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Periodontal granulation tissue preservation in surgical periodontal disease treatment: a pilot prospective cohort study

  • Rodriguez, Jose A. Moreno ;
  • Ruiz, Antonio J. Ortiz (Department of Stomatology, Faculty of Medicine, University of Murcia)
  • Received : 2021.11.05
  • Accepted : 2022.02.09
  • Published : 2022.08.31

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.

Keywords

References

  1. Henderson B, Kaiser F. Bacterial modulators of bone remodeling in the periodontal pocket. Periodontol 2000 2018;76:97-108. https://doi.org/10.1111/prd.12160
  2. Bosshardt DD. The periodontal pocket: pathogenesis, histopathology and consequences. Periodontol 2000 2018;76:43-50. https://doi.org/10.1111/prd.12153
  3. Sculean A, Gruber R, Bosshardt DD. Soft tissue wound healing around teeth and dental implants. J Clin Periodontol 2014;41 Suppl 15:S6-22. https://doi.org/10.1111/jcpe.12206
  4. Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. J Periodontol 2018;89 Suppl 1:S159-72. https://doi.org/10.1002/JPER.18-0006
  5. Caffesse RG, Echeverria JJ. Treatment trends in periodontics. Periodontol 2000 2019;79:7-14. https://doi.org/10.1111/prd.12245
  6. Sanz M, Herrera D, Kebschull M, Chapple I, Jepsen S, Beglundh T, et al. Treatment of stage I-III periodontitis-The EFP S3 level clinical practice guideline. J Clin Periodontol 2020;47 Suppl 22:4-60. https://doi.org/10.1111/jcpe.13290
  7. Ramfjord SP, Nissle RR. The modified widman flap. J Periodontol 1974;45:601-7. https://doi.org/10.1902/jop.1974.45.8.601
  8. Jenkins WM, Wragg PF, Gilmour WH. Formation of interdental soft tissue defects after surgical treatment of periodontitis. J Periodontol 1990;61:564-70. https://doi.org/10.1902/jop.1990.61.9.564
  9. Miron RJ, Sculean A, Cochran DL, Froum S, Zucchelli G, Nemcovsky C, et al. Twenty years of enamel matrix derivative: the past, the present and the future. J Clin Periodontol 2016;43:668-83. https://doi.org/10.1111/jcpe.12546
  10. Cairo F, Carnevale G, Billi M, Prato GPP. Fiber retention and papilla preservation technique in the treatment of infrabony defects: a microsurgical approach. Int J Periodontics Restorative Dent 2008;28:257-63.
  11. Takei HH, Han TJ, Carranza FA Jr, Kenney EB, Lekovic V. Flap technique for periodontal bone implants. Papilla preservation technique. J Periodontol 1985;56:204-10. https://doi.org/10.1902/jop.1985.56.4.204
  12. Cortellini P, Prato GP, Tonetti MS. The modified papilla preservation technique. A new surgical approach for interproximal regenerative procedures. J Periodontol 1995;66:261-6. https://doi.org/10.1902/jop.1995.66.4.261
  13. Cortellini P, Prato GP, Tonetti MS. The simplified papilla preservation flap. A novel surgical approach for the management of soft tissues in regenerative procedures. Int J Periodontics Restorative Dent 1999;19:589-99.
  14. Knowles JW, Burgett FG, Nissle RR, Shick RA, Morrison EC, Ramfjord SP. Results of periodontal treatment related to pocket depth and attachment level. Eight years. J Periodontol 1979;50:225-33. https://doi.org/10.1902/jop.1979.50.5.225
  15. Kaldahl WB, Kalkwarf KL, Patil KD, Molvar MP, Dyer JK. Long-term evaluation of periodontal therapy: I. Response to 4 therapeutic modalities. J Periodontol 1996;67:93-102. https://doi.org/10.1902/jop.1996.67.2.93
  16. Park JC, Kim JM, Jung IH, Kim JC, Choi SH, Cho KS, et al. 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 2011;38:721-31. https://doi.org/10.1111/j.1600-051X.2011.01716.x
  17. Gousopoulou E, Bakopoulou A, Apatzidou DA, Leyhausen G, Volk J, Staufenbiel I, et al. Evaluation of stemness properties of cells derived from granulation tissue of peri-implantitis lesions. Clin Exp Dent Res 2021;7:739-53. https://doi.org/10.1002/cre2.406
  18. Ronay V, Belibasakis GN, Schmidlin PR, Bostanci N. Infected periodontal granulation tissue contains cells expressing embryonic stem cell markers. A pilot study. Schweiz Monatsschr Zahnmed 2013;123:12-6.
  19. Lin NH, Menicanin D, Mrozik K, Gronthos S, Bartold PM. Putative stem cells in regenerating human periodontium. J Periodontal Res 2008;43:514-23.
  20. Lange DE, Plagmann HC, Eenboom A, Promesberger A. Clinical methods for the objective evaluation of oral hygiene. Dtsch Zahnarztl Z 1977;32:44-7.
  21. Kirkland O. Modified flap operation in surgical treatment of periodontoclasia. J Am Dent Assoc 1932;19:1918-21.
  22. 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
  23. Moreno Rodriguez JA, Ortiz Ruiz AJ, Caffesse RG. Supra-alveolar attachment gain in the treatment of combined intra-suprabony periodontal defects by non-incised papillae surgical approach. J Clin Periodontol 2019;46:927-36. https://doi.org/10.1111/jcpe.13158
  24. Nibali L, Koidou VP, Nieri M, Barbato L, Pagliaro U, Cairo F. Regenerative surgery versus access flap for the treatment of intra-bony periodontal defects: a systematic review and meta-analysis. J Clin Periodontol 2020;47 Suppl 22:320-51. https://doi.org/10.1111/jcpe.13237
  25. Retzepi M, Tonetti M, Donos N. 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 2007;34:903-11. https://doi.org/10.1111/j.1600-051X.2007.01119.x
  26. Retzepi M, Tonetti M, Donos N. Gingival blood flow changes following periodontal access flap surgery using laser Doppler flowmetry. J Clin Periodontol 2007;34:437-43. https://doi.org/10.1111/j.1600-051X.2007.01062.x
  27. Haney JM, Nilveus RE, McMillan PJ, Wikesjo UM. Periodontal repair in dogs: expanded polytetrafluoroethylene barrier membranes support wound stabilization and enhance bone regeneration. J Periodontol 1993;64:883-90. https://doi.org/10.1902/jop.1993.64.9.883
  28. De Sanctis M, Zucchelli G, Clauser C. Bacterial colonization of barrier material and periodontal regeneration. J Clin Periodontol 1996;23:1039-46. https://doi.org/10.1111/j.1600-051X.1996.tb00534.x
  29. Simonelli A, Minenna L, Trombelli L, Farina R. Single flap approach with or without enamel matrix derivative in the treatment of severe supraosseous defects: a retrospective study. Clin Oral Investig 2021;25:6385-92. https://doi.org/10.1007/s00784-021-03941-5
  30. 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
  31. Okuda K, Momose M, Miyazaki A, Murata M, Yokoyama S, Yonezawa Y, et al. Enamel matrix derivative in the treatment of human intrabony osseous defects. J Periodontol 2000;71:1821-8. https://doi.org/10.1902/jop.2000.71.12.1821
  32. Jentsch H, Purschwitz R. 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 2008;35:713-8. https://doi.org/10.1111/j.1600-051X.2008.01253.x
  33. Kasaj A, Rohrig B, Reichert C, Willershausen B. Clinical evaluation of anorganic bovine-derived hydroxyapatite matrix/cell-binding peptide (P-15) in the treatment of human infrabony defects. Clin Oral Investig 2008;12:241-7. https://doi.org/10.1007/s00784-008-0191-y
  34. Sculean A, Kiss A, Miliauskaite A, Schwarz F, Arweiler NB, Hannig M. Ten-year results following treatment of intra-bony defects with enamel matrix proteins and guided tissue regeneration. J Clin Periodontol 2008;35:817-24. https://doi.org/10.1111/j.1600-051X.2008.01295.x
  35. Slotte C, Asklow B, Sultan J, Norderyd O. A randomized study of open-flap surgery of 32 intrabony defects with and without adjunct bovine bone mineral treatment. J Periodontol 2012;83:999-1007. https://doi.org/10.1902/jop.2011.110490
  36. Cortellini P, Buti J, Pini Prato G, Tonetti MS. 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 2017;44:58-66. https://doi.org/10.1111/jcpe.12638
  37. Rasperini G, Tavelli L, Barootchi S, McGuire MK, Zucchelli G, Pagni G, et al. Interproximal attachment gain: the challenge of periodontal regeneration. J Periodontol 2021;92:931-46. https://doi.org/10.1002/JPER.20-0587
  38. Moreno-Rodriguez JA, Ortiz-Ruiz AJ. Papilla preservation periodontal surgery in periodontal reconstruction for deep combined intra-suprabony defects. Retrospective analysis of a registry-based cohort. J Clin Exp Dent 2021;13:e769-75. https://doi.org/10.4317/jced.58265
  39. Apatzidou DA, Nile C, Bakopoulou A, Konstantinidis A, Lappin DF. Stem cell-like populations and immunoregulatory molecules in periodontal granulation tissue. J Periodontal Res 2018;53:610-21. https://doi.org/10.1111/jre.12551
  40. Hoang T, Jorgensen MG, Keim RG, Pattison AM, Slots J. Povidone-iodine as a periodontal pocket disinfectant. J Periodontal Res 2003;38:311-7. https://doi.org/10.1034/j.1600-0765.2003.02016.x
  41. Liao H, Zhang H, Xiang J, Chen G, Cao Z. The effect of the surgical microscope on the outcome of root scaling. Am J Transl Res 2020;12:7199-210.
  42. Chang J, Meng HW, Lalla E, Lee CT. The impact of smoking on non-surgical periodontal therapy: a systematic review and meta-analysis. J Clin Periodontol 2021;48:60-75.