Periodontal granulation tissue preservation in surgical periodontal disease treatment: a pilot prospective cohort study
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Purpose: The aim of this study was to evaluate the clinical outcomes of periodontal granulation tissue preservation (PGTP) in access flap periodontal surgery. Methods: Twenty patients (stage III–IV periodontitis) with 42 deep periodontal pockets that did not resolve after non-surgical treatment were consecutively recruited. Access flap periodontal surgery was modified using PGTP. The clinical periodontal parameters were evaluated at 9 months. The differences in the amount of granulation tissue width (GTw) preserved were evaluated and the influence of smoking was analyzed. Results: GTw >1 mm was observed in 97.6% of interproximal defects, and the granulation tissue extended above the bone peak in 71.4% of defects. At 9 months, probing pocket depth reduction (4.33±1.43 mm) and clinical attachment gain (CAG; 4.10±1.75 mm) were statistically significant (P<0.001). The residual probing depth was 3.2±0.89 mm. When GTw extended above the interproximal bone peak (i.e., the interproximal supra-alveolar granulation tissue thickness [iSUPRA-GT] was greater than 0 mm), a significant CAG was recorded in the supra-alveolar component (1.67±1.32 mm, P<0.001). Interproximal gingival recession (iGR) was significant (P<0.05) only in smokers, with a reduction in the interdental papillary tissue height of 0.93±0.76 mm. In non-smokers, there was no increase in the iGR when the iSUPRA-GT was >0 mm. The clinical results in smokers were significantly worse. Conclusions: PGTP was used to modify access flap periodontal surgery by preserving affected tissues with the potential for recovery. The results show that preserving periodontal granulation tissue is an effective and conservative procedure in the surgical treatment of periodontal disease.
Abstract
Purpose: The aim of this study was to evaluate the clinical outcomes of periodontal granulation tissue preservation (PGTP) in access flap periodontal surgery. Methods: Twenty patients (stage III–IV periodontitis) with 42 deep periodontal pockets that did not resolve after non-surgical treatment were consecutively recruited. Access flap periodontal surgery was modified using PGTP. The clinical periodontal parameters were evaluated at 9 months. The differences in the amount of granulation tissue width (GTw) preserved were evaluated and the influence of smoking was analyzed. Results: GTw >1 mm was observed in 97.6% of interproximal defects, and the granulation tissue extended above the bone peak in 71.4% of defects. At 9 months, probing pocket depth reduction (4.33±1.43 mm) and clinical attachment gain (CAG; 4.10±1.75 mm) were statistically significant (P<0.001). The residual probing depth was 3.2±0.89 mm. When GTw extended above the interproximal bone peak (i.e., the interproximal supra-alveolar granulation tissue thickness [iSUPRA-GT] was greater than 0 mm), a significant CAG was recorded in the supra-alveolar component (1.67±1.32 mm, P<0.001). Interproximal gingival recession (iGR) was significant (P<0.05) only in smokers, with a reduction in the interdental papillary tissue height of 0.93±0.76 mm. In non-smokers, there was no increase in the iGR when the iSUPRA-GT was >0 mm. The clinical results in smokers were significantly worse. Conclusions: PGTP was used to modify access flap periodontal surgery by preserving affected tissues with the potential for recovery. The results show that preserving periodontal granulation tissue is an effective and conservative procedure in the surgical treatment of periodontal disease.
참고문헌 (42)
- Henderson B, "Bacterial modulators of bone remodeling in the periodontal pocket", Periodontol 2000, 76, pp.97~108 (2018)
- Bosshardt DD, "The periodontal pocket: pathogenesis, histopathology and consequences", Periodontol 2000, 76, pp.43~50 (2018)
- Sculean A, "Soft tissue wound healing around teeth and dental implants", J Clin Periodontol, 41(Suppl 15), pp.S6~S22 (2014)
- Tonetti MS, "Staging and grading of periodontitis: Framework and proposal of a new classification and case definition", J Periodontol, 89(Suppl 1), pp.S159~S172 (2018)
- Caffesse RG, "Treatment trends in periodontics", Periodontol 2000, 79, pp.7~14 (2019)
- Sanz M, "Treatment of stage I-III periodontitis-The EFP S3 level clinical practice guideline", J Clin Periodontol, 47(Suppl 22), pp.4~60 (2020)
- Ramfjord SP, "The modified widman flap", J Periodontol, 45, pp.601~607 (1974)
- Jenkins WM, "Formation of interdental soft tissue defects after surgical treatment of periodontitis", J Periodontol, 61, pp.564~570 (1990)
- Miron RJ, "Twenty years of enamel matrix derivative: the past, the present and the future", J Clin Periodontol, 43, pp.668~683 (2016)
- Cairo F, "Fiber retention and papilla preservation technique in the treatment of infrabony defects : a microsurgical approach", Int J Periodontics Restorative Dent, 28, pp.257~263 (2008)
- Takei HH, "Flap technique for periodontal bone implants. Papilla preservation technique", J Periodontol, 56, pp.204~210 (1985)
- Cortellini P, "The modified papilla preservation technique. A new surgical approach for interproximal regenerative procedures", J Periodontol, 66, pp.261~266 (1995)
- Cortellini P, "A novel surgical approach for the management of soft tissues in regenerative procedures", Int J Periodontics Restorative Dent, 19, pp.589~599 (1999)
- Knowles JW, "Results of periodontal treatment related to pocket depth and attachment level. Eight years", J Periodontol, 50, pp.225~233 (1979)
- Kaldahl WB, "Long-term evaluation of periodontal therapy: I. Response to 4 therapeutic modalities", J Periodontol, 67, pp.93~102 (1996)
- Park JC, "Isolation and characterization of human periodontal ligament (PDL) stem cells (PDLSCs) from the inflamed PDL tissue: in vitro and in vivo evaluations", J Clin Periodontol, 38, pp.721~731 (2011)
- Gousopoulou E, "Evaluation of stemness properties of cells derived from granulation tissue of peri-implantitis lesions", Clin Exp Dent Res, 7, pp.739~753 (2021)
- Ronay V, "Infected periodontal granulation tissue contains cells expressing embryonic stem cell markers. A pilot study", Schweiz Monatsschr Zahnmed, 123, pp.12~16 (2013)
- Lin NH, "Putative stem cells in regenerating human periodontium", J Periodontal Res, 43, pp.514~523 (2008)
- Lange DE, "Clinical methods for the objective evaluation of oral hygiene", Dtsch Zahnarztl Z, 32, pp.44~47 (1977)
- Kirkland O, "Modified flap operation in surgical treatment of periodontoclasia", J Am Dent Assoc, 19, pp.1918~1921 (1932)
- Wachtel H, "Microsurgical access flap and enamel matrix derivative for the treatment of periodontal intrabony defects : a controlled clinical study", J Clin Periodontol, 30, pp.496~504 (2003)
- Moreno Rodríguez JA, "Supra-alveolar attachment gain in the treatment of combined intra-suprabony periodontal defects by non-incised papillae surgical approach", J Clin Periodontol, 46, pp.927~936 (2019)
- Nibali L, "Regenerative surgery versus access flap for the treatment of intra-bony periodontal defects : a systematic review and meta-analysis", J Clin Periodontol, 47(Suppl 22), pp.320~351 (2020)
- Retzepi M, "Comparison of gingival blood flow during healing of simplified papilla preservation and modified Widman flap surgery : a clinical trial using laser Doppler flowmetry", J Clin Periodontol, 34, pp.903~911 (2007)
- Retzepi M, "Gingival blood flow changes following periodontal access flap surgery using laser Doppler flowmetry", J Clin Periodontol, 34, pp.437~443 (2007)
- Haney JM, "Periodontal repair in dogs : expanded polytetrafluoroethylene barrier membranes support wound stabilization and enhance bone regeneration", J Periodontol, 64, pp.883~890 (1993)
- De Sanctis M, "Bacterial colonization of barrier material and periodontal regeneration", J Clin Periodontol, 23, pp.1039~1046 (1996)
- Simonelli A, "Single flap approach with or without enamel matrix derivative in the treatment of severe supraosseous defects : a retrospective study", Clin Oral Investig, 25, pp.6385~6392 (2021)
- Di Tullio M, "Treatment of supra-alveolar-type defects by a simplified papilla preservation technique for access flap surgery with or without enamel matrix proteins", J Periodontol, 84, pp.1100~1110 (2013)
- Okuda K, "Enamel matrix derivative in the treatment of human intrabony osseous defects", J Periodontol, 71, pp.1821~1828 (2000)
- Jentsch H, "A clinical study evaluating the treatment of supra-alveolar-type defects with access flap surgery with and without an enamel matrix protein derivative : a pilot study", J Clin Periodontol, 35, pp.713~718 (2008)
- Kasaj A, "Clinical evaluation of anorganic bovine-derived hydroxyapatite matrix", cell-binding peptide (P-15) in the treatment of human infrabony defects, 2008, pp.12, 241~247
- Sculean A, "Ten-year results following treatment of intra-bony defects with enamel matrix proteins and guided tissue regeneration", J Clin Periodontol, 35, pp.817~824 (2008)
- Slotte C, "A randomized study of open-flap surgery of 32 intrabony defects with and without adjunct bovine bone mineral treatment", J Periodontol, 83, pp.999~1007 (2012)
- Cortellini P, "Periodontal regeneration compared with access flap surgery in human intra-bony defects 20-year follow-up of a randomized clinical trial: tooth retention, periodontitis recurrence and costs", J Clin Periodontol, 44, pp.58~66 (2017)
- Rasperini G, "Interproximal attachment gain : the challenge of periodontal regeneration", J Periodontol, 92, pp.931~946 (2021)
- Moreno-Rodríguez JA, "Papilla preservation periodontal surgery in periodontal reconstruction for deep combined intra-suprabony defects. Retrospective analysis of a registry-based cohort", J Clin Exp Dent, 13, pp.e769~e775 (2021)
- Apatzidou DA, "Stem cell-like populations and immunoregulatory molecules in periodontal granulation tissue", J Periodontal Res, 53, pp.610~621 (2018)
- Hoang T, "Povidone-iodine as a periodontal pocket disinfectant", J Periodontal Res, 38, pp.311~317 (2003)
- Liao H, "The effect of the surgical microscope on the outcome of root scaling", Am J Transl Res, 12, pp.7199~7210 (2020)
- Chang J, "The impact of smoking on non-surgical periodontal therapy : a systematic review and meta-analysis", J Clin Periodontol, 48, pp.60~75 (2021)