Periodontitis- full mouth disinfection or quadrant scaling?

Conventional treatment for periodontitis is scaling and root planing quadrant by quadrant. In the mid 1990s a one-stage full mouth disinfection protocols involving the use of antiseptics was proposed. Subsequently, a full- mouth scaling and root planing (FMS) approach within 24 h without the use of antiseptics was suggested. The aim of the review was to assess the effectiveness of full-mouth disinfection (FMD) or full-mouth scaling and root planing (FMS) compared with quadrant scaling and root planing (Q- SRP).

Methods

Searches were conducted in the Medline, Embase and CENTRAL databases. Randomised controlled trials in adults. Trials comparing FMD or FMS with Q-SRP with a follow-up period of greater than 6 months were considered. Two reviewers independently selected studies and Study selection and abstracted data. The domains of random sequence generation; allocation concealment; blinding; incomplete data; selective outcome reporting; and other biases were used to assess study quality. The primary outcomes were changes in probing pocket depth (PD), clinical attachment levels (CAL) and bleeding on probing (BOP). The secondary outcomes were post-treatment complications, such as pain rating and body temperature.

Results

13 studies involving a total of 430 patients were included.
9 compared FMS with Q-SRP; 4 compared FMD with FMS.
5 studies were considered to be at low risk of bias.
The weighted mean difference (WMD) of probing pocket depth reduction was 0.25 mm (95%CI; 0.01 to 0.49: p < 0.04) for FMD vs. Q-SRP in single-rooted teeth with moderate pockets, and clinical attachment level gain in single- and multi-rooted teeth with moderate pockets was 0.33 mm (0.04 to 0.63: p < 0.03) for FMD vs. Q-SRP.
No statistically significant differences were found in other sub analyses of FMD vs. Q-SRP, FMS vs. Q-SRP and FMD vs. FMS.

Conclusions

The authors concluded:

the meta-analysis results showed that FMD was better than Q-SRP for achieving probing pocket depth reduction and clinical attachment level gain in moderate pockets. Additionally, regardless of the treatment, no serious complications were observed. FMD, FMS and Q-SRP are all effective for the treatment of adult chronic periodontitis, and they do not lead to any obvious discomfort among patients. Moreover, FMD had modest additional clinical benefits over Q-SRP, so we prefer to recommend FMD as the first choice for the treatment of adult chronic periodontitis.

Comments

This review covers similar ground to a recent updated Cochrane systematic review of full mouth treatment modalities for chronic periodontitis (Dental Elf – 23^rd Apr 2015). The Cochrane review included 12 RCTs almost all of which are included in this current review. Both review have conducted a large number of meta-analysis most of which only include a small number of studies. In addition the size of the included studies themselves are small with the largest study including 41 patients. The authors of this current review suggest that the result show that FMD was better while in contrast the Cochrane reviewers concluded;

From the twelve included trials there is no clear evidence that FMS or FMD provide additional benefit compared to conventional scaling and root planing.

As there are only a small number of studies available using a small number of participants its. is further research is likely to have an impact on the findings.