Abstract
BackgroundPeriodontal intrabony defects are usually treated surgically with the aim of increasing attachment and bone levels and reducing risk of progression. However, recent studies have suggested that a minimally invasive non-surgical therapy (MINST) leads to considerable clinical and radiographic defect depth reductions in intrabony defects. The aim of this study is to compare the efficacy of a modified MINST approach with a surgical approach (modified minimally invasive surgical therapy, M-MIST) for the treatment of intrabony defects.MethodsThis is a parallel-group, single-centre, examiner-blind non-inferiority randomised controlled trial with a sample size of 66 patients. Inclusion criteria are age 25–70, diagnosis of periodontitis stage III or IV (grades A to C), presence of ≥ 1 ‘intrabony defect’ with probing pocket depth (PPD) > 5 mm and intrabony defect depth ≥ 3 mm. Smokers and patients who received previous periodontal treatment to the study site within the last 12 months will be excluded. Patients will be randomly assigned to either the modified MINST or the M-MIST protocol and will be assessed up to 15 months following initial therapy. The primary outcome of the study is radiographic intrabony defect depth change at 15 months follow-up. Secondary outcomes are PPD and clinical attachment level change, inflammatory markers and growth factors in gingival crevicular fluid, bacterial detection, gingival inflammation and healing (as measured by geometric thermal camera imaging in a subset of 10 test and 10 control patients) and patient-reported outcomes.DiscussionThis study will produce evidence about the clinical efficacy and potential applicability of a modified MINST protocol for the treatment of periodontal intrabony defects, as a less invasive alternative to the use of surgical procedures.Trial registrationClinicalTrials.gov, NCT03797807. Registered on 9 January 2019.
Highlights
Periodontal intrabony defects are usually treated surgically with the aim of increasing attachment and bone levels and reducing risk of progression
Nibali et al Trials (2019) 20:461 a non-specific reduction of the bacterial load below the gingival margin [4], which can be achieved by oral hygiene instructions and non-surgical periodontal therapy (NSPT)
The treatment of intrabony defects has gradually evolved from radical surgical elimination of the defect by removal of some of the adjacent healthy supportive or non-supportive bone [9] to more conservative surgical approaches [10] and to regenerative surgical procedures resulting in regeneration of periodontal attachment measurable clinically, radiographically and histologically [11]
Summary
Periodontal intrabony defects are usually treated surgically with the aim of increasing attachment and bone levels and reducing risk of progression. The treatment of intrabony defects has gradually evolved from radical surgical elimination of the defect by removal of some of the adjacent healthy supportive or non-supportive bone [9] to more conservative surgical approaches [10] and to regenerative surgical procedures resulting in regeneration of periodontal attachment measurable clinically, radiographically and histologically [11]. Even these less invasive surgeries are associated with potential morbidity and high costs due to the use of bone graft and barrier materials, and they are not always predictable [12]. A recent consensus report of the American Academy of Periodontology considers surgical intervention still the treatment of choice for intrabony defects [15]
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