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SANZ et al .
Economic considerations Cost-effectiveness has not been evaluated in these studies. Furthermore, there is no evidence that the use of one type of instru - ment is superior in terms of requisite treatment time. Applicability The majority of studies were conducted in well-controlled research environments, in specifically selected populations and under local anaesthetic. Clinicians should be aware that new instrument choices (i.e. mini instruments) were not evaluated in the available studies. The choice of instrument should be based upon the experience/skills and preference of the operator together with patient preference. R2.3 | Are treatment outcomes of subgingival instrumentation better when delivered quadrant-wise over multiple visits or as a full mouth procedure (within 24 hr)? Evidence-based recommendation (2.3) We suggest that subgingival periodontal instrumentation can be performed with either traditional quadrant-wise or full mouth delivery within 24 hr. Supporting literature Suvan et al. (2019) Quality of evidence Eight RCTs ( n = 212) with a follow-up of ≥6 months. Grade of recommendation Grade B—↑ Strength of consensus Strong consensus (3.8% of the group abstained due to potential CoI)
Clinical relevance No substantial differences were observed between the two treat - ment modalities. Balance of benefits and harm Clinicians should be aware that there is evidence of systemic impli - cations (e.g. acute systemic inflammatory response) with full-mouth protocols. Thus, such an approach should always include careful consideration of the general health status of the patient. Ethical considerations There is a potential ethical dilemma in that patient preference may conflict with the clinician's recommendation in terms of mode of treatment delivery. Patient autonomy should be respected. Legal considerations Potential adverse systemic effects of full-mouth treatment proto - cols in certain risk patients should be considered. Economic considerations Limited evidence on the cost-effectiveness of different modes of delivery is available. Patient preferences Patient-reported outcomes were inconsistently reported, and there is no evidence supporting one approach over the other. Reports of increased discomfort and side effects, evident in stud - ies on full-mouth disinfection, were not included in the present analysis. Applicability The majority of studies were conducted in well-controlled environ - ments, included specifically selected populations and were under - taken in a number of different continents.
Background
Intervention Subgingival instrumentation has traditionally been delivered during multiple sessions (e.g. quadrant-wise). As an alternative, full-mouth protocols have been suggested. Full-mouth protocols included single stage and two-stage therapy within 24 hr; however, protocols including antiseptics (full-mouth disinfection) were not included in this analysis. Available evidence Eight RCTs ( n = 212) with a follow-up of ≥6 months were included demonstrating a low risk of bias. Outcome measures reported were PPD reduction (primary outcome), CAL gain, BOP reduction and pocket closure (secondary outcomes).
6.2 | Intervention: Use of adjunctive physical agents to subgingival instrumentation
R2.4 | Are treatment outcomes with adjunctive application of laser superior to non-surgical subgingival instrumentation alone? Evidence-based recommendation (2.4) We suggest not to use lasers as adjuncts to subgingival instrumentation . Supporting literature Salvi et al. (2019) Quality of evidence Two RCTs ( n = 46, wavelengths 2,780 nm and 2,940 nm) and 3 RCTs ( n = 101, wavelength range 810–980 nm) with single laser application reporting 6-month outcomes. Two RCTs reported mean PPD changes. Grade of recommendation Grade B—↓ Strength of consensus Simple majority (3.8% of the group abstained due to potential CoI)
Risk of bias Study quality assessment identified all eight studies at low risk of bias.
Consistency The evidence suggested that outcomes of treatment were not de - pendent on the type of delivery (protocol) employed. The evidence was considered strong and consistent. No indications of publication bias were observed, and heterogeneity was low. The results con - firm the findings of a recent Cochrane systematic review (Eberhard, Jepsen, Jervoe-Storm, Needleman, & Worthington, 2015).
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