Subgingival instrumentation – Part II
PD Dr. Kristina Bertl, PhD MSc MBA
Effective instrumentation of the root surface is an indispensable part of treating patients with periodontitis. In Part I of the topic ‘subgingival instrumentation’ based on the results of the Perio Workshop 2019, the effectiveness of ‘standard techniques’ [(ultra)sonic instruments, hand instruments or a combination of the two] was described. Part II of this topic will now focus on newer approaches, such as laser Technology and photodynamic therapy, as supplements to mechanical cleaning.
As part of the Perio Workshop 2019, Salvi et. al. (2020) published a systematic review on the following two Questions:
- Does the adjunctive application of laser Technology lead to improved clinical outcomes among periodontitis patients after subgingival instrumentation?
- Does the adjunctive application of photodynamic therapy lead to improved clinical outcomes among periodontitis patients after subgingival instrumentation?
However, a comprehensive literature search unfortunately revealed that very few studies with a follow-up of at least six months are available on this topic. In total, ten studies on the use of laser Technology and eight studies on the use of photodynamic therapy were found. However, because of substantial differences in study design and Quality, only two studies regarding the use of photodynamic therapy could be used for statistical analysis. This analysis showed no additional effect for photodynamic therapy compared with subgingival instrumentation alone. With regard to the additional effect of using laser technology, the authors were only able to conclude that the data after the six-month follow-up exhibited very high variability, and that a definitive conclusion cannot be drawn.
This means that some gaps in research remain in this area. Hopefully these can be closed in future, so that we can obtain detailed information on this subject.
You can find another article on this topic in the Prophy Community:
- Giovanni E Salvi, Alexandra Stähli, Julia C Schmidt, Christoph A Ramseier, Anton Sculean, Clemens Walter. Adjunctive laser or antimicrobial photodynamic therapy to non-surgical mechanical instrumentation in patients with untreated periodontitis: A systematic review and meta-analysis. J Clin Periodontol. 2020 Jul;47 Suppl 22:176-198. doi: 10.1111/jcpe.13236.