Schrittweises Vorgehen bei der Parodontitistherapie

Die systematische Parodontitistherapie besteht aus einem vierstufigen, aufeinander aufbauenden Behandlungskonzept, welches federführend von europäischen parodontalen Fachgesellschaften in einem Adolopment-Verfahren erarbeitet und von der Deutschen Gesellschaft für Parodontologie (DG PARO) sowie der Deutschen Gesellschaft für Zahn-, Mund- und Kieferheilkunde (DGZMK) in einer deutschen aktuellen S3-Leitlinie implementiert wurde. Im Juli des letzten Jahres ist die neue Behandlungsrichtlinie für die Parodontitistherapie gesetzlich krankenversicherter Patienten in Kraft getreten. Diese gliedert die parodontale Behandlung in vier Phasen. Dieser Beitrag stellt die einzelnen Abschnitte der systematischen Parodontitistherapie der S3-Leitlinie vor, die anhand einer klinischen Falldokumentation einer Parodontitistherapie, in welcher alle Stufen bzw. Phasen durchlaufen wurden, veranschaulicht werden sollen.

Publication History

Article published online:
10 June 2022

• Literatur

• 1 Kebschull M, Jepsen S, Kocher T. et al. Die Behandlung von Parodontitis Stadium I bis III. Die deutsche Implementierung der S3-Leitlinie „Treatment of Stage I – III Periodontitis“ der European Federation of Periodontology (EFP). AWMF ed.; 2020. Im Internet (Stand: 06.05.2022): https://www.awmf.org/uploads/tx_szleitlinien/083-043l_S3_Behandlung-von-Parodontitis-Stadium-I-III_2021-02_2.pdf
• 2 Sanz M, Herrera D, Kebschull M. et al. Treatment of stage I–III periodontitis – The EFP S3 level clinical practice guideline. J Clin Periodontol 2020; 47 (Suppl. 22) 4-60
• 3 Hajishengallis G. Periodontitis: from microbial immune subversion to systemic inflammation. Nat Rev Immunol 2015; 15: 30-44
• 4 Page RC, Kornman KS. The pathogenesis of human periodontitis: an introduction. Periodontol 2000 1997; 14: 9-11
• 5 Meyle J, Chapple I. Molecular aspects of the pathogenesis of periodontitis. Periodontol 2000 2015; 69: 7-17
• 6 Ramseier CA, Woelber JP, Kitzmann J. et al. Impact of risk factor control interventions for smoking cessation and promotion of healthy lifestyles in patients with periodontitis: A systematic review. J Clin Periodontol 2020; 47 (Suppl. 22) 90-106
• 7 Van der Weijden FA, Slot DE. Efficacy of homecare regimens for mechanical plaque removal in managing gingivitis a meta review. J Clin Periodontol 2015; 42 (Suppl. 16) S77-S91
• 8 Graetz C, El-Sayed KF, Sälzer S. et al. S3-Leitlinie „Häusliches mechanisches Biofilmmanagement in der Prävention und Therapie der Gingivitis“ (Langversion). Stand: November 2018. Im Internet (Stand: 14.05.2022): https://www.awmf.org/uploads/tx_szleitlinien/083-022l_S3_Haeusliches-mechanisches-Biofilmmanagement-Praevention-Therapie-Gingivitis_2021-02.pdf
• 9 Auschill T, Sälzer S, Arweiler N. S3-Leitlinie „Häusliches chemisches Biofilmmanagement in der Prävention und Therapie der Gingivitis“ (Langversion). Stand: November 2018. Im Internet (Stand: 14.05.2022): https://www.awmf.org/uploads/tx_szleitlinien/083-016l_S3_Haeusliches-chemisches-Biofilmmanagement-Praevention-Therapie-Gingivitis_2021-02.pdf
• 10 Kwok V, Caton JG. Commentary: prognosis revisited: a system for assigning periodontal prognosis. J Periodontol 2007; 78: 2063-2071
• 11 Deacon S, Glenny A-M, Deery C. et al. Different types of powered toothbrushes for plaque control and healthy gums. Cochrane Database Syst Rev 2010; (12) CD004971
• 12 Chapple IL, Van der Weijden F, Doerfer C. et al. Primary prevention of periodontitis: managing gingivitis. J Clin Periodontol 2015; 42 (Suppl. 16) S71-S76
• 13 Magnusson I, Lindhe J, Yoneyama T. et al. Recolonization of a subgingival microbiota following scaling in deep pockets. J Clin Periodontol 1984; 11: 193-207
• 14 Papapanou PN, Sanz M, Buduneli N. et al. Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol 2018; 89 (Suppl. 01) S173-S182
• 15 Kerner W, Brückel J. Definition, Klassifikation und Diagnostik des Diabetes mellitus. Diabetologie und Stoffwechsel 2015; S02: 98-101
• 16 Deschner J, Haak T, Jepsen S. et al. [Diabetes mellitus and periodontitis. Bidirectional relationship and clinical implications. A consensus document]. Internist 2011; 52: 466-477
• 17 Taylor GW. Bidirectional interrelationships between diabetes and periodontal diseases: an epidemiologic perspective. Ann Periodontol 2001; 6: 99-112
• 18 Tsai C, Hayes C, Taylor GW. Glycemic control of type 2 diabetes and severe periodontal disease in the US adult population. Community Dent Oral Epidemiol 2002; 30: 182-192
• 19 Lim LP, Tay FB, Sum CF. et al. Relationship between markers of metabolic control and inflammation on severity of periodontal disease in patients with diabetes mellitus. J Clin Periodontol 2007; 34: 118-123
• 20 Madianos PN, Koromantzos PA. An update of the evidence on the potential impact of periodontal therapy on diabetes outcomes. J Clin Periodontol 2018; 45: 188-195
• 21 Tomar SL, Asma S. Smoking-attributable periodontitis in the United States: findings from NHANES III. National Health and Nutrition Examination Survey. J Periodontol 2000; 71: 743-751
• 22 Leite FRM, Nascimento GG, Baake S. et al. Impact of Smoking Cessation on Periodontitis: A Systematic Review and Meta-analysis of Prospective Longitudinal Observational and Interventional Studies. Nicotine Tob Res 2019; 21: 1600-1608
• 23 Fisher EL, Garaas R, Blakey GH. et al. Changes over time in the prevalence of caries experience or periodontal pathology on third molars in young adults. J Oral Maxillofac Surg 2012; 70: 1016-1022
• 24 Blakey GH, Gelesko S, Marciani RD. et al. Third molars and periodontal pathology in American adolescents and young adults: a prevalence study. J Oral Maxillofac Surg 2010; 68: 325-329
• 25 Li ZB, Qu HL, Zhou LN. et al. Nonimpacted third molars affect the periodontal status of adjacent teeth: a cross-sectional study. J Oral Maxillofac Surg 2017; 75: 1344-1350
• 26 Kindler S, Holtfreter B, Koppe T. et al. Third molars and periodontal damage of second molars in the general population. J Clin Periodontol 2018; 45: 1365-1374
• 27 Blakey GH, Parker DW, Hull DJ. et al. Impact of removal of asymptomatic third molars on periodontal pathology. J Oral Maxillofac Surg 2009; 67: 245-250
• 28 Suvan J, Leira Y, Moreno Sancho FM. et al. Subgingival instrumentation for treatment of periodontitis. A systematic review. J Clin Periodontol 2020; 47 (Suppl. 22) 155-175
• 29 Herrera D, Alonso B, Leon R. et al. Antimicrobial therapy in periodontitis: the use of systemic antimicrobials against the subgingival biofilm. J Clin Periodontol 2008; 35: 45-66
• 30 Teughels W, Feres M, Oud V. et al. Adjunctive effect of systemic antimicrobials in periodontitis therapy: A systematic review and meta-analysis. J Clin Periodontol 2020; 47 (Suppl. 22) 257-281
• 31 Harks I, Koch R, Eickholz P. et al. Is progression of periodontitis relevantly influenced by systemic antibiotics? A clinical randomized trial. J Clin Periodontol 2015; 42: 832-842
• 32 Jockel-Schneider Y, Pretzl B, Ehmke B. et al. Adjuvante systemische Antibiotikagabe bei subgingivaler Instrumentierung im Rahmen der systematischen Parodontitistherapie. AWMF; 2018. Im Internet (Stand: 06.05.2022): https://secure.owidi.de/documents/10165/1373255/S3-Leitlinie+%2528Langversion%2529+Adjuvante+systemische+Antibiotikagabe+bei+subgingivaler+Instrumentierung+im+Rahmen+der+systematischen+Parodontitistherapie/d493c3bf-95dc-4e39-8f3d-0b1031f71d23
• 33 Sanz-Sanchez I, Montero E, Citterio F. et al. Efficacy of access flap procedures compared to subgingival debridement in the treatment of periodontitis. A systematic review and meta-analysis. J Clin Periodontol 2020; 47 (Suppl. 22) 282-302
• 34 Matuliene G, Pjetursson BE, Salvi GE. et al. Influence of residual pockets on progression of periodontitis and tooth loss: results after 11 years of maintenance. J Clin Periodontol 2008; 35: 685-695
• 35 Buchanan SA, Robertson PB. Calculus removal by scaling/root planing with and without surgical access. J Periodontol 1987; 58: 159-163
• 36 Fleischer HC, Mellonig JT, Brayer WK. et al. Scaling and root planing efficacy in multirooted teeth. J Periodontol 1989; 60: 402-409
• 37 Graetz C, Schutzhold S, Plaumann A. et al. Prognostic factors for the loss of molars-an 18-years retrospective cohort study. J Clin Periodontol 2015; 42: 943-950
• 38 Erpenstein H, Borchard R. Resektive Knochenchirurgie. In: Erpenstein H, Diedrich P. Hrsg. Atlas der Parodontalchirurgie. München: Urban und Fischer; 2004: 171
• 39 Dommisch H, Walter C, Dannewitz B. et al. Resective surgery for the treatment of furcation involvement: A systematic review. J Clin Periodontol 2020; 47 (Suppl. 22) 375-391
• 40 Hirschfeld L, Wasserman B. A long-term survey of tooth loss in 600 treated periodontal patients. J Periodontol 1978; 49: 225-237
• 41 McFall jr. WT. Tooth loss in 100 treated patients with periodontal disease. A long-term study. J Periodontol 1982; 53: 539-549
• 42 Goldman MJ, Ross IF, Goteiner D. Effect of periodontal therapy on patients maintained for 15 years or longer. A retrospective study. J Periodontol 1986; 57: 347-353
• 43 Wood WR, Greco GW, McFall jr. WT. Tooth loss in patients with moderate periodontitis after treatment and long-term maintenance care. J Periodontol 1989; 60: 516-520
• 44 Carnevale G, Pontoriero R, di Febo G. Long-term effects of root-resective therapy in furcation-involved molars. A 10-year longitudinal study. J Clin Periodontol 1998; 25: 209-214
• 45 Kao RT, Nares S, Reynolds MA. Periodontal regeneration – intrabony defects: a systematic review from the AAP Regeneration Workshop. J Periodontol 2015; 86: S77-S104
• 46 Mellonig JT. Enamel matrix derivative for periodontal reconstructive surgery: technique and clinical and histologic case report. Int J Periodontics Restorative Dent 1999; 19: 8-19
• 47 Bosshardt DD. Biological mediators and periodontal regeneration: a review of enamel matrix proteins at the cellular and molecular levels. J Clin Periodontol 2008; 35: 87-105
• 48 Cortellini P, Tonetti MS. Long-term tooth survival following regenerative treatment of intrabony defects. J Periodontol 2004; 75: 672-678
• 49 Cortellini P, Buti J, Pini Prato G. et al. Periodontal regeneration compared with access flap surgery in human intra-bony defects 20-year follow-up of a randomized clinical trial: tooth retention, periodontitis recurrence and costs. J Clin Periodontol 2017; 44: 58-66
• 50 Nibali L, Koidou VP, Nieri M. et al. Regenerative surgery versus access flap for the treatment of intra-bony periodontal defects: A systematic review and meta-analysis. J Clin Periodontol 2020; 47 (Suppl. 22) 320-351
• 51 Cortellini P, Prato GP, Tonetti MS. The simplified papilla preservation flap. A novel surgical approach for the management of soft tissues in regenerative procedures. Int J Periodontics Restorative Dent 1999; 19: 589-599
• 52 Jepsen S, Gennai S, Hirschfeld J. et al. Regenerative surgical treatment of furcation defects: A systematic review and Bayesian network meta-analysis of randomized clinical trials. J Clin Periodontol 2020; 47 (Suppl. 22) 352-374
• 53 Chapple ILC, Mealey BL, Van Dyke TE. et al. 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. J Clin Periodontol 2018; 45 (Suppl. 20) S68-S77
• 54 Lang NP, Tonetti MS. Periodontal risk assessment (PRA) for patients in supportive periodontal therapy (SPT). Oral Health Prev Dent 2003; 1: 7-16
• 55 Joss A, Adler R, Lang NP. Bleeding on probing. A parameter for monitoring periodontal conditions in clinical practice. J Clin Periodontol 1994; 21: 402-408
• 56 Lang NP, Joss A, Orsanic T. et al. Bleeding on probing. A predictor for the progression of periodontal disease?. J Clin Periodontol 1986; 13: 590-596
• 57 Lang NP, Adler R, Joss A. et al. Absence of bleeding on probing. An indicator of periodontal stability. J Clin Periodontol 1990; 17: 714-721
• 58 Ramseier CA, Mirra D, Schutz C. et al. Bleeding on probing as it relates to smoking status in patients enrolled in supportive periodontal therapy for at least 5 years. J Clin Periodontol 2015; 42: 150-159
• 59 Ramseier CA, Nydegger M, Walter C. et al. Time between recall visits and residual probing depths predict long-term stability in patients enrolled in supportive periodontal therapy. J Clin Periodontol 2019; 46: 218-230