Advertisement

Nonsurgical Periodontal Therapy: a Review of Current Standards of Care and Innovations to Improve Gingival and Periodontal Health

  • Maria L. GeisingerEmail author
  • Maninder Kaur
  • Hussein Basma
Clinical Periodontics (Y Stathopoulou, Section Editor)
  • 8 Downloads
Part of the following topical collections:
  1. Topical Collection on Clinical Periodontics

Abstract

Purpose of Review

Regular home care delivered by patients as well as professional mechanical debridement is a cornerstone of periodontal and peri-implant health. This report will examine current therapies for nonsurgical periodontal and peri-implant diseases, including oral hygiene measures and behavioral modification, scaling and root planing, adjunctive systemic and local antibiotic therapy, and novel pharmacologic and physical adjunctive treatments.

Recent Findings

Periodontitis is a highly prevalent, destructive disease and has been estimated to result in $54 billion of lost productivity yearly worldwide. Additionally, it is estimated that up to 5 million dental implants are placed each year and, with the increasing number of implants comes increasing numbers of cases of peri-implant mucositis and peri-implantitis. Nonsurgical therapy is the first line of treatment and long-term prevention for both of these conditions. Mechanical therapy requires a high level of operator skill and an understanding of expected results and the modifiers which may affect treatment outcomes. Proper patient selection, patient compliance, and assessment of optimal treatment options are required for successful results of therapy. Adjunctive therapy in high-risk patients, for example, smokers, may improve treatment outcomes, and care should be taken to select adjunctive therapies based upon their mechanisms of action and the deficits in host defense noted in patients with additional risk factors. Furthermore, long-term maintenance and surveillance of disease recurrence are necessary in the management of these chronic diseases.

Summary

Nonsurgical therapy is a cost-effective intervention to address periodontal diseases, and patients with select risk factors may receive additional benefit when adjunctive therapies are employed during this phase of treatment.

Keywords

Periodontal diseases Periodontitis Oral health Oral hygiene Gingivitis Nonsurgical therapy 

Notes

Acknowledgments

The authors would like to thank Ms. Elizabeth Bolton for her assistance with this manuscript.

Compliance with Ethical Standards

Conflict of Interest

Dr. Geisinger reports her role as Vice Chair of the American Dental Association’s Council on Scientific Affairs and Chair of the ADA Seal Subcommittee, reviewing the safety and efficacy of over-the-counter patient-delivered products for dental health and oral hygiene.

Maninder Kaur and Hussein Basma each declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    • Eke PI, Thorton-Evans GO, Wei L, Borgnakke WS, Dye BA, Genco RJ. Periodontitis in US adults: National Health and Nutrition Examination Survey 2009–2014. J Dent Res. 2018;149(7):576–88. This work describes the updated prevalence data for periodontitis and periodontal findings in adults based upon the NHANES III data from 2009 to 2014. As periodontitis is the most common oral disease in the US adult population, readers should be aware of its most recent prevalence numbers. Google Scholar
  2. 2.
    • Mombelli A. Microbial colonization of the periodontal pocket and its significance for periodontal therapy. Periodontol 2000. 2018;76(1):85–96. This work reviews the microbial etiology of periodontitis and the over 700 bacterial species and 1500 putative periodontal pathogens present in the oral cavity that may contribute to periodontal disease. The complex microbial interactions described in this review article are of critical importance as a rationale for all nonsurgical therapy to treat periodontal diseases. CrossRefPubMedGoogle Scholar
  3. 3.
    Westfelt E, Rylander H, Dahlén G, Lindhe J. The effect of supragingival plaque control on the progression of advanced periodontal disease. J Clin Periodontol. 1998;25(7):536–41.CrossRefPubMedGoogle Scholar
  4. 4.
    Slots J. Subgingival microflora and periodontal disease. J Clin Periodontol. 1979;6:351–82.CrossRefPubMedGoogle Scholar
  5. 5.
    Drisko CH. Nonsurgical periodontal therapy. Periodontol 2000. 2001;25:77–88.CrossRefPubMedGoogle Scholar
  6. 6.
    Nyman S, Lindhe J, Rosling B. Periodontal surgery in plaque-infected dentitions. J Clin Periodontol. 1977;4(4):240–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Cohen RE, on behalf of the Research, Science, and Therapy Committee, American Academy of Periodontology. Position paper: periodontal maintenance. J Periodontol. 2003;74:1395–401.CrossRefPubMedGoogle Scholar
  8. 8.
    Drisko CL. Periodontal self-care: evidence based support. Periodontol 2000. 2013;62:243–55.CrossRefPubMedGoogle Scholar
  9. 9.
    Straub AM, Salvi GE, Lang NP: Supragingival plaque formation in the human dentition. Lang NP, Attstrom R, Loe H. Proceedings of the European workshop on Mechanical Plaque Control. 1998; Quintessence, Chicago.Google Scholar
  10. 10.
    American Dental Association: Brushing your Teeth. Available at: https://www.mouthhealthy.org/en/az-topics/b/brushing-your-teeth Accessed April 12, 2019.
  11. 11.
    Slot DE, Dorfer CE, van der Weijden GA. The efficacy of interdental brushes on plaque and parameters of periodontal inflammation: a systematic review. Int J Dent Hyg. 2008;6(4):253–64.CrossRefPubMedGoogle Scholar
  12. 12.
    Berchier CE, Slot DE, Haps S, van der Weijden GA. The efficacy of dental floss in addition to a toothbrush on plaque and parameters of gingival inflammation: a systematic review. Int J Dent Hyg. 2008;6(4):265–79.CrossRefPubMedGoogle Scholar
  13. 13.
    Featherston JD. The science and practice of caries prevention. J Am Dent Assoc. 2000;131:887–99.CrossRefGoogle Scholar
  14. 14.
    Macgregor ID, Rugg-Gunn AJ. Toothbrushing duration in 60 uninstructed young adults. Community Dent Oral Epidemiol. 1985;13(3):121–2.CrossRefPubMedGoogle Scholar
  15. 15.
    Van der Weijden GA, Hioe KP. A systematic review of the effectiveness of self-performed mechanical plaque removal in adults with gingivitis using a manual toothbrush. J Clin Periodontol. 2005;32(Suppl 6):214–28.CrossRefPubMedGoogle Scholar
  16. 16.
    Geisinger ML, Robinson M, Kaur M, Gerlach RW, Griffin R, Geurs NC, et al. Individualized oral health education improves oral hygiene compliance and clinical outcomes in pregnancy women with gingivitis. Oral Hyg Health. 2013;1:111.  https://doi.org/10.4172/2332-0702.1000111.CrossRefGoogle Scholar
  17. 17.
    Rayant GA, Sheiham A. An analysis of factors affecting compliance with tooth-cleaning recommendations. J Clin Periodontol. 1980;7(4):289–99.CrossRefPubMedGoogle Scholar
  18. 18.
    Glavind L, Zeuner E, Attrstrom R. Evaluation of various feedback mechanisms in relation to compliance by adult patients with oral home care instructions. J Clin Periodontol. 1983;10(10):57–68.CrossRefPubMedGoogle Scholar
  19. 19.
    Less W. Mechanics of teaching plaque control. Dent Clin N Am. 1972;16:647–59.PubMedGoogle Scholar
  20. 20.
    Curry-Chiu ME, Catley D, Voelker MA, Bray KK. Dental hygienists’ experiences with motivational interviewing: a qualitative study. J Dent Educ. 2015;79(8):897–906.PubMedGoogle Scholar
  21. 21.
    • Woelber JP, Spann-Algoe N, Hanna G, et al. Training of dental professionals in motivational interviewing can heighten interdental cleaning self-efficacy in periodontal patients. Fron Psychol. 2016;7:254. Behavior modification and improved patient-delivered oral home care are critical to the success of periodontal therapy and the long-term maintenance of results. This report discusses strategies that dental professionals can employ to improve patient outcomes and increase motivation for oral hygiene measures. Google Scholar
  22. 22.
    Stenman J, Lundgren J, Wennstrom JL, et al. A single session of motivational interviewing as an additive means to improve adherence in periodontal infection control: a randomized controlled trial. J Clin Periodontol. 2012;39:947–54.CrossRefPubMedGoogle Scholar
  23. 23.
    Paraskevas S, van der Weijden GA. A review of the effects of stannous fluoride on gingivitis. J Clin Periodontol. 2006;33:1–13.CrossRefPubMedGoogle Scholar
  24. 24.
    Kazmierczak M, Mather M, Ciancio S, et al. A clinical evaluation of anticalculus dentifrices. J Clin Prev Dent. 1990;12:13.Google Scholar
  25. 25.
    Department of Health and Human Services. Food and Drug Administration. Federal Register. May 23, 2009 www.fda.gov/downloads/Drugs/DevelopmentApprovalProcess/DevelopmentResources/Over-the-CounterOTCDrugs/StatusofOTCRulemakings/ucm096081.pdf Accessed April 12, 2019.
  26. 26.
    Lanigan RS. Final report on the safety assessment of sodium metaphosphate, sodium trimetaphosphate, and sodium hexametaphosphate. Int J Toxicol. 2001;20(Suppl 3):75–89.PubMedGoogle Scholar
  27. 27.
    Centers for Disease Control and Prevention. National Biomonitoring Program. Factsheet: Triclosan. www.cdc.gov/biomonitoring/Triclosan_FactSheet.html Accessed April 12, 2019.
  28. 28.
    United States Environmental Protection Agency. Report of the Cancer Assessment Review Committee (CARC). Triclosan. January 8, 2008. www3.epa.gov/pesticides/chem_search/cleared_reviews/csr_PC-054901_4-Jan-08_a.pdf Accessed April 12, 2019.
  29. 29.
    Pradeep AR, Karvekar S, Nagpal K, Patnaik K, Guruprasad CN, Kumaraswamy KM. Efficacy of locally delivered 1.2% rosuvastatin gel to non-surgical treatment of patients with chronic periodontitis: a randomized, placebo-controlled trial. J Periodontol. 2015;86(6):738–45.CrossRefPubMedGoogle Scholar
  30. 30.
    Ralston D, Carrasco R, Jacobsen PL, Wink C. Comparison of plaque removal capabilities between two dentifrices. Oral Hyg Health. 2014;2:157.  https://doi.org/10.4172/2332-0702,1000157.CrossRefGoogle Scholar
  31. 31.
    Vanni R, Waldne-Tomic NM, Belibasakis GN, Attin T, Schmidlin PR, Thurnheer T. Antibacterial efficacy of a propolis toothpaste and mouthrinse against a supragingival multispecies biofilm. Oral Health Prev Dent. 2015;13:531–5.PubMedGoogle Scholar
  32. 32.
    De Camargo SP, Esmerino LA, Chibinski AC, et al. In vitro evaluation of toothpastes with natural compounds. Eur J Dent. 2015;9:580–6.CrossRefGoogle Scholar
  33. 33.
    Namiranian H, Serino G. The effect of toothpaste containing Aloe vera on established gingivitis. Swed Dent J. 2012;36:179–85.PubMedGoogle Scholar
  34. 34.
    Azaripour A, Mahmoodi B, Habibi E, Willershausen I, Schmidmann I, Willershausen B. Effectiveness of a miswak extract-containing toothpaste on gingival inflammation: a randomized clinical trial. Int J Dent Hyg. 2017;15:195–202.CrossRefPubMedGoogle Scholar
  35. 35.
    • Brooks JK, Bashirelahi N, Reynolds MA. Charcoal and charcoal-based dentifrices: a literature review. J Am Dent Assoc. 2017;148:661–7. Charcoal is currently a very common additional ingredient in dentifrice. This systematic review assesses the current evidence regarding the safety and efficacy of such charcoal-containing dentifrices and finds that they may have high levels of abrasivity and the inclusion of charcoal may limit the availability of fluoride in such dentifrices.CrossRefPubMedGoogle Scholar
  36. 36.
    Haps S, Slot DE, Berchier CE, van der Weijden GA. The effect of cetylpyridinium chloride-containing mouth rinses as adjuncts to toothbrushing on plaque parameters of gingival inflammation: a systematic review. Int J Dent Hyg. 2008;6(4):290–303.CrossRefPubMedGoogle Scholar
  37. 37.
    Stoeken JE, Paraskevas S, van der Weijden GA. The long-term effect of a mouthrinse containing essential oils on dental plaque and gingivitis: a systematic review. J Periodontol. 2007;78(7):1218–28.CrossRefPubMedGoogle Scholar
  38. 38.
    Sharma N, Charles CH, Lynch MC, et al. Adjunctive benefit of an essential oil containing mouthrinse in reducing plaque and gingivitis in patients who brush and floss regularly: a six-month study. J Am Dent Assoc. 2004;135(4):496–504.CrossRefPubMedGoogle Scholar
  39. 39.
    Eley BM. Antibacterial agents in the control of supragingival plaque-a review. Br Dent J. 1999;186(6):286–96.PubMedGoogle Scholar
  40. 40.
    Anauate-Netto C, Anido-Anido A, Leegoy HR, et al. Randomized, double-blind, placebo-controlled clinical trial on the effects of propolis and chlorhexidine mouthrinses on gingivitis. Braz Dent Sci. 2014;17(1):11–5.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Ercan N, Erdemir EO, Ozkan SY, Hendek MK. The comparative effect of propolis in two different vehicles; mouthwash and chewing gum on plaque accumulation and gingival inflammation. Eur J Dent. 2015;9(2):272–6.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Kilian M, Chapple ILC, Hanig M, Marsh PD, Meuric V, Pedersen AML, et al. The oral microbiome – an update for oral healthcare professionals. Br Dent J. 2016;221:657–66 **.CrossRefPubMedGoogle Scholar
  43. 43.
    Tsouronakis I, Palaiologou-Gallis AA, Stoute D, Maney P, Lallier TE. Effects of essential oil and chlorhexidine mouthwashes on gingival fibroblast survival and migration. J Periodontol. 2013;84:1211–20.CrossRefGoogle Scholar
  44. 44.
    • Yaacob M, Worthington HV, Deacon SA, et al. Powered versus manual toothbrushing for oral health. Cochrane Database Syst Rev. 2014;6:CD002281. This systematic review and meta-analysis reports updated information summarizing randomized controlled trial findings that mechanical toothbrushing reduces plaque and gingival bleeding in short (0–3 months) and long-term (> 6 months) use intervals. For patients who are unable to achieve adequate plaque control with a manual toothbrush, use of a powered toothbrush may aid them in successful oral hygiene measures and reduce periodontal inflammation and disease progression. Google Scholar
  45. 45.
    Sicilia A, Arregui I, Gallego M, Cabezas B, Cuesta S. A systematic review of powered vs. manual toothbrushes in periodontal cause-related therapy. J Clin Periodontol. 2002;29(Suppl 3):39–54.CrossRefPubMedGoogle Scholar
  46. 46.
    Hallmon WW, Rees TD. Local anti-infective therapy: mechanical and physical approaches. A systematic review. Ann Periodontol. 2003;8(1):99–114.CrossRefPubMedGoogle Scholar
  47. 47.
    Cugini MA, Haffajee AD, Smith C, Kent RL Jr. Socransky SS. The effect of scaling and root planing on the clinical and microbiological parameters of periodontal diseases: 12-month results. J Clin Periodontol. 2000;27(1):30–6.CrossRefPubMedGoogle Scholar
  48. 48.
    Cobb CM. Non-surgical pocket therapy: mechanical. Ann Periodontol. 1996;1:443–90.CrossRefPubMedGoogle Scholar
  49. 49.
    Stambaugh RV, Dragoo M, Smith DM, Carasali L. The limits of subgingival scaling. Int J Periodont Res Dent. 1981;1(5):30–41.Google Scholar
  50. 50.
    Rabbani GM, Ash MM, Caffesse RG. The effectiveness of sub gingival scaling and root planing in calculus removal. J Periodontol. 1981;52:119–23.CrossRefPubMedGoogle Scholar
  51. 51.
    Waerhaug J. Healing of the dentoepithelial junction following sub gingival plaque control. II. As observed on extracted teeth. J Periodontol. 1978;49:119–34.CrossRefPubMedGoogle Scholar
  52. 52.
    Tunkel J, Heinecke A, Flemmig TF. A systematic review of efficacy of machine-driven and manual subgingival debridement in the treatment of chronic periodontitis. J Clin Periodontol. 2002;29(Suppl 3):72–81.CrossRefPubMedGoogle Scholar
  53. 53.
    Badersten A, Nilveus R, Egelberg J. Effect of nonsurgical periodontal therapy. I. Moderately advanced periodontitis. J Clin Periodontol. 1981;8:57–72.CrossRefPubMedGoogle Scholar
  54. 54.
    Badersten A, Nilveus R, Egelberg J. Effect of nonsurgical periodontal therapy. II. Severely advanced periodontitis. J Clin Periodontol. 1984;11:63–76.CrossRefPubMedGoogle Scholar
  55. 55.
    • Fang H, Han M, Li Q-L. et al.Comparison of full-mouth disinfection and quadrant-wise scaling in the treatment of adult chronic periodontitis: a systematic review and meta-analysis. J Periodont Res. 2016;51:417–30. This meta-analysis assessed the advantages of full-mouth disinfection versus quadrant-wise ScRP. While statistically significant reduction in periodontal clinical parameters was seen, these reductions may not be clinically significant for all patients. In patients with more rapid periodontal destruction and/or more virulent periodontal pathogens, full-mouth disinfection may offer an advantage. Google Scholar
  56. 56.
    Danser MM, Timmerman MF, van Winkelhoff AJ, van der Velden U. The effect of periodontal treatment on periodontal bacteria on the oral mucous membranes. J Periodontol. 1996;67:478–85.CrossRefPubMedGoogle Scholar
  57. 57.
    Troil-Linden B, Saarela M, Mättö J, Alaluusua S, Jousimies-Somer H, Asikainen S. Source of suspected periodontal pathogens re-emerging after periodontal treatment. J Clin Periodontol. 1996;23:601–7.CrossRefGoogle Scholar
  58. 58.
    Van Winkelhof A, Van der Velden U, de Graaff J. Microbial succession in recolonizing deep periodontal pockets after a single course of supra-and subgingival debridement. J Clin Periodontol. 1988;15:116–22.CrossRefGoogle Scholar
  59. 59.
    Heitz-Mayfield LJA, Salvi GE. Peri-implant mucositis. J Periodontol. 2018;89(Suppl 1):S257–66.CrossRefPubMedGoogle Scholar
  60. 60.
    Schwarz F, Derks J, Monje A, Wang H-L. Peri-implantitis. J Periodontol. 2018;89(Suppl 1):S267–90.CrossRefPubMedGoogle Scholar
  61. 61.
    Kurggan S, Önder C, Blaci N, Fentoglu Ö, Eser F, Balseven M, et al. Gingival crevicular fluid tissue/blood vessel-type plasminogen activator and plasminogen activator inhibitor-2 levels in patients with rheumatoid arthritis: effects of nonsurgical periodontal therapy. J Periodontal Res. 2017;52(3):574–81.CrossRefGoogle Scholar
  62. 62.
    Heitz-Mayfield LJA, Lang NP. Surgical and nonsurgical periodontal therapy. Learned and unlearned concepts. Periodontol 2000. 2019;79:218–31.Google Scholar
  63. 63.
    Borgnakke WS, Ylostalo PV, Taylor GW, Genco RJ. Effect of periodontal disease on diabetes: systematic review of epidemiologic observational evidence. J Periodontol. 2013;84(Suppl 4):S135–52.PubMedGoogle Scholar
  64. 64.
    • Sabharwal A, Gomes-Filho IS, Stellrecht E, Scannapieco FA. Role of periodontal therapy in management of common complex systemic diseases and conditions; an update. Periodontol 2000. 2018;78:212–26. This work describes a systematic review of literature from 2010 to 2018 evaluating current strength of evidence of periodontal treatment and its effects on various systemic conditions and diseases. There is moderate evidence in patients with diabetes mellitus and respiratory diseases that periodontal therapy may improve long-term medical outcomes. CrossRefPubMedGoogle Scholar
  65. 65.
    Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: framework and proposal of a new classification and case definition. J Periodontol. 2018;89(Suppl 1):S159–72.CrossRefPubMedGoogle Scholar
  66. 66.
    Papapanou PN, Sanz M, Buduneli N, et al. Periodontitis: consensus report of workgroup 2 of the 2107 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions.Google Scholar
  67. 67.
    Bouaziz W, Davideau JL, Tenebaum H, Huck O. Adiposity measurements and non-surgical periodontal therapy outcomes. J Periodontol. 2015;86:1030–7.CrossRefPubMedGoogle Scholar
  68. 68.
    Giannobile WV, Braun TM, Caplis AK, Doucette-Stamm L, Duff GW, Kornman KS. Patient stratification for preventative care in dentistry. J Dent Res. 2013;92:694–701.CrossRefPubMedPubMedCentralGoogle Scholar
  69. 69.
    Tonetti MS. Cigarette smoking and periodontal diseases: etiology and management of disease. Ann Periodontol. 1998;3:88–101.CrossRefPubMedGoogle Scholar
  70. 70.
    Lang NP, Suvan JE, Tonetti MS. Risk factor assessment tools for the prevention of periodontitis progression: a systematic review. J Clin Periodontol. 2015;42(Suppl 16):S59–70.CrossRefPubMedGoogle Scholar
  71. 71.
    Papapanou PN. Patterns of alveolar bone loss in the assessment of periodontal treatment priorities. Swed Dent J Suppl. 1989;66:1–45.PubMedGoogle Scholar
  72. 72.
    Lang NP, Joss A, Orsanic T, Gusberti FA, Siegrist BE. Bleeding on probing. A predictor for the progression of periodontal disease? J Clin Periodontol. 1986;12:590–6.CrossRefGoogle Scholar
  73. 73.
    Lang NP, Adler R, Joss A, Nyman S. Absence of bleeding on probing. An indicator of periodontal stability. J Clin Periodontol. 1990;17:714–20.CrossRefPubMedGoogle Scholar
  74. 74.
    DeRossi SS, Sollecito TP. The oral-medical disease connection: pregnancy, cardiovascular disease, and diabetes. Compend Contin Educ Dent. 2012;33:406–13.PubMedGoogle Scholar
  75. 75.
    Dietrich T, Sharma P, Walter C, Weston P, Beck J. The epidemiological evidence behind the association between periodontitis and incident atherosclerotic cardiovascular disease. J Clin Periodontol. 2013;40(Suppl 14):S70–84.PubMedGoogle Scholar
  76. 76.
    Scannapieco FA, Cantos A. Oral inflammation and infection, an chronic medical diseases: implications for the elderly. Periodontol 2000. 2016;72:915–23.CrossRefGoogle Scholar
  77. 77.
    Teles R, Wang CY. Mechanisms involved in the association between periodontal diseases and cardiovascular disease. Oral Dis. 2011;17:450–561.CrossRefPubMedPubMedCentralGoogle Scholar
  78. 78.
    Meimandi M, Ardakani MRT, Nejad AE, Yousefnejad P, Saebi K, Tayeed MH. The effect of photodynamic therapy in the treatment of chronic periodontitis: a review of literature. J Lasers Med Sci. 2017;8(Suppl 1):S7–S11.CrossRefPubMedPubMedCentralGoogle Scholar
  79. 79.
    Queiroz AC, Suaid FA, de Andrade PF, Oliveira FS, Novaes AB Jr, Taba M Jr, et al. Adjunctive effect of antimicrobial photodynamic therapy to nonsurgical periodontal treatment in smokers: a randomized clinical trial. Lasers Med Sci. 2015;30:617–25.CrossRefPubMedGoogle Scholar
  80. 80.
    Song X, Yaskell T, Klepac-Ceraj V, Lynch MC, Soukos NS. Antimicrobial action of minocycline microspheres versus 810-nm diode laser on human dental plaque microcosm biofilms. J Periodontol. 2014;85:335–42.CrossRefPubMedGoogle Scholar
  81. 81.
    Preshaw PM, Hefti AF, Jepsen S, Etienne D, Walker C, Bradshaw MH. Subantimicrobial dose doxycycline as adjunctive treatment for periodontitis. J Clin Periodontol. 2004;31:697–707.CrossRefPubMedGoogle Scholar
  82. 82.
    Emingil G, et al. Adjunctive effects of a sub-antimicrobial dose of doxycycline on clinical parameters and potential biomarkers of periodontal tissue catabolism. Dent J. 2019;7(1):9.  https://doi.org/10.3390/dj7010009.CrossRefGoogle Scholar
  83. 83.
    Bali SK, Madaiah H, Dharmapalan J, Janarthanam S, Tarannum F. Effect of systemic long-term, low-dose aspirin on periodontal status and soluble CD14 in gingival crevicular fluid: a case-control study. J Invest Clin Dent. 2018;9:e12353.  https://doi.org/10.1111/jicd.12353.CrossRefGoogle Scholar
  84. 84.
    Preshaw PM. Host modulation therapy with anti-inflammatory agents. Periodontol 2000. 2018;76:131–49.CrossRefPubMedGoogle Scholar
  85. 85.
    Fredman G, Oh SF, Ayilavarapu S, Hasturk H, Serhan CN, Van Dyke TE. Impaired phagocytosis in localized aggressive periodontitis: rescue by resolvin E1. PLoS One. 2011;6:e24422.CrossRefPubMedPubMedCentralGoogle Scholar
  86. 86.
    Umrania VV, Rao Deepika PC, Kulkarni M. Evaluation of dietary supplementation of omega-3 polyunsaturated fatty acids as an adjunct to scaling and root planing on salivary interleukin-1β levels in patients with chronic periodontitis: a clinico-immunological study. J Indian Soc Periodontol. 2017;21(5):386–90.PubMedPubMedCentralGoogle Scholar
  87. 87.
    Nevins M, Kim S-W, Camelo M, Martin IS, Kim D, Nevins M. A prospective 9-month human clinical evaluation of laser-assisted new attachment procedure (LANAP) therapy. Int J Periodont Res Dent. 2014;34(1):20–7.Google Scholar
  88. 88.
    Nevins M, Camelo M, Schupbach P, Kim S-W, Kim DM, Nevins M. Human clinical and histological evaluation of laser-assisted new attachment procedure. Int J Periodont Res Dent. 2012;32(5):496–507.Google Scholar
  89. 89.
    Harris DM, Nicholson DM, McCarthy D, Yukna RA, et al. Change in clinical indices following laser or scalpel treatment for periodontitis: a split-mouth, randomized, multi-center trial. SPIE BiOS, 2014, Proceedings in Lasers in Dentistry Vol 8929: 8929OG(2014).Google Scholar
  90. 90.
    Ren C, McGrath C, Jin L, Zhang C, Yang Y. The effectiveness of low-level laser therapy as an adjunct to non-surgical periodontal treatment: a meta-analysis. J Periodontal Res. 2017;52:8–20.CrossRefPubMedGoogle Scholar
  91. 91.
    Akram Z, Al-Shareef SAA, Daood U, et al. Bactericidal efficacy of photodynamic therapy against periodontal pathogens in periodontal disease: a systematic review. Photomed Laser Surg. 2016;34(4):137–49.CrossRefPubMedGoogle Scholar
  92. 92.
    Kikuchi T, Mogi M, Okabe I, Okada K, Goto H, Sasaki Y, et al. Adjunctive application of antimicrobial photodynamic therapy in nonsurgical periodontal treatment: a review of literature. Int J Mol Sci. 2015;16:24111–26.CrossRefPubMedPubMedCentralGoogle Scholar
  93. 93.
    Tabenski L, Moder D. Cieplik.F, et al. antimicrobial photodynamic therapy vs. local minocycline in addition to non-surgical therapy of deep periodontal pockets: a controlled randomized clinical trial. Clin Oral Invest. 2017;21:2253–64.CrossRefGoogle Scholar
  94. 94.
    De Melo Soares MS, D’Almeida Borges C, de Mendonca Invernici M, et al. Antimicrobial photodynamic therapy as adjunct to non-surgical periodontal treatment in smokers: a randomized clinical trial. Clin Oral Investig 2018 Nov 3. [Epub ahead of print]  https://doi.org/10.1007/s00784-018-2740-3.
  95. 95.
    Queiroz AC, Suaid FA, de Andrade PF, Novaes AB Jr, Taba M Jr, Palioto DB, et al. Antimicrobial photodynamic therapy associated to nonsurgical periodontal treatment in smokers: microbiological results. J Photochem Photobiol. 2014;141:170–5.CrossRefGoogle Scholar
  96. 96.
    Heitz-Mayfield LJA. Systemic antibiotics in periodontal therapy. Austr Dent J. 2009;54:S96–S101.CrossRefGoogle Scholar
  97. 97.
    Sgolastra F, Gatto R, Petrucci A, Monaco A. Effectiveness of systemic amoxicillin/metronidazole as adjunctive therapy to scaling and root planing in the treatment of chronic periodontitis: a systematic review and meta-analysis. J Periodontol. 2012;83:1257–69.CrossRefPubMedGoogle Scholar
  98. 98.
    Sgolastra F, Petrucci A, Gatto R, Monaco A. Effectiveness of systemic amoxicillin/metronidazole as an adjunctive therapy to full-mouth scaling and root planing in the treatment of aggressive periodontitis: a systematic review and meta-analysis. J Periodontol. 2012;83:731–43.CrossRefPubMedGoogle Scholar
  99. 99.
    Silva MP, Feres M, Sirotto TA, et al. Clinical and microbiological benefits of metronidazole alone or with amoxicillin as adjuncts in the treatment of chronic periodontitis: a randomized placebo-controlled clinical trial. J Clin Periodontol. 2011;38:828–37.CrossRefPubMedGoogle Scholar
  100. 100.
    Feres M, Soares GM, Mendes JA, et al. Metronidazole alone or with amoxicillin as adjuncts to non-surgical treatment of chronic periodontitis: a 1-year double-blinded, placebo controlled, randomized clinical trial. J Clin Periodontol. 2012;39:1149–58.CrossRefPubMedGoogle Scholar
  101. 101.
    Cosgarea R, Heumann C, Juncar R, Tristiu R, Lascu L, Salvi GE, et al. One year results of a randomized controlled clinical study evaluating the effects of non-surgical periodontal therapy of chronic periodontitis in conjunction with three or seven days systemic administration of amoxicillin/metronidazole. PLoS One. 2017;12(6):e0179592.CrossRefPubMedPubMedCentralGoogle Scholar
  102. 102.
    Assem NZ, Alves MLF, Lopes AB, Gualberto ECJ, Garcia VG, Theodoro LH. Antibiotic therapy as an adjunct to scaling and root planing in smokers: a systematic review and meta-analysis. Braz Oral Res. 2017;31:e67.CrossRefPubMedGoogle Scholar
  103. 103.
    Bonito AJ, Lux L, Lohr KN. Impact of local adjuncts to scaling and root planing in periodontal disease therapy: a systematic review. J Periodontol. 2005;76(8):1227–36.CrossRefPubMedGoogle Scholar
  104. 104.
    • Smiley CJ, Tracy SL, Abt E, et al. Evidence-based clinical practice guideline on the nonsurgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts. J Am Dent Assoc. 2015;146(7):525–35. This work outlines practice guidelines for the most effective use of adjunctive therapies with scaling and root planing.CrossRefPubMedGoogle Scholar
  105. 105.
    Paquette D, Oringer R, Lessem J, Offenbacher S, Genco R, Persson GR, et al. Locally delivered minocycline microspheres for the treatment of periodontitis in smokers. J Clin Periodontol. 2003;30:787–94.CrossRefPubMedGoogle Scholar
  106. 106.
    Chambrone L, Vargas M, Arboledan S, Serna M, Guerrero M, Sousa J, et al. Efficacy of local and systemic antimicrobials in the non-surgical treatment of smokers with chronic periodontitis: a systematic review. J Periodontol. 2016;87:1320–32.CrossRefPubMedGoogle Scholar
  107. 107.
    Caton J, Ryan ME. Clinical studies on the management of periodontal diseases utilizing subantimicrobial dose doxycycline (SDD). Pharmacol Res. 2011;63(2):114–20.CrossRefPubMedGoogle Scholar
  108. 108.
    Geisinger ML, Holmes CM, Geurs NC, Vassilopoulos PJ, Reddy MS. Host modulation for smokers undergoing periodontal maintenance: a review of current evidence. Clin Adv in Periodont. 2011;1(1):54–60.CrossRefGoogle Scholar
  109. 109.
    Needleman I, Suvan J, Gilthorpe MS, Tucker R, St George G, Giannobile W, et al. A randomized-controlled trial of low-dose doxycycline for periodontitis in smokers. J Clin Periodontol. 2007;34:325–33.CrossRefPubMedPubMedCentralGoogle Scholar
  110. 110.
    Haffajee AD, Socransky SS, Gunsolley JC. Systemic anti-infective periodontal therapy. A systematic review. Ann Periodontol. 2003;8(1):115–81.CrossRefPubMedGoogle Scholar
  111. 111.
    Flemmig TF, Rumetsch M, Klaiber B. Efficacy of systemically administered acetylsalicylic acid plus scaling on periodontal health and elastase-alpha-1-proteinase inhibitor in gingival crevicular fluid. J Clin Periodontol. 1996;23(3 Pt 1):153–9.CrossRefPubMedGoogle Scholar
  112. 112.
    Geisinger ML, Holmes CM, Vassilopoulos PJ, Geurs NC, Reddy MS. Adjunctive treatment of chronic periodontitis with systemic low-dose aspirin therapy. Clin Adv in Periodontics. 2012;2(3):195–9.CrossRefGoogle Scholar
  113. 113.
    Naqvi AZ, Hasturk H, Mu L, Phillips RS, Davis RB, Halem S, et al. Docosahexaenoic acid and periodontitis in adults: a randomized controlled trial. J Dent Res. 2014;93(8):767–73.CrossRefPubMedPubMedCentralGoogle Scholar
  114. 114.
    Petit C, Batol F, Bugueno IM, Schwinte P, Benkirane-Jessel N, Huck O. Contribution of Statins towards periodontal treatment: a review. Med Inflamm 2019; 27; 2019: 6367402 doi:  https://doi.org/10.1155/2019/6367402. eCollection 2019.
  115. 115.
    Bertl K, Steiner I, Pandis N, Buhlin K, Klinge B, Stavropoulos A. Statins in nonsurgical and surgical periodontal therapy. A systematic review and meta-analysis of preclinical in vivo trials. J Periodontal Res. 2018;53:267–87.CrossRefPubMedGoogle Scholar
  116. 116.
    Axelsson P, Nystrom B, Lindhe J. The long-term effect of a plaque control program on tooth mortality, caries, and periodontal disease in adults. Results after 30 years of maintenance. J Clin Periodontol. 2004;31(9):749–57.CrossRefPubMedGoogle Scholar
  117. 117.
    Gaunt F, Devine M, Pennington M, Vernazza C, Gwynnett E, Steen N, et al. The cost-effectiveness of supportive periodontal care for patients with chronic periodontitis. J Clin Periodontol. 2008;35:67–82.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Maria L. Geisinger
    • 1
    Email author
  • Maninder Kaur
    • 1
  • Hussein Basma
    • 1
  1. 1.Department of PeriodontologyUniversity of Alabama at BirminghamBirminghamUSA

Personalised recommendations