Regenerative techniques in periodontal therapy

The remarkable ability of the periodontium to repair once the long-term etiologic factors have been eliminated is now belatedly being recognized as a key consideration in periodontal therapy. This will force many practitioners interested in comprehensive periodontal treatment to reconsider the classic resective approach to pocket elimination. Resective techniques have been and will probably remain the foundation of periodontal therapy for some time to come. However, the knowledge that is now available concerning the reparative potential of the periodontium opens new treatment avenues for selected patients. In addition, as more research and clinical information becomes available, we can anticipate that the philosophy of repair will play an ever-increasing role in the therapeutic approach to periodontal treatment. This fact should not make the practitioner who is secure with his present treatment philosophy uncomfortable, since the required therapeutic modifications can easily be incorporated into the office routine without confusion. If the clinician then completes each step of the treatment plan with close attention to detail, regeneration will occur in many cases. It should be reiterated that many of the concepts introduced in this paper are based on the authors' clinical observations and are applicable only to select patients. Admittedly, basic research on this subject is sparse, however, the efficacy of this treatment modality has been well substantiated clinically by many therapists. The authors estimate that regenerative therapy is utilized in 10 to 20 per cent of their patients. They believe it is the therapeutic program of choice in many cases showing extensive periodontal destruction, since an innovative and skilled therapist treating a well motivated patient can utilize regenerative periodontal therapy in conjunction with sophisticated restorative dentistry in order to avoid complete dentures.