Results: After 12 months of non‐surgical mechanical periodontal therapy, the mean percentage of sites with plaque decreased from 84.1% to 23.6%, and the mean number of sites with bleeding on probing decreased from 82.1% to 29.5%. Since the risk of bias between the studies was low (Egger's test: bias not significant), meta‐analysis was performed by combining all the different statin gels against the placebo. Georgios N. Belibasakis, Head of Division of Oral Diseases, Head of Section of Periodontology and Dental Prevention, Head of Section of Cariology and Endodontics, Department of Dental Medicine, Karolinska Institutet, Alfred Nobels allé 8, SE 141 04 Huddinge, Sweden. Azithromycin may be an alternative adjunctive systemic antibiotic in non-surgical periodontal therapy. By Hcd Deutscher, Shm Derman, A G Barbe, Rainer Seemann and M J Noack. pmid:24460795. Since then, the pool of host modulatory agents has expanded and is now often supported by longer‐term clinical trials (Preshaw, 2018). Material and methods: The electronic database of MEDLINE (via Pubmed) was searched up to December 2017 for randomised clinical trials in English comparing non-surgical periodontal treatment and probiotics versus periodontal treatment … Bleeding, suppuration and probing depth in sites with probing attachment loss. Industry provided atorvastatin, Moderate chronic periodontitis with PPD 5–6 mm, CAL 4–6 mm and vertical bone loss ≥3 mm on intra‐oral periapical radiographs and at least 20 teeth, 1.2% rosuvastatin gel (rosuvastatin added to a gel containing methylcellulose and a solvent), Placebo (no details on preparation methods), Not reported. If you do not receive an email within 10 minutes, your email address may not be registered, A comparison was made between the response to treatment with periodontal surgery and 500 mg azithromycin per day for 3 days and treatment with periodontal surgery only. While this allowed to remove biases related to systemic conditions that might have an impact on oral health and on the treatment response, it is also important to recognize that host modulators might be particularly beneficial for these patients, whose healing capacity might be impaired. Pameijer CH, Stallard RE, Hiep N. Surface characteristics of teeth following periodontal instrumentation: a scanning electron microscope study. Only one study investigated locally delivered statins in furcation class II defects and it showed that both rosuvastatin 1.2% and atorvastatin 1.2% gels led to an improved PPD reduction compared to placebo (3.3 ± 0.46 mm and 2.43 ± 0.62 mm vs. 1.63 ± 0.49 mm) (Garg & Pradeep, 2017) (Table 1). The sustainability and predictability of the outcome depends on various factors, including the efficient removal of the biofilm, patient's individual host response, personal oral hygiene care, and routine maintenance care (Lang, Salvi, & Sculean, 2019). A recent systematic review and meta-analysis evaluating the association between oral hygiene and periodontitis showed that the risk of periodontitis increased by twofold to … Number of times cited according to CrossRef: Evidence-based, personalised and minimally invasive treatment for periodontitis patients - the new EFP S3-level clinical treatment guidelines. The authors do not have any conflict of interest in relation to this manuscript to declare. No details on instruments used, Placebo (same ingredients as the green tea gel but without green tea extract), Primary outcome (PPD reduction) and CAL gain were presented whenever reported by the studies. The effect of dental plaque on gingival health has been early considered. Regular maintenance therapy (i.e. Nine studies met the inclusion criteria for assessing the effect of NSPT combined with BPs (local or systemic) versus NSPT combined with placebo (Table 1). Recent evidence suggests that statins may also attenuate periodontal inflammation by decreasing inter‐leukin IL‐1β and increasing IL‐10 levels in GCF of patients with periodontitis (Cicek Ari et al., 2016). Since only three studies assessed topic BPs in infrabony defects and used one site per patient (Gupta et al., 2018; Pradeep, Kanoriya, et al., 2017; Sharma & Pradeep, 2012a), while two additional studies employed multiple sites per patient (Sharma & Pradeep, 2012b; Sharma et al., 2017), meta‐analysis is not presented here, but meta‐analysis of the five combined studies is provided as supplementary material (Appendix S8). Search strategy and review process An electronic search of SCOPUS, MEDLINE, PubMed, … Information regarding periodontal regenerative therapy in patients with diabetes mellitus (DM) is limited. J Clin Periodontol 1985;12:374-88. Hardy JH, Newman HN, Strhan JD. This article reviews recent evidence on the systemic and oral connection and discusses these findings as they relate to patient care. Insufficient data are available on the role of other local modulators (aloe vera, green tea, and ginko biloba), while the benefit of essential oils mouth rinses/irrigation, of the systemic administration of omega‐3 PUFA, certain micronutrients, BPs, and NSAIDs is inconclusive. In another study using a probiotic preparation containing Streptococcus oralis KJ3, Streptococcus uberis KJ2, and Streptococcus rattus JH145 (108 CFU of each strain/tablet) administered for 3 months, no significant improvements compared to placebo were noted (Laleman et al., 2015). Maintenance visits at 3‐month intervals: OH instructions, supra and subgingival SRP as needed, and removal of supragingival plaque and stain by polishing, 10 mg alendronate a day or 5 mg risedronate/day. Methods: An … Two studies assessed local statins in multiple sites per patient and, therefore, they were not considered in the aforementioned meta‐analysis (Priyanka et al., 2017; Rao, Pradeep, Bajaj, et al., 2013). medical history and smoking history) will be needed to corroborate these findings and also clarify which type of statin is more effective. Industry provided simvastatin, Chronic periodontitis and at least one infrabony defect with PPD > 5 mm and radiographic evidence of vertical bone loss of 3 mm in at least 1 site, 1 tooth and 1 site/tooth per patient; no details on probe used, 1.2% simvastatin gel (simvastatin added to a 4% methylcellulose gel), Chronic periodontitis with PPD ≥ 5 mm and periodontal attachment loss ≥4 mm and vertical bone loss ≥3 mm on intra‐oral periapical radiographs, Multiple posterior teeth per pts and 1 site/tooth; UNC‐15 colour‐coded probe, No details on instruments used. A systematic review. In class II furcation defects, subgingival delivery at the base of the pocket of aloe gel compared to placebo gel significantly improved PPD reduction (2.43 vs. 1.86 mm) at 12 months (Ipshita et al., 2018). A clinical study. The objective of this systematic review was to study the hypothesis whether the clinical outcome, in terms of pocket depth reduction, after non-surgical periodontal therapy in non-obese is better than in obese individuals. Effect of non-surgical periodontal therapy III. The effect of supragingival plaque control on the subgingival microflora. Development of a thermosensitive statin loaded chitosan-based hydrogel promoting bone healing. J Periodontal Res. ABSTRACT. T. Hussain. Likewise, twice a day mouthwash rinses with essential oils compared to placebo for 2 weeks after NSPT led to similar PPD reduction (1.1 vs. 1 mm) (Azad, Schwiertz, & Jentsch, 2016). Nevertheless, particularly for local statins, the trend of benefit in comparison with placebo was large enough to possibly overweight the aforementioned limitations. Working off-campus? Jun 17th, 2016. Future and adequately powered multi‐centred trials are needed to clarify the role of local host modulators in furcation class II defects, and the role of micronutrients, dietary supplementation and omega‐3 PUFA. … As only three studies met the inclusion criteria for assessing the effect of omega‐3 PUFAs combined with NSPT, meta‐analysis was not performed (Table 1). Four studies investigated the use of essential oils either in the form of mouthwash rinses and/or subgingival irrigation after NSPT (Table 1). Eleven patients received alendronate for <6 months and nine for ≥6 months, National/academic. ABSTRACT. Lindhe J, Westfelt E, Nyman S, Socransky S, Heijl L, Bratthall G. Healing following surgical/nonsurgical treatment of periodontal disease. Finally, the role of daily dietary supplementation with fruit, vegetable, and berry juice was investigated in an RCT in 60 patients (Chapple et al., 2012). The present study aimed at investigating whether non-surgical periodontal treatment can reduce the Haemoglobin A1c (HbA1c) % level in type 2 diabetic patients. Methods This prospective study included deep intrabony defects in patients with or … Non-Surgical Periodontal Treatment Created in Periodontal Therapy Periodontal (gum) disease is an infection caused by bacterial plaque, a thin, sticky layer of microorganisms (called a biofilm) that collects at the gum line in the absence of effective daily oral hygiene. VIII Issue 1 Jan–Mar 2016 1c 10.5368/aedj.2016. SUPPORTIVE PERIODONTAL THERAPY- A REVIEW 1 Ravi Chandu Katta 1 Post graduate student 2 Vijay Kumar Chava 2 Professor and Head In one study, there were seven drop‐outs due to AE in the placebo, but none in the drug group (Preshaw et al., 2004), whereas one study reported one drop‐out in the drug group and two in the placebo group (Caton et al., 2000) and another study reported that three out of nine withdrawals were due to possible drug‐related AEs (Golub et al., 2001). The effect of the thermal diode laser (wavelength 808–980 nm) in non-surgical periodontal therapy: a systematic review and meta-analysis. When the p value was not reported and/or was not a punctual value (e.g. In particular, the measurements provided included the reduction in infrabony/furcation defect depth (IBD), defined as the vertical distance from the crest of the alveolar bone/furcation fornix to the base of the defect, and the percentage of defect depth reduction (%DDR) or bone defect fill, calculated as the difference between the distance from the cemento‐enamel junction and the bottom of the defect before and after the treatment divided by the depth of the defect (difference between top and bottom of the defect at baseline). This therapy involves patient oral home care on a daily basis for success. Chronic periodontitis, with more than 16 teeth, at least four of which had a PPD ≥ 5 mm, and radiographic evidence of alveolar bone loss of 30%–50%. Effect of non surgical periodontal therapy on the concentration of volatile sulphur compund in mouth air of group of nigerian young adults. When both mean and SD of PE were present, PPD reduction and its 95% CI were extrapolated by a summary independent sample t test or summary Tukey posthoc test depending on the number of treated groups. J Periodontol 1990;61:293-9. Only one study investigated the effect of statins on furcation class II defects (Garg & Pradeep, 2017), which suggested a significant benefit in terms of PPD reduction. No details on instruments used, 50 mg diclofenac potassium twice a day for 2 months, then 2 months wash‐out and 2 months of therapy, Placebo gel capsules twice a day (no details on preparation methods and composition), All teeth/6 sites per tooth; PCP UNC‐15 probe, SRP with ultrasonic scaler and hand instruments was performed at 1‐week intervals in two session. Role of “diseased” root cementum in healing following treatment of periodontal disease. Keywords: Antibiotics, laser, periodontium, root planing, scaling. Singapore Dent J, 12(1):13-22, 01 Dec 1987 Cited by: 1 article … Likewise, studies in infrabony defects (Pradeep, Kanoriya, et al., 2017; Sharma & Pradeep, 2012a, 2012b; Sharma et al., 2017) showed a significantly higher reduction in IBD (ranging from 1.88 to 2.50 mm compared to 0.09 to 0.12 mm) and in %DDR (ranging from 40.4% to 46.1% compared to 1.86% to 2.5%) 6 months after applying local BPs instead of placebo together with NSPT. Nov 1996; 1(1):443-490. J Periodontol 1982;53:296-301. Overall, while GCF volume decreased from baseline to 6 months in both placebo and SDD group, inter‐group differences were not statistically significant (Emingil et al., 2004, 2006, 2019; Emingil, Atilla, Sorsa, & Tervahartiala, 2008; Emingil, Gürkan, Atilla, & Kantarci, 2011; Golub et al., 2001; Gürkan, Cinarcik, & Hüseyinov, 2005; Lee et al., 2004). In case of missing or incomplete data and absence of further clarification by study authors, the study was excluded from the analysis. Hence, it could be suggested that SDD might be a useful adjunctive therapy in cases of severe periodontitis (stage III and IV). In particular, adequate sample size calculation was provided in six out of nine studies in the BP group, in eight out of 12 studies in the statin group, in seven out of 14 studies in the SDD group, in all probiotic and omega‐3 studies, and in 10 out of 12 studies in the “other” group. Grand Challenges in Oral Infections and Microbes. Miyazaki A, Yamaguchi T, Nishikata J, Okuda K, Suda S, Orima K. Schwarz F, Sculean A, Berakdar M, Georg T, Becker J. Henry CA, Dyer B, Wagner M, Judy M, Matthews JL. Overall, funnel plot and Egger's test did not show evidence for small‐study effects in the meta‐analyses performed. No AE were reported for the use of probiotics, essential oils, or omega‐3 PUFA. Chamberlain D, Garrett S, Renvert S, Egelberg J. Healing after treatment of periodontal intraosseous defects IV. Considering the role of the inflammatory host response in the pathogenesis of periodontitis, different host modulators have been proposed to enhance the outcomes of non‐surgical periodontal therapy (NSPT), but their efficacy has not been fully clarified. The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) were adopted (Moher, Liberati, Tetzlaff, & Altman, 2009). The present systematic review and meta‐analysis aim to evaluate the efficacy of the currently available host‐modulating agents as adjuncts to NSPT in systemically healthy periodontitis patients in terms of improved clinical periodontal outcomes. Yusof WZ. is the most widely studied and the review suggests a moderate benefit when added to NSPT, which becomes clinically more relevant in deep pockets (≥7 mm). Periodontitis is an infectious inflammatory destructive disease initiated by the microbial biofilm in a susceptible host. J Clin Dent 2007;18:34-8. de Almeida JM, Theodoro LH, Bosco AF, Nagata MJ, Oshiiwa M, Garcia VG. Conversely, all studies on NSAIDs either did not provide information or were underpowered. Only four studies (Kurian et al., 2018; Pankaj et al., 2018; Pradeep, Patnaik, et al., 2017; Pradeep et al., 2016) used one site per patient, so meta‐analysis is not reported. Nikolaos Donos, Professor & Chair Periodontology and Implant Dentistry, Lead Centre for Immunobiology & Regenerative Medicine, Head Centre for Oral Clinical Research, Barts & The London School of Medicine & Dentistry, Institute of Dentistry, Queen Mary University of London (QMUL), Turner Street, London E1 2AD, UK. Overall all studies on local modulators (statins, BPs, metformin, aloe vera) reported that patients tolerated them well without any complications, adverse reactions/side‐effects, or allergic symptoms. Magnusson I, Lindhe J, Yoneyama T, Liljenberg B. Recolonization of a subgingival microbiota following scaling in deep pockets. If there was gingival recession, supragingival root planing was performed. Non surgical periodontal therapy 1. There was no limit to time for debridement during the 4 hr of available appointment time. Materials and method: Electronic databases of PubMed and Cochrane Library were searched from 1992 to 2018. when a punctual p value was reported and the tn−1 value was calculable. Data extraction was performed by two calibrated examiners (EC, NB), with 75% of the data checked in duplicate. An RCT was selected if the subject was type 2 diabetic … A quantitative study of cementum removal with hand curettes. J Periodontol 1988;59:794-803., Journal of Evolution of Medical and Dental Sciences. Industry provided alendronate and atorvastatin, Moderate to severe chronic periodontitis with PPD ≥ 5 mm or clinical attachment level (CAL) ≥4 mm and vertical bone loss ≥3 mm on intra‐oral periapical radiographs, SRP performed with ultrasonic scalers and Gracey curettes. Clinical, microbiologic, and histologic responses to non‐surgical therapy are evaluated to provide guidelines for expected treatment results. A 2-year clinical study. Use the link below to share a full-text version of this article with your friends and colleagues. The use of non‐antibiotic, anti‐collagenolytic properties of tetracyclines (particularly doxycycline) dates back to more than 25 years ago (Golub et al., 1983; Golub, Suomalainen, & Sorsa, 1992) and these were the first agents introduced as host‐modulating drugs, not only for periodontitis but also for other collagenolytic diseases (Gu, Walker, Ryan, Payne, & Golub, 2012). Lindhe J, Nyman S. Scaling and granulation tissue removal in periodontal therapy. An improvement in CAL gain was also reported by studies applying 1% bisphosphonate gel (from 1.15 to 4.03 mm) or 1% metformin gel (from 1.17 to 4.06 mm) instead of placebo in infrabony defects (Table 1) (details of meta‐analyses are presented in Appendices S19 and S20). A review of nonsurgical periodontal therapy. Within each host modulator group, secondary outcomes were extracted only if there were at least three articles assessing them. Ultrasonic instrumentation and irrigation of residual pockets (PPD ≥ 5 mm) persisting after initial NSPT with essential oils instead of placebo did not lead to better PPD outcomes (Feng et al., 2011). Overall, a balanced sex distribution was reported by the majority of the studies, although few of them included only males (Rao, Pradeep, Bajaj, et al., 2013; Rao, Pradeep, Kumari, et al., 2013; Sharma et al., 2017) or females (Elgendy & Kazem, 2018; Rocha et al., 2004). Kho P, Smales FC, Hardie J. No clear clinical benefit was associated to the use of probiotics and no definitive conclusions could be drawn for the other included host modulators, although promising results emerged on the use of local BPs and metformin gels in infrabony defects, which need to be confirmed by future studies. The mean prediction interval ranged from −1.61 to 2.37 mm. Research is still needed on the clinical benefit of the granulation tissue removal that is a feature of periodontal surgical therapy and, to a lesser extent, occurs through indirect trauma in nonsurgical therapy. Local bisphosphonate and metformin gels showed potential for clinical use in infrabony defects, which needs to be confirmed. Essential oils (Cymbopogon flexuosus, Thymus zygis and Rosmarinus officinalis) mouthwash twice a day for 2 weeks, Placebo mouthwash twice a day for 2 weeks (emulsifier and water). Efficacy of scaling and root planing. Ann Med Health Sci Res 2013;3:433-7. The current review provides the most accurate reflection of available literature to date to answer the question of whether periodontal treatment affects the general health of type 2 diabetic patients by improving glycemic control compared to no periodontal treatment after at least 3-month follow-up. This systematic review and meta-analysis dealt with the question as to a positive effect ensuing from the systemic administration and local drug delivery of the antibiotic AZM in the nonsurgical treatment of periodontitis, compared with SRP on its own. Likewise, smoking was heterogeneously reported, with few studies excluding smokers, others including few of them and others considering only smoker patients (Table 1). Ten studies met the inclusion criteria, nine of them examined the clinical outcome, while the other one investigated the tooth survival in susceptible individuals after non-surgical periodontal therapy. Reasons for exclusion at the full‐text stage are reported in the Supplementary material (Appendix S2). 18 clinical studies were evaluated after the inclusion, exclusion criteria. Although previous systematic reviews on this topic 5,26) were conducted, we … Thereby, effective periodontal therapy is still a long-term task and a difficult problem. This systematic review aimed to investigate whether non-surgical periodontal therapy (NSPT) can reduce systemic inflammatory levels and improve metabolism in patients undergoing haemodialysis (HD) and/or peritoneal dialysis (PD). Twelve studies assessed the effect of local statin gels in association with NSPT for the treatment of infrabony or furcation class II defects (Table 1). Chen TL, Lin SL, Liu GQ, Liu JC, Song PZ, Xu B. Andersen R, Loebel N, Hammond D, Wilson M. Treatment of periodontal disease by photodisinfection compared to scaling and root planing. While the preliminary study showed a higher reduction in PPD at 6 months (Cavalca Cortelli et al., 2009), the larger trial did not confirm this finding (Cortelli et al., 2009). Any queries (other than missing content) should be directed to the corresponding author for the article. Regarding systemic host modulators, all studies comparing SDD to placebo showed a benefit in terms of CAL gain (up to 1.19 mm in moderate pockets and up to 1.96 mm in deep pockets at 6 months) when SDD was employed (Table 1). Non-Surgical Periodontal Treatment AAP treatment guidelines stress that periodontal health should be achieved in the least invasive and most cost-effective manner. OBJECTIVE The aim of this systematic review was to give the best available evidence on the impact of … Aim: Aim of this review was to present a comprehensive outline of the use of hard tissue lasers in Periodontics with respect to non-surgical periodontal treatment. 1% flurbiprofen toothpaste twice a day for 12 months, Placebo toothpaste twice a day (Boots PIC, Nottingham, England), Periodontitis, with a minimum of two sites, one each of two quadrants, with PPD ≥ 5 mm and BOP, All teeth, 6 sites per tooth; Florida Probe, Full mouth supra‐ and subgingival scaling and root planing followed by supragingival polishing. The cornerstone of management of chronic periodontitis is the non-surgical periodontal treatment… J Clin Periodontol 1985;12:676-86. While comparable PPD reduction was shown in infrabony defects when 1% alendronate and 1.2% atorvastatin gels were employed, rosuvastatin gel led to better clinical outcomes than metformin gel (Pankaj et al., 2018). Lasers used in the treatment of periodontal and peri-implant diseases include: diode lasers, which typically operate in the 810- to 980-nanometer (nm) wavelength;8… Role of “diseased” root cementum in healing following treatment of periodontal disease. Each quadrant was taken 30–45 min, Fruit and vegetable supplement daily for 8 months, Fruit and vegetable and berry supplement daily for 8 months, Placebo (capsules of identical appearance and containing primarily microcrystalline cellulose), Moderate to severe periodontitis, no <20 remaining teeth, at least 6 sites having PPD 6 mm, CAL 4 mm; X‐ray showing multiple sites of alveolar bone resorption exceeding root length of 1/3, Unclear number of teeth, 2 sites per tooth; probe type is not reported, Supragingival ultrasonic scaling and subgingival scaling, Ginkgo biloba extract gel (no information on duration), Unclear number of teeth, 6 sites per tooth; PCP UNC‐15 probe, Full mouth SRP, when needed local anaesthesia was given. In addition, because SRP is the gold standard in nonsurgical therapy, most randomized controlled trials have studied the effectiveness of the adjunctive use of a specific laser technology to SRP alone. This systematic review investigated the efficacy of host modulators combined with NSPT in reducing probing pocket depth (PPD) in periodontitis patients. Most studies in the SDD category did not report any serious AE or patient drop‐outs directly attributed to the medication. Non-Surgical Periodontal Therapy Page 1 of 7 ... (2015) published the results of a 4 year systematic review and meta-anayl sis on the nonsurgical periodontal treatment for patients with chronic periodontitsi via scainl g and roo t planing (SRP) with and/or without adjunctive services. Hibst R, Keller U. OHDM 2014;3:71-80. Periodontal … Since less than three studies reported on radiographic outcomes for other host modulators, data were not extracted. generalized chronic periodontitis defined as CAL ≥ 30% of the teeth and PPD ≥ 5 mm (Armitage, 3 teeth per patient (150 teeth), 6 sites/tooth; Williams periodontal probe, Full mouth SRP performed in a single visit using hand scaler and universal curette at 30–45 min. From the studies included in this review, local statins appear to be overall safe, well‐tolerated and not associated to adverse reactions or complications, so their implementation in clinical practice could be considered as an additional tool to improve treatment outcomes. The use of antiseptics, enzymes and oxygenating agents as adjuncts in supragingival plaque control in Manson and Eley's Periodontics 5. Potential biases will need to be confirmed in a larger number of studies. It is important to emphasize that the outcomes of the current meta‐analyses need to be interpreted with caution. Nonsurgical periodontal therapy: A review II. Immunomodulatory Properties of Stem Cells in Periodontitis: Current Status and Future Prospective. Additional details on GCF parameters and other secondary outcomes are reported in Appendix S28. Funnel plot (Appendix S13) and Egger's test (p = .15 for PPD) did not show evidence for small‐study effects. No details on instruments used, Supragingival irrigation once daily with 300 ml water followed by 200 ml of buffered 0.3% acetylsalicylic acid, 1% citric acid, 1.5% sodium bicarbonate, Placebo (supragingival irrigation with 500 ml water once daily), Chronic periodontitis, with at least four teeth with PPD > 4 mm and loss of attachment >2 mm, with a minimum of two inter‐proximal areas with radiographic evidence of bone loss, Placebo once a day for 6 months (no details on preparation methods and composition). Screening of Electronic databases of PubMed and Cochrane Library were searched from to... 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