDD) significantly improved clinical parameters associated with periodontal health in patients with adult periodontitis (AP) when used as an adjunct to a maintenance schedule of supragingival scaling and dental prophylaxis. In this double-blind, placebo-controlled, parallel-group, multicenter study, the efficacy and safety of SDD were evaluated in conjunction with scaling and root planing (SRP) in patients with AP. METHODS: Patients (n = 190) received SRP at the baseline visit and were randomized to receive either SDD 20 mg bid or placebo bid for 9 months. Efficacy parameters included the per-patient mean changes in clinical attachment level (CAL) and probing depth (PD) from baseline, the per-patient percentages of tooth sites with attachment loss (AL) > or = 2 mm and > or = 3 mm from baseline, and the per-patient percentage of tooth sites with bleeding on probing. Prior to analysis, tooth sites were stratified by the degree of disease severity evident at baseline RESULTS: In tooth sites with mild to moderate disease and severe disease (n = 183, intent-to-treat population), improvements in CAL and PD were significantly greater with adjunctive SDD than with adjunctive placebo at 3, 6, and 9 months (all P <0.05). In tooth sites with severe disease, the per-patient percentage of sites with AL > or = 2 mm from baseline to month 9 was significantly lower with adjunctive SDD than with adjunctive placebo (P<0.05). Improvements in clinical outcomes occurred without detrimental shifts in the normal periodontal flora or the acquisition of doxycycline resistance or multiantibiotic resistance. SDD was well tolerated, with a low incidence of discontinuations due to adverse events. CONCLUSIONS: The adjunctive use of SDD with SRP is more effective than SRP alone and may represent a new approach in the long-term management of AP.

Adult↗
PubMed2004

Patient evaluation of a novel non-injectable anesthetic gel: a multicenter crossover study comparing the gel to infiltration anesthesia during scaling and root planing.

BACKGROUND: Periodontal scaling procedures commonly require some kind of anesthesia. From the patient's perspective, the choice of anesthetic method is a trade-off between the degree of anesthesia and accepting the side effects. The present study evaluates the preferences for a novel non-injection anesthetic product (a gel, containing lidocaine 25 mg/g plus prilocaine 25 mg/g and thermosetting agents) versus injection anesthesia (lidocaine 2% adrenaline) in conjunction with scaling and/or root planing (SRP). METHODS: In a multicenter, crossover, randomized, open study patients were asked, after they had experienced both products, if they preferred anesthetic gel or injection anesthesia. In addition, the adequacy of anesthesia and occurrence of post-procedure problems were assessed. The patients were also asked about their willingness to return if they were offered anesthetic gel at their next visit and their maximum willingness to pay (WTP) for this option. RESULTS: One-hundred seventy (170) patients at eight centers in Belgium were included in the study. There were 157 per protocol (PP) patients. A vast majority of the PP patients (70%) preferred the anesthetic gel to injection anesthesia (22%). The most common reason was less post-procedure numbness. Eighty percent (80%) of the patients expressed satisfactory anesthesia with the gel and 96% with injection anesthesia (P <0.001). Post-procedure problems were significantly less with the gel than with injection (P <0.001): numbness 15% versus 66%, unpleasant sensations such as soreness and pain 44% versus 63%, and problems connected with daily activities 19% versus 69%. The majority of patients (60%) who preferred gel were also willing to pay for it. A conservative estimate of the median WTP was $10.00. Furthermore, anesthetic gel would make almost every second patient (45%) more or much more willing to return for the next treatment. CONCLUSIONS: The data suggest that a somewhat less profound anesthesia with gel is clearly preferred by the patients because of the low incidence of post-procedure problems as compared to conventional injection anesthesia. The median WTP is likely in excess of the acquisition cost of the product, which indicates a favorable cost-benefit ratio for the individual patient.

Administration, Topical↗
PubMed2004

Quantification and analysis of pain in nonsurgical scaling and/or root planing.

BACKGROUND: Three efficacy studies, comprising a database of 337 subjects, were conducted as part of the clinical evaluation of the noninjectable anesthetic gel Oraqix (AstraZeneca, Södertälje, Sweden). The authors discuss some of the challenges encountered when they interpreted the results of the clinical studies and present the results from an alternative analysis of the anesthetic efficacy. METHODS: The three multicenter studies were double-blind, randomized and placebo-controlled. Clinicians applied gel in the subjects' periodontal pockets before scaling and/or root planing, or SRP. Subjects recorded overall pain on a 100-millimeter visual analog scale, or VAS. In the studies, the evaluation of the anesthetic efficacy was based on absolute treatment difference (active-placebo). Investigators used an alternative post hoc approach to evaluate the effect expressed as a ratio (active:placebo). RESULTS: The studies demonstrated consistent and significant lower pain scores for the anesthetic gel versus the placebo gel, with point estimates of absolute treatment difference being 8, 4 and 10 mm. The alternative analysis verified that the estimated treatment effect in terms of a ratio was close to 50 percent in all three studies. CONCLUSIONS: Treatment effects of the anesthetic gel relative to the placebo gel were described more appropriately by means of ratios instead of absolute differences. In this sample of 337 subjects, it was shown that pain was reduced by 50 percent when the anesthetic gel was used compared with when the placebo gel was used. CLINICAL IMPLICATIONS: The authors found that the anesthetic periodontal gel is effective in reducing pain resulting from SRP.

Adult↗
PubMed2003

Intrapocket anesthesia for scaling and root planing in pain-sensitive patients.

BACKGROUND: In 2 previous multicenter studies evaluating the efficacy of a novel anesthetic gel (lidocaine 25 mg/g plus prilocaine 25 mg/g), there was a rather small, although statistically significant, overall difference between the active and placebo gels. There were, however, large center variations. At centers where the placebo-treated patients reported high pain scores, the difference between treatments was large, suggesting that the anesthetic gel is most effective in patients who experience the procedure as painful. The present multicenter, double-blind, randomized study evaluated the anesthetic effect of this gel in pain-sensitive patients by using a visual analog scale (VAS) and a verbal rating scale (VRS). METHODS: One hundred thirteen (113) patients with moderate to severe periodontitis were screened for pain sensitivity upon probing. Eighty-five reported VAS > or = 30 mm on probing and were included in the treatment phase (43 anesthetic and 42 placebo gel). The periodontal pockets of one quadrant in each patient were treated with gel for 30 to 45 seconds, followed by scaling and/or root planing. RESULTS: The results were similar between centers. The median overall VAS pain score was 11 mm in the anesthetic group and 27 mm in the placebo group. The Hodges-Lehmann point estimate of the treatment difference was 10 mm (P = 0.004). No pain or only mild pain was reported by 70% in the anesthetic group and by 48% in the placebo group (P = 0.003). Two patients in the anesthetic group and 7 patients in the placebo group required rescue anesthesia. CONCLUSIONS: This study confirms the favorable anesthetic efficacy of active gel over placebo in selected pain-sensitive patients. It suggests that the gel may be a valuable alternative to conventional injection anesthesia.

Adult↗
PubMed1989

[Effects of scaling and root planing on clinical parameters and bacterial flora in periodontal pockets. 2. Correlation between decrease of probing pocket depth and pretreatment status].

Scaling and root planing is one of the most fundamental and effective procedures in periodontal therapy. The purpose of this study was to investigate statistically whether clinical or microbiological parameters before treatment are related to changes in probing pocket depth (PD). Two kinds of numerical values represented changes in PD. One was pocket difference (A-B: A; PD before the treatment and B; PD after treatment) and the other was rate of pocket decrase [(A-B)/A x 100]. Twenty four sites in six patients with periodontal pockets deeper than 4 mm were selected for this study. Clinical parameters such as PD, probing attachment level (PAL), gingival crevicular fluid (GCF) volume, gingival bleeding index (GBI) and suppurative index (SI) were recorded at each site. Subgingival plaques sampled at the same site were evaluated by phase contrast microscopy. The results obtained were as follows: 1. Of all the clinical parameters changes in PD were most positively correlated with PD before treatment. 2. The microbiological approach revealed that total bacterial count divided by PD value was more negatively correlated with changes in PD than total bacterial number. It was further, revealed that numbers of rods and motile bacteria were more closely correlated with changes in PD than the counts of bacterial groups. At sites where coccoid cells were relatively dominant, PD tended to decrease readily. Motile bacteria, on the other hand, exhibited just the opposite relationship. These results suggest that periodontal treatment should be more effective in periodontal pockets harboring both smaller numbers of rods and motile bacteria.

Dental Scaling↗
PubMed2001

[The efficacy of the chlorhexidine chip following scaling and root planing (SRP) and compared to SRP alone].

OBJECTIVE: To evaluate the clinical efficacy and safety of the adjunctive use of Chlorhexidine Chip (CHX; commercial name, Perio Chip) following scaling and root planing (SRP) in periodontitis. METHODS: One center, blinded, randomized, split-mouth and active control study was designed. Sixty-five adult periodontitis patients were enrolled into the baseline after SRP. Each subject had at least one tooth with pocket depth of 5 mm or more and bleeding on probing (BOP) in each side of the mouth. Then the tooth was selected as a target and its parameters of probing depth (PD), attachment loss (AL), BOP, gingival index (GI), plaque index (PI) and staining index (SI) were recorded. Each side of mouth was randomly assigned to one of two treatments--drug placement after SRP or SRP alone. All the adverse events and parameters were recorded at time of 3-month, 6-month and meanwhile the patients received oral hygiene instruction and scaling. The same was conducted at 6-week, 4.5-month except for recording of parameters and scaling of the target teeth. RESULTS: Reduction of PD and gain of attachment at 6-month in group of SRP plus CHX (1.32 mm, 0.94 mm) were significantly higher than those in group of SRP alone (0.77 mm, 0.40 mm) (P < 0.001). Forty-four point six percent (44.6%) of patients reflected adverse reactions related to drug placement. Toothaches, the main reactions, were mild to moderate in nature and spontaneously resolved within 2-4 days. CONCLUSIONS: The chlorhexidine chip is indeed a safe and effective control-delivered drug for topical use when patient in his supportive periodontal therapy.

Adult↗
PubMed1990

Effects of subgingival irrigation on bacteremia following scaling and root planing.

The purpose of this study was to determine the effects of professional subgingival irrigation, together with subsequent patient administered home marginal irrigation, on the incidence of bacteremia after scaling and root planing (Sc/RP). A total of 60 periodontal maintenance patients were assigned to either Group 1: subgingival irrigation, with 0.12% CHX and daily marginal irrigation with 0.04% CHX; Group 2: subgingival irrigation with 0.12% CHX and daily marginal irrigation with water; Group 3: subgingival and daily marginal irrigation with water; Group 4: Non-irrigation (control). Patients entered the study after receiving a thorough periodontal maintenance appointment including a complete examination, Sc/RP, and standard oral hygiene instruction. Blood samples were taken at the 3-month visit before and after Sc/RP. Microbiological culturing was done using the Septi-Chek system, selective and non-selective media. Results from 54 patients showed that bacteremia was detected prior to Sc/RP in 2 patients and after Sc/RP in 10 patients. No significant effect by treatment regimens on post Sc/RP bacteremia could be detected. The organisms isolated included Eubacterium lentum, Propionibacterium acnes, Streptococcus species, Neisseria species, Candida albicans, Staphylococcus species, and un-identified Gram-negative rods.

Adult↗
PubMed2005

Impact of local adjuncts to scaling and root planing in periodontal disease therapy: a systematic review.

BACKGROUND: Chronic periodontitis affects many adults in the United States, some severely enough to threaten tooth loss. Of particular clinical importance is whether scaling and root planing (SRP) accompanied by a local adjunctive therapeutic agent improves outcomes over time compared to SRP alone. The adjunctive therapeutic agents investigated include: tetracycline, minocycline, metronidazole, a group of other antibiotics, chlorhexidine, and a group of antimicrobials. Primary outcomes considered are reductions in probing depth (PD) and gains in clinical attachment level (CAL). METHODS: RTI-UNC Evidence-Based Practice Center staff searched MEDLINE (1966 through December 2002) and EMBASE (through February 2002) to identify clinical trials published in English that 1) involved adults with chronic periodontitis but no serious comorbidities; 2) tested one or more chemical antimicrobial agents as an adjunct to SRP alone or with a placebo; 3) had a concurrent control group that received the same SRP as the treatment group; 4) reported outcomes for specified, fixed time periods; and 5) if multiple antimicrobials were tested, reported outcomes for each agent separately. We performed qualitative analyses and meta-analyses of PD and CAL effect sizes when the necessary data were available from at least three studies at 6-month follow-up. RESULTS: Among the locally administered adjunctive antimicrobials, the most positive results occurred for tetracycline, minocycline, metronidazole, and chlorhexidine. Adjunctive local therapy generally reduced PD levels. Differences between treatment and SRP-only groups in the baseline-to-follow-up period typically favored treatment groups but usually only modestly (e.g., from about 0.1 mm to nearly 0.5 mm) even when the differences were statistically significant. Effects for CAL gains were smaller and statistical significance less common. The marginal improvements in PD and CAL were a fraction of the improvement from SRP alone. CONCLUSIONS: Whether such improvements, even if statistically significant, are clinically meaningful remains a question. A substantial agenda of future research to address this and other issues (e.g., costs, patient-oriented outcomes) is suggested.

Adult↗
PubMed1999

Metronidazole dental gel as an alternative to scaling and root planing in the treatment of localized adult periodontitis. Is its efficacy proved?

Eight randomized clinical trials, comparing the application of 25% metronidazole dental gel (Elzylol dental gel) once a week for two weeks with scaling and root planing in the "split-mouth" design for treating adult periodontitis, were evaluated and scored according to ANTCZAK et al. (1986) and BEGG et al. (1996). The aim of this investigation was to determine whether both treatment methods are of equal value. With a maximum of 1.0 in each case, the scores determined were (M +/- SD) 0.107 +/- 0.033 (range 0.072-0.168) for reporting the study protocol and 0.285 +/- 0.084 (range 0.120-0.400) for the data analysis, presentation and discussion. Though the study results show that both treatment modalities are of equal value, the quality of the trials does not allow a comparative therapy assessment at present. The state of the data is inadequate for applying local metronidazole dental gel as an alternative to mechanical instrumentation in adult periodontitis.

Adult↗
PubMed1990

Long-term assessment of periodontal surgery versus curettage or scaling and root planing.

The various treatments for periodontal disease must be assessed in light of the recently articulated goals of periodontal therapy to preserve teeth for a lifetime and to enhance esthetics and comfort as well as oral health. This article examines the long-term comparisons of periodontal surgery, curettage, and scaling and root planing in improving attachment levels instead of the more traditional pocket depth.

Dental Scaling↗