Full‐ Versus Partial‐Mouth Disinfection in the Treatment of Periodontal Infections. Long‐Term Clinical Observations of a Pilot Study

Abstract

A classical treatment for chronic adult periodontitis consists of four to six consecutive sessions of scaling and root planing at a 1- to 2-week interval. Such a so-called "quadrant or sextant therapy" might result in a reinfection of a previously disinfected area by bacteria from an untreated region. The purpose of this study was to investigate, over an 8-month period, the clinical benefits of full-mouth disinfection within a 24-hour period in the control of chronic periodontitis. Ten adult patients with advanced chronic periodontitis were randomly assigned to a test and a control group. The control group received the standard scheme of initial periodontal therapy, consisting of scaling and root planing of the four quadrants was performed within 24 hours and immediately followed by a thorough supra- and subgingival chlorhexidine application to limit any transfer of bacteria. The latter involved tongue brushing with a 1% chlorhexidine gel for 60 seconds, mouthrinsing with a 0.2% chlorhexidine solution twice for 60 seconds, repeated subgingival irrigation of all pockets with a 1% chlorhexidine gel (3 times within 10 minutes), and mouthrinsing twice daily with a 0.2% chlorhexidine solution during 2 weeks. In addition, both groups received thorough oral hygiene instructions. The plaque index, gingival index, probing depth, gingival recession, and bleeding on probing were recorded prior to professional cleaning and at 1, 2, 4, and 8 months afterwards. Although the test group scored higher plaque indices than the control group, especially at months 2 and 4, the gingival index and bleeding tendency showed similar improvements with time. However, when the gingival/plaque ratio was considered, the latter was lower in the test group at all follow-up visits. For pockets > or = 7 mm, full-mouth disinfection showed a significantly (P = 0.01) higher reduction in probing depth at each follow-up visit with, at month 8, a reduction of 4 mm (from 8 mm to 4 mm), in comparison to 3 mm (from 8 mm to 5 mm) for the classical therapy. The increase in gingival recession in the full-mouth disinfection group remained below 0.7 mm, while in the control group it reached 1.9 mm after 8 months. This resulted in a gain of clinical attachment level of 3.7 mm for the test group versus 1.9 mm for the control group. A radiographical examination also indicated a superior improvement for the test group when compared to the control group. This pilot study suggests that a full-mouth disinfection in one day results in an improved clinical outcome in chronic periodontitis as compared to scalings per quadrant at 2-week intervals over several weeks.

Full-mouth treatment versus quadrant root surface debridement in the treatment of chronic periodontitis: a systematic review

“…Three of the stud ies were considered in group A, or low risk of bias (Wennström et 33,27 and two were in group C or high risk of bias Quirynen et al 2000). 31,30 Examiners were con sidered not blind in one study (Quir ynen et al 2000) because one treatment group (FRp) has been added later to the study 30 (Table 3).…”

“…Vandekerckhove et al 31 reported eight months' follow up of the Quirynen et al 17 study. Higher reduction in probing depth was reported for the FMD group in initially moderate and deep pockets but this was statistically signifi cant only for the deep (≥7 mm) category (p = 0.01).…”

“…Meta-analysis was not possible due to variation in the reporting data, dis infectant regimen, missing data and the fact that three of the four studies available are reported from the same study group. 30,31,33 …”

“…Only microbiological data were reported in the article, the clinical data were reported in one of the included studies 31 Bollen et al 1998 35 The duration of the study was less than six months (4 months)…”

“…17 Additional probing depth reduction of 1 to 1.2 mm has been claimed as a result of this treatment approach. 18 On the other hand, several studies demonstrated an additional but only small clinical improvement when subgingival chlorhex idine irrigation was used as an adjunc tive therapy to scaling and root planing, whereas other studies failed to show even such an effect. [19][20][21] These observations suggested that the clinical benefi ts might periodontitis in adults using the end be due to full-mouth therapy only.…”