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Dr. Parvez A. Khan

Authors : Dr. Parvez A. Khan.

Chronic periodontitis is initiated by gram-negative tooth-associated microbial biofilms that elicit a host response, which results in bone and soft tissue destruction. Major drivers of this aggressive tissue destruction are matrixmetalloprotienases (MMPs), cathepsinsand other osteoclast-derived enzymes. The microbiological aspects of periodontitis states that specific plaque hypothesis and the non-specific plaque hypothesis.

Consensus is that neither view is correct, but via a middle path, that damage is due to a shift in the relative populations of more and less dangerous bacteria in the plaque. This is called the ecological plaque hypothesis. The disease is associated with a variable microbial pattern. The treatment is a professional agreement among dentists and patient regarding smoking cessationand to maintain good oral hygiene; are key to effective treatment and positive outcomes for patients.

The typical initial treatment known to be effective is scaling and root planning(SRP) to mechanically debride the depths of the periodontal pocket and disrupt the biofilm present. In patients with chronic periodontitis, subgingival debridement (in conjunction with supragingival plaque control) is an effective treatment in reducing probing pocket depth and improving the clinical attachment level. In fact it is more effective than supragingival plaque control alone. Full mouth disinfection protocols are favored by some clinicians.

In patients with chronic periodontitis in moderately deep pockets slightly more favourable outcomes for pocket reduction and gain in probing attachment were found following FMD compared to control. However, these additional improvements were only modest and there was only a very limited number of studies available for comparison, thus limiting general conclusions about the clinical benefit of full-mouth disinfection.Open flap debridement is used by some practitioners particularly in deeper pocket areas.

The advantages of this approach is better visualization of the root surface to be cleaned. This must be weighed against the risks of surgery. Open flap surgery is more effective than non-surgical periodontal therapy in deep pockets. Both scaling and root planing alone and scaling and root planing combined with flap procedure are effective methods for the treatment of chronic periodontitis in terms of attachment level gain and reduction in gingival inflammation. In the treatment of deep pockets open flap debridement results in greater PPD reduction and clinical attachment gain.

( to be contd…)


Dr. Parvez A. Khan
Dr. Parvez A. Khan