The significance of maintenance care in the treatment of periodontal disease

Abstract The present investigation was performed to assess the efficacy of a maintenance care program to prevent recurrence of disease in patients subjected to treatment of advanced periodontitis. In addition, the periodontal status was monitored of a group of patients who following the end of active treatment were referred back to genera] practitioners for maintenance care. The material consisted of 90 patients who in 1972 were referred for specialist treatment of advanced periodontal disease. The patients were first subjected to an initial examination including assessment of oral hygiene, gingivitis, probing depths and attachment levels. They were on an individual basis given case presentation, instructed how to practice proper tooth‐cleaning methods, their teeth were scaled and eventually the periodontal pockets were treated using the modified Widman technique. During the first 2 months following surgery the patients were recalled once every 2 weeks for professional tooth cleaning. Two months after the end of surgical treatment, the patients were reexamined to provide baseline data. Every third patient was thereafter referred back to the general dentist for maintenance care. Two out of three patients were maintained in a carefully designed and controlled maintenance care program at the university clinic. This program involved recalls once every 2–3 months and included instruction and practice in oral hygiene, meticulous scaling and professional tooth cleaning. The patients were reexamined 3 and 6 years after the baseline examination. The results demonstrated that in patients suffering from destructive periodontitis, a treatment program that involved oral hygiene instruction, scaling, root planing and modified Widman flap procedures resulted in the establishment of clinically healthy gingiva and shallow pockets. Patients who were placed on a carefully designed recall program were over a 6‐year period able to maintain excellent oral hygiene standards and unaltered attachment levels. In contrast patients who subsequent to active treatment were not maintained in a supervised program showed obvious signs of recurrent periodontitis at the follow‐up examinations.