Full-mouth treatment versus quadrant root surface debridement in the treatment of chronic periodontitis: A systematic review

Department of Adult Dental Care, School of Clinical Dentistry, University of Sheffield, Claremont Crescent, Sheffield.
British dental journal official journal of the British Dental Association: BDJ online (Impact Factor: 1.08). 11/2008; 205(9):E18; discussion 496-7. DOI: 10.1038/sj.bdj.2008.874
Source: PubMed


Non-surgical periodontal therapy has been proven to be an effective treatment for patients with chronic periodontitis. Conventional non-surgical therapy by debridement of the root surfaces is performed on a quadrant basis with 1-2 week intervals. This time interval may result in re-colonisation by the bacteria of the instrumented pockets and impair healing. Therefore, a new approach of full-mouth non-surgical therapy to be completed within two consecutive days with (full-mouth disinfection) or without (full-mouth debridement) use of oral antiseptics has been suggested. The aim of this review was to compare the clinical outcomes of the three modalities of non-surgical therapy (full-mouth disinfection [FMD], full-mouth debridement [FRp], quadrant scaling and root planing [Q]).
Standard searches of Medline and Embase databases and appropriate hand searching provided the published studies, which were then assessed against pre-determined inclusion criteria. Meta-analysis was performed wherever possible using Review Manager 4.2 software.
Seven randomised controlled trials (RCTs) were included in the review and these failed to show any statistically significant differences between the FRp and Q approaches. Further studies are required to reach conclusion regarding the advantages of FMD approach.
Mechanical debridement is an important component of treatment for chronic periodontitis and this review suggests that both the traditional quadrant approach and the newer the full-mouth debridement could be equally effective.

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    • "In line with this, Teughels et al. [12] reported more favorable clinical and microbiological results with the FDIS strategy than with SRP alone, whereas later studies have found little or no additional effect of this technique [13] [14]. Recently, Preus et al. [15] found no difference in clinical effect between SRP and FDIS when combined with systemically delivered, adjunctive metronidazole (MET) in patients with a metronidazole-sensitive subgingival "
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    ABSTRACT: Objective: The benefit of full-mouth disinfection (FDIS) over traditional scaling and root planing (SRP) in the treatment of chronic, destructive periodontitis remains equivocal and it is not known whether the use of adjunctive antibiotics may enhance the effect of FDIS. Therefore, the aim of this study was to evaluate the effect of conventional SRP completed over 21 days or 1-day FDIS, with or without systemically delivered adjunctive metronidazole (MET) on the presence of P. gingivalis and T. forsythia after 3 and 12 months. Materials and methods: One hundred and eighty-four patients with moderate-to-severe periodontitis were randomly allocated to one of four treatment groups; (1) FDIS+MET; (2) FDIS+placebo; (3) SRP+MET; (4) SRP+placebo. Prior to treatment, pooled subgingival samples were obtained from the five deepest pockets. The same sites were sampled again 3 and 12 months after treatment. All samples were analyzed for P. gingivalis and T. forsythia by PCR, whereas A. actinomycetemcomitans and other bacteria were identified by culture techniques. Results: At baseline, 47% of the samples were positive for P. gingivalis, while almost all samples were positive for T. forsythia. The occurrence of P. gingivalis and T. forsythia was significantly reduced at 3 and 12 months after treatment in the FDIS+MET group, but not in the other treatment groups. Conclusion: FDIS+MET had a significant effect in patients with P. gingivalis and T. forsythia, resulting in a significant reduction in number of patients where these micro-organisms could be detected at 3 and 12 months post-therapy.
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    ABSTRACT: Nuclear factor-kappa B (NF-kappaB) is involved in osteoclast differentiation and activation. Thus, the blockade of the NF-kappaB pathway might be a novel therapeutic strategy for treating bone metabolic diseases. Periodontitis is subgingival inflammation caused by bacterial infection; this disease also is thought to be a chronic focal point responsible for systemic diseases. In this study, NF-kappaB decoy oligodeoxynucleotides (ODNs) were topically applied for experimental periodontitis in a debris-accumulation model and wound healing in a bone-defect model of beagle dogs to investigate the effect of decoy ODN on bone metabolism. Application of NF-kappaB decoy ODN significantly reduced interleukin-6 activity in crevicular fluid and improved alveolar bone loss in the analysis of dental radiographs and DEXA. Direct measurement of exposed root that lost alveolar bone support revealed that NF-kappaB decoy treatment dramatically protected bone from loss. In a bone-defect model, NF-kappaB decoy ODN promoted the healing process as compared with control scrambled decoy in micro-CT analysis. Overall, inhibition of NF-kappaB by decoy strategy prevented the progression of bone loss in periodontitis and promoted the wound healing in bone defects through the inhibition of osteoclastic bone resorption. Targeting of NF-kappaB might be a potential therapy in various bone metabolic diseases.
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