Changes in Osseous Morphology Following Non-Surgical Periodontal Therapy: A Possible Paradigm Shift for the Treatment of Intrabony Defects?

Sub-gingival non-surgical periodontal therapy (NSPT) constitutes step 2 of periodontal therapy, aiming to disrupt the subgingival microbial biofilm and resolve or reduce inflammation of the supracrestal periodontal tissues. A plethora of original studies and reviews have been published over several decades, highlighting its fundamental importance in periodontal therapy and in tooth survival. Evidence shows that step 2 therapy leads to probing pocket depth reduction, associated with increase in gingival recession, clinical attachment level gain and improvements in patient-reported outcome measures, as well as to a reduction in local and, to some extent, systemic inflammatory markers. In cases of intrabony defects, NSPT has traditionally been considered a necessary step to improve periodontal tissue tone and reduce inflammation, thus paving the way for the surgical step, such as periodontal regeneration. This commentary presents compelling arguments for a paradigm shift showing that step 2 therapy also leads to changes in osseous morphology, particularly evident in, but probably not limited to, intrabony defects. This introduces a new dawn, where attempts should be made to understand the mechanisms behind this phenomenon and to maximise the potential of non-surgical therapy to achieve disease resolution and defect/pocket improvements while reducing patient morbidity even in complex periodontal defects.