Interclinician disparity in periodontal decision making: need for consensus statements on surgical treatment

The clinical factors involved in the decision-making process for surgical treatment have been described. However, there is still little standardization of the criteria upon which such a decision should be based. The impact of this lack of practice guidelines on the recommendation of surgery in clinical practice is unclear. The objective of the present study was to investigate the recommendation of surgical therapy during the corrective/reparative treatment phase by trained clinicians with various backgrounds on the basis of clinical data.

Fifteen clinicians (10 periodontal students and/or recent graduates from two dental schools and five experienced practitioners) were asked to make a treatment decision (surgery or no surgery) at a tooth level. Therefore, they were given 23 initially treated patients with details on demographics and smoking habits. Radiographs and clinical information on 573 teeth at baseline (prior to root debridement) and at 9 mo of follow-up were provided.

Clinicians interpret clinical data quite differently in their advice of surgery when practice guidelines are not provided, as the results showed high variation in surgical recommendation. Experienced practitioners showed most variation, with a range from 13 to 50% in surgical recommendation. Clinicians linked to a training center shared a common treatment philosophy as to when periodontal surgery should be performed. This philosophy differed markedly among the two dental schools. Most disagreement among the 15 clinicians was found for deep pockets and for multirooted teeth. Disease status, tooth type, age, and full-mouth plaque levels had a significant impact on decision making.

The substantial variation in recommending surgery calls for consensus statements on surgical treatment.