References

Sanz M, Herrera D, Kebschull M EFP workshop participants and methodological consultants. Treatment of stage I–III periodontitis: the EFP S3 level clinical practice guideline. J Clin Periodontol. 2020; 47 Suppl 22:4-60 https://doi.org/10.1111/jcpe.13290
West N, Chapple I, Claydon N British Society of Periodontology and Implant Dentistry Guideline Group Participants. BSP implementation of European S3-level evidence-based treatment guidelines for stage I–III periodontitis in UK clinical practice. J Dent. 2021; 106 https://doi.org/10.1016/j.jdent.2020.103562
Suvan J, Leira Y, Moreno Sancho FM Subgingival instrumentation for treatment of periodontitis. A systematic review. J Clin Periodontol. 2020; 47:155-175 https://doi.org/10.1111/jcpe.13245
Breininger DR, O'Leary TJ, Blumenshine RV Comparative effectiveness of ultrasonic and hand scaling for the removal of subgingival plaque and calculus. J Periodontol. 1987; 58:9-18 https://doi.org/10.1902/jop.1987.58.1.9
Rateitschak-Plüss EM, Schwarz JP, Guggenheim R Non-surgical periodontal treatment: where are the limits? An SEM study. J Clin Periodontol. 1992; 19:240-244 https://doi.org/10.1111/j.1600-051x.1992.tb00460.x
Liss A, Wennström JL, Welander M Patient-reported experiences and outcomes following two different approaches for non-surgical periodontal treatment: a randomized field study. BMC Oral Health. 2021; 21 https://doi.org/10.1186/s12903-021-02001-4
Farman M, Joshi RI Full-mouth treatment versus quadrant root surface debridement in the treatment of chronic periodontitis: a systematic review. Br Dent J. 2008; 205 https://doi.org/10.1038/sj.bdj.2008.874
Paterson M, Johnston W, Sherriff A, Culshaw S Periodontal instrumentation technique: an exploratory analysis of clinical outcomes and financial aspects. Br Dent J. 2023; 1-8 https://doi.org/10.1038/s41415-022-5405-1
Stein JM, Yekta-Michael SS, Schittenhelm F Comparison of three full-mouth concepts for the non-surgical treatment of stage III and IV periodontitis: a randomized controlled trial. J Clin Periodontol. 2021; 48:1516-1527 https://doi.org/10.1111/jcpe.13548
Eberhard J, Jepsen S, Jervøe-Storm PM Full-mouth treatment modalities (within 24 hours) for chronic periodontitis in adults. Cochrane Database Syst Rev. 2015; 2015 https://doi.org/10.1002/14651858.CD004622.pub3
Mattila K, Vesanen M, Valtonen V Effect of treating periodontitis on C-reactive protein levels: a pilot study. BMC Infect Dis. 2002; 2 https://doi.org/10.1186/1471-2334-2-30
Bansal T, Pandey A, Deepa D, Asthana AK C-reactive protein (CRP) and its association with periodontal disease: a brief review. J Clin Diagn Res. 2014; 8:ZE21-24 https://doi.org/10.7860/JCDR/2014/8355.4646
Schenkein HA, Loos BG Inflammatory mechanisms linking periodontal diseases to cardiovascular diseases. J Periodontol. 2013; 84:S51-69 https://doi.org/10.1902/jop.2013.134006
Naruishi K, Nagata T Biological effects of interleukin-6 on gingival fibroblasts: cytokine regulation in periodontitis. J Cell Physiol. 2018; 233:6393-6400 https://doi.org/10.1002/jcp.26521
Al-Isa M, Alotibi M, Alhashemi H Effect of non-surgical periodontal therapy on the fibrinogen levels in chronic periodontitis patients. Saudi Dent J. 2019; 31:188-193 https://doi.org/10.1016/j.sdentj.2018.12.001

Step 2 for the treatment of periodontal diseases

From Volume 51, Issue 5, May 2024 | Pages 312-314

Authors

Melissa Shemie

BDS, MFDS RCS (Eng)

Specialist Trainee in Periodontology, King's College London

Articles by Melissa Shemie

Email Melissa Shemie

Mira Shah

BEng (Hons), BDS, MFDS RCS (Ed)

BEng (Hons), BDS, MFDS RCS (Ed), Specialist Trainee in Periodontology, King's College London

Articles by Mira Shah

Email Mira Shah

Ian Dunn

BChD, FCGDent, MSc (Perio), BChD, FCGDent

Specialist Periodontist, Rose Lane Dental Practice, Liverpool

Articles by Ian Dunn

Email Ian Dunn

Abstract

This article discusses the modalities of treatment involved in step 2 of periodontal therapy, including exploring looking at the evidence-based recommendations produced by the S3 stages I–III periodontal treatment guideline.

CPD/Clinical Relevance: Step 2 of periodontal therapy is essential for removal of the subgingival biofilm and reduction in the bacterial load.

Article

Step 2 of therapy, also known as cause-related therapy, aims to control (by elimination or reduction) the subgingival biofilm and calculus by carrying out subgingival professional mechanical plaque removal (PMPR) on the root surface.1,2 This is implemented after successful step 1 therapy in all periodontitis patients regardless of the severity of periodontal disease. Step 2 is usually performed after a detailed periodontal assessment and successful implementation of step 1, which looks to educate the patient regarding their disease, address individual risk factors and improve oral hygiene.

Periodontitis is an inflammatory disease initiated by bacteria, specifically their endotoxin. This is identified by the host and the resulting inflammation is largely responsible for the bony destruction that we observe.

The aim of step 2 of therapy, subgingival PMPR, is to reduce the bacterial load, associated endotoxin and calculus, and in turn, reduce gingival inflammation, probing pocket depths, and the number of diseased sites.3 During subgingival instrumentation, there may be associated removal of the cementum (endotoxin-associated root surface) although cementum removal is no longer considered necessary in the management of periodontitis.

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