Page 11 - IDX-DecisionTree-Booklet-Digital

Step 4

Adjunctive Systemic Antimicrobials Re-evaluation
(When indicated) (~4-6 Weeks Post-Therapy)

• Re-chart pocket depths, BOP, suppuration.
• If available, re-test microbial load (especially
red/orange/green/purple complex counts) to
assess reduction.
• Evaluate response: if pockets reduced (e.g., ≤4–5
mm, minimal BOP), hygiene stable, transition to
Step 6 (Maintenance Phase).
• If deep pockets (≥6 mm) with BOP/suppuration
or persistently elevated microbial load → proceed
to Step 5.
• Follow Up

Step 5

Advanced/Surgical
or Intensified Therapy

• For residual sites: surgical access (open flap
debridement) to facilitate subgingival cleaning,
granulation tissue removal, root/implant surface
decontamination.
• Incorporate adjuncts: local antimicrobials
(minocycline microspheres, doxycycline gel), laser
treatment (e.g., Nd:YAG or Er:YAG) for deep pockets
or implants.
• Consider host-modulation therapy (e.g., sub-
antimicrobial dose doxycycline) when systemic
inflammatory burden exists.

• After surgery or intensification, move to
maintenance phase with short recall intervals.