Periodontal disease remains one of the most common oral health issues globally, with implications not only for oral function and aesthetics but also for systemic health. With the evolution of clinical guidelines and long-term outcome studies, practitioners now have access to clearer, evidence-based strategies for treating different stages of periodontitis.
In this article, we’ll break down current best practices for managing periodontitis—from Stage I to Stage IV—and look at what the latest research says about treatment outcomes for both single- and multirooted teeth.
Stepwise Approach to Treating Stage I–III Periodontitis
The 2020 Clinical Practice Guidelines (CPG) by Sanz et al. provide a structured, step-by-step treatment approach for managing Stage I–III periodontitis:
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Behavioral changes and supragingival plaque control: Begin with education, smoking cessation, and reinforcement of proper oral hygiene practices.
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Non-surgical therapy: This involves supra- and subgingival instrumentation, with or without adjunctive therapies like antimicrobials.
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Surgical intervention: Indicated when non-surgical approaches fail to resolve inflammation or deep pockets remain.
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Supportive periodontal care: Long-term maintenance therapy is critical for preventing relapse and sustaining results.
This phased approach is both logical and adaptable, emphasizing minimal intervention while supporting progressive treatment when necessary.
Management of Stage IV Periodontitis: A Multidisciplinary Approach
For Stage IV periodontitis, the guidelines (Herrera et al., 2022) recommend starting with the same CPG used for Stage I–III but include additional rehabilitative interventions. These may involve:
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Orthodontic tooth movement to reposition compromised teeth
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Tooth splinting for stabilization of mobile dentition
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Occlusal adjustments to eliminate traumatic contacts
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Fixed or removable prostheses (tooth- or implant-supported) to restore function and aesthetics
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Ongoing supportive periodontal care to maintain clinical improvements
Stage IV cases typically involve advanced tissue destruction and functional impairment, requiring a combination of surgical, restorative, and prosthetic treatments.
What About Single-Rooted Teeth?
According to a study by Kim et al. (2007), both non-surgical and surgical periodontal therapies show positive outcomes in single-rooted teeth, especially when bone loss is not too advanced.
However, the study also noted that interproximal bone loss and infra-bony defects can significantly compromise treatment results. Interestingly, treatment success appeared to depend more on site-specific or tooth-related factors (e.g., bone morphology) rather than overall patient-related factors like age or systemic health. This reinforces the need for individualized treatment planning based on detailed periodontal assessment.
Can Multirooted Teeth with Furcation Involvement Survive Long-Term?
Yes—with the right treatment, even teeth with furcation involvement can demonstrate excellent longevity. Research by Huynh-Ba et al. (2009) showed that multirooted teeth, particularly those with initial Degree I furcation involvement, responded well to non-surgical periodontal therapy, with long-term survival rates of up to 100%.
That said, complications like vertical root fractures and endodontic failures were more common in teeth that underwent resective surgical procedures. This highlights the importance of early diagnosis and conservative management where possible.
Conclusion: Evidence-Based Periodontal Care in 2025 and Beyond
Current research and guidelines underscore that effective periodontal care relies on a structured, patient-centered approach. For early-to-moderate cases, non-surgical therapy combined with behavior modification remains the cornerstone of treatment. For advanced disease, multidisciplinary management becomes essential—often involving surgical, prosthetic, and even orthodontic elements.
Success is not just about cleaning teeth—it’s about strategic intervention, tailored care, and long-term maintenance.
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