Anna Simonelli

Single flap approach with and without guided tissue regeneration and a hydroxyapatite biomaterial in the management of intraosseous periodontal defects

BACKGROUND The single flap approach (SFA) is a minimally invasive procedure designed for periodontal reconstructive procedures of intraosseous periodontal defects characterized by a dominant unilateral, buccal or oral, extension. This study evaluates the adjunctive effect of guided tissue regeneration (GTR) combined with a hydroxyapatite (HA) biomaterial in the management of intraosseous periodontal defects accessed with SFA compared to SFA alone. METHODS Twenty-four intraosseous defects (in 24 patients) were randomly allocated to treatment with SFA or SFA + HA/GTR. Clinical outcomes were assessed 6 months post-surgery. RESULTS Five sites in the SFA + HA/GTR group showed incomplete closure at week 2, which resolved spontaneously. There were no statistically significant or clinically meaningful differences in mean (+/-SD) clinical attachment gain (4.7 +/- 2.5 versus 4.4 +/- 1.5 mm), probing depth reduction (5.3 +/- 2.4 versus 5.3 +/- 1.5 mm), and gingival recession increase (0.4 +/- 1.4 versus 0.8 +/- 0.8 mm) between the SFA + HA/GTR and SFA groups. CONCLUSIONS SFA with and without HA/GTR seems to be a valuable minimally invasive approach in the treatment of deep intraosseous periodontal defects. Under the present experimental conditions, the additional HA/GTR protocol offers no significant adjunctive effect.

Single-Flap Approach for Surgical Debridement of Deep Intraosseous Defects: A Randomized Controlled Trial

BACKGROUND The single-flap approach (SFA) consists of the elevation of a limited mucoperiosteal flap to allow surgical access to periodontal defects from either the buccal or oral aspect only, leaving the interproximal supracrestal gingival tissues intact. The aim of the present randomized controlled trial is to assess the effectiveness of a buccal SFA used for the surgical debridement of deep intraosseous defects compared to the double-flap approach (DFA). METHODS Fourteen patients were treated according to SFA principles and 14 patients received the DFA. In all patients, root surfaces and defects were thoroughly debrided, and conditions for the primary intention healing and blood clot stability were ensured by a proper flap design and suture technique. The clinical attachment level (CAL), probing depth (PD), and gingival recession (REC) were assessed immediately before surgery and at 6 months post-surgery. RESULTS The results of the study indicate that: 1) the SFA and DFA resulted in significant CAL gains and PD reductions at 6 months post-surgery; and 2) the SFA was similarly effective compared to the DFA in terms of CAL gain and PD reduction. CONCLUSION The surgical debridement of intraosseous periodontal defects resulted in comparable, substantial CAL gains and PD reductions as well as limited postoperative REC increases when defects were accessed with the SFA or DFA.

Age-related treatment response following non-surgical periodontal therapy

BACKGROUND To date, no studies have evaluated the effect of patient age on the treatment response following non-surgical periodontal therapy (NSPT). AIM To evaluate the outcomes of NSPT in two cohorts of patients with a substantial age difference. MATERIALS AND METHODS Two groups of periodontitis patients with a substantial age difference (younger group, Y, and older group, O) were retrospectively selected. The effectiveness of NSPT was assessed by evaluating the changes in the prevalence of sites with different pocket probing depths (PPD) as well as the changes in patient- and site-specific bleeding on probing (BoP) scores. RESULTS Y group comprised 57 patients, mean age: 34.7 +/- 4.4 years, and O group comprised 60 patients, mean age: 58.9 +/- 5.3 years (p<0.0001). NSPT resulted in a significant improvement of PPD and BoP in both age groups. No statistically significant inter-group differences were observed in the investigated clinical parameters as well as their changes with respect to pre-treatment. However, multiple regression analysis showed a significantly higher risk of showing residual pockets following treatment in group O. CONCLUSIONS The results of the present study seem to indicate that age has a limited effect on treatment response following NSPT in periodontitis patients.

Single-Flap Approach in Combination with Enamel Matrix Derivative in the Treatment of Periodontal Intraosseous Defects

Twenty-four periodontal intraosseous defects were accessed with a buccal single-flap approach (SFA) and treated with enamel matrix derivative (EMD) or EMD + deproteinized bovine bone mineral (DBBM) according to the surgeon,s discretion. EMD with or without DBBM was clinically effective in the treatment of periodontal intraosseous defects accessed with a buccal SFA. The adjunctive use of DBBM in predominantly one-wall defects seemed to compensate for, at least in part, the unfavorable osseous characteristics in terms of the outcomes of the procedure.

Single versus double flap approach in periodontal regenerative treatment.

AIM to compare the outcomes of a regenerative strategy based on recombinant human platelet-derived growth factor-BB (rhPDGF-BB, 0.3 mg/ml) and β-tricalcium phosphate (β-TCP) in the treatment of intraosseous defects accessed with the Single Flap Approach (SFA) versus Double Flap Approach based on papilla preservation techniques (DFA). MATERIALS AND METHODS Fifteen and 13 defects, randomly assigned to SFA or DFA, respectively, were grafted with rhPDGF-BB + β-TCP. Probing parameters were assessed before and 6 months after surgery. Pain (VAS(pain)) was self-reported using a visual analogue scale. RESULTS Twelve SFA sites and DFA 6 sites showed complete flap closure at 2 weeks post-surgery. No significant differences in 6-month changes in probing parameters and radiographic defect fill were found between groups. Significantly lower VAS(pain) was observed in SFA group compared to DFA group at day +1, +2 and +6. A significantly greater number of analgesics were consumed in the DFA group compared to the SFA group at day +1. CONCLUSIONS When combined with rhPDGF-BB and β-TCP, the SFA may result in similar clinical outcomes, better quality of early wound healing, and lower pain and consumption of analgesics during the first postoperative days compared to the DFA.

Change in the Gingival Margin Profile After the Single Flap Approach in Periodontal Intraosseous Defects

BACKGROUND The aim of the present study is to evaluate the association of patient-related and site-specific factors, as well as the adopted treatment modality, with the change in buccal (bREC) and interdental (iREC) gingival recession observed at 6 months after treatment of periodontal intraosseous defects with the single flap approach (SFA). METHODS Sixty-six patients contributing 74 intraosseous defects accessed with a buccal SFA and treated with different modalities were selected retrospectively. A two-level (patient and site) model was constructed, with the 6-month changes in bREC and iREC as the dependent variables. RESULTS (1) Significant 6-month increases in bREC (-0.6 ± 0.7 mm) and iREC (-0.9 ± 1.1 mm) were observed. (2) bREC change was significantly predicted by presurgery interproximal probing depth (PD) and depth of osseous dehiscence at the buccal aspect. (3) iREC change was significantly predicted by presurgery interproximal PD and the treatment modality, with defects treated with SFA in combination with a graft material and a bioactive agent being less prone to iREC increase compared to defects treated with SFA alone. CONCLUSIONS After buccal SFA, greater post-surgery increase in bREC must be expected for deep intraosseous defects associated with a buccal dehiscence. The combination of a graft material and a bioactive agent in adjunct to the SFA may limit the postoperative increase in iREC.

Effect of a Connective Tissue Graft in Combination With a Single Flap Approach in the Regenerative Treatment of Intraosseous Defects

BACKGROUND In the attempt to limit the post-surgery increase in buccal gingival recession (bREC), effect of a connective tissue graft (CTG) when combined with a buccal single flap approach (SFA) in the regenerative treatment of intraosseous defects is evaluated. METHODS Data related to 30 patients with an intraosseous defect treated with a buccal SFA with (SFA+CTG group; n = 15) or without (SFA group; n = 15) placement of a CTG and regenerative treatment were retrospectively derived at three clinical centers. bREC and probing parameters were assessed at presurgery and 6 months post-surgery. RESULTS In addition to a significant attachment gain and probing depth reduction, adjunctive use of a CTG to a buccal SFA in the regenerative treatment of periodontal intraosseous defects associated with a buccal bone dehiscence resulted in a limited post-surgery bREC, a lower prevalence of defects with a clinically detectable apical displacement of the gingival margin, and an increase in gingival width and thickness. CONCLUSION Adjunctive use of a CTG in the regenerative treatment of intraosseous defects associated with buccal bone dehiscence accessed by buccal SFA may support the stability of the gingival profile.BACKGROUND In the attempt to limit the post-surgery increase in buccal gingival recession (bREC), effect of a connective tissue graft (CTG) when combined with a buccal single flap approach (SFA) in the regenerative treatment of intraosseous defects is evaluated. METHODS Data related to 30 patients with an intraosseous defect treated with a buccal SFA with (SFA+CTG group; n = 15) or without (SFA group; n = 15) placement of a CTG and regenerative treatment were retrospectively derived at three clinical centers. bREC and probing parameters were assessed at presurgery and 6 months post-surgery. RESULTS In addition to a significant attachment gain and probing depth reduction, adjunctive use of a CTG to a buccal SFA in the regenerative treatment of periodontal intraosseous defects associated with a buccal bone dehiscence resulted in a limited post-surgery bREC, a lower prevalence of defects with a clinically detectable apical displacement of the gingival margin, and an increase in gingival width and thickness. CONCLUSION Adjunctive use of a CTG in the regenerative treatment of intraosseous defects associated with buccal bone dehiscence accessed by buccal SFA may support the stability of the gingival profile.

Regenerative Periodontal Treatment with the Single Flap Approach in Smokers and Nonsmokers

The present study was performed to evaluate the impact of smoking status on 6-month clinical outcomes of a regenerative procedure based on enamel matrix derivative and deproteinized bovine bone mineral in the treatment of intraosseous defects accessed with buccal single flap approach. A total of 22 defects were selected in smoking (n = 11) and nonsmoking (n = 11) patients. Regenerative treatment resulted in similar clinical attachment level (CAL) gain in both smokers and nonsmokers. A trend toward lower 6-month CAL gain and probing depth reduction was observed in patients smoking 11 to 20 cigarettes per day compared to those smoking 1 to 10 cigarettes per day.

Esiti clinici e complicanze postoperatorie della chirurgia mucogengivale in un caso di malattia di von Willebrand di tipo I

Riassunto Obiettivi Descrivere gli esiti clinici e le complicanze postoperatorie del trattamento chirurgico di recessioni gengivali in un paziente affetto da malattia di von Willebrand (von Willebrand Disease, vWD) di tipo I. Materiali e metodi Due recessioni gengivali, Classe I di Miller, di origine traumatica e localizzate sugli elementi 2.3 e 4.3 sono state trattate utilizzando una tecnica bilaminare. In corrispondenza del sito 2.3 e stato preparato un lembo a busta a spessore parziale. Un innesto epitelio-connettivale e stato prelevato dall’emipalato sinistro, adattato all’interno del sito ricevente e stabilizzato con suture riassorbibili 6/0. In corrispondenza del sito 4.3 e stato creato un lembo a spessore parziale. Un innesto di tessuto epitelio-connettivale e stato prelevato dall’emipalato destro e fissato al letto ricevente. Il lembo e stato poi avanzato coronalmente e suturato. Il paziente, al momento della chirurgia, non era consapevole di essere affetto da vWD di tipo I. Risultati Complicanze di natura emorragica si sono verificate soprattutto in corrispondenza delle aree palatine nei 7 giorni successivi alla chirurgia. A distanza di 7 e 15 giorni dalla chirurgia risultava evidente un processo di guarigione rallentato, in particolare in corrispondenza dei siti donatori palatini. Test di laboratorio sono stati condotti con lo scopo di verificare l’eventuale presenza di un disordine ematologico. E stata formulata una diagnosi di vWD di tipo I. Alla visita di rivalutazione, un anno dopo la chirurgia, e stato ottenuta una copertura radicolare da parziale a completa associata a un incremento del tessuto cheratinizzato dei siti trattati chirurgicamente. Conclusioni La chirurgia mucogengivale puo essere eseguita con successo in pazienti affetti da vWD di tipo I. Gli episodi emorragici possono rappresentare una complicanza rilevante nel primo periodo postoperatorio.