Bilan de réévaluation

The adjunctive use of specific systemic antibiotics may be considered for specific patient categories (e.g. generalized periodontitis Stage III in young adults).

The complete removal of subgingival biofilm and calculus at teeth with deep probing depths (≥6 mm) or complex anatomical surfaces (root concavities, furcations, infra bony pockets) may be difficult, and hence, the endpoints of therapy may not be achieved, and further treatment should be implemented. If no periodontal pockets >4 mm with bleeding on probing or deep pockets [≥6 mm]) :

• Repeated subgingival instrumentation with or without adjunctive therapies

• Access flap periodontal surgery

• Resective periodontal surgery

• Regenerative periodontal surgery

In the presence of deep residual pockets (PPD ≥ 6 mm) in patients with Stage III periodontitis after the first and second steps of periodontal therapy, we suggest performing access flap surgery. In the presence of moderately deep residual pockets (4–5 mm), we suggest repeating subgingival instrumentation.

• there is insufficient evidence for a recommendation on the choice of flap procedures. Access periodontal surgery can be carried out using different flap designs (open flap debridement with intra-sulcular incisions (OFD); flaps with para-marginal incisions, such as modified Widman flap (MWF) and papilla preservation flaps)

In cases of deep (PPD ≥ 6 mm) residual pockets in patients with Stage III periodontitis after an adequate second step of periodontal therapy, we suggest using resective periodontal surgery, yet considering the potential increase of gingival recession.

We recommend not to perform periodontal (including implant) surgery in patients not achieving and maintaining adequate levels of self-performed oral hygiene.

We recommend treating teeth with residual deep pockets associated with intrabony defects 3 mm or deeper with periodontal regenerative surgery. In regenerative therapy, we recommend the use of either barrier membranes or enamel matrix derivative with or without the addition of bone-derived grafts.

• We recommend the use of specific flap designs with maximum preservation of interdental soft tissue such as papilla preservation flaps. Under some specific circumstances, we also recommend limiting flap elevation to optimize wound stability and reduce morbidity.

What is the adequate management of molars with Class II and III furcation involvement and residual pockets?

• Furcation involvement is no reason for extraction.

• We recommend treating mandibular molars with residual pockets associated with Class II furcation involvement with periodontal regenerative surgery.

• We suggest treating molars with residual pockets associated with maxillary buccal Class II furcation involvement with periodontal regenerative surgery

  • We recommend treating molars with residual pockets associated with mandibular and maxillary buccal Class II furcation involvement with periodontal regenerative therapy using enamel matrix derivative alone or bone-derived graft with or without resorbable membranes*

• In mandibular Class III and multiple Class II furcation involvement in the same tooth nonsurgical instrumentation, OFD, tunneling, root separation or root resection may be considered

• In maxillary Class III and multiple Class II furcation involvement in the same tooth nonsurgical instrumentation, OFD, tunneling, root separation or root resection may be considered

Suivi

We recommend that supportive periodontal care visits should be scheduled at intervals of 3 to a maximum of 12 months and ought to be tailored according to patient's risk profile and periodontal conditions after active therapy.

We recommend taking into account patients' needs and preferences when choosing a toothbrush design, and when choosing an interdental brush design

If anatomically possible, we recommend that tooth brushing should be supplemented by the use of interdental brushes.