Subgingival instrumentation – Part I
PD Dr. Kristina Bertl, PhD MSc MBA
Based on the results of the Perio Workshop 2019, we previously discussed possible local and systemic adjunctive therapies for treating periodontitis (Adjunctive therapies in non-surgical periodontal treatment Part I, Part II and Part III). However, the key component of periodontal treatment remains subgingival Instrumentation.
Accordingly, as part of the Perio Workshop 2019 Suvan et. at (2020) undertook a systematic review of the following three Questions:
- How effective is subgingival Instrumentation in the treatment of patients with periodontitis?
- Which subgingival instrumentation treatment method is most effective for treating patients with periodontitis? (Ultra)sonic instruments, hand instruments or a combination of the two?
- Does the number of subgingival instrumentation treatment sessions and the time interval between them affect the outcome?
Based on the results of eleven studies, the first Question was answered as follows: Approximately six months after therapy, subgingival instrumentation results in an average reduction in probing pocket depth of 1.5 mm for a baseline pocket depth of 4–6 mm, whereas a reduction of approximately 2.6 mm can be expected for probing depths that are deeper at the start of treatment (≥ 7 mm). The average percentage of successfully treated probing depths was 74% (a successfully treated probing depth is defined here as a probing depth of ≤ 4 mm without bleeding).
The results for the second and third Questions can be summarized very simply: Neither a specific method ([ultra]sonic instruments, hand instruments or a combination of the two; six studies) nor a specific treatment schedule (multiple weekly quadrant/sextant-based visits or ‘full-mouth’ therapy within 24 hours; 13 studies) results in a statistically significantly better clinical or patient-related outcome.
The results for the second and third questions are particularly interesting for daily dental practice, because they enable us to be flexible and to treat the patient according to their wishes, without needing to worry that this will reduce treatment quality.
You can find another article on this topic in the Prophy Community:
- Jeanie Suvan, Yago Leira, Federico Manuel Moreno Sancho, Filippo Graziani, Jan Derks, Cristiano Tomasi. Subgingival instrumentation for treatment of periodontitis. A systematic review. J Clin Periodontol. 2020 Jul; 47 Suppl 22:155-175. doi: 10.1111/jcpe.13245.