Microsurgical approach to periodontal regeneration. Initial evaluation in a case cohort

Improvements in flap design and soft tissue manipulation are considered key elements in improving the outcomes of regenerative periodontal surgery. Improved visual acuity and better soft tissue handling resulting from the application of a microsurgical approach hold great promise to further improve predictability of periodontal regeneration. The aim of this study was to preliminarily evaluate the outcomes of a microsurgical approach in the regenerative therapy of deep intrabony defects.

This patient cohort study involved 26 patients with one deep interdental intrabony defect each. They were treated with periodontal regeneration using guided tissue regeneration membranes. Defects were accessed with previously described papilla preservation flaps performed with the aid of an operating microscope and microsurgical instruments. A stringent plaque control regimen was enforced in all the patients during the 1-year observation period. Outcomes included evaluation of the complete primary closure of the interdental space (closure), gains in clinical attachment (CAL), and reductions in probing depths (PD).

Closure was achieved in all treated defects and was maintained in 92.3% of cases for the entire healing period. Associated gains in CAL were 5.4 +/- 1.2 mm on average, corresponding to a CAL gain of 82.8 +/- 14.7% of the initial intrabony component of the defect. Average PD reduction was 5.8 +/- 1.4 mm and was associated with minimal increase in gingival recession (0.4 +/- 0.7 mm).

The use a microsurgical approach was associated with very high ability to obtain and maintain primary closure of the interdental tissues over the barrier membranes. The procedure resulted in clinically important amounts of CAL gains and minimal recessions.