title: Single minimally invasive surgical technique with an enamel matrix derivative to treat multiple adjacent intra-bony defects: clinical outcomes and patient morbidity.
abstract: OBJECTIVE
  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 multiple deep intra-bony defects in a single surgical procedure.
  
  
  METHODS
  Forty-four deep intra-bony defects in 20 patients (>or=2 defects/patient) were surgically accessed with the MIST. This technique was designed to limit the mesio-distal flap extension and the 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 level (CAL) gain was 4.4+/-1.4 mm (p<0.0001 compared with baseline). Seventy-three per cent of defects showed CAL improvements >or=4 mm. This corresponded to an 83+/-20% resolution of the defect (15 defects were completely filled). Residual probing pocket depths (PDs) were 2.5+/-0.6 mm. A minimal increase of 0.2+/-0.6 mm in gingival recession between baseline and 1 year was recorded. Twelve patients reported a mild perception of the hardship of the surgical procedure. Primary closure was obtained and maintained in all treated sites over time. Only six subjects reported moderate post-operative pain that lasted for 21+/-5 h.
  
  
  CONCLUSIONS
  These data indicate that a MIST in combination with EMD can be applied successfully for the treatment of multiple deep intra-bony defects in the same surgical procedure with excellent clinical outcomes and very limited patient morbidity.
authors.affiliation: Accademia Toscana di Ricerca Odontostomatologica (ATRO), Florence, Italy. studiocortellini@cortellini.191.it
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Cortellini
authors.forename: Michele
authors.initials: M
authors.lastname: Nieri
authors.forename: Giovanpaolo Pini
authors.initials: GP
authors.lastname: Prato
authors.forename: Maurizio S
authors.initials: MS
authors.lastname: Tonetti
mesh_terms: D000328:Adult; D016301:Alveolar Bone Loss / Q000601:surgery*; D018786:Bone Substitutes / Q000627:therapeutic use*; 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; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control; D017060:Patient Satisfaction; D017622:Periodontal Attachment Loss / Q000601:surgery*; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013536:Suture Techniques; D016896:Treatment Outcome
chemical_list: D018786:Bone Substitutes; D003746:Dental Enamel Proteins; C109069:enamel matrix proteins