How is periodontitis treated?

The treatment of periodontitis is basically a systematic treatment, i.e. involving several stages. To be precise, there are four distinct treatment stages. After an intensive special examination in which all the pocket depths are measured, the first two stages focus on eliminating the cause, i.e. the infection (so-called "causal therapy stages"). In the subsequent third stage, if required, the defects caused by the infection can then be corrected (the so-called "corrective therapy stage"). The fourth stage ("supportive periodontal therapy") aims to secure the results of the periodontal treatment in the long term.

The stage-one treatment, usually consisting of three sessions and carried out by a dental hygienist or a prophylaxis assistant, aims at completely removing existing bacterial deposits right to the gum margin and also at ensuring that no new deposits of plaque bacteria occur. Additionally, special instructions are issued to the patient, based on the findings of the examination, to optimise plaque control at home. Without these measures, all further stages of therapy would only be of short-term success. This stage is also referred to as periodontal pre-treatment.

The subsequent stage-two treatment aims at the complete removal of all bacterial deposits from the root surface and thus counts as the actual non-surgical periodontal therapy. This stage of therapy is carried out under local anaesthetic and combined with disinfectory measures. The removal of bacteria from potential niches that could act as reservoirs for bacteria is also part of this therapy stage. Two to three months after the stage-two treatment is carried out, the success of the treatment is checked by a re-examination of the pockets and a comparison with the findings of the original examination. If no pockets requiring treatment are to be found, the objective of the periodontitis therapy has been achieved and a follow-up treatment is given (stage four). This is usually the case in most instances of periodontitis. However, if there are residual pockets that still need treatment, a corrective therapy (stage-three treatment) will be required.

The stage-three treatment consists of removing the incurred bone defects associated with the remaining residual pockets. In the case of very deep periodontal bone pockets, bone reconstruction measures (regeneration therapy) may need to be implemented. If the bone pockets are shallow, elimination of the pocket by means of ablation and contouring of the bone crater (resective therapy) will probably be preferred. The success of the treatment - especially in the case of bone reconstruction measures - is checked at the earliest after a half a year. However, during this period stage four will have already begun.

The stage-four treatment is the final stage of every periodontal therapy (supportive periodontal therapy). As a follow-up treatment it is the key to long-term success and aims at securing the results of the periodontal therapy. This stage consists of regular professional dental cleaning sessions in which, if required, still existing residual pockets (e.g. in the aesthetically critical front teeth region) are also dealt with. The frequency of the treatment sessions varies, depending on the particular risk profile of the individual patient. Usually the intervals in the first year after periodontitis therapy are 3 months. If conditions remain stable, the intervals can be prolonged during the following years to a maximum of 6 months.

The importance of this stage four cannot be emphasised enough, as we know all too well that, if this stage is not carried out in full, there is a very good chance that periodontitis will reoccur.