Evaluation of the Efficacy of Autologous Platelet Rich Fibrin With Modified Minimally Invasive Surgical Technique (M-MIST) in the Treatment of Intrabony Defects: A Randomized Clinical Trial

INTRODUCTION

In the last two decades, some clinical investigators have focused their interest on the development of minimally invasive surgical approaches in periodontal surgery. Harrel & Rees proposed the minimally invasive surgery (MIS) with the aim to produce minimal wounds, minimal flap reflection and gentle hand ling of the soft and hard tissues in periodontal surgery. Cortellini & Tonetti tested the use of operative microscopes and microsurgical instruments to increase visual acuity and accuracy in the application of papilla preservation flaps in periodontal regeneration. The increased patient acceptance and decreased morbidity with minimally invasive surgery offers a promising therapeutic modality and may replace the need for more extensive surgical procedures. Recently, a new surgical approach, the ''minimally invasive surgical technique (MIST)'', has been proposed to treat isolated intrabony defects with periodontal regeneration. Results from a cohort study in isolated deep intrabony defects showed marked improvements in terms of clinical attachment level (CAL) gains and PD reduction. The background foundations for this technique are the concepts of the MIS, and the application of papilla preservation techniques with a microsurgical approach. The cited study also reported a very limited patient morbidity and a reduced length of the surgical procedure following application of the MIST. An enhancement of this technique, the modified minimally invasive surgical technique (M-MIST), has been recently designed to further reduce the surgical invasiveness, with three major objectives in mind: (1) minimize the interdental tissue tendency to collapse, (2) enhance the wound/soft tissue stability and (3) reduce patient morbidity.

Periodontal researchers and clinicians, in an effort to develop effective regenerative therapies, have sought to understand key events involved in the regeneration of the periodontium. An increased knowledge of specific cellular response and function within the periodontium has led to the development of numerous treatment modalities exhibiting different degrees of success.

Treatments including ''grafting'' with bone or bone substitutes, stimulation of cells with growth factors, hormones, or extracellular matrix proteins; cell occlusive barrier membranes for selective cell growth in periodontal defects; and modification of the tooth root surface have all been explored for their ability to predictably regenerate the periodontium. Although some treatments have yielded promising results, there remains a need for a treatment that leads to faster and more predictable regeneration of the periodontium.

The development of bioactive surgical additives, which are being used to regulate the inflammation and increase the speed of healing process, is one of the great challenges in clinical research. In this sense, healing is a complex process, which involves cellular organization, chemical signals, and the extracellular matrix for tissue repair. The understanding of healing process is still incomplete, but it is well known that platelets play an important role in both hemostasis and wound healing processes.