Consolidated principles and modern approaches for non surgical periodontal treatment|Principi consolidati e approcci moderni nella terapia parodontale non chirurgica della parodontite

Non-surgical periodontal therapy is the treatment that aims at removal of the etiological and risk factors of periodontitis, with the aim of preventing further damage to the periodontium and im­proving the clinical condition of the patient suffering from periodontitis. It consists of several phases, which include the plaque control, the professional removal of bacterial plaque and its retentive factors in the supragingival and subgingival areas. The purpose of this narrative review is to illustrate, in the light of the current guidelines for the treatment of periodontitis, the essential steps to obtain the preservation or restoration of a healthy periodontal condition. The patient’s plaque control is one of the fundamental aspects of periodontal therapy and strongly affects its short and long-term success. There are different ways to obtain the patient’s collaboration and his active participation in therapy, the so-called adherence. This process must be accompanied with personalized, effective and achievable oral hygiene measures. The main characteristics of the tools for plaque control are illustrated (manual or electric toothbrushes, dental floss or interproxi­mal brush etc.) and their indications to guide dental professionals in the choice of suggestions to the patient. For the removal of the supra and subgingival plaque, the principles are illus­trated according to a modern orienta­tion of mini-invasiveness. Manual or mechanical instruments, micro-powder jets, have precise characteristics that are illustrated to help understanding the advantages and disadvantages or limitations of each of them. Historically, the use of curettes was associated with the removal of large amounts of root cement, which was believed to be colonized by bacteria and toxins. The current orientation involves the removal of plaque and calculus (because it is re­tentive of plaque), without intentional removal of the root cement. The instruments, in the light of different objectives, take on other functions, with often integrated therapies performed with the different tools to optimize the advantages of each of them. Mechanical tools are efficient means for remov­ing supragingival calculus and can be used, with the right precautions for use, even in the subgingival area where they are effective, especially in areas that are difficult to access. Additional therapies are illustrated, in accordance with the literature, if they produce an effective advantage over non-surgical periodontal therapy alone, recommending the most appropriate conditions and timing. The objectives of non-surgical periodontal therapy are also illustrated, such as the reduction of plaque indexes, inflammation and the probing depth, necessary to achieve the stability of periodontal health. The objectives of the therapy also include an improvement in the quality of life perceived by the patient, who shortly after execution shows less discomfort and better masticatory function. Finally, the limits of non-surgical periodontal therapy are clarified which, while obtaining sub­stantial improvements in the patient’s clinical condition by itself, must be integrated into a broader program of periodontal therapy, sometimes including also surgical phases, and is always fol­lowed by periodontal support therapy that aims at long-term maintenance.