Minimal invasiveness in the surgical treatment of intraosseous defects: A systematic review

Abstract

The modern approach to regenerative treatment of periodontal intraosseous defects should aim at maximizing the clinical outcomes while minimizing the invasiveness (pain, complications, aesthetic impairment, chair time, and costs) of the procedure. The present systematic review evaluated the effect of flap design, regenerative technology, and perioperative and postoperative adjunctive protocols on invasiveness. Overall, the results of the 13 included trials indicate that: (a) the elevation of a single (buccal or lingual) flap positively influences the intensity of postoperative pain and improves the quality of early wound healing compared with double flaps; (b) while the adjunctive use of a membrane is associated with significantly longer surgery‐related chair time and higher postoperative pain, the adjunctive use of enamel matrix derivative at sites receiving a graft significantly reduces postoperative pain; also, graft materials showed no significant impact on invasiveness; (c) open flap debridement performed through the elevation of a single flap may lead to substantial clinical improvements of the lesion with reduced surgery‐related chair time and costs, thus representing a promising alternative to regenerative treatment. However, for such an approach, a histological evaluation of the nature of the reconstructed tissues is still lacking, and the presurgery conditions (eg, probing depth, defect severity, and defect morphology), which may benefit in terms of invasiveness, have not yet been defined; and (d) intraoperative and postoperative low‐level laser biostimulation of the defect site may favorably modulate the postoperative course.

Complications and treatment errors related to regenerative periodontal surgery

“…In a very recent systematic review, Simonelli et al 48 have evaluated the effect of flap design, regenerative technology, and preoperative and postoperative adjunctive protocols on the clinical outcomes and invasiveness. The results, based on the analysis of 13 included trials, indicated that a minimally invasive approach such as the elevation of a single (buccal or lingual) flap positively influenced the intensity of postoperative pain and improved the quality of early wound healing compared with double flaps.…”

“…In a very recent systematic review, Simonelli et al 48 Taken together, the available evidence indicates that due to the significant impact of the specific flap design on the outcomes of regenerative surgery, the use of conventional access flap surgery with its potential complications may be viewed as treatment error.…”

Effectiveness of concentrated growth factor and laser therapy on wound healing, inferior alveolar nerve injury and periodontal bone defects post‐mandibular impacted wisdom tooth extraction: A randomized clinical trial

“…Deep periodontal pockets and bone defects formed in the distal side of the second molar after the operation were currently treated by the placement of autogenous or xenogeneic bone grafts, 6 artificial bone material, guided tissue regeneration 7,8 or tissue engineering 9 . All of these methods have shown significant curative effects; however, their drawbacks of being expensive or technically sensitive limited their uses 10 .…”

Can vitamins improve periodontal wound healing/regeneration?

“…16 Surgical as well as nonsurgical periodontal treatment approaches, employing a multitude of biomaterials, and biological mediators, were proposed to re-establish the destroyed periodontal tissues and prevent further disease progression, thereby enhancing teeth prognosis and quality of life. [17][18][19][20][21][22] Initiation of periodontitis requires a challenging of the periodontal tissues via the dysbiotic subgingival oral microbial biofilm's virulence factors, spurring an immune response, which principally dictates the course of the disease and associated tissue destruction. 23,24 In the primary phase, polymorphonuclear lymphocytes (PMNs) liberate lysozymes, proteinases, and reactive oxygen species (ROS), [25][26][27][28][29] in an attempt to eradicate the subgingival tissue-invading periodontal pathogens of the subgingival dysbiotic plaque.…”

“…A multitude of investigations associated periodontitis with major systemic conditions, including unfavorable pregnancy outcomes, 11 cardiovascular disorders, 12 diabetes mellitus, 13,14 gestational diabetes 15 and rheumatoid arthritis 16 . Surgical as well as nonsurgical periodontal treatment approaches, employing a multitude of biomaterials, and biological mediators, were proposed to re‐establish the destroyed periodontal tissues and prevent further disease progression, thereby enhancing teeth prognosis and quality of life 17–22 …”