[en] Subgingival debridement is the part of nonsurgical therapy which aims to remove the biofilm without intentionally removing the cementum or subgingival calculus. The objective of this review was to describe the end point of this therapy, the different methods used and how often it should be carried out. The literature shows that several methods are currently available for subgingival debridement, namely hand instrumentation, (ultra)sonic instrumentation, laser, photodynamic therapy and air-polishing. None of these methods seems superior to any other regarding clinical benefits or microbiological differences. However, less treatment discomfort is reported using laser, photodynamic therapy or air-polishing compared with hand- and/or (ultra)sonic instrumentation. Subgingival debridement can be carried out when, during supportive periodontal therapy, pockets of 5 mm or deeper are detected.
Research Center/Unit :
d‐BRU - Dental Biomaterials Research Unit - ULiège [BE]
Disciplines :
Dentistry & oral medicine
Author, co-author :
Laleman, Isabelle ; Centre Hospitalier Universitaire de Liège - CHU > > Service de parodontologie, chirurgie bucco-dentaire et chirurgie implantaire
Cortellini, Simone
De Winter, Senne
Rodriguez Herrero, Esteban
Dekeyser, Christel
Quirynen, Marc
Teughels, Wim
Language :
English
Title :
Subgingival debridement: end point, methods and how often?
American Academy of Periodontology statement on the efficacy of lasers in the non-surgical treatment of inflammatory periodontal disease. J Periodontol 2011: 82: 513–514.
Anderson GB, Palmer JA, Bye FL, Smith BA, Caffesse RG. Effectiveness of subgingival scaling and root planing: single versus multiple episodes of instrumentation. J Periodontol 1996: 67: 367–373.
Ando Y, Aoki A, Watanabe H, Ishikawa I. Bactericidal effect of erbium YAG laser on periodontopathic bacteria. Lasers Surg Med 1996: 19: 190–200.
Aoki A, Mizutani K, Schwarz F, Sculean A, Yukna RA, Takasaki AA, Romanos GE, Taniguchi Y, Sasaki KM, Zeredo JL, Koshy G, Coluzzi DJ, White JM, Abiko Y, Ishikawa I, Izumi Y. Periodontal and peri-implant wound healing following laser therapy. Periodontol 2000 2015: 68: 217–269.
Armitage GC, Xenoudi P. Post-treatment supportive care for the natural dentition and dental implants. Periodontol 2000 2016: 71: 164–184.
Atkinson DR, Cobb CM, Killoy WJ. The effect of an air-powder abrasive system on in vitro root surfaces. J Periodontol 1984: 55: 13–18.
Badersten A, Nilvéus R, Egelberg J. Effect of nonsurgical periodontal therapy. I. Moderately advanced periodontitis. J Clin Periodontol 1981: 8: 57–72.
Badersten A, Nilveus R, Egelberg J. Effect of nonsurgical periodontal therapy. II. Severely advanced periodontitis. J Clin Periodontol 1984: 11: 63–76.
Badersten A, Nilveus R, Egelberg J. Effect of nonsurgical periodontal therapy. III. Single versus repeated instrumentation. J Clin Periodontol 1984: 11: 114–124.
Berkstein S, Reiff RL, McKinney JF, Killoy WJ. Supragingival root surface removal during maintenance procedures utilizing an air-powder abrasive system or hand scaling. An in vitro study. J Periodontol 1987: 58: 327–330.
Bosshardt DD, Sculean A, Donos N, Lang NP. Pattern of mineralization after regenerative periodontal therapy with enamel matrix proteins. Eur J Oral Sci 2006: 114(Suppl 1): 225–231.
Campos FE, Gomes JB, Marin C, Teixeira HS, Suzuki M, Witek L, Zanetta-Barbosa D, Coelho PG. Effect of drilling dimension on implant placement torque and early osseointegration stages: an experimental study in dogs. J Oral Maxillofac Surg 2012: 70: e43–e50.
Campos GN, Pimentl SP, Ribeiro FV, Casarin RCV, Cirano FR, Saraceni CHC, Casati MZ. The adjunctive effect of photodynamic therapy for residual pockets in single-rooted teeth: a randomized controlled clinical trial. Lasers Med Sci 2013: 28: 317–324.
Cappuyns I, Cionca N, Wick P, Giannopoulou C, Mombelli A. Treatment of residual pockets with photodynamic therapy, diode laser, or deep scaling. A randomized, split-mouth controlled clinical trial. Lasers Med Sci 2012: 27: 979–986.
Chace R. Methods and values of tooth planing in periodontal therapy. J Periodontol 1961: 32: 233–236.
Chambrone L, Chambrone D, Lima LA, Chambrone LA. Predictors of tooth loss during long-term periodontal maintenance: a systematic review of observational studies. J Clin Periodontol 2010: 37: 675–684.
Chan YK, Needleman IG, Clifford LR. Comparison of four methods of assessing root surface debridement. J Periodontol 2000: 71: 385–393.
Chondros P, Nikolidakis D, Christodoulides N, Rössler R, Gutknecht N, Sculean A. Photodynamic therapy as adjunct to non-surgical periodontal treatment in patients on periodontal maintenance: a randomized controlled clinical trial. Lasers Med Sci 2009: 24: 681–688.
Claffey N, Egelberg J. Clinical indicators of probing attachment loss following initial periodontal treatment in advanced periodontitis patients. J Clin Periodontol 1995: 22: 690–696.
Claffey N, Nylund K, Kiger R, Garrett S, Egelberg J. Diagnostic predictability of scores of plaque, bleeding, suppuration and probing depth for probing attachment loss. 3 1/2 years of observation following initial periodontal therapy. J Clin Periodontol 1990: 17: 108–114.
Cobb CM. Lasers and the treatment of periodontitis: the essence and the noise. Periodontol 2000 2017: 75: 296–316.
Cohen RE, Research, Science and Therapy Committee, American Academy of Periodontology. Position paper: periodontal maintenance. J Periodontol 2003: 74: 1395–1401.
Corrêa MG, Oliveira DH, Saraceni CHC, Ribeiro FV, Pimentel SP, Cirano FR, Casarin RCV. Short-term microbiological effects of photodynamic therapy in non-surgical periodontal treatment of residual pockets: a split-mouth RCT. Lasers Surg Med 2016: 48: 944–950.
D'Aiuto F, Ready D, Parkar M, Tonetti MS. Relative contribution of patient-, tooth-, and site-associated variability on the clinical outcomes of subgingival debridement. I. Probing depths. J Periodontol 2005: 76: 398–405.
Daly CG, Kieser JB, Corbet EF, Seymourt GJ. Cementum involved in periodontal disease: a review of its features and clinical management. J Dent 1979: 7: 185–193.
Dentino A, Lee S, Mailhot J, Hefti AF. Principles of periodontology. Periodontol 2000 2013: 61: 16–53.
Drisko CL. Periodontal debridement: still the treatment of choice. J Evid-Based Dent Pract 2014: 14(Suppl): 33–41.e1.
Flemmig TF, Hetzel M, Topoll H, Gerss J, Haeberlein I, Petersilka G. Subgingival debridement efficacy of glycine powder air polishing. J Periodontol 2007: 78: 1002–1010.
Flemmig TF, Petersilka GJ, Mehl A, Hickel R, Klaiber B. The effect of working parameters on root substance removal using a piezoelectric ultrasonic scaler in vitro. J Clin Periodontol 1998: 25: 158–163.
Folwaczny M, Mehl A, Aggstaller H, Hickel R. Antimicrobial effects of 2.94 mum Er:YAG laser radiation on root surfaces: an in vitro study. J Clin Periodontol 2002: 29: 73–78.
Gankerseer EJ, Walmsley AD. Preliminary investigation into the performance of a sonic scaler. J Periodontol 1987: 58: 780–784.
Graziani F, Karapetsa D, Alonso B, Herrera D. Nonsurgical and surgical treatment of periodontitis: how many options for one disease? Periodontol 2000 2017: 75: 152–188.
Guentsch A, Preshaw PM. The use of a linear oscillating device in periodontal treatment: a review. J Clin Periodontol 2008: 35: 514–524.
Hägi TT, Hofmänner P, Eick S, Donnet M, Salvi GE, Sculean A, Ramseier CA. The effects of erythritol air-polishing powder on microbiologic and clinical outcomes during supportive periodontal therapy: six-month results of a randomized controlled clinical trial. Quintessence Int Berl Ger 1985 2015: 46: 31–41.
Hägi TT, Hofmänner P, Salvi GE, Ramseier CA, Sculean A. Clinical outcomes following subgingival application of a novel erythritol powder by means of air polishing in supportive periodontal therapy: a randomized, controlled clinical study. Quintessence Int Berl Ger 1985 2013: 44: 753–761.
Heasman PA, McCracken GI, Steen N. Supportive periodontal care: the effect of periodic subgingival debridement compared with supragingival prophylaxis with respect to clinical outcomes. J Clin Periodontol 2002: 29(Suppl 3): 163–172.
Heitz-Mayfield LJA. Disease progression: identification of high-risk groups and individuals for periodontitis. J Clin Periodontol 2005: 32(Suppl 6): 196–209.
Heitz-Mayfield LJA, Lang NP. Surgical and nonsurgical periodontal therapy. Learned and unlearned concepts. Periodontol 2000 2013: 62: 218–231.
Horning GM, Cobb CM, Killoy WJ. Effect of an air-powder abrasive system on root surfaces in periodontal surgery. J Clin Periodontol 1987: 14: 213–220.
Ishikawa I, Aoki A, Takasaki AA, Mizutani K, Sasaki KM, Izumi Y. Application of lasers in periodontics: true innovation or myth? Periodontol 2000 2009: 50: 90–126.
Jenkins WM, Said SH, Radvar M, Kinane DF. Effect of subgingival scaling during supportive therapy. J Clin Periodontol 2000: 27: 590–596.
Jepsen K, Jepsen S. Antibiotics/antimicrobials: systemic and local administration in the therapy of mild to moderately advanced periodontitis. Periodontol 2000 2016: 71: 82–112.
Jung RE, Pjetursson BE, Glauser R, Zembic A, Zwahlen M, Lang NP. A systematic review of the 5-year survival and complication rates of implant-supported single crowns. Clin Oral Implants Res 2008: 19: 119–130.
Kieser JB. Nonsurgical periodontal therapy. In Lang NP, Karring T, editors. Proceedings of the 1st European workshop on periodontology. Quintessence Publishing: Germany, 1994: 131–158.
Kocher T, Langenbeck M, Rühling A, Plagmann HC. Subgingival polishing with a teflon-coated sonic scaler insert in comparison to conventional instruments as assessed on extracted teeth. (I) Residual deposits. J Clin Periodontol 2000: 27: 243–249.
König J, Schwahn C, Fanghänel J, Plötz J, Hoffmann T, Kocher T. Repeated scaling versus surgery in young adults with generalized advanced periodontitis. J Periodontol 2008: 79: 1006–1013.
Kontturi-Närhi V, Markkanen S, Markkanen H. Effects of airpolishing on dental plaque removal and hard tissues as evaluated by scanning electron microscopy. J Periodontol 1990: 61: 334–338.
Krohn-Dale I, Bøe OE, Enersen M, Leknes KN. Er:YAG laser in the treatment of periodontal sites with recurring chronic inflammation: a 12-month randomized, controlled clinical trial. J Clin Periodontol 2012: 39: 745–752.
Lang N, Feres M, Corbet E, Ding Y, Emingil G, Faveri M, Humagain M, Izumi Y, Kamil W, Kemal Y, Mahanonda R, Rajpal J, Sakellari D, Tan WC, Yamazaki K. Group B. Consensus paper. Non-surgical periodontal therapy: mechanical debridement, antimicrobial agents and other modalities. J Int Acad Periodontol 2015: 17: 34–36.
Lang NP, Tonetti MS. Periodontal risk assessment (PRA) for patients in supportive periodontal therapy (SPT). Oral Health Prev Dent 2003: 1: 7–16.
Lee CT, Huang HY, Sun TC, Karimbux N. Impact of patient compliance on tooth loss during supportive periodontal therapy: a systematic review and meta-analysis. J Dent Res 2015: 94: 777–786.
Listgarten MA, Levin S, Schifter CC, Sullivan P, Evian CI, Rosenberg ES, Laster L. Comparative longitudinal study of 2 methods of scheduling maintenance visits; 2-year data. J Clin Periodontol 1986: 13: 692–700.
Lulic M, Leiggener Görög I, Salvi GE, Ramseier CA, Mattheos N, Lang NP. One-year outcomes of repeated adjunctive photodynamic therapy during periodontal maintenance: a proof-of-principle randomized-controlled clinical trial. J Clin Periodontol 2009: 36: 661–666.
MacAlpine R, Magnusson I, Kiger R, Crigger M, Garrett S, Egelberg J. Antimicrobial irrigation of deep pockets to supplement oral hygiene instruction and root debridement. I. Bi-weekly irrigation. J Clin Periodontol 1985: 12: 568–577.
Matia JI, Bissada NF, Maybury JE, Ricchetti P. Efficiency of scaling of the molar furcation area with and without surgical access. Int J Periodontics Restorative Dent 1986: 6: 24–35.
Matuliene G, Pjetursson BE, Salvi GE, Schmidlin K, Brägger U, Zwahlen M, Lang NP. Influence of residual pockets on progression of periodontitis and tooth loss: results after 11 years of maintenance. J Clin Periodontol 2008: 35: 685–695.
McColl E, Patel K, Dahlen G, Tonetti M, Graziani F, Suvan J, Laurell L. Supportive periodontal therapy using mechanical instrumentation or 2% minocycline gel: a 12 month randomized, controlled, single masked pilot study. J Clin Periodontol 2006: 33: 141–150.
McCracken G, Asuni A, Ritchie M, Vernazza C, Heasman P. Failing to meet the goals of periodontal recall programmes. What next? Periodontol 2000 2017: 75: 330–352.
Meyer K, Lie T. Root surface roughness in response to periodontal instrumentation studied by combined use of microroughness measurements and scanning electron microscopy. J Clin Periodontol 1977: 4: 77–91.
Moëne R, Décaillet F, Andersen E, Mombelli A. Subgingival plaque removal using a new air-polishing device. J Periodontol 2010: 81: 79–88.
Mongardini C, Di Tanna GL, Pilloni A. Light-activated disinfection using a light-emitting diode lamp in the red spectrum: clinical and microbiological short-term findings on periodontitis patients in maintenance. A randomized controlled split-mouth clinical trial. Lasers Med Sci 2014: 29: 1–8.
Müller N, Moëne R, Cancela JA, Mombelli A. Subgingival air-polishing with erythritol during periodontal maintenance: randomized clinical trial of twelve months. J Clin Periodontol 2014: 41: 883–889.
Nguyen N-T, Byarlay MR, Reinhardt RA, Marx DB, Meinberg TA, Kaldahl WB. Adjunctive non-surgical therapy of inflamed periodontal pockets during maintenance therapy using diode laser: a randomized clinical trial. J Periodontol 2015: 86: 1133–1140.
Nordland P, Garrett S, Kiger R, Vanooteghem R, Hutchens LH, Egelberg J. The effect of plaque control and root debridement in molar teeth. J Clin Periodontol 1987: 14: 231–236.
Nyman S, Westfelt E, Sarhed G, Karring T. Role of ‘diseased’ root cementum in healing following treatment of periodontal disease. A clinical study. J Clin Periodontol 1988: 15: 464–468.
Obeid PR, D'Hoore W, Bercy P. Comparative clinical responses related to the use of various periodontal instrumentation. J Clin Periodontol 2004: 31: 193–199.
Page RC, Krall EA, Martin J, Mancl L, Garcia RI. Validity and accuracy of a risk calculator in predicting periodontal disease. J Am Dent Assoc 2002: 133: 569–576.
Petersilka GJ. Subgingival air-polishing in the treatment of periodontal biofilm infections. Periodontol 2000 2011: 55: 124–142.
Petersilka GJ, Steinmann D, Häberlein I, Heinecke A, Flemmig TF. Subgingival plaque removal in buccal and lingual sites using a novel low abrasive air-polishing powder. J Clin Periodontol 2003: 30: 328–333.
Petersilka GJ, Tunkel J, Barakos K, Heinecke A, Häberlein I, Flemmig TF. Subgingival plaque removal at interdental sites using a low-abrasive air polishing powder. J Periodontol 2003: 74: 307–311.
Rabbani GM, Ash MM, Caffesse RG. The effectiveness of subgingival scaling and root planing in calculus removal. J Periodontol 1981: 52: 119–123.
Ramfjord SP, Knowles JW, Nissle RR, Burgett FG, Shick RA. Results following three modalities of periodontal therapy. J Periodontol 1975: 46: 522–526.
Ratka-Krüger P, Mahl D, Deimling D, Mönting JS, Jachmann I, Al-Machot E, Sculean A, Berakdar M, Jervøe-Storm P-M, Braun A. Er:YAG laser treatment in supportive periodontal therapy. J Clin Periodontol 2012: 39: 483–489.
Renvert S, Persson GR. A systematic review on the use of residual probing depth, bleeding on probing and furcation status following initial periodontal therapy to predict further attachment and tooth loss. J Clin Periodontol 2002: 29(Suppl 3): 82–91.
Rosén B, Olavi G, Badersten A, Rönström A, Söderholm G, Egelberg J. Effect of different frequencies of preventive maintenance treatment on periodontal conditions. 5-Year observations in general dentistry patients. J Clin Periodontol 1999: 26: 225–233.
Rühling A, Fanghänel J, Houshmand M, Kuhr A, Meisel P, Schwahn C, Kocher T. Photodynamic therapy of persistent pockets in maintenance patients-a clinical study. Clin Oral Investig 2010: 14: 637–644.
Sculean A, Schwarz F, Berakdar M, Romanos GE, Brecx M, Willershausen B, Becker J. Non-surgical periodontal treatment with a new ultrasonic device (Vector-ultrasonic system) or hand instruments. J Clin Periodontol 2004: 31: 428–433.
Shah S, Walmsley AD, Chapple IL, Lumley PJ. Variability of sonic scaling tip movement. J Clin Periodontol 1994: 21: 705–709.
Sharman WM, Allen CM, van Lier JE. Photodynamic therapeutics: basic principles and clinical applications. Drug Discov Today 1999: 4: 507–517.
Slot DE, Timmerman MF, Versteeg PA, van der Velden U, van der Weijden FA. Adjunctive clinical effect of a water-cooled Nd:YAG laser in a periodontal maintenance care programme: a randomized controlled trial. J Clin Periodontol 2012: 39: 1159–1165.
Slots J. Periodontitis: facts, fallacies and the future. Periodontol 2000 2017: 75: 7–23.
Smart GJ, Wilson M, Davies EH, Kieser JB. The assessment of ultrasonic root surface debridement by determination of residual endotoxin levels. J Clin Periodontol 1990: 17: 174–178.
Tomasi C, Schander K, Dahlén G, Wennström JL. Short-term clinical and microbiologic effects of pocket debridement with an Er:YAG laser during periodontal maintenance. J Periodontol 2006: 77: 111–118.
Trombelli L, Franceschetti G, Farina R. Effect of professional mechanical plaque removal performed on a long-term, routine basis in the secondary prevention of periodontitis: a systematic review. J Clin Periodontol 2015: 42(Suppl 16): S221–S236.
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: 72–81.
Van der Weijden GA, Timmerman MF. A systematic review on the clinical efficacy of subgingival debridement in the treatment of chronic periodontitis. J Clin Periodontol 2002: 29(Suppl 3): 55–91.
Wennström JL, Dahlén G, Ramberg P. Subgingival debridement of periodontal pockets by air polishing in comparison with ultrasonic instrumentation during maintenance therapy. J Clin Periodontol 2011: 38: 820–827.
Wilson TG, Glover ME, Malik AK, Schoen JA, Dorsett D. Tooth loss in maintenance patients in a private periodontal practice. J Periodontol 1987: 58: 231–235.
Yamaguchi H, Kobayashi K, Osada R, Sakuraba E, Nomura T, Arai T, Nakamura J. Effects of irradiation of an erbium: YAG laser on root surfaces. J Periodontol 1997: 68: 1151–1155.
