BEYOND ROUTINE SUBGINGIVAL INSTRUMENTATION: AN EVIDENCE-BASED FRAMEWORK FOR INDIVIDUALIZED SUPPORTIVE PERIODONTAL THERAPY IN PERIODONTITIS PATIENTS
DOI:
https://doi.org/10.31435/ijitss.3(51).2026.6663Keywords:
Periodontitis, Supportive Periodontal Therapy, Periodontal Maintenance, Subgingival Instrumentation, Periodontal Risk Assessment, Personalized Periodontal CareAbstract
Background: Supportive periodontal therapy (SPT) is essential for maintaining periodontal stability after active treatment of periodontitis. Although subgingival instrumentation is a well-established component of active periodontal therapy, its routine repetition during maintenance visits remains clinically debated. Evidence supporting instrumentation during disease resolution cannot be directly extrapolated to all patients receiving long-term supportive care.
Aim: This narrative review critically evaluates current evidence regarding routine versus selective subgingival instrumentation during SPT and proposes an evidence-based framework for individualized periodontal maintenance.
Methods: A targeted narrative synthesis of randomized and prospective clinical studies, systematic reviews, consensus reports, and evidence-based periodontal guidelines was undertaken. Particular attention was given to probing pocket depth, clinical attachment level, bleeding on probing, residual pockets, microbiological outcomes, risk factors, and patient adherence.
Evidence synthesis: Available comparative evidence does not demonstrate a consistent additional benefit of routine subgingival instrumentation for every periodontally stable patient. A two-year randomized trial (Angst et al., 2019) found comparable overall maintenance with or without routine subgingival instrumentation, whereas a more recent randomized trial (Isola et al., 2026) reported additional improvements in bleeding-related and residual-pocket outcomes when subgingival instrumentation was included. These apparently divergent findings support context-dependent rather than universal treatment decisions.
Conclusions: SPT should move from automatic procedure-based protocols toward individualized, risk-based care. Subgingival instrumentation remains an important therapeutic tool, but its use during maintenance should be guided by current disease activity, residual pocket characteristics, patient-level risk factors, and longitudinal stability.
References
Angst, P. D. M., Finger Stadler, A. F., Mendez, M., Oppermann, R. V., van der Velden, U., & Gomes, S. C. (2019). Supportive periodontal therapy in moderate-to-severe periodontitis patients: A two-year randomized clinical trial. Journal of Clinical Periodontology, 46(11), 1083-1093. https://doi.org/10.1111/jcpe.13178
Angst, P. D. M., van der Velden, U., Susin, C., & Gomes, S. C. (2024). Supportive periodontal care with or without subgingival instrumentation: Microbiological results of a 2-year randomized clinical trial. Journal of Clinical Periodontology, 51(10), 1302-1310. https://doi.org/10.1111/jcpe.14038
Axelsson, P., Nyström, B., & Lindhe, J. (2004). The long-term effect of a plaque control program on tooth mortality, caries and periodontal disease in adults: Results after 30 years of maintenance. Journal of Clinical Periodontology, 31(9), 749-757. https://doi.org/10.1111/j.1600-051X.2004.00563.x
Chapple, I. L. C., Mealey, B. L., Van Dyke, T. E., Bartold, P. M., Dommisch, H., Eickholz, P., Geisinger, M. L., Genco, R. J., Glogauer, M., Goldstein, M., Griffin, T. J., Holmstrup, P., Johnson, G. K., Kapila, Y., Lang, N. P., Meyle, J., Murakami, S., Plemons, J., Romito, G. A., ... Yoshie, H. (2018). 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. Journal of Periodontology, 89(Suppl 1), S74-S84. https://doi.org/10.1002/JPER.17-0719
Echeverría, J. J., Echeverría, A., & Caffesse, R. G. (2019). Adherence to supportive periodontal treatment. Periodontology 2000, 79(1), 200-209. https://doi.org/10.1111/prd.12256
Farooqi, O. A., Wehler, C. J., Gibson, G., Jurasic, M. M., & Jones, J. A. (2015). Appropriate recall interval for periodontal maintenance: A systematic review. Journal of Evidence-Based Dental Practice, 15(4), 171-181. https://doi.org/10.1016/j.jebdp.2015.10.001
Heasman, L., Stacey, F., Preshaw, P. M., McCracken, G. I., Hepburn, S., & Heasman, P. A. (2006). The effect of smoking on periodontal treatment response: A review of clinical evidence. Journal of Clinical Periodontology, 33(4), 241-253. https://doi.org/10.1111/j.1600-051X.2006.00902.x
Heitz-Mayfield, L. J. A. (2005). Disease progression: Identification of high-risk groups and individuals for periodontitis. Journal of Clinical Periodontology, 32(Suppl 6), 196-209. https://doi.org/10.1111/j.1600-051X.2005.00803.x
Isola, G., Annunziata, M., Angjelova, A., Alibrandi, A., Tartaglia, G. M., & Scannapieco, F. A. (2026). Effectiveness of two supportive periodontal care protocols and outcome predictors during periodontitis: A randomized controlled trial. Journal of Periodontology, 97(3), 435-449. https://doi.org/10.1002/JPER.70007
Jenkins, W. M., Said, S. H., Radvar, M., & Kinane, D. F. (2000). Effect of subgingival scaling during supportive therapy. Journal of Clinical Periodontology, 27(8), 590-596. https://doi.org/10.1034/j.1600-051X.2000.027008590.x
Lang, N. P., Joss, A., Orsanić, T., Gusberti, F. A., & Siegrist, B. E. (1986). Bleeding on probing. A predictor for the progression of periodontal disease? Journal of Clinical Periodontology, 13(6), 590-596. https://doi.org/10.1111/j.1600-051X.1986.tb00852.x
Lang, N. P., & Tonetti, M. S. (2003). Periodontal risk assessment (PRA) for patients in supportive periodontal therapy (SPT). Oral Health & Preventive Dentistry, 1(1), 7-16.
Matuliene, G., Pjetursson, B. E., Salvi, G. E., Schmidlin, K., Brägger, U., Zwahlen, M., & Lang, N. P. (2008). Influence of residual pockets on progression of periodontitis and tooth loss: Results after 11 years of maintenance. Journal of Clinical Periodontology, 35(8), 685-695. https://doi.org/10.1111/j.1600-051X.2008.01245.x
Sanz, M., Bäumer, A., Buduneli, N., Dommisch, H., Farina, R., Könönen, E., Linden, G., Meyle, J., Preshaw, P. M., Quirynen, M., Roldan, S., Sanchez, N., Sculean, A., Slot, D. E., Trombelli, L., West, N., & Winkel, E. (2015). Effect of professional mechanical plaque removal on secondary prevention of periodontitis and the complications of gingival and periodontal preventive measures: Consensus report of group 4 of the 11th European Workshop on Periodontology on effective prevention of periodontal and peri-implant diseases. Journal of Clinical Periodontology, 42(Suppl 16), S214-S220. https://doi.org/10.1111/jcpe.12367
Sanz, M., Ceriello, A., Buysschaert, M., Chapple, I., Demmer, R. T., Graziani, F., Herrera, D., Jepsen, S., Lione, L., Madianos, P., Mathur, M., Montanya, E., Shapira, L., Tonetti, M., & Vegh, D. (2018). Scientific evidence on the links between periodontal diseases and diabetes: Consensus report and guidelines of the joint workshop on periodontal diseases and diabetes by the International Diabetes Federation and the European Federation of Periodontology. Journal of Clinical Periodontology, 45(2), 138-149. https://doi.org/10.1111/jcpe.12808
Sanz, M., Herrera, D., Kebschull, M., Chapple, I., Jepsen, S., Berglundh, T., Sculean, A., & Tonetti, M. S. (2020). Treatment of stage I-III periodontitis-The EFP S3 level clinical practice guideline. Journal of Clinical Periodontology, 47(Suppl 22), 4-60. https://doi.org/10.1111/jcpe.13290
Suvan, J., Leira, Y., Moreno Sancho, F. M., Graziani, F., Derks, J., & Tomasi, C. (2020). Subgingival instrumentation for treatment of periodontitis: A systematic review. Journal of Clinical Periodontology, 47(Suppl 22), 155-175. https://doi.org/10.1111/jcpe.13245
Tonetti, M. S., Greenwell, H., & Kornman, K. S. (2018). Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. Journal of Clinical Periodontology, 45(Suppl 20), S149-S161. https://doi.org/10.1111/jcpe.12945
Trombelli, L., Franceschetti, G., & Farina, R. (2015). Effect of professional mechanical plaque removal performed on a long-term, routine basis in the secondary prevention of periodontitis: A systematic review. Journal of Clinical Periodontology, 42(Suppl 16), S221-S236. https://doi.org/10.1111/jcpe.12339
Wood, W. R., Greco, G. W., & McFall, W. T. (1989). Tooth loss in patients with moderate periodontitis after treatment and long-term maintenance care. Journal of Periodontology, 60(9), 516-520. https://doi.org/10.1902/jop.1989.60.9.516
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Weronika Jagiełło, Natalia Le Hong, Natalia Dymel, Natasza Jankowska, Karolina Kukuczka, Gabriela Karpińska, Kamila Kędzior, Sonia Krzykawska
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.
