8 (Perio Exam III) Periodontal Patient Management

What is periodontal maintenance?

Procedures performed at selected intervals to help the periodontal patient maintain oral health after active therapy.

Is periodontal maintenance the same as a prophylaxis?

No, periodontal maintenance following active therapy is not synonymous with a prophylaxis.

What are key components of a periodontal maintenance visit?

Medical/dental history update, radiographic review, extraoral and intraoral exam, dental exam, periodontal evaluation, removal of bacterial deposits from pockets/crevices, scaling and root planing if indicated, polishing, and review of plaque control.

What is the main goal of periodontal maintenance?

Preservation of gingival and periodontal health achieved during active periodontal treatment.

What periodontal findings should be recorded during assessment?

Plaque index, bleeding on probing, probing depths, clinical attachment levels, mobility/fremitus, furcations, mucogingival defects, local factors, and residual calculus.

For non-periodontitis patients, what distinguishes periodontal health from gingivitis?

BOP less than 10% indicates periodontal health, BOP 10% or greater indicates gingivitis.

What defines a periodontitis patient in the diagnosis flowchart?

Interproximal attachment loss on 2 or more non adjacent teeth.

What indicates active periodontitis in a periodontitis patient?

BOP 10% or greater with deep probing depths of 5 mm or greater.

In the lecture, what is diagnosis based on?

Attachment level and bleeding on probing.

In the lecture, what is treatment need based on?

Deep probing depth, not simply bone loss or calculus presence.

What CDT code is associated with prophylaxis?

D1110.

What CDT codes are associated with SRP?

D4341 for 4 or more teeth per quadrant and D4342 for 1–3 teeth per quadrant.

When is D4346 used?

Scaling in the presence of generalized moderate or severe gingival inflammation with significant erythema, pseudopockets, subgingival calculus, and BOP 10% or greater.

What are the phases of periodontal treatment?

Preliminary/emergency, nonsurgical Phase I, surgical Phase II, restoration Phase III, and maintenance Phase IV.

What happens in the preliminary/emergency phase?

Emergency treatment and extraction of hopeless teeth.

What happens in nonsurgical Phase I therapy?

Consultation, plaque control/OHI, correction of contributing factors, and prophylaxis or SRP depending on diagnosis.

What happens in surgical Phase II therapy?

Periodontal surgeries, implant surgeries, and possibly endodontic therapy.

What happens in maintenance Phase IV therapy?

Supportive periodontal therapy and possible occlusal guard use.

How soon should gingivitis be re-evaluated after treatment?

In 2–4 weeks.

How soon should periodontitis be re-evaluated after treatment?

In 4–8 weeks.

What clinical findings suggest successful re-evaluation in periodontitis patients?

PPD 5 mm or less, no BOP, and plaque-free score of 80% or greater.

What maintenance interval is commonly recommended for periodontitis patients?

Every 3 months.

Why is a 3-month periodontal maintenance interval recommended?

Pathogenic bacteria return to pretreatment levels in about 9–12 weeks in susceptible patients.

What risk factors support shorter maintenance intervals?

Smoking, diabetes, stress, residual pockets, impaired host response, poor compliance, BOP, deeper pockets, tooth loss, and poor oral hygiene.

According to the lecture’s cited 2024 study, how does a 6-month recall compare with a 3-month recall?

A 6-month recall increases recurrence risk by 43% compared with 3 months.

What does the lecture say about deep intrabony defects and nonsurgical therapy?

Deep periodontal pockets associated with intrabony defects are unlikely to fully resolve with nonsurgical therapy alone.

When should a patient be referred to a periodontist after re-evaluation?

When deep pockets with BOP remain, intrabony defects are present, surgery may be needed, mucogingival defects exist, crown lengthening is needed, implant therapy is planned, or advanced Stage III/IV disease requires specialty care.

What is the difference between implant mucositis and peri-implantitis?

Implant mucositis is inflammation without bone loss, peri-implantitis includes inflammation with progressive bone loss.

What may be required if peri-implant inflammation and bone loss continue after nonsurgical treatment?

Surgical therapy using resective or regenerative techniques.

What CDT code is listed for scaling and debridement of a single implant?

D6081.

According to McGuire and Nunn, what factors support a good prognosis?

Etiologic factors can be controlled, adequate periodontal support, teeth can be maintained by patient and professional care, and systemic factors are controlled.

What factors are associated with a poor or questionable prognosis?

Greater attachment loss, furcation involvement, mobility, poor crown-to-root ratio, lack of compliance, and systemic factors.

What does the lecture say about compliance and tooth loss?

Non-compliant patients show significantly more tooth loss than compliant patients.

What reasons for non-compliance are listed?

Fear, lack of information, finances, and lack of compassion from the practitioner.

When should a powered toothbrush be recommended?

When the patient has reduced dexterity, impairment, or poor oral hygiene with a manual brush.

According to the lecture, what matters more than manual vs powered toothbrush choice?

Time and technique.

What oral hygiene sequence is recommended in the lecture?

Floss, Waterpik, brush, then mouthwash later or at least 30 minutes after brushing.

Why should mouthwash not be used immediately after brushing?

It rinses away concentrated fluoride from toothpaste.

What does the lecture say about compliance with oral hygiene sequence?

Compliance matters more than perfect order.

What important scheduling point does the lecture make about periodontal maintenance appointments?

45–60 minutes may be insufficient appointment length should be individualized based on patient complexity