Non-surgical periodontal therapy: An update on current evidence

Table 1 Summary of the systematic reviews for mechanical non surgical periodontal therapy

Systematic review	No. of studies	Treatment modalities	Tested clinical parameters	Conclusion
Mechanical therapy
Tunkel et al[17]	27	Machine driven vs subgingival debridement	Tooth loss, CAL, PPD, BOP	No difference between ultrasonic/sonic and manual debridement in the treatment of chronic periodontitis for single-rooted teeth. Ultrasonic/sonic subgingival debridement requires less time than hand instrumentation
Van der Weijden et al[25]	26	Subginigval debridement + supragingival plaque control	BOP, PPD, CAL	Improvement in PPD and CAL by subgingival debridement (with supragingival plaque control)
Slots et al[19]	15	Vector® ultrasonic scaler vs conventional ultrasonic instruments and/or hand instrumentation	Calculus removal, time of instrumentation, root surface aspects, patients' perception, BOP, PPD, CAL and microbiological effects	Comparable clinical and microbiological effect of all 3 modalities. Vector® ultrasonic system is more time consuming
Laser therapy
Schwarz et al[29]	11	Laser monotherapy vs mechanical debidement	Clinical data Laser safety data	Er:YAG laser monotherapy resulted in similar clinical outcomes, both in the short and long term compared with mechanical debridement. Insufficient evidence to support the clinical application of either CO(2), Nd:YAG, Nd:YAP, or different diode lasers
Karlsson et al[32]	4	Laser therapy + SRP	BOP, PPD, CAL	No consistent evidence for efficacy of laser as an adjunct to NSPT in adults with chronic periodontitis
Slots et al[30]	8	Nd:YAG Laser monotherapy vs Laser + SRP	Plaque, BOP, gingivitis, PPD, CAL, and GR	No beneficial effect of a pulsed Nd:YAG laser compared to ultrasonics and/or hand instrumentation in the initial periodontitis
Sgolastra et al[31]	5	Er:YAG laser vs SRP	CAL, PPD and GR	No evidence of effectiveness of Er:YAG laser compared to SRP
Photodynamic therapy
Azarpazhooh et al[40]	5	Monotherapy or adjunctive PDT	PPD, CAL, GR, Full mouth plaque and bleeding scores	Routine use of PDT for clinical management of periodontitis cannot be recommended
Sgolastra et al[39]	4	PDT used alone or adjunctive to scaling root planning	CAL, PPD, GR	PDT adjunctive to conventional treatment provides short-term benefits, but microbiological outcomes are contradictory. No evidence of effectiveness for the use of PDT as alternative to SRP

CA: Clinical attachment level; PPD: Probing pocket depth; BOP: Bleeding on probing; SRP: Scaling and root planing; GR: Gingival recession; PDT: Photodynamic therapy; Er:YAG: Erbium-doped: yttrium-aluminum garnet; Nd:YAG: Neodinium doped: yttrium-aluminum garnet.