non surgical periodontal therapy review article
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. Therefore, in the future it would be interesting to investigate the role of host modulators in systemically compromised patients, namely patients affected by diseases with an immune‐inflammatory pathogenesis. Moreover, before applying routinely these host modulators, properly powered studies performed by independent research groups are recommended. Additional information like baseline PPD values and type of outcomes considered can be found in Appendix S3. 1986;21(5):496-503. This review showed a great heterogeneity on the type of bleeding scores used, which did not allow to make relevant comparisons. Effect of non-surgical periodontal therapy IV. Fourteen studies reported on the systemic use of a sub‐antimicrobial dose of doxycycline (SDD) (up to 40 mg a day) in combination with NSPT, although original data were extracted only from seven studies (Caton et al., 2000; Emingil, Gürkan, Atilla, Berdeli, & Cinarcik, 2006; Gürkan, Emingil, Cinarcik, & Berdeli, 2008; Lee et al., 2004; Needleman et al., 2007; Novak, Johns, Miller, & Bradshaw, 2002; Preshaw et al., 2004) (Table 1). 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. 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). 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). A number of treatment procedures, such as gingival curettage and aggressive removal of contaminated root cementum, have been unlearned. starch), 4 smokers in SDD and 5 smokers in placebo group, Severe, generalized chronic periodontitis. 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). Materials and method: Electronic databases of PubMed and Cochrane Library were searched from 1992 to 2018. The effect of the thermal diode laser (wavelength 808–980 nm) in non-surgical periodontal therapy: a systematic review and meta-analysis. Factors that may limit the effectiveness of nonsurgical therapy as a closed … Nonsurgical therapy aims to eliminate both living bacteria in the microbial biofilm and calcified biofilm microorganisms from the tooth surface and adjacent soft tissues. The study showed that neither the fruit and vegetable (FV) supplementation nor the fruit, vegetable, and berry juice (FV) supplementation improved PPD reduction compared to placebo at 8 months after NSPT. However, since the main goal of periodontal treatment is to establish a healthy periodontal condition, characterized by shallow pockets with no bleeding on probing, it would be interesting in the future to collect data on pocket closure (% of pockets ≤4 mm) (Tomasi, Leyland, & Wennstrom, 2007), or closure of furcation defects in case of molar teeth. In this context, administration of pharmacological or bioactive agents as adjuncts to NSPT may facilitate resolution (Van Dyke, 2017) or inhibition (Salvi & Lang, 2005a) of the inflammation. For all the aforementioned reasons, there is not enough convincing evidence to recommend the use of a systemic medication that needs to be taken regularly and for a long period of time, with the potential risk of having adverse reactions in periodontal patients. Correlation between oral hygiene and periodontal condition, Evidence‐based clinical practice guideline on the nonsurgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts, Clinical and microbiological effects of probiotic lozenges in the treatment of chronic periodontitis: A 1‐year follow‐up study, Factors influencing the outcome of non‐surgical periodontal treatment: A multilevel approach, European Workshop in Periodontology group C, Advances in the progression of periodontitis and proposal of definitions of a periodontitis case and disease progression for use in risk factor research: Group C Consensus report of the 5th European workshop in periodontology, Purpose and problems of periodontal disease classification, Pro‐resolving mediators in the regulation of periodontal disease, The effect of a selective cyclooxygenase‐2 inhibitor (celecoxib) on chronic periodontitis. However, the authors commented on the … The statistical unit of analysis was the patient for systemic host modulators and mouth rinses, while for obvious reasons, the site was the unit of analysis for locally delivered host modulators in infrabony/furcation defects (topic application). … Information regarding periodontal regenerative therapy in patients with diabetes mellitus (DM) is limited. Considering the limited sample size of the included papers, it was decided to perform meta‐analysis only when ≥5 articles within the same host modulator category and with similar study design were identified for each primary or secondary outcome (Faggion, Wu, Scheidgen, & Tu, 2015). However, the adjunctive use of azithromycin … SRP was performed until a smooth, hard, and clean surface was obtained, 0.05% zoledronic acid gel (zoledonic acid added to a gel containing carbopol 934P, 1% triethanolamine and methyl paraben and propyl paraben solutions), Placebo (gel containing carbopol 934P, 1% triethanolamine and methyl paraben and propyl paraben solutions), No external financial support or sponsorship, Established periodontal disease, with PPD ≥ 3 mm in at least three teeth, gingival index of 2 or 3, plaque index of 2 or <3, gingival recession, All teeth (at least 15/pt)/6 sites per tooth; Michigan probe type O, Removal of all subgingival calcified deposits to obtain a smooth, hard surface in 4 sessions, Placebo (pill with a similar appearance to the medication), In BP group 13 current smokers, 19 past smokers, and 9 never smoked; in control group 9 smokers, 12 past smokers, and 4 never smoked, Moderate chronic periodontitis (mean CAL 1.4–2.4 mm or ≥eight sites with CAL loss ≥3 mm distributed in at least three quadrants or in at least six teeth, not counting straight buccal and lingual surfaces and distal surfaces of the second molars) to severe (mean CAL loss ≥2.5 mm or one or more sites in three out of four quadrants with CAL loss ≥5 mm), All teeth (unclear number)/6 sites per tooth; no details on probe used, Baseline: Full‐mouth SRP, OH and plaque control instructions. Dent Update 2013;40:289-95. Single versus reapeted instrumentation. This therapy involves patient oral home care on a daily basis for success. Each study was judged as at low, moderate, high, or unclear risk of bias on the basis of five domains: (a) bias arising from the randomization process; (b) bias due to deviations from intended interventions; (c) bias due to missing outcome data; (d) bias in measurement of the outcome; (e) bias in selection of the reported result. Therefore, we do not encourage their everyday clinical use or to conduct future studies to test these medications in their current standard formulation or dosage regimen. Funnel plot and Egger's test did not show evidence for small‐study effects in moderate pockets (p = .09 and p = .88 for PPD at 6 and 9 months, respectively) (Appendices S9 and 10). Magnusson I, Lindhe J, Yoneyama T, Liljenberg B. Recolonization of a subgingival microbiota following scaling in deep pockets. As a matter of fact, statins are known to have pleiotropic pharmacological effects besides their hypolipidemic effects, including antioxidant and anti‐inflammatory properties, angiogenesis stimulation, improvements in endothelial function and positive regulation of bone formation pathways (Adam & Laufs, 2008; Mennickent, Bravo, Calvo, & Avello, 2008; Petit et al., 2019). Assessment, motivation and reinforcement of oral hygiene should be performed at each appointment. For risk of bias reporting, we applied both a “combined” and “per‐host modulator” approach. Then sucralose, citric acid, and methylparaben, propylparaben and sodium citrate were added), In SDD group 67 past smokers and 34 current smokers; in placebo group 69 past smokers and 40 current smokers, Adult periodontitis (CAL and PPD between 5 and 9 mm, with BOP]) in at least 2 tooth sites within each of 2 quadrants, All teeth of 2 quadrants (no number specified); UNC‐15 probe, SRP performed on the 2 qualifying quadrants until the crown and root surfaces were visually and/or tactilely free of all deposits, with a time allowance of up to 1 hr per quadrant. The mean prediction interval ranged from 0.06 to 0.38 mm at 6 months and from 0.15 to 0.45 mm at 9 months. Studies involving only supragingival debridement and/or oral hygiene instructions were excluded. Hardy JH, Newman HN, Strhan JD. If not available, baseline and follow‐up data of mean PPD and CAL were presented. For locally delivered modulators, most of the studies considered only one site per patient. Chamberlain D, Garrett S, Renvert S, Egelberg J. Healing after treatment of periodontal intraosseous defects IV. In 30 patients receiving NSPT, Keskiner et al. I2 was 0% (95% CI 0%–64.1%) both for moderate and deep pockets. Funnel plot (Appendices S4 and S5) and Egger's test did not show evidence for small‐study effects (p = .16 at 6 months and p = .65 at 9 months), while I2 was 95.1% (95% CI 93.1%–96.3%) at 6 months and 65.4% (95% CI 0%–82.7%) at 9 months. Therapy involves patient oral home care on a daily basis for success ”... Professional tooth cleaning or non-surgical periodontal therapy mg/day systemic celecoxib or placebo for months. Enough to possibly overweight the aforementioned limitations patients receiving NSPT, Keskiner et al to that of surgical treatment patient! A number of studies ending at the Faculty of Dentistry, University of Malaya Nagata... 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