4. Reassessment

Two to three months after our surfacing, the re-evaluation comes. This stage concludes the initial therapy. It will allow us to assess the benefit of our first treatment and to evaluate the need for further treatment.
In practice, three parameters will be analysed.

  • Plaque control, which shows the patient's cooperation. Even more than during our first examination, each dental surface will be carefully examined in order to highlight the slightest deposit that could compromise the stability of our treatment. The patient's attention is immediately drawn to this.
  • Inflammation, which is indicated by the presence of bleeding on probing. These inflammatory signs give an indication of the presence of residual subgingival bacterial activity.
  • The depth of the pockets, which will be compared with the initial parameters. Indeed, the appreciation of the gain of attachment is the most objective expression of a favorable response.

Rigorous analysis of these three benchmarks will allow us to assess whether our treatment was successful, both at the level of the patient as a whole and at the level of each site.
We can reasonably speak of overall success when 75% of the diseased sites have been treated. As for the criteria for success at the site level, we are looking for a pocket depth of less than 5 mm with no bleeding on probing.

Différentes situations peuvent se présenter lors de cette première évaluation :

Plaque control is insufficient as is the response to initial treatment

In this situation, periodontitis cannot be stabilised. The patient must be persuaded that plaque control is an absolute necessity in the continuation of treatment, otherwise all therapeutic manoeuvres must be suspended pending a positive result.

Plaque control is effective and the response to treatment is satisfactory for all sites

In these cases, the periodontal disease is considered stabilised and the maintenance phase can be considered.

Plaque control is effective and the response to treatment is generally satisfactory but not complete

If some sites have been refractory to our initial treatment or if, despite slight improvement, their condition cannot predict long-term stability, further localised treatment (surgical or non-surgical) will be indicated.

Plaque control is effective, but the overall response to treatment is inadequate

If, after the initial treatment, all the clinical parameters still reveal a general inflammation of the periodontal tissues, or even a worsening of the initial situation, several hypotheses, which can be added, are then possible:

  • The bacterial flora is particularly virulent and antibiotic therapy is indicated.
  • The patient suffers from an undiagnosed or unstabilised general pathology that hinders the healing process. A further medical examination should be carried out.
  • The patient's resistance is impaired by heavy smoking. Rigorous palliative periodontal treatment remains the only way to slow down periodontal destruction.