Videoscope-Assisted Minimally Invasive Periodontal Surgery: One-Year Outcome and Patient Morbidity

The role of surgical flap design (minimally invasive flap vs. extended flap with papilla preservation) on the healing of intrabony defects treated with an enamel matrix derivative: a 12-month two-center randomized controlled clinical trial

Objectives

Minimally 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 methods

Forty-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.

Results

After 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.

Conclusions

Within 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 relevance

In intrabony defects, the application of EMD in conjunction with either MIST/M-MIST or M-PPT/SPPT resulted in substantial clinical improvements.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00784-021-04155-5.

Minimally Invasive Periodontology: A Treatment Philosophy and Suggested Approach

Severe periodontitis is a highly prevalent dental disease. With the advent of implant dentistry, teeth are often extracted and replaced. Periodontal surgery, where indicated, could also result in increased trauma to the patient. This literature review discusses different treatment modalities for periodontitis and proposes a treatment approach emphasizing maximum preservation of teeth while minimizing morbidity to the patient. Scientific articles were retrieved from the MEDLINE/PubMed database up to January 2021 to identify appropriate articles that addressed the objectives of this review. This was supplemented with hand searching using reference lists from relevant articles. As tooth prognostication does not have a high predictive value, a more conservative approach in extracting teeth should be abided by. This may involve repeated rounds of nonsurgical periodontal therapy, and adjuncts such as locally delivered statin gels and subantimicrobial-dose doxycycline appear to be effective. Periodontal surgery should not be carried out at an early phase in therapy as improvements in nonsurgical therapy may be observed up to 12 months from initial treatment. Periodontal surgery, where indicated, should also be minimally invasive, with periodontal regeneration being shown to be effective over 20 years of follow-up. Biomarkers provide an opportunity for early detection of disease activity and personalised treatment. Quality of life is proposed as an alternative end point to the traditional biomedical paradigm focused on the disease state and clinical outcomes. In summary, minimally invasive therapy aims to preserve health and function of the natural dentition, thus improving the quality of life for patients with periodontitis.

How to train periodontal endoscopy? Results of a pilot study removing simulated hard deposits in vitro

OBJECTIVES

There is uncertainty regarding the benefits of periodontal endoscopy (PE) for subgingival instrumentation. Moreover, the influence of operators' experience and training with such a device on treatment results is unclear. Therefore, we compared in an in vitro study the use of PE for scaling and root planing (SRP) with the conventional non-surgical therapy, hypothesizing that using a PE allows to remove more simulated hard deposits than without (nPE), influenced by the operators' experience and training.

MATERIAL AND METHODS

A sonic device and Gracey curettes were utilized by 11 operators (six dentists, five dental hygienists) in periodontitis manikins heads. The time required for treatment and the proportion of removed simulated hard deposits by SRP were measured.

RESULTS

Using the PE led to a significant difference in removal of simulated hard deposits (%) (mean ± SD) irrespective of operators' experience (PE 90.78 ± 12.10% (range 58.80-100%); nPE 79.98 ± 22.15% (range 38.10-100%, p < 0.001)), sub-analyses for different tooth types demonstrated a significant difference in favor of PE for front teeth (p < 0.001) and in the upper jaw independent of the tooth type (p < 0.001). Comparison of treatment times for two quadrants with and without PE showed a significantly longer treatment time with PE (∆22.27 ± 17.98 mins, p <0.001).

CONCLUSIONS

Within the present pilot study, the use of PE led to more removal of simulated hard deposits but was concomitantly related to more time and financial effort. Using PE was most beneficial in the front area.

CLINICAL RELEVANCE

PE may provide additional benefits for the removal of hard deposits compared to traditional SRP. The beneficial effect of PE seems not to be influenced by operators experience nor by pocket probing depth.

Videoscope-Assisted Minimally Invasive Surgery (VMIS) for Bone Regeneration around Teeth and Implants: A Literature Review and Technique Update

Background&mdash;The literature related to minimally invasive periodontal surgery is reviewed. This includes the original minimally invasive surgery (MIS) procedure for bone regeneration, the modification of MIS for the minimally invasive surgery technique (MIST) and modified MIST (M-MIST) procedures, and the introduction of the videoscope for oral surgical procedures and the ability to perform videoscope-assisted minimally invasive surgery (VMIS). The evolution from MIS through MIST to the current VMIS is reviewed. The results from studies of each of these methods are reported. Conclusion&mdash;The use of small incisions that produce minimal trauma and preserve most of the blood supply to the periodontal and peri-implant tissues results in improved regenerative outcomes, minimal to absent negative esthetic outcomes, and little or no patient discomfort. Minimally invasive procedures are a reliable method to regenerate periodontal tissues.

Videoscope Assisted Minimally Invasive Surgery (VMIS): 36-Month Results

BACKGROUND

Clinical outcomes from videoscope assisted minimally invasive surgery (VMIS) at 36 to 58 months are reported.

METHODS

Fourteen patients having sites with residual probing depth (PD) of at least 5 mm and 2 mm loss of clinical attachment level (CAL) after initial non-surgical therapy were treated with VMIS.

RESULTS

At 36 months or greater post-surgery there was a statistically significant improvement (P <0.001) in mean PD and CAL (PD: 3.80 ± 1.18 mm, CAL: 4.16 ± 1.18 mm) in all surgical sites compared with baseline. There was a mean improvement in soft tissue height (0.36 ± 0.64 mm, P = 0.03). In most cases, patients reported no postoperative discomfort.

CONCLUSIONS

Improvements from VMIS appear to be favorable when compared with previously reported results of periodontal regenerative surgery. All improvements were stable over time. The lack of post-surgical recession after VMIS has not been reported with traditional regenerative surgery.