Latest evidence provides guidance for treating chronic periodontitis
Typical treatment for mild to moderate periodontal disease is scaling and root planning (SRP), possibly followed or accompanied by adjuncts like antiseptics or antimicrobials. A systematic review of 72 research articles that provided data on clinical attachment gain and were at least 6 months in duration were included. This review revealed some interesting findings.
Why clinical attachment gain?
Clinical attachment is a valid metric and a more stable indicator of periodontal improvement than probing depth reduction or bleeding. Gains in clinical attachment account for about 50% of probing depth reduction.
What was the improvement?
A modest benefit of 0.49 mm net gain in clinical attachment was discovered. This benefit was found to outweigh any adverse effects like discomfort or sensitivity.
Why wasn't the finding greater?
There are several reasons. Baseline levels of disease were not included in the assessment of mean change. Therefore, it is possible that the value reported may underrepresent the true effect of treatment, especially in deeper pockets. Second, there was inconsistency among the studies in how sites and teeth were assessed. Some included only periodontally involved areas, others the whole mouth. Whole mouth measurements may also lead to an underestimation of the treatment effect.
What about adjunctive therapy?
The review also included adding a variety of different systemic and locally delivered antimicrobial agents. Systemic subantimicrobial doxycycline provided a small net benefit to the SRP. Locally delivered antimicrobials were lacking in evidenc
What about lasers?
There was insufficient evidence on the potential benefits of lasers. This is due to the wide variety available along with mutiple protocols for use.
What does this mean for patients?
The reviewers recommended 'in favour' of SRP as the initial treatment of choice for patients with chronic periodontitis. In favour means that the scientific research favors this intervention. They were also in favour of adding systemic subantimicrobial doxycycline to the SRP. For the additional use of locally delivered atnimicrobials, the reviewers found that eveidence was lacking, and felt this was a decision left to the expert opinion of the clinician