AAP treatment guidelines stress that periodontal health should be achieved in the least invasive and most cost-effective manner. This is often accomplished through non-surgical periodontal treatment.
Non-surgical periodontal treatment does have its limitations. When it does not achieve periodontal health, surgery may be indicated to restore periodontal health.
SCALING AND ROOT PLANING
Scaling and root planing is a careful cleaning of the root surfaces to remove plaque and calculus [tartar] from deep periodontal pockets and to smooth the tooth root to remove bacterial toxins. Scaling and root planing is sometimes followed by adjunctive therapy such as local delivery antimicrobials, systemic antibiotics, and host modulation, as needed on a case-by-case basis.
Most periodontists would agree that after scaling and root planing, many patients do not require any further active treatment. However, the majority of patients will require ongoing maintenance therapy to sustain health.
TRAY DELIVERY SYSTEMS
A tray delivery system consists of a custom-fit tray made from impressions of the patient’s mouth. Patients use the tray at home to deliver medications that have been prescribed by their dentist. Tray delivery systems were cleared by the Food and Drug Administration (FDA) since they are similar to fluoride trays traditionally used to prevent tooth decay. However, the FDA clearance process did not determine that any specific medication delivered via tray delivery systems has been proven to be a safe or effective way to treat gum disease.
The AAP has reviewed several studies about the treatment of periodontal disease using tray drug delivery systems. The results of these studies, where tray drug delivery systems were used as adjunct to non-surgical periodontal therapy, provide no strong evidence that show adjunctive use of tray delivery systems is more effective than traditional non-surgical periodontal therapy alone. When determining the best course of treatment for your specific case, be sure to discuss the pros and cons of all available treatment options with your dental professional.

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