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References

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Tonetti MS, Jepsen S, Jin L, Otomo-Corgel J Impact of the global burden of periodontal diseases on health, nutrition and wellbeing of mankind: A call for global action. J Clin Periodontol. 2017; 44:456-462 https://doi.org/10.1111/jcpe.12732
Billings M, Holtfreter B, Papapanou PN Age-dependent distribution of periodontitis in two countries: findings from NHANES 2009 to 2014 and SHIP-TREND 2008 to 2012. J Clin Periodontol. 2018; 45:S130-S148 https://doi.org/10.1111/jcpe.12944
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Sanz M, Herrera D, Kebschull M Treatment of stage I-III periodontitis-The EFP S3 level clinical practice guideline. J Clin Periodontol. 2020; 47:4-60 https://doi.org/10.1111/jcpe.13290
Wennstrom JL, Tomasi C, Bertelle A, Dellasega E Full-mouth ultrasonic debridement versus quadrant scaling and root planing as an initial approach in the treatment of chronic periodontitis. J Clin Periodontol. 2005; 32:851-859 https://doi.org/10.1111/j.1600-051X.2005.00776.x
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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 https://doi.org/10.1111/j.1600-051X.2008.01245.x
Siow DSF, Goh EXJ, Ong MMA, Preshaw PM Risk factors for tooth loss and progression of periodontitis in patients undergoing periodontal maintenance therapy. J Clin Periodontol. 2023; 50:61-70 https://doi.org/10.1111/jcpe.13721
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 https://doi.org/10.1111/jcpe.13553
Jenkins WM, Said SH, Radvar M, Kinane DF Effect of subgingival scaling during supportive therapy. J Clin Periodontol. 2000; 27:590-596 https://doi.org/10.1034/j.1600-051x.2000.027008590.x
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 https://doi.org/10.1111/jcpe.12638
Loos BG, Needleman I Endpoints of active periodontal therapy. J Clin Periodontol. 2020; 47:61-71 https://doi.org/10.1111/jcpe.13253
Caton JG, Armitage G, Berglundh T A new classification scheme for periodontal and peri-implant diseases and conditions - Introduction and key changes from the 1999 classification. J Clin Periodontol. 2018; 45:S1-S8 https://doi.org/10.1111/jcpe.12935
Bertl K, Pandis N, Stopfer N The impact of a “successfully treated stable periodontitis patient status” on patient-related outcome parameters during long-term supportive periodontal care. J Clin Periodontol. 2022; 49:101-110 https://doi.org/10.1111/jcpe.13582
Smiley CJ, Tracy SL, Abt E Systematic review and meta-analysis on the nonsurgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts. J Am Dent Assoc. 2015; 146:508-524 https://doi.org/10.1016/j.adaj.2015.01.028
Suvan J, Leira Y, Moreno Sancho FM Subgingival instrumentation for treatment of periodontitis. A systematic review. J Clin Periodontol. 2020; 47:155-175 https://doi.org/10.1111/jcpe.13245
Caffesse RG, Sweeney PL, Smith BA Scaling and root planing with and without periodontal flap surgery. J Clin Periodontol. 1986; 13:205-210 https://doi.org/10.1111/j.1600-051x.1986.tb01461.x
Heitz-Mayfield LJ, Trombelli L, Heitz F A systematic review of the effect of surgical debridement vs non-surgical debridement for the treatment of chronic periodontitis. J Clin Periodontol. 2002; 29:92-102 https://doi.org/10.1034/j.1600-051x.29.s3.5.x
Graziani F, Karapetsa D, Mardas N Surgical treatment of the residual periodontal pocket. Periodontol 2000. 2018; 76:150-163 https://doi.org/10.1111/prd.12156
Ribeiro FV, Casarin RC, Palma MA Clinical and patient-centered outcomes after minimally invasive non-surgical or surgical approaches for the treatment of intrabony defects: a randomized clinical trial. J Periodontol. 2011; 82:1256-1266 https://doi.org/10.1902/jop.2011.100680
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Ammons WF, Smith DH Flap curettage: rationale, technique, and expectations. Dent Clin North Am. 1976; 20:215-226
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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

Authors

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

Abstract

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.

Article

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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