Background: Mechanical plaque removal has been commonly accepted to be the basis for periodontal treatment.\nThis study aims to compare the effectiveness of ultrasonic and manual subgingival scaling at different initial\nprobing pocket depths (PPD) in periodontal treatment.\nMethods: English-language databases (PubMed, Cochrane Central Register of Controlled Trials, EMBASE, Medline,\nand ClinicalTrials.gov, by January, 2019) were searched. Weighted mean differences in primary outcomes, PPD and\nclinical attachment loss (CAL) reduction, were estimated by random effects model. Secondary outcomes, bleeding\non probing (BOP), gingival recession (GR), and post-scaling residual dental calculus, were analyzed by comparing\nthe results of each study. The quality of RCTs was appraised with the Cochrane Collaboration risk of bias tool. The\nGRADE approach was used to assess quality of evidence.\nTen randomized controlled trials were included out of 1434 identified. Initial PPD and follow-up periods\nformed subgroups. For 3-months follow-up: (1) too few shallow initial pocket studies available to draw a conclusion;\n(2) the heterogeneity of medium depth studies was so high that could not be merged to draw a conclusion; (3)\ndeep pocket studies showed no statistical differences in PPD and CAL reduction between ultrasonic and manual\ngroups. For 6-months follow-up: (1) too few shallow initial PPD studies to draw a conclusion; (2) at medium pocket\ndepth, PPD reduction showed manual subgingival scaling better than ultrasound. No statistical differences were\nobserved in CAL reduction between the two approaches; (3) for deep initial PPD studies, both PPD and CAL\nreduction showed manual subgingival scaling better. GR results indicated no statistical differences at medium and\ndeep initial pocket studies between the two methods. BOP results showed more reduction at deep pocket depths\nwith manual subgingival scaling. No conclusion could be drawn about residual dental calculus.\nConclusion: When initial PPD was 4-6 mm, PPD reduction proved manual subgingival scaling....................
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