Non-surgical periodontal therapy

The main goal of non-surgical periodontal therapy is to remove the subgingival biofilm and reduce the numbers of periodontopathogenic marker bacteria. This is achieved through mechanical cleaning of the tooth and root surfaces, if necessary with adjunctive antibiotic use.

Dental treatment situation

Mechanical reduction of bacteria

All hard and soft deposits are removed from the tooth and root surfaces by means of subgingival scaling and root planing (SRP). The aim of this is to reduce the amount of plaque below a critical threshold. It should be noted that supragingival cleaning is not suitable on its own for periodontal therapy. Only subgingival instrumentation leads to a fundamental change in the microbial flora, resulting in regression of the inflammation. The success of this measure depends largely on the effectiveness of plaque removal, however. If any live bacteria remain in niches, reinfection occurs rapidly. Experts therefore recommend that SRP should be performed according to the “full-mouth disinfection” principle. Ideally, this will involve the anti-infective measures, including subgingival curettage of all quadrants, being carried out in a single session. This is the best possible way of preventing recolonization of areas that have already been cleaned. Alternatively, subgingival cleaning can also be carried out on 2 consecutive days.

Adjunctive antibiotic therapy

Mechanical cleaning represents the basis for the treatment of periodontitis. It can be supplemented with additional measures, but not replaced. In order to reduce the numbers of bacteria in areas that are difficult to access and in the tissue, adjunctive antibiotic therapy is helpful in certain cases. The decision whether or not to take this step is guided primarily by the individual microbial spectrum and by the bacterial load, in addition to the clinical parameters. Marker bacteria analyses therefore provide a basis for decision-making regarding whether adjunctive antibiotic therapy is necessary to supplement SRP. In addition, the composition of the subgingival flora determines which antibiotic active ingredient will be most effective in an individual case. This means that pathogenic bacterial species can be reduced in a targeted manner, over- and undertreatment reliably avoided and unnecessary adverse effects averted.