periodontitis stage 4 grade c treatment

0000101613 00000 n Theodoridis C, Grigoriadis A, Menexes G, Vouros I. Outcomes of implant therapy in patients with a history of aggressive periodontitis. New and exciting things were happening at this past EuroPerio9 held in Amsterdam from June 20th-23rd, 2018. Step 2: Establish Stage is divided into two sections. ; Echeverra, J.J. 0000001859 00000 n Patients in stage IV, grade C had TLPD rates of 0.24 0.31, 0.15 0.24 (number of teeth/patient/year . ; Eickholz, P.; Pretzl, B. Prognostic value of the periodontal risk assessment in patients with aggressive periodontitis. Thorough non-surgical periodontal treatment consisting of scaling and root planing was provided, followed by a series of regenerative periodontal surgeries including guided tissue regeneration (GTR) and guided bone regeneration(GBR) to manage advanced bone defects. Department of Scientific Information, Evidence Synthesis & Translation Research, ADA Science & Research Institute, LLC. Stage IV periodontitis shares the severity and complexity characteristics of stage III periodontitis, but includes the anatomical and functional sequelae of tooth and periodontal attachment loss (tooth flaring and drifting, bite collapse, etc. Int J Periodontics Restorative Dent. Ramesh A, Ravi S, Kaarthikeyan G. Comprehensive rehabilitation using dental implants in generalized aggressive periodontitis. Background: 24 No. . official website and that any information you provide is encrypted 104.236.29.24 0000001972 00000 n The recently published clinical practice guideline (CPG) for the treatment of periodontitis in stages I-III provided evidence-based recommendations for the treatment of periodontitis patients, defined according to the 2018 classification. J Am Dent Assoc 2015;146(7):525-35. concluded that periodontitis is associated with (1) higher HbA1c levels in individuals without diabetes and in individuals with type 2 diabetes, (2) worsened diabetes-related complications in individuals with type 2 diabetes, and (3) an increased prevalence of complications in individuals with type 1 diabetes. 0000099634 00000 n 2021 Mar;106:103562. doi: 10.1016/j.jdent.2020.103562. 0000010094 00000 n In 2018, the American Academy of Periodontology and the European Federation of Periodontology published the World Workshop Classification System for Periodontal and Peri-Implant Diseases and Conditions, which established a new approach to diagnosing periodontal disease to replace the system developed in 1999. A stage 2 mobility is present when tooth mobility is increased in any direction other than axial over a distance of >0.5 mm and up to 1 mm. The aim of this study was to understand if important factors such as smoking, gender, age, plaque, pus, and probing pocket depth could influence the histomorphological pattern of generalized stage IIIIV, grade C periodontitis (GPIIIIVC), which is a particular form of periodontitis. A systematic review and meta-analysis. FOIA Periodontol. 0000001056 00000 n Epub 2021 Feb 8. %PDF-1.4 % F: 904-443-7012, 252 15th Avenue South, For mild to moderate periodontitis, the focus will be on clinical attachment loss (CAL). The present S3 Level CPG informs clinical practice, health systems, policymakers and, indirectly, the public on the available and most effective modalities to treat patients with stage IV periodontitis and to maintain a healthy dentition over lifetime, according to the available evidence at the time of publication. Clinical periodontal measurements, real-time PoC aMMP-8, IFMA aMMP-8, and Western immunoblot analyses were performed before and 1 month after anti-infective scaling and root planing periodontal treatment. and transmitted securely. The goal of periodontal treatment is to eliminate dysbiotic plaque biofilm from the tooth surface and to establish an environment that allows the maintenance of health. J Periodontol. A 2018 systematic review by Graziani et al. doi: 10.1111/prd.12104. Barrier membranes should be placed between the bone defect and gingival tissues to achieve guided tissue regeneration. Durable bonds at the adhesive/dentin interface: an impossible mission or simply a moving target. Rabelo CC, Feres M, Gonalves C, Figueiredo LC, Faveri M, Tu YK, et al. Cortellini P, Prato GP, Tonetti MS. Orange Park, Florida 32073 The guidelines can be followed so consistent diagnosing can occur. ; Dutta, V. Comparative evaluation of the marginal gingival epithelium in smokers and nonsmokers: A histomorphometric and immunohistochemical study. J Clin Periodontol. Bethesda, MD 20894, Web Policies permission provided that the original article is clearly cited. Cureus. . future research directions and describes possible research applications. During the one and two-year follow-ups, the teeth and implants did not show any signs of instability, attachment loss or bone loss. Jepsen K, Jerve-Storm PM, Henrichs I, Lensing I, Mller AL, Cosgarea R, Keilig L, Bourauel C, Jepsen S. Clin Oral Investig. Once the determination of periodontitis has been made, the disease is classified according to one of four Stages (I-IV) based upon the most severe area of disease presentation, which describe the disease severity and extent of disease, focusing on attachment and bone loss (Table 1A). Recommendations for treating stage I-III periodontitis in the Taiwanese population: A consensus report from the Taiwan Academy of Periodontology. hb``f``g`e`\ @16s0080 ^`K'4m`6GH00@QegVc4kX71j0~dH'X!~uZ)FB Z00% (; J( endstream endobj 17 0 obj <>>> endobj 18 0 obj <>/Font<>/ProcSet[/PDF/Text]/Properties<>>>/Rotate 0/TrimBox[0.0 0.0 792.0 612.0]/Type/Page>> endobj 19 0 obj <> endobj 20 0 obj <>stream Supportive periodontal treatment: Pocket depth changes and tooth loss. Periodontal disease and tooth decay are the two biggest threats to dental health. More importantly, predisposing factors should be identified and removed. This website is using a security service to protect itself from online attacks. 2015;42(7):647-57. Periodontitis is not as readily reversible as gingivitis. The guidelines have not been updated since 1999, so this is a pretty big deal! 0000118363 00000 n 2002;29 Suppl 3:136-59. Periodontitis is much more common in certain dog and cat breeds, but it can affect any individual. Root scaling (removing plaque and calculus on exposed root surfaces) and planing (smoothing the root surfaces by removing textural irregularities and diseased cementum) are performed, followed by gingival curettage that removes the infected and inflamed inside layer of a periodontal pocket. Bookshelf HHS Vulnerability Disclosure, Help Epub 2017 Jun 15. Eke PI, Borgnakke WS, Genco RJ. 2018 May;16(2):210-218. doi: 10.1111/idh.12290. Epub 2019 Sep 14. Stage IV grade C periodontitis; Aggressive periodontitis; Dental implants; Maintenance; Regeneration. Your IP: Conclusions: There are several actions that could trigger this block including submitting a certain word or phrase, a SQL command or malformed data. In order to consider both aims, 18 patients were enrolled in this study. Established periodontal disease with 25-50% attachment loss. J Periodontol 2018;89 Suppl 1:S74-S84. American Journal of Orthodontics and Dentofacial Orthopedics, 157(2), 156-164.e117. VIDCAST: How Heartland Dental Helps Maximize Potential, QUIZ: Test Your Historical Women in Dentistry Knowledge, A Letter to Dental Hygienists from Your Temp Hygienist, Caviar Tongue: Are Dental Hygiene Patients Displaying Signs of Aging?, Barodontalgia: How Pressure Changes can Cause Tooth Squeeze Pain, Childrens Oral Health: Strategies to Help Prevent Early Childhood Caries, Study: Periodontal Disease Increases Risk Esophageal and Gastric Cancer by 43%-52%, Hygienist Spotlight: The Multifaceted Hygienist Behind Teacher Tina RDH, Research Looks at Work-related Musculoskeletal Disorders in Dental Professionals, OraVerse: How to Help Dental Patients Rebound from Numb Feeling Faster, The Effectiveness of Toothpastes in Blocking Dentin Tubule Permeability. Graetz C, Slzer S, Plaumann A, Schlattmann P, Kahl M, Springer C, et al. The https:// ensures that you are connecting to the Deep infrabony defects in multirooted teeth with bone loss that undermines a furcation can infect the pulp through a furcation canal, resulting in secondary endodontic disease. Multiple requests from the same IP address are counted as one view. 2022 Dec 10;10(12):2505. doi: 10.3390/healthcare10122505. All in all, this Staging and Grading system helps your periodontist provide a patient-centered evaluation and treatment plan as well as an effective way to communicate more clearly with our patients. J. Clipboard, Search History, and several other advanced features are temporarily unavailable. The site is secure. Lang, N.P. 4.2 Sequence for the treatment of stage IV periodontitis. Sex differences in destructive periodontal disease: Exploring the biologic basis. Periodontal disease and its related risk factors have been studied with growing interest [. 2008 Mar;39(3):211-5. Maxillary canine teeth with pockets on their palatal side that have already progressed to form an oronasal fistula require extraction and oronasal fistula repair. Jacksonville, FL 32211 ; Tonetti, M.S. This S3 Level CPG was developed by the European Federation of Periodontology (EFP), following methodological guidance from the Association of Scientific Medical Societies in Germany and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process. Periodontitis and respiratory diseases: A systematic review with meta-analysis. A recent change to the classification of periodontal disease helps your periodontist express the severity and complexity of the disease (Staging) as well as the patients risk for progression (Grading). Al-Zahrani, M. S., Alhassani, A. Development of periodontitis is also affected by other intrinsic (eg, genetics, tooth crowding, thin alveolar bone, age) and extrinsic (eg, diet, stress, concurrent disease, oral hygiene) factors. BMC Cardiovasc Disord 2017;17(1):50. Zitzmann, N. (2018). A new classification scheme for periodontal and peri-implant diseases and conditions - Introduction and key changes from the 1999 classification. The current classification system was endorsed by the American Dental Association in 2021. Periodontitis presents differently for everybody. Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: Consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. 2006 Oct;17 Suppl 2:35-51. Deas DE, Mealey BL. Clinical Case Report on Treatment of Generalized Aggressive Periodontitis: 5-Year Follow-up. Oral Microbiome, Oral Health and Systemic Health: A Multidirectional Link. Methods: Twenty-four patients with stage IV/grade C periodontitis who received combined periodontal and orthodontic treatment were included in this study. Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. 2018;45:149161. The periodontist will also compare the amount of bacterial biofilm to the destruction level. Pregnancy complications: An umbrella review of 23 systematic reviews found that periodontitis during pregnancy seems to contribute to increased risk of preterm birth, low birthweight infants and preeclampsia. Quantitative analysis of the percentage of inflammatory cells and the vascular area were performed using a camera equipped with an image analysis system (Image-Pro Premier 9.1; Immagini e Computer, Milan, Italy). Treatment of early periodontitis includes tooth scaling and root planingaccompanied by improved oral hygiene. 0000094964 00000 n 0000027419 00000 n Background: This case report shows that within the limitations of this study a successful outcome can be achieved with an early diagnosis and treatment involving elimination of infectious microorganisms and meticulous long-term maintenance combined with regenerative techniques and implant placement to restore the masticatory function and improve the quality of life for the patient. 2015 May;113(5):371-82. F: 904-398-1810, 9432 Baymeadows Road, Suite 200, Genco R, Williams R. Periodontal Disease and Overall Health: A Clinicians Guide. Kwon T, Lamster IB, Levin L. Current Concepts in the Management of Periodontitis. The simplified papilla preservation flap. Plaque is a typical biofilm, composed of many microorganisms that differ from their planktonic forms. Modern Periodontics is dedicated to provide optimal oral health through education, prevention and treatment. Content is neither intended to nor does it establish a standard of care or the official policy or position of the ADA; and is not a substitute for professional judgment, advice, diagnosis, or treatment. Two key processes involved in the evolution of this pathology are angiogenesis and inflammatory infiltrate. A sample size of 18 subjects (11 non-smokers and 7 smokers) is sufficient to detect a clinically important difference of 0.45% between groups in reducing the vascular area, assuming a mean in healthy and non-smoking patients of 1% [, Similarly, as the mean of inflammatory infiltrates reported by literature in healthy and non-smoking patients is 9% with a standard deviation of 1.5% [. The trusted provider of veterinary information since 1955, Congenital and Developmental Anomalies of the Mouth and Dentition in Large Animals, Irregular Wear of the Dentition in Large Animals, Developmental Abnormalities of the Mouth and Dentition in Small Animals, Last review/revision Dec 2013 | Modified Oct 2022. . Clin Oral Implants Res. Use to remove results with certain terms Mengel R, Behle M, Flores-de-Jacoby L. Osseointegrated implants in subjects treated for generalized aggressive periodontitis: 10-year results of a prospective, long-term cohort study. Conclusions: The paper describes a simple matrix based on stage and grade to appro- Methods: ; G.G. sharing sensitive information, make sure youre on a federal ; Greenwell, H.; Kornman, K.S. 0000028483 00000 n 2022 May;52(3):511-525. Removal of the bacterial plaque on the tooth surfaces is of utmost importance. Considering the vascular area, young patients showed a significant increase compared to older patients and it was higher in non-smokers than smokers. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). I 'hfW$gLSV(LgtB-erO8n=xO$0O~=~_|HHt>2q{|swiG "nx#+2>>?>|.> ?>|8~/|~!u`},,K@J-wT|}Y%|@iT, py.x\},\jVc+|o-1 5O SlH'0DSb4~]4w8N8#. 0000056742 00000 n the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, Methods: The study included 27 adult patients (13 smoker, 14 non-smoker) with stage III/IV-grade C periodontitis and 25 healthy adult subjects. ; E.B. They may even be beneficial by helping to limit the numbers of periodontopathogenic bacteria. 1899;41:248-64. Gingivitis is common in dogs and cats and refers to inflammation of the gingiva in response to plaque antigen. Association between periodontitis and arterial hypertension: A systematic review and meta-analysis. %i}F/5>e3cv4qg j. Abstracts of Presentations at the Association of Clinical Scientists 143. Meyer-Bumer, A.; Pritsch, M.; Cosgarea, R.; el Sayed, N.; Kim, T.S. The action you just performed triggered the security solution. 0000026481 00000 n A summary of current work. Cardiovascular diseases: Although a causal relationship has not been established, the presence of periodontal disease has been associated with various cardiovascular diseases including myocardial infarction. Subsiding of Periodontitis in the Permanent Dentition in Individuals with Papillon-Lefvre Syndrome through Specific Periodontal Treatment: A Systematic Review. The authors declare no conflict of interest. ; Mealey, B.L. The treatment plan for the management of stage IV periodontitis should include a successful outcome after completing the interventions in steps 1, 2 and 3, according to the EFP S3 Level clinical practice guideline for treatment of stage I-III periodontitis (Sanz, Herrera, et al., 2020 . Find support for a specific problem in the support section of our website. The effects of fixed orthodontic retainers on periodontal health: A systematic review. Keywords: GPIIIIVC patients have been chosen to better define the histomorphological characteristics of a low prevalence illness. In a biofilm, microorganisms are more resistant to antibiotics, disinfectants, and antibacterial agents. Please enable it to take advantage of the complete set of features! Before J Clin Periodontol. The extent of disease is categorized by the extent of stage-defining destruction. Here is shown a periodontitis case definition system based on a staging and grading framework. Pathogenesis of inflammatory periodontal disease. Tonetti, M.S. 16 38 However further investigation and clinical studies are required to confirm these results. Awad, M. A., Locker, D., Korner-Bitensky, N., & Feine, J. S. (2000). Dental cleaning on an awake animal improves the cosmetic appearance of the tooth crowns but does not improve periodontal health. Stefanski S, Svensson B, Thor A. Implant survival following sinus membrane elevation without grafting and immediate implant installation with a one-stage technique: an up-to-40-month evaluation. Sarahs passion is education. Cochrane Database Syst Rev 2018;1:CD009376. This is especially true if multiple teeth are missing and insufficient crown-root ratios are obvious. If more than 30% of the teeth are involved, then periodontitis is considered generalized. ; Bissada, N.F. Buffoli, B.; Garzetti, G.; Calza, S.; Scotti, E.; Borsani, E.; Cappa, V.; Rimondini, L.; Mensi, M. Periodontitis Stage IIIIV, Grade C and Correlated Factors: A Histomorphometric Study. J. Clin. Extraction indicated if client and patient will not commit to daily home oral hygiene. 2012 Oct;39(8):541-4, 547-8, 551-2. Int. Please note that many of the page functionalities won't work as expected without javascript enabled. HHS Vulnerability Disclosure, Help 2017 Mar-Apr;21(2):160-3. This is achieved through professional dental cleaning (scaling and polishing) with power and hand instruments under general anesthesia. Hn|:F Leow NM, Moreno F, Marletta D, et al. Due to the high number of zeros, the gingival recession was summarized both as the percentage of zero values and the geometric mean and sd of non-zero values. Feature papers are submitted upon individual invitation or recommendation by the scientific editors and must receive 22. Recent epidemiologic trends in periodontitis in the USA. -, Caton J.C., Armitage G., Berglundh T., Chapple I.L.C., Jepsen S., Kornman K.S., Mealey B.L., Papapanou P.N., Sanz M., Tonetti M. A new classification scheme for periodontal and peri-implant diseases and conditionsIntroduction and key changes from the 1999 classification. Masamatti SS, Kumar A, Virdi MS. Periodontal diseases in children and adolescents: a clinician's perspective part. Stage III/grade C (55.77%) was the most common in the study by Graetz et al. Disclaimer/Publishers Note: The statements, opinions and data contained in all publications are solely National Library of Medicine 2023 Jan 17;16:235-244. doi: 10.2147/JIR.S395777. 1 (2021): Jan - Mar / 2021 - published Dec 2020, https://doi.org/10.14295/bds.2021.v24i1.2238, Magnetic resonance imaging texture analysis of the temporomandibular joint for changes in the articular disc in individuals with migraine headache, Impact of photoinitiator quality on chemical-mechanical properties of dental adhesives under different light intensities, Knowledge and attitudes related to erosive tooth wear of professional wine tasters: a cross-sectional study, Insights on the role of cytokines in carious lesions, Biomechanics of implant-supported restorations, Diagnostic accuracy of dental pulse oximeter with customized sensor holder, thermal test and electric pulp test for the evaluation of pulp vitality: An in vivo study, Comparative evaluation of post-operative pain after pulpectomy with k-files, kedo-s files and mtwo files in deciduous molars-a randomized clinical trial, Treatment Considerations for Patient With Amelogenesis Imperfecta: A Review, Randomized, double-blind, placebo-controlled clinical trial on the effects of propolis and chlorhexidine mouthrinses on gingivitis, Effects of Typified Propolis on Mutans Streptococci and Lactobacilli: A Randomized Clinical Trial. Clinical Periodontology and Implant Dentistry, Help us to further improve by taking part in this short 5 minute survey, The Role of Wnt and R-spondin in the Stomach During Health and Disease, Zimmermann-Laband-1 Syndrome: Clinical, Histological, and Proteomic Findings of a 3-Year-Old Patient with Hereditary Gingival Fibromatosis, Neuromyelitis Optica Spectrum Disorder and Anti-MOG Syndromes, Oral and Psychological Alterations in Haemophiliac Patients, https://doi.org/10.3390/biomedicines7020043, Malignant and Potentially Malignant Disorders of the Oral Cavity: Updates from Pathogenesis to Therapy, http://creativecommons.org/licenses/by/4.0/. No special Gut microbiota-dependent trimethylamine n-oxide pathway contributes to the bidirectional relationship between intestinal inflammation and periodontitis. trailer <<1B1783BF7F6145A9AFE30DDB3A361986>]/Prev 244117>> startxref 0 %%EOF 53 0 obj <>stream Young patients showed a significant increase in vascular area percentage compared to older patients (0.60% vs. 0.46%, p-value = 0.0006) and this percentage was also higher in non-smokers compared to smokers (0.41% vs. 0.55%, p-value = 0.0008). Correction of anatomic conditions that predispose the patient to periodontitis, impair aesthetics, or impede placement of prosthetic appliances, Extraction of teeth that cannot be successfully treated, Placement of implants when teeth are lost. Martin-Cabezas R, Seelam N, Petit C, et al. Periodontitis as a Manifestation of Systemic Diseases, Patient education and oral hygiene instruction, Complete removal of supragingival calculus, Restoration or temporization of carious lesions. Periodontol 2000. Biomechanical properties of periodontal tissues in non-periodontitis and periodontitis patients assessed with an intraoral computerized electronic measurement device. o [pig guinea] Jepsen, S.; Caton, J.G. We use cookies on our website to ensure you get the best experience. Firm, fibrous items that allow tooth penetration can wipe plaque from the tooth surfaces during chewing. Periodontitis is a disease that leads to serious functional and esthetic dysfunctions. Shallow periodontal pockets are treated in a closed fashion, but pockets >6 mm deep require open surgery (creation of a periodontal flap) to expose the root surface and alveolar bone for adequate treatment (root scaling/planing and alveoloplasty). Next, we look at the patient-specific factors that contribute to the complexity of long-term management such as probing depths, the number of lost teeth, the shape of bone loss, access for hygiene, occlusal trauma, tooth alignment, and many others. Continuous variables such as PPD and CAL loss were summarized as geometric mean and standard deviation (sd). 8 The host response to the bacterial challenge leads to clinical signs such as deep pockets, bleeding on probing, gingival recession, and tooth mobility, which can ultimately cause tooth loss. Stage 4: There is advanced periodontitis, with >50% of attachment loss as measured by probing of the clinical attachment level or by radiographic determination of the distance of the alveolar margin from the cementoenamel junction relative to the length of the root, or there is a stage 3 furcation involvement in multirooted teeth (see below). Clinicians should initially assume Grade B disease and seek specific evidence to shift towards grade A or C, if available. Depending on disease distribution and extent, periodontitis can be categorized into a localized (<30% of teeth involved) generalized or molar/incisor pattern [, The worst periodontal condition is evident in patients with generalized stage IIIIV, grade C periodontitis. Staging intends to classify the severity and extent of a patients disease based on a measurable amount of destroyed/damaged tissue from periodontitis. Given the lack of benefits and the conflicting data in the literature, the benefits . In particular, our null hypothesis had been to find a statistically significant major mean percentage of the vascular area and inflammatory cells in non-smoker patients due to the effects of smoking on biological tissues. These data are in accordance with Preshaw et al. Editors Choice articles are based on recommendations by the scientific editors of MDPI journals from around the world. Considering the vascular area, young patients showed a significant increase compared to older patients (0.60% vs. 0.46%. ADA is not responsible for information on external websites linked to this resource. A stage 1 mobility is present when tooth mobility is increased in any direction other than axial over a distance of >0.2 mm and up to 0.5 mm. In teeth with healthy periodontal tissues, no gingivitis or periodontitis is evident. J Prosthet Dent. 0000028594 00000 n 2020 Jul;47 Suppl 22(Suppl 22):4-60. doi: 10.1111/jcpe.13290. An official website of the United States government. Tonetti, M. S. (2018). J Dent Res 2022;101(3):270-77. Kasprzak, A.; Surdacka, A.; Tomczak, M.; Konkol, M. Role of high endothelial postcapillary venules and selected adhesion molecules in periodontal diseases: A review. Cloudflare Ray ID: 7a2d94e769f715b3 Some less common causes of gingivitis, including systemic disease (eg, uremic stomatitis), autoimmune disease, juvenile gingivitis, etc, may require more than only plaque removal. Malinowski, B.; Wsierska, A.; Zalewska, K.; Sokoowska, M.M. A., Melis, M., & Zawawi, K. H. (2021). 2022 John Wiley & Sons A/S. Angeline Kuznia and Douglas I. Storch, of Modern Periodontics PA. | All Rights Reserved 2018. American Academy of Periodontology. Probing depth (PD), bleeding on probing (BOP) and percentage of relative bone height (RBH%) were measured and calculated. Ramrez V, Hach M, Lpez R. Definition of aggressive periodontitis in periodontal research. Periodontitis requires more aggressive periodontal treatment. Part I: Implant survival and patients' perception. Jambhekar S, Kernen F, Bidra AS. Feature papers represent the most advanced research with significant potential for high impact in the field. eCollection 2023. Biomedicines 2019, 7, 43. Six months after periodontal therapy, all implants were inserted using a one-stage approach and Six months later, they were restored with porcelain fused to metal crowns. Periodontitis exists in different forms, and its etiology is related to multiple component causes. Bookshelf 2021 Dec;120(12):2072-2088. doi: 10.1016/j.jfma.2021.06.029. Hermes CR, Baumhardt SG, Rsing CK. Unauthorized use of these marks is strictly prohibited. Patients often require several treatment sessions for complete debridement of the tooth surfaces.21 After scaling, root planing, and other adjunctive treatment approaches such as use of antibiotic therapy, the periodontal tissues require approximately 4 weeks to demonstrate optimal effects of nonsurgical therapy.21, Many moderate to advanced cases require surgical access to the root surface for root planing and reducing pocket depth, which will allow the patient to achieve successful home care.21, A patient with gingivitis can revert to a state of health with a reduced periodontium, but due to the host-related disease susceptibility, a periodontitis patient remains a periodontitis patient, even following successful therapy, and requires lifelong supportive care to prevent recurrence of disease.2 Further, patients with more severe periodontitis Stage and Grade have been found to be more likely to experience disease recurrence and tooth loss without regular periodontal maintenance visits.

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