Cortellini Pierpaolo, Tonetti Maurizio S
J Clin Periodontol. 2009 Feb;36(2):157-63. doi: 10.1111/j.1600-051X.2008.01352.x.
This paper describes a modified surgical approach of the minimally invasive surgical technique (modified minimally invasive surgical technique, M-MIST) and preliminarily evaluates its applicability and clinical performances in the treatment of isolated deep intrabony defects in combination with amelogenins.
Twenty deep isolated intrabony defects in 20 patients were studied. Fifteen were surgically accessed with the M-MIST, while in five sites, which presented a lingual intrabony component, the conventional MIST had to be applied. The M-MIST consisted of a buccal incision of the defect-associated papilla, according to the principles of the papilla preservation techniques. Only a buccal flap was raised while the interdental papilla was left in situ. The granulation tissue filling the defect was dissected and removed, leaving the interdental and palatal tissues untouched. Root instrumentation and application of the regenerative material were performed before suturing. Primary closure of the flaps was attained with a single internal modified mattress suture. Surgery was performed with the aid of an operating microscope and microsurgical instruments.
The surgical chair-time of the M-MIST-treated sites (N=15) was 56+/-8.64 min. Early wound healing was uneventful: primary wound closure was attained and maintained in all sites. No oedema or haematoma was noted. Patients did not report pain or discomfort. The 1-year clinical attachment level (CAL) gain was 4.5+/-1.4 mm in defects 6+/-1.5 mm deep. Residual probing depths (PDs) were 3.1+/-0.6 mm. A minimal increase of 0.1+/-0.3 mm in gingival recession between baseline and 1 year was observed.
M-MIST was applicable on 15 isolated interproximal defects out of 20 selected ones. It resulted in very limited patient morbidity and excellent clinical improvements. These outcomes should be confirmed in a larger study.
本文描述了一种改良的微创手术技术（改良微创外科技术，M-MIST），并初步评估其在联合应用釉原蛋白治疗孤立性深部骨内缺损中的适用性和临床效果。
研究了20例患者的20个深部孤立性骨内缺损。其中15个采用M-MIST进行手术治疗，而在5个存在舌侧骨内成分的部位，不得不采用传统的MIST。M-MIST包括根据乳头保留技术的原则对与缺损相关的乳头进行颊侧切口。仅掀起颊侧瓣，而将牙间乳头留在原位。切除并去除填充缺损的肉芽组织，不触及牙间和腭部组织。在缝合前进行牙根器械操作和应用再生材料。通过单根内部改良褥式缝合实现瓣的一期关闭。手术在手术显微镜和显微外科器械的辅助下进行。
M-MIST治疗部位（N = 15）的手术椅旁时间为56±8.64分钟。早期伤口愈合顺利：所有部位均实现并维持了一期伤口关闭。未观察到水肿或血肿。患者未报告疼痛或不适。在深度为6±1.5毫米的缺损中，1年临床附着水平（CAL）增加4.5±1.4毫米。残余探诊深度（PDs）为3.1±0.6毫米。观察到基线至1年期间牙龈退缩仅轻微增加0.1±0.3毫米。
M-MIST适用于20个选定缺损中的15个孤立性邻间缺损。它导致患者发病率非常有限且临床改善良好。这些结果应在更大规模的研究中得到证实。
