Periodontal microsurgery: Reaching new heights of precision

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Abstract

The use of magnification to perform various procedures in medical and dental field, particularly endodontics has long been recognized. Unfortunately, its application in periodontics is not widely popularized. The objective of this article is to emphasize the application of microsurgical principles in various periodontal surgical procedures and to reinforce the incorporation of microscope into periodontal practice. The most recent periodontal journals were reviewed and a search of databases such as PubMed or Medline and Google Scholar was conducted for relevant material from published literature up to 2017. Medical Subject Headings words looked for were “periodontal microsurgery” and “minimally invasive periodontal surgery.” The available literature, specifically to periodontal surgical procedures was analyzed and compiled. The analysis indicates that incorporation of magnification in periodontal practice is associated with improved visual acuity, ergonomic benefits, decreased patient morbidity, rapid healing, and enhanced patient acceptance.

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Most cited references 76

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A long-term survey of tooth loss in 600 treated periodontal patients.

Paula B. Wasserman, L HIRSCHFELD (1978)

1. Six hundred patients in a private periodontal practice were reexamined an average of 22 years after their active treatment and the patterns of tooth loss were observed. 2. During the post-treatment period, 300 patients had lost no teeth from periodontal disease, 199 had lost one to three teeth, 76 had lost 4 to 9 teeth and 25 had lost 10 to 23 teeth. 3. Of 2,139 teeth that originally had been considered of questionable prognosis, 666 were lost. Of these, 394 were lost by one sixth of the patients and only 272 by the other five-sixths. 4. Of 1,464 teeth which originally had furcation involvements, 460 were lost, 240 of them by one-sixth of the patients who deteriorated most. 5. The mortality of teeth which were treated with periodontal surgery was compared with that of teeth which did not have surgery. Tooth retention seemed more closely related to the case type than the surgery performed. 6. In general, periodontal disease is bilaterally symmetrical and there is a predictable order of likelihood of tooth loss according to position in the arch.

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Long-term maintenance of patients treated for advanced periodontal disease.

J Lindhe, Jeffry S. Nyman (1984)

The aim of the present investigation was to evaluate the periodontal conditions of a group of patients who, following active treatment of extremely advanced periodontal disease, had been maintained for 14 years in a well-supervised maintenance care program. The present sample included 61 subjects out of an initial group of 75 individuals who in 1969 were referred to and treated by the authors. Following an initial examination, the patients were given detailed instructions in proper plaque control measures and were subjected to scaling and root planning and surgical elimination of pathologically deepened pockets. After the termination of the active treatment phase, the patients were placed in a maintenance care program including recall appointments every 3-6 months. At the initial examination, immediately after the completion of the active treatment phase and then once a year, all patients were examined regarding oral hygiene, gingival conditions, probing depths and clinical attachment levels. In addition, the interproximal alveolar bone height was determined from full mouth radiographs obtained before active treatment, at the completion of active therapy and 1, 3, 5, 8, 10, 12 and 14 years after treatment. The results from the repeated examinations demonstrated that treatment of advanced forms of periodontal disease resulted in clinically healthy periodontal conditions and that this state of "periodontal health" could be maintained in most patients and sites over a period of 14 years. It was also demonstrated that the treatment and maintenance programs described were equally effective in young and older patients. The individual mean values describing probing depths, attachment levels, and bone heights did not vary significantly over the 14 years of observation. A more detailed analysis of the data revealed, however, that a small number of sites in a few patients lost a substantial amount of attachment. This attachment loss occurred at different time intervals during the course of the maintenance period. Thus, 43 surfaces in 15 different patients were exposed to recurrent periodontal disease of a significant magnitude. This recurrent inflammatory periodontal disease caused the loss of 16 teeth in 7 different patients during the maintenance period. The data reported question the validity of using individual mean values to describe alterations of the periodontal conditions during maintenance following active periodontal therapy.

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Long-term effect of surgical/non-surgical treatment of periodontal disease.

J Lindhe, Anne D. Haffajee, E Westfelt … (1984)

The present investigation describes the effect of periodontal therapy in a group of patients who, following active treatment, were monitored over a 5-year period. One aim of the study was to analyze the rôle played by the patients' self-performed plaque control in preventing recurrent periodontitis. In addition, probing depth and attachment level alterations were studied separately for sites with initial probing depths of greater than or equal to 4 mm which were treated initially by either surgical or non-surgical procedures. Following active treatment (surgical/non-surgical), the patients were maintained on a plaque control regimen for 6 months, which included professional tooth cleaning once every 2 weeks. During the subsequent 18 months, the interval between the recall appointments was extended to 12 weeks and included prophylaxis as well as oral hygiene instruction. Following the 24-month examination, the interval between the recall appointments was further extended, now to 4-6 months. In addition, the maintenance program was restricted to oral hygiene instruction and professional, supragingival tooth cleaning, but further subgingival instrumentation was avoided. Clinical examinations including assessments of the oral hygiene, the gingival conditions, the probing depths and the attachment levels were performed at Baseline and after 24 and 60 months after completion of active therapy. Assessments of plaque and gingivitis were repeated annually. The results of the examinations showed that the patients' standard of self-maintained oral hygiene had a decisive influence on the long-term effect of treatment. Patients who during the 5 years of monitoring consistently had a high frequency of plaque-free tooth surfaces showed little evidence of recurrent periodontal disease, while patients who had a low frequency of plaque-free tooth surfaces had a high frequency of sites showing additional loss of attachment. The present findings demonstrated that sites with an initial pocket depth exceeding 3 mm responded equally well to non-surgical and surgical treatments. This statement is based on probing depth and attachment level data from sites which were free of plaque at the 6-, 12-, 24-, 36-, 48-, and 60-month reexaminations. It is suggested that the critical determinant in periodontal therapy is not the technique (surgical or non-surgical) that is used for the elimination of the subgingival infection, but the quality of the debridement of the root surface.

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Author and article information

Journal

Journal ID (nlm-ta): J Indian Soc Periodontol

Journal ID (iso-abbrev): J Indian Soc Periodontol

Journal ID (publisher-id): JISP

Title: Journal of Indian Society of Periodontology

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 0972-124X

ISSN (Electronic): 0975-1580

Publication date (Print): Jan-Feb 2018

Volume: 22

Issue: 1

Pages: 5-11

Affiliations

[1] Division of Periodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India

[1 ] Department of Periodontics, Surendera Dental College and Research Institute, Sriganganagar, Rajasthan, India

[2 ] Department of Prosthodontics, Surendera Dental College and Research Institute, Sriganganagar, Rajasthan, India

Author notes

Address for correspondence: Dr. Anu Bhatia, 5 ^th Floor, Division of Periodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi - 110 029, India. E-mail: bhatiaanu01@ 123456gmail.com

Article

Publisher ID: JISP-22-5

DOI: 10.4103/jisp.jisp_364_17

PMC ID: 5855270

PubMed ID: 29568165

SO-VID: 5d7db0b1-9c1d-4c4d-99d4-3099cd3f3535

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Periodontal microsurgery: Reaching new heights of precision

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Arab Journal of Forensic Sciences & Forensic Medicine (AJFSFM)

Most cited references 76

A long-term survey of tooth loss in 600 treated periodontal patients.

Long-term maintenance of patients treated for advanced periodontal disease.

Long-term effect of surgical/non-surgical treatment of periodontal disease.

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