title: A randomized controlled trial comparing surgical and non-surgical periodontal therapy: a 3-year clinical and cost-effectiveness analysis.
abstract: OBJECTIVE
  To compare immediate surgery to scaling and root planing (SRP) in the treatment of advanced periodontitis focusing on the prevalence of residual pockets after treatment and cost-effectiveness (1); to elucidate the adjunctive effects of azithromycin in a second-treatment phase (2) up to 36 months.
  
  
  METHODS
  Thirty-nine patients (18 males, 21 females; mean age: 54.6) received oral hygiene instructions and were randomly allocated to surgery (n = 19) or SRP (n = 20). Patients with residual pockets (≥6 mm) at 6 months received re-debridement of these sites and systemic azithromycin. Clinical measurements were performed at 12, 24 and 36 months whereby residual pockets underwent re-debridement. Patients were evaluated in terms of clinical response parameters and cost-effectiveness. Chair-time was used to assess the financial impact of treatment.
  
  
  RESULTS
  Only six patients in the surgery group required additional treatment at 6 months, whereas 14 patients in the SRP underwent this therapy. Both treatment arms were equally effective in terms of clinical outcome demonstrating <2% residual pockets at 36 months. Surgery imposed an extra 746 Euro on the patient up to 6 months compared to SRP. At 36 months, 69 Euro of this amount could be offset due to the lower need for re-treatment during maintenance phase.
  
  
  CONCLUSIONS
  Surgery was ultimately associated with a significantly lower need for re-treatment during supportive care, however, at significantly higher costs over the 3 years.
authors.affiliation: Faculty of Medicine and Health Sciences, Dental School, Department of Periodontology and Oral Implantology, Ghent University, Ghent, Belgium.
authors.forename: S Reza
authors.initials: SR
authors.lastname: Miremadi
authors.affiliation: Faculty of Medicine and Health Sciences, Dental School, Department of Periodontology and Oral Implantology, Ghent University, Ghent, Belgium.|Faculty of Odontology, Department of Prosthodontics, Malmö University, Malmö, Sweden.
authors.forename: Hugo
authors.initials: H
authors.lastname: De Bruyn
authors.affiliation: Faculty of Medicine and Health Sciences, Dental School, Department of Periodontology and Oral Implantology, Ghent University, Ghent, Belgium.
authors.forename: Harold
authors.initials: H
authors.lastname: Steyaert
authors.affiliation: Faculty of Medicine and Health Sciences, Dental School, Department of Periodontology and Oral Implantology, Ghent University, Ghent, Belgium.
authors.forename: Katrijn
authors.initials: K
authors.lastname: Princen
authors.affiliation: Faculty of Medicine and Health Sciences, Dental School, Department of Periodontology and Oral Implantology, Ghent University, Ghent, Belgium.|Faculty of Medicine and Pharmacy, Dental Medicine, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Cosyn
keywords: azithromycin; periodontitis; randomized controlled trial; scaling and root planing; surgery