Abstract
Severe periodontitis is a highly prevalent dental disease. With the advent of implant dentistry, teeth are often extracted and replaced. Periodontal surgery, where indicated, could also result in increased trauma to the patient. This literature review discusses different treatment modalities for periodontitis and proposes a treatment approach emphasizing maximum preservation of teeth while minimizing morbidity to the patient. Scientific articles were retrieved from the MEDLINE/PubMed database up to January 2021 to identify appropriate articles that addressed the objectives of this review. This was supplemented with hand searching using reference lists from relevant articles. As tooth prognostication does not have a high predictive value, a more conservative approach in extracting teeth should be abided by. This may involve repeated rounds of nonsurgical periodontal therapy, and adjuncts such as locally delivered statin gels and subantimicrobial-dose doxycycline appear to be effective. Periodontal surgery should not be carried out at an early phase in therapy as improvements in nonsurgical therapy may be observed up to 12 months from initial treatment. Periodontal surgery, where indicated, should also be minimally invasive, with periodontal regeneration being shown to be effective over 20 years of follow-up. Biomarkers provide an opportunity for early detection of disease activity and personalised treatment. Quality of life is proposed as an alternative end point to the traditional biomedical paradigm focused on the disease state and clinical outcomes. In summary, minimally invasive therapy aims to preserve health and function of the natural dentition, thus improving the quality of life for patients with periodontitis.
Highlights
Periodontitis is a multifactorial and bidirectional inflammatory disease initiated by the accumulation of microbial deposits; nonresolving inflammation and individual susceptibility likewise lead to an overgrowth of periodontal pathobionts which play a role in the progression of periodontitis [1]
With a prevalence of 35% and 11.2%, respectively, untreated dental caries and severe periodontitis are two of the most common dental diseases [6, 7]. While their aetiologies may differ, both conditions involve establishing a dysbiotic polymicrobial community influenced by host factors and inflammation, whose activities converge to initiate the disease [8]. Both conditions may result in tooth loss, which is associated with an impaired oral health-related quality of life [9]. us, the prevention and control of caries and periodontitis should be an aim of every dentist. e concept of minimally invasive dentistry is based on tissue preservation; preferably by prevention and early
Periodontitis is a major cause of tooth loss among adults; the downstream sequelae include loss of self-esteem, quality of life, and masticatory dysfunction which may compromise nutrition and general health [13]. e 2017 World Workshop classification considers the number of teeth lost due to periodontitis as a stage defining the level of severity, with ≥5 teeth possibly leading to the need for complex rehabilitation [14]
Summary
Periodontitis is a multifactorial and bidirectional inflammatory disease initiated by the accumulation of microbial deposits; nonresolving inflammation and individual susceptibility likewise lead to an overgrowth of periodontal pathobionts which play a role in the progression of periodontitis [1]. With a prevalence of 35% and 11.2%, respectively, untreated dental caries and severe periodontitis are two of the most common dental diseases [6, 7] While their aetiologies may differ, both conditions involve establishing a dysbiotic polymicrobial community influenced by host factors and inflammation, whose activities converge to initiate the disease [8]. It is an evolving treatment philosophy in healthcare based on scientific advances and a more recent focus on patient-reported outcome measures In cariology, this has taken the form of early diagnosis, remineralization of early lesions, and minimally invasive cavity preparation techniques [11]. This concept has focused mainly on surgical techniques that minimize surgical trauma, optimizing wound healing and reducing patient morbidity [12]. erefore, this literature review aims to discuss periodontitis and different treatment modalities, with the purpose of integrating these into a holistic treatment approach which includes a patient’s quality of life as an endpoint (Figure 1). e effectiveness of this approach is discussed in terms of clinical performance and patient perception
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