Bna. Vandekerchkove et al., FULL-MOUTH VERSUS PARTIAL-MOUTH DISINFECTION IN THE TREATMENT OF PERIODONTAL INFECTIONS - LONG-TERM CLINICAL OBSERVATIONS OF A PILOT-STUDY, Journal of periodontology, 67(12), 1996, pp. 1251-1259
A CLASSICAL TREATMENT FOR CHRONIC ADULT PERIODONTITIS consists Of four
to six consecutive sessions of scaling and root planing at a 1- to 2-
week interval. Such a so-called ''quadrant or sextant therapy'' might
result in a reinfection of a previously disinfected area by bacteria f
rom an untreated region. The purpose of this study was to investigate,
over an 8-month period, the clinical benefits of full-mouth disinfect
ion within a 24-hour period in the control of chronic periodontitis. T
en adult patients with advanced chronic periodontitis were randomly as
signed to a test and a control group. The control group received the s
tandard scheme of initial periodontal therapy, consisting of scaling a
nd root planing per quadrant at 2-week intervals. In the full-mouth di
sinfection group, scaling and root planing of the four quadrants was p
erformed within 24 hours and immediately followed by a thorough supra-
and subgingival chlorhexidine application to limit any transfer of ba
cteria. The latter involved tongue brushing with a 1% chlorhexidine ge
l for 60 seconds, mouthrinsing with a 0.2% chlorhexidine solution twic
e for 60 seconds, repeated subgingival irrigation of all pockets with
a 1% chlorhexidine gel (3 times within 10 minutes), and mouthrinsing t
wice daily with a 0.2% chlorhexidine solution during 2 weeks. In addit
ion, both groups received thorough oral hygiene instructions. The plaq
ue index, gingival index, probing depth, gingival recession, and bleed
ing on probing were recorded prior to professional cleaning and at 1,
2, 4, and 8 months afterwards. Although the test group scored higher p
laque indices than the control group, especially at months 2 and 4, th
e gingival index and bleeding tendency showed similar improvements wit
h time. However, when the gingival/plaque ratio was considered, the la
tter was lower in the test group at all follow-up visits. For pockets
greater than or equal to 7 mm, full-mouth disinfection showed a signif
icantly (P = 0.01) higher reduction in probing depth at each follow-up
visit with, at month 8, a reduction of 4 mm (from 8 mm to 4 mm), in c
omparison to 3 mm (from 8 mm to 5 mm) for the classical therapy. The i
ncrease in gingival recession in the full-mouth disinfection group rem
ained below 0.7 mm, while in the control group it reached 1.9 mm after
8 months. This resulted in a gain of clinical attachment level of 3.7
mm for the test group versus 1.9 mm for the control group. A radiogra
phical examination also indicated a superior improvement for the test
group. when compared to the control group. This pilot study suggests t
hat a full-mouth disinfection in one day results in an improved clinic
al outcome in chronic periodontitis as compared to scalings per quadra
nt at 2-week intervals over several weeks.