A randomized multi-centre study on the effectiveness of non-surgical periodontal therapy in general practice

Cristiano Tomasi, Anna Liss, Maria Welander, Anna Ydenius Alian, Kajsa H Abrahamsson, Jan L Wennström, Cristiano Tomasi, Anna Liss, Maria Welander, Anna Ydenius Alian, Kajsa H Abrahamsson, Jan L Wennström

Abstract

Aim: To evaluate the effectiveness of two non-surgical treatment protocols for periodontitis patients in general dental practice.

Materials and methods: Ninety-five dental hygienists (59 dental clinics) were randomly assigned to one of two treatment protocols: (i) establishment of adequate self-performed oral hygiene prior to a single session of ultrasonic instrumentation (guided periodontal infection control [GPIC]) or (ii) conventional non-surgical therapy (CNST) including patient education and scaling and root planing integrated in multiple sessions. Residual pockets at 3 months were retreated in both groups. The primary outcome was pocket closure (probing pocket depth ≤ 4 mm) at 6 months. Multilevel models were utilized.

Results: Based on data from 615 patients, no significant differences with regard to clinical outcomes were observed between treatment protocols. Treatment-related costs (i.e., chair time, number of sessions) were significantly lower for GPIC than CNST. Smoking and age significantly affected treatment outcomes.

Conclusions: No significant differences between the two approaches were observed in regard to clinical outcomes. GPIC was more time-effective. Patient education should include information on the detrimental effects of smoking.

Clinicaltrials: gov (NCT02168621).

Keywords: effectiveness; field study; infection control; non-surgical therapy; periodontitis.

Conflict of interest statement

All authors declare no conflicts of interest.

© 2022 The Authors. Journal of Clinical Periodontology published by John Wiley & Sons Ltd.

Figures

FIGURE 1
FIGURE 1
Flow chart of the clinical field study outline. DH, dental hygienist; ITT, Intention To Treat; OH, Oral Hygiene; VAS, Visual Analog Scale
FIGURE 2
FIGURE 2
(a) Mean bleeding on probing (BoP) scores for experimental sites (baseline probing pocket depth [PPD] ≥ 5 mm) and (b) proportion of pockets closed at the 6‐month examination. Mean values and SD. CNST, conventional non‐surgical therapy; GPIC, guided periodontal infection control
FIGURE 3
FIGURE 3
Predicted probability of pocket closure at 6 months according to smoking and tooth type
FIGURE 4
FIGURE 4
Predicted proportion of teeth with probing pocket depth (PPD) ≥5 mm at 6 months according to smoking habit
FIGURE A1
FIGURE A1
Predicted number of teeth with probing pocket depth (PPD) ≥5 mm at 6 months according to smoking habit
FIGURE A2
FIGURE A2
Scatter plot with clinical outcome expressed as number of teeth with probing pocket depth (PPD) ≥5 mm at baseline and at 6 months and colour depicting the perceived improvement from the patient. The black line represents the border between areas, and the two regression lines with 95% confidence interval represent the clinical outcome trend for the two perceived outcome categories, with a significant difference (p < .001).

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