Long-term periodontal and peri-implant tissue stability under supportive therapy

Supportive periodontal and peri-implant maintenance therapy is strongly associated with improved long-term retention and stability of natural teeth and dental implants. Lack of regular professional follow-up after initial therapy is a major risk factor for disease recurrence and tooth or implant loss. Despite well-established benefits, patient compliance with maintenance regimens remains suboptimal, and the ideal protocols and intervals for sustained tissue health are under debate, AIM: This review aimed to synthesize current evidence regarding the impact of supportive therapy on long-term periodontal and peri-implant tissue stability, including optimal maintenance intervals, protocols, risk profiles, and emerging technologies for personalized care.

A comprehensive literature review was conducted using PubMed, Embase, and Scopus databases, focusing on longitudinal and cohort studies, randomized controlled trials, systematic reviews, and recent consensus guidelines addressing the effects of supportive therapy on periodontal and peri-implant outcomes. Data on maintenance intervals, clinical protocols, risk assessment tools, recurrence after nonsurgical and surgical therapies, and adjunctive innovations (AI, imaging, biomarker testing) were collated and critically appraised.

Long-term studies consistently demonstrate that regular supportive periodontal care (SPC) and supportive peri-implant care (SPIC) markedly reduce rates of tooth and implant loss, progression of periodontitis and peri-implantitis, and minimize the need for complex surgical re-interventions. Frequent recalls-every 3-6 months for moderate- to high-risk patients and up to 12 months for low-risk-result in significantly better outcomes. Protocols incorporating individualized risk assessment (e.g., Personalized Risk Assessment (PRA) and Implant Disease Risk Assessment (IDRA) algorithms), thorough mechanical biofilm removal, personalized oral hygiene instructions, and modification of risk factors enhance tissue stability. Non-compliance and residual pockets (≥5-6 mm) are major predictors of recurrence. While both conventional and emerging biofilm control methods (ultrasonic scaling, air-polishing, guided biofilm therapy) are effective, no single protocol shows superior long-term results. Recent advances in chair-side biomarker testing and AI-supported image analysis offer promising tools for early detection and proactive management of at-risk patients. Although early data are encouraging, the clinical integration of these technologies remains largely guided by expert interpretation pending long-term outcome validation.

Consistent adherence to structured supportive therapy protocols following active periodontal or implant interventions is essential for the long-term health and stability of periodontal and peri-implant tissues. Maintenance intervals and protocols should be individualized based on patient, site, and prosthetic risk profiles, with cumulative and interceptive strategies employed for disease prevention and early management of recurrence CLINICAL RELEVANCE: The implementation of personalized supportive therapy regimens-including regular recalls, risk-based protocol selection, and integration of emerging technologies-substantially enhances the longevity and stability of teeth and implants. Improving patient and clinician awareness, and adopting risk-stratified approaches, can reduce disease recurrence, treatment burden, and long-term healthcare costs.