S3 guideline – Subgingival instrumentation

In collaboration with the German Society for Periodontology (DGParo), in October 2019 the German Society for Dental, Oral and Maxillary Medicine (DGZMK) published a new S3 guideline on the topic of ‘Subgingival instrumentation’, which is now valid for five years. This new guideline primarily focuses on the following two main topics:

Based on a comprehensive literature search and statistical analysis, the guideline’s authors issued the following recommendations:

1. Instruments – laser instruments versus conventional instruments
Subgingival instrumentation using an Erbium-YAG laser may be considered. However, subgingival instrumentation using an Erbium-YAG laser instead of conventional hand and/or (ultra)sonic instruments does not lead to a significant improvement in the clinical effectiveness of subgingival instrumentation.

2. Non-antibiotic adjuvants
a. Adjuvant use of lasers
In the context of primary therapy, a single laser application should not be used as an adjunct to subgingival instrumentation. A single adjuvant laser application does not result in a significant improvement in the clinical effectiveness of subgingival instrumentation. The value of a repeated application of laser therapy over a longer period of time was not systemically researched in the context of this guideline.

b. Adjuvant photodynamic therapy
In the context of primary therapy, a single application of photodynamic therapy should not be used as an adjunct to subgingival instrumentation. Based on meta-analysis, a single adjuvant application of photodynamic therapy has a small positive effect (0.21 mm additional reduction in probing pocket depth). The value of a repeated application of photodynamic therapy over a longer period of time was not systemically researched in the context of this guideline.

c. Use of antiseptics in subgingival instrumentation
Adjuvant subgingival application of chlorhexidine (0.12%) or PVP iodine mouth rinses, chlorhexidine gel or chlorhexidine chips should not be used at the time of subgingival instrumentation. The adjuvant use of pocket irrigation with 0.12% chlorhexidine or PVP iodine or the application of chlorhexidine gel or a chlorhexidine chip at the time of subgingival instrumentation does not result in a significant improvement in clinical effectiveness.

d. Adjuvant use of antiseptics in full-mouth disinfection
As part of a full-mouth disinfection as proposed by Quirynen, chlorhexidine preparations should not be used an adjunct to subgingival instrumentation. Compared with conventional full-mouth scaling, the adjuvant use of chlorhexidine in a full-mouth disinfection as proposed by Quirynen does not lead to a significant improvement in the clinical effectiveness of subgingival instrumentation.

e. Adjuvant use of probiotics
The studies on this topic are characterized by extremely heterogeneous results, the micro-organisms used, high confidence intervals, small case numbers and, in some studies, by a greatly elevated risk of bias. Based on the currently available evidence, it is therefore not possible to give a final recommendation regarding the benefit of adjuvant use of probiotics.

The wording of the recommendations has been taken directly from the guideline.

Tip – previous reports on DGZMK guidelines!