I thank Col. Cuenin for his kind comments concerning our study. I truly appreciate his remarks testifying that our study is consistent with the "therapeutic endpoints of nonsurgical periodontal therapy," and that our study adds "to our evidence-based body of knowledge."
However, he takes exception, and properly so, with our "categorizing surgical therapy into a single ‘traditional’ grouping." He notes that surgery consists of that used to gain access to the plaque and calculus-laden tooth surfaces so as to treat periodontal disease, and that used to modify the morphology of the periodontium. Our study involved the use of access surgery, and, while we thought that it would be understood that this is the only type of surgery that is presented to a newly diagnosed periodontal patient, it is appropriate that Col. Cuenin calls on us to make this distinction between periodontal access surgery and periodontal plastic surgery.
Col. Cuenin expresses concern when he states that "simplification of surgery as an either/or choice is not a service to the dental profession." We stated that our "results would indicate that patients have a choice in treatment options: either the traditional approach of [access] surgery or extraction of hopeless teeth, or an approach based on an antimicrobial strategy."
Why giving patients a choice "is not a service to the dental profession" is not clear to me. Many individuals who contact me indicate that they are not given a choice when they are told that they have advanced forms of periodontal disease, but are only offered access surgical therapy, which most of these individuals decline. It would seem to be a service to the dental profession to be able to offer these individuals with advanced disease a treatment option based on an antimicrobial approach.
I appreciate Col. Cuenin’s comments and the opportunity to clarify that the surgery that we referred to in our report was access surgery, and not those forms of surgery that seek to restore form and function to the periodontal tissues.
