Surgical and non-surgical treatment of chronic periodontal disease

Khalaf F. Al-Shammari, DDS, MS, Rodrigo F. Neiva, DDS, Roger W. Hill, DDS, MS, and Hom-Lay Wang, DDS, MSD

Department of Periodontics/Prevention/Geriatrics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA

Purpose: The aim of this paper is to provide guidelines for treatment planning of chronic periodontal disease (CPD) based on an evidence-based approach to the available research data.
Materials and Methods: Critical appraisal of longitudinal trials developed for the comparison of different modalities of periodontal treatment is included.
Results: Treatment of CPD can be broadly classified into either surgical or non-surgical approaches. Non-surgical therapy includes plaque control, supra- and subgingival scaling, root planing (SRP), and the adjunctive use of chemotherapeutic agents. Surgical therapy can be divided into either resective or regenerative procedures. The majority of articles reviewed agree that when adequate access for root debridement is achieved, non-surgical treatment of CPD seems to be as effective as surgical treatment in the long-term maintenance of clinical attachment levels (CAL). SRP is limited by the presence of furcation involvements, deep pocket depths, and root anatomy.
Conclusion: Decision-making in periodontal therapy requires a thorough understanding of the long-term outcomes of all available treatment modalities. Studies have consistently shown that SRP can provide similar improvements of clinical attachment levels when compared to surgical treatment. However, several factors need to be considered when deciding on which treatment approach to select for the treatment of chronic periodontal disease. (Int Chin J Dent 2002; 2: 15-32.)