title: A minimally invasive surgical technique with an enamel matrix derivative in the regenerative treatment of intra-bony defects: a novel approach to limit morbidity.
abstract: OBJECTIVE
  This study was undertaken to describe a new surgical approach (minimally invasive surgical technique, MIST) and to evaluate preliminarily its clinical performance and patient perception associated with the application of enamel matrix derivative (EMD) in the treatment of isolated deep intra-bony defects.
  
  
  METHODS
  Thirteen deep isolated intra-bony defects in 13 patients were surgically accessed with the MIST. This technique was designed to limit the mesio-distal flap extension and the corono-apical 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 root surfaces. Stable primary closure of the flaps was obtained with internal modified 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 patient perception was also recorded.
  
  
  RESULTS
  Early wound healing was uneventful: primary wound closure was obtained and maintained in all sites with the exception of one site with a small wound dehiscence at week 1. No oedema or haematoma were noted. Patients did not report any pain. Three patients experienced slight discomfort for 2-days post-operatively. The 1-year clinical attachment level (CAL) gain was 4.8+/-1.9 mm. The 1-year percent resolution of the defect was 88.7+/-20.7%, and reached 100% of the baseline intra-bony component in seven sites. Residual probing depths (PD) were 2.9+/-0.8 mm. Differences between baseline and 1-year CAL and PD were both clinically and statistically highly significant (p<0.0001). A minimal increase of 0.1+/-0.9 mm in gingival recession between baseline and 1 year was recorded (p=0.39).
  
  
  CONCLUSIONS
  This case cohort indicates that MIST associated with EMD resulted in excellent clinical improvements while limiting patient morbidity. These preliminary findings need to be confirmed in a larger study.
authors.affiliation: Accademia Toscana di Ricerca Odontostomatologica, Florence, Italy. studiocortellini@cortellini.191.it
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Cortellini
authors.forename: Maurizio S
authors.initials: MS
authors.lastname: Tonetti
mesh_terms: D000328:Adult; D016301:Alveolar Bone Loss / Q000145:classification / Q000601:surgery*; D001294:Attitude to Health; D015331:Cohort Studies; D003746:Dental Enamel Proteins / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D016557:Guided Tissue Regeneration, Periodontal / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D008866:Microsurgery / Q000295:instrumentation / Q000379:methods; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control; D017060:Patient Satisfaction; D017622:Periodontal Attachment Loss / Q000145:classification / Q000601:surgery; D010514:Periodontal Pocket / Q000145:classification / Q000601:surgery; D013524:Surgical Flaps / Q000145:classification / Q000473:pathology; D013529:Surgical Wound Dehiscence / Q000517:prevention & control; D013536:Suture Techniques; D014945:Wound Healing / Q000502:physiology
chemical_list: D003746:Dental Enamel Proteins; C109069:enamel matrix proteins