Subgingival instrumentation for treatment of periodontitis. A systematic review

Objectives To evaluate the efficacy of subgingival instrumentation (PICOS‐1), sonic/ultrasonic/hand instruments (PICOS‐2) and different subgingival instrumentation delivery protocols (PICOS‐3) to treat periodontitis. Methods Systematic electronic search (CENTRAL/MEDLINE/EMBASE/SCOPUS/LILACS) to Marc...

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Bibliographic Details
Published in:Journal of clinical periodontology 2020-07, Vol.47 (S22), p.155-175
Main Authors: Suvan, Jeanie, Leira, Yago, Moreno Sancho, Federico Manuel, Graziani, Filippo, Derks, Jan, Tomasi, Cristiano
Format: Article
Language:English
Subjects:
Clinical trials
Dental Scaling
Dentistry
Gingiva
Gum disease
Humans
nonsurgical treatment
Odontologi
Parodontit
periodontal disease
Periodontitis
Periodontitis - therapy
pocket closure
scaling and root planning
subgingival instrumentation
Ultrasonics
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Summary:Objectives To evaluate the efficacy of subgingival instrumentation (PICOS‐1), sonic/ultrasonic/hand instruments (PICOS‐2) and different subgingival instrumentation delivery protocols (PICOS‐3) to treat periodontitis. Methods Systematic electronic search (CENTRAL/MEDLINE/EMBASE/SCOPUS/LILACS) to March 2019 was conducted to identify randomized controlled trials (RCT) reporting on subgingival instrumentation. Duplicate screening and data extraction were performed to formulate evidence tables and meta‐analysis as appropriate. Results As only one RCT addressed the efficacy of subgingival instrumentation compared with supragingival cleaning alone (PICOS‐1), baseline and final measures from 9 studies were considered. The weighted pocket depth (PD) reduction was 1.4 mm (95%CI: 1.0 1.7) at 6/8 months, and the proportion of pocket closure was estimated at 74% (95%CI: 64–85). Six RCTs compared hand and sonic/ultrasonic instruments for subgingival instrumentation (PICOS‐2). No significant differences were observed between groups by follow‐up time point or category of initial PD. Thirteen RCTs evaluated quadrant‐wise versus full‐mouth approaches (PICOS‐3). No significant differences were observed between groups irrespective of time‐points or initial PD. Five studies reported patient‐reported outcomes, reporting no differences between groups. Conclusions Nonsurgical periodontal therapy by mechanical subgingival instrumentation is an efficacious means to achieve infection control in periodontitis patients irrespective of the type of instrument or mode of delivery. Prospero ID: CRD42019124887.
ISSN:0303-6979
1600-051X
DOI:10.1111/jcpe.13245