PMC Stage 4: There is advanced periodontitis, with >50% of attachment loss as measured by probing of the clinical attachment level or by radiographic determination of the distance of the alveolar margin from the cementoenamel junction relative to the length of the root, or there is a stage 3 furcation involvement in multirooted teeth (see below). Chapple ILC, Mealey BL, Van Dyke TE, et al. Bezrukova IV.The concept of maintenance therapy for periodontal inflammations characterized by an aggressive course .Stomatologiia (Mosk). Enter search terms to find related veterinary topics, multimedia and more. Generalized stage IV, grade C periodontitis results in rapid bone destruction in the periodontium and can lead to early tooth loss. Younes, R.; Ghorra, C.; Khalife, S.; Igondjo-Tchen-Changotade, S.; Yousfi, M.; Willig, C.; Senni, K.; Godeau, G.; Naaman, N. Pertinent cell population to characterize periodontal disease. American Academy of Periodontology Surgical Procedures. Cureus. Conclusions: The paper describes a simple matrix based on stage and grade to appro- Stage III/grade C (55.77%) was the most common in the study by Graetz et al. Chronic kidney disease: Although there is no evidence on causal association, studies have shown a high periodontitis prevalence in chronic kidney disease populations also demonstrating racial and ethnic disparities. ; M.M. Periodont. . Disclaimer. A slow rate of progression (Grade A) would be seen in older patients or patients with heavy biofilm deposits that show minimal periodontal bone destruction. https://doi.org/10.3390/biomedicines7020043, Buffoli B, Garzetti G, Calza S, Scotti E, Borsani E, Cappa V, Rimondini L, Mensi M. Periodontitis Stage IIIIV, Grade C and Correlated Factors: A Histomorphometric Study. Results: Females showed a significant increase in the percentage of inflammatory cells compared to males (6.29% vs. 2.28%, Periodontitis is a disease that, if untreated, leads to serious functional and aesthetic impairments, as well as a strong conditioning of social life, resulting in impairment in life quality [, This disease is characterized by a microbially-associated, host-mediated inflammation that results in the loss of periodontal attachment, clinically detected as clinical attachment loss (CAL) [, In 2018, the American Academy of Periodontology and the European Federation of Periodontology published a new classification of periodontal diseases. This treatment of periodontal disease can be non-surgical or surgical with the optimal treatment being based on individual patient, site, and systemic factors. Prevalence, General and Periodontal Risk Factors of Gastroesophageal Reflux Disease in China. F: 904-249-8554, 1409 Kingsley Avenue, Suite 9A, Paper should be a substantial original Article that involves several techniques or approaches, provides an outlook for As a review, the periodontal classifications were revised in 1999 and classified as chronic, aggressive (localized and generalized), necrotizing, and a manifestation of systemic disease.1 New technology, research, and information has emerged in the past 18 years which led to the new revisions. The trusted provider of veterinary information since 1955, Congenital and Developmental Anomalies of the Mouth and Dentition in Large Animals, Irregular Wear of the Dentition in Large Animals, Developmental Abnormalities of the Mouth and Dentition in Small Animals, Last review/revision Dec 2013 | Modified Oct 2022. ; Karring, T.; Berglundh, T.; Giannobile, W.V. The stages, consisting of Stage I-IV are below for review. Established periodontal disease with 25-50% attachment loss. No special 2014;65(1):107-33. [Introduction and interpretation of the European Federation of Periodontology S3 level clinical practice guideline for treatment of periodontitis]. Periodontal Disease and Overall Health: A Clinicians Guide. 0000087237 00000 n Pregnancy complications: An umbrella review of 23 systematic reviews found that periodontitis during pregnancy seems to contribute to increased risk of preterm birth, low birthweight infants and preeclampsia. (This article belongs to the Special Issue. 2022 Jan 17;10(1):186. doi: 10.3390/biomedicines10010186. Federal government websites often end in .gov or .mil. Hu KF, Ho YP, Ho KY, Wu YM, Wang WC, Chou YH. F: 904-278-1176, Copyright Drs. Pjetursson BE, Rast C, Brgger U, Schmidlin K, Zwahlen M, Lang NP. Schnabl D, Thumm FM, Kapferer-Seebacher I, Eickholz P. Healthcare (Basel). To fully understand the "Three Steps to Staging and Grading a . Sarahs passion is education. Periodontitis and traumatic occlusion have. Firm, fibrous items that allow tooth penetration can wipe plaque from the tooth surfaces during chewing. J Clin Periodontol 2018;45 Suppl 20:S286-S91. ), which require additional interventions following completion of active periodontal therapy. Extensive disease seen in younger patients or with minimal bacterial deposits represents a high rate of progression (Grade C). J Periodontol 2000;71(Supplement):856. Periodontitis exists in different forms, and its etiology is related to multiple component causes. The link you have selected will take you to a third-party website. 0000101987 00000 n Eighteen subjects were enrolled in this study. 2000. Cardiovascular diseases: Although a causal relationship has not been established, the presence of periodontal disease has been associated with various cardiovascular diseases including myocardial infarction. In order to consider both aims, 18 patients were enrolled in this study. 2021 Dec;120(12):2072-2088. doi: 10.1016/j.jfma.2021.06.029. Diagnosis and Classification of Periodontitis, American Academy of Periodontology: Resources for Patients, National Institute of Dental and Craniofacial Research: Periodontal (Gum) Disease, Centers for Disease Control and Prevention: Periodontal Disease, https://www.perio.org/for-patients/periodontal-treatments-and-procedures/surgical-procedures/, ADA supports USDA proposal to modernize WIC, Gallup Indian Medical Center holds first GKAS event, Cardiac Implantable Devices and Electronic Dental Instruments, Roughly 42 percent of all dentate U.S. adults 30 years of age or older have periodontitis. These data are difficult to explain considering the multifactorial etiology of GPIIIIVC [. Zitzmann, N. (2018). Teeth that have become mobile because of loss of attachment should be extracted. 0000057263 00000 n The aim of this study was to understand if important factors such as smoking, gender, age, plaque, pus, and probing pocket depth could influence the histomorphological pattern of generalized stage III-IV, grade C periodontitis (GPIII-IVC), which is a particular form of periodontitis. Periodontitis is caused by the host's response to subgingival plaque. generalized). Unable to load your collection due to an error, Unable to load your delegates due to an error, Collaborators, The aim of this study was to understand if important factors such as smoking, gender, age, plaque, pus, and probing pocket depth could influence the histomorphological pattern of generalized stage IIIIV, grade C periodontitis (GPIIIIVC), which is a particular form of periodontitis. Peri-implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. Systemic antibiotics in the treatment of aggressive periodontitis. Page, R.C. Also, a periodontist will compare radiographs taken over time to further assess rates of progression. Journal of Periodontology, 93, 354-363. Lindhe, J.; Lang, N.P. The most significant effect is related to smoking in patients with a similar periodontal condition. HHS Vulnerability Disclosure, Help Angle H. Classification of malocclusion. Association between periodontitis and arterial hypertension: A systematic review and meta-analysis. doi:10.1002/jper.18-0157. Cao R, Li Q, Wu Q, et al. Biomedicines. This is achieved through professional dental cleaning (scaling and polishing) with power and hand instruments under general anesthesia. Barrier membranes should be placed between the bone defect and gingival tissues to achieve guided tissue regeneration. doi: 10.1016/S0140-6736(05)67728-8. A randomized controlled trial of implant-retained mandibular overdentures. Step 2: Establish Stage is divided into two sections. Zhonghua Kou Qiang Yi Xue Za Zhi. The data show that the test group achieved better results, with greater reductions in PPD, gains in CAL, and decreases in BDH, BDD, MD BDW, BLBDW, and BDV. A stage 2 mobility is present when tooth mobility is increased in any direction other than axial over a distance of >0.5 mm and up to 1 mm. MeSH 1899;41:248-64. Periodontitis Stage III-IV, Grade C and Correlated Factors: A Histomorphometric Study Authors Barbara Buffoli 1 , Gianluca Garzetti 2 , Stefano Calza 3 , Eleonora Scotti 4 , Elisa Borsani 5 , Veronica Cappa 6 7 , Lia Rimondini 8 9 , Magda Mensi 10 Affiliations Sarah has clinical experience in both the private and public health sectors. Clin Oral Investig. Clinical or Laboratorial Research Manuscript, Case Report / Clinical Technique Manuscript, Department of Periodontics, Faculty of Dentistry, Qazvin University of Medical Sciences, Qazvin, Iran, Postgraduate Student, Department of Periodontics, School of Dentistry, Tehran University of Medical Sciences, International Campus, Tehran, Iran, All the contents of this journal, except where otherwise noted, is licensed under a, Vol. Respiratory diseases: Research suggests associations between periodontitis and respiratory diseases such as asthma, chronic obstructive pulmonary disease and pneumonia, possibly due to inflammatory processes and aspiration of microorganisms from the periodontal pocket. Berglundh T, Armitage G, Araujo MG, et al. Oral Microbiome, Oral Health and Systemic Health: A Multidirectional Link. Aim: ; Kim, H.D. Jepsen, S.; Caton, J.G. Published by John Wiley & Sons Ltd. Step 3: Establish Grade focuses on assessing risk factors, systemic considerations, and outcomes of non-surgical periodontal therapy. Females showed a significant increase in inflammatory infiltrate compare to males (and it was higher in non-smokers than in smokers). The constant action of the etiological factors, which induces and sustains pathological changes, can induce irreversible changes. Correction of anatomic conditions that predispose the patient to periodontitis, impair aesthetics, or impede placement of prosthetic appliances, Extraction of teeth that cannot be successfully treated, Placement of implants when teeth are lost. Tooth loss in generalized aggressive periodontitis: Prognostic factors after 17 years of supportive periodontal treatment. Gomes-Filho IS, Cruz SSD, Trindade SC, et al. 0000039969 00000 n The results are reported as the estimates and 95% confidence intervals. The binary coded variable BoP was summarized as counts and percentages. doi: 10.1111/jcpe.12935. Evidence-based clinical practice guideline on the nonsurgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts. Smiley CJ, Tracy SL, Abt E, et al. The owner might falsely believe the condition has been treated, while periodontal disease continues to thrive. Angiogenesis together with inflammatory infiltrate are associated with the evolution of gingival inflammatory processes [. ; Bursiewicz, W.; Socha, M.; Ozorowski, M.; Pawlak-Osiska, K.; Wiciski, M. The role of Tannerella forsythia and Porphyromonas gingivalis in pathogenesis of esophageal cancer. You can email the site owner to let them know you were blocked. Periodontal disease and cancer: Epidemiologic studies and possible mechanisms. J Prosthet Dent. J Periodontol 2018;89 Suppl 1:S74-S84. 22. Cloudflare Ray ID: 7a2d94e769f715b3 8600 Rockville Pike Editors select a small number of articles recently published in the journal that they believe will be particularly Please enable it to take advantage of the complete set of features! Patients often require several treatment sessions for complete debridement of the tooth surfaces.21 After scaling, root planing, and other adjunctive treatment approaches such as use of antibiotic therapy, the periodontal tissues require approximately 4 weeks to demonstrate optimal effects of nonsurgical therapy.21, Many moderate to advanced cases require surgical access to the root surface for root planing and reducing pocket depth, which will allow the patient to achieve successful home care.21, A patient with gingivitis can revert to a state of health with a reduced periodontium, but due to the host-related disease susceptibility, a periodontitis patient remains a periodontitis patient, even following successful therapy, and requires lifelong supportive care to prevent recurrence of disease.2 Further, patients with more severe periodontitis Stage and Grade have been found to be more likely to experience disease recurrence and tooth loss without regular periodontal maintenance visits. 2009 Jul;20(7):667-76. 2023 Jan 13;12:1125463. doi: 10.3389/fcimb.2022.1125463. A systematic review. 2022 John Wiley & Sons A/S. ; Bissada, N.F. These authors contributed equally to this work. BMC Oral Health 2019;19(1):176. Buffoli, B.; Dalessandri, M.; Favero, G.; Mensi, M.; Dalessandri, D.; di Rosario, F.; Stacchi, C.; Rezzani, R.; Salgarello, S.; Rodella, L.F. AQP1 expression in human gingiva and its correlation with periodontal and peri-implant tissue alterations. All in all, this Staging and Grading system helps your periodontist provide a patient-centered evaluation and treatment plan as well as an effective way to communicate more clearly with our patients. To fully understand the Three Steps to Staging and Grading a Patient, four stages were developed to differentiate between severity, complexity and extent, and distribution of periodontitis. 2021 Mar;106:103562. doi: 10.1016/j.jdent.2020.103562. Distribution of Periodontal Pockets Among Smokers and Nonsmokers in Patients with Chronic Periodontitis: A Cross-sectional Study. ; Schroeder, H.E. Even large accumulations of supragingival plaque are easily removed by toothbrushing. 0000001972 00000 n Oral Dis 2020;26(2):439-46. Moderate Periodontitis Ann Clin Lab Sci. Wang Q, Sun Y, Zhou T, Jiang C, A L, Xu W. Front Cell Infect Microbiol. Sgolastra F, Petrucci A, Gatto R, Monaco A. Dementias: Periodontitis and periodontal pathogens have been associated with dementias and Alzheimers Disease. 0000094964 00000 n Allen, P. F., Thomason, J. M., Jepson, N. J., Nohl, F., Smith, D. G., & Ellis, J. The connective tissue side of the flap needs to be debrided before wound closure to avoid contact of infected and inflamed granulation tissue with the planed root surfaces. Histomorphometric analyses were performed by two blinded investigators at the Section of Anatomy and Physiopathology of the University of Brescia. 563 University Boulevard North, Sarah has received her associate, bachelor and master degrees in dental hygiene with an education focus. https://doi.org/10.3390/biomedicines7020043, Subscribe to receive issue release notifications and newsletters from MDPI journals, You can make submissions to other journals. Periodontal diseases. A systematic review and meta-analysis. and transmitted securely. Maintenance visit regularity has a different impact on periodontitis-related tooth loss depending on patient staging and grading. Severe or very severe periodontitis will be considered Stage III or Stage IV. Prevention of gingivitis is the same as its treatment: plaque removal and control. Periodontitis is not as readily reversible as gingivitis. We used univariate linear regression models to evaluate the relationship between log-transformed outcome variables (inflammatory infiltrate and vascular area) and clinical determinants: gender (male/female), age (coded as <51 and 51 years old), smoking habit (smoker/non-smoker), PPD (coded as <9 mm and 9 mm), presence of plaque on tooth surface (yes/no), and pus (yes/no). Periodontitis exists in different forms, and its etiology is related to multiple component causes. future research directions and describes possible research applications. An official website of the United States government. Based on the findings from step 1, a determination of mild-moderate periodontitis can be made, which is considered Stage I or Stage II. I 'hfW$gLSV(LgtB-erO8n=xO$0O~=~_|HHt>2q{|swiG "nx#+2>>?>|.> ?>|8~/|~!u`},,K@J-wT|}Y%|@iT, py.x\},\jVc+|o-1 5O SlH'0DSb4~]4w8N8#. In this case report, we present a patient with stage IV/ grade C periodontitis who achieved a good treatment outcome following nonsurgical periodontal treatment, orthodontic treatment, and prosthodontic treatment with a Maryland bridge, bringing new insight into the treatment of advanced periodontal disease. ; Sanz, M.; Tonetti, M. A new classification scheme for periodontal and peri-implant diseases and conditionsIntroduction and key changes from the 1999 classification. Jepsen S, Caton JG, Albandar JM, et al. These results suggested that even if these factors are commonly related to the worsening of periodontal status, some of them (pus and periodontal probing depth (PPD)) do not affect the inflammatory and vascular patterns. In these situations, significantly rapid progressive damage to the attachment apparatus, which can lead (especially in stage IV) to tooth loss and occlusion impairment, is appreciated [, About the etiology of this pathology, periodontitis is a complex disease with a genetic and epigenetic basis and/or causes related to patient behaviors (e.g., medications or environmental factors), which contribute to the progression of the periodontal lesion. Keywords: The .gov means its official. Scaling and root planing (SRP) complemented by systemic antibiotics, access surgery, regenerative techniques and implant placement are among the treatments used for patients with this condition. For mild to moderate periodontitis, the focus will be on clinical attachment loss (CAL). The recently published clinical practice guideline (CPG) for the treatment of periodontitis in stages I-III provided evidence-based recommendations for the treatment of periodontitis patients, defined according to the 2018 classification. 0000027037 00000 n In 2018, the American Academy of Periodontology and the European Federation of Periodontology published the World Workshop Classification System for Periodontal and Peri-Implant Diseases and Conditions, which established a new approach to diagnosing periodontal disease to replace the system developed in 1999. 1999 Dec;19(6):589-99. . Association of periodontitis with Oral Cancer: A Case-Control Study. In order to quantify the percentage of inflammatory cells and the percentage of the vascular area, digitally fixed images (arbitrary standardized area) for each section (five serial sections/sample) were analyzed by an optical light microscope (Olympus BX50, Olympus, Hamburg, Germany). Bethesda, MD 20894, Web Policies J Clin Periodontol. 0000028701 00000 n Tomasi, C.; Leyland, A.H.; Wennstrm, J.L. Eighteen subjects with GPIII-IVC were enrolled in this study. Local placement of a gel containing antibiotics (eg, doxycycline) into cleaned periodontal pockets may be helpful. Accessibility Modern Periodontics is dedicated to provide optimal oral health through education, prevention and treatment. Unauthorized use of these marks is strictly prohibited. Theodoridis C, Grigoriadis A, Menexes G, Vouros I. Outcomes of implant therapy in patients with a history of aggressive periodontitis. concluded that periodontitis is associated with (1) higher HbA1c levels in individuals without diabetes and in individuals with type 2 diabetes, (2) worsened diabetes-related complications in individuals with type 2 diabetes, and (3) an increased prevalence of complications in individuals with type 1 diabetes. Next, we look at the patient-specific factors that contribute to the complexity of long-term management such as probing depths, the number of lost teeth, the shape of bone loss, access for hygiene, occlusal trauma, tooth alignment, and many others. All analyses were performed using the statistical software R (version 3.5.2, Out of 18 patients, 72% were females, 55.6% were more than 51 years old and smokers. Manifestations of systemic diseases and conditions that affect the periodontal attachment apparatus: Case definitions and diagnostic considerations. Garbo D, Aimetti M, Bongiovanni L, Vidotto C, Mariani GM, Baima G, Romano F. Life (Basel). BSP implementation of European S3 - level evidence-based treatment guidelines for stage I-III periodontitis in UK clinical practice. All articles published by MDPI are made immediately available worldwide under an open access license. 2008 Mar;39(3):211-5. Step 3: Establish Grade focuses on assessing risk factors, systemic considerations, and outcomes of non-surgical periodontal therapy.3. the subject, RBL/age). Periodontol 2000 2020;83(1):213-33. doi: 10.1111/jcpe.12945. Considering the presence/absence of pus, no significant differences were observed. They can sometimes be saved through major periodontal surgery procedures, but disease will recur without drastic changes in home oral hygiene. ; Dutta, V. Comparative evaluation of the marginal gingival epithelium in smokers and nonsmokers: A histomorphometric and immunohistochemical study. Periodontitis Stage I Stage II Stage III Stage IV Staging and Grading Periodontitis The 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions resulted in a new classification of periodontitis characterized by a multidimensional staging and grading system. Al-Zahrani, M. S., Alhassani, A. Clin Oral Implants Res. Genco R, Williams R. Periodontal Disease and Overall Health: A Clinicians Guide. Methods and Results A 62-year-old South Asian female presented with unstable Stage IV Grade C periodontitis, poor oral hygiene and multiple autoimmune conditions including oral lichen planus. During the one and two-year follow-ups, the teeth and implants did not show any signs of instability, attachment loss or bone loss. The extent of disease is categorized by the extent of stage-defining destruction. ?mKml2~ sharing sensitive information, make sure youre on a federal In Graetz's study, risk factors were not documented, and diabetic patients were de . trailer <<1B1783BF7F6145A9AFE30DDB3A361986>]/Prev 244117>> startxref 0 %%EOF 53 0 obj <>stream A sample size of 18 subjects (11 non-smokers and 7 smokers) is sufficient to detect a clinically important difference of 0.45% between groups in reducing the vascular area, assuming a mean in healthy and non-smoking patients of 1% [, Similarly, as the mean of inflammatory infiltrates reported by literature in healthy and non-smoking patients is 9% with a standard deviation of 1.5% [. Lastly, certain risk factors are associated with progressive bone loss including smoking and diabetes. Shallow periodontal pockets are treated in a closed fashion, but pockets >6 mm deep require open surgery (creation of a periodontal flap) to expose the root surface and alveolar bone for adequate treatment (root scaling/planing and alveoloplasty). Teughels W, Dhondt R, Dekeyser C, Quirynen M. Treatment of aggressive periodontitis. Epub 2017 Jun 15. Periodontal disease increases with age, 70.1% of adults 65 years and older have . Malinowski, B.; Wsierska, A.; Zalewska, K.; Sokoowska, M.M. The bacteria found in the presence of teeth with periodontal disease include Bacteroides fragilis, Peptostreptococcus, Porphyromonas gulae, Porphyromonas salivosa, Porphyromonas denticanis, Prevotella intermedia, Treponema spp, Bacteroides splanchnicus, and many others. Background: Would you like email updates of new search results? | Privacy Policy, Copyright Drs. 104.236.29.24 Periodontal Disease and Pregnancy Outcomes: Overview of Systematic Reviews. MDPI and/or EFP Workshop Participants and Methodological Consultant. permission is required to reuse all or part of the article published by MDPI, including figures and tables. 0000056248 00000 n B.B., G.G. This was a long time coming as both the American Academy of Periodontology and European Federation of Periodontology (EFP) have been working on this for quite some time. J Clin Periodontol 2018;45 Suppl 20:S1-S8. Tonetti, M.S. The https:// ensures that you are connecting to the Get Directions ; Reynolds, M.A. 169. 8 The host response to the bacterial challenge leads to clinical signs such as deep pockets, bleeding on probing, gingival recession, and tooth mobility, which can ultimately cause tooth loss. Your IP: Prevention of periodontitis is more complicated. Next, your periodontist will assess the rate of progression (Grade A, B, and C) for their specific patient. Risk factor analysis is used as grade modier. 25, Much of the literature agrees that, after non-surgical and/or surgical periodontal treatment, patients could benefit from more frequent visits, possibly every 3-6 months.26, 27 These appointments could include a review of home oral hygiene behaviors, ascertainment of exposure to risk factors such as tobacco use, professional plaque removal, and subgingival debridement, as needed.26-28 Patients also could be assessed to determine if active therapy is needed to treat recurrent periodontal disease.27, Researchers generally agree the maintenance phase is key to allow for close monitoring of the attachment level and pocket depth along with the other clinical variables, such as bleeding, exudation, tooth mobility.21. Am Heart J 2016;180:98-112. Methods: The study included 27 adult patients (13 smoker, 14 non-smoker) with stage III/IV-grade C periodontitis and 25 healthy adult subjects. Deep infrabony defects in multirooted teeth with bone loss that undermines a furcation can infect the pulp through a furcation canal, resulting in secondary endodontic disease. Interestingly, some of the common human periodontopathogens such as Haemophilus (formerly Actinobacillus) actinomycetemcomitans are notably absent in animals. Periodontitis is a microbially-associated, host-mediated inflammation that results in loss of periodontal attachment. Caton, J. G., Armitage, G., Berglundh, T., Chapple, I. L., Jepsen, S., Kornman, K. S., . Prakash et al. J Med Case Rep. 2015;9:211. J Clin Periodontol. Evidence of the association of periodontitis with systemic conditions is mixed (see the related Oral Health Topic page, Oral/Systemic Health). Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: Consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. Arn, M. L., Dritsas, K., Pandis, N., & Kloukos, D. (2020). Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. The four stages (stage 1-4) of periodontitis are determined by several variables. ; Echeverra, J.J. analyzed the data; L.R. hb``f``g`e`\ @16s0080 ^`K'4m`6GH00@QegVc4kX71j0~dH'X!~uZ)FB Z00% (; J( endstream endobj 17 0 obj <>>> endobj 18 0 obj <>/Font<>/ProcSet[/PDF/Text]/Properties<>>>/Rotate 0/TrimBox[0.0 0.0 792.0 612.0]/Type/Page>> endobj 19 0 obj <> endobj 20 0 obj <>stream 2007 Dec;78(12):2229-37. According to ADA clinical practice guidelines on non-surgical treatment,23 derived from a 2015 systematic review,23 scaling and root planing without adjuncts is the treatment of choice for patients who have periodontitis.