periodontitis stage 4 grade c treatment

"Periodontitis Stage IIIIV, Grade C and Correlated Factors: A Histomorphometric Study" Biomedicines 7, no. Tonetti, M. S. (2018). ; Bursiewicz, W.; Socha, M.; Ozorowski, M.; Pawlak-Osiska, K.; Wiciski, M. The role of Tannerella forsythia and Porphyromonas gingivalis in pathogenesis of esophageal cancer. Prevention of periodontitis is more complicated. Caton, J. G., Armitage, G., Berglundh, T., Chapple, I. L., Jepsen, S., Kornman, K. S., . J Dent. Clin Oral Implants Res. F: 904-443-7012, 252 15th Avenue South, The authors affirmed that men seemed to be more susceptible to the risk of periodontal disease than women; on the contrary, men did not show a higher risk of more rapid periodontal destruction than women [, Our results showed a significant decrease in the percentage of the vascular area in patients older than 50 years. Effects of smoking on non-surgical periodontal therapy in patients with periodontitis Stage III or IV, and Grade C. Chronic Periodontitis Prevention, Diagnosis and Treatment: A Systematic Review [Internet]. American Journal of Orthodontics and Dentofacial Orthopedics, 157(2), 156-164.e117. Stefanski S, Svensson B, Thor A. Implant survival following sinus membrane elevation without grafting and immediate implant installation with a one-stage technique: an up-to-40-month evaluation. ". Cardiovascular diseases: Although a causal relationship has not been established, the presence of periodontal disease has been associated with various cardiovascular diseases including myocardial infarction. Tooth loss and radiographic bone loss in patients without regular supportive care: A retrospective study. J Clin Periodontol 2021;48(8):1008-18. 2022 Dec 16;12(12):2131. doi: 10.3390/life12122131. https://doi.org/10.1177/154405910608500613, https://doi.org/10.1016/j.ajodo.2019.10.010, https://doi.org/10.1177/00220345000790090401, European Federation of Periodontology (EFP). the subject, RBL/age). The stages, consisting of Stage I-IV are below for review. Federal government websites often end in .gov or .mil. Although calculus gives the appearance of unhealthy teeth, its contribution to periodontal disease is minor. It occurs with the destruction of the supporting periodontal tissue and migration of alveolar bone, periosteum, and periodontal ligament versus the tooth apex. J. Clin. Periodontol 2000. 2015;69:717. 0000110265 00000 n 2001;16:389393. 0000039969 00000 n 2022 Dec 9;57(12):1202-1208. doi: 10.3760/cma.j.cn112144-20220719-00394. Eldzharov A, Kabaloeva D, Nemeryuk D, Goncharenko A, Gatsalova A, Ivanova E, Kostritskiy I, Carrouel F, Bourgeois D. J Clin Med. This case highlights the need for consideration of multiple risk factors, especially when presenting in combination. She loves not only educating patients but also students pursuing a dental hygiene career, and current dental professionals. These results suggested that even if these factors are commonly related to the worsening of periodontal status, some of them (pus and periodontal probing depth (PPD)) do not affect the inflammatory and vascular patterns. ; Schroeder, H.E. 104.236.29.24 Stage 3: There is moderate periodontitis, with 25%50% of attachment loss as measured by probing of the clinical attachment level or by radiographic determination of the distance of the alveolar margin from the cementoenamel junction relative to the length of the root, or there is a stage 2 furcation involvement in multirooted teeth (see below). This website is using a security service to protect itself from online attacks. Chapple ILC, Mealey BL, Van Dyke TE, et al. The legacy of this great resource continues as the Merck Veterinary Manual in the US and Canada and the MSD Vet Manual outside of North America. This can reverse gingivitis, returning the gingiva to a healthy, uninflamed state. 8 The host response to the bacterial challenge leads to clinical signs such as deep pockets, bleeding on probing, gingival recession, and tooth mobility, which can ultimately cause tooth loss. and M.M. Shallow periodontal pockets are treated in a closed fashion, but pockets >6 mm deep require open surgery (creation of a periodontal flap) to expose the root surface and alveolar bone for adequate treatment (root scaling/planing and alveoloplasty). This treatment of periodontal disease can be non-surgical or surgical with the optimal treatment being based on individual patient, site, and systemic factors. A Feature New and exciting things were happening at this past EuroPerio9 held in Amsterdam from June 20th-23rd, 2018. ; Mealey, B.L. Cortellini P, Prato GP, Tonetti MS. Conclusions: The paper describes a simple matrix based on stage and grade to appro- Despite the bone damage, the amount of bone loss in this stage of periodontal disease is minor so that usually no additional treatment is required. Grading is based on supplemental considerations like direct evidence of disease progression, indirect evidence of disease progression (radiographic bone loss divided by age), smoking patterns, and diabetes and glycemic control.3. Periodontal disease and cancer: Epidemiologic studies and possible mechanisms. Local placement of a gel containing antibiotics (eg, doxycycline) into cleaned periodontal pockets may be helpful. Products that slow or prevent the attachment of pellicle or the adhesion of pioneering plaque bacteria may provide some benefit. Step 2: Establish Stage is divided into two sections. Gut microbiota-dependent trimethylamine n-oxide pathway contributes to the bidirectional relationship between intestinal inflammation and periodontitis. For mild to moderate periodontitis, the focus will be on clinical attachment loss (CAL). Periodontitis as a Manifestation of Systemic Diseases, Patient education and oral hygiene instruction, Complete removal of supragingival calculus, Restoration or temporization of carious lesions. J Clin Periodontol. BSP implementation of European S3 - level evidence-based treatment guidelines for stage I-III periodontitis in UK clinical practice. Response of chronic and aggressive periodontitis to treatment. Considering the vascular area, young patients showed a significant increase compared to older patients (0.60% vs. 0.46%. Effect of non-surgical periodontal therapy on glycemic control of type 2 diabetes mellitus: a systematic review and Bayesian network meta-analysis. Risk factor analysis is used as grade modier. All rights reserved. Please confirm that you are a health care professional. A periodontal pocket is defined as a pathologically deepened gingiva sulcus, according to the definition reported by the American Academy of Periodontology. Systemic antibiotics in the treatment of aggressive periodontitis. Saving such teeth also requires endodontic therapy (see below), and the prognosis is determined by the extent of periodontal disease. A stage 1 mobility is present when tooth mobility is increased in any direction other than axial over a distance of >0.2 mm and up to 0.5 mm. J Formos Med Assoc. Once grade is established based on evidence of progression, it can be . Development of periodontitis is also affected by other intrinsic (eg, genetics, tooth crowding, thin alveolar bone, age) and extrinsic (eg, diet, stress, concurrent disease, oral hygiene) factors. The simplified papilla preservation flap. ; Kim, H.D. Sarah has clinical experience in both the private and public health sectors. Shin, Y.J. 2013;26(2):84-8. F: 904-249-8554, 1409 Kingsley Avenue, Suite 9A, Attachment and bone loss associated with periodontal disease are results of the bodys immune response to plaque biofilm and its metabolic byproducts. For mild to moderate periodontitis, the focus will be on clinical attachment loss (CAL). contributed reagents/materials/analysis tools; B.B. For the future, new Randomized Clinical Trials RCTs will be needed to verify whether smoking is a key factor in inflammatory and vascular periodontal alteration. Kasprzak, A.; Surdacka, A.; Tomczak, M.; Konkol, M. Role of high endothelial postcapillary venules and selected adhesion molecules in periodontal diseases: A review. Written informed consent was obtained from all patients. 2015;42(7):647-57. Extensive disease seen in younger patients or with minimal bacterial deposits represents a high rate of progression (Grade C). Females showed a significant increase in inflammatory infiltrate compared to males (6.29% vs. 2.28%. A workshop titled the World Workshop occurred in November 2017.1 This World Workshop consisted of expert participants, along with the AAP and EFP, as they were tasked with reviewing multiple publications, including review papers and consensus reports that led to the new guidelines.1. Orthodontic treatment (OT) is more often included in the multidisciplinary treatment for adult patients with stage III-IV periodontitis due to impaired smile aesthetics, functional problems, or as an . The goal of periodontal treatment is to eliminate plaque, biofilm and calculus, from the tooth surface and establish an environment that can be maintained in health.21 Treatment of periodontitis can be non-surgical or surgical. A novel surgical approach for the management of soft tissues in regenerative procedures. Quintessence Int. Sex differences in destructive periodontal disease: Exploring the biologic basis. F: 904-278-1176, Copyright Drs. Qiao Y, Wang Z, Li Y, et al. Periodontitis is a more severe disease that involves inflammation of the periodontal ligament and alveolar bone, eventually causing loss of attachment (periodontal pocketing, gingival recession, bone resorption). 563 University Boulevard North, Oral Maxillofac. https://doi.org/10.3390/biomedicines7020043, Buffoli, Barbara, Gianluca Garzetti, Stefano Calza, Eleonora Scotti, Elisa Borsani, Veronica Cappa, Lia Rimondini, and Magda Mensi. Get Directions Ma KS, Hasturk H, Carreras I, et al. Results: Ask Kara RDH: Why Isnt Todays RDH Addressing New Infection Control QUIZ: Test Your Ultrasonic Insert Knowledge! Stage 3-4, Grade C periodontitis (at least one site with probing depth (PD) and clinical attachment level (CAL) 5 mm in their incisors and/or first molars and at least 6 other teeth with similar PD and CAL measurements, with alveolar bone loss confirmed by radiography; familial aggregation; presence of 16 teeth; Int J Periodontics Restorative Dent. Texture of the diet, toys, and treats can affect the self-cleansing mechanisms of the teeth. Deas DE, Mealey BL. hb``f``g`e`\ @16s0080 ^`K'4m`6GH00@QegVc4kX71j0~dH'X!~uZ)FB Z00% (; J( endstream endobj 17 0 obj <>>> endobj 18 0 obj <>/Font<>/ProcSet[/PDF/Text]/Properties<>>>/Rotate 0/TrimBox[0.0 0.0 792.0 612.0]/Type/Page>> endobj 19 0 obj <> endobj 20 0 obj <>stream A randomized controlled trial of implant-retained mandibular overdentures. Ravida A, Galli M, Saleh MHA, et al. In these situations, significantly rapid progressive damage to the attachment apparatus, which can lead (especially in stage IV) to tooth loss and occlusion impairment, is appreciated [, About the etiology of this pathology, periodontitis is a complex disease with a genetic and epigenetic basis and/or causes related to patient behaviors (e.g., medications or environmental factors), which contribute to the progression of the periodontal lesion. Association between periodontitis and arterial hypertension: A systematic review and meta-analysis. Biomedicines 2019, 7, 43. Accessibility 4.2 Sequence for the treatment of stage IV periodontitis. The goal of periodontal treatment is to eliminate dysbiotic plaque biofilm from the tooth surface and to establish an environment that allows the maintenance of health. The S3 Level CPG for the treatment of stage IV periodontitis culminated in recommendations for different interventions, including orthodontic tooth movement, tooth splinting, occlusal adjustment, tooth- or implant-supported fixed or removable dental prostheses and supportive periodontal care. Stage 1: There is gingivitis only, without attachment loss; the height and architecture of the alveolar margin are normal. A summary of current work. Part I: Implant survival and patients' perception. However further investigation and clinical studies are required to confirm these results. We do not control or have responsibility for the content of any third-party site. Now that the charts are available, implementation into schools, clinics, and private practices can occur. Interestingly, some of the common human periodontopathogens such as Haemophilus (formerly Actinobacillus) actinomycetemcomitans are notably absent in animals. If the gingivitis does not resolve, further examination should be performed to identify additional complicating conditions such as persistent subgingival plaque and calculus or the presence of predisposing factor(s). Not only does she love learning, but she also loves to educate others. Angeline Kuznia and Douglas I. Storch, of Modern Periodontics PA. | All Rights Reserved 2018. Thorough non-surgical periodontal treatment consisting of scaling and root planing was provided, followed by a series of regenerative periodontal surgeries including guided tissue regeneration (GTR) and guided bone regeneration(GBR) to manage advanced bone defects. Background: Periodontitis is a disease that leads to serious functional and esthetic dysfunctions. Maxillary sinus floor elevation using the (transalveolar) osteotome technique with or without grafting material. Barrier membranes should be placed between the bone defect and gingival tissues to achieve guided tissue regeneration. Liu Z, Gao X, Liang L, Zhou X, Han X, Yang T, Huang K, Lin Y, Deng S, Wang Z, Wang C. J Inflamm Res. The Merck Veterinary Manual was first published in 1955 as a service to the community. A recent change to the classification of periodontal disease helps your periodontist express the severity and complexity of the disease (Staging) as well as the patients risk for progression (Grading). J Clin Periodontol 2018;45 Suppl 20:S286-S91. The .gov means its official. 0000026481 00000 n 2020 Apr;91(4):442-453. doi: 10.1002/JPER.19-0141. Preshaw, P.M.; Henne, K.; Taylor, J.J.; Valentine, R.A.; Conrads, G. Age-related changes in immune function (immune senescence) in caries and periodontal diseases: A systematic review. Prakash, P.; Rath, S.; Mukherjee, M.; Malik, A.; Boruah, D.; Sahoo, N.K. articles published under an open access Creative Common CC BY license, any part of the article may be reused without See this image and copyright information in PMC. -. Jacksonville, FL 32256 Disclaimer/Publishers Note: The statements, opinions and data contained in all publications are solely Prior to treatment planning, it is critically important to undertake a definitive and comprehensive diagnosis and case evaluation, obtain relevant patient information, and engage in frequent re-evaluations during and after treatment. Feature papers represent the most advanced research with significant potential for high impact in the field. Awad, M. A., Locker, D., Korner-Bitensky, N., & Feine, J. S. (2000). ; Sanz, M.; Tonetti, M. A new classification scheme for periodontal and peri-implant diseases and conditionsIntroduction and key changes from the 1999 classification. Considering the presence/absence of pus, no significant differences were observed. Angle H. Classification of malocclusion. There are early radiographic signs of periodontitis. Unable to load your collection due to an error, Unable to load your delegates due to an error. Periodontal disease is a chronic infection that can result in the destruction of tooth-supporting structures (i.e., the gingiva, periodontal ligament, and/or alveolar bone) and eventual tooth loss.6, According to analysis of data from the National Health and Nutrition Examination Survey (NHANES) collected from 2009 to 2014, roughly 42% of dentate adults 30 years of age or older in the United States have some form of periodontitis (mild, moderate or severe).7 The prevalence of periodontitis increases with age; it is significantly more common in males than in females, and in non-Hispanic Blacks and Hispanics than non-Hispanic whites.7. [. 2022 Dec 10;10(12):2505. doi: 10.3390/healthcare10122505. A systematic review and a Bayesian Network meta-analysis. Periodontal diseases. Results: Females showed a significant increase in the percentage of inflammatory cells compared to males (6.29% vs. 2.28%, Periodontitis is a disease that, if untreated, leads to serious functional and aesthetic impairments, as well as a strong conditioning of social life, resulting in impairment in life quality [, This disease is characterized by a microbially-associated, host-mediated inflammation that results in the loss of periodontal attachment, clinically detected as clinical attachment loss (CAL) [, In 2018, the American Academy of Periodontology and the European Federation of Periodontology published a new classification of periodontal diseases. Journal of Periodontology, 89. doi:10.1002/jper.17-0739. Extraction is often the best treatment for teeth with increased mobility that have a guarded to poor prognosis. Oral Microbiome, Oral Health and Systemic Health: A Multidirectional Link. 2019. Masamatti SS, Kumar A, Virdi MS. Periodontal diseases in children and adolescents: a clinician's perspective part. Allen, P. F., Thomason, J. M., Jepson, N. J., Nohl, F., Smith, D. G., & Ellis, J. Bookshelf Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. government site. 0000118400 00000 n Caton, J.C.; Armitage, G.; Berglundh, T.; Chapple, I.L.C. Treatment of early periodontitis includes tooth scaling and root planingaccompanied by improved oral hygiene. 0000056742 00000 n J Clin Periodontol. After the Stage is determined, the case is assigned one of three Grades (A, B, C) that indicate the potential for disease progression and treatment outcome (Table 1B). The relationship between body mass index and stage/grade of periodontitis: a retrospective study. Conclusions: In this case report, we present a patient with stage IV/ grade C periodontitis who achieved a good treatment outcome following nonsurgical periodontal treatment, orthodontic treatment, and prosthodontic treatment with a Maryland bridge, bringing new insight into the treatment of advanced periodontal disease. The aim is to provide a snapshot of some of the Epub 2021 Oct 28. Abstracts of Presentations at the Association of Clinical Scientists 143. Lancet. 0000087237 00000 n 2004;83(3):22-5. The aim of this article is to report a comprehensive periodontal . J Clin Periodontol 2018;45 Suppl 20:S171-S89. Dementias: Periodontitis and periodontal pathogens have been associated with dementias and Alzheimers Disease. You are accessing a machine-readable page. 2018 May;16(2):210-218. doi: 10.1111/idh.12290. 8600 Rockville Pike Similarly, if periodontitis has progressed apically and reached the apex of the root of a tooth, secondary endodontic disease will develop. You seem to have javascript disabled. FOIA 1996-2023 MDPI (Basel, Switzerland) unless otherwise stated. BACKGROUND The current study's aim was to evaluate and compare demineralized freeze-dried bone allograft (DFDBA) with and without concentrated growth factor (CGF) membrane in the treatment of periodontal intrabony defects on both a clinical . Prevention of gingivitis is the same as its treatment: plaque removal and control. In order to quantify the percentage of inflammatory cells and the percentage of the vascular area, digitally fixed images (arbitrary standardized area) for each section (five serial sections/sample) were analyzed by an optical light microscope (Olympus BX50, Olympus, Hamburg, Germany). GPIIIIVC patients have been chosen to better define the histomorphological characteristics of a low prevalence illness. Kanmaz B, Lappin DF, Nile CJ, Buduneli N. J Periodontol. Measuring the effect of intra-oral implant rehabilitation on health-related quality of life in a randomized controlled clinical trial. Am Heart J 2016;180:98-112. The extent of disease is categorized by the extent of stage-defining destruction. A separate guideline covering the treatment of Stage IV periodontitis will be published. Some dogs and cats may not allow regular toothbrushing, so the plaque should be removed by wiping with a gauze pad at least every second or third day. Periodontal disease and its related risk factors have been studied with growing interest [. Comparison of the Marginal Bone Loss in One-stage versus Two-stage Implant Surgery. Int J Cardiol 2016;203:1044-51. the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, o [pig guinea] Evaluation of Microcirculation, Cytokine Profile, and Local Antioxidant Protection Indices in Periodontal Health, and Stage II, Stage III Periodontitis. All in all, this Staging and Grading system helps your periodontist provide a patient-centered evaluation and treatment plan as well as an effective way to communicate more clearly with our patients. Combined periodontal and prosthodontic treatment demands of patients require a structured coordination of pretreatments and an adequate choice of restorations. performed the experiments; S.C. and V.C. Scaling and root planing (SRP) complemented by systemic antibiotics, access surgery, regenerative techniques and implant placement are among the treatments used for patients with this condition. The recently published clinical practice guideline (CPG) for the treatment of periodontitis in stages I-III provided evidence-based recommendations for the treatment of periodontitis patients, defined according to the 2018 classification. 0000131229 00000 n Generalized periodontitis Stage IV Grade C Immunology of periodontitis Innate immunity: In innate immunity, the role of neutrophils, Toll-like receptors and defensins has been well studied. The authors declare no conflict of interest. Given the lack of benefits and the conflicting data in the literature, the benefits . 2017 Nov;28(11):1354-9. Periodontal disease and carotid atherosclerosis: A meta-analysis of 17,330 participants. Sanz M, Herrera D, Kebschull M, Chapple I, Jepsen S, Beglundh T, Sculean A, Tonetti MS; EFP Workshop Participants and Methodological Consultants. The https:// ensures that you are connecting to the ; G.G. A stage 1 furcation involvement exists when a periodontal probe extends less than halfway under the crown in any direction of a multirooted tooth with attachment loss. 0000001972 00000 n . Stage 4: There is advanced periodontitis, with >50% of attachment loss as measured by probing of the clinical attachment level or by radiographic determination of the distance of the alveolar margin from the cementoenamel junction relative to the length of the root, or there is a stage 3 furcation involvement in multirooted teeth (see below). The effect of periodontal treatment on diabetes-related parameters such as glycemic control is still inconclusive. A stage 2 mobility is present when tooth mobility is increased in any direction other than axial over a distance of >0.5 mm and up to 1 mm. J Clin Periodontol 2018;45 Suppl 20:S219-S29. Kwon T, Lamster IB, Levin L. Current Concepts in the Management of Periodontitis. A patient is said to have periodontitis if: interdental clinical. The periodontist will also compare the amount of bacterial biofilm to the destruction level. The worst periodontal condition is evident in patients with generalized stage III-IV, grade C periodontitis. Zeng XT, Leng WD, Lam YY, et al. 2022 May;52(3):511-525. Performance & security by Cloudflare. ; Karring, T.; Berglundh, T.; Giannobile, W.V. Depression is related to edentulism and lack of functional dentition: An analysis of NHANES data, 2005-2016. Sgolastra F, Petrucci A, Gatto R, Monaco A. Garbo D, Aimetti M, Bongiovanni L, Vidotto C, Mariani GM, Baima G, Romano F. Life (Basel). Results: The S3 Level CPG for the treatment of stage IV periodontitis culminated in recommendations for different interventions, including orthodontic tooth movement, tooth splinting,. Pathogenesis of inflammatory periodontal disease. Periodontitis requires more aggressive periodontal treatment. Please include what you were doing when this page came up and the Cloudflare Ray ID found at the bottom of this page. Extraction treatment on orthodontic patients with Stage /Grade C periodontitis: a preliminary study October 2021 Zhonghua kou qiang yi xue za zhi = Zhonghua kouqiang yixue zazhi = Chinese . CASE PRESENTATION Chief complaints interesting to readers, or important in the respective research area. generalized). The results are reported as the estimates and 95% confidence intervals. Based on the findings from step 1, a determination of mild-moderate periodontitis can be made, which is considered Stage I or Stage II. Author to whom correspondence should be addressed. Ann Clin Lab Sci. Clipboard, Search History, and several other advanced features are temporarily unavailable. Maxillary canine teeth with pockets on their palatal side that have already progressed to form an oronasal fistula require extraction and oronasal fistula repair. doi: 10.1111/jcpe.12945. Plaque is a typical biofilm, composed of many microorganisms that differ from their planktonic forms. Root scaling (removing plaque and calculus on exposed root surfaces) and planing (smoothing the root surfaces by removing textural irregularities and diseased cementum) are performed, followed by gingival curettage that removes the infected and inflamed inside layer of a periodontal pocket. J Clin Periodontol 2021. 2021 Mar 18;10(6):1262. doi: 10.3390/jcm10061262. Yardley, PA: Professional Audience Communications, Inc.; 2010. The connective tissue side of the flap needs to be debrided before wound closure to avoid contact of infected and inflamed granulation tissue with the planed root surfaces. Periodontitis and respiratory diseases: A systematic review with meta-analysis. . Get Directions She previously taught in two dental hygiene programs as clinical and didactic faculty. %PDF-1.4 % 2012 Oct;39(8):541-4, 547-8, 551-2. Considering the vascular area, young patients showed a significant increase compared to older patients and it was higher in non-smokers than smokers. Epub 2021 Feb 8. The bacteria found in the presence of teeth with periodontal disease include Bacteroides fragilis, Peptostreptococcus, Porphyromonas gulae, Porphyromonas salivosa, Porphyromonas denticanis, Prevotella intermedia, Treponema spp, Bacteroides splanchnicus, and many others. P: 904-249-8448 This site needs JavaScript to work properly. Yardley, PA: Professional Audience Communications, Inc.; 2010. Here is shown a periodontitis case definition system based on a staging and grading framework. J Periodontol. In this study, we did not compare the percentage of the vascular area and inflammatory cells with healthy patients, but we evaluated how some factors (smoking, age, PPD, plaque) influenced these percentages in GPIIIIVC patients. Periodontal and Orthodontic Synergy in the Management of Stage IV Periodontitis: Challenges, Indications and Limits. 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. Recommendations for treating stage I-III periodontitis in the Taiwanese population: A consensus report from the Taiwan Academy of Periodontology. 2022 Jan 17;10(1):186. doi: 10.3390/biomedicines10010186. Biomedicines. Patients often require several treatment sessions for complete debridement of the tooth surfaces.21 After scaling, root planing, and other adjunctive treatment approaches such as use of antibiotic therapy, the periodontal tissues require approximately 4 weeks to demonstrate optimal effects of nonsurgical therapy.21, Many moderate to advanced cases require surgical access to the root surface for root planing and reducing pocket depth, which will allow the patient to achieve successful home care.21, A patient with gingivitis can revert to a state of health with a reduced periodontium, but due to the host-related disease susceptibility, a periodontitis patient remains a periodontitis patient, even following successful therapy, and requires lifelong supportive care to prevent recurrence of disease.2 Further, patients with more severe periodontitis Stage and Grade have been found to be more likely to experience disease recurrence and tooth loss without regular periodontal maintenance visits.

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