Relative effects of plaque control and instrumentation on the clinical parameters of human periodontal disease

Abstract

The healing events of 7 patients with generalized chronic periodontitis were monitored clinically during 3 consecutive phases of treatment: 1) tooth brushing and flossing, 2) subgingival use of the Perio-Aid, and 3) supra and subgingival instrumentation. The clinical parameters evaluated were plaque score, bleeding score, probing pocket depth, probing attachment level, and gingival recession. Each phase continued until maximum effects were achieved (5, 3, and 9 months respectively) determined by minimal or no changes in bleeding scores and probing pocket depths between 3 successive examinations. The results showed limited improvement in the bleeding scores and probing pocket depths with tooth brushing and flossing only (Phase 1). During use of the Perio-Aid (Phase 2), there was no additional improvement, but the initial limited gains made during Phase 1 were maintained. By the end of Phase 2, however, a slight loss of probing attachment level was noticeable. After instrumentation (Phase 3), there was further and more pronounced improvement in bleeding scores and probing pocket depths, as well as a reversal of the probing attachment loss. The results of this study indicate that significant improvement in periodontal pockets should not be expected following home care procedures alone, and that instrumentation may account for the bulk of improvement seen following a combined therapy of plaque control and instrumentation.