Impact of a two-stage subgingival instrumentation scheme involving air polishing on attachment gain after active periodontal therapy.

BACKGROUND

The aim of this study was to evaluate whether clinical attachment level gain (ΔCAL) in deep untreated periodontal lesions may be improved by a two-stage, subgingival instrumentation scheme involving air polishing.

METHODS

This 6-month, randomized, controlled, examiner-masked clinical trial was performed in 44 patients with periodontitis with untreated periodontal lesions ≥6 mm. At baseline, day 28, 84, and 168 CAL, probing depth (PD), bleeding on probing (BOP), and plaque control record (PlaCR) were recorded. After baseline examination control group patients received full-mouth sub- and supragingival instrumentation using scalers and curets. In the test group initial subgingival cleaning was limited to the removal of soft bacterial deposits by air polishing. Subgingival scaling and root planing was performed only after the first re-evaluation at day 28.

RESULTS

In deep lesions ≥6 mm a significant reduction of mean CAL scores was observed at day 28 and at day 168 for both experimental groups. Differences between the groups however did not reach the level of significance. Mean PD was also significantly reduced at day 28 and at 168 in both experimental groups, with no significant differences between the groups. Mean BOP scores did not change significantly in both groups during the 168-day observation period. Only in the test group mean PlaCR scores were significantly reduced at day 168 compared with baseline.

CONCLUSIONS

Subgingival instrumentation of untreated PD ≥6 mm by air polishing alone results in a significant short-term gain of CAL comparable to conventional scaling and root planing. Its sequential two-step combination with scaling and root planing, however, does not additionally enhance long-term gain of CAL.