Effects of Mechanical versus Manual Non Surgical Periodontal Therapy on Patient Comfort and Periodontal Healing: A Randomized Controlled Clinical Trial

Abstract

Few studies have focused on the problem of pain and discomfort experienced during and after periodontal debridment. The aim of this study was to evaluate the effect of manual versus hand driven non surgical periodontal instrumentation on the patient's comfort, perception of pain and dental hypersensitivity during and after the instrumentation. Moreover, the influence of the treatment modality on the healing of slight to moderate periodontitis was assessed with careful attention to indices of periodontal inflammation. 22 subjects with a minimum of 4≥6mm periodontal pockets with 3 to 4mm attachment loss in different quadrants, the presence of ≥20 teeth with a minimum of four molars were enrolled. PD (probing depth, 6 sites per tooth), number of sites with PD> 6mm, buccal and lingual recessions were collected. Two quadrants Mouth Bleeding and Plaque Scores (T.M.P.S, T.M.B.S.) were assessed as the presence or absence of bleeding on probing and plaque following disclosing in quadrants 1–4 and 2–3. Non surgical periodontal treatment was delivered in two appointments performed within one week. In the first appointment the first and the fourth quadrants (patient's right side) were completely treated by mechanical or manual devices according to the randomization codes. In the second appointment the remaining two quadrants (patient's left side) were instrumented with the other therapeutical approach. The duration of each session, need for local anesthesia and additional information were recorded during the instrumentation appointments. All the patients were requested to fill in a form regarding pain, hypersensitivity, and need for painkillers following the two debridment appointments. Two drop outs were observed. Mean pain scores after treatment were higher in manual than in machine driven side (3.11±1.40 vs 2.33±1.41), whereas mean dentine hypersensitivity scores were slightly higher in mechanical side (4.40±1.56 vs 3.77±1.11). The need for painkillers after both treatment approaches was minimal. 6 out of 20 patients asked for local anesthesia and clustering regarding the request for both treated sides was observed. The mean instrumentation time was significantly lower for mechanical versus manual instrumentation (84.57±12.92 vs 119.25±13.50, p<0.001). Periodontal healing was similar in both the hand and machine driven instrumented sides. TMPS and TMBS were significantly lower at baseline compared to re-evaluation visits and the within group changes were significant lower at re-evaluation. Most of patients well tolerated non surgical periodontal treatment despite the type of instruments that are chosen by the clinician. Pain is infrequently reported and is more common after manual instrumentation compared to machine driven one. The need for local anesthesia is quite uncommon and is surely subject-dependent. Temporary, slight dentine hypersensitivity is a common adverse effect reported by most of patients after subgingival debridment. Machine driven debridment shows a dramatic advantage compared to manual treatment due to the lower amount of time needed to complete the instrumentation.