Int J Periodontics Restorative Dent. 2024;44(1):71-79. doi: 10.11607/prd.6673.
The purpose of the present study was to describe a novel protocol for a minimally invasive pocket elimination surgery (MI-PES) in the posterior maxilla and mandible, which consists of the combined use of (1) an access flap based on an internally beveled gingivectomy with minimal to no papilla mobilization at the buccal aspect, and (2) a resective procedure with an apically positioned flap on the lingual aspect. The interproximal bone defects were accessed with a single (lingual) flap, and the bone architecture was modified by the adoption of piezoelectric inserts for controlled bone recontouring associated with fiber retention. Mean probing depth (PD) was 5.5 ± 0.8 mm before surgery and 2.7 ± 0.6 mm at the 6-month reevaluation. All treated pockets showed a postsurgical PD < 4 mm. Gingival recession (REC) was 0.3 ± 0.5 mm at baseline and increased to 1.6 ± 0.8 mm at 6 months. When buccal and lingual pockets were analyzed separately, a trend toward a similar PD reduction, less REC increase, and greater clinical attachment level gain was recorded for buccal pockets. These preliminary observations seem to support the use of MI-PES as a valuable option for pocket elimination, at least when residual pockets are associated with a shallow interproximal osseous crater in the posterior maxilla or mandible.
本研究的目的是描述一种用于上颌后牙区和下颌后牙区的微创袋内翻瓣切除术（MI-PES）的新方案，该方案结合了（1）一种基于内斜牙龈切除术的切口瓣，颊侧无需或仅需轻微移动乳头，以及（2）一种在舌侧采用有顶瓣的切除性手术。采用单个（舌侧）瓣进入邻间骨缺损，并采用压电插入物进行骨轮廓修整，以控制与纤维保留相关的骨重塑，从而改善骨结构。手术前平均探诊深度（PD）为 5.5 ± 0.8mm，6 个月复查时为 2.7 ± 0.6mm。所有治疗的牙周袋术后 PD<4mm。牙龈退缩（REC）在基线时为 0.3 ± 0.5mm，在 6 个月时增加到 1.6 ± 0.8mm。当颊侧和舌侧牙周袋分别进行分析时，发现颊侧牙周袋的 PD 降低更明显、REC 增加更少、临床附着水平增加更多，这一趋势具有统计学意义。这些初步观察结果似乎支持将 MI-PES 作为一种有价值的牙周袋消除方法，至少在残余牙周袋与上颌后牙或下颌后牙的浅邻间牙槽骨凹陷相关时如此。
