Sable News


3 Steps to Take Back Control of Difficult Periodontal Cases

sable industries difficult periodontal cases


We’ve talked to many dental industry professionals who feel like they’re going in circles with their periodontal patients.


In other words, they still feel like they're not getting anywhere with treatments – even with the best intentions and the most compassionate approach to care. 


Does this sound familiar to you?


  • It starts with giving your patients as much conservative nonsurgical periodontal care as possible. That’s Phase I. 
  • Then, you examine your patients’ data over a sustained period to decide if they’re best off with surgery. That’s Phase II. 
  • Phase III is supportive periodontal therapy, and that’s where you might start to feel like you’ve gone off-course.

Patient needs often call for more intensive care than can be provided in 3-month intervals. If you don't feel like your patients are progressing, take a more intensive approach. So, let’s investigate how to get back on track and provide more individualized, successful periodontal care.



1. Perform Complete Periodontal Examinations on Patients


Your first step toward more successful, lasting results is ensuring all facets of a periodontal exam are subject to a thorough examination.


The American Academy of Periodontology (AAP) offers a complete periodontal exam procedure outline to guide you through the necessary steps.


Note that the AAP collects and separates natural teeth and dental implant data. While implants and natural teeth resemble one another, they’re different enough that you must fully grasp what makes them different.



2. Adopt the 2017 AAP Guidelines


Look to the AAP’s 2017 grading and staging periodontitis guidelines for a summarized methodology for the flow of new patients (NP) and the grading classification of patients of record (POR). 


NPs become PORs once they get treated, which can be a catalyst for the treatment spiral. Far too often, patients linger between 3- and 6-month treatment intervals and aren’t assessed regularly enough to use alternative treatments as an intervention. 


Many dental offices often overlook the periodontal re-evaluation exam. Yearly monitoring of periodontal health is suggested for adult PORs. Yet, hygiene services are frequently limited to intervals between 3 and 6 months when nonsurgical and surgical interventions are needed. 


Patients who don’t respond favourably to non-surgical treatments upon re-evaluation will likely need surgical interventions (in-house or via periodontist referral). 


Scientific-based data, collected over time, is crucial to this process. Start procuring this data if no adequate record exists and compare it ASAP. 


Move patients steadily through the continuum once you’ve begun intervening with different options. Examples of timeframes are: 


  • Intervals of 6 months to 4 months 
  • Intervals of 4 months to 3 months 
  • Intervals of 3 months to isolated active SRP areas using anesthetic 
  • Intervals of 3 months to active full-mouth SRP using anesthetic 
  • Intervals of 3 months to isolated periodontal surgery 
  • Intervals of 3 months to limited or complete periodontal referral


3. Treat Dental Conditions that Hinder Periodontal Progress


Persistent pocketing:


  • 12-18 months after Phase I, you must monitor pocket depths 
  • If pockets depths stay equal to or greater than 4mm in the anterior or remain 5mm or more in the posterior, consider a pocket reduction referral 
  • Note that exceeding 5 mm in probing depth is challenging to maintain as healthy, presenting more calculus and plaque


Deep restorative margins: 


  • Is there enough space between the margin and bone to accommodate either the existing restorative margin or a new margin? 
  • Without adequate distance between tissue and bone, there will be constant inflammation. 
  • Crown tightening is a possible procedure in this instance (which could entail osseous surgery).


Lack of attached gingivae/mucogingival involvement: 


  • Examine the tissue attachment around implants/teeth, and the frenum pulls 
  • By rolling the unattached tissues, probes can help decipher if enough tissue exists 
  • Soft tissue grating is a possible procedure


Mobile teeth:


  • Radiographs and complete periodontal records with help you assess teeth mobility 
  • Shortened roots and bone loss in the anterior regions often respond well to splinting teeth together 
  • It’s possible to treat class II/Class II+ or a plus-or-minus moderate-to-advanced bone loss by splitting teeth periodontally, using a night guard, or occlusal adjustment.


Unresolved periodontal issues:


  • Without a clear diagnosis or a conservatively reached resolution, exploratorily flapping an area can help 
  • Direct visual inspections can offer a more precise diagnosis and treatment plan


Beyond the above examples, you should examine three other dental/periodontal conditions:


  • Furcations/isolated recession areas 
  • Unresponsiveness to surgical or conservative treatments 
  • Advanced periodontal issues.


Take Control of Your Toughest Periodontal Cases


The needs of periodontal patients often require more intensive care than what can be offered in 3-month intervals. The steps outlined in this article lay out a practical course of action to take when your patients seem to be stuck in a rut. This knowledge should enable you to provide your periodontal patients with better care. 

Generic Administrator at 5:06 AM
RSS icon Facebook icon Twitter icon LinkedIn icon


Blog Contributor Portrait
Name: Generic Administrator
Posts: 21
Last Post: February 29, 2024
Blog Contributor Portrait
Name: Suzanne Chalk
Posts: 8
Last Post: February 27, 2020
Blog Contributor Portrait
Name: Christopher Zielinsky
Posts: 23
Last Post: January 15, 2020

Latest Posts

Show All Recent Posts



Dental Hygienist Dentists Dental Practices Off Topic Software Solutions Dental Office Tooth Enamel Endocrine Disruptors Oral Health Tooth Decay Bioactive Glass Dental Fillings Oral Surgery Oral Surgery Recovery Dental Patients Dentist Anxiety Patient Therapy Oil Pulling Teeth Whitening Bad Breath Tooth Discolouration Oral Screening Ergonomics Musculoskeletal Disorders Dental Equipment Handpiece Dental School Chairside Burnout Ondontophobia Pet Dental Care