Non-surgical Periodontal Treatment: SRP and Innovative Therapeutic Approaches

Periodontitis is a major public health problem, that can have local and systemic consequences ranging from tooth loss to the aggravation of other chronic diseases. The consequences of which have an impact on patient's overall general health and quality of life. Periodontal treatments include a large range of techniques and concepts from plaque control to periodontal debridement, surgery and regeneration. Regardless of the treatment proposed, it always begins with the same first essential simple step that is etiological therapy which includes oral hygiene management and the control of periodontal risk factors. The aim of this first step, presented in this chapter, consists mainly in reducing oral bacterial load and inflammation by the means of daily oral hygiene methods and sub-gingival biofilm disruption. Although understanding of the pathogenesis and molecular and cellular mechanisms involved in periodontitis has increased, treatment wise, non-surgical debridement remains the keystone of every periodontal treatment and supportive periodontal therapy. Once risk factors are monitored and plaque control mastered by the patient, root instrumentation can be performed with hand or power-driven instruments. However effective, sub-gingival biofilm disruption has some limits and can be improved with adjunctive therapies such as antiseptics, antibiotics, air polishing or other emerging devices and therapies. Unfortunately, the lack of clear clinical guidelines, concerning these adjunctive therapies, still remains, thus pointing out the necessity of more standardized clinical studies. Also, if some patients can return to a healthy periodontal state, most periodontal patients will remain at periodontal risk for life. Proper assessment of the patient's periodontal risk will help establish correct monitoring of patients successfully treated for their periodontal disease.