Periodontitis Management

• What it is: A chronic inflammatory disease caused by a dysbiotic biofilm, influenced by host factors (e.g., smoking, diabetes).

• Treatment Pathway (EFP S3 guideline, Stage I–III):

  1. Behavioral & Risk Control: Oral hygiene instruction, smoking cessation, diabetes control.

  2. Non-surgical Care: Supra- and subgingival instrumentation (scaling & root planing).

  3. Re-evaluation: Assess pocket depth and healing.

  4. Adjunctive Options (if pockets persist):

     • Subantimicrobial-dose doxycycline.

     • Local/systemic antimicrobials (select cases).

     • Periodontal surgery.

• Surgical Options:

  • Resective surgery → reduces pocket depth.

  • Regenerative surgery → rebuilds lost tissues in intrabony and furcation defects.

    • Uses biologics (e.g., enamel matrix derivative) and/or biomaterials (bone grafts, membranes).

    • Papilla-preserving flap designs improve outcomes.

    • Success depends on defect shape, wound stability, and patient compliance.

• Long-term Success:

  • Supportive periodontal care with tailored recall intervals.

  • Meticulous plaque control.

  • Smoking cessation.

• Future Directions: New biomaterials (bioactive ceramics, polymer scaffolds) and biologics are being studied to improve predictability and reduce morbidity.