Evidence that full-mouth scaling superior to conventional treatment approaches is unclear

Abstract

Data sources: The Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials, Medline, Embase, CINHAL, the US National Institutes of Health Trials Register and the WHO Clinical Trials Registry Platform.

Study selection: Randomised controlled trials (RCTs) with at least three months follow-up comparing full-mouth scaling and root planing within 24 hours with adjunctive use of an antiseptic such as chlorhexidine (FMD) or without the use of antiseptic (FMS), compared to conventional quadrant scaling and root planing (control).

Data extraction and synthesis: Methodological guidelines of the Cochrane Collaboration were followed. Two review authors selected the papers and determined eligibility based on the titles and abstracts, and any disagreements were resolved by discussion. Four review authors carried out the data extraction. The characteristics of studies excluded at the full-text stage are described in detail. The Cochrane risk of bias tool was used to assess bias in the included studies. Tooth loss and changes in pocket probing depths were the primary outcome measures while attachment level and bleeding on probing were the secondary outcomes.

Results: Twelve trials recruiting 389 participants were included. No studies assessed the primary outcome tooth loss. Ten trials compared FMS and control and there was no evidence for benefit of FMS in any of the outcome measures. Six trials were included in the meta-analysis comparing FMD and control, which did not reveal a benefit for FMD over conventional scaling and root planing. Three trials compared FMS and FMD and did not demonstrate a benefit of one over the other. The quality of evidence was assessed as 'low' due to study design limitations and the small number of trials and participants.

Conclusions: From the 12 included trials there is no clear evidence that FMS or FMD provide additional benefit compared to conventional scaling and root planing. In practice, the decision to select one approach to non-surgical periodontal therapy over another should include patient preference and the convenience of the treatment schedule.