OBJECTIVE: To study the effects of one or two repeated subgingival instrumentations (RSI) in achieving the endpoints of therapy (EoT) in open pockets [residual probing pocket depth (PPD) ≥ 6 mm and PPD 4-5 mm with bleeding on probing (BoP)] after steps I-II of therapy.
METHODS: Twenty-five patients (3,552 total sites; 1,450 open pockets) with stage III-IV periodontitis received steps I-II of periodontal therapy and were re-evaluated after 4-6 weeks (T1). Residual pockets received RSI at T1 and at 3 months (T2). EoT (PPD < 4 or PPD < 6 BoP-) rate at T1, T2 and 6 months (T3) was computed. The number of needed surgeries and treatment costs were calculated.
RESULTS: At T1, 67.6% of open pockets achieved EoT. At residual PPD ≥ 6 mm at T1 (n = 172), one and two RSI resulted in 33.1% and 45.9% of EoT at T2 and T3, respectively. At residual PPD 4-5 mm with BoP at T1 (n = 298), one and two RSI resulted in 66.8% and 72.1% of EoT at T2 and T3, respectively. PPD at T1 predicted EoT after RSI in both cases, while tooth type only in residual PPD 4-5 mm BoP + . At T1, mean number of surgeries per patient and associated costs were significantly higher than after one/two RSI.
CONCLUSIONS: RSI may achieve EoT in residual PPD 4-5 mm BoP + and PPD ≥ 6 mm in a considerable number of cases.
CONCLUSIONS: These findings may support the administration of one/two cycles of RSI prior to surgical approach.
BACKGROUND: ClinicalTrials.gov identification number: NCT04826926.

The main goal of periodontology is to prevent and arrest gingivitis and periodontitis to avoid tooth loss and focal infection of periodontal origin. Periodontal scaling or flap surgery of moderate-to-severe periodontitis have shortcomings, most likely because removal of herpesviruses and bacterial pathogens in deep periodontal lesions and the adjacent inflamed gingiva requires systemic antimicrobial treatment (or gingivectomy). Valacyclovir (1000 mg twice daily on day 1, and 500 mg twice daily on day 2 and on day 3) is a potent anti-herpesvirus agent. Antibiotic combinations against bacterial pathogens include amoxicillin-metronidazole (250 mg of each, thrice daily for 4 days; for systemically healthy adults) and ciprofloxacin-metronidazole (500 mg of each, twice daily for 4 days; for immunosuppressed individuals and patients exposed to contaminated water and poor sanitation). Supportive antiseptic treatment may consist of 0.1%-0.2% sodium hypochlorite (regular household bleach) as cooling spray in ultrasonic scalers, flosser fluid in oral irrigators, and mouthrinse in patient self-care. The anti-infective treatment described here helps control cases of severe periodontitis and constitutes an exceedingly inexpensive alternative to conventional (mechanical) periodontal therapy.

OBJECTIVE: The aim of this meta-review was to evaluate whether there is a meaningful clinical benefit regarding the use of systemic adjunctive antibiotics in the treatment of patients with periodontitis. Additionally, a consensus regarding possible recommendations for future administration of antibiotics should be reached.
METHODS: A structured literature search was performed by two independent investigators focusing on systematic reviews (SR) covering adjunctive systemic antibiosis during non-surgical periodontal therapy. Additionally, recent randomized clinical trials (RCT, July 2015 to July 2017) were searched systematically to update the latest SR. Results were summarized and discussed in a plenary to reach a consensus.
RESULTS: Mostly, systematic reviews and RCTs showed a significant positive effect of adjunctive systematic antibiosis compared to controls. These positive effects gain clinical relevance in patients with severe periodontal disease aged 55 years and younger.
CONCLUSIONS: Systemic antibiotics as an adjunct to non-surgical periodontal therapy should be sensibly administered and restrictively used. Only certain groups of periodontitis patients show a significant and clinically relevant benefit after intake of systemic antibiosis during periodontal therapy.
CONCLUSIONS: Avoiding antibiotic resistance and possible side effects on the human microbiome should be a focus of dentists and physicians. Thus, a sensible administration of antibiotics is mandatory. This manuscript suggests guidelines for a reasonable use.

OBJECTIVE: The recent ADA-commissioned Clinical Practice Guideline on the nonsurgical treatment of chronic periodontitis has provided the most exhaustive library of clinical trials on scaling and root planing (SRP) with or without adjuncts. This network meta-analysis (NMA) compared the adjuncts against each other.
METHODS: A star-shaped NMA was performed based on 36 indirect comparisons of clinical attachment-level (CAL) gains among nine adjuncts in 74 studies from the Clinical Practice Guideline.
RESULTS: All pairwise differences were accompanied by wide confidence intervals, and none of the adjuncts were statistically significantly superior to another. Local doxycycline hyclate and photodynamic therapy with a diode laser had the highest probabilities for ranking first and second, respectively. Publication bias was evident, with fewer than expected studies with small effects. The lack of these studies inflated the treatment effects by an estimated by 20%.
CONCLUSIONS: Adjuncts improve CAL gain by about a third of a mm over 6-12 months compared with SRP alone, but no significant differences were found among the adjuncts. The patient-perceived benefit of this gain is unclear because CAL is a physical measure made by the clinician and not a patient-oriented outcome. Publication bias inflated the observed treatment effects.

暂无摘要。

BACKGROUND: A panel of experts convened by the American Dental Association Council on Scientific Affairs presents an evidence-based clinical practice guideline on nonsurgical treatment of patients with chronic periodontitis by means of scaling and root planing (SRP) with or without adjuncts.
METHODS: The authors developed this clinical practice guideline according to the American Dental Association\'s evidence-based guideline development methodology. This guideline is founded on a systematic review of the evidence that included 72 research articles providing clinical attachment level data on trials of at least 6 months\' duration and published in English through July 2014. The strength of each recommendation (strong, in favor, weak, expert opinion for, expert opinion against, and against) is based on an assessment of the level of certainty in the evidence for the treatment\'s benefit in combination with an assessment of the balance between the magnitude of the benefit and the potential for adverse effects.
UNASSIGNED: For patients with chronic periodontitis, SRP showed a moderate benefit, and the benefits were judged to outweigh potential adverse effects. The authors voted in favor of SRP as the initial nonsurgical treatment for chronic periodontitis. Although systemic subantimicrobial-dose doxycycline and systemic antimicrobials showed similar magnitudes of benefits as adjunctive therapies to SRP, they were recommended at different strengths (in favor for systemic subantimicrobial-dose doxycycline and weak for systemic antimicrobials) because of the higher potential for adverse effects with higher doses of antimicrobials. The strengths of 2 other recommendations are weak: chlorhexidine chips and photodynamic therapy with a diode laser. Recommendations for the other local antimicrobials (doxycycline hyclate gel and minocycline microspheres) were expert opinion for. Recommendations for the nonsurgical use of other lasers as SRP adjuncts were limited to expert opinion against because there was uncertainty regarding their clinical benefits and benefit-to-adverse effects balance. Note that expert opinion for does not imply endorsement but instead signifies that evidence is lacking and the level of certainty in the evidence is low.

Considerable disagreements and variations exist in diagnosis and treatment planning of periodontal disease. Achieving high interrater periodontal diagnosis can prove challenging. The objectives of this study were to measure variations in periodontal diagnosis and treatment planning among predoctoral periodontics faculty members after consensus training and to compare such variation with those identified in third- and fourth-year dental students. Nine electronically stored case vignettes and survey instruments were made available to eighteen faculty members and twenty dental students under standardized conditions. A chi-square test was used to compare responses between groups, and multirater kappa tests were used to evaluate interrater agreement/reliability. Of the nine cases, only one differed between groups significantly in terms of treatment. Also, third-year students differed from fourth-year students on the diagnosis of aggressive periodontitis versus chronic periodontitis. Most respondents were able to distinguish clearly among diagnoses of chronic periodontitis, aggressive periodontitis, and gingivitis. This study established a baseline assessment of the current status of consensus after training. We will reassess variations after addressing the specific challenges identified. Programs designed and implemented to help decrease the variation in periodontal diagnosis and treatment planning among faculty members may ultimately translate into better agreement and better standardization of dental instruction.

暂无摘要。

Non-surgical root debridement is usually the first step in the treatment of chronic periodontitis. This can be performed in one day or in multiple sessions over several weeks using manual instruments and/or power-driven instruments. Besides scaling and root planing, the removal of plaque-retaining factors and mechanical oral hygiene measures are essential for a favourable treatment outcome.

BACKGROUND: The remit of this working group was to update the existing knowledge base in non-surgical periodontal therapy. The published systematic reviews from the fourth EAP Workshop formed the starting point for this update and in addition specific innovations not covered in previous workshops were included.
METHODS: The literature was systematically searched and critically reviewed. Five manuscripts were produced in five specific topics identified as areas where innovative approaches have been developed in non-surgical periodontal therapy and which were deemed to be strategically important for patient care and clinical practice.
RESULTS: The results and conclusions of the review process are presented in the following papers, together with the group consensus statements, clinical implications and directions for future research: A systematic review of the effects of full mouth debridement with and without antiseptics in patients with chronic periodontitis. Advances in Power Driven Instrumentation. Laser application in non-surgical periodontal therapy - a systematic review. Antimicrobial therapy in periodontitis: the use of systemic antimicrobials against the subgingival biofilm. The cost-effectiveness of supportive periodontal-care for patients with chronic periodontitis.