Most forms of periodontal disease are plaque-associated disorders, so it is understood that surgical access procedures can be considered only as adjunctive to specific therapy. In other words, it is imperative to eliminate the causative condition to the extent possible before initiating the surgical phase of treatment. Periodontal diseases are plaque/biofilm-induced chronic inflammatory conditions. The etiology is infection; specific pathogens in supragingival plaque accumulate around the tooth and inside the periodontal pocket subgingivally. The host’s susceptibility, manifested by an exaggerated inflammatory response, also is a factor in tissue breakdown. Periodontal pathogenic microorganisms in people with hyperinflammatory genotypes may amplify the local inflammatory response, which may result in the characteristic severe tissue destruction seen in patients with advanced periodontitis.

The increased inflammatory response to plaque accumulation in susceptible hosts increases overgrowth of opportunistic microbiota.¹ Furthermore, environmental and systemic risk factors, such as smoking and diabetes, can worsen the expression of periodontal disease.²