After calculus removal, advanced therapy may also include surgical treatment to allow for improved oral hygiene (osseous surgery) or regeneration of the damaged periodontal supporting structure. In all instances, whether non-surgical or surgical, advanced therapy starts with gaining visual access to accomplish instrumentation for the removal of calculus that was not removed during initial therapy. Advanced periodontal therapy may take the form of non-surgical debridement with advanced visualization, localized minimally invasive surgery, or generalized surgical access. This may be a repetition of the treatment performed during initial therapy, but in most instances advanced periodontal therapy is required. If signs of inflammation are present at the reevaluation following initial periodontal treatment or at any periodontal maintenance appointment, further periodontal treatment is indicated.
These guidelines for periodontal treatment combined the 2018 classification of periodontal disease with the previously defined decision points in therapy. Later in 2022, the same group who had developed the decision points published clinical guidelines for periodontal therapy. The decision points aided in defining critical phases where further evaluation was necessary but did not define what further treatment may be indicated. Based on the finding of the reevaluation, a decision could then be made regarding whether the patient could be placed in a periodontal maintenance program or if more advanced periodontal therapy was indicated. The purpose of the decision points was to define where reevaluation of the response to the treatment performed up to that point should be assessed so a determination could be made as to whether treatment had been successful.
The decision points were based on the 2018 classification system, and they defined points during the clinical treatment of a patient with periodontal disease where reassessment of the patient’s periodontal condition was required. These decision points were outlined by Harrel et al.
Due to the need for clinical guidance, specific decision points for treatment were developed by a group of academic and clinical periodontists with many years of experience in the private practice of periodontics, teaching of periodontics within an academic institution, and clinical periodontal research. While multiple treatment possibilities were outlined by the EFP, specific decision points to guide clinical treatment were difficult to ascertain. Treatment was addressed by the EFP in 2020. While the new classification gives definitive parameters for the stage and grade of periodontal disease, it does not give treatment recommendations for the different stages.
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