Minimally invasive non-surgical periodontal therapy of intrabony defects: A prospective multi-centre cohort study.

debridement intrabony defects minimally invasive non‐surgical therapy (MINST) periodontitis

Journal

Journal of clinical periodontology
ISSN: 1600-051X
Titre abrégé: J Clin Periodontol
Pays: United States
ID NLM: 0425123

Informations de publication

Date de publication:
06 May 2024
Historique:
revised: 10 03 2024
received: 23 11 2023
accepted: 14 03 2024
medline: 7 5 2024
pubmed: 7 5 2024
entrez: 6 5 2024
Statut: aheadofprint

Résumé

To assess the potential benefits of minimally invasive non-surgical therapy (MINST) in teeth with intrabony defects and to explore factors associated with the outcomes. A multi-centre trial was conducted in 100 intrabony defects in periodontitis patients in private practice. Steps 1 and 2 periodontal therapy including MINST were provided. Clinical and radiographic data were analysed at baseline and 12 months after treatment, with the primary aim being change in radiographic defect depth at 12 months. Eighty-four patients completed the 12-month follow up. The mean total radiographic defect depth reduced by 1.42 mm and the defect angle increased by 3° (both p < .05). Statistically significant improvements in probing pocket depth (PPD) and clinical attachment level (CAL) were seen at 12 months compared to baseline (p < .001). Fifty-six defects (66.7%) achieved pocket closure (PPD ≤ 4 mm) and 49 defects (58.3%) achieved the composite outcome (PPD ≤ 4 mm and CAL gain ≥3 mm). Deeper and narrower angled defects were positively correlated with radiographic and clinical improvements, respectively. Improvements in clinical and radiographic outcomes were seen after MINST. This study highlights the generalizability and wide applicability of this approach, further supporting its effectiveness in the treatment of intrabony defects. NCT03741374. https://clinicaltrials.gov/study/NCT03741374?cond=minimally%20invasive%20non%20surgical%20therapy&locStr=UK&country=United%20Kingdom&distance=50&rank=2.

Identifiants

pubmed: 38710583
doi: 10.1111/jcpe.13984
doi:

Banques de données

ClinicalTrials.gov
['NCT03741374']

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2024 The Authors. Journal of Clinical Periodontology published by John Wiley & Sons Ltd.

Références

Aimetti, M., Ferrarotti, F., Mariani, G. M., & Romano, F. (2017). A novel flapless approach versus minimally invasive surgery in periodontal regeneration with enamel matrix derivative proteins: A 24‐month randomized controlled clinical trial. Clinical Oral Investigations, 21(1), 327–337. https://doi.org/10.1007/s00784-016-1795-2
Ainamo, J., & Bay, I. (1975). Problems and proposals for recording gingivitis and plaque. International Dental Journal, 25(4), 229–235.
Anoixiadou, S., Parashis, A., & Vouros, I. (2022). Enamel matrix derivative as an adjunct to minimally invasive non‐surgical treatment of intrabony defects: A randomized clinical trial. Journal of Clinical Periodontology, 49(2), 134–143. https://doi.org/10.1111/jcpe.13567
Caton, J., & Zander, H. A. (1976). Osseous repair of an infrabony pocket without new attachment of connective tissue. Journal of Clinical Periodontology, 3(1), 54–58. https://doi.org/10.1111/j.1600-051X.1976.tb01850.x
Claffey, N., & Egelberg, J. (1995). Clinical indicators of probing attachment loss following initial periodontal treatment in advanced periodontitis patients. Journal of Clinical Periodontology, 22(9), 690–696. https://doi.org/10.1111/j.1600-051X.1995.tb00828.x
Cortellini, P., Cortellini, S., Bonaccini, D., & Tonetti, M. S. (2022). Modified minimally invasive surgical technique in human intrabony defects with or without regenerative materials—10‐year follow‐up of a randomized clinical trial: Tooth retention, periodontitis recurrence, and costs. Journal of Clinical Periodontology, 49(6), 528–536. https://doi.org/10.1111/jcpe.13627
Cortellini, P., Tonetti, M. S., Lang, N. P., Suvan, J. E., Zucchelli, G., Vangsted, T., Silvestri, M., Rossi, R., McClain, P., Fonzar, A., Dubravec, D., & Adriaens, P. (2001). The simplified papilla preservation flap in the regenerative treatment of deep intrabony defects: Clinical outcomes and postoperative morbidity. Journal of Periodontology, 72(12), 1702–1712. https://doi.org/10.1902/jop.2001.72.12.1702
Guerrero, A., Griffiths, G. S., Nibali, L., Suvan, J., Moles, D. R., Laurell, L., & Tonetti, M. S. (2005). Adjunctive benefits of systemic amoxicillin and metronidazole in non‐surgical treatment of generalized aggressive periodontitis: A randomized placebo‐controlled clinical trial. Journal of Clinical Periodontology, 32(10), 1096–1107. https://doi.org/10.1111/j.1600-051X.2005.00814.x
Hamp, S.‐E., Nyman, S., & Lindhe, J. (1975). Periodontal treatment of multi rooted teeth. Journal of Clinical Periodontology, 2(3), 126–3553. https://doi.org/10.1111/j.1600-051X.1975.tb01734.x
Harrel, S. K. (1999). A minimally invasive surgical approach for periodontal regeneration: Surgical technique and observations. Journal of Periodontology, 70(12), 1547–1557. https://doi.org/10.1902/jop.1999.70.12.1547
Koidou, V. P., Hagi‐Pavli, E., Cross, S., Nibali, L., & Donos, N. (2022). Molecular profiling of intrabony defects' gingival crevicular fluid. Journal of Periodontal Research, 57(1), 152–161. https://doi.org/10.1111/jre.12948
Laster, L., Laudenback, K., & Stoller, N. (1975). An evaluation of clinical tooth mobility measurements. Journal of Periodontology, 46(10), 603–607. https://doi.org/10.1902/jop.1975.46.10.603
Liñares, A., Cortellini, P., Lang, N. P., Suvan, J., & Tonetti, M. S. (2006). Guided tissue regeneration/deproteinized bovine bone mineral or papilla preservation flaps alone for treatment of intrabony defects. II: Radiographic predictors and outcomes. Journal of Clinical Periodontology, 33(5), 351–358. https://doi.org/10.1111/j.1600-051X.2006.00911.x
Liu, S., Hu, B., Zhang, Y., Li, W., & Song, J. (2016). Minimally invasive surgery combined with regenerative biomaterials in treating intra‐bony defects: A meta‐analysis. PLoS One, 11(1), e0147001. https://doi.org/10.1371/journal.pone.0147001
Matuliene, G., Pjetursson, B. E., Salvi, G. E., Schmidlin, K., Brägger, U., Zwahlen, M., & Lang, N. P. (2008). Influence of residual pockets on progression of periodontitis and tooth loss: Results after 11 years of maintenance. Journal of Clinical Periodontology, 35(8), 685–695. https://doi.org/10.1111/j.1600-051X.2008.01245.x
Needleman, I., Worthington, H. V., Giedrys‐Leeper, E., & Tucker, R. (2006). Guided tissue regeneration for periodontal infra‐bony defects. Cochrane Database of Systematic Reviews, 19(2), CD001724. https://doi.org/10.1002/14651858.CD001724.pub2
Nibali, L., Koidou, V., Salomone, S., Hamborg, T., Allaker, R., Ezra, R., Zou, L., Tsakos, G., Gkranias, N., & Donos, N. (2019). Minimally invasive non‐surgical vs. surgical approach for periodontal intrabony defects: A randomised controlled trial. Trials, 20(1), 461. https://doi.org/10.1186/s13063-019-3544-8
Nibali, L., Koidou, V. P., Nieri, M., Barbato, L., Pagliaro, U., & Cairo, F. (2020). Regenerative surgery versus access flap for the treatment of intra‐bony periodontal defects: A systematic review and meta‐analysis. Journal of Clinical Periodontology, 47, 320–351. https://doi.org/10.1111/jcpe.13237
Nibali, L., Mehta, J., Al‐Shemeri, D., Anoixiadou, S., Parashis, A., & Vouros, I. (2023). Association between defect morphology and healing of intrabony defects treated with minimally invasive non‐surgical therapy: A pilot exploratory analysis of two cohorts. Journal of Periodontal Research, 58(4), 708–714. https://doi.org/10.1111/jre.13119
Nibali, L., Pometti, D., Chen, T.‐T., & Tu, Y.‐K. (2015). Minimally invasive non‐surgical approach for the treatment of periodontal intrabony defects: A retrospective analysis. Journal of Clinical Periodontology, 42(9), 853–859. https://doi.org/10.1111/jcpe.12443
Nibali, L., Pometti, D., Tu, Y. K., & Donos, N. (2011). Clinical and radiographic outcomes following non‐surgical therapy of periodontal infrabony defects: A retrospective study. Journal of Clinical Periodontology, 38(1), 50–57. https://doi.org/10.1111/j.1600-051X.2010.01648.x
Nibali, L., Sultan, D., Arena, C., Pelekos, G., Lin, G. H., & Tonetti, M. (2021). Periodontal infrabony defects: Systematic review of healing by defect morphology following regenerative surgery. Journal of Clinical Periodontology, 48, 100–113. https://doi.org/10.1111/jcpe.13381
Nibali, L., Yeh, Y., Pometti, D., & Tu, Y. (2018). Long‐term stability of intrabony defects treated with minimally invasive non‐surgical therapy. Journal of Clinical Periodontology, 45(12), 1458–1464. https://doi.org/10.1111/jcpe.13021
Ørstavik, D., Kerekes, K., & Eriksen, H. M. (1986). The periapical index: A scoring system for radiographic assessment of apical periodontitis. Dental Traumatology, 2(1), 20–34. https://doi.org/10.1111/j.1600-9657.1986.tb00119.x
Papapanou, P. N., & Tonetti, M. S. (2000). Diagnosis and epidemiology of periodontal osseous lesions. Periodontology 2000, 22(1), 8–21. https://doi.org/10.1034/j.1600-0757.2000.2220102.x
Rams, T. E., Listgarten, M. A., & Slots, J. (2018). Radiographic alveolar bone morphology and progressive periodontitis. Journal of Periodontology, 89(4), 424–430. https://doi.org/10.1002/JPER.17-0279
Reynolds, M. A., Kao, R. T., Camargo, P. M., Caton, J. G., Clem, D. S., Fiorellini, J. P., Geisinger, M. L., Mills, M. P., Nares, S., & Nevins, M. L. (2015). Periodontal regeneration – Intrabony defects: A consensus report from the AAP regeneration workshop. Journal of Periodontology, 86(2S), S105–S107. https://doi.org/10.1902/jop.2015.140378
Ribeiro, F. V., Casarin, R. C. V., Palma, M. A. G., Júnior, F. H. N., Sallum, E. A., & Casati, M. Z. (2011). Clinical and patient‐centered outcomes after minimally invasive non‐surgical or surgical approaches for the treatment of intrabony defects: A randomized clinical trial. Journal of Periodontology, 82(9), 1256–1266. https://doi.org/10.1902/jop.2011.100680
Ribeiro, F. V., Mehta, J. J., Monteiro, M. F., Moore, J., Casati, M. Z., & Nibali, L. (2023). Minimal invasiveness in nonsurgical periodontal therapy. Periodontology 2000, 91(1), 7–19. https://doi.org/10.1111/prd.12476
Rosling, B., Nyman, S., & Lindhe, J. (1976). The effect of systematic plaque control on bone regeneration in infrabony pockets. Journal of Clinical Periodontology, 3(1), 38–53. https://doi.org/10.1111/j.1600-051X.1976.tb01849.x
Santamaria, P., Sari, A., & Nibali, L. (2023). Molecular profiling of gingival crevicular fluid fails to distinguish between infrabony and suprabony periodontal defects. Journal of Clinical Periodontology, 50(10), 1315–1325. https://doi.org/10.1111/jcpe.13849
Sanz, M., Herrera, D., Kebschull, M., Chapple, I., Jepsen, S., Beglundh, T., Sculean, A., Tonetti, M. S., & EFP Workshop Participants and Methodological Consultants. (2020). Treatment of stage I‐III periodontitis‐the EFP S3 level clinical practice guideline. Journal of Clinical Periodontology, 47(S22), 4–60. https://doi.org/10.1111/jcpe.13290
Tonetti, M. S., Greenwell, H., & Kornman, K. S. (2018). Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. Journal of Clinical Periodontology, 1(45), S149–S161. https://doi.org/10.1002/JPER.18-0006
Tonetti, M. S., Lang, N. P., Cortellini, P., Suvan, J. E., Adriaens, P., Dubravec, D., Fonzar, A., Fourmousis, I., Mayfield, L., Rossi, R., Silvestri, M., Tiedemann, C., Topoll, H., Vangsted, T., & Wallkamm, B. (2002). Enamel matrix proteins in the regenerative therapy of deep intrabony defects. Journal of Clinical Periodontology, 29(4), 317–325. https://doi.org/10.1034/j.1600-051X.2002.290407.x
Trombelli, L., Farina, R., Vecchiatini, R., Maietti, E., & Simonelli, A. (2020). A simplified composite outcome measure to assess the effect of periodontal regenerative treatment in intraosseous defects. Journal of Periodontology, 91(6), 723–731. https://doi.org/10.1002/JPER.19-0127
Trombelli, L., Simonelli, A., Pramstraller, M., Wikesjö, U. M. E., & Farina, R. (2010). Single flap approach with and without guided tissue regeneration and a hydroxyapatite biomaterial in the management of intraosseous periodontal defects. Journal of Periodontology, 81(9), 1256–1263. https://doi.org/10.1902/jop.2010.100113
Tsitoura, E., Tucker, R., Suvan, J., Laurell, L., Cortellini, P., & Tonetti, M. (2004). Baseline radiographic defect angle of the intrabony defect as a prognostic indicator in regenerative periodontal surgery with enamel matrix derivative. Journal of Clinical Periodontology, 31(8), 643–647. https://doi.org/10.1111/j.1600-051X.2004.00555.x
Tu, Y. K., Baelum, V., & Gilthorpe, M. S. (2005). The relationship between baseline value and its change: Problems in categorization and the proposal of a new method. European Journal of Oral Sciences, 113(4), 279–288. https://doi.org/10.1111/j.1600-0722.2005.00229.x
Updegrave, W. J. (1951). The paralleling extension‐cone technique in intraoral dental radiography. Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology, 4(10), 1250–1261. https://doi.org/10.1016/0030-4220(51)90084-9

Auteurs

Jaimini Mehta (J)

Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK.

Marco Montevecchi (M)

Division of Periodontology and Implantology, Department of Biomedical and Neuromotor Sciences, School of Dentistry and Dental Hygiene, University of Bologna, Bologna, Italy.

Ruben Garcia-Sanchez (R)

Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK.

Olanrewaju Onabolu (O)

Private Practice, Claremont Dental Practice, Twickenham & Ten Dental Clapham, London, UK.

Antonio Liñares (A)

Unit of Periodontology, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain.

Fernando Eriksson (F)

Private practice, South Coast Dental Specialists, Dorset, UK.

Carlo Ghezzi (C)

Private practice, "StudioCarloGhezzi", Milan, Italy.

Camilla Donghi (C)

Private practice, "StudioCarloGhezzi", Milan, Italy.

Emily Ming-Chieh Lu (EM)

Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK.

Luigi Nibali (L)

Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK.
'Ravenscourt Dental Practice' & 'The Dentist', London, UK.

Classifications MeSH