Periodontal treatment
PD, TePe, tooth
Baseline periodontal measurements were obtained 2 weeks prior to the treatment, which was followed by professional supragingival tooth cleaning and individual oral hygiene instructions for all included patients. These treatments included manual toothbrushes and interdental brushes. All patients were provided the same type of toothpaste (Elmex Enamel Protection, Gaba GmbH, Germany) and tooth (CS 5460, Curaprox, Curaden, Switzerland) and interdental (TePe, Tepe Mundhygienprodukten, Sweden) brushes. Oral hygiene instructions were reinforced at each follow-up visit, but no further treatment was rendered.Two weeks later, under local anaesthesia, subjects in the control group underwent full-mouth SRP performed with ultrasonic (Satelec/Acteon suprasson newtron ultrasonic scaler) and hand instruments (LM SharpDiamond 1/2, 7/8, 11/12, 13/14 SD mini Gracey and Gracey curettes, LM Dental™, Finland). Subsequently, all teeth were polished using a low-abrasive paste (Lunos Super Soft, RDA < 5, Dürr Dental, Germany). Mechanical debridement took on average 3.5 h per patient.In the test group, full-mouth SRP was performed as follows: in all pockets with PD ≥ 4 mm a sodium hypochlorite/amino acid gel (Perisolv®, Regedent AG, Zürich, Switzerland) was instilled into the pockets and kept there for 60 s before subgingival instrumentation. Subgingival instrumentation was carried out with the same ultrasonic and hand instruments and the application of sodium hypochlorite/amino acid gel was repeated until the instrumentation was considered sufficient (i.e., for a total of 2–3 times) (Fig. Application of sodium hypochlorite/amino acid gel to the periodontal pocketApplication of a mixture of natural and cross-linked hyaluronic acid (high molecular)to the periodontal pocket