The purpose of this article is to evaluate the long-term effects of different modalities of periodontal treatment in pockets of different depths and different levels of attachment loss.
43 patients with 1038 teeth were followed for years. Patients had half of their mouth assigned to one of the three treatments: (a) subgingival curettage, (b) Modified Widman flap, and (c) pocket elimination surgery. Patients had recall visits every 3 months. Results were evaluated for pocket depths up to 3 mm (class I), 4-6 mm (class II), and 7-12 mm (class III).
Results showed that pockets were initially deeper interproximally. Treatment was equally effective for pockets of the same depth range in different parts of the mouth. Pockets deeper than 4 mm stayed reduced for the 8 year period and ranged 3-4 mm. Attachment is initially gained in pockets deeper than 5 mm and lost in pockets of 1-3 mm. Pockets of 7-12 mm had their depth significantly decreased over eight years; 4-6 mm pockets had also a significant reduction in depth; no differences were observed for pockets of 1-3 mm. Pocket elimination produce a greater loss of attachment. All methods presented loss of attachment during the 8-year period. All the methods promoted sustained decrease in pocket depth of 4-6 mm, although the curettage group experienced less pocket reduction. The gained attachment was significant for curettage and modified Widman over 8 years and pocket elimination over 4 years. Pockets of 7-12 were significantly less reduced after curettage and sustained for all methods. Greatest attachment gain was obtained by Mod. Widman and the gain was sustained over 8 years for all methods, except curettage over 7 years.
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