Clinical performance of minimally invasive periodontal surgery in the treatment of infrabony defects: Systematic review and meta‐analysis

Abstract

Aim To assess the effectiveness, in terms of clinical performance and patient perception, of minimally invasive periodontal surgeries (MIPSs), and to compare MIPSs to traditional surgery in the treatment of periodontal infrabony defects. Materials and Methods An electronic search and a manual search were carried out to identify studies investigating clinical (CAL, PPD, REC), radiographic (bone fill) and patient's centred (VAS) outcomes at least 6 months after MIPSs. A linear mixed‐effect model was used for meta‐analysis. Subgroup analyses were performed according to the study quality (RCT or case series). A meta‐analysis assessing differences in clinical parameters between MIPSs and traditional flaps was also performed. Results Meta‐analysis from the 18 included studies revealed a PPD reduction of 4.24 mm (95% CI = 3.79–4.69 mm), a CAL gain of 3.89 mm (95% CI = 3.42–4.35 mm), a REC increase of 0.44 mm (95% CI = 0.11–0.77 mm), a radiographic bone fill gain of 58.25% (95% CI = 42.30%–74.21%) and a VAS value of 1.16 (95% CI = 0.78–1.54). Based on 2 RCTs, MIPSs are more effective than traditional surgery for PPD reduction (0.93 mm, 95% CI = 1.71–0.15) and CAL gain (1 mm, 95% CI = 1.75–.24). Conclusion Minimally invasive periodontal surgeries may be considered for the treatment of periodontal infrabony defects. However, the real effect cannot be systematically evaluated due to the paucity of studies comparing MIPSs to traditional flap for periodontal reconstructive surgery.

Guest Editorial: Time to reflect on new evidence about periodontal regenerative surgery of intrabony defects

“…Slightly more dated systematic reviews on this topic have also shown us that: i) minimally invasive flaps lead to improved clinical and radiographic outcomes compared with larger flaps (‘traditional’ approaches) (Clementini et al, 2019); ii) when minimally invasive flaps are employed, the addition of biomaterials does not seem to improve clinical outcomes (Liu et al, 2016).…”

“…These are important outcomes trying to answer the question about predictability: 'In how many cases will using a regenerative approach with biomaterials lead to the desired clinical outcome (translating into tooth retention long-term)?' Slightly more dated systematic reviews on this topic have also shown us that: i) minimally invasive flaps lead to improved clinical and radiographic outcomes compared with larger flaps ('traditional' approaches) (Clementini et al, 2019); ii) when minimally invasive flaps are employed, the addition of biomaterials does not seem to improve clinical outcomes (Liu et al, 2016).…”

Minimally Invasive Periodontology: A Treatment Philosophy and Suggested Approach

“…e microsurgical approach facilitated gentle handling of tissues and precise wound closure, resulting in a > 90% rate of primary closure reported by some studies [120][121][122]. Other advantages include improved visual acuity, enhanced revascularization, and maximum preservation of the tissue [123,124]. Various double-layer suturing approaches have been suggested when a microsurgical approach is used [120,125,126].…”

“…Subsequent systematic reviews and meta-analyses have established that regenerative outcomes with a minimally International Journal of Dentistry invasive surgery are superior to access flaps [28,124]. Furthermore, the additional use of biomaterials or membranes has been used in combination with a minimally invasive surgery with successful outcomes of up to six years and low postsurgical morbidity [31,[132][133][134][135][136][137] but does not appear to enhance regenerative outcomes, indicating enhanced healing potential with a minimally invasive surgical approach [138][139][140][141].…”

Periodontal regenerative therapy in patients with type 2 diabetes using minimally invasive surgical technique with enamel matrix derivative under 3‐year observation: A prospective cohort study

“…It has been reported that with M‐MIST, in particular, significant tissue regeneration even without the use of adjunctive biomaterials was achieved, suggesting that it is an excellent modality that promotes periodontal tissue regeneration 24 . The enhanced tissue regenerative effect of minimally invasive approaches is statistically demonstrated in systematic reviews and meta‐analyses 25,26 …”