The most important treatment for all cases of advanced periodontitis is the complete removal of bacterial plaque and calculus
from the tooth crown, gingival sulcus, and root surfaces. This allows healing and stops disease progression.
For periodontal pockets < 5 mm deep with mild to moderate (0% to 50%) radiographic evidence of bone loss (Figure 3), treatment consists of scaling (manual or ultrasonic débridement) the tooth surface (crown), gingival sulcus, and root surface
and root planing. For 5-mm periodontal pockets with mild to moderate bone loss, treatment should include scaling, root planing,
and administering a local doxycycline gel (Doxirobe—Pfizer Animal Health).
Before treating periodontal pockets > 5 mm deep, the client must agree to attempt home care and return for follow-up appointments.
If the client cannot agree to these requirements, extraction should be considered or recommended.
To treat patients with deep pockets and horizontal bone loss, mucogingival surgery (flap exposure) and open curettage
are required to access and clean the pockets (Figure 4). In cases of vertical bone loss, mucogingival surgery combined with open curettage and guided tissue regeneration can result
in periodontal tissue (including alveolar bone) regeneration—contradicting the dogma "Periodontitis is irreversible."
Mucogingival surgery and guided tissue regeneration are advanced procedures that should be performed only after a clinician
has received ample training and, ideally, hands-on experience. These procedures may be best referred to a board-certified
veterinary dentist (a list is available at
SCALING AND ROOT PLANING
Periodontal bacterial ultrasonic débridement involves using an ultrasonic scaler to remove plaque, calculus, and necrotic
or diseased tissue from the tooth and root surface. The newer generations of ultrasonic equipment, including the piezoelectric
ultrasonic scalers, are designed to operate both above and below the gum line. It is important to use a light touch and to
keep the tip of the ultrasonic scaler constantly moving. However, even with the best and newest ultrasonic equipment, a thorough
subgingival curettage and root planing performed with hand instruments (curettes) should always be included in periodontal
treatment (Figure 5).
Curettes have many designs, but a key feature is a blunt tip to prevent injury to the delicate gingival tissues. The curette
should always be sharp; sharpening stones are available. Insert the curette into the pocket, adapt the sharp edge of the blade
to the root surface to engage the subgingival calculus and plaque, and pull the curette to scrape the root surface (Figure 6). Use many overlapping strokes to débride each root surface. The procedure is complete when the root surface is smooth and
clean. Root planing can be a labor-intensive and technique-sensitive process and can require spending many minutes on each
tooth. It is important to avoid excessive removal of normal cementum during this procedure.
LOCAL ANTIBIOTIC TREATMENT
Doxirobe, a polymer gel mixed with doxycycline, is a veterinary product used for nonsurgical treatment of periodontal pockets
> 4 mm. The gel is injected through a bendable cannula into periodontal pockets. On contact with fluids, the gel hardens and
remains in the pocket for several weeks, slowly releasing the doxycycline. In addition to its antimicrobial properties, doxycycline
decreases the effect of collagenase, an enzyme released in the sulcus during active periodontal inflammation. This product
is not a substitute for periodontal surgery when surgery is indicated (pockets > 6 mm).