Periodontal attachment loss induced by mechanical subgingival instrumentation in shallow sulci

Among the many important outcomes of the 1985 National Institute of Dental Research (NIDR) workshop on professionally administered oral hygiene procedures, were the conclusions that professional treatment (including scaling and root planing) in shallow sulci resulted in permanent loss of attachment, and that regular instrumentation should not be carried out at periodontal disease-free sites. The purpose of this paper is to examine studies related to the periodontal outcome of subgingival instrumentation in shallow sulci.

Literature published between 1982 and 2000 was searched, using the Medline database, for original research papers and review articles that focused on an association between subgingival instrumentation in shallow sites and periodontal attachment loss. References cited in key papers were manually traced when not acquired otherwise.

Thirteen clinical studies--12 human and 1 animal--ranging in length from 6 months to 5 years, were selected for review. Periodontal attachment loss in shallow sulci (< 4.0 mm) in subjects with periodontitis was assessed as a result of manual and/or ultrasonic supra- and subgingival instrumentation. Following multiple episodes of subgingival instrumentation, probing attachment loss ranging from 0.28 mm to > or = 1.5 mm has been documented, and losses ranging from a "minor apical shift" to > 2.0 mm have been reported following a single episode of subgingival instrumentation.

Such findings suggest important implications for the dental hygiene clinical management and maintenance of periodontally healthy patients with shallow sulci, and warrant further study.