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Meta-Analysis
. 2020 Jul:47 Suppl 22:155-175.
doi: 10.1111/jcpe.13245.

Subgingival instrumentation for treatment of periodontitis. A systematic review

Jeanie Suvan  1 , Yago Leira  1 , Federico Manuel Moreno Sancho  1 , Filippo Graziani  2 , Jan Derks  3 , Cristiano Tomasi  3
Affiliations
Meta-Analysis

Subgingival instrumentation for treatment of periodontitis. A systematic review

Jeanie Suvan et al. J Clin Periodontol. 2020 Jul.

Abstract

Objectives: To evaluate the efficacy of subgingival instrumentation (PICOS-1), sonic/ultrasonic/hand instruments (PICOS-2) and different subgingival instrumentation delivery protocols (PICOS-3) to treat periodontitis.

Methods: Systematic electronic search (CENTRAL/MEDLINE/EMBASE/SCOPUS/LILACS) to March 2019 was conducted to identify randomized controlled trials (RCT) reporting on subgingival instrumentation. Duplicate screening and data extraction were performed to formulate evidence tables and meta-analysis as appropriate.

Results: As only one RCT addressed the efficacy of subgingival instrumentation compared with supragingival cleaning alone (PICOS-1), baseline and final measures from 9 studies were considered. The weighted pocket depth (PD) reduction was 1.4 mm (95%CI: 1.0 1.7) at 6/8 months, and the proportion of pocket closure was estimated at 74% (95%CI: 64-85). Six RCTs compared hand and sonic/ultrasonic instruments for subgingival instrumentation (PICOS-2). No significant differences were observed between groups by follow-up time point or category of initial PD. Thirteen RCTs evaluated quadrant-wise versus full-mouth approaches (PICOS-3). No significant differences were observed between groups irrespective of time-points or initial PD. Five studies reported patient-reported outcomes, reporting no differences between groups.

Conclusions: Nonsurgical periodontal therapy by mechanical subgingival instrumentation is an efficacious means to achieve infection control in periodontitis patients irrespective of the type of instrument or mode of delivery. Prospero ID: CRD42019124887.

Keywords: nonsurgical treatment; periodontal disease; pocket closure; scaling and root planning; subgingival instrumentation.

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