Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Oral Health
Published in: BMC Oral Health 1/2020

Open Access 01-12-2020 | Wound Debridement | Research article

Treating periodontitis-a systematic review and meta-analysis comparing ultrasonic and manual subgingival scaling at different probing pocket depths

Authors: Xin Zhang, Zixuan Hu, Xuesong Zhu, Wenjie Li, Jun Chen

Published in: BMC Oral Health | Issue 1/2020

Login to get access

Abstract

Background

Mechanical plaque removal has been commonly accepted to be the basis for periodontal treatment. This study aims to compare the effectiveness of ultrasonic and manual subgingival scaling at different initial probing pocket depths (PPD) in periodontal treatment.

Methods

English-language databases (PubMed, Cochrane Central Register of Controlled Trials, EMBASE, Medline, and ClinicalTrials.gov, by January, 2019) were searched. Weighted mean differences in primary outcomes, PPD and clinical attachment loss (CAL) reduction, were estimated by random effects model. Secondary outcomes, bleeding on probing (BOP), gingival recession (GR), and post-scaling residual dental calculus, were analyzed by comparing the results of each study. The quality of RCTs was appraised with the Cochrane Collaboration risk of bias tool. The GRADE approach was used to assess quality of evidence.

Results

Ten randomized controlled trials were included out of 1434 identified. Initial PPD and follow-up periods formed subgroups. For 3-months follow-up: (1) too few shallow initial pocket studies available to draw a conclusion; (2) the heterogeneity of medium depth studies was so high that could not be merged to draw a conclusion; (3) deep pocket studies showed no statistical differences in PPD and CAL reduction between ultrasonic and manual groups. For 6-months follow-up: (1) too few shallow initial PPD studies to draw a conclusion; (2) at medium pocket depth, PPD reduction showed manual subgingival scaling better than ultrasound. No statistical differences were observed in CAL reduction between the two approaches; (3) for deep initial PPD studies, both PPD and CAL reduction showed manual subgingival scaling better. GR results indicated no statistical differences at medium and deep initial pocket studies between the two methods. BOP results showed more reduction at deep pocket depths with manual subgingival scaling. No conclusion could be drawn about residual dental calculus.

Conclusion

When initial PPD was 4-6 mm, PPD reduction proved manual subgingival scaling was superior, but CAL results showed no statistical differences between the two means. When initial PPD was ≥6 mm, PPD and CAL reductions suggested that manual subgingival scaling was superior.
Appendix
Available only for authorised users
Literature
1.
Chapple ILC, Van der Weijden F, Doerfer C, Herrera D, Shapira L, Polak D, Madianos P, Louropoulou A, Machtei E, Donos N, et al. Primary prevention of periodontitis: managing gingivitis. J Clin Periodontol. 2015;42(Suppl 16):S71–6.PubMed
2.
Kassebaum NJ, Bernabé E, Dahiya M, Bhandari B, Murray CJL, Marcenes W. Global burden of severe periodontitis in 1990-2010: a systematic review and meta-regression. J Dent Res. 2014;93(11):1045–53.PubMedPubMedCentral
3.
Chapple ILC, Bouchard P, Cagetti MG, Campus G, Carra M-C, Cocco F, Nibali L, Hujoel P, Laine ML, Lingstrom P, et al. Interaction of lifestyle, behaviour or systemic diseases with dental caries and periodontal diseases: consensus report of group 2 of the joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases. J Clin Periodontol. 2017;44(Suppl 18):S39–51.PubMed
4.
Tonetti MS, Jepsen S, Jin L, Otomo-Corgel J. Impact of the global burden of periodontal diseases on health, nutrition and wellbeing of mankind: a call for global action. J Clin Periodontol. 2017;44(5):456–62.PubMed
5.
Badersten A, Nilveus R, Egelberg J. Effect of nonsurgical periodontal therapy I: moderately advanced periodontitis. J Clin Periodontol. 1981;8(1).
6.
Obeid PR, D'Hoore W, Bercy P. Comparative clinical responses related to the use of various periodontal instrumentation. J Clin Periodontol. 2004;31(3):193–9.PubMed
7.
Arabaci T, Ciçek Y, Canakçi CF. Sonic and ultrasonic scalers in periodontal treatment: a review. Int J Dent Hyg. 2007;5(1):2–12.PubMed
8.
Heitz-Mayfield LJ, Lang NP. Surgical and nonsurgical periodontal therapy. Learned and unlearned concepts. Periodontology. 2000;62(1):218–31.
9.
Suvan JE. Effectiveness of mechanical nonsurgical pocket therapy. Periodontology. 2000;37:48–71.
10.
Beuchat M, Busslinger A, Schmidlin PR, Michel B, Lehmann B, Lutz F. Clinical comparison of the effectiveness of novel sonic instruments and curettes for periodontal debridement after 2 months. J Clin Periodontol. 2001;28(12):1145–50.PubMed
11.
Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, VA W. Cochrane handbook for systematic reviews of interventions, 2nd edn. Chichester UK: John Wiley & Sons; 2019.
12.
Ioannou I, Dimitriadis N, Papadimitriou K, Sakellari D, Vouros I, Konstantinidis A. Hand instrumentation versus ultrasonic debridement in the treatment of chronic periodontitis: a randomized clinical and microbiological trial. J Clin Periodontol. 2009;36(2):132–41.PubMed
13.
Malali E, Kadir T, Noyan U. Er:YAG lasers versus ultrasonic and hand instruments in periodontal therapy: clinical parameters, intracrevicular micro-organism and leukocyte counts. Photomed Laser Surg. 2012;30(9):543–50.PubMed
14.
Wennström JL, Tomasi C, Bertelle A, Dellasega E. Full-mouth ultrasonic debridement versus quadrant scaling and root planing as an initial approach in the treatment of chronic periodontitis. J Clin Periodontol. 2005;32(8):851–9.PubMed
15.
Kargas K, Tsalikis L, Sakellari D, Menexes G, Konstantinidis A. Pilot study on the clinical and microbiological effect of subgingival glycine powder air polishing using a cannula-like jet. Int J Dent Hyg. 2015;13(3):161–9.PubMed
16.
D'Ercole S, Piccolomini R, Capaldo G, Catamo G, Perinetti G, Guida L. Effectiveness of ultrasonic instruments in the therapy of severe periodontitis: a comparative clinical-microbiological assessment with curettes. New Microbiol. 2006;29(2):101–10.PubMed
17.
Christgau M, Männer T, Beuer S, Hiller KA, Schmalz G. Periodontal healing after non-surgical therapy with a modified sonic scaler: a controlled clinical trial. J Clin Periodontol. 2006;33(10):749–58.PubMed
18.
Sculean A, Schwarz F, Berakdar M, Romanos GE, Brecx M, Willershausen B, Becker J. Non-surgical periodontal treatment with a new ultrasonic device (vector-ultrasonic system) or hand instruments. J Clin Periodontol. 2004;31(6):428–33.PubMed
19.
Schwarz F, Bieling K, Venghaus S, Sculean A, Jepsen S, Becker J. Influence of fluorescence-controlled Er:YAG laser radiation, the vector system and hand instruments on periodontally diseased root surfaces in vivo. J Clin Periodontol. 2006;33(3):200–8.PubMed
20.
Yukna RA, Scott JB, Aichelmann-Reidy ME, LeBlanc DM, Mayer ET. Clinical evaluation of the speed and effectiveness of subgingival calculus removal on single-rooted teeth with diamond-coated ultrasonic tips. J Periodontol. 1997;68(5):436–42.PubMed
21.
Gellin RG, Miller MC, Javed T, Engler WO, Mishkin DJ. The effectiveness of the titan-S sonic scaler versus curettes in the removal of subgingival calculus. A human surgical evaluation. J Periodontol. 1986;57(11):672–80.PubMed
22.
Papapanou PN, Sanz M, Buduneli N, Dietrich T, Feres M, Fine DH, Flemmig TF, Garcia R, Giannobile WV, Graziani F, et al. Periodontitis: consensus report of workgroup 2 of the 2017 world workshop on the classification of periodontal and Peri-implant diseases and conditions. J Periodontol. 2018;89(Suppl 1):S173–s182.PubMed
23.
Needleman I, Garcia R, Gkranias N, Kirkwood KL, Kocher T, Iorio AD, Moreno F, Petrie A. Mean annual attachment, bone level, and tooth loss: a systematic review. J Clin Periodontol. 2018;45(Suppl 20):S112–s129.PubMed
24.
Dibart S, Capri D, Casavecchia P, Nunn M, Skobe Z. Comparison of the effectiveness of scaling and root planing in vivo using hand vs rotary instruments. Int J Periodontics Restorative Dentistry. 2004;24(4):370–7.
25.
Van Dijk LJ, Lie MA, Van den Heuvel ER, Van der Weijden GA. Adult periodontitis treated with a new device for subgingival lavage-a randomized controlled clinical trial using a split-mouth design. Int J Dent Hyg. 2018;16(4):559–68.PubMed
26.
Wang Y, Li W, Shi L, Zhang F, Zheng S. Comparison of clinical parameters, microbiological effects and calprotectin counts in gingival crevicular fluid between Er: YAG laser and conventional periodontal therapies: a split-mouth, single-blinded, randomized controlled trial. Medicine. 2017;96(51):e9367.PubMedPubMedCentral
27.
Dukić W, Bago I, Aurer A, Roguljić M. Clinical effectiveness of diode laser therapy as an adjunct to non-surgical periodontal treatment: a randomized clinical study. J Periodontol. 2013;84(8):1111–7.PubMed
28.
Slot DE, Timmerman MF, Versteeg PA, van der Velden U, van der Weijden FA. Adjunctive clinical effect of a water-cooled Nd: YAG laser in a periodontal maintenance care programme: a randomized controlled trial. J Clin Periodontol. 2012;39(12):1159–65.PubMed
29.
Biagini G, Checchi L, Miccoli MC, Vasi V, Castaldini C. Root curettage and gingival repair in periodontitis. J Periodontol. 1988;59(2):124–9.PubMed
30.
Oberholzer R, Rateitschak KH. Root cleaning or root smoothing. An in vivo study. J Clin Periodontol. 1996;23(4):326–30.PubMed
31.
Slot DE, Kranendonk AA, Van der Reijden WA, Van Winkelhoff AJ, Rosema NAM, Schulein WH, Van der Velden U, Van der Weijden FA. Adjunctive effect of a water-cooled Nd:YAG laser in the treatment of chronic periodontitis. J Clin Periodontol. 2011;38(5):470–8.PubMed
32.
Romeo U, Palaia G, Botti R, Leone V, Rocca JP, Polimeni A. Non-surgical periodontal therapy assisted by potassium-titanyl-phosphate laser: a pilot study. Lasers Med Sci. 2010;25(6):891–9.PubMed
33.
Yukna RA, Carr RL, Evans GH. Histologic evaluation of an Nd:YAG laser-assisted new attachment procedure in humans. Int J Periodontics Restorative Dentistry. 2007;27(6):577–87.
34.
Feng XH, Lu RF, He L. A short-term clinical evaluation of periodontal treatment with an Er:YAG laser for patients with chronic periodontitis: a split-mouth controlled study. Beijing Da Xue Xue Bao. 2011;43(6):886–90.PubMed
35.
Wu K-Y, Xu C-J, Chi Y-T, Sun X-J, Wang H-F. Detection of Dickkopf-1 and alkaline phosphatase activity in gingival crevicular fluid from chronic periodontitis with Er:YAG laser as an adjunctive treatment. Shanghai Kou Qiang Yi Xue. 2017;26(3):285–9.PubMed
36.
Petelin M, Perkič K, Seme K, Gašpirc B. Effect of repeated adjunctive antimicrobial photodynamic therapy on subgingival periodontal pathogens in the treatment of chronic periodontitis. Lasers Med Sci. 2015;30(6):1647–56.PubMed
37.
Mittal A, Nichani AS, Venugopal R, Rajani V. The effect of various ultrasonic and hand instruments on the root surfaces of human single rooted teeth: a Planimetric and Profilometric study. J Ind Soc Periodontol. 2014;18(6):710–7.
38.
Kishida M, Sato S, Ito K. Comparison of the effects of various periodontal rotary instruments on surface characteristics of root surface. J Oral Sci. 2004;46(1):1–8.PubMed
39.
Khosravi M, Bahrami ZS, Atabaki MS, Shokrgozar MA, Shokri F. Comparative effectiveness of hand and ultrasonic instrumentations in root surface planing in vitro. J Clin Periodontol. 2004;31(3):160–5.PubMed
40.
Gagnot G, Mora F, Poblete MG, Vachey E, Michel JF, Cathelineau G. Comparative study of manual and ultrasonic instrumentation of cementum surfaces: influence of lateral pressure. Int J Periodontics Restorative Dentistry. 2004;24(2):137–45.
41.
Schwarz F, Aoki A, Sculean A, Georg T, Scherbaum W, Becker J. In vivo effects of an Er:YAG laser, an ultrasonic system and scaling and root planing on the biocompatibility of periodontally diseased root surfaces in cultures of human PDL fibroblasts. Lasers Surg Med. 2003;33(2):140–7.PubMed
42.
Croft LK, Nunn ME, Crawford LC, Holbrook TE, McGuire MK, Kerger MM, Zacek GA. Patient preference for ultrasonic or hand instruments in periodontal maintenance. Int J Periodontics Restorative Dentistry. 2003;23(6):567–73.
43.
Braun A, Krause F, Nolden R, Frentzen M. Subjective intensity of pain during the treatment of periodontal lesions with the vector-system. J Periodontal Res. 2003;38(2):135–40.PubMed
44.
Kocher T, Rosin M, Langenbeck N, Bernhardt O. Subgingival polishing with a teflon-coated sonic scaler insert in comparison to conventional instruments as assessed on extracted teeth (II). Subgingival roughness. J Clin Periodontol. 2001:28(8).
45.
Kocher T, Rühling A, Momsen H, Plagmann HC. Effectiveness of subgingival instrumentation with power-driven instruments in the hands of experienced and inexperienced operators. A study on manikins. J Clin Periodontol. 1997;24(7):498–504.PubMed
46.
Copulos TA, Low SB, Walker CB, Trebilcock YY, Hefti AF. Comparative analysis between a modified ultrasonic tip and hand instruments on clinical parameters of periodontal disease. J Periodontol. 1993;64(8):694–700.PubMed
47.
Kepic TJ, O'Leary TJ, Kafrawy AH. Total calculus removal: an attainable objective? J Periodontol. 1990;61(1):16–20.PubMed
48.
Garnick JJ, Dent J. A scanning electron micrographical study of root surfaces and subgingival bacteria after hand and ultrasonic instrumentation. J Periodontol. 1989;60(8):441–7.PubMed
49.
Breininger DR, O'Leary TJ, Blumenshine RV. Comparative effectiveness of ultrasonic and hand scaling for the removal of subgingival plaque and calculus. J Periodontol. 1987;58(1):9–18.PubMed
50.
Hunter RK, O'Leary TJ, Kafrawy AH. The effectiveness of hand versus ultrasonic instrumentation in open flap root planing. J Periodontol. 1984;55(12):697–703.PubMed
51.
Thornton S, Garnick J. Comparison of ultrasonic to hand instruments in the removal of subgingival plaque. J Periodontol. 1982;53(1):35–7.PubMed
52.
Nishimine D, O'Leary TJ. Hand instrumentation versus ultrasonics in the removal of endotoxins from root surfaces. J Periodontol. 1979;50(7):345–9.PubMed
53.
D'Silva IV, Nayak RP, Cherian KM, Mulky MJ. An evaluation of the root topography following periodontal instrumentation--a scanning electron microscopic study. J Periodontol. 1979;50(6):283–90.PubMed
54.
Ewen SJ, Scopp IW, Witkin RT, Ortiz-Junceda M. A comparative study of ultrasonic generators and hand instruments. J Periodontol. 1976;47(2):82–6.PubMed
55.
Stewart JL, Drisko RR, Herlach AD. Comparison of ultrasonic and hand instruments for the removal of calculus. J Am Dental Assoc. 1939;75(1):153–7.
56.
Gutknecht N, Van Betteray C, Ozturan S, Vanweersch L, Franzen R. Laser supported reduction of specific microorganisms in the periodontal pocket with the aid of an Er,Cr:YSGG laser: a pilot study. Sci World J. 2015;2015:450258.
57.
Maritato M, Orazi L, Laurito D, Formisano G, Serra E, Lollobrigida M, Molinari A, De Biase A. Root surface alterations following manual and mechanical scaling: a comparative study. Int J Dent Hyg. 2018;16(4):553–8.PubMed
58.
Foroutan T, Amid R, Karimi MR. Comparison of manual tools, ultrasonic and erbium-doped yttrium aluminum garnet (Er:YAG) laser on the debridement effect of the surface of the root of teeth suffering from periodontitis. J Lasers Med Sci. 2013;4(4):199–205.PubMedPubMedCentral
59.
Geng SF, Xu L, Ying P, Cao CF. Clinical evaluation of manual and ultrasonic subgingival scaling using image analysis. Shanghai Kou Qiang Xue. 1992;1(2):73–6.
60.
Kahl M, Haase E, Kocher T, Rühling A. Clinical effects after subgingival polishing with a non-aggressive ultrasonic device in initial therapy. J Clin Periodontol. 2007;34(4):318–24.PubMed
61.
Kocher T, Plagmann HC. Root debridement of molars with furcation involvement using diamond-coated sonic scaler inserts during flap surgery -- a pilot study. J Clin Periodontol. 1999;26(8):525–30.PubMed
62.
Badersten A, Nilveus R, Egelberg J. Effect of nonsurgical periodontal therapy II: severely advanced periodontitis. J Clin Periodontol. 1984;11(1).
63.
Oosterwaal PJ, Matee MI, Mikx FH, van't Hof MA, Renggli HH. The effect of subgingival debridement with hand and ultrasonic instruments on the subgingival microflora. J Clin Periodontol. 1987;14(9):528–33.PubMed
Metadata
Title
Treating periodontitis-a systematic review and meta-analysis comparing ultrasonic and manual subgingival scaling at different probing pocket depths
Authors
Xin Zhang
Zixuan Hu
Xuesong Zhu
Wenjie Li
Jun Chen
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Oral Health / Issue 1/2020
Electronic ISSN: 1472-6831
DOI
https://doi.org/10.1186/s12903-020-01117-3

Other articles of this Issue 1/2020

BMC Oral Health 1/2020 Go to the issue

Research article

Cinnamaldehyde is a biologically active compound for the disinfection of removable denture: blinded randomized crossover clinical study

Research article

Topical povidone iodine inhibits bacterial growth in the oral cavity of patients on mechanical ventilation: a randomized controlled study

Research article

Assessment of oral health conditions presented in photographs - is there a difference between dentists and non-dental professional caregivers?

Research article

Impacts of contracted endodontic cavities compared to traditional endodontic cavities in premolars

Review

The role of the oral microbiota in chronic non-communicable disease and its relevance to the Indigenous health gap in Australia

Research article

Prevalence of middle mesial canal and radix entomolaris of mandibular first permanent molars in a western Chinese population: an in vivo cone-beam computed tomographic study