3. JOURNAL INFORAMATION
• Tittle of article : Success of non-surgical periodontal therapy in adult periodontitis
patients:
• A retrospective analysis
• Established :29 March 2019
• International Journal of Dental Hygiene Published by John Wiley & Sons Ltd
• volume : 18
• Issue : 4
4. INTRODUCTION:
A systematic review of the literature evaluated the effect of subgingival debridement in
terms of bleeding on probing, pocket depth and probing attachment level in patients
with chronic periodontitis. Subgingival debridement was found to be an effective
treatment in reducing probing pocket depth and improving the clinical attachment
leve
When a pocket depth smaller or equal to 5mm is reached, the treatment can be
considered successful
• .Various factors have an impact on the success of the active non‐ surgical periodontal
therapy
• The aim of the present study was to evaluate the success of active non‐surgical
periodontal therapy in patients with adult periodontitis
5. MATERIALS AND METHODS :
• This report was prepared according to the guidelines suggested by the STROBE8,9 and
RECORD10,11 checklists.
• . All data were procured retrospectively from the treatment records.
• They were treated within 12 months following their intake appointment at the
specialist Clinic for Periodontology The Netherlands, from 2013 up to 2016. The clinical
diagnosis before active periodontal treatment was moderate‐to‐severe adult
periodontitis
• . The first appointment included intra and extra‐oral assessment, full‐mouth
periodontal charting and a complete set of radiographs.
• The parameters that were collected included probing pocket depth (PPD; millimetre),
bleeding on pocket probing (BOPP scored as absent or present) and furcation
involvement PPD and BOPP were recorded at six sites
6. SUBJECT
• Following the intake appointment, the active phase of non‐surgical periodontal
therapy was started. Dental hygienists were responsible for the professional tooth
debridement and oral hygiene instructions. All patients received 2 to 5 one‐hour
sessions of thorough supra‐ and subgingival scaling and root planing of all teeth
involved.
• Elective systemic antimicrobial medication consisting of a combination of amoxicillin
(375 mg) and metronidazole (250 mg) three times daily for seven days was provided
after the treatment sessions at the indication of the periodontist responsible for the
treatment
• Data extraction and analysis
7. RESULTS :
• Demography :
• In total 1182 patients included in this study were treated for adult periodontitis
between 2013 and 2016. The mean age at intake was 52.6 ± 9.8 years (range 36‐86),
and 28.6% of the patients were smokers. The average time of treatment between
intake and evaluation was 7.3 ± 1.9 months
• | Treatment success
• In total, 39% of the patients ended with pockets not deeper than 5 mm at the
evaluation appointment. The success at the front teeth was higher (85%) than at molar
teeth (47%). At evaluation, the mean percentage of BOPP at patient level was 13.9 ± 11
• a threshold for bleeding on probing of <10% is used for defining a clinical case of
health, 44% (n = 515) could be considered as a successfully treated periodontitis
patient. When ≤5 mm probing pocket depth is combined with <10% BOPP only in
19% of the patients (n = 226), success was achieved.
8. Non‐treatment success
If the treatment outcome was not successful, that is the presence of residual pockets
deeper than 5 mm
tooth‐related factors were evaluated
Endodontic treatment was associated with the absence of success ranging from 8% to
11% of the cases. At the premolar teeth in 10% of the patients, the presence of pockets
deeper than 5 mm was associated with furcation involvement. In molar teeth, this was
55%
Similarly in 80% of the patients without success, the severity of bone loss at intake was
higher (as defined by the presence of >50% bone loss
At a patient level, non‐smoking was associated with a higher percentage of success
than outcome of treatment in patients that did smoke . In smokers, treatment in 71%
of the cases was unsuccessful. In non‐smokers, treatment was successful in 43% of the
patients and unsuccessful in 57%.
9. DISCUSSION :
Overall 39% of the patients finished with the predefined level of success being overall
with pockets ≤5 mm. Treatment success was more frequently obtained in the front
teeth region (85%) and the premolar region (78%). Smoking status, severity of disease
and molar furcation involvement appeared to be factors that negatively interfered with
success
on comprehensive periodontal therapy; the defined outcome of periodontal therapy to
be a significant reduction of clinical signs of gingival inflammation
10. RELATION BETWEEN TOOTH TYPE AND THE EFFECT OF ACTIVE
NON‐SURGICAL PERIODONTAL THERAPY
• The results of the present study show a higher percentage of success in single‐rooted
teeth (front teeth: 85%) as compared to molar teeth (47%
• molar furcation sites responded less favourably to periodontal therapy compared to
non‐molar sites and molar flat‐surface sites of similar probing depth.
• Possible reason for this is that multi‐rooted teeth can show difficulties in treatment of
the periodontal infection due to local anatomical conditition
• However, there seem to be more site‐associated factors influencing treatment outcome
besides tooth type.
• One of these influencers is furcation involvement where outcomes from clinical trials
showed that molars with furcation involvement responded less favourably to
non‐surgical therapy
• Complete debridement of molars will be rarely obtained because of the complex
morphology in the furcation area
11. • Effect of endodontic treated teeth on active non‐surgical therapy:
• Patients with teeth that have been endodontically treated show more bone loss
compared to contra‐ lateral teeth without an endodontic treatment.
• the present study, patients that did not have a successful treatment response had
endodontic treatment, which varied between 8% and 11% depend‐ ent on tooth type
• This therefore did not provide a clear explanation why treatment was unsuccessfu
• Effect smoking status and non‐surgical periodontal therapy
• Smoking has proven to be a major risk factor in the prevalence, extent and severity of
periodontitis
• that cigarette smoking is a factor associated with deeper periodontal pockets.
• Duane49 shows that there is a strong association between chronic smoking and bone
loss which is in agreement with the present study
• Several studies have also shown that smokers have a poorer response to non‐surgical
periodontal therapy than non‐smokers
12. SEVERITY OF PERIODONTITIS
AND TREATMENT SUCCESS
• According to the literature, all severities of periodontitis can be treated well and
should show a positive effect following the nonsurgical periodontal therapy.56,57 In
the present study, severity of periodontitis is determined by bone loss >50% (yes/no)
and initial pocket depth ≥9 mm (yes/no).
13. CONCLUSION:
• This present study shows that active non‐surgical periodontal therapy in patients with
adult periodontitis resulted in approximately one third of the cases in the success
endpoint of no pockets deeper than 5 mm. Sub‐analysis showed that the outcome
appeared to be dependent on different factors, such as tooth type, furcation
involvement and smoking. Treatment success was higher at single‐rooted teeth than at
molar teeth, especially in those with furcation involvement.
• Success rate was also related to the severity of periodontal disease at intake and to the
smoking status.
14. JOURNAL INFORAMTION
• Journal of clinical periodontology
• Article tittle: A randomized multi-centre study on the effectiveness of non-surgical
periodontal therapy in general practice
• established date : 10 July 2022
•
15. INTRODUCTION :
• The initial phase of patient are included education for the establishment of adequate
self-performed infection control prior to the initiation of mechanical instrumentation,
which was carried out in one session of ultrasonic debridement. At the 3-month
evaluation, residual pathology guided the clinician in the allocation of additional
mechanical subgingival instrumentation.
• The overall objective of the current field study was to evaluate the effectiveness of
clinical and patient-centred outcomes of the GPIC approach when compared with
conventional non-surgical periodontal treatment (CNST). It was hypothesized that the
treatment effect obtained by GPIC should not be inferior to CNST at 6 month
16. MATERIALS AND METHODS
• Study design
• The study was designed as a multi-centre, quasi-randomized, two-armed field study
focusing on the effectiveness of non-surgical treatment of patient with periodontitis
• therapist
• All interventions were performed by registered dental hygienists (DHs) within the
Public Dental Service Of 120 DHs invited, 95 (employed at 59 clinics within general
dental care) agreed to participate.Each DH was randomized to one of two treatment
protocols (GPIC or CNST)
• , Adult patients diagnosed with periodontitis were considered. The patient should have
a minimum of 18 teeth with ≥5 teeth showing periodontal pockets at proximal sites
(PPD ≥ 5 mm and bleeding on probing [BoP] . Subjects having received subgingival
instrumentation within 6 months prior to enrolment were not considered. Recruitment
was started in June 2014 and completed by December 2017.
•
17. MATERIALS AND METHODS
• | Interventions
1. | Guided periodontal infection control :The protocol included dedicated visits
focusing on patient education and motivation towards efficient self-performed
infection control Prior to subgingival debridement, the patient had to demonstrate
sufficient oral hygiene (full-mouth plaque score < 30%). Then, full- mouth ultrasonic
debridement was performed during a single session.
2. | Conventional non-surgical treatment :The conventional treatment approach
comprised, in an integrated manner, patient education, motivation and SRP at
consecutive appointments. No specific directives in regard to therapy were provided.
The number of sessions required to complete CNST was judged by the DH .
two four weeks after the baseline phase of treatment, patients in both groups were
scheduled for oral hygiene control. Subsequently, patients were recalled at 3 months for
evaluation and re- instrumentation (SRP using hand and/or ultrasonic instruments) of
sites with residual PPD ≥5 mm and clinical signs of inflammation. An additional
evaluation was performed at 6 months.
18. • | Data collection
• Patient characteristics (e.g., age, gender and systemic health status)were noted. PPD
and BoP were assessed at four sites per tooth
• Dental plaque was scored as present/absent at four sites/tooth in quadrants
• In addition, the following information was recorded for each treatment session:
• • Local anaesthesia (volume) used during treatment
• • Time (minutes) used for patient education/motivation
• • Time (minutes) used for mechanical instrumentatio
• Patient-reported outcome
• Impact of the treatment on self-perceived oral health was assessed.At the 6-month
evaluation, patients responded to the question: “How do you judge your oral health
after treatment compared to before treat- ment?”. Patient response was scored on a 5-
point scale from “very much improved” to “worse
• Data analysis
19. RESULTS
• DHs were randomly assigned to GPIC (n = 47) and CNST (n = 48). Of 825 invited
patients, 689 agreed to participate in the study. While 74 patients did not complete the
baseline phase of treatment, the modified intention-to-treat analysis comprised 615
patients (GPIC: 280; CNST: 335). A total of 48 patients were lost to follow-up prior to
the 6-month evaluation
• 2. Treatment time including patient education/motivation and mechanical
instrumentation during the baseline phase was 96 ± 33 min for GPIC and 120 ± 50 min
for CNST (p < .001). The time used for re-treatment at 3 months was similar in both
groups. Overall, the average treatment time was 134±40min for GPIC and 161±61min
for CNST (p < .001). More anaesthesia was used in CNST during the baseline treatment
phase, while no differences were observed during retreatment..
20. | TREATMENT OUTCOMES
• resulted in a significant reduction of BoP at 6 months. About 69%–72% of all initial
pockets were closed. No significant differences between treatment groups were
observed,
• b). The proportion of closed pockets for initially shallow sites was 72% (GPIC) and 75%
(CNST). The respective proportions for initially deep sites were 30% and 33%.
• Treatment outcomes at patient level were associated with disease severity (staging).
While about 75% of all pockets resolved in patients with stage II periodontitis, the
respective proportions of pocket closure were about 66% and 50% in patients with
localized and generalized stage III–IV periodontitis,
after treatment, while about 62% presented with >4 teeth with residual pockets. No
differences between groups were observe
• 3, more than 75% of all patients judged their oral health to be significantly improved
(“much improved” and/or “very much improved
• pocket closure was affected by age, smoker versus non smoker ,and molar versus
incisor/ canine
21.
22. DISCUSSION
• The present multi-centre study evaluated the effectiveness of two treatment protocols
of non-surgical periodontal therapy. While no significant differences in clinical
outcomes were observed between the two protocols at 6 months, treatment time and
number of sessions were significantly lower for the guided periodontal infection
control procedure than conventional non-surgical therapy. In addition, multi- level
regression analyses revealed that smoking habits and age among patients affected the
probability of pocket closure.
• who reported that pocket closure was more frequent at initially shallow (86%) than at
deep sites (50%).
• the same study population did not report any significant differences between groups
in terms of treatment discomfort or pain
• Patients categorized as smokers showed a lower probability of pocket closure at 6
month
• Age was also found to have a significant impact, as indicated by a lower response to
treatment in older patients
23. CONCLUSION
• This field study demonstrated that both GPIC and CNST were effective non-surgical
treatment protocols for periodontitis. GPIC was more time-effective. Patient education
should include information on the detrimental effects of smoking on periodontal
health.
