Thamaraiselvan Murugan, Narayan Siddharth, Soundarajan Subasree
Department of Periodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India.
Contemp Clin Dent. 2022 Apr-Jun;13(2):101-107. doi: 10.4103/ccd.ccd_1046_20. Epub 2022 Jun 21.
Minimally invasive therapeutic approaches have become the standard of care for many medical procedures. Conventional periodontal surgical therapies involve extensive tissue reflection, resulting in increased morbidity which stands to reason out that Minimally invasive surgery (MIS) approach for periodontal therapy would result in less morbidity and better esthetics for the patient. Thus, the aim of this review is to assess the clinical efficacy of MIS periodontal therapy compared to conventional access flap surgery for the treatment of intrabony periodontal defects.
An electronic and manual search was done to identify and collect studies evaluating MIS periodontal therapy for the treatment of intrabony periodontal defects in terms of periodontal probing depth (PPD) reduction, clinical attachment level (CAL) gain, and gingival recession (REC) with a minimum of 6 month follow-up published in English. Six studies which satisfied the inclusion criteria were included for the review and the data extracted.
The six included studies contributed to a total of 193 patients who underwent 93 MIS therapies for treating intrabony defects with at least a 6-month follow-up. Clinical evaluation showed a PPD reduction ranging from 3.55 ± 0.88 mm to 5.2 ± 1.6 mm, while CAL gain ranged from 2.82 ± 1.19 mm to 4.5 ± 1.1 mm, while the change in gingival margin level ranged from 0.06 mm to 0.5 mm. Only one study directly compared single flap approach (SFA) (a type of MIS) to double flap approach (papilla preservation flap) which reported PPD reduction and CAL gain to be better in SFA.
Even though the above evidence compels us to believe that minimally invasive periodontal surgery is less invasive, less time consuming, and less morbid, the lack of enough studies directly comparing MIS with conventional access flap surgeries suggest that these conclusions are arbitrary. Thus, there is currently an absence of adequate evidence to substantiate the beneficial effect of minimally invasive periodontal surgical approach compared to a conventional access flap surgery for the treatment of intrabony periodontal defects.
微创治疗方法已成为许多医疗程序的标准治疗方式。传统的牙周手术治疗需要广泛的组织翻瓣，导致发病率增加，因此可以推断，牙周治疗的微创手术方法对患者而言将导致更低的发病率和更好的美观效果。因此，本综述的目的是评估与传统翻瓣手术相比，微创牙周治疗对治疗骨内牙周缺损的临床疗效。
通过电子检索和手工检索，以识别和收集评估微创牙周治疗对骨内牙周缺损治疗效果的研究，这些研究需用英文发表，且至少随访6个月，内容涉及牙周探诊深度（PPD）降低、临床附着水平（CAL）增加和牙龈退缩（REC）情况。纳入6项符合纳入标准的研究进行综述并提取数据。
这6项纳入研究共涉及193例患者，他们接受了93次微创治疗以治疗骨内缺损，且至少随访6个月。临床评估显示，PPD降低范围为3.55±０.88毫米至5.2±1.6毫米，CAL增加范围为2.82±1.１9毫米至4.5±1.1毫米，牙龈边缘水平变化范围为0.06毫米至0.5毫米。只有一项研究直接比较了单瓣法（一种微创方法）和双瓣法（乳头保留瓣），结果显示单瓣法在PPD降低和CAL增加方面效果更好。
尽管上述证据使我们相信微创牙周手术的侵入性更小、耗时更少且发病率更低，但缺乏足够的直接比较微创治疗与传统翻瓣手术的研究，这表明这些结论是随意得出的。因此，目前缺乏充分证据来证实与传统翻瓣手术相比，微创牙周手术方法对治疗骨内牙周缺损具有有益效果。
