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.

Keywords

chronic periodontitis - horizontal bone defects - conventional access flap - periodontal microsurgery - dental loupes

Publication History

Article published online:
16 October 2023

• References

• 1 American Academy of Periodontology Task Force report on the update to the 1999 classification of periodontal diseases and conditions. J Periodontol 2015; 86 (07) 835-838
• 2 Heitz-Mayfield LJ, Lang NP. Surgical and nonsurgical periodontal therapy. Learned and unlearned concepts. Periodontol 2000 2013; 62 (01) 218-231
• 3 Verma PK, Srivastava R, Gautam A, Chaturvedi TP. Multiple regenerative techniques for class II furcation defect. Eur J Gen Dent 2012; 1: 90-93
• 4 Sanz-Sánchez I, Montero E, Citterio F, Romano F, Molina A, Aimetti M. Efficacy of access flap procedures compared to subgingival debridement in the treatment of periodontitis. A systematic review and meta-analysis. J Clin Periodontol 2020; 47 (Suppl. 22) 282-302
• 5 Perumal MP, Ramegowda AD, Lingaraju AJ, Raja JJ. Comparison of microsurgical and conventional open flap debridement: a randomized controlled trial. J Indian Soc Periodontol 2015; 19 (04) 406-410
• 6 Yadav VS, Salaria SK, Bhatia A, Yadav R. Periodontal microsurgery: reaching new heights of precision. J Indian Soc Periodontol 2018; 22 (01) 5-11
• 7 Patel C, Mehta R, Joshi S, Hirani T, Joshi C. Comparative evaluation of treatment of localized gingival recessions with coronally advanced flap using microsurgical and conventional techniques. Contemp Clin Dent 2018; 9 (04) 613-618
• 8 Harrel SK, Rees TD. Granulation tissue removal in routine and minimally invasive procedures. Compend Contin Educ Dent 1995; 16 (09) 960 , 962, 964 passim
• 9 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 (02) 157-163
• 10 Wachtel H, Schenk G, Böhm S, Weng D, Zuhr O, Hürzeler MB. Microsurgical access flap and enamel matrix derivative for the treatment of periodontal intrabony defects: a controlled clinical study. J Clin Periodontol 2003; 30 (06) 496-504
• 11 Silness J, Löe H. Periodontal disease in pregnancy II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand 1964; 22 (01) 121-135
• 12 Löe H, Silness J. Periodontal disease in pregnancy I. Prevalence and severity. Acta Odontol Scand 1963; 21: 533-551
• 13 Clark DC, Chin Quee T, Bergeron MJ, Chan EC, Lautar-Lemay C, de Gruchy K. Reliability of attachment level measurements using the cementoenamel junction and a plastic stent. J Periodontol 1987; 58 (02) 115-118
• 14 Huang LH, Neiva RE, Soehren SE, Giannobile WV, Wang HL. The effect of platelet-rich plasma on the coronally advanced flap root coverage procedure: a pilot human trial. J Periodontol 2005; 76 (10) 1768-1777
• 15 Heller GZ, Manuguerra M, Chow R. How to analyze the visual analogue scale: myths, truths and clinical relevance. Scand J Pain 2016; 13 (01) 67-75
• 16 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 (04) 522-532
• 17 Ucak O, Ozcan M, Seydaoglu G, Haytac MC. Microsurgical instruments in laterally moved, coronally advanced flap for miller class III isolated recession defects: a randomized controlled clinical trial. Int J Periodont Restor Dent 2017; 37 (01) 109-115
• 18 Andrade PF, Grisi MF, Marcaccini AM. et al. Comparison between micro- and macrosurgical techniques for the treatment of localized gingival recessions using coronally positioned flaps and enamel matrix derivative. J Periodontol 2010; 81 (11) 1572-1579
• 19 Lindhe J, Nyman S. Scaling and granulation tissue removal in periodontal therapy. J Clin Periodontol 1985; 12 (05) 374-388
• 20 Reddy S, Prasad MG, Bhowmik N. et al. Open flap debridement using microsurgical loupes and modified Widman flap approach-a case series. Int J Appl Dent Sci 2019; 5 (02) 96-99
• 21 Reddy KR, Tatapudi R, Reddy RS, Kumar CN, Teja TN, Swathi G. Assessment of linear measurements with intra oral grid on intra oral periapical image–A comparison of digital and conventional film images using bisecting angle and paralleling techniques. J Indian Acad Oral Med Radiol 2019; 31 (04) 339
• 22 Rathore P, Manjunath S, Singh R. Evaluating and comparing the efficacy of the microsurgical approach and the conventional approach for the periodontal flap surgical procedure: a randomized controlled trial. Dent Med Probl 2022; 10.17219/dmp/147183
• 23 Katariya C, Rajasekar A. Comparison between conventional and micro-assisted periodontal surgery: case series. J Adv Pharm Technol Res 2022; 13 (Suppl. 01) S348-S352
• 24 Kahn S, de Oliveira LZ, Dias AT, Fernandes GVO. Clinical evaluation and biological understanding of the early step-by-step healing after periodontal microsurgery: a case report with PES analysis comparing initial and 31-day result. J Adv Periodontol Implant Dent 2022; 14 (02) 141-145
• 25 Singh SK, Sharma N, Malhotra S, Dodwad V, Vaish S, Singh DK. Coverage of localized gingival recession using coronally advanced flap: A comparison between microsurgical and macrosurgical techniques. Indian J Dent Sci. 2017; 9 (02) 88