Randomized Controlled Trials in Periodontology and Implantology

This chapter will focus on the scope and quality of randomized trials (RCTs) in periodontology and implantology using published systematic reviews/meta-analyses of RCTs as a guide to the clinical questions addressed and identify quality problems and gaps in order to suggest directions for future research. In many cases, the reviews point to bias and poor-quality data in studies in this field. First, in this chapter, studies comparing the efficacy of nonsurgical (scaling and root planing, coronal scaling), gingival flap procedures (modified Widman flap, open flap debridement, access flaps), osseous resective surgery will be discussed. Most of these studies were undertaken before regenerative modalities were widely available. Nonsurgical periodontal therapy will receive further attention addressing the efficacy of these treatments alone and when combined with adjunctive therapies. Regenerative surgical therapy will then be examined and its efficacy compared to other treatment modalities. Periodontal therapy that includes the use of various wavelengths and types of lasers will be reviewed. Periodontal plastic surgery procedures to correct mucogingival defects will be examined. RCTs that examine the relationship of periodontitis and periodontal therapy with systemic diseases, obesity, preterm/low birth weight, and smoking will then be discussed. Finally, we will discuss the RCTs related to implantology. Implant-site development including ridge preservation at the time of tooth extraction and horizontal or vertical ridge augmentation and maxillary sinus floor augmentation techniques will be discussed. Short vs long dental implants, timing of dental implants including immediate or delayed implant placement, provisionalization and loading protocols, and guided vs nonguided implant placement techniques will be compared. Finally, the management of peri-implant diseases and implant maintenance therapies will be reviewed.