The American Academy of Periodontology 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, including scaling – this usually consists of placing a fine ultrasonic tip or hand scaler/curette in between the tooth and gum tissue to remove bacterial plaque and calculus (tartar) below the gum line – and root planing – 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. This initial periodontal therapy along with good personal oral hygiene allows the gum tissue to heal and reattach to the tooth. Four to six weeks later, periodontal pockets are eliminated due to gum shrinkage (if the disease is in its earliest stage). Then the patient can personally maintain these areas with routine brushing and flossing.
Most periodontists would agree that after scaling and root planing, many patients do not require any further active treatment, including surgical therapy. However, the majority of patients will require ongoing maintenance therapy to sustain health. Non-surgical therapy does have its limitations, however, and when it does not achieve periodontal health, surgery may be indicated to restore periodontal anatomy damaged by periodontal diseases and to facilitate oral hygiene practices.