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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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