perio maintenance

Question 1

Define Periodontal Stability

Answer 1

Periodontitis patient that has been successfully treated and hv ‘closed pockets’
- closed pockets: No BOP at 4mm sites
- BOP <10%, PPD </= 4mm with no BOP at 4mm sites

Question 2

Define Periodontal Maintenance

Answer 2

• Procedures carried out at selected intervals based on an individual’s risk, to assist the periodontal patient in maintaining oral health
• Patient is in a stable state and oral health has been achieved

Question 3

What are the aims of Periodontal Maintenance?

Answer 3

• To minimise recurrence and progression of perio disease in previously treated Perio & gingi patient
• To reduce incidence of tooth loss by monitoring dentition and any prosthetic replacement of natural teeth
• Increase probability of locating and treating, in a timely manner, any other diseases present within oral cavity

Question 4

Studies that show perio maintenance is important to prevent and minimize disease progression

Answer 4

1. Axelsson & Lindhe 1981: recall group showed more improvement (99% tooth surfaces showed improvement vs 45% in non-recall group). No change or <1mm attachment loss vs greater attachment loss in non-recall group.
2. Randow et al 1986: Treated perio patients without regular maintenance showed recurrence rate of almost 10% –> shows importance of maintenance, if not disease worsens.
3. Moser et al 2002: Perio patients with regular maintenance showed that abutments of extensive FDP had minor CALoss over 10-11 years. Shows that maintenance helps to reduce attachment loss over 10 years.

Question 5

What is Axelsson & Lindhe 1981 study about?

Answer 5

Recall vs non-recall group
- Recall group showed that 99% of tooth surfaces showed improvement overtime, no change or <1mm attachment loss noted
- Non-recall group showed only 45% of tooth surfaces showed improvement. With 55% further attachment loss.

TLDR: recall group showed improvement and minimal to no attachment loss over time. non-recall showed less improvement and had worsening of attachment loss.

Question 6

What is Randow et al 1986 study about?

Answer 6

Patients without regular maintenance after periodontitis treatment showed recurrence rate of almost 10% over 6 years.

Shows the importance of maintenance

*Tells you that perio tx is worse outcome if u dont maintain

Question 7

Moser et al 2002 study?

Answer 7

Regular maintenance after Periodontitis treatment showed little (1.3-2%) attachment loss over 10-11 years

Shows the importance of maintenance in maintaing CALevels

Question 8

4 rationales for periodontal maintenance

Answer 8

1. Effective home plaque control directly related to success of perio tx (px come and we reinforce)
- baegle dog model study showed that following initial perio tx, periodontal attachments were essentially miantained by controlled OH

**2. To prevent diseaseprogression and re-infection **
- study showed that perio pt with non-recall had greater attachment loss
- perio pt under recall: 99% of tooth surfaces showed improvements, no change or <1mm attachment loss comapred to 45% in non-recall group
- showed that perio pt are at high risk for re-infection and disease progression if not under customized & meticulous SPT

3. Maintain attachment levels
   - Studies showed that perio patients can still suffer from re-infection and in an unpredictable manner
   - Customized SPT can maintain CAlevels over long periods
   - Allows us to intervene at appropriate timings, catch the disease in its active state and prevent further progression

**4. To sustain effects of perio tx **
- Studies showed that after inital tx, perio pt who were under regular SPT had as little as 1.3-2% attachment loss over 10-11 years.
- Studies showed that perio patients who were not under SPT after perio tx had recurrent perio at 3-5x higher rate than natural progression of disease.
- This shows that perio tx is ineffective if SPT is omitted or neglected. Outcomes for patients may be worse.