Periodontal maintenance
I- Introduction:
The long-term success of periodontal treatment depends not only on the type of active treatment but also on postoperative monitoring and the establishment of an organized recall system or so-called maintenance therapy.
II- Definitions:
The follow-up of periodontal treatment has been the subject of various names; maintenance, periodontal maintenance, supportive periodontal therapy and more recently supportive periodontal care.
Maintenance is defined as a set of personal and professional means allowing effective control of PB and recurrence of periodontal disease.
- Personal maintenance: this is combined with rigorous long-term dental hygiene, carried out by the patient himself.
- Professional maintenance: this is carried out by the practitioner during clinical monitoring sessions and reinforcement of motivation for oral hygiene.
III- The goals of maintenance therapy:
It is well established that periodontal treatment without proper PB control inevitably leads to failure, controlled clinical trials have shown that with regular maintenance including scaling and proper hygiene measures, it is possible to stabilize the attachment level for several years.
- Eliminate gingivitis before it transforms into periodontitis in at-risk individuals.
- Stabilize Periodontal Disease and prevent its recurrence and therefore preserve periodontal health.
- Slowing the progression of the disease in uncooperative patients.
- In the case of refractory periodontitis where the goal will be to slow the progression of periodontal disease.
IV- practical therapeutic plan:
- Diagnostic phase:
- Questioning:
It is always necessary, by asking a few judiciously asked questions, to ensure that there has been no change in the patient’s general condition (what has happened since the last session? at the oral-dental level? general condition? stress?)
All treatments carried out in the interval between 2 sessions will also be recorded.
- Periodontal examination:
- Gum condition: inflammation or not?
- Probing of pockets: attachment level, special attention to furcations, bleeding on probing (bleeding index).
- Tooth mobility.
- Plaque control with developer, performed with the patient in front of the mirror, to allow the patient to visualize the areas where additional effort will be required.
- Dental examination:
Allows the presence of caries, particularly root caries, to be objectified, which always tend to occur more frequently in the event of recessions.
- X-ray assessment:
Radiology can provide important information about possible worsening of periodontal disease.
- Bacteriological and immunological examination:
Examination of plaque and gingival fluid helps to support the diagnosis (presence of supposedly pathogenic bacterial strains, presence of large quantities of enzymes in the fluid)
- Therapeutic phase:
- Information and motivation reinforcement:
Plaque control should be reviewed and corrected until the patient demonstrates sufficient competence, even if this requires additional instruction sessions.
- Descaling and resurfacing:
This is an intervention that consists of removing plaque and tartar from the surface of the teeth. Depending on the location of the deposits, the scaling will be supra or subgingival.
Professional removal of deposits allows;
– To delay the formation of a new organized PB.
– To reduce the risk of root caries.
– To improve patient motivation.
- Drug treatment:
In addition to mechanical treatment, an anti-infective product, either antimicrobial or antiseptic, can be added.
- Treatment of recurrences:
The choice of treatment to counteract recurrence must be based on an analysis of the causes of recurrence:
– Inadequate or insufficient treatment.
– Inadequate restorations placed after the end of periodontal treatment.
– The patient did not attend his follow-up visits.
– Presence of certain general diseases.
V- Frequency of visits:
In the months following periodontal treatment, check-ups are more frequent to ensure periodontal stabilization of the patient’s motivation (monthly or bimonthly check-ups in severe forms)
In patients considered to be stable and with correct hygiene, biannual check-ups can be recommended; Anglo-Saxon and Scandinavian periodontists recommend reminders every 3 months.
- Conditions that may influence the frequency of check-ups:
Related to PB control | Patient motivationPatient knowledge and ability to apply oral hygiene care.Speed of BP formation.Presence of retention factors complicating or preventing effective oral hygiene care.Speed of tartar formation.Specific periodontal risk factors.Trauma due to inadequate brushing. |
Related to tissue destruction | Tendency to develop gingivitis and tissue destruction: → resistance of host tissues → pathogenicity of PB bacteria |
Others | Occlusal report. Caries activity. |
- Intervals between control visits:
Classification | Features | Intervals between control visits |
Class A | Excellent results maintained for a year or more, patient shows adequate oral hygiene, little tartar, no occlusal problems, no complicated prosthesis, no residual pockets and no teeth with less than 50% bone remaining. | 6 months to 1 year |
Class B | Good results usually maintained for at least a year, but the patient shows certain factors which are:- Low or no HBD.- Significant tartar formation.- Systemic disease predisposing to periodontal relapse- Some remaining pockets.- Occlusal problems- Recurrence of caries. | 3 to 4 months |
Class C | Generally poor results following periodontal treatment and/or presence of some of the following factors: – Number of teeth with less than 50% bone support. – Residual pockets being too advanced to be improved by periodontal surgery. | 1 to 2 months |
Conclusion :
At the end of any periodontal treatment, there should be daily PB monitoring by the patient and professional follow-up by the practitioner.
These restrictive precautions are justified by the frequent recurrences of periodontal disease and the decreasing motivation of the majority of patients. Maintenance remains to this day one of the most effective means of preventing recurrences of periodontal disease .
Periodontal maintenance
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