Periodontal Microsurgery Research Articles

Comparison of Microsurgical and Conventional Techniques for Augmentation of Keratinized Mucosa Around Dental İmplants

Objective: This study aims to compare the clinical outcomes of periodontal microsurgery with conventional periodontal surgery in keratinized mucosa augmentation around the implant. Materials and Methods: Ten patients with at least 2 implants with a keratinized mucosal width of < 2 mm were included. Free gingival graft (FGG) was applied in the test group with the microsurgery technique whereas in the control group with the conventional periodontal surgery technique. Keratinized mucosa width (KMW) and palatal mucosal thickness (MT) were measured at baseline and 3rd month. Graft shrinkage(GS) was evaluated at the 3rd month. Donor site wound healing was evaluated at the 10th day and 3rd month. Feedback forms were collected on the 10th day. Results: KMW values increased significantly in both groups at 3rd month compared to baseline. The percentage of GS was lower in the test group at 3rd month, but this difference was not significant. MT values in the test group were closer to the baseline values at 3rd month compared to the control group. Wound healing scores were similar in both groups at the 10th day and 3rd month. Postoperative pain levels decreased more rapidly in the test group. Conclusion: The microsurgical technique provides a faster increase in palatal mucosal thickness and lower graft shrinkage during the healing period and an earlier reduction in postoperative pain levels.

Comparing the Effectiveness of Conventional and Microsurgical Access Flap Techniques in Managing Horizontal Bony Defects in Chronic Periodontitis Patients: A Clinical and Radiographic Study

Abstract Objective Periodontal microsurgery is descendant of conventional periodontal surgery to reduce surgical trauma, improve wound healing, and enhance patient compliance. This study compared the efficacy of conventional and microsurgical access flap in the management of horizontal bony defects in chronic periodontitis patients. Materials and Methods Eight pairs of contralateral horizontal bone defects in chronic periodontitis patients were randomly allocated to control group and test group. Microsurgical access flap was carried out in test group under magnification, while control group received conventional access flap. Plaque index (PI), gingival index (GI), probing pocket depth (PPD), relative attachment level (RAL), and relative gingival marginal level (RGML) were recorded at baseline, 3 months, and 6 months. Wound healing index (WHI) was evaluated after 1 week, 2 weeks, and 4 weeks. Pain perception was evaluated using visual analog scale (VAS) post-surgery and after 24 hours. Radiographic defect depth was measured at baseline and after 6 months. Statistical Analysis The statistical analysis was done by SPSS statistical software. The intragroup comparison was done by repeated measures analysis of variance. The intergroup difference between both groups was done by Student's t-test. The descriptive statistics for VAS and WHI was done by Wilcoxon signed rank test. The mean difference between clinical parameters from baseline to follow-up intervals was calculated by post-hoc least significance difference analysis. Results There was significant reduction in PI, GI, PPD, and RAL within both the groups (p < 0.05). There was increase in RGML within both the groups from baseline to 6 months (p < 0.05). In the intergroup comparison, test group showed better WHI and better pain perception (VAS) compared to control group (p < 0.05). No difference was found between both the groups in terms of radiographic defect depth (p > 0.5). Conclusion Both the procedures were effective in improving the clinical parameters but the microsurgical group showed better results in terms of wound healing and less postoperative pain. Both procedures showed no significant effect on radiographic defect depth.

Performance and Strength Characteristics of Suture Knots in Periodontal Microsurgery: An In Vitro Study.

This study is aimed to investigate the types of knot failure (untying or breaking) and the tension required to break different sutures diameters. One hundred and fifty knots were fabricated using polyamide sutures diameters of 6/0, 7/0, and 8/0. The studied knots were either squared or slipped with different numbers of throws (2, 3, 4, 5 and 6), and the following data were recorded: type of failure (untied or broken), number of throws, the tension required to untie or break each knot, slippage, and elongation of the knot. The knots were created in a standardized way. with a device and weights and then subjected to a controlled tension. The knots that got untied were: 1&#61;1, 1x1, 2&#61;1, and 2x1, whereas the remaining knots got broken. Notably, at least three throws were required to prevent untying, but separately, as in 1&#61;1&#61;1 or 1x1x1. The mean tension to break the knots of 6/0, 7/0, and 8/0 sutures were 3.1, 1.3, and 0.6 N, respectively (P < 0.05), and they were independent of the knot type. Results from this study demonstrated that the knots with geometries of 2&#61;2/2x2 and 1&#61;1&#61;1/1x1x1 were secure, and additional throws does not increase their security. Furthermore, tensile strength reduces with decreased suture size.

Periodontal Microsurgery: An Advanced Approach for Minimal Invasive Periodontal Therapy

The use of magnification and microsurgery to perform various procedures are recent developments in medical and dental field. The available literature specifically of periodontal surgical procedures was analysed and compiled, and it indicated that when magnification is incorporated in periodontal practice, it improves visual acuity, decreased patient morbidity, ergonomic benefits, rapid healing, and enhanced patient acceptance. The illumination and magnifi¬cation provided by the operating micro¬scope as well as the use of microsurgical instrumentation have allowed microsur¬geons to perform procedures with more precision. Microsurgery is an interesting concept in the minds of many dental professionals, yet the inability of most clinicians to perform such procedures shows the dental professions lack of understanding of what microsurgery truly encompasses. The objective of the present paper is to offer a brief review on periodontal microsurgery, role of magnification systems, application of microsurgical principles in various periodontal surgical procedures, advantages of microsurgery over conventional surgery and to reinforce the use of microscope into periodontal practice.

Conceptual Approach to Periodontal Microsurgery

Periodontal treatment modalities have evolved since the 20th century. This era of periodontal treatment is progressing towards minimally invasive techniques. Nowadays, microscopes and surgical loupes are being used in different fields of dentistry. Periodontal surgeries like root coverage procedures, esthetic surgeries, scaling &amp; root planing have also incorporated these methods for better esthetic results and patient compliance. Unlike in other fields of dentistry, there is more to be explored in the periodontal field with microsurgical methods. This article aims to discuss the evolution of periodontal treatment with microsurgical procedures and its principles. The literature concerning the efficacy of microsurgical approaches in treating periodontal diseases has been evaluated.

Periodontal microsurgery: Magnification and beyond

Background: In clinical dentistry, new heights of precision have taken place with periodontal microsurgery. It enhances visual acuity, improves accessibility with better primary wound closure. Unlike macro surgical procedures, patient acceptance, post operative pain and esthetics were found to be better with the periodontal microsurgery. Microsurgery works on principles like, refinement of motor skills, minimal tissue trauma in order to achieve adequate wound healing. This paper emphasizes widely on the microsurgical concepts used in periodontics.

Periodontal Microsurgery: A Boon for Precision

The surgical operating microscope increases illumination and visual acuity for the periodontist to perform clinical procedures with improved precision over conventional surgeries. Presently, using a surgical microscope gives an impression of being the best option which helps in better diagnostic ability and treatment quality. This review highlights the basics of periodontal plastic surgery, including the role of magnification and microsurgical instruments, knot tying, clinical applications, and microsurgical effects on aesthetics. This mini-literature review infers that improved visual acuity of microsurgery provides significant advantages of less patient discomfort, rapid healing, improved esthetics, and patient compliance. Periodontal microsurgery combined with minimally invasive surgical techniques benefits the ability of a clinician‘s precision in manipulating the tissues, thereby offering the simplest and the best probable outcome.

English

BACKGROUND The present study was conducted to compare clinical outcomes and gingival crevicular fluid (GCF) interleukin (IL)-6 cytokine levels in microsurgical and conventional open flap debridement procedure. METHODS Thirty sites in chronic periodontitis patients were randomly assigned into Group I (microsurgical) and Group II (conventional) open flap debridement in a split-mouth design. Gingival bleeding index (GBI), probing pocket depth (PPD), relative attachment level (RAL) were recorded at baseline and 3 months. GCF IL-6 cytokine levels were assessed at baseline and on 3rd day postoperatively. Pain perception using visual analog score (VAS) and soft tissue healing using early healing index (EHI) were assessed after on 7th day post-surgery. RESULTS There was a significant reduction in gingival bleeding index, probing pocket depth, relative attachment level within both the groups. Intergroup gingival bleeding index scores were statistically significant at the end of 3 months. The difference in visual analog scores between the two groups was found to be statistically insignificant whereas early healing index scores between the groups was found to be statistically significant. Group I showed lower levels of IL-6 on 3rd day postoperatively. It was also found that there was positive correlation of IL-6 levels with clinical parameters such as PPD and RAL. CONCLUSIONS Open flap debridement using microsurgical approach can substantially improve clinical parameters and wound healing compared with conventional macrosurgical approach. IL-6 levels were lower in microsurgical group indicating less invasive surgical approach. KEY WORDS Open Flap Debridement, Periodontal Microsurgery, Wound Healing, IL-6, Cytokine, GCF.

MICROPERIODONTICS- Refining our professionalism

Surgical Precision to restore both biologic and aesthetic demands of patients is most important in today’s periodontal practice. Technical skills of the clinician are challenged by the limited range of visual acuity. Periodontal microsurgery increases the efficiency of basic periodontal surgical procedures by improving normal vision through magnification along with advance lighting system. Incorporation of magnification in periodontal practice gives precise outcomes which are not achieved with traditional macro surgery in terms of improved visual acuity, ergonomic benefits, decreased patient morbidity, enhanced patient acceptance, rapid healing, passive wound closure and reduced tissue trauma.The aim of this review is to enlighten about periodontal microsurgery, its role in magnification, micro-surgical instrumentation, microsurgical suturing techniques, clinical advancement and application. Keywords: Ergonomics; magnification; microsurgery; precision; techniques

Applications of microsurgery in periodontics

Periodontal microsurgery is an advance in the field of periodontal surgical procedures. It has been described as the methodology where there is modification and refinement of the existing surgical procedure with the use of magnification to improve visualization and has implications and applicability to all specialties. The criteria for the success of the treatments performed to improve esthetics may be different compared to the surgical procedures where the main goal is to improve periodontal health and restore the function. Therefore, the use of the surgical microscope in periodontal surgery is less documented with only few studies addressing the advantages of the application of magnification to periodontal surgery. The resource for the article was obtained through search in the web with the inclusion of case reports and comparative studies. This article presents an overview of magnifying tools available and their applications in periodontics.

Application of periodontal microsurgery in the augmentation of attached gingiva around an implant

This study aimed to evaluate the clinical effect of periodontal microscopic surgery on the augmentation of attached gingiva and determined the clinical principle on how to use minimally invasive surgery to improve the surgery success rate. Twenty patients with insufficient attached gingiva around implants were selected. Periodontal microscopic surgery for free gingival graft was performed to increase the width of the attached gingiva around the implants. The survival state of the free gingiva was observed after surgery, and the width of the attached gingiva around the implants was recorded before and after surgery and 1 year after surgery. The shrinkage rate of the free gingival flap 1 year after surgery was analyzed to evaluate the stability of the flap. The flaps of the 20 cases all survived. One year after the operation, the width of the attached gingiva was (3.05±0.44) mm, which increased compared with that of preoperation (2.56±0.31) mm and decreased compared with that of postoperative day (2.13±0.28) mm. The shrinkage rate of the attached gingiva was 41.22%±5.04%. The application of microscopic surgery on the augmentation surgery of attached gingiva can increase the success rate and improve the quality and quantity of attached gingiva around implants.

Periodontal microsurgery: Reaching new heights of precision.

The use of magnification to perform various procedures in medical and dental field, particularly endodontics has long been recognized. Unfortunately, its application in periodontics is not widely popularized. The objective of this article is to emphasize the application of microsurgical principles in various periodontal surgical procedures and to reinforce the incorporation of microscope into periodontal practice. The most recent periodontal journals were reviewed and a search of databases such as PubMed or Medline and Google Scholar was conducted for relevant material from published literature up to 2017. Medical Subject Headings words looked for were “periodontal microsurgery” and “minimally invasive periodontal surgery.” The available literature, specifically to periodontal surgical procedures was analyzed and compiled. The analysis indicates that incorporation of magnification in periodontal practice is associated with improved visual acuity, ergonomic benefits, decreased patient morbidity, rapid healing, and enhanced patient acceptance.

Periodontal microsurgery using Zucchelli’s modification of coronally advanced flap with PRF membrane for root coverage

Introduction: Marginal tissue recession (MTR) is a most common mucogingival condition found in population. The patient’s concerns include poor esthetics leading to root exposure and sensitivity, affecting patient’s quality of life. Multiple novel techniques have been introduced for treating isolated as well as multiple MTR. Zucchelli introduced a modification of coronally advanced flap(CAF) for treating multiple MTR in the esthetic region. Results from many randomized clinical trials have shown autologous plateletrich fibrin (PRF) having remarkable ability of promoting soft-tissue wound healing. This case report highlights the use of Zucchelli’s modification of CAF with PRF under the periodontal microscope to treat multiple MTR.

Periodontology Microsurgery: An Advanced Surgical Technique

The purpose of this article is to limelight the benefit of periodontal microsurgery in the surgical disciplines. It reviews the benefits and potential applications of magnification and microsurgery in the specialty of periodontics. The increased demand for mucogingival aesthetics has required the optimisation of periodontal procedures. Microsurgery is a minimally invasive technique that is performed with the surgical microscope and adapted instruments and suture materials. Although this hardware and knowledge of various operations are necessary to achieve patient aesthetic expectations, clinicians must be willing to undergo an extended period of systematic training to become familiar with novel operating procedures and instruments. This article describes the application of the surgical microscope to provide enhanced perioplastic treatment.

Periodontal Microsurgery and Microsurgical Instrumentation: A Review

AbstractIncreasing surgical refinement of procedures to meet both biologic and esthetic demands of patients is seen in today's periodontal practice. For these new technologies, instruments, and surgical techniques are necessary. Technical skills of the clinician are challenged by the limit of range of visual acuity. Periodontal microsurgery improves the outcome of basic periodontal surgical procedures by enhancing normal vision through magnification along with favorable lighting system. It gives enhanced outcomes not possible with traditional macrosurgery in terms of passive wound closure and reduced tissue trauma. The purpose of this review is to provide brief knowledge of periodontal microsurgery: the role of magnification, microsurgical instrumentation and applications of microsurgery.

Periodontal microsurgery: A leap in surgical intervention

Recent developments in medical and dental field have shown that magnification and microsurgery can greatly improve clinical practice. The main aim of surgical intervention is not only the survival of the patient or one of his organs but also the effort to preserve a maximum amount of function and to improve patient comfort. These demands are mostly met owing to a minimally invasive surgical approach. The improved visual acuity provided by magnification opens a whole new world for those who make effort and take time to become proficient in microsurgical principles and procedures. The promising periodontal microsurgery will provide new possibilities to improve the therapeutic results for variety of periodontal surgeries. The purpose of this paper is to provide a brief review of periodontal microsurgery, role of magnification systems, and advantages of microsurgery over conventional surgery.

Comparison of microsurgical and conventional open flap debridement: A randomized controlled trial.

Background:Residual calculus exists not only on teeth treated by scaling alone but also on teeth treated by flap surgery. Periodontal microsurgery enables more definite removal of calculus, atraumatic handling of tissues through optical magnification. The purpose of this study was to compare the clinical outcomes of microsurgery with conventional open flap debridement in patients with chronic periodontitis.Materials and Methods:Thirteen chronic periodontitis patients were randomly assigned for test (microsurgical) and control (conventional) open flap debridement in a split mouth design. At baseline, 3, 6 and 9 months the following clinical parameters were recorded: Probing pocket depth, relative attachment level, gingival recession, gingival bleeding index. Postoperative healing at 1-week by early healing index and pain scale for 7 days were assessed.Results:Paired t-test was used to compare means within the groups, and unpaired t-test was applied to compare the means of the two groups. At 3, 6 and 9 months postoperatively there was a significant reduction in gingival bleeding index, probing pocket depth, relative attachment level within both the groups and there was no significant difference between both the groups. Gingival margin level and gingival recession increased in both the groups, but it was not statistically significant. Early healing Index score of 1 was found in 85% of test sites and 28% of control sites. The mean pain scale was 0 in test site and 1.07 ± 0.75 in control site.Conclusions:In open flap debridement procedure, a microsurgical approach can substantially improve the early healing index and induce less postoperative pain compared with applying a conventional macroscopic approach.

EFFECT OF SMOKING ON THE PERIODONTAL MICROSURGERY TECHNIQUE ON THE TREATMENT OF GINGIVAL RECESSION

This paper aims to evaluate the effects of smoking on periodontal microsurgery technique using the subepithelial connective tissue graft (SCTG) for treatment of gingival recession on smokers. 14 patients nonsmokers and 12 smokers were selected, presenting Miller’s Class I and II gingival recession ≥ 2.0 mm. For both groups, the subepithelial connective tissue graft was used with the aid of a surgical microscope. The clinical parameters of width and height of the gingival recession, height and thickness of keratinized tissue, probing depth and clinical attachment level were evaluated before and six months after surgery. At the end of the study, there were obtained an average percentage of 96.66% of root coverage on nonsmokers and 82.49% on smokers (p=0.03). Complete root coverage was observed in 78,57% and 50% of patients, respectively. Therapy can benefit both groups, but smokers have less favorable outcomes to root coverage with periodontal microsurgery using the SCTG.

Periodontal microsurgery - A must for perio-aesthetics

Treatment modalities addressing both biologic and esthetic demands are most often expected from today's periodontal practice. New technologies, instruments, and surgical techniques are necessary to help clinician ensure the best results and satisfy the patient's expectations. Microsurgical equipments help to enhance normal vision through magnification along with favorable lighting enabling to perform precise periodontal surgical procedures. With increasing awareness and the desire to get the best treatment among patients, these magnificent magnifying tools come handy for an innovative periodontal micro-surgeon. Here is an attempt to present the advantages of microsurgery offered in periodontics in this era of patient-driven dentistry.

Endodontic-periodontal microsurgery for combined endodontic-periodontal lesions: An overview.

Endodontic and periodontal microsurgery has surpassed the success rates for traditional endodontic and periodontal surgical procedures. Excellent healing results are being attributed to both the techniques, when employed, for isolated endodontic or periodontal defects. Combined endodontic-periodontal lesions have been referred to as a true challenge, requiring not only endodontic microsurgical management but also concurrent bone grafting and membrane barriers techniques. The prevention of epithelial downgrowth and regeneration of periodontal cementum, fiber, and bone seals the fate of these cases. Achieving primary closure with submergence of grafts has a positive effect on GTR outcome. New techniques of periodontal microsurgery, such as minimally invasive papilla preserving flaps with passive internal mattress suturing, have managed to obtain 90% primary flap closure over grafted sites. Root surface treatment and conditioning has also shown to be beneficial for GTR. Endodontic microsurgery for the combined lesion has not integrated these advances yet. These advances, along with a recently suggested treatment strategy, are ushering in the level next in management of the combined lesions. This article offers an overview of the combined lesion, the disease, its classification, treatment strategy, regenerative tools, microsurgical recommendations, and outcome studies.