Non-Surgical Periodontal Therapy
Non-Surgical Periodontal Therapy
The exam tests debridement technique, adjunct selection, and the discipline of reevaluation before surgery.
Core rules
- SRP removes biofilm and calculus; it cannot regenerate lost attachment. Hand and ultrasonic instruments give comparable outcomes; ultrasonic tips reach furcations and deep pockets faster but need adapted power and irrigation.
- Full-mouth versus quadrant debridement: comparable healing; thoroughness and plaque control decide the outcome, not the schedule.
- Reevaluate at 6–8 weeks (never before about 4 weeks), then choose maintenance, further debridement, or surgery.
- Adjuncts: chlorhexidine 0.12–0.2% short term (staining, taste alteration); local delivery for isolated sites; systemic antibiotics only as an adjunct to SRP in Grade C/Stage III–IV, typically amoxicillin 500 mg plus metronidazole 400–500 mg three times daily for 7 days.
- Host modulation: subantimicrobial-dose doxycycline 20 mg twice daily suppresses MMPs; it is not an antibiotic regimen.
- Smoking cessation and glycemic control multiply the effect of debridement.
Worked example
A 48-year-old non-smoker, HbA1c 6.2%, Stage III Grade B, with 6 mm pockets and heavy calculus. Do full-mouth SRP with oral hygiene instruction and reevaluate at 8 weeks. Residual PD ≥5 mm with BOP on a molar with a vertical defect → proceed to regenerative surgery. No antibiotics: Grade B without systemic risk means resistance risk without meaningful benefit.
Traps
Prescribing antibiotics alone or prophylactically; long-term chlorhexidine; mistaking subantimicrobial doxycycline for an antimicrobial dose; declaring failure before 6 weeks; assuming deep pockets must resolve with perfect debridement.