Impact of a two‐stage subgingival instrumentation schemeinvolvingair‐polishingon attachment gain after activeperiodontal therapy

Background

To evaluate whether clinical attachment levelgain (ΔCAL) in deepuntreated periodontal lesionsmay be improved by a two-stage, subgingival instrumentation schemeinvolving air-polishing.

Methods

This 6-month, randomized, controlled, examiner-blinded clinical trial was performed in 44 periodontitis patients with untreated periodontal lesions ≥ 6 mm. At baseline, day 28, 84, and 168 clinical attachment level (CAL), probing pocket depth (PPD), bleeding on probing (BoP) and plaque control record (PlaCR) were recorded. After baseline examination control grouppatients received full-mouth sub- and supragingival instrumentation using scalers and curettes. In the test group initial subgingival cleaningwas limited to the removal of soft bacterial deposits by air-polishing. Subgingival scaling and root planing was performed only after the first reevaluation at day 28.

Results

In deep lesions ≥ 6 mm a significant reduction of mean CAL scores was observed at day 28 and at day 168 for both experimental groups. Differences between the groupshowever did not reach the level of significance. Mean PPD was also significantly reduced at day 28 and at 168 in both experimental groups, with no significant differences between the groups. Mean BoP scores did not change significantly in both groups during the 168-day observation period. Only in the test group mean PlaCR scores were significantly reduced at day 168 compared to baseline.

Conclusions

Subgingival instrumentation of untreated periodontal pockets ≥ 6 mm by air-polishing alone resultsin a significant short-term gain of CAL comparable to conventional scaling and root planing. Its sequential two-step combination with scaling and root planinghowever does not additionally enhancelong-termgain of CAL.

(ClinicalTrials.gov: NCT03098498).

One-sentence summary

A two-step combination of air-polishing and scaling and root planing does not improve attachment gain in untreated deep periodontal lesions.

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