STEP 2
Aim: · Controlling (reducing/eliminating) the subgingival biofilm and calculus (subgingival instrumentation) with possible removal of root surface (cementum). · Subgingival instrumentation may be supplemented with the following adjunctive interventions: physical or chemical agents, host-modulating agents (local or systemic), topical antimicrobials, subgingival locally delivered or systemic antimicrobials. · It should be implemented in all periodontitis patients, irrespective of the stage of their disease and it should be re-evaluated after an adequate healing period.
Subgingival instrumentation
Recommended interventions
Recommended
Suggested
Recommended
Recommended
Suggested
weeks
24H
Subgingival instrumentation is recommended to treat periodontitis with reduction of pocket dephts, gingival inflammation and the number of diseased sites.
Subgingival periodontal instrumentation is performed with hand or powered (sonic/ultrasonic) instruments, either alone or in combination.
Subgingival periodontal instrumentation can be performed with either traditional quadrant-wise or full mouth delivery within 24 hours.
Use of adjunctive physical agents to subgingival instrumentation
Not recommended
NOT recommended
NOT suggested
NOT suggested
NOT suggested
Lasers as adjunct to subgingival instrumentation are not suggested.
Adjunctive photo-dynamic therapy at wavelength ranges of either 660-670 nm or 800-900 nm is not suggested as adjunct to subgingival instrumentation.
Use of adjunctive antiseptics/antibiotics (local or systemic) to subgingival instrumentation
Not recommended
NOT recommended
NOT suggested
NOT recommended
Routine use of systemic antibiotics as adjunct to subgingival instrumentation in patients with periodontitis is not recommended.
Open recommendation
CHX
Locally administered sustained-release chlorhexidine may be considered as an adjunct to subgingival instrumentation.
Chlorhexidine mouth rinses for a limited period of time may be considered as adjuncts to subgingival instrumentation.
Specific locally administered sustained-release antibiotics may be considered as an adjunct to subgingival instrumentation.
The adjunctive use of specific systemic antibiotics may be considered for specific patient categories (e.g. generalized stage III periodontitis in young adults).
Use of adjunctive host-modulating agents (local or systemic) to subgingival instrumentation
Not recommended
NOT recommended
NOT suggested
NOT suggested
NOT recommended
NOT suggested
Administration of statin gels / systemic or local bisphosphonates / systemic or local nonsteroidal anti-inflammatory drug / omega-3 polyunsaturated fatty acids and metformin gel are not recommended to be added to subgingival instrumentation.
Probiotics are not suggested as an adjunct to subgingival instrumentation.
Systemic administration of sub-antimicrobial dose doxycycline is not suggested.
Re-evaluation after step 2
Endpoints: · No periodontal pockets ≥ 5 mm with bleeding on probing. · No deep pockets [≥ 6 mm]. If these endpoints are achieved, the patient should join a SPC program.
This document is a graphic adaptation of the actual clinical practice guidelines and the reader is referred for the correct explanation to the original article: “Treatment of stage I-III periodontitis - The EFP S3-level clinical guideline” by Sanz and coworkers, J Clin Periodontology 2020 . https://onlinelibrary.wiley.com/doi/10.1111/jcpe.13290
www.efp.org
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