Minimally Invasive Non-surgical Vs. Surgical Approach for Periodontal Intrabony Defects: a Randomised Controlled Trial

Overview

Journal Trials

Publisher Biomed Central

Specialties General Medicine
Pharmacology

Date 2019 Jul 29

PMID 31351492

Citations 10

Authors

L Nibali

V Koidou

S Salomone

T Hamborg

R Allaker

R Ezra

L Zou

G Tsakos

N Gkranias

N Donos

Affiliations

Soon will be listed here.

Abstract

Background: Periodontal intrabony defects are usually treated surgically with the aim of increasing attachment and bone levels and reducing risk of progression. However, recent studies have suggested that a minimally invasive non-surgical therapy (MINST) leads to considerable clinical and radiographic defect depth reductions in intrabony defects. The aim of this study is to compare the efficacy of a modified MINST approach with a surgical approach (modified minimally invasive surgical therapy, M-MIST) for the treatment of intrabony defects.

Methods: This is a parallel-group, single-centre, examiner-blind non-inferiority randomised controlled trial with a sample size of 66 patients. Inclusion criteria are age 25-70, diagnosis of periodontitis stage III or IV (grades A to C), presence of ≥ 1 'intrabony defect' with probing pocket depth (PPD) > 5 mm and intrabony defect depth ≥ 3 mm. Smokers and patients who received previous periodontal treatment to the study site within the last 12 months will be excluded. Patients will be randomly assigned to either the modified MINST or the M-MIST protocol and will be assessed up to 15 months following initial therapy. The primary outcome of the study is radiographic intrabony defect depth change at 15 months follow-up. Secondary outcomes are PPD and clinical attachment level change, inflammatory markers and growth factors in gingival crevicular fluid, bacterial detection, gingival inflammation and healing (as measured by geometric thermal camera imaging in a subset of 10 test and 10 control patients) and patient-reported outcomes.

Discussion: This study will produce evidence about the clinical efficacy and potential applicability of a modified MINST protocol for the treatment of periodontal intrabony defects, as a less invasive alternative to the use of surgical procedures.

Trial Registration: ClinicalTrials.gov, NCT03797807. Registered on 9 January 2019.

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References

Hamp S, Nyman S, Lindhe J . Periodontal treatment of multirooted teeth. Results after 5 years. J Clin Periodontol. 1975; 2(3):126-35. DOI: 10.1111/j.1600-051x.1975.tb01734.x. View

LASTER L, Laudenbach K, Stoller N . An evaluation of clinical tooth mobility measurements. J Periodontol. 1975; 46(10):603-7. DOI: 10.1902/jop.1975.46.10.603. View

Cortellini P, Tonetti M . Focus on intrabony defects: guided tissue regeneration. Periodontol 2000. 2001; 22:104-32. DOI: 10.1034/j.1600-0757.2000.2220108.x. View

Papapanou P, Tonetti M . Diagnosis and epidemiology of periodontal osseous lesions. Periodontol 2000. 2001; 22:8-21. DOI: 10.1034/j.1600-0757.2000.2220102.x. View

Serino G, Rosling B, Ramberg P, Socransky S, Lindhe J . Initial outcome and long-term effect of surgical and non-surgical treatment of advanced periodontal disease. J Clin Periodontol. 2001; 28(10):910-6. DOI: 10.1034/j.1600-051x.2001.028010910.x. View

Tsakos G, Marcenes W, Sheiham A . Evaluation of a modified version of the index of Oral Impacts On Daily Performances (OIDP) in elderly populations in two European countries. Gerodontology. 2002; 18(2):121-30. DOI: 10.1111/j.1741-2358.2001.00121.x. View

Wachtel H, Schenk G, Bohm S, Weng D, Zuhr O, Hurzeler M . Microsurgical access flap and enamel matrix derivative for the treatment of periodontal intrabony defects: a controlled clinical study. J Clin Periodontol. 2003; 30(6):496-504. DOI: 10.1034/j.1600-051x.2003.00013.x. View

Paulander J, Wennstrom J, Axelsson P, Lindhe J . Some risk factors for periodontal bone loss in 50-year-old individuals. A 10-year cohort study. J Clin Periodontol. 2004; 31(7):489-96. DOI: 10.1111/j.1600-051X.2004.00514.x. View

Guerrero A, Griffiths G, Nibali L, Suvan J, Moles D, Laurell L . Adjunctive benefits of systemic amoxicillin and metronidazole in non-surgical treatment of generalized aggressive periodontitis: a randomized placebo-controlled clinical trial. J Clin Periodontol. 2005; 32(10):1096-107. DOI: 10.1111/j.1600-051X.2005.00814.x. View

10.

Needleman I, Worthington H, Giedrys-Leeper E, Tucker R . Guided tissue regeneration for periodontal infra-bony defects. Cochrane Database Syst Rev. 2006; (2):CD001724. DOI: 10.1002/14651858.CD001724.pub2. View

11.

Cortellini P, Tonetti M . A minimally invasive surgical technique with an enamel matrix derivative in the regenerative treatment of intra-bony defects: a novel approach to limit morbidity. J Clin Periodontol. 2007; 34(1):87-93. DOI: 10.1111/j.1600-051X.2006.01020.x. View

12.

Cortellini P, Tonetti M . Improved wound stability with a modified minimally invasive surgical technique in the regenerative treatment of isolated interdental intrabony defects. J Clin Periodontol. 2009; 36(2):157-63. DOI: 10.1111/j.1600-051X.2008.01352.x. View

13.

Papapanou P, Wennstrom J . The angular bony defect as indicator of further alveolar bone loss. J Clin Periodontol. 1991; 18(5):317-22. DOI: 10.1111/j.1600-051x.1991.tb00435.x. View

14.

Nibali L, Pometti D, Tu Y, Donos N . Clinical and radiographic outcomes following non-surgical therapy of periodontal infrabony defects: a retrospective study. J Clin Periodontol. 2010; 38(1):50-7. DOI: 10.1111/j.1600-051X.2010.01648.x. View

15.

Locker D, Quinonez C . To what extent do oral disorders compromise the quality of life?. Community Dent Oral Epidemiol. 2010; 39(1):3-11. DOI: 10.1111/j.1600-0528.2010.00597.x. View

16.

Ribeiro F, Casarin R, Palma M, Junior F, Sallum E, Casati M . 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. 2011; 82(9):1256-66. DOI: 10.1902/jop.2011.100680. View

17.

Cortellini P, Tonetti M . Clinical and radiographic outcomes of the modified minimally invasive surgical technique with and without regenerative materials: a randomized-controlled trial in intra-bony defects. J Clin Periodontol. 2011; 38(4):365-73. DOI: 10.1111/j.1600-051X.2011.01705.x. View

18.

Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D . Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011; 20(10):1727-36. PMC: 3220807. DOI: 10.1007/s11136-011-9903-x. View

19.

Mishra A, Avula H, Pathakota K, Avula J . Efficacy of modified minimally invasive surgical technique in the treatment of human intrabony defects with or without use of rhPDGF-BB gel: a randomized controlled trial. J Clin Periodontol. 2012; 40(2):172-9. DOI: 10.1111/jcpe.12030. View

20.

Heitz-Mayfield L, Lang N . Surgical and nonsurgical periodontal therapy. Learned and unlearned concepts. Periodontol 2000. 2013; 62(1):218-31. DOI: 10.1111/prd.12008. View