Comparative evaluation of osseous bone splitting by piezosurgery and intramarrow penetration in localized intra-bony defects in patients with chronic periodontitis: a clinico-radiographical pilot study

Manav Varshney; Sumit Malhotra; Aruna Nautiyal

doi:10.18203/2320-6012.ijrms20261348

Authors

Manav Varshney Department of Periodontology and Oral Implantology, ITS Centre for Dental Studies and Research, Ghaziabad, Uttar Pradesh, India https://orcid.org/0009-0004-7651-8313
Sumit Malhotra Department of Periodontology and Oral Implantology, ITS Centre for Dental Studies and Research, Ghaziabad, Uttar Pradesh, India https://orcid.org/0000-0002-4257-8762
Aruna Nautiyal Department of Periodontology and Oral Implantology, ITS Centre for Dental Studies and Research, Ghaziabad, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20261348

Keywords:

Periodontitis, Intra-bony defects, Piezo-surgery, Osseous bone splitting, Intra-marrow penetration

Abstract

Chronic periodontitis leads to intrabony defects that compromise tooth stability. Conventional treatments often show limited bone regeneration. Techniques like bone splitting by piezosurgery and intra marrow penetration (IMP) have emerged to enhance bone healing. This study aimed to explore their comparative effectiveness in promoting osseous regeneration and improving clinical outcomes in affected patients. 16 patients with probing depth ≥6 mm were selected and randomly underwent open flap debridement (OFD), followed by osseous bone splitting of the defect using piezosurgery (group A) and IMP (group B), with subsequent bone graft placement in the defect. Full mouth gingival index, plaque index, pocket probing depth and relative attachment level were assessed at baseline and 6 month visits. Defect base level (DBL), crestal bone level (CBL), intrabony defect depth (INTRA) and defect angle (ANG) were also analysed. Intragroup comparison shows statistically significant results in all clinical and radiological parameters in group A and group B (p<0.05). Intergroup comparison shows similar results in both the groups at 6 months interval. Both techniques of bone splitting using piezosurgery and IMP have shown promising results in the management of localized intra-bony defects in patients with chronic periodontitis.

Metrics

Metrics Loading ...

References

Heitz‐Mayfield LJ, Trombelli L, Heitz F, Needleman I, Moles D. A systematic review of the effect of surgical debridement vs. non‐surgical debridement for the treatment of chronic periodontitis. J Clin Periodontol. 2002;29:92-102. DOI: https://doi.org/10.1034/j.1600-051X.29.s3.5.x

Bottino MC, Thomas V, Schmidt G, Vohra YK, Chu TM, Kowolik MJ, et al. Recent advances in the development of GTR/GBR membranes for periodontal regeneration—A materials perspective. Dent Mater J. 2012;28(7):703-21. DOI: https://doi.org/10.1016/j.dental.2012.04.022

Pagliaro U, Nieri M, Rotundo R, Cairo F, Carnevale G, Esposito M, et al. Clinical guidelines of the Italian Society of Periodontology for the reconstructive surgical treatment of angular bony defects in periodontal patients. J Periodontol. 2008;79(12):2219-32. DOI: https://doi.org/10.1902/jop.2008.080266

Trombelli L. Which reconstructive procedures are effective for treating the periodontal intraosseous defect? Periodontol 2000. 2005;37(1):88-105. DOI: https://doi.org/10.1111/j.1600-0757.2004.03798.x

Cheng LL. Access flap surgery treatment for intrabony defects may result in improved clinical outcomes. J Am Dent Assoc. 2014;145(4):376-7. DOI: https://doi.org/10.14219/jada.2013.43

Gamal AY, Mailhot JM. The effects of EDTA gel conditioning exposure time on periodontitis-affected human root surfaces: Surface topography and PDL cell adhesion. J Int Acad Periodontol. 2003;5(1):11-22.

Wikesjö UM, Crigger M, Nilvéus R, Selvig KA. Early healing events at the dentin-connective tissue interface. Light and transmission electron microscopy observations. J Periodontol. 1991;62(1):5-14. DOI: https://doi.org/10.1902/jop.1991.62.1.5

Kao RT, Nares S, Reynolds MA. Periodontal regeneration—Intrabony defects: A systematic review from the AAP Regeneration Workshop. J Periodontol. 2015;86:S77-S104. DOI: https://doi.org/10.1902/jop.2015.130685

El-Destawy MT, Khedr MF, Hosny MM, Bilal AM, Elshamy AM, El Sayed IS, et al. A novel approach of periodontal osseous wall piezosplitting and sequential bone expansion in management of localized intra-bony defects with wide angulation: A randomized controlled trial. Healthcare. 2023;11(6):791. DOI: https://doi.org/10.3390/healthcare11060791

Cortellini P. Radiographic defect angle influences the outcomes of GTR therapy in intrabony defects. J Dent Res. 1999;78:2208.

Sharma P, Manjunath RG, Gummaluri SS, Kunche L. Intramarrow penetration synergized with advanced platelet rich fibrin in periodontal regeneration: A randomized controlled trial. J Indian Soc Periodontol. 2023;27:301-7. DOI: https://doi.org/10.4103/jisp.jisp_199_22

El-Ghaysh A. The validity of intramarrow penetration with open flap debridement in the treatment of intrabony defects in patients with chronic peridontitis. EC Dent Sci. 2017;6:266-76.

Seshan H, Konuganti K, Zope S. Piezosurgery in periodontology and oral implantology. J Indian Soc Periodontol. 2009;13(3):155-6. DOI: https://doi.org/10.4103/0972-124X.60229

Kodama T, Minabe M, Sugiyama T, Mitarai E, Fushimi H, Kitsugi D, et al. Guided tissue regeneration using a collagen barrier and bone swaging technique in noncontained infrabony defects. Int J Periodontics Restor Dent. 2013;33:805-12. DOI: https://doi.org/10.11607/prd.1111

Crea A, Deli G, Littarru C, Lajolo C, Orgeas GV, Tatakis DN. Intrabony defects, open-flap debridement, and decortication: a randomized clinical trial. J Periodontol. 2014;85(1):34-42. DOI: https://doi.org/10.1902/jop.2013.120753

Saini AK, Tewari S, Narula SC, Sharma RK, Tanwar N, Sangwan A. Comparative clinical and radiographic evaluation of demineralized freeze-dried bone allograft with and without decortication in the treatment of periodontal intrabony defects: a randomized controlled clinical study. Quintessence Int. 2020;51(10):822-37.

Kim CS, Choi SH, Chai JK. Periodontal repair in surgically created intrabony defects in dogs: Influence of the number of bone walls on healing response. J Periodontol. 2004;75:229-35. DOI: https://doi.org/10.1902/jop.2004.75.2.229

Yilmaz S, Kabadayi C, Ipci SD, Cakar G, Kuru B. Treatment of intrabony periodontal defects with platelet-rich plasma versus platelet-poor plasma combined with a bovine-derived xenograft: a controlled clinical trial. J Periodontol. 2011;82(6):837-44. DOI: https://doi.org/10.1902/jop.2010.100503

Koel D, Chatterjee A. Treatment of horizontal defect with and without platelet-rich fibrin matrix: A randomized comparative clinical study. J Indian Soc Periodontol. 2018;22(5):406-13. DOI: https://doi.org/10.4103/jisp.jisp_129_18

Ugale GM, Male RB, Bhandari VD, Baghele ON, Metri R, Ugale MS. Evaluation of platelet-rich fibrin in the treatment of decorticated intrabony defects: a randomized clinical trial. Quintessence Int. 2023;54(10):808-20.

Klein F, Kim TS, Hassfeld S. Radiographic defect depth and width for prognosis and description of periodontal healing of intrabony defects. J Periodontol. 2001;72:1639-46. DOI: https://doi.org/10.1902/jop.2001.72.12.1639

Steffensen B, Webert HP. Relationship between the radiographic periodontal defect angle and healing after treatment. J Periodontol. 1989;60:248-54. DOI: https://doi.org/10.1902/jop.1989.60.5.248

Sebaoun JD, Kantarci A, Turner JW, Carvalho RS, Van Dyke TE, Ferguson J. Modeling of trabecular bone and lamina dura following selective alveolar decortication in rats. J Periodontol. 2008;79:1679-88. DOI: https://doi.org/10.1902/jop.2008.080024