Clinical and microbiologic study of periodontal surgery by means of apically positioned flaps with and without osseous recontouring

In periodontitis lesions with interproximal craters, periodontal flap surge ry with osseous recontouring allows more apical positioning of the soft per iodontal tissue than flap surgery without osseous recontouring. The present study determined the clinical and microbiologic responses to periodontal s urgery with and without osseous recontouring in adult periodontitis lesions with interproximal craters. in 7 osseous surgery patients, osteoplasty and ostectomy were performed from the lingual/palatal aspect to eliminate inte rproximal osseous defects and to partly mimic the original alveolar bony tr ansition to neighboring teeth, in 7 nonosseous surgery patients, the surgic al flap was adapted to the preexisting osseous level. Clinical monitoring i ncluded periodontal probing depth, Plaque Index, gingival bleeding index, a nd radiographic examination. Samples of the subgingival microbiota were exa mined. in sites treated with osseous surgery, mean pocket depth was 5.5 mm at baseline, 1.9 mm at 1 month, 2.0 mm at 3 months, and 2.1 mm at 6 months. in sites not receiving osseous recontouring surgery, the corresponding pec ker depths were 5.9 mm, 3.1 mm, 3.8 mm, and 4.1 mm. At baseline in the osse ous surgery group, Actinobacillus actinomycetemcomitans was recovered from one patient and Porphyromonas gingivalis from 5 patients; posttreatment, th ese microbiota were not detected in any patient. In the nonosseous surgery group, the presence of A actinomycetemcomitans increased posttreatment, and levels of P gingivalis remained essentially unchanged after therapy This s tudy suggests that in patients not receiving adjunctive antibiotic therapy, apically positioned flap surgery with osseous recontouring is more effecti ve than apically positioned flap surgery without osseous recontouring in re ducing periodontal pocket depth and levels of major periodontal pathogens.