What factors determine whether to treat with a prophylaxis or SRP in patients with gingival recession?

[Apexica]

I've seen patients that have normal probing depths but they also have gingival recession. Here's an example where the probing depth is normal (3 mm) but there is 3 mm of recession. That corresponds to 6 mm of clinical attachment loss.

Referring to this table:

That example would be a Stage 3 if going by clinical attachment loss (6 mm) but a Stage 1 if going by probing depth (3 mm). With our office's software, entering the Stage number automatically determines the treatment plan. A Stage 1 treatment would be prophylaxis and a Stage 3 would be SRP. So how should this situation be classified? Would you go by probing depth or by clinical attachment loss? Can this still be considered a Stage 3 and treatment planned with SRP even if you don't observe much calculus?

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[SuxDrugs&Rocuronium]

No. For there to be periodontitis present there must be at least two non adjacent sites with probing depths of >3. What you are explaining is gingival recession or periodontal health on a reduced periodontium. That patient gets a prophy (or perio maintenance if they have previously had srp)

 

[Apexica]

No. For there to be periodontitis present there must be at least two non adjacent sites with probing depths of >3. What you are explaining is gingival recession or periodontal health on a reduced periodontium. That patient gets a prophy (or perio maintenance if they have previously had srp)

I agree on the treatment. For the sake of classification, in that case above are you saying it's not considered periodontitis? Even with the 6 mm of attachment loss and bone loss extending to about halfway down the root? You would still consider that a Stage 1?

 

[SuxDrugs&Rocuronium]

This is from the 2017 classification:

CAL ≥ 3mm with pocketing ≥ 3mm is
detectable at ≥ 2 teeth but the observed CAL cannot be ascribed
to non-periodontitis related causes such as:

1. Gingival recession of traumatic origin
2. Dental caries extending in the cervical area of the tooth
3. Presence of CAL on the distal aspect of a second molar and
associated with malposition or extraction of a third molar
4. An endodontic lesion draining through the marginal
periodontium
5. The occurrence of a vertical root fracture