[The stages of comprehensive periodontal therapy--diagnosis-driven treatment planning]

Abstract

The rationale and the stages of the comprehensive periodontal treatment are overviewed. The consecutive phases are logically following each other. Basically three major therapeutical categories can be established, such as: 1. absolutely healthy from periodontal point of view, 2. gingivitis, 3. periodontitis. Within the periodontitis group the basic principles and strategies are totally different for the management of chronic and aggressive periodontitis cases. Principally the comprehensive periodontal therapy can be divided into four main phases: phase I. initial or cause related therapy, phase II. surgical therapy, phase III. periodontal reconstruction, and phase IV. periodontal maintenance. The classic non-surgical and surgical techniques can cure inflammation, arrest the progression of periodontal destruction and restore gingival-periodontal health, and the outcome is quite predictable for gingivitis and chronic periodontitis. The long-lasting results are dependent on the patients' motivation and maintenance. The late therapeutical results and the maintenance of aggressive periodontitis cases are less predictable. Technically the vertical component of the bone loss can be fully corrected by regenerative surgical techniques. So far the horizontal bone loss should be considered as an irreversible feature as no periodontal regenerative techniques are available to restore the lost alveolar crest and interdental septa.