DOI: 10.25442/hku.30145942.v1
title: Supporting data for "Novel Concepts of Minimally Invasive Periodontal Therapy on the Management of Intrabony Periodontal Defects"

description: Intrabony periodontal defect is a risk factor for tooth loss and should be actively managed. However, deep residual periodontal defects with an intrabony component after Step 1 and Step 2 periodontal therapy are difficult to resolve through repeated subgingival reinstrumentation, thus necessitating different surgical intervention approaches.The application of minimally invasive nonsurgical periodontal therapy, utilizing instruments with enhanced instrumentability, appears to improve treatment outcomes compared to conventional approaches. The periodontal endoscope was introduced to facilitate subgingival visualization during subgingival instrumentation. It has been evaluated in various clinical scenarios, including as an adjunct to subgingival instrumentation during Step 2 to manage periodontal disease and Step 3 to manage residual periodontal defects. The use of the periodontal endoscope seems to enhance the efficacy of calculus removal during subgingival instrumentation. However, the currently available evidence provides conflicting clinical information, leaving the clinical indications for the periodontal endoscope unclear.Endoscopic-assisted Subgingival Debridement EASD was demonstrated to be non-inferior to papillary preservation flap surgery in a noninferiority Randomized Controlled Trial RCT (Chapter 3). EASD was reported to achieve non-inferior changes in Clinical Attachment Level CAL at diseased sites compared to papillar preservation flap surgery. No significant intergroup differences were observed in the changes in Probing Pocket Depth PPD, gingival recession REC, radiographic defect depth and angle, and the percentage of sites with pocket resolution. Additionally, the group that received EASD reported shorter chairside time and better early wound healing index. Thus, EASD was validated as a treatment alternative to surgical intervention for managing isolated residual periodontal defects with intrabony components.The currently available systematic reviews provide conflicting comments on the application of the periodontal endoscope in managing periodontal disease. This variation may be due to the lack of specific clinical scenarios in the focus questions of the systematic reviews. A systematic review targeting the evaluation of the clinical efficacy of the periodontal endoscope in managing residual periodontal defects was conducted (Chapter 4). It revealed that EASD resulted in 0.41mm and 0.84mm more PPD reduction than root surface debridement at 3- and 6-months post-operatively, respectively. EASD also achieved 0.21mm more CAL gain when compared to Access Flap Periodontal Surgery AFPS, while AFPS resulted in 0.29mm more PPD reduction when compared to EASD at 3-months post-operatively.Based on the current findings of previous reports, future research direction for the periodontal endoscope were placed on periodontal regeneration. Flapless application of Enamel Matrix Derivatives after nonsurgical periodontal treatment was evaluated in several clinical trials, but the results appeared to be conflicting. Following the findings of previous reports (Chapter 3 and 4), a research protocol for a noninferiority RCT was established to compare periodontal regeneration in combination with endoscopic-assisted subgingival debridement versus the entire papillary preservation technique in managing intra-bony periodontal defects (Chapter 5). The purpose is to evaluate if EASD can be a noval approach of minimal invasive therapy for periodontal regeneration.