Effect of a Connective Tissue Graft in Combination With a Single Flap Approach in the Regenerative Treatment of Intraosseous Defects

Trombelli, Leonardo; Simonelli, Anna; Minenna, Luigi; Rasperini, Giulio; Farina, Roberto

doi:10.1902/jop.2016.160471

Cited by 23 publications

(34 citation statements)

References 32 publications

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“…With NIPSA, the incision is moved away from the gingival margin and the area of the papillae, without incising or detaching these tissues, so the incision is far from the periodontal defect to be treated, accessing the defect from the apical aspect and maintaining a firm soft tissue roof which acts as a “dome” protecting the underlying interproximal defect and thus avoiding collapse of the papillae and recession of the marginal soft tissue. However, as shown in other studies on marginal access to the defect that obtained similar results to those reported here, the marginal location of the incision and the detachment of the papillae and marginal tissues seem to significantly increase postoperative recession of soft tissues …”

Section: Discussionsupporting

confidence: 90%

“…However, as shown in other studies on marginal access to the defect that obtained similar results to those reported here, the marginal location of the incision and the detachment of the papillae and marginal tissues seem to significantly increase postoperative recession of soft tissues. 32,33 With respect to WC, complete closure of the incision line (WC = 2) was achieved more frequently (73%), and significantly (P < 0.05) with NIPSA than with MIST (40%), where a result similar to other studies was obtained. 11,34 In addition, with NIPSA, there was no case of interproximal tissue necrosis, compared with 33% with MIST.…”

Section: Discussionsupporting

confidence: 82%

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Periodontal reconstructive surgery of deep intraosseous defects using an apical approach. Non‐incised papillae surgical approach (NIPSA): A retrospective cohort study

Rodríguez

Ruiz

Caffesse

2018

Journal of Periodontology

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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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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 82%

Periodontal reconstructive surgery of deep intraosseous defects using an apical approach. Non‐incised papillae surgical approach (NIPSA): A retrospective cohort study

Rodríguez

Ruiz

Caffesse

2018

Journal of Periodontology

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“…None of the controlled studies, however, reported data on soft tissue alterations. The recession observed in observational studies (WMD = 0.7 mm) was statistically significant and corresponded well with findings reported in studies on periodontal reconstructive therapy (Heden, Wennström, & Lindhe, ; S. Jepsen et al., ; Tonetti et al., , ; Trombelli, Simonelli, Minenna, Rasperini, & Farina, ). It remains unclear, however, whether the reconstructive techniques applied at peri‐implant defects resulted in a better aesthetic outcome as compared to controls.…”

Section: Discussionsupporting

confidence: 87%

Efficacy of reconstructive surgical therapy at peri‐implantitis‐related bone defects. A systematic review and meta‐analysis

Tomasi

Regidor²,

Ortiz‐Vigón

et al. 2019

J Clinic Periodontology

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Objectives The present systematic review aimed at evaluating the efficacy of reconstructive surgical therapy at peri‐implantitis‐related bone defects. Methods Studies reporting on outcomes of reconstructive surgery at peri‐implantitis‐related bone defects at 12 months were identified through an electronic search. Following data extraction, two different sets of meta‐analyses were performed. Primarily, controlled studies were used to evaluate the potential benefit of reconstructive surgical therapy over controls. Secondly, overall outcome of reconstructive surgical therapy was assessed by comparing baseline values with outcomes at 12 months. Results were expressed as weighted mean differences (WMD) or risk ratios (RR). Heterogeneity was described by I2 and prediction intervals. Results The potential benefit of reconstructive techniques over control procedures was evaluated in three studies, representing a total of 116 implants. Altogether, 16 studies reported on the outcome of reconstructive measures at 12 months after surgery. The meta‐analyses identified a larger improvement in marginal bone levels (MBL, WMD = 1.7 mm) and in defect fill (WMD = 57%) for test procedures, but found no differences for clinical measures (reduction of probing depth (PD) and bleeding on probing (BOP). Changes of clinical attachment and soft tissue levels were not considered. In terms of overall outcome, therapy resulted in improved MBL (WMD = 2.0 mm) and CAL (WMD = 1.8 mm), in recession (WMD = 0.7 mm), in reduced PD (WMD = 2.8 mm) and in reduced BOP (Implants: RR = 0.4/Sites: RR = 0.2). None of the included studies addressed patient‐reported outcome measures. Conclusions The available evidence on reconstructive therapy at peri‐implantitis‐related defects is limited by (a) the low number of controlled studies, (b) the lack of controlled studies for commonly used procedures, (c) the heterogeneity between studies and (d) the choice of outcome measures. A high variability for predicted outcomes at 12 months was noted. The interpretation of the demonstrated larger MBL gain for test procedures is difficult as graft material may not be distinguishable from newly formed bone. Potential aesthetic and patient‐reported advantages remain to be demonstrated.

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“…Thick gingival tissues show greater resistance to recession due to surgical trauma and tissue remodelling following different surgical procedures, including regenerative surgery. It may also be speculated that the conversion from a thin to a thick phenotype may have a beneficial effect on the long-term stability of the gingival profile, since thick biotypes were shown to be less prone to developing gingival recessions [48,49].…”

Section: Free Connective Tissue Grafts In Periodontal Regenerativementioning

confidence: 99%

Combination Therapy for Reconstructive Periodontal Treatment in the Lower Anterior Area: Clinical Evaluation of a Case Series

Nemcovsky

Beitlitum

2018

Dentistry Journal

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Clinically, periodontal regeneration may be achieved by the application of barrier membranes, grafts, wound-healing modifiers, and their combinations. Combination therapy refers to the simultaneous application of various periodontal reconstructive treatment alternatives to obtain additive effects. This approach may lead to assemblage of different regenerative principles, such as conductivity and inductivity, space provision and wound stability, matrix development and cell differentiation. The application of autogenous connective tissue grafts during periodontal regenerative treatment with enamel matrix proteins derivative (EMD) has been previously reported. The present case series present a modified approach for treatment of severe periodontally involved lower incisors presenting with thin gingival biotype, gingival recession, minimal attached and keratinized gingiva width and muscle and/or frenum pull. In all cases a combination therapy consisting of a single buccal access flap, root conditioning, EMD application on the denuded root surfaces and a free connective tissue graft was performed. Clinical and radiographic outcomes were consistently satisfactory, leading to probing depth reduction, clinical attachment gain, minimal gingival recession, increased attached and keratinizing gingival width, elimination of frenum and/or muscle pull together with radiographic bone fill of the defects. It may be concluded that the present combination therapy for reconstructive periodontal treatment in the lower anterior area is a valuable alternative for indicated cases.

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Effect of a Connective Tissue Graft in Combination With a Single Flap Approach in the Regenerative Treatment of Intraosseous Defects

Abstract: Adjunctive use of a CTG in the regenerative treatment of intraosseous defects associated with buccal bone dehiscence accessed by buccal SFA may support the stability of the gingival profile.

Cited by 23 publications

References 32 publications

Periodontal reconstructive surgery of deep intraosseous defects using an apical approach. Non‐incised papillae surgical approach (NIPSA): A retrospective cohort study

Periodontal reconstructive surgery of deep intraosseous defects using an apical approach. Non‐incised papillae surgical approach (NIPSA): A retrospective cohort study

Efficacy of reconstructive surgical therapy at peri‐implantitis‐related bone defects. A systematic review and meta‐analysis

Combination Therapy for Reconstructive Periodontal Treatment in the Lower Anterior Area: Clinical Evaluation of a Case Series

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