***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The purpose of this study was to compare the long term effectiveness of scaling and root planing alone to scaling and root planing followed by periodontal surgery .  Seventeen subjects with moderate to advanced periodontitis received through scaling and root planing as well as oral hygiene instruction . A modified Widman flap was then r and omly performed for one-half of each subject 's dentition . Recall prophylaxis and oral hygiene reinforcement were administered for 4 years after completion of therapy . Shallow crevices ( 1 - -3 mm)subjected to either procedure tended to increase slightly in depth and exhibit a slight loss of attachment when compared to pretreatment measurements . Moderately deep pockets ( 4 - -6 mm ) treated by either procedure were reduced and demonstrated a sustained gain or maintenance of attachment level . Pockets initially greater than or equal to 7 mm exhibited the greatest reduction in depth and attachment gain . Gingivitis was reduced following either procedure for moderate and deep pockets . No difference in supragingival plaque retention was noted and both procedures reduced calculus . The results indicate that both procedures were effective in treating moderate to advanced periodontitis . However , the additional flap procedure tended to result in greater pocket reduction and attachment gain for deeper pockets Three methods for treatment of periodontal pockets  ( subgingival curettage , modified Widman flap surgery , and pocket elimination ) were applied as a clinical trial to 82 patients . Follow up results over one to five years after the initial treatment are reported . The variations in attachment levels and pocket depth were analyzed statistically as related to methods of treatment and yearly time intervals following the initial treatment . The most favorable results regarding gain or maintenance of attachment levels and reduction of pocket depth were observed interproximally . Subgingival curettage provided the greatest gain in attachment level up to three years postoperatively , but after four to five years there was no significant difference in results following the three methods . The most significant loss of attachment and return of pocket depth occurred on the buccal aspects of the teeth , and the results were not significantly different for the three methods except at the first year of follow up when the attachment level was maintained best after curettage BACKGROUND AND OBJECTIVE Tooth loss ( TL ) , one of the most visible results of the evolution of periodontitis , causes physiological and psychological impacts on a patient 's life . This prospect i ve study aim ed to evaluate the incidence , underlying reasons and influence of risk predictors for the occurrence of TL in a program of periodontal maintenance therapy ( PMT ) over 5 years . METHODS The sample comprised 212 individuals diagnosed with chronic moderate-severe periodontitis , who had finished active periodontal treatment , were incorporated in a PMT program .  Individuals were divided in to two groups : 96 regular compliers ( RC ) and 116 irregular compliers ( IC ) . Full-mouth periodontal examination was performed . Social , demographic , behavioral and biological variables of interest were collected at all PMT visits . The effect of risk predictors and confounders for TL , as well as the underlying reasons of TL , were assessed by univariate and multivariate analysis . RESULTS TL was significantly lower among RC ( 0.12 teeth lost/year ) in comparison to IC ( 0.36 teeth lost/year ; p < 0.01 ) . Individuals that were > 55 years old , males and smokers lost significantly more teeth in both groups ( with IC > RC ) . The number of teeth lost due to periodontal reasons was significantly higher than TL for other reasons in both groups ( p < 0.01 ) . The final linear and logistic model for TL included : male gender , smoking , probing depth 4 - 6 mm in up to 10 % of sites and irregular compliance . CONCLUSION IC individuals undergoing PMT presented higher rates of TL when compared to RC individuals . Findings demonstrated the influence of irregular compliance and the importance of monitoring other risk predictors for TL such as smoking , male gender and severity of probing depth during PMT Eighty-two periodontal patients were treated in a split mouth design with coronal scaling ( CS ) , root planing ( RP ) , modified Widman surgery ( MW ) , and flap with osseous resection surgery ( FO ) which were r and omly assigned to various quadrants in the dentition . Therapy was performed in 3 phases : non-surgical , surgical , and supportive periodontal treatment ( SPT ) < or = 7 years . Clinical data consisted of probing depth ( PD ) , clinical attachment level ( CAL ) , gingival recession ( REC ) , bleeding on probing ( BOP ) , suppuration ( SUP ) , and supragingival plaque ( PL ) . Because of the necessity to exit many CS treated sites due to breakdown , data for CS were reported only up to 2 years . All therapies produced mean PD reduction with FO > MW > RP > CS following the surgical phase for all probing depth severities . By the end of year 2 there were no differences between the therapies in the 1 to 4 mm sites . There were no differences in PD reduction between MW and RP treated sites by the end of year 3 in the 5 to 6 mm sites and by the end of year 5 in the > or = 7 mm sites . FO produced greater PD reduction in > or = 5 mm sites through year 7 of SPT . Following the surgical phase , FO produced a mean CAL loss and CS and RP produced a slight gain in 1 - 4 mm sites . RP and MW produced a greater gain of CAL than CS and FO following the surgical phase in 5 to 6 mm sites , but the magnitude of difference decreased during SPT . Similar CAL gains were produced by RP , MW , and FO in sites > or = 7 mm . These gains were greater than that produced by CS and were sustained during SPT . Recession was produced with FO > MW > RP > CS . This relationship was maintained throughout SPT . The prevalences of BOP , SUP , and PL were greatly reduced throughout the study and were comparable between sites treated by RP , MW , and FO while the CS sites had more BOP and SUP The present investigation was performed to examine if triclosan and a copolymer , incorporated in a dentifrice and used by periodontitis-susceptible subjects could influence clinical symptoms characteristic of recurrent periodontitis . 60 subjects , 34 to 67 years of age , were recruited for the study . They were r and omly selected from a group of patients previously treated for advanced periodontal disease . This treatment had included oral hygiene instruction , subgingival debridement , but no surgical therapy . The patients had , during a 3 - 5 year period following active therapy , been enrolled in a maintenance care program but had , at various intervals , exhibited signs of recurrent periodontitis . The patients were stratified into 2 balanced groups with respect to mean probing pocket depth . The test group , included 30 individuals who used a dentifrice containing triclosan/copolymer/fluoride , i.e. 0.3 % triclosan , 2 % copolymer and 1100 ppm F from 0.243 % sodium fluoride ( Colgate Total ) . The control group also included 30 subjects who used a dentifrice  identical to the one used in the test group but without the triclosan/copolymer content . Following the baseline examination , including clinical and radiographical assessment s , all volunteers received detailed information on how to brush their teeth in a proper way . This information was repeated on an individual need basis during the course of the subsequent 36 months . No professional subgingival therapy was delivered between the baseline and the 36-month examinations , but the subjects were recalled every 3 months . Re-examinations were performed after 6 , 12 , 24 , and 36 months of the trial . A 2nd set of radiographs was obtained at the final examination , i.e. , at 36 months . The results demonstrated that in subjects susceptible to periodontal disease , meticulous , self-performed , supragingival plaque control maintained over a 3-year period failed to prevent recurrent periodontitis . In a similar group of subjects and plaque control program , however , the daily use of a triclosan-containing dentifrice reduced ( i ) the frequency of deep periodontal pockets , and ( ii ) the number of sites that exhibited additional probing attachment and bone loss The purpose of the present study was to assess in a clinical trial over 5 years the results following 4 different modalities of periodontal therapy ( pocket elimination or reduction surgery , modified Widman flap surgery , subgingival curettage , and scaling and rool planing ) . 90 patients were treated . The treatment methods were applied on a r and om basis to each of the 4 quadrants of the dentition . The patients were given professional tooth cleaning and oral hygiene instructions every 3 months . Pocket depth and attachment levels were scored once a year . 72 patients completed the 5 years of observation . Both patient means for pocket depth and attachment level as well as % distribution of sites with loss of attachment greater than or equal to 2 mm and greater than or equal to 3 mm were compared . For 1 - 3 mm probing depth , scaling and root planing , as well as subgingival curettage led to significantly less attachment loss than pocket elimination and modified Widman flap surgery . For 4 - 6 mm pockets , scaling and root planing and curettage had better attachment results than pocket elimination surgery . For the 7 - 12 mm pockets , there was no statistically significant difference among the results following the various procedures AIM A clinical trial was performed to determine ( i ) the initial outcome of non-surgical and surgical access treatment in subjects with advanced periodontal disease and ( ii ) the incidence of recurrent disease during 12 years of maintenance following active therapy . MATERIAL AND METHODS Each of the 64 subjects included in the trial showed signs of ( i ) generalized gingival inflammation , ( ii ) had a minimum of 12 non-molar teeth with deep pockets ( > or = 6 mm ) and with > or = 6 mm alveolar bone loss . They were r and omly assigned to 2 treatment groups ; one surgical ( SU ) and one non-surgical ( SRP ) . Following a baseline examination , all patients were given a detailed case presentation which included oral hygiene instruction . The subjects in SU received surgical access therapy , while in SRP non-surgical treatment was provided . After this basic therapy , all subjects were enrolled in a maintenance care program and were provided with meticulous supportive periodontal therapy ( SPT ) 3 - 4 times per year . Sites that at a recall appointment bled on gentle probing and had a PPD value of > or = 5 mm were exposed to renewed subgingival instrumentation . Comprehensive re-examinations were performed after 1 , 3 , 5 and 13 years of SPT . If a subject between annual examinations exhibited marked disease progression ( i.e. , additional PAL loss of > or = 2 mm at > or = 4 teeth ) , he/she was exited from the study and given additional treatment . RESULTS It was observed that ( i ) surgical therapy ( SU ) was more effective than non-surgical scaling and root planing ( SRP )  in reducing the overall mean probing pocket depth and in eliminating deep pockets , ( ii ) more SRP-treated subjects exhibited signs of advanced disease progression in the 1 - 3 year period following active therapy than SU-treated subjects . CONCLUSION In subjects with advanced periodontal disease , surgical therapy provides better short and long-term periodontal pocket reduction and may lead to fewer subjects requiring additional adjunctive therapy 
    Output:
    
Supportive therapy , which encompasses PMPR , may limit the incidence and yearly rate of tooth loss as well as the loss in clinical attachment in patients treated for periodontitis .