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Flap Debridement (flap + debridement)

Distribution by Scientific Domains
Medical Sciences100%

Kinds of Flap Debridement

  • open flap debridement
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    Selected Abstracts

    Five-year results of a prospective, randomized, controlled study evaluating treatment of intra-bony defects with a natural bone mineral and GTR

    JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 1 2007
    Anton Sculean
    Abstract Background: Treatment with a natural bone mineral (NBM) and a guided tissue regeneration (GTR) has been shown to promote periodontal regeneration. However, until now there are only very limited data on the long-term clinical results following this regenerative technique. Aim: To present the 5-year results of a prospective, randomized, controlled clinical study evaluating the treatment of deep intra-bony defects either with open flap debridement (OFD) and a combination of an NBM and GTR (test) or OFD alone (control). Methods: Nineteen patients diagnosed with advanced chronic periodontitis, and each of whom displayed one intra-bony defect, received randomly the test or the control treatment. Results were evaluated at baseline, at 1 and at 5 years following therapy. Results: No statistically significant differences in any of the investigated parameters were observed at baseline between the two groups. At 1 year after therapy, the test group showed a reduction in mean probing depth (PD) from 9.1±1.1 to 3.7±0.8 mm (p<0.001) and a change in mean clinical attachment level (CAL) from 10.4±1.3 to 6.4±1.2 mm (p<0.001). At 5 years, mean PD and CAL measured 4.3±0.8 and 6.7±1.6 mm, respectively. At 5 years, both PD and CAL were statistically significantly improved compared with baseline (p<0.001) without statistically significant differences between the 1- and 5-year results. In the control group, mean PD was reduced from 8.9±1.3 to 4.9±1.2 mm (p<0.001) and mean CAL changed from 10.6±1.4 to 8.8±1.5 mm (p<0.01). At 5 years, mean PD and CAL measured 5.6±1.1 and 9.1±1.3 mm, respectively, and were still statistically significantly improved compared with baseline (p<0.01). No statistically significant differences were found between the 1- and 5-year results. The test treatment, at both 1 and 5 years, yielded statistically significantly higher CAL gains than the control one (p<0.01). Compared with baseline, at 5 years a CAL gain of 3 mm was found in nine defects (90%) of the test group but in none of the defects treated with OFD alone. Conclusions: It was concluded that (i) treatment of intra-bony defects with OFD+NBM+GTR may result in significantly higher CAL gains than treatment with OFD, and (ii) the clinical results obtained after both treatments can be maintained over a period of 5 years. [source]

    Open flap debridement with or without intentional cementum removal: a 4-month follow-up

    JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 9 2005
    Antonio Wilson Sallum
    Abstract Objectives: The aim of this study was to investigate the influence of cementum removal on periodontal repair. Material and Methods: Forty subjects with chronic periodontitis and presenting, at least, two proximal sites in anterior teeth (upper or lower) with probing depth 5 mm were selected. After oral hygiene instructions and ultrasonic supragingival instrumentation, the subjects were randomly assigned for one of the following groups: CIC, scaled with Gracey curettes; CIUS, scaled with ultrasonic device; CDC, calculus deattachment with Gracey curettes and brushing with saline solution; and CDUS, calculus deattachment with ultrasonic device and brushing with saline solution. Full-thickness flaps were reflected and the instrumentation was performed with a clinical microscope. Probing depth (PD), relative gingival margin level (RGML) and relative attachment level (RAL) were registered at five experimental periods: baseline and 30, 60, 90 and 120 days postoperative. Results: All the approaches were able to markedly reduce the PD values from the baseline to the other evaluation periods (p<0.0001). The increase in RGML values was statistically significant only for the CDUS group. There were no statistically significant differences between the baseline and postoperative values in all groups for the RAL changes. The changes in RAL were statistically significant only among the groups CDC and CDUS (p<0.0001). Conclusion: The conventional scaling and root planing and the calculus deattachment were effective in reducing the probing depth values, regardless of the instrumentation method. [source]

    Five-year results following treatment of intrabony defects with enamel matrix proteins and guided tissue regeneration

    JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 7 2004
    Anton Sculean
    Abstract Background: Treatment with enamel matrix proteins (EMD) or guided tissue regeneration (GTR) has been shown to enhance periodontal regeneration. However, until now there are limited data on the long-term results following these treatment modalities. Aim: The aim of the present clinical study was to present the 5-year results following treatment of intrabony defects with EMD, GTR, combination of EMD and GTR, and open flap debridement (OFD). Material and Methods: Forty-two patients, each of whom displayed one intrabony defect of a probing depth of at least 6 mm, were randomly treated with one of the four treatment modalities. The following parameters were evaluated prior to surgery, at 1 year and at 5 years after: plaque index, gingival index, bleeding on probing, probing pocket depth (PPD), gingival recession, and clinical attachment level (CAL). No statistically significant differences in any of the parameters were observed at baseline between the four groups. Results: The sites treated with EMD demonstrated a mean CAL gain of 3.4±1.1 mm (p<0.001) and of 2.9±1.6 mm (p<0.001) at 1 and 5 years, respectively. The sites treated with GTR showed a mean CAL gain of 3.2±0.8 (p<0.001) at 1 year and of 2.7±0.9 mm (p<0.001) at 5 years. The mean CAL gain at sites treated with EMD+GTR was 3.0±1.0 mm (p<0.001) and 2.6±0.7 mm (p<0.001) at 1 and 5 years, respectively. The sites treated with OFD demonstrated a mean CAL gain of 1.6±1.0 mm (p<0.001) at 1 year and 1.3±1.2 mm (p<0.001) at 5 years. At 1 year, the only statistically significant difference between the four different treatments was found in terms of PPD reduction and CAL gain between EMD and OFD (p<0.05). However, at 5 years there were no statistically significant differences in any of the investigated parameters between the four different treatments. Conclusion: Within the limits of the present study, it may be concluded that the short-term clinical results following treatment with EMD, GTR, EMD+GTR, and OFD can be maintained over a period of 5 years. [source]

    Effectiveness of a combination of platelet-rich plasma, bovine porous bone mineral and guided tissue regeneration in the treatment of mandibular grade II molar furcations in humans

    JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 8 2003
    Vojislav Lekovic
    Abstract Objective: A combination of platelet-rich plasma (PRP), bovine porous bone mineral (BPBM) and guided tissue regeneration (GTR) has been shown to be effective as regenerative treatment for intrabony periodontal defects. The purpose of this study was to evaluate the effectiveness of PRP, BPBM and GTR used in combination as regenerative treatment for grade II molar furcation defects in humans. Material and methods: Using a split-mouth design, a total of 52 grade II mandibular molar furcation defects were treated either with PRP/BPBM/GTR (experimental group, n=26) or with an open flap debridement (control group, n=26). The primary outcomes evaluated in this study included changes in pocket depth, attachment level and re-entry bone levels (horizontal and vertical) between baseline and 6 months postoperatively. Results: The results showed that the experimental group presented with significantly greater pocket reduction (4.07±0.33 mm for experimental and 2.49±0.38 mm for control sites), gain in clinical attachment (3.29 ± 0.42 mm for experimental and 1.68±0.31 mm for control sites), vertical defect fill (2.56± 0.36 mm for experimental and ,0.19±0.02 for control sites) and horizontal defect fill (2.28±0.33 mm for experimental and 0.08±0.02 mm for control sites) than the control group. Conclusions: It was concluded that the PRP/BPBM/GTR combined technique is an effective modality of regenerative treatment for mandibular grade II furcation defects. Further studies are necessary to elucidate the role played by each component of the combined therapy in achieving these results. Zusammenfassung Ziel: Eine Kombination von plättchemreichen Plasma (PRP), bovinem porösem Knochenmineral (BPBM) und gesteuerter Geweberegeneration (GTR) wurde als effektiv bei der regenerativen Behandlung von intraalveolären parodontalen Knochendefekten gezeigt. Der Zweck dieser Studie war die Evaluation der Effektivität von PRP, BPBM und GTR in der Kombination als regenerative Behandlung für Grad II Furkationsdefekte bei menschlichen Molaren. Material und Methoden: Unter Nutzung eines split-mouth Design wurden 52 Grad II Unterkiefermolaren Furkationsdefekte entweder mit PRP/BPBM/GTR (experimentelle Gruppe, n=26) oder mit einer offenen Reinigung (Lappenoperation) (Kontrollgruppe, n=26) behandelt. Die primären Ergebnisse die in dieser Studie evaluiert wurden, bezogen die Veränderung der Sondierungstiefen, des Stützgewebeniveaus und des Knochenniveaus bei reentry-Operationen (horizontal und vertikal) zwischen Basis und 6 Monate post operationem ein. Ergebnisse: Die Ergebnisse zeigten, dass die experimentelle Gruppe eine höhere Reduktion der Sondierungstiefen (4.07±0.33 mm für experimentelle und 2.49±0.38 mm für Kontrollflächen), einen höheren Stützgewebegewinn (3.29±0.42 mm für experimentelle und 1.68± 0.31 mm für Kontrollflächen), eine größere vertikale Defektfüllung (2.56±0.36 mm für experimentelle und ,0.19±0.02 für Kontrollflächen) sowie horizontale Defektfüllung (2.28± 0.33 mm für experimentelle und 0.08±0.02 mm für Kontrollflächen) verglichen mit den Kontrollen zeigte. Schlussfolgerungen: Es wird gefolgert, dass die Kombination von PRB/BPBM/GTR eine effektive Modifikation der regenerativen Behandlung bei Grad II Furkationsdefekten bei unteren Molaren ist. Weitere Studien sind notwendig, um die Rolle jeder Komponente dieser kombinierten Therapie in der Erzielung dieser Ergebnisse zu erfassen. Résumé Objectif: Une combinaison de plasma riche en plaquette (PRP), de minéral d'os bovin poreux (BPBM) et de régénération tissulaire guidée (GTR) a prouvé son efficacité en tant que traitement régénératif pour les lésions intra-osseuses parodontales. Cette étude se propose d'évaluer l'intérêt de l'utilisation en combinaison de PRP, BPBM et GTR comme traitement de régénération des lésions furcatoires molaires de classe II chez l'homme. Matériels et Méthodes: Par une étude conçue en bouche croisée, 52 lésions furcatoires molaires mandibullaires ont été traitées soit avec PRP/BPBM/GTR (groupe expérimental, n=26) ou par simple lambeau d'accès (groupe contrôle, n=26). Les objectifs primaires évalués dans cette étude étaient la modification de la profondeur de poche, le niveau d'attache et les niveaux osseux lors de la réentrée (en horizontal et en vertical) mesurés six mois post-op. Résultats: les résultats montrent que le groupe expérimental présentait significativement une plus importante réduction de poche (4.07±0.33 mm contre 2.49±0.38 mm pour les sites contrôles), un gain d'attache clinique plus important (3.29± 0.42 mm contre 1.68±0.31 mm pour les sites contrôles), un comblement vertical des lésions(2.56±0.36 mm contre ,0.19±0.02 pour les sites contrôles) et un comblement horizontal des lésions (2.28±0.33 mm contre 0.08± 0.02 mm pour les sites contrôles). Conclusions: Nous en concluons que la technique combinant PRP/BPBM/GTR est un traitement régénératif efficace pour les lésions de furcation molaire mandibulaire de classe II. Des études complémentaires sont nécessaires pour élucider le rôle joué par chaque élément de cette combinaison dans l'obtention de ces résultats. [source]

    A controlled re-entry study on the effectiveness of bovine porous bone mineral used in combination with a collagen membrane of porcine origin in the treatment of intrabony defects in humans

    JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 12 2000
    Paulo M. Camargo
    Abstract Aim: The purpose of this study was to evaluate the clinical effectiveness of a bovine porous bone mineral used in combination with a porcine derived collagen membrane as a barrier in promoting periodontal regeneration in intrabony defects in humans. Material and Methods: The study employed a split-mouth design. 22 paired intrabony defects were treated and surgically re-entered 6 months after treatment. Experimental sites were grafted with bovine porous bone mineral and received a collagen membrane for guided tissue regeneration. Control sites were treated with an open flap debridement. Results: Preoperative pocket depths, attachment levels and trans-operative bone measurements were similar for control and experimental sites. Post surgical measurements revealed a significantly greater reduction in pocket depth (differences of 1.89±0.31 mm on buccal 0.88±0.27 mm on lingual measurements) and more gain in clinical attachment (differences of 1.51±0.33 mm on buccal and 1.50±0.35 mm on lingual measurements) in experimental sites. Surgical reentry of the treated defects revealed a significantly greater amount of defect fill in favor of experimental sites (differences of 2.67±0.91 mm on buccal and 2.54±0.87 mm on lingual measurements). Conclusions: The results of this study indicate that clinical resolution of intrabony defects can be achieved using a combination of bovine porous bone mineral and an absorbable, porcine derived collagen membrane when employing a technique based on the principles of guided tissue regeneration. The nature of the attachment between the newly regenerated tissue and the root surfaces needs to be evaluated histologically to confirm the presence of new attachment. [source]

    Enamel matrix derivative (Emdogain®) for periodontal tissue regeneration in intrabony defects

    AUSTRALIAN DENTAL JOURNAL, Issue 1 2010
    M Esposito
    Background:, Periodontitis is a chronic infective disease of the gums caused by bacteria present in dental plaque. This condition induces the breakdown of the tooth supporting apparatus until teeth are lost. Surgery may be indicated to arrest disease progression and regenerate lost tissues. Several surgical techniques have been developed to regenerate periodontal tissues including guided tissue regeneration (GTR), bone grafting (BG) and the use of enamel matrix derivative (EMD). EMD is an extract of enamel matrix and contains amelogenins of various molecular weights. Amelogenins are involved in the formation of enamel and periodontal attachment formation during tooth development. Objectives:, To test whether EMD is effective, and to compare EMD versus GTR, and various BG procedures for the treatment of intrabony defects. Search strategy:, We searched the Cochrane Oral Health Group Trials Register, CENTRAL, MEDLINE and EMBASE. Several journals were handsearched. No language restrictions were applied. Authors of randomized controlled trials (RCTs) identified, personal contacts and the manufacturer were contacted to identify unpublished trials. Most recent search: February 2009. Selection criteria:, RCTs on patients affected by periodontitis having intrabony defects of at least 3 mm treated with EMD compared with open flap debridement, GTR and various BG procedures with at least 1 year follow-up. The outcome measures considered were: tooth loss, changes in probing attachment levels (PAL), pocket depths (PPD), gingival recessions (REC), bone levels from the bottom of the defects on intraoral radiographs, aesthetics and adverse events. The following time-points were to be evaluated: 1, 5 and 10 years. Data collection and analysis:, Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two authors. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CI). It was decided not to investigate heterogeneity, but a sensitivity analysis for the risk of bias of the trials was performed. Main results:, Thirteen trials were included out of 35 potentially eligible trials. No included trial presented data after 5 years of follow-up, therefore all data refer to the 1-year time point. A meta-analysis including nine trials showed that EMD treated sites displayed statistically significant PAL improvements (mean difference 1.1 mm, 95% CI 0.61 to 1.55) and PPD reduction (0.9 mm, 95% CI 0.44 to 1.31) when compared to placebo or control treated sites, though a high degree of heterogeneity was found. Significantly more sites had <2 mm PAL gain in the control group, with RR 0.53 (95% CI 0.34 to 0.82). Approximately nine patients needed to be treated (NNT) to have one patient gaining 2 mm or more PAL over the control group, based on a prevalence in the control group of 25%. No differences in tooth loss or aesthetic appearance as judged by the patients were observed. When evaluating only trials at a low risk of bias in a sensitivity analysis (four trials), the effect size for PAL was 0.62 mm (95% CI 0.28 to 0.96), which was less than 1.1 mm for the overall result. Comparing EMD with GTR (five trials), GTR showed statistically significant more postoperative complications (three trials, RR 0.12, 95% CI 0.02 to 0.85) and more REC (0.4 mm 95% CI 0.15 to 0.66). The only trial comparing EMD with a bioactive ceramic filler found statistically significant more REC (-1.60 mm, 95% CI ,2.74 to ,0.46) at the EMG treated sites. Authors' conclusions:, One year after its application, EMD significantly improved PAL levels (1.1 mm) and PPD reduction (0.9 mm) when compared to a placebo or control, however, the high degree of heterogeneity observed among trials suggests that results have to be interpreted with great caution. In addition, a sensitivity analysis indicated that the overall treatment effect might be overestimated. The actual clinical advantages of using EMD are unknown. With the exception of significantly more postoperative complications in the GTR group, there was no evidence of clinically important differences between GTR and EMD. Bone substitutes may be associated with less REC than EMD. Plain language summary:, Enamel matrix derivative (Emdogain®) for periodontal tissue regeneration in intrabony defects. Emdogain might have some advantages over other methods of regenerating the tissue supporting teeth lost by gum disease, such as less postoperative complications, but has not been shown to save more compromised teeth or that patients noticed any aesthetic improvement 1 year after its application. Bacteria in plaque can cause gum disease (periodontitis) that breaks down tissue supporting teeth. Surgical cleaning tries to stop the disease to save loose teeth. Bone grafting, guided tissue regeneration and enamel matrix derivatives (such as Emdogain) aim to regenerate support tissues. Emdogain contains proteins (derived from developing pig teeth) believed to regenerate tooth attachment. The review found that adjunctive application of Emdogain regenerates about 1 mm more tissue than surgical cleaning alone, although it is unclear to which extent such improvement is noticeable since patients did not find any difference in the aesthetic results. Emdogain showed similar clinical results to guided tissue regeneration, but is simpler to use and determines less complications. Bone substitutes may induce less gum retraction than Emdogain. No serious adverse reactions to Emdogain were reported in trials. [source]