Clinical guidelines for periodontitis: diagnosis, treatment and supportive care

Periodontitis is a chronic inflammatory disease of the tissues that support the teeth: the gums, periodontal ligament, root cementum, and alveolar bone. Unlike gingivitis, periodontitis already involves attachment loss and destruction of bone support, so the disease cannot be completely reversed, but it can be halted, stabilized, and managed over the long term with proper treatment. [1]

Modern clinical guidelines consider periodontitis not as a single, identical disease affecting all patients, but as a condition with varying severity, rate of progression, prevalence, risk factors, and treatment complexity. Therefore, the international classification of periodontitis uses stages and risk levels: the stage indicates the severity and complexity of treatment, while the risk level helps assess the likelihood of further tissue destruction and the expected response to therapy. [2]

The primary goal of treatment is to remove bacterial biofilm and tartar from tooth surfaces and roots, create conditions the patient can maintain at home, and then regularly monitor the progress. The American Dental Association defines the goal of therapy as the removal of plaque, biofilm, and tartar from the tooth surface, creating an environment that can be maintained in a healthy state. [3]

The European Federation of Periodontology clinical guidelines recommend a stepwise approach: behavior modification and risk factor management, followed by subgingival instrumentation, surgical interventions for areas that have not responded to treatment, and then mandatory maintenance periodontal therapy. This approach is important because a one-time cleaning without long-term monitoring is usually ineffective in addressing chronic disease. [4] [5]

Periodontitis is not an uncommon dental problem. The World Health Organization estimates that severe periodontal disease affects more than 1 billion people worldwide, with poor oral hygiene and tobacco use being the main risk factors. [6]

Clinical element	What does it mean for the patient?	Practical significance
Loss of attachment	The gums and ligaments are less able to hold the tooth in place	You need to measure pockets and evaluate stability
Bone loss	The bone around the tooth is destroyed by inflammation	An x-ray evaluation is required.
Bleeding on probing	A sign of active inflammation	Helps evaluate response to treatment
Periodontal pocket	The depression between the tooth and the gum	The deeper the pocket, the more difficult it is to clean it at home.
Stage	The severity and complexity of the case	Determines the scope of treatment
Risk level	Probability of progression	Affects the frequency of observation
Supportive therapy	Regular visits after active treatment	Reduces the risk of relapse
Risk factors	Smoking, diabetes, poor hygiene and others	Require separate correction

Source for the table: [7] [8]

Code according to ICD 10 and ICD 11

In the International Classification of Diseases, 10th revision, diseases of the gums and periodontium are classified under the heading K05 "Gingivitis and periodontal diseases". For periodontitis, the most commonly used codes are K05.2 "Acute periodontitis", K05.3 "Chronic periodontitis", K05.4 "Periodontosis", K05.5 "Other periodontal diseases" and K05.6 "Periodontological disease, unspecified"; however, the clinical stage according to the modern periodontal classification is not automatically equal to the administrative code. [9]

In the International Classification of Diseases, 11th revision, periodontal diseases are classified in block DA0C "Periodontoid diseases". Within this block are listed DA0C.0 "Acute periodontitis", DA0C.1 "Aggressive periodontitis", DA0C.2 "Periodontosis", DA0C.3 "Necrotizing periodontal diseases", DA0C.4 "Periodontoid abscess", DA0C.Y "Other specified periodontal diseases" and DA0C.Z "Periodontoid disease, unspecified"; the World Health Organization indicates that the International Classification of Diseases, 11th revision is the global standard for diagnostic health information. [10] [11]

Coding system	Code	Formulation	Comment for the article
ICD 10	K05	Gingivitis and periodontal disease	General section
ICD 10	K05.2	Acute periodontitis	Used in acute process
ICD 10	K05.3	Chronic periodontitis	Often corresponds to a long-term inflammatory process
ICD 10	K05.4	Periodontosis	The term does not replace the modern classification of periodontitis stages.
ICD 10	K05.6	Periodontal disease, unspecified	Used when there is a lack of clarification
ICD 11	DA0C	Periodontal diseases	General block of periodontal diseases
ICD 11	DA0C.0	Acute periodontitis	An acute process in the tissues supporting the tooth
ICD 11	DA0C.Z	Periodontal disease, unspecified	Administrative option with incomplete detailing

Source for the table: [12] [13]

Diagnosis: What should be done before starting treatment

Quality clinical recommendations begin not with prescribing a procedure, but with a comprehensive diagnosis. The doctor must assess the patient's complaints, bleeding, swelling, gum recession, tooth mobility, periodontal pocket depth, plaque and tartar levels, the condition of fillings and crowns, bite, habits, and general risk factors. [14]

A key diagnostic method is periodontal probing. The dentist or periodontist measures the depth of pockets around the teeth, notes bleeding on probing, the presence of pus, gingival recession, and loss of clinical attachment. This data is necessary not only for diagnosis but also for comparison after treatment. [15]

Radiographic diagnostics are used to assess the bone level around the teeth. Without a bone assessment, it is impossible to reliably determine the severity of periodontitis, differentiate early from advanced disease, and determine whether there are vertical bone defects, damage to the root zone of multi-rooted teeth, or signs of a more complex progression. [16]

Following the initial examination, the diagnosis should be based on severity, extent, and expected rate of progression. The American Dental Association states that the stage reflects the severity, complexity, extent, and distribution of the lesion, while the risk factor takes into account signs of progression, the relationship between bone loss and age, smoking, diabetes, and glycemic control. [17]

Before treatment begins, the patient should receive an explanation of the diagnosis, causes, risk factors, treatment options, expected benefits, and possible consequences of treatment refusal. The European Federation of Periodontology specifically emphasizes that the discussion of the diagnosis should culminate in the agreement on a personalized care plan, which may be modified as treatment progresses. [18]

Diagnostic stage	What is being assessed?	Why is this necessary?
Complaints and anamnesis	Bleeding, odor, pain, mobility, smoking, diabetes, medications	Helps identify the risk and causes of progression
Gum examination	Swelling, redness, recession, pus	Shows inflammation activity
Flight index	Amount of soft plaque	Assesses the quality of home hygiene
Bleeding index	Blood after probing	Helps assess inflammation and response to treatment
Probing pockets	Depth of pockets around teeth	Determines the severity and location of the lesion
Radiological evaluation	Bone tissue level	Confirms bone loss
Evaluation of fillings and crowns	Plaque-retaining areas	Helps eliminate local causes of inflammation
Risk assessment	Smoking, diabetes, age, rate of bone loss	Determines the forecast and frequency of monitoring

Source for the table: [19] [20]

General treatment strategy: 4 steps of clinical guidelines

The first step in treatment is not instrumentation, but behavioral modification and risk factor control. The European Federation of Periodontology recommends achieving successful removal of supragingival biofilm, teaching the patient home hygiene, managing risk factors, smoking cessation, and improving diabetes control. [21]

At this stage, supragingival plaque and tartar are professionally removed, as well as plaque-retaining factors. These include overhanging filling margins, poorly cleaned crowns, defective restorations, cavities, crowded teeth, and areas where food is constantly stuck. [22]

The second step is subgingival instrumentation, which involves removing subgingival biofilm and calculus using manual or sonic and ultrasonic instruments. Guidelines indicate that this type of instrumentation should be performed on all patients with periodontitis, regardless of stage, and the results should then be re-evaluated after a sufficient healing period. [23]

The third step is necessary for those areas that have responded poorly to the first and second steps. If deep pockets, bleeding, vertical bone defects, or root canal involvement persist, the clinician may consider surgical access, regenerative techniques, or resection procedures to reduce pocket depth and create conditions for long-term control. [24]

The fourth step is maintenance periodontal therapy after active treatment. The European Federation of Periodontology indicates that it is necessary for all patients after successful active treatment, because such patients remain at high risk of relapse or progression. [25]

Treatment step	The main goal	What it usually includes
Step 1	Change behavior and reduce risk	Hygiene education, plaque control, smoking cessation, diabetes management
Step 2	Remove subgingival biofilm and calculus	Scaling, root smoothing, pocket treatment
Re-evaluation	Understand the response to treatment	Measurement of pockets, bleeding, plaque
Step 3	Treat areas without sufficient response	Surgical access, regeneration, resection methods
Step 4	Prevent relapse	Maintenance visits every 3-12 months according to risk
At every step	Maintain patient control at home	Interdental cleaning, technique correction, motivation
At stage 4	Restore function	Interdisciplinary treatment, splinting, orthodontics, prosthetics
With risk factors	Reduce the likelihood of progression	Dealing with smoking, diabetes, dry mouth, medications

Source for the table: [26] [27] [28]

Non-surgical treatment: the basic stage of therapy

Non-surgical treatment is the primary initial step for most patients with periodontitis. The American Dental Association describes it as professional removal of supragingival and subgingival bacterial biofilm and calculus, creation of a biologically acceptable root surface, and mandatory daily self-removal of plaque by the patient. [29]

Scaling and root planing are often referred to as "deep cleaning," but clinically, they are not a cosmetic procedure but a therapeutic treatment of the tooth surface and root. The American Academy of Periodontology explains that scaling removes plaque, tartar, and bacterial toxins below the gum line, while root planing helps make the surface less hospitable to reattachment of plaque and toxins. [30]

An important practical point: treatment may require multiple sessions. This depends on the number of teeth, pocket depth, sensitivity, tartar volume, root anatomy, and the patient's overall health. The American Dental Association notes that patients often require multiple treatment sessions to completely remove plaque from the tooth surface. [31]

After non-surgical treatment, tissues are not immediately assessed the next day to determine the final result. Guidelines indicate that after scaling, root planing, and additional methods, periodontal tissues require approximately 4 weeks to show the optimal effect of non-surgical therapy. [32]

The success of non-surgical treatment depends not only on the doctor but also on the patient. Cochrane emphasizes that self-care is important for people with gum disease, and the success of dental treatment depends on regular hygiene, including brushing teeth at least twice a day and cleaning between teeth. [33]

Element of non-surgical treatment	What does a doctor do?	What does the patient do?
Hygiene training	Demonstrates brushing and interdental cleaning techniques	Follows recommendations daily
Supragingival cleaning	Removes plaque and tartar above the gum	Maintains the result with a brush
Subgingival treatment	Removes biofilm and calculus from pockets	Reduces plaque re-accumulation
Root smoothing	Treats root surfaces	Controls sensitivity and hygiene
Eliminating holding factors	Corrects fillings, crowns, and carious areas	Indicates food is stuck
Re-evaluation	Measures pockets and bleeding	Shows which areas are difficult to clean
Correction of the plan	Prescribes additional measures if necessary	Maintains a maintenance regimen
Long-term control	Schedules follow-up visits	Arrives on schedule

Source for the table: [34] [35]

Antiseptics, antibiotics, laser and additional methods

Adjunctive treatments for periodontitis should not replace mechanical removal of biofilm and calculus. The European Federation of Periodontology considers chlorhexidine rinses only as a possible adjunct for a limited period, and not as a standalone treatment for periodontitis. [36]

Chlorhexidine does have a proven effect against plaque and gingivitis, but its use is limited by side effects. Cochrane notes that chlorhexidine mouthwashes reduce plaque and moderately reduce gingivitis, but when used for 4 weeks or longer, they cause tooth staining, may promote tartar formation, impair taste, and irritate the oral mucosa. [37]

Routine use of systemic antibiotics for periodontitis is not recommended. The European Federation of Periodontology states that systemic antibiotics as an adjunct to subgingival instrumentation should not be used routinely, but may be considered in certain patient groups, such as stage 3 generalized periodontitis in young adults. [38]

Regarding doxycycline, there are differences between guidelines. The older position of the American Dental Association suggests the possibility of subantimicrobial doxycycline after scaling and root planing in patients with moderate to severe periodontitis, whereas the 2020 European guidelines do not recommend systemic subantimicrobial doxycycline as an adjunct to subgingival planing. [39] [40]

Laser therapy should not be presented as a guaranteed replacement for standard treatment. The European Federation of Periodontology does not recommend lasers as an adjunct to subgingival instrumentation, and the American Academy of Periodontology notes that controlled studies have shown similar results with lasers compared to certain non-surgical methods, but improper wavelength or power can damage periodontal tissue. [41] [42]

Method	Modern position	Practical conclusion
Chlorhexidine mouthwash	A short course is available as an addition.	Do not use for months without a prescription.
Local extended-release chlorhexidine	Can be considered as a supplement	The solution is individual
Local prolonged-release antibiotics	May be considered in individual cases	Does not replace mechanical processing
Systemic antibiotics	Not recommended routinely	Only for strict indications
Subantimicrobial dose of doxycycline	Recommendations vary	Consider local protocols and risk
Laser	Not offered as a standard add-on	It cannot be considered a universal replacement for scaling
Probiotics	Not recommended as an adjunct to subgingival treatment.	Should not replace treatment
Nonsteroidal anti-inflammatory drugs, omega-3, metformin gel, bisphosphonates	Not recommended as a standard supplement.	Do not use as a “self-treatment for periodontitis”

Source for the table: [43] [44]

Surgical treatment and complex cases

Surgical treatment is considered not initially, but after the basic steps, if areas with deep pockets, bleeding, complex bone defects, or difficult-to-reach root surfaces remain. The goal is to access deep areas, reduce pocket depth, restore tissue where possible, or reshape the tissue so that the patient can maintain a clean home. [45]

The American Dental Association notes that many moderate to advanced cases require surgical access to the root surface to smooth the root and reduce pocket depth so the patient can successfully manage their teeth at home. This is an important rationale: surgery is not needed "for the sake of surgery," but for the sake of a controlled, cleanable, and stable environment around the teeth. [46]

Regenerative surgery can be used for isolated vertical bone defects and lesions of the root division zone if the anatomy of the defect and the tooth's prognosis offer a chance for restoration. The European Federation of Periodontology describes the possibility of regeneration using enamel matrix derivatives, bone-based materials, and absorbable membranes in certain clinical situations. [47]

In stage 4 periodontitis, treatment becomes multidisciplinary. The European Federation of Periodontology's stage 4 guidelines indicate that such patients may have tooth loss, chewing difficulties, grade 2 or higher tooth mobility, severe alveolar ridge defects, tooth displacement, and malocclusion, so they may require a combination of periodontal treatment, orthodontics, splinting, and prosthetics. [48]

An important principle in stage 4 is to avoid extracting questionable but potentially salvageable teeth too early. Stage 4 guidelines explicitly state that early extraction of teeth with a questionable but not hopeless prognosis is not supported by current evidence; a thorough diagnosis should be performed first, the prognosis of each tooth should be assessed, and attempts should be made to preserve the teeth that can be reasonably salvaged. [49]

Clinical situation	Possible tactics	Target
Residual deep pockets	Surgical approach	Clean hard to reach areas
Vertical bone defect	Regenerative therapy according to indications	Try to restore support
Root division zone damage	Special periodontal therapy	Preserve a multi-rooted tooth if the prognosis is acceptable
Tooth mobility	Temporary or long-term splinting	Stabilize teeth and function
Teeth displacement	Orthodontic treatment after stabilization	Restore the position of teeth and bite
Tooth loss	Prosthetics or implantological rehabilitation	Restore chewing function
Chewing disorder	Interdisciplinary plan	Restore comfort and quality of life
Questionable tooth prognosis	Individual assessment	Do not delete without persistence analysis

Source for the table: [50] [51]

Supportive periodontal therapy

Maintenance therapy begins after active treatment, when the inflammation has been brought under control. Its goal is not "just checking your teeth once a year," but rather regularly preventing relapses, identifying new active pockets, adjusting home hygiene, and removing plaque or tartar before they can lead to further tissue destruction. [52]

The European Federation of Periodontology recommends that maintenance visits be scheduled at intervals of 3 to 12 months, with the specific frequency depending on the patient's risk profile and the periodontal status after active therapy. This means that a patient with smoking, diabetes, residual pockets, or poor hygiene typically requires more frequent monitoring than a patient with stable periodontal status. [53]

The goals of maintenance therapy are quite strict: there should be no pockets deeper than 4 millimeters with bleeding on probing, and there should be no deep pockets of 6 millimeters or more. If such areas appear, this is a signal for additional diagnostics and treatment, and not just another preventive cleaning. [54]

During maintenance visits, repeated individualized instructions on mechanical hygiene, including interdental cleaning, are important. A Cochrane study found that floss or interdental brushes, in addition to brushing, can reduce gingivitis or plaque, and that interdental brushes may be more effective than floss for gingivitis, although the quality of the evidence is rated as low to very low. [55]

Behavioral interventions, mobile apps, mirrors, diaries, and motivational talks may help individual patients, but the evidence base is still limited. A 2026 Cochrane review concluded that there is insufficient evidence for the effectiveness of behavioral interventions for clinical measures of gingivitis and periodontitis in adults, so clear technique, consistency, and outcome monitoring remain key. [56]

Element of supportive therapy	What do they check?	Why is this important?
Pocket depth	Are there any residual or new deep pockets?	Early sign of relapse
Bleeding	Is there active inflammation?	Helps to assess stability
Plaque and tartar	Where biofilm accumulates again	Shows weak hygiene areas
Interdental cleaning	Is the size of the brushes appropriate?	Improves control between teeth
Risk factors	Smoking, diabetes, dry mouth, medications	They are changing the forecast
Fillings and crowns	Are there any plaque retention areas?	Eliminates local causes of inflammation
Visit interval	3-12 months at risk	Personalizes monitoring
New complaints	Mobility, odor, discomfort	Helps not to miss progression

Source for the table: [57] [58]

Risk factor control

Smoking is one of the most important modifiable risk factors for periodontitis. The Centers for Disease Control and Prevention (CDC) notes that smoking is associated with gum disease, and periodontitis has been found to be particularly common among adult smokers aged 30 years and older; the European Federation of Periodontology recommends smoking cessation interventions as part of the first step of treatment.[59][60]

Diabetes mellitus requires special attention because it is associated with a more severe course of periodontal disease and a poorer tissue response to inflammation. The World Health Organization points to a link between diabetes and the development and progression of periodontal disease, and the European Federation of Periodontology considers diabetes control a necessary first step in therapy. [61] [62]

Poor oral hygiene remains a key factor because bacterial biofilm triggers and maintains inflammation. The Centers for Disease Control and Prevention explains that plaque can be removed with regular brushing and flossing, but if not removed, it hardens into tartar, which cannot be removed with brushing and requires professional treatment. [63]

Diet, obesity, stress, medications with oral side effects, hormonal changes, crowded teeth, and bruxism also influence the risk and management of the disease. The Centers for Disease Control and Prevention lists these factors among those associated with gum disease, so clinical recommendations should include not only dental procedures but also an overall assessment of the patient's health. [64]

The World Health Organization recommends a common risk factor approach: reduce tobacco use, limit alcohol consumption, maintain a diet low in free sugars and sufficient fruits and vegetables, and use water as the primary beverage. For periodontitis, this does not replace treatment, but it does help reduce overall inflammatory and behavioral risk. [65]

Risk factor	What is recommended	Practical commentary
Smoking	Quitting Tobacco Use	Improves the prognosis of treatment
Diabetes	Blood glucose control	Important for reducing inflammation
Poor hygiene	Individual training and flight monitoring	The basic part of all steps of therapy
Tartar	Professional removal	You can't delete it at home
Crowding of teeth	Special hygiene products, sometimes orthodontics	Reduces plaque retention zones
Dry mouth and medications	Identify the cause and adjust care	Increases the risk of oral problems
Obesity and nutrition	Lifestyle correction	Supports overall metabolic health
Bruxism	Assessment of dental overload	May complicate the prognosis of individual teeth

Source for the table: [66] [67]

What is important for patients to understand about the prognosis?

Periodontitis cannot be considered permanently cured after one procedure. Even after successful active treatment, the patient remains at risk because bacterial biofilm forms daily, and risk factors can recur or worsen. [68]

A good prognosis is possible if the clinical goals are achieved: no deep pockets, no bleeding pockets larger than 4 mm, regular interdental cleaning, and maintenance visits. The European Federation of Periodontology uses these criteria as guidelines for transitioning to maintenance therapy and stability monitoring. [69] [70]

A poor prognosis is more likely in patients with smoking, poor diabetes control, deep pockets, tooth mobility, root canal involvement, poor home hygiene, and irregular visits. These patients require shorter follow-up intervals and a more rigorous maintenance therapy plan. [71] [72]

At stage 4, the prognosis depends not only on the pockets but also on function: the number of remaining teeth, their distribution, chewing ability, tooth displacement, malocclusion, and the ability to create restorations that the patient can clean. Therefore, treatment often requires the participation of a periodontist, orthodontist, prosthodontist, and general dentist. [73]

The most practical conclusion for patients: if gums are bleeding, teeth are loose, an unpleasant odor has developed, the bite has changed, or food is constantly getting stuck between the teeth, don't wait for it to "go away." Periodontitis can progress for a long time without causing severe pain, and an annual dental examination helps detect and prevent progression. [74]

Sign	A favorable option	Unfavorable option
Bleeding	Decreases after treatment	Maintained or intensified
Pocket depth	No deep pockets	Pockets of 6 mm or more are preserved
Home hygiene	Daily interdental cleaning	Irregular care
Smoking	The patient has quit or does not smoke	Smoking continues
Diabetes	Glycemic control is stable	Glucose control is poor
Support visits	The patient arrives on schedule	Visits are missed
Preservation of teeth	There is a rational forecast	The tooth cannot be maintained
Function	Chewing has been restored	There is a bite disorder and mobility

Source for the table: [75] [76]

FAQ

Can periodontitis be treated with home hygiene alone? No, if periodontal pockets, subgingival calculus, and bone loss are already present, brushing alone is not enough. Home hygiene is essential, but clinical guidelines require professional removal of supragingival and subgingival biofilm and calculus. [77]

What is first-line treatment? Non-surgical therapy is usually the basis: hygiene education, risk factor control, plaque and calculus removal, scaling, and root planing. The American Dental Association recommends that scaling and root planing alone are the treatment of choice for patients with periodontitis. [78]

When are antibiotics needed? Antibiotics are not routinely recommended because they do not replace mechanical removal of biofilm and increase the risk of adverse effects and bacterial resistance. European guidelines only allow their use in certain patient groups, such as stage 3 generalized periodontitis in young adults. [79]

Is chlorhexidine necessary? It can be used as a short-term adjunct, but not as a permanent standalone treatment. Cochrane shows a reduction in plaque and gingivitis, but also notes tooth staining, taste disturbance, tartar formation, and mucosal irritation with long-term use. [80]

Does laser help? Lasers are not considered a necessary standard adjunct to subgingival instrumentation. The European Federation of Periodontology does not recommend them as an adjunct, and the American Academy of Periodontology warns that improper laser parameters can cause tissue damage. [81] [82]

How often should I visit after treatment? The interval should be individualized. The European Federation of Periodontology recommends maintenance visits every 3-12 months, depending on the risk and condition of the periodontium after active treatment. [83]

Is it possible to save teeth in severe periodontitis? It is often possible if the teeth are reasonably salvageable and the patient undergoes comprehensive treatment. Stage 4 periodontitis guidelines emphasize that most cases can be successfully treated while preserving the natural dentition in acceptable health and function. [84]

When is surgery necessary? Not everyone needs surgery. It is considered if, after basic therapy, deep pockets, bleeding, complex bone defects, or areas that cannot be stabilized by non-surgical methods remain. [85]

Which is better for interdental cleaning: floss or interdental brushes? The choice depends on the width of the spaces and the condition of the gums. Cochrane suggests that floss and interdental brushes may reduce gingivitis or plaque compared to brushing alone, and interdental brushes may be more effective than floss for gingivitis, although the evidence is limited. [86]

Why does periodontitis recur after treatment? Most often, it's due to recurring biofilm and tartar buildup, irregular interdental cleaning, smoking, poor diabetes control, or missed maintenance visits. This is why maintenance therapy is a separate, mandatory step, not an optional extra. [87]

Key points from experts

Professor Mariano Sanz, Professor and Head of Periodontology at the Complutense University of Madrid and Professor at the Faculty of Dentistry at the University of Oslo, is a key practitioner for clinical guidelines: periodontitis treatment should begin with a clear diagnosis, an explanation of the causes and risk factors to the patient, and then move on to a personalized plan, because the stage, degree of risk, and the patient's ability to maintain hygiene determine the outcome no less than the procedure itself. [88] [89]

Professor Iain Chapple, Professor of Periodontology and Head of the School of Dentistry at the University of Birmingham, emphasizes that periodontitis cannot be viewed solely as a localized gum problem: inflammation, diabetes, smoking, immune response, and metabolic health all influence prognosis and must be considered in treatment plans. [90] [91]

Professor David Herrera, Professor of Periodontology, Associate Dean for Clinics, and Co-Director of the European Federation of Periodontology Program at the Universidad Complutense de Madrid, says: "Modern treatment should be stepwise—behavior and risk management, subgingival instrumentation, re-evaluation, adjunctive treatments only when indicated, and mandatory maintenance therapy." [92] [93]

Professor Maurizio Tonetti, Clinical Professor of Periodontology at the Faculty of Dentistry at Hong Kong University and Executive Director of the European Research Group on Periodontology, says: "The treatment of advanced periodontitis must consider the safety of each tooth, the risk of progression, the possibility of regeneration, the function of the dentition, and the long-term maintenance of the result." [94] [95]

Brief conclusions

Clinical recommendations for periodontitis are built around step-by-step management of chronic inflammation: diagnosis, stage and risk assessment, hygiene education, smoking and diabetes control, subgingival treatment, re-evaluation, surgery only when indicated, and mandatory maintenance therapy. The main mistake is to view treatment as a single cleaning, because periodontitis requires long-term monitoring and regular re-evaluation. [96] [97]