Raj Subash Chandra, Tabassum Shaheda, Mohanty Devapratim, Katti Neelima, Baral Debajani, Sil Swoyangprava
Department of Periodontics, SCB Dental College and Hospital, Cuttack, Odisha, India.
Int J Health Sci (Qassim). 2024 Jul-Aug;18(4):5-13.
The aim of the present study is to evaluate and compare healing outcomes, probing pocket depth (PPD) reduction, clinical attachment, and alveolar bone level following Modified Widman Flap (MWF) with and without 4× prismatic loupe in infrabony pockets.
Patients having at least one infrabony pocket with PPD ≥5 mm and angular bone loss ≥3 mm bilaterally were randomly assigned to a microsurgical (test) group with MWF using 4× magnifying loupes and conventional (control) group by MWF only. At baseline, 3 and 6 months plaque index, bleeding index, PPD, and relative clinical attachment level were taken. The healing outcome was evaluated with a healing index by Landry. Pain score was assessed with Visual Analog Scale (VAS). The percentage of defect depth (DD) reduction was assessed by cone beam computed tomography (CBCT) and periapical radiograph. Continuous data between groups were analyzed using an unpaired "t" test. Within-group comparison was done using repeated measures analysis of variance followed by multiple pairwise comparisons and paired "t" test.
There was a statistically significant ( = 0.004) reduction in intrabony DD in each group evaluated through CBCT. The mean VAS score after 1 week of surgical procedure was 3.67 at the conventional site compared to 2.9 at the microsurgical site, which was statistically significant ( = 0.004). Statistically significant ( ≤ 0.05) healing scores were observed for microsurgery group (84.6% after 1 week) compared to control group (15.4% after 1 week).
Although blinding of patients and surgeons was difficult and healing indices used are subjective, it can be concluded that microsurgery under 4× magnifying loupe is as effective as conventional MWF in the treatment of infrabony pockets but clinical parameters are greatly enhanced by microsurgery with improved healing and less patient discomfort.
本研究旨在评估和比较改良威德曼瓣术（MWF）在有或无4倍棱柱放大镜辅助下治疗骨下袋后的愈合效果、探诊深度（PPD）减少情况、临床附着以及牙槽骨水平。
双侧至少有一个PPD≥5mm且角形骨吸收≥3mm的骨下袋患者被随机分为使用4倍放大镜的显微手术（试验）组和仅采用MWF的传统（对照）组。在基线、3个月和6个月时，记录菌斑指数、出血指数、PPD和相对临床附着水平。用兰德里愈合指数评估愈合效果。用视觉模拟量表（VAS）评估疼痛评分。通过锥形束计算机断层扫描（CBCT）和根尖片评估缺损深度（DD）减少的百分比。组间连续数据采用不成对“t”检验进行分析。组内比较采用重复测量方差分析，随后进行多重两两比较和配对“t”检验。
通过CBCT评估，每组骨内DD均有统计学显著降低（P = 0.004）。手术1周后，传统手术部位的平均VAS评分为3.67，而显微手术部位为2.9，具有统计学显著性（P = 0.004）。与对照组（1周后为15.4%）相比，显微手术组的愈合评分具有统计学显著性（P≤0.05）（1周后为84.6%）。
尽管患者和外科医生的盲法操作困难且所使用的愈合指数具有主观性，但可以得出结论，4倍放大镜辅助下的显微手术在治疗骨下袋方面与传统MWF一样有效，但显微手术能显著改善临床参数，促进愈合且减少患者不适。
