rdcjournalRoyal Dental College JournalE-Volume 8 Issue 1MultidisciplinaryEnglishJanuary- DecemberNNY2025075Periodontology To Flap or Not To Flap: Decision Making in Periodontal TherapyEnglishY5961Harish KumarVV1EnglishNSanthoshVC2EnglishYSunandaSudhakaran3EnglishYAishwaryaPradeep4  EnglishY10.67091/JRDC.025.8113Decision-making in periodontal therapy plays a crucial role in determining treatment outcomes and long-term periodontal stability. Periodontal management generally follows a phased approach, beginning with non- surgical periodontal therapy and progressing to surgical intervention when indicated. Although flap surgery improves access to root surfaces and alveolar bone, it is not required in every clinical situation. The dilemma of whether to perform flap surgery is particularly relevant in cases with moderate to advanced periodontal destruction. This review discusses the rationale, indications, and clinical parameters guiding the choice between flap and non-flap periodontal therapy, while integrating the contemporary P4 Medicine model to promote evidence-based and patient-centered periodontal care.EnglishFlap surgery, Non-surgical Periodontal therapy, Periodontal pocket, Periodontitishttps://www.rdcjournal.org/abstract?id=308References16191.Kinane DF, Stathopoulou PG, Papapanou PN. Periodontal diseases. Nat Rev Dis Primers. 017;3:17038.doi:10.1038/nrdp.2017.38 2.Pihlstrom BL, Michalowicz BS, Johnson NW. Periodontal diseases. Lancet. 2005;366(9499):1809-1820.doi:10.1016S0140-6736(05)67728-8. 3.American Academy of Periodontology. Comprehensive periodontal therapy. J Periodontol. 2011;82(7):943-949.doi:10.1902/jop.2011.117001. 4.Waerhaug J. Healing of the dento-epithelial junction following subgingival plaque control: as observed on extracted teeth. J Periodontol. 1978;49(3):119-134.doi: 10.1902/jop.1978.49.3.119. 5.Kirkland O. The Suppurative Periodontal Pus Pocket; Its Treatment by the Modified Flap Operation. Journal of the American Dental Association. 1931;18:1462-1470. 6.Heitz-Mayfield LJ, Lang NP. Surgical and non-surgical periodontal therapy. Periodontol 2000. 2013;62(1):281-231.doi: 10.1111/prd.12008. 7.Cobb CM. Non-surgical pocket therapy: Mechanical. Ann Periodontol. 1996;1(1):443-490.doi: 10.1902/annals.1996.1.1.443 8.Badersten A, Nilveus R, Egelberg J. Effect of non-surgical therapy.I. Moderately advanced periodontitis.J Clin Periodontol. 1981;8(1):57-72.doi: 10.1111/j.1600-051x.1981.tb02024.x. 9.Serino G, Rosling B, Ramberg P, Lindhe J. Initial outcome and long-term effect of surgical and non-surgical treatment of advanced periodontal disease.J Clin Periodontol. 2001;28(10):910-916.doi: 10.1034/j.1600-051x.2001.028010910.x. 10.Matuliene G,Pjetursson BE, Salvi GE, Schmidlin K, Brand;auml;gger U, Zwahlen M, et al. Influence of residual pockets on progression of periodontitis and tooth loss:results after 11 years of maintenance.J Clin Periodontol. 2008;35(8):685-695.doi: 10.1111/j.1600-051X.2008.01245.x. 11.Cortellini P,Pini Prato G, Tonetti MS. Periodontal regenerationof human infrabony defects.Periodontol 2000. 2015;68(1):282-307. doi:10.1902/jop.1993.64.4.254. 12.Needleman I, Almond N, Leow N, Phillips J. Outcomes of periodontal therapy: Strengthening the relevance of research to patients. A co-created review. Periodontol 2000. 2023 Feb 14. doi: 10.1111/prd.12483. 13.Manresa C, Sanz-Miralles EC, Twigg J, Bravo M. Supportive periodontal therapy (SPT) for maintaining the dentition in adults treated for periodontitis. Cochrane Database of Systematic Reviews. 2018(1).doi: 10.1002/14651858.CD009376.pub2.