Periodontal maintenance in a specialist periodontal clinic and in general dental practice

OBJECTIVES: To monitor the efficacy of periodontal maintenance whether conducted in a specialist periodontology clinic or in the practice of the referring general dentist. MATERIALS AND METHODS: Thirty-five subjects with a diagnosis of moderate-severe chronic periodontitis who were referred to the specialist clinic received periodontal non-surgical therapy. Following a 6-month healing phase, subjects were randomly allocated to one of two groups: A (n=18, periodontal maintenance provided within the specialist clinic) or B (n=17, periodontal maintenance provided by the referring general dentist in accordance with written instructions provided by the specialist). All subjects were examined at months 0 (corresponding to 6 months post-completion of non-surgical therapy), 6 and 12. Full-mouth plaque index (PI), % bleeding on probing (%BOP) and probing depth (PD) measurements were recorded. PDs were also recorded at eight test sites which, prior to non-surgical therapy, exhibited PD 5-8 mm, BOP and radiographic alveolar bone loss. Standardized radiographs were exposed at test sites at months 0 and 12, and bone changes assessed using digital subtraction radiography (DSR). RESULTS: As a result of the non-surgical therapy, statistically significant improvements in all clinical parameters were recorded. In the maintenance period, mean PI increased significantly from months 0 to 12 (p<0.05), but this increase did not differ significantly between groups A and B (p>0.05). No other clinical parameters changed significantly in the maintenance phase of the study. Reductions in %BOP, mouth mean PD and mean test sites PD achieved by the non-surgical therapy were maintained and did not differ significantly whether subjects were allocated to group A or group B (p>0.05). Current smokers had significantly deeper PD than non-smokers and former smokers at all time points (p<0.05), although otherwise, smoking status did not affect the outcomes of the study. DSR analysis identified statistically non-significant, slight, alveolar bone loss in both groups between months 0 and 12. CONCLUSION: In the short term, periodontal maintenance can be provided in general dental practice with the same expected outcomes compared with maintenance that is provided in a specialist clinic, providing that general dentists are given specific instructions regarding the maintenance regimen. A strong emphasis on effective plaque control is necessary.