Open flap debridement with or without intentional cementum removal: a 4-month follow-up

Clinical efficacy of hand and power-driven instruments for subgingival instrumentation during periodontal surgical therapy: a systematic review

OBJECTIVE

This systematic review aims to assess the available literature on the clinical efficacy of hand versus power-driven instruments for subgingival instrumentation during surgical periodontal therapy (ST).

MATERIALS AND METHODS

A search of the literature was carried out on MEDLINE via Ovid, Embase, Web of Science, the Cochrane Database, LILACS, and Scopus. RCTs comparing the use of powered instruments (test) to hand scalers (control) for subgingival instrumentation in terms of changes in probing pocket depth (PPD) after surgical periodontal treatment were included and screened in duplicate. Descriptive synthesis of the data and risk of bias assessment were undertaken.

RESULTS

Four RCTs met the inclusion criteria and were included in this systematic review. ST in all studies was performed by means of open flap debridement. Gracey curettes were the most commonly used hand instruments, while sonic and ultrasonic devices were used in the test group. Sites with initial PPD ≥ 6 mm had pocket reduction ranging from 2.93 to 4.89 mm in the control group and from 2.77 to 3.86 mm in the test group. All studies found no significant difference between the different types of instruments/devices in terms of PPD reduction.

CONCLUSIONS

Despite the limited number of studies, both manual and power-driven instruments appear to be effective in reducing PPD after surgical treatment of periodontitis.

CLINICAL RELEVANCE

Based on the findings of this systematic review, the clinician may make a decision whether to use manual or powered instruments during ST on a case-by-case basis and considering other factors, such as the risk of creating high concentrations of aerosols.

Approximal plaque pH lowering after sugar intake in a periodontally infected dentition

OBJECTIVES

The aim of this study was to evaluate the effect of periodontal inflammation on the approximal plaque pH after a sucrose rinse.

MATERIALS AND METHODS

Thirty-two periodontitis patients (aged 38-72 years; 9M/23F) were included. All patients were in need of periodontal surgery. Two non-adjacent interdental spaces, one healthy (no bleeding on probing [BoP] and probing pocket depth [PPD] < 4 mm) and one periodontally diseased (BoP and PPD ≥5 mm) were selected. Before and after surgery, the approximal plaque pH was measured before and after 2, 5 and 10 min after a 1-min rinse with sucrose solution.

RESULTS

In periodontally diseased interdental spaces, a significant pH drop was seen 5 min after rinsing. In healthy spaces and after surgery, a significant pH drop was seen after 2 min. A multilevel regression analysis showed that greater probing pocket depths were significantly associated with pH change measured 5 min after rinsing (p < .05). Further on, the approximal pH drop after a sucrose rinse tended to be delayed in dentitions with ≥10% of PPD ≥5 mm (p = .052).

CONCLUSIONS

The results suggest that an ongoing periodontal inflammation could temporarily neutralize acidic metabolic products after a sugar challenge. This may further suggest that plaque pH measured after a sugar rinse might be used to identify an ongoing periodontal disease.