Subgingival Instrumentation for Treatment of Periodontitis

Subgingival Instrumentation for Treatment of Periodontitis. A Systematic Review:

Abstract

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 to supragingival cleaning alone (PICOS‐1), baseline and final measures from 11 studies were considered. The weighted pocket depth (PD) reduction was 1.7 mm (95%CI: 1.3‐2.1) 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 vs 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