ONE-STAGE FULL-MOUTH DISINFECTION VERSUS QUADRANT-WISE SCALING AND ROOT PLANING IN THE TREATMENT OF GENERALIZED AGGRESSIVE PERIODONTITITS: A RANDOMIZED 6-MONTH CLINICAL AND MICROBIOLOGICAL TRIAL

Aim: Data concerning treatment outcomes in patients with generalized aggressive periodontitis (GAgP) are limited. The aim of the present study was to investigate six-month clinical and microbiologic outcomes of the one-stage full-mouth disinfection (OSFMD) with compared to conventional quadrant scaling and root planing (SRP) in the management of patients with GAgP. Methods: Thirty-two consecutive patients with previously untreated GAgP were selected among those referred to the Section of Periodontology, C.I.R. Dental School, University of Torino (Italy). Subjects were randomly assigned by a computer generated list to the OSFMD according to the protocol by Quirynen et al. (test group) and to conventional quadrant-wise SRP (control group) at one-week interval. Random assignment resulted in 17 patients (mean age 34.76 ± 4.78 years) in the test group and 15 in the control one (mean age 36.87±3.87 years). Clinical measurements were recorded at baseline, 3 and 6 months by one masked and calibrated examiner. Subgingival samples were collected at the same time points from moderate (4 to 5 mm) and deep (≥ 6 mm) pocket sites and analyzed using a polymerase chain reaction for Aggregatibacter actinomycetemcomitans, Prevotella intermedia and bacteria of the red complex. Results: All patients completed the study. At baseline there were no statistically significant differences between test and control groups relative to demographic characteristics, clinical as well as microbiological parameters (p>0.05). Both therapies led to a statistically significant decrease in Full Mouth Plaque Score (FMPS), Full Mouth Bleeding Score (FMBS) and in overall mean Probing Depth (PD) and clinical attachment level (CAL) at 3 and 6 months compared to baseline (p<0.001). The FMPS and FMBS values remained below 20% during the experimental period in both groups. The clinical parameters improved during the first three months postoperatively whereas remained nearly unchanged between 3 and 6 months. At 6 months the mean overall PD reduction and the mean CAL gain amounted to 1.3± 0.3 mm and 1.1 ± 0.4 mm, respectively, in the test group and to 1.1 ± 0.5 mm and 0.9 ± 0.6 mm, respectively, in the control group. Between-group analysis did not indicate significant statistical differences except for the greater PD reduction at initially deep pocket sites (≥ 6 mm) favoring the test group. The OSFMD resulted in a mean reduction of 2.5 ± 0.5 mm (p<0.001) at 3 months and 2.4 ± 0.7 mm (p <0.001) at 6 months. With regard to microbiological parameters the quadrant SRP decreased significantly the number of sites colonized by A. actinomycetemcomitans, P. gingivalis, T. forsythia at 3 months. However, a nearly complete recolonization was observed at 6 months. The OSFMD resulted in a reduction of all five periodontal pathogens (p <0.001) at 3 months. At 6 month from baseline a recolonization of all the target bacteria was observed except for the P. gingivalis that maintained the 3-month values. Conclusion: The OSFMD is a viable approach to deal with GAgP patients resulting in statistically significant greater decrease in the number of sites with PD ≥ 6 mm and in better early control of subgingival recolonization by periodontal pathogens.