Full-Mouth Disinfection For The Treatment of Adult Chronic Periodontitis (Review)

Full-mouth disinfection for the treatment of adult chronic
periodontitis (Review)
Eberhard J, Jepsen S, Jerve-Storm PM, Needleman I, Worthington HV
This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library
2008, Issue 4
http://www.thecochranelibrary.com
Full-mouth disinfection for the treatment of adult chronic periodontitis (Review)
Copyright 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
T A B L E O F C O N T E N T S
1 HEADER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1 ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2 PLAIN LANGUAGE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2 BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3 OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3 METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5 RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8 DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9 AUTHORS CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9 ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10 CHARACTERISTICS OF STUDIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18 DATA AND ANALYSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 1.1. Comparison 1 FMS versus control, Outcome 1 Change in PPD; single and multirooted teeth. . . . 21
Analysis 1.2. Comparison 1 FMS versus control, Outcome 2 Change in PPD; single rooted teeth. . . . . . . . 22
Analysis 1.3. Comparison 1 FMS versus control, Outcome 3 Change in PPD; multirooted teeth. . . . . . . . 23
Analysis 1.4. Comparison 1 FMS versus control, Outcome 4 Change in CAL; single and multirooted teeth. . . . 24
Analysis 1.5. Comparison 1 FMS versus control, Outcome 5 Change in CAL; single rooted teeth. . . . . . . . 25
Analysis 1.6. Comparison 1 FMS versus control, Outcome 6 Change in CAL; multirooted teeth. . . . . . . . 26
Analysis 1.7. Comparison 1 FMS versus control, Outcome 7 Change in BOP; single and multirooted teeth. . . . 27
Analysis 1.8. Comparison 1 FMS versus control, Outcome 8 Changes in BOP; single rooted teeth. . . . . . . 28
Analysis 1.9. Comparison 1 FMS versus control, Outcome 9 Changes in BOP; multirooted teeth. . . . . . . . 29
Analysis 2.1. Comparison 2 FMD versus control, Outcome 1 Change in PPD; single and multirooted teeth. . . . 30
Analysis 2.2. Comparison 2 FMD versus control, Outcome 2 Change in PPD; single rooted teeth. . . . . . . . 31
Analysis 2.3. Comparison 2 FMD versus control, Outcome 3 Change in PPD; multirooted teeth. . . . . . . . 32
Analysis 2.4. Comparison 2 FMD versus control, Outcome 4 Change in CAL; single and multirooted teeth. . . . 33
Analysis 2.5. Comparison 2 FMD versus control, Outcome 5 Change in CAL; single rooted teeth. . . . . . . . 34
Analysis 2.6. Comparison 2 FMD versus control, Outcome 6 Change in CAL; multirooted teeth. . . . . . . . 35
Analysis 2.7. Comparison 2 FMD versus control, Outcome 7 Change in BOP; single and multirooted teeth. . . . 36
Analysis 2.8. Comparison 2 FMD versus control, Outcome 8 Changes in BOP; single rooted teeth. . . . . . . 37
Analysis 2.9. Comparison 2 FMD versus control, Outcome 9 Changes in BOP; multirooted teeth. . . . . . . 38
Analysis 3.1. Comparison 3 FMS versus FMD, Outcome 1 Change in PPD; single and multirooted teeth. . . . . 39
Analysis 3.2. Comparison 3 FMS versus FMD, Outcome 2 Change in PPD; single rooted teeth. . . . . . . . 40
Analysis 3.3. Comparison 3 FMS versus FMD, Outcome 3 Change in PPD; multirooted teeth. . . . . . . . . 41
Analysis 3.4. Comparison 3 FMS versus FMD, Outcome 4 Change in CAL; single and multirooted teeth. . . . . 42
Analysis 3.5. Comparison 3 FMS versus FMD, Outcome 5 Change in CAL; single rooted teeth. . . . . . . . 43
Analysis 3.6. Comparison 3 FMS versus FMD, Outcome 6 Change in CAL; multirooted teeth. . . . . . . . . 44
Analysis 3.7. Comparison 3 FMS versus FMD, Outcome 7 Change in BOP; single and multirooted teeth. . . . . 45
Analysis 3.8. Comparison 3 FMS versus FMD, Outcome 8 Changes in BOP; single rooted teeth. . . . . . . . 46
Analysis 3.9. Comparison 3 FMS versus FMD, Outcome 9 Changes in BOP; multirooted teeth. . . . . . . . 47
47 APPENDICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
49 WHATS NEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
49 HISTORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
49 CONTRIBUTIONS OF AUTHORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
49 DECLARATIONS OF INTEREST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
49 SOURCES OF SUPPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
50 INDEX TERMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
i Full-mouth disinfection for the treatment of adult chronic periodontitis (Review)
[Intervention Review]
Full-mouth disinfection for the treatment of adult chronic
periodontitis
Jrg Eberhard
1
, Sren Jepsen
2
, Pia-Merete Jerve-Storm
2
, Ian Needleman
3
, Helen V Worthington
4
1
Department of Operative Dentistry and Periodontology, University Hospital Kiel, Kiel, Germany.
2
Department of Periodontology,
Operative and Preventive Dentistry, University Hospital Bonn, Bonn, Germany.
3
Unit of Periodontology, Division of Restorative
Dental Sciences, UCL Eastman Dental Institute, London, UK.
4
Cochrane Oral Health Group, MANDEC, School of Dentistry, The
University of Manchester, Manchester, UK
Contact address: Jrg Eberhard, Department of Operative Dentistry and Periodontology, University Hospital Kiel, Arnold-Heller-Str.
16, Kiel, 24105, Germany. [email protected].
Editorial group: Cochrane Oral Health Group.
Publication status and date: Edited (no change to conclusions), published in Issue 4, 2008.
Review content assessed as up-to-date: 13 November 2007.
Citation: Eberhard J, Jepsen S, Jerve-Storm PM, Needleman I, Worthington HV. Full-mouth disinfection for the treat-
ment of adult chronic periodontitis. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD004622. DOI:
10.1002/14651858.CD004622.pub2.
A B S T R A C T
Background
In an attempt to enhance treatment outcomes, alternative protocols for anti-infective periodontal therapy have been introduced.
Objectives
To evaluate the effectiveness of full-mouth disinfection or full-mouth scaling compared to conventional quadrant scaling for periodon-
titis.
Search strategy
Data sources included electronic databases, handsearched journals and contact with experts. The Cochrane Oral Health Group Trials
Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE were searched. Reference lists
fromrelevant articles were scanned and the authors of eligible studies were contacted to identify trials and obtain additional information.
Date of most recent searches: December 2006: CENTRAL (The Cochrane Library 2006, Issue 4).
Selection criteria
Randomised controlled trials were selected with at least 3 months follow up comparing full-mouth scaling and root planing within 24
hours with (FMD) or without (FMS) the adjunctive use of an antiseptic (chlorhexidine) with conventional quadrant scaling and root
planing (control). The methodological quality of the studies was assessed within the data extraction form, mainly focusing on: method
of randomisation, allocation concealment, blindness of examiners and completeness of follow up.
Data collection and analysis
Data extraction and quality assessment were conducted independently by multiple review authors. The primary outcome measure was
tooth loss, secondary outcomes were reduction of probing depth, bleeding on probing and gain in probing attachment. The Cochrane
Collaboration statistical guidelines were followed.
1 Full-mouth disinfection for the treatment of adult chronic periodontitis (Review)
Main results
The search identied 216 abstracts. Review of these abstracts resulted in 12 publications for detailed review. Finally, seven randomised
controlled trials (RCTs) which met the criteria for eligibility were independently selected by two review authors. None of the studies
included reported on tooth loss. All treatment modalities led to signicant improvements in clinical parameters after a follow up of at
least 3 months. For the secondary outcome, reduction in probing depth, the mean difference between FMD and control was 0.53 mm
(95% condence interval (CI) 0.28 to 0.77) in moderately deep pockets of single rooted teeth and for gain in probing attachment 0.33
mm (95% CI 0.04 to 0.63) in moderately deep single and multirooted teeth. Comparing FMD and FMS the mean difference in one
study for gain in probing attachment amounted to 0.74 mm in favour of FMS (95% CI 0.17 to 1.31) for deep pockets in multirooted
teeth, while another study reported a mean difference for reduction in bleeding on probing of 18% in favour of FMD (95% CI -34.30
to -1.70) for deep pockets of single rooted teeth. No signicant differences were observed for any of the outcome measures, when
comparing FMS and control.
Authors conclusions
In patients with chronic periodontitis in moderately deep pockets slightly more favourable outcomes for pocket reduction and gain in
probing attachment were found following FMD compared to control. However, these additional improvements were only modest and
there was only a very limited number of studies available for comparison, thus limiting general conclusions about the clinical benet
of full-mouth disinfection.
P L A I N L A N G U A G E S U M M A R Y
Full-mouth disinfection for the treatment of adult chronic periodontitis
Full-mouth scaling, full-mouth disinfection and quadrant scaling are equally suitable for the treatment of adult chronic periodontitis.
Therapy of chronic periodontitis is based on the mechanical removal of subgingival bacteria frominfected root surfaces in order to arrest
and control the loss of tooth supporting bone and tissues. Non-surgical periodontal therapy can be carried out either quadrantwise in
discrete sessions over a period of several weeks, or within 24 hours in one or two sessions termed full-mouth scaling. The latter can
be supplemented with the extended use of an antiseptic agent in the context of full-mouth disinfection. The rationale for full-mouth
approaches is to eliminate or reduce pathogenic bacteria from oral habitats that may lead to re-infection of already treated sites. The
results of this review have shown that the treatment effects of full-mouth scaling or full-mouth disinfection compared to conventional
scaling and root planing are modest and the implications for periodontal care are not profound. In practice the decision to select
one approach to non-surgical periodontal therapy over another needs to include patient preferences and convenience of the treatment
schedule.
B A C K G R O U N D
Some 5%to 20%of the populationsuffers fromsevere, generalised
periodontitis, though mild to moderate periodontitis affects the
majority of adults (AAP 1996; Oliver 1991). Periodontitis is seen
as resulting from a complex interplay of bacterial infection and
host response, modied by behavioural and systemic risk factors.
There is considerable evidence to support scaling and root planing
(SRP) as one of the most effective procedures for the treatment
of infectious periodontal diseases (Heitz-Mayeld 2002; van der
Weijden 2002).
In patients with periodontitis, key pathogens such as Aggregatibac-
ter actinomycetemcomitans, Porphyromonas gingivalis and Prevotella
intermedia were found to colonise nearly all niches in the oral cav-
ity, suchas the tongue, the mucosa, the saliva, or the tonsils (Beikler
2004). A translocation of these pathogens may occur rapidly and
a recently root planed deep pocket might be re-colonised from
remaining untreated pockets or from other intraoral niches, be-
fore a less pathogenic ecosystem can be established. Based on this
hypothesis a full-mouth disinfection (FMD) approach consisting
of scaling and root planing of all pockets in two visits within 24
hours in combination with adjunctive chlorhexidine treatments
of all oral niches has been proposed (Quirynen 1995), which was
subsequently evaluated in a series of studies by the same research
group (Bollen 1998; Mongardini 1999; Vandekerckhove 1996).
A later report indicated that this full-mouth treatment approach
resulted in superior clinical outcomes and microbiological effects
than conventional quadrant scaling and root planing (control), ir-
respective of the adjunctive use of chlorhexidine (Quirynen 2000).
More recent studies fromother research centres, however, failed to
demonstrate an advantage of full-mouth scaling within 24 hours
versus the control regimen (Apatzidou 2004; Jerve-Storm 2006;
Koshy 2005; Wennstrm 2005).
To date, no systematic review has been conducted to address the
issue of full-mouth treatment concepts which may have great im-
pact on clinical practice.
O B J E C T I V E S
The purpose of this systematic review was to evaluate the clin-
ical effects of full-mouth disinfection or full-mouth scaling for
the treatment of chronic periodontitis compared to conventional
quadrant scaling and root planing (control).
M E T H O D S
Criteria for considering studies for this review
Types of studies
Randomised controlled clinical trials of at least 3 months follow
up were considered for this review.
Types of participants
The participants of the included studies had a clinical diagnosis
of chronic periodontitis based on the international classication
of periodontal diseases (Armitage 1999). Data from studies on
patients with aggressive periodontitis were not included.
Types of interventions
(1) Full-mouth disinfection (FMD) versus quadrant scaling and
root planing (control). FMD comprising scaling and root plan-
ing of all quadrants within 24 hours. Adjunctive chlorhexidine
treatments could include rinsing, pocket irrigation, spraying of
the tonsils and tongue brushing. Control treatment was rendered
by quadrant scaling and root planing in four sessions separated by
intervals of at least 1 week.
(2) Full-mouth scaling (FMS) versus quadrant scaling and root
planing (control). To be inclusive, all FMS approaches were in-
cluded as long as the treatment was completed within 24 hours.
Types of outcome measures
Primary outcomes
-Tooth loss.
Secondary outcomes
-Change in probing depth.
-Change in clinical attachment level.
-Change in bleeding on probing.
Factors that were recorded to assess the heterogeneity of outcomes
across studies were:
-Plaque levels
-Time allowed for treatment
-Age of patients
-Initial probing depth
-Smoking status
-Study quality.
Search methods for identication of studies
The searches attempted to identify all relevant trials irrespective
of language. Papers not in English were translated by members of
The Cochrane Collaboration.
Electronic searching - the databases searched were (date of most
recent searches 1st December 2006):
Cochrane Oral Health Group Trials Register
Cochrane Central Register of Controlled Trials (CENTRAL) (The
Cochrane Library 2006, Issue 4)
MEDLINE (from 1966) and MEDLINE Pre-indexed
EMBASE (from 1980)
CINAHL
CANCERLIT via PubMed.
Sensitive search strategies were developed for each database using
a combination of free text and MeSH terms. These are described
in detail in Appendix 1; Appendix 2; Appendix 3 and Appendix
4.
Incomplete information and ambiguous data were researched fur-
ther by contacting the author and/or researcher responsible for the
study directly. For unpublished material the conference proceed-
ings of the International Association for Dental Research (IADR),
American Academy of Periodontology (AAP) and European Fed-
eration of Periodontology (EFP) were searched. Relevant in press
manuscripts were sought from Journal of Clinical Periodontology,
Journal of Periodontology, Journal of Dental Research, and Journal of
Periodontal Research and by contact with the journal editors. The
following journals had been identied as being important for this
review to be handsearched: Journal of Periodontology, Journal of
Clinical Periodontology, and Journal of Periodontal Research. These
journals were handsearched by two review authors (Jrg Eberhard
(JE) and Sren Jepsen (SJ)) for the period 1980 to the present.
Date of most recent searches: 1st December 2006:
CENTRAL (The Cochrane Library 2006, Issue 4)
MEDLINE, EMBASE, CINAHL: limit 2005-2006 (December).
Data collection and analysis
Selection of studies
Titles and abstracts were managed by downloading to EndNote
9 software. The selection of papers, the decision about eligibility
and data extraction was carried out independently, in duplicate,
by two review authors (Jrg Eberhard (JE) and Sren Jepsen (SJ)).
Any disagreements were resolved by discussion. A screening form
was used to evaluate the selected papers. Kappa scores were used to
assess agreement between review authors based on a 2x2 contin-
gency table. Agreement was assessed both for study eligibility and
for quality assessment items. A Kappa score of >0.81 was regarded
as equating to almost complete agreement. Studies meeting the
inclusion criteria underwent validity criteria and data extraction.
The full text of the included studies was evaluated by two review
authors (JE and SJ). Data entry to a computer and data extrac-
tion was carried out by two review authors (Pia-Merete Jerve-
Storm(PS) and Helen Worthington (HW)). Studies rejected were
recorded in a table of excluded studies and reasons for exclusion
were recorded for all studies rejected at the full-text stage.
Data extraction
The following data were extracted:
-General study characteristics: year of the study, country of origin,
authors, funding, university/private practice based
-Specic trial characteristics: population, gender, age, severity of
periodontal disease
-Primary outcomes: number of teeth before and after treatments
-Secondary outcomes: probing depth, attachment level, bleeding
on probing before and after different treatment modalities.
Quality assessment
The methodological quality of included studies was assessed
mainly using components shown to affect study outcomes includ-
ing method of randomisation, allocation concealment and blind-
ing of examiners and therapists. In addition, completeness of fol-
low up was examined. Methodological quality was used in sensi-
tivity analyses to test the robustness of the conclusions but was
not used to exclude studies qualifying for the review on the basis
of their inclusion criteria. The denitions of categories from the
Cochrane Handbook for Systematic Reviews of Interventions 4.2.6
(updated September 2006) (Higgins 2006) were used.
The method of randomisation was classied as:
-Adequate, when random number generation was used such as
computer generated schemes
-Inadequate, when other methods of randomisation were used
(such as alternate assignment, hospital number)
-Unclear, when method of randomisation was not reported or
explained.
Allocation concealment (i.e. howthe randomisation sequence was
hidden from the examiners) was classied as follows:
-Adequate, when examiners were kept unaware of randomisation
sequence (for example, by means of central randomisation, se-
quentially numbered, opaque envelopes)
-Inadequate, when other methods of allocation concealment were
used (such as alternate assignment, hospital number)
-Unclear, when method of allocation concealment was not re-
ported or explained.
Blindness of examiners:
-Blindness of examiners, with regard to treatment alternatives used
in the trial, was determined as yes/no/uncertain.
Completeness of follow up was assessed dichotomously (yes/no)
by answering the following questions:
-Was the number of patients at baseline and at completion of the
follow up reported for both groups
-Were all the patients who entered the trial properly accounted for
at completion
-Did the analysis take into account the drop outs/losses to follow
up or the excluded patients.
Data synthesis
Patient means were the basis for data analysis. For dichotomous
outcomes, the estimates of effect of an intervention were expressed
as risk ratios together with 95% condence intervals (CI). For
continuous outcomes, mean differences (MD) and 95% CI were
used to summarise the data for each group. The analysis for the
continuous outcome variables was conducted using the generic
inverse variance statistical method where the mean differences and
standard errors were entered. Where there were studies of similar
comparisons reporting the same outcome measures a meta-analysis
was performed. Risk ratios were combined for dichotomous data,
and mean differences for continuous data, using random-effects
models.
Heterogeneity was assessed by inspection of a graphical display of
the estimated treatment effects from trials along with Cochrans
test for heterogeneity undertaken prior to each meta-analysis, and
I
2
statistics. Heterogeneity was investigated for aspects of study
quality and for potential sources of heterogeneity specied a priori
as follows: randomisation, allocation concealment, blind outcome
assessment, including/excluding unpublished literature. The asso-
ciation of these factors with estimated effects were examined by
performing random-effects metaregression analysis in Stata ver-
sion 7.0 (Stata Corporation, USA), using the program Metareg.
Further potential sources of heterogeneity were investigated as de-
termined fromthe study reports, although these were clearly iden-
tied as post hoc analyses.
R E S U L T S
Description of studies
See: Characteristics of includedstudies; Characteristics of excluded
studies.
The literature search provided 216 titles and abstracts to be
screened. Twelve full papers were selected by the two review au-
thors (Jrg Eberhard (JE) and Sren Jepsen (SJ)) to read and from
these nine randomised controlled trials (RCTs) could be identied
and seven were found to be eligible. There was complete agree-
ment between the two review authors. Excluded articles and the
reasons for exclusion are presented in the respective tables.
Risk of bias in included studies
The methodological quality of the included studies is summarised
in Additional Table 1. Seven trials are included (Apatzidou 2004;
Jerve-Storm 2006; Koshy 2005; Mongardini 1999; Quirynen
2006; Wennstrm 2005; Zanatta 2006). One trial (Mongardini
1999) was reported in two articles, and one of these reports in-
cluded a third group (described as FRp group) which was not ran-
domised and is not included in this review (Quirynen 2000).
Table 1. Quality assessment
Study Randomisation Allocation conceal-
ment
Blinding Withdrawals clear Risk of bias
Apatzidou 2004 unclear unclear no yes high
Jerve-Storm 2006 adequate adequate yes yes low
Koshy 2005 adequate adequate yes yes low
Mongardini 1999 adequate adequate uncertain yes moderate
Table 1. Quality assessment (Continued)
Quirynen 2006 adequate adequate yes unclear moderate
Wennstrom 2005 adequate adequate yes yes low
Zanatta 2006 unclear unclear yes unclear moderate
Of all seven trials, four described the method of randomisation,
which was performed with the aid of a computer (Jerve-Storm
2006; Koshy 2005; Quirynen 2006; Wennstrm 2005). In three
papers, the method of randomisation was uncertain or not stated
(Apatzidou 2004; Mongardini 1999; Zanatta 2006). Four papers
provided adequate information about allocation concealment (
Jerve-Storm 2006; Koshy 2005; Quirynen 2006; Wennstrm
2005). The completeness of follow up, as described by the num-
ber of subjects that were entered into the study and subse-
quently nished it, was described adequate in ve of the cases (
Apatzidou 2004; Jerve-Storm 2006; Koshy 2005; Mongardini
1999; Wennstrm 2005). In two studies it was unclear if the anal-
ysis take into account the drop outs/losses to follow up or the ex-
cluded patients (Quirynen 2006; Zanatta 2006).
Effects of interventions
Tooth survival
No data were available for the primary outcome tooth survival.
Four studies provided data for the comparison single and mul-
tirooted teeth between full-mouth scaling (FMS) and control 6
months after baseline (Apatzidou 2004; Jerve-Storm2006; Koshy
2005; Wennstrm 2005). One additional study which compared
FMS, full-mouth disinfection (FMD) and control after 3 months
was also included in the meta-analysis (Zanatta 2006). One study
provided data for the comparison between FMD and control 6
months after baseline (Koshy 2005). One study evaluated the ef-
fect of FMD compared to control after 8 months (Mongardini
1999) and another compared the three different treatment modal-
ities after 8 months (Quirynen 2006).
Three studies separated the data in subcategories single rooted
or multirooted teeth in terms of probing pocket depth (PPD) (
Koshy 2005; Mongardini 1999; Quirynen 2006). It must be em-
phasized, that one study evaluated the range of pocket depth 4
to 5.5 mm and > 6 mm respectively (Quirynen 2006), while the
other six studies classied pocket depths in 5 to 6 mm and > 6
mm respectively. Two studies provided data from the rst quad-
rant only (Mongardini 1999; Quirynen 2006), whereas the other
ve studies generated the data from the whole mouth.
FMS versus control
Comparison of FMS versus control (PPD Comparison 1,
Outcomes 1.1-1.3)
Four studies were includedinthe meta-analysis for moderate pock-
ets in single and multirooted teeth. There was no statistically sig-
nicant difference between FMS and control for the moderate
pockets (5 to 6 mm) (P = 0.60), mean difference -0.05 mm (95%
condence interval (CI) -0.23 mm to 0.13 mm, Chi
2
= 0.79, 3
degrees of freedom (df ), P = 0.85, I
2
= 0%). The same was found
for the deep pockets (> 6 mm) (P = 0.96), mean difference -0.01
mm (95% CI -0.30 mm to 0.28 mm, Chi
2
= 0.40, 3 df, P = 0.94,
I
2
= 0%).
Only two studies were included in the meta-analysis for single
rooted teeth alone, there were no statistically signicant differences
either for moderate (P = 0.48, mean difference 0.11 mm (95% CI
-0.19 mm to 0.41 mm, Chi
2
= 0.00, 1 df, P = 0.95, I
2
= 0%))
or deep pockets (P = 0.31, mean difference 0.29 mm (95% CI -
0.27 mmto 0.85 mm, Chi
2
= 0.19, 1 df, P = 0.67, I
2
= 0%)). The
same two studies were included in a meta-analysis for multirooted
teeth. No statistically signicant differences were found between
FMS and control (moderate pockets: P = 0.22, mean difference
0.83 mm (95% CI -0.51 mm to 2.16 mm, Chi
2
= 18.3, 1 df, P
< 0.0001, I
2
= 94.5%); deep pockets: P = 0.66, mean difference
0.12 mm (95% CI -0.42 mm to 0.65 mm, Chi
2
= 0.51, 1 df, P =
0.48, I
2
= 0%)).
Comparison of FMS versus control (clinical attachment level
(CAL) Comparison 1, Outcomes 1.4-1.6)
Five studies were included in the meta-analysis for moderate pock-
ets in single and multirooted teeth (Apatzidou 2004; Jerve-Storm
2006; Quirynen 2006; Wennstrm 2005; Zanatta 2006). The
same ve studies were included in the meta-analysis for deep pock-
ets. No statistically signicant differences between FMS and con-
trol were found, neither for moderate pockets (P = 0.17, mean
difference 0.13 mm) nor for deep pockets (P = 0.13, mean differ-
ence 0.28 mm). There was no evidence of heterogeneity for the
moderate pockets, but some evidence for the deep pockets. Only
one study (Koshy 2005) provided data for single rooted and mul-
tirooted teeth alone. No statistically signicant differences were
found.
Comparison of FMS versus control (bleeding on probing
(BOP) Comparison 1, Outcomes 1.7-1.9)
Five studies were included in the meta-analysis for single and mul-
tirooted teeth combined (Apatzidou 2004; Jerve-Storm 2006;
Koshy 2005; Quirynen 2006; Zanatta 2006). There was no statis-
tically signicant difference between FMS and control for the full-
mouth evaluation (P = 0.96). There was little evidence of hetero-
geneity between the trials. Only one trial calculated the changes of
BOP for single and multirooted teethseparately (Quirynen 2006).
Once again no statistically signicant differences were found.
It has to be stated, that full-mouth evaluation was carried out on
basis of all pockets in four studies (Apatzidou 2004; Koshy 2005;
Wennstrm2005; Zanatta 2006). One study evaluatedfull-mouth
BOP only in pockets initial > 5 mm (Jerve-Storm 2006), and
one study only in the subcategories single or multirooted teeth (
Quirynen 2006).
FMD versus control
Comparison of FMD versus control (PPD Comparison 2,
Outcomes 2.1-2.3)
Only one study reported data for both single and multirooted
teeth (Zanatta 2006). No statistically signicant differences were
found.
There were three studies (Koshy 2005; Mongardini 1999;
Quirynen 2006) comparing changes in PPD for single rooted
teeth, and there was a statistically signicant difference in favour of
the FMD treatment for the moderate pockets (P < 0.0001, mean
difference 0.53 mm (95% CI 0.28 mm to 0.77 mm, Chi
2
= 0.26,
2 df, P = 0.88, I
2
=0%)), with no evidence of any heterogeneity.
There was no statistically signicant difference for the deep pock-
ets (P = 0.13, mean difference 0.68 mm (95% CI -0.20 mm to
1.57 mm, Chi
2
= 4.86, 2 df, P = 0.09, I
2
= 58.9%)).
The same three studies were included in a meta-analysis of multi-
rooted teeth. No statistically signicant differences were found.
Comparison of FMD versus control (CAL Comparison 2,
Outcomes 2.4-2.6)
There were two studies (Quirynen 2006; Zanatta 2006) compar-
ing changes in CAL for single and multirooted teeth combined,
and there was a statistically signicant difference in favour of the
FMD treatment for the moderate pockets (P = 0.03, mean differ-
ence 0.33 mm (95% CI 0.04 mm to 0.63 mm, Chi
2
= 1.13, 1 df,
P = 0.29, I
2
= 11.4%)), with no evidence of heterogeneity. There
was no statistically signicant difference for the deep pockets.
Two studies (Koshy 2005; Mongardini 1999) compared change
in CAL changes for single and multirooted teeth separately. There
were no statistically signicant differences between the test and
control groups for either moderate or deep pockets.
Comparison of FMD versus control (BOP Comparison 2,
Outcomes 2.7-2.9)
Four trials provided some data for BOP (Koshy 2005; Mongardini
1999; Quirynen 2006; Zanatta 2006). There were no statistically
signicant differences in the change in BOP between the test and
control groups in terms of single rooted teeth for moderate or deep
pockets, and multirooted teeth for moderate or deep pockets.
FMS versus FMD
Comparison of FMS versus FMD (PPD Comparison 3,
Outcomes 3.1-3.3)
Only one study reported data for single and multirooted teeth
combined (Zanatta 2006). No statistically signicant differences
were found for moderate or deep pockets.
There were two trials (Koshy 2005; Quirynen 2006) comparing
changes in PPD for single rooted teeth and multirooted teeth
considered separately and no statistically signicant difference was
found for the moderate or deep pockets.
Comparison of FMS versus FMD (CAL Comparison 3,
Outcomes 3.4-3.6)
There were two studies (Koshy 2005; Quirynen 2006) comparing
changes in CAL for single and multirooted teeth combined. No
statistically signicant difference was found neither for the mod-
erate nor for deep pockets.
One trial (Koshy 2005) provided data for the change in CAL be-
tween FMS and FMD in terms of single rooted teeth and multi-
rooted teeth separately. There were no statistically signicant dif-
ferences for moderate and deep pockets for single rooted teeth, nor
for moderate pockets for multirooted teeth, however there was a
statistically signicant difference in favour of FMS for the deep
pockets (P = 0.01, mean difference 0.74 mm (95% CI 0.17 mm
to 1.31 mm)).
Comparison of FMS versus FMD (BOP Comparison 3,
Outcomes 3.7-3.9)
There was no statistically signicant difference between the two
groups in BOP for single and multirooted teeth combined. Only
one trial evaluated BOP for single rooted teeth alone (Quirynen
2006). No statistically signicant difference was found for moder-
ate pockets, however a statistically signicant difference in favour
of FMD for the deep pockets was found (P = 0.03, mean differ-
ence -18.00% (95% CI -34.30% to -1.70%)). The same study
presented the data for multirooted teeth, no statistical signicant
difference was found neither for moderate pockets, nor for deep
pockets.
There were insufcient trials in the meta-analyses to undertake
sensitivity analysis for quality components. Generally there was
little heterogeneity and none found where there were signicant
differences between study groups.
D I S C U S S I O N
The present systematic review addressed the question of evidence
for periodontitis therapy by full-mouth strategies within 24 hours
with or without adjunctive antiseptics compared to conventional
quadrant approach over a much longer treatment period of up to
6 weeks. Alterations from the original protocol were included re-
garding the objectives and interventions evaluated. These changes
became relevant because of the implementation of the full-mouth
scaling (FMS) strategy as a similar treatment to the full-mouth
disinfection (FMD) procedure.
This systematic review found an overall mean increase in probing
pocket depth (PPD) reduction for FMDover conventional scaling
and root planing (SRP) in single rooted teeth with initial PPD
of 5 to 6 mm (PPD mean difference 0.53 mm, 95% condence
interval (CI) 0.28 to 0.77). This nding was based on three studies
including 77 patients, with lowto moderate risk of bias. For single
and multirooted teeth combined with initial PPDof 5 to 6 mman
overall mean increase in clinical attachment level (CAL) gain for
FMD over conventional SRP was shown (CAL mean difference
0.33 mm, 95% CI 0.04 to 0.63). This nding was based on two
studies with 57 patients, the studies being assessed as moderate
risk of bias. For multirooted teeth with initially deep pockets the
CAL gain after FMS was superior compared to FMD (CAL mean
difference 0.74, 95%CI 0.17 to 1.31), and the change in bleeding
on probing (BOP) for single rooted teeth was greater for FMS
compared to FMD in deep pockets. Each of these two ndings
was based on one study, and these were assessed as low risk of bias.
For all the other comparisons the meta-analyses did not reveal
statistically signicant differences between the treatment strategies
FMS, FMDand conventional SRP, or FMDcompared with FMS.
For the inclusion of studies in this systematic review, very strin-
gent criteria were employed resulting in the inclusion of seven ran-
domised controlled trials (RCTs) relevant for meta-analysis. Since
tooth survival is of tangible benet to the subject, it would have
been desirable to evaluate, which therapy was superior in prevent-
ing tooth loss. However, it is recognised that tooth loss is difcult
to assess due to the rare incidence and numerous confounding
factors. Thus, no study reported tooth survival rates, but clinical
parameters were used as surrogate variables. The selected articles
included only studies of at least 3 months follow up and studies
presenting clinical data. A follow up of 3 months after baseline
was selected, because complete healing can be expected after this
time period (Proye 1982). As a consequence, a number of classic
studies on full-mouth disinfection could not be included in this
systematic review (Bollen 1998; Quirynen 1995).
The results of the seven RCTs included in this review show a
substantial variability in their results. Differences in study design
and methods could have affected the outcomes. The studies in-
cluded several clinical differences that we hypothesised could af-
fect heterogeneity. This included the time point of probing in
relation to subgingival instrumentation and the type of probe
used. For example probing was performed after root instrumen-
tation by the Leuven group (Mongardini 1999; Quirynen 2006)
and before root instrumentation in the other included studies (
Apatzidou 2004; Jerve-Storm 2006; Koshy 2005; Wennstrm
2005; Zanatta 2006). Although probing after root instrumenta-
tion may be a reasonable procedure if large amounts of calculus
interfere with probing accuracy, the values for probing depth re-
duction and attachment gain are higher compared to measure-
ments performed before instrumentation. In addition, some stud-
ies used computerized constant force probes and a stent for the
measurement of probing depth and clinical attachment, in con-
trast to studies that used manual probes. Another aspect which
inuenced the treatment results could have been the instruments
used for root treatment, manual or powered or a combination of
both, even though recent reviews reported no differences in the
efcacy in the root instrumentation when manual or ultrasonic in-
struments were compared (Drisko 2000; Tunkel 2002). Of course
differences existed for the use of chlorhexidine and the time sched-
ule for full-mouth approaches ranging from 12 to 24 hours.
More discrepancies might have resulted fromthe fact that the Leu-
ven group did not include any oral hygiene instructions at base-
line; all patients received standard oral hygiene instructions only
after the rst session of scaling and root planing. In contrast, all
other studies the patients showed a high level of oral hygiene al-
ready prior to baseline. In this context it should be recognised that
the Leuven studies were designed as proof of principle, aimed to
increase the chance of cross-contamination in the control group (
Quirynen 2006). Furthermore, even though all studies included
minimal observation periods of 3 months, re-evaluation was con-
ducted at varying time points 3 to 8 months after treatment.
Pockets of varying depth may respond differently to therapy.
Therefore, sites are usually analysed in three categories of initial
probing depth: 1 to 3 mm, 4 to 6 mm, and > 6 mm. This approach
of presenting results based on these three categories was performed
by most studies included in the present systematic review, with the
exception of one study using a range of 4 to 5.5 mm (Quirynen
2006). With respect to this subgroup analysis, it is interesting to
see that FMD improved the clinical outcomes in moderate pock-
ets, but not in deep pockets. This phenomenon may be related to
the relatively low number of deep as compared to moderate sites
that had been studied.
A U T H O R S C O N C L U S I O N S
Implications for practice
This systematic review was aimed to compare the clinical effects
of conventional mechanical treatment and full-mouth disinfec-
tion (FMD) and full-mouth scaling (FMS) approaches for the
treatment of chronic periodontitis. It has been demonstrated that
the FMD approach resulted in a modest additional reduction of
probing depth compared to the conventional treatment for sites
with an initial probing depth of 5 to 6 mm in single rooted teeth.
It may be questioned whether this small difference in outcome
can justify the extensive use of chlorhexidine over a period of sev-
eral months. All three interventions can result in improvements in
clinical measures of periodontitis. Additional improvements from
FMDare inconsistent across tooth types and initial pocket depths.
Therefore, no recommendations regarding additional benets can
be made on the basis of the clinical data to date. Decision to select
one approach to non-surgical periodontal therapy over another
need to include patient preferences and convenience of the treat-
ment schedule.
Implications for research
In order to combine studies for a meta-analysis, which can support
and strengthen the ndings of individual studies and produce an
overall pooled estimate of effect a mean measure of the effect and
the standard error of the mean is necessary and without these data
it is impossible to perform any analysis. Reporting of standard
deviation or standard error provides a more precise description
of the data prole and should be therefore a mandatory piece of
information in scientic reports.
The treatment effects of full-mouth scaling or full-mouth disinfec-
tion compared to conventional scaling and root planing are mod-
est and the implications for periodontal care are not profound.
On the basis of these conclusions it is the opinion of the review
authors not to recommend further research efforts towards this
issue of periodontitis treatment.
A C K N O W L E D G E M E N T S
We would like to appreciate the excellent support by Sylvia Bick-
ley and Anne-Marie Glenny (Cochrane Oral Health Group) to
effectively nalise this review.
R E F E R E N C E S
References to studies included in this review
Apatzidou 2004 {published data only}
Apatzidou DA, Kinane DF. Quadrant root planing versus same-day
full-mouth root planing. I. Clinical ndings. Journal of Clinical
Periodontology 2004;31(2):13240.
Jerve-Storm 2006 {published data only}
Jerve-Storm PM, Semaan E, AlAhdab H, Engel S, Fimmers R,
Jepsen S. Clinical outcomes of quadrant root planing versus full-
mouth root planing. Journal of Clinical Periodontology 2006;33(3):
20915.
Koshy 2005 {published data only}
Koshy G, Kawashima Y, Kiji M, Nitta H, Umeda M, Nagasawa T,
et al.Effects of single-visit full-mouth ultrasonic debridement versus
quadrant-wise ultrasonic debridement. Journal of Clinical
Mongardini 1999 {published data only}
Mongardini C, van Steenberghe D, Dekeyser C, Quirynen M.

One stage full- versus partial-mouth disinfection in the treatment of
chronic adult or generalized early-onset periodontitis. I. Long-term
clinical observations. Journal of Periodontology 1999;70(6):63245.
Quirynen M, Mongardini C, de Soete M, Pauwels M, Coucke W,
van Eldere J, et al.The role of chlorhexidine in the one-stage full-
mouth disinfection treatment of patients with advanced adult
periodontitis. Long-term clinical and microbiologial observations.
Journal of Clinical Periodontology 2000;27(8):57889.
Quirynen 2006 {published data only}
Quirynen M, De Soete M, Boschmans G, Pauwels M, Coucke W,
Teughels W, et al.Benet of one-stage full-mouth disinfection is
explained by disinfection and root planing within 24 hours: a
randomized controlled trial. Journal of Clinical Periodontology
2006;33(9):63947.
Wennstrm 2005 {published data only}
Wennstrm JL, Tomasi C, Bertelle A, Dellasega E. Full-mouth
ultrasonic debridement versus quadrant scaling and root planing as
an initial approach in the treatment of chronic periodontitis.
Zanatta 2006 {published data only}
Zanatta GM, Bittencourt S, Nociti FH Jr, Sallum EA, Sallum AW,
Casati MZ. Periodontal debridement with povidone-iodine in
periodontal treatment: short-term clinical and biochemical
observations. Journal of Periodontology 2006;77(3):498505.
References to studies excluded from this review
Bollen 1998 {published data only}
Bollen CM, Mongardini C, Papaioannou W, van Steenbergh D,
Quirynen M. The effect of a one-stage full-mouth disinfection on
different intra-oral niches. Clinical and microbiological
observations. Journal of Clinical Periodontology 1998;25(1):5666.
Eren 2002 {published data only}
Eren KS, Gurgan CA, Bostanci HS. Evaluation of non-surgical
periodontal treatment using 2 time intervals. Journal of
Quirynen 1995 {published data only}
Quirynen M, Bollen CM, Vandekerckhove BN, Dekeyser C,
Papaioannou W, Eyssen H. Full- vs. partial-mouth disinfection in
the treatment of periodontal infections: short-term clinical and
microbiological observations. Journal of Dental Research 1995;74
(8):145967.
Vandekerckhove 1996 {published data only}
Vandekerckhove BN, Bollen CM, Dekeyser C, Darius P, Quirynen
M. Full- versus partial-mouth disinfection in the treatment of
periodontal infections. Long-term clinical observations of a pilot
study. Journal of Periodontology 1996;67(12):12519.
Additional references
AAP 1996
American Academy of Periodontology. Epidemiology of the
periodontal disease. Journal of Periodontology 1996;67:93545.
AAP 1999
American Academy of Periodontology. International workshop for
classication of periodontal diseases and conditions. Annals of
Periodontology 1999;4:7112.
Armitage 1999
Armitage GC. Development of a classication system for
periodontal diseases and conditions. Annals of Periodontology 1999;
4(1):16.
Begg 1994
Begg CB, Mazumdar M. Operating characteristics of a rank
correlation test for publication bias. Biometrics 1994;50(4):
1088101.
Beikler 2004
Beikler T, Abdeen G, Schnitzer S, Slzer S, Ehmke B, Heinecke A,
et al.Microbiological shifts in intra- and extraoral habitats following
mechanical periodontal therapy. Journal of Clinical Periodontology
2004;31(9):77783.
Drisko 2000
Drisko CL, Cochran DL, Blieden T, Bouwsma OJ, Cohen RE,
Damoulis P, et al.Position paper: sonic and ultrasonic scalers in
periodontics. Research, Science and Therapy Committee of the
American Academy of Periodontology. Journal of Periodontology
2000;71(11):1792801.
Egger 1997
Egger M, Davey-Smith G, Schneider M, Minder C. Bias in meta-
analysis detected by a simple, graphical test. BMJ 1997;315(7109):
62934.
Heitz-Mayeld 2002
Heitz-Mayeld LJ, Trombelli L, Heitz F, Needleman I, Moles D. A
systematic review of the effect of surgical debridement vs non-
surgical debridement for the treatment of chronic periodontitis.
Journal of Clinical Periodontology 2002;29 Suppl 3:92102.
Higgins 2006
Higgins JPT, Green S, editors. Cochrane Handbook for Systematic
Reviews of Interventions 4.2.6 [updated September 2006]. The
Cochrane Library Issue 4. Chichester, UK: John Wiley & Sons, Ltd,
2006.
Oliver 1991
Oliver RC, Brown LJ, Loe H. Variations in the prevalence and
extent of periodontitis. Journal of the American Dental Association
1991;122(6):438.
Proye 1982
Proye M, Caton J, Polson A. Initial healing of periodontal pockets
after a single episode of root planing monitored by controlled
probing forces. Journal of Periodontology 1982;53(5):296301.
Quirynen 2000
Quirynen M, Mongardini C, de Soete M, Pauwels M, Coucke W,
van Eldere J, et al.The role of chlorhexidine in the one-stage full-
mouth disinfection treatment of patients with advanced adult
periodontitis. Long-term clinical and microbiological observations.
Tunkel 2002
Tunkel J, Heinecke A, Flemmig TF. A systematic review of efcacy
of machine-driven and manual subgingival debridement in the
treatment of chronic periodontitis. Journal of Clinical
Periodontology 2002;29 Suppl 3:7281.
van der Weijden 2002
van der Weijden U, Timmerman MF. A systematic review on the
clinical efcacy of subgingival debridement in the treatment of
chronic periodontitis. Journal of Clinical Periodontology 2002;29
Suppl 3:5571.
Indicates the major publication for the study

C H A R A C T E R I S T I C S O F S T U D I E S
Characteristics of included studies [ordered by study ID]
Apatzidou 2004
Methods RCT
Parallel
2 treatment groups
25 weeks duration
Examiner blinded
Participants 40 individuals, 2 Asian (1 in each group), 38 Caucasian, 20 individuals in each group
17 female, aged 31 to 70
15 smokers
Chronic periodontitis
Interventions Test group (FM-SRP): FMS 2 sessions same day
Control group (Q-SRP): QRP 4 sessions - 2-weekly intervals
OHI before study start unknown
Hand and US instruments
Time per Q: 1 hour
Maintenance at 7 weeks (FMS) or 13 weeks (QRP) and 6 months from baseline (both groups)
Outcomes Whole mouth recordings (baseline, 6-week re-assessment after last instrumentation (FM-SRP: 7 weeks;
Q-SRP: 13 weeks from baseline), 6 months)
PPD, CAL, BOP (6 sites per tooth)
Manual probe
Computer-assisted disk probe for selected sites
MGI, PI, BOP, SUP, PPS, RAL (selected site clinical analysis = 1 deepest pocket per quadrant)
Average pain VAS score (0 to 10), body temperature, number of analgesics, cold sores or oral ulcers
Notes
Risk of bias
Item Authors judgement Description
Allocation concealment? Unclear B - Unclear
Jerve-Storm 2006
Methods RCT
Parallel
2 treatment groups
6 months duration
Examiner blinded
Participants 20 individuals, all Caucasian, 10 individuals in each group
9 female, age 53.1 +/- 10.2
2 smokers (1 in each group)
Interventions Test group (FM-RP): FMS 2 sessions within 24 hours on 2 consecutive days
Control group (QRP): QRP 4 sessions - 1-week intervals
Before randomisation repeated OHI
Hand and US instruments
Time per Q: 1 hour
Maintenance at 1, 3, 4, 5, and 6 months (both groups)
Outcomes Whole mouth recordings (baseline, 3 and 6 months)
Data split in 1 quadrant and whole mouth and initial moderate (PPD 5 - 6 mm) and deep pockets (PPD
> 6 mm)
PPD, RAL, BOP (6 sites per tooth)
BOP whole mouth recordings only for PPD > 4 mm
Computer-assisted probe with stent for all measurements
Notes
Risk of bias
Allocation concealment? Yes A - Adequate
Koshy 2005
Methods RCT
Parallel
3 treatment groups
6 months duration
Examiner blinded
Participants 36 individuals, all Japanese, 12 individuals in each group
23 female, age 34 to 66
Non-smokers
Interventions Test group 1 (FMD+water): FMS 1 session US scaling with water (duration 2 - 2 1/2 hour)
Test group 2 (FMD+povidone): FMS 1 session US scaling with 1% povidone iodine (duration 2 - 2 1/2
Koshy 2005 (Continued)
hour), patients rinsing with 0.05% CHX twice a day for 1 month, tongue brushing
Control group (QMD): QRP 4 sessions US scaling with water - 1-week intervals (duration 40 - 50 min
each)
US instruments
Maintenance every month from baseline (both groups)
Outcomes Whole mouth recordings (baseline, 1, 3 and 6 months)
Data split in single/multirooted teeth and initial moderate (PPD 5 - 6 mm) and deep pockets (PPD > 6
mm)
PI, PPD, PAL, BOP (6 sites per tooth)
Manual probe with stent for all measurements
Average pain VAS score (0 to 10), body temperature, number of analgesics
Notes PAL is equal to RAL
Risk of bias
Mongardini 1999
Methods RCT
Double-blind
Parallel
8 months
Participants 40 individuals
8 AP: 5 males, 3 females
12 CP: 5 males, 7 females
4 sites per quadrant PPD > 7 mm
Interventions Test group: SRP 24 h, CHX = 1%,1 min, tongue 0.2%, 2 min, rinse 1%, 10 min, subg. 0.2%, 2 x day, 1
min, 2 m, 0.2%, spray, 2 x day, 2 m, repeat subg. after 8 days
Control: SRP 8 weeks
Outcomes PPD
CAL
Notes
Risk of bias
Quirynen 2006
Methods RCT
Parallel
5 treatment groups
8 months duration
Examiner blinded
Participants 71 individuals, all Caucasian, neg. control group: 15, FMS: 14, 3 x FMD: 14 per group
18 smokers
Interventions Control group (FRp): FMS 2 sessions scaling within 24 hours
Test group 1 (FM-CHX): FM 2 sessions scaling within 24 hours, after instrumentation: brushing the
tongue with 1% CHX-gel, rinsing twice with 0.2% CHX, praying pharynx with 0.2% CHX, subg.
irrigation 3 times with 1% CHX-gel. Patients brushing the tongue and spraying the tonsils with 0.2%
CHX twice a day for 2 months. Patients rinsing twice a day with 0.2% CHX for 2 months
Test group 2 (FMF): FMS 2 sessions scaling within 24 hours, after instrumentation: brushing the tongue
with 1% CHX-gel, rinsing twice with 0.2% CHX, spraying pharynx with 0.2% CHX, subg. irrigation 3
times with 1% CHX-gel. Patients brushing the tongue and spraying the tonsils with 0.2% CHX twice a
day for 2 months. Patients rinsing twice a day with AmF/SnF2.
Test group 3 (FM-CHX+F): FMD 2 sessions scaling within 24 hours, after instrumentation: brushing
the tongue with 1% CHX-gel, rinsing twice with 0.2% CHX, spraying pharynx with 0.2% CHX, subg.
irrigation 3 times with 1% CHX-gel. Patients brushing the tongue and spraying the tonsils with 0.2%
CHX twice a day for 2 months. Patients rinsing twice a day with 0.2%CHX for 2 months and AmF/SnF2
for another 6 months
Neg. control group (NC): QRP 4 sessions scaling - 2-week intervals, no antiseptics
First OHI after rst scaling session (all groups)
Hand instruments
Oral hygiene controls and re-instructions after 1, 2 and 4 months from baseline
Outcomes First quadrant recordings (baseline, 2, 4 and 8 months)
Data split in single/multirooted teeth and initial medium (PPD 4 - 5.5 mm) and deep pockets (PPD > 5
mm)
SBI, PI, PPD, GR, CAL (as sum of PPD and ging. recession), BOP (6 sites per tooth)
Manual probe
Notes Drop outs: 85 enrolled, 71 completed the study. Time point for drop outs unclear
Risk of bias
Wennstrm 2005
Methods RCT, multicentre: university (Sweden) & private dental ofce (Italy)
Paralell
2 treatment groups
6 months duration
Examiner blinded
Participants 41 individuals, 20 individuals in test group, 21 individuals in cintrol group
20 smokers
Interventions Test group (FM-UD-test): FMS 1-h session ultrasonic scaling with water, re-instrumentation after 3
months in PPD > 4 mm
Control group (Q-SRP-control): QRP 4 sessions hand instrumentation - 1-week intervals (time recorded,
no time restriction), re-instrumentation after 3 months in PPD > 4 mm
US versus hand instruments
Maintenance 1 month following completion of instrumentation (both groups)
Data split in initial moderate (PPD 5 - 6 mm) and deep pockets (PPD > 6 mm)
PI, PPD, PAL, BOP (6 sites per tooth),
Manual probe
Average pain VAS score (100 mm scale)
Notes Drop outs: 42 enrolled, 41 completed the study, 1 drop out before baseline
Risk of bias
Zanatta 2006
Methods RCT
Parallel
3 treatment groups
3 months duration
Examiner blinded
Participants 36 individuals, 13 individuals in control group, 12 in test group 1, 15 in test group 2
18 female, age 27 to 72
Interventions Test group 1 (PDG): FMS 1 session ultrasonic scaling with 0.9% NaCl (duration 45 min)
Test group 2 (PD-PIG): FMS 1 session ultrasonic scaling with 0.5% povidone iodine (duration 45 min)
Control group (CG): QRP 4 sessions ultrasonic scaling with water - 1-week intervals (duration unclear)
Before randomisation OHI
Zanatta 2006 (Continued)
US instruments
Maintenance twice weekly from baseline
Data split initial moderate (PPD 5 - 6 mm) and deep pockets (PPD > 6 mm)
PI, PPD, GR, CAL, BOP (6 sites per tooth)
Computerised probe with stent for all measurements
Notes Drop outs: 45 enrolled, 40 completed the study. Time point for drop outs unclear
Risk of bias
Allocation concealment? Unclear B - Unclear
BOP:bleeding on probing
CAL: clinical attachment level
CHX: chlorhexidine gluconate
FMD: (full-mouth disinfection) full-mouth subgingival scaling and root planing with use of antiseptics
FMS: full-mouth subgingival scaling and root planing
GR: gingival recession
MGI: modied gingival index
OHI: oral hygiene instruction
PI: plaque index
PPD: probing pocket depth
QRP: quadrantwise subgingival scaling and root planing, clockwise in 4 sessions
RAL: relative attachment level
RCT: randomised controlled trial
SBI: sulcus bleeding index
SRP: scaling and root planing
SUP: suppuration
US: ultrasonic
VAS: visual analogue scale
Characteristics of excluded studies [ordered by study ID]
Bollen 1998 6 out of 16 patients suffering from aggressive periodontitis
Eren 2002 Patients received FMS for 4 consecutive days
Quirynen 1995 2-month data only
(Continued)
Vandekerckhove 1996 Complete data not available
FMS: full-mouth scaling
D A T A A N D A N A L Y S E S
Comparison 1. FMS versus control
Outcome or subgroup title
No. of
studies
No. of
participants
Statistical method Effect size
1 Change in PPD; single and
multirooted teeth
4 Mean Difference (IV, Random, 95% CI) Subtotals only
1.1 Full mouth 0 0 Mean Difference (IV, Random, 95% CI) Not estimable
1.2 5 mm - 6 mm 4 126 Mean Difference (IV, Random, 95% CI) -0.05 [-0.23, 0.13]
1.3 > 6 mm 4 126 Mean Difference (IV, Random, 95% CI) -0.01 [-0.30, 0.28]
2 Change in PPD; single rooted
teeth
2.2 5 mm - 6 mm 2 53 Mean Difference (IV, Random, 95% CI) 0.11 [-0.19, 0.41]
2.3 > 6 mm 2 53 Mean Difference (IV, Random, 95% CI) 0.29 [-0.27, 0.85]
3 Change in PPD; multirooted
teeth
4 Change in CAL; single and
multirooted teeth
5 Change in CAL; single rooted
teeth
6 Change in CAL; multirooted
teeth
7 Change in BOP; single and
multirooted teeth
7.1 Full mouth 5 150 Mean Difference (IV, Random, 95% CI) 0.17 [-6.20, 6.55]
7.2 5 mm - 6 mm 0 0 Mean Difference (IV, Random, 95% CI) Not estimable
7.3 > 6 mm 0 0 Mean Difference (IV, Random, 95% CI) Not estimable
8 Changes in BOP; single rooted
teeth
8.2 5 mm - 6 mm 1 29 Mean Difference (IV, Random, 95% CI) -10.0 [-30.39,
10.39]
9 Changes in BOP; multirooted
teeth
Comparison 2. FMD versus control
No. of
studies
No. of
participants
multirooted teeth
teeth
2.2 5 mm - 6 mm 3 77 Mean Difference (IV, Random, 95% CI) 0.53 [0.28, 0.77]
teeth
multirooted teeth
4.2 5 mm - 6 mm 2 57 Mean Difference (IV, Random, 95% CI) 0.33 [0.04, 0.63]
teeth
teeth
multirooted teeth
teeth
teeth
Comparison 3. FMS versus FMD
No. of
studies
No. of
participants
multirooted teeth
teeth
teeth
multirooted teeth
teeth
teeth
6.3 > 6 mm 1 24 Mean Difference (IV, Random, 95% CI) 0.74 [0.17, 1.31]
multirooted teeth
teeth
8.3 > 6 mm 1 28 Mean Difference (IV, Random, 95% CI) -18.0 [-34.30, -1.70]
teeth
9.2 5 mm - 6 mm 1 28 Mean Difference (IV, Random, 95% CI) -10.0 [-48.04,
28.04]
Analysis 1.1. Comparison 1 FMS versus control, Outcome 1 Change in PPD; single and multirooted teeth.
Review: Full-mouth disinfection for the treatment of adult chronic periodontitis
Comparison: 1 FMS versus control
Outcome: 1 Change in PPD; single and multirooted teeth
Study or subgroup FMS Control Mean Difference Weight Mean Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI
1 Full mouth
Subtotal (95% CI) 0 0 0.0 % 0.0 [ 0.0, 0.0 ]
Heterogeneity: not applicable
Test for overall effect: not applicable
2 5 mm - 6 mm
Apatzidou 2004 20 2.3 (1) 20 2.5 (1) 8.6 % -0.20 [ -0.82, 0.42 ]
Jerve-Storm 2006 10 1.6 (0.56) 10 1.8 (0.54) 14.2 % -0.20 [ -0.68, 0.28 ]
Wennstrm 2005 20 1.8 (0.4) 21 1.8 (0.5) 43.1 % 0.0 [ -0.28, 0.28 ]
Zanatta 2006 12 2.19 (0.41) 13 2.2 (0.38) 34.2 % -0.01 [ -0.32, 0.30 ]
Subtotal (95% CI) 62 64 100.0 % -0.05 [ -0.23, 0.13 ]
Heterogeneity: Tau
2
= 0.0; Chi
2
= 0.79, df = 3 (P = 0.85); I
2
=0.0%
Test for overall effect: Z = 0.53 (P = 0.60)
3 > 6 mm
Apatzidou 2004 20 4.4 (1.3) 20 4.3 (1.2) 14.3 % 0.10 [ -0.68, 0.88 ]
Jerve-Storm 2006 10 1.7 (1.69) 10 2.1 (1.35) 4.8 % -0.40 [ -1.74, 0.94 ]
Wennstrm 2005 20 2.9 (0.7) 21 2.9 (0.7) 46.7 % 0.0 [ -0.43, 0.43 ]
Zanatta 2006 12 4.36 (0.54) 13 4.37 (0.73) 34.2 % -0.01 [ -0.51, 0.49 ]
Subtotal (95% CI) 62 64 100.0 % -0.01 [ -0.30, 0.28 ]
Heterogeneity: Tau
2
= 0.0; Chi
2
= 0.40, df = 3 (P = 0.94); I
2
=0.0%
-4 -2 0 2 4
Favours control Favours FMS
Analysis 1.2. Comparison 1 FMS versus control, Outcome 2 Change in PPD; single rooted teeth.
Outcome: 2 Change in PPD; single rooted teeth
1 Full mouth
Subtotal (95% CI) 0 0 0.0 % 0.0 [ 0.0, 0.0 ]
2 5 mm - 6 mm
Koshy 2005 12 2.96 (0.5) 12 2.84 (0.6) 46.1 % 0.12 [ -0.32, 0.56 ]
Quirynen 2006 14 1.4 (0.58) 15 1.3 (0.54) 53.9 % 0.10 [ -0.31, 0.51 ]
Subtotal (95% CI) 26 27 100.0 % 0.11 [ -0.19, 0.41 ]
Heterogeneity: Tau
2
= 0.0; Chi
2
= 0.00, df = 1 (P = 0.95); I
2
=0.0%
3 > 6 mm
Koshy 2005 12 4.26 (1.1) 12 3.8 (1.3) 33.6 % 0.46 [ -0.50, 1.42 ]
Quirynen 2006 14 2.5 (0.85) 15 2.3 (1.03) 66.4 % 0.20 [ -0.49, 0.89 ]
Subtotal (95% CI) 26 27 100.0 % 0.29 [ -0.27, 0.85 ]
Heterogeneity: Tau
2
= 0.0; Chi
2
= 0.19, df = 1 (P = 0.67); I
2
=0.0%
-4 -2 0 2 4
Analysis 1.3. Comparison 1 FMS versus control, Outcome 3 Change in PPD; multirooted teeth.
Outcome: 3 Change in PPD; multirooted teeth
1 Full mouth
Subtotal (95% CI) 0 0 0.0 % 0.0 [ 0.0, 0.0 ]
2 5 mm - 6 mm
Koshy 2005 12 2.62 (0.6) 12 2.48 (0.6) 49.3 % 0.14 [ -0.34, 0.62 ]
Quirynen 2006 14 2.5 (0.45) 15 1 (0.63) 50.7 % 1.50 [ 1.10, 1.90 ]
Subtotal (95% CI) 26 27 100.0 % 0.83 [ -0.51, 2.16 ]
Heterogeneity: Tau
2
= 0.87; Chi
2
= 18.33, df = 1 (P = 0.00002); I
2
=95%
3 > 6 mm
Koshy 2005 12 3.81 (0.7) 12 3.9 (1.2) 49.3 % -0.09 [ -0.88, 0.70 ]
Quirynen 2006 14 2.6 (0.86) 15 2.3 (1.14) 50.7 % 0.30 [ -0.43, 1.03 ]
Subtotal (95% CI) 26 27 100.0 % 0.12 [ -0.42, 0.65 ]
Heterogeneity: Tau
2
= 0.0; Chi
2
= 0.51, df = 1 (P = 0.48); I
2
=0.0%
-4 -2 0 2 4
Analysis 1.4. Comparison 1 FMS versus control, Outcome 4 Change in CAL; single and multirooted teeth.
Outcome: 4 Change in CAL; single and multirooted teeth
1 Full mouth
Subtotal (95% CI) 0 0 0.0 % 0.0 [ 0.0, 0.0 ]
2 5 mm - 6 mm
Apatzidou 2004 20 1 (0.9) 20 0.9 (0.9) 11.5 % 0.10 [ -0.46, 0.66 ]
Jerve-Storm 2006 10 1.1 (0.61) 10 0.9 (0.7) 10.8 % 0.20 [ -0.38, 0.78 ]
Quirynen 2006 14 1.18 (0.42) 15 0.9 (0.57) 24.1 % 0.28 [ -0.08, 0.64 ]
Wennstrm 2005 20 1.3 (0.5) 21 1.3 (0.5) 31.5 % 0.0 [ -0.31, 0.31 ]
Zanatta 2006 12 1.74 (0.55) 13 1.61 (0.41) 22.1 % 0.13 [ -0.25, 0.51 ]
Subtotal (95% CI) 76 79 100.0 % 0.13 [ -0.05, 0.30 ]
Heterogeneity: Tau
2
= 0.0; Chi
2
= 1.42, df = 4 (P = 0.84); I
2
=0.0%
3 > 6 mm
Apatzidou 2004 20 2.2 (0.8) 20 1.4 (0.8) 25.3 % 0.80 [ 0.30, 1.30 ]
Jerve-Storm 2006 10 0.7 (0.99) 10 1.4 (1.69) 4.6 % -0.70 [ -1.91, 0.51 ]
Quirynen 2006 14 1.91 (0.61) 15 1.58 (0.74) 25.6 % 0.33 [ -0.16, 0.82 ]
Wennstrm 2005 20 2.2 (0.7) 21 2.1 (0.7) 32.6 % 0.10 [ -0.33, 0.53 ]
Zanatta 2006 12 3.19 (0.81) 13 3.01 (1.08) 11.9 % 0.18 [ -0.56, 0.92 ]
Subtotal (95% CI) 76 79 100.0 % 0.28 [ -0.08, 0.64 ]
Heterogeneity: Tau
2
= 0.08; Chi
2
= 7.46, df = 4 (P = 0.11); I
2
=46%
-4 -2 0 2 4
Analysis 1.5. Comparison 1 FMS versus control, Outcome 5 Change in CAL; single rooted teeth.
Outcome: 5 Change in CAL; single rooted teeth
1 Full mouth
Subtotal (95% CI) 0 0 0.0 % 0.0 [ 0.0, 0.0 ]
2 5 mm - 6 mm
Koshy 2005 12 2.08 (0.6) 12 1.89 (0.6) 100.0 % 0.19 [ -0.29, 0.67 ]
Subtotal (95% CI) 12 12 100.0 % 0.19 [ -0.29, 0.67 ]
3 > 6 mm
Koshy 2005 12 3.3 (1) 12 2.83 (1.1) 100.0 % 0.47 [ -0.37, 1.31 ]
Subtotal (95% CI) 12 12 100.0 % 0.47 [ -0.37, 1.31 ]
-4 -2 0 2 4
Analysis 1.6. Comparison 1 FMS versus control, Outcome 6 Change in CAL; multirooted teeth.
Outcome: 6 Change in CAL; multirooted teeth
1 Full mouth
Subtotal (95% CI) 0 0 0.0 % 0.0 [ 0.0, 0.0 ]
2 5 mm - 6 mm
Koshy 2005 12 1.74 (0.6) 12 1.56 (0.3) 100.0 % 0.18 [ -0.20, 0.56 ]
Subtotal (95% CI) 12 12 100.0 % 0.18 [ -0.20, 0.56 ]
3 > 6 mm
Koshy 2005 12 3.02 (0.6) 12 2.64 (1) 100.0 % 0.38 [ -0.28, 1.04 ]
Subtotal (95% CI) 12 12 100.0 % 0.38 [ -0.28, 1.04 ]
-4 -2 0 2 4
Analysis 1.7. Comparison 1 FMS versus control, Outcome 7 Change in BOP; single and multirooted teeth.
Outcome: 7 Change in BOP; single and multirooted teeth
1 Full mouth
Apatzidou 2004 20 57 (18) 20 58 (19) 22.5 % -1.00 [ -12.47, 10.47 ]
Jerve-Storm 2006 10 41.2 (18.41) 10 42.4 (18.8) 12.9 % -1.20 [ -17.51, 15.11 ]
Koshy 2005 12 61.9 (13.1) 12 49.18 (17.6) 20.0 % 12.72 [ 0.31, 25.13 ]
Wennstrm 2005 20 50.4 (22) 21 55.7 (24) 16.5 % -5.30 [ -19.38, 8.78 ]
Zanatta 2006 12 23 (12) 13 27 (13) 28.1 % -4.00 [ -13.80, 5.80 ]
Subtotal (95% CI) 74 76 100.0 % 0.17 [ -6.20, 6.55 ]
Heterogeneity: Tau
2
= 12.75; Chi
2
= 5.27, df = 4 (P = 0.26); I
2
=24%
2 5 mm - 6 mm
Subtotal (95% CI) 0 0 0.0 % 0.0 [ 0.0, 0.0 ]
3 > 6 mm
Subtotal (95% CI) 0 0 0.0 % 0.0 [ 0.0, 0.0 ]
-100 -50 0 50 100
Analysis 1.8. Comparison 1 FMS versus control, Outcome 8 Changes in BOP; single rooted teeth.
Outcome: 8 Changes in BOP; single rooted teeth
1 Full mouth
Subtotal (95% CI) 0 0 0.0 % 0.0 [ 0.0, 0.0 ]
2 5 mm - 6 mm
Quirynen 2006 14 40 (28) 15 50 (28) 100.0 % -10.00 [ -30.39, 10.39 ]
Subtotal (95% CI) 14 15 100.0 % -10.00 [ -30.39, 10.39 ]
3 > 6 mm
Quirynen 2006 14 35 (22) 15 39 (36) 100.0 % -4.00 [ -25.56, 17.56 ]
Subtotal (95% CI) 14 15 100.0 % -4.00 [ -25.56, 17.56 ]
-100 -50 0 50 100
Analysis 1.9. Comparison 1 FMS versus control, Outcome 9 Changes in BOP; multirooted teeth.
Outcome: 9 Changes in BOP; multirooted teeth
1 Full mouth
Subtotal (95% CI) 0 0 0.0 % 0.0 [ 0.0, 0.0 ]
2 5 mm - 6 mm
Quirynen 2006 14 35 (57) 15 24 (42) 100.0 % 11.00 [ -25.65, 47.65 ]
Subtotal (95% CI) 14 15 100.0 % 11.00 [ -25.65, 47.65 ]
3 > 6 mm
Quirynen 2006 14 35 (36) 15 39 (36) 100.0 % -4.00 [ -30.22, 22.22 ]
Subtotal (95% CI) 14 15 100.0 % -4.00 [ -30.22, 22.22 ]
-100 -50 0 50 100
Analysis 2.1. Comparison 2 FMD versus control, Outcome 1 Change in PPD; single and multirooted teeth.
Comparison: 2 FMD versus control
Study or subgroup FMD Control Mean Difference Weight Mean Difference
1 Full mouth
Subtotal (95% CI) 0 0 0.0 % 0.0 [ 0.0, 0.0 ]
2 5 mm - 6 mm
Zanatta 2006 15 2.32 (0.46) 13 2.2 (0.38) 100.0 % 0.12 [ -0.19, 0.43 ]
Subtotal (95% CI) 15 13 100.0 % 0.12 [ -0.19, 0.43 ]
3 > 6 mm
Zanatta 2006 15 4.02 (0.72) 13 4.37 (0.73) 100.0 % -0.35 [ -0.89, 0.19 ]
Subtotal (95% CI) 15 13 100.0 % -0.35 [ -0.89, 0.19 ]
-4 -2 0 2 4
Favours control Favours FMD
Analysis 2.2. Comparison 2 FMD versus control, Outcome 2 Change in PPD; single rooted teeth.
1 Full mouth
Subtotal (95% CI) 0 0 0.0 % 0.0 [ 0.0, 0.0 ]
2 5 mm - 6 mm
Koshy 2005 12 3 (0.2) 12 2.48 (0.6) 46.4 % 0.52 [ 0.16, 0.88 ]
Mongardini 1999 12 1.84 (1.01) 12 1.09 (1.22) 7.8 % 0.75 [ -0.15, 1.65 ]
Quirynen 2006 14 1.8 (0.45) 15 1.3 (0.54) 45.7 % 0.50 [ 0.14, 0.86 ]
Subtotal (95% CI) 38 39 100.0 % 0.53 [ 0.28, 0.77 ]
Heterogeneity: Tau
2
= 0.0; Chi
2
= 0.26, df = 2 (P = 0.88); I
2
=0.0%
3 > 6 mm
Koshy 2005 12 4.02 (1.4) 12 3.8 (1.3) 23.9 % 0.22 [ -0.86, 1.30 ]
Mongardini 1999 12 3.73 (1.73) 12 1.91 (1.36) 18.0 % 1.82 [ 0.57, 3.07 ]
Quirynen 2006 14 2.6 (0.86) 15 2.3 (1.03) 58.1 % 0.30 [ -0.39, 0.99 ]
Subtotal (95% CI) 38 39 100.0 % 0.68 [ -0.20, 1.57 ]
Heterogeneity: Tau
2
= 0.36; Chi
2
= 4.86, df = 2 (P = 0.09); I
2
=59%
-4 -2 0 2 4
Analysis 2.3. Comparison 2 FMD versus control, Outcome 3 Change in PPD; multirooted teeth.
1 Full mouth
Subtotal (95% CI) 0 0 0.0 % 0.0 [ 0.0, 0.0 ]
2 5 mm - 6 mm
Koshy 2005 12 3.44 (1.1) 12 3.9 (1.2) 27.0 % -0.46 [ -1.38, 0.46 ]
Mongardini 1999 12 1.5 (1.07) 12 0.8 (1.36) 24.8 % 0.70 [ -0.28, 1.68 ]
Quirynen 2006 14 1.5 (0.81) 15 1 (0.63) 48.2 % 0.50 [ -0.03, 1.03 ]
Subtotal (95% CI) 38 39 100.0 % 0.28 [ -0.34, 0.91 ]
Heterogeneity: Tau
2
= 0.15; Chi
2
= 3.77, df = 2 (P = 0.15); I
2
=47%
3 > 6 mm
Koshy 2005 12 1.49 (0.4) 12 1.56 (0.3) 57.5 % -0.07 [ -0.35, 0.21 ]
Mongardini 1999 12 2.96 (2) 12 1.59 (1.37) 12.8 % 1.37 [ 0.00, 2.74 ]
Quirynen 2006 14 2.7 (0.92) 15 2.3 (1.14) 29.7 % 0.40 [ -0.35, 1.15 ]
Subtotal (95% CI) 38 39 100.0 % 0.32 [ -0.34, 0.98 ]
Heterogeneity: Tau
2
= 0.20; Chi
2
= 5.07, df = 2 (P = 0.08); I
2
=61%
-4 -2 0 2 4
Analysis 2.4. Comparison 2 FMD versus control, Outcome 4 Change in CAL; single and multirooted teeth.
1 Full mouth
Subtotal (95% CI) 0 0 0.0 % 0.0 [ 0.0, 0.0 ]
2 5 mm - 6 mm
Quirynen 2006 14 1.38 (0.5) 15 0.9 (0.57) 50.4 % 0.48 [ 0.09, 0.87 ]
Zanatta 2006 15 1.79 (0.64) 13 1.61 (0.41) 49.6 % 0.18 [ -0.21, 0.57 ]
Subtotal (95% CI) 29 28 100.0 % 0.33 [ 0.04, 0.63 ]
Heterogeneity: Tau
2
= 0.01; Chi
2
= 1.13, df = 1 (P = 0.29); I
2
=11%
3 > 6 mm
Quirynen 2006 14 2.32 (0.79) 15 1.58 (0.74) 63.9 % 0.74 [ 0.18, 1.30 ]
Zanatta 2006 15 3.12 (0.94) 13 3.01 (1.08) 36.1 % 0.11 [ -0.65, 0.87 ]
Subtotal (95% CI) 29 28 100.0 % 0.48 [ -0.13, 1.09 ]
Heterogeneity: Tau
2
= 0.08; Chi
2
= 1.73, df = 1 (P = 0.19); I
2
=42%
-4 -2 0 2 4
Analysis 2.5. Comparison 2 FMD versus control, Outcome 5 Change in CAL; single rooted teeth.
1 Full mouth
Subtotal (95% CI) 0 0 0.0 % 0.0 [ 0.0, 0.0 ]
2 5 mm - 6 mm
Koshy 2005 12 2 (0.6) 12 1.89 (0.6) 60.3 % 0.11 [ -0.37, 0.59 ]
Mongardini 1999 12 1.06 (1.05) 12 0.29 (1.19) 39.7 % 0.77 [ -0.13, 1.67 ]
Subtotal (95% CI) 24 24 100.0 % 0.33 [ -0.28, 0.93 ]
Heterogeneity: Tau
2
= 0.08; Chi
2
= 1.61, df = 1 (P = 0.20); I
2
=38%
3 > 6 mm
Koshy 2005 12 2.74 (1.3) 12 2.83 (1.1) 57.5 % -0.09 [ -1.05, 0.87 ]
Mongardini 1999 12 2.29 (1.84) 12 0.64 (1.22) 42.5 % 1.65 [ 0.40, 2.90 ]
Subtotal (95% CI) 24 24 100.0 % 0.73 [ -0.97, 2.44 ]
Heterogeneity: Tau
2
= 1.19; Chi
2
= 4.67, df = 1 (P = 0.03); I
2
=79%
-4 -2 0 2 4
Analysis 2.6. Comparison 2 FMD versus control, Outcome 6 Change in CAL; multirooted teeth.
1 Full mouth
Subtotal (95% CI) 0 0 0.0 % 0.0 [ 0.0, 0.0 ]
2 5 mm - 6 mm
Koshy 2005 12 1.49 (0.4) 12 1.56 (0.3) 58.7 % -0.07 [ -0.35, 0.21 ]
Mongardini 1999 12 0.94 (1.14) 12 -0.08 (1.07) 41.3 % 1.02 [ 0.14, 1.90 ]
Subtotal (95% CI) 24 24 100.0 % 0.39 [ -0.66, 1.45 ]
Heterogeneity: Tau
2
= 0.48; Chi
2
= 5.29, df = 1 (P = 0.02); I
2
=81%
3 > 6 mm
Koshy 2005 12 2.28 (0.8) 12 2.64 (1) 56.1 % -0.36 [ -1.08, 0.36 ]
Mongardini 1999 12 2.04 (1.5) 12 0.54 (1.1) 43.9 % 1.50 [ 0.45, 2.55 ]
Subtotal (95% CI) 24 24 100.0 % 0.53 [ -1.29, 2.35 ]
Heterogeneity: Tau
2
= 1.52; Chi
2
= 8.14, df = 1 (P = 0.004); I
2
=88%
-4 -2 0 2 4
Analysis 2.7. Comparison 2 FMD versus control, Outcome 7 Change in BOP; single and multirooted teeth.
1 Full mouth
Koshy 2005 12 56.4 (13.5) 12 49.18 (17.6) 35.6 % 7.22 [ -5.33, 19.77 ]
Mongardini 1999 12 64 (20) 12 36 (24) 29.0 % 28.00 [ 10.32, 45.68 ]
Zanatta 2006 15 25 (21) 13 27 (13) 35.3 % -2.00 [ -14.76, 10.76 ]
Subtotal (95% CI) 39 37 100.0 % 9.99 [ -5.60, 25.59 ]
Heterogeneity: Tau
2
= 136.83; Chi
2
= 7.29, df = 2 (P = 0.03); I
2
=73%
2 5 mm - 6 mm
Subtotal (95% CI) 0 0 0.0 % 0.0 [ 0.0, 0.0 ]
3 > 6 mm
Subtotal (95% CI) 0 0 0.0 % 0.0 [ 0.0, 0.0 ]
-100 -50 0 50 100
Analysis 2.8. Comparison 2 FMD versus control, Outcome 8 Changes in BOP; single rooted teeth.
1 Full mouth
Subtotal (95% CI) 0 0 0.0 % 0.0 [ 0.0, 0.0 ]
2 5 mm - 6 mm
Quirynen 2006 14 51 (28) 15 50 (28) 100.0 % 1.00 [ -19.39, 21.39 ]
Subtotal (95% CI) 14 15 100.0 % 1.00 [ -19.39, 21.39 ]
3 > 6 mm
Quirynen 2006 14 53 (22) 15 39 (36) 100.0 % 14.00 [ -7.56, 35.56 ]
Subtotal (95% CI) 14 15 100.0 % 14.00 [ -7.56, 35.56 ]
-100 -50 0 50 100
Analysis 2.9. Comparison 2 FMD versus control, Outcome 9 Changes in BOP; multirooted teeth.
1 Full mouth
Subtotal (95% CI) 0 0 0.0 % 0.0 [ 0.0, 0.0 ]
2 5 mm - 6 mm
Quirynen 2006 14 45 (45) 15 24 (42) 100.0 % 21.00 [ -10.74, 52.74 ]
Subtotal (95% CI) 14 15 100.0 % 21.00 [ -10.74, 52.74 ]
3 > 6 mm
Quirynen 2006 14 31 (28) 15 39 (36) 100.0 % -8.00 [ -31.39, 15.39 ]
Subtotal (95% CI) 14 15 100.0 % -8.00 [ -31.39, 15.39 ]
-100 -50 0 50 100
Analysis 3.1. Comparison 3 FMS versus FMD, Outcome 1 Change in PPD; single and multirooted teeth.
Comparison: 3 FMS versus FMD
Study or subgroup FMS FMD Mean Difference Weight Mean Difference
1 Full mouth
Subtotal (95% CI) 0 0 0.0 % 0.0 [ 0.0, 0.0 ]
2 5 mm - 6 mm
Zanatta 2006 12 2.19 (0.41) 15 2.32 (0.46) 100.0 % -0.13 [ -0.46, 0.20 ]
Subtotal (95% CI) 12 15 100.0 % -0.13 [ -0.46, 0.20 ]
3 > 6 mm
Zanatta 2006 12 4.36 (0.54) 15 4.02 (0.72) 100.0 % 0.34 [ -0.14, 0.82 ]
Subtotal (95% CI) 12 15 100.0 % 0.34 [ -0.14, 0.82 ]
-4 -2 0 2 4
Favours FMD Favours FMS
Analysis 3.2. Comparison 3 FMS versus FMD, Outcome 2 Change in PPD; single rooted teeth.
1 Full mouth
Subtotal (95% CI) 0 0 0.0 % 0.0 [ 0.0, 0.0 ]
2 5 mm - 6 mm
Koshy 2005 12 2.96 (0.5) 12 3 (0.2) 61.4 % -0.04 [ -0.34, 0.26 ]
Quirynen 2006 14 1.4 (0.58) 14 1.8 (0.45) 38.6 % -0.40 [ -0.78, -0.02 ]
Subtotal (95% CI) 26 26 100.0 % -0.20 [ -0.55, 0.15 ]
Heterogeneity: Tau
2
= 0.03; Chi
2
= 2.07, df = 1 (P = 0.15); I
2
=52%
3 > 6 mm
Koshy 2005 12 4.26 (1.1) 12 4.02 (1.4) 28.3 % 0.24 [ -0.77, 1.25 ]
Quirynen 2006 14 2.5 (0.85) 14 2.6 (0.86) 71.7 % -0.10 [ -0.73, 0.53 ]
Subtotal (95% CI) 26 26 100.0 % 0.00 [ -0.54, 0.53 ]
Heterogeneity: Tau
2
= 0.0; Chi
2
= 0.31, df = 1 (P = 0.58); I
2
=0.0%
-4 -2 0 2 4
Analysis 3.3. Comparison 3 FMS versus FMD, Outcome 3 Change in PPD; multirooted teeth.
1 Full mouth
Subtotal (95% CI) 0 0 0.0 % 0.0 [ 0.0, 0.0 ]
2 5 mm - 6 mm
Koshy 2005 12 2.62 (0.6) 12 3.44 (1.1) 49.1 % -0.82 [ -1.53, -0.11 ]
Quirynen 2006 14 2.5 (0.45) 14 1.5 (0.81) 50.9 % 1.00 [ 0.51, 1.49 ]
Subtotal (95% CI) 26 26 100.0 % 0.11 [ -1.67, 1.89 ]
Heterogeneity: Tau
2
= 1.56; Chi
2
= 17.24, df = 1 (P = 0.00003); I
2
=94%
3 > 6 mm
Koshy 2005 12 3.81 (0.7) 12 1.49 (0.4) 50.8 % 2.32 [ 1.86, 2.78 ]
Quirynen 2006 14 2.6 (0.86) 14 2.7 (0.92) 49.2 % -0.10 [ -0.76, 0.56 ]
Subtotal (95% CI) 26 26 100.0 % 1.12 [ -1.25, 3.49 ]
Heterogeneity: Tau
2
= 2.84; Chi
2
= 34.97, df = 1 (P<0.00001); I
2
=97%
-4 -2 0 2 4
Analysis 3.4. Comparison 3 FMS versus FMD, Outcome 4 Change in CAL; single and multirooted teeth.
1 Full mouth
Subtotal (95% CI) 0 0 0.0 % 0.0 [ 0.0, 0.0 ]
2 5 mm - 6 mm
Quirynen 2006 14 1.18 (0.42) 14 1.38 (0.5) 63.3 % -0.20 [ -0.54, 0.14 ]
Zanatta 2006 12 1.74 (0.55) 15 1.79 (0.64) 36.7 % -0.05 [ -0.50, 0.40 ]
Subtotal (95% CI) 26 29 100.0 % -0.14 [ -0.42, 0.13 ]
Heterogeneity: Tau
2
= 0.0; Chi
2
= 0.27, df = 1 (P = 0.60); I
2
=0.0%
3 > 6 mm
Quirynen 2006 14 1.91 (0.61) 14 2.32 (0.79) 61.5 % -0.41 [ -0.93, 0.11 ]
Zanatta 2006 12 3.19 (0.81) 15 3.12 (0.94) 38.5 % 0.07 [ -0.59, 0.73 ]
Subtotal (95% CI) 26 29 100.0 % -0.21 [ -0.68, 0.25 ]
Heterogeneity: Tau
2
= 0.02; Chi
2
= 1.25, df = 1 (P = 0.26); I
2
=20%
-4 -2 0 2 4
Analysis 3.5. Comparison 3 FMS versus FMD, Outcome 5 Change in CAL; single rooted teeth.
1 Full mouth
Subtotal (95% CI) 0 0 0.0 % 0.0 [ 0.0, 0.0 ]
2 5 mm - 6 mm
Koshy 2005 12 2.08 (0.6) 12 2 (0.6) 100.0 % 0.08 [ -0.40, 0.56 ]
Subtotal (95% CI) 12 12 100.0 % 0.08 [ -0.40, 0.56 ]
3 > 6 mm
Koshy 2005 12 3.3 (1) 12 2.74 (1.3) 100.0 % 0.56 [ -0.37, 1.49 ]
Subtotal (95% CI) 12 12 100.0 % 0.56 [ -0.37, 1.49 ]
-4 -2 0 2 4
Analysis 3.6. Comparison 3 FMS versus FMD, Outcome 6 Change in CAL; multirooted teeth.
1 Full mouth
Subtotal (95% CI) 0 0 0.0 % 0.0 [ 0.0, 0.0 ]
2 5 mm - 6 mm
Koshy 2005 12 1.74 (0.6) 12 1.49 (0.4) 100.0 % 0.25 [ -0.16, 0.66 ]
Subtotal (95% CI) 12 12 100.0 % 0.25 [ -0.16, 0.66 ]
3 > 6 mm
Koshy 2005 12 3.02 (0.6) 12 2.28 (0.8) 100.0 % 0.74 [ 0.17, 1.31 ]
Subtotal (95% CI) 12 12 100.0 % 0.74 [ 0.17, 1.31 ]
-4 -2 0 2 4
Analysis 3.7. Comparison 3 FMS versus FMD, Outcome 7 Change in BOP; single and multirooted teeth.
1 Full mouth
Koshy 2005 12 61.9 (13.1) 12 56.4 (13.5) 58.4 % 5.50 [ -5.14, 16.14 ]
Zanatta 2006 12 23 (12) 15 25 (21) 41.6 % -2.00 [ -14.61, 10.61 ]
Subtotal (95% CI) 24 27 100.0 % 2.38 [ -5.75, 10.51 ]
Heterogeneity: Tau
2
= 0.0; Chi
2
= 0.79, df = 1 (P = 0.37); I
2
=0.0%
2 5 mm - 6 mm
Subtotal (95% CI) 0 0 0.0 % 0.0 [ 0.0, 0.0 ]
3 > 6 mm
Subtotal (95% CI) 0 0 0.0 % 0.0 [ 0.0, 0.0 ]
-100 -50 0 50 100
Analysis 3.8. Comparison 3 FMS versus FMD, Outcome 8 Changes in BOP; single rooted teeth.
1 Full mouth
Subtotal (95% CI) 0 0 0.0 % 0.0 [ 0.0, 0.0 ]
2 5 mm - 6 mm
Quirynen 2006 14 40 (28) 14 51 (28) 100.0 % -11.00 [ -31.74, 9.74 ]
Subtotal (95% CI) 14 14 100.0 % -11.00 [ -31.74, 9.74 ]
3 > 6 mm
Quirynen 2006 14 35 (22) 14 53 (22) 100.0 % -18.00 [ -34.30, -1.70 ]
Subtotal (95% CI) 14 14 100.0 % -18.00 [ -34.30, -1.70 ]
-100 -50 0 50 100
Analysis 3.9. Comparison 3 FMS versus FMD, Outcome 9 Changes in BOP; multirooted teeth.
1 Full mouth
Subtotal (95% CI) 0 0 0.0 % 0.0 [ 0.0, 0.0 ]
2 5 mm - 6 mm
Quirynen 2006 14 35 (57) 14 45 (45) 100.0 % -10.00 [ -48.04, 28.04 ]
Subtotal (95% CI) 14 14 100.0 % -10.00 [ -48.04, 28.04 ]
3 > 6 mm
Quirynen 2006 14 35 (36) 14 31 (28) 100.0 % 4.00 [ -19.89, 27.89 ]
Subtotal (95% CI) 14 14 100.0 % 4.00 [ -19.89, 27.89 ]
-100 -50 0 50 100
A P P E N D I C E S
Appendix 1. CENTRAL search strategy
#1 Exp PERIODONTAL DISEASES
#2 periodont*
#3 ((dental near scaling) or (tooth near scaling) or (tooth near scale*) or (teeth near scaling) or (teeth near scaled) or (supragingival
next scaling) or (subgingival next scaling))
#4 Exp DENTAL PROPHYLAXIS
#5 ((dental near prophylaxis) or (oral next prophylaxis)
#6 ((root near plane*) or (root near planning))
#7 ((mechanical* near debride*) or (periodontal next debridement))
#8 (subgingival near curettage)
#9 Exp SUBGINGIVAL CURRETTAGE
#10 (pocket near irrigat*)
#11 CHLORHEXIDINE
#12 chlorhexidine
#13 (eludril or chlorohex or corsodyl)
#14 #1 or #2
#15 (#3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13)
#16 ((full-mouth near disinfection) or ((full next mouth) near disinfection) or ((full next mouth) near scaling) or (full-mouth near
scaling) or (full-mouth near root-planing) or ((full next mouth) near (root next planing)) or (full-mouth near debridement) or ((full
next mouth) near debridement))
#17 #14 AND #15 AND #16
Appendix 2. MEDLINE (OVID) search strategy
1.exp Periodontal Diseases/
2. periodont$.mp. [mp=title, original title, abstract, name of substance, mesh subject heading]
3. ((dental adj6 scaling) or (tooth adj6 scaling) or (tooth adj6 scale$) or (teeth adj6 scaling) or (teeth adj6 scale$) or (supragingival$
adj (scaling or scale$)) or (subgingival$ adj (scaling or scale$))).mp. [mp=title, original title, abstract, name of substance, mesh subject
heading]
4. exp Dental Prophylaxis/
5. (dental prophylaxis or oral prophylaxis).mp. [mp=title, original title, abstract, name of substance, mesh subject heading]
6. ((root adj plane$) or (root adj6 planing)).mp. [mp=title, original title, abstract, name of substance, mesh subject heading]
7. ((mechanical$ adj6 debride$) or periodontal asj debridem$).mp. [mp=title, original title, abstract, name of substance, mesh subject
heading]
8. (subgingival adj curettage).mp. [mp=title, original title, abstract, name of substance, mesh subject heading]
9. exp Subgingival Curettage/
10. (pocket adj6 irrigat$).mp. [mp=title, original title, abstract, name of substance, mesh subject heading]
11. CHLORHEXIDINE/
12. chlorhexidine.mp. [mp=title, original title, abstract, name of substance, mesh subject heading]
13. (Eludril or Chlorohex or corsodyl).mp. [mp=title, original title, abstract, name of substance, mesh subject heading]
14. or/1-2
15. or/3-13
16. ((full-mouth adj6 disinfection) or (full mouth adj6 disinfection) or (full mouth adj6 debridement) or (full mouth adj6 debridement)
or full mouth scaling or full-mouth scaling).mp. [mp=title, original title, abstract, name of substance, mesh subject heading]
17. 14 and 15 and 16
Appendix 3. CINAHL (OVID) search strategy
1. exp Periodontal Diseases/
2. periodont$.mp. [mp=title, cinahl subject headings, abstract, instrumentation]
3. ((dental adj6 scaling) or (tooth adj6 scaling) or (tooth adj6 scale$) or (teeth adj6 scaling) or (teeth adj6 scale$) or (supragingival$
adj (scaling or scale$)) or (subgingival$ adj (scaling or scale$))).mp. [mp=title, cinahl subject headings, abstract, instrumentation]
4. exp Dental Prophylaxis/
5. (dental prophylaxis or oral prophylaxis).mp. [mp=title, cinahl subject headings, abstract, instrumentation]
6. ((root adj plane$) or (root adj6 planing)).mp. [mp=title, cinahl subject headings, abstract, instrumentation]
7. ((mechanical$ adj6 debride$) or periodontal asj debridem$).mp. [mp=title, cinahl subject headings, abstract, instrumentation]
8. (subgingival adj curettage).mp. [mp=title, cinahl subject headings, abstract, instrumentation]
9. exp Subgingival Curettage/
10. (pocket adj6 irrigat$).mp. [mp=title, cinahl subject headings, abstract, instrumentation]
11. CHLORHEXIDINE/
12. chlorhexidine.mp. [mp=title, cinahl subject headings, abstract, instrumentation]
13. (Eludril or Chlorohex or corsodyl).mp. [mp=title, cinahl subject headings, abstract, instrumentation]
14. or/1-2
15. or/3-13
16. ((full-mouth adj6 disinfection) or (full mouth adj6 disinfection) or (full mouth adj6 debridement) or (full mouth adj6 debridement)
or full mouth scaling or full-mouth scaling).mp. [mp=title, cinahl subject headings, abstract, instrumentation]
17. 14 and 15 and 16
Appendix 4. EMBASE (OVID) search strategy
Same as MEDLINE search.
W H A T S N E W
Last assessed as up-to-date: 13 November 2007.
30 July 2008 Amended Converted to new review format.
H I S T O R Y
Protocol rst published: Issue 1, 2004
Review rst published: Issue 1, 2008
C O N T R I B U T I O N S O F A U T H O R S
Helen Worthington: statistical analysis, data input.
Pia-Merete Jerve-Storm: data extraction, data input.
Ian Needleman: protocol development, consulting the review process.
Sren Jepsen: literature search, review of full-text articles, composition of the nal review.
Jrg Eberhard: literature search, review of full-text articles, data extraction.
D E C L A R A T I O N S O F I N T E R E S T
Pia-Merete Jerve-Storm and Sren Jepsen are among the authors of one of the included trials, however, they were not involved in the
quality assessment of this trial.
S O U R C E S O F S U P P O R T
Internal sources
School of Dentistry, The University of Manchester, UK.
University Hospital Schleswig-Holstein, Campus Kiel, Germany.
University College London, UK.
University Hospital Bonn, Germany.
External sources
No sources of support supplied
I N D E X T E R M S
Medical Subject Headings (MeSH)
Anti-Infective Agents, Local [
therapeutic use]; Chlorhexidine [
therapeutic use]; Chronic Disease; Dental Scaling [
methods]; Dis-
infection [methods]; Periodontal Index; Periodontitis [
therapy]; Randomized Controlled Trials as Topic; Root Planing [
methods];
Tooth Loss [prevention & control]
MeSH check words
Adult; Humans

Full-Mouth Disinfection For The Treatment of Adult Chronic Periodontitis (Review)

Uploaded by

Copyright:

Available Formats

Full-Mouth Disinfection For The Treatment of Adult Chronic Periodontitis (Review)

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Full-Mouth Disinfection For The Treatment of Adult Chronic Periodontitis (Review)

Uploaded by

Copyright:

Available Formats

Full-mouth disinfection for the treatment of adult chronic

Mongardini C, van Steenberghe D, Dekeyser C, Quirynen M.

Indicates the major publication for the study

therapeutic use]; Chlorhexidine [

therapeutic use]; Chronic Disease; Dental Scaling [

therapy]; Randomized Controlled Trials as Topic; Root Planing [

You might also like