Abstract
BACKGROUND:
A
panel of experts convened by the American Dental Association Council on
Scientific Affairs presents an evidence-based clinical practice
guideline on nonsurgical treatment of patients with chronic
periodontitis by means of scaling and root planing (SRP) with or without
adjuncts.
METHODS:
The
authors developed this clinical practice guideline according to the
American Dental Association's evidence-based guideline development
methodology. This guideline is founded on a systematic review of the
evidence that included 72 research articles providing clinical
attachment level data on trials of at least 6 months' duration and
published in English through July 2014. The strength of each
recommendation (strong, in favor, weak, expert opinion for, expert
opinion against, and against) is based on an assessment of the level of
certainty in the evidence for the treatment's benefit in combination
with an assessment of the balance between the magnitude of the benefit
and the potential for adverse effects.
PRACTICAL IMPLICATIONS AND CONCLUSIONS:
For
patients with chronic periodontitis, SRP showed a moderate benefit, and
the benefits were judged to outweigh potential adverse effects. The
authors voted in favor of SRP as the initial nonsurgical treatment for
chronic periodontitis. Although systemic subantimicrobial-dose
doxycycline and systemic antimicrobials showed similar magnitudes of
benefits as adjunctive therapies to SRP, they were recommended at
different strengths (in favor for systemic subantimicrobial-dose
doxycycline and weak for systemic antimicrobials) because of the higher
potential for adverse effects with higher doses of antimicrobials. The
strengths of 2 other recommendations are weak: chlorhexidine chips and
photodynamic therapy with a diode laser. Recommendations for the other
local antimicrobials (doxycycline hyclate gel and minocycline
microspheres) were expert opinion for. Recommendations for the
nonsurgical use of other lasers as SRP adjuncts were limited to expert
opinion against because there was uncertainty regarding their clinical
benefits and benefit-to-adverse effects balance. Note that expert
opinion for does not imply endorsement but instead signifies that
evidence is lacking and the level of certainty in the evidence is low.
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