Full-mouth disinfection for the treatment of adult chronic periodontitis

 

Abstract

Background

In an attempt to enhance treatment outcomes, alternative protocols for anti-infective periodontal therapy have been introduced.

Objectives

To evaluate the effectiveness of full-mouth disinfection or full-mouth scaling compared to conventional quadrant scaling for periodontitis.

Search methods

Data sources included electronic databases, handsearched journals and contact with experts. The Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE were searched. Reference lists from relevant articles were scanned and the authors of eligible studies were contacted to identify trials and obtain additional information.
Date of most recent searches: December 2006: CENTRAL (The Cochrane Library 2006, Issue 4).

Selection criteria

Randomised controlled trials were selected with at least 3 months follow up comparing full-mouth scaling and root planing within 24 hours with (FMD) or without (FMS) the adjunctive use of an antiseptic (chlorhexidine) with conventional quadrant scaling and root planing (control). The methodological quality of the studies was assessed within the data extraction form, mainly focusing on: method of randomisation, allocation concealment, blindness of examiners and completeness of follow up.

Data collection and analysis

Data extraction and quality assessment were conducted independently by multiple review authors. The primary outcome measure was tooth loss, secondary outcomes were reduction of probing depth, bleeding on probing and gain in probing attachment. The Cochrane Collaboration statistical guidelines were followed.

Main results

The search identified 216 abstracts. Review of these abstracts resulted in 12 publications for detailed review. Finally, seven randomised controlled trials (RCTs) which met the criteria for eligibility were independently selected by two review authors. None of the studies included reported on tooth loss. All treatment modalities led to significant improvements in clinical parameters after a follow up of at least 3 months. For the secondary outcome, reduction in probing depth, the mean difference between FMD and control was 0.53 mm (95% confidence interval (CI) 0.28 to 0.77) in moderately deep pockets of single rooted teeth and for gain in probing attachment 0.33 mm (95% CI 0.04 to 0.63) in moderately deep single and multirooted teeth. Comparing FMD and FMS the mean difference in one study for gain in probing attachment amounted to 0.74 mm in favour of FMS (95% CI 0.17 to 1.31) for deep pockets in multirooted teeth, while another study reported a mean difference for reduction in bleeding on probing of 18% in favour of FMD (95% CI -34.30 to -1.70) for deep pockets of single rooted teeth. No significant differences were observed for any of the outcome measures, when comparing FMS and control.

Authors' conclusions

In patients with chronic periodontitis in moderately deep pockets slightly more favourable outcomes for pocket reduction and gain in probing attachment were found following FMD compared to control. However, these additional improvements were only modest and there was only a very limited number of studies available for comparison, thus limiting general conclusions about the clinical benefit of full-mouth disinfection.

 

Plain language summary

Full-mouth disinfection for the treatment of adult chronic periodontitis

Full-mouth scaling, full-mouth disinfection and quadrant scaling are equally suitable for the treatment of adult chronic periodontitis.
Therapy of chronic periodontitis is based on the mechanical removal of subgingival bacteria from infected root surfaces in order to arrest and control the loss of tooth supporting bone and tissues. Non-surgical periodontal therapy can be carried out either quadrantwise in discrete sessions over a period of several weeks, or within 24 hours in one or two sessions termed full-mouth scaling. The latter can be supplemented with the extended use of an antiseptic agent in the context of full-mouth disinfection. The rationale for full-mouth approaches is to eliminate or reduce pathogenic bacteria from oral habitats that may lead to re-infection of already treated sites. The results of this review have shown that the treatment effects of full-mouth scaling or full-mouth disinfection compared to conventional scaling and root planing are modest and the implications for periodontal care are not profound. In practice the decision to select one approach to non-surgical periodontal therapy over another needs to include patient preferences and convenience of the treatment schedule.

 

摘要

背景

全口消毒治療成人慢性牙周炎

為了改進治療結果,已經有不同的抗感染牙周治療方式

目標

評估全口消毒或全口洗牙比起傳統分次洗牙對牙周炎的治療療效

搜尋策略

資料來源包含電子資料庫,手動搜尋期刊和聯絡專家.搜尋The Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. 檢視相關文獻的引用文獻,詢問找到試驗的作者是否有其他試驗和資訊.最近一次搜尋: 2006年12月CENTRAL (The Cochrane Library 2006, 第四期).

選擇標準

至少追蹤三個月以上的隨機對照試驗,比較於24小時內進行全口洗牙和牙根平滑術的病患,併用抗菌劑(chlorhexidine) (FMD)或不併用(FMS),與傳統分次洗牙和牙根平滑術(對照組).評估資料擷取表內資料的方法學品質,主驗評估:隨機分配方式,對治療分派的保密,試驗者盲性和追蹤其完整性

資料收集與分析

由多位作者獨立進行資料擷取和品質評估.主要結果是掉牙,次要結果是附著深度的降低,附著處的流血和牙周附著水平增量.遵守The Cochrane Collaboration statistical guidelines

主要結論

發現216 摘要,並更仔細研究資料來源的 12 個文獻.最後兩位檢閱者獨立找到7個合格的隨機對照試驗. 沒有試驗有研究掉牙結果. 追蹤至少3個月後,所有治療組都有顯著的臨床參數改進.次級結果變項方面中等深度單一牙根平滑術的附著深度降低方面, FMD和對照組的平均差為0.53 公釐 (95% CI 0.28−0.77). 中等深度多牙根狀況下,牙周附著水平增量為0.33公釐(95% CI 0.04−0.62).比較FMD和FMS,一試驗於深囊多牙根狀況下的牙周附著水平平均差為0.74公釐,顯示FMS組較佳(95% CI 0.17 to 1.31).但另一試驗顯示FMD組, 深囊單牙根牙附著處的流血降低18%(95% CI −33.74 – 2.26). FMS與對照組相比時,其他結果變相沒有顯著差異.

作者結論

慢性牙周炎且中等深度牙周囊袋的病患使用FMD治療後的囊袋減少和牙周附著稍微優於對照組, 但這些改進只是中度的,可供比較的試驗數目少,限制我們做出關於全口消毒臨床效益的一般結論

翻譯人

本摘要由成功大學附設醫院尹子真翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

全口洗牙,全口消毒和傳統洗牙都適用於成人慢性牙周炎.慢性牙周炎的治療是以機械方式由牙根表面除掉齦下細菌,以控制對支持牙齒的骨頭和組織之損傷.非手術療法可用幾週間的幾次間斷療程,或24小時內的1−2次療程.後者可再加上抗菌藥全口殺菌.全口殺菌的理論是消除或減少口腔可再次讓治療過的區域感染的細菌.本回顧顯示全口洗牙或全口消毒與傳統洗牙和牙根平滑術相當,於牙周治療的應用不大.臨床上,採非手術療法需考慮病患喜好和療程方便性