A randomized controlled trial on immediate surgery versus root planing in patients with advanced periodontal disease: a cost-effectiveness analysis

J Clin Periodontol. 2014 Feb;41(2):164-71. doi: 10.1111/jcpe.12201.


Aim: To compare immediate surgery to scaling and root planing (SRP) in the treatment of advanced periodontal disease focusing on the prevalence of residual sites and cost-effectiveness (1); to evaluate the adjunctive effects of azithromycin in a second treatment phase (2).

Materials and methods: Thirty-nine patients (18 males, 21 females; mean age: 54.6) received oral hygiene instructions and were randomly allocated to surgery (n = 19) or SRP (n = 20). Patients with residual pockets (≥6 mm) at 6 months received re-debridement of these sites and systemic azithromycin. Treatment groups were followed up to 12 months and evaluated in terms of clinical response parameters and cost-effectiveness. Chair-time was used to assess the financial impact of treatment.

Results: Both treatment arms were equally effective in terms of clinical outcome demonstrating less than 1% residual pockets at 12 months. Surgery imposed an extra 746 Euro on the patient up to 6 months when compared to SRP. At 12 months, 46 Euro of this amount could be offset as a result of a reduced need for supportive care. Only 6 patients in the surgery group needed systemic antibiotics, whereas 14 patients in the SRP needed such additional treatment.

Conclusions: Although 700 Euro could be saved on average by performing SRP instead of surgery, the latter significantly reduced the need for supportive care and systemic antibiotics.

Keywords: azithromycin; cost effectiveness; periodontitis; randomized controlled trial; scaling and root planing; surgery.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anti-Bacterial Agents / economics
  • Anti-Bacterial Agents / therapeutic use
  • Azithromycin / economics
  • Azithromycin / therapeutic use
  • Chronic Periodontitis / economics
  • Chronic Periodontitis / surgery*
  • Chronic Periodontitis / therapy
  • Combined Modality Therapy / economics
  • Cost-Benefit Analysis
  • Dental Plaque Index
  • Dental Scaling / economics
  • Dental Scaling / methods*
  • Drug Costs
  • Female
  • Follow-Up Studies
  • Health Care Costs
  • Humans
  • Male
  • Middle Aged
  • Oral Hygiene / education
  • Periodontal Attachment Loss / surgery
  • Periodontal Attachment Loss / therapy
  • Periodontal Index
  • Periodontal Pocket / surgery
  • Periodontal Pocket / therapy
  • Prospective Studies
  • Root Planing / economics
  • Root Planing / methods*
  • Single-Blind Method
  • Time Factors
  • Treatment Outcome


  • Anti-Bacterial Agents
  • Azithromycin