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Billy A. Smith Journal of Periodontology, 1987
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Introduction
Traditional suggested that in order to getreattachment pocket epithelium shouldbe eliminated.
Many studies have shown that pocketepithelium not always completelyremoved out.
Incomplete removal of pocket epitheliumhave shown good long-term clinicalresults can be achieved.
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Introduction
Recent studies has shown bothcompletely removal and non-removalhave similar result in gaining attachment
and pocket reduction. This article evaluated the need to
eliminate pocket epithelium during
mucoperiosteal flap surgery in order toestablish and maintain health of theperiodontal status.
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Materials and Methods
30 patients were included in this study 5 males and 8 females rank age 30-72 year
The rest is median age of 40 year
Total of 104 teeth constituted the finalsample.
The University of Michigan School ofDentistry who were diagnosed Moderate and advance periodontitis
Pocket at 2 bicuspids and molars on eitherMax or Man arch
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Materials and Methods
After completion of hygienic phase, theneed for additional therapy was requiredfor continuation in the study.
Mucoperiosteal flaps aimed at
reattachment and readaptation wereindicated bilaterally as part of proposedtreatment plan.
Upon completion of hygienic phase and at
1 month and 3 months after surgery,following measurements and indices weretaken for GI; PD; Level of attachment; GR; FI and Mobility
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Materials and Methods
Clinical attachment level; probing depthand GR were measure on 2 bicuspids and2 molars. MB; B; DB; ML and Lingual
All biometric measurements were taken atbaseline (immediately before surgery)
GR was taken
at pre-baseline Immediately after flaps were replaced and
sutured
1-3 months after surgery
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Materials and Methods
Split mouth design was used in thisstudy
A reverse bevel incision as part of a
modified Widman flap Intracrevicular incision as part of a crevicular
mucoperiosteal flap
Toss of the coin method was used torandomized.
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Reverse bevel
incision
Intracrevicularincision
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Materials and Methods
All patients were seen at 1 and 3months post-surgery, and all clinicalmeasurements were done by the same
examiner. All data was calculated by using t-test
Baseline and 1 month post surgical
Baseline and 3 months post surgical
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Results
MW flap reduced PD significantly at 1 and3 months regardless of initial depth.
Crevicular flap reduced significantly in
>4mm group only. There was no significant different of
interproximal attachment loss betweenboth techniques in 1 and 3 months.
There were significant loss of attachmentat 3months in both surgical technique. CFwas seen loss of attachment since 1month.
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Results
There was no significant differentbetween this two surgical techniques.
There was no GR happened after
performing at the interproximal or buccaland lingual area. However, it occurred increvicular flap at 1 and 3 months.
There were no significant change inmobility or furcation involvementbetween the two surgical techniques.
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Discussion
The surgery without removing pocketepithelium shown gain clinical attachmentand reduction in PD.
PI and GCF flow level did not shown anydifferent after MW and CF following withfrequently OHI and rubber cup prophylaxis.
During the study a low grade of gingival
score were observed, because of aprofessional oral dental cleaning and 2surgical procedures.
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Discussion
MW surgical technique was shown pocketreduction over CF surgical technique.
An interproximal gain in clinical attachmentwas seen in both techniques, but not Buccal
and lingual site. Greater GR was performed in MW, because of
a reverse incision approach was used.
Possible explanation were Gingival shrinkage during healing
When epithelium was retained, the fibrin clot maynot have held the flap in the desired position, andapical displacement would have occurred.
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Discussion
Kerry et. al cited there were no changein mobility after 3months MW or crevicalcurretage.
Many authors supported the lack ofremoval of the pocket epitheliumshowed in gaining clinical attachmentand PD reduction. Meanwhile, other
authors claimed that long junctionalepithelium would replace at that area inMW flap.
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Discussion
Listgarten et. al cited that the bonding oflong juctional epithelium was weakerthan the true connective attachment.
Magnusson et.al suggested that longjunctional epithelium had ability toagainst plaque infection.
Beaumont et.al supported that longjuctional epithelium resistant toperiodontal disease in Beagle dog.
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Clinical significance
CF advantages over MW Easy
Adequate maintenance
Less time consuming If connective tissue attachment is sought
using adjunctive therapeutic resourcesthen a reverse bevel incision is
indicated. This type of flap left theconnective tissue opened, so it enhancepotential of reattachment.
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Conclusion
CF that retain pocket epithelium showed
Gain clinical attachment
Reduction of PD over MW flap.
It not imperative to remove pocketepithelium during flap operations foraccessibility and when aiming at
readaptation.