***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A classical treatment for chronic adult periodontitis consists of four to six consecutive sessions of scaling and root planing at a 1- to 2-week interval . Such a so-called " quadrant or sextant therapy " might result in a reinfection of a previously disinfected area by bacteria from an untreated region . The purpose of this study was to investigate , over an 8-month period , the clinical benefits of full-mouth disinfection within a 24-hour period in the control of chronic periodontitis . Ten adult patients with advanced chronic periodontitis were r and omly assigned to a test and a control group . The control group received the st and ard scheme of initial periodontal therapy , consisting of scaling and root planing of the four quadrants was performed within 24 hours and immediately followed by a thorough supra- and subgingival chlorhexidine application to limit any transfer of bacteria . The latter involved tongue brushing with a 1 % chlorhexidine gel for 60 seconds , mouthrinsing with a 0.2 % chlorhexidine solution twice for 60 seconds , repeated subgingival irrigation of all pockets with a 1 % chlorhexidine gel ( 3 times within 10 minutes ) , and mouthrinsing twice daily with a 0.2 % chlorhexidine solution during 2 weeks . In addition , both groups received thorough oral hygiene instructions . The plaque index , gingival index , probing depth , gingival recession , and bleeding on probing were recorded prior to professional cleaning and at 1 , 2 , 4 , and 8 months afterwards . Although the test group scored higher plaque indices than the control group , especially at months 2 and 4 , the gingival index and bleeding tendency showed similar improvements with time . However , when the gingival/plaque ratio was considered , the latter was lower in the test group at all follow-up visits . For pockets > or = 7 mm , full-mouth disinfection showed a significantly ( P = 0.01 ) higher reduction in probing depth at each follow-up visit with , at month 8 , a reduction of 4 mm ( from 8 mm to 4 mm ) , in comparison to 3 mm ( from 8 mm to 5 mm ) for the classical therapy . The increase in gingival recession in the full-mouth disinfection group remained below 0.7 mm , while in the control group it reached 1.9 mm after 8 months . This result ed in a gain of clinical attachment level of 3.7 mm for the test group versus 1.9 mm for the control group . A radiographical examination also indicated a superior improvement for the test group when compared to the control group . This pilot study suggests that a full-mouth disinfection in one day results in an improved clinical outcome in chronic periodontitis as compared to scalings per quadrant at 2-week intervals over several weeks A treatment for periodontal infections often consists of consecutive rootplanings ( per quadrant , at a 1- to 2-week interval ) , without a proper disinfection of the remaining intra-oral niches ( untreated pockets , tongue , saliva , mucosa and tonsils ) . Such an approach , could theoretically lead to a reinfection of previously-treated pockets . The present study aims to examine the effect of a full-mouth disinfection on the microbiota in the above-mentioned niches . Moreover , the clinical benefit of such an approach was investigated . 16 patients with severe periodontitis were r and omly allocated to a test and a control group . The patients from the control group were scaled and rootplaned , per quadrant , at 2-week intervals and obtained oral hygiene instructions . The patients from the test group received a full-mouth disinfection consisting of : scaling and rootplaning of all pockets in 2 visits within 24 h , in combination with tongue brushing with 1 % chlorhexidine gel for 1 min , mouth rinsing with a 0.2 % chlorhexidine solution for 2 min and subgingival irrigation of all pockets ( 3x in 10 min ) with 1 % chlorhexidine gel . Besides oral hygiene , the test group rinsed 2x daily with 0.2 % chlorhexidine and sprayed the tonsils with a 0.2 % chlorhexidine for 2 months . Plaque sample s ( pockets , tongue , mucosa and saliva ) were taken at baseline and after 2 and 4 months , and changes in probing depth , attachment level and bleeding on probing were reported . The full-mouth disinfection result ed in a statistically significant additional reduction/elimination of periodontopathogens , especially in the subgingival pockets , but also in the other niches . These microbiological improvements were reflected in a statistically-significant higher probing depth reduction and attachment gain in the test patients . These findings suggest that a disinfection of all intra-oral niches within a short time span leads to significant clinical and microbiological improvements for up to 4 months AIM The objective was to determine clinical and microbiological effects and perceived treatment discomfort of root debridement by subgingival air polishing compared with ultrasonic instrumentation during supportive periodontal therapy ( SPT ) . MATERIAL AND METHODS The trial was conducted as a split-mouth design ed study of 2-month duration including 20 recall patients previously treated for chronic periodontitis . Sites with probing pocket depth ( PPD ) of 5 - 8 mm and bleeding on probing ( BoP+ ) in two quadrants were r and omly assigned to subgingival debridement by ( i ) glycine powder/air polishing applied with a specially design ed nozzle or ( ii ) ultrasonic instrumentation . Clinical variables were recorded at baseline , 14 and 60 days post-treatment . Primary clinical efficacy variable was PPD reduction . Microbiological analysis of subgingival sample s was performed immediately before and after debridement , 2 and 14 days post-treatment . RESULTS Both treatment procedures result ed in significant reductions of periodontitis-associated bacterial species immediately and 2 days after treatment , and in significant reduction in BoP , PPD and relative attachment level at 2 months . There were no statistically significant differences between the treatment procedures at any of the examinations intervals . Perceived treatment discomfort was lower for air polishing than ultrasonic debridement . CONCLUSION This short-term study revealed no pertinent differences in clinical or microbiological outcomes between subgingival air polishing and ultrasonic debridement of moderate deep pockets in SPT patients AIM To test recolonization of periodontal lesions after full-mouth scaling and root planing ( FM-SRP ) or multiple session-SRP ( MS-SRP ) in a r and omized clinical trial and whether FM-SRP and MS-SRP result in different clinical outcomes . MATERIAL S AND METHODS Thirty-nine subjects were r and omly assigned to FM-SRP or MS-SRP groups . At baseline and after 3 months , probing pocket depth ( PPD ) , plaque index ( PlI ) and bleeding on probing ( BoP ) were recorded . At baseline , immediately after treatment , after 1 , 2 , 7 , 14 and 90 days , paper point sample s from a single site from the maxillary right quadrant were collected for microbiological analysis of five putative pathogens by polymerase chain reaction . RESULTS FM-SRP and MS-SRP result ed in significant reductions in PPD , BoP and PlI and the overall detection frequencies of the five species after 3 months without significant differences between treatments . Compared with MS-SRP , FM-SRP result ed in less recolonization of the five species , significantly for Treponema denticola , in the tested sites . CONCLUSION FM-SRP and MS-SRP result in overall clinical ly and microbiologically comparable outcomes where recolonization of periodontal lesions may be better prevented by FM-SRP OBJECTIVES The beneficial effects of the one-stage , full-mouth disinfection remain controversial in the scientific literature . This might be due to the fact that an entire mouth disinfection with the use of antiseptics has been confused with a full-mouth scaling and root planing . This parallel , single blind RCT study aim ed to compare several full-mouth treatment strategies with each other . MATERIAL AND METHODS Seventy-one patients with moderate periodontitis were r and omly allocated to one of the following treatment strategies : scaling and root planing , quadrant by quadrant , at two-week intervals ( negative control , NC ) , full-mouth scaling and root planing within 2 consecutive days ( FRP ) , or three one-stage , full-mouth disinfection ( FM ) protocol s within 2 consecutive days applying antiseptics to all intra-oral niches for periopathogens using as antiseptics : chlorhexidine ( FMCHX ) for 2 months , amine fluoride/stannous fluoride for 2 months ( FMF ) , or chlorhexidine for 2 months followed by amine fluoride/stannous fluoride for another 6 months ( FMCHX+F ) . At baseline and after 2 , 4 , and 8 a series of periodontal parameters were recorded . RESULTS All treatment strategies result ed in significant ( p<0.05 ) improvements of all clinical parameters over the entire duration of the study . Inter-treatment differences were often encountered . The NC group nearly always showed significant smaller improvements than the two CHX groups . The differences between the FRP or FM groups , and the two CHX groups only sporadically reached a statistical significance . CONCLUSION These observations indicate that the benefits of the " OSFMD " protocol are partially due to the use of the antiseptics and partially to the completion of the therapy in a short time AIM This split-mouth , r and omized , clinical trial aim ed to evaluate the efficacy of erbium-doped : yttrium-aluminium-garnet ( Er : YAG ) laser application in non-surgical periodontal treatment . MATERIAL S AND METHODS A total of 27 patients underwent four modalities of non-surgical therapy : supragingival debridement ; scaling and root planing (SRP)+Er : YAG laser ; Er : YAG laser ; and SRP .  Each strategy was r and omly assigned and performed in one of the four quadrants . Clinical outcomes were evaluated at 3 and 6 months . Subjective benefits of patients have been evaluated by means of question naires . RESULTS Six months after therapy , Er : YAG laser showed no statistical difference in clinical attachment gain with respect to supragingival scaling [ 0.15 mm ( 95 % CI -0.16 ; 0.46 ) ] , while SRP showed a greater attachment gain than the supragingival scaling [ 0.37 mm ( 95 % CI 0.05 ; 0.68 ) ] . No difference result ed between Er : YAG laser+SRP and SRP alone [ 0.05 mm ( 95 % CI -0.25 ; 0.36 ) ] . CONCLUSIONS The adjunctive use of Er : YAG laser to conventional SRP did not reveal a more effective result than SRP alone . Furthermore , the sites treated with Er : YAG laser showed similar results of the sites treated with supragingival scaling The objective of this study was to compare and contrast the morphologic changes in tooth root surfaces treated in vitro by scaling and root planing followed by irradiation with the Er : YAG laser using air/water surface cooling and the CO2 and Nd : YAG lasers , both with and without surface coolant . The experimental unit consisted of 42 freshly extracted teeth which were divided equally and r and omly assigned to the following 7 treatment groups : untreated control , S/RP only , CO2 laser with and without air/water surface cooling , Nd : YAG laser with and without/air water surface cooling , and Er : YAG laser with air/water surface coolant . Specimens treated with CO2 laser irradiation were subjected to energy densities ranging from 100 to 400 J/cm2 ; those treated with the Nd : YAG from 286 to 1857 J/cm2 ; and the Er : YAG was used within a range of 20 to 120 J/cm2 . The degree of morphologic change following CO2 and Nd : YAG irradiation appeared directly related to energy density but unrelated to the use of surface coolant . Laser induced surface changes included cavitation , globules of melted and resolidified mineral , surface crazing , and production of a superficial char layer . In contrast , the Er : YAG laser produced root surface changes that might be expected from acid etching , i.e. , removal of the smear layer and exposure of the collagen matrix . In addition , sharply defined microfractures of the mineralized structure were noted and unlike the CO2 and Nd : YAG lasers , there was no evidence of melting or surface char . Given the parameters of this study , it appears that both the CO2 and Nd : YAG lasers alter the root surface in an undesirable manner . The Er : YAG laser , however , when used at low energy densities shows sufficient potential for root surface modification to warrant further investigation OBJECTIVES To test whether use of a water-cooled Nd : YAG laser adjunctive to supra- and subgingival debridement ( SRP ) with h and and ultrasonic instruments results in greater clinical improvement than SRP alone . Another objective was to investigate the reduction in the number of microorganisms . METHODS This study was an examiner-blind , r and omized and controlled clinical trial using a split-mouth design . Nineteen subjects with moderate-to-severe generalized periodontitis were selected . Immediately following SRP in two r and omly chosen contra-lateral quadrants , all pockets 4 mm were additionally treated with the Nd : YAG laser ( 1064 nm , 6 W , 400 mJ ) . Clinical assessment s ( Plaque index , bleeding on pocket probing , probing pocket depth ) were performed pre-treatment and at 3 months post-treatment . In each quadrant , one site was sample d for microbiological evaluation at pre-treatment , immediately post-instrumentation and 3 months post-treatment . RESULTS At the 3-month visit , the clinical parameters had significantly improved for both regimens . No significant differences between treatment modalities were observed for any of the clinical 
    Output:
    
Three distinct aspects were evaluated independently : the modification of conventional instruments , the advent of new technologies , and the development of new treatment protocol s. EVIDENCE SYNTHESIS Twenty-two publications were selected : 4 were related to modifications of st and ard therapies ( new tip design s and local anesthetics ) , 14 to new technologies ( new ultrasonic devices , air abrasive systems , endoscope and lasers ) , and 4 to new treatment protocol s. CONCLUSIONS These technological advances and the development of new protocol s may improve patient-related outcomes and cost-effectiveness , although they have not shown significant differences in efficacy when compared with conventional SRP