5. Complementary treatments

As the oral cavity is a single microbiological entity, periodontitis must be considered as one and only one infection and not as a sum of several local infections. This is why the disease must be treated in its entirety if we aim for long-term stability. Indeed, a single tooth can serve as a bacterial niche for the other teeth that have been previously treated. In this perspective, we do not hesitate to use additional treatments to turn the overall success (>75%) into a complete success. Depending on different parameters, which again are related to the patient or the site to be treated, different treatments can be proposed.


When the site is directly accessible to ultrasonic instruments, periodontal curettes and irrigation syringes, a localised resurfacing often completes the initial treatment.

Periodontal surgery

However, in the presence of inaccessible sites :

  • deep pockets or intraosseous lesions,
  • inter-radicular lesions

It is useful to have access to the bone and root surfaces.
In this case, periodontal surgery will be indicated, either to complete the surfacing, or to treat a bone or muco-gingival defect by subtraction or regeneration techniques.

Flattening surgery
One of the objectives of surgical treatment is to restore a tissue architecture compatible with the maintenance of periodontal health by facilitating effective plaque control by the patient. In the presence of bone deformity, one surgical approach is to perform an osteoplasty to directly reduce the pocket, but more importantly, to achieve a periodontal deflecting morphology that facilitates oral hygiene.

Guided Tissue Regeneration
The more complex techniques which aim to regenerate ad integrum all the destroyed tissues, meet very strict anatomical and biological criteria (such as the morphology of the lesion, the presence of local and environmental factors) which significantly reduce their indications (< 5%). Moreover, the results are not always predictable. In short, after the initial enthusiasm for these techniques, the additional cost and the risk/benefit ratio associated with these methods now call for caution before resorting to these methods and for using them only in favourable and predictable cases.

Treatment of furcations
Because of their morphology, furcations are a point of "least resistance". If they are affected by periodontitis, they represent an important risk factor because they favour the progression of the disease.

For this reason, furcation damage should be diagnosed as soon as possible, as the prognosis of the tooth depends on it.
The choice of a treatment procedure depends mainly on the severity of the damage, both horizontally (grade 1, 2 and 3) and vertically (pocket depth).
Other factors should also be taken into account:

  • General factors such as the patient's general state of health, oral hygiene (witness to the patient's cooperation), behavioural habits (smoking), or financial capabilities.
  • Local factors: the location of the tooth (maxillary or mandibular, first or second molar), the anatomy of the tooth (is the furcation high or low, the distance between the roots), its endodontic state, the state of decay of its crown, the current and future (hypothetical) prosthetic role of the tooth, the residual bone volume around the tooth or the bone level of the adjacent teeth

In the light of these different parameters, we will have the choice between several therapeutic approaches, from the most conservative to the most radical, from simple curettage (with or without osteoplasty) to extraction, including root resection or tunneling techniques.

Taking into account the numerous local and general reservations, the following approach can be recommended for simplicity:

  • If the patient is completely dentate, we will try, within reasonable limits of course, to use conservative therapeutic methods, preserving the tooth.
  • If the tooth with the affected furcation is to be used as a prosthetic abutment, our prosthetic outcome must be predictable. The safest prosthetic approach should be chosen. Extraction is preferred if the furcation is severely affected (grade 2 and 3). The implant is nowadays far more reliable than a periodontally compromised tooth.
  • If the patient is unwilling to cooperate (insufficient plaque control), treatment can be palliative and then radical.