Periodontal therapeutics - a viable option?

Summary Research in recent years in periodontology has seen a shift from surgery towards medicine. While surgery, particularly regenerative, and including implants, continues to form an important element of periodontal treatment, the volume of treatment required and the results of recent and ongoing non‐surgical studies clearly show that most future periodontics will be based on a physician‐type approach. Improved diagnostics based on more precise periodontal disease classification, simplification of mechanical oral hygiene equipment and procedures, and the development of conventional and non‐conventional chemical and physical adjuncts may be expected to reduce the rate of common periodontal disease advance, resulting in less complex treatments, and more of the latter coming to lie within the competence of the generalist and the hygienist working together. The rationale for non‐surgical adjunctive therapy is extensive, far beyond the usual antimicrobial logic. It will also be important to control the oral microflora for systemic reasons, since increasingly strong links are being established between focal infection of oral origin, much of it periodontal, and a range of systemic diseases, including coronary heart disease, stroke, gastrointestinal disorders, and low birth weight, apart from severe, overt systemic infections. All these developments derive from a greatly improved understanding of the fundamentally ecological nature of the natural microbial biofilm that is dental plaque, and of its interactions with its human host. Résumé Au cours de ces dernières années, la recherche s'est tournée de la chirurgie vers la médecine. Alors que la chirurgie, notamment régénératrice, y compris les implants, constitue toujours un élément important du traitement parodontal, l'importance du traitement requis et les résultats d'études non chirurgicales, récentes et encore en cours montrent que la parodontologie future se basera sur une approche de type médical. Les diagnostics de meilleure qualité, basés sur une classification plus précise des parodontologies, la simplification des dispositifs et des procédures mécaniques d'hygiène bucco‐dentaire et le développement des auxiliaires chimiques et physiques conventionnels et non conventionnels devraient réduire le taux de progression de la maladie parodontale, avec pour conséquence une simplification des traitements qui seront davantage du ressort des généralistes et des hygiénistes faisant équipe ensemble. Le concept de t