Clinical Evaluation Of One-stage Full-mouth And Quadrant Subgingival Scaling Treatment Of Chronic Periodontitis

Periodontitis is a destructive disease of the periodontal tissues. Chronic periodontitis has been reported to affect over 30% of the adult population, with severe disease reported in 7%-13% of adults. This chronic inflammation will cause periodontal ligament and alveolar bone breakdown with the formation of pockets. Such pockets are ideal environments for bacteria, especially the gram-negative species. Progression of the disease can lead to functional problems and tooth loss. Recent studies also report a link between periodontal disease and other systemic diseases like atherosclerosis, cardiovascular diseases, diabetes and pre-term childbirth, so we need to focus on the treatment of periodontitis. Non-surgical periodontal treatment, such as scaling and root planing (SRP) are still the mainstay of any management plan for patients. The principal aspect of the treatment is the removal of the components of the subgingival plaque biofilm, which have a major role in the initiation and progression of the disease, in order to change the subgingival environment. The aim of the treatment plan is total treatment—that is, the coordination of all treatment procedures for the purpose of creating a well-functioning dentition in a healthy periodontal environment. Clinical periodontist usually use quadrant sub-gingival scaling do the full-mouth treatment in 4-6 times, this method takes a long period to finish the whole therapy and also have possibility of cross infection between the treated and untreated pockets. Several studies have shown that the periodontopathogens that colonized in other intraoral niches such as tongue dorsum, tonsils, saliva and other mucous membrane will recolonize in the pockets and cause re-infection. There are different opinions about this treatment due to the different type, different severity, different interval time, taking disinfectants or not.Objectives: The aim of this study was to test if the one-stage full-mouth sub-gingival scaling is better than the quadrant sub-gingival scaling. Compare the change in clinical features of two different methods, in order to find a superior, high efficiency and economic way for periodontal treatment.Methods: 23 patients with moderate chronic periodontal disease and without system disease were recruited into this study. Women are not pregnant, did not take antibiotics for three months and did not have periodontal therapy for six months. Have at least 20 teeth left. Chose one tooth with PD≥4mm to be tested in each patient. Subjects were randomized into two groups. After the supra-gingival scaling for one week, the one-stage group received full-mouth sub-gingival scaling within the same day, while the quadrant group received quadrant sub-gingival scaling at 1-weekly intervals over four consecutive sessions. The level of IL-6 in gingival crevicular fluid and the volumn of gingival crevicular fluid were recorded at baseline,4 weeks and 8 weeks after the therapy. The data of clinical indexes include plaque index(PLI) by the method of Silness&L?e and sulcus bleeding index(SBI)by the method of Mazza.The distance from the gingival margin to the apical extent of the pocket was probing depth(PD).The distance from the gingival margin to the cemento-enamel junction(CEJ) reduced by PD was attachment level(AL).The data of clinical indexes were recorded at baseline and 8 weeks after therapy. The data of clinical index were measured after collecting GCF sample avoiding the effect to the quality and the quantity of GCF and all by myself. The radioim- munoassay kit was used in IL-6 dection.Results:1.At the baseline date, two groups were comparative and there were on statistically significant differences in clinical indexes and in the volumn of gingival crevicular fluid and on the levels of IL-6 in GCF(P>0.05).(Table 3.1)2. Both therapies resulted in significant improvements in PLI,SBI,PD and AL at 8 weeks compared to baselin(P<0.05).Though there was no statistically significant differences between the two groups(P>0.05). (Table 3.2)3.A significant decrease was shown in the volumn of GCF of two groups at 4 weeks and 8 weeks compared to baseline(P<0.05).But there was no statistically significant differences of the volumn of GCF between 4 weeks and 8 weeks of each group(P>0.05). (Table 3.3)4.There was no statistically significant differences of the volumn of GCF between the two groups(P>0.05). (Table 3.3)5.A significant decrease was shown in the level of IL-6 in GCF of the two groups at 4 weeks and 8 weeks compared to baseline(P<0.05). But there was no statistically significant differences of the IL-6 level in GCF between 4 weeks and 8 weeks of each group(P>0.05). (Table 3.4)6. There was no statistically significant differences of the IL-6 level in GCF between the two groups(P>0.05).(Table 3.4)Conclusion:1. Both one-stage group and quadrant group treatment result in clinical reduction of plaque index, sulcus bleeding index, porobing depth and gain clinical attachment levels. The volumn of GCF and IL-6 level in GCF was decreased after therapy.2. Traditional quadrant approach and the newer one-stage full-mouth sub-gingival scaling could be equally effective.There are no significant differences of the two different ways in changing of clinical features and the level of IL-6 in gingival crevicular fluid. It suggested that the one-stage sub-gingival scaling is a safe, efficiency and economic method. It can decrease the times of return visit, enhance the compliance and reduce the financial burden of patients, it is suitable for clinical application.3. The volum of gingival crevicular fluid and the level of IL-6 in it could be an indictor of periodontal inflammation.