Dental Unfiltered Episode 175- Clinical Unfiltered | SRPs vs. Periodontal Therapy w/ Dr. Polly
Mar 12, 2026
Dr. Polly, a periodontist and educator known as Periopolly, dives into periodontal therapy choices and practical clinical reasoning. They revisit landmark SRP vs flap research and question how modern instruments change outcomes. Conversations cover calculus removal limits, when to opt for flap or conservative osseous approaches, regeneration considerations, and the crucial role of hygienists in patient communication and referral.
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SRP Frequently Leaves Tenacious Residual Calculus
- SRP often leaves substantial residual calculus in mid-to-deep pockets even when performed correctly.
- The 1986 Cafessi split-mouth study showed only ~32–43% of root surface free of calculus in 4–6+ mm pockets after SRP, revealing a real limitation.
Instrumentation Advances Change But Don’t Eliminate The Problem
- Newer extended and micro‑mini curettes likely improve reach into deep pockets compared with instruments available in 1986.
- Polly and Dr. Sasha acknowledge instrumentation advances could change SRP effectiveness but note even flapped access still leaves residue.
Always Start With SRP For Inflamed Middepth Pockets
- Do at least perform SRP when you identify inflamed pockets around 5–6 mm; doing nothing is harmful.
- Use SRP as step one and then reassess for further therapy like laser access or flap surgery if inflammation persists.