Modified Widman Flap Research Articles

A Blissful Role of Probiotic Therapy as an Adjunct to Periodontal Surgery in the Treatment of Periodontitis.

Background Periodontitis is a chronic inflammatory disease that alters the alveolar bone structure, requiring treatment ranging from non-surgical to surgical periodontal therapies based on its severity. Surgical interventions, such as the modified Widman flap procedure and the open flap technique combined with methods like platelet-rich fibrin (PRF), guided tissue regeneration (GTR), and bone grafts, aim to reduce periodontal pockets and regenerate lost tissues. The presence of pathogenic bacteria and the absence of beneficial bacteria contribute to periodontitis, with probiotics-live microorganisms that offer health benefits emerging as a promising adjunct in periodontal therapy. Probiotics can inhibit harmful organisms and enhance the oral mucosal lining, potentially improving clinical outcomes when used alongside surgical procedures. This study aims to evaluate the efficacy of combining probiotics with open flap debridement (OFD) in managing chronic periodontitis, comparing it to OFD alone. Methodology Eighty individuals were recruited in this double-blind, randomization clinically controlled, split-mouth trial. The enrolled individuals were categorized in a random manner into either Group A (OFD) or Group B (OFD with probiotic therapy, OFD + P). Results Based on the results, significant differences were observed between the OFDand OFD + Pgroups. At baseline, the mean probing pocket depth (PPD) was 6.49 mm in the OFD group and 5.68 mm in the OFD + P group. After three weeks, the PPD decreased to 4.71 mm in the OFD group and 3.95 mm in the OFD + P group, with a p-value of 0.021, indicating a significant difference. By 12 weeks, the PPD was 3.20 mm for OFD and 2.74 mm for OFD + P, though the difference was not statistically significant (p-value 0.108). For relative attachment level (RAL), a significant difference was noted after three weeks with a p-value of 0.018; however, differences at baseline and 12 weeks were not significant. The gingival index (GI) did not show significant differences between the groups at any time point. Within-group analyses revealed significant improvements in PPD, RAL, and GI for both groups over time, with all p-values < 0.001. The OFD + P group demonstrated superior outcomes compared to the OFD group in PPD and RAL after three weeks. Conclusion The use of probiotics in managing periodontal disease offers a cost-effective and convenient treatment option for periodontitis. Its integration into periodontal therapy should be emphasized for its potential benefits across all age groups, benefiting both periodontal surgeons and general dentists. Further research is needed to understand how well probiotics persist in the oral microflora and their precise effects on periodontal health. The future of periodontal therapy could greatly benefit from probiotics as a natural, food-based approach to enhancing immunity and improving oral health.

Assessment of Wound Healing Using MMP-8 Levels in GCF of Diabetics With Chronic Periodontitis After Diode Laser Assisted Flap Surgery.

Inflammatory cytokines like Matrix Metalloproteinases (MMPs) are associated with the destruction observed in periodontal disease (3). There has been evidence of significant increases in MMP levels in patients with systemic disorders, such as Diabetes Mellitus (DM), which is associated with microvascular complications, causing increased MMP activity, directly or indirectly, due to oxidative stress. Objective: The aim of this study was conducted in order to assess wound healing using MMP-8 levels in GCF of diabetics with chronic periodontitis after diode laser assisted flap surgery. This interventional, comparative clinical trial, was conducted after obtaining approval from the Institutional Ethics Committee (IEC), (Study protocol number: 48/2020), and registered with Clinical Trials Registry of India (CTRI/2022/07/043898). Purposive sampling technique was used to select 30 patients with chronic periodontitis (15 systemically healthy patients, and 15 diabetic patients), who visited the Department of Periodontology. Out of the 30 patients initially selected, 3 patients were lost to follow up and 1 patient was excluded from the study due to lack of compliance towards oral hygiene maintenance. Intragroup comparison of the clinical parameters at baseline and 3 months in both groups was statistically significant (p=0.000). This concludes that there was statistically significant improvement in the periodontal parameters of non-diabetic patients after diode laser assisted flap surgery. Inter-group comparison of the clinical parameters did not show statistical significance at baseline and at 3 months (p > 0.05). It can be concluded that there was comparable changes in the periodontal parameters in both groups after surgery. MMP-8 could be used as a futuristic tool for assessing wound healing especially in diabetics, so that necessary treatment interventions can be undertaken prior to development of any post-op complications. Laser assisted Modified Widman flap showed noteworthy improvement in the clinical parameters in both groups. Thus, proving that laser assisted MWF surgery is a favorable treatment modality, especially in diabetics who are immunocompromised and prone to infections.

Assessment of Wound Healing Using MMP-8 Levels in GCF of Diabetics With Chronic Periodontitis After Diode Laser Assisted Flap Surgery.

Inflammatory cytokines like Matrix Metalloproteinases (MMPs) are associated with the destruction observed in periodontal disease. There has been evidence of significant increases in MMP levels in patients with systemic disorders, such as Diabetes Mellitus (DM), which is associated with microvascular complications, causing increased MMP activity, directly or indirectly, due to oxidative stress. The aim of this study was conducted in order to assess wound healing using MMP-8 levels in GCF of diabetics with chronic periodontitis after diode laser assisted flap surgery. This interventional, comparative clinical trial, was conducted after obtaining approval from the Institutional Ethics Committee (IEC), (Study protocol number: 48/2020), and registered with Clinical Trials Registry of India (CTRI/2022/07/043898). Purposive sampling technique was used to select 30 patients with chronic periodontitis (15 systemically healthy patients, and 15 diabetic patients), who visited the Department of Periodontology. Out of the 30 patients initially selected, 3 patients were lost to follow up and 1 patient was excluded from the study due to lack of compliance towards oral hygiene maintenance. Intragroup comparison of the clinical parameters at baseline and 3 months in both groups was statistically significant (p=0.000). This concludes that there was statistically significant improvement in the periodontal parameters of non-diabetic patients after diode laser assisted flap surgery. Inter-group comparison of the clinical parameters did not show statistical significance at baseline and at 3 months (p > 0.05). It can be concluded that there was comparable changes in the periodontal parameters in both groups after surgery. MMP-8 could be used as a futuristic tool for assessing wound healing especially in diabetics, so that necessary treatment interventions can be undertaken prior to development of any post-op complications. Laser assisted Modified Widman flap showed noteworthy improvement in the clinical parameters in both groups. Thus, proving that laser assisted MWF surgery is a favorable treatment modality, especially in diabetics who are immunocompromised and prone to infections.

Surgical Management of Plaque Induced Gingival Enlargement: A Case Report

Introduction: Gingival enlargement or gingival overgrowth, a common trait of gingival disease, is characterized by an increase in the size of gingiva with multifactorial etiology. Purpose: This case report aimed to discuss gingival enlargement case along with the treatment plan of the patient.Case presentation: A 50-year-old female patient reported the swelling in the gums of teeth in lower front region since six months ago. Gingival enlargement was treated with modified Widman flap procedure, internal bevel incision, and bone recontouring. These treatment modalities showed significant clinical improvement in the form of pocket depth reduction and gingival contour Conclusion: Dental plaque bacteria served as initial factor of inflammation which induce the occurrence of gingival enlargement. Surgical treatment can be done if the initial phase still presenting gingival enlargement with firm consistency with minimum inflammation.

Clinical Evaluation of Diode Laser-Assisted Surgical Periodontal Therapy: A Randomized Split-Mouth Clinical Trial and Bacteriological Study.

Background: Stage 3 grade C periodontitis (S3GCP) has always been a challenge for clinicians. However, it is proposed that the use of lasers in addition to periodontal therapy can result in a more efficient therapy outcome. Objective: The aim of this clinical study was to determine the effects of additional application of diode laser (DL, 810 nm ±5) on clinical and microbiological values during Modified Widman Flap (MWF) periodontal surgery in the S3GCP patients. Methods: A total of 18 patients were randomly assigned to the test site (MWF + activeDL) and the control site (MFW alone). Clinical parameters and microbial samples were taken preoperatively, and postoperatively at 6 weeks, 3 months, and 6 months. Visual analog scale (VAS), tissue edema (TE), tissue color (TC), and pain medication (PM) consumption, were evaluated postoperatively at 10th day. Results: All bacteria were significantly decreased at follow-up times compared with preoperative amounts in both therapy sites (p < 0.05). Bacterial amounts of Treponema denticola, Prevotella intermedia, Tannerella forsythia, and Aggregatibacter actinomycetemcomitans at 6 weeks, Porphyromonas gingivalis and T. denticola at 3 months, T. denticola and A. actinomycetemcomitans at 6 months were statistically lower in the test site than the control site. All clinical parameters significantly improved after MWF surgery at follow-up times compared with preoperative values in intragroup comparisons, but a significant difference was not detected in the intergroup comparison. No differences were found in terms of VAS, PM, TE, and only TC was statistically more pink in the test site than the control site. Conclusions: The present study findings suggest that the use of DL together with MWF may have positive effects in the therapy of S3GCP patients by reducing the microbial load. Clinical Trial.org: NCT05108727.

Comparative evaluation of postoperative pain and tissue response in patients undergoing conventional flap surgeries with or without 940 nm diode laser exposure - A randomized clinical study.

Over the past few years, a growing body of evidence has allowed us to ascertain that the initiation of periodontitis stems from the existence of oral microbial biofilm and that this requires definitive treatment. Owing to its exceptional usability, affordability, and antibacterial activity, the "diode laser" (DL) has increasingly become a popular and important tool in a dentist's armamentarium. However, there is a scarcity of scientific evidence on the utility and advantages of using "diode laser" in periodontal flap surgery. The study aimed to determine the efficacy of 940 nm diode laser exposure in combination with conventional periodontal flap surgery for the treatment of chronic periodontitis to evaluate postoperative discomfort and clinical parameters. A total of 10 subjects (7 males and 3 females) with generalized chronic periodontitis were recruited and completed the study without any dropouts. For this split-mouth study, 40 sample sites with pocket probing depth (PPD) 5-7 mm post periodontal Phase I therapy were selected. The quadrants were randomly allocated to Groups A, B, C, and D using the fish bowl lottery method. Kirkland flap surgery with laser and modified Widman flap (MWF) with laser were performed in Group A and C, respectively, while Kirkland flap surgery and MWF surgery were performed in Group B and Group D. Clinical parameters including visual analog scale (VAS) score and gingival inflammation were determined at 3rd and 7th day postoperatively while PPD, clinical attachment level (CAL), and sulcus bleeding index (SBI) were recorded at baseline and 6 months following treatment. Wilcoxon signed-rank test and Kruskal-Wallis test were used for intra-group and inter-group comparison of parameters, respectively. Statistically significant difference was attained with postoperative discomfort in laser-assisted groups on 1st and 3rd day postoperatively (P < 0.001). There was no significant difference in the proportion of subjects with gingival inflammation. A statistically significant reduction in mean PPD at 6 months postoperatively was seen among all study groups (P < 0.05) but the inter-group difference was not statistically significant. SBI score reduced significantly from baseline to 6 months follow-up among all four groups (P < 0.05). However, we did not find the inter-group difference to be statistically non-significant. Diode laser as an adjunct to the surgical procedure can demonstrate appreciable benefits by increasing the CAL and minimizing the postoperative pain and the probing pocket, but such additional effects were not observed with gingival inflammation.

Soft tissue re-growth after different crown lengthening techniques among Indian patients.

Patients often report complaining of fractured or decayed teeth with severe morphological deformities. However, all these clinical scenarios require the same level of care and consideration to rehabilitate form, function and esthetics. Some cases have sufficient clinical crown height while others often require an interdisciplinary approach in the form of orthodontic/surgical extrusion or surgical periodontal options. A common factor delaying treatment is soft tissue regrowth after crown lengthening which delays the impression required for final prosthesis. Therefore, it is of interest to compare the prevalence of soft tissue regrowth a week after different crown lengthening techniques including laser gingivectomy, electrocautery gingivectomy, modified Widman flap and apically repositioned. The parameters assessed included 1-week postoperative soft tissue regrowth after crown lengthening, age of patients and gender. It was observed that laser and electrocautery-assisted gingivectomy had a higher rate of soft tissue regrowth as compared to surgical techniques. It was further noted that laser and electrocautery assisted gingivectomy had a higher frequency of soft tissue rebound growth compared to surgical crown lengthening using modified widman flap and apically repositioned flap, which was statistically insignificant. Patients within the age groups of 26-60 years were found to have a higher tendency of soft tissue regrowth, which was found to be clinically and statistically significant (p<0.05).

Clinical and microbiological evaluation of 940-nm diode laser as an adjunct to modified Widman flap for the management of chronic periodontitis: A 6-month randomized split-mouth clinical trial.

Background. The present randomized clinical trial aimed to determine the additive clinical and microbiological benefits of diode laser (DL) with modified Widman flap (MWF) to manage chronic periodontitis. Methods. Seventy-two sites in 36 healthy non-smoking patients diagnosed with chronic periodontitis were randomly assigned to the test group (MWF + active DL) or control group (MWF + sham DL). Clinical (probing pocket depth [PPD], clinical attachment level [CAL]) and microbiological (colony-forming units [CFUs]) measurements were recorded at baseline and 6- and 6-month postoperative intervals. Results. Compared to baseline, 6-month results showed significant changes in clinical and microbiological parameters in both groups. However, the intergroup comparison revealed significantly lower PPD (1.90±0.48 mm vs. 2.35±0.41 mm), CAL (4.43±0.57 mm vs. 4.93±0.58 mm), and CFUs for Porphyromonas gingivalis (6.32±0.18 vs. 8.88 ±1.88), Prevotella intermedia (7.62±1.86 vs. 8.12±1.78), and Aggregatibacter actinomycetemcomitans (6.43±1.44 vs. 7.24±1.22) in the test group after six months. Conclusion. Within the limitations, the present study confirmed the useful role of DL with MWF to manage chronic periodontitis.

Cirurgia periodontal de retalho de Widman modificada no sextante anterior: caso clínico

Introduction: The treatment of periodontal disease is considered complex, including, in the first phase, a non-surgical therapy, and then, eventually, a surgical therapy. The modified Widman flap presents itself as a technique that allows a decrease in the probing depth of the pockets with maximum preservation of the periodontal tissue, indicating when aesthetics is an important factor. Descrition of the case report: A 53-year-old female patient was diagnosed with periodontitis stage IV grade B. Non-surgical periodontal treatment was started, using root planing. In the revaluation consultation, it was found that the depth of probing of the pockets did not reach normality. Treatment was continued using the Widman flap periodontal surgical technique modified in the anterior sextant. Conclusions: The modified Widman flap surgical technique proved to be a treatment option, achieving stability and periodontal health.

Comparative evaluation of the efficacy of diode laser as an adjunct to modified Widman flap surgery for the treatment of chronic periodontitis: A randomized split-mouth clinical trial.

Background:Periodontitis is a chronic inflammatory disease that is mainly initiated by plaque biofilm which may require treatment using periodontal flap surgery. Recently, diode lasers have become popular in the field of periodontology owing to advantages such as antibacterial effect, promoting angiogenesis, and providing hemostasis. However, scientific data on application of diode laser in periodontal flap surgery and its benefits are limited. Hence, the aim of the study was to investigate the adjunctive effect of removal of remnant pocket epithelium by 980 nm diode laser and biostimulation in modified Widman flap (MWF) surgery for the treatment of chronic periodontitis.Materials and Methods:A total of 20 patients with generalized chronic periodontitis with pocket probing depth (PPD) ≥5mm post Phase I therapy were selected for this split-mouth study. MWF surgery was performed in Group 1, and in Group 2, MWF surgery with adjunctive diode laser de-epithelization and biostimulation was done. Clinical parameters including PPD, clinical attachment level, plaque index, and gingival index were recorded at baseline and 3 months following treatment, and postprocedural pain (Visual Analog Scale [VAS] score) was assessed 1-week posttreatment. In addition, colony-forming units/milliliter (CFU/ml) of anaerobic bacteria at baseline and 3 months were microbiologically examined.Results:MWF surgery along with diode laser led to a significant improvement in Group 2 compared to Group 1 in clinical parameters such as PPD, relative clinical attachment level, VAS score as well as microbial parameter CFU/ml after 3 months.Conclusion:Diode laser as an adjunct to MWF in chronic periodontitis can provide enhanced clinical attachment gain with little postoperative discomfort.

Clinical evaluation of impact of periodontal phenotype on the outcome of open flap debridement in patients with chronic periodontitis: A comparative interventional study.

Several studies have implicated the role of periodontal phenotype (PP) in the outcome of various periodontal interventions. However investigations have not been performed to estimate such impact on the outcome of open flap debridement (OFD) for the management of chronic periodontitis. A total of 73 individuals with chronic periodontitis underwent scaling and root planing (SRP). Eightweeks following SRP, modified Widman flap (MWF) surgery was performed in 40 patients (20 of either PP) presenting with probing depth (PD) ≥4mm and gingival index (GI) ≥1 at ≥4 sites distributed over ≥2 anterior teeth with radiographic evidence of horizontal bone loss. PD, clinical attachment level (CAL), gingival recession, plaque index, GI, and bleeding on probing (BOP) were recorded at baseline, 3 and 6 months. PP was assessed using transparency of periodontal probe through the gingival margin at midfacial level. A total of 34 patients were re-evaluated after intervention. All periodontal parameters improved in both groups after periodontal surgery. PD & PP were found to have positive correlation with CAL gain in ≥7mm probing sites. Attachment gain of>2 mm was observed in more percentage of sites in thick PP than in thin PP. PP can be an important factor influencing CAL gain in OFD.

Effect of Flap Design for Enamel Matrix Derivative Application in Intraosseous Defects.

To systematically review the literature addressing the focused question: What is the effectiveness of different surgical and nonsurgical procedures combined with enamel matrix derivative (EMD) on clinical, radiographic, and patient-centered outcomes in intraosseous defects? Electronic (Medline, Scopus, and Cochrane databases) and hand literature searches were performed for studies including at least 1 treatment arm where EMD had been applied according to 1 of the following procedures: modified Widman flap; papilla preservation variants (PPVs), including papilla preservation technique, modified papilla preservation technique, and simplified papilla preservation technique; minimally invasive variants, including minimally invasive surgical approach and minimally invasive surgical technique; single-flap variants (SFVs), including single-flap approach and modified minimally invasive surgical technique; or nonsurgical application (flapless approach). Data from 42 selected articles were used to perform a network meta-analysis, and a hierarchy of surgical and nonsurgical applications of EMD was built separately for EMD and EMD + graft based on 6- to 12-mo clinical and radiographic outcomes. Among surgical approaches, EMD was associated with best regenerative outcomes when applied through SFVs, with a mean clinical attachment level gain of 3.93 mm and a reduction in the intrabony component of the defect of 3.35 mm. For EMD + graft, limited differences in regenerative outcomes were observed among surgical procedures. PPVs were associated with the highest residual probing depth for EMD (4.08 mm) and EMD + graft (4.32 mm). In the treatment of periodontal intraosseous defects, 1) SFVs appear to optimize the regenerative outcomes of EMD; 2) substantial regenerative outcomes can be obtained with SFVs and conservative double flaps (i.e., PPVs and minimally invasive variants) when EMD is combined with a graft; and 3) residual probing depth was higher following PPVs for EMD and EMD + graft. The results of the present systematic review and meta-analysis can be used by clinicians to identify the most effective surgical or nonsurgical procedure to treat an intraosseous defect with EMD or EMD + graft. The main findings indicate that when EMD application is indicated, surgical access based on a single flap seems the most appropriate to optimize clinical outcomes. The application of EMD + graft can be effectively combined with single flaps and conservative double flaps.

Comparison of the effect of sodium bicarbonate and glycine air polishing systems on tooth surface roughness: An atomic force microscopic analysis.

A variety of prophylactic materials are used in the dental office for the removal of stains and calculus. To evaluate tooth surface changes caused by the application of air abrasive powders (sodium bicarbonate, SBAP and glycine air powder, GPAP) along with scaling and root planing (SRP), under atomic force microscope (AFM) and to analyze the histological soft tissue changes caused by these agents, using light microscopy. This study was conducted in two phases: in vitro and in vivo. In the in vitro phase, hard tissue analysis was done under AFM following air powder polishing. Eighteen extracted teeth were chosen. SRP and tooth sectioning were carried out. Subsequently, each section of the tooth was mounted on a glass plate with self-cure acrylic resin and air polished using SBAP and GPAP. In the vivo phase, the soft tissue was analyzed under a light microscope for surface roughness. A biopsy specimen was taken from patients who had received phase I therapy, and flap surgery was planned using a modified Widman flap technique. This study compared surface changes in enamel and cementum, under AFM, as indicated by RA after SRP, SRP and SBAP, and SRP and GPAP; comparisons were then drawn across the three groups. The mean AFM values were 108.5 and 144.7, 102.7 and 81.7, and 95.6 and 7.4, at the crown and root, for SRP, SRP and SBAP, and SRP and GPAP interventions, respectively. GPAP was the least rough on soft tissues. SBAP and GPAP were better than hand instrumentation as indicated by AFM and histological section analysis.

Clinical and Cytotoxic Comparison of Two Periodontal Dressings after Periodontal Flap Surgery

Aim: Postoperative coverage of periodontal surgery sites can help protect the treated area, facilitate wound healing and decrease postperiodontal surgery pain. The aim of this study was to compare the cytotoxic and clinical efficacy of two periodontal dressings after periodontal flap surgery. Materials and methods: In this study 23 patients requiring modified Widman flap in at least two quadrants in the same arch were selected; one quadrant was dressed with Reso-pac, and the other was dressed with Coe-pak. The clinical efficacy of these two dressings was evaluated by comparing plaque, granulation tissue formation, pain, bleeding on probing, and color of gingiva. To compare their cytotoxicity, human gingival fibroblast were exposed to 1-and 3-day extracts of the dressings and MTT test was used to measure cell viability after 24 and 48 hours. Cell apoptosis and necrosis were evaluated by flow cytometric analysis. Data were analyzed by Chi-square and independent t-test and SPSS 20 Software. Results: Plaque and granulation tissue formation rates were significantly lower in Reso-pac covered sites compared to coe-pak (p value < 0.001). Other variables including pain, bleeding and gingival color did not show any significant differences (p value 0.05). Viable fibroblast cells were higher for Reso-pac compared to Coe-pak (p < 0.05). A higher percentage of necrotic cells in the day one Coe-pak extract group after 24 and 48 hours were observed compared to Reso-pac (6.23 and 4.97. 2.71 and 2.76). Conclusion: According to our results, Reso-pac is as effective as Coe-pack. It also has further positive effects of less plaque accumulation and granulation tissue formation and is more biocompatible for HGF cells with less cytotoxic effects on cells in the first days after surgery. Clinical significance: Reso-pac may be considered as a dressing of choice in periodontal surgeries with less plaque accumulation and granulation tissue formation plus better biocompatibility and ease of application compared to Coe-pak. © 2019, Jaypee Brothers Medical Publishers (P) Ltd. All rights reserved.

Use of modified vertical internal mattress suture versus simple loop interrupted suture in modified Widman flap surgery: a randomized clinical study.

Close approximation and stabilization of gingival flaps, vital for optimum outcome of surgical procedures, may be difficult to achieve in deep periodontal pockets by routinely used suturing techniques. Modified vertical internal mattress sutures have been reported to be useful in reducing dead space along with achievement of wound stability. The present study compares the outcome of flap closure by use of modified vertical internal mattress sutures and simple loop interrupted sutures in the surgical management of chronic periodontitis. In total, 83 participants with chronic periodontitis received scaling and root planing. After 8 weeks, modified Widman flap surgery was performed in 48 patients at sites with probing pocket depth ≥ 4 mm. Modified vertical internal mattress sutures were placed in the test group (n = 24) and simple loop interrupted sutures were used in the control group (n = 24). Plaque Index (Silness and Loe), Gingival Index (Loe and Silness), bleeding on probing, probing pocket depth, clinical attachment level, and gingival recession were recorded on the day of surgery, and at 3 and 6 months of follow-up. Statistically significant improvement was noted in all the clinical parameters of both groups. The test group showed significantly greater improvement in probing pocket depth, clinical attachment level, bleeding on probing, and Gingival Index, although Plaque Index scores were similar. This improvement was confined to nonmolars only. Flap closure by modified vertical internal mattress suturing technique results in better improvement in periodontal clinical parameters than the use of simple loop interrupted sutures, especially in nonmolars.

Minimally invasive erbium flap (MINIETM flap)—a retrospective surgical treatment for chronic periodontitis

This clinical retrospective split-mouth study was designed to evaluate the efficacy of two (FDA approved) erbium laser wavelengths in a minimally invasive flapped approach for the treatment of generalized chronic periodontitis. Twenty-eight (28) patients diagnosed with generalized chronic periodontitis with pocket depths ranging from 4 to 9 mm had 551 posterior teeth surgically treated in a minimally invasive manner and were followed over 6 months. Minimally invasive erbium (MINIE) flaps were performed in all four posterior sextants (distal of cuspid to distal of second molar) in a traditional split-mouth design. Mean baseline probings were 5.4 mm. Patients were randomly assigned to Laser 1 (Er:YAG, Erbium doped yttrium, aluminium, garnet, 2940 nm or Laser 2 (Er, Cr:YSGG, Erbium, chromium doped yttrium, scandium, gallium, garnet, 2780 nm) in the first appointment. The alternate laser wavelength was used in the second appointment. Pre-surgical examination for pocket depth (PD), recession (RC), and clinical attachment levels (CAL) was performed and then repeated 6 months post-surgery. Patients with history of traditional flap surgery (> 5 years ago) completed a visual acuity test (VAT) describing their surgical experience compared to the conventional approach. The results showed statistically significant improvements in PD (1.43 mm) and reduction in CAL (1.41 mm), whereas the change in RC (0.01 mm) was not statistically significant. Clinical improvements of PD and CAL in this study are consistent with the range reported in previous landmark papers implementing a modified Widman flap (MWF) or osseous surgery (OS). The difference compared to traditional procedures was that there was no statistically significant change in RC over 6 months. The patients’ experience was much improved compared to traditional flap surgery [1, 2].

Unilateral Inflammatory Fibro-Epithelial Hyperplasia: A Case Report

Gingival enlargement is one of the common features of gingival disease which can be seen in the form of fibrous and/or, inflammatory overgrowth or, combination of both. Gingival enlargement is most commonly seen due to the presence of local factors such as plaque and calculus. These local factors result in the inflammatory hyperplasia of marginal gingiva and interdental papilla and may be localized or, generalized. Such type of enlargements may lead to difficulty in mastication, altered speech and unesthetic appearance which may cause psychological problems. The present case report reveals the successful management of a case with gingival enlargement which was treated with Kirkland flap for the upper anterior and right posterior regions while modified Widman flap procedure that was performed for lower anterior region to excise the tissue along with the pocket lining.

Scaling and root planing vs. conservative surgery in the treatment of chronic periodontitis.

A renewed interest in conservative surgical techniques has been fueled by new technology, changes in referral patterns to periodontists and a desire to achieve periodontal health in the least invasive, most cost-efficient manner possible. Trends suggest that an increasing amount of periodontal care is being provided in the offices of general dentists. If true, it is likely that patients receiving care in these offices will be offered simpler surgical treatment modalities that do not require an extensive armamentarium. The purpose of this article was to review the effectiveness of six relatively simple surgical techniques - gingivectomy, flap debridement, modified Widman flap, excisional new attachment procedure, modified excisional new attachment procedure and laser-assisted new attachment procedure - and to compare the results obtained using these procedures with the well-known clinical benefits of scaling and root planing. The intent was to determine whether the benefits of surgical procedures in the hands of most general dentists extend beyond those of conventional nonsurgical therapy.

Long-Term Effect of Four Surgical Periodontal Therapies and One Non-Surgical Therapy: A Systematic Review and Meta-Analysis.

The aim of this systematic review is to evaluate the long term (≥ 2 years) effect of four surgical and non-surgical therapies in treating periodontal disease. An electronic search of four databases and a hand search of peer-reviewed journals for relevant articles were conducted. Prospective human controlled clinical trials were included that compared surgical therapy to non-surgical therapy in ≥ 10 patients diagnosed with chronic periodontitis with a follow-up period of ≥ 2 years and that reported change in probing depth (PD) and clinical attachment level (CAL) after the therapy. Random effect meta-analysis was performed to compare the outcome of surgical and non-surgical therapy in shallow, moderate, and deep PD. Eight human prospective clinical trials were included. In 1- to 3-mm PD, scaling and root planing (SRP), modified Widman flap (MWF), and osseous surgery (OS) resulted in 23.2%, 39.4%, and 61.39% CAL loss, respectively; SRP, MWF, and OS resulted in increased mean PD of 2.5%, 3.3%, and 6.3%, respectively. In 4- to 6-mm PD, SRP, MWF, and OS resulted in 8.4%, 6.5%, and 5.22% CAL gain, respectively; SRP, MWF, and OS resulted in 18.7%, 25.4%, and 30.8% PD reduction, respectively. In PD ≥ 7 mm, SRP, MWF, and OS resulted in 9.8%, 14.2%, and 9.38% CAL gain, respectively; SRP, MWF, and OS resulted in mean PD reduction of 21.6%, 33.1%, and 42.8%, respectively. Surgical therapy had significantly more CAL loss than non-surgical therapy in shallow PD. In moderate PD, MWF had significantly more PD reduction than SRP, and there was significantly less CAL gain with surgical therapy. In deep PD, OS had significantly higher PD reduction than SRP.

The clinical efficacy of laser assisted modified Widman flap: A randomized split mouth clinical trial.

The objective of the study was to compare the clinical efficacy of use of a diode laser (DL) (810 nm) as an adjunct to modified Widman flap (MWF) surgery to that of MWF alone. Twenty-five patients between the ages of 20 and 50 years with generalized chronic periodontitis were selected for the study. Control sites (Group A) were randomly selected to receive an MWF, and the contralateral test sites (Group B) received MWF in conjunction with low-level laser therapy. The energy density of 4 J/cm² was applied to the gingival surface after periodontal treatment. The study tooth/site was treated along with any additional teeth in the quadrant in which the site was located if needed. Randomization was done using a coin flip. The DL was used to de-epithelialize the inner part of the periodontal flap and photo-biostimulate the surgical area. Plaque index (PI), papillary bleeding index (PBI), probing depth (PD), and clinical attachment level (CAL) scores were recorded at baseline and at 6 and 9 months. Data were expressed as the mean ± standard deviation. Statistical analyzes were performed using paired Student's t-testfor intragroup comparisons and unpaired Student's t-test for intergroup comparisons. No significant difference was observed in PI scores between the two groups at baseline, 6 and 9 months. PBI scores were significantly lower in Group B versus Group A at 6 months (P < 0.01). However, no significant difference was observed between the two groups in PBI scores at the end of 9 months. PD reduction in Group B versus Group A was statistically significant at the end of 9 months (P < 0.01). Gains in CAL were significantly greater in Group B versus Group A at 6 and 9 months. The use of an 810 nm DL provided additional benefits to MWF surgery in terms of clinical parameters.