Personalized Decision-Making in Periodontal Therapy: Systemic and Demographic Factors Influencing Surgical vs. Non-Surgical Re-Treatment

Background/Objectives: The aim of this retrospective cohort study was to identify and analyze the demographic, systemic, and clinical factors associated with the type of periodontal therapy (surgical vs. non-surgical re-treatment) to better inform multifactorial approaches in periodontal treatment planning. Methods: Electronic health records were analyzed to identify two distinct patient cohorts. The surgical cohort included patients who received one or more surgical procedures (i.e., gingival flap, osseous surgery). The non-surgical re-treatment cohort included patients who received scaling and root planing on more than one occasion and had no history of surgical treatment. Bivariate analyses (t-tests and Chi-square tests) were used to compare cohort characteristics, and a multivariable binary logistic regression model was developed to identify independent predictors of receiving surgical treatment. Results: A total of 3794 patients were included in the final analysis. The non-surgical re-treatment cohort presented with significantly more severe periodontal disease at baseline, including a higher number of bleeding sites and deep pockets (p < 0.001). The logistic regression analysis revealed that a higher number of bleeding sites (OR = 0.984) and deep pockets (OR = 0.987) were significantly associated with a decreased likelihood of receiving surgical treatment. Patients with high blood pressure (OR = 0.620) or arthritis (OR = 0.611) also had significantly lower odds of receiving surgery. Conversely, White patients had significantly higher odds (OR = 1.366) of receiving surgical therapy compared to non-White patients. Conclusions: Within the limitations of this study, the selection between surgical and non-surgical periodontal therapy is a multifactorial decision. Initial disease severity, specific systemic conditions, and patient race were significant predictors of the treatment provided. These findings highlight the necessity of adopting a multifactorial risk assessment framework in periodontology—one that integrates systemic and demographic risk factors alongside clinical parameters to tailor equitable, patient-specific care.