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It is evident that mechanical therapy remains the primary focus for successful treatment whereas HMT is only recommended as an adjunct to conventional therapy for better clinical outcome. Also, the modification of risk factors either modifiable (e.g. smoking, uncontrolled diabetes) or non-modifiable (e.g. genetics, gender etc) plays a pivotal role in successful treatment. There are many clinical situations in which desired clinical results cannot be achieved with mechanical therapy alone e.g. presence of risk factors, presence of systemic disease etc., therefore, adjunctive use of HMT is indicated.217 The adjunctive use of host modulation therapy can enhance therapeutic responses, slow the progression of the disease, and allow for more predictable management of patients, particularly in those patients at increased risk caused by factors beyond the reach of conventional therapeutic approaches.