title: Enhanced root planing and systemic metronidazole administration improve clinical and microbiological outcomes in a two-step treatment procedure.
abstract: BACKGROUND
  Recently we described a non-surgical two-step treatment concept, in which we distinguished between a first scaling and root planing step (SRP) and an additional second enhanced root planing step (ERP). Until now it is difficult to determine how often a root surface should be instrumented during ERP.
  
  
  METHODS
  The aim of the present study was to investigate the outcomes after different root planing intensities during ERP in 37 patients with aggressive periodontitis after SRP. During ERP a full-mouth root planing was performed. The patients were randomly assigned to one of two root planing regimens (group 1, N = 12 and group 2, N = 11), based on number of curet strokes per root surface (instrumentation frequency, IF) and probing depth. Group 1: PD 1 to 3.5 mm, 4 IF (for group 2, 8 IF); PD 4 to 6 mm, 8 IF (group 2, 14 IF); PD 6.5 to 9 mm, 12 IF (group 2, 20 IF); and PD >9 mm, 16 IF (group 2, 24 IF). Group 3 patients (controls; N = 14) received only the initial SRP. All three groups received the same adjunctive systemic antibiotic treatment.
  
  
  RESULTS
  In all groups, the results showed statistically significant differences in PD and clinical attachment level (CAL) after 6 and 24 months compared to baseline data. Compared with the controls, a significant reduction in PD was observed in groups 1 and 2. The reduction in mean PD was distinctly greater in group 2 (higher IF). Furthermore, Porphyromonas gingivalis (Pg) and Actinobacillus actinomycetemcomitans (Aa) were completely suppressed in group 2 after 24 months.
  
  
  CONCLUSIONS
  The present results show that the extent of root planing has a distinct influence on treatment outcomes. Patients treated with the highest instrumentation frequency showed the best long-term results.
authors.affiliation: Department of Conservative Dentistry, Friedrich Schiller University of Jena, Jena, Germany. bernd.w.sigusch@med.uni-jena.de
authors.forename: Bernd W
authors.initials: BW
authors.lastname: Sigusch
authors.forename: Arndt
authors.initials: A
authors.lastname: Güntsch
authors.forename: Anne
authors.initials: A
authors.lastname: Pfitzner
authors.forename: Eike
authors.initials: E
authors.lastname: Glockmann
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage*; D017622:Periodontal Attachment Loss; D010518:Periodontitis / Q000188:drug therapy* / Q000382:microbiology; D016745:Root Planing / Q000379:methods*; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D008795:Metronidazole