Cerrahi Olmayan Periodontal Tedavide Cep Kapanması

Öz

Amaç: Bu çalışma, evre III derece C periodontitis teşhisi konmuş hastalarda cerrahi olmayan periodontal tedavi (COPT) sonrası farklı diş tiplerinde ve sondalama derinliği (SD) aralıklarında cep kapanma (CK) değerlerini incelemeyi amaçlamıştır. Gereç ve Yöntemler: 12 sigara içmeyen, sistemik olarak sağlıklı hastaya COPT uygulanmış ve 3 ay sonra yeniden değerlendirilmiştir. SD, sondalamada kanama ve CK gibi klinik parametreler hesaplanmıştır. Farklı diş tiplerinde (kesici dişler, premolarlar ve molarlar) ve SD aralıklarında (1-3 mm, 4-6 mm, >6 mm) CK yüzdelerini ve SD verilerini karşılaştırmak için uygun istatistiksel analizler gerçekleştirilmiştir. İstatistiksel anlamlılık değeri 0.05 olarak belirlenmiştir. Bulgular: COPT'den sonra, SD'de anlamlı azalma gözlenmiştir (1.29±0.41 mm, p<0.05). Bu azalma özellikle >6 mm ceplerde daha fazla bulunmuştur (2.63±0.76 mm, p<0.05). CK oranları diş tipleri arasında değişiklik göstermiş olup, molarların; kesiciler ve premolarlara göre daha düşük orana sahip olduğu saptanmıştır (p<0.05). CK yüzdesi, kesici dişler için 74.07±18.90, premolarlar için 74.21±16.97 ve molarlar için 57.52±12.48 olarak belirlenmiştir. Kesici dişlerde, 4-6 mm SD’de CK yüzdesi, >6 mm SD’deki CK yüzdesine göre anlamlı yüksektir (77.74±21.03 vs. 46.91±25.02, p<0.05). Benzer eğilim premolar ve molar dişlerde de gözlenmiştir (p<0.05). Sonuç: COPT, periodontal sağlık göstergelerini etkili bir şekilde iyileştirmesiyle birlikte derin periodontal ceplere sahip dişlerde, özellikle molar, cep kapanma başarısının düşük olduğu tespit edilmiştir. Diş tipi ve SD aralıkları gibi bölgesel faktörlere göre özelleştirilmiş tedavi yaklaşımları, evre III derece C periodontitiste tedavi sonuçlarını optimize etmek için önemli olacağı düşünülmektedir.

Anahtar Kelimeler

• Periodontitis
• Periodontal cep
• Kök yüzeyi diştaşı temizliği

Pocket Closure in Non-Surgical Periodontal Treatment

Öz

Objectives: This study assesses the efficacy of pocket closure (PC) following non-surgical periodontal treatment (NSPT) in patients diagnosed with stage III grade C periodontitis, examining various tooth types and probing depth (PD) ranges. Materials and Methods: 12 non-smoker, systemically healthy patients underwent NSPT and were reassessed after 3 months. Clinical parameters, including PD, bleeding on probing, and PC, were evaluated. Statistical analyses were conducted to assess changes in clinical measurements and PC rates among tooth types (incisors, premolars, and molars) and PD ranges (1-3 mm, 4-6 mm, >6 mm). Statistical significance was set at α=0.05. Results: Following NSPT, significant reductions in PD were observed (1.29±0.41 mm, p<0.05), particularly in PD >6 mm (2.63±0.76 mm, p<0.05). PC rates varied among tooth types, with molars exhibiting lower rates compared to incisors and premolars (p<0.05). The percentage of PC was 74.07±18.90 for incisors, 74.21±16.97 for premolars, and 57.52±12.48 for molars. For incisors, the percentage of PC was significantly higher for PD of 4-6 mm compared to PD>6 mm (77.74±21.03 vs. 46.91±25.02, p<0.05). Similar trends were observed in premolars and molars (p<0.05). Conclusion: NSPT effectively improves periodontal health indicators, but achieving complete closure of deep pockets remains challenging, particularly in molars. Tailored treatment approaches based on site-specific factors including tooth type and PD ranges, are crucial for optimizing treatment outcomes in stage III grade C periodontitis.

Anahtar Kelimeler

• Periodontitis
• Periodontal pocket
• Root scaling

Kaynakça

1. Papapanou PN, Sanz M, Buduneli N, Dietrich T, Feres M, Fine DH, et al. Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. 2018;89 Suppl 1:S173-S82.
2. Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. J Periodontol. 2018;89 Suppl 1:S159-S72.
3. Cobb CM. Clinical significance of non-surgical periodontal therapy: an evidence-based perspective of scaling and root planing. J Clin Periodontol. 2002;29 Suppl 2:6-16.
4. Heitz-Mayfield LJ, Trombelli L, Heitz F, Needleman I, Moles D. A systematic review of the effect of surgical debridement vs non-surgical debridement for the treatment of chronic periodontitis. J Clin Periodontol. 2002;29 Suppl 3:92-102; discussion 60-2.
5. Sanz M, Herrera D, Kebschull M, Chapple I, Jepsen S, Beglundh T, et al. Treatment of stage I-III periodontitis- The EFP S3 level clinical practice guideline. J Clin Periodontol. 2020;47 Suppl 22(Suppl 22):4-60.
6. Zhang X, Hu Z, Zhu X, Li W, Chen J. Treating periodontitis-a systematic review and meta-analysis comparing ultrasonic and manual subgingival scaling at different probing pocket depths. BMC Oral Health. 2020;20(1):176.
7. Schmidlin PR, Beuchat M, Busslinger A, Lehmann B, Lutz F. Tooth substance loss resulting from mechanical, sonic and ultrasonic root instrumentation assessed by liquid scintillation. J Clin Periodontol. 2001;28(11):1058- 66.
8. Tomasi C, Abrahamsson KH, Apatzidou D. Subgingival instrumentation. Periodontol 2000. 2023;00:1-13.

9. Quirynen M, Bollen CM, Vandekerckhove BN, Dekeyser C, Papaioannou W, Eyssen H. Full- vs. partial-mouth disinfection in the treatment of periodontal infections: short-term clinical and microbiological observations. J Dent Res. 1995;74(8):1459-67.
10. Suvan J, Leira Y, Moreno Sancho FM, Graziani F, Derks J, Tomasi C. Subgingival instrumentation for treatment of periodontitis. A systematic review. J Clin Periodontol. 2020;47 Suppl 22:155-75.
11. Matuliene G, Pjetursson BE, Salvi GE, Schmidlin K, Bragger U, Zwahlen M, et al. Influence of residual pockets on progression of periodontitis and tooth loss: results after 11 years of maintenance. J Clin Periodontol. 2008;35(8):685-95.
12. Loos BG, Needleman I. Endpoints of active periodontal therapy. J Clin Periodontol. 2020;47 Suppl 22(Suppl 22):61-71.
13. Citterio F, Gualini G, Chang M, Piccoli GM, Giraudi M, Manavella V, et al. Pocket closure and residual pockets after non-surgical periodontal therapy: A systematic review and meta-analysis. J Clin Periodontol. 2022;49(1):2-14.
14. Tomasi C, Leyland AH, Wennstrom JL. Factors influencing the outcome of non-surgical periodontal treatment: a multilevel approach. J Clin Periodontol. 2007;34(8):682-90.
15. Citterio F, Kanmaz B, Baima G, Romano F, Buduneli N, Aimetti M. Pocket closure in stage III-IV grade C periodontitis: A multilevel analysis following non-surgical periodontal therapy. Int J Dent Hyg. 2023;00:1-7.
16. Goncalves TE, Feres M, Zimmermann GS, Faveri M, Figueiredo LC, Braga PG, et al. Effects of scaling and root planing on clinical response and serum levels of adipocytokines in patients with obesity and chronic periodontitis. J Periodontol. 2015;86(1):53-61.
17. Chapple ILC, Mealey BL, Van Dyke TE, Bartold PM, Dommisch H, Eickholz P, et al. Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: Consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Clin Periodontol. 2018;45 Suppl 20:S68-S77.
18. Cobb CM. Non-surgical pocket therapy: mechanical. Ann Periodontol. 1996;1(1):443-90.
19. Morrison EC, Ramfjord SP, Hill RW. Short-term effects of initial, nonsurgical periodontal treatment (hygienic phase). J Clin Periodontol. 1980;7(3):199-211.
20. Preshaw PM, Kupp L, Hefti AF, Mariotti A. Measurement of clinical attachment levels using a constantforce periodontal probe modified to detect the cementoenamel junction. J Clin Periodontol. 1999;26(7):434-40.
21. Meseli SE, Kuru B, Kuru L. Relationships between initial probing depth and changes in the clinical parameters following non-surgical periodontal treatment in chronic periodontitis. J Istanb Univ Fac Dent. 2017;51(3):11-7.
22. Apatzidou DA, Kinane DF. Quadrant root planing versus same-day full-mouth root planing. I. Clinical findings. J Clin Periodontol. 2004;31(2):132-40.
23. Werner N, Heck K, Walter E, Ern C, Bumm CV, Folwaczny M. Probing pocket depth reduction after nonsurgical periodontal therapy: Tooth-related factors. J Periodontol. 2024;95(1):29-39.
24. Jiao J, Shi D, Cao ZQ, Meng HX, Lu RF, Zhang L, et al. Effectiveness of non-surgical periodontal therapy in a large Chinese population with chronic periodontitis. J Clin Periodontol. 2017;44(1):42-50.
25. Angst PD, Piccinin FB, Oppermann RV, Marcantonio RA, Gomes SC. Response of molars and non-molars to a strict supragingival control in periodontal patients. Braz Oral Res. 2013;27(1):55-60.
26. P MK, Nagate RR, Chaturvedi S, Al-Ahmari MMM, Al-Qarni MA, Gokhale ST, et al. Importance of periodontal phenotype in periodontics and restorative dentistry: a systematic review. BMC Oral Health. 2024;24(1):41.