Full-mouth ultrasonic debridement versus quadrant scaling and root planing as an initial approach in the treatment of chronic periodontitis.
OBJECTIVE
To evaluate the clinical efficacy of (i) a single session of "full-mouth ultrasonic debridement" (Fm-UD) as an initial periodontal treatment approach and (ii) re-instrumentation of periodontal pockets not properly responding to initial subgingival instrumentation.


METHODS
Forty-one patients, having on the average 35 periodontal sites with probing pocket depth (PPD) > or =5 mm, were randomly assigned to two different treatment protocols following stratification for smoking: a single session of full-mouth subgingival instrumentation using a piezoceramic ultrasonic device (EMS PiezonMaster 400, A+PerioSlim tips) with water coolant (Fm-UD) or quadrant scaling/root planing (Q-SRP) with hand instruments . At 3 months, all sites with remaining PPD> or =5 mm were subjected to repeated debridement with either the ultrasonic device or hand instruments. Plaque, PPD, relative attachment level (RAL) and bleeding following pocket probing (BoP) were assessed at baseline, 3 and 6 months. Primary efficacy variables were percentage of "closed pockets" (PPD< or =4 mm), and changes in BoP, PPD and RAL.


RESULTS
The percentage of "closed pockets" was 58% at 3 months for the Fm-UD approach and 66% for the Q-SRP approach (p>0.05). Both treatment groups showed a mean reduction in PPD of 1.8 mm, while the mean RAL gain amounted to 1.3 mm for Fm-UD and 1.2 mm for Q-SRP (p>0.05). The re-treatment at 3 months resulted in a further mean PPD reduction of 0.4 mm and RAL gain of 0.3 mm at 6 months, independent of the use of ultrasonic or hand instruments. The efficiency of the initial treatment phase (time used for instrumentation/number of pockets closed) was significantly higher for the Fm-UD than the Q-SRP approach: 3.3 versus 8.8 min. per closed pocket (p<0.01). The efficiency of the re-treatment session at 3 months was 11.5 min. for ultrasonic and 12.6 min. for hand instrumentation (p>0.05).


CONCLUSIONS
The results demonstrated that a single session of Fm-UD is a justified initial treatment approach that offers tangible benefits for the chronic periodontitis patient.
Wennström
Jan L
JL
Department of Periodontology, Faculty of Odontology, The Sahlgrenska Academy, Göteborg University, Göteborg, Sweden. wennstrom@odontologi.gu.se
Tomasi
Cristiano
C
Bertelle
Alberto
A
Dellasega
Ester
E
D000328:Adult; D000368:Aged; D002908:Chronic Disease; D012534:Dental Scaling / Q000295:instrumentation* / Q000379:methods*; D017050:Episode of Care; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000628:therapy; D010518:Periodontitis / Q000628:therapy*; D019233:Retreatment; D016037:Single-Blind Method; D014464:Ultrasonic Therapy