Subgingival instrumentation for treatment of periodontitis. A systematic review
Open accessAbstract
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.
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A comprehensive systematic review found that scaling and root planing has a weighted average probing depth reduction of 1.40 mm for sites with baseline probing depth of 4 to 6 mm.
“A comprehensive systemic review article found the PD reductions for the SRP (which is the gold standard for nonsurgical periodontal treatment) have a weighted average PD reduction of 1.40 mm for those sites with baseline PD of 4 to 6 mm.35”
From Evaluating efficacy of a novel dentifrice in reducing probing depths in Stage I and II periodontitis maintenance patients: A randomized, double-blind, positive controlled clinical trial (2021) · cites this paper as [35]
Section 3.5 (page unavailable) reports a weighted PD reduction of 1.4 mm at 6–8 months for sites considered together, not for the initially shallow sites. For initially shallow sites, it reports 1.5 mm at 3–4 months and 1.6 mm at 6–8 months; the Discussion describes shallow sites as 4–6 mm. (LLM, conf=0.88)
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Treatment of stage I–III periodontitis—The EFP S3 level clinical practice guideline
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“The size of the improvement observed between baseline and the 6-month follow-up is in agreement with those reported in a systematic review with Stage II/III periodontitis (Suvan et al., 2020).”
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- Authors
- Suvan, J., Leira, Y., Moreno Sancho, F. M., Graziani, F., Derks, J., & Tomasi, C.
- Affiliations
- Periodontology Unit and Department of Clinical Research University College London Eastman Dental Institute London UK
- Eastman Dental Hospital (GB)
- University of Pisa (IT)
- University of Gothenburg (SE)
- Corresponding author
- Tomasi, Cristiano
- ORCID
- Venue
- Journal of Clinical Periodontology
- Publisher
- Wiley
- Published
- 2020-07
- Volume
- 47
- Issue
- S22
- Pages
- 155-175
- ISSN
- 0303-6979 (ISSN-L)
- 1600-051X
- OpenAlex
- W2998289360
- Cited by
- 351
- References
- 61
- Citations by year
- 2026: 46 · 2025: 78 · 2024: 65 · 2023: 63 · 2022: 44 · 2021: 30 · 2020: 25
- FWCI
- 3.50
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal Of Clinical Periodontology (publishedVersion)
- PubMed (publishedVersion)
- CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- National Institute for Health and Care Research (NIHR-INF-0387)
- Topics
- Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
- Health Sciences › Medicine › Urology › Periodontal Regeneration and Treatments
- Health Sciences › Dentistry › Oral Surgery › Dental Implant Techniques and Outcomes
- Keywords
- subgingival instrumentation, periodontitis, non-surgical periodontal therapy, ultrasonic scaling, hand scaling, pocket depth reduction, patient-reported outcomes, infection control
- MeSH terms
- Humans, Periodontitis, Dental Scaling, Ultrasonics
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