Clinical Evaluation of Influence of Gingival Biotype on the Outcome of Open Flap Debridement in Patients With Chronic Periodontitis- An Interventional Study
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Enrollment
- 40
- Locations
- 1
- Primary Endpoint
- clinical attachment level
Study Overview
Brief Summary
The influence of periodontal thickness has been documented in outcome of various periodontal interventions like non surgical periodontal therapy, mucogingival therapy, guided tissue regeneration (GTR), crown lengthening and implant dentistry. There is lack of study showing the influence of gingival biotype on outcome of surgical procedure. The present study is therefore undertaken to evaluate the influence of gingival biotype on the outcome of open flap debridement for treatment of chronic periodontitis.
Detailed Description
Periodontitis is inflammation of the periodontal tissues resulting in clinical attachment loss, alveolar bone loss, and periodontal pocketing. Chronic periodontal disease can be successfully treated by non-surgical or surgical mechanical therapy provided adequate plaque control is maintained during the supportive phase of treatment. Elimination of these pockets by the therapist is necessary to allow the patient better access for plaque control. The goal of periodontal therapy, therefore, should include the creation of an oral environment in which the patient can cleanse every surface of every tooth. Ideally, this would be best accomplished by complete regeneration of the lost attachment apparatus and reestablishment of a minimal depth of sulcus.
It is seen that in pockets with shallow probing depths(1-3mm), there is reduction of pocket depth and loss of attachment by all the treatment modalities and more following surgical treatment. Lindhe et al. (1982) defined a critical probing depth below which the nonsurgical therapy is most likely to lead to loss of probing attachment In sites with moderate probing depth (4-6mm), there is more pocket reduction following MWF than subgingival curettage and SRP. Attachment gain is seen following all techniques and more following modified widman flap (MWF).
Deep pockets(>7mm) have shown reduction in probing depth following all the treatment modalities but more reduction is seen following MWF. More gain in attachment is seen following MWF than subgingival curettage.
Ramfjord observed an increase in pocket depth following periodontal treatment in shallow pockets. He also found loss of attachment with surgical therapy in moderate probing depth.
Histological findings in humans have revealed that there is loss of crestal bone as a consequence of periodontal surgical treatment. The resorption pattern varied with thickness of connective tissue covering the bone and was modified by injury to bone due to contact or near contact during instrumentation. Measurement indicated resorption occurs if retained tissue is 0.45 mm or less.
Study Design
- Study Type
- Interventional
- Allocation
- Non Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- None
Eligibility Criteria
- Ages
- 25 Years to 55 Years (Adult)
- Sex
- All
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •Systemically healthy patients with moderate to severe chronic periodontitis
- •Age 25-55 years
- •Clinical attachment loss(CAL) ≥3 mm
- •Probing pocket depth (PPD) ≥5 mm
- •Possessing ≥20 natural teeth.
Exclusion Criteria
- •Patients with vertical bone loss
- •Current or former smokers or use of tobacco in any form
- •Pregnant women, lactating mothers and women taking oral contraceptives
- •Patient who had undergone periodontal treatment within 6 months prior to the study
- •Patient on anti-inflammatory drugs or antibiotics or history of treatment with medication known to influence periodontal status or healing such as statins, glucocorticoids, phenytoin, calcium channel blockers, immunosuppressants, bisphosphonates or any other host modulatory drug within six months of commencement of study
- •Patient with average plaque index ≥1.5 after phase 1 therapy
- •Miller Grade II /Grade III tooth mobility after SRP
- •Periapical infection in any tooth of the surgical treatment segment.
Arms & Interventions
thin biotype
Modified Widman flap surgery followed by meticulous debridement, root planning and thorough irrigation with normal sterile saline solution
Intervention: open flap debridement (Procedure)
thick biotype
Modified Widman flap surgery followed by meticulous debridement, root planning and thorough irrigation with normal sterile saline solution
Intervention: open flap debridement (Procedure)
Outcomes
Primary Outcomes
clinical attachment level
Time Frame: 6 months
clinical attachment level is measured from cementoenamel junction to base of pocket
Secondary Outcomes
No secondary outcomes reported