Diagnosis and management of chronic and aggressive periodontitis part 2: periodontal management

The aim of periodontal treatment is to maintain the remaining periodontal tissues and improve gingival health.¹ The treatment strategy for managing periodontal disease includes:

This is primarily achieved through non-surgical treatment. A further corrective phase may include periodontal surgery and finally the successfully treated patient enters the maintenance phase.¹

Following the clinical assessment and the establishment of the diagnosis of periodontitis, periodontal management should involve delivery of a phased treatment with steps as follows:

An effective maintenance programme should include:

There are a number of factors that affect prognosis, with position in arch affecting likelihood of tooth loss, risk being greatest for maxillary second molars and least for mandibular canines (Table 1).^23,24 Teeth with increased probing depth, mobility, furcation involvement, unsatisfactory crown-to-root ratio, malposition and those used as fixed abutments have worse initial prognosis.²⁵ Prognosis can change over time, with good oral hygiene being a critical positive factor, and mobility decreasing likelihood for improvement. Continued smoking doubles the likelihood of a worsening prognosis.²⁵ During maintenance, phase sites with bleeding on probing have three times higher risk of attachment loss compared to non-bleeding sites.²⁶ Documented monitoring with indices is required to alert to early intervention, as presence of plaque deposits and bleeding on probing adversely affects prognosis, with 16% or more BOP sites reported as likely to lose further clinical attachment.²⁶