Subgingival irrigation--an adjunct to periodontal therapy. Current status and future directions

Science, in the search for truth, is dynamic and constantly changing. Periodically, an innovative idea such as subgingival irrigation emerges, which needs to be tested and retested. If the results are statistically and clinically meaningful, it then can be incorporated into treatment and maintenance regimes. This article addresses advantages and limitations of subgingival irrigation as it pertains to the treatment of patients with periodontitis. The subject is controversial, because while the role of supragingival irrigation is being recognized in the treatment of gingivitis, the status of subgingival irrigation in periodontitis therapy still needs further clarification. Four major themes are addressed within this text: (1) to explore the biologic rationale for subgingival irrigation, since treatment decisions must be based upon scientific data and not upon empiricisms; (2) to place in perspective the ability of subgingival irrigation (which also will be referred to as irrigation or lavage) to enhance periodontal health by assessing data from controlled studies; (3) to encourage use of subgingival irrigation as an adjunct to conventional therapy, in certain situations; and (4) to discourage bad execution of a good idea, because if limitations of lavage are not recognized, therapists may engage in ineffective treatment.