Cochrane · intervention · CD004622
Full‐mouth treatment modalities (within 24 hours) for periodontitis in adults
Jervøe-Storm, P-M, Eberhard, J, Needleman, I, et al. · Cochrane Database of Systematic Reviews · 2022 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
16
current version
GRADE rated
9
No studies
3
Included studies
20
as reported
No studies 3 · 18.8%Ungraded 4 · 25%Very low 3 · 18.8%Low 6 · 37.5%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Adults with a clinical diagnosis of (chronic) periodontitis (1999 International Classification of Periodontal Diseases); studies of aggressive periodontitis, systemic disorders or antibiotic use excluded | Twenty RCTs with 944 participants; adults aged 23 to 77 with periodontitis |
| Intervention | Full-mouth scaling (FMS): subgingival instrumentation of all quadrants within 24 hours, without antiseptic; Full-mouth disinfection (FMD): subgingival instrumentation of all quadrants within 24 hours plus adjunctive antiseptic (chlorhexidine) treatments | Full-mouth scaling (FMS) (n=13); Full-mouth disinfection (FMD) (n=13) |
| Comparison | Quadrant subgingival instrumentation (SRP) (control), each quadrant in a separate session at least one week apart | Quadrant subgingival instrumentation (control) (n=20) |
| Outcomes | Primary: Tooth loss; Change in probing pocket depth (PPD) (after 3-4 and 6-8 months); Secondary: Change in clinical attachment level (CAL); Change in bleeding on probing (BOP); Adverse events; Pocket closure (number/proportion of sites with PPD of 4 mm or less after treatment) | Change in probing pocket depth (n=20); Change in clinical attachment level (n=19); Change in bleeding on probing (n=16); Tooth loss (n=0); Adverse events (n=13); Pocket closure (n=9) |
| Study designs | Randomised controlled trials (RCTs) with at least three months of follow-up; split-mouth and cross-over designs excluded | Randomised controlled trials (n=20) |
| Timing | At least three months of follow-up | Follow-up 3 to 12 months |
Search date: 2021-06. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid; CINAHL EBSCO
Questions and results
Current version onlyFull-mouth disinfection (FMD): scaling/root planing (subgingival instrumentation) of all quadrants within 24 hours plus adjunctive antiseptic (chlorhexidine) treatments (rinsing, pocket irrigation, tongue/tonsil brushing) vs Quadrant scaling and root planing (control): SRP of each quadrant in separate sessions at least one week apart
Population: Adults with a clinical diagnosis of (chronic) periodontitis (1999 classification); studies of aggressive periodontitis, systemic disorders or antibiotic use excluded
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pocket closure (sites with PPD <=4 mm) | Pocket closure (number/proportion of sites with PPD <=4 mm after treatment): 9 studies reported; all showed an increase in closed pockets after treatment; 8 of 9 found no between-group difference; Koshy 2005 found a… | 9 studies | Ungraded |
Tooth loss | Tooth loss: None of the studies comparing FMD vs control reported tooth loss. | 0 studies | No studies |
Change in bleeding on probing (BOP) 6 to 8 months (SoF); similar at 3 to 4 months | MD 9.54 [-2.24, 21.32] | 4 studies · 92 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Adverse events | 13 studies provided adverse-event/participant-reported information; 3 reported an event after FMD or FMS; most important harm was increased body temperature. FMD/chlorhexidine-specific harms reported by Fonseca 2015… | 13 studies | Ungraded |
Change in probing pocket depth (PPD) 6 to 8 months (SoF); similar at 3 to 4 months | MD 0.11 [-0.04, 0.27] | 6 studies · 214 participants | Low Downgraded: risk of bias, imprecision |
Change in clinical attachment level (CAL) 6 to 8 months (SoF); similar at 3 to 4 months | MD 0.07 [-0.11, 0.24] | 6 studies · 214 participants | Low Downgraded: risk of bias, imprecision |
Full-mouth scaling (FMS): scaling/root planing (subgingival instrumentation) of all quadrants within 24 hours, without antiseptic vs Quadrant scaling and root planing (control): SRP of each quadrant in separate sessions at least one week apart
Population: Adults with a clinical diagnosis of (chronic) periodontitis (1999 classification); studies of aggressive periodontitis, systemic disorders or antibiotic use excluded
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Change in clinical attachment level (CAL) 6 to 8 months (SoF); similar at 3 to 4 months | MD 0.10 [-0.05, 0.26] | 5 studies · 148 participants | Low Downgraded: risk of bias |
Change in bleeding on probing (BOP) 6 to 8 months (SoF); similar at 3 to 4 months | MD 2.64 [-8.81, 14.09] | 3 studies · 80 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Adverse events | 13 studies provided adverse-event/participant-reported information; 3 reported an event after FMD or FMS; most important harm was increased body temperature after treatment. Narrative, not separated by comparison and… | 13 studies | Ungraded |
Change in probing pocket depth (PPD) 6 to 8 months (SoF); similar at 3 to 4 months | MD 0.03 [-0.14, 0.20] | 5 studies · 148 participants | Low Downgraded: risk of bias |
Tooth loss | Tooth loss: None of the studies comparing FMS vs control reported tooth loss. | 0 studies | No studies |
Pocket closure (sites with PPD <=4 mm) | Pocket closure (sites with PPD <=4 mm after treatment): 9 studies reported; all showed increased closed pockets after treatment; 8 of 9 found no between-group difference; Koshy 2005 found a greater change in both… | 9 studies | Ungraded |
Full-mouth scaling (FMS): scaling/root planing (subgingival instrumentation) of all quadrants within 24 hours, without antiseptic vs Full-mouth disinfection (FMD): scaling/root planing (subgingival instrumentation) of all quadrants within 24 hours plus adjunctive antiseptic (chlorhexidine) treatments (rinsing, pocket irrigation, tongue/tonsil brushing)
Population: Adults with a clinical diagnosis of (chronic) periodontitis (1999 classification); studies of aggressive periodontitis, systemic disorders or antibiotic use excluded
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Change in clinical attachment level (CAL) 6 to 8 months (SoF); 3 to 4 months favoured FMD | MD -0.05 [-0.23, 0.13] | 4 studies · 112 participants | Low Downgraded: risk of bias, imprecision |
Change in probing pocket depth (PPD) 6 to 8 months (SoF); similar at 3 to 4 months | MD -0.11 [-0.30, 0.07] | 4 studies · 112 participants | Low Downgraded: risk of bias, imprecision |
Change in bleeding on probing (BOP) 6 to 8 months (SoF); similar at 3 to 4 months | MD -0.20 [-13.27, 12.87] | 2 studies · 42 participants | Very low Downgraded: risk of bias, imprecision |
Tooth loss | Tooth loss: None of the studies comparing FMS vs FMD reported tooth loss. | 0 studies | No studies |
Full-mouth disinfection (FMD): scaling/root planing (subgingival instrumentation) of all quadrants within 24 hours plus adjunctive antiseptic (chlorhexidine) treatments (rinsing, pocket irrigation, tongue/tonsil brushing) vs Quadrant scaling and root planing (control): SRP of each quadrant in separate sessions at least one week apart
Population: Adults with a clinical diagnosis of chronic periodontitis; studies of aggressive periodontitis, systemic disorders or antibiotic use excluded
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Change in clinical attachment level (CAL) 3 to 4 months (SoF); similar at 6 to 8 months | MD 0.04 [-0.25, 0.33] | 2 studies · 44 participants | Low Downgraded: risk of bias, imprecision |
Tooth loss | Tooth loss: Not reported in any of the trials. | 0 studies | No studies |
Change in bleeding on probing (BOP) 3 to 4 months (SoF); similar at 6 to 8 months | MD 12.59 [-8.58, 33.77] | 3 studies · 68 participants | Low Downgraded: risk of bias, imprecision |
Change in probing pocket depth (PPD) 3 to 4 months (SoF); similar at 6 to 8 months | MD 0.13 [-0.09, 0.34] | 2 studies · 44 participants | Low Downgraded: risk of bias, imprecision |
Adverse events | Adverse events reported in 8 studies; most important harm was an increased body temperature after FMS or FMD treatments; narrative, not separated by comparison and not GRADE-rated. | 8 studies | Ungraded |
Full-mouth scaling (FMS): scaling/root planing (subgingival instrumentation) of all quadrants within 24 hours, without antiseptic vs Quadrant scaling and root planing (control): SRP of each quadrant in separate sessions at least one week apart
Population: Adults with a clinical diagnosis of chronic periodontitis; studies of aggressive periodontitis, systemic disorders or antibiotic use excluded
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Change in probing pocket depth (PPD) 3 to 4 months (SoF); similar at 6 to 8 months | MD 0.01 [-0.17, 0.19] | 3 studies · 82 participants | Low Downgraded: risk of bias, imprecision |
Change in clinical attachment level (CAL) 3 to 4 months (SoF); similar at 6 to 8 months | MD -0.02 [-0.26, 0.22] | 3 studies · 82 participants | Low Downgraded: risk of bias, imprecision |
Tooth loss | Tooth loss: Not reported in any of the trials. | 0 studies | No studies |
Adverse events | Adverse events reported in 8 studies; most important harm was an increased body temperature after FMS or FMD treatments; narrative, not separated by comparison and not GRADE-rated. | 8 studies | Ungraded |
Change in bleeding on probing (BOP) 3 to 4 months (SoF); similar at 6 to 8 months | MD -2.86 [-7.65, 1.93] | 4 studies · 120 participants | Low Downgraded: risk of bias, imprecision |
Full-mouth scaling (FMS): scaling/root planing (subgingival instrumentation) of all quadrants within 24 hours, without antiseptic vs Full-mouth disinfection (FMD): scaling/root planing (subgingival instrumentation) of all quadrants within 24 hours plus adjunctive antiseptic (chlorhexidine) treatments (rinsing, pocket irrigation, tongue/tonsil brushing)
Population: Adults with a clinical diagnosis of chronic periodontitis; studies of aggressive periodontitis, systemic disorders or antibiotic use excluded
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Change in bleeding on probing (BOP) 3 to 4 months (SoF); similar at 6 to 8 months | MD -1.59 [-9.97, 6.80] | 2 studies · 45 participants | Low Downgraded: risk of bias, imprecision |
Change in clinical attachment level (CAL) 3 to 4 months (SoF); 6 to 8 months NS | MD -0.25 [-0.42, -0.07] | 2 studies · 45 participants | Low Downgraded: risk of bias, imprecision |
Change in probing pocket depth (PPD) 3 to 4 months (SoF); similar at 6 to 8 months | MD -0.11 [-0.34, 0.12] | 2 studies · 45 participants | Low Downgraded: risk of bias, imprecision |
Tooth loss | Tooth loss: Not reported in any of the trials. | 0 studies | No studies |
Full-mouth disinfection (FMD): scaling/root planing (subgingival instrumentation) of all quadrants within 24 hours plus adjunctive antiseptic (chlorhexidine) treatments (rinsing, pocket irrigation, tongue/tonsil brushing) vs Quadrant scaling and root planing (control): SRP of each quadrant in separate sessions at least one week apart
Population: Adults with a clinical diagnosis of chronic periodontitis (International Classification of Periodontal Diseases); studies of aggressive periodontitis excluded
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Tooth loss | no estimate extracted | 0 studies | No studies |
Change in clinical attachment level (CAL) 3 to 8 months · single- and multi-rooted combined, moderate pockets (5-6 mm) | MD 0.33 [0.04, 0.63] | 2 studies | Ungraded |
Change in bleeding on probing (BOP) 3 to 8 months | FMD vs control BOP: no statistically significant differences for single- or multi-rooted teeth in moderate or deep pockets (4 trials). | 4 studies | Ungraded |
Adverse events | Adverse events / patient-reported outcomes reported in 4 of 7 trials (pain VAS, analgesic use, raised axillary body temperature, occasional labial herpes/oral ulcers); reported narratively, not separated by comparison. | 4 studies | Ungraded |
Change in probing pocket depth (PPD) 3 to 8 months · single-rooted teeth, moderate pockets (5-6 mm) | MD 0.53 [0.28, 0.77] | 3 studies | Ungraded |
Full-mouth scaling (FMS): scaling/root planing (subgingival instrumentation) of all quadrants within 24 hours, without antiseptic vs Quadrant scaling and root planing (control): SRP of each quadrant in separate sessions at least one week apart
Population: Adults with a clinical diagnosis of chronic periodontitis (International Classification of Periodontal Diseases); studies of aggressive periodontitis excluded
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Change in probing pocket depth (PPD) 3 to 8 months · single- and multi-rooted combined, moderate pockets (5-6 mm) | MD -0.05 [-0.23, 0.13] | 4 studies | Ungraded |
Tooth loss | no estimate extracted | 0 studies | No studies |
Adverse events | Adverse events / patient-reported outcomes reported in 4 of 7 trials (pain VAS, analgesic use, raised axillary body temperature); reported narratively, not separated by comparison. | 4 studies | Ungraded |
Change in bleeding on probing (BOP) 3 to 8 months | FMS vs control BOP (whole-mouth): no significant difference (P=0.96; 5 studies); single-/multi-rooted subgroups NS. | 5 studies | Ungraded |
Change in clinical attachment level (CAL) 3 to 8 months · moderate pockets (5-6 mm) | MD 0.13 | 5 studies | Ungraded |
Full-mouth scaling (FMS): scaling/root planing (subgingival instrumentation) of all quadrants within 24 hours, without antiseptic vs Full-mouth disinfection (FMD): scaling/root planing (subgingival instrumentation) of all quadrants within 24 hours plus adjunctive antiseptic (chlorhexidine) treatments (rinsing, pocket irrigation, tongue/tonsil brushing)
Population: Adults with a clinical diagnosis of chronic periodontitis (International Classification of Periodontal Diseases); studies of aggressive periodontitis excluded
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Tooth loss | no estimate extracted | 0 studies | No studies |
Change in bleeding on probing (BOP) 3 to 8 months · single-rooted teeth, deep pockets (>6 mm) | MD -18.00 [-34.30, -1.70] | 1 study | Ungraded |
Change in clinical attachment level (CAL) 3 to 8 months · single-rooted teeth, deep pockets (>6 mm) | MD 0.74 [0.17, 1.31] | 2 studies | Ungraded |
Change in probing pocket depth (PPD) 3 to 8 months | FMS vs FMD PPD: no significant differences for single- and multi-rooted combined (Zanatta 2006) or single-/multi-rooted separately in moderate or deep pockets (up to 3 studies). | 3 studies | Ungraded |
Full-mouth disinfection (FMD): scaling/root planing (subgingival instrumentation) of all quadrants within 24 hours plus adjunctive antiseptic (chlorhexidine) treatments (rinsing, pocket irrigation, tongue/tonsil brushing) vs Quadrant scaling and root planing (control): SRP of each quadrant in separate sessions at least one week apart
Population: Patients with periodontitis (chronic or aggressive, grouped by diagnosis per the international classification)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR At least 3 months follow-up (planned) | no estimate extracted | 0 studies | No studies |