Patients with Stage IV advanced periodontitis face significant challenges in managing their dental health. In addition to addressing the periodontal condition, the goal of therapy is to rehabilitate the aesthetic and functional aspects of the patient’s condition and ensure long-term maintenance for continued oral health. Without proper treatment, these patients are at a high risk of edentulism. Therefore, a comprehensive and multi-specialty approach is crucial in managing Stage IV periodontitis.
The classification of periodontitis is based on stage and grade, as defined by the World Workshop on Periodontal and Peri-implant Diseases and Conditions in 2017. Stage IV periodontitis is characterized by extensive interdental attachment loss and bone loss that extends beyond the mid-root. Patients in this stage require complex rehabilitation due to masticatory dysfunction and other functional consequences. The management of Stage IV patients is more complicated than that of Stage III patients.
Early diagnosis and immediate treatment planning are essential in preventing further tooth loss and complications with rehabilitation. Studies have shown that Stage IV periodontitis patients have a higher risk of tooth loss compared to Stage I patients. The European Federation on Periodontology (EFP) has developed clinical practice guidelines that emphasize the importance of an interdisciplinary approach to rehabilitate Stage IV periodontitis patients. Failure to treat or provide adequate treatment can result in additional loss of periodontal tissue and complete edentulism.
The assessment of Stage IV periodontitis patients involves evaluating the amount of periodontal breakdown, tooth loss due to periodontal disease, individual tooth prognosis, restorative factors, and the overall prognosis of care. Four major phenotypes have been identified to categorize Stage IV patients. The “no-treatment” option is strongly discouraged due to the risk of complete edentulism.
Supportive therapy before, during, and after active therapy is recommended to improve oral hygiene and patient motivation. This includes controlling secondary occlusal trauma, orthodontic therapy, and various methods of rehabilitation depending on the extent of edentulous spaces and the restorability of retained teeth. The use of implant-supported fixed or removable prostheses may also be considered.
Studies have shown that patient compliance with supportive periodontal therapy significantly impacts tooth mortality and the risk of tooth loss. Therefore, patient education and motivation are essential. The management of Stage IV periodontitis patients requires careful planning and a multi-disciplinary approach to achieve optimal function and aesthetics.
In conclusion, the treatment of patients with Stage IV advanced periodontitis is complex and requires a multi-specialty approach. Early diagnosis, immediate treatment planning, and patient compliance are crucial for successful management. The use of clinical practice guidelines and a comprehensive treatment plan can help patients achieve and maintain periodontal health, function, and aesthetics.