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

Abstract

Aim The modified minimally invasive surgical technique (M‐MIST) optimizes wound stability in the treatment of intrabony defects. Short‐term observations show similar results as with flap alone or adjunctive regenerative materials. This study aims to compare the stability of the long‐term outcomes, complication‐free survival, and costs of the three treatment options. Materials and Methods Forty‐five intrabony defects in 45 patients were randomized to M‐MIST alone (N = 15), combined with enamel matrix derivative (M‐MIST + EMD, N = 15), or EMD plus bone‐mineral‐derived xenograph (M‐MIST + EMD + BMDX, N = 15). Supportive periodontal care (SPC) and necessary re‐treatment were provided for 10 years. Results Three subjects were lost to follow‐up. Clinical attachment level differences between 1 and 10 years were −0.1 ± 0.7 mm for M‐MIST, −0.1 ± 0.8 mm for M‐MIST + EMD, and −0.3 ± 0.6 mm for M‐MIST + EMD + BMDX (p > .05 for within‐ and between‐group differences). Four episodes of recurrence occurred in the M‐MIST group, four in the M‐MIST + EMD group, and five in the M‐MIST + EMD + BMDX group. No significant differences in complication‐free survival were observed between the three groups (p = .47). Complication‐free survival was 7.46 years (95% confidence interval: 7.05–7.87) for the whole population. The M‐MIST + EMD + BMDX group lost one treated tooth. Data indicated no significant inter‐group difference of the total cost of recurrence over 10 years. When the baseline cost of treatment was considered, the total cost was lower for M‐MIST alone. Conclusions Teeth with deep pockets associated with intrabony defects can be successfully maintained over the long term with either M‐MIST alone or by adding a regenerative material in the context of a careful SPC programme. M‐MIST alone provided similar short‐ and long‐term benefits as regeneration, at a lower cost. These findings need to be confirmed in larger, independent studies.

Prognostic value of a composite outcome measure for periodontal stability following periodontal regenerative treatment: A retrospective analysis at 4 years

“…Relying on the results of the present analysis, we may assume that both 6‐month residual PD and 6‐month CAL change may substantially influence the long‐term stability of the regenerative outcomes. In this respect, the presence/absence of a residual pocket represented the main difference between COM1/COM2 and COM4, further corroborating the current evidence on the predictive value of residual PD for disease progression/recurrence following active periodontal therapy, in general, 40–42 and regenerative procedures, in particular 11,13,43 . Moreover, defects categorized in COM3 showed an intermediate behavior between COM1/2 and COM4 in terms of proportion of stable defects at 4 years and need for surgical reintervention, thus suggesting the importance of a relevant CAL gain in mitigating the detrimental effect of the residual pocket on the long‐term stability of the regenerative outcome.…”

“…However, longterm data stemming from well-designed RCTs on different regenerative modalities seem to suggest that the stability of periodontal condition can be maintained irrespectively of the regenerative device used, provided the patients are enrolled in a stringent SPC regimen. 12,13,15 High prevalence of periodontal stability between 6 months to 4 years and 100% tooth survival were observed among defects in COM1 group. All cases in this group did not need surgical retreatment during the observation period.…”

“…[10][11][12][13][14][15][16] In this respect, high levels of periodontal stability and tooth retention rates have been reported after guided tissue regeneration (GTR) 11,12,15,16 as well as the application of enamel matrix derivative (EMD) either alone [13][14][15] or in association with a bone substitute. 10,13 According to the same trials, however, recurrences of periodontal breakdowns may occur, thus calling for retreatment, adjunctive treatments, or tooth extractions. Despite some tools for the evaluation of tooth prognosis have been developed and partly validated, 17 none of the above is specifically designed to estimate periodontal stability and tooth prognosis following periodontal regenerative treatment.…”

Efficacy of access flap and pocket elimination procedures in the management of peri‐implantitis: A systematic review and meta‐analysis

“…Data from three studies with a follow-up ranging from 2 to 5 years indicated a substantial risk varying from 8% to 44%. Corresponding data on severely compromised teeth followed over 10 years after periodontal therapy (Cortellini et al, 2020(Cortellini et al, , 2022 indicated lower risk of recurrence as expressed by >7 mean years of complication-free survival. In contrast to disease recurrence, the outcome "implant loss" was consistently reported.…”

Longevity of teeth in patients susceptible to periodontitis: Clinical outcomes and risk factors associated with tooth loss after active therapy and 30 years of supportive periodontal care

“…Modern periodontal therapy is rich with treatment approaches, regenerative in particular, that may help clinicians to preserve more teeth during the active phase, as highlighted by the Guidelines of the European Federation of Periodontology (Sanz et al, 2020). Regenerative surgery reportedly improves the long‐term prognosis of teeth with furcation involvement (Huynh‐Ba et al, 2009; Dannewitz et al, 2016; Nibali et al, 2020), teeth with furcation involvement associated with deep intrabony defects (Cortellini, Cortellini, & Tonetti, 2020; Cortellini, Stalpers, et al, 2020), teeth with deep intrabony defects (Cortellini et al, 2017; Nibali et al, 2020; Cortellini et al, 2022), and even teeth with a baseline “hopeless” prognosis (Cortellini et al, 2011; Cortellini, Cortellini, & Tonetti, 2020; Cortellini, Stalpers, et al, 2020).…”