Data on PPD reduction (primary outcome) are herein presented for the different host modulators. Owing to the heterogeneity of the studies, the random‐effect model was applied. An experimental study in the dog. The sample was selected to be systematically healthy. SRP was performed until the root surface was considered clean and smooth, 1% alendronate gel (alendronate added to a gel containing carbopol 934P, 1% triethanolamine, 0.1% methyl paraben, and 0.05% propyl paraben), Placebo (gel containing polyacrilic acid 934P, 1% triethanolamine, 0.1% methyl paraben, and 0.05% propyl paraben), Not reported. In 30 patients receiving NSPT, Keskiner et al. Numerous investigations support the efficacy of scaling and root planing in the treatment of periodontal disease. Effect of Non-surgical Periodontal Therapy on Glycemic Control of Type 2 Diabetes Mellitus A Systematic Review and Bayesian Network Meta-analysis J Clin Periodontol 1982;9:52. 1996 Periodontal Literature Review Industry provided atorvastatin, Moderate chronic periodontitis with PPD 5–6 mm, CAL 4–6 mm and vertical bone loss ≥3 mm on intra‐oral periapical radiographs and at least 20 teeth, 1.2% rosuvastatin gel (rosuvastatin added to a gel containing methylcellulose and a solvent), Placebo (no details on preparation methods), Not reported. J Periodontol 1982;53:296-301. Since the risk of bias between the studies was low (Egger's test: bias not significant), meta‐analysis was performed by combining all the different statin gels against the placebo. Data on GCF volume and composition were identified in studies employing NSAIDs, SDD, probiotics, and micronutrients, but only in the SDD group ≥3 studies (a total of eight) reported GCF outcomes. If you do not receive an email within 10 minutes, your email address may not be registered, Ten studies met the inclusion criteria, nine of them examined the clinical outcome, while the other one investigated the tooth survival in susceptible individuals after non-surgical periodontal therapy. Details on adverse effects and patient‐reported outcomes are presented in Appendix S37. J Periodontol 1972;43:628-33. Advances in technology have resulted in the introduction of a range of … To investigate the effectiveness of desensitizing agents (DA) on dentin hypersensitivity (DH) after non-surgical periodontal treatment (NSPT) through a systematic review and meta-analysis. Since only three studies assessed topic BPs in infrabony defects and used one site per patient (Gupta et al., 2018; Pradeep, Kanoriya, et al., 2017; Sharma & Pradeep, 2012a), while two additional studies employed multiple sites per patient (Sharma & Pradeep, 2012b; Sharma et al., 2017), meta‐analysis is not presented here, but meta‐analysis of the five combined studies is provided as supplementary material (Appendix S8). Electronic databases (PubMed, EMBASE, CENTRAL, CNKI, and WFPD) were searched for randomized controlled trials … Van Der Weijden, F. Nonsurgical therapy remains the cornerstone of periodontal treatment. Potentially expected AEs are commonly reported AEs following non-surgical and surgical periodontal therapy such as gingival bleeding, bruising and swelling in the first 2–3 days post-therapy and increase in tooth sensitivity in the first 1–2 weeks post-therapy. Effect of non-surgical periodontal therapy IV. Tanwar, et al. All defects were either three walled or combined defects at the inter‐proximal sites of the adjoining teeth, 1 tooth and 1 site/tooth per patient; UNC‐15 calibrated periodontal probe, No details on instruments used. Cobb CM. A Systematic Review. Mechanical removal of the microbial biofilm by NSPT entails the elimination of the inflammation‐inducing cause (i.e. 15. Eleven patients received alendronate for <6 months and nine for ≥6 months, National/academic. However, few studies considered more than one site with the same characteristics (either infrabony or furcation class II defects) per patient (Table 1). Likewise, studies in infrabony defects (Pradeep, Kanoriya, et al., 2017; Sharma & Pradeep, 2012a, 2012b; Sharma et al., 2017) showed a significantly higher reduction in IBD (ranging from 1.88 to 2.50 mm compared to 0.09 to 0.12 mm) and in %DDR (ranging from 40.4% to 46.1% compared to 1.86% to 2.5%) 6 months after applying local BPs instead of placebo together with NSPT. The present review focuses on the best available evidence, for the current management of the chronic periodontal patients, gathered from systematic reviews and meta-analysis of mechanical non surgical periodontal therapy (NSPT) (subgingival debridement, laser therapy and photodynamic therapy) and the adjunctive chemotherapeutic approaches such as systematic … A comparison was made between the response to treatment with periodontal surgery and 500 mg azithromycin per day for 3 days and treatment with periodontal surgery only. All mucosal surfaces were disinfected with CHX gel for 1 min, 2 tablets probiotic containing S. oralis KJ3, S. uberis KJ2 and S. rattus JH145/day for 3 months, All pockets: 1.52 ± 0.38 Moderate pockets (4–6 mm): 1.78 ± 0.38 Deep pockets (≥7 m): 3.20 ± 0.99, 2 placebo tablets/day for 3 months (tablets were identical in shape, texture, taste and composition a part from the probiotic part), All pockets: 1.62 ± 0.41 Moderate pockets (4–6 mm): 1.82 ± 0.42 Deep pockets (≥7 m): 3.43 ± 0.84, Academic/national and tablets provided by industry, All pockets: 0.71 ± 0.28 Moderate pockets (4–6 mm): 0.98 ± 0.25 Deep pockets (≥7 m): 1.65 ± 0.54, All pockets: 0.75 ± 0.37 Moderate pockets (4–6 mm): 0.98 ± 0.30 Deep pockets (≥7 m): 1.82 ± 0.65. The microbiological effects in moderately deep pockets. Two studies also showed that there were no significant alterations in laboratory parameters among the placebo and SDD groups (blood, urine, kidney tests) (Lee et al., 2004; Preshaw et al., 2004), although one study showed clinically significant changes in liver enzyme ALT in four patients taking SDD compared to one patient taking placebo (Caton et al., 2001). Each study was judged as at low, moderate, high, or unclear risk of bias on the basis of five domains: (a) bias arising from the randomization process; (b) bias due to deviations from intended interventions; (c) bias due to missing outcome data; (d) bias in measurement of the outcome; (e) bias in selection of the reported result. When the p value was not reported and/or was not a punctual value (e.g. Although no conclusive evidence can be drawn in relation to the use of local BPs and metformin gels, data emerging from this review suggest a trend for a benefit in terms of PPD reduction, CAL gain, and radiographic defect fill when adding them to NSPT in infrabony defects (Supplementary material). A review of nonsurgical periodontal therapy Nonsurgical therapy remains the cornerstone of periodontal treatment. Industry provided alendronate and aloe vera, Chronic periodontitis patients having at least one intrabony defect with PPDs ≥ 5 mm or CAL ≥ 4 mm. :Nonsurgical periodontal therapy: A review Journal of Oral Research and Review Vol. Effect of topical administration of propolis in chronic periodontitis. No details on instruments used. No restrictions on the definition of NSPT were applied; however, the included studies had to specify that NSPT included some level of subgingival debridement and/or root planing and that the same protocol was applied to both test and control groups. Funnel plot (Appendix S13) and Egger's test (p = .15 for PPD) did not show evidence for small‐study effects. For all the aforementioned reasons, there is not enough convincing evidence to recommend the use of a systemic medication that needs to be taken regularly and for a long period of time, with the potential risk of having adverse reactions in periodontal patients. Learn about our remote access options, Centre for Oral Immunobiology & Regenerative Medicine & Centre for Oral Clinical Research, Barts and The London School of Medicine & Dentistry, Institute of Dentistry, Queen Mary University of London (QMUL), London, UK. Out of the 58 included studies, 14 studies did not report information on sample size calculation and 44 reported a priori power analysis or sample size calculation, out of which three were underpowered (one of the BP group, one of the statin group and one of the NSAIDs group) (Gupta et al., 2018; Pradeep et al., 2015; Yen et al., 2008) (Appendix S36). Four studies evaluated topical or systemic NSAIDs in adjunct to NSPT (Table 1). Nonsurgical therapy for teeth and implants‐When and why? Kalkwarf K, Kaldahl W, Patil K. Evaluation of furcation region response to periodontal therapy. The benefits of periodontal maintenance therapy (PMT) in maintaining the homeostasis of periodontal tissues obtained after active periodontal therapy (APT), which includes surgical and non-surgical procedures, has been extensively documented in numerous studies [1–6].A classic problem in PMT programs is difficulty in maintaining the patient’s compliance and in … Attention to detail, patient compliance and proper selection of adjunctive antimicrobial agents for sustained plaque control are important elements in achieving successful long-term results. Initial healing of periodontal pockets after a single episode of root planing monitored by controlled probing force. Ann Periodontol. Additional information like baseline PPD values and type of outcomes considered can be found in Appendix S3. This systematic review and meta-analysis dealt with the question as to a positive effect ensuing from the systemic administration and local drug delivery of the antibiotic AZM in the nonsurgical treatment of periodontitis, compared with SRP on its own. No details on instruments used, Supragingival irrigation once daily with 300 ml water followed by 200 ml of buffered 0.3% acetylsalicylic acid, 1% citric acid, 1.5% sodium bicarbonate, Placebo (supragingival irrigation with 500 ml water once daily), Chronic periodontitis, with at least four teeth with PPD > 4 mm and loss of attachment >2 mm, with a minimum of two inter‐proximal areas with radiographic evidence of bone loss, Placebo once a day for 6 months (no details on preparation methods and composition). However, further adequately powered multi‐centre randomized clinical trials are recommended to confirm these findings. Non-Surgical Periodontal Treatment Created in Periodontal Therapy Periodontal (gum) disease is an infection caused by bacterial plaque, a thin, sticky layer of microorganisms (called a biofilm) that collects at the gum line in the absence of effective daily oral hygiene. The use of non‐antibiotic, anti‐collagenolytic properties of tetracyclines (particularly doxycycline) dates back to more than 25 years ago (Golub et al., 1983; Golub, Suomalainen, & Sorsa, 1992) and these were the first agents introduced as host‐modulating drugs, not only for periodontitis but also for other collagenolytic diseases (Gu, Walker, Ryan, Payne, & Golub, 2012). While the inclusion of such studies in this review might have provided additional data to either corroborate or disprove our findings, we were, nevertheless, compelled to abide by the qualitative criteria set for the inclusion of studies in this systematic review. Presented By : Dr. Abhishek Gaur Guided By : Dr. Balaji Manohar Dr. Ravikiran N. Dr. Neema Dr. Aditi Mathur Dr. Barkha Makhijani 2. This review aims to highlight concepts relating to nonsurgical and surgical periodontal therapy, which have been learned and unlearned over the past few decades. Most studies in the SDD category did not report any serious AE or patient drop‐outs directly attributed to the medication. Then sucralose, citric acid, and methylparaben, propylparaben and sodium citrate were added), Placebo (no details on preparation methods and composition but similar colour and consistency), Chronic periodontitis defined by a minimum of two sites per quadrant with pocketing or inter‐proximal attachment loss of >6 mm and one‐third radiographic bone loss, All teeth (unclear number)/6 sites per tooth; UNC CP‐15 markings – 0.2 N force, SRP performed using a single device, FSI‐ 100 inserts, and Gracey curettes ultrasonic on a quadrant by quadrant basis within 1 month over four visits. Few studies also indicated that SDD led to a higher number of sites showing PPD reduction ≥2 and ≥3 mm compared to placebo (Caton et al., 2000; Preshaw et al., 2004), as well as to a higher number of sites with CAL gain ≥2 and ≥3 mm. Expert opinion in a review article states that the usual interval for maintenance dental review is 3–6 months, ... investigating the effect of smoking cessation on the outcomes of non-surgical periodontal therapy included two studies that suggested a beneficial effect of smoking cessation in addition to non-surgical periodontal treatment. J Clin Periodontol 1985;12:283-93. In addition, nonsurgical therapy aims to create an environment in which the host can more effectively prevent pathogenic microbial recolonization using personal oral hygiene methods. Complete elimination of such pathogenic microorganisms is perhaps over-ambitious. Considering the limited sample size of the included papers, it was decided to perform meta‐analysis only when ≥5 articles within the same host modulator category and with similar study design were identified for each primary or secondary outcome (Faggion, Wu, Scheidgen, & Tu, 2015). Only four studies (Kurian et al., 2018; Pankaj et al., 2018; Pradeep, Patnaik, et al., 2017; Pradeep et al., 2016) used one site per patient, so meta‐analysis is not reported. Improved periodontal conditions following therapy. As only three studies met the inclusion criteria for assessing the effect of omega‐3 PUFAs combined with NSPT, meta‐analysis was not performed (Table 1). Compared with NSPT plus placebo, all studies showed that the use of BPs led to a significantly greater PPD reduction both in infrabony and furcation defects (Table 1). Any disagreement was resolved by discussion and, whenever necessary, a third reviewer (ND) was consulted. Both ultrasonic and universal or area‐specific curettes were used under local anaesthesia, Placebo twice a day (no details on preparation, but tablets identical in appearance), Moderate to advanced chronic adult periodontitis (AAP Types III and IV), 2 pre‐molar and first permanent molar in each quadrant/6 sites/tooth; Florida Probe. Non-Surgical Periodontal Treatment Created in Periodontal Therapy Periodontal (gum) disease is an infection caused by bacterial plaque, a thin, sticky layer of microorganisms (called a biofilm) that collects at the gum line in the absence of effective daily oral hygiene. The cornerstone of management of chronic periodontitis is the non-surgical periodontal treatment… Controlling Systemic Risk Factors.Several risk factors have well established associations with both periodontal and systemic diseases, such as diabetes, smoking, stress, immunodeficiency, medications, obesity, hormones, and nutrition. Non‐surgical periodontal therapy (NSPT) includes the improvement of oral hygiene and the use of subgingival scaling and root planing (SRP) for removing the soft and calcified biofilm deposits from the affected root surfaces. Conclusions: Satisfactory healing … Systemic SDD (for 6–9 months) enhances the response to NSPT, particularly in ≥7 mm pockets. If there was gingival recession, supragingival root planing was performed. This review aims to highlight concepts relating to nonsurgical and surgical periodontal therapy, which have been learned and unlearned over the past few decades. II. Likewise, smoking was heterogeneously reported, with few studies excluding smokers, others including few of them and others considering only smoker patients (Table 1). Information regarding periodontal regenerative therapy in patients with diabetes mellitus (DM) is limited. Nyman S, Sarhed G, Ericsson I, et al. Clinical, microbiologic, and histologic responses to non‐surgical therapy are evaluated to provide guidelines for expected treatment results. Lindhe J, Westfelt E, Nyman S, Socransky S, Heijl L, Bratthall G. Healing following surgical/nonsurgical treatment of periodontal disease. In incidents of NSPT failure, more than just patient compliance should be considered. Then sucralose, citric acid, and methylparaben, propylparaben and sodium citrate were added), In SDD group 67 past smokers and 34 current smokers; in placebo group 69 past smokers and 40 current smokers, Adult periodontitis (CAL and PPD between 5 and 9 mm, with BOP]) in at least 2 tooth sites within each of 2 quadrants, All teeth of 2 quadrants (no number specified); UNC‐15 probe, SRP performed on the 2 qualifying quadrants until the crown and root surfaces were visually and/or tactilely free of all deposits, with a time allowance of up to 1 hr per quadrant. Chronic periodontitis, with more than 16 teeth, at least four of which had a PPD ≥ 5 mm, and radiographic evidence of alveolar bone loss of 30%–50%. A Cochrane systematic review, Effect of risk of bias on the effect size of meta‐analytic estimates in randomized controlled trials in periodontology and implant dentistry, Subgingival ultrasonic instrumentation of residual pockets irrigated with essential oils: A randomized controlled trial, Adjunctive supragingival irrigation with acetylsalicylic acid in periodontal supportive therapy, 1.2% Rosuvastatin and 1.2% atorvastatin gel local drug delivery and redelivery in the treatment of class II furcation defects: A randomized controlled clinical trial, Low‐dose doxycycline therapy: Effect on gingival and crevicular fluid collagenase activity in humans, Minocycline reduces gingival collagenolytic activity during diabetes. In the “other” category, we included essential oils, vitamins, micronutrients, and metformin. Moreover, owing to the long treatment regime of SDD (6–9 months), it is plausible to anticipate that patient's compliance might be an issue that clinicians should not underestimate. This pilot study compared the regenerative outcomes of minimally invasive periodontal surgery using enamel matrix derivative (EMD) between DM and non-DM patients. In case of chronic periodontitis, non-surgical periodontal treatment with oral hygiene instruction, scaling and root planing under local anesthesia, was performed by one or more periodontists. Bibliographies of review articles and of all studies included for data extraction were screened. Relative effects of plaque control and instrumentation on the clinical parameters of human periodontal disease. Westfelt E, Bragd L, Socransky S, Haffajee A, Nyman S, Lindhe J. Aim: Aim of this review was to present a comprehensive outline of the use of hard tissue lasers in Periodontics with respect to non-surgical periodontal treatment. A high level of agreement was found between the reviewers at both screening stages (K > 0.9). Any queries (other than missing content) should be directed to the corresponding author for the article. Ehizele AO, Akhionbare O. Twelve studies assessed the effect of local statin gels in association with NSPT for the treatment of infrabony or furcation class II defects (Table 1). The nature of root surfaces after curette, cavitron and alpha-sonic instrumentation. Owing to the heterogeneity of NSAIDs used and to the different regimes applied (local vs. systemic), no meta‐analysis could be performed. Among the studies testing NSAIDs, four did not report any AE other than a mild skin rash in the placebo group (Yen et al., 2008). Shanghai Kou Qiang Yi Xue 2004;13:333-5. J Periodontol 1975;46:522-6. 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