J Clin Periodontol 2014; 41: 157163 doi: 10.1111/jcpe.

12199

One-stage full-mouth disinfection

combined with a periodontal
dressing: a randomized
controlled clinical trial

Johan A. J. Keestra1, Wim Coucke2

and Marc Quirynen1
1

Department of Periodontology, School of

Dentistry, Oral Pathology & Maxillo-facial
Surgery, Faculty of Medicine, Catholic
University Leuven, Leuven, Belgium;
2
Department of Clinical Biology, Scientific
Institute of Public Health, Brussels, Belgium

Keestra JAJ, Coucke W, Quirynen M. One-stage full-mouth disinfection combined

with a periodontal dressing: a randomized controlled clinical trial. J Clin
Periodontol 2014; 41: 157163. doi: 10.1111/jcpe.12199.

Abstract
Aim: To compare the clinical benefit of a periodontal dressing applied after a
one-stage full-mouth disinfection (OSFMD) in patients with chronic periodontitis
up to 3 months after therapy.
Material and Methods: This randomized, controlled split-mouth study included
24 patients. After OSFMD, a test and a control side were selected by means of a
computer-generated randomization list. Test sides received a periodontal dressing
(Coepak) for 7 days and the control sides received no periodontal dressing.
After 7 days the periodontal dressing was removed and the pain experience was
recorded. After 3 months, the clinical periodontal parameters were recorded.
Results: The periodontal dressing group showed a significant (p < 0.05) additional pocket depth reduction and additional clinical attachment gain for the
moderate pockets of single- and multi-rooted teeth compared with the control
group. A significant (p < 0.05) lower percentage of sites with probing pocket
depth 5 mm were shown for the periodontal dressing group compared with the
control group (2.7  16.3% versus 4.8  21.4%). The pain intensity was significantly reduced when using a periodontal dressing (5.13  0.89 versus
3.42  1.27).
Conclusion: The use of a periodontal dressing for 7 days after a OSFMD offers
an additional short-term clinical improvement and lowers the pain intensity.

Periodontitis is an inflammatory disease that results in the destruction of

the teeth-supporting tissues. It is a
result of an imbalance between the
wide range of microorganisms, the
host response and some essential
Conflict of interest and source of
funding statement
This article has been prepared without
any sources of institutional, private or
corporate financial support, and there
are no potential conflicts of interest.

modifying factors (Socransky & Haffajee 1992). The primary clinical signs
are bleeding on probing (BOP),
pocket formation (PPD), gingival
recession (REC) and at a later stage
increased tooth mobility. The goals of
treatment are to reduce the infection,
resolve inflammation and create a
clinical condition, which is compatible with periodontal health (Lang &
Tonetti 2003).
It has been shown that non-surgical periodontal therapy, consisting
of scaling and root planing, results

2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

Key words: chronic periodontitis; full-mouth

disinfection; non-surgical therapy; periodontal
dressing
Accepted for publication 17 November 2013

in clinical improvements (Badersten

et al. 1981). This is usually done in a
quadrant wise approach (QSRP). In
1995 Quirynen and co-workers
introduced the one-stage full-mouth
disinfection (OSFMD). With this
procedure scaling and root planing
was performed in two sessions
within 24 h and was supplemented
with supra- and subgingival use of
chlorhexidine (Quirynen et al. 1995,
2006, Mongardini et al. 1999).
Periodontal dressings were introduced in 1923 in order to protect

157

158

Keestra et al.

wounds after periodontal surgery

(Ward 1923). Nowadays, it is still
used after resective periodontal
surgery as well as after recession
coverage. The periodontal dressing
protects the tissue and keeps the tissue in close contact with the teeth. It
stabilizes the coagulum and protects
it from different forces during talking and eating (Wikesj
o et al. 1992).
Wound healing is a complex process involving different phases such
as; homeostasis phase, inflammatory
phase, proliferation and remodelling
phase (Stadelmann et al. 1998). The
first and most important step is the
formation of a fibrin clot. This clot
will protect the wound and attract
inflammatory cells. When a tissue is
wounded, platelets start to release
inflammatory factors, cytokines and
growth factors to facilitate the healing (Barrientos et al. 2008). When all
the steps are successfully accomplished, the healing will result in
reduction of the swelling, recession
of the gingival margin due to resolution of inflammation and formation
of long junctional epithelium.
Sigusch et al. (2005) introduced
the use of a periodontal dressing as
an adjunctive tool for the treatment
of patients with aggressive periodontitis. The group with the periodontal
dressing applied for 7 days showed a
significant pocket reduction and clinical attachment gain compared with
the control group. Genovesi et al.
(2012) applied a periodontal dressing
for 7 days after non-surgical therapy
for the treatment of patients with
moderate-to-advanced periodontitis.
The results were similar to the
results of Sigusch et al. (2005).
The aim of this randomized clinical
trial was to evaluate, in a splitmouth design, the effect of a periodontal dressing applied for 7 days
after OSFMD.
Material and Methods

This study was designed as a randomized-controlled split-mouth trial

to compare the clinical effects of two
different periodontal treatments,
OSFMD alone or combined with a
periodontal dressing for 7 days with
a 3 months follow-up period. The
ethical committee at the University
Hospital Leuven approved the protocol. All participants had to sign an
informed consent before entering the

Fig. 1. Study design.

study. The study started in September 2010 and ended in June 2012.
Twenty-six
volunteers
were
selected for this prospective study
(Fig. 1). All patients consulted or
were referred to the Department of
Periodontology of the University
Hospitals Leuven for the treatment of
chronic periodontitis. The general
health of all the patients was good.
The following inclusion/exclusion criteria had to be fulfilled:

Inclusion criteria

Age between 30 and 75 years.

A minimum of 18 teeth, wisdom
teeth excluded.
Previously untreated moderate
chronic periodontitis (Armitage
1999) with radiographic evidence
of generalized alveolar bone loss
>30%.
Presence of at least one pocket
with probing pocket depth (PPD)
6 mm per quadrant, which was
BOP.
Presence of at least three teeth
per quadrant.

Exclusion criteria

Periodontal treatment in the last

3 years.
Antibiotic intake 6 months before
the screening visit.
Pregnancy.
Systemic diseases with an impact
on periodontal healing (e.g. Diabetes).

The purpose of the study was

explained to the patients who met the
inclusion criteria and they were asked
to participate by signing an informed
consent form. The following clinical
parameters (in sequential order) were
recorded by only one trained and calibrated periodontist (J.K.).

The plaque score (PS) was

detected visually or with the
probe at 4 sites per tooth (mesial,
distal, buccal and lingual); the
scores ranged from 0 (absent) to
1 (present) (OLeary et al. 1972).
The PPD was recorded to the
nearest 0.5 mm at six sites per
single-rooted teeth and ten sites
for multi-rooted teeth.
The amount of gingival recession
(REC, the distance from the cemento-enamel junction to the
gingival margin) was measured to
the nearest 0.5 mm at the same
sites as the PPD.
The BOP was evaluated 30 s
after probing in the depth of the
pockets at four sites per tooth
(mesial, distal, buccal and lingual); the scores ranged from 0
(absent) to 1 (present).
The clinical attachment level
(CAL) was calculated for each site
as the sum of the PPD and the
REC.

These variables were recorded

using the Merritt B probe (Hu-Friedy, Chicago, IL, USA).
After the clinical examination,
oral hygiene instructions were given
(the modified-Bass technique, interdental cleaning and tongue scraping
in the case of tongue coating). After
1 or 2 weeks OSFMD was performed by one periodontist (J.K.).
Scaling and root planing using ultrasonic and hand instruments was performed in two sessions within 24 h
and was supplemented with:

Tongue brushing (by the patient)

for 60 s with chlorhexidine 1% gel.
Rinsing twice with a chlorhexidine 0.12% solution for 1 min.
Spraying the pharynx with a
0.12% chlorhexidine spray.
Subgingival irrigation of all the
pockets three times within

2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

159

Full-mouth disinfection with periodontal dressing

10 min. with the chlorhexidine
1% gel using a syringe (the tip of
the needle was blunted so that
the resistance offered by the bottom of the pocket could be felt).

difference between the two treatments. Treatment was used as a

fixed factor. Position, tooth number
and patient were used as nested random factors. Normal quantile plots
and residual dot plots were used to
assess the normality and variability
distribution of the data and did not
indicate any deviation from the basic
assumptions.
Significance
was
determined by using an a of 0.05;
p-values lower than 0.05 were
considered significant. S-Plus 7 (Tibco, Palo Alto, CA, USA) was used
for the statistical analyses.

pared with the control group the test

group showed a significant reduction
of the pain intensity, which was 1.71
(p < 0.0001).
The mean values for PPD, REC
and CAL are presented in Table 2.
The control group showed a significant reduction of the PPD with
1.20 mm (p = 0.0001) and CAL with
0.74 mm (p = 0.0001) compared to
the baseline. The test group also
showed a significant reduction of the
PPD with 1.49 mm (p = 0.0001) and
CAL with 1.01 mm (p = 0.0001)
compared to the baseline. The test
group showed a significantly higher
reduction of the PPD with 0.29
(p < 0.0001) mm and CAL with
0.26 mm (p < 0.0001). The control
group showed a significant increase
of
the
REC
with
0.45 mm
(p = 0.0001) compared to the baseline. The test group also showed a
significant increase of the REC with
0.48 mm (p = 0.0001) compared to
the baseline. The test group showed
no significant difference of the REC.
Those three clinical parameters were
also divided into moderate pockets
(46 mm) and deep pockets (>6 mm).
The control group showed a significant reduction of the PPD of the
moderate pockets with 1.87 mm
(p = 0.0018) and for the deep pockets
3.27 mm (p = 0.0018). The significant
reduction was also seen for the CAL
of the moderate pockets with
1.20 mm (p = 0.0018) and for the
deep pockets 1.83 mm (p = 0.0018)
compared to the baseline. The test
group also showed a significant
reduction of the PPD of the moderate
pockets with 2.20 mm (p = 0.0018)
and for the deep pockets 3.56 mm
(p = 0.0018). Again the significant
reduction was also seen for the CAL
of the moderate pockets with
1.53 mm (p = 0.0018) and for the
deep
pockets
2.10 mm
(p =

Additionally, the patients had to

rinse twice daily for 1 min. with a
0.12% chlorhexidine solution for
2 months (Quirynen et al. 1995,
2006, Mongardini et al. 1999).
The first treatment was started at
the right side (first and fourth quadrant). At the end of the first treatment, a test and control side was
selected by means of a computergenerated randomization list. If the
first quadrant was selected as the test
side, the third quadrant was selected
after the second treatment as the test
side. Hereby, the periodontal dressing
was always placed in one upper and
one lower quadrant. The operator
(J.K.) mixed the periodontal dressing
(Coepak, Alsip, IL, USA) according
to the manufacturers instructions.
The oral hygiene instructions were
given and each patient had to avoid
brushing the periodontal dressing
area as long as the periodontal dressing was in place.
After 1 week, the periodontal
dressing was removed from the test
sides and oral hygiene instructions
were repeated, identical to the first
time. The patients had to compare
the difference between the sides with
the periodontal dressing and the
sides without the periodontal dressing. During this appointment the
patients had to fill out a pain intensity scale on a scale from 0 to 10
(0 = no pain, 5 = moderate pain and
10 = worst imaginable pain) and the
amount of pain medication was
recorded. After 3 months, all clinical
examinations were recorded by only
one trained and calibrated periodontist (J.K.).

Twenty-six patients passed the inclusion / exclusion criteria. Two

patients were excluded because they
did not show up at the final appointment after 3 months. Finally, a total
of twenty-four patients were statistically analysed. Table 1 presents the
demographic characteristics. All
patients belonged to the Caucasian
race with an average age of 48.3
(range 3364 years). The total number of teeth and mean percentage of
sites (with PPD < 4 mm, PPD
46 mm and PPD > 6 mm) were
equally distributed.
The mean values for PS and BOP
are presented in Table 2. The control
group showed a significant reduction
of the PS with 37% (p = 0.0001) and
BOP with 39% (p = 0.0001) compared to the baseline. The test group
also showed a significant reduction of
the PS with 48% (p = 0.0001) and
BOP with 51% (p = 0.0001) compared to the baseline. The test group
showed a significantly higher reduction of the PS with 11% (p < 0.0001)
and BOP with 12% (p < 0.0001).
The pain sensation was measured
7 days after OSFMD, the results are
presented in Table 2. When com-

Statistical analyses

Table 1. Demographic characteristics and mean  SD full-mouth clinical parameters

A power analysis was carried out.

Based on these calculations, it was
defined that 22 patients would be
necessary. Considering a drop out of
about 15%, it was established that
at least 25 patients were needed. The
concordance correlation coefficient
was used to quantify the degree of
agreement or congruence between
two measurements. Linear mixed
models were fit to assess the

Results

Variable
Gender (male/female)
Age (years)
Smokers (n)
Total tooth (n)
Multi rooted (n)
Single-rooted (n)
Mean % (number) of sites with
PPD <4 mm
PPD 46 mm
PPD >6 mm

2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

Control

Test

13/11
48.4  9.2
0
304
79
225

13/11
48.4  9.2
0
303
79
224

57.4  49.5
36.1  48
6.5  24.7

54.9  48.8
37.4  48.4
7.8  26.8

BOP, bleeding on probing; CAL, clinical attachment level; PPD, probing pocket depth; PS, plaque score; REC, gingival recession; SE, standard error; SD, standard deviation.

0.4000
0.12
0.0018
7.71

1.00

5.93

1.19

1.83

0.13

0.0018

7.72

1.22

5.78

1.37

2.10

0.13

0.27

>0.9999
<0.0001
<0.0001
0.13
0.03
0.04
0.0018
0.0001
0.0018
0.76
1.76
1.04
0.24
3.94
5.03

1.62
3.21
3.84

1.17
1.44
1.16

1.43
0.74
1.20

0.13
0.07
0.07

0.0018
0.0001
0.0018

0.26
4.03
5.02

0.80
1.81
0.96

1.76
3.03
3.46

1.03
1.46
1.07

1.44
1.01
1.53

0.13
0.07
0.07

0.01
0.26
0.33

0.6032
0.4011
>0.9999
0.15
0.03
0.04
0.0018
0.0001
0.0018
0.16
0.05
0.06
1.20
1.02
0.92
4.01
0.81
0.89
0.96
0.85
0.71
7.46
0.33
0.23
0.0018
0.0001
0.0018
0.16
0.05
0.06
3.27
0.45
0.67
1.29
1.03
1.04
0.73
0.84
0.77
7.47
0.33
0.25

4.31
0.78
0.90

0.0001
0.0018
0.08
0.07
1.20
1.87
1.03
0.84
2.43
2.94

3.56
0.48
0.66

0.0001
0.0018
2.22
2.57

0.95
0.69

1.49
2.20

0.08
0.07

0.30
0.03
0.01

<0.0001
<0.0001
<0.0001
<0.0001
<0.0001
2.22
2.11
0.19
0.05
0.05
0.0001
0.0001
43.4
42.9
47.2
47.4

45.5
44.8
0.89
1.64
0.72

33.4
34.0

37.4
38.5

2.47
3.01

0.0001
0.0001

73.0
74.3
3.42
3.69
4.79

44.4
43.7
1.27
1.72
0.74

25.1
24.3

SD
SD
p value
SE
SD
SD

70.8
72.2
5.13
3.62
4.79

PS (% of sites)
BOP (% of sites)
Pain intensity
PPD (mm)
PPD moderate pockets
(46 mm)
PPD deep pockets (>6 mm)
REC (mm)
REC moderate pockets
(46 mm)
REC deep pockets (>6 mm)
CAL (mm)
CAL moderate pockets
(46 mm)
CAL deep pockets (>6 mm)

Variable

Baseline
control

3 months
control

Change control

Baseline test

3 months test

48.2
50.6

2.48
3.01

10.8
12.1
1.71
0.29
0.32

p value
SE
p value
SE

Change test

Inter group comparison

at 3 months

Keestra et al.

Table 2. Outcome variables for single and multi-rooted teeth together

160

Table 3. Number and percentage of subjects presenting low [14 sites with probing
pocket depth (PPD) 5 mm], moderate risk
(58 sites with PPD 5 mm) or high (9
sites with PPD 5 mm) risk for disease progression according to Lang & Tonetti (2003)
Categories

Control
(%)

Test (%)

p value

Low risk
Moderate
risk
High risk

10 (41.7)
5 (20.8)

16 (66.7)
5 (20.8)

0.0422
>0.9999

9 (37.5)

3 (12.5)

<0.0001

0.0018) compared to the baseline. The

test group showed a significantly
higher reduction of the PPD of the
moderate pockets with 0.32 mm
(p < 0.0001) and for the CAL of the
moderate
pockets
0.33 mm
(p < 0.0001). The deep pockets of the
test group showed no significantly
higher reduction of the PPD with
0.30 mm and for the CAL 0.27 mm
compared with the control group.
The control group showed a significant increase of the REC of the moderate
pockets
with
0.67 mm
(p = 0.0018) and for the deep pockets
1.43 mm (p = 0.0018) compared to
the baseline. The test group also
showed a significant increase of the
REC of the moderate pockets with
0.66 mm (p = 0.0018) and for the
deep pockets 1.44 mm (p = 0.0018)
compared to the baseline. The test
group showed no significant difference of the REC of moderate pockets
or deep pockets. Additionally the outcome variables for single-rooted teeth
(Table S1) and for multi-rooted teeth
(Table S2) are available online.
The data for the residual sites at
subject level are presented in
Table 3. It presents numbers and
percentage of subjects exhibiting different thresholds of residual sites
with PPD 5 mm according to the
individual risk profile for periodontal disease progression introduced by
Lang & Tonetti (2003). The test
group showed fewer subjects (n = 3)
for high risk of disease progression
(9 with PPD 5 mm), in comparison with the control group (n = 9).
Conversely, the test group showed
more subjects (n = 16) for low risk
of disease progression (14 sites with
PPD 5 mm), in comparison with
the control group (n = 10).
Table 4 presents the mean percentage of sites with PPD 5 mm,
PPD 6 mm and PPD 7 mm after

2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

Full-mouth disinfection with periodontal dressing

Table 4. Mean number (mean percentage)  SD of sites with probing pocket depth (PPD)
5 mm, as well as sites with PPD 6 mm and 7 mm at 3 months
PPD category threshold
PPD 5 mm
PPD 6 mm
PPD 7 mm

Control

Test

p value

4.8  21.3
1.2  10.9
0.4  6.2

2.7  16.3
0.7  8.2
0.2  4.9

<0.0001
0.0066
0.0333

3 months. The test group had

significant less percentage of sites
with PPD 5 mm (2.7% versus
4.8%, p < 0.0001), PPD 6 mm
(0.7% versus 1.2%, p = 0.0066) and
PPD 7 mm (0.2% versus 0.4%,
p = 0.0333) compared with control
group.
Discussion

This randomized controlled clinical

trial demonstrated that the application of a periodontal dressing after
OSFMD for 7 days resulted in
significant clinical improvements
compared to OSFMD without periodontal dressing.
For the teeth with moderate pockets the results with the periodontal
dressing group showed a significant
additional pocket depth reduction
and a clinical additional attachment
gain compared to OSFMD. In contrast, the results for the teeth with
deep pockets showed no significant
additional pocket depth reduction
nor additional clinical attachment
gain although there could be a tendency that this effect occur. These
non-significant results could be
explained because there were not
enough deep pockets present in the
study population. Hung had systematically assessed the effect of nonsurgical therapy. The periodontal
dressing group showed higher results
compared to the systematic review
(Hung & Douglass 2002). For the moderate pockets the results showed a
pocket depth reduction of 1.02 mm versus 2.20 mm and a clinical attachment
gain of 0.53 mm versus 1.53 mm. The
deep pockets showed a pocket depth
reduction of 1.98 mm versus 3.56 mm
and a clinical attachment gain of
1.14 mmversus2.10 mm.
The same results were seen for
the single and multi-rooted teeth.
For the teeth with moderate pockets
the results with the periodontal
dressing group showed a significant
additional pocket depth reduction
and a significant additional clinical

attachment gain compared to

OSFMD. In contrast the results for
the teeth with deep pockets showed
no significant additional pocket
depth reduction nor additional clinical attachment gain albeit there
could be a tendency that this effect
occur. These non-significant results
could be explained because there
were not enough deep pockets present in the study population.
Residual pockets are important
to evaluate the success of the periodontal treatment or to decide if
additional periodontal surgery is
needed. Mostly, when residual pockets of 5 mm or higher are present
after non-surgical therapy, periodontal surgery may be necessary. The
periodontal dressing group showed a
significant lower percentage of sites
with PPD 5 mm compared with the
control group. Less sites of the periodontal dressing group could needed
periodontal surgery.
The presence of residual pockets
(5 mm) after periodontal surgery is
one of the most important risk indicator for recurrence of periodontitis
in maintenance patients (Lang &
Tonetti 2003). The periodontal dressing group presented significant lower
mean number/percentage of the low
risk
group
(14
sites
with
PPD 5 mm) after 3 months compared with the control group. The
control group was able to bring
41.7% patients to a low risk profile
and the periodontal dressing group
was able to bring 66.7% patients to
a low risk profile.
The present analysis showed the
additional benefit of using a periodontal dressing combined with
OSFMD in a short-term basis. The
periodontal dressing might well
accelerate the healing instead of
improving it. This additional result
could be disappearing in a few
months or stay stable over time. Sigusch et al. (2005) showed that the
result of the periodontal dressing
group remained stable in the next
24 months.

2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

161

A potential limitation of the present analysis is the lack of blindness

since operator and examiner were
the same. This lack of blindness
could possibly affect the final outcome. The examiner might have
remembered which sides were treated
with periodontal dressing. However,
it is entirely possible that, over the
course of 3 months, the examiner
could have forgotten.
Pain is a common problem after
non-surgical therapy. Pain varies
over time. It is not felt in a constant
intensity (Boormans et al. 2009).
It is thus difficult for patients to
summarize their differing pain levels
with a single number. This is a disadvantage when using the numeric
rating scale (Kahneman et al. 1993).
The control group showed a 5.1 on
the pain intensity scale, according to
the numeric rating scale moderate
pain. The periodontal dressing group
had 3.4 on the pain intensity scale
which is mild pain. This was significantly lower than the control group.
Is this clinically relevant compared
to the possible side effects? In the
beginning, chewing and speaking are
difficult. If the periodontal dressing
is placed with great pressure it could
cause impaired healing or swelling.
After several days, it could create an
unpleasant taste, odour and colour.
It is very important that the patient
is well informed about the usage of
periodontal dressing.
The amount of plaque is critical
for the success of periodontal treatment. A PS of less than 11% for the
periodontal dressing sides could be
the cause because of the additional
results. A level of plaque has not yet
been established that results in periodontal health. A full-mouth PS of
2040% might be tolerable by most
patients. (Axelsson et al. 2004) It is
important to realize that the PS has
to be related to the host response
(Van Dyke & Serhan 2003). In a
split-mouth design it would be
expected that the oral hygiene would
be the same but it was interesting to
see that the PS differs between test
en control sides. The lower PS could
be the explanation for the additional
result on the periodontal dressing
sides but it does not explain why
there is less plaque present.
When the gingiva is damaged
after non-surgical therapy wounds
can form. Healing after non-surgical

162

Keestra et al.

therapy occurs because existing tissues repair themselves. In a couple

of seconds the homeostasis process
starts, forming a blood clot. The
blood clot has three main functions:
protection denuded tissue, provisional matrix for cell migration and
reservoir of growth factors and cytokines (Stadelmann et al. 1998). During this coagulation process, some
products act as chemotactic agents
attracting phagocytic cells to the
inflammation side. The platelets produce some proteins that could be
antimicrobial, for example, betalysine which causes lysis of Grampositive bacteria (Yeaman 2010).
The platelets also produce growth
factors and cytokines that stimulate
the wound healing (Barrientos et al.
2008). When all the steps are successfully accomplished, the healing
will result in reduction of the swelling, recession of the gingival margin
due to resolution of inflammation
and formation of long junctional
epithelium. The saliva and the movements of the cheeks are probably the
main cause that only a small portion
of the blood remains present. When
the periodontal dressing is applied at
the wound, the blood clot is more
protected, the gingiva is more stabilized, more portion of the blood clot
might be present and the gingiva will
adhere more closely to the tooth.
This may be the reason for the better clinical outcomes and the reduction of pain after non-surgical
therapy.
A few studies have investigated
the possible antimicrobial effect of
the periodontal dressing (ONeil
1975, Haugen et al. 1977, Cheshire
et al. 1996). The periodontal dressing that was used consisted of zinc
oxide non-eugenol. The reaction is
based on a metallic oxide and fatty
acids. According to the information
from the manufacturer two possible
anti-infective ingredients were visible,
lorothidol (fungicide) and chlorothymol (antibacterial). No anti-inflammatory ingredients were observed.
So far, there is no study available
that can actually prove whether
these ingredients have an effect on
the plaque accumulation. ONeil stated in 1975 that the use of an antimicrobial agent is not necessary in
the periodontal dressing because it
forms a physical barrier to saliva,
bacterial contamination and food

impaction. Further research is

needed to prove if periodontal dressing has some anti-infective effect.
Our data are in agreement with
two other studies. Sigusch et al.
(2005) introduced the use of a periodontal dressing as an adjunctive
tool in the treatment of patients with
aggressive periodontitis. The patients
were treated with non-surgical therapy, systemic antibiotics (Metronidazole 500 mg b.i.d. for 8 days) and
periodontal dressing. Three treatment groups were used; in group 1
the periodontal dressing was removed after 34 days, in group 2 the
periodontal dressing was removed
after 78 days and the control
group. The non-surgical therapy
consisted of two parts, part one scaling and root planing in 34 sessions
and part two manual root curettage
in one session. The usage of chlorhexidine was not mentioned. After
6 months group 1 showed an additional pocket depth reduction of
0.7 mm and also an additional probing attachment gain of 0.7 mm compared with the control group. Group
2 showed an additional pocket depth
reduction of 1.8 mm and also an
additional probing attachment gain
of 1.8 mm. Genovesi et al. (2012)
used a periodontal dressing for
7 days during the non-surgical
treatment of patients with moderateto-advanced periodontitis in a splitmouth design. The patients were
treated with a full-mouth scaling and
root planing within 24 h and this
was followed by curettage of the epithelium. Also here, the usage of
chlorhexidine was again not mentioned. After 2 months, the periodontal dressing group showed an
additional pocket depth reduction of
0.8 mm compared with the control
group. The additional probing
attachment gain for the periodontal
dressing group was 1.1 mm compared with the control group.
The results of this randomized
clinical trial show the additional
effects that a periodontal dressing has
when it is combined with OSFMD.
The additional effects of the periodontal dressing could be explained
by: protection of the wound, stabilization of the tissues, availability of
the blood clot and maybe some antimicrobial effects of the periodontal
dressing. Within the limitations of
this study a periodontal dressing has

additional benefits that are statistically significant for the moderate

pockets. It is important to mention
that periodontal dressing causes less
pain after OSFMD. To reduce the
pain a periodontal dressing could be
a good alternative to pain medication. Further randomized clinical trials are necessary to confirm this
result and this should be done with
more patients involved, as this may
lead to a significant effect in the
deep pockets as well.
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Clinical Relevance

Scientific rationale for the study:

Previous studies have suggested that
scaling and root planing combined
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Principal findings: Periodontal dressing applied after OSFMD showed

significant superior results in all clinical
parameters
compared
to
OSFMD alone after 3 months. The
results included a significant reduction of pain after OSFMD and
reducing the residual pockets up to
3 months post-treatment.

2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

163

Supporting Information

Additional Supporting Information

may be found in the online version
of this article:
Table S1. Outcome variables for
single-rooted teeth.
Table S2. Outcome variables for
multi-rooted teeth.
Address:
Johan A.J. Keestra
Department of Periodontology,
School of Dentistry, Oral
Pathology & Maxillo-facial Surgery, Faculty
of Medicine, Catholic University Leuven,
Kapucijnenvoer 33, B-3000 Leuven, Belgium.
E-mail: hanskeestra@gmail.com

Practical implications: Periodontal

dressing applied after OSFMD can
reduce the pain after OSFMD and
offers a clinical benefit for the
treatment of patients with chronic
periodontitis.