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Influence of operator skill level on the clinical outcome of non-surgical periodontal treatment: a retrospective study

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Abstract

Objectives

The aim of this study is to evaluate the effect of operators experience and skill on treatment results of initial non-surgical periodontal therapy.

Materials and methods

Initial periodontal treatment was carried out by either second-year periodontal residents (PR) or last year dental students (DS). From the treatment records of patients in each group, plaque and bleeding indices, and pocket depth (PD) at baseline and at re-evaluation were collected retrospectively on each tooth at six locations. Data were separated according to tooth type, area, and probing depth categories, sub-grouped to 1–3, 4–5, and ≥ 6 mm.

Results

Fifty and 49 records of DS and PR patients, accordingly, were analyzed. Initial periodontal treatment improved patient compliance in both groups and reduced signs of inflammation with significantly superior results in the PR group. Significant change in percentage of pockets was recorded in each category. The increase in percentage of sites with PD 1–3 mm and decrease in percentage of PD ≥ 6 mm pockets was significantly (p ≤ 0.001) superior in patients treated by PR. Percentage of 4–5 mm pockets was significantly reduced in both groups (p ≤ 0.01), with a significantly greater reduction in the mandibular molar and anterior teeth in the PR group.

Conclusions

Experience and skill significantly affect the outcome of non-surgical periodontal therapy, with more positive improvement in patient compliance and clinical parameters when performed by a more qualified operator.

Clinical relevance

Improvement of operator skills may decrease the number of residual pockets and increase patient compliance following non-surgical periodontal treatment.

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References

  1. Ishikawa I, Baehni P (2004) Nonsurgical periodontal therapy-where do we stand now? Periodontology 2000 36:4–14

    Article  Google Scholar 

  2. Wennstrom JL, Tomasi C (2015) Non-surgical therapy Clinical Periodontology and Implant Dentistry, Sixth Edition. Edited by Niklaus P. Lang and Jan Lindhe:. Published 2015 by John Wiley & Sons, Ltd 38 :749–764

  3. Claffey N, Polyzois I, Ziaka P (2004) An overview of nonsurgical and surgical therapy. Periodontology 2000 36:35–44

    Article  Google Scholar 

  4. Cercek JK, Kiger RD, Garrett S, Egelberg J (1983) Relative effects of plaque control and instrumentation on the clinical parameters of human periodontal disease. J Clin Periodontol 10:46–56

    Article  Google Scholar 

  5. Cobb CM (1996) Non-surgical pocket therapy. Ann Periodontol 1:443–490

    Article  Google Scholar 

  6. Haffajee AD, Cugini MA, Dibart S, Smith C, Kent RL Jr, Socransky SS (1997) The effect of SRP on the clinical and microbiological parameters of periodontal diseases. J Clin Periodontol 24:324–334

    Article  Google Scholar 

  7. Suvan JE (2005) Effectiveness of mechanical nonsurgical pocket therapy. Periodontology 2000 37:48–71

    Article  Google Scholar 

  8. Adriaens PA, Adriaens LM (2004) Effects of nonsurgical periodontal therapy on hard and soft tissues. Periodontology 2000 36:121–145

    Article  Google Scholar 

  9. Mousques T, Listgarten MA, Philips RW (1980) Effect of scaling and root planing on the composition of the human subgingival microbial flora. J Periodontal Res 15:144–151

    Article  Google Scholar 

  10. Loos B, Claffey N, Crigger M (1988) Effects of oral hygiene measurers on clinical and microbiological parameters of periodontal disease. J Clin Periodontol 18:211–216

    Article  Google Scholar 

  11. Umeda M, TakeuchiY NK, Huang Y, Koshy G, Ishikawa I (2004) Effect of nonsurgical periodontal therapy on the microbiota. Periodontology 2000 36:98–120

    Article  Google Scholar 

  12. Haffajee AD, Teles RP, Socransky SS (2006) The effect of periodontal therapy on the composition of the subgingival microbiota. Periodontology 2000 42:219–258

    Article  Google Scholar 

  13. Cobb CM (2002) Clinical significance of non-surgical periodontal therapy: an evidence-based perspective of scaling and root planing. J Clin Periodontol 29(suppl 2):6–16

    Google Scholar 

  14. van der Weijden GA, Timmerman MF (2002) A systematic review on the clinical efficacy of subgingival debridement in the treatment of chronic periodontitis. J Clin Periodontol 29(suppl 3):55–71

    Article  Google Scholar 

  15. Lindhe J, Nyman S (1984) Long-term maintenance of patients treated for advanced periodontal disease. J Clin Periodontol 11:504–511

    Article  Google Scholar 

  16. Kornman KS (1986) The role of supragingival plaque in the prevention and treatment of periodontal disease. A review of current concepts. J Periodontal Res 21:5–22

    Article  Google Scholar 

  17. Jin L, Wong KY, Leung WK, Corbet EF (2000) Comparison of treatment response patterns following scaling and root planing in smokers and non-smokers with untreated adult periodontitis. Journal of Clin Dent 11:35–41

    Google Scholar 

  18. Rabbani GM, Ash MM, Caffesse RG (1981) The effectiveness of subgingival scaling and root planing in calculus removal. J Periodontol 52:119–123

    Article  Google Scholar 

  19. Waerhaug J (1978a) Healing of dentoepithelial junction following subgingival plaque control. I. As observed in human biopsy material. J Periodontol 49:1–8

    Article  Google Scholar 

  20. Waerhaug J (1978b) Healing of dentoepithelial junction following subgingival plaque control. II. As observed on extracted teeth. J Periodontol 49:119–134

    Article  Google Scholar 

  21. Stambaugh RV, Dragoo M, Smith DM, Carasali L (1981) The limits of subgingival scaling. Int J Periodontics and Restorative Dent 1:30–41

    Google Scholar 

  22. Oda S, Nitta H, Setoguchi T, Izumi Y, Ishikawa I (2004) Current concepts and advances in manual and power-driven instrumentation. Periodontology 2000 36:45–58

    Article  Google Scholar 

  23. Kocher T, Ruehling A, Momsen H, Plagmann HC (1997) Effectiveness of subgingival instrumentation with power-driven instruments in the hands of experienced and inexperienced operators. A study on manikins. J Clin Periodontol 24:498–504

    Article  Google Scholar 

  24. Graetz C, Schwendicke F, Plaumann A, Rauschenbach S, Springer C, Kahl M, Sȁlzer S, Dörfer CE (2017) Subgingival instrumentation to remove simulated plaque in vitro: influence of operators’ experience and type of instrument. Clin Oral Invest 19:987–995

    Article  Google Scholar 

  25. Eaton KA, Kieser JB, Davis RM (1985) The removal of root surface deposits. J Clin Periodontol 12:141–152

    Article  Google Scholar 

  26. Brayer WK, Mellonig JT, Dunlap RM, Marinak KW, Carson RE (1989) Scaling and root planing effectiveness: the effect of root surface access and operator experience. J Periodontol 60:67–72

    Article  Google Scholar 

  27. Fleischer HC, Mellonig JT, Brayer WK, Gray JL, Barnett JD (1989) Scaling and root planing efficacy in multirooted teeth. J Periodontol 60:402–409

    Article  Google Scholar 

  28. Badersten A, Nilvéus R, Egelberg J (1985) Effect of non-surgical periodontal therapy (IV). Operator variability. J Clin Periodontol 12:190–200

    Article  Google Scholar 

  29. O'Leary TJ (1972) The plaque control record. J Periodontol 43:38–40

    Article  Google Scholar 

  30. Mühlemann HR, Son S (1971) Gingival sulcus bleeding—a leading symptom in initial gingivitis. Helvetica Odontologica Acta 15:107–113

    Google Scholar 

  31. Segelnick SL, Weinberg MA (2006) Reevaluation of initial therapy: when is the appropriate time? J Periodontol 77:1598–1601

    Article  Google Scholar 

  32. Magnusson I, Lindhe J, Yoneyama T, Liljenberg B (1984) Recolonization of a subgingival microbiota following scaling in deep pockets. J Clin Periodontol 11:193–207

    Article  Google Scholar 

  33. Axelsson P, Nystrom B, Lindhe J (2004) The long-term effect of a plaque control program on tooth mortality, caries and periodontal disease in adults. Results after 30 years of maintenance. J Clin Periodontol 31:749–757

    Article  Google Scholar 

  34. Axelsson P, Lindhe J (1981a) Effect of controlled oral hygiene procedures on caries and periodontal disease in adults. J Clin Periodontol 8:239–248

    Article  Google Scholar 

  35. Axelsson P, Lindhe J (1981b) The significance of maintenance care in the treatment of periodontal disease. J Clin Periodontol 8:281–294

    Article  Google Scholar 

  36. Bakdash B (1994) Oral hygiene compliance as risk factor in periodontitis. J Periodontol 65(suppl 5):539–544

    Article  Google Scholar 

  37. König J, Plagmann HC, Langenfeld N, Kocher T (2001) Retrospective comparison of clinical variables between compliant and non-compliant patients. J Clin Periodontol 28:227–232

    Article  Google Scholar 

  38. Wilson TG (1996) Compliance and its role in periodontal therapy. Periodontol 12:16–2338

    Article  Google Scholar 

  39. Wilson TG (1998) How patient compliance to suggested oral hygiene and maintenance affect periodontal therapy. Dent Clin N Am 42:389–403

    Google Scholar 

  40. Heasman P, Jacobs DJ, Chapple I (1989) An evaluation of the effectiveness and patient compliance with plaque control methods in the prevention of periodontal disease. Clin Prev Dent 11:24–28

    Google Scholar 

  41. Meitner SW, Zander HA, Iked HP, Polson AP (1979) Identification of inflamed gingival surfaces. J Clin Periodontol 6:93–97

    Article  Google Scholar 

  42. Polson AP, Caton JG (1985) Current diagnosis of bleeding in the diagnosis of periodontal diseases. J Periodontol 56(11 Suppl):1–3

    Article  Google Scholar 

  43. Lang NP, Adler R, Joss A, Nyman S (1990) Absence of bleeding on probing. An indicator of periodontal stability. J Clin Periodontol 17:714–721

    Article  Google Scholar 

  44. Sherman PR, Hutchens LH, Jewson LG (1990b) The effectiveness of subgingival scaling and root planing. II. Clinical responses related to residual calculus. J Periodontol 61(1):9–15

    Article  Google Scholar 

  45. Lang NP, Joss A, Tonetti MS (1996) Monitoring disease during supportive periodontal treatment by bleeding on probing. Periodontology 2000 12:44–55

    Article  Google Scholar 

  46. Armitage GC (1996) Manual periodontal probing in supportive periodontal treatment. Periodontology 2000 12:33–39

    Article  Google Scholar 

  47. Lindhe J, Nyman S, Karring T (1982a) Scaling and root planing in shallow pockets. J Clin Periodontol 9:415–418

    Article  Google Scholar 

  48. Lindhe J, Socransky SS, Nymann S, Haffajee A, Westfelt E (1982b) “Critical probing depths” in periodontal therapy. J Clin Periodontol 9:115–128

    Article  Google Scholar 

  49. Hallmon WW, Rees TD (2003) Local anti-infective therapy: mechanical and physical approaches. A systematic review. Ann Periodontol 8:99–114

    Article  Google Scholar 

  50. Lavanchy D, Bickel M, Baehni P (1987) The effect of plaque control after scaling and root planing on the subgingival microflora in human periodontitis. J Clin Periodontol 14:295–299

    Article  Google Scholar 

  51. Sbordone L, Ramaglia L, Guletta E, Iacono V (1990) Recolonization of the subgingival microflora after scaling and root planing in human periodontitis. J Periodontol 61:579–584

    Article  Google Scholar 

  52. Dahlén G, Lindhe J, Sato K, Hanamura H, Okamoto H (1992) The effect of supragingival plaque control on the subgingival microbiota in subjects with periodontal disease. J Clin Periodontol 19:802–809

    Article  Google Scholar 

  53. McNabb H, Mombelli A, Lang NP (1992) Supragingival cleaning three times a week: the microbiological effects in moderately deep pockets. J Clin Periodontol 19:348–356

    Article  Google Scholar 

  54. Hellström MK, Ramberg P, Krok L, Lindhe J (1996) The effect of supragingival plaque control on the subgingival microflora in human periodontitis. J Clin Periodontol 23:934–940

    Article  Google Scholar 

  55. Ramfjord SP, Morrison EC, Burgett FG, Nissle RR, Shick RA, Zann GJ, Knowles JW (1982) Oral hygiene and maintenance of periodontal support. J Periodontol 53:26–30

    Article  Google Scholar 

  56. Ramfjord SP (1987) Maintenance care for treated periodontitis patients. J Clin Periodontol 13:433–437

    Article  Google Scholar 

  57. Caffesse RG, Sweeney PL, Smith BA (1986) Scaling and root planing with and without periodontal flap surgery. J Clin Periodontol 13:205–210

    Article  Google Scholar 

  58. Kepic TJ, O’Leary TJ, Kafrawy AH (1990) Total calculus removal: an attainable objective. J Periodontol 61:16–20

    Article  Google Scholar 

  59. Buchanan SA, Robertson PA (1987) Calculus removal by scaling/root planing with and without surgical access. J Periodontol 58:159–163

    Article  Google Scholar 

  60. Sherman PR, Hutchens LH, Jewson LG, Moriarty JM, Greco GW, McFall WT (1990a) The effectiveness of subgingival scaling and root planing. I. Clinical detection of residual calculus. J Periodontol 61:3–8

    Article  Google Scholar 

  61. Greenstein G (1992) Periodontal response to mechanical non-surgical therapy: a review. J Periodontol 63:118–130

    Article  Google Scholar 

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Acknowledgements

The authors are grateful to Dr. Ronit Bar-Ness Greenstein (The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel) for helpful discussion and significant help in writing the manuscript.

Funding

The work was supported by the Department of Periodontology and Implant Dentistry, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.

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Authors and Affiliations

  1. Department of Periodontology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel

    Avital Kozlovsky & Zvi Artzi

  2. Private practise, Petach-Tiqua, Israel

    Alex Rapaport

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  1. Avital Kozlovsky
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Correspondence to Avital Kozlovsky.

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Conflict of interests

Author A: Avital Kozlovsky declares that she has no conflict of interests.

Author B: Alex Rapaport declares that he has no conflict of interests.

Author C: Zvi Artzi declares that he has no conflict of interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of institutional ethical committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, informed consent was obtained from all individual participants included in the study.

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Kozlovsky, A., Rapaport, A. & Artzi, Z. Influence of operator skill level on the clinical outcome of non-surgical periodontal treatment: a retrospective study. Clin Oral Invest 22, 2927–2932 (2018). https://doi.org/10.1007/s00784-018-2380-7

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  • DOI: https://doi.org/10.1007/s00784-018-2380-7

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