Comparisons between ultrasonic subgingival debridement with or without manual root planing on clinical parameters improving of periodontitis: a split-mouth randomized clinical trial

To evaluate the adjunctive clinical efficacy of manual root planing following ultrasonic subgingival debridement (SD) in the treatment of generalized severe periodontitis. Twenty-nine patients diagnosed with Stage III or IV periodontitis were enrolled in this single-blind, split-mouth, randomized controlled trial (RCT). Quadrants were randomly assigned to receive either ultrasonic subgingival debridement alone (SD group) or ultrasonic subgingival debridement followed by manual root planing (SRP group). Clinical parameters, including Probing Pocket Depth (PPD), Clinical Attachment Level (CAL), and Bleeding Index (BI), were recorded at baseline, 3, and 6 months. Twenty-nine patients completed the study. Both treatment modalities yielded statistically significant improvements in all clinical parameters compared with baseline (p < 0.05). The SRP group resulted in superior outcomes compared with ultrasonic subgingival debridement alone. Analysis revealed a significantly greater PPD reduction in the SRP group at 3 months (adjusted MD: 0.20 mm; 95% CI [0.13, 0.27]; p < 0.01), and this advantage was sustained at 6 months (adjusted MD: 0.11 mm; 95% CI [0.05, 0.18]; p < 0.01). SRP achieved superior CAL gain at 3 months (adjusted MD: 0.10 mm; 95% CI [0.01, 0.19]; p < 0.05). Crucially, regarding clinical endpoints, the SRP group exhibited a significantly lower prevalence of residual deep pockets (PPD ≥ 5 mm) at 3 months and 6 months compared with the SD group (p < 0.05), indicating a higher rate of pocket closure. Both treatment modalities achieved significant reductions in Bleeding Index (BI) scores compared to baseline (p < 0.05), with no statistically significant inter-group differences observed at any time point. While ultrasonic debridement alone is effective, the adjunctive use of manual root planing yields statistically significant, though modest, additional benefit in PPD reduction and CAL gain in generalized severe periodontitis. While it effectively reduces the burden of residual pockets in the short term, its long-term advantage is attenuated, highlighting the necessity of strict supportive periodontal therapy.