Clinical effects of closed root planing compared to papilla reflection and fiber optic augmentation

A systematic review on the clinical efficacy of subgingival debridement in the treatment of chronic periodontitis

OBJECTIVE

The purpose of this study was to perform a systematic review of the literature and to evaluate, in patients with chronic periodontitis, what the effect is of subgingival debridement (SGD), in terms of bleeding on probing, pocket depth and probing attachment level.

MATERIAL AND METHODS

An electronic search of the Cochrane Oral Health Group specialized register and MEDLINE were performed using specific search terms to identify studies assessing in patients with chronic periodontitis the effect of subgingival debridement with regard to clinical outcomes. This was performed on titles registered up to 2001. The only papers included were those which utilized data based on the patient as unit of observation.

RESULTS

The searches identified 702 abstracts. Titles and abstracts were independently screened by two reviewers (G.A.W. & M.F.T.) to identify publications that met specific inclusion criteria. The agreement between the two reviewers was assessed. The kappa score for agreement was 0.80. Review of these abstracts resulted in 114 publications for detailed review. Finally, 26 papers which met the criteria of eligibility were independently selected by the two reviewers. The kappa score for agreement on this decision was 0.92. Disagreement regarding inclusion of both abstracts and full papers was resolved by discussion between the reviewers. No randomized controlled trials (RCT) could be retrieved that were specifically designed to answer the question formulated at the outset of this systematic review. From the 10 controlled studies, four provide a definitive 'yes' that SGD is effective with regard to clinical outcomes. In the one study where subgingival debridement was not supported by oral hygiene instruction, the paper provided a definitive 'no'. The weighted mean of attachment gain of SGD in pockets initially >or=5 mm was 0.64 mm as compared with 0.37 mm for supragingival plaque control only (SPC). The reduction of pocket depth was 0.59 mm and 1.18 mm for SPC and SGD, respectively. Of the 18 papers that provided only information on the effect of treatment as compared with the baseline values, eight showed SGD to be beneficial with regard to clinical attachment level change while the remaining 10 provided no such an analysis. The weighted mean of this effect was a 0.74-mm gain of attachment as a result of treatment in pockets initially >or= 4 mm.

CONCLUSIONS

In patients with chronic periodontitis, subgingival debridement (in conjunction with supragingival plaque control) is an effective treatment in reducing probing pocket depth and improving the clinical attachment level. In fact it is more effective than supragingival plaque control alone.

Contemporary interpretation of probing depth assessments: diagnostic and therapeutic implications. A literature review

This paper addresses the diagnostic and therapeutic implications of increased probing depths. In general, in untreated and treated patients, when deep and shallow probing depths are compared, the data indicate that deep sites are associated with increased bleeding upon probing, elevated subgingival temperatures, higher levels of pathogens, more probing errors, a greater amount of infiltrated connective tissue, reduced ability to remove subgingival deposits with root planing, and diminished effectiveness of oral hygiene to alter the subgingival microbiota. Clinical trials demonstrate that probing depth is not a good predictor of future disease progression. However, deep sites are at greater risk of disease progression than shallow sites in untreated and treated patients. Furthermore, the deeper the probing depth, the greater the risk of future disease progression. Overall, the preponderance of evidence indicates that it is advantageous, but not always necessary, for patients to have shallow probing depths. With regards to surgical reduction of probing depths beyond that attained with non-surgical therapy, clinicians need to consider the advantages (e.g., ease of maintenance, reduced risk of disease progression) and disadvantages (e.g., root sensitivity, cosmetic defects) of treatment procedures. Since numerous variables require consideration (e.g., response to root planing, goals of therapy, acceptable level of risk for future disease progression), treatment decisions will vary depending on the patient and the desired clinical outcome at specific sites.

IL-1 in gingival crevicular fluid following closed root planing and papillary flap debridement

Interleukin (IL)-1 alpha and beta are cytokines which can mediate inflammatory, bone resorbing, and reparative effects in the periodontium, but few longitudinal data exist exploring their role following periodontal therapy. This study examined gingival crevicular fluid (GCF) concentrations of IL-1 alpha and IL-1 beta at sites with shallow sulci (SS) or inflamed moderate/advanced pockets (M/AP) before and 6 months after treatment with closed scaling/root planing (SC/RP) or papillary flap debridement (PFD), all in the same subject (n = 14 patients). No significant differences were noted in IL-1 alpha or beta concentrations (determined with two-site enzyme-linked immunosorbent assays) between SS and M/AP sites at baseline. While both therapies improved clinical parameters of periodontal disease, IL-1 alpha concentration increased significantly (p < 0.05) in M/AP-PFD sites 6 months after treatment, but were unchanged in other groups. IL-1 beta concentrations were numerically lower after therapy, except for a significant increase (p < 0.05) in M/AP-PFD sites. These data suggest that surgical wound healing in an inflamed, plaque-infected site (M/AP-PFD) results in prolonged production of IL-1, which may be a reflection of the extent of tissue trauma and delayed wound healing. In spite of increased IL-1 levels, these sites demonstrated significant short-term improvement in clinical attachment level (+ 1.8 mm, p < or = 0.001) postoperatively.

Report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The committee screened several hundred articles, citing 518 published papers. Some are present quality in research, others provide clinical interest, and some are identified as misleading. New techniques in pulp physiology and pathology are reported. Laser use and techniques in prevention, restorative dentistry, and materials use are reported. Epidemiology of selected diseases and the results of various formulations for treatment are cited. Diagnosis of craniomandibular dysfunction is well represented as well as references to literature reviews and other sophisticated scientific investigation. Research on adhesives is presented in respect to bonding agents for dentin and enamel. Several clinical studies are included, along with customary laboratory reports on several materials.