Nonsurgical Periodontal Therapy: a Review of Current Standards of Care and Innovations to Improve Gingival and Periodontal Health

Abstract

Regular home care delivered by patients as well as professional mechanical debridement is a cornerstone of periodontal and peri-implant health. This report will examine current therapies for nonsurgical periodontal and peri-implant diseases, including oral hygiene measures and behavioral modification, scaling and root planing, adjunctive systemic and local antibiotic therapy, and novel pharmacologic and physical adjunctive treatments. Periodontitis is a highly prevalent, destructive disease and has been estimated to result in $54 billion of lost productivity yearly worldwide. Additionally, it is estimated that up to 5 million dental implants are placed each year and, with the increasing number of implants comes increasing numbers of cases of peri-implant mucositis and peri-implantitis. Nonsurgical therapy is the first line of treatment and long-term prevention for both of these conditions. Mechanical therapy requires a high level of operator skill and an understanding of expected results and the modifiers which may affect treatment outcomes. Proper patient selection, patient compliance, and assessment of optimal treatment options are required for successful results of therapy. Adjunctive therapy in high-risk patients, for example, smokers, may improve treatment outcomes, and care should be taken to select adjunctive therapies based upon their mechanisms of action and the deficits in host defense noted in patients with additional risk factors. Furthermore, long-term maintenance and surveillance of disease recurrence are necessary in the management of these chronic diseases. Nonsurgical therapy is a cost-effective intervention to address periodontal diseases, and patients with select risk factors may receive additional benefit when adjunctive therapies are employed during this phase of treatment.