27 October 2020

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Supportive periodontal therapy (SPT): does it really stop progression of periodontitis?

Alessandra Abbà

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Periodontitis can be defined as inflammation of the periodontal tissues. The inflammatory response due to the accumulation of pathogenic bacteria in subgingival plaque leads to clinical attachment loss, alveolar bone loss and periodontal pocketing.
Untreated periodontal disease may lead to progressive mobility of affected teeth, resulting lastly in tooth loss, with consequent aesthetic and functional disease.
Initial efforts of treatment of periodontitis focus on reducing\eliminating pathogenic agents. This is usually achieved both with mechanical debridement  and with assisting patients to perform effective oral hygiene. A surgical treatment may also be necessary in order to allow access for debridement to permit effective patient‐performed oral hygiene. In some specific case, another treatment option that aims to the regeneration of the lost bone is possible using particular surgical techniques.
Considering that patients with a history of periodontitis are at increased risk of reinfection, a program of supportive periodontal therapy (SPT) has been created in order to keep them closely monitored. According to the American Academy of Periodontology, SPT should provide for all components of a typical dental recall examination, including periodontal re-evaluation and risk assessment (local, systemic and behavioral), supragingival and subgingival debridement, in particular for sites with persistent signs of periodontitis.
Success of SPT  has been reported in a number of long-term, retrospective studies. This review aimed to assess the evidence available from randomised controlled trials (RCTs).

Materials&Methods

Authors included in this research randomised controlled trials assessing the effect of different periodontal maintenance protocols on BoP, PPD and CAL and evaluating SPT  (with a minimum follow-up of 12 months):

- Vs monitoring only or alternative approaches to mechanical debridement;

- Vs SPT  with adjunctive interventions; 

- Vs different approaches to or providers of SPT; 

- Vs different time intervals for SPT  delivery.

Split-mouth studies where authors considered there could be a risk of contamination were excluded. 

Results:

No included trials measured the primary outcome 'tooth loss '; studies evaluated signs of inflammation, including bleeding on probing (BoP), clinical attachment level (CAL) and probing pocket depth (PPD).
There was no evidence of a difference between SPT delivered by a specialist versus a general practitioner for BoP or PPD at 12 months (very low-quality evidence).
Both studies comparing mechanical debridement with or without the use of adjunctive local antibiotics.found no evidence of a difference between groups at 12 months (low to very low-quality evidence). The use of adjunctive photodynamic therapy did not demonstrate evidence of benefit compared to mechanical debridement  only (very low-quality evidence). No trials evaluated SPT  versus monitoring only.

Conclusions
Supportive periodontal therapy (SPT) is employed to reduce the probability of re-infection and progression of the periodontitis. The evidence available for the comparisons evaluated is of low to very low quality, so there is insufficient evidence to determine the superiority of different protocols or adjunctive strategies to improve tooth maintenance during SPT.

For additional information: Supportive periodontal therapy (SPT) for maintaining the dentition in adults treated for periodontitis