Supportive periodontal care during active orthodontic therapy in patients with history of stage IV periodontitis: A narrative review.

The present narrative review aims to summarize the existing literature on recommendations for supportive periodontal care (SPC) in patients undergoing combined periodontal-orthodontic treatment. It outlines a comprehensive step-4 treatment sequence in patients diagnosed with stage IV periodontitis and concurrent orthodontic problems. The delivery of SPC characterizes step 4 of the comprehensive treatment sequence, focusing on the prevention of bacterial re-infection and the recurrence of the disease. Step 4 includes repeated assessments of residual probing pocket depths (PPD) greater than 5 mm, bleeding on probing (BoP) and/or suppuration around teeth and implants, as well as evaluation of furcation involvement. Extensive evidence indicates the efficacy of rigorous self-performed plaque control and adherence to regular SPC following active periodontal therapy as vital for managing caries and periodontitis, thereby reducing possible tooth loss. Current evidence indicates that patients with stage IV periodontal disease can safely proceed with orthodontic treatment following active periodontal therapy. Nonetheless, it is the authors' recommendation for patients undergoing periodontal-orthodontic treatment to participate in an SPC program scheduled every 3-4 months.