Greenstein Gary
Department of Periodontology, University of Medicine and Dentistry of New Jersey, Newark, USA.
J Periodontol. 2002 Jul;73(7):797-812. doi: 10.1902/jop.2002.73.7.797.
This commentary compares the abilities of full-mouth disinfection (FDIS), full-mouth root planing (FRP), and partial-mouth disinfection (PDIS) to improve periodontal health. FDIS consists of 4 quadrants of root planing completed within 24 hours with adjunctive chlorhexidine therapies (e.g., rinsing, subgingival irrigation, tongue brushing). FRP denotes 4 quadrants of root planing performed within 24 hours, and PDIS refers to root planing individual quadrants of the dentition, spaced 2 weeks apart. A basic premise of administering full-mouth therapy (FDIS or FRP) is to eliminate or reduce bacterial reservoirs within the oral cavity that could inhibit optimal healing of treated sites or cause periodontal disease initiation or progression.
Controlled clinical trials that compared the abilities of PDIS and full-mouth root planing with and without adjunctive chlorhexidine chemotherapy to alter periodontal status were reviewed.
Several studies conducted at one treatment center indicated that FDIS and FRP attained greater therapeutic improvements than PDIS with respect to decreasing probing depths (PD), gaining clinical attachment (CAL), diminishing bleeding upon probing, and reducing the subgingival microflora. However, the magnitude of PD reductions and gains of clinical attachment must be carefully interpreted, because initial PD measurements were usually determined after scaling and root planing, which may have caused the results to be overstated. Furthermore, in studies that addressed the utility of FDIS, it was not possible to determine if benefits induced beyond PDIS were due to FRP or administration of multifaceted intraoral chlorhexidine treatments ora combination of both therapies. One investigation that had protocol limitations indicated that similar results were attained by FRP with and without adjunctive chemotherapy. In contrast, recent studies from 2 other treatment centers indicated that there were no significant differences when the efficacy of quadrant-by-quadrant root planing was compared to FRP or FDIS with regard to PD reduction, gains of clinical attachment, and impact on the magnitude and quality of the immune response. POSSIBLE CLINICAL IMPLICATIONS: Conceptually, full-mouth therapy (FRP or FDIS) could reduce the number of patient visits and facilitate more efficient use of treatment time. In addition, there appears to be no major adverse reactions to full-mouth root planing with or without adjunctive chemotherapy. However, small study populations and non-corroborating data from different treatment centers indicate that additional randomized clinical trials are needed to determine if full-mouth therapy provides clinically relevant improvements beyond PDIS.
本评论比较了全口消毒（FDIS）、全口根面平整（FRP）和部分口内消毒（PDIS）改善牙周健康的能力。全口消毒包括在24小时内完成4个象限的根面平整，并辅以洗必泰治疗（如冲洗、龈下冲洗、舌面刷牙）。全口根面平整是指在24小时内完成4个象限的根面平整，而部分口内消毒是指对牙列的各个象限进行根面平整，间隔2周进行一次。进行全口治疗（FDIS或FRP）的一个基本前提是消除或减少口腔内可能抑制治疗部位最佳愈合或导致牙周病发生或进展的细菌储存库。
回顾了比较部分口内消毒和全口根面平整（有无洗必泰辅助化疗）改变牙周状况能力的对照临床试验。
在一个治疗中心进行的多项研究表明，在减少探诊深度（PD）、获得临床附着（CAL）、减少探诊出血和减少龈下微生物群方面，全口消毒和全口根面平整比部分口内消毒取得了更大的治疗改善。然而，探诊深度减少的幅度和临床附着的增加必须谨慎解读，因为初始探诊深度测量通常是在洁治和根面平整后确定的，这可能导致结果被高估。此外，在研究全口消毒效用的研究中，无法确定全口消毒比部分口内消毒带来的益处是由于全口根面平整还是多方面的口内洗必泰治疗或两种疗法的组合。一项存在方案局限性的调查表明，全口根面平整无论有无辅助化疗都能取得类似结果。相比之下，另外两个治疗中心最近的研究表明，逐个象限进行根面平整与全口根面平整或全口消毒在减少探诊深度、获得临床附着以及对免疫反应的程度和质量的影响方面没有显著差异。
从概念上讲，全口治疗（全口根面平整或全口消毒）可以减少患者就诊次数，并有助于更有效地利用治疗时间。此外，无论有无辅助化疗，全口根面平整似乎都没有重大不良反应。然而，研究样本量小以及来自不同治疗中心的数据缺乏佐证表明，需要进行更多的随机临床试验来确定全口治疗是否能提供超越部分口内消毒的临床相关改善。
