Surgical vs.

Non-Surgical Periodontal Treatment

A Comparative Report


DHB
Endo-Perio SS

Dominguez, Isabel Beatrice
Buela, John Christian
Dianati, Maryam
Esteban, Royce Albert
Guarin, Francis James
Mashalian, Dara
Pastores, Reginald Dwight
Pauco, Allen
Posada, Reagan
Shiroudeskandari, Fatemeh

Dr. Yvonne Vanessa Chua

Introduction

Periodontal treatment, as we all know, constitutes an array of procedures that are needed for the
betterment of the surrounding structures of the tooth. Procedures are grouped into two ways in
which a dental practitioner may control periodontal disease; the Non-Surgical and the Surgical
modes of treatments
In this brief report, we will discuss the numerous procedures and treatment modalities
done in both groups and compare the advantages and disadvantages of each.

Non-Surgical Periodontal Treatment
Non-Surgical Periodontal Treatment is considered as a non-invasive way to handle
periodontal disease which deals with less damage to surrounding tooth structure.
Treatment methods depend upon the type of disease and how far the condition has
progressed. Many times, the early stages of periodontal disease are best treated with non-
surgical periodontal therapy.
AAP treatment guidelines stress that periodontal health should be achieved in the
least invasive and most cost-effective manner.
This is often accomplished through non-
surgical periodontal treatment.
Non-surgical periodontal treatment
does have its limitations. When it does not
achieve periodontal health, surgery may be
indicated to restore periodontal health. The
following are treatment protocols classified
under Non-Surgical Periodontal treatment

Plaque Control
Mechanical plaque control, as measured by the oral hygiene effort of the
individual patient, is the most important predictive factor in determining
the overall prognosis of the treatment therapy. It is very critical in every
phase of therapy that plaque control must be maintained and preferrably
with plaque free result. It is an effective way of treating and preventing
gingivitis, periodontitis, and perhaps any microbial etiology disease as
related to oral health. (Bui, D; 2001)
Supra/Subgingival Scaling (SRP)
Scaling and root planing is a careful cleaning of the root surfaces to
remove plaque and calculus [tartar] from deep periodontal pockets and to
smooth the tooth root to remove bacterial toxins. Scaling and root planing
is often followed by adjunctive therapy such as local delivery
antimicrobials and host modulation, as needed on a case-by-case basis.
Most periodontists would agree that after scaling and root planing, many
patients do not require any further active treatment. However, the majority
of patients will require ongoing maintenance therapy to sustain health.
Exodontia
the removal of a tooth from themouth. Extractions are performed for a
wide variety of reasons, including tooth decay that has destroyed enough
tooth structure to render the tooth non-restorable.
Endodontics
The dental specialtyconcerned with the study and treatment of the dental
pulp. Endodontists perform a variety of procedures including endodontic
therapy (commonly known as "root canal therapy"),endodontic
retreatment, surgery, treating cracked teeth, and treating dental trauma.
Root canal therapy is one of the most common procedures. If the dental
pulp (containingnerves, arterioles, venules, lymphatic tissue, and fibrous
tissue) becomes diseased or injured, endodontic treatment is required to
save the tooth.
Occlussal Adjustments
Occlusal adjustment is the scientific grinding and/or reshaping of the
occluding surfaces of teeth to develop and improve upon their harmonious
relationships between each other, their supporting structures, muscles of
mastication, and temporomandibular joints.
Temporizations
Minor Tooth Movement
Re-Evaluation
Re-evaluation is done as a routine check-up to schedule patients according
to the need of recall and the severity of the disease. Some patients may
need more routine check-ups than most.
Advantages and Disadvantages
Mainly non-invasive, technique sensitive with a more hectic recall schedule and
monitoring. When nonsurgical therapy has been insufficient in controlling inflammation
and disease progression in periodontal patients, it is time to call in the specialist for
periodontal surgery.
An indication for immediate referral is when the extent, severity,
and progression of the disease are so severe the general dentist knows scaling and root
planing alone will not combat the disease process and the treatment modalities will far
exceed what can be achieved through nonsurgical periodontal therapy. (Illyes, K; 2000)

Examples


Scaling and Root Planing



Surgical Periodontal Treatment
In advanced cases of periodontal disease, the first line of treatment, scaling and root
planing, combined with excellent home care to keep new bacterial deposits from forming,
is sometimes not enough to bring the disease under control. In some cases, periodontal
surgery is necessary.
Surgery is only rarely needed to control periodontal diseaseHowever, when
there is periodontal disease, and the gum has unzipped so far down the root of the tooth
that dental instruments are no longer effective (about 5-6 millimeters), periodontal
surgery may be necessary. If not done, the bacterial deposits will remain on the tooth and
cause further bone destruction; ultimately causing the teeth to develop painful abscesses
or simply to loosen and fall out.
The following procedures are classified as Surgical periodontal procedures
Orthodontic Treatment
Periodontal Surgery
o Periodontal Flap Surgery
o Mucogingival Surgery
o Regenerative Surgery
o Implant Surgery
Continuation of Endodontic Therapy
Reevaluation of Teeth and Periodontium
Implant Surgery and Final Restoration
Advantages and Disadvantages
General consideration for periodontal surgery comprise patient age and status of
the dentition including importance of the tooth, amount of attachment/bone
present, probing depth, and long term prognosis. Three advantages for
periodontal surgery consist of access to enhance root debridement, particularly in
multi-rooted teeth, improved access for plaque control by the patient during home
care, and esthetic improvement for certain types of procedures (root coverage
grafting).
Periodontal surgeries are not indicated for all patients even with advanced
periodontal disease. Contraindications include uncontrolled medical conditions
such as unstable angina, uncontrolled hypertension, uncontrolled diabetes,
myocardial infarction or stroke within 6 months; poor plaque control; high caries
rate; and unrealistic patient expectations or desires. (Illyes, K; 2000)
Examples
Gingivectomy
Osseous Surgery
Guided Tissue Regeneration

Crown Lengthening Procedure

Indications for Surgical Procedures
Periodontal Flap surgery For management of periodontitis
Mucogingival surgery For correcting periodontal defects
Regenerative surgery For regenerating periodontal structures

Factors that influence the response to surgery
- Medical Conditions
- Psychological Conditions
- Smoking
- Poor oral health
- Morphology
- Aggressive Periodontitis

Detailed Comparison
A study according to Al-Shammari, K et. al was able to tabulate and compare both
procedures according to different studies across the globe

In this table the different surgical techniques sited were compared in years as to the
outcome of the treatment in 1 to 5 years time as indicated.
The author collected data from both Sweden and Denmark. The results show that,
Apically Positioned Flap, Modified Windman Flap alongside Scaling and Root Planing
with or without Osseous Recontouring results in an overall gain in Clinical Attachment
Level and better Oral Health as well as reduction of Pocket Depths within the span of 2-5
years.







This table mentions the significant comparison of surgical and non surgical, which
basically share almost the same results and product of therapy.

Indications and Contraindications
Indications for Surgical Technique
Age: < 40 (The younger
generation)
Pockets: > 7 mm
Fibrous gingiva/ Deep
Pockets
Hyperplastic gingiva
Furcations > Class II
Restricted access to root
anatomy
Failure of previous SRP
Calculus: Diffuse/Embedded
Hypercementosis
Contraindications for Surgical
Technique
Age: > 70 (The older
generation)
Poor Oral Hygeine
Smoking: > 2 Packs
Pockets < 6 mm
Refractory disease
Indications for Non-Surgical
Technique
Poor Oral Hygeine
Smoking: > - 2 Packs
Significant Systemic Disease
Pockets: < 6 mm
Significant systemic disease
Inflammed edematous
gingiva
Contraindications for Non-Surgical
Technique
Fibrous gingiva/deep pockets
Hyperplastic gingiva
Hypercementosis
Hard to reach calcular
infiltration
Difficult tooth morphology


Conclusions:
Is periodontal surgery better than non-periodontal surgery?
In molar furcations, premolar grooves and inaccessible anterior sites which may not respond well
to conservative scaling, however; with good oral hygiene, good oral debridement may be able to
make the conservative approach more successful.
Surgery results in greater short-term probing depth compared to non-surgery, however, the
probing depth advantage is lost over time. In shallow pockets, surgery creates greater loss of
attachment compared to non-surgery.

References
Al-Shammari, K et. al (2002). Surgical and Non-surgical Treatment of Chronic
Periodontal Disease. International Chinese Journal of Dentistry . Retrieved February 6,
2014
Illyes, K., (2000). Non-Surgical Periodontal Therapy. to: University of Tennessee Health
Science Center
Caranza, Newman. Textbook of clincal periodontology. Eighth edition. WB Saunders,
1996.
Grant, Stern, Listgarten. Textbook of Periodontics. Sixth Edition. The C.V. Mosby
Company, 1988.
Genco, R., Goldman, H., Cohen, W. Contemporary Periodontics. The C.V. Mosby
Company , 1990.