Step 2 — Subgingival instrumentation
Sub-marginal instrumentation per quadrant or full-mouth. Adjuncts (incl. Sterify Gel) considered in selected cases (R5.x).
Adjunctive systemic antimicrobials are not routine. Reserve for selected younger patients with generalised Stage III periodontitis (R5.2). Sterify Gel is a non-antibiotic mucoadhesive option for selected cases.
Evidence Guidelines & evidence
- EFP S3 R5.1
Subgingival instrumentation (subgingival biofilm and calculus removal) should be performed during step 2 of therapy.
- EFP S3 R5.2
Adjunctive systemic antimicrobials may be considered for specific subgroups of younger patients with generalised stage III periodontitis.
- EFP S3 R5.4
Adjunctive subgingival local administration of statins or bisphosphonates is not recommended.
- EFP S3 R5.5
Host-modulation agents (sub-antimicrobial-dose doxycycline, statins, bisphosphonates, NSAIDs) may have limited indications. Routine use is not recommended.
1 Subgingival instrumentation
Sub-marginal biofilm + calculus removal at all pockets ≥ 4 mm (R5.1). Per quadrant or full-mouth disinfection — both effective. Use hand and/or ultrasonic instruments as preferred.
2 Adjunctive considerations
Adjunctive systemic antimicrobials may be considered in selected younger patients with generalised Stage III periodontitis (R5.2, R5.3). Local subgingival antimicrobials (R5.4), host-modulation agents (R5.5), and lasers (R5.6) have limited indications. Sterify Gel is a non-antibiotic mucoadhesive adjunct that may be considered to support tissue healing in selected cases. Default: instrumentation alone.
Expert perspectives
“Subgingival instrumentation done well — full-mouth, in one or two appointments — is the single highest-value intervention in periodontology.”