Billy A.

Smith Journal of Periodontology, 1987

Introduction
Traditional suggested that in order to get reattachment pocket epithelium should be eliminated. Many studies have shown that pocket epithelium not always completely removed out. Incomplete removal of pocket epithelium have shown good long-term clinical results can be achieved.

Introduction
Recent studies has shown both completely removal and non-removal have similar result in gaining attachment and pocket reduction. This article evaluated the need to eliminate pocket epithelium during mucoperiosteal flap surgery in order to establish and maintain health of the periodontal status.

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 final sample. The University of Michigan School of Dentistry who were diagnosed

Moderate and advance periodontitis Pocket at 2 bicuspids and molars on either

Max or Man arch

Materials and Methods

After completion of hygienic phase, the need for additional therapy was required for continuation in the study. Mucoperiosteal flaps aimed at reattachment and readaptation were indicated bilaterally as part of proposed treatment plan. Upon completion of hygienic phase and at 1 month and 3 months after surgery, following measurements and indices were taken for

GI; PD; Level of attachment; GR; FI and Mobility

Materials and Methods

Clinical attachment level; probing depth and GR were measure on 2 bicuspids and 2 molars.
MB; B; DB; ML and Lingual

All biometric measurements were taken at baseline (immediately before surgery) GR was taken

at pre-baseline Immediately after flaps were replaced and

sutured 1-3 months after surgery

Materials and Methods

Split mouth design was used in this study

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 to randomized.

Reverse bevel incision

Intracrevicular incision

Materials and Methods

All patients were seen at 1 and 3 months post-surgery, and all clinical measurements 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

Results
MW flap reduced PD significantly at 1 and 3 months regardless of initial depth. Crevicular flap reduced significantly in >4mm group only. There was no significant different of interproximal attachment loss between both techniques in 1 and 3 months. There were significant loss of attachment at 3months in both surgical technique. CF was seen loss of attachment since 1month.

Results
There was no significant different between this two surgical techniques. There was no GR happened after performing at the interproximal or buccal and lingual area. However, it occurred in crevicular flap at 1 and 3 months. There were no significant change in mobility or furcation involvement between the two surgical techniques.

Discussion
The surgery without removing pocket epithelium shown gain clinical attachment and reduction in PD. PI and GCF flow level did not shown any different after MW and CF following with frequently OHI and rubber cup prophylaxis. During the study a low grade of gingival score were observed, because of a professional oral dental cleaning and 2 surgical procedures.

Discussion

MW surgical technique was shown pocket reduction over CF surgical technique. An interproximal gain in clinical attachment was 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 may

not have held the flap in the desired position, and apical displacement would have occurred.

Discussion
Kerry et. al cited there were no change in mobility after 3months MW or crevical curretage. Many authors supported the lack of removal of the pocket epithelium showed in gaining clinical attachment and PD reduction. Meanwhile, other authors claimed that long junctional epithelium would replace at that area in MW flap.

Discussion
Listgarten et. al cited that the bonding of long juctional epithelium was weaker than the true connective attachment. Magnusson et.al suggested that long junctional epithelium had ability to against plaque infection. Beaumont et.al supported that long juctional epithelium resistant to periodontal disease in Beagle dog.

Clinical significance

CF advantages over MW
Easy Adequate maintenance Less time consuming

If connective tissue attachment is sought using adjunctive therapeutic resources then a reverse bevel incision is indicated. This type of flap left the connective tissue opened, so it enhance potential of reattachment.

Conclusion

CF that retain pocket epithelium showed

Gain clinical attachment
Reduction of PD over MW flap.

It not imperative to remove pocket epithelium during flap operations for accessibility and when aiming at readaptation.