Periodontal diseases are multifactorial diseases where host-microbial interactions lead to the destruction of periodontal soft and hard tissues, Various forms of periodontitis can be efficiently treated with non-surgical and surgical therapy, but periodic periodontal maintenance is important for the maintenance of periodontal health after active periodontal treatment. Periodontal maintenance is defined as the procedures that are performed at selected intervals after active periodontal treatment to assist the periodontal patient in maintaining oral health. The term periodontal maintenance can be used interchangeably with the term supportive periodontal therapy. However, in a position paper by the American Academy of Periodontology, term periodontal maintenance was preferred over supportive periodontal therapy. GOALS OF SPT: 1) To prevent or minimize the recurrence and progression of periodontal disease in patients who have been treated previously. 2) To prevent or reduce the incidence of tooth loss by monitoring the dentition. 3) To locate and treat other diseases or conditions found in the oral cavity in a timely manner. OBJECTIVES OF SPT: 1) Preservation of alveolar bone support (radiographically) 2) Maintenance of stable, clinical attachment level 3) Reinforcement and re-evaluation of proper home care 4) Maintenance of a healthy and functional oral environment to prevent occurrence of new disease TYPES OF SPT: 1. Preventive maintenance therapy • Periodontally healthy individuals. 2. Trial maintenance therapy • Mild to moderate periodontitis 3. Compromised maintenance therapy • Medically compromised patients where active therapy is not possible. 4. Post-maintenance treatment therapy • maintenance for prevention of recurrence of disease. MULTILEVEL RISK ASSESSMENT: At Subject Level (Lang and Tonetti et al.,2003) At Tooth Level At Site Level MODIFIED PERIODONTAL RISK ASSESSMENT (Chandra et al., 2007) The recall hour should be planned to meet the patient’s individual needs: It basically consists of four different sections which may require various amounts of time during a regularly scheduled visit: 1) Examination, re-evaluation, and diagnosis (ERD) 2) Motivation, reinstruction, and instrumentation (MRI) 3) Treatment of reinfected sites (TRS) 4) Polishing of the entire dentition, application of fluorides, and determination of future SPT (PFD) Compliance (also called adherence and therapeutic alliance) has been defined as “the extent to which a person’s behavior coincides with medical or health advice” Types of compliance Non-compliance Erratic compliance Complete compliance The first study on the degree of compliance with supportive periodontal treatment was published in 1984 by Wilson et al. stating that approximately 1000 patients followed for up to 8 years, only 16% complied with suggested SPT intervals, 34% never came back for maintenance, and the rest complied erratically.

3. Non surgical therapy Surgical periodontal therapy

4. Supportive periodontal treatment
Supportive periodontal therapy

5. 1.To prevent or minimize
the recurrence and
progression of
periodontal disease in
patients who have been
treated previously.
To prevent or reduce the
incidence of tooth loss by
monitoring the dentition.
To locate and treat other
diseases or conditions
found in the oral cavity in
a timely manner.

9. What happens to the periodontal status of
patients who are treated and not maintained

11. What is the periodontal status of patients who
are treated for periodontal disease and are on
regular periodontal maintenance

13. Schallhorn, Snider et al (1981)
POST
TREATMENT
MAINTENANCE
COMPROMISE
MAINTENANCE
TRIAL
MAINTENANCE
PREVENTIVE
MAINTENANCE
Shumaker ND, Metcalf BT, Toscano NT, Holtzclaw DJ. Periodontal and peri implant maintenance: a critical factor in long-term treatment success.
Compend Contin Educ Dent. 2009 Sep;30(7):388-90, 392, 394 passim; quiz 407, 418.

16. At subject level
At tooth level
At site level

17. <10% surfaces BOP +ve: low risk
>25% surfaces BOP +ve : high risk
4 remaining pockets
PD≥5mm: low risk
8 residual pockets: high risk
Loss of upto 4 teeth: low risk
More than 8 teeth : high risk
Bone loss in % / age
Presence or
absence
Cigarette smoking
Lang NP, Tonetti MS. Periodontal risk assessment (PRA) for patients in supportive periodontal therapy (SPT). Oral Health Prev Dent. 2003 Jan 1;1(1):7-16.

18. Low PRA patient
Moderate PRA
patient
High PRA patient

19. Viswa Chandra et al (2007)
Viswa Chandra.R Evaluation of a Novel Periodontal Risk Assessment Model in Patients Presenting for Dental Care Oral Health Prev Dent 2007; 5: 39-48

20. Trombelli et al (2009)
Trombelli L, Farina R, Ferrari S, Pasetti P, Calura G. Comparison between two methods for periodontal risk assessment. Minerva Stomatol. 2009 Jun;58(6):277-87.

21. Tooth positioning in dental arch
Residual alveolar bone support
Mobility
Iatrogenic factors

22. Bleeding on probing
Suppuration
Clinical attachment level

23. Muthukumar, Diviya Periodontal Maintainnce: a review IJIRD 2013;11(2):392-398
MAINTENANCE RECALL PROCEDURE

27. Compliance (also called adherence and therapeutic alliance)
has been defined as “the extent to which a person’s behavior
coincides with medical or health advice”

28. The first study on the degree of compliance with
supportive periodontal treatment was
published in 1984 by Wilson et al.
It reviewed all the patients whose progress
could be followed after treatment for
periodontitis in a private periodontal office of
approximate 1000 patients followed for up to 8
years, only 16% complied with suggested SPT
intervals, 34% never came back for
maintenance, and the rest complied erratically.

29. • Improving compliance (Wilson suggests):
• Counselling them about their condition, the role of treatment
and the importance of compliance.
• Simplify instructions to patients
• Teach them self performed plaque control
• Accommodating patient needs
• Positive reinforcement

35. Muthukumar, Diviya Periodontal Maintainnce: a review IJIRD 2013;11(2):392-398

36. (a) Guidelines for referral based on complexity scores. (b) Modifying factors relevant to periodontal treatment for application to
complexity scores. (c) Medical history that significantly affects clinical management. BPE, Basic Periodontal Examination; GDP, general
dental practitioner.

37. Dowell, P., & Chapple, I. L. C. (2002). The British Society of Periodontology Referral Policy and Parameters of Care. Dental Update, 29(7), 352–353.

38. Dowell, P., & Chapple, I. L. C. (2002). The British Society of Periodontology Referral Policy and Parameters of Care. Dental Update, 29(7), 352–353.