Utilization of a Videoscope to Improve Clinical Outcomes of Periodontal Regeneration. A Pilot Study

Objectives: Periodontal disease leads to destruction of supporting tissues of teeth which may result in tooth loss. Regeneration of damaged tissues is a viable approach towards improving the prognosis of affected teeth. The aim of this pilot study was to compare clinical outcomes of traditional guided tissue regeneration (GTR) to the recently developed video-assisted minimally invasive surgery (vMIS) procedure over a 6-month period. Hypothesis: 1.Clinical and radiographic outcomes of periodontal regenerative therapy are enhanced when utilizing the videoscope to assist in visualization of the surgical field during MIS 2. To determine if improved visualization of the surgical field, and hence direct visualization and confirmation of thorough debridement of periodontal lesions, favors GCF levels of growth factors and cytokines/chemokines towards tissue regeneration compared to control groups. Materials and Methods: Eight patients presenting with 13 vertical bone defects (n=13) were randomly assigned to either the vMIS (n=8) or GTR (n=5) surgical group. Clinical parameters measured included probing depth (PD), gingival index (GI), plaque index (PI), and width of keratinized gingiva (KW) at baseline and 6 months. Standardized peri-apical radiographs and cone beam computed tomography (CBCT) images were compared at baseline and at 6 months. GCF (gingival crevicular fluid) samples were collected, and levels of cytokines and growth factors compared over a period of 6 months. Repeated measures ANOVA or a student’s t-test were used to compare outcomes over a 6-month period. RESULTS: None of the subjects were lost to follow-up and no subjects experienced complications. The results show that there was no difference between GTR and VMIS groups with regards to the clinical parameters that were examined, with both groups showing similar PD reduction at 6 months compared to baseline (Table 1). Radiographically, there was a statistically significant improvement of residual defect depth for the VMIS group compared to the GTR group of ~1.5mm (p<0.05) and post-graft cc (grafted area) with a difference of 0.02mm3 (p<0.05) (Table 5). In the VMIS group, there was a decrease in defect depth of 2.07mm (p<0.05). In the GTR group, there was a decrease in defect depth of 1.07mm and defect width of of 1.20mm (p<0.05) Table 3). Regarding the other variables, none showed significant differences between groups or across time points. GCF results are pending. CONCLUSION: This pilot study showed that both VMIS and GTR procedures resulted in similar reductions of PD for teeth with deep intra-bony defects at 6 months. However, VMIS procedures were much less invasive and were effective at reducing periodontal bony defects. Since this is a pilot study, further independent studies are needed with larger groups of patients and longer follow up periods.