Modified Widman flap and non-surgical therapy using chlorhexidine chip in the treatment of moderate to deep periodontal pockets: A comparative study

Abstract

Introduction:It is a well established fact that periodontitis is caused by a group of highly specific microorganisms, organized as a bio-film on the tooth surface. Hence, therapeutic modalities are directed against elimination or adequate suppression of these organisms. Thorough debridement of these sites is possible mainly by scaling and root planing (SRP) and open- flap debridement in deeper sites. Open- flap debridement includes conventional surgical procedures such as the modified Widman flap procedure. Surgical procedures, however, have a number of disadvantages and hence efforts have been on at improving various non-surgical approaches, which are directed more specifically at the microbial nature of periodontal disease. Use of local drug-delivery devices is one such approach. The combined therapy of SRP and local drug delivery has been showing promising results in improving all the parameters in periodontal disease.Materials and Methods:This study compares the clinical, as well as, microbiological results of a split-mouth trial using modified Widman flap and non-surgical therapy of SRP and the use of a controlled release drug-delivery device (Chlorhexidine chip), in the management of moderate to deep pockets.Results and Conclusion:The results showed that the non-surgical most sites subjected to the non-surgical treatment were found to be maintainable without further deterioration, during the study period.

Influence of periodontal surgery on the subgingival microbiome—A systematic review and meta‐analysis

“…Follow‐up time points varied and ranged from 6 weeks to 12 months after surgical procedure. Microbiological follow‐up time points were reported as follows: 3 months in 75% (21 out of 28), 25,28,30,32,34,36–51 6 months in 57% (16 out of 28), 8,25,27,30,32–34,36,38,39,42,44–46,50,51 12 months in 29% (8 out of 28), 8,25,27,31,33,34,42,50 9 months in 11% (3 out of 28), 25,30,34 1.5 months 26 and 2 months 52 in 7% (2 out of 28) and 4 months 52 and 10 months 35 in 4% (1 out of 28) 35 of the studies.…”

“…Studies provided detailed description of the sampling method including removal of supragingival plaque prior subgingival plaque sample collection, type of curette used and sampling site. In the majority of the studies, subgingival plaque samples were collected with a sterile periodontal curette (57%) 8,25,26,28,30,33,34,36,37,44–48,52,54 . The second most common sampling method used was sterile paper points (35%) 27,31,32,40–43,49–51 .…”

“…The length of time varied from 10 s 27,49,50 to 30 s 32,42 . Whilst some studies collected samples only from one site of the mouth, for example the deepest site or the surgical site, 28,30,45,46 other studies collected samples on various or even all teeth present 25,35,37 . Table 2 summarises the methods used for collection of subgingival plaque samples.…”

“…The reporting of the microbiological outcomes was heterogeneous amongst studies and the presence of periodontal disease‐associated species was dependant on the microbiological detection technique used. The three studies 8,30,46 using dark field microscopy described the bacteria based on their morphological category. The eight studies 26,27,31,41,43,48,51,52 reporting microbiological data from culture techniques used morphological categories but also cultivated specific pathogens to assess the effect of periodontal surgery on the subgingival bacteria.…”

Pulsed short waves in the remineralization of alveolar bone structures of the jaw in patients with diabetes mellitus – a series of cases

“…Surgical and periodontal treatments Given the long duration of chronic marginal periodontitis, initiation of periodontal therapy immediately after endodontic therapy was chosen (3); antibiotic therapy with clindamycin 600 mg 3x1/day for five days was also administered. Periodontal therapy consisted of irrigation of periodontal pockets with antiseptic chlorhexidine gluconate solution (10). An open periodontal approach was used, which consisted of scaling and root planing using both ultrasound loops and manual Gracey curettes; with the same curettes, the inner epithelium of periodontal pockets was also curetted (11).…”