An assessment of clinical effectiveness of modified flap operation technique in patients with periodontal disease and implants

Abstract

Increasing amount of patients with moderate and severe generalized periodontitis (MGP, SGP) with probing pocket depth (PPD) of 5-12 mm with on the average of 4-6 periodontal pockets (PP) per 1 sextant became to be reason for development of surgical technique, supplying solution for functional and aesthetic goals.

To assess clinical effectiveness of modified flap operation technique for MGP and SGP cases providing reduction of surgical invasiveness.

30 patients (28-64 y.o.) with MGP and SGP were observed and treated. PPD0=5-12 mm, intrabony periodontal defects with an intrabony component, interdental spaces ˃ 2 mm. Periodontal status check-up included: Plaque Index (PI), Bleeding on Probing Index (BOP), Schour & Massler (PMA), PPD, Clinical Attachment Level (CAL), type of exudate in PP (PPE), Gingival recession (GR), panoramic X-ray. Depending on type of flap operation technique, patients were divided into 2 groups: test group -15 patients – modification of Modified Widman Flap (MWF) and control group -15 patients – traditional MWF. The presurgical preparation in both groups included manual and machined scaling, root planning. In test group an additional repeated laser curettage (2 procedures) was applied (diode laser, continuous regimen, 980 nm, 2 Watts) with tip insertion depth 2 mm. The indications for overpassing to surgical phase were: reduction of РI, РМА, ВОР, РPD, PPE=0. The modification of flap operation in test group included: fixation of orthodontic buttons on involved and neighbouring to the defect zone teeth, combination of intrasulcular and horizontal incisions in base of interdental papillae and two vertical incisions (4-6 teeth per operating zone ). Full thickness vestibular muco-periosteal flap exposition till muco-gingival junction. Ultrasonication of PP (1-2 min). Flap deepithelization by diode laser, grid-like osteotomy and corticotomy of bony pocket walls, ultrasonication (10 sec per each perforation). Bone pockets filled with «Emdogain» (according instruction), autogenous bone. Wound closure with modified single horizontal matress suture, fixation of proximal thread ends by knots on 2 orthodontic buttons, 2 mm coronally repositioned flap to CEJ. Splinting by soft orhodontic chain with slight tension, protective dressing. Suture removal after 14 days. General therapy – analgetics, antiedematous medications, course – 5 days. Control observations on 5,7,14 day; 6,12 months.

The comparison of clinical results in both groups revealed enhancement of clinical condition in patients of test group. Elimination of general inflammatory reaction signs on 2-3 days earlier comparing to data from control group, sufficient wound closure, sutures tension saving and coronal flap reposition, absence of gingival recession during14 days postoperation. After 12 months: PPD reduction on 2-3 mm, CAL reduction - 2 mm, РРЕ=0, ВОР=0 and minimal gingival recession - PPD0=5-7 мм – GR=1-2 mm; PPD0≥7mm – GR=2-4 mm. In patients of control group after 12 months periodontal status was worse due to substantial increased recession: PPD0=5-7 mm - GR≥ 2-4 mm; PPD≥7 mm- GR≥ 4-5 мм.

Clinical approbation of modified minimally-invasive surgical operation in patients with moderate and severe GP has certain benefits comparing to traditional flap operation technique.