KEY WORDS
Risk factors, oral hygiene, smoking,
scaling, laser, maintenance
Non-surgical periodontal therapy
– evidence and opinion
28
Learning objectives
• Revise approaches to modifiable
risk factor management to improve
outcomes of non-surgical
periodontal therapy
• Appreciate the importance of
each component of non-surgical
periodontal therapy in determining
a successful outcome when
managing patients
Mandeep S. Ghuman
Prim Dent J. 2019;8(4):28-33
ABSTRACT
Effective non-surgical periodontal therapy is fundamental to achieve and maintain
periodontal health, particularly in individuals who are susceptible to periodontitis.
This article aims to highlight current evidence and published guidance, together
with personal insights and suggestions from the author’s clinical experience to
help with management of patients utilising this common treatment modality.
Introduction
Non-surgical periodontal treatment
comprises the following components:
1 Modifiable risk factor management
2 Professional removal of biofilm
from tooth surfaces and
periodontal pockets
3 Periodontal re-evaluation
4 Supportive periodontal therapy
(SPT), commonly termed
periodontal maintenance
This article will focus discussion on
three of the above components. Whilst
periodontal re-evaluation is of crucial
importance in ongoing management
of periodontitis patients, it will only
be mentioned briefly, and the reader
is directed to an excellent series of
recent articles discussing this topic
specifically.1-4
What to check before
treatment
Prior to embarking upon treatment, a
clear and understandable explanation
to the patient of diagnosis, disease
process and aetiology are important.
The chronic nature of the condition
should be emphasised and described
author
Dr Mandeep S. Ghuman
BSc(Hons) BDS MClinDent(Perio) PhD
MFDSRCS(Eng) MPerioRCS(Ed) FHEA
Clinical Lecturer and Honorary Consultant
in Periodontology, Periodontology Unit, Centre
for Host Microbiome Interactions, Faculty of
Dentistry, Oral and Craniofacial Sciences,
King’s College London
not as being ‘curable’, but instead
‘controllable’, to stabilise the
periodontal tissues and minimise risk
of further disease progression. The
largely irreversible nature of periodontal
tissue loss caused by periodontitis
should also be mentioned as current
regenerative treatment modalities
are only applicable in limited clinical
situations and can lack predictability.
In contrast, there is overwhelming
evidence for the effectiveness of
non-surgical periodontal therapy in
controlling periodontitis, provided the
patient develops self-efficacy and takes
ownership of their clinical predicament,
and treatment is carried out effectively
in conjunction with the partnering
clinician. Patient relevant benefits
including tooth retention, reduced gum
bleeding, and fresher breath, as well
as potential benefits to systemic health,
should be stated. Conversely, possible
adverse effects – namely increased
gum recession potentially leading to
impaired aesthetics and food packing
as well dentine sensitivity – also
should be clearly communicated,
and patient understanding checked
and documented in the notes.
p r i m a r y d e n ta l j o u r n a l
Modifiable risk factor
management
It must be highlighted that the identification
and incorporation of risk factors is part of
periodontal assessment and diagnosis. It
is important to evaluate these factors and
communicate the importance of their role in
influencing disease progression to patients,
and subsequently aim to correct them. The
increasing importance of diabetes has
now been recognised formally with the
publication of guidance by NHS England.5
The other more well-known major risk
factors are accumulation of plaque and
smoking, and are discussed below.
How important is good
plaque control?
Although universally known, the
importance of effective oral hygiene has
been demonstrated again recently. A
randomised controlled trial on healthy,
non-smoking patients showed that a
three-month oral hygiene phase alone
produced dramatic reductions in the
proportion of pocket depths ≥4mm.6
Furthermore, the beneficial effects of this
distinct introductory oral hygiene phase
seem to be apparent five years following
active treatment during the supportive
periodontal therapy phase.7 Should
oral hygiene not remain optimal, there
is an increased likelihood of relapse
and continued attachment loss.8
Facilitating effective self-performed
plaque control by patients can be very
challenging. There are many (often
complex) reasons why patients persistently
present with suboptimal oral hygiene.
These should be explored with patients in
a non-judgemental manner to understand
their perspective, and realistic expectations
should be initially set. For patients willing
to engage, it should be established via
direct observation whether patients are
using appropriate aids and methods
to clean their teeth, and whether their
technique is effective. Patients with limited
manual dexterity due to disability or illness
can find it difficult to carry out effective
oral hygiene, and will need more time
and support to improve. With an ageing
Vol. 8 No. 4 winter 2019/20
Figure 1: An example of manual toothbrush with a head size of only 2cm long to
facilitate oral hygiene in tight areas. Note the simple design with uniform flat trimmed
round-ended bristles. Medium stiffness bristles are adequate for most patients
population and the associated rise of
cognitive disorders an increasing number
of patients will fall into this category. It
should be borne in mind that effective
oral hygiene may also be hindered for
iatrogenic reasons with sub optimally
designed and/or executed restorative
work that will need to be corrected or
replaced to ensure it is cleansable.
Toothbrushing
Manual and electric toothbrushes require
distinct techniques in order to be effective,
but patients are often not aware of this
unless specifically directed, especially
when changing from the former to the
latter. It should not be automatically
assumed that use of an electric brush
will result in an improved outcome. For
those patients who prefer to use manual
toothbrushes, these should be checked
as the sizes of the heads of those most
frequently commercially available in
pharmacies and supermarkets are often
too large to be accommodated in some
areas, including the buccal aspects of the
upper molar regions due to obstruction of
the ramus on opening and lingual aspects
of the lower molars due to resistance from
the tongue musculature. An example of
a manual toothbrush with a reasonable
size of head is shown in Figure 1. Most
electric toothbrushes come with small
or medium sized brush heads already
placing them at advantage to most
manual versions. Other key advantages
of electric toothbrushes are as follows:
1 Timer function: manual toothbrushing
is often not carried out for a sufficient
length of time for effective plaque
control
2 Pressure sensors: useful when trying
to arrest abrasive technique
3 Smartphone app connection: provides
real time feedback on coverage, and
long-term monitoring to promote as
a habit
Interdental cleaning
Whilst there has been controversy in
news media questioning the importance
of interdental cleaning in preventing
periodontal diseases, there is a growing
body of evidence to suggest that when
carried out regularly and effectively,
plaque accumulation and subsequent
inflammation is substantially reduced.9,10
Evidence suggesting that teeth presenting
with persistent gingival inflammation are
more likely to be lost in the long term
also reinforces its importance.11 The
European Federation of Periodontology
has produced clear brief guidance and
recommendations for interdental cleaning
for patients and dental healthcare
professionals.12 It states that “daily
cleaning between your teeth using special
interdental brushes is essential for treating
and preventing gum disease. Floss is of
little value unless the spaces between
your teeth are too tight for the interdental
brushes to fit without hurting or causing
harm”. Most patients will need to use
at least two different brush sizes which
should be checked for appropriate fit
by the treating clinician, after which the
ability of the patient to carry this out
should be checked. Brushes are more
likely to engage plaque-retaining root
concavities and furcation regions where
attachment loss has occurred. Patients
often report smaller brush sizes frustrating
to use because of bending and fracture,
so in these areas more robust silicone
sticks can be recommended, or floss for
anterior teeth where access is easier for
29
 Non-surgical periodontal therapy
– evidence and opinion
the patient. Whilst irrigators and air-based
methods have been heavily marketed
for use in interdental cleaning, there is
limited evidence for their effectiveness.10
Should the patient wish to include these
as part of their dental hygiene regime,
then their use should be adjunctive to the
aforementioned mechanical methods.
How to help achieve
optimal plaque control
Whilst essential, provision of information
alone rarely instigates enduring behaviour
change, so a number of evidence-based
strategies and tools have been developed
to aid this including:
• Oral Hygiene TIPPS as part of
the Prevention and Treatment of
Periodontal Diseases in Primary Care
guidance produced by Scottish Dental
Clinical Effectiveness Programme.13
• Capability opportunity motivation
– behaviour (COM-B) model and
the GPS approach.14 The latter is
described below and tackles perhaps
the most difficult component of the
former – how to motivate patients.
G goal-setting: ask the patient what
aspect of their oral hygiene they
would like to improve. Should
they respond requesting your
recommendation, then this is valid as
the patient has given you their choice.
The goals should be SMART – specific,
measurable, achievable, realistic
and time-orientated. It is wise initially
to encourage one small change so
that success can be rewarded and
further change encouraged.
P planning: ask the patient when,
where and how they can achieve
the goal set. Again, the patient is
encouraged to come up with the
solution and ideally this should be
written down. Situations that may
stop the patient from performing
that goal should also be discussed,
and strategies for how these can
be overcome written down.
S self-monitoring: use of paper
diaries, sticker charts or apps to
monitor their adherence. This is
where smartphone-linked toothbrushes
can be particularly helpful.
30
These approaches involve working
with patients to develop appropriate
solutions for self-care and treatment,
but need sufficient time to discuss,
agree and review.
Other tips to engage patients
to produce sustained
improvements in oral hygiene
Often stimulation of bleeding from the
gums will deter patients from carrying
out effective oral hygiene as they believe
it will worsen the condition. This is a
natural response, but clear explanation
is required to correct this assumption and
to check patient understanding so that
this common hurdle can be overcome.
As treatment progresses, presence of
bleeding can be used to further improve
plaque control for patients who can
target these areas specifically.
Emphasise the benefits and positive
outcomes so that it is perceived as being
more directly rewarding – use of terms
such as ‘reduced bleeding’, ‘fresher
breath’, ‘firmer gums’ and ‘improved
appearance’ may help.
To promote self-efficacy give patients
choice about which aspect of their oral
hygiene they would like to improve first
and the method they would prefer to
use. Instil confidence in the patient that
they are able to improve their own
oral health.
Suggest environmental cues to encourage
routine behaviour – a simple one is to
ask patients to place their interdental
cleaning aids directly in front of their
toothbrush to prompt them to do it first.
Alternatively, carry cases for brushes
can be suggested to allow use at a place
and time more convenient for patients.
Patients are more likely to change
behaviour if it is regarded as being
enjoyable, so ask whether they can
link oral hygiene practices to other
more pleasant grooming activities.
Furthermore, patients should be
encouraged to have incentives and
reward themselves when these practices
have been carried out.
How bad is smoking
for gum health?
Smoking increases the risk of developing
periodontitis by approximately five-fold
and it has been argued as being the most
important modifiable risk factor.15,16 The
proportion of the UK adult population
who smoke cigarettes continues to decline
gradually and is currently approximately
just under 15%. Delivering Better Oral
Health has produced clear guidance on
the risks to oral health that should be
communicated to smoking patients, along
with approaches to encourage smoking
cessation.17
Should patients continue to smoke, it
is important they are informed of, and
understand that:
1 There is an increased likelihood
of development of periodontitis,
or continued disease progression
if already present;
2 In case of the latter, periodontal
treatment provided is less likely to
be effective and less predictable.
Are e-cigarettes any better?
E-cigarettes have become increasingly
common, and it is now estimated that 7%
of the adult UK population (3.6 million)
use these.18 Due to their relatively recent
rise in popularity there are no clinical
studies assessing their long-term effects
on oral tissues, however when compared
to cigarette smoking, differences of
short-term effects on periodontal tissues
have been noted.19 In vitro studies show
exposure of periodontal cells to vaping
compounds produce deleterious effects,
but whether this translates clinically is far
from certain.20 Clearly there is a need
for more research in this area, and the
main governmental dental research body
in the US, National Institute for Dental
and Craniofacial Research (NIDCR), has
prioritised this as a key research area.
Recently, there have been reports of
cases of e-cigarette or vaping product
use-associated lung injury (EVALI).21 Cases
have predominately been reported in the
US, with a recently confirmed case in the
UK. The majority of cases are associated
with illicit preparations containing
p r i m a r y d e n ta l j o u r n a l

tetrahydrocannabinol (THC) – the main
psychoactive component of cannabis,
and vitamin E acetate oil.22 Other than
EVALI, the US has a much larger problem
with use of e-cigarette use in children
and higher addiction rates due to lax
regulation resulting in preparations with
much higher levels of nicotine. Fortunately
in the UK, tighter regulation has resulted
in preparations with lower maximum
nicotine limits and licit vaping products in
the UK do not appear to contain THC nor
vitamin E acetate.23 Public Health England
have recently reiterated their advice on
e-cigarettes: ‘Smokers should consider
switching completely and vapers should
stop smoking’, and that they are at least
95% less harmful than smoking, but are
monitoring the situation.24 Readers who
are particularly interested in this subject,
and the effects of different regulatory
regimes are advised to listen to the
excellent referenced podcast.25
How can plaque biofilm
and calculus removal
be improved?
Although hand and powered
instrumentation have been shown to be
equally effective in removing plaque and
calculus,26 use of the latter, specifically
ultrasonics, is now more common, most
likely as it is less time consuming and
induces less operator fatigue. Similar to
hand instruments, both magnetostrictive
and piezoelectric types come with a
range of tip shapes to improve adaptation
Figure 2: Examples of straight and
curved piezoelectric scaling tips.
Curved tips may help to access
interproximal regions of premolars
and molars, especially furcation
involved upper molars. Appropriate
power settings should be used to
minimise risk of fracture and tips
should be checked regularly
for wear
for regions that may be more difficult to
debride. Use of curved tips (see Figure 2)
help to access mesial and distal aspect
concave regions of premolars and molars,
especially furcation regions of upper
molars. Diamond-coated tips may further
enhance calculus removal in these regions
and produce a smoother root surface
to promote healing. However, these
should be used with caution to minimise
risk of excessive tooth tissue removal.
Furthermore, long slender straight tips are
more able to access bases of deeper and
narrower pockets than hand instruments,
particularly around the incisors and the
mid-buccal/palatal regions of the posterior
teeth where the gingiva can be thin and
tight against a bulbous tooth surface,
impeding hand instrument insertion. Again,
the importance of sufficient time needed
to do this effectively cannot be overstated.
As tactile feedback is diminished it is
important to check subgingival surfaces
with an appropriate probe or explorer
for residual calculus. Gentle debridement
technique with light overlapping contacting

references
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Factors affecting decision making
at reassessment of periodontitis.
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Factors affecting decision making
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findings – systemic factors. Br Dent J.
2019;227(9):797-801.
3 S. Kalsi A, I. Bomfim D, Hussain Z.
Factors affecting decision making
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Part 3: interpretation of clinical
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2019;227(10):869-74.
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5 Commissioning Standard: Dental
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standard-dental-care-for-people.pdf.
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8 Lindhe J, Nyman S. Long-term
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9 Chapple ILC, Van Der Weijden F,
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10 Worthington HV, MacDonald L,
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use of interdental cleaning devices,
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periodontal diseases and dental
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11 Schatzle M, Loe H, Lang NP,
et al. The clinical course of
chronic periodontitis. IV. Gingival
inflammation as a risk factor in
tooth mortality. J Clin Periodontol.
2004;31(12):1122-7.
12 EFP Workshop 2014 Guidelines
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periodontitis and peri-implantitis.
Available from: http://www.efp.org/
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guidelines.html.
13 Scottish Dental Clinical Effectiveness
Programme – Oral Hygiene TIPPS
video Available from: http://www.
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periodontal-management/oral-
hygiene-tipps-video/.
14 Newton JT, Asimakopoulou K.
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Enhancing oral health related
behaviour through behaviour
change techniques. Br Dent J.

Vol. 8 No. 4 winter 2019/20 31

 Non-surgical periodontal therapy
– evidence and opinion

strokes almost parallel to the long axis
to be debrided is favoured to minimise
risk of damage to root surfaces and
improve capacity for healing. Indeed,
this approach is now the focus of modern
minimally-invasive non-surgical therapy
(MINST) techniques, where there have
been case reports showing impressive
attachment and bone gain mostly in
angular defects, reducing the need for
surgical intervention.27 Clinical trials are
now underway to test the effectiveness
of this promising treatment modality.
It is therefore important that power
settings are appropriate as they may
vary for different tips to achieve effective
calculus removal and minimise risk of tip
fracture. Reduction in tip performance
due to wear is also another common
reason why calculus and biofilm removal
may become less effective over time.
Tip wear results in an exponential loss
of vibration amplitude and normally
the terminal 1-2mm is responsible for
removing the majority of the deposit.
Despite the possible added benefit of fluid
lavage, cavitation, and microstreaming,
it is essential that the working ends of
the tips actually contact hard deposits
otherwise they will not be removed.
Whilst air polishing devices have become
more popular recently, their use at present
is largely indicated for biofilm removal
where calculus is not present, as in the
case of prophylaxis procedures or as
part of supportive periodontal therapy.
When should we
prescribe antibiotics?
Judicious use of systemic antibiotics is
becoming increasingly urgent due to the
continued rise of antibiotic resistance,
and thankfully they are rarely indicated
for most of the common periodontal
conditions. There is little evidence for
their effectiveness as a monotherapy in
treatment of periodontitis as mechanical
disruption of the dysbiotic biofilm is
essential. Thus, their use is largely
adjunctive, usually in molar-incisor pattern
periodontitis where often there are no
other significant identifiable modifiable
risk factors. They may also be indicated
for necrotising periodontal diseases
and acute periodontal abscesses (with
systemic complications) which can incur
rapid destruction of the tissues and are
characterised by invasion of periodontal
tissues by certain anaerobic bacterial
species. The current FGDP Antimicrobial
Prescribing guidelines are clear and
sensible and should continue to be
followed.28
Current status
on use of lasers
Use of lasers as part of periodontal
therapy in the UK has become
increasingly popular in recent years
following the trend in the US. The
rationale for their use includes promoting
destruction of bacteria and biofilm
together with enhancement of wound
healing. Anecdotal observations and
case reports have suggested that they
have promising potential to enhance
periodontal treatment, reducing the need
for surgical intervention.29,30 However,
more objective assessment of their
effectiveness is hampered by a lack of
controlled clinical studies together with
a wide variation of types available,
settings employed and the protocols/
modes of utilisation. Cost-effectiveness
is also another potential issue with high
initial capital expense, maintenance costs
and need for increased treatment time.
A recent systematic review showed that
whilst adjunctive use of lasers produced
a statistically significant improvement
in pocket depths and attachment levels
of moderate to advanced periodontitis
over mechanical instrumentation alone,
this was very modest clinically (<1mm)
and not sustained in the long term.31 A
similar conclusion was also arrived at
when antimicrobial photodynamic therapy
(laser treatment in conjunction with a
photosensitiser) was used as an adjunct.32
There is inadequate evidence comparing
mechanical instrumentation versus
lasers alone, as well as for treatment
of residual probing depths following
conventional non-surgical treatment, so
no recommendations can be made.31
Overall, on the basis of current evidence,
the use of lasers, even as adjuncts to
conventional non-surgical periodontal
treatment, is not justified. However, this
is an area of highly active research,
so it is hoped that better quality studies

2017;223(3):147-50. Britain. 2019. Available from: The Lancet. 2019;394(10214): freakonomics.com/podcast/

15 Grossi SG, Zambon JJ, Ho
AW, et al. Assessment of risk
for periodontal disease. I. Risk
indicators for attachment loss. J
Periodont. 1994;65(3):260-7.
16 Grossi SG, Genco RJ, Machtei EE,
et al. Assessment of risk for
periodontal disease. II. Risk
indicators for alveolar bone loss.
J Periodont. 1995;66(1):23-9.
17 Delivering better oral health:
an evidence-based toolkit for
prevention – Third edition. Available
from: https://assets.publishing.
service.gov.uk/government/
uploads/system/uploads/
attachment_data/file/605266/
Delivering_better_oral_health.pdf.
18 ASH Fact Sheet: Use of e-cigarettes
(vaporisers) among adults in Great
https://ash.org.uk/wp-content/
uploads/2019/09/Use-of-e-
cigarettes-among-adults-2019.pdf.
19 Wadia R, Booth V, Yap HF, Moyes
DL. A pilot study of the gingival
response when smokers switch
from smoking to vaping. Br Dent J.
2016;221(11):722-6.
20 Sancilio S, Gallorini M, Cataldi
A, di Giacomo V. Cytotoxicity and
apoptosis induction by e-cigarette
fluids in human gingival fibroblasts.
Clin Oral Investig. 2016;20(3):
477-83.
21 Blagev DP, Harris D, Dunn AC, et
al. Clinical presentation, treatment,
and short-term outcomes of lung
injury associated with e-cigarettes
or vaping: a prospective
observational cohort study.
2073-83.
22 Kalininskiy A, Bach CT, Nacca
NE, et al. E-cigarette, or vaping,
product use associated lung injury
(EVALI): case series and diagnostic
approach. Lancet Respir Med.
2019;7(12):1017-26.
23 Nyakutsikwa B, Britton J,
Bogdanovica I, Langley T. Vitamin
E acetate is not present in licit e‐
cigarette products available on
the UK market. Addiction. 2019.
24 Vaping and lung disease in the
US: PHE’s advice. Available from:
https://publichealthmatters.blog.
gov.uk/2019/10/29/vaping-and-
lung-disease-in-the-us-phes-advice/.
25 Freakonomics Radio - The Truth
About the Vaping Crisis (Ep.
398). Available from: http://
vaping-nicotine/.
26 Tunkel J, Heinecke A, Flemmig TF.
A systematic review of efficacy
of machine-driven and manual
subgingival debridement in the
treatment of chronic periodontitis.
J Clin Periodontol. 2002;29
Suppl 3:72-81; discussion 90-1.
27 Nibali L, Yeh YC, Pometti D, Tu
YK. Long‐term stability of intrabony
defects treated with minimally
invasive non‐surgical therapy.
J Clin Periodontol. 2018;45(12):
1458-64.
28 Antimicrobial Prescribing for
General Dental Practitioners
– Periodontal Disease 2014.
Available from: https://www.fgdp.
org.uk/antimicrobial-prescribing-
standards/periodontal-disease.

32 p r i m a r y d e n ta l j o u r n a l

in the future will produce more robust
evidence, particularly for specific clinical
situations, such as infrabony defects.
How effective is non-surgical
periodontal therapy?
Numerous studies have shown that sites
with probing depths up to 6mm can be
largely treated with effective non-surgical
therapy, and that surgical options should
only be considered after a successful
non-surgical treatment at sites of at least
6mm.33 Even when large probing depths
(≥7mm) are initially present, the majority of
reduction of probing depths arise as a result
of the non-surgical phase of treatment.34 By
the end of active periodontal treatment, it
is preferable for all pockets to be less than
6mm as long term data show that the risk of
tooth loss is significantly higher otherwise.35
Should this not be achieved with non-
surgical periodontal therapy alone with
modifiable risk factors optimally controlled,
then referral for specialist opinion may
be sought. Readers are also advised to
refer to recently published NHS England
commissioning guidelines which discuss
care pathways to manage periodontal
health of patients.36
What is supportive
periodontal therapy (SPT)
and why is it important?
Once a patient’s periodontal condition has
been improved with active periodontal
therapy to a satisfactory standard as
agreed by patient and treating clinician(s),
an effective supportive periodontal
therapy (SPT) programme is essential
in order to minimise risk of relapse.37,38
Despite extensive evidence demonstrating
its fundamental importance, a recent
systemic review showing compliance
with SPT was generally unsatisfactory.
with the most frequent reason cited by
patients being a lack of information and
motivation.39 Thus, the importance and
level of commitment required for regular
monitoring and management of patients’
periodontal conditions – on a lifelong
basis for susceptible patients – needs to
be communicated clearly to patients at
the outset when discussing management
options.
SPT encompasses:
1 Review of risk factors – medical/
lifestyle/local;
2 Reinforcement of oral hygiene,
smoking cessation and diabetic
control advice;
3 Removal of plaque and calculus
both supra and subgingivally, where
detected. At sites >4mm with calculus
or bleeding on probing, further root
surface debridement is indicated, with
use of local anaesthetic as necessary;
4 Annual re-evaluation with full
periodontal charting.
With regular effective long-term SPT the
majority of sites remain stable, however
relapse may occur in a very small
proportion, normally in more susceptible
patients.8,35 Thus, the programme needs
to be individually tailored to target
those areas of greatest need. In most
cases, SPT is carried out by dental care
professionals (DCPs), and in the opinion
of this author, it is essential that they are
given adequate appointment lengths (a
minimum of 45 minutes per session) and
nursing support to manage periodontitis
patients, particularly for those with
advanced disease. Furthermore, at sites
with residual pocketing, particularly
where inflammation and/or bleeding is
noted, administration of local anaesthetic
may be necessary to aid effective re-
debridement. This also highlights the need
for an appropriately detailed prescription
to be provided to DCP colleagues to
clearly communicate the proposed
plan and arrangements for follow-up.
There is no definitive guidance on how
often patients should be recalled, but
patient susceptibility should be taken
into account,40 and can range from two
to six-monthly follow ups. However, a
recent study suggests patients who are
recalled more frequently or do not miss
appointments are more likely to remain
periodontally stable and are less likely
to lose teeth after 20 years.41 For treated
periodontitis patients, their condition
should be re-evaluated annually with
appropriate charting to inform further
recall intervals.
Conclusion
Supporting patients to control modifiable
risk factors, together with effective
professional biofilm removal, followed by
ongoing monitoring and maintenance are
crucial aspects to achieve success with
non-surgical periodontal therapy. Overall,
evidence suggests that, when applied
correctly, current commonly available
treatment methods are highly successful in
controlling disease to attain periodontal
health in the majority of patients.

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