Journal of Periodontal and Implant Science

Korean Academy of Periodontology (대한치주과학회)
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Single-flap versus double-flap approach for periodontal pocket reduction in supraosseous defects: a comparative study

  • Received : 2020.07.01
  • Accepted : 2021.03.05
  • Published : 2021.08.30
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Abstract

Purpose: The single-flap approach (SFA) is a minimally invasive technique with limited mucoperiosteal flap elevation to gain access to the buccal/palatal aspects, thus limiting post-surgical complications. The purpose of the present study was to gain insights into the impact of the SFA over the double-flap approach (DFA) on periodontal flap treatment outcomes and patient compliance in terms of discomfort and time taken for surgical procedures. Methods: Twenty patients with persistent probing pocket depths of ≥5 mm were scheduled for the SFA (test site) and for the DFA (control site). All the clinical periodontal parameters were recorded at baseline, 3 months, and 6 months. Radiographic bone level (cone-beam computed tomography) was evaluated at baseline and 6 months. Patients' postoperative pain perception and wound healing were also assessed. Results: The SFA showed a significant reduction in periodontal pocket depth, gain in clinical attachment level (CAL), and gain in bone level when compared with the DFA. The SFA substantially improved wound healing and induced less postoperative pain than the DFA. Conclusions: The SFA resulted in substantial improvement in the composite outcome measures, as shown by a reduction in pocket depth with minimal gingival recession, gain in CAL, early wound healing, less postoperative discomfort, and better patient-centered outcomes.

Keywords

Acknowledgement

The authors would like to acknowledge the statistician and fellow colleagues who helped during the research.

References

  1. Stadler AF, Mendez M, Oppermann RV, Gomes SC. Tooth loss in patients under periodontal maintenance in a private practice: a retrospective study. Braz Dent J 2017;28:440-6. https://doi.org/10.1590/0103-6440201701476
  2. McLeod DE, Lainson PA, Spivey JD. The effectiveness of periodontal treatment as measured by tooth loss. J Am Dent Assoc 1997;128:316-24. https://doi.org/10.14219/jada.archive.1997.0195
  3. Caton JG, Zander HA. The attachment between tooth and gingival tissues after periodic root planing and soft tissue curettage. J Periodontol 1979;50:462-6. https://doi.org/10.1902/jop.1979.50.9.462
  4. Caton J, Nyman S, Zander H. Histometric evaluation of periodontal surgery. II. Connective tissue attachment levels after four regenerative procedures. J Clin Periodontol 1980;7:224-31. https://doi.org/10.1111/j.1600-051X.1980.tb01965.x
  5. Barrington EP. An overview of periodontal surgical procedures. J Periodontol 1981;52:518-28. https://doi.org/10.1902/jop.1981.52.9.518
  6. Suchetha A, Tanwar E, Darshan BM, Apoorva SM, Bhat D. Post-operative complications after periodontal surgery. Int J Appl Dent Sci 2018;4:152-6.
  7. Steffer MR, Harrel SK, Rossmann JA, Kerns DG, Rivera-Hidalgo F, Abraham CM, et al. Comparison of minimally invasive and conventional flap surgery for treatment of intrabony periodontal defects: a pilot case-controlled study. J Contemp Dent 2013;3:61-7. https://doi.org/10.5005/jp-journals-10031-1038
  8. Trombelli L, Simonelli A, Schincaglia GP, Cucchi A, Farina R. Single-flap approach for surgical debridement of deep intraosseous defects: a randomized controlled trial. J Periodontol 2012;83:27-35. https://doi.org/10.1902/jop.2011.110045
  9. Checchi L, Montevecchi M, Checchi V, Laino G. A coronally positioned single flap approach in periodontal reconstructive surgery. Dent Cadmos 2008;76:45-58.
  10. Cortellini P, Tonetti MS. Improved wound stability with a modified minimally invasive surgical technique in the regenerative treatment of isolated interdental intrabony defects. J Clin Periodontol 2009;36:157-63. https://doi.org/10.1111/j.1600-051X.2008.01352.x
  11. Azuma H, Kono T, Morita H, Tsumori N, Miki H, Shiomi K, et al. Single flap periodontal surgery induces early fibrous tissue generation by wound stabilization. J Hard Tissue Biol 2017;26:119-26. https://doi.org/10.2485/jhtb.26.119
  12. Trombelli L, Simonelli A, Minenna L, Vecchiatini R, Farina R. Simplified procedures to treat periodontal intraosseous defects in esthetic areas. Periodontol 2000 2018;77:93-110. https://doi.org/10.1111/prd.12213
  13. Schincaglia GP, Hebert E, Farina R, Simonelli A, Trombelli L. Single versus double flap approach in periodontal regenerative treatment. J Clin Periodontol 2015;42:557-66. https://doi.org/10.1111/jcpe.12409
  14. Di Tullio M, Femminella B, Pilloni A, Romano L, D'Arcangelo C, De Ninis P, et al. Treatment of supraalveolar-type defects by a simplified papilla preservation technique for access flap surgery with or without enamel matrix proteins. J Periodontol 2013;84:1100-10. https://doi.org/10.1902/jop.2012.120075
  15. Trombelli L, Farina R, Franceschetti G, Calura G. Single-flap approach with buccal access in periodontal reconstructive procedures. J Periodontol 2009;80:353-60. https://doi.org/10.1902/jop.2009.080420
  16. Farina R, Simonelli A, Rizzi A, Pramstraller M, Cucchi A, Trombelli L. Early postoperative healing following buccal single flap approach to access intraosseous periodontal defects. Clin Oral Investig 2013;17:1573-83. https://doi.org/10.1007/s00784-012-0838-6
  17. Perumal MP, Ramegowda AD, Lingaraju AJ, Raja JJ. Comparison of microsurgical and conventional open flap debridement: a randomized controlled trial. J Indian Soc Periodontol 2015;19:406-10. https://doi.org/10.4103/0972-124X.156884
  18. Trombelli L, Farina R, Vecchiatini R, Maietti E, Simonelli A. A simplified composite outcome measure to assess the effect of periodontal regenerative treatment in intraosseous defects. J Periodontol 2020;91:723-31. https://doi.org/10.1002/JPER.19-0127
  19. Wachtel H, Schenk G, Bohm S, Weng D, Zuhr O, Hurzeler MB. Microsurgical access flap and enamel matrix derivative for the treatment of periodontal intrabony defects: a controlled clinical study. J Clin Periodontol 2003;30:496-504. https://doi.org/10.1034/j.1600-051X.2003.00013.x
  20. Graziani F, Gennai S, Cei S, Ducci F, Discepoli N, Carmignani A, et al. Does enamel matrix derivative application provide additional clinical benefits in residual periodontal pockets associated with suprabony defects? A systematic review and meta-analysis of randomized clinical trials. J Clin Periodontol 2014;41:377-86. https://doi.org/10.1111/jcpe.12218
  21. Gupta M, Lamba AK, Verma M, Faraz F, Tandon S, Chawla K, et al. Comparison of periodontal open flap debridement versus closed debridement with Er,Cr:YSGG laser. Aust Dent J 2013;58:41-9. https://doi.org/10.1111/adj.12021
  22. Cortellini P, Nieri M, Prato GP, Tonetti MS. Single minimally invasive surgical technique with an enamel matrix derivative to treat multiple adjacent intra-bony defects: clinical outcomes and patient morbidity. J Clin Periodontol 2008;35:605-13. https://doi.org/10.1111/j.1600-051X.2008.01242.x
  23. Harrel SK. A minimally invasive surgical approach for periodontal bone grafting. Int J Periodontics Restorative Dent 1998;18:161-9.
  24. Kotsilkov K. Minimally invasive single flap approach with connective tissue wall for periodontal regeneration. J IMAB 2017;23:1673-80. https://doi.org/10.5272/jimab.2017233.1673
  25. Trombelli L, Simonelli A, Minenna L, Rasperini G, Farina R. Effect of a connective tissue graft in combination with a single flap approach in the regenerative treatment of intraosseous defects. J Periodontol 2017;88:348-56. https://doi.org/10.1902/jop.2016.160471
  26. Pippi R. Post-surgical clinical monitoring of soft tissue wound healing in periodontal and implant surgery. Int J Med Sci 2017;14:721-8. https://doi.org/10.7150/ijms.19727
  27. Prabhu P, Julius A, Elumalai M, Prabhu MN. Wound healing in periodontics. Biosci Biotechnol Res Asia 2014;11:791-6. https://doi.org/10.13005/bbra/1339
  28. Trombelli L, Farina R, Franceschetti G, Minenna L. Management of the soft tissues according to the principles of the single flap approach in the treatment of periodontal intraosseous defects. Dent Clin 2008;3:5-11.
  29. Farina R, Simonelli A, Minenna L, Rasperini G, Trombelli L. Single-flap approach in combination with enamel matrix derivative in the treatment of periodontal intraosseous defects. Int J Periodontics Restorative Dent 2014;34:497-506. https://doi.org/10.11607/prd.2050
  30. Jayakumar A, Rohini S, Naveen A, Haritha A, Reddy K. Horizontal alveolar bone loss: a periodontal orphan. J Indian Soc Periodontol 2010;14:181-5. https://doi.org/10.4103/0972-124X.75914
  31. Persson RE, Hollender LG, Laurell L, Persson GR. Horizontal alveolar bone loss and vertical bone defects in an adult patient population. J Periodontol 1998;69:348-56. https://doi.org/10.1902/jop.1998.69.3.348
  32. Papapanou PN, Wennstrom JL, Grondahl K. Periodontal status in relation to age and tooth type. A crosssectional radiographic study. J Clin Periodontol 1988;15:469-78. https://doi.org/10.1111/j.1600-051X.1988.tb01602.x
  33. Nielsen IM, Glavind L, Karring T. Interproximal periodontal intrabony defects. Prevalence, localization and etiological factors. J Clin Periodontol 1980;7:187-98. https://doi.org/10.1111/j.1600-051X.1980.tb01962.x
  34. Cortellini P, Tonetti MS, Lang NP, Suvan JE, Zucchelli G, Vangsted T, et al. The simplified papilla preservation flap in the regenerative treatment of deep intrabony defects: clinical outcomes and postoperative morbidity. J Periodontol 2001;72:1702-12. https://doi.org/10.1902/jop.2001.72.12.1702
  35. Tonetti MS, Fourmousis I, Suvan J, Cortellini P, Bragger U, Lang NP, et al. Healing, post-operative morbidity and patient perception of outcomes following regenerative therapy of deep intrabony defects. J Clin Periodontol 2004;31:1092-8. https://doi.org/10.1111/j.1600-051X.2004.00615.x
  36. Trombelli L, Simonelli A, Pramstraller M, Wikesjo UM, Farina R. Single flap approach with and without guided tissue regeneration and a hydroxyapatite biomaterial in the management of intraosseous periodontal defects. J Periodontol 2010;81:1256-63. https://doi.org/10.1902/jop.2010.100113
  37. Oh SL, Joshi S. Single-flap approach in periodontal regeneration for intraosseous defects: case series. Clin Adv Periodontics 2020;10:69-74. https://doi.org/10.1002/cap.10082