Abstract

Surgical treatment of deep periodontal pockets associated with intraosseous defects has traditionally been performed either with or without resection of the osseous defect. A non-resective approach may provide more gain of attachment while a resective approach may give better pocket reduction. The increased pocket reduction following osseous resection is probably accomplished at the expense of some attachment loss in areas involved by the surgical procedure. Previous studies have compared periodontal surgery with and without osseous resection (i.e. Rosling et al. 1976, Knowles et al. 1979 and Smith et al. 1980). However, the effect of osseous resection does not seem to have been addressed specifically in relation to deep intrabony defects. The purpose of the present study was to compare a non-resective approach to an approach which involved partial resection of the osseous defect for the treatment of deep intraosseous lesions.

Materials and Methods

Sixteen patients with 26 proximal periodontal defects having: 1) a probing pocket depth ≥ 7 mm and 2) an intraosseous defect ≥ 5 mm after initial preparation were studied.

Fourteen defects received non-resective surgery consisting of: 1) inverse bevel full thickness flaps; 2) debridement and root planing; 3) citric acid conditioning of the root surfaces and 4) suturing the thinned flaps to achieve primary closure. Twelve defects were treated with partial resective surgery. This procedure was the same as the non-resective surgery except that osseous resection, consisting of both osteotomy and osteoplasty was performed. The resection was partial due to concern about sacrificing supporting bone, yet enough to satisfy the criterion set up that the immediate postoperative probing depth from the sutured flap margin to the fundus of the defect should be less than 6 mm. Thus, the partial resective group of defects had a postoperative probing depth of 4.8 ± 0.9 mm compared to 8.2 ± 1.2 mm for the non-resective group.

The results of the two treatment modalities were evaluated 6 months following therapy with respect to changes in probing pocket depths, probing attachment levels and probing bone levels for the tooth surfaces involved by the osseous defect as well as adjacent tooth surfaces involved in the surgical procedure. The soft tissue probings were made using a probe with 0.5 mm diameter and a probing force of 0.75N. During probing bone measurements, the probe was forced through the soft tissue until definite bony resistance was met.

Results

Both procedures resulted in some but limited amounts of gain in probing attachment and probing bone levels at the defect sites. The probing attachment level improved 1.1 ± 0.9 mm for the non-resective group and 0.7 ± 1.0 mm for the partial resective group. The probing bone level improved 1.2 ± 1.2 mm for the non-resective group and 0.7 ± 1.2 mm for the partial resective group. Thus, a tendency towards better regeneration of the defect sites was observed following the non-resective surgery as compared to the partial resective approach.

The pocket reduction was slightly better following the partial resective approach than following the non-resective surgery. The residual probing depth for the defect sites was 5.3 ± 1.6 mm for the non-resective group and 4.0 ± 0.7 mm for the partial resective group.

Both procedures caused a slight loss of probing attachment level and probing bone level for buccal, lingual and proximal surfaces adjacent to the defect sites. The average loss was less for the non-resective group which varied from 0.2 mm to 0.9 mm as compared to the partial resective group where it varied from 1.2 mm to 1.5 mm.

Conclusions

In conclusion, the 6-month, results comparing a non-resectiye and a partially resective approach to the treatment of deep intraosseous defects demonstrated limited differences between the two procedures. The amount of regeneration which can be achieved seems to be modest following both procedures. Therefore, the selection of a procedure for an individual site ought to be based upon the ramifications of greater sacrifice of attachment on adjacent tooth surfaces in the partial resective approach in contrast to the possible disadvantage of relatively deeper residual probing depth in a non-resective approach.

LLU Discipline

Periodontics

Department

Dentistry

School

Graduate School

First Advisor

Jan Egelberg

Second Advisor

J. Steve Garrett

Third Advisor

Stefan Renvert

Degree Name

Master of Science (MS)

Degree Level

M.S.

Year Degree Awarded

1982

Date (Title Page)

8-1982

Language

English

Library of Congress/MESH Subject Headings

Periodontitis -- surgery; Postoperative Complications

Type

Thesis

Page Count

4; vi; 34

Digital Format

PDF

Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.

Collection

Loma Linda University Electronic Theses and Dissertations

Collection Website

http://scholarsrepository.llu.edu/etd/

Repository

Loma Linda University. Del E. Webb Memorial Library. University Archives

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