REFRACTORY PERIODONTITIS

Evidence accumulated in the mid 1960s confirm that periodontitis was primarily the result of dental plaque accumulation. This concept was only proved experimentally but provided an effective means of managing diseased patients. As a result of the over whelming influence of the plaque focused concept of periodontal disease, reports of individuals who did not respond to therapy based on this concept were met with skepticism. Beginning in the late 70s and early 1980s a series of reports demonstrate that a substantial number of patients treated by the plaque focused concept continued to show signs of disease progression. Although it is likely that many of these non responsive patients did not maintain adequate plaque control, many patients appeared to have a reasonable standard of oral hygiene and were seen on a regular basis for professional maintenance care. In spite of these efforts, some patients continued to show signs of disease progression and their clinical condition was termed Refractory periodontitis. As increasing information emerged relative to the microbial, inflammatory and immunologic nature of periodontitis, it was anticipated that a specific pattern characteristic of refractory patients would emerge. Refractory periodontitis has been defined by the American Academy of periodontology as “those patients who are unresponsive to any treatment provided, whatever the throughness or frequency”. This should be distinguished from recurrent disease, in which a complete remission occurs after therapy, followed by recurrence of the disease as a result of reformation of the plaque and calculus. To classify cases as refractory [unresponsive], the clinician must clearly differentiate them from incompletely treated cases. In such patients the irritants may not have been completely removed, and the disease may temporarily have become less severe but never completely resolved.