Maintenance phase

In the maintenance phase, the aim is to maintain the successfully stabilized periodontal state in the long term. Besides lifelong regular follow-up and tooth cleaning, maintaining the patient’s motivation to cooperate is a key requirement.

A patient and a doctor shake hands

If the patient shows a marked improvement in the clinical and microbiological parameters, he/she then moves on to the maintenance phase, in which he/she should visit the practice at regular intervals. The objectives of this treatment phase are:

  • to maintain the level of attachment
  • to prevent tooth loss
  • to check for periodontal infection
  •  to prevent reinfection
  • diagnostic monitoring

However, one of the biggest challenges, in view of the fact that lifelong treatment is often required, is the continuous remotivation of the patient.

Risk assessment

The frequency of examinations in the maintenance phase depends on the patient’s individual risk of disease flare-up.

According to the German Society of Periodontology (DG PARO) risk assessment, a preliminary risk classification is carried out on the basis of:

  • determination of the bleeding score
  • number of sites with a probing depth of ≥ 5 mm
  • number of missing teeth
  • bone resorption
  • and cigarette consumption

The final risk is then established after ascertainment of additional systemic (diabetes mellitus, HIV infection, gingivoperiodontal manifestation of systemic diseases) and genetic factors (detection of interleukin-1B polymorphism with GenoType IL-1). The patient-specific recall interval is derived from this.

Check-ups

Depending on the patient’s risk profile, check-ups take place at intervals of 3-12 months.These involve checking the patient’s clinical and hygiene status, removing any deposits present and remotivating the patient with regard to oral hygiene. In the maintenance phase, regular reviews of the subgingival microbial spectrum may help to detect reinfection and recurrences at an early stage. They thus help to maintain stable clinical findings in the long term. Should the infection flare up again, it is necessary to return to the active phase of the treatment plan.