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Pasqualini E, Castro F, Curado D, Martelete A, Heboyan A, Saleh MH, Fernandes JCH, Fernandes GVO. Minimally invasive periodontal regeneration with the buccal approach: a systematic review and meta-analysis of clinical studies. Evid Based Dent 2024; 25:54. [PMID: 38182662 DOI: 10.1038/s41432-023-00964-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/17/2023] [Accepted: 11/28/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE The aim of this study was to investigate clinical periodontal parameters after treatment using the Minimally Invasive Surgical Technique (MIST), Modified Minimally Invasive Surgical Technique (M-MIST), and/or any technique for papilla preservation, such as Entire Papilla Preservation (EPP), modified-papilla preservation technique (M-PPT), or simplified-papilla preservation technique (SPPT). METHODS The focus question was "For patients with periodontal intrabony defects (P), what is the best minimally invasive regenerative approach (I), comparing MIST, M-MIST, and papilla preservation techniques' outcomes (C) to improve PD, CAL, GR, and periodontal stability (O)?" An online search was conducted on PubMed, Cochrane Library, and Embase. Only randomized clinical trials and case series with a minimum of 10 enrolled patients were included. The risk of bias was evaluated using the Critical Appraisal tools in JBI Systematic Reviews. The meta-analysis compared the data obtained for the periodontal parameters analyzed, and the heterogeneity was verified. RESULTS After the screening, nine articles were included. Seven studies applied MIST and its modifications; two used M-PPT, one SPPT, and one approached EPP. A general statistically significant PD reduction and CAL gain were noted between the groups, comparing baseline and follow-up for all articles, independently of the technique or materials used. Also, all studies showed a non-significant increase in the gingival recession. Four studies had a low risk of bias, four had a moderate risk, and only 1 had a high risk. Moderate heterogeneity was found in one analysis for CAL (65.73%); moderate and substantial heterogeneity was found in the PD results (71.91% and 89.19%); and no heterogeneity was found within all analyses for gingival recession (0%). CONCLUSION MIST, M-MIST, and papilla preservation techniques demonstrated their potential and efficacy to improve periodontal conditions of sites with intrabony defects with minimal morbidity.
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Affiliation(s)
- Elisa Pasqualini
- Masters' student, FCS, Universidade Fernando Pessoa, 4249-004, Porto, Portugal
| | - Filipe Castro
- FP-I3ID, FCS, Universidade Fernando Pessoa, 4249-004, Porto, Portugal
| | - Denise Curado
- Periodontics and Oral Medicine Department, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | | | - Artak Heboyan
- Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Str. Koryun 2, Yerevan, 0025, Armenia
| | - Muhammad H Saleh
- Periodontics and Oral Medicine Department, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | | | - Gustavo Vicentis Oliveira Fernandes
- Periodontics and Oral Medicine Department, University of Michigan School of Dentistry, Ann Arbor, MI, USA.
- A.T. Still University - Missouri School of Dentistry & Oral Health, St. Louis, MO, USA.
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Minimally Invasive Non-Surgical Technique in the Treatment of Intrabony Defects-A Narrative Review. Dent J (Basel) 2023; 11:dj11010025. [PMID: 36661562 PMCID: PMC9858434 DOI: 10.3390/dj11010025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/01/2022] [Accepted: 01/04/2023] [Indexed: 01/13/2023] Open
Abstract
Intrabony defects occur frequently in periodontitis and represent sites that, if left untreated, are at increased risk for disease progression. Although resective or repair procedures have been used to treat intrabony defects, aiming at their elimination, the treatment of choice is surgical periodontal regeneration. The development of periodontal regeneration in the last 30 years has followed two distinctive, though totally different, paths. The interest of researchers has so far focused on regenerative materials and products on one side, and on novel surgical approaches on the other side. In the area of materials and products, three different regenerative concepts have been explored namely, barrier membranes, bone grafts, and wound healing modifiers/biologics, plus many combinations of the aforementioned. In the area of surgical approaches, clinical innovation in flap design and handling, as well as minimally invasive approaches, has radically changed regenerative surgery. Recently, a minimally invasive non-surgical technique (MINST) for the treatment of intrabony defects was proposed. Initial clinical trials indicated comparable results to the surgical minimally invasive techniques in both clinical and radiographic outcomes. These results support the efficacy of this treatment approach. The aim of this review is to present the evidence on the application of minimally invasive non-surgical techniques and their efficacy in the treatment of intrabony defects.
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Priyanka M, Reddy K, Pradeep K. Efficacy of rh-PDGF-BB and Emdogain with or without DFDBA using M-MIST in the treatment of intrabony defects. Niger J Clin Pract 2023; 26:116-124. [PMID: 36751833 DOI: 10.4103/njcp.njcp_1725_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background The versatile combination of emdogain or enamel matrix derivative (EMD), recombinant human platelet-derived growth factor-BB (rhPDGF-BB), and demineralized freeze-dried bone allograft (DFDBA) has not been utilized in the treatment of intrabony defects yet. Aim The present study attempted to investigate the efficacy of a combination of simple, uncomplicated nature of modified minimally invasive surgical technique (M-MIST) with EMD, rhPDGF-BB, and DFDBA in the surgical management of intrabony defects and to assess the possible favorable effects for a period of 6 months. Patients and Methods Thirty healthy subjects were included in the present double-blind, randomized controlled, two-arm parallel study. The test group was treated with M-MIST by using rhPDGF-BB, EMD, and DFDBA, and the control group was treated with M-MIST by using rhPDGF-BB and EMD. Results Differences between the mean values of primary clinical parameters including relative attachment level, probing depth, and gingival recession at baseline and those at 6 months after surgery were statistically significant in both groups. Inter-group comparison for clinical attachment level gain, probing depth reduction, and change in the position of gingival margin revealed no statistically significant differences. Inter-group comparison revealed significant differences in linear bone growth (LBG) and percentage bone fill (% BF) but no significant differences in the residual defect depth and change in the alveolar crest position. Conclusion The additional use of DFDBA provides superior benefits in terms of LBG and % BF in intrabony defects. This improvement might be attributed to the use of an osteoinductive scaffold.
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Affiliation(s)
- M Priyanka
- Department of Periodontics, Smile Central Multi-Speciality Dental Clinic, Hyderabad, Telangana, India
| | - K Reddy
- Sri Sai College of Dental Surgery, Vikarabad, Telangana, India
| | - K Pradeep
- Department of Preventive Dental Sciences, College of Dentistry, Riyadh, KSA
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Sarafidou K, Lazaridi I, Gotsis S, Kirmanidou Y, Vasilaki D, Hirayama H, Michalakis K. Tooth preservation vs. extraction and implant placement in periodontally compromised patients: A systematic review and analysis of studies. J Prosthodont 2022; 31:e87-e99. [PMID: 35794083 DOI: 10.1111/jopr.13560] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/11/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The aim of this systematic review was to identify studies with a minimum of 5-years follow-up, reporting on the management of periodontally compromised teeth with either extraction and subsequent implant placement or teeth preservation with conventional periodontal treatment and application of regenerative procedures. The outcomes of these two approaches, based on clinical and radiographic data and the incidence of tooth- and implant-loss, were also investigated. MATERIAL AND METHODS A systematic search for studies reporting on clinical and radiographic outcomes of periodontal treatment or replacement of periodontally compromised teeth with implants was conducted in 3 electronic databases, followed by a hand-search in 8 journals. Only randomized controlled trials (RCTs), cohort studies, and case series with prospective design were included. RESULTS The initial search resulted in 1080 papers. After the first two screenings, 24 publications were selected for inclusion in this systematic review. The treatment protocols for the teeth preservation group contained nonsurgical and/or surgical periodontal treatment with or without regeneration procedures. The implant studies included extraction of periodontally involved teeth and implant placement with or without bone and soft tissue augmentation, followed by restoration with fixed dental prostheses (FDPs). Survival rates ranged between 81.8% and 100% in the tooth retention group, and between 94.8% and 100% in the implant group. In the extraction group, no complications were reported for 76.09% of the implants. Similarly, no complications were reported for 86.83% of the tooth retention group. The lack of standardized comparable studies prohibited conduction of a metaanalysis. CONCLUSION Both treatment approaches, treatment of periodontally compromised teeth, or tooth extraction followed by implant placement, present high survival rates. The application of bone regeneration techniques improves the long-term prognosis of periodontally involved teeth. Hence, treatment of periodontally involved teeth with subsequent application of a rigorous maintenance protocol can be a viable alternative for a number of years, before proceeding to extraction and replacement with dental implants. More well-designed randomized controlled trials are needed in order to draw definite conclusions on the subject.
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Affiliation(s)
- Katia Sarafidou
- Department of Prosthodontics, Aristotle University of Thessaloniki, Faculty of Health Sciences, School of Dentistry, Thessaloniki, Greece
| | - Ioanna Lazaridi
- Division of Regenerative Dentistry and Periodontology, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Sotirios Gotsis
- Graduate and Postgraduate Prosthodontics, Tufts University School of Dental Medicine, Boston, MA, USA
| | - Yvoni Kirmanidou
- Private Practice limited to Prosthodontics, Thessaloniki, Greece
| | - Dimitra Vasilaki
- Private Practice limited to Prosthodontics, Thessaloniki, Greece
| | - Hiroshi Hirayama
- Department of Restorative Sciences and Biomaterials, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA
| | - Konstantinos Michalakis
- Department of Restorative Sciences and Biomaterials, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
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Apatzidou DA. A pioneer surgical technique for isolated periodontal defects by “closed” retraction of the papilla; A feasibility study. FRONTIERS IN DENTAL MEDICINE 2022. [DOI: 10.3389/fdmed.2022.956601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AimA pioneer periodontal surgical approach employing the closed surgical technique (CST) in combination with the tissue-engineered biocomplex aimed to gain access to the osseous defect and improve soft-tissue architecture.MethodsThe CST was applied in four systemically healthy periodontitis patients/defects who were followed for 12-months. It avoids papilla dissection and retraction of flaps in an open manner thus, suturing is not required. It is designed for the reconstruction of residual isolated periodontal defects and is best indicated in the aesthetic region. It can be applied as a sole treatment approach to facilitate deep instrumentation of the defect, or it could be combined with subgingival application of regenerative materials. Hereby, the biocomplex was applied containing autologous alveolar Bone-Marrow Mesenchymal-Stem-Cells, seeded into collagen scaffolds, enriched with autologous fibrin/platelet lysate.ResultsThe CST minimized post-operative discomfort and led to improved treatment outcomes with probing pocket depth reduction [average (SD)] of 24.4 (18.5) %, gain in clinical attachment levels of 25.8 (20.1) %, and evidence of remineralisation of the alveolar crest.ConclusionThe CST is a tissue-friendly operation and facilitates subgingival application of biological agents via tunneling the soft-tissues. However, surgical experience is required for non-traumatic manipulation of the gingival tissues during “closed” retraction of the flaps.Clinical trial registrationRegistered with Clinicaltrials.gov; ClinicalTrials.gov ID: NCT02449005.
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Enamel matrix derivative as adjunctive to non-surgical periodontal therapy: a systematic review and meta-analysis of randomized controlled trials. Clin Oral Investig 2022; 26:4263-4280. [PMID: 35389113 PMCID: PMC9203394 DOI: 10.1007/s00784-022-04474-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/22/2022] [Indexed: 11/24/2022]
Abstract
Objectives To assess the potential additional benefit of the local application of enamel matrix derivative (EMD) on the clinical outcomes following non-surgical periodontal therapy (NSPT) (steps 1 and 2 periodontal therapy). Materials and Methods A systematic literature search was performed in several electronic databases, including Medline/PubMed, Embase, The Cochrane Register of Central Trials (CENTRAL), LILACS, and grey literature. Only randomized controlled clinical trials (RCTs) were eligible for inclusion. Clinical attachment level (CAL) change (primary outcome), probing pocket depth (PPD), and bleeding on probing (BoP) reductions (secondary outcomes) were evaluated. The Cochrane Risk of Bias tool (RoB 2.0) was used to assess the quality of the included trials. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) between test and control sites were estimated using a random-effect model for amount of mean CAL and PPD change. Results Six RCTs were included for the qualitative analysis, while data from 4 studies were used for meta-analysis. Overall analysis of CAL gain (3 studies) and PPD reduction (4 studies) presented WMD of 0.14 mm (p = 0.74; CI 95% − 0.66; 0.94) and 0.46 mm (p = 0.25; CI 95% − 0.33; 1.26) in favor of NSPT + EMD compared to NSPT alone respectively. Statistical heterogeneity was found to be high in both cases (I2 = 79% and 87%, respectively). Conclusions Within their limitations, the present data indicate that the local application of EMD does not lead to additional clinical benefits after 3 to 12 months when used as an adjunctive to NSPT. However, due to the high heterogeneity among the studies, additional well-designed RCTs are needed to provide further evidence on this clinical indication for the use of EMD. Clinical relevance The adjunctive use of EMD to NSPT does not seem to additionally improve the clinical outcomes obtained with NSPT alone. Supplementary Information The online version contains supplementary material available at 10.1007/s00784-022-04474-1.
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Anoixiadou S, Parashis A, Vouros I. Enamel matrix derivative as an adjunct to minimally invasive non-surgical treatment of intrabony defects: A randomized clinical trial. J Clin Periodontol 2021; 49:134-143. [PMID: 34708441 DOI: 10.1111/jcpe.13567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/10/2021] [Accepted: 10/12/2021] [Indexed: 12/18/2022]
Abstract
AIM To compare the efficacy of minimally invasive non-surgical technique (MINST) with or without enamel matrix derivative (EMD) in the treatment of intrabony defects ≤7 mm. MATERIALS AND METHODS Thirty-six patients were randomly assigned to the two groups. The control group received MINST, while the experimental MINST+EMD. Clinical measurements were recorded at baseline and at 6 and 12 months, and radiographic measurements were made at baseline and 12 months. RESULTS All subjects completed the study, 18 in each group. Significant improvements were observed in both groups at 12 months (p < .001) with no differences in mean PD reduction (4.0 ± 1.4 vs. 4.2 ± 1.7 mm), CAL gain (3.5 ± 1.4 vs. 3.4 ± 1.6 mm), and defect resolution (1.9 ± 1.1 vs. 1.8 ± 0.9 mm) for the MINST and the MINST+EMD groups, respectively (p > .05). A trend for greater pocket closure (PD ≤4 mm and no BoP) was achieved with the application of EMD (77.8% vs. 55.6% sites), particularly for sites with baseline PD ≤8 mm (92.3% vs. 69.2% sites), accompanied by an increased number of successful composite outcome results (61.1% vs. 44.4% sites). CONCLUSIONS MINST demonstrates significant improvements 12 months after treatment of intrabony defects ≤7 mm. The additional application of EMD does not further improve the mean clinical or radiographic outcomes. This study is registered in ClinicalTrials.gov (NCT03622255).
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Affiliation(s)
- Styliani Anoixiadou
- Department of Preventive Dentistry Periodontology and Implant Biology, Faculty of Dentistry, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas Parashis
- Department of Preventive Dentistry Periodontology and Implant Biology, Faculty of Dentistry, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Private Practice, Athens, Greece
| | - Ioannis Vouros
- Department of Preventive Dentistry Periodontology and Implant Biology, Faculty of Dentistry, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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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. Clin Oral Investig 2021; 26:1811-1821. [PMID: 34491446 PMCID: PMC8816368 DOI: 10.1007/s00784-021-04155-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/17/2021] [Indexed: 02/06/2023]
Abstract
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.
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Ng E, Tay JRH, Ong MMA. Minimally Invasive Periodontology: A Treatment Philosophy and Suggested Approach. Int J Dent 2021; 2021:2810264. [PMID: 34257659 PMCID: PMC8245214 DOI: 10.1155/2021/2810264] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 01/20/2023] Open
Abstract
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.
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Affiliation(s)
- Ethan Ng
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore 168938, Singapore
| | - John Rong Hao Tay
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore 168938, Singapore
| | - Marianne Meng Ann Ong
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore 168938, Singapore
- Oral Health Academic Clinical Programme, Duke-NUS Medical School, Singapore 169857, Singapore
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Schallhorn RA, McClain PK, Benhamou V, Doobrow JH, Grandin HM, Kasaj A. Application of enamel matrix derivative in conjunction with non-surgical therapy for treatment of moderate to severe periodontitis: A 12-month, randomized prospective, multicenter study. J Periodontol 2020; 92:619-628. [PMID: 32996172 DOI: 10.1002/jper.19-0579] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 05/07/2020] [Accepted: 05/09/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Treatment of periodontitis aims to halt progressive bone and attachment loss and regenerate periodontal structures. In this study, the effect of using an enamel matrix derivative (EMD) as an adjunct to non-surgical periodontal therapy (test) versus non-surgical therapy alone (control) was evaluated. METHODS A prospective, split-mouth, multicenter study evaluated scaling and root planing (SRP) with and without EMD in 51 patients presenting with moderate to severe periodontitis (PPD = 5 to 8 mm) in at least 2 pockets per contralateral quadrants within the same arch. The primary outcome variable was change in clinical attachment level (CAL) after 12 months. Secondary variables included probing pocket depth (PPD), bleeding on probing (BoP), gingival margin level, dentin hypersensitivity, and percent of pockets converted to sites no longer requiring surgical treatment. RESULTS CAL changed significantly (P < 0.001) from baseline to 12 months for both treatment modalities (test = -2.2 ± 1.5 mm versus control = -2.1 ± 1.3 mm) and similarly for PPD; the difference between groups was not significant. A significant difference, favoring test conditions, was observed in percentage of both healthy PPDs (pockets < 5 mm) and converted pockets (sites no longer requiring surgical treatment); 79.8% of test versus 65.9% of control sites. BoP decreased significantly more (P < 0.05) in test sites (BoP at 17.8% test versus 23.1% control). CONCLUSIONS Both test and control treatments resulted in significant improvements in CAL and PPD. The adjunct use of EMD with SRP resulted in significantly greater improvements in overall periodontal health with less frequent BoP and a higher number of healthy PPDs.
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Affiliation(s)
| | | | | | | | - H Michelle Grandin
- Alfred E. Mann Institute, University of Southern California, Los Angeles, California, USA
| | - Adrian Kasaj
- Department of Periodontology and Operative Dentistry, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Sultan N, Jafri Z, Sawai M, Bhardwaj A. Minimally invasive periodontal therapy. J Oral Biol Craniofac Res 2020; 10:161-165. [PMID: 32489815 DOI: 10.1016/j.jobcr.2020.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 11/16/2022] Open
Abstract
Historically, surgical techniques were governed by specific incisions and surgical designs. With the advent of anesthesia, the complicated cases were managed but at the cost of the tissues leading to morbidities of various degrees. The innovations and the advances in the surgical techniques led to the ideology that surgeries could be done with minimal tissue manipulation and sacrifice. Thus the concept of "minimally invasive dentistry" was introduced with the primary goal to achieve satisfactory therapeutic results with minimal trauma during the process. In context to the management of periodontitis, this modality includes use of conservative incisions which preserves as much soft tissue as possible, avoiding continuous incisions and vertical incisions, use of magnification etc. The ultimate goal of any treatment modality is the resolution of the disease and regeneration if possible with minimal postoperative pain and morbidity. Minimal invasive periodontal therapy involves treatment options which cure the disease with reduced postoperative pain, improved healing and better patient acceptance. This paper covers the advent of minimal invasive periodontal therapy modalities both surgical and non-surgical along with the literature review.
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Affiliation(s)
- Nishat Sultan
- Department of Periodontology, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, 110025, India
| | - Zeba Jafri
- Department of Periodontology, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, 110025, India
| | - Madhuri Sawai
- Department of Periodontology, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, 110025, India
| | - Ashu Bhardwaj
- Department of Periodontology, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, 110025, India
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Clementini M, Ambrosi A, Cicciarelli V, De Risi V, Sanctis M. Clinical performance of minimally invasive periodontal surgery in the treatment of infrabony defects: Systematic review and meta‐analysis. J Clin Periodontol 2019; 46:1236-1253. [DOI: 10.1111/jcpe.13201] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 09/17/2019] [Accepted: 09/21/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Marco Clementini
- Department of Periodontology Università Vita‐Salute San Raffaele Milano Italy
| | - Alessandro Ambrosi
- Faculty of Medicine and Surgery Università Vita‐Salute San Raffaele Milano Italy
| | - Valerio Cicciarelli
- Department of Periodontology Università Vita‐Salute San Raffaele Milano Italy
| | | | - Massimo Sanctis
- Department of Periodontology Università Vita‐Salute San Raffaele Milano Italy
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Moreno Rodríguez JA, Ortiz Ruiz AJ, Caffesse RG. Periodontal reconstructive surgery of deep intraosseous defects using an apical approach. Non-incised papillae surgical approach (NIPSA): A retrospective cohort study. J Periodontol 2018; 90:454-464. [PMID: 30421495 DOI: 10.1002/jper.18-0405] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/06/2018] [Accepted: 10/13/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND The objective of this study was to compare a minimally-invasive surgical technique (MIST) and a non-incised papilla surgical approach (NIPSA) in periodontal reconstructive surgery of deep intraosseous defects. METHODS Data on 30 patients with a deep intraosseous defect treated with MIST (n = 15) or NIPSA (n = 15) were analyzed retrospectively. All patients met the same inclusion criteria and were treated following the same protocol, except for the surgical management of soft tissue (MIST versus NIPSA). Clinical parameters at baseline and at 1-year post-surgery, early healing at 1 week, and postoperative pain were assessed. RESULTS NIPSA and MIST resulted in significant clinical attachment gain (CAG) (P < 0.001) and probing depth reduction (PDr) (P < 0.001) at 1-year post-surgery. However, NIPSA resulted in significantly lower recession of the tip of the interdental papilla compared with MIST (P < 0.001). Smoking negatively influenced early healing in both techniques (P < 0.05). CONCLUSIONS NIPSA and MIST both resulted in significant improvements in clinical parameters. NIPSA showed significant soft tissue preservation. NIPSA may represent a promising papillae preservation technique in the treatment of intraosseous periodontal defects.
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Affiliation(s)
| | | | - Raúl G Caffesse
- Visiting Professor, Postgraduate Periodontics, Complutense University of Madrid, Spain
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Videoscope-Assisted Minimally Invasive Surgery (VMIS) for Bone Regeneration around Teeth and Implants: A Literature Review and Technique Update. Dent J (Basel) 2018; 6:dj6030030. [PMID: 29986378 PMCID: PMC6162722 DOI: 10.3390/dj6030030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/02/2018] [Accepted: 07/03/2018] [Indexed: 11/17/2022] Open
Abstract
Background—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—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.
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Ultrasonic Surgical Aspirator to Treat Deep Infrabony Defects: A New Flapless Minimally Invasive Approach. Adv Med 2018; 2018:3612359. [PMID: 30155496 PMCID: PMC6091290 DOI: 10.1155/2018/3612359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/25/2018] [Accepted: 06/02/2018] [Indexed: 11/17/2022] Open
Abstract
The primary outcome of the present study was to assess the percentage of pocket closure, and the secondary aim was to evaluate the clinical performance in terms of clinical attachment level (CAL) gain, probing pocket depth (PPD) reduction, and gingival recession (REC) after the use of cavitron ultrasonic surgical aspirator (CUSA) in deep infrabony defects. Fourteen deep infrabony defects in 11 patients who were previously treated with active periodontal therapy followed by one year of supportive periodontal therapy (at least three sessions) were additionally treated by the aid of CUSA. Eighty-six percent of the initial defects (12 out of 14) resulted in a PD < 5 mm, showing complete resolution six months after CUSA treatment, without any adverse event and with negligible pain (VAS from 0 to 3). CUSA showed potential as a method to promote pocket healing, reduce PPD, and increase clinical attachment (P < 0.001) in deep infrabony defects. This trial is registered with ClinicalTrials.gov NCT03567161.
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Harrel SK, Nunn ME, Abraham CM, Rivera-Hidalgo F, Shulman JD, Tunnell JC. Videoscope Assisted Minimally Invasive Surgery (VMIS): 36-Month Results. J Periodontol 2017; 88:528-535. [PMID: 28183218 DOI: 10.1902/jop.2017.160705] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
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.
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Affiliation(s)
- Stephen K Harrel
- Department of Periodontology, Baylor College of Dentistry, Texas A&M University, Dallas, TX
| | - Martha E Nunn
- Department of Periodontology, Creighton University, Omaha, NE
| | - Celeste M Abraham
- Department of Periodontology, Baylor College of Dentistry, Texas A&M University, Dallas, TX
| | | | - Jay D Shulman
- Department of Periodontology, Baylor College of Dentistry, Texas A&M University, Dallas, TX
| | - John C Tunnell
- Department of Periodontology, Baylor College of Dentistry, Texas A&M University, Dallas, TX
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A novel flapless approach versus minimally invasive surgery in periodontal regeneration with enamel matrix derivative proteins: a 24-month randomized controlled clinical trial. Clin Oral Investig 2016; 21:327-337. [PMID: 27044318 DOI: 10.1007/s00784-016-1795-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 03/14/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVES This investigation was designed to compare the effectiveness of enamel matrix derivative (EMD) proteins in combination with flapless or flap procedure in periodontal regeneration of deep intrabony defects. MATERIALS AND METHODS Thirty chronic periodontitis patients who had at least one residual periodontal defect with an intrabony component of ≥3 mm were consecutively enrolled. Defects were randomly assigned to test or control treatments which both consisted of the use of EMD to reach periodontal regeneration. Test sites (n = 15) were treated according to a novel flapless approach, whereas control sites (n = 15) by means of minimally invasive surgery (MIST). Clinical and radiographic parameters were recorded at baseline, 12 and 24 months post-operatively. RESULTS Both therapeutic modalities yielded similar probing depth (PD) reduction and clinical attachment level (CAL) gain at 24 months. In flapless-treated sites, a mean PD reduction of 3.6 ± 1.0 mm and a CAL gain of 3.2 ± 1.1 mm were observed. In the MIST group, they were 3.7 ± 0.6 and 3.6 ± 0.9 mm. The operative chair time was twice as long in the MIST compared to the flapless group, whereas comparable patient-oriented outcomes were observed. CONCLUSION The flapless procedure may be successfully applied in the regenerative treatment of deep intrabony defects reaching clinical outcomes comparable with those of minimally invasive surgical approaches and may present important advantages in terms of reduction of operative chair time. CLINICAL RELEVANCE The use of EMD as an adjunct to non-surgical periodontal treatment may be considered a suitable option to treat defects mainly in the anterior sextants.
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Liu S, Hu B, Zhang Y, Li W, Song J. Minimally Invasive Surgery Combined with Regenerative Biomaterials in Treating Intra-Bony Defects: A Meta-Analysis. PLoS One 2016; 11:e0147001. [PMID: 26785405 PMCID: PMC4718618 DOI: 10.1371/journal.pone.0147001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 12/26/2015] [Indexed: 11/23/2022] Open
Abstract
Background With the popularity of minimally invasive surgery (MIS) in periodontics, numerous publications have evaluated the benefits of MIS with or without various regenerative biomaterials in the treatment of periodontal intra-bony defects. However, it is unclear if it is necessary to use biomaterials in MIS. Thus, we conducted a meta-analysis of randomized clinical trials in patients with intra-bony defects to compare the clinical outcomes of MIS with regenerative biomaterials for MIS alone. Methods The authors retrieved English publications on relevant studies from Cochrane CENTRAL, PubMed, Medline, Embase, Clinical Evidence, and ClinicalTrails.gov (up to June 30, 2015). The main clinical outcomes were the reduction of probing pocket depths (PPDs), gain of clinical attachment level (CAL), recession of gingival margin (REC) and radiographic bone fill. Review Manager 5.2 (Cochrane Collaboration, Oxford, England) was used to calculate the heterogeneity and mean differences of the main clinical outcomes. Results In total, 464 studies in the literature were identified but only four were ultimately feasible. The results showed no significant difference regarding CAL gain (P = 0.32) and PPD reduction (P = 0.40) as well as REC increase (P = 0.81) and radiographic bone fill (P = 0.64) between the MIS plus biomaterials group and the MIS alone group. Conclusions The meta-analysis suggested no significant difference in treatment of intra-bony defects between the MIS plus biomaterials group and the MIS alone group, indicating that it is important to take costs and benefits into consideration when a decision is made about a therapeutic approach. There needs to be an in-depth exploration of the induction of intrinsic tissue healing of MIS without biomaterials to achieve optimal outcomes.
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Affiliation(s)
- Shan Liu
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Bo Hu
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Yuanyuan Zhang
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC, 27157, United States of America
| | - Wenyang Li
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Jinlin Song
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
- * E-mail:
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Cortellini P, Tonetti MS. Clinical concepts for regenerative therapy in intrabony defects. Periodontol 2000 2015; 68:282-307. [DOI: 10.1111/prd.12048] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 12/14/2022]
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Kao RT, Nares S, Reynolds MA. Periodontal regeneration - intrabony defects: a systematic review from the AAP Regeneration Workshop. J Periodontol 2014; 86:S77-104. [PMID: 25216204 DOI: 10.1902/jop.2015.130685] [Citation(s) in RCA: 164] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Previous systematic reviews of periodontal regeneration with bone replacement grafts and guided tissue regeneration (GTR) were defined as state of the art for clinical periodontal regeneration as of 2002. METHODS The purpose of this systematic review is to update those consensus reports by reviewing periodontal regeneration approaches developed for the correction of intrabony defects with the focus on patient-, tooth-, and site-centered factors, surgical approaches, surgical determinants, and biologics. This review adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for systematic reviews. A computerized search of the PubMed and Cochrane databases was performed to evaluate the clinically available regenerative approaches for intrabony defects. The search included screening of original reports, review articles, and reference lists of retrieved articles and hand searches of selected journals. All searches were focused on clinically available regenerative approaches with histologic evidence of periodontal regeneration in humans published in English. For topics in which the literature is lacking, non-randomized observational and experimental animal model studies were used. Therapeutic endpoints examined included changes in clinical attachment level, changes in bone level/fill, and probing depth. For purposes of analysis, change in bone fill was used as the primary outcome measure, except in cases in which this information was not available. The SORT (Strength of Recommendation Taxonomy) grading scale was used in evaluating the body of knowledge. RESULTS 1) Fifty-eight studies provided data on patient, tooth, and surgical-site considerations in the treatment of intrabony defects. 2) Forty-five controlled studies provided outcome analysis on the use of biologics for the treatment of intrabony defects. CONCLUSIONS 1) Biologics (enamel matrix derivative and recombinant human platelet-derived growth factor-BB plus β-tricalcium phosphate) are generally comparable with demineralized freeze-dried bone allograft and GTR and superior to open flap debridement procedures in improving clinical parameters in the treatment of intrabony defects. 2) Histologic evidence of regeneration has been demonstrated with laser therapy; however, data are limited on clinical predictability and effectiveness. 3) Clinical outcomes appear most appreciably influenced by patient behaviors and surgical approach rather than by tooth and defect characteristics. 4) Long-term studies indicate that improvements in clinical parameters are maintainable up to 10 years, even in severely compromised teeth, consistent with a favorable/good long-term prognosis.
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Harrel SK, Abraham CM, Rivera-Hidalgo F, Shulman JD, Nunn ME. Videoscope-assisted minimally invasive periodontal surgery (V-MIS). J Clin Periodontol 2014; 41:900-7. [PMID: 25039580 DOI: 10.1111/jcpe.12294] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2014] [Indexed: 11/28/2022]
Abstract
AIM Small incision surgery has become routine in many areas of medicine but has not been widely accepted in periodontal therapy. A videoscope to assist minimally invasive surgery (MIS) has been developed. The clinical outcomes from MIS performed using this videoscope (V-MIS) are reported. MATERIALS AND METHODS Patients were evaluated for residual defects following non-surgical therapy consisting of root planing with local anaesthetic. Thirty patients having 110 sites with residual pocket probing depth (PPD) of at least 5 mm, 2 mm loss of clinical attachment level (CAL), and radiographic evidence of bone loss were surgically treated. V-MIS was performed utilizing the videoscope for surgical visualization. RESULTS At re-evaluation 6 months post surgery, there was a statistically significant improvement (p < .001) in mean PPD and CAL (PPD 3.88 ± 1.02 mm, CAL 4.04 ± 1.38 mm) in 1, 2, and 3 wall defects. All PPD at re-evaluation were 3 mm or less. There was a mean post-surgical increase in soft tissue height (0.13 ± 0.61 mm, p = 0.168) with a decrease in recession. CONCLUSIONS The improvement in PPD and CAL from V-MIS, in the authors' opinion, appears to be favourable when compared to previously reported results of periodontal regenerative surgery. The lack of post-surgical recession following V-MIS has not been reported with traditional regenerative surgery.
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Affiliation(s)
- Stephen K Harrel
- Texas A&M University, Baylor College of Dentistry, Dallas, TX, USA
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Harrel SK, Wilson TG, Rivera-Hidalgo F. A videoscope for use in minimally invasive periodontal surgery. J Clin Periodontol 2013; 40:868-74. [PMID: 23782239 DOI: 10.1111/jcpe.12125] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2013] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Minimally invasive periodontal procedures have been reported to produce excellent clinical results. Visualization during minimally invasive procedures has traditionally been obtained by the use of surgical telescopes, surgical microscopes, glass fibre endoscopes or a combination of these devices. All of these methods for visualization are less than fully satisfactory due to problems with access, magnification and blurred imaging. CLINICAL INNOVATION A videoscope for use with minimally invasive periodontal procedures has been developed to overcome some of the difficulties that exist with current visualization approaches. This videoscope incorporates a gas shielding technology that eliminates the problems of fogging and fouling of the optics of the videoscope that has previously prevented the successful application of endoscopic visualization to periodontal surgery. In addition, as part of the gas shielding technology the videoscope also includes a moveable retractor specifically adapted for minimally invasive surgery. DISCUSSION The clinical use of the videoscope during minimally invasive periodontal surgery is demonstrated and discussed. CONCLUSION The videoscope with gas shielding alleviates many of the difficulties associated with visualization during minimally invasive periodontal surgery.
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Affiliation(s)
- Stephen K Harrel
- Baylor College of Dentistry Texas A&M Health Science Center, Dallas, TX 75229, USA.
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Harrel SK, Abraham CM, Rivera-Hidalgo F, Steffer MR, Rossmann JA, Kerns DG, Al-Hashimi I, Solomon ES, Cipher DJ. Comparison of Minimally Invasive and Conventional Flap Surgery for Treatment of Intrabony Periodontal Defects: A Pilot Case Controlled Study. ACTA ACUST UNITED AC 2013. [DOI: 10.5005/jp-journals-10031-1038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
The purpose of this study was to compare the clinical outcome of conventional flap surgery and minimally invasive surgery for the regenerative treatment of periodontal intrabony defects in a prospective, case-controlled study design. For this purpose, nine healthy individuals with 15 periodontal intrabony defects were included in the study. Patients were randomly assigned to undergo either minimally invasive surgery or conventional flap surgery for treatment of their intrabony periodontal defect. Each patient had preoperative and postoperative X-ray and measurement of periodontal parameters by a blinded examiner. All bony defects were treated with allograft consisting of enamel matrix derivative and demineralized freeze-dried bone. Results of this study indicated that both minimally invasive and conventional flap surgery improved pocket depth and clinical attachment levels after 6 months of surgery with no significant difference between the two surgeries. The overall result of our study suggests that minimally invasive surgery is as effective as conventional flap surgery in the treatment of intrabony periodontal defects and that both techniques appear to provide a comparable outcome.
How to cite this article
Steffer MR, Harrel SK, Rossmann JA, Kerns DG, Rivera-Hidalgo F, Abraham CM, Al-Hashimi I, Solomon ES, Cipher DJ. Comparison of Minimally Invasive and Conventional Flap Surgery for Treatment of Intrabony Periodontal Defects: A Pilot Case Controlled Study. J Contemp Dent 2013;3(2):61-67.
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Clinical and microbiological changes after minimally invasive therapeutic approaches in intrabony defects: a 12-month follow-up. Clin Oral Investig 2012; 17:1635-44. [PMID: 23053707 DOI: 10.1007/s00784-012-0855-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 09/25/2012] [Indexed: 01/15/2023]
Abstract
OBJECTIVES This 12-month randomized, controlled trial evaluated the clinical effects and microbiological changes of minimally invasive nonsurgical and surgical approaches for the therapy of intrabony defects. MATERIALS AND METHODS Twenty-nine subjects with intrabony defects in single-rooted tooth were randomly assigned to; (1) minimally invasive nonsurgical technique (MINST) or (2) minimally invasive surgical technique (MIST). Quantities of Aggregatibacter actinomycetemcomitans, Tannerella forsythia, and Porphyromonas gingivalis, determined by using real-time PCR, were evaluated at baseline, 3, 6, and 12 months after the treatments. Clinical recordings--probing depth (PD), position of the gingival margin (PGM), and relative clinical attachment level (RCAL)--were obtained at baseline and 12 months post-therapy. The primary outcome variable of the study was RCAL. RESULTS Both treatment modalities resulted in an improvement in all clinical recordings, with significant PD reductions (p < 0.05), RCAL gains (p < 0.05), and no change in the PGM (p > 0.05) after 12 months in both MINST and MIST groups. No clinical differences were observed between groups (p > 0.05). Regarding the microbiological outcomes, at the re-examinations, a significant decrease was observed for T. forsythia and P. gingivalis when compared with baseline (p < 0.05) for both treatments. The amount of A. actinomycetemcomitans did not reduced decrease throughout the study (p > 0.05). Intergroup differences in the microbiological assay were not found at any time point (p > 0.05). CONCLUSIONS Both MINST and MIST provided comparable clinical results and microbiological changes in the treatment of intrabony defects over 12 months follow-up. CLINICAL RELEVANCE This randomized, controlled, parallel trial revealed that both therapeutic modalities may promote clinical and microbiological benefits at 12 months post-therapy.
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Cortellini P. Minimally Invasive Surgical Techniques in Periodontal Regeneration. J Evid Based Dent Pract 2012; 12:89-100. [DOI: 10.1016/s1532-3382(12)70021-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bertoldi C, Pellacani C, Lalla M, Consolo U, Pinti M, Cortellini P, Cossarizza A. Herpes Simplex I virus impairs regenerative outcomes of periodontal regenerative therapy in intrabony defects. A pilot study. J Clin Periodontol 2012; 39:385-92. [DOI: 10.1111/j.1600-051x.2012.01850.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2011] [Indexed: 11/27/2022]
Affiliation(s)
- Carlo Bertoldi
- Department of Specialistic Surgeries Head-Neck; University of Modena and Reggio Emilia; Modena; Italy
| | - Chiara Pellacani
- Department of Specialistic Surgeries Head-Neck; University of Modena and Reggio Emilia; Modena; Italy
| | - Michele Lalla
- Chair of Statistics; Department of Political Economy; University of Modena and Reggio Emilia; Modena; Italy
| | - Ugo Consolo
- Department of Specialistic Surgeries Head-Neck; University of Modena and Reggio Emilia; Modena; Italy
| | - Marcello Pinti
- Department of Biomedical Sciences; University of Modena and Reggio Emilia; Modena; Italy
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Trombelli L, Simonelli A, Schincaglia GP, Cucchi A, Farina R. Single-Flap Approach for Surgical Debridement of Deep Intraosseous Defects: A Randomized Controlled Trial. J Periodontol 2012; 83:27-35. [DOI: 10.1902/jop.2011.110045] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Dannan A. Minimally invasive periodontal therapy. J Indian Soc Periodontol 2011; 15:338-43. [PMID: 22368356 PMCID: PMC3283929 DOI: 10.4103/0972-124x.92565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2010] [Accepted: 11/09/2011] [Indexed: 11/24/2022] Open
Abstract
Minimally invasive dentistry is a concept that preserves dentition and supporting structures. However, minimally invasive procedures in periodontal treatment are supposed to be limited within periodontal surgery, the aim of which is to represent alternative approaches developed to allow less extensive manipulation of surrounding tissues than conventional procedures, while accomplishing the same objectives. In this review, the concept of minimally invasive periodontal surgery (MIPS) is firstly explained. An electronic search for all studies regarding efficacy and effectiveness of MIPS between 2001 and 2009 was conducted. For this purpose, suitable key words from Medical Subject Headings on PubMed were used to extract the required studies. All studies are demonstrated and important results are concluded. Preliminary data from case cohorts and from many studies reveal that the microsurgical access flap, in terms of MIPS, has a high potential to seal the healing wound from the contaminated oral environment by achieving and maintaining primary closure. Soft tissues are mostly preserved and minimal gingival recession is observed, an important feature to meet the demands of the patient and the clinician in the esthetic zone. However, although the potential efficacy of MIPS in the treatment of deep intrabony defects has been proved, larger studies are required to confirm and extend the reported positive preliminary outcomes.
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Affiliation(s)
- Aous Dannan
- Department of Periodontology, Faculty of Dental Medicine, Witten/Herdecke University, Witten, Germany
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Ribeiro FV, Casarin RC, Palma MA, Júnior FH, Sallum EA, Casati MZ. Clinical and Patient-Centered Outcomes After Minimally Invasive Non-Surgical or Surgical Approaches for the Treatment of Intrabony Defects: A Randomized Clinical Trial. J Periodontol 2011; 82:1256-66. [DOI: 10.1902/jop.2011.100680] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ribeiro FV, Casarin RC, Júnior FH, Sallum EA, Casati MZ. The Role of Enamel Matrix Derivative Protein in Minimally Invasive Surgery in Treating Intrabony Defects in Single-Rooted Teeth: A Randomized Clinical Trial. J Periodontol 2011; 82:522-32. [DOI: 10.1902/jop.2010.100454] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Dilsiz A, Canakci V, Aydin T. The Combined Use of Nd:YAG Laser and Enamel Matrix Proteins in the Treatment of Periodontal Infrabony Defects. J Periodontol 2010; 81:1411-8. [DOI: 10.1902/jop.2010.100031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Rethman MP, Harrel SK. Minimally Invasive Periodontal Therapy: Will Periodontal Therapy Remain a Technologic Laggard? J Periodontol 2010; 81:1390-5. [DOI: 10.1902/jop.2010.100150] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Harrel SK, Wilson TG, Nunn ME. Prospective Assessment of the Use of Enamel Matrix Derivative With Minimally Invasive Surgery: 6-Year Results. J Periodontol 2010; 81:435-41. [DOI: 10.1902/jop.2009.090393] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Comparative study of DFDBA in combination with enamel matrix derivative versus DFDBA alone for treatment of periodontal intrabony defects at 12 months post-surgery. Clin Oral Investig 2010; 15:225-32. [DOI: 10.1007/s00784-009-0369-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2009] [Accepted: 11/19/2009] [Indexed: 10/20/2022]
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Trombelli L, Farina R, Franceschetti G, Calura G. Single-Flap Approach With Buccal Access in Periodontal Reconstructive Procedures. J Periodontol 2009; 80:353-60. [DOI: 10.1902/jop.2009.080420] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Cortellini P, Tonetti MS. Improved wound stability with a modified minimally invasive surgical technique in the regenerative treatment of isolated interdental intrabony defects. J Clin Periodontol 2009; 36:157-63. [DOI: 10.1111/j.1600-051x.2008.01352.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Wilson TG, Carnio J, Schenk R, Myers G. Absence of Histologic Signs of Chronic Inflammation Following Closed Subgingival Scaling and Root Planing Using the Dental Endoscope: Human Biopsies – A Pilot Study. J Periodontol 2008; 79:2036-41. [DOI: 10.1902/jop.2008.080190] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Wilson TG, Harrel SK, Nunn ME, Francis B, Webb K. The Relationship Between the Presence of Tooth-Borne Subgingival Deposits and Inflammation Found With a Dental Endoscope. J Periodontol 2008; 79:2029-35. [DOI: 10.1902/jop.2008.080189] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Trombelli L, Farina R. Clinical outcomes with bioactive agents alone or in combination with grafting or guided tissue regeneration. J Clin Periodontol 2008; 35:117-35. [DOI: 10.1111/j.1600-051x.2008.01265.x] [Citation(s) in RCA: 155] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cortellini P, Nieri M, Pini Prato G, Tonetti MS. Single minimally invasive surgical technique with an enamel matrix derivative to treat multiple adjacent intra-bony defects: clinical outcomes and patient morbidity. J Clin Periodontol 2008; 35:605-13. [DOI: 10.1111/j.1600-051x.2008.01242.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Ozcelik O, Cenk Haytac M, Seydaoglu G. Enamel matrix derivative and low-level laser therapy in the treatment of intra-bony defects: a randomized placebo-controlled clinical trial. J Clin Periodontol 2007; 35:147-56. [DOI: 10.1111/j.1600-051x.2007.01176.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Cortellini P, Tonetti MS. Minimally invasive surgical technique and enamel matrix derivative in intra-bony defects. I: clinical outcomes and morbidity. J Clin Periodontol 2007; 34:1082-8. [DOI: 10.1111/j.1600-051x.2007.01144.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Miliauskaite A, Selimovic D, Hannig M. Successful Management of Aggressive Periodontitis By Regenerative Therapy: A 3-Year Follow-Up Case Report. J Periodontol 2007; 78:2043-50. [DOI: 10.1902/jop.2007.060492] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Cortellini P, Tonetti MS. A minimally invasive surgical technique with an enamel matrix derivative in the regenerative treatment of intra-bony defects: a novel approach to limit morbidity. J Clin Periodontol 2007; 34:87-93. [PMID: 17243998 DOI: 10.1111/j.1600-051x.2006.01020.x] [Citation(s) in RCA: 140] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
AIMS This study was undertaken to describe a new surgical approach (minimally invasive surgical technique, MIST) and to evaluate preliminarily its clinical performance and patient perception associated with the application of enamel matrix derivative (EMD) in the treatment of isolated deep intra-bony defects. METHODS Thirteen deep isolated intra-bony defects in 13 patients were surgically accessed with the MIST. This technique was designed to limit the mesio-distal flap extension and the corono-apical reflection in order to reduce the surgical trauma and increase flap stability. The incision of the defect-associated papilla was performed according to the principles of the papilla preservation techniques. EMD was applied on the debrided root surfaces. Stable primary closure of the flaps was obtained with internal modified mattress sutures. Surgery was performed with the aid of an operating microscope and microsurgical instruments. Clinical outcomes were collected at baseline and at 1 year. Intra-operative and post-operative patient perception was also recorded. RESULTS Early wound healing was uneventful: primary wound closure was obtained and maintained in all sites with the exception of one site with a small wound dehiscence at week 1. No oedema or haematoma were noted. Patients did not report any pain. Three patients experienced slight discomfort for 2-days post-operatively. The 1-year clinical attachment level (CAL) gain was 4.8+/-1.9 mm. The 1-year percent resolution of the defect was 88.7+/-20.7%, and reached 100% of the baseline intra-bony component in seven sites. Residual probing depths (PD) were 2.9+/-0.8 mm. Differences between baseline and 1-year CAL and PD were both clinically and statistically highly significant (p<0.0001). A minimal increase of 0.1+/-0.9 mm in gingival recession between baseline and 1 year was recorded (p=0.39). CONCLUSIONS This case cohort indicates that MIST associated with EMD resulted in excellent clinical improvements while limiting patient morbidity. These preliminary findings need to be confirmed in a larger study.
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Allen EP, Brodine AH, Burgess JO, Cronin RJ, Donovan TE, Summitt JB. Annual review of selected dental literature: report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2006; 96:174-99. [PMID: 16990070 DOI: 10.1016/j.prosdent.2006.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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