lindadouglas The osseous in itself does not restore health; it just creates a situation/architecture that can be maintained. It's not double-dipping at all. If SRP is not done before osseous, they just don't heal well. The results of surgery are always better if you can achieve as much healing and bacterial reduction as possible fi rst through SRP. Adjuncts to promote bone regeneration/grafting are not very predictable at the best of times, and are likely doomed if there is an overload of infl ammation and perio pathogens present. This also needs to be accompanied by measures to improve the patient's self-care and education on the importance of regular attendance for perio maintenance. On occasion, after I have done SRP, the periodontist has even decided surgery was not needed after all. In fact, I think I remember reading a classic study that shows that perio surgery done without addressing the infl ammation by SRP fi rst results in even more bone loss than if no surgery was done. It might have been Axelson and Lindhe. ■ 4/17/2021 I think of it more as " initial infection control " (infection reduction) before any surgery. It has several purposes, one of which is the patient is given a chance to show some commitment before expensive surgery. If I know I'm sending to a periodontist-now or later-I just send them. They can fi gure out their own plan. They don't need me at the moment. If I'm unsure if I will be sending, then I might do the initial SRP/infection control in my offi ce. These days, I'm doing less SRP than I used to. I'm much more likely to simply refer from the start. Several reasons for that as well. ■ 4/17/2021 I'm sure it is much easier for the perio to fl ap and suture and do the surgery without a ton of crud and infl ammation. A perio when I was a student told me he did osseous once on a patient who was a mess. He said never again. ■ 4/17/2021 STDMDNJ Periodontal therapy begins with initial preparation after examination and radiographs. Sometimes the order has to be adjusted or steps eliminated, but they have to be considered before defi nitive surgical intervention. 1. Oral hygiene instruction. 2. Scaling and root planing (deep cleaning). 3. Removal of faulty fi llings/crowns. 4. Endodontics (root canals). 5. Removal of hopeless teeth (extraction). 6. Removal of hopeless roots (root resection). 7. Occlusal equilibration (bite adjustment). 8. Minor tooth movement (orthodontics). 9. Stabilization. 10. Night guard. 11. Reevaluation. ■ 4/17/2021 Chase consensus or discuss discord online! Curious how your offi ce policies compare to others? Are you at odds with a colleague on the best way forward? Head to dentaltown.com/messageboard and browse thousands of topics-or start your own thread-to fi nd the answers you're looking for. dentaltown.com \\ JANUARY 2023 31 Member Since: 01/31/07 Post: 14 of 27 dalmacija Member Since: 04/14/15 Post: 12 of 27 Timmy G aka Nowhere Man Member Since: 04/14/02 Post: 10 of 27 Member Since: 06/09/06 Post: 9 of 27 4/17/2021http://www.dentaltown.com/messageboard http://www.dentaltown.com