Abstract
BACKGROUND: Periodontitis requires long-term management to prevent recurrence and tooth loss. While active periodontal therapy (APT) aims to reduce probing pocket depth (PPD) and improve clinical attachment level (CAL), strict supportive periodontal care (SPC) is essential for maintaining these clinical outcomes. This study systematically reviewed the long-term benefits of APT interventions (test groups) compared to standard control interventions (control groups) in patients undergoing SPC as part of randomized controlled trials (RCTs). METHODS: A systematic search of databases and journals identified RCTs with a minimum follow-up of 10 years. Studies comparing APT interventions, such as regenerative techniques, to standard care in patients adhering to SPC were included. Primary outcomes assessed included tooth loss, and secondary outcomes included PPD reduction, CAL gain, and patient-reported outcome measures (PROMs). Descriptive analyses were undertaken on all studies, and meta-analyses were conducted to analyze the weighted mean differences (WMDs) for PPD, CAL, and tooth loss between test and control interventions when appropriate. RESULTS: From an initial screening of 4582 articles, 9 were deemed suitable and included for descriptive analyses. Four publications of 3 studies were included in meta-analyses comparing guided tissue regeneration (GTR) and open flap debridement (OFD) over a 10-to 20-year SPC follow-ups. Regenerative techniques demonstrated significant CAL gains at 1-year follow-up compared to control groups. At 10 to 20 years, PPD and CAL outcomes were comparable between groups. Tooth loss was minimal across all groups. Variability in SPC protocols and operator experience may have influenced outcomes. CONCLUSIONS: Long-term periodontal stability does not appear to be affected by the choice of initial intervention in patients who adhere to a rigorous SPC program. While regenerative techniques offer short-term advantages, their long-term benefits may reduce in comparison to non-regenerative methods under SPC. Future research should focus on standardized SPC protocols and cost-effectiveness to optimize periodontal care. PLAIN LANGUAGE SUMMARY: Periodontitis is a chronic immune-inflammatory condition that can lead to increased risk of tooth loss if not managed. Treatment such as non-surgical periodontal therapy (NSPT), adjunctive therapies, or various surgeries can improve periodontal health. This systematic review examined randomized controlled trials (RCTs) where patients received different periodontal treatments and were then followed up for ≥10 years while attending maintenance visits. Periodontal surrogate and true endpoints were compared between the test and control groups. The findings suggest that long-term outcomes were similar between groups, provided patients remained in consistent maintenance care. This highlights that the key to long-term success is not necessarily which active treatment is used, but possibly the adherence to structured maintenance. These results allow clinicians and researchers to understand the types of treatments that may have lasting benefits and reinforces the importance of long-term care in preventing disease progression.