Table 1.

Brief summary of studies investigating methods to reduce the systemic impact of professional mechanical plaque removal (PMPR).

Authors	Study	Periodontitis Definition	Follow-up	Treatment(s)	Results
Graziani et al., 2015 [81]	Randomized clinical trial	Proximal attachment loss of ≥3 mm in ≥2 non-adjacent teeth (Tonetti & Claffey 2005), bleeding on probing on at least 25% of their total sites, and documented radiographic bone loss	3 months	Full-mouth vs. quadrant scaling	Full-mouth PMPR resulted in significant increase of CRP, IL-6 or TNF-α compared to quadrant (conventional) PMPR
Keceli et al., 2020 [87]	Randomized placebo-controlled clinical trial	Periodontitis stage II–III (2017 World Workshop)	6 months	PMPR + Folic acid (FA) + vs. PMPR alone	FA group resulted in no significant change in homocysteine (Hcy) and CRP levels in GCF compared to placebo group
Zekonis et al., 2016 [88]	Prospective cohort study	PPD ≥ 6 mm on at least 2 teeth, and radiographic evidence of horizontal and vertical bone loss.	1-, 2- and 3-years	PMPR + supragingival irrigations with 0.5% hydrogen peroxide	Plasma levels of high sensitivity CRP (hs-CRP) and white blood cell (WBC) count decreased significantly after 1 and 2 years, whereas at 3 years a less evident decrease was found
Lee et al., 2008 [89]	Prospective single-masked, split-mouth, crossover interventional study	At least five sites per quadrant with PPD ≥ 5 mm and radiographic evidence of alveolar bone loss.	Day 0	PMPR (ultrasonic instrumentation) + 0.02% chlorhexidine (CHX) irrigations with sterile water	CHX irrigations did not have any influence on increasing levels of lipopolysaccharide (LPS) and IL-6
Rasperini et al., 2019 [90]	Randomized clinical trial	at least two sites with PPD > 7 mm, bleeding on probing > 25%	Day 0, 1 month and 3 months	PMPR + macronutrient complex vs. PMPR + olive oil-filled capsules	No statistically significant differences were observed between groups in terms of salivary and serum MMP-8/-9 levels at any time point. CRP serum levels were reduced after 3 months in both groups, but not significantly
Graziani et al., 2019 [91]	Randomized clinical trial	AL of ≥3 mm in ≥2 non-adjacent teeth (Tonetti, Claffey, & European Workshop in Periodontology Group C, 2005), bleeding on probing on at least 25% of total sites and documented radiographic bone loss	3 months	PMPR + EMD vs. PMPR	At 24 h significant increase of CRP, D-dimer and cystatin C in control group and, only increase in CRP and fibrinogen in EMD group. At 3 months, biomarkers levels significantly decreased and returned to baseline values in both groups, except for glucose that was significant lower in the EMD group

PPD = probing pocket depth; AL = attachment loss; PMPR: professional mechanical plaque removal; CHX: chlorhexidine; EMD: Emdogain.