Supportive periodontal therapy: from surgical wound disinfection to maintenance therapy|Terapia parodontale di supporto: dalla disinfezione della ferita post-chirurgica alla terapia di mantenimento

Wound management after periodontal surgery must follow specific timing and procedures, in order to allow proper healing of hard and soft tissues. At each post-surgical check-up appointment, the clinician should polish the treated area to minimize the inflammatory reactions where the patient cannot yet perform the usual home oral hygiene maneuvers. It is also essential giving to the patient appropriate post-operative instructions based on the type of surgery performed and the wound maturation. Usually, after an osseous resective surgery the sutures are removed at seven days, and already from the following week the patient gradually resumes home procedures. After a regenerative surgery, on the other hand, particular attention must be paid to the complete closure of the surgical wound before giving the patient new instructions for the home maneuvers, which will resume in a much more gradual and delicate way. At the end of active therapy, whether surgical or non-surgical, the patient undergoes a new re-evaluation by the periodontist in order to establish the new baseline parameters as a reference point during supportive periodontal therapy. The main objective of the latter is to prevent recurrence of periodontal disease in patients previously treated with active therapy, in order to keep the bacterial load and consequent inflammation low, and thus avoid the progression of the disease and the possible tooth loss. Many studies have shown that a system of hygiene recalls and personalized supportive therapy allow the long-term tooth maintenance in periodontal patients. There are different systems to establish a risk profile of disease progression in an individualized way for each patient, to determine frequency and modality of the supportive therapy necessary to maintain stable the attachment levels obtained during active therapy. With these methods the clinician can easily identify patients who have a worse periodontal prognosis and can thus implement personalized therapeutic strategies to control individual risk factors. The tools used during supportive therapy are the same used during the phases of diagnosis, instruction for home oral hygiene maneuvers, and non-surgical therapy. It is important to choose minimally invasive tools, which allow not to damage the cleansed dental substance in the repetition of the sessions. The actual operative session includes several phases which aim to check the periodontal status and re-motivate the patient where he is in difficulty in home oral hygiene maneuvers, to eliminate the residual supra and subgingival calculus and plaque, to treat dentinal hypersensitivity with specific products and to diagnose any new oral pathologies (caries, soft tissue diseases, periodontal recurrences), also through the use of radiological investigations. Adjuvant systems such as lasers, photodynamic therapy and topical antimicrobial agents have shown through the literature no additional benefit in the supportive therapy session compared to mechanical therapy alone. In conclusion, supportive care must be an integral part not only of periodontal therapy, but of the patient’s whole dental therapy. In fact, it is essential that the patient is made aware of the risks, but above all of the benefits that regularity in the frequency of recalls can give, also from a systemic point of view due to the numerous correlations between oral health and general health