Current Views on Periodontal Therapy

The more things change, the more they remain the same. Although periodontal therapy has undergone many changes in the past decade, the basics of periodontal therapy remain the same. Periodontal disease is primarily a bacterial infection. No matter what therapeutic modality is used, the main goal of therapy must be to reduce and then maintain the bacterial load at a level that the host (patient) can successfully defend. It may, in fact, be true that the most important factor in successful periodontal therapy is not the therapeutic modality, but the post-treatment maintenance program.

During the past decade, the research on and treatment of periodontal disease has been heavily weighted toward regeneration. Periodontists were quick to jump on the bandwagon of regeneration as the "new and improved" treatment of periodontitis. At previous national periodontal meetings, a significant number of the lectures were about using periodontal membranes to regenerate lost periodontal structures. In the evening, companies gave lavish parties to promote their regeneration products.

At the most recent national periodontal meeting, very few of the lectures were about regeneration using periodontal membranes. No lavish parties were given, and one company was even giving away their membranes. Their profits were down, and they were no longer planning on selling membranes for regeneration.

The point is not to denigrate the use of periodontal membranes. The use of membranes for regeneration does have its place in the armamentarium used to treat periodontal disease. However, time has shown that periodontal regeneration with membranes is not the panacea we had all hoped for. Time has again proven that the standard treatment modalities for periodontal therapy may still be the most effective. This is not to say that future therapeutic modalities will not bring about significant changes in the way we treat periodontal disease. However, at the present time, the standard therapeutic modalities are the only methods that have stood the test of time. Therefore, this issue of the Journal of the California Dental Association is dedicated to reviewing some of the standard therapeutic modalities used in the treatment of early to moderate periodontitis.

As a review of the current views about periodontal regeneration, Dr. William Becker discusses regeneration of lost periodontal structures using different materials. Dr. Becker has been involved with much of the research regarding periodontal regeneration. He reviews current literature regarding regeneration and discusses whether regeneration is really possible.

Dr. Greg Filippelli and I discuss osseous resective surgery as a surgical treatment option to treat early to moderate periodontitis. While the concept of pocket reduction is a fundamental objective of periodontal therapy, traditionally, there has been discussion and controversy associated with the different treatment methods utilized. Dr. Filippelli and I address this controversy, as well as discuss surgical pocket therapy directed toward pocket reduction through recontouring the underlying bone.

Dr. Perry Klokkevold discusses the new approaches to the diagnosis and treatment of periodontal disease in light of dentistry's improved understanding of the pathogenesis and appreciation for the influence of host factors.

Finally, Dr. Handelsman, Dr. Ravon, and I discuss surgical crown lengthening. Surgical crown lengthening is one of the most important periodontal surgical therapies, yet seems to be one of the least performed. Dr. Handelsman, Dr. Ravon and I discuss the indications for crown lengthening, as well as several of the benefits of completing it prior to final preparation of the permanent restoration.

It is hoped that these articles will help bring the reader up to date on some of the current views on these topics. It is important to be aware that some of these topics were included in this journal because it was believed that they would bring about controversy. It is hoped that through discussion of the controversies, we may all expand our knowledge of the treatment of periodontal disease. Whether you strongly agree or disagree with the position of the articles in this journal, if something is learned, my goal in putting this journal together has been reached.