FULL-MOUTH VERSUS PARTIAL-MOUTH DISINFECTION IN THE TREATMENT OF PERIODONTAL INFECTIONS - LONG-TERM CLINICAL OBSERVATIONS OF A PILOT-STUDY

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.