Pocket epithelium removal via crestal and subcrestal scalloped internal bevel incisions

This study assessed the extent of pocket epithelium removal by crestal and subcrestal scalloped inverse bevel incisions during mucoperiosteal flap surgery. Fifty-six gingival biopsies were obtained from 52 participants, who had extractions of periodontally involved teeth. Sulcular incisions which severed the epithelial attachment served as controls. Experimental scalloped internal bevel incisions were made: (1) at the gingival crest extending apical to the osseous crest (crestal incision) and (2) 1 to 2 mm apical to the gingival margin extending apical to the osseous crest (subcrestal incision). In the two procedures the initial incisions were followed by sulcular incisions to sever the epithelial attachment. After both crestal and subcrestal incisions full thickness flaps were reflected, pocket contents were removed, and flaps were replaced against the teeth. Gingival biopsies were then obtained from control and experimental sites followed by extraction of teeth. All specimens were processed, embedded in paraffin, sectioned, stained with hematoxylin and eosin and examined for residual pocket epithelium. Control incisions eliminated pocket epithelium in two of 20 specimens. Crestal incisions eliminated pocket epithelium in 11 of 25 areas, while subcrestal incisions eliminated pocket epithelium in 13 of 25 areas. All 10 papillary areas treated by crestal incisions and 8 of the 10 papillary areas treated by subcrestal incisions displayed residual pocket epithelium. Neither crestal nor subcrestal scalloped internal bevel incisions consistently eliminated all pocket epithelium.