Minimally Invasive Periodontal Therapy

Clinical Techniques and Visualization Technology

Edited by Stephen Harrel and Thomas G. Wilson

Chapter 3 Ultrasonic Endoscopic Debridement

John Y. Kwan and Suzanne M. Newkirk

WILEY Blackwell

> 2000 Research Forum Abstract
> Retrospective Analysis of Positive Radiographic Bone Changes...
> Enhanced Periodontal Debridement with the Use of Micro Ultrasonic, Periodontal Endoscopy (pdf)

2000 Research Forum Abstract
Presented at the 2000 Annual Meeting of the American Academy of Periodontology
Honolulu, Hawaii

Reviewed by the Subcommittee on Research Submissions of the Annual Meeting Committee
1-year Clinical Results Comparing 2 Antibiotic Regimens Following Full Mouth Micro Ultrasonic Debridement

John Y. Kwan, DDS, Oakland, CA, UC San Francisco
Connie L. Drisko, DDS
L. Jane Goldsmith, PhD
David E. Miles, BS, University of Louisville, Louisville, KY

The aim of this 1-year longitudinal study was to compare the adjunctive clinical effects of 2 systemic antibiotic regimens following full mouth micro ultrasonic debridement. Two hundred three (203) consecutive patients were treated in a private practice by full mouth micro ultrasonic debridement (FMMUD) plus a short course of antibiotics. Group M/A (N=101) received FMMUD plus systemic metronidazole 250mg tid and amoxicillin 250 mg tid for 7 days. Group M (N=102) received FMMUD plus metronidazole 250mg tid for 5 days. Full mouth probing depths (PD) were recorded at baseline, 6 weeks and 12 months. Statistical analysis included weighted general linear multivariate model (GLMM) and generalized estimating equations (GEE). Results showed that differences between groups were statistically significant at baseline (P=0.001) using weighted GLMM (weighting based on number of sites per patient contributing to the analysis). Initial mean full mouth probing depths were 3.22mm for M/A and 2.949mm for M. Using the GlMM, differences were statistically significant over 3 visits when the 2 groups were considered together (P=0.00005). Differences between groups over time were statistically significant at P=0.001, with greater mean probing depth reduction occurring in the M/A group. From baseline to 6 weeks, the number of M/A sites with 1mm PD reduction was statistically higher than M (P=0.00005) but was not significantly different between 6 weeks and 12 months (P=0.0292). The number of M/A sites improved by 2mm or more between baseline and 6 weeks (P=0.0007) and the 6 week to 12 month visit (P=0.0203) was significaltly greater than that of the M sites. It can be concluded that probing depth reduction was significantly greater following full mouth micro ultrasonic debridement and a 7 day course of systemic metronidazole plus amoxicillin than full mouth micro ultrasonic debridement plus a 5 day course of metronidazole.





metro only



250mg 3x/day
7 days

250mg 3x/day
5 days


sites probing 6-12mm pre-tx




sites <5mm after 12 months




%change from 6-12mm to <5mm after 12 months




sites probing 7-9mm pre-tx




sites <5mm after 12 months




% change from 7-9mm to <5mm after 12 months




sites probing 10-12mm pre-tx




sites <5mm after 12 months




% change from 10-12mm to <5mm after 12 months





Retrospective Analysis of Positive Radiographic Bone Changes as a Result of Micro Ultrasonic Debridement with Adjunctive Systemic Antibiotics

John Y. Kwan, DDS, unpublished evaluation, 1999

Non-Surgical treatment utilizing micro ultrasonic instrumentation and adjunctive systemic antibiotics has been shown to result in significant improvements in clinical probing depths and reduction in bleeding and probing. Patients treated in this fashion have also shown radiographic improvement. In private clinical practice, it is not always that radiographs are consistent in angulation, processing, type of film (original or duplication), and/or area covered. Since many baseline radiographs come from a ref erring source, subsequent radiographs for comparison may or may not be close to the "same shot".

However, in the course of practice there are instances when two films are close in comparison and allow us to appreciate changes in the periodontal hard tissues that can be interpreted as being positive. 68 sites in 28 patients were selected for analysis because of their appreciable Osseous change upon visual examination, and because angulation was very close to the same before treatment and one year following treatment. All patients presented with a diagnosis of chronic adult periodontal disease, and were treated non-surgically in one session, under local anesthesia and given a course of systemic antibiotics. Antibiotic regimens were either metronidazole and amoxicillin, each 250 mg tid for 5 days. Instrumentation was accomplished with micro ultrasonic instrumentation only, no hand instrumentation was done. Patients were reevaluated at 6 weeks, and then placed on SPT at 3-4 month intervals with clinical and radiographic reevaluation done one year from initial treatment.

Radiographs were sent to Ernest Hausmann, DDS, PhD, Department of Oral Biology, State University of New York Buffalo. Each radiograph was scanned and digitized for comparative analysis, consistent with previous published protocol for analysis of unstandardized x-rays.

Analysis indicated that mean gain in height was 1.70mm, SD 1.52mm, p=.0001

With this analysis of unstandardized radiographs, gains over 1.00mm can be interpreted as being "true gains" with confidence. 18 sites showed bone gain of over 2.5mm, up to as much as 6.7mm. The analysis of these 68 sites indicate that bone can regenerate with non-surgical treatment, and the changes shown with this sample are highly statistically significant.