Non-surgical periodontal
therapy, including patient motivation, instruction in
oral hygiene and thorough scaling and
root planing has been shown to be an acceptable and effective treatment for chronic destructive
periodontitis. Even in deep
periodontal pockets clinical attachment levels may be maintained by scaling and
root planing alone provided that effective plaque control is assured by recall appointments at regular intervals. Even if personal
oral hygiene procedures do not reach the required standard of perfection, non-surgical periodontal
therapy may significantly delay the loss of periodontal attachment. Scaling and
root planing are best performed with hand instruments. Ultrasonic devices save some time but leave rough root surfaces which are highly susceptible to the accumulation of further subgingival plaque. The intervals at which scaling and
root planing have to be performed in order to alter successfully the pathogenic subgingival flora and to maintain a flora consistent with periodontal health have not been conclusively established. The limitations of non-surgical periodontal
therapy lie within the operator's skill at gaining access to all root surfaces in furcations and deep
periodontal pockets. Non-surgical periodontal
therapy may have to extend over long time periods. For this reason, limited flap surgery in order to gain access to root surfaces, which would otherwise be too time-consuming to treat with scaling and
root planing alone, might still be valuable.