In general 80% of patients will respond to routine therapy, but the problem remains: what do we do about those who do not respond? Are there new developments currently available or on the horizon that will also later what we now accept as being routine therapy, meaning that more patients will respond to treatment and that treatment might either be less invasive, or more predictable, or both?

There is mounting evidence that patients who so-called refractory periodontitis might be hyper-immune. As such, novel approaches to managing these patients will likely include host modulation therapy (using a collagenase inhibitor such as Periostat®), anti-inflammatory treatment (in combination with host modulation therapy), both of which can be combined with mechanical treatment (scaling and root planning and /or surgery) to effect better outcomes.

Learning Objectives:

• Understand refractory periodontitis and the novel approaches available for better outcomes
• Review the administration and side effects of both systemic and locally administered antimicrobial (LAAs)
• Identify the needs for adjunctive topical therapies for the patient when clinical improvements of periodontitis have been observed
• Identify new trends in therapy, their potential for complications and the potential for a novel approach to managing periodontitis
• Understand how novel periodontal therapies might impact general health