Efficacy of Minimally Invasive Non-Surgical Therapy (MINST) in Managing Stage III/IV Periodontitis

Introduction: Minimally invasive non-surgical therapy (MINST) was introduced as an alternative approach in the management of periodontitis. This technique uses a combination of mini/micro instruments with magnification loupes or microscopes for optimal root debridement without flap elevation. This systematic review of randomized controlled trials (RCTs) evaluates the efficacy of MINST in managing Stage III/IV periodontitis. Methods: A review protocol was created according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRIS-MA) guidelines. Although the PRISMA guideline was followed, this review protocol was not registered in PROS-PERO. Online search was conducted on three databases, PubMed, EMBASE, and Google Scholar to find articles published in English from 2013 up to June 2023. Only RCTs using MINST as an intervention were included. Results: Out of 129 studies, 6 RCTs involving a total of 223 patients met the criteria. The included studies then divided into 3 groups based on intervention comparisons; MINST vs minimally invasive surgical treatment (MIST), MINST with/without adjunct material, and MINST vs conventional non-surgical periodontal therapy (CNST). Minimally invasive non-surgical therapy (MINST) showed comparable efficacy to MIST in the treatment of single intrabony defects with significant probing depth (PD) reduction and clinical attachment level (CAL) gain. After one session of full-mouth MINST, a minimal residual pocket was achieved, and the use of adjunct materials effectively enhanced the treatment outcome. Conclusion: Moderate evidence supports MINST as an effective and minimally traumatic approach for managing advanced periodontitis, offering comparable clinical outcomes to surgical therapy. Further high-quality trials with long-term follow-up are recommended.