Top

Published in:

01-09-2013 | Original Article

Clinical and microbiological changes after minimally invasive therapeutic approaches in intrabony defects: a 12-month follow-up

Authors: Fernanda V. Ribeiro, Renato C. V. Casarin, Maria A. G. Palma, Francisco H. N. Júnior, Enilson A. Sallum, Márcio Z. Casati

Published in: Clinical Oral Investigations | Issue 7/2013

Abstract

Objectives

This 12-month randomized, controlled trial evaluated the clinical effects and microbiological changes of minimally invasive nonsurgical and surgical approaches for the therapy of intrabony defects.

Materials and methods

Twenty-nine subjects with intrabony defects in single-rooted tooth were randomly assigned to; (1) minimally invasive nonsurgical technique (MINST) or (2) minimally invasive surgical technique (MIST). Quantities of Aggregatibacter actinomycetemcomitans, Tannerella forsythia, and Porphyromonas gingivalis, determined by using real-time PCR, were evaluated at baseline, 3, 6, and 12 months after the treatments. Clinical recordings—probing depth (PD), position of the gingival margin (PGM), and relative clinical attachment level (RCAL)—were obtained at baseline and 12 months post-therapy. The primary outcome variable of the study was RCAL.

Results

Both treatment modalities resulted in an improvement in all clinical recordings, with significant PD reductions (p < 0.05), RCAL gains (p < 0.05), and no change in the PGM (p > 0.05) after 12 months in both MINST and MIST groups. No clinical differences were observed between groups (p > 0.05). Regarding the microbiological outcomes, at the re-examinations, a significant decrease was observed for T. forsythia and P. gingivalis when compared with baseline (p < 0.05) for both treatments. The amount of A. actinomycetemcomitans did not reduced decrease throughout the study (p > 0.05). Intergroup differences in the microbiological assay were not found at any time point (p > 0.05).

Conclusions

Both MINST and MIST provided comparable clinical results and microbiological changes in the treatment of intrabony defects over 12 months follow-up.

Clinical relevance

This randomized, controlled, parallel trial revealed that both therapeutic modalities may promote clinical and microbiological benefits at 12 months post-therapy.

DF Vasconcelos, São Paulo, SP, Brazil

Gracey, Hu-Friedy, Chicago, IL, USA

Cavitron, Dentsply, Tulsa, OK, USA

UI25KSF10S, Hu-Friedy, Chicago, IL, USA

6.0 polygalactin-A; Vicryl, Johnson & Johnson, São Paulo, SP, Brazil

Tylenol®—750 mg, Janssen-Cilag Farmacêutica Ltda, São Paulo, SP, Brazil

Hu Friedy do Brasil, Rio de Janeiro, RJ, Brazil

Dentsply, Ribeirão Preto, SP, Brazil

SYBR Green kit, Roche Diagnostic Co., Indianapolis, IN, USA

Socransky SS, Haffajee AD, Cugini MA, Smith C, Kent RL Jr (1998) Microbial complexes in subgingival plaque. J Clin Periodontol 25:134–144PubMedCrossRef

Papapanou PN, Wennström JL (1991) The angular bony defect as indicator of further alveolar bone loss. J Clin Periodontol 18:317–322PubMedCrossRef

Kaldahl WB, Kalkwarf KL, Patil KD, Molvar MP, Dyer JK (1996) Long-term evaluation of periodontal therapy. I. Response to 4 therapeutic modalities. J Periodontol 67:93–102PubMedCrossRef

Cortellini P, Tonetti MS (2007) A minimally invasive surgical technique with an enamel matrix derivative in the regenerative treatment of intrabony defects: a novel approach to limit morbidity. J Clin Periodontol 34:87–93PubMedCrossRef

Esposito M, Grusovin MG, Papanikolaou N, Coulthard P, Worthington HV (2009) Enamel matrix derivative (Emdogain(R)) for periodontal tissue regeneration in intrabony defects. Cochrane Database Syst Rev 7:CD003875

Ramfjord SP, Caffesse RG, Morrison EC et al (1987) 4 modalities of periodontal treatment compared over 5 years. J Clin Periodontol 14:445–452PubMedCrossRef

Nibali L, Pometti D, Tu YK, Donos N (2011) Clinical and radiographic outcomes following non-surgical therapy of periodontal infrabony defects: a retrospective study. J Clin Periodontol 38:50–57PubMedCrossRef

Cortellini P, Tonetti MS (2007) Minimally invasive surgical technique and enamel matrix derivative in intrabony defects. I: clinical outcomes and morbidity. J Clin Periodontol 34:1082–1088PubMedCrossRef

Cortellini P, Nieri M, Prato GP, Tonetti MS (2008) Single minimally invasive surgical technique with an enamel matrix derivative to treat multiple adjacent intrabony defects: clinical outcomes and patient morbidity. J Clin Periodontol 35:605–613PubMedCrossRef

10.

Wilson TG Jr, Carnio J, Schenk R, Myers G (2008) Absence of histologic signs of chronic inflammation following closed subgingival scaling and root planing using the dental endoscope: human biopsies—a pilot study. J Periodontol 79:2036–2041PubMedCrossRef

11.

Wilson TG, Harrel SK, Nunn ME, Francis B, Webb K (2008) The relationship between the presence of tooth-borne subgingival deposits and inflammation found with a dental endoscope. J Periodontol 79:2029–2035PubMedCrossRef

12.

Rethman MP, Harrel SK (2010) Minimally invasive periodontal therapy: will periodontal therapy remain a technologic laggard? J Periodontol 81:1390–1395PubMedCrossRef

13.

Ribeiro FV, Casarin RC, Palma MA, Júnior FH, Sallum EA, Casati MZ (2011) Clinical and patient-centered outcomes after minimally invasive non-surgical or surgical approaches for the treatment of intrabony defects: a randomized clinical trial. J Periodontol 82:1256–1266PubMedCrossRef

14.

Hunter JG, Sackier JM (1993) Minimally invasive high tech surgery: Into the 21st century. In: Hunter JG, Sackier JM (eds) Minimally invasive surgery. McGraw-Hill, New York, pp 3–6

15.

Harrel SK, Rees TD (1995) Granulation tissue removal in routine and minimally invasive procedures. Compend Contin Educ Dent 16:960, 962, 964 passim

16.

Harrel SK, Wilson TG, Nunn ME (2005) Prospective assessment of the use of enamel matrix proteins with minimally invasive surgery. J Periodontol 76:380–384PubMedCrossRef

17.

Ribeiro FV, Nociti FH Jr, Sallum EA, Sallum AW, Casati MZ (2010) Use of enamel matrix protein derivative with minimally-invasive surgical approach in intrabony periodontal defects: clinical and patient-centered outcomes. Braz Dent J 21:60–67PubMedCrossRef

18.

Ribeiro FV, Casarin RC, Júnior FH, Sallum EA, Casati MZ (2011) The role of enamel matrix derivative protein in minimally invasive surgery in treating intrabony defects in single-rooted teeth: a randomized clinical trial. J Periodontol 82:522–532PubMedCrossRef

19.

Harrel SK, Wilson TG Jr, Nunn ME (2010) Prospective assessment of the use of enamel matrix derivative with minimally invasive surgery: 6-year results. J Periodontol 81:435–441PubMedCrossRef

20.

Armitage GC (1999) Development of a classification system for periodontal diseases and conditions. Ann Periodontol 4:1–6PubMedCrossRef

21.

Ainamo J, Bay I (1975) Problems and proposals for recording gingivitis and plaque. Int Dent J 25:229–235PubMed

22.

Muhlemann HR, Son S (1971) Gingival sulcus bleeding—a leading symptom in initial gingivitis. Helvetica Odontol Acta 15:107–113

23.

Takei H, Yamada H, Hau T (1989) Maxillary anterior esthetics. Preservation of the interdental papilla. Dent Clin North Am 33:263–273PubMed

24.

Cortellini P, Prato GP, Tonetti MS (1995) The modified papilla preservation technique. A new surgical approach for interproximal regenerative procedures. J Periodontol 66:261–266PubMedCrossRef

25.

Cortellini P, Prato GP, Tonetti MS (1999) The simplified papilla preservation flap. A novel surgical approach for the management of soft tissues in regenerative procedures. Int J Periodontics Restor Dent 19:589–599

26.

Del Peloso Ribeiro E, Bittencourt S, Sallum EA, Nociti FH Jr, Gonçalves RB, Casati MZ (2008) Periodontal debridement as a therapeutic approach for severe chronic periodontitis: a clinical, microbiological and immunological study. J Clin Periodontol 35:789–798PubMedCrossRef

27.

Casarin RC, Ribeiro Edel P, Mariano FS, Nociti FH Jr, Casati MZ, Gonçalves RB (2010) Levels of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, inflammatory cytokines and species-specific immunoglobulin G in generalized aggressive and chronic periodontitis. J Periodontal Res 45:635–642PubMedCrossRef

28.

Genco R, Kornman K, Williams R et al (1996) Consensus report periodontal diseases: pathogenesis and microbialfactors. Ann Periodontol 1:926–932CrossRef

29.

Socransky SS, Smith C, Haffajee AD (2002) Subgingival microbial profiles in refractory periodontal disease. J Clin Periodontol 29:260–268PubMedCrossRef

30.

Choi BK, Park SH, Yoo YJ et al (2000) Detection of major putative periodontopathogens in Korean advanced adult periodontitis patients using a nucleic acid-based approach. J Periodontol 9:1387–1394CrossRef

31.

Doungudomdacha S, Rawlinson A, Walsh TF, Douglas CW (2001) Effect of non-surgical periodontal treatment on clinical parameters and the numbers of Porphyromonas gingivalis, Prevotella intermedia and Actinobacillus actinomycetemcomitans at adult periodontitis sites. J Clin Periodontol 28:437–445PubMedCrossRef

32.

Papapanou PN, Teanpaisan R, Obiechina NS et al (2002) Periodontal microbiota and clinical periodontal status in a rural sample in southern Thailand. Eur J Oral Sci 5:345–352CrossRef

33.

Heitz-Mayfield L, Tonetti MS, Cortellini P et al (2006) Microbial colonization patterns predict the outcomes of surgical treatment of intrabony defects. J Clin Periodontol 33:62–68PubMedCrossRef

34.

Silva MP, Feres M, Sirotto TA et al (2011) Clinical and microbiological benefits of metronidazole alone or with amoxicillin as adjuncts in the treatment of chronic periodontitis: a randomized placebo-controlled clinical trial. J Clin Periodontol 38:828–837PubMedCrossRef

35.

Saglie FR, Marfany A, Camargo P (1988) Intragingival occurrence of Actinobacillus actinomycetemcomitans and Bacteroides gingivalis in active destructive periodontal lesions. J Periodontol 59:259–265PubMedCrossRef

36.

Rudney JD, Chen R, Sedgewick GJ (2005) Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Tannerella forsythensis are components of a polymicrobial intracellular flora within human buccal cells. J Dent Res 84:59–63PubMedCrossRef

37.

Renvert S, Wikström M, Dahlén G, Slots J, Egelberg J (1990) Effect of root debridement on the elimination of Actinobacillus actinomycetemcomitans and Bacteroides gingivalis from periodontal pockets. J Clin Periodontol 17:345–350PubMedCrossRef

38.

Ioannou I, Dimitriadis N, Papadimitriou K, Sakellari D, Vouros I, Konstantinidis A (2009) Hand instrumentation versus ultrasonic debridement in the treatment of chronic periodontitis: a randomized clinical and microbiological trial. J Clin Periodontol 36:132–141PubMedCrossRef

39.

Cortelli JR, Cortelli SC, Jordan S, Haraszthy VI, Zambon JJ (2005) Prevalence of periodontal pathogens in Brazilians with aggressive or chronic periodontitis. J Clin Periodontol 32:860–866PubMedCrossRef

40.

Feres M, Haffajee AD, Allard KA, Som S, Socransky SS (2001) Change in subgingival microbial profiles in adult periodontitis subjects receiving either systemically administered amoxicillin or metronidazole. J Clin Periodontol 28:597–609PubMedCrossRef

41.

Colombo AP, Teles RP, Torres MC et al (2005) Effects of non-surgical mechanical therapy on the subgingival microbiota of Brazilians with untreated chronic periodontitis: 9-month results. J Periodontol 76:116–122CrossRef

42.

Haffajee AD, Teles RP, Socransky SS (2006) The effect of periodontal therapy on the composition of the subgingival microbiota. Periodontol 2000 42:219–258PubMedCrossRef

43.

Pedrazzoli V, Kilian M, Karring T, Kirkegaard E (1991) Effect of surgical and non-surgical periodontal treatment on periodontal status and subgingival microbiota. J Clin Periodontol 18:598–604PubMedCrossRef

44.

Haffajee AD, Cugini MA, Dibart S, Smith C, Kent RLJ, Socransky SS (1997) The effect of SRP on the clinical and microbiological parameters of periodontal diseases. J Clin Periodontol 24:324–334PubMedCrossRef

45.

Cugini MA, Haffajee AD, Smith C, Kent RLJ, Socransky SS (2000) The effects of scaling and root planing on the clinical and microbiological parameters of periodontal diseases: 12 month results. J Clin Periodontol 27:30–36PubMedCrossRef

46.

Darby IB, Hodge PJ, Riggio MP, Kinane DF (2005) Clinical and microbiological effect of scaling and root planing in smoker and non-smoker chronic and aggressive periodontitis patients. J Clin Periodontol 32:200–206PubMedCrossRef

47.

Teles RP, Haffajee AD, Socransky SS (2006) Microbiological goals of periodontal therapy. Periodontol 2000 42:180–218PubMedCrossRef

48.

van Assche N, van Essche M, Pauwels M, Teughels W, Quirynen M (2009) Do periodontopathogens disappear after full-mouth tooth extraction? J Clin Periodontol 36:1043–1047PubMedCrossRef

49.

Heitz-Mayfield LJA, Trombelli L, Heitz F, Needleman I, Moles D (2002) A systematic review of the effect of surgical debridement vs. non-surgical debridement for the treatment of chronic periodontitis. J Clin Periodontol 29(suppl 3):92–102PubMedCrossRef

50.

Heitz-Mayfield LJ (2005) How effective is surgical therapy compared with nonsurgical debridement? Periodontol 2000(37):72–87CrossRef

51.

Cobb CM (2002) Clinical significance of non-surgical periodontal therapy: an evidence-based perspective of scaling and root planing. J Clin Periodontol 29:6–16PubMedCrossRef

52.

Adriaens PA, Adriaens LM (2004) Effects of nonsurgical periodontal therapy on hard and soft tissues. Periodontol 2000 36:121–145PubMedCrossRef

53.

Tonetti MS, Pini-Prato G, Cortellini P (1993) Periodontal regeneration of human infrabony defects. IV Determinants of the healing response. J Periodontol 64:934–940PubMedCrossRef

54.

Lindhe J, Nyman S (1984) Long-term maintenance of patients treated for advanced periodontal disease. J Clin Periodontol 11:504–514PubMedCrossRef

55.

Casarin RC, Del Peloso Ribeiro E, Nociti FH Jr et al (2008) A double-blind randomized clinical evaluation of enamel matrix derivative proteins for the treatment of proximal class-II furcation involvements. J Clin Periodontol 35:429–437PubMedCrossRef

56.

Pontoriero R, Wennstrom J, Lindhe J (1999) The use of barrier membranes and enamel matrix proteins in the treatment of angular bone defects. A prospective controlled clinical study. J Clin Periodontol 26:833–840PubMedCrossRef

57.

Sipos PM, Loos BG, Abbas F, Timmerman MF, van der Velden U (2005) The combined use of enamel matrix proteins and a tetracycline-coated expanded polytetrafluoroethylene barrier membrane in the treatment of intra-osseous defects. J Clin Periodontol 32:765–772PubMedCrossRef

58.

Sculean A, Schwarz F, Chiantella GC et al (2007) Five-year results of a prospective, randomized, controlled study evaluating treatment of intrabony defects with a natural bone mineral and GTR. J Clin Periodontol 34:72–77PubMedCrossRef

59.

Paolantonio M, Femminella B, Coppolino E et al (2010) Autogenous periosteal barrier membranes and bone grafts in the treatment of periodontal intrabony defects of single-rooted teeth: a 12-month reentry randomized controlled clinical trial. J Periodontol 81:1587–1595PubMedCrossRef

60.

Badersten A, Nilveus R, Egelberg J (1984) Effect of non-surgical periodontal therapy. II. Severely advanced periodontitis. J Clin Periodontol 11:63–76PubMedCrossRef

61.

Badersten A, Nilvéus R, Egelberg J (1987) Effect of non-surgical periodontal therapy. VIII. Probing attachment changes related to clinical characteristics. J Clin Periodontol 14:425–432PubMedCrossRef

62.

Claffey N, Nylund K, Kiger R, Garrett S, Egelberg J (1990) Diagnostic predictability of scores of plaque, bleeding, suppuration and probing depth for probing attachment loss. 3.5 years of observation following initial periodontal therapy. J Clin Periodontol 17:108–114PubMedCrossRef

63.

Zucchelli G, De Sanctis M (2008) A novel approach to minimizing gingival recession in the treatment of vertical bony defects. J Clin Periodontol 79:567–574CrossRef

64.

Trombelli L, Farina R, Franceschetti G, Calura G (2009) Single-flap approach with buccal access in periodontal reconstructive procedures. J Periodontol 80:353–360PubMedCrossRef

65.

McGuire MK, Nunn ME (1996) Prognosis versus actual outcome. III. The effectiveness of clinical parameters in accurately predicting tooth survival. J Periodontol 67:666–674PubMedCrossRef

66.

Gutierrez MA, Mellonig JT, Cochran DL (2003) Evaluation of enamel matrix derivative as an adjunct to non-surgical periodontal therapy. J Clin Periodontol 30:739–745PubMedCrossRef

67.

Sculean A, Windisch P, Keglevich T, Gera I (2003) Histologic evaluation of human intrabony defects following non-surgical periodontal therapy with and without application of an enamel matrix protein derivative. J Periodontol 74:153–160PubMedCrossRef

68.

Konig J, Schwahn C, Fanghanel J, Plotz J, Hoffmann T, Kocher T (2008) Repeated scaling versus surgery in young adults with generalized advanced periodontitis. J Periodontol 79:1006–1013PubMedCrossRef

Title: Clinical and microbiological changes after minimally invasive therapeutic approaches in intrabony defects: a 12-month follow-up
Authors: Fernanda V. Ribeiro
Renato C. V. Casarin
Maria A. G. Palma
Francisco H. N. Júnior
Enilson A. Sallum
Márcio Z. Casati
Publication date: 01-09-2013
Publisher: Springer Berlin Heidelberg
Published in: Clinical Oral Investigations / Issue 7/2013
Print ISSN: 1432-6981
Electronic ISSN: 1436-3771
DOI: https://doi.org/10.1007/s00784-012-0855-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Clinical and microbiological changes after minimally invasive therapeutic approaches in intrabony defects: a 12-month follow-up

Abstract

Objectives

Materials and methods

Results

Conclusions

Clinical relevance

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Materials and methods

Results

Conclusions

Clinical relevance

Please log in to get access to this content

Other articles of this Issue 7/2013

Clinical and microbiological results following nonsurgical periodontal therapy with or without local administration of piperacillin/tazobactam

Trial quality checklists: on the need to multiply (not add) scores

Reply to the letter to the editor: Development of digital shade guides for color assessment using a digital camera with ring flashes

Trends in World Dental Research: an overview of the last three decades using the Web of Science

Erratum to: A micro-computed tomography study of canal configuration of multiple-canalled mesiobuccal root of maxillary first molar

Beneficial effect of methylprednisolone after mandibular third molar surgery: a randomized, double-blind, placebo-controlled split-mouth trial