Reconstrucción quirúrgica periodontal mediante una nueva técnica para el abordaje apical de defectos periodontales profundos : non-incised papillae surgical approach (NIPSA)

Abstract

Aim The aim of this study was to describe the non-incised papillae surgical approach (NIPSA) procedure and to evaluate the effectiveness as a periodontal reconstructive technique in the management of deep periodontal defects. Materials & methods NIPSA has been investigated for the regenerative treatment of deep periodontal defects throught a series of clinical studies. Group of patients were recruited from a private practice in Murcia (Spain). Inclusion criteria included: no relevant systemic conditions, a diagnosis of periodontitis, full-mouth plaque and bleeding scores <20%, non-surgical therapy and compliance with maintenance for at least one year, one residual interproximal pocket (PPD >5mm) with bleeding on probing. Clinical measurements including probing pocket depth, clinical attachment level, and recession were record-ed prior to surgery and 12 months after. Wound closure was assessed one week after surgery and classified as complete or incomplete closure, or necrosis of the interproximal tissue. The surgical protocol included: 1) pre-surgical micro-instrumentation of the superficial extent of the periodontal pocket; 2) an apical oblique/horizontal incision made in the buccal aspect of the alveolar mucosa on healthy cortical bone as separate from the papillae and marginal gingivae as possible; 3) coronal flap elevation and coronal pulling of the papillae with a micro-papillae elevator to increase space provi-sion; 4) Roots conditioning with enamel matrix derivate and defects grafting with a composite graft of enamel matrix derivative and bovine xenograft, after roots planning and scaling; 5) primary wound closure via the double-suturing technique. Conclusion The advantages of NIPSA are papilla preservation, marginal-tissue adaptation promoting a space for the clot, wound stability, and primary healing.