Editorial

With the development of more and more sophisticated techniques of reconstruction (bone grafts, membranes, growth factors), the so-called « resective » surgical techniques, based on the elimination of the pockets, are being used less and less, and are considered to be out of date as being too mutilating.

Yet, in daily clinical practice, some periodontists amongst us have not totally abandoned these techniques because they allow them to achieve the therapeutic objectives that they set. Indeed, we may ask « what is the goal of periodontal treatment ? »

It must provide a long-term cessation of bone destruction and, within the biological limits of healing, promote the regeneration of the destroyed tissues.

However, indications for bone regeneration are very limited and, faced with the majority of cases of periodontal diseases, what are we to do ?

In cases of moderately deep bony lesions without a major vertical component, after initial preparation aiming to fully control the bacterial factor, we raise a flap to permit debridement of the bony lesions and we position our flaps at the residual bony crest in order to eliminate the pockets. What can a clinician wish for if not to restore to the patient a long-lasting healthy periodontium ? Clinical experience proves that if patients can ensure easy maintenance, the results remain stable over a long period without further pocketing and without further loss of attachment.

Despite the prolific literature on grafting materials, we have tried for many years to envisage the time when we can predict the reliability of these techniques and the maintenance of attachment levels for the very long term.

On reading the recent press, the current taste is for articles on the techniques of periodontal surgery, where osteoplasty is combined with the apical positioning of flaps. This is why we wanted, in the JPIO , to take a historical view of this surgical treatment philosophy, and to show, with the article by François Alcouffe and Francis Mora, that it has never stopped being part of our daily practice in spite of the effects of the periodontal « fashion » of the day.

Another area than that of the treatment of periodontal diseases is that of pre-prosthetic tissue management, which doubles the demands on the clinician.

It is necessary to obtain an optimum aesthetic result as well as to respect the periodontal tissues.

According to the amount of destruction of tooth tissue, the preparations will encroach upon the periodontal tissues and on the biologic space.

In such cases, prior surgery with modification to the hard and the soft tissues is indicated. These technical principles are directly inspired by resective periodontal surgery and are key to the integration of periodontal and restorative treatments. All practitioners who construct fixed prostheses must to fully master this simple surgical approach, which is enlarged upon in the articles by Marc Danan and Diego Capri and their teams.

Also, Alain Borghetti reminds us about mucogingival surgery. Even if it is usually an « additive » procedure, to him it may also be resective and is used to remove excess gingival tissue that may be incompatible with maintenance of good periodontal health.