|
The EFP S3-level clinical practice guideline has been enormously valuable in bringing consistency and evidence-based structure to periodontal care.
It defines a treatment endpoint as aiming for no pockets >4 mm with bleeding on probing and very low overall inflammation. This sets an appropriately ambitious target for periodontal health.
But it also raises an important clinical question:
Should this endpoint always be interpreted as a mandatory threshold for further intervention, or should it be viewed as an ideal target rather than an absolute requirement for stability?
This question has become increasingly interesting in light of emerging evidence on treatment endpoints and long-term outcomes.
A landmark position paper by Loos and Needleman (2020) highlighted that residual deep pockets (particularly ≥6 mm) and higher inflammatory burden are associated with increased risk of disease progression and tooth loss. This reinforces what many clinicians recognise intuitively: not all residual pockets carry equal significance.
More recently, a 10-year cohort study by Schröder et al (2025) explored whether “less than perfect” endpoints might still support long-term periodontal stability.
Interestingly, patients achieving moderate clinical endpoints, allowing limited residual pockets ≥5 mm, showed similar tooth loss outcomes to those achieving the strictest endpoint of periodontal health, provided disease burden remained controlled.
This does not weaken the importance of aiming high. Rather, it may suggest a more applicable question:
Is periodontal success defined by eliminating every residual defect, or by reducing disease to a level where risk is acceptably controlled and maintainable?
This is particularly relevant in everyday practice, where many patients do not fit idealised models. Residual pockets may persist despite excellent treatment, yet remain stable over time within a well-maintained, low-inflammatory environment.
It may be that the most meaningful threshold lies not in the presence of any residual 5 mm site, but in the extent of residual disease, the presence of ≥6 mm pockets, inflammatory burden, and critically, stability over time.
For the referring general dental practitioner, this has practical implications:
- Not every residual pocket necessarily signals treatment failure
- Stability may sometimes be a more important endpoint than perfection
- Supportive periodontal care remains central to long-term outcomes
- Re-intervention decisions may increasingly be guided by risk, not pocket depth alone
These questions sit at the heart of modern “treat-to-target” thinking in periodontology and are likely to shape how endpoints are interpreted in the years ahead.
| 
