Impact of Debridement Invasiveness on Attachment Gain After Antiinfective Periodontal Therapy (ATTGAIN16)

This study compared the gain of periodontal attachment after concomitant one-stage removal of bacterial biofilms and subgingival calculus with a two-stage procedure removing subgingival calculus 6 weeks after the initial removal of soft subgingival bacterial biofilms.

The concomitant removal of subgingival calculus and soft bacterial biofilms in a one-stage procedure might impair periodontal healing in deep infrabony pockets due to the mechanical disruption of demineralized bone sections at the bottom of periodontal lesions. This randomized controlled clinical trial therefore aims at comparing the resulting attachment gain 6 months after one-stage antiinfective periodontal therapy comprising the concomitant subgingival removal of soft bacterial biofilms and calculus with a two-stage approach removing subgingival calculus only 6 weeks after the initial removal of soft subgingival bacterial biofilms.

The examiner performing the assessment of periodontal attachment gain is not aware of the type of the preceding intervention therapy (one-stage vs. two-stage) provided to the patient.

Initially soft subgingival bacterial biofilms are removed from periodontal lesions by an airpolishing device and erythritol cleaning powder. 6 weeks later subgingival calculus is mechanically removed in a second step by mechanical scaling and root planing

Soft subgingival bacterial biofilms, as well as subgingival calculus are concomitantly removed from periodontal lesions by mechanical scaling and root planing

Measuring the distance between the cemento-enamel-junction and the probeable bottom of the periodontal pocket

Recording the possible appearance of a bleeding spot immediately after the probing of periodontal lesions for the measurement of clinical attachment loss

Visual Assessment of the inflammatory status of the gingiva according to the criteria set by Lobene et al.

Measuring the extent of supragingival plaque coverage according to the criteria set by Silness and Loe

Inclusion Criteria: presence of periodontal disease minimum of 1 tooth with an infrabony periodontal lesion and pocket depth ≥ 6mm minimum of 15 natural teeth Exclusion Criteria: systemic disease interfering with periodontal healing (e.g. diabetes) antibiotic therapy ≤ 12 month prior to study participation necessity for preventive antibiotic therapy during dental interventions inability to comply with the study protocol