Periodontal assessment and maintenance
An appropriate recall interval for periodontal therapy is of particular interest as periodontal regeneration following active treatment requires an isochronal maintenance program. Current professional habitude recommends a 3 month rationale for periodontal recall interval. The justification of this recall interval is to allow sufficient time for periodontal healing, assess re-colonisation of periodontopathogens, and allow reiteration of oral hygiene instruction (Darcey and Ashley, 2011).
A frequently cited study for the justification of the 3-month interval is Stanton et al (1969) time series study investigating the rate of wound healing of human gingivae by measuring hydroxyproline present in gingival collagen against time (N= 99). Their results yielded a 50% regeneration of collagen after 25 days. Through regression analysis their existing data, they extrapolated full connective tissue repair would require at least 49 days. Weaknesses with this study include inadequate follow up necessitating them to estimate their findings and their small sample size. As well, it did not relate directly to periodontal therapy, as their study only investigated wound healing following a gingivectomy. Canton et al (1982) investigated the maintenance of healed pockets following root planning to evaluate clinical stability of 128 periodontal pockets over the course of 3 months. They observed that across 4 to 16 weeks following root planning there was a significant improvement in plaque control, pocket depths, and clinical reattachment. He concluded that evidence of healing observed at a 1 month interval continued for 3.5 months thus justifying a 3 month interval. However its small sample size, low confidence interval, and poor generalizability categorizes this as low quality study.
More recently Darcey and Ashley (2011), criticized that the aforementioned studies as a blanket generalization of the disease. Susceptibility to periodontal disease is an outcome of bacterial infection, host response and behaviour factors, and is unique to each patient (Axelsson and Lindhe, 1981; Merchant, 2005). The complex interplay between these risk factors led to the development of mathematical algorithms providing a more objective and quantitative assessment of risks factors and ultimately designating appropriate individualized recall intervals. These risk calculators provide an age related risk score from low(1) to high(5) (Garcia et al., 2009). Currently the only longitudinal validation of the risk calculator is a 15 year retrospective cohort study which was carried out by the original developers making it susceptible to bias (Page et al., 2003). No external validation has been possible due to the researchers not publishing the assessment algorithm. Overall, the literature implies that variations in disease susceptibility justifies an individualized risk-based periodontal recall interval.
A Cochrane systematic review investigated the...