Active Periodontal Treatment Research Articles

Supportive care after active periodontal treatment: a review.

This review concerns the most significant questions regarding supportive (maintenance) care after active periodontal treatment: the effectiveness and ideal frequency of maintenance appointments, the adequacy of the supportive therapy according to patient needs, the possible alternatives to currently accepted protocols, and the relative value of personal oral hygiene in the overall context of supportive care. Periodontal diseases are infections with a high potential for recurrence, progressive loss of attachment and eventually, tooth loss. Current therapies for periodontal diseases are highly predictable in arresting disease activity. Supportive periodontal care has been shown to be very effective in maintaining support when adapted to each particular case. Nevertheless, current maintenance therapies may be unsuccessful in preventing further loss of attachment in a small number of sites for some patients. Tests aiming at bacterial identification and the subgingival application of antimicrobials may be helpful in the management of such cases, however the practical value in a specific setting is not known. There is growing evidence of the fundamental role of personal oral hygiene in supportive periodontal care. In cases with rapid and severe periodontal destruction and where local and/or systemic risk factors are present, personal oral hygiene becomes a key factor in the long-term preservation of periodontal support.

Compliance with supportive periodontal therapy and its relation to the bleeding index.

This is a retrospective study of 418 patients who received active periodontal treatment between the years of 1984 and 1990. The patients were instructed to return for supportive periodontal treatment (SPT) at 3 to 6-month intervals. The objective of this study was to evaluate patient compliance with periodic recall visits, and to study the relationship of bleeding upon probing in those who returned regularly. The patients were divided into 3 groups: patients who returned periodically for supportive treatment, patients who interrupted the proposed maintenance treatment, and patients who never returned after active periodontal treatment. Analysis was made for each group to correlate the degree of compliance with gender, disease classification, and type of treatment received. To analyze bleeding upon probing, 2 groups of patients were selected: a test group with 39 patients who had attended at least 10 recall visits and participated in the study for more than 40 months, and a control group of 21 patients who interrupted the SPT for at least 12 months. The results showed that 26% of the treated patients returned for SPT and, of those, 40% returned irregularly. There was a statistical significant difference in compliance in relation to disease classification and the type of treatment received, but no correlation was found between compliance and gender. There was a statistically significant difference in compliance between the test group and the control group in relation to the variation of the bleeding index.

Scaling and granulation tissue removal in periodontal therapy*

The present clinical trial was performed to study whether subgingival scaling is a method of therapy which is equally effective as "access" flaps in reducing gingivitis and probing depths and in improving probing attachment levels. The study was also designed to assess whether granulation tissue removal is a determining factor for proper healing in the treatment of periodontal disease. 15 patients with advanced periodontal disease were included in the study. Each patient had at least 4 sites in each quadrant of the jaws with probing depths exceeding 6 mm. A baseline examination was performed to assess the following parameters: the oral hygiene status, the gingival conditions, the probing pocket depths and the probing attachment levels. In addition, in each quadrant, 3 approximal sites were selected for analysis of the subgingival microbiota. All of these sites showed signs of gingivitis. One site had a probing depth of less than 4 mm, another a probing depth between 4 and 6 mm and the third site had a probing depth exceeding 6 mm. The subgingival bacterial samples were studied by dark-field microscopy and the % of spirochetes and motile rods was assessed. By random selection the 4 jaw quadrants in each patient were treated for periodontal disease by the use of (1) the modified Widman flap procedure, (2) the modified Kirkland flap procedure or by (3) nonsurgical scaling and root planing. In all, 20 quadrants were treated with each of the 3 procedures. After the termination of active periodontal treatment, all patients were recalled for professional tooth cleaning once every 2 weeks during a 12-week period. Subsequently, they were recalled for prophylaxis every 3 months. The patients were examined 6 and 12 months after treatment using the same parameters as used at baseline. The data from the examinations demonstrated that subgingival scaling is an effective measure in the treatment of periodontal disease. Both in terms of average gingivitis resolution and average probing depth reduction, non-surgical therapy appeared to be equally effective as a surgical approach to treatment. It was also observed, however, that following non-surgical treatment, a larger number of sites with pockets exceeding 6 mm remained than following surgical therapy. Most of these deep pockets in non-surgically treated quadrants bled on probing to the base of the pocket. In addition, the subgingival microbiota of such sites were found to harbor more than 20% spirochetes and motile rods.(ABSTRACT TRUNCATED AT 400 WORDS)

Alterations of the position of the marginal soft tissue following periodontal surgery.

The present study was performed to examine the alterations of the position of the marginal soft tissue ("gingival margin") on the buccal surface of teeth in patients who following periodontal surgery were enrolled in a supervised maintenance care program for 10--11 years. The material consisted of 43 patients with severe destruction of the periodontal tissues. Following initial treatment comprising scaling, root planing and instructions in plaque control measures, deepened periodontal pockets were eliminated by the use of an apically repositioned flap procedure including osseous surgery to eliminate bony defects. After treatment, the patients were recalled once every 3--6 months for maintenance care. In all patients, the distance between the cemento-enamel junction and the gingival margin on the buccal surfaces of all treated teeth was assessed (1) prior to surgery, (2) after initial healing, and (3) at a reexamination 10--11 years after treatment. In addition, the presence or absence of keratinized gingiva was determined. The results showed that (1) during active periodontal treatment the position of the gingival margin was shifted in an apical direction, (2) this displacement was to some extent compensated for by a coronal regrowth during the postoperative maintenance care period, (3) the alterations of the position of the gingival margin followed a similar pattern in areas with and without a zone of keratinized gingiva, (4) the number of gingival units devoid of keratinized gingiva decreased during the maintenance care period.