Periodontitis in Essen-Rüttenscheid: Systematic Treatment and Long-Term Tooth Stability

The supporting structures of a tooth include the gums, root cementum, periodontal ligament and jawbone. With periodontitis, an inflammatory response can cause progressive loss of these supporting tissues.

The disease is initiated by dysbiotic bacterial biofilm at the gum margin and within periodontal pockets. Its severity and rate of progression are not determined by bacteria alone, however. Individual inflammatory response and risk factors also play important roles.

Periodontitis is therefore neither simply “tartar under the gums” nor a disease that can be dealt with permanently through a single cleaning appointment.

Gingivitis is inflammation of the gums without periodontitis-related loss of supporting tissues.

Periodontitis additionally involves loss of attachment and jawbone.

This distinction is important: gingivitis can generally resolve when plaque is effectively controlled. Periodontal supporting tissue that has already been lost does not automatically regenerate completely simply because inflammation is treated.

Early diagnosis is therefore important.

Periodontitis can remain relatively inconspicuous for a long time. Possible signs include:

• bleeding gums,
• red or swollen gums,
• gum recession,
• teeth appearing longer,
• bad breath,
• changes in the spaces between teeth,
• tooth migration,
• mobility of individual teeth,
• or discomfort when chewing.

These signs do not allow reliable self-diagnosis.

Bleeding gums do not automatically mean periodontitis. Conversely, advanced disease may be present even when the patient notices very little pain.

Diagnosis is based on several findings.

Periodontal examination

A periodontal probe is used to assess periodontal pockets and bleeding on probing, among other findings. This identifies sites of inflammation and the extent of involvement of the supporting tissues.

Radiographic diagnostics

Radiographs can help assess the condition of the bony periodontal support.

Three-dimensional CBCT (DVT) is not automatically required for routine periodontal diagnosis. Additional imaging is used only when a specific clinical question medically justifies it.

Staging and grading

Periodontitis is now classified by stage and grade.

The stage describes factors including extent, severity and complexity. The grade takes into account expected or observed progression and important risk factors.

This classification helps adapt treatment and follow-up to the individual situation.

People with similar amounts of plaque do not necessarily develop the same severity of disease.

Relevant factors include:

Smoking

Tobacco use increases the risk of periodontitis and can adversely affect treatment outcomes. Smoking history therefore forms part of periodontal risk assessment.

Diabetes mellitus

There is a two-way relationship between diabetes and periodontitis. Periodontal risk can be increased particularly when diabetes is inadequately controlled.

If you have diabetes, this should be taken into account during treatment planning.

Oral hygiene and biofilm control

Effective, sustainable home oral hygiene is a central requirement for treatment. Without adequate daily biofilm control, inflammatory processes are more difficult to stabilise over the long term.

Other individual factors

Age, genetic factors, general health, medication and local anatomical or restorative factors can also be relevant.

Modern periodontal therapy is not a single procedure but a structured treatment pathway.

The EFP guideline for Stage I–III periodontitis describes four consecutive treatment steps.

At the start, the diagnosis, causes and personal risk factors are discussed.

This includes in particular:

• understandable information about the disease,
• instruction in home oral hygiene,
• control of supragingival biofilm,
• professional removal of accessible deposits,
• support with smoking cessation where relevant,
• and consideration of good metabolic control in patients with diabetes.

This first step is not a cosmetic pretreatment. It establishes the basis for later therapy to work over the long term.

The second step involves mechanical removal of deposits and biofilm from periodontal pockets that require treatment.

Root surfaces are treated using suitable hand and/or powered instruments.

The aim is to reduce the microbial burden in the pockets and create conditions in which inflammation can subside.

The term “deep cleaning” only partly describes this step. It is targeted periodontal treatment based on a previously recorded periodontal examination.

After a healing period, the response of the tissues is reassessed.

Relevant periodontal findings are recorded again. Not every pocket responds in the same way.

If inflammation has been substantially reduced and the condition is well controlled, the patient can move into supportive maintenance.

If deep or inflamed residual pockets remain, it must be decided whether further treatment is needed.

Additional measures may be required for residual pockets or more complex defects.

Depending on the findings, these may include:

• repeat non-surgical instrumentation,
• periodontal surgical access,
• resective procedures,
• or regenerative procedures for selected defect types.

Not every patient needs a surgical third step.

The decision depends on residual pocket depth, signs of inflammation, defect morphology, whether the teeth are worth preserving and the patient's risk profile.

Long-term maintenance begins after successful active treatment.

Supportive periodontal therapy is not an optional extra but a central part of the treatment concept.

Depending on risk, it can include:

• examination of the gums and periodontal findings,
• review and adjustment of oral hygiene,
• professional biofilm control,
• treatment of problem areas,
• and early identification of changes.

Intervals are determined by individual risk and disease grade — not by a blanket rule such as “once a year”.

DG PARO emphasises that risk-based supportive therapy is required over the long term.

No.

Professional teeth cleaning can be an important preventive measure and can form part of supportive care. It does not replace systematic treatment of diagnosed periodontitis.

The distinction is especially important when there are periodontal pockets requiring subgingival treatment.

More about professional teeth cleaning

HELBO photodynamic therapy is available at the practice.

The procedure uses a photosensitiser together with light of a defined wavelength to influence microorganisms photochemically.

The medical context is important:

HELBO is neither standard nor replacement therapy for periodontitis at the practice. Dr. Hayim uses it only for selected patients and after an individual indication has been established.

The EFP S3 treatment guideline for Stage I–III periodontitis, which remains an important reference, does not suggest routine photodynamic adjunctive therapy with subgingival instrumentation.

More recent studies and meta-analyses continue to investigate possible additional effects in selected patient groups. This evidence does not amount to a general recommendation for every patient with periodontitis.

HELBO is therefore presented in our practice as a clinically selected adjunct, not the core treatment.

Waterlase iPlus, a hard-tissue laser system, is also available in the practice.

Laser procedures are studied for different periodontal applications and may be used as adjuncts in selected situations.

The same principle applies: systematic non-surgical therapy is based on biofilm control and subgingival instrumentation. The EFP guideline does not suggest laser as a routine adjunct to subgingival instrumentation.

The presence of a laser at the practice is therefore not used as a reason to replace standard treatment or promise a better result.

No.

The root surface and periodontal pocket environment is biologically complex. Responsible periodontal treatment cannot promise complete and permanent elimination of microorganisms.

Even with photodynamic or laser-assisted procedures, a statement such as “all bacteria are eliminated” would be medically too absolute.

The aim is instead to control disease-relevant biofilm and inflammation sufficiently to achieve periodontal stability and maintain it for as long as possible.

Not as a general rule.

Inflammation can improve substantially after successful non-surgical treatment. Periodontal supporting tissue that has already been lost does not, however, automatically regenerate completely.

In selected intrabony defects or other suitable anatomical situations, regenerative periodontal surgery may be considered.

Whether true regenerative treatment is appropriate depends on defect morphology, tooth prognosis, oral hygiene, risk factors and other clinical requirements.

A blanket statement that “bone grows back after periodontitis treatment” would therefore be misleading.

That depends on why the tooth is mobile and how much periodontal support remains.

If part of the mobility is caused by acute inflammation, stability may improve after successful treatment.

When there has been substantial loss of supporting tissues, the original anchorage cannot simply be restored completely.

Some teeth can remain functional for a long time despite reduced periodontal support. Others have a poor prognosis.

Each tooth is therefore assessed individually.

No.

The goal is to preserve teeth when this is medically reasonable and the prognosis is acceptable.

With very advanced bone loss, unfavourable fractures, inflammation that cannot be controlled or other serious factors, extraction of individual teeth may be appropriate.

Stage IV disease may additionally require complex functional and prosthetic rehabilitation. The current EFP Stage IV guideline therefore emphasises an often multidisciplinary approach.

More about dental restorations · More about dental implants

Current or previous periodontitis is also relevant to implant planning.

Active periodontal disease should be taken into account diagnostically and therapeutically before implant placement. After implant treatment, controlled oral hygiene remains important.

Periodontitis around natural teeth and peri-implantitis around implants are not the same disease, but they share relevant inflammatory and biofilm-related risk factors.

Dental implants in Essen-Rüttenscheid

The word “curable” can be misleading.

Active inflammation can be treated and the disease can often be stabilised. Previous attachment and bone loss remain part of the disease history, however, and the risk of renewed progression may persist.

Realistic treatment goals are therefore to:

• control inflammation,
• prevent or slow further tissue destruction as far as possible,
• stabilise teeth that can reasonably be retained,
• and secure the result through long-term maintenance.

Periodontitis should therefore be understood more as a chronic disease that can be controlled over time than as a problem that is “gone forever” after one cleaning.

Very important.

Smoking is one of the major modifiable risk factors for periodontitis. It can adversely influence disease progression and treatment outcome.

Professional periodontal treatment cannot simply technically “cancel out” the effects of smoking.

Support with smoking reduction or cessation therefore forms part of a risk-oriented treatment concept.

Diabetes and periodontitis can influence each other.

Inadequate blood-glucose control in particular can be associated with greater periodontal risk. Guidelines and professional organisations therefore emphasise periodontal health in people with diabetes.

If you have diabetes, it is useful to include current information about metabolic control in your medical history.

The dental practice does not replace specialist diabetes care.

Costs depend on diagnosis, insurance status and the required scope of treatment.

For patients with German statutory health insurance, the Federal Joint Committee's periodontal guideline regulates systematic periodontal therapy within contractual dental care. The current version has been in force since 1 July 2025.

According to current KZBV patient information, after active treatment the system includes structured supportive periodontal therapy over a defined period; frequency and specific measures depend, among other factors, on the established disease grade.

Private adjunctive procedures such as HELBO or selected laser applications need to be distinguished from this standard pathway.

Before any chargeable supplementary service, it should therefore be clear why it is being considered, what it is intended to supplement and what it will cost.

Dr. med. dent. J. Hayim M.Sc. holds a Master of Science in Oral Implantology and Periodontology.

He also holds a Master degree in laser dentistry from the University of Vienna.

These qualifications do not alter the core principle of this page: standard treatment follows the periodontal findings and a guideline-oriented pathway. Laser or photodynamic procedures do not automatically become the main treatment.

If periodontitis is suspected, diagnosis comes before treatment. The treatment plan is then based on the extent of disease, individual risk factors and how well the condition can be stabilised over the long term.

Dr. med. dent. J. Hayim M.Sc. Rüttenscheider Str. 194–196 45131 Essen

Phone: +49 201 48682900 Email: praxis@hayim.de

Patient communication and appointment scheduling are supported in German, English, French, Spanish and Turkish.

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The medical information on this page follows in particular the European Federation of Periodontology (EFP) S3 clinical guideline for treatment of Stage I–III periodontitis, current guidance for Stage IV disease, and current German periodontal-treatment framework information from DG PARO, KZBV and G-BA.

The role of adjunctive photodynamic and laser procedures is deliberately described conservatively. Their availability at the practice does not replace guideline-based biofilm control, subgingival instrumentation or supportive periodontal therapy.

Practice information about HELBO, Waterlase iPlus and Dr. Hayim's qualifications comes from verified clinic information. No guaranteed outcomes or claims of complete bacterial elimination are derived from device or manufacturer information.

Editorial review date: 8 August 2026. This page does not replace an individual periodontal examination, diagnosis, informed consent or treatment planning.