Clinical and radiographic long-term study of teeth with periodontal destruction treated by a modified flap operation

Forty-three patients with severe periodontal destruction were treated by a modified flap operation and their periodontal condition reassessed about 4 years later. The aim of the study was to see what would happen to the periodontium when the responsibility for oral hygiene was left to the patients themselves. Before the operation the importance of plaque in the etiology of periodontal disease was explained to the patients. They were requested to return for reexamination every 6 months, but no recall system was used. A highly significant reduction in the depth of the gingival pockets was achieved and the average loss of bony support during the observation time was only 0.3 mm. However, an increased bleeding index, loss of marginal bone and deepening of the gingival pockets were found around teeth provided with artificial crowns, especially when the crowns had ill-fitting margins extended into the gingival pocket.