Dentaltown January 2023 - 30
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SRP Before Osseous?
A new associate with concerns about his offi ce's treatment policies gets Townie feedback.
BeardownDoc
Member Since: 07/08/18
Post: 1 of 27
Newish grad here, currently working in a big DSO. We have a periodontist come to our
offi ce once or twice a month. My patient had full-mouth SRP done two years ago, came to
only their fi rst perio maintenance visit, and now showed up with bleeding/infl amed 5-, 6- and
7-mm pockets. I decided to send them to perio to evaluate for osseous surgery. My owner
doc was upset that I didn't plan an SRP before sending the case to perio. Am I wrong for not
doing SRP before the perio consult? Seems like double-dipping to me. Why would you do
SRP before osseous? ■
4/14/2021
Jamar M Jackson
Member Since: 04/03/05
Post: 2 of 27
fl etch33
Member Since: 01/06/06
Post: 3 of 27
Rivermen22
Member Since: 02/08/15
Post: 4 of 27
skepticalperio
Member Since: 12/13/14
Post: 8 of 27
A patient who has had one perio maintenance in two years is not a candidate for osseous
surgery. I would repeat SRP if it's been two years without maintenance. ■
This is a terrifi c question and it pertains to a lot of perio patients, many of whom are not
compliant. Several good points to think about in the replies.
1. There is no evidence that repeated SRP is benefi cial. In a compliant patient, SRP once
should be followed by osseous or regenerative surgery for pockets > 5 mm.
2. Improving oral health before surgery is of course a good idea. Perio Protect is one
option, although there is no rigorous evidence supporting it over traditional oral health
instructions (demonstrating interproximal cleaning, recommending an electric toothbrush
with pressure sensor and/or water fl osser). Reassess oral health in a few weeks and,
if reasonable, then surgery. However ...
3. No perio treatment is predictable in a noncompliant patient. So for your case, I would
do Step 2 above, institute a three-month recall interval, and proceed to surgery as
indicated if the patient shows up two or three times in a row.
4. Explain all this to your patient as you go. ■
4/17/2021
4/15/2021
Going straight to osseous with very infl amed tissues and loads of calculus is a total mess.
A good round of SRP will get the tissues healthy, lead to much less bleeding during the
surgery and make postoperative healing much easier. ■
Two weeks in Perio Protect trays three times a day for 15 minutes will reduce swelling and
bleeding, the SCRP won't be as bad and you won't be working in a toilet. ■
4/14/2021
4/14/2021
30 JANUARY 2023 // dentaltown.com
http://www.dentaltown.com
Dentaltown January 2023
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