ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title In Patients with Chronic Periodontitis, Scaling and Root Planing with the Adjunctive Use of Ozonized Water Subgingival Irrigation Is More Effective in Improving Clinical And Microbiological Parameters than Scaling and Root Planing Alone
Clinical Question In patients with chronic periodontitis, is scaling and root planing with the adjunctive use of ozonized water subgingival irrigation more effective in improving clinical and microbiological parameters than scaling and root planing alone?
Clinical Bottom Line The adjunctive use of ozonized water subgingival irrigation, utilizing a modified subgingival tip inserted 3 mm into the pocket for 1 minute, with scaling and root planing is more effective in improving periodontal health and reducing anaerobic bacterial cell count in periodontal pockets for patients with chronic periodontitis. This is based on a single trial of 30 patients. The adjunctive use of ozonized water subgingival irrigation is within the capability of the average general dental practice. However, due to the low stability of ozone in water at room temperature, using ozonized water as home irrigation could be challenging and is therefore less likely to be accepted by the average patient.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 26436042Issac/201530 systemically healthy patients with chronic periodontitis, 35 to 55 years old Non-randomized controlled trial
Key resultsThis controlled trial study consisted of 30 chronic periodontitis patients with probing depth ≥ 6 mm on at least one tooth on contralateral sides of opposite arches. In each patient, a mandibular site with probing depth ≥ 6 mm was assigned as the test site and was treated with scaling and root planing (SRP) and ozonized water subgingival irrigation. A contralateral maxillary site with probing depth ≥ 6 mm was assigned as the control site and received SRP only. In addition, the mandibular teeth of each subject received ozonized water subgingival irrigation on a weekly basis during the study period. After 4 weeks, the test site showed significant improvement in gingival index (GI), probing pocket depth (PD), and clinical attachment level (CAL) [GI p < 0.0001; PD p < 0.0001; CAL p = 0.001] when comparing to the control site. Moreover, there was a significant difference in mean anaerobic colony count (p < 0.0001) between the test site and control site after 4 weeks of trial period. Mean anaerobic colony count was reduced by 28.5% in test site, while it was increased by 41.8% in control site after 4 weeks.
Evidence Search ("chronic periodontitis"[MeSH Terms] OR ("chronic"[All Fields] AND "periodontitis"[All Fields]) OR "chronic periodontitis"[All Fields]) AND ("therapeutic irrigation"[MeSH Terms] OR ("therapeutic"[All Fields] AND "irrigation"[All Fields]) OR "therapeutic irrigation"[All Fields] OR "irrigation"[All Fields]) AND adjunct[All Fields]
Comments on
The Evidence
This non-randomized controlled trial study has assessed the effectiveness of ozonized water subgingival irrigation as an adjunct to SRP in improving clinical and microbiological parameters in patients with chronic periodontitis. The study is considered non-randomized because assignment of test and control sites in each participant was not performed randomly. A mandibular site was always selected as the test site, and a contralateral maxillary site was always selected as the control site. Moreover, the article did not explain how the sites were selected in each arch when more than one tooth had probing depth ≥ 6 mm. This study was not double-blinded since both the clinician and participant knew about the intervention of ozonized water irrigation at the test site. Baseline values in clinical and microbiological parameters were similar at test and control sites. The sites were treated the same other than the intervention at the test site. Nevertheless, employing placebo irrigation at the control sites would have elucidated the benefits of ozonized water as a specific agent even more. This study has more than 80% completion rate, but a 4-week analysis may be insufficient to evaluate the long term effects of ozonized water as an useful adjunct to SRP. Further studies therefore are needed to assess the long-term effects of ozonized water. This study shows adequate compliance of the participants, unlikely recall bias, and no competing interests.
Applicability The participants included in this study are representative of patients seen in general dental practice and periodontal specialty clinics. The use of ozonized water subgingival irrigation as an adjunct to SRP in treating patients with chronic periodontitis is within the capability of the average general dental practice and periodontal specialty clinics. However, using ozonized water irrigation at home could be challenging to patients since ozone dissipates quickly at room temperature. More studies are needed to evaluate the long-term benefits of ozonized water as an adjunct in treating chronic periodontitis.
Specialty/Discipline (General Dentistry) (Periodontics)
Keywords Chronic periodontitis, subgingival irrigation, ozonized water
ID# 3056
Date of submission: 03/31/2016spacer
E-mail laoe@livemail.uthscsa.edu
Author Emily Lao
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author David Lasho, DDS, MSD
Faculty mentor/Co-author e-mail lasho@uthscsa.edu
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