As described in Chapter 22, non-surgical root surface instrumentation is effective in controlling periodontal disease in many situations. Nonetheless there are limitations as to what can be achieved and in specific circumstances surgical techniques have a role to play in disease management (Figs 24.1, 24.2). Non-surgical techniques are generally most effective in shallow and moderate pockets and less so in deep pockets (greater than 6 mm). However, there is no absolute cut-off depth of pocket at which non-surgical debridement is ineffective. Nonsurgical therapy may be unable to achieve thorough root debridement if there is reduced access to a pocket or if furcation defects or root grooves are present.
Thorough non-surgical therapy should be used in the first instance and the outcome assessed. If a site fails to respond to non-surgical debridement (indicated by suppuration, bleeding, loss of attachment, or persistent or increasing pocketing) it may be amenable to surgical intervention (Fig. 24.3).
Periodontal surgery can be used to:
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