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     A decision about extraction should be based not only on the condition of the individual tooth and its supporting tissues but also upon the possible consequences of the extraction. Where periodontal breakdown is advanced, the extraction of weak teeth may create an insoluble prosthetic problem. Such developments need to be anticipated prior to extraction. The provision of removable prostheses may be necessary at this time, and care should be taken with their design, even if temporary.
     3. Patient information
     Some time should be allowed prior to definitive treatment to explain to the patient the nature of the problem and the kind of treatment needed. Where different lines of treatment are available, these options, with their advantages and disadvantages, should be explained. Frequently, decisions have to be made by the patient, and these can be made intelligently only on the basis of information.
     4. Plaque control and scaling
     Plaque control and scaling are the most important procedures in periodontal treatment. Where the condition is diagnosed and treated at an early stage, they are the only treatments required. They also provide a clue as to patient attitude, dexterity and level of cooperation. Where that level of cooperations is inadequate, any indicated surgical treatment or other complicated treatment would not be justified. This phase of treatment should also include the correction of filling overhangs and the replacement of defective restorations. It is unrealistic and unjust to expect a high level of plaque control where conditions exist which make that impossible; therefore, all plaque retention factors should be corrected at this stage.
     5. Initial occlusal adjustment
     This is necessary for repair of the periodontal lesion and may be carried out alongside plaque control. Gross occlusal disharmonies should be eliminated and temporary splints applied to very mobile teeth. At this stage, any minor tooth movement necessary can be carried out. Such movement should be complete and any retention apparatus is in place before any surgery is carried out. A bite-guard is provided in cases of difinite bruxism.
     6. Reaeessment
     A reassessment of the periodontal condition should be made at this stage. The tissue response to the treatment already provided may be better than anticipated, so that little or no surgery may be required. Pockets may shrink and mobile teeth become stable after the relatively simple procedures carried out so far. Dramatic stabilization of neighbouring teeth can follow the extraction of an infected tooth.
     On the other hand, tissue response or patient cooperation may not be as satisfactory as anticipated and a reappraisal of the case will be needed.
     7. Surgery
     The management of the surgical phase of treatment depends upon the size of the problem and the patient’ s domestic and work commitments and their physical and emotional status. Not every patient can cope with several surgical procedures under local anaesthesia over an extended period of time. Furthermore, some patients find it difficult to maintain a satisfactory level of plaque control with a surgical wound, sutures and dressings in th