A Fundamental Approach in Modern Periodontology

    Periodontal diseases are characterized by inflammatory destruction of the gingiva and supporting tissues and represent one of the most common causes of tooth loss in adult individuals. If left untreated, they may lead to irreversible periodontal damage and an increased risk of systemic health complications. Within this context, non-surgical approaches in contemporary periodontology offer scientifically proven, patient-friendly, and minimally invasive treatment solutions.

    In this regard, the two-part video series “Non-Surgical Periodontal Therapy”, prepared by Prof. Dr. Ali Çekici, addresses modern periodontal treatment strategies based on current scientific guidelines, covering both theoretical principles and clinical applications.

Clinical Basis and Scientific Evidence of Non-Surgical Therapy

    Non-surgical periodontal therapy (NSPT) aims to control periodontal inflammation through the removal of subgingival biofilm and mineralized bacterial deposits. The primary objectives of NSPT are to reduce inflammation, achieve periodontal attachment gain, and prepare the patient for potential further therapeutic interventions.

    According to the most recent S3-level clinical practice guideline published by the European Federation of Periodontology (EFP), NSPT can result in significant reductions in periodontal pocket depth, resolution of inflammation, and stabilization of clinical attachment levels in patients with Stage I–III periodontitis. The guideline emphasizes that non-surgical approaches may be sufficient in many cases and that treatment success depends not only on mechanical instrumentation but also on patient motivation, oral hygiene performance, and adherence to regular maintenance protocols.

    A recent meta-analysis published in 2024 reported a mean pocket depth reduction of approximately 0.47 mm and a mean clinical attachment gain of 0.50 mm at a three-month follow-up after NSPT. At six months, these values increased to 0.56 mm and 0.45 mm, respectively. These findings support the effectiveness and sustainability of non-surgical periodontal therapy when appropriate clinical protocols and patient compliance are achieved.

Treatment Limitations, Phases, and Patient Compliance

    While NSPT alone may be sufficient for some patients, surgical intervention may be required in specific sites in advanced cases. However, one of the most important outcomes of NSPT is the establishment of an inflammation-free, well-maintained oral environment and the development of an informed and motivated patient profile. This significantly enhances the success rates of both prosthetic and surgical treatment procedures.

Protocol and Clinical Implementation Tools

    In general, the treatment protocol includes professional tooth surface debridement, oral hygiene instruction, root surface instrumentation, correction of plaque-retentive anatomical factors, and supportive periodontal care.

    The effective implementation of this protocol extends beyond mechanical debridement alone and aims to improve patient awareness and long-term treatment sustainability. Ultrasonic devices (piezoelectric or magnetostrictive systems) and periodontal hand instruments (such as Gracey curettes) should be selected and applied according to the patient’s periodontal condition. Proper instrumentation is a critical determinant of clinical success, particularly in the management of deep periodontal pockets and anatomically challenging areas.

Long-Term Follow-up and Behavioral Support

    Following NSPT, the sustainability of treatment success relies on regular maintenance sessions and continuous patient compliance. Long-term follow-up not only prevents disease recurrence but also reinforces positive behavioral changes. Therefore, NSPT should be regarded not merely as a mechanical procedure but as a patient-centered, multidisciplinary behavioral management process.

Watch the Course:

    You can watch the two-part video series prepared by Prof. Dr. Ali Çekici, which presents contemporary, evidence-based approaches to non-surgical periodontal therapy.

References

1. Sanz M, Herrera D, Kebschull M, et al. Treatment of stage I–III periodontitis—The EFP S3 level clinical practice guideline. J Clin Periodontol. 2020;47(Suppl 22):4–60. doi:10.1111/jcpe.13290
2. Corbella S, Alberti A, Donos N, et al. Efficacy of different protocols of non-surgical periodontal therapy in patients with type 2 diabetes: A systematic review and meta-analysis. J Periodontal Res. 2025;60(5):417–437. doi:10.1111/jre.13327