Supportive Therapy

Question 1

What are the 3 stages of periodontal treatment?

Answer 1

Initial therapy
Corrective therapy
Supportive therapy

Question 2

What is supportive therapy?

Answer 2

The Phase of a patient’s management directed at preventing relapse or recurrence of periodontal disease after intensive periodontal therapy has been completed

Question 3

What is supportive therapy heavily affected by?

Answer 3

Patients contribution

Question 4

What is the biological basis of supportive periodontal treatment

Answer 4

1. Plaque aetiology of periodontal diseases
2. Balance between microbial challenge, patient’s host defences, conducive environment /ecology
3. Individual patient risk assessment
4. Role of inflammation – international views
5. Less clinical attachment loss (CAL) and tooth loss occur with regular SPT
6. Tooth loss is inversely proportional to SPT frequency
7. Recurrent periodontitis can be limited or prevented by optimal oral hygiene
8. SPT provides for monitoring following periodontal treatment or implant provision

Question 5

What is essential for supportive therapy to be successful?

Answer 5

1. Sufficiently high level of plaque control

2. Patient removal of soft deposits is essential

Question 6

What did a study comparing periodontal patients who visited the dentist sporadically and periodontal patients who regularly visited the dentist show?

Answer 6

Loss of periodontal support is similar in groups who are sporadic dental attenders and groups who receive “traditional dental care”
“Traditional dental care” does not adequately emphasize plaque control -limited periodontal care provided

Question 7

Name the 2 scientists (or pair or scientists( who conducted studies on supportive therapy

Answer 7

1. Nyman et al 1975

2. Axelsson & Lindhe, 1978, 1981

Question 8

What did nyman et al’s study consist of?

Answer 8

20 pts with advanced periodontitis
After treatment:
OHI and scaling- every 2 weeks
No further loss of attachment after 2 years
2 mm attachment loss in control group 
(on 6 month recalls)

Question 9

What did nyman et al’s study show?

Answer 9

Loss of periodontal support is similar in groups who are sporadic dental attenders and groups who receive “traditional dental care”
“Traditional dental care” does not adequately emphasize plaque control -limited periodontal care provided

Question 10

What did Axelsson & Lindhe’s study consist of?

Answer 10

3 year period, 375 subjects
OHI and scaling every 2 months in supportive phase of therapy for 2 years
Then every 3 months for 3rd year

Question 11

What did What did Axelsson & Lindhe’s study show?

Answer 11

In the recall group:
Plaque levels low
Gingivitis levels minimal
99%  of sites -improvement, no change or < 1mm loss of attachment
In the non recall group:
Increase in plaque
Increase in gingivitis
45% - improvement, no change, < 1mm loss of attachment
55% - 2-5 mm loss of attachment
20% - pockets 4+mm

Question 12

What tests and examination should you carry out when recalling a patient after periodontal treatment?

Answer 12

1. Gingival indices
2. Pocket depths
3. Bleeding on
4. Probing
5. Suppuration
6. Furcation
7. Mobility
8. Recession
9. Attachment levels

Question 13

What would the results of a successful treatment be when recalling a patient?

Answer 13

1. Marginal Bleeding Free Scores > 80%
2. Plaque Free Scores > 80%
3. Smoking – quit/ reduce to < 10 cig/day
4. PPD < 5 mm
5. No Bleeding on probing
6. No furcation

Question 14

What are the benefits of oral hygiene instructions to patients?

Answer 14

1. Healing will result in a change in gingival morphology
2. Furcation access
3. Wider embrasures
4. Post surgery, good OH is critical to success
5. New restorations can be placed

Question 15

What does supportive treatment do to plaque?

Answer 15

Supportive therapy disrupts plaque flora, and it takes time to establish complex and more pathogenic plaque
Residual calculus or newly formed calculus can be removed

Question 16

What can repeated scaling lead to?

Answer 16

Repeated subgingival scaling may leave grooves and furrows on the root surface act as PRFs.
Avoidance of need for repeated instrumentation is preferable

Question 17

Which areas should you investigate for disease progression ?

Answer 17

Identify disease progression in:
Patient
Tooth
Tooth site

Question 18

name some risk factors that could increase a patients chance of getting periodontal disease again?

Answer 18

1. systemic factors
2. smoking
3. compliance
4. support loss with age
5. oral hygiene

Question 19

name some risk factors associated with the tooth that could increase a patients chance of getting periodontal disease again?

Answer 19

1, Its position in arch

2. tooth morphology
3. furcation involvement
4. PRFs

Question 20

When Should Supportive Therapy Start?

Answer 20

After active therapy (initial and/or corrective)

Question 21

Name some important parts of the healing phase?

Answer 21

1. Bone remodels over several years
2. Attachment levels fairly stable after 6 months
3. Different regimens in first 6 months proposed
4. Can disrupt healing if scale subgingivally in first 6 weeks

Question 22

What is the most common recall time scale?

Answer 22

3 months interval is most commonly recommended (especially, for the first year)
Then, if the periodontal condition remains stable, 6 months interval in the following years.

Question 23

What should you do in your appointment when you recall a patient?

Answer 23

Update medical and dental history
Assess oral hygiene/plaque scores,smoking
Clinical examination and diagnosis- check the patients periodontal status

Question 24

What can happen to patients if they don’t receive adequate supportive treatment?

Answer 24

Without SPT, the effect of initial and corrective phases of periodontal therapy cannot be maintained