Publication details
Lateral approach for the regenerative treatment of intrabony defects associated with edentulous spaces. A pilot case
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| Year of publication | 2023 |
| Type | Conference abstract |
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| Description | Aim Within this report, a lateral approach for regenerative treatment of the intrabony periodontal defects associated with edentulous spaces is suggested, described, and evaluated. The goal of the method is to prevent the most common complications of the gold-standard flap design for this indication and create more favourable conditions for periodontal regeneration. Methods Basic prerequisites for periodontal regeneration are space provision and stable soft tissues. In case of regenerative treatment of the intrabony defects associated with edentulous spaces, gold standard for flap design, as described by Cortellini, includes: crestal incision right above the treated site, releasing vertical incision(s) and reflection of both buccal and oral flaps. Most common complications are exposure of the regenerative material and marginal flap dehiscence, leading to improper regeneration of periodontal tissues and poor results. To prevent these complications and to guarantee an undisturbed healing process, we propose novel surgical approach with specific flap design. (For comparison, see Figure 1) The flap is defined with a curved vertical incision on the buccal side on the opposite aspect off the treated defect, and a sulcular incision on buccal and defect-associated aspect. A full-thickness flap is then raised and hyper-mobilized, ensuring proper access but maintaining uncut soft tissues above the defect. For the elevation of the flap, both sharp and blunt dissection is performed, using instruments like periosteal elevator, microblade and/or tunnelling instruments. After degranulation, and scaling of the affected root surface, a regenerative strategy is applied. In this case, amelogenins and bovine bone xenograft is used. In the presented case, we treated an intrabony defect distal to lower right second molar. Such defects frequently develop after a third molar removal. Results In the reported case, we treated a residual periodontal pocket of 7 mm and positive BOP in the area of 47D – distal aspect of the lower right second molar. An intrabony defect was present. The lesion was associated with a third molar removal. The lateral approach was performed, as described above (Figure 2). Access was optimal. Debridement of buccal, distal and even disto-lingual root surface was possible, using ultrasound tips and Gracey curettes. In this case, after degranulation, debridement and complete haemostasis, the regenerative strategy was applied as follows: amelogenins (Emdogain®, Straumann) for 4 minutes, bovine bone xenograft (BioOss®, Geistlich) mixture with blood. Reposition of the flap was passive. The wound was closed with interrupted sutures (Resolon® 5-0, Resorba). Adjuvant systemic antibiotics were prescribed, and patient was instructed about specific home care. Healing was uneventful. At re-evaluation after 4 months, former probing depth was reduced to 4 mm, BOP negative, no reported discomfort (Figures 3 and 4). X-ray analysis shows a significant bone fill and a defect angle reduction (Figures 5 and 6). Conclusions This lateral approach is specifically tailored for regenerative treatment of intrabony periodontal defects next to edentulous spaces. Possible common complications of a gold-standard flap design are prevented by a shift of the most vulnerable area away from the regenerated site. Moreover, the intact soft tissues above the defect act as a membrane and keep the regenerative material undisturbed during the healing. Altogether, less complications and better results of regeneration might be expected, compared with a standard flap design (Figure 1). We suggest the use of this approach especially in cases of distal or disto-buccal intrabony defects, which frequently develop in lower second molars after third molar removal. The project is supported by St. Anne‘s University Hospital, grant No. IIT/2023/5 |