The granulation tissue preservation technique in regenerative periodontal surgery—a randomized controlled clinical trial

Abstract

Objectives: To investigate if the application of the granulation tissue preservation technique (GTPT) in regenerative therapy of infrabony periodontal defects results in more clinical attachment level (CAL) gain and more radiographic bone gain (RBG) than the conventional resective approach 12 months after surgery.Materials and methods: Forty patients exhibiting at least one infrabony defect with a probing pocket depth (PPD) ≥6 mm and a radiographic infrabony component (INFRA X-ray ) ≥3 mm were randomly treated with the GTPT (test group) or the double-flap approach with resection of the defect-filling granulation tissue (control group). Enamel matrix derivatives were applied in both groups. Clinical and radiographic parameters were recorded at baseline (t0), 6 months (t1), and 12 months (t2) after surgery. The primary outcome variable was CAL gain between t0 and t2.Results: When all patients were considered, ΔCAL t0-t2 did not differ significantly between the two groups (p = .160). Significant PPD reduction (test group: 4.38 ± 1.36 mm; control group: 4.06 ± 2.38 mm), CAL gain (test group: 3.75 ± 1.24 mm; control group: 2.88 ± 2.09 mm), and RBG (test group: 3.06 ± 1.74 mm; control group: 3.27 ± 2.19 mm) were achieved at t2 in both groups. Using multivariate linear regression, PPD t0 and group were identified as variables with the greatest influence on ΔCAL t0-t2 . PPD t0 and INFRA X-ray were identified as variables with the greatest influence on RBG t0-t2 . Patients with a defect angle >22°showed significantly more CAL gain in the test group (t0-t1: 3.08 ± 1.38 mm; t0-t2: 3.62 ± 0.96 mm) than in the control group (t0-t1: 1.77 ± 1.54 mm; t0-t2: 2.18 ± 1.83 mm).Conclusions: Regarding all patients, the study failed to show significant differences between the test and control groups. However, the GTPT appears to lead to more CAL gain in noncontaining infrabony defects.

Prognostic value of a composite outcome measure for periodontal stability following periodontal regenerative treatment: A retrospective analysis at 4 years

“…18 According to COM, treatment outcomes are classified into four different scenarios, including "successful treatment" when a clinically relevant result (i.e., a CAL gain ≥3 mm) is associated with the absence of a residual pocket (i.e., PD ≤4 mm) (COM1), "treatment failure" when limited CAL gain (<3 mm) is associated with a residual pocket (i.e., PD >4 mm) (COM4), and intermediate conditions characterized by limited CAL gain in association with pocket closure (COM2) or relevant CAL gain in association with a residual pocket (COM3). Since its description in 2020, COM has been used by other authors to describe the effect of periodontal regenerative treatments at both short-term [33][34][35][36] and long-term observation intervals. 14 In the present study, the association between COM and the 4-year clinical outcomes of periodontal regenerative treatment (as assessed in terms of periodontal stability, need for surgical retreatment due to disease recurrence, and tooth survival) was evaluated.…”

Periodontal granulation tissue – To remove or not to remove, that is the question

“…Advancement in knowledge of stem cell properties together with molecular characterization of periodontal granulation tissue using modern analytical techniques has encouraged recent clinical investigation of treatment modalities which attempt to optimize the preservation of granulation tissue during advanced periodontal therapy, and the approach has also been investigated in the management of periimplantitis. [53][54][55][56] An overview of the studies is presented in Table 2.…”

“…[50][51][52] Nevertheless, despite the common practice of removing granulation tissue during periodontal surgical procedures, development of novel techniques and protocols which utilize its preservation, and its effect on treatment outcomes in the surgical management of periodontitis and peri-implantitis have also been reported. [53][54][55][56]…”

“…Concerning regenerative therapy of infrabony defects, Adam et al 53 . postulate that granulation tissue is capable of providing soft tissue support, which can be achieved through mobilizing the entire tissue from the defect during mucoperiosteal flap preparation.…”

“…The non‐removal of granulation tissue especially above interproximal bone peaks for the purpose of soft tissue stabilization is similar to preserving the attachment of supracrestal periodontal fibres during MINST which allows for the deposition of new cementum and bone in the defect more apically 18 . Furthermore, meticulous decontamination of microbial‐infected root surfaces is another common aspect underpinning both MINST and the surgical granulation tissue preservation techniques especially with the use of fine microinstruments 18,53,55 . As the maturation of granulation tissue leads to either periodontal repair or regeneration, the scrupulous removal of microbial insult in conjunction with blood clot stability is necessary to avoid delayed or interrupted healing which allows the formation of new tissue during the granulation phase 17 …”