Efficacy of alternative or additional methods to professional mechanical plaque removal during supportive periodontal therapy: A systematic review and meta‐analysis

• Published in: Journal of clinical periodontology 2020-07, Vol.47 (S22), p.144-154
• Main Authors: Trombelli, Leonardo, Farina, Roberto, Pollard, Alexander, Claydon, Nicholas, Franceschetti, Giovanni, Khan, Iftekhar, West, Nicola
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - therapeutic use; Clinical trials; Combined Modality Therapy; Dental Scaling; Dentistry; disease progression; Doxycycline; Doxycycline - therapeutic use; Gum disease; Humans; Meta-analysis; periodontal diseases; Periodontal Diseases - therapy; Periodontitis; Periodontitis - drug therapy; Photodynamic therapy; secondary prevention; Treatment Outcome
• ISSN: 0303-6979; 1600-051X
• DOI: 10.1111/jcpe.13269

Aims To systematically review the literature addressing the following focused questions: “What is the efficacy of either (#1) alternative or (#2) additional methods to professional mechanical plaque removal (PMPR) on progression of attachment loss during supportive periodontal therapy (SPT) in periodontitis patients?”. Methods A systematic search for randomized clinical trials was performed. Change in clinical attachment level (CAL) from baseline was the primary outcome. Results Routine PMPR performed with either a combination of ultrasonic/hand instruments or Er:Yag laser showed similarly effective in preventing CAL loss. Moreover, a routine SPT regimen based on PMPR led to stability of CAL irrespective of a daily sub‐antimicrobial doxycycline dose (SDD). Finally, an adjunctive photodynamic therapy (PDT) did not enhance the magnitude of CAL gain when sites with probing depth ≥4 mm were repeatedly treated. After pooling all data, the results of the meta‐analysis showed no statistical differences in CAL change from baseline: mean overall CAL change was −0.233 mm (95% confidence interval: −1.065, 0.598; p = .351). Conclusions Weak evidence indicate that in treated periodontitis patients enrolled in a 3–4 month SPT based on PMPR, Er:Yag laser (as alternative), SDD and PDT (as additional) do not produce a greater clinical effect on periodontal conditions compared to PMPR.