The issue begins with a discussion of nonsurgical periodontal therapy, now a mainstay of conventional practice. Apatzidou and Kinane explain that both scaling and root planing alone and scaling and root planing combined with surgical flap procedures are effective in treating chronic periodontitis in terms of achieving attachment level gain and reducing gingival inflammation. They review results from the studies of Quirynen and colleagues,7 who advocate the use of one-stage full-mouth disinfection (scaling and root planing all teeth completed over two sessions within 24 hours with the use of chlorhexidine for mouth rinsing and disinfection of all intraoral niches). Apatzidou and Kinane also discuss efficacy of ultrasonic instrumentation compared with conventional manual instrumentation. It is clear that, regardless of approach, disruption and removal of the microbial biofilm and the initiation and establishment of meticulous plaque control constitute the key elements of successful nonsurgical periodontal treatment.
Krayer and colleagues review the use of antibiotics, antiseptics, anti-inflammatory agents, and other host modulatory agents in periodontal therapy. It seems evident from this review that all pharmaceutical approaches available to date should be used not as stand-alone interventions, but to augment mechanical therapy to treat periodontal disease.
One technology that seems to fascinate both dental professionals and the public is the medical laser. Cobb and colleagues' review of the literature argues that the use of the laser to treat periodontal diseases does not achieve results that exceed those of present standards of care. Furthermore, many questions remain to be answered regarding the use of lasers as a singular modality or as an adjunct for the treatment of periodontitis.
Periodontists have long hoped to identify procedures to predictably regenerate lost periodontal tissues. Thus, several reviews that summarize the strengths and weaknesses of growth factors, guided tissue regeneration, and bone grafts are all covered herein. Further information on future approaches that may be in use for periodontal regeneration, such as gene therapy, RNA interference, and stem cells, are also reviewed. RNA-based therapeutics, such as RNA interference, and other approaches for tissue regeneration are still in their infancy. While not yet available for clinical applications, such theoretical approaches offer exciting prospects for future strategies to regain the tissues lost to the ravages of periodontal inflammation.
A welcome addition to the dentist's armamentarium is the dental implant. This rapidly improving technology adds an important option for the replacement of lost teeth. While osseointegration of dental implants is a predictable treatment modality, the placement of implants in the periodontal patient presents a unique situation for the dental practitioner. Greenstein and colleagues' comprehensive review on the use of implants in the periodontal patient should help the dentist decide whether to attempt to treat the periodontally involved tooth or extract it in favor of implant placement.
A clinical situation sometimes challenging to treat is gingival recession. This condition must be corrected should it cause patient discomfort or affect esthetics. Kassab and colleagues provide a comprehensive review of the indications for correction of recessions, as well as a variety of techniques presently available for this purpose
A growing literature suggests that periodontal inflammation and infection may have serious ramifications for systemic health. If true, it is possible that prevention or treatment of periodontal disease could reduce the risk for such systemic conditions as cardiovascular disease and stroke, adverse pregnancy outcomes, diabetes mellitus, and respiratory diseases, such as pneumonia. Thus, an effort is made here to review pertinent clinical trials that have attempted to determine how periodontal therapy affects these systemic conditions.
Finally, it is clear that periodontal treatment certainly affects restorative treatment planning. Andreana addresses issues pertinent to considerations affecting restorative treatment. It is our hope that this work will inform the modern evidence-based dental practitioner with the background necessary to manage periodontal diseases.