ASK THE PERIODONTIST – The Latest Updates On The Perio Treatment Guidelines

The S3 Treatment Guidelines embrace the 4 steps to periodontal care and help guide the management of our periodontitis patients.

Step 1 is the foundation for optimal treatment response and long-term stability. It focuses on educating and motivating our patients on achieving and maintaining good levels of plaque control, as well as encouraging positive behavioural changes, such as tobacco cessation.

Once we have an engaged patient, we can proceed to step 2 of therapy. This stage is aimed at eliminating or reducing the subgingival biofilm and calculus, which can be achieved through various forms of subgingival professional mechanical plaque removal (PMPR). The treatment may be carried out by hand or powered instruments and may be supplemented by adjuncts such as systemic antibiotics. The guidelines specifically advise against the use of lasers for this stage of therapy.

On reassessment, there may be sites with residual probing pocket depths which may benefit from further subgingival PMPR or surgery. However, in the absence of bleeding, it may be reasonable to consider monitoring these sites.  For residual probing pocket depths of ≥6mm, surgery may be indicated and if appropriate, patients may be referred to level 2 or 3 services for the procedures to be performed by an adequately trained health professional.

Surgery can be broadly divided into access flaps, resective surgeries and regeneration. Multiple factors need to be considered when choosing the specific type of surgery and optimal plaque control is a pre-requisite for all potential surgical cases. Important aims of surgery include pocket closure, facilitation of maintenance, and optimisation of aesthetics. It is recommended that regenerative therapy is attempted for sites with intrabony defects of 3mm or deeper for class II furcation involvements in lower molars and buccal class II furcation involvements in the upper molars. Regenerative materials that may be used include membranes, grafts, and biologics, often in combination.

The final step of periodontal therapy is life-long supportive care for our periodontitis patient. This is a very cost-effective step in maintaining periodontal stability and is tailored to the individual. Recall intervals may range from 3-12 months, and the appointments allow for monitoring of disease, performing supra- or subgingival PMPR as required, and supporting our patients with maintaining optimal levels of oral hygiene and positive lifestyle changes.

These 4 steps of periodontal care are essential for successful treatment outcomes. It is our duty to effectively communicate the importance of compliance and life-long commitment to our patients to help them achieve better periodontal health.