New ideas and advancing technologies in periodontology: surgical options with advancing technologies

Extensive clinical studies over the last two decades have documented the effectiveness of both non-surgical and surgical periodontal therapy. When deemed necessary, surgery is usually performed as an elective phase of therapy, within a programme of ongoing maintenance care. Traditionally surgical therapy has been aimed at the treatment of the periodontal pocket by resective procedures. However, research has now focused on reconstructive surgery, with the objective of regenerating the structure of the lost periodontium (cementum, periodontal ligament and also alveolar bone). With advancing technology, materials and surgical modalities that have been advocated to facilitate periodontal reconstruction fall into the following main categories: 1. Chemical and biochemical conditioning agents, e.g. citric acid, fibronectin, tetracycline, growth and differentiation factors. 2. Transplants of autogenous or allogeneic (osteogenic or osteoinductive) materials, e.g. osseous coagulum, decalcified freeze-dried bone allograft. 3. Implants of alloplastic (osteoconductive) 'filler' materials, e.g. hydroxyapatite, tricalcium phosphate. 4. Guided tissue regeneration (GTR) utilising membranes, e.g. Teflon (e-PTFE), collagen, polylactic acid. 5. Combined techniques, e.g. GTR and allograft/alloplast. The scientific evaluation and the role of these reconstructive surgical procedures in contemporary dental practice is discussed in this paper.