Surgical periodontal therapy with and without initial scaling and root planing in the management of chronic periodontitis: a randomized clinical trial

J Clin Periodontol. 2014 Jul;41(7):693-700. doi: 10.1111/jcpe.12259.


Aim: To compare the outcomes of surgical periodontal therapy with and without initial scaling and root planing.

Methods: Twenty-four patients with severe chronic periodontitis were enrolled in this pilot, randomized controlled clinical trial. Patients were equally allocated into two treatment groups: Control group was treated with scaling and root planing, re-evaluation, followed by Modified Widman Flap surgery and test group received similar surgery without scaling and root planing. Clinical attachment level, probing depth and bleeding on probing were recorded. Standardized radiographs were analysed for linear bone change from baseline to 6 months. Wound fluid inflammatory biomarkers were also assessed.

Results: Both groups exhibited statistically significant improvement in clinical attachment level and probing depth at 3 and 6 months compared to baseline. A statistically significant difference in probing depth reduction was found between the two groups at 3 and 6 months in favour of the control group. No statistically significant differences in biomarkers were detected between the groups.

Conclusions: Combined scaling and root planing and surgery yielded greater probing depth reduction as compared to periodontal surgery without initial scaling and root planing.

Keywords: initial therapy; modified Widman Flap; periodontal surgery; periodontal therapy; periodontitis; scaling and root planing; wound healing.

Publication types

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

MeSH terms

  • Alveolar Process / diagnostic imaging
  • Biomarkers / analysis
  • Chronic Periodontitis / surgery*
  • Chronic Periodontitis / therapy
  • Combined Modality Therapy
  • Dental Scaling / methods*
  • Female
  • Follow-Up Studies
  • Gingival Crevicular Fluid / chemistry
  • Humans
  • Interleukin-1beta / analysis
  • Interleukin-6 / analysis
  • Male
  • Matrix Metalloproteinase 8 / analysis
  • Matrix Metalloproteinase 9 / analysis
  • Middle Aged
  • Periodontal Attachment Loss / surgery
  • Periodontal Attachment Loss / therapy
  • Periodontal Index
  • Periodontal Pocket / surgery
  • Periodontal Pocket / therapy
  • Pilot Projects
  • Radiography
  • Root Planing / methods*
  • Surgical Flaps / surgery
  • Treatment Outcome
  • Vascular Endothelial Growth Factor A / analysis


  • Biomarkers
  • IL6 protein, human
  • Interleukin-1beta
  • Interleukin-6
  • VEGFA protein, human
  • Vascular Endothelial Growth Factor A
  • MMP8 protein, human
  • Matrix Metalloproteinase 8
  • MMP9 protein, human
  • Matrix Metalloproteinase 9