P4 Medicine as a model for precision periodontal care

Abstract

Objectives: P4 Medicine is based on a proactive approach for clinical patient care incorporating the four "pillars" of prediction, prevention, personalization, and participation for patient management. The purpose of this review is to demonstrate how the concepts of P4 medicine can be incorporated into the management of periodontal diseases (particularly periodontitis) termed P4 periodontics.

Methods: This is a narrative review that used current literature to explore how P4 periodontics can be aligned with the 2018 Classification of Periodontal Diseases, current periodontal treatment paradigms, and periodontal regenerative technologies.

Results: The proposed model of P4 periodontics is highly aligned with the 2018 Classification of Periodontal Diseases and represents a logical extension of this classification into treatment paradigms. Each stage of periodontitis can be related to a holistic approach to clinical management. The role of "big data" in future P4 periodontics is discussed and the concepts of a treat-to-target focus for treatment outcomes are proposed as part of personalized periodontics. Personalized regenerative and rejuvenative periodontal therapies will refocus our thinking from risk management to regenerative solutions to manage the effects of disease and aging.

Conclusions: P4 Periodontics allows us to focus not only on early prevention and intervention but also allow for personalized late-stage reversal of the disease trajectory and the use of personalized regenerative procedures to reconstruct damaged tissues and restore them to health.

Clinical significance: P4 Periodontics is a novel means of viewing a holistic, integrative, and proactive approach to periodontal treatment.

Keywords: P4 Medicine; Patient management; Periodontics.

Fig. 1

Stages of plaque-associated periodontal disease. Adapted, with permission from publisher, from Papapanou et al. [8]

Fig. 2

Grades of plaque-associated periodontal disease. Adapted, with permission from publisher, from Papapanou et al. [8]

Fig. 3

Incorporation of P4 Periodontics into the classification of plaque-induced periodontal disease

Fig. 4

Periodontal care and P4 periodontics. Incorporation of the principles of P4 medicine into periodontics. In this model, the management of plaque-associated periodontal disease can incorporate all of the elements of P4 medicine: personalization, prediction, prevention, and participation. Adapted, with permission from publisher, from Kornman et al. [22]

Fig. 5

The basis of this concept is that medicine should move from being a reactive to a proactive clinical approach for patient care

Fig. 6

Patient disease stratification will incorporate both periodontal and systemic parameters as well as response to treatment. Modified with permission from Kornman et al. [22]

Fig. 7

Workflow of customized scaffold design and fabrication, showing the different stages involving digital data acquisition, implant creation, internal design/porosity, and 3D printing