Maintenance Periodontal Therapy

Question 1

Maintenance/Supportive Periodontal therapy is essential for

Answer 1

The long-term stabilisation of periodontal disease.

Question 2

Maintenance or supportive periodontal therapy is

Answer 2

A tailor-made individualised programme of maintenance requirements based on patient risk assessment for disease progression is important

Question 3

What is important in maintenance or supportive periodontal therapy?

Answer 3

The need for teamwork in long term patient management

Question 4

Describe the process of maintenance therapy (the flowchart)

Answer 4

1. NSPT
2. Good compliance ie residual pockets > or equal to 5mm and bleeding
3. Reinstrumentation and adjunctive therapy then maintenance
4. Periodontal surgery then maintenance
   Or…
5. NSPT
6. Poor compliance ie. residual inflammation
7. More NSPT
   Or…
8. NSPT
9. Excellent response
10. Maintenance

Question 5

Describe initial/active therapy

Answer 5

OHI-education

Subgingival scaling and root instrumentation- Elimination of pathogenic bacteria and root instrumentation

Motivation- ensure patient can achieve a level of plaque control compatible with periodontal health.
•Risk factors - identify- e.g. smoking

Question 6

Reassessment after non surgical treatment- when and what

Answer 6

4 - 6 weeks after initial treatment
•Look for tissue changes
•Evaluate compliance

•Repeat probing depths, bleeding indices and plaque score.
Stability?
•Decide on future care

Question 7

Stability is achieved when?

Answer 7

Elimination of pockets > 4mm
•BOP at ≤ 10% of sites
•No BOP at 4mm sites
•Elimination of suppuration
•Plaque score ≤ 20%

Question 8

Maintenance periodontal care- what does it involve?

Answer 8

Check patient compliance to OHI
•Re-instruction in oral hygiene practices
•Smoking cessation advice
•Removal of supra-gingival plaque and calculus
•Monitoring – early detection of deepening pockets which should undergo active treatment
•Debridement of root surfaces to base of sulcus/pocket

Question 9

Maintenance periodontal care- frequency of visits?

Answer 9

Must be based on the individual needs and risk profile.

•A risk analysis of the patient’s susceptibility to periodontal disease recurrence is conducted and helps to guide the frequency of visits required.

Question 10

What does a risk analysis involve?

Answer 10

•% sites bleeding on probing
•Number of residual sites >4mm
•Number of lost teeth
•Loss of support in relation to age
•Systemic and genetic factors
•Environmental factors eg smoking

Question 11

Example for high vs low risk patient

Answer 11

A *smoker with *significant attachment loss for age and *deep residual pockets, with *furcation involvement

has a high risk for disease recurrence and will require more frequent maintenance visits than a

*non-smoking patient with *good oral hygiene, *shallow pockets and *mild attachment loss.

Question 12

Patients with a moderate to high risk of periodontal disease recurrence need

Answer 12

3-monthly recalls.

Question 13

Patients with a lower risk for disease may be recalled every

Answer 13

6 months

Question 14

Low risk patients with chronic gingivitis or mild periodontitis who demonstrated continued disease stabilisation over time may be recalled

Answer 14

Annually

Question 15

Continued disease stabilisation over time is indicated by

Answer 15

stable attachment levels, absence BOP and low plaque levels

Question 16

… is essential, even for very low risk patients as a recall period greater than this is associated with a high incidence of disease recurrence

Answer 16

Annual review

Question 17

Key points about maintenance periodontal therapy?

Answer 17

Prevents the recurrence of periodontal disease (and has been shown to be successful in maintaining periodontal health over long periods)

You need a (detailed analysis of risk for further disease and an) *individual tailor-made programme for each patient (which includes the frequency of recall and plaque control regime)

Early detection of periodontal breakdown and institution of scaling/root instrumentation when required.

Question 18

Stages of perio care

Answer 18

Active periodontal care
Reassessment after NSPT
Maintenance periodontal care

Question 19

Stuff about GDC but its not on the learning outcomes…