Therapeutic Options

Overview

The sixth learning objective of this course is to evaluate whether bone preserving/augmenting strategies meet periodontal health goals. The dental professional's recommendations to the patient for plaque control procedures and products are essential to achieving the goal of a healthy periodontal attachment for life. Likewise, non-surgical approaches such as scaling and root planing (SRP), locally-delivered sustained-release antimicrobials and sub-antimicrobial systemic tetracyclines have been proven to improve periodontal health (measured by factors such as reduced pocket depth, increased attachment levels, increased bone, decreased need for surgical therapies) in prospective, randomized, controlled clinical trials, the gold standard of evidence-based practice. Most surgical therapies have been clinically evaluated by the results of a series of case reports and the outcomes of research with animal models. In general, surgical therapy trials cannot be double-blinded and clinical outcomes may be less predictable due to variability in factors such as practitioners' skill, experience, bias, procedures, reproducibility of outcome measures, etc. Additionally, there may be a lack of consensus as to what constitutes acceptable periodontal health. Some may consider the retention of teeth and the absence of the signs of infection as acceptable endpoints. Others may consider optimum bone height as important. Despite these controversies and concerns, periodontal osseous and regenerative surgical therapies provide an option that is very effective for many appropriate patients. Surgical and non-surgical therapies can work together to meet patients' needs in managing a chronic, non-curable disease; although currently long term clinical data is mixed when comparing the outcomes of surgical therapies with those of non-surgical therapies.10 Most agree that the goal for all periodontal therapies is to reduce, eliminate and/or repair the damage to the periodontal structures resulting from the deleterious effects of the host response to pathogenic organisms.