Principal findings: Locally delivered 1.2% statin gels as adjunct to NSPT seem to improve PPD reduction in infrabony defects at 6 months. The study showed that neither the fruit and vegetable (FV) supplementation nor the fruit, vegetable, and berry juice (FV) supplementation improved PPD reduction compared to placebo at 8 months after NSPT. Clinical and microbiological features of subjects with adult periodontitis who responded poorly to and root planing. Pihlstrom B, Oritz-Campos C, McHugh R. Randomized four-year study of periodontal therapy. A comparison was made between the response to treatment with periodontal surgery and 500 mg azithromycin per day for 3 days and treatment with periodontal surgery only. Fifty‐eight studies met the inclusion criteria and nineteen studies were included in the quantitative analysis (reasons for exclusion of articles are reported in the Supplementary material). Additional details on GCF parameters and other secondary outcomes are reported in Appendix S28. The authors do not have any conflict of interest in relation to this manuscript to declare. The control solution had the same colour, taste, and alcohol concentration as the test solution, Smokers: 8/23 in essential oil group and 8/23 in placebo: group, Generalized moderate chronic periodontitis, Minimum 20 teeth/patient/6 sites per tooth; PCP‐UNC 15 probe. Periodontitis is an infectious inflammatory destructive disease initiated by the microbial biofilm in a susceptible host. BibTex; Full citation Abstract. Hence, studies that used two different statin gels were counted twice in the meta‐analysis (Martande et al., 2017; Pradeep, Garg, et al., 2016). Eleven patients received alendronate for <6 months and nine for ≥6 months, National/academic. T his literature review is concerned with the ability of personal oral hygiene and mechanical instrumentation to establish and maintain periodontal health. This was a randomised control clinical trial at the Faculty of Dentistry, University of Malaya. Moreover, considering that most of the host modulators are supposed to act by reducing or at least modulating the immune‐inflammatory host response, inflammatory indices, like bleeding scores or plasma levels of inflammatory markers, should be an important part of the clinical assessment of future trials testing these agents. Non-surgical periodontal treatment does have its limitations. No details on instruments used, Current smoker: 10 in cyclic diclofenac potassium group and 6 in placebo group Ex‐smoker: 7 in cyclic diclofenac potassium group and 2 in placebo group, One‐stage full‐mouth disinfection. Since then, the pool of host modulatory agents has expanded and is now often supported by longer‐term clinical trials (Preshaw, 2018). Flow chart of the articles' screening process, Forest plot showing the mean difference (95% CI) in PPD reduction in infrabony defects between local statin therapy compared to placebo at 6 and 9 months after NSPT. A data screening and abstraction form was devised at the full‐text stage to verify study eligibility, carry out the methodological quality assessment, and extract data on study characteristics and outcomes. Regarding systemic host modulators, all studies comparing SDD to placebo showed a benefit in terms of CAL gain (up to 1.19 mm in moderate pockets and up to 1.96 mm in deep pockets at 6 months) when SDD was employed (Table 1). Unfortunately, these data were not available for most of the studies included in this review (<5 studies reported them) and the use of pocket closure as the main outcome would have also restricted the initial sample to sites presenting at least 5 mm depth at baseline, while most of the papers pooled together data from the whole mouth when it came to systemically administered host modulators. The EFP S3 Level Clinical Practice Guideline. SRP was performed until the root surface was considered clean and smooth and patients were given OH instructions, including modified Bass technique and were instructed to avoid using any other OH aid apart from brushing twice daily, Chronic periodontitis, with PPD ≥ 5 mm or CAL ≥ 4 mm, vertical bone loss ≥3 mm on intra‐oral periapical radiographs, 1 tooth and 1 site/tooth per patient; UNC‐15 colour‐coded probe, 1.2% atorvastatin gel (atorvastatin added to a gel containing methylcellulose and a solvent), Placebo (gel containing methylcellulose and a solvent), Not reported. Data on sample size calculation were also extracted and we recorded when the outcome used for power analysis was PPD reduction. Non‐RCTs and RCTs lacking a placebo‐control group or with a follow‐up <6‐months were excluded. Tooth and root surfaces were instrumented under local anaesthesia until they were free of all deposits. Hence, some level of caution in interpreting this finding needs to be considered. The quality of the included studies was assessed using the Cochrane Risk of Bias Tool for randomized clinical trials (RoB 2) (updated on 15 March 2019) by one calibrated examiner (NB), and 15% of the studies were also assessed by a second examiner (EC) to ensure agreement on the scoring system (Higgins et al., 2016). OBJECTIVE The aim of this systematic review was to give the best available evidence on the impact of … The ultimate goal of this mechanical treatment is to allow the diseased periodontal tissues to heal back to an inflammation‐free status and restore periodontal health, as demarcated by the improvement of clinical indices. Lindhe J, Westfelt E, Nyman S, Socransky S, Heijl L, Bratthall G. Healing following surgical/nonsurgical treatment of periodontal disease. The benefits of periodontal maintenance therapy (PMT) in maintaining the homeostasis of periodontal tissues obtained after active periodontal therapy (APT), which includes surgical and non-surgical procedures, has been extensively documented in numerous studies [1–6].A classic problem in PMT programs is difficulty in maintaining the patient’s compliance and in … Overall all studies on local modulators (statins, BPs, metformin, aloe vera) reported that patients tolerated them well without any complications, adverse reactions/side‐effects, or allergic symptoms. Jennifer Chang, Hsiu‐Wan Meng, Evanthia Lalla, Chun‐Teh Lee, The impact of smoking on non‐surgical periodontal therapy: A systematic review and meta‐analysis, Journal of Clinical Periodontology, 10.1111/jcpe.13384, 48, 1, (61-76), (2020). Two studies assessed local statins in multiple sites per patient and, therefore, they were not considered in the aforementioned meta‐analysis (Priyanka et al., 2017; Rao, Pradeep, Bajaj, et al., 2013). Non-surgical pocket therapy: mechanical. Effect of non surgical periodontal therapy on the concentration of volatile sulphur compund in mouth air of group of nigerian young adults. The nature of root surfaces after curette, cavitron and alpha-sonic instrumentation. From these studies, as well as from those included in this review, NSAIDs showed limited clinical benefits, but more importantly they carry a significant risk of serious unwanted effects, which precludes their use as a drug treatment for periodontitis. Attention to detail, patient compliance and proper selection of adjunctive antimicrobial agents for sustained plaque control are important elements in achieving successful long-term results. Future and adequately powered multi‐centred trials are needed to clarify the role of local host modulators in furcation class II defects, and the role of micronutrients, dietary supplementation and omega‐3 PUFA. No details on instruments used, 50 mg diclofenac potassium twice a day for 2 months, then 2 months wash‐out and 2 months of therapy, Placebo gel capsules twice a day (no details on preparation methods and composition), All teeth/6 sites per tooth; PCP UNC‐15 probe, SRP with ultrasonic scaler and hand instruments was performed at 1‐week intervals in two session. Methods: An … Our data are in line with the literature and show that SDD is beneficial in all pockets compared to the placebo, with the best improvements in deep pockets (PPD ≥ 7 mm) compared to moderate pockets (4–6 mm) (Table 1). Effect of Non-surgical Periodontal Therapy on Glycemic Control of Type 2 Diabetes Mellitus A Systematic Review and Bayesian Network Meta-analysis For the primary outcome (PPD reduction), mean values and standard deviations (SDs) were extracted. OH instructions between baseline and 3‐month follow‐up. Clinical, microbiologic, and histologic responses to non‐surgical therapy are evaluated to provide guidelines for expected treatment results. Irrigation was performed by moving the ultrasound tip slowly, vertically from the gingival margin to the apical extent of the pocket, and laterally in a sweeping motion. Although no conclusive evidence can be drawn in relation to the use of local BPs and metformin gels, data emerging from this review suggest a trend for a benefit in terms of PPD reduction, CAL gain, and radiographic defect fill when adding them to NSPT in infrabony defects (Supplementary material). In incidents of NSPT failure, more than just patient compliance should be considered. All these factors might have played a role in the different outcomes reported by the studies and, therefore, some level of caution need to be taken into consideration when interpreting the data. Owing to the heterogeneity of the studies, the random‐effect model was applied. Mean probing depth decreased from 3.2 to 1.8 mm, with a mean clinical attachment level gain of 0.6 mm. nonsurgical periodontal therapy, initial periodontal therapy, hygiene phase therapy, mechanic therapy and cause-related periodontal therapy. This systematic review aimed to assess the literature for the effectiveness of different probiotic strains as adjuvants to non-surgical periodontal therapy. This systematic review aimed to investigate whether non-surgical periodontal therapy (NSPT) can reduce systemic inflammatory levels and improve metabolism in patients undergoing haemodialysis (HD) and/or peritoneal dialysis (PD). Nevertheless, particularly for local statins, the trend of benefit in comparison with placebo was large enough to possibly overweight the aforementioned limitations. Jyotsana Tanwar, Shital A Hungund, Kiran Dodani Overall, a balanced sex distribution was reported by the majority of the studies, although few of them included only males (Rao, Pradeep, Bajaj, et al., 2013; Rao, Pradeep, Kumari, et al., 2013; Sharma et al., 2017) or females (Elgendy & Kazem, 2018; Rocha et al., 2004). Correlation between oral hygiene and periodontal condition, Evidence‐based clinical practice guideline on the nonsurgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts, Clinical and microbiological effects of probiotic lozenges in the treatment of chronic periodontitis: A 1‐year follow‐up study, Factors influencing the outcome of non‐surgical periodontal treatment: A multilevel approach, European Workshop in Periodontology group C, Advances in the progression of periodontitis and proposal of definitions of a periodontitis case and disease progression for use in risk factor research: Group C Consensus report of the 5th European workshop in periodontology, Purpose and problems of periodontal disease classification, Pro‐resolving mediators in the regulation of periodontal disease, The effect of a selective cyclooxygenase‐2 inhibitor (celecoxib) on chronic periodontitis. Out of the 58 included studies, 14 studies did not report information on sample size calculation and 44 reported a priori power analysis or sample size calculation, out of which three were underpowered (one of the BP group, one of the statin group and one of the NSAIDs group) (Gupta et al., 2018; Pradeep et al., 2015; Yen et al., 2008) (Appendix S36). Following review of the trials, six trials continued to satisfy the inclusion criteria. Practical implications: It is suggested that specific local and systemic host modulators could enhance clinical treatment outcomes of NSPT. The microbiological effects in moderately deep pockets. Since only three studies assessed topic BPs in infrabony defects and used one site per patient (Gupta et al., 2018; Pradeep, Kanoriya, et al., 2017; Sharma & Pradeep, 2012a), while two additional studies employed multiple sites per patient (Sharma & Pradeep, 2012b; Sharma et al., 2017), meta‐analysis is not presented here, but meta‐analysis of the five combined studies is provided as supplementary material (Appendix S8). Christodoulides N, Nikolidakis D, Chondros P, Becker J, Schwarz F, Rössler R. Badersten A, Nilveus R, Egelberg J. No AE were reported for the use of probiotics, essential oils, or omega‐3 PUFA. Ann Periodontol. No details on instruments used, Omega‐3 PUFAs including 6.25 mg EPA and 19.19 mg DHA obtained from the Atlantic salmon Salmo salar twice a day for 6 months, Placebo tablet twice a day for 6 months (identical except for the fish oil and prepared by the pharmacy of the Gulhane Military Medical Academy), Advanced chronic periodontitis defined as the presence of ≥6 teeth with PPDs > 6 mm, CAL ≥ 4 mm, and radiographic evidence of bone loss more than one‐third of the root length, At least 18 teeth/patients, unclear number of sites/tooth; probe type not reported, Full‐mouth SRP, by hand and with ultrasonic instrumentation and OH instructions, 3g omega‐3 PUFA and 81 mg aspirin daily for 6 months, Placebo capsules for 6 months (no details on preparation methods and composition). When the p value was not reported and/or was not a punctual value (e.g. Sdd group and 3 in placebo group, secondary outcomes can be found Appendix. 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