Breif overview of the supportive periodontal therapy and its importance after prophylactic phase of periodontal treatment.

1. - C H AR L E S J AM E S
SUPPORTIVE PERIODONTAL
TREATMENT

2. INTRODUCTION.
• Preservation of periodontal health equally important as
elimination of periodontal disease.
• Third World Workshop of the American Academy of
Periodontology 1989 had renamed the maintenance
phase as “SUPPORTIVE PERIODONTAL THERAPY”.
• Maintenance phase should be a step in total patient
care.

3. RATIONALE FOR SPT.
• Incomplete sub-gingival plaque removal
• Transfer of periodontal bacteria within family members.
• Remaining pockets provide space for reinfection by
pathogens.
• Microscopic nature of dento-gingival unit healing.

4. Goals of SPT.
• To prevent or minimize the recurrence and
progression of periodontal disease in patients
who have been previously treated.
• To prevent tooth loss by monitoring the
dentition.
• To locate and treat other diseases of the oral
cavity in a timely manner.

5. Phase I
Re-evaluation
Phase IV
(maintenance)
Phase II
(periodontal
surgery)
Phase III
(restorative)
Correct sequence of treatment

6. Objectives.
• Bone support
• Stable CAL
• Proper home care and oral
hygiene
• Patient education
• Maintenance of proper oral
function.
• Assessment of patients
general health.

7. Maintenance program.
SPT
Examination and evaluation
(14min)
Maintenance Rꭖ and
oral hygiene
reinforcement (36min)
Report, clean-up and
scheduling (10min)

8. Examination and evaluation
 Patient greeting
 Medical history changes
 Oral hygiene status
 Gingival changes
 Pocket depth changes
 Mobility changes
 Occlusal changes
 Dental caries
 Oral pathologic examination
 Restorative, prosthetic and implant status (components,
stability ,wear and symptoms surrounding it.)

9. Radiographic Examination Of Recall Patients :
Root form/dental implants
Peri-apical or vertical bite-
wing radiographs at 6, 12
and 36 months after
prosthetic placement, then
every 36 months
Periodontal disease not under good
control.
Peri-apical and/or vertical bite wing
radiographs of problem every 12 to 24
months; full mouth series every 3 to 5 yrs.
History of periodontal treatment with
disease under good control.
Bite wing examination every 24 to 36
month; full mouth series every 5 yrs.

10. SPT clinical examination
Stable periodontal status (
no microbial testing
required)
Periodic SPT
Progressive and Aggressive
Periodontitis
SPT and Anti microbial
therapy
Clinical microbiological re-
evaluation
Refractory
Periodontitis
Selection of
alternative
clinical treatment
or antimicrobial
regimen
Microbial Testing

11. Maintenance Treatment And Oral
Hygiene Reinforcement
• Oral hygiene reinforcement.
• Scaling .
• Polishing.
• Chemical irrigation or site specific
antimicrobial placement.

12. Report ,Clean up and scheduling
• Write report in chart
• Discuss report with patient
• clean and disinfect operatory
• schedule next recall visit
• Schedule further periodontal treatment
• Schedule or refer for restorative or prosthetic
treatment .

13. Frequency of SPT
• Patients with gingivitis but no previous
attachment loss- SPT twice a year.
• Patients with previous history of
periodontitis- twice within 6 months.
• Active clinical therapy – four times a year.

14. Compliance affecting SPT
Patients who comply to suggested recall visits are periodontally
healthy and keep their teeth longer.
Improving compliance-
• Counselling them about their condition ,
treatment and importance of compliance.
• Simplify instructions to patients.
• Teach them self performed plaque control.
• Accommodate patients needs also.
• Positive reinforcement.

15. CONCLUSION.
 Effectiveness of “Supportive Periodontal
Treatment” depends mostly on the patients
compliance to the treatment and his knowledge
on the severity of the disease.
 Healing of periodontium is a complex process
and takes time and proper management.
 More than the actual surgical or restorative
treatment , the maintenance determines the
prognosis of the disease.