Supporting Periodontal Maintenance With Power Instrumentation

Effective biofilm removal is integral to the long-term success of implant therapy. Ultrasonic instrumentation can help clinicians maximize scaling and root planing results as part of a comprehensive periodontal maintenance regimen.

Periodontal maintenance (PM) typically occurs at 2-, 3-, or 4-month intervals for the life of the dentition and implant replacements for individuals with periodontitis.¹ Evidence reveals that PM improves outcomes over time in relation to tooth loss and disease advancement.^2–7 Integral to PM is selective removal of plaque biofilm and calculus, as well as root planing and implant debridement.¹ It is important to complete PM appointments efficiently and effectively; therefore, ultrasonic instrumentation is often employed.

Effectiveness is dependent on assessing the periodontal conditions accurately, having adequate time for PM, and selecting appropriate therapy. Effective PM is achieved with the reduction of clinical signs of inflammation, such as the absence of erythema, edema, and bleeding on probing. Furthermore, reduced clinical attachment loss and a halt in advancing bone loss indicates effective treatment of the periodontium.⁸ Choosing multiple ultrasonic inserts or tips (UITs) for varying periodontal conditions and applying appropriate technique are critical to effectiveness (Table 1).

Periodontal evaluation includes recording sites of gingival inflammation (erythema and edema), bleeding on probing, periodontal pocket depth (PPD), clinical attachment level (CAL), furcation involvement, and mobility.^1,9 An important consideration is the location of plaque biofilm and calculus type and texture within these conditions.

The presence of localized gingival inflammation, triggered by deposit reaccumulation and host response, indicates a need for site-specific debridement. In these areas, place the active tip of a curved UIT at the epithelial attachment and debride with oblique strokes toward the gingival margin (Figure 1). This method of removing lighter deposits supports the use of the side of the active tip instead of the point. Moving from the gingival margin apically encourages using the point on the root or the epithelial attachment, both of which should be avoided unless heavier calculus is being removed or narrow pocketing exists.

Effective PM is critical in supporting periodontal health. Identifying the periodontal conditions and local, oral risk factors allows for site-specific instrumentation.

References

1. Cohen RE; Research, Science and Therapy Committee. Position paper: periodontal maintenance. J Periodontol. 2003;74:1395–1401.
2. Manresa C, Sanz-Miralles EC, Twigg J, Bravo M. Supportive periodontal therapy for maintaining the dentition in adults treated for periodontitis. Cochrane Database Syst Rev. 2018;1:CD009376.
3. Gay IC, Tran DT, Weltman R, et al. Role of supportive maintenance therapy on implant survival: a university-based 17 years retrospective analysis. Int J Dent Hyg. 2016;14:267–271.
4. Lee CT, Huang HY Sun TC, Karimbux N. Impact of patient compliance on tooth loss during supportive periodontal therapy: a systematic review and meta-analysis. J Dent Res. 2015;94:777–786.
5. Ramseier CA, Nydegger M, Walter C, et al. Time between recall visits and residual probing depths predict long term stability in patients enrolled in supportive periodontal therapy. J Clin Periodontol. 2019;46:218–230.
6. De Wet LM, Slot DE, Van der Weijden GA. Supportive periodontal treatment: Pocket depth changes and tooth loss. Int J Dent Hyg. 2018;16:210–218.
7. Zangrando MS, Damante CA, Sant’ Ana AC, et al. Long-term evaluation of periodontal parameters and implant outcomes in periodontally compromised patients: a systematic review. J Periodontol. 2015;86:201–221.
8. Chapple ILC, Mealey BL, Van Dyke TF, et al. 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. J Periodontol. 2018;89:S74–S84.
9. American Academy of Periodontology. Comprehensive periodontal therapy: A statement by the American Academy of Periodontology. J Periodontol. 2011;82:943–949.

This information originally appeared in Hodges KO. The intersection of periodontal maintenance and ultrasonic instrumentation. Dimensions of Dental Hygiene. 2019;17(4):14–16.