Effectiveness of Endoscope-Assisted Subgingival Debridement Versus Repeated Root Surface Debridement or Access Flap Periodontal Surgery in Step 3 Periodontal Therapy: A Systematic Review and Meta-Analysis

Abstract

Objectives: Periodontitis is a multifactorial inflammatory disease leading to the progressive destruction of the tooth-supporting apparatus. The management of residual periodontal pockets remains a challenge for Step 3 periodontal therapy. This systematic review aims to evaluate the potential and efficacy of the periodontal endoscope in managing residual periodontal pockets during Step 3 periodontal therapy.

Material and methods: A comprehensive search was conducted in Medline, PubMed, Cochrane Library, Embase, Scopus, and Web of Science databases up to December 2024. Studies included were randomized controlled trials (RCTs) comparing periodontal endoscope-assisted subgingival debridement (EASD) with repeated root surface debridement (RSD) and access flap periodontal surgery (AFPS). Data extraction and risk of bias assessment were performed independently by two reviewers.

Results: Five RCTs were included, involving 155 subjects and 4072 sites. EASD showed a significantly higher periodontal probing depth (PPD) reduction compared to repeated RSD, with a weighted mean difference (WMD) of 0.5 mm (95% CI: 0.19-0.81) at 3-month postoperation. At 6-month postoperation, the WMD of PPD and clinical attachment level (CAL) changes were 0.84 mm (95% CI: 0.60-1.09) and 0.89 mm (95% CI: 0.45-1.34), respectively, in favor of EASD. EASD showed a significantly higher prevalence ratio (20%) of pocket resolution (PPD ≤ 4 mm) compared to repeated RSD at 6-month postoperation. No significant differences were observed between EASD and AFPS in the changes of CAL, PPD and prevalence of pocket resolution (PPD ≤ 4 mm). The overall certainty of the evidence was deemed to be "low" for EASD versus repeated RSD comparisons and "moderate" for EASD versus AFPS comparisons.

Conclusions: EASD demonstrated superior clinical outcomes compared to repeated RSD in managing residual periodontal pockets. Further high-quality research is necessary to validate these findings and explore the long-term benefits of EASD.

Keywords: endoscopes; meta‐analysis; periodontal debridement; periodontitis; systematic review.

Figure 1

Flow diagram.

Figure 2

Mean difference of clinical attachment level (CAL) 3‐ or 6‐month posttreatment of endoscope‐assisted subgingival debridement (EASD) or repeated root surface debridement (RSD). Please note Zhang et al. (2020) and Wu et al. (2022) shared same last author; supported by multiple grants, including one supporting both reports; same human ethics approval number; reported studies took place over similar period – April 2016–Februray 2019 (Zhang et al. 2020) or October 2017 to December 2019 (Wu et al. 2022); exact male/female count in RSD group of 8/10 and exact dropout count but different mean age reported; nil same data reported from either paper.

Figure 3

Mean difference of probing pocket depth (PPD) 3‐ or 6‐month posttreatment of endoscope‐assisted subgingival debridement (EASD) or repeated root surface debridement (RSD). Please refer to Table 1 for data concerning Zhang et al. (2020) and Wu et al. (2022).

Figure 4

Prevalence ratio of pocket resolution (PPD ≤ 4 mm) 3‐ or 6‐month posttreatment of endoscope‐assisted subgingival debridement (EASD) or repeated root surface debridement (RSD). Please refer to comments on Figure 3 or Table 1 concerning Zhang et al. (2020) and Wu et al. (2022).

Figure 5

Grade assessment on evidence comparing endoscope‐assisted subgingival debridement (EASD) versus access flap periodontal surgery (AFPS).