A pioneer surgical technique for isolated periodontal defects by “closed” retraction of the papilla: A feasibility study

Abstract

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AimA pioneer periodontal surgical approach employing the closed surgical technique (CST) in combination with the tissue-engineered biocomplex aimed to gain access to the osseous defect and improve soft tissue architecture.MethodsThe CST was applied in four systemically healthy periodontitis patients/defects who were followed for 12 months. It avoids papilla dissection and retraction of flaps in an open manner; thus, suturing is not required. It is designed for the reconstruction of residual isolated periodontal defects and is best indicated in the aesthetic region. It can be applied as a sole treatment approach to facilitate deep instrumentation of the defect, or it could be combined with subgingival application of regenerative materials. Hereby, the biocomplex was applied containing autologous alveolar bone marrow mesenchymal stem cells, seeded into collagen scaffolds, enriched with autologous fibrin/platelet lysate.ResultsThe CST minimized postoperative discomfort and led to improved treatment outcomes with probing pocket depth reduction [average (SD)] of 24.4% (18.5), gain in clinical attachment levels of 25.8% (20.1), and evidence of remineralisation of the alveolar crest.ConclusionThe CST is a tissue-friendly operation and facilitates subgingival application of biological agents via tunneling the soft tissues. However, surgical experience is required for nontraumatic manipulation of the gingival tissues during “closed” retraction of the flaps.Clinical trial registrationRegistered with Clinicaltrials.gov; ClinicalTrials.gov ID: NCT02449005.

Keywords

• closed flap retraction
• tissue engineering
• tissue trauma
• papilla reconstruction
• intrabony defect
• soft tissue tunneling