Changing concepts of periodontal treatment: surgical and non-surgical

Periodontal disease can be successfully treated by non-surgical procedures including supra- and subgingival scaling and root planing with hand or ultrasonic instruments. This non-surgical treatment is recommended for the initial management of all cases with the institution of a plaque control programme. Such management should be the basis of all periodontal therapy. The results obtained are mainly dependent on the skillfulness of the operator and the morphology of the pockets as well as upon patient related factors. Additional treatment, i.e. periodontal surgery, may be necessary if resolution of subgingival inflammation is not obtained. Pocket elimination by the use of surgical procedures (gingivectomy, flap operation with bone surgery) may be preferred in regions of the mouth where the aesthetic result is unimportant and where the removal of alveolar bone does not jeopardize the periodontal support of neighbouring teeth. In situations with deep infrabony pockets especially in anterior regions and in furcation areas a reconstructive surgical technique is the therapy of choice. Recent research in the field of guided tissue regeneration may, in the future, change the traditional approach to periodontal surgery.