Minimally invasive surgical technique and enamel matrix derivative in intra‐bony defects. I: clinical outcomes and morbidity

Abstract Aims: This case cohort study was designed to evaluate the clinical performance and the intra‐operative and post‐operative morbidity of the minimally invasive surgical technique (MIST) associated with the application of an enamel matrix derivative (EMD) in the treatment of isolated deep intra‐bony defects. Material and Methods: Forty deep isolated intra‐bony defects in 40 patients were surgically accessed with the MIST. This technique was designed to limit the mesio‐distal flap extension and the corono‐apical flap reflection in order to reduce the surgical trauma and increase flap stability. The incision of the defect‐associated papilla was performed according to the principles of the papilla preservation techniques. EMD was applied on the debrided and dried root surfaces. Stable primary closure of the flaps was obtained with modified internal mattress sutures. Surgery was performed with the aid of an operating microscope and microsurgical instruments. Clinical outcomes were collected at baseline and at 1 year. Intra‐operative and post‐operative morbidity was evaluated with questionnaires. Results: The 1‐year clinical attachment gain was 4.9±1.7 mm ( p <0.0001 compared with baseline). This corresponded to a 77.6±21.9% resolution of the defect. Residual probing pocket depths were 3±0.6 mm. A minimal increase of 0.4±0.7 mm in gingival recession between baseline and 1 year was recorded. No patients experienced intra‐operative pain, while only 14 reported a very moderate perception of the hardship of the surgical procedure [7±12 visual‐analogue scale (VAS) units, on average]. Primary closure was obtained in all treated sites. At the 1‐week follow‐up visit, 38 sites (95%) were still closed. Only 12 subjects reported moderate post‐operative pain (VAS 19±10) that lasted for 26±17 h. Conclusions: These data indicate that the minimally invasive surgical technique, in combination with EMD, can be successfully applied in the treatment of isolated deep intra‐bony defects, resulting in excellent clinical outcomes with very limited intra‐ and post‐operative morbidity.