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===Surgery=== If nonsurgical therapy is found to have been unsuccessful in managing signs of disease activity, periodontal surgery may be needed to stop progressive bone loss and regenerate lost bone where possible. Many surgical approaches are used in the treatment of advanced periodontitis, including open flap debridement and osseous surgery, as well as guided tissue regeneration and bone grafting. The goal of periodontal surgery is access for definitive calculus removal and surgical management of bony irregularities which have resulted from the disease process to reduce pockets as much as possible. Long-term studies have shown, in moderate to advanced periodontitis, surgically treated cases often have less further breakdown over time and, when coupled with a regular post-treatment maintenance regimen, are successful in nearly halting tooth loss in nearly 85% of diagnosed people.<ref>{{cite journal | vauthors = Kaldahl WB, Kalkwarf KL, Patil KD, Molvar MP, Dyer JK | title = Long-term evaluation of periodontal therapy: II. Incidence of sites breaking down | journal = Journal of Periodontology | volume = 67 | issue = 2 | pages = 103β8 | date = February 1996 | pmid = 8667129 | doi = 10.1902/jop.1996.67.2.103 }}</ref><ref>{{cite journal | vauthors = Hirschfeld L, Wasserman B | title = A long-term survey of tooth loss in 600 treated periodontal patients | journal = Journal of Periodontology | volume = 49 | issue = 5 | pages = 225β37 | date = May 1978 | pmid = 277674 | doi = 10.1902/jop.1978.49.5.225 }}</ref>
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