Effectiveness of Endoscope‐Assisted Subgingival Debridement Versus Repeated Root Surface Debridement or Access Flap Periodontal Surgery in Step 3 Periodontal Therapy: A Systematic Review and Meta‐Analysis

Abstract

<h3>Objectives</h3><p>Periodontitis is a multifactorial inflammatory disease leading to the progressive destruction of the tooth-supporting apparatus. The management of residual periodontal pockets remains a challenge for Step 3 periodontal therapy. This systematic review aims to evaluate the potential and efficacy of the periodontal endoscope in managing residual periodontal pockets during Step 3 periodontal therapy.</p><h3>Material and Methods</h3><p>A comprehensive search was conducted in Medline, PubMed, Cochrane Library, Embase, Scopus, and Web of Science databases up to December 2024. Studies included were randomized controlled trials (RCTs) comparing periodontal endoscope-assisted subgingival debridement (EASD) with repeated root surface debridement (RSD) and access flap periodontal surgery (AFPS). Data extraction and risk of bias assessment were performed independently by two reviewers.</p><h3>Results</h3><p>Five RCTs were included, involving 155 subjects and 4072 sites. EASD showed a significantly higher periodontal probing depth (PPD) reduction compared to repeated RSD, with a weighted mean difference (WMD) of 0.5 mm (95% CI: 0.19–0.81) at 3-month postoperation. At 6-month postoperation, the WMD of PPD and clinical attachment level (CAL) changes were 0.84 mm (95% CI: 0.60–1.09) and 0.89 mm (95% CI: 0.45–1.34), respectively, in favor of EASD. EASD showed a significantly higher prevalence ratio (20%) of pocket resolution (PPD ≤ 4 mm) compared to repeated RSD at 6-month postoperation. No significant differences were observed between EASD and AFPS in the changes of CAL, PPD and prevalence of pocket resolution (PPD ≤ 4 mm). The overall certainty of the evidence was deemed to be “low” for EASD versus repeated RSD comparisons and “moderate” for EASD versus AFPS comparisons.</p><h3>Conclusions</h3><p>EASD demonstrated superior clinical outcomes compared to repeated RSD in managing residual periodontal pockets. Further high-quality research is necessary to validate these findings and explore the long-term benefits of EASD.</p>