THE EFFECT OF POSTSURGICAL FLAP PLACEMENT ON PROBING DEPTH AND ATTACHMENT LEVEL - A 2-YEAR LONGITUDINAL-STUDY

POSTSURGICAL FLAP PLACEMENT might affect the outcome of the operative procedure. Modified Widman flap surgery with primary closure and flap approximation (usually away from the bone crest) and apically position ed flap surgery with near crestal bone positioning are both widely use d in surgical periodontal treatment. Several comparative investigation s have studied these modalities, however, none have been able to show conclusively that either is superior to the other. The purpose of this longitudinal study was to explore the optimal postsurgical flap place ment in respect to final probing depth and changes in clinical attachm ent level. Following routine hygienic phase of treatment, 12 subjects (186 teeth) with adult periodontitis received surgical periodontal tre atment. Prior to the flap surgery, probing depth and clinical attachme nt level were recorded. Sounding depth measurements were taken to reco rd postoperative flap placement. Patients were placed on a 3-month mai ntenance program. Probing depth and clinical attachment level were aga in measured at 2 years postoperatively and compared to baseline measur ements. An overall positive correlation (R = 0.43; P = 0.0248) was fou nd between immediate postoperative sounding measurements and probing d epth after 2 years. Conversely, attachment level changes over the 2-ye ar period showed only weak inverse correlation (R = 0.27; P = 0.0121) with sounding depth measurement immediately postsurgically. Sites wher e postoperative sounding depth were less than or equal to 3 mm had a m ean probing depth (2.52 mm) which was significantly (P <0.001) smaller compared to sites with sound depth greater than or equal to 4 mm (3.5 8 mm). Changes in clinical attachment level varied between sites and s ounding depth groups; however, none of these differences were statisti cally significant. Based on our findings it is suggested that followin g periodontal flap surgery, in those cases where minimal probing depth is desired, the flap be secured to the underlying structures at or sl ightly coronally to the bone crest (less than or equal to 3 mm). Such an approach is likely to result in optimal pocket reduction with minim al attachment loss, which when supplemented with maintenance care and personal oral hygiene is likely to remain unchanged and prevent future periodontal relapse.