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Academy Report
Position Paper
Guidelines for Periodontal Therapy*
The American Academy of Periodontology offers the following Guidelines for Periodontal Therapy. These
guidelines are intended to fulfill the Academy’s obligation to the public and to the dental profession. This paper
sets forth the clinical objectives and scope of periodontal therapy. These guidelines are designed to give guid-
ance to state legislatures and agencies that regulate the practice of periodontology and should be consid-
ered in their entirety. J Periodontol 2001;72:1624-1628.

R
esearch has provided evidence that chronic odontal ligament, cementum, alveolar bone, and sites
inflammatory periodontal diseases are treat- for tooth replacements). Tissue regeneration, man-
able.1-8 Studies have also been directed at pro- agement of periodontal-endodontic lesions, and pro-
viding information to permit better understanding of viding dental implants as tooth replacements are,
mechanisms of disease progression and pathogene- when indicated, integral components of comprehen-
sis in order to make treatment of periodontal dis- sive periodontal therapy. Tooth extraction and implant
eases more effective and predictable.9-11 As a result site development may accompany either periodontal
of advances in knowledge and therapy, the great or implant therapy. Patient management during ther-
majority of patients retain their dentition over their apy may include the administration of intravenous
lifetime with proper treatment, reasonable plaque conscious sedation.
control, and continuing maintenance care.12-21 How- The goals of periodontal therapy are to preserve
ever, there are some situations when traditional ther- the natural dentition, periodontium and peri-implant
apy is not effective in arresting the disease. In these tissues; to maintain and improve periodontal and peri-
instances, the progression of the disease may be implant health, comfort, esthetics, and function. Cur-
slowed, but eventually the teeth may be lost.14-21 rently accepted clinical signs of a healthy periodon-
Adherence to the following guidelines will not guar- tium include the absence of inflammatory signs of
antee a successful outcome and will not obviate all disease such as redness, swelling, suppuration, and
complications or postcare problems in periodontal bleeding on probing; maintenance of a functional
therapy. Additionally, these guidelines should not be periodontal attachment level; minimal or no recession
deemed inclusive of all methods of care, or exclu- in the absence of interproximal bone loss; and func-
sive of treatment reasonably directed at obtaining the tional dental implants.
same results. It should also be noted that these guide- PERIODONTAL EXAMINATION
lines describe summaries of patient evaluation and
All patients should receive a comprehensive peri-
treatment procedures that have been presented in
odontal examination. Such an examination includes
considerably more detail within textbooks of peri-
discussion with the patient regarding the chief com-
odontology as well as in the medical and dental lit-
plaint, medical and dental history review, clinical
erature. Ultimately judgments regarding the appro-
examination, and radiographic analysis. Microbio-
priateness of any specific procedure must be made
logic, genetic, biochemical, or other diagnostic tests
by the practitioner in light of all the circumstances
may also be useful, on an individual basis, for assess-
presented by the individual patient.
ing the periodontal status of selected patients or sites.
SCOPE OF PERIODONTICS Some or all of the following procedures may be
Periodontics is the specialty of dentistry that encom- included in a comprehensive periodontal examina-
passes prevention, diagnosis, and treatment of dis- tion:
eases of the supporting and surrounding tissues of 1. Extra- and intraoral examination to detect non-
teeth and dental implants. The specialty includes periodontal oral diseases or conditions.
maintenance of the health, function, and esthetics of 2. General periodontal examination to evaluate the
all supporting structures and tissues (gingiva, peri- topography of the gingiva and related structures; to
assess probing depth, recession, and attachment
* This paper was revised under the direction of the Committee on
Research, Science and Therapy and approved by the Board of Trustees
level; to evaluate the health of the subgingival area
of the American Academy of Periodontology in September 2001. with measures such as bleeding on probing and sup-

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Academy Report
puration; to assess clinical furcation status; and to or refractory. Facial recession involving loss of peri-
detect endodontic-periodontal lesions. odontal attachment and gingival tissue affects chil-
3. Assessment of the presence, degree and/or dis- dren and adults. The prevalence increases with age
tribution of plaque, calculus and gingival inflammation. and adults over 50 have the greatest degree of
4. Dental examination, including caries assess- involvement. This mucogingival condition is often
ment, proximal contact relationships, the status of treatable.23 Edentulous ridge defects result from loss
dental restorations and prosthetic appliances, and of osseous tissue and can compromise esthetics or
other tooth- or implant-related problems. complicate future implant placement. Other diseases
5. Determination of the degree of mobility of teeth and anomalies not explicitly described herein may
and dental implants. also involve the periodontium.
6. Occlusal examination.
7. Interpretation of a satisfactory number of DEVELOPMENT OF A TREATMENT PLAN
updated, diagnostic quality periapical and bite-wing The clinical findings together with a diagnosis and
radiographs or other diagnostic imaging needed for prognosis should be used to develop a logical plan
implant therapy. of treatment in order to eliminate or alleviate the signs
8. Evaluation of potential periodontal systemic and symptoms of periodontal diseases and thereby
interrelationships. arrest or slow further disease progression. The treat-
9. Assessment of suitability to receive dental ment plan should be used to establish the methods
implants. and sequence of delivering appropriate periodontal
treatment. When indicated, the plan should include:
ESTABLISHING A DIAGNOSIS AND 1. Medical consultation or referral for treatment
PROGNOSIS when appropriate.
The purpose of the comprehensive periodontal 2. Periodontal procedures to be performed.
examination is to determine the periodontal diag- 3. Consideration of adjunctive restorative, pros-
nosis and prognosis and/or suitability for dental thetic, orthodontic and/or endodontic consultation or
implants. This process includes an evaluation of peri- treatment.
odontal and peri-implant tissues to determine the 4. Provision for reevaluation during and after peri-
suitability of the patient for treatments including non- odontal or dental implant therapy.
surgical, surgical, regenerative and reconstructive 5. Consideration of chemotherapeutic agents for
therapy, or dental implant placement. This informa- adjunctive treatment.
tion should be recorded in the patient’s chart and 6. Consideration of diagnostic testing that may
communicated to the patient and the referring den- include microbiological, genetic or biochemical
tist when appropriate. assessment or monitoring during the course of peri-
odontal therapy.
PERIODONTAL DISEASES AND CONDITIONS 7. Periodontal maintenance program.
Diseases of the periodontium may be categorized as
gingival diseases, periodontitis, necrotizing periodontal INFORMED CONSENT AND PATIENT
diseases, abscesses of the periodontium, and devel- RECORDS
opmental or acquired deformities and conditions.22 Where reasonably foreseeable risks, potential com-
Gingivitis is gingival inflammation without attachment plications, or the possibility of failure are associated
loss or with non-progressing attachment loss. Other with treatment, informed consent should be obtained
gingival diseases may be modified by systemic fac- prior to the commencement of therapy. The infor-
tors, medications or malnutrition. Periodontitis is gin- mation given to the patient in these circumstances
gival inflammation with progressing attachment loss. should include the following:
Different forms include, but are not limited to, chronic 1. The diagnosis, etiology, proposed therapy, pos-
periodontitis, aggressive periodontitis, periodontitis sible alternative treatment(s), and the prognosis with
as a manifestation of systemic disease, necrotizing and without the proposed therapy or possible alter-
ulcerative periodontitis, and periodontitis associated natives.
with endodontic lesions. Periodontitis may be further 2. Recommendations for referral to other health
characterized by degree of attachment loss as slight, care providers as necessary.
moderate, or severe; by extent as localized or gen- 3. The reasonably foreseeable inherent risks and
eralized; and by post-treatment status as recurrent potential complications associated with the proposed

J Periodontol • November 2001 Position Paper 1625

Academy Report
therapy, including failure with the ultimate loss of tomy and osteoplasty. Dental tissue procedures
teeth or dental implants. include root resection, tooth hemisection, and odon-
4. The need for periodontal maintenance treatment toplasty. Combined osseous and dental tissue pro-
after active therapy due to the potential for disease cedures may be required for management of
recurrence. endodontic-periodontal lesions.
A record of the patient’s consent to the proposed 3. Periodontal regenerative procedures include: soft
therapy should be maintained. Moreover, complete tissue grafts, bone replacement grafts, root biomod-
records of diagnosis, treatment, results, and recom- ification, guided tissue regeneration, and combina-
mended follow-up are essential, starting with the ini- tions of these procedures for osseous, furcation, and
tial examination and continuing for as long as the recession defects. Periodontal reconstructive proce-
patient is under care. Where reasonably foreseeable dures include: guided bone regeneration, ridge aug-
risks, potential complications, or the possibility of mentation, ridge preservation, implant site develop-
failure are associated with treatment, it is advisable ment, and sinus grafting.
to obtain the informed consent in writing prior to com- 4. Periodontal plastic surgery for gingival aug-
mencement of therapy. mentation, for correction of recession or soft tissue
defects, or for other enhancement of oral esthetics.
TREATMENT PROCEDURES 5. Occlusal therapy, which may include: minor
A broad range of therapies exist in periodontics. No tooth movement, occlusal adjustment, splinting, or
single treatment approach can provide the only provision of devices to reduce occlusal trauma.
means of treating any one or all periodontal diseases. 6. Preprosthetic periodontal procedures include:
One treatment modality may be appropriate for one exploratory flap surgery, resective procedures, regen-
section of the mouth while another approach may be erative or reconstructive procedures, or crown length-
suitable at other sites. ening surgery, performed to facilitate restorative or
When indicated, treatment should include: prosthetic treatment plans.
1. Patient education, training in personal oral 7. Selective extraction of teeth, roots, or implants
hygiene, and counseling on control of risk factors when indicated, in order to facilitate periodontal ther-
(e.g., smoking, medical status, stress) with referral apy, implant therapy, implant site development, or
when appropriate. implant, restorative and/or prosthetic treatment plans.
2. Removal of supragingival and accessible sub- 8. Replacement of teeth by dental implants.
gingival bacterial plaque and calculus is accomplished 9. Procedures to facilitate orthodontic treatment
by periodontal scaling. Comprehensive periodontal including, but not limited to, tooth exposure, frenulec-
root planing is used to treat root surface irregulari- tomy, fiberotomy, gingival augmentation, and implant
ties or alterations caused by periodontal pathoses. In placement.
some instances, these procedures may be incorpo- 10. Management of periodontal systemic interre-
rated into the surgical treatment. lationships when appropriate.
3. Finishing procedures, which include post-treat-
ment evaluation with review and reinforcement of PERIODONTAL MAINTENANCE THERAPY
personal daily oral hygiene when appropriate. Upon completion of active periodontal treatment, fol-
The following courses of treatment may be indi- low-up periodontal maintenance visits should include:
cated in addition to the above outlined procedures: 1. Update of medical and dental histories.
1. Chemotherapeutic agents. These agents may 2. Evaluation of current extra- and intraoral, peri-
be used to reduce, eliminate, or change the quality odontal and peri-implant soft tissues as well as den-
of microbial pathogens; or alter the host response tal hard tissues and referral when indicated (e.g., for
through local or systemic delivery of appropriate treatment of carious lesions, pulpal pathosis, or other
agent(s). conditions).
2. Resective procedures. These procedures are 3. Assessment of the oral hygiene status with rein-
designed to reduce or eliminate periodontal pockets struction when indicated.
and create an acceptable gingival form that will facil- 4. Mechanical toothcleaning to disrupt/remove
itate effective oral hygiene and periodontal mainte- dental plaque and biofilms, stain, and calculus. Local
nance treatment. Soft tissue procedures include gin- delivery or systemic chemotherapeutic agents may
givectomy, gingivoplasty, and various mucogingival be used as adjunctive treatment for recurrent or
flap procedures. Osseous procedures include ostec- refractory disease.

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Academy Report
5. Elimination or mitigation of new or persistent 2. Accepted therapeutic procedures have been per-
risk and etiologic factors with appropriate treatment. formed to arrest the progression of the periodontal
6. Identification and treatment of new, recurrent, or disease(s).
refractory areas of periodontal pathoses. 3. Periodontal root planing has left subgingival root
7. Establishment of an appropriate, individualized surfaces without clinically detectable calculus deposits
interval for periodontal maintenance treatment. or rough areas.
The patient should be kept informed of: 4. Gingival crevices are generally without bleeding
1. Areas of persistent, recurrent, refractory, or new on probing or suppuration.
periodontal disease. 5. A recommendation has been made for the cor-
2. Changes in the periodontal prognosis. rection of any tooth form, tooth position, restoration,
3. Advisability of further periodontal treatment or or prosthesis considered to be contributing to the
retreatment of indicated sites. periodontal disease process.
4. Status of dental implants. 6. An appropriate periodontal maintenance pro-
5. Other oral health problems noted that may gram, specific to individual circumstances, has been
include caries, defective restorations, and non-peri- recommended to the patient for long-term control of
odontal mucosal diseases or conditions. the disease, as well as for the maintenance of den-
tal implants, if present.
FACTORS MODIFYING RESULTS
REFERENCES
The results of periodontal treatment may be
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J Periodontol • November 2001 Position Paper 1627

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tions and future directions. Periodontol 2000 1997;14: ACKNOWLEDGMENTS
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1628 Guidelines for Periodontal Therapy Volume 72 • Number 11