“Critical probing depths” in periodontal therapy

Abstract

Abstract The present investigation was carried out on 15 individuals who were referred for treatment of moderately advanced periodontal disease. All patients were first subjected to a Baseline examination comprising assessment of oral hygiene and gingival conditions, probing depths and attachment levels. Following case presentation and instructions in oral hygiene measures, the patients were given periodontal treatment utilizing a split mouth design. In one side of the jaw scaling and root planing were performed in conjunction with a modified Widman flap procedure while in the contralateral jaw quadrants the treatment was restricted to scaling and root planing only. The period from initial treatment to 6 months after treatment was considered to be the Healing phase and from 6–24 months after treatment the maintenance phase. During the healing phase the patients were recalled for professional tooth cleaning once every 2 weeks. During the maintenance phase the interval between the recall appointments was extended to 3 months. Reexaminations were carried out 6, 12 and 24 months after the completion of active treatment. The results revealed that treatment resulted in loss of clinical attachment in sites with initially shallow pockets, while sites with initially deep pockets gained clinical attachment. With the use of regression analysis “critical probing depths” were calculated for the two methods of treatment used. It was found that the critical probing depth value for scaling and root planing was significantly smaller than the corresponding value for scaling and root planing used in combination with modified Widman flap surgery (2.9 vs 4.2 mm). In addition, the surgical modality of therapy resulted in more attachment loss than the non‐surgical approach when used in sites with initially shallow pockets. On the other hand, in sites with initial probing depths above the critical probing depth value more gain of clinical attachment occurred following Widman flap surgery than following scaling and root planing. The data obtained from the reexaminations 12 and 24 months after active treatment demonstrated that the probing depths and the attachment levels obtained following active therapy and healing were maintained more or less unchanged during a maintenance care period which involved careful prophylaxis once every 3 months. However, the data also disclosed that the level of oral hygiene maintained by the patients during healing and maintenance was more critical for the resulting probing depths and attachment levels than the mode of initial therapy used. Thus, sites which during the maintenance period were found to be free from supragingival plaque were associated with shallow pockets and maintained attachment levels. In contrast, sites which harboured plaque exhibited increasing probing depths and further attachment loss.