Kassebaum NJ, Bernabe E, Dahiya M Global burden of severe periodontitis in 1990-2010: a systematic review and meta-regression. J Dent Res. 2014; 93:1045-1053
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Matuliene G, Pjetursson BE, Salvi GE Influence of residual pockets on progression of periodontitis and tooth loss: results after 11 years of maintenance. J Clin Periodontol. 2008; 35:685-695
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Leow NM, Moreno F, Marletta D Recurrence and progression of periodontitis and methods of management in long-term care: A systematic review and meta-analysis. J Clin Periodontol. 2022; 49:291-313
Jenkins WM, Said SH, Radvar M, Kinane DF Effect of subgingival scaling during supportive therapy. J Clin Periodontol. 2000; 27:590-596
Cortellini P, Buti J, Pini Prato G, Tonetti MS Periodontal regeneration compared with access flap surgery in human intra-bony defects 20-year follow-up of a randomized clinical trial: tooth retention, periodontitis recurrence and costs. J Clin Periodontol. 2017; 44:58-66
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Step 3 for the treatment of periodontal diseases: non-regenerative periodontal surgery

From Volume 51, Issue 5, May 2024 | Pages 324-330


Viren Vithlani

BDS, MFDS RCS(Ed), BDS, MFDS RCS (Ed), MClinDent Periodontology (Hons), MPerio RCS (Ed)

General Dental Practitioner, AJ Moore and Associate, Long Eaton, Nottingham

Articles by Viren Vithlani

Email Viren Vithlani

Mark Ide

BDS, MSc, PhD, FDS(RestDent), FDSRCS(Eng), FHEA, BDS, MSc, PhD, FDS (RestDent), FDSRCS (Eng)

Professor/Honorary Consultant in Periodontology

Articles by Mark Ide


This article outlines the key aspects of considering non-regenerative periodontal surgery in step 3 of the UK version of the EFP S3-level clinical practice guidelines for the treatment of periodontitis. The third step of periodontal treatment is aimed at treating those sites that have not responded adequately, targeting non-responding or residual deep pockets. The purpose of non-regenerative surgery is to achieve access to root surfaces associated with residual pockets for further subgingival instrumentation, aiming to eliminate those lesions that add complexity to the management of periodontitis (such as infrabony defects, root concavities and furcations). At these localized sites, the main objective of periodontal surgery is to improve direct vision and access for professional instrumentation, to reduce or correct anatomical factors, partially regenerate lost periodontal tissue where possible, and ultimately create an environment that is easy and comfortable for the patient and the dental professional to maintain.

CPD/Clinical Relevance: Knowledge of the non-regenerative surgical treatment of Stage III and IV periodontitis patients is valuable for dental clinicians.


Periodontitis is major public health problem. It is the sixth most prevalent disease, making it the most common chronic inflammatory non-communicable disease of humans,1 affecting an estimated 743 million adults globally. The Global Burden of Disease 2017 study estimated that 11.2% of the population has severe periodontitis, with that figure shown to be increasing.2 The prevalence of mild to moderate disease is almost up to 50%, and higher (60%) in patients over 65.3 It accounts for a substantial amount of tooth loss and disability owing to the impact on aesthetics, chewing function, social inequality and quality of life. It untreated or inadequately treated, more years are lost to disability from periodontitis than from any other disease. In addition, on a global scale, economic analysis has shown that it is the third most costly disease behind diabetes and cardiovascular disease.4

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