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The ultimate goal of regenerative periodontal therapy is to completely restore lost periodontal attachment Characterized by formation of new root cementum with inserting collagen fibres, new periodontal ligament and new alveolar bone (Karring et al. 2003).
Microbiological contamination of barrier membranes have been associated with compromised clinical outcomes, leading to a reduced gain in clinical attachment level
To prevent these complications the most important element is to Achieve and maintain primary soft tissue closure in particular in the inter-dental area.
Thus modified flap designs allowing access to the defect area while preserving the interdental papilla have been recently developed and used Narrow interdental spaces hinders primary flap closure due to crowding or tooth migration
A MODIFIED SURGICAL APPROACH FOR GTR TO MAINTAIN THE INTEGRITY OF INTERPROXIMAL SOFT TISSUE ABOVE INTRA-BONY DEFECTS.
Informed consent
A single infrabony defect in the
Case Report
Pre-operative
Bone Defect
Intrasulcular incision
Vertical Incision
Preparation of the Internal Pedicle Flap, at the base of the buccal flap a horizontal incision is performed
The Internal pedicle flap is elevated from the base of the flap in a coronal direction
CLINICAL RESULTS
2 1.8 1.6 Group 1 Group 2 Group 3 Group 4
1.4
1.2 1 0.8 0.6 0.4 0.2 0
Base line
Fig 1.
3
Group 1 Group 2 Group 3 Group 4
2.5
1.5
0.5
Base line
Figure 2
0.35
0.3 0.25 0.2 0.15 0.1 0.05 0
Base line
Fig 3.
5.5 0.62 5.8 0.73 5.4 0.59 5.8 1.00 3,9 0.84 3.6 0.78
5.7 1.06 5.9 0.70 5.6 0.77 5.5 0.74 3.5 0.96 4.6 1.0 3.4 0.80 5.2 0.77
Gp 1
Gp 2
Gp 3
Gp 4
3 wks after 5.9 1.03 6.0 0.742 6.4 0.83 6.0 0.91 1st step 6 mths after 4.8 0.83 4.3 0.74 4.4 1.0 5.7 0.96 2nd step 24 mths 5.1 0.90 4.0 1.07 4.2 0.87 5.9 0.76 after 2nd step
8.0 1.00 8.1 0.93 4.2 1.06 5.9 1.19 3.6 0.98 7.0 1.03
3 wks after 9.6 1.1 1st step 6 mths after 8.1 0.83 2nd step 24 mths 8.7 1.02 after 2nd step
9.0 0.98
8.2 0.77 9.1 1.23
CF CELL RESULTS
3 Group 1 Group 2 Group 3 Group 4
2.5
1.5
0.5
Base line
Figure 2
Base line
MICROBACTERIAL RESULTS
Positive samples of P gingivalis
Time
Baseline 3 wks after 1st step
Gp 1
10(83%)
Gp 2
11(73%)
Gp 3
8(73%)
Gp 4
9(90%) 8(80%)
6 mths after 3(25%) 2nd step 24 mths 7(58%) after 2nd step
0(0%)
0(0%)
2(18%)
1(9%)
4(40%)
7(70%)
Positive sample of Aa
Time Baseline
Gp 1 3(25%)
Gp 2 6(40%)
Gp 3 5(45%)
Gp 4 4(40%)
3 wks after 4(33%) 1st step 6 mths after 2(16%) 2nd step 24 mths 4(33%) after 2nd step
5(33%)
1(6%) 0(0%)
3(27%)
1(9%) 1(9%)
3(30%)
4(40%) 3(30%)
No antibiotic sensitivity test done No comparison of LDD Bacterial Resistance not addressed