Introduction

The 2017 World Workshop classification recognizes periodontitis as a condition, for which patients retain a lifelong susceptibility. With this in mind, clinicians should think of “management” of periodontitis, as opposed to “treatment” of periodontitis. This is similar to other, chronic, noncommunicable diseases, such as diabetes. Most patients with diabetes “manage” their condition, often via a mixture of pharmacological and non-pharmacological means. In a similar fashion, patients with periodontitis also manage their condition, this time using almost exclusively non-pharmacological means (mechanical disruption of plaque biofilm). Having this conversation with patients at the outset of treatment is recommended to obtain informed consent and to empower patients to manage their disease. As part of this process, the lifelong nature of management of periodontitis should be stressed. In practice, the lifelong management of periodontitis takes different forms and needs to be personalized to the individual patient.

After the phase of active periodontal therapy (APT), patients are entered into the maintenance phase of treatment called supportive periodontal therapy (SPT) or supportive periodontal care (SPC). With this support in place, most patients can expect to retain most teeth (Carvalho et al. 2021). The evidence supporting SPT and the steps involved in delivering SPT are detailed below.

Technique

• Duration of recall

  Just as periodontal disease and therapy is highly individualized between patients, so is the recall therapy. The recall interval should be titrated for individual patients based on analyses of factors such as probing pocket depth (PPD), plaque levels, and risk factor control over time (Sanz et al. 2020). These are discussed in more detail below. Initially, a short (3–6 month) recall interval may be prudent (Ramseier et al. 2019). If the patient maintains stability in their periodontal condition, this can be relaxed to a longer (6–12 month) interval. If, however, the longer interval leads to a recurrence of unstable periodontal disease, the interval can be shortened again. In addition, patients with rapidly progressing disease (Grade C) may warrant a shorter recall interval compared with patients with slower progressing disease (Grade A) (Carvalho et al. 2021). This dynamic assessment of recall interval would be very familiar to practitioners. Finally, as outlined below, not all steps need to be followed at all intervals. For example, a patient with less-than-ideal plaque control may be seen at 3-month intervals for a plaque score and reinforcement of oral hygiene instructions as well as a generalized supragingival professional mechanical plaque removal (PMPR) and then seen every 6–12 months for a 6-point pocket chart measuring PPD (± recession) and bleeding on probing. Similarly, the division of these appointments can be shared between the specialist, dentist, and hygienist.

• Anamnesis
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