Non surgical periodontal therapy (NSPT) has been shown to improve probing pocket depths (PPD) and clinical attachment levels (CAL) in mild to moderate periodontitis cases with probing pocket depths of less than 6 mm. Treatment of periodontitis is directed primarily towards the reduction of pathogens embedded in the subgingival biofilm. This shift in paradigm has led to better understanding of the underlying host immune responses and to development of novel treatment strategies that may improve therapeutic outcomes and overall clinical management of periodontitis patients. The current paradigm of etiopathogenesis for periodontitis suggests that though periodontal diseases are pathogen and site specific, the host- microbial interactions leading to overproduction of destructive enzymes and pro-inflammatory mediators determine the extent and severity of tissue destruction. Periodontitis involves a complex interaction between environmental (such as specific bacteria) and host (genetic and immunological) factors that leads to loss of periodontal attachment apparatus. According to data from the World Health Organization report gingival bleeding and calculus, which primarily reflects poor oral hygiene, are most prevalent in adults from all regions of the world while advanced disease with deep periodontal pockets (≥ 6 mm) affects approximately 10% to 15% of the adult population. Periodontal diseases are biofilm-mediated, chronic infectious diseases and are the most common cause of tooth loss in the modern world. At the end, the review summarizes the analysis of the current evidence that suggests that thorough subgingival debridement remains the mainstay of NSPT and that adjunct use of chemotherapeutic agents may offer better management of clinical parameters in periodontitis patients. The review also attempts to briefly introduce future developments in some of these modalities. The present review focuses on the best available evidence, for the current management of the chronic periodontal patients, gathered from systematic reviews and meta-analysis of mechanical non surgical periodontal therapy (NSPT) (subgingival debridement, laser therapy and photodynamic therapy) and the adjunctive chemotherapeutic approaches such as systematic and local antibiotics and antiseptics, subgingival pocket irrigation and host modulation therapies. Chemotherapeutic agents, either systemic and local antimicrobials or host modulating drugs, played pivotal role in better and more predictable management of periodontal disease.
The use of laser and photodynamic therapy show great promise but their effectiveness has still not been conclusively proven. Various therapeutic modalities have been developed adjuvant to mechanical periodontal therapy. The current paradigm of periodontal disease stresses greater role of host-mediated inflammatory response in tissue destruction characteristic of periodontal disease.
Till recently periodontal treatment was directed primarily towards reduction of bacterial load by subgingival debridement of root surfaces and modification of environmental risk factors. Periodontal disease is an inflammatory condition that involves a complex interaction between pathogenic bacteria, environmental and acquired factors and host related factors.