Abstract
ObjectivesMinimally invasive flap designs have been introduced to enhance blood clot stability and support wound healing. Limited data appear to suggest, that in intrabony defects, better clinical outcomes can be achieved by means of minimally invasive flap compared to more extended flaps. The aim of this study was to evaluate the healing of intrabony defects treated with either minimally invasive surgical flaps or with modified or simplified papilla preservation techniques in conjunction with the application of an enamel matrix derivative (EMD).Materials and methodsForty-seven subjects were randomly assigned to either test (N = 23) or control (N = 24) procedures. In the test group, the intrabony defects were accessed by means of either minimally invasive surgical technique (MIST) or modified minimally invasive surgical technique (M-MIST) according to the defect localization while the defects in the control group were treated with either the modified or simplified papilla preservation (MPP) or the simplified papilla preservation technique (SPP). EMD was used as regenerative material in all defects. The following clinical parameters were recorded at baseline and after 12 months: full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), probing depths (PD), clinical attachment level (CAL), and gingival recession (GR). Early healing index (EHI) score was assessed in both groups 1 week following the surgery. CAL gain was set as primary outcome.ResultsAfter 12 months follow-up, the CAL gain was 4.09 ± 1.68 mm in test group and 3.79 ± 1.67 mm in control group, while the PD reduction was 4.52 ± 1.34 mm and 4.04 ± 1.62 mm for test and control sites. In both groups, a minimal GR increase (0.35 ± 1.11 mm and 0.25 ± 1.03 mm) was noted. No residual PDs ≥ 6 mm were recorded in both groups. CAL gains of 4–5 mm were achieved in 30.4% and in 29.2% of test and control group, respectively. Moreover, CAL gains ≥ 6 mm were recorded in 21.7% of experimental sites and in 20.8% of control sites. No statistically significant differences in any of the evaluated parameters were found between the test and control procedures (P > 0.05). After 1 week post-surgery, a statistically significant difference (P < 0.05) between the groups was found in terms of EHI score.ConclusionsWithin the limits of this pilot RCT, the results have failed to show any differences in the measured parameters following treatment of intrabony defects with EMD, irrespective of the employed surgical technique.Clinical relevanceIn intrabony defects, the application of EMD in conjunction with either MIST/M-MIST or M-PPT/SPPT resulted in substantial clinical improvements.
Highlights
Regenerative periodontal therapy aims at reconstructing the lost periodontal structures caused by periodontal disease or trauma and is histologically characterized by formation of cementum with inserting collagen fibers, periodontal1 3 Vol.:(0123456789)Clinical Oral Investigations ligament, and bone [1]
The main objective of the present study was to compare the efficacy of minimally invasive surgical flaps (MIST/MMIST) with the more extended papilla preservation flaps on the healing of intrabony defects treated with enamel matrix derivative (EMD)
The clinical attachment level (CAL) gains recorded at intrabony defects treated by means of minimally invasive flaps and EMD (4.09 ± 1.68 mm) are similar to those reported in other studies [39, 40]
Summary
Clinical Oral Investigations ligament, and bone [1] This healing would lead to the resolution or reduction of the intrabony defect component and of probing depths, gain of clinical attachment level, and minimize soft tissues recession [2]. A number of clinical factors such as patient compliance, morphology of the intrabony defects, regenerative materials (i.e., GTR, EMD, and combination of EMD/bone graft), and surgical flap management have been shown to decisively influence the clinical outcomes following regenerative periodontal therapy [3,4,5,6,7]. The lack of surgical flap stability may result in the detachment of the fibrin clot followed by apical migration of epithelial cells leading to formation of a long junctional epithelium and no or limited periodontal regeneration. Would closure enabling primary intention healing is considered a prerequisite to stabilize the blood clot and to support a healing process that facilitates periodontal regeneration
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