Efficacy of access flap procedures compared to subgingival debridement in the treatment of periodontitis. A systematic review and meta‐analysis

Abstract

Aim: This systematic review aimed to answer the following focused questions: (a) "In patients with periodontitis, how effective are access flaps (AFs) as compared to subgingival debridement in attaining probing depth (PD) reduction?" and (b) "In patients with periodontitis, does the type of AF impact PD reduction?". Material and Methods: Randomized clinical trials were searched in three databases. Besides PD, information concerning clinical attachment level (CAL) and other relevant outcomes was also collected. Meta-analyses were performed whenever possible and results were categorized based on the initial PD. Results: Thirty-six publications were included. AFs resulted in a significantly greater PD reduction in deep pockets (>6 mm or ≥6 mm), as compared to subgingival debridement, in short-(n = 4; weighted mean difference [WMD] = 0.67 mm; 95% confidence interval [CI] 0.37,0.97; p < .001) and long-term studies (n = 4; WMD = 0.39 mm; 95% CI 0.09,0.70; p = .012), while in moderately deep pockets (4-6, 5-6 or 4-5 mm) only in short-term studies (n = 4; WMD = 0.34; 95% CI 0.21,0.46; p < .001). In shallow pockets (1-3 or 1-4 mm), AFs led to greater CAL (n = 7; WMD = −0.43 mm; 95% CI −0.56, −0.28; p < .001). There was not enough evidence to answer question PICO 2. Conclusions: AFs resulted in greater PD reduction in the treatment of deep and moderate pockets. K E Y W O R D S clinical attachment level, periodontal debridement, periodontitis, probing depth, systematic review | 283 SANZ-SÁNCHEZ Et Al. subgingival scaling and root planing (SRP). Although, theoretically, these are well-differentiated procedures, they are performed clini

Treatment of stage I–III periodontitis—The EFP S3 level clinical practice guideline

“…In the presence of moderately deep residual pockets (4–5 mm), we suggest repeating subgingival instrumentation. Supporting literature Sanz‐Sanchez et al. (2020) Quality of evidence Thirteen RCTs (500 patients) with moderate‐to‐high risk of bias. Five studies were restricted to pockets associated with intrabony defects.…”

“…Supporting literature Sanz-Sanchez et al (2020) Quality of evidence Thirteen RCTs (500 patients) with moderate-tohigh risk of bias. Five studies were restricted to pockets associated with intrabony defects.…”

Periodontal management in a primary polycythemia rubra vera patient: A case report

“…This may compromise the long‐term prognosis of respective teeth if it left without any further intervention. Therefore, surgical pocket reduction surgeries of sites with PPD of more than 5 mm were considered in this case as the presence of deep residual PPD of more than 6 mm showed greater PPD reduction in access flaps surgery as compared to repeated subgingival instrumentation alone 12 . Even though he did not show any evidence of prolonged bleeding during the mechanical debridement procedure, it was crucial to consult the patient's physician prior to the planned surgical therapy.…”

Clinical outcomes following periodontal surgery and root surface decontamination by erythritol-based air polishing. A randomized, controlled, clinical pilot study

“…Moreover, teeth exhibiting residual pockets with probing depths (PD) ≥ 6 mm and BOP were at higher risk for extraction/tooth loss on longterm basis [2]. Consequently, such sites are indicated for additional corrective surgical therapy aiming to decrease probing depths or/and to reconstruct the bony defects [3,4].…”