Based on the enthusiastic acceptance of nonsurgical treatment and minimally invasive surgery in medicine and dentistry, the future for the discipline in periodontal treatment is bright. As improvements in visualization technology come to the marketplace, a minimally invasive nonsurgical approach will likely become the routine first step in periodontal therapy. With diligence and expert application, many if not most periodontal therapy may likely be performed nonsurgically. However, for the foreseeable future, there will almost certainly remain situations where surgical care will be necessary.
Goals and pitfalls of periodontal therapy
The basic tenants of periodontal therapy are unlikely to change no matter what physical approach is taken. There is almost universal agreement that periodontal diseases stem from the combination of microbiota and the body’s response to these microbiota and their byproducts. Part of treatment will be to balance this dynamic system to limit the insult to the tissue. At present, personal oral hygiene is important to remove local etiologic factors, but we have very little influence on the systemic response. Without the body’s defenses, we would rapidly lose teeth from periodontal diseases, and yet much of the destruction from periodontal diseases stems from this defense mechanism.
Periodontal therapy whether through a traditional approach or a minimally invasive approach is a process of minimizing the risk factors for periodontal destruction, repairing the destruction that has already occurred, and once we have repaired the damage, to keep the process from reoccurring. At the heart of our therapy is the debridement of the root, the reduction of the microbiological load within the sulcus/pocket, and stimulating periodontal regeneration. This chapter will look at how these goals may be addressed in the future through a minimally invasive approach.
There is a possibility that if the root surfaces could be completely debrided of calculus and biofilm, then “spontaneous” regeneration of periodontal tissues might result. When this is possible through a nonsurgical approach, surgical periodontal treatment could cease to be a necessity. The problem is that using traditional approaches in many instances, surgical access is currently necessary for complete debridement. The major problem facing nonsurgical periodontal therapy is the deficiencies in the current technology available for visualizing the pocket. A third generation of the glass fiber endoscope is scheduled for the introduction in the near future. This device will have the same basic technology as is currently available but will give a much clearer image. As mentioned in Chapter 2, the next step in improvement will most likely be the development of a miniature camera, similar to the one in the surgical videoscope but much smaller so that it can be placed into the intact sulcus/pocket. This is a technology that is available at this time but not currently economically practical. A videoscope for nonsurgical periodontal therapy will not change what is currently done with a glass fiber endoscope; but due to improved visualization, it should make the therapy much easier to perform.
Methods for the removal of root-borne deposits will also improve. One possible approach would be a device to detect calculus that could be used in combination with the videoscope. Wilson’s study on the near-universal associatio/>