Treatment of intrabony defects.

New attachment of periodontal tissues can be obtained following surgical treatment of intrabony pockets. To day flap procedures with complete surgical opening to the defect and removal of all soft material from the intrabony lesion often followed by bone transplantation constitute the accepted approach to obtain a new connective tissue attachment. However, since the epithelium of elevated full thickness flaps are well preserved, the placement of these flaps adjacent to the treated areas facilitate the migration of epithelium into the defects. In a search for means to retard epithelial proliferation into the defects, disintegration of epithelium of free gingival grafts within the first days following transplantation might possibly be utilized in new attachment attempts. It has been demonstrated in three-wall intrabony defects in monkeys and in humans, that if the intrabony defect is covered with a free transplantat following a split flap procedure the epithelial migration into the defect will be delayed. This procedure resulted in a greater amount of new attachment when compared with traditional flap surgery and less residual pockets. The succes of new attachment procedures is directly related to the abscense of plaque in the area where regeneration takes place. Without absolute plaque control a further loss of attachment can be seen.