Minimally invasive non-surgical therapy (MINST) in stage III periodontitis patients: 6-month results of a split-mouth, randomised controlled clinical trial

Abstract

Objectives To determine if minimally invasive non-surgical therapy (MINST) outperforms classical non-surgical periodontal therapy for stage III periodontitis with primarily suprabony (horizontal) type defects. Materials and methods In a split-mouth randomised controlled trial, 20 patients’ dental quadrants were randomly assigned to MINST or classical non-surgical treatment. The primary outcome variable was the number of sites with probing pocket depth ≥ 5 mm and BOP. Treatment method, tooth type, smoking status, and gender were evaluated using a multivariate multilevel logistic regression model. Results After 6 months, the percentage of sites with PD ≥ 5 mm and BOP that healed (MINST = 75.5%; control group = 74.1%; p = 0.98), and the median number of persisting sites (MINST: 6.5, control group: 7.0; p = 0.925) were similar in both groups. In the test and control groups, respectively, median probing pocket depths (2.0 mm vs. 2.1 mm) and clinical attachment level (1.7 mm vs. 2.0 mm) changed significantly (p < 0.05) but similarly. Significantly less gingival recession occurred in the MINST group’s deep molar pockets compared to the control group (p = 0.037). Men (OR = 0.52, p = 0.014) and non-molars (OR = 3.84, p 0.001) had altered odds for healing of sites with PD ≥ 5 mm and BOP. Conclusions MINST reduces gingival recession associated with molar teeth, although it performs similarly to traditional non-surgical therapy in treating stage III periodontitis with predominately horizontal-type defects. Clinical relevance MINST performs similarly to non-surgical periodontal therapy in stage III periodontitis with predominantly suprabony defects. Trial registration Clinicaltrials.gov (NCT04036513) on June 29, 2019.

Effectiveness of Ultrasonic and Manual Instrumentation in Nonsurgical Periodontal Therapy: Are Additional Therapies More Effective? A Systematic Review

“…It is well known that the goal of typical nonsurgical periodontal treatment is to remove biofilm to create the ideal environment for efficient bacterial plaque management [5,68,69]. Historically, scaling and root planing with manual instrumentation has been the most commonly used method of root surface debridement, with both clinical and microbiological benefits [70][71][72], as demonstrated by the studies included in this review [19][20][21][22][23][24][25][26][27].…”

“…Nonsurgical periodontal therapy plays a fundamental role in the treatment of periodontal disease and consists of removing the main aetiological factors, i.e., supra-and subgingival biofilm and bacterial toxins, with the aim of reducing gingival inflammation, bleeding on probing and the probing depth. The cause is usually bacterial, although, depending on the situation, there may be several causes that alone are not able to induce the disease state but can be recognized as independent inflammatory states (oedematous and bleeding tissue, gingival hypertrophy, bleeding) [3][4][5][6].…”

“…Periodontal debridement can be performed using either ultrasonic or manual instruments, as has been well documented in the scientific literature [3][4][5][6].…”