nach oben

Erschienen in:

01.07.2013 | Original Article

Early postoperative healing following buccal single flap approach to access intraosseous periodontal defects

verfasst von: Roberto Farina, Anna Simonelli, Alessandro Rizzi, Mattia Pramstraller, Alessandro Cucchi, Leonardo Trombelli

Erschienen in: Clinical Oral Investigations | Ausgabe 6/2013

Einloggen, um Zugang zu erhalten

Abstract

Aim

This study aims to evaluate the early postoperative healing of papillary incision wounds and its association with (1) patient/site-related factors and technical (surgical) aspects as well as with (2) 6-month clinical outcomes following buccal single flap approach (SFA) in the treatment of intraosseous periodontal defects.

Methods

Forty-three intraosseous defects in 35 patients were accessed with a buccal SFA alone or in combination with a reconstructive technology (graft, enamel matrix derivative (EMD), graft + EMD, or graft + membrane). Postoperative healing was evaluated at 2 weeks using the Early Wound-Healing Index (EHI).

Results

EHI ranged from score 1 (i.e., complete flap closure and optimal healing) to score 4 (i.e., loss of primary closure and partial tissue necrosis). SFA resulted in a complete wound closure at 2 weeks in the great majority of sites. A significantly more frequent presence of interdental contact point and interdental soft tissue crater, and narrower base of the interdental papilla were observed at sites with either EHI > 1 or EHI = 4 compared to sites with EHI = 1. No association between EHI and the 6-month clinical outcomes was observed.

Conclusions

At 2 weeks, buccal SFA may result in highly predictable complete flap closure.

Clinical relevance

Site-specific characteristics may influence the early postoperative healing of the papillary incision following SFA procedure. Two-week soft tissue healing, however, was not associated with the 6-month clinical outcomes.

Linghorne WJ, O'Connell DC (1950) Studies in the regeneration and reattachment of supporting structures of the teeth; soft tissue reattachment. J Dent Res 29:419–428PubMedCrossRef

Yumet JA, Polson AM (1985) Gingival wound healing in the presence of plaque-induced inflammation. J Periodontol 56:107–119PubMedCrossRef

Wikesjö UM, Nilvéus R (1990) Periodontal repair in dogs: effect of wound stabilization on healing. J Periodontol 61:719–724PubMedCrossRef

Haney JM, Nilvéus RE, McMillan PJ, Wikesjö UM (1993) Periodontal repair in dogs: expanded polytetrafluoroethylene barrier membranes support wound stabilization and enhance bone regeneration. J Periodontol 64:883–890PubMedCrossRef

Wikesjö UM, Nilvéus RE, Selvig KA (1992) Significance of early healing events on periodontal repair: a review. J Periodontol 63:158–165PubMedCrossRef

Polimeni G, Xiropaidis AV, Wikesjö UM (2006) Biology and principles of periodontal wound healing/regeneration. Periodontol 2000 41:30–47CrossRef

Hiatt WH, Stallard RE, Butler ED, Badgett B (1968) Repair following mucoperiosteal flap surgery with full gingival retention. J Periodontol 39:11–16PubMedCrossRef

Werfully S, Areibi G, Toner M, Bergquist J, Walker J, Renvert S, Claffey N (2002) Tensile strength, histological and immunohistochemical observations of periodontal wound healing in the dog. J Periodontal Res 37:366–374PubMedCrossRef

Wikesjö UM, Crigger M, Nilvéus R, Selvig KA (1991) Early healing events at the dentin-connective tissue interface. Light and transmission electron microscopy observations. J Periodontol 62:5–14PubMedCrossRef

10.

Trombelli L (2010) Flap design and suturing techniques to optimize reconstructive outcomes. In: Sculean A (ed) Periodontal regenerative therapy. Quintessence Publishing, New Malden, pp 241–258

11.

Trombelli L, Farina R (2012) Flap design for periodontal healing. In Larjava H (ed.) Oral wound healing: cell biology and clinical management, Publisher: Blackwell-Wiley, pp 229–241

12.

Wachtel H, Schenk G, Böhm S, Weng D, Zuhr O, Hürzeler MB (2003) Microsurgical access flap and enamel matrix derivative for the treatment of periodontal intrabony defects: a controlled clinical study. J Clin Periodontol 30:496–504PubMedCrossRef

13.

Trombelli L, Simonelli A, Pramstraller M, Wikesjö UME, Farina R (2010) Single flap approach with and without guided tissue regeneration and a hydroxyapatite biomaterial in the management of intraosseous periodontal defects. J Periodontol 81:1256–1263PubMedCrossRef

14.

Trombelli L, Simonelli A, Schincaglia GP, Cucchi A, Farina R (2012) Single flap approach for surgical debridement of deep intraosseous defects: a randomized controlled Trial. J Periodontol 83:27–35PubMedCrossRef

15.

Cortellini P, Tonetti MS (2011) 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 38:365–373PubMedCrossRef

16.

Cortellini P, Pini Prato G, Tonetti MS (1995) Periodontal regeneration of human intrabony defects with titanium reinforced membranes. A controlled clinical trial. J Periodontol 66:797–803PubMedCrossRef

17.

Cortellini P, Prato GP, Tonetti MS (1995) The modified papilla preservation technique. A new surgical approach for interproximal regenerative procedures. J Periodontol 66:261–266PubMedCrossRef

18.

Cortellini P, Pini Prato G, Tonetti MS (1996) The modified papilla preservation technique with bioresorbable barrier membranes in the treatment of intrabony defects. Case reports. Int J Periodontics Restorative Dent 16:546–559PubMed

19.

Cortellini P, Prato GP, Tonetti MS (1999) The simplified papilla preservation flap. A novel surgical approach for the management of soft tissues in regenerative procedures. Int J Periodontics Restorative Dent 19:589–599PubMed

20.

Cortellini P, Tonetti MS (2001) Microsurgical approach to periodontal regeneration. Initial evaluation in a case cohort. J Periodontol 72:559–569PubMedCrossRef

21.

Cortellini P, Tonetti MS (2005) Clinical performance of a regenerative strategy for intrabony defects: scientific evidence and clinical experience. J Periodontol 76:341–350PubMedCrossRef

22.

Cortellini P, Tonetti MS (2007) 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 34:87–93PubMedCrossRef

23.

Cortellini P, Tonetti MS (2007) Minimally invasive surgical technique and enamel matrix derivative in intra-bony defects. I: Clinical outcomes and morbidity. J Clin Periodontol 34:1082–1088PubMedCrossRef

24.

Cortellini P, Nieri M, Prato GP, Tonetti MS (2008) Single minimally invasive surgical technique with an enamel matrix derivative to treat multiple adjacent intra-bony defects: clinical outcomes and patient morbidity. J Clin Periodontol 35:605–613PubMedCrossRef

25.

Cortellini P, Tonetti MS (2009) Improved wound stability with a modified minimally invasive surgical technique in the regenerative treatment of isolated interdental intrabony defects. J Clin Periodontol 36:157–163PubMedCrossRef

26.

Trombelli L, Farina R, Franceschetti G (2007) Single flap approach in periodontal reconstructive surgery (article in Italian). Dental Cadmos 8:15–25

27.

Trombelli L, Farina R, Franceschetti G, Calura G (2009) Single flap approach with buccal access in periodontal reconstructive procedures. A case series. J Periodontol 80:353–360PubMedCrossRef

28.

O'Leary TJ, Drake RB, Naylor JE (1972) The plaque control record. J Periodontol 43:38PubMedCrossRef

29.

Trombelli L (2005) Which reconstructive procedures are effective for treating the periodontal intraosseous defect? Periodontol 2000(37):88–105CrossRef

30.

Velvart P (2002) Papilla base incision: a new approach to recession-free healing of the interdental papilla after endodontic surgery. Int Endod J 35:453–460PubMedCrossRef

31.

Vergara JA, Quiñones CR, Nasjleti CE, Caffesse RG (1997) Vascular response to guided tissue regeneration procedures using nonresorbable and bioabsorbable membranes in dogs. J Periodontol 68:217–224PubMedCrossRef

32.

Zanetta-Barbosa D, Klinge B, Svensson H (1993) Laser Doppler flowmetry of blood perfusion in mucoperiosteal flaps covering membranes in bone augmentation and implant procedures. A pilot study in dogs. Clin Oral Implants Res 4:35–38PubMedCrossRef

33.

Holm-Pedersen P, Löe H (1971) Wound healing in the gingiva of young and old individuals. Scand J Dent Res 79:40–53PubMed

34.

Ashcroft GS, Mills SJ, Ashworth JJ (2002) Ageing and wound healing. Biogerontology 3:337–345PubMedCrossRef

35.

Gosain A, DiPietro LA (2004) Aging and wound healing. World J Surg 28:321–326PubMedCrossRef

36.

Mörmann W, Meier C, Firestone A (1979) Gingival blood circulation after experimental wounds in man. J Clin Periodontol 6:417–424PubMedCrossRef

37.

Retzepi M, Tonetti M, Donos N (2007) Comparison of gingival blood flow during healing of simplified papilla preservation and modified Widman flap surgery: a clinical trial using laser Doppler flowmetry. J Clin Periodontol 34:903–911PubMedCrossRef

38.

Kohl JT, Zander HA (1961) Morphology of interdental gingival tissues. Oral Surg Oral Med Oral Pathol 14:287–295PubMedCrossRef

39.

Wirthlin MR, Yeager JE, Hancock EB, Gaugler RW (1980) The healing of gingival wounds in miniature swine. J Periodontol 51:318–327PubMedCrossRef

40.

Polson AM, Proye MP (1983) Fibrin linkage: a precursor for new attachment. J Periodontol 54:141–147PubMedCrossRef

41.

Trombelli L, Heitz-Mayfield LJ, Needleman I, Moles D, Scabbia A (2002) A systematic review of graft materials and biological agents for periodontal intraosseous defects. J Clin Periodontol 29(Suppl 3):117–135, discussion 160–162PubMedCrossRef

42.

Needleman IG, Worthington HV, Giedrys-Leeper E, Tucker RJ (2006) Guided tissue regeneration for periodontal infra-bony defects. Cochrane Database Syst Rev 19:CD001724

43.

Esposito M, Grusovin MG, Papanikolaou N, Coulthard P, Worthington HV (2009) Enamel matrix derivative (Emdogain(R)) for periodontal tissue regeneration in intrabony defects. Cochrane Database Syst Rev 7:CD003875

44.

Trombelli L, Farina R (2008) Clinical outcomes with bioactive agents alone or in combination with grafting or guided tissue regeneration. J Clin Periodontol 35(8 Suppl):117–135PubMedCrossRef

45.

Tu YK, Needleman I, Chambrone L, Lu HK, Faggion CM Jr (2012) A Bayesian network meta-analysis on comparisons of enamel matrix derivatives, guided tissue regeneration and their combination therapies. J Clin Periodontol 39:303–314PubMedCrossRef

46.

Selvig KA, Kersten BG, Chamberlain AD, Wikesjö UM, Nilvéus RE (1992) Regenerative surgery of intrabony periodontal defects using ePTFE barrier membranes: scanning electron microscopic evaluation of retrieved membranes versus clinical healing. J Periodontol 63:974–978PubMedCrossRef

47.

Sigurdsson TJ, Hardwick R, Bogle GC, Wikesjö UM (1994) Periodontal repair in dogs: space provision by reinforced ePTFE membranes enhances bone and cementum regeneration in large supraalveolar defects. J Periodontol 65:350–356PubMedCrossRef

48.

Trombelli L, Kim CK, Zimmerman GJ, Wikesjö UM (1997) Retrospective analysis of factors related to clinical outcome of guided tissue regeneration procedures in intrabony defects. J Clin Periodontol 24:366–371PubMedCrossRef

49.

Tonetti MS, Prato GP, Cortellini P (1996) Factors affecting the healing response of intrabony defects following guided tissue regeneration and access flap surgery. J Clin Periodontol 23:548–556PubMedCrossRef

50.

Tal H (1984) The prevalence and distribution of intrabony defects in dry mandibles. J Periodontol 55:149–154PubMedCrossRef

Titel: Early postoperative healing following buccal single flap approach to access intraosseous periodontal defects
verfasst von: Roberto Farina
Anna Simonelli
Alessandro Rizzi
Mattia Pramstraller
Alessandro Cucchi
Leonardo Trombelli
Publikationsdatum: 01.07.2013
Verlag: Springer-Verlag
Erschienen in: Clinical Oral Investigations / Ausgabe 6/2013
Print ISSN: 1432-6981
Elektronische ISSN: 1436-3771
DOI: https://doi.org/10.1007/s00784-012-0838-6

Bestellen Sie unseren kostenlosen Newsletter Update Zahnmedizin und bleiben Sie gut informiert – ganz bequem per eMail.

Newsletter bestellen

Springer Medizin

Early postoperative healing following buccal single flap approach to access intraosseous periodontal defects

Abstract