Clinical Significance Of Nonsurgical Periodontal Therapy An Evidence Based

J Clin Periodontol 2002; 29 (Suppl. 2): 6–16 Printed in Denmark. All rights reserved

Clinical significance of non-surgical periodontal therapy: an evidence-based perspective of scaling and root planing
Cobb C M: Clinical significance of non-surgical periodontal therapy: an evidence-based perspective of scaling and root planing. J Clin Periodontol 2002; 29 (Suppl 2): 6–16. # BlackwellMunksgaard, 2002.
Abstract

Charles M. Cobb
Department of Periodontics, School of Dentistry, University of Missouri, Kansas City, MO, USA

Analysis of Egyptian hieroglyphics and medical papyri indicate that non-surgical periodontal treatment was common 3000–4000 years ago. Even today, scaling and root planing (SRP) remains an essential part of successful periodontal therapy. The collective evidencefrom numerous clinical trials reveals a consistency of clinical response in the treatment of chronic periodontitis by SRP using manual, sonic, or ultrasonic instrumentation. Thus, SRP remains the ‘gold standard’ to which more recently developed therapeutic modalities must be compared. Inherent to the clinical evaluation of SRP are such concerns as manual versus sonic and ultrasonic instrumentation,control of sub-gingival bacterial populations, removal of calculus, root smoothness and changes in various clinical parameters, e.g. probing depth, attachment levels, bleeding on probing and gingival inflammation. Lastly, an abbreviated discussion is presented on a relatively new paradigm of complete mouth ‘disinfection’ in a compressed time-frame that includes SRP as a significant component of thetreatment regimen.

Key words: scaling and root planing; nonsurgical therapy; ultrasonic instrumentation; sub-gingival bacterial plaque; root surface smoothness

Introduction

Abu I-Qasim in 10th century Cordova, Spain, appears to have been the first to give serious thought to the role played by dental calculus, presence of which led to ‘corruption’ of the gingivae. He recommended a‘professional’ cleaning of the teeth, over several days, which was facilitated by a set of 14 scalers (Weinberger 1948, Held 1989), strongly suggesting that the use of manual scaling instruments has been ongoing for at least a thousand years. However, Egyptian hieroglyphics and medical papyri indicate that, in fact, non-surgical

periodontal therapy may have been common as far back as 2000 years BC(Weinberger 1948). Our ancient predecessors were unaware of the existence of bacteria. Their primary focus during scaling of the teeth was undoubtedly the removal of calculus and extrinsic tooth stain. In spite of the limitations in scientific knowledge by modern standards, the clinical observation revealed an improvement in gingival health and appearance. Hence, in both a historical and modern context,in the practice of dentistry, the removal of sub- and supragingival plaque and calculus is an important part of any

systematic treatment of periodontal disease.
Manual and sonic/ultrasonic instrumentation

Numerous studies have reported on the comparative efficiency of sonic and/or ultrasonic versus manual instrumentation. Collectively, these studies indicate that manual instrumentationgenerally takes longer to achieve the same clinical end-points than do sonic and/or ultrasonic scaling instruments (Badersten et al. 1981, 1984a, 1985a, Loos et al. 1987, 1989, Checchi & Pelliccioni 1988,

Perspective on scaling and root planing

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Kawanami et al. 1988, Laurell & Pettersson 1988, Laurell 1990, Dragoo 1992, Copulos et al. 1993, Grant et al. 1993, Boretti et al. 1995, Drisko1995, Kocher et al. 1997, Yukna et al. 1997). In fact, several studies have reported that use of sonic and/or ultrasonic instruments can result in a 20–50% savings in time compared with manual instrumentation when used for periodontal debridement procedures (Checchi & Pelliccioni 1988, Dragoo 1992, Copulos et al. 1993, Drisko 1995). The time required to achieve clinical endpoints is only one of...