Your Patients Are Unique
It seems that many of us suffer from “one size fits all”. This is not surprising; it’s how we were trained. I’m referring the hygienic phase of periodontal treatment. This is where every periodontal patient receives instructions in plaque control, comprehensive scaling and root planing, then a revaluation to determine additional (surgical) needs. I could never buy into this approach. I always thought we could be more sophisticated in our diagnosis and subsequent treatment planing. I think we can get to an end point in treatment sooner in fewer appointments.
I don’t like to categorize patients but I do feel, as a general rule, that periodontal patients can be placed in one of three groups. The first group is those patients with minimal attachment loss, no furcation involvement, incomplete plaque control, substantial calculus build-up and a profound inflammatory response. You all can relate to these patients. These are the cases that have an almost 100% chance of success from improved plaque control along with scaling and root planing.
The next group presents an entirely different picture. These patients have deep pockets (many greater that 7 or 8 mm), significant furcation involvement and calculus that is very difficult to remove. Radiographs often reveal abnormal bony topography. These patients have little chance of success from non-surgical treatment alone. They require a surgical phase to provide access for complete calculus removal. If you believe this is true then why put the patient through comprehensive scaling and root planing first? Wouldn’t it be more efficient to do a gross debridement, then move directly into a surgical phase? I think so.
The third group of patients is the one in between. These patients have moderate pocket depth, little if any furcation involvement and calculus that is not too tenacious. These are the patients that may or may not respond adequately to scaling and root planing. These patients deserve to be treated non-surgically first then re-evaluated to determine additional treatment needs.