Clinical Comparison of Guided Biofilm Therapy and Scaling and Root Planing in the Active Phase of Periodontitis Management
European Journal of Dentistry (2024)
Abstract
Objective: The aim of this randomized, controlled, split-mouth study was to compare full-mouth air polishing followed by ultrasonic debridement (known as Guided Biofilm Therapy [GBT]) versus traditional Scaling and Root Planing (SRP), in terms of pocket closure in patients with stages III and IV periodontitis.
Materials and Methods: The patients underwent periodontal therapy in two sessions. At the beginning of the first session, quadrants I and IV and II and III were randomly assigned to GBT or SRP treatment. Periodontal parameters were collected at baseline, 6 weeks (T1), and 3 months (T2) after therapy. The primary outcome was the number of experimental sites (PPD >4 and <10 mm) becoming closed pockets (PPD ≤4 mm BOP negative) at T1 and T2.
Results: A total of 32 patients were selected. Mean PPD reduced from 6.23 to 3.33 mm at T2 for GBT, and from 6.21 to 3.32 mm at T2 for SRP. Both treatments reached comparable percentage of closed pockets at T1 (77.9% for GBT vs. 80.1% for SRP, p=0.235) and T2 (84.1% for GBT vs. 84.4% for SRP, p=0.878).
Conclusion: GBT is a suitable option in the active phase of periodontitis management in patients with stages III and IV periodontitis.
Keywords
Citazione
Mensi M, Sordillo A, Marchetti S, Calza S, Scotti E. Clinical Comparison of Guided Biofilm Therapy and Scaling and Root Planing in the Active Phase of Periodontitis Management. European Journal of Dentistry. 2024. doi: 10.1055/s-0044-1791221
Study Highlights
Context: First study applying full GBT protocol in the initial/active phase of periodontitis treatment (not just maintenance). Previous studies only used air-polishing as adjunct after SRP.
Design: Single-blinded, split-mouth RCT | n=32 (31 completed) | 3-month follow-up | Ethics: ASST Spedali Civili di Brescia #2519 | ClinicalTrials.gov registered
Population: Adults 18-75y with stages III-IV periodontitis, ≥6 experimental sites/quadrant (PPD >4 and <10mm, CAL ≥3mm), ≥5 teeth/quadrant, systemically healthy, non-/light smokers (<10 cig/day)
Interventions compared:
| Protocol | Steps |
|---|---|
| GBT (Test) | Plaque disclosing → Full-mouth air-polishing (soft tissues + supra/subgingival) with erythritol+CHX → Perioflow tip at experimental sites → Ultrasonic calculus removal (PS tips) → Manual only if needed (no root planing) |
| SRP (Control) | Plaque disclosing → Full-mouth ultrasonic debridement (PS tips) → Manual curettes at experimental sites → Rubber cup + prophy paste (RDA 27) |
Primary outcome: Pocket closure (PPD ≤4mm AND BOP-negative) at experimental sites
Non-inferiority margin: 10% difference in pocket closure
Key Results - Pocket Closure:
| Timepoint | GBT | SRP | Difference | p-value |
|---|---|---|---|---|
| 6 weeks (T1) | 77.9% [70.9-84.9] | 80.1% [75.3-85.0] | -2.23% | 0.235 |
| 3 months (T2) | 84.1% [77.7-90.5] | 84.4% [79.0-89.7] | -0.25% | 0.878 |
Non-inferiority confirmed (<10% difference)
Key Results - PPD Reduction at Experimental Sites:
| Group | Baseline | T1 | T2 | Change T0→T2 |
|---|---|---|---|---|
| GBT | 6.23mm | 3.55mm | 3.33mm | -2.89mm |
| SRP | 6.21mm | 3.45mm | 3.32mm | -2.89mm |
No significant difference between groups (p=0.812)
Key Results - Other Parameters (Experimental Sites):
| Parameter | GBT T0→T2 change | SRP T0→T2 change | Between-group p |
|---|---|---|---|
| CAL | -2.65mm | -2.59mm | 0.987 |
| BOP | -60.1% | -59.0% | 0.575 |
| PI | -52.1% | -53.4% | 0.436 |
| REC | -0.07mm (NS) | -0.13mm (NS) | 0.608 |
Treatment Time:
- GBT: 55.44 min [48.9-62.0]
- SRP: 51.13 min [44.7-57.5]
- Difference: 4.31 min (NS, p=0.064)
No significant time savings in active treatment (unlike maintenance/prophylaxis)
Clinical significance:
- GBT achieves equivalent clinical outcomes to gold-standard SRP in stages III-IV periodontitis
- 84% pocket closure at 3 months exceeds literature benchmarks (Suvan 2020 meta-analysis: 74% at 6-8 months)
- PPD reduction of ~2.9mm exceeds Wennström 2005 (~1.8mm)
- No recession increase with either protocol (conservative approach preserved cementum)
- No side effects observed (emphysema, swelling)
Key differentiator from previous studies: Previous air-polishing studies (Park 2018, Jentsch 2020, Tsang 2018, Caygur 2017) applied air-polishing AFTER SRP as adjunct. This study applies full-mouth air-polishing BEFORE ultrasonic as the primary biofilm removal method (true GBT protocol).
Proposed mechanism for comparable efficacy:
- Air-polishing effectively removes biofilm from pockets
- Ultrasonic provides adequate calculus removal in both protocols
- No aggressive root planing = preserved cementum = attachment gain rather than recession
- Piezoelectric instrumentation may be key factor (better access to deep pockets/furcations than manual alone)
Limitations:
- Split-mouth design risk of carry-over effect (CHX in powder may affect control quadrants)
- Conservative manual instrumentation even in SRP group
- Light smokers only
- No cost-effectiveness analysis
Future directions:
- Parallel-design trials with larger samples
- Subgroup analysis by smoking status
- Long-term outcomes (>3 months)
- Patient comfort/preference data
Related publications from Brescia group:
- Mensi 2020 (doi:10.1111/idh.12442) — Plaque disclosing RCT
- Mensi 2021 (Clin Oral Investig) — Subgingival air-polishing adjunct in periodontitis
- Mensi 2022 (doi:10.1111/idh.12537) — GBT vs US+P for gingivitis (Part 1)
- Mensi 2024 (doi:10.1111/idh.12812) — GBT vs US+P 12-month maintenance