| 35
SANZ et al .
R3.3 | What is the efficacy of pocket elimination/reduction surgery in comparison with access flap surgery? Evidence-based recommendation (3.3) In cases of deep (PPD ≥ 6 mm) residual pockets in patients with Stage III periodontitis after an adequate second step of periodontal therapy, we suggest using resective periodontal surgery, yet considering the potential increase of gingival recession. Supporting literature Polak et al. (2020) Quality of evidence Nine RCTs (four could be used for the quantitative analysis). High risk of bias. Limited available data. Grade of recommendation Grade B— ↑ Strength of consensus Simple majority (2.6% of the group abstained due to potential CoI)
• open flap debridement with intra-sulcular incisions (OFD); • flaps with para-marginal incisions, such as modified Widman flap (MWF) and • papilla preservation flaps.
R3.2 | How effective are the different access flap procedures?
Evidence-based recommendation (3.2) In cases of deep (PPD ≥ 6 mm) residual pockets and intrabony defects in patients with Stage III periodontitis after adequate first and second steps of periodontal therapy, there is insufficient evidence for a recommendation on the choice of flap procedures. Access periodontal surgery can be carried out using different flap designs. Supporting literature Sanz-Sanchez et al. (2020) Quality of evidence Three RCTs compared MWF with OFD. One RCT compared the efficacy of papilla preservation flaps (single flap approach versus OFD) in the presence of intrabony pockets. Two RCTs compared minimally invasive surgery with conventional surgery. Moderate to high risk of bias. Limited available data. Grade of recommendation Grade 0—↔ Strength of consensus Consensus (0% of the group abstained due to potential CoI)
Background
Available evidence Resective periodontal surgery attained statistically signifi - cantly higher PPD reduction than access flaps at 6 months (WMD = 0.59 mm; 95% CI [0.06–1.12]) and one year (WMD = 0.47 mm; 95% CI [0.24; 0.7]). For pockets 4–6 mm, dif - ferences were statistically significant at 1 year (WMD = 0.34 mm; 95% CI [0.19; 0.48]), while pockets 7 mm or deeper showed greater difference between the groups (WMD = 0.76 mm; CI [0.35; 1.17]). The differences were lost with time (3- and 5-year follow-up). There were no differences in CAL gains between the surgical modalities in the long term (3–5 years). Post-operative re - cession was statistically significantly greater following resective surgery than access flaps at 1-year post-op (two studies). No dif - ferences reported at 5-year follow-up (one study). No differences in recession over time in initially shallow pockets between the two modalities.
Background
Available evidence Out of three available studies comparing MWF with OFD, only one showed statistically significantly greater PPD reduction for MWF than OFD. There were no statistically significant differences in % PPD re - duction in deep infrabony pockets between papilla preservation flap (single flap approach) and conventional flaps (one study). Two studies comparing minimally invasive surgery with conventional surgery did not demonstrate a significant added value in PPD reduction or CAL gain .
Risk of bias High risk of bias, scarcity of quantitative data (only 4 RCTs).
7.3 | Intervention: resective flap procedures
Clinical relevance and effect size The paucity of the data on percentage of shallow pockets or inci - dence of re-treatment prevents assessments of the clinical relevance of the differences. Balance of benefit and harm Data on PROMs, the percentage of residual pockets or the need of re-treatment were not reported in any of the studies.
The third relevant question was whether resective flap procedures (those that, in addition to gaining access for subgingival debride - ment, aim to change the architecture of the hard and/or the soft tissues to attain shallow probing depths) are more efficacious than conservative surgical procedures in achieving the endpoints of peri - odontal in the treatment of patients with Stage III periodontitis.
Made with FlippingBook Annual report