I commend Dr. Loesche and colleagues for their article, "The Nonsurgical Treatment of Patients With Periodontal Disease: Results After Five Years" (March JADA).
The results of this study are certainly consistent with what we currently understand to be the therapeutic endpoints of nonsurgical periodontal therapy.1,2 The inclusion of the systemic antimicrobials metronidazole or doxycycline further enhanced this success as noted by the authors. Though I am aware that surgical therapy was considered and potentially recommended by one examiner, my particular concern is the observation of the authors categorizing surgical therapy into a single "traditional" grouping.
This simplification of surgery as an either/or choice is not a service to the dental profession. The authors state "[our] results would indicate that patients have a choice in treatment options: either the traditional approach of surgery or extraction of hopeless teeth, or an approach based on an antimicrobial strategy." The 2001 Glossary of Periodontal Terms defines periodontal surgery as "any surgical procedure used to treat periodontal disease or to modify the morphology of the periodontium."3
This surgical modification in morphology can entail many different techniques with varied goals. These techniques can include replaced flap surgery, resective flap surgery or regenerative flap surgery. These procedures, correctly planned and expertly performed, can result in a form and function of periodontal support that is more conducive to routine maintenance. The resulting reduction in probing depths and the gain in clinical attachment levels that results from such corrective periodontal surgical treatment(s) is a therapeutic endpoint oftentimes unachievable by a sole nonsurgical approach.4
Successful therapeutic intervention, whether it be nonsurgical or surgical in nature, needs to be evidence-based. "The evidence-based medicine method of answering clinical questions involves searching the literature for relevant studies, assessing study quality, interpreting the findings and applying them in light of patients’ preferences and societal values."5
I appreciate and applaud the study in question adding to our evidence-based body of knowledge. However, the dental profession needs to be wary of that old adage, "If all you have is a hammer, the whole world looks like a nail!"
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