Improved wound stability with a modified minimally invasive surgical technique in the regenerative treatment of isolated interdental intrabony defects

Cortellini P, Tonetti MS. Improved wound stability with a modified minimally invasive surgical technique in the regenerative treatment of isolated interdental intrabony defects. J Clin Periodontol 2009; 36: 157-163. doi: 10.1111/j.1600-051X.2008.01352. This paper describes a modified surgical approach of the minimally invasive surgical technique (modified minimally invasive surgical technique, M-MIST) and preliminarily evaluates its applicability and clinical performances in the treatment of isolated deep intrabony defects in combination with amelogenins. Twenty deep isolated intrabony defects in 20 patients were studied. Fifteen were surgically accessed with the M-MIST, while in five sites, which presented a lingual intrabony component, the conventional MIST had to be applied. The M-MIST consisted of a buccal incision of the defect-associated papilla, according to the principles of the papilla preservation techniques. Only a buccal flap was raised while the interdental papilla was left in situ. The granulation tissue filling the defect was dissected and removed, leaving the interdental and palatal tissues untouched. Root instrumentation and application of the regenerative material were performed before suturing. Primary closure of the flaps was attained with a single internal modified mattress suture. Surgery was performed with the aid of an operating microscope and microsurgical instruments. The surgical chair-time of the M-MIST-treated sites (N=15) was 56 +/- 8.64 min. Early wound healing was uneventful: primary wound closure was attained and maintained in all sites. No oedema or haematoma was noted. Patients did not report pain or discomfort. The 1-year clinical attachment level (CAL) gain was 4.5 +/- 1.4 mm in defects 6 +/- 1.5 mm deep. Residual probing depths (PDs) were 3.1 +/- 0.6 mm. A minimal increase of 0.1 +/- 0.3 mm in gingival recession between baseline and 1 year was observed. M-MIST was applicable on 15 isolated interproximal defects out of 20 selected ones. It resulted in very limited patient morbidity and excellent clinical improvements. These outcomes should be confirmed in a larger study.