Minimally-Invasive Non-Surgical vs. Surgical Approach for Periodontal Intrabony Defects: A Randomised Controlled Trial

Abstract

Background: Periodontal intrabony defects are usually treated surgically with the aim to increase attachment and bone levels and reduce risk of progression. However, recent studies have suggested that a minimally-invasive non-surgical therapy (MINST) leads to considerable clinical and radiographic defect depth reductions in intrabony defects. The aim of this study is to compare the efficacy of a modified MINST approach with a surgical approach (modified minimally-invasive surgical therapy, M-MIST) for the treatment of intrabony defects. Methods: This is a parallel-group single-centre examiner-blind non-inferiority randomised controlled trial with a sample size of 66 patients. Inclusion criteria are age 25-70, diagnosis of periodontitis stage III or IV (grades A to C), presence of ≥1 ‘intrabony defect’ with probing pocket depth (PPD) >5 mm and intrabony defect depth ≥3mm. Smokers and patients who received previous periodontal treatment to the study site within the last 12 months will be excluded. Patients will be randomly assigned to either the modified MINST or the M-MIST protocol and will be assessed up to 15 months following initial therapy. The primary outcome of the study is radiographic intrabony defect depth change at 15 months follow-up. Secondary outcomes are PPD and clinical attachment loss (CAL) change, inflammatory markers and growth factors in gingival crevicular fluid, bacterial detection, gingival inflammation and healing (as measured by geometric/thermal camera imaging in a subset of 10 test and 10 control patients) and patient-reported outcomes. Discussion: This study will produce evidence about the clinical efficacy and potential applicability of a modified MINST protocol for the treatment of periodontal intrabony defects, as a less invasive alternative to the use of surgical procedures. Trial registration: This study was registered on clinicaltrials.gov NCT03797807 (date registered: 9 January 2019). Keywords: Periodontitis, intrabony defect, minimally-invasive, quality of life, bone

Observation on the Effect of Bone Grafting Alone and Guided Tissue Regeneration Combined with Bone Grafting to Repair Periodontal Intraosseous Defects

“…Clinically, periodontal intraosseous defects are often treated by surgery. Among them, bone grafting is a method for treating inflammation and destruction of the periodontal soft tissue and periodontal bone, and its curative effect is exact [14]. With the development of stomatology and the research and development of new materials, how to promote the regeneration of periodontal tissue, restore the function of periodontal tissue, give attention to gingival aesthetics, and eliminate the symptoms of infection and destruction on the basis of simple bone grafting has become a new direction for the clinical treatment of the periodontal intraosseous defect [15,16].…”

Molecular profiling of intrabony defects' gingival crevicular fluid

“…Twenty‐one systemically healthy, non‐smoker patients with periodontitis stage III or IV, grades A to C, 9 were included in this case‐control study. The patients included represent a cohort of consecutive patients participating in a longitudinal randomized clinical trial, 10 approved by the Research Ethics Committee, London, UK (clinicaltrials.gov reference NCT03797807, ethics approval REC 18/LO/1956). Written informed consent was granted from all subjects.…”

Comparison of periodontal status and salivary IL-15 and -18 levels in cigarette-smokers and individuals using electronic nicotine delivery systems

“…Furthermore, treatment outcomes following periodontal therapy were not assessed as this was beyond the objectives of the current investigation. Surgical and/or non-surgical mechanical debridement are usually performed for the treatment of periodontitis [36,37]. It is well-established that tobacco-smoking is a factor that retards periodontal wound healing following therapeutic interventions as it delays connective tissue organization and epithelial migration [36,38].…”