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

Background: Improvements in flap design and soft tissue manipulation are co nsidered 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 furt her improve predictability of periodontal regeneration. The aim of this stu dy was to preliminarily evaluate the outcomes of a microsurgical approach i n the regenerative therapy of deep intrabony defects. Methods: This patient cohort study involved 26 patients with one deep inter dental intrabony defect each. They were treated with periodontal regenerati on using guided tissue regeneration membranes. Defects were accessed with p reviously described papilla preservation flaps performed with the aid of an operating microscope and microsurgical instruments. A stringent plaque con trol regimen was enforced in all the patients during the I-year observation period. Outcomes included evaluation of the complete primary closure of th e interdental space (closure), gains in clinical attachment (CAL), and redu ctions in probing depths (PD). Results: 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). Conclusions: The use of a microsurgical approach was associated with very h igh ability to obtain and maintain primary closure of the interdental tissu es over the barrier membranes. The procedure resulted in clinically importa nt amounts of CAL gains and minimal recessions.