The systemic inflammatory response following hand instrumentation versus ultrasonic instrumentation—A randomized controlled trial

Johnston, William; Paterson, Michael; Piela, Krystyna; Davison, Emily; Simpson, Annabel; Goulding, Marilyn; Ramage, Gordon; Sherriff, Andrea; Culshaw, Shauna

doi:10.1111/jcpe.13342

Cited by 9 publications

(22 citation statements)

References 25 publications

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“…In smokers with periodontal disease, nonsurgical mechanical therapy (also here not further specified) induced a significantly higher increase of IL-8 compared to non-smokers with periodontal disease [33]. When comparing hand versus ultrasonic instrumentation in terms of inflammatory markers, no differences between IL-6, CRP, and TNF-α levels at days 1 and 7 after instrumentation were discerned [17]. Also, numerous in vitro studies showed that human gingival fibroblasts secrete increased levels of IL-8 in response to LPS from P. gingivalis [3,13,24].…”

Section: Discussionmentioning

confidence: 88%

“…Even though it has been well established that manual and ultrasonic instrumentation result in similar clinical outcomes in periodontitis patients [1,17,31], the two treatment modalities might influence the biofilm-cell interactions on a molecular level. Differences in biofilm removal 14 or water irrigation are likely to induce different cell responses of surrounding epithelial cells.…”

Section: Discussionmentioning

confidence: 99%

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A novel in vitro periodontal pocket model to evaluate the effect of root surface instrumentation on biofilm-epithelial cell interactions

et al. 2022

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Objective To develop a novel in vitro periodontal pocket model for evaluating the effect of two different root surface instrumentation modalities on biofilm-epithelial cell interactions. Materials and methods An artificial periodontal pocket model was created using an impression material. Dentin discs were prepared and incubated for 3.5 days with a biofilm consisting of 12 bacterial strains. Then, the discs were inserted into the pocket model and instrumented for 10 s or 10 strokes either with ultrasonics (US) or hand instruments (HI). Subsequently, a glass slide coated with epithelial cells was placed in close vicinity to the discs. After incubation of the pocket model in a 5% CO2 atmosphere for 6 h, residual bacteria of the biofilm as well as bacteria adhering to or invaded into epithelial cells were determined using colony-forming unit (cfu) counts and real-time PCR. Further, as a parameter of the pro-inflammatory cell response, interleukin (IL)-8 expression was determined by ELISA. Results Compared to untreated control, HI reduced the cfu counts by 0.63 log10 (not significant) and US by 1.78 log10 (p = 0.005) with a significant difference between the treatment modalities favoring US (p = 0.048). By trend, lower detection levels of Tannerella forsythia were detected in the US group compared to HI. Concerning the interaction with epithelial cells, half of the control and the HI samples showed epithelial cells with attaching or invading bacteria, while US displayed bacteria only in two out of eight samples. In addition, US resulted in significantly lower IL-8 secretion by epithelial cells compared to the untreated control. Between HI and controls, no statistically significant difference in IL-8 secretion was found. Conclusion This newly developed in vitro model revealed in terms of biofilm-epithelial cell interaction after root surface instrumentation that compared to hand curettes, ultrasonic instrumentation appeared to be more effective in removing bacterial biofilm and in decreasing the inflammatory response of epithelium to biofilm. Clinical relevance Ultrasonic instrumentation might be more advantageous to reduce cellular inflammatory response than hand instruments.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

A novel in vitro periodontal pocket model to evaluate the effect of root surface instrumentation on biofilm-epithelial cell interactions

et al. 2022

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“…6,29,30,31,32 Interestingly, treatment time for HI demonstrated a stronger correlation with disease severity, while ultrasonic showed a weaker correlation. 20 It could therefore be speculated that UI offers greater time saving, particularly for the treatment of patients affected by more severe periodontal disease. Limitations of such a subgroup analysis must be considered when interpreting such speculation.…”

Section: Discussionmentioning

confidence: 99%

“…This study is a post hoc analysis using pooled data generated by two separate studies: a randomised controlled trial (RCT) and a cohort study. 20,21 Both studies had the primary outcome of investigating systemic inflammatory effects following non-surgical periodontal treatment. The current study evaluated secondary outcome data from these studies and analysed the clinical effects of non-surgical periodontal therapy by one of three approaches: hand instrumentation (HI), ultrasonic instrumentation (UI) and combination instrumentation (CI).…”

Section: Methodsmentioning

confidence: 99%

Periodontal instrumentation technique: an exploratory analysis of clinical outcomes and financial aspects

et al. 2023

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Objective This exploratory post hoc analysis sought to investigate clinical outcomes comparing non-surgical treatment for periodontal disease using exclusively hand instruments, exclusively ultrasonic instruments or a combination approach. Differences in time efficiency and equipment use with each treatment method were evaluated. Methods In total, 55 patients with periodontitis were treated across two studies (randomised controlled trial and cohort study) with non-surgical periodontal therapy using hand instruments (HI), ultrasonic instruments (UI) or a combination approach (CI). All patients were re-evaluated 90 days after treatment. Clinical parameters, time taken and financial implications of non-surgical periodontal therapy were explored with a descriptive analysis within this post hoc analysis. Results There were no clinically relevant differences in clinical parameters across all groups at day 90. Inter-group comparisons showed no clinically relevant differences in treatment outcome between groups. UI required less time on average to complete treatment compared to HI. UI provided using a half mouth approach had fewest overall episodes of expenditure and lowest maintenance costs. Conclusions Comparison of clinical outcomes between HI, UI and CI yielded no clinically relevant differences. When comparing HI and UI, UI had a shorter treatment time on average. Full mouth treatment was associated with the least patient visits. UI was least costly on a recurring basis.

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“…This study was a secondary analysis from a randomized‐controlled trial (RCT), 6 and sought to define whether the use of hand (HI) or ultrasonic instruments (UI) has differing impacts on the subgingival plaque microbiota. As such, we investigated the microbial impacts of each instrumentation technique at a range of short‐term follow‐up time points (day 1, day 7, and day 90), to establish whether such findings may translate to compositional shifts in vivo.…”

Section: Introductionmentioning

confidence: 99%

Longitudinal changes in subgingival biofilm composition following periodontal treatment

Johnston

Rosier

Carda‐Diéguez

et al. 2023

Journal of Periodontology

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BackgroundCurrent periodontal treatment involves instrumentation using hand and/or ultrasonic instruments, which are used either alone or in combination based on patient and clinician preference, with comparable clinical outcomes. This study sought to investigate early and later changes in the subgingival biofilm following periodontal treatment, to identify whether these changes were associated with treatment outcomes, and to investigate whether the biofilm responded differently to hand compared with ultrasonic instruments.MethodsThis was a secondary‐outcome analysis of a randomized‐controlled trial. Thirty‐eight periodontitis patients received full‐mouth subgingival instrumentation using hand (n = 20) or ultrasonic instrumentation (n = 18). Subgingival plaque was sampled at baseline and 1, 7, and 90 days following treatment. Bacterial DNA was analyzed using 16S rRNA sequencing. Periodontal clinical parameters were evaluated before and after treatment.ResultsBiofilm composition was comparable in both (hand and ultrasonics) treatment groups at all time points (all genera and species; p[adjusted] > 0.05). Large‐scale changes were observed within groups across time points. At days 1 and 7, taxonomic diversity and dysbiosis were reduced, with an increase in health‐associated genera including Streptococcus and Rothia equating to 30% to 40% of the relative abundance. When reassessed at day 90 a subset of samples reformed a microbiome more comparable with baseline, which was independent of instrumentation choice and residual disease.ConclusionsHand and ultrasonic instruments induced comparable impacts on the subgingival plaque microbiome. There were marked early changes in the subgingival biofilm composition, although there was limited evidence that community shifts associated with treatment outcomes.

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The systemic inflammatory response following hand instrumentation versus ultrasonic instrumentation—A randomized controlled trial

Cited by 9 publications

References 25 publications

A novel in vitro periodontal pocket model to evaluate the effect of root surface instrumentation on biofilm-epithelial cell interactions

A novel in vitro periodontal pocket model to evaluate the effect of root surface instrumentation on biofilm-epithelial cell interactions

Periodontal instrumentation technique: an exploratory analysis of clinical outcomes and financial aspects

Longitudinal changes in subgingival biofilm composition following periodontal treatment

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