Table 1 Included studies characteristics (Primary outcome measures)

Pilot study on the clinical and microbiological effect of subgingival glycine powder air polishing using a cannula-like jet [15]

- Kargas, K.2015

moderate pockets

ultrasonic instrumentation (Piezonâ, Instrument A, EMS, Nyon, Switzerland), hand instruments (Gracey curettes 3/4, 11/12, 13/14, Hu-Friedy, Chicago, IL, USA)

6 Months

(a) Must have been previously diagnosed with generalized chronic periodontitis (according to American Academy of Periodontology) and successfully treated; (b) Subsequently, entered the supportive treatment phase (SPT), with at least two non-bleeding residual pockets > 4 mm in each quadrant; (c) Have at least 20 natural teeth; (d) Non-smoker; (e) Could not taken an antibiotic, anti-inflammatory medication, corticosteroids or other immunosuppressive drugs during the previous 6 months; (f) Pregnant or lactating women were also excluded from this study.

None

No smoker

- PPD, CAL

- 52.50 ± 9.54

- 12/15

- Greece

Er:YAG lasers versus ultrasonic and hand instruments in periodontal therapy: clinical parameters, intracrevicular micro-organism and leukocyte counts [13]

- Malali, E.2012

4-6 mm, > 7 mm

a magnetostrictive ultrasonic scaler (Cavitron Bobcat Pro, Dentsply International Inc., USA), manual periodontal curettes (Gracey, SG # 5/6, 7/8, 11/12, 13/14, Mini Five Gracey SAS # 5/6, 11/12, Hu-Friedy Ins. Co., USA)

3 Months

Patients with generalized periodontal breakdown and who had at least four single-rooted teeth, two moderately deep (probing depth [PD] of 4–6 mm) and two deep pockets (PD ≥ 7 mm) that had no endodontic lesion and no crown, with mobility 0–2, and with bleeding on probing (BOP) were selected.

(a) Periodontal treatment within the last 6 months; (b) Any systemic disease that would influence the periodontal tissues; (c) Antibiotic used within last 6 months; (d) Pregnancy and smoking.

No smoker

- PPD、CAL

- 48.83 ± 7.23

- 11/19

- Turkey

Hand instrumentation versus ultrasonic debridement in the treatment of chronic periodontitis: a randomized clinical and microbiological trial [12]

- Ioannou, I.2009

< 4 mm, 4-6 mm, > 6 mm

UD: (EMS Piezon®, EMS, Nyon, Switzerland) with A and P instruments (Swiss InstrumentsPM, EMS) under water irrigation, SRP:Hu-Friedy Gracey Standard Curettes SG 3/4, 11/12, 13/14, After Five® Curettes SAS 3/4, 11/12, 13/14, Hu-Friedy.

3 Months, 6 Months

(a) Existence of a minimum of four sites with PPD 5 mm in at least two quadrants of each of the patients, demonstrating bleeding on probing; (b) No periodontal treatment during the previous 6 months.

(a) Compromised medical condition; (b) Systemic antibiotics during treatment or for the last 3 months; (c) Ongoing drug therapy that might affect periodontal therapy; (d) Requirement for prophylactic antibiotic cover of the patient; (e) Use of chlorhexidine mouthwash or any other antimicrobial agent; (f) Pregnancy for female patients.

SRP: 50% of patients is smoker;

- PPD, CAL

- SRP:49.62 ± 2.07, UD:50.47 ± 2.58

UD: 52.9% of patients is smoker.

- SRP:50/50 UD:70.6/29.4

- Greece

Non-surgical periodontal treatment with a new ultrasonic device (Vector™-ultrasonic system) or hand instruments a prospective, controlled clinical study [18]

- Sculean, A. 2004

4-6 mm, > 6 mm

VUS: Vector probe, (Durr Dental, Bietigheim-Bissingen,Germany) using straight and curved metal curettes and a polishing fluid (HA particles < 10um) according to the instructions given by the manufacturer, SRP:Hand instruments (Gracey Curettes, Hu-Friedy Co., Chicago, IL, USA).

6 Months

(a) No treatment of periodontitis for the last 2 years; (b) No use of antibiotics for the 12 months prior to treatment; (c) No systemic diseases, and (d) Good level of oral hygiene. As criterion for a good level of oral hygiene a mean plaque index (PI) score < 1 was chosen.

None

Unclear

- PPD、CAL

- 54

- 24/14(VUS:10/9; SRP:11/8)

-Germany

Periodontal healing after non-surgical therapy with a modified sonic scaler: A controlled clinical trial [17]

- Christgau, M. 2006

< 4 mm, 4-6 mm, > 6 mm

UD:the modified sonic scaler system SonicFlex 2003 L (KaVo), SRP:Gracey-curettes #1/2, #7/8, #11/12, #13/14, HuFriedy, Chicago, IL, USA.

6 Months, 1 Month (excluded)

All had generalized moderate to progressive chronic periodontitis, but were systemically healthy and had not received systemic antibiotics for at least 3 months before. Each patient had to show at least four teeth per quadrant with a PPD of at least 4 mm.

None

14/6

- PPD, CAL

- 45.6 ± 8.0

- 14/6

- Germany

Full-mouth ultrasonic debridement versus quadrant scaling and root planing as an initial approach in the treatment of chronic periodontitis* [14]

- Wennström, J. L. 2005

5-6 mm, 7 mm

UD:EMS Piezon Master 400 with A + PerioSlim tips, water coolant and power setting to 75%; EMS, Nyon, Switzerland, SRP:LM-dental, Turku, Finland.

3 Months, 6 Months

(a) A minimum of 18 teeth; (b) At least eight teeth must show probing pocket depths (PPD) of 5 mm and bleeding on probing (BOP). At least two of these teeth must have a PPD of 7 mm and at additional two teeth, the pockets must measure 6 mm; (c) Unremarkable general health according to medical history and clinical judgement; (d) Female patients must not be pregnant.

(a) Subgingival instrumentation within 12 months prior to the baseline examination; (b) The use of antibiotics within 3 months prior to the start of the study; (c) Compromised medical conditions requiring prophylactic antibiotic coverage; (d) Ongoing drug therapy that might affect the clinical signs and symptoms of periodontitis.

Italy: UD 4/11, SRP 4/10, Sweden: UD 7/10, SRP 6/11

- PPD、CAL

- 25-75 years old, mean age 49.8

- 19/22(SRP11/10;UD8/12)

- Italy, Sweden

Effectiveness of ultrasonic instruments in the therapy of severe periodontitis: a comparative clinical-microbiological assessment with curettes [16]

- D’Ercole, S. 2006

≥6 mm

UD:a power-driven mechanism (Vector® System), SRP: the type of manual instuments is unclear

3 Months, 6 Months, 1 Month (excluded)

(a) Positive for diagnosis of mild-to-severe chronic periodontitis; (b) Good general health according to their medical history; (c) Negative for the use of any antibiotic or antiinflammatory drugs within the 3 months preceding the beginning of the study; (d) Negative for periodontal therapy within 1 year preceding the beginning of the study; (e) Experimental sites (test and control) localized in the interproximal position of two different teeth in the same subject (split-mouth design); (f) Probing depth (PD) values equal to or more than 6 mm in the experimental sites; (g) Difference of PD in the experimental sites (test and control) not exceeding 2 mm; (h) Presence of at least ten teeth for each dental arch. Pregnant or nursing females were excluded from the study.

None

No-smoker

- PPD、CAL

- 40.8 ± 3.9

- 11/7

- Unclear