The 19th century was the time when possible etiology
and, therefore, prevention and treatment of periodontal
disease have been proposed. Furthermore, the gained
knowledge was transferred to clinical practice through the
development of techniques and instruments for curettage,
debridement, and scaling. This was the time when
periodontal surgery started.
Leonard Koecker (1785–1850) was a dentist originally
from Germany who later practiced in Baltimore (Figure 1)
and emphasized the importance of dental health in his
work 1. In a paper published in the “Philadelphia Journal of
Medicine and Physical Sciences” in 1821, he highlighted
the inflammatory changes in the gums and the presence of
tartar on teeth, which could lead to tooth loss. Koecker believed
that poor dental health was linked to various disorders.
His influential book Principles of Dental Surgery, released
in 1826, advocated for the use of astringent powder
and a horsehair toothbrush and a toothbrush placing bristles
at the spaces of the teeth after each meal to maintain oral
hygiene. He also supported the odontogenic focal infection
theory early on, recommending the extraction of severely
affected teeth and roots to prevent systemic infections 2.
Even though Koecker advocated for adequate oral hygiene
practice, Levi Spear Parmly (1790–1859) was considered
the father of oral hygiene and the inventor of the oral floss. In the 20th century, periodontics thrived in Europe,
particularly in two leading centers: Vienna and Berlin. In
Vienna, Bernhard Gottlieb (1885–1950) conducted extensive
microscopic studies on human periodontal disease. He
emphasized that merely removing calculus and other
deposits was not enough; it was also crucial to eliminate the
periodontal pocket. Gottlieb’s scientific work sought to
explain the biology of cementum, the tooth-eruption process,
gingival epithelium attachment to the tooth, and traumatic
occlusion. Balint J. Orban (1899–1960), a younger colleague
of Gottlieb, continued his work and expanded his knowledge
through detailed histological studies. In Berlin, prominent
figures in periodontology included Oskar Weski (1879–1952)
and Robert Neumann (1882–1958). Weski introduced the
concept of the periodontium and its components: cementum,
gingiva, alveolar bone, and the periodontal ligament. He also
conducted pioneering studies on the relationship between
histopathological changes in periodontal disease and
radiographic images 12.
From the 1950s onward, the United States and
Scandinavia played a leading role in both basic and clinical
periodontal research, achieving significant progress in
experimental pathology, microbiology, and immunology.
Irving Glickman (1914–1972) emerged as a leading
researcher in the United States during this period, while Jens
Waerhaug (1907–1980) of Oslo, Norway, was a key figure in
Scandinavia. His dissertation, The gingival pocket; anatomy,
pathology, deepening and elimination, published in 1952,
marked the beginning of a new era in understanding the
biology of the periodontium 13-15. The researchers at that time
knew that the cause of periodontal disease was chronic
inflammation, probably on the clinical and histologic levels.
However, there was insufficient data for understanding
inflammation or inflammation-resolving mechanisms to
explain the etiology of periodontal disease
