Supportive periodontal therapy (SPT) aims to prevent the recurrence and progression of periodontal disease in patients who have received prior treatment, with an emphasis on monitoring oral health and timely intervention for other oral diseases. The success of SPT relies significantly on patient compliance and understanding of their condition, as ongoing maintenance is crucial for prognosis. Regular examinations and evaluations are essential components of SPT, tailored to the patient's previous treatment and periodontal status.

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.