Palabras clave
cirugía periodontal
pérdida ósea alveolar
defecto intraóseo
cirugía reconstructiva
regeneración ósea guiada
pérdida ósea alveolar
defecto intraóseo
cirugía reconstructiva
regeneración ósea guiada
Cómo citar
Tratamiento regenerativo de defectos intraóseos mediante colgajos mínimamente invasivos: Revisión sistemática exploratoria. (2022). Odontoestomatología, 24(40), 1-17. https://doi.org/10.22592/ode2022n40e318
Resumen
Objetivo: Analizar los resultados clínicos del tratamiento regenerativo de defectos intraóseos mediante colgajos mínimamente invasivos en pacientes con periodontitis.
Métodos: Se realizó una revisión sistemática exploratoria o scoping review. Se buscaron artículos en las bases de datos Pubmed, Scopus, Ebsco Complete y OpenGrey, evaluándose indicadores clínicos (profundidad de sondaje, nivel de inserción clínica, recesión del margen gingival), radiográficos y el diseño de colgajo utilizado, con un seguimiento de al menos 6 meses.
Resultados: 13 artículos fueron incluidos, observando en promedio una reducción de profundidad de sondaje de 4,69 mm, ganancia de inserción de 4,23 mm, y una variación de la recesión de −0,44 mm. Los grupos intervenidos con Modified Papilla Preservation Technique y Entire Papilla Preservation Technique presentan mejores resultados clínicos. Single Flap Approach es el que presenta mayor recesión.
Conclusión: Los colgajos mínimamente invasivos tienen excelentes resultados clínicos, sin beneficios adicionales con la aplicación conjunta de biomateriales.
Referencias
1. Sanz M, Tonetti M. Introduction : classifying periodontitis. Eur Fed Periodontol. 2019;(March):1–9.
2.Nibali L, Koidou VP, Nieri M, Barbato L, Pagliaro U, Cairo F. Regenerative surgery versus access flap for the treatment of intra-bony periodontal defects: A systematic review and meta-analysis. J Clin Periodontol. 2020;47(S22):320–51.
3.Papapanou PN, Tonetti MS. Diagnosis and epidemiology of periodontal osseous lesions. Periodontol 2000. 2000;22(1):8–21.
4.Mancini L, Adriano F, Marchetti E. Periodontal Regeneration. Encyclopedia MDPI 2021 ;1:87–98.
5. Ryder MI, Armitage GC. Minimally invasive periodontal therapy for general practitioners. Periodontol 2000. 2016;71(1):7–9.
6. Reynolds MA, Kao RT, Nares S, Camargo PM, Caton JG, Clem DS, et al. Periodontal Regeneration — Intrabony Defects: Practical Applications From the AAP Regeneration Workshop. Clin Adv Periodontics. 2015;5(1):21–9.
7. Nibali L, Sultan D, Arena C, Pelekos G, Lin GH, Tonetti M. Periodontal infrabony defects: Systematic review of healing by defect morphology following regenerative surgery. J Clin Periodontol. 2021;48(1):100–13.
8. Stavropoulos A, Bertl K, Spineli LM, Sculean A, Cortellini P, Tonetti M. Medium- and long-term clinical benefits of periodontal regenerative/reconstructive procedures in intrabony defects: Systematic review and network meta-analysis of randomized controlled clinical studies. J Clin Periodontol. 2021;48(3):410–30.
9. Cortellini P, Buti J, Pini Prato G, Tonetti MS. Periodontal regeneration compared with access flap surgery in human intra-bony defects 20-year follow-up of a randomized clinical trial: tooth retention, periodontitis recurrence and costs. J Clin Periodontol. 2017;44(1):58–66.
10. Clementini M, Ambrosi A, Cicciarelli V, De Risi V, de Sanctis M. Clinical performance of minimally invasive periodontal surgery in the treatment of infrabony defects: Systematic review and meta-analysis. J Clin Periodontol. 2019;46(12):1236–53.
11. Trombelli L, Simonelli A, Quaranta A, Tu YK, Li H, Agusto M, et al. Effect of Flap Design for Enamel Matrix Derivative Application in Intraosseous Defects. JDR Clin Transl Res. ahead of print 2020:1–11.
12. Sultan N, Jafri Z, Sawai M, Bhardwaj A. Minimally invasive periodontal therapy. J Oral Biol Craniofacial Res. 2020;10(2):161–5. Available from: https://doi.org/10.1016/j.jobcr.2020.04.014
13. Cortellini P, Prato GP, Tonetti MS. The modified papilla preservation technique. A new surgical approach for interproximal regenerative procedures. J. Periodontol. 1995; 66: 261–266.
14. Cortellini P, Prato GP, Tonetti MS. The simplified papilla preservation flap. A novel surgical approach for the management of soft tissues in regenerative procedures. Int J Periodontics Restor Dent. 1999; 19:589–599.
15. Trombelli L, Farina R, Franceschetti G. Use of the single flap approach in periodontal reconstructive surgery. Dent. Cadmos. 2007; 8:15–25.
16. Cortellini P, Tonetti MS. A minimally invasive surgical technique with an enamel matrix derivative in the regenerative treatment of intrabony defects: A novel approach to limit morbidity. J Clin Periodontol. 2007;34(1):87–93.
17. Cortellini P, Tonetti MS. Improved wound stability with a modified minimally invasive surgical technique in the regenerative treatment of isolated interdental intrabony defects. J Clin Periodontol. 2009;36(2):157–63.
18. Aslan S, Buduneli N, Cortellini P. Entire Papilla Preservation Technique: A Novel Surgical Approach for Regenerative Treatment of Deep and Wide Intrabony Defects. Int J Periodontics Restorative Dent. 2017;37(2):227–33.
19. Wu YC, Lin LK, Song CJ, Su YX, Tu YK. Comparisons of periodontal regenerative therapies: A meta-analysis on the long-term efficacy. J Clin Periodontol. 2017;44(5):511–9.
20. Graziani F, Gennai S, Cei S, Cairo F, Baggiani A, Miccoli M, et al. Clinical performance of access flap surgery in the treatment of the intrabony defect. A systematic review and meta-analysis of randomized clinical trials. J Clin Periodontol. 2012;39(2):145–56.
21. Ribeiro FV, Casarin RCV, Palma MAG, Júnior FHN, Sallum EA, Casati MZ. Clinical and Patient-Centered Outcomes After Minimally Invasive Non-Surgical or Surgical Approaches for the Treatment of Intrabony Defects: A Randomized Clinical Trial. J Periodontol. 2011;82(9):1256–66.
22. Aslan S, Buduneli N, Cortellini P. Clinical outcomes of the entire papilla preservation technique with and without biomaterials in the treatment of isolated intrabony defects: A randomized controlled clinical trial. J Clin Periodontol. 2020;47(4):470–8.
23. Corbella S, Alberti A, Calciolari E, Taschieri S, Francetti L. Enamel matrix derivative for the treatment of partially contained intrabony defects: 12-month results. Aust Dent J. 2019;64(1):27–34.
24. Aslan S, Buduneli N, Cortellini P. Entire papilla preservation technique in the regenerative treatment of deep intrabony defects: 1-Year results. J Clin Periodontol. 2017;44(9):926–32.
25. Pilloni A, Rojas MA, Marini L, Russo P, Shirakata Y, Sculean A, et al. Healing of intrabony defects following regenerative surgery by means of single-flap approach in conjunction with either hyaluronic acid or an enamel matrix derivative: a 24 month randomized controlled clinical trial. Clin Oral Investig. 2021; 25(8):5095-5107.
26. Miliauskaite A, Selimovic D, Hassan M, Nagano F, Soell M, Sano H, et al. Papilla preservation technique combined with Emdogain in the treatment of intrabony defects: a novel treatment regimen for chronic periodontitis. Stomatologija. 2008;10(1):22–6.
27. Trombelli L, Farina R, Minenna L, Toselli L, Simonelli A. Regenerative periodontal treatment with the single flap approach in smokers and nonsmokers. Int J Periodontics Restor Dent. 2018;38(4):e59–67.
28. Trombelli L, Simonelli A, Pramstraller M, Wikesjö UME, Farina R. Single Flap Approach With and Without Guided Tissue Regeneration and a Hydroxyapatite Biomaterial in the Management of Intraosseous Periodontal Defects. J Periodontol. 2010;81(9):1256–63.
29. Cortellini P, Nieri M, Pini Prato G, Tonetti MS. Single minimally invasive surgical technique with an enamel matrix derivative to treat multiple adjacent intra-bony defects: Clinical outcomes and patient morbidity. J Clin Periodontol. 2008;35(7):605–13.
30. Oh SL, Joshi S. Single-Flap Approach in Periodontal Regeneration for Intraosseous Defects: Case Series. Clin Adv Periodontics. 2020 Jun 1;10(2):69–74.
31. Ribeiro FV, Nociti Júnior FH, Sallum EA, Sallum AW, Casati MZ. Use of enamel matrix protein derivative with minimally invasive surgical approach in intra-bony periodontal defects: Clinical and patient-centered outcomes. Braz Dent J. 2010;21(1):60–7.
32. Trombelli L, Farina R, Minenna L, Toselli L, Simonelli A. Regenerative Periodontal Treatment with the Single Flap Approach in Smokers and Nonsmokers. Int J Periodontics Restorative Dent. 2018 Jul;38(4):e59–67.
33. Tatsumi M, Yanagita M, Yamashita M, Hasegawa S, Ikegami K, Kitamura M, et al. Long-term exposure to cigarette smoke influences characteristics in human gingival fibroblasts. J Periodontal Res. 2021;56(5):951–63.
34. Alanazi H, Park HJ, Chakir J, Semlali A, Rouabhia M. Comparative study of the effects of cigarette smoke and electronic cigarettes on human gingival fibroblast proliferation, migration and apoptosis. Food Chem Toxicol . 2018;118(May):390–8. https://doi.org/10.1016/j.fct.2018.05.049
35. Chaffee BW, Couch ET, Ryder MI. The tobacco-using periodontal patient: The role of the dental practitioner in tobacco cessation and periodontal diseases management Benjamin. HHS Public Heal. 2017;71(1):52–64.
36. Aslan S, Buduneli N, Cortellini P. Reconstructive surgical treatment of isolated deep intrabony defects with guided tissue regeneration using entire papilla preservation technique: A prospective case series. J Periodontol. 2020;(May):1–8.
37. Pei X. New surgery approaches preserving entire papilla to treat isolated interdental intrabony defects: A narrative review. Clin Exp Dent Res. 2021;(November 2020):1–7.
38. Windisch P, Iorio-Siciliano V, Palkovics D, Ramaglia L, Blasi A, Sculean A. The role of surgical flap design (minimally invasive flap vs. extended flap with papilla preservation) on the healing of intrabony defects treated with an enamel matrix derivative: a 12-month two-center randomized controlled clinical trial. Clin Oral Investig 2021;(0123456789). https://doi.org/10.1007/s00784-021-04155-5
39. Aimetti M, Ferrarotti F, Mariani GM, Romano F. A novel flapless approach versus minimally invasive surgery in periodontal regeneration with enamel matrix derivative proteins: a 24-month randomized controlled clinical trial. Clin Oral Investig. 2017;21(1):327–37.
40. Isidor F, Karring T. Long‐term effect of surgical and non‐surgical periodontal treatment. A 5‐year clinical study. J Periodontal Res. 1986;21(5):462–72.
41. Froum SJ, Weinberg MA, Rosenberg E, Tarnow D. A Comparative Study Utilizing Open Flap Debridement with and Without Enamel Matrix Derivative in the Treatment of Periodontal Intrabony Defects: A 12-Month Re-Entry Study. J Periodontol. 2001;72(1):25–34.
42. Tugnait A, Clerehugh V. Gingival recession its significance and management. J Dent 2001;29 (6): 381-394
43. Trombelli L, Simonelli A, Minenna L, Vecchiatini R, Farina R. Simplified procedures to treat periodontal intraosseous defects in esthetic areas. Periodontol 2000. 2018 Jun 1;77(16):93–110.
44. Cortellini P, Tonetti MS. Clinical and radiographic outcomes of the modified minimally invasive surgical technique with and without regenerative materials: A randomized-controlled trial in intra-bony defects. J Clin Periodontol. 2011;38(4):365–73.
45. Cortellini P. Minimally invasive surgical techniques in periodontal regeneration. J Evid Based Dent Pract 2012;12(3 SUPPL.):89–100. http://dx.doi.org/10.1016/S1532-3382(12)70021-0
46. Retzepi M, Tonetti M, Donos N. Comparison of gingival blood flow during healing of simplified papilla preservation and modified Widman flap surgery: A clinical trial using laser Doppler flowmetry. J Clin Periodontol. 2007;34(10):903–11.
47. Graziani F, Peric M, Marhl U, Petrini M, Bettini L, Tonetti M, et al. Local application of enamel matrix derivative prevents acute systemic inflammation after periodontal regenerative surgery: A randomized controlled clinical trial. J Clin Periodontol. 2020 Jun;47(6):747–55.
48. Miron RJ, Sculean A, Cochran DL, Froum S, Zucchelli G, Nemcovsky C, et al. Twenty years of enamel matrix derivative: the past, the present and the future. J Clin Periodontol. 2016;43(8):668–83.
49. Lee JH, Park YS, Kim YT, Kim DH, Jeong SN. Assessment of early discomfort and wound healing outcomes after periodontal surgery with and without enamel matrix derivative: an observational retrospective case-control study. Clin Oral Investig. 2020;24(1):229–37.
50. Zhou S, Sun C, Huang S, Wu X, Zhao Y, Pan C, et al. Efficacy of Adjunctive Bioactive Materials in the Treatment of Periodontal Intrabony Defects: A Systematic Review and Meta-Analysis. Biomed Res Int. 2018;2018.
51. Sculean A, Alessandri R, Miron R, Salvi GE, Bosshardt DD. Enamel Matrix Proteins and Periodontal Wound Healing and Regeneration. Clin Adv Periodontics. 2011;1(2):101–17.
52. Esposito M, Grusovin MG, Papanikolaou N, Coulthard P, Worthington H V. Enamel matrix derivative (Emdogain®) for periodontal tissue regeneration in intrabony defects. A Cochrane systematic review. Eur J Oral Implantol. 2009;2(4):247–66.
53. Kao RT, Nares S, Reynolds MA. Periodontal Regeneration – Intrabony Defects: A Systematic Review from the AAP Regeneration Workshop. J Periodontol. 2015;86(2-s):S77–104.
54. Rojas MA, Marini L, Pilloni A, Sahrmann P. Early wound healing outcomes after regenerative periodontal surgery with enamel matrix derivatives or guided tissue regeneration: A systematic review. BMC Oral Health. 2019;19(1):1–16.
55. Liu S, Hu B, Zhang Y, Li W, Song J. Minimally invasive surgery combined with regenerative biomaterials in treating intra- bony defects: A meta-analysis. PLoS One. 2016;11(1):1–13.
56. Aimetti M, Fratini A, Manavella V, Giraudi M, Citterio F, Ferrarotti F, et al. Pocket resolution in regenerative treatment of intrabony defects with papilla preservation techniques: A systematic review and meta-analysis of randomized clinical trials. J Clin Periodontol. 2021;48(6):843–58.
57. Liu B, Ouyang X, Kang J, Zhou S, Suo C, Xu L, et al. Efficacy of periodontal minimally invasive surgery with and without regenerative materials for treatment of intrabony defect: a randomized clinical trial. Clin Oral Investig 2021;(0123456789). https://doi.org/10.1007/s00784-021-04134-w
2.Nibali L, Koidou VP, Nieri M, Barbato L, Pagliaro U, Cairo F. Regenerative surgery versus access flap for the treatment of intra-bony periodontal defects: A systematic review and meta-analysis. J Clin Periodontol. 2020;47(S22):320–51.
3.Papapanou PN, Tonetti MS. Diagnosis and epidemiology of periodontal osseous lesions. Periodontol 2000. 2000;22(1):8–21.
4.Mancini L, Adriano F, Marchetti E. Periodontal Regeneration. Encyclopedia MDPI 2021 ;1:87–98.
5. Ryder MI, Armitage GC. Minimally invasive periodontal therapy for general practitioners. Periodontol 2000. 2016;71(1):7–9.
6. Reynolds MA, Kao RT, Nares S, Camargo PM, Caton JG, Clem DS, et al. Periodontal Regeneration — Intrabony Defects: Practical Applications From the AAP Regeneration Workshop. Clin Adv Periodontics. 2015;5(1):21–9.
7. Nibali L, Sultan D, Arena C, Pelekos G, Lin GH, Tonetti M. Periodontal infrabony defects: Systematic review of healing by defect morphology following regenerative surgery. J Clin Periodontol. 2021;48(1):100–13.
8. Stavropoulos A, Bertl K, Spineli LM, Sculean A, Cortellini P, Tonetti M. Medium- and long-term clinical benefits of periodontal regenerative/reconstructive procedures in intrabony defects: Systematic review and network meta-analysis of randomized controlled clinical studies. J Clin Periodontol. 2021;48(3):410–30.
9. Cortellini P, Buti J, Pini Prato G, Tonetti MS. Periodontal regeneration compared with access flap surgery in human intra-bony defects 20-year follow-up of a randomized clinical trial: tooth retention, periodontitis recurrence and costs. J Clin Periodontol. 2017;44(1):58–66.
10. Clementini M, Ambrosi A, Cicciarelli V, De Risi V, de Sanctis M. Clinical performance of minimally invasive periodontal surgery in the treatment of infrabony defects: Systematic review and meta-analysis. J Clin Periodontol. 2019;46(12):1236–53.
11. Trombelli L, Simonelli A, Quaranta A, Tu YK, Li H, Agusto M, et al. Effect of Flap Design for Enamel Matrix Derivative Application in Intraosseous Defects. JDR Clin Transl Res. ahead of print 2020:1–11.
12. Sultan N, Jafri Z, Sawai M, Bhardwaj A. Minimally invasive periodontal therapy. J Oral Biol Craniofacial Res. 2020;10(2):161–5. Available from: https://doi.org/10.1016/j.jobcr.2020.04.014
13. Cortellini P, Prato GP, Tonetti MS. The modified papilla preservation technique. A new surgical approach for interproximal regenerative procedures. J. Periodontol. 1995; 66: 261–266.
14. Cortellini P, Prato GP, Tonetti MS. The simplified papilla preservation flap. A novel surgical approach for the management of soft tissues in regenerative procedures. Int J Periodontics Restor Dent. 1999; 19:589–599.
15. Trombelli L, Farina R, Franceschetti G. Use of the single flap approach in periodontal reconstructive surgery. Dent. Cadmos. 2007; 8:15–25.
16. Cortellini P, Tonetti MS. A minimally invasive surgical technique with an enamel matrix derivative in the regenerative treatment of intrabony defects: A novel approach to limit morbidity. J Clin Periodontol. 2007;34(1):87–93.
17. Cortellini P, Tonetti MS. Improved wound stability with a modified minimally invasive surgical technique in the regenerative treatment of isolated interdental intrabony defects. J Clin Periodontol. 2009;36(2):157–63.
18. Aslan S, Buduneli N, Cortellini P. Entire Papilla Preservation Technique: A Novel Surgical Approach for Regenerative Treatment of Deep and Wide Intrabony Defects. Int J Periodontics Restorative Dent. 2017;37(2):227–33.
19. Wu YC, Lin LK, Song CJ, Su YX, Tu YK. Comparisons of periodontal regenerative therapies: A meta-analysis on the long-term efficacy. J Clin Periodontol. 2017;44(5):511–9.
20. Graziani F, Gennai S, Cei S, Cairo F, Baggiani A, Miccoli M, et al. Clinical performance of access flap surgery in the treatment of the intrabony defect. A systematic review and meta-analysis of randomized clinical trials. J Clin Periodontol. 2012;39(2):145–56.
21. Ribeiro FV, Casarin RCV, Palma MAG, Júnior FHN, Sallum EA, Casati MZ. Clinical and Patient-Centered Outcomes After Minimally Invasive Non-Surgical or Surgical Approaches for the Treatment of Intrabony Defects: A Randomized Clinical Trial. J Periodontol. 2011;82(9):1256–66.
22. Aslan S, Buduneli N, Cortellini P. Clinical outcomes of the entire papilla preservation technique with and without biomaterials in the treatment of isolated intrabony defects: A randomized controlled clinical trial. J Clin Periodontol. 2020;47(4):470–8.
23. Corbella S, Alberti A, Calciolari E, Taschieri S, Francetti L. Enamel matrix derivative for the treatment of partially contained intrabony defects: 12-month results. Aust Dent J. 2019;64(1):27–34.
24. Aslan S, Buduneli N, Cortellini P. Entire papilla preservation technique in the regenerative treatment of deep intrabony defects: 1-Year results. J Clin Periodontol. 2017;44(9):926–32.
25. Pilloni A, Rojas MA, Marini L, Russo P, Shirakata Y, Sculean A, et al. Healing of intrabony defects following regenerative surgery by means of single-flap approach in conjunction with either hyaluronic acid or an enamel matrix derivative: a 24 month randomized controlled clinical trial. Clin Oral Investig. 2021; 25(8):5095-5107.
26. Miliauskaite A, Selimovic D, Hassan M, Nagano F, Soell M, Sano H, et al. Papilla preservation technique combined with Emdogain in the treatment of intrabony defects: a novel treatment regimen for chronic periodontitis. Stomatologija. 2008;10(1):22–6.
27. Trombelli L, Farina R, Minenna L, Toselli L, Simonelli A. Regenerative periodontal treatment with the single flap approach in smokers and nonsmokers. Int J Periodontics Restor Dent. 2018;38(4):e59–67.
28. Trombelli L, Simonelli A, Pramstraller M, Wikesjö UME, Farina R. Single Flap Approach With and Without Guided Tissue Regeneration and a Hydroxyapatite Biomaterial in the Management of Intraosseous Periodontal Defects. J Periodontol. 2010;81(9):1256–63.
29. Cortellini P, Nieri M, Pini Prato G, Tonetti MS. Single minimally invasive surgical technique with an enamel matrix derivative to treat multiple adjacent intra-bony defects: Clinical outcomes and patient morbidity. J Clin Periodontol. 2008;35(7):605–13.
30. Oh SL, Joshi S. Single-Flap Approach in Periodontal Regeneration for Intraosseous Defects: Case Series. Clin Adv Periodontics. 2020 Jun 1;10(2):69–74.
31. Ribeiro FV, Nociti Júnior FH, Sallum EA, Sallum AW, Casati MZ. Use of enamel matrix protein derivative with minimally invasive surgical approach in intra-bony periodontal defects: Clinical and patient-centered outcomes. Braz Dent J. 2010;21(1):60–7.
32. Trombelli L, Farina R, Minenna L, Toselli L, Simonelli A. Regenerative Periodontal Treatment with the Single Flap Approach in Smokers and Nonsmokers. Int J Periodontics Restorative Dent. 2018 Jul;38(4):e59–67.
33. Tatsumi M, Yanagita M, Yamashita M, Hasegawa S, Ikegami K, Kitamura M, et al. Long-term exposure to cigarette smoke influences characteristics in human gingival fibroblasts. J Periodontal Res. 2021;56(5):951–63.
34. Alanazi H, Park HJ, Chakir J, Semlali A, Rouabhia M. Comparative study of the effects of cigarette smoke and electronic cigarettes on human gingival fibroblast proliferation, migration and apoptosis. Food Chem Toxicol . 2018;118(May):390–8. https://doi.org/10.1016/j.fct.2018.05.049
35. Chaffee BW, Couch ET, Ryder MI. The tobacco-using periodontal patient: The role of the dental practitioner in tobacco cessation and periodontal diseases management Benjamin. HHS Public Heal. 2017;71(1):52–64.
36. Aslan S, Buduneli N, Cortellini P. Reconstructive surgical treatment of isolated deep intrabony defects with guided tissue regeneration using entire papilla preservation technique: A prospective case series. J Periodontol. 2020;(May):1–8.
37. Pei X. New surgery approaches preserving entire papilla to treat isolated interdental intrabony defects: A narrative review. Clin Exp Dent Res. 2021;(November 2020):1–7.
38. Windisch P, Iorio-Siciliano V, Palkovics D, Ramaglia L, Blasi A, Sculean A. The role of surgical flap design (minimally invasive flap vs. extended flap with papilla preservation) on the healing of intrabony defects treated with an enamel matrix derivative: a 12-month two-center randomized controlled clinical trial. Clin Oral Investig 2021;(0123456789). https://doi.org/10.1007/s00784-021-04155-5
39. Aimetti M, Ferrarotti F, Mariani GM, Romano F. A novel flapless approach versus minimally invasive surgery in periodontal regeneration with enamel matrix derivative proteins: a 24-month randomized controlled clinical trial. Clin Oral Investig. 2017;21(1):327–37.
40. Isidor F, Karring T. Long‐term effect of surgical and non‐surgical periodontal treatment. A 5‐year clinical study. J Periodontal Res. 1986;21(5):462–72.
41. Froum SJ, Weinberg MA, Rosenberg E, Tarnow D. A Comparative Study Utilizing Open Flap Debridement with and Without Enamel Matrix Derivative in the Treatment of Periodontal Intrabony Defects: A 12-Month Re-Entry Study. J Periodontol. 2001;72(1):25–34.
42. Tugnait A, Clerehugh V. Gingival recession its significance and management. J Dent 2001;29 (6): 381-394
43. Trombelli L, Simonelli A, Minenna L, Vecchiatini R, Farina R. Simplified procedures to treat periodontal intraosseous defects in esthetic areas. Periodontol 2000. 2018 Jun 1;77(16):93–110.
44. Cortellini P, Tonetti MS. Clinical and radiographic outcomes of the modified minimally invasive surgical technique with and without regenerative materials: A randomized-controlled trial in intra-bony defects. J Clin Periodontol. 2011;38(4):365–73.
45. Cortellini P. Minimally invasive surgical techniques in periodontal regeneration. J Evid Based Dent Pract 2012;12(3 SUPPL.):89–100. http://dx.doi.org/10.1016/S1532-3382(12)70021-0
46. Retzepi M, Tonetti M, Donos N. Comparison of gingival blood flow during healing of simplified papilla preservation and modified Widman flap surgery: A clinical trial using laser Doppler flowmetry. J Clin Periodontol. 2007;34(10):903–11.
47. Graziani F, Peric M, Marhl U, Petrini M, Bettini L, Tonetti M, et al. Local application of enamel matrix derivative prevents acute systemic inflammation after periodontal regenerative surgery: A randomized controlled clinical trial. J Clin Periodontol. 2020 Jun;47(6):747–55.
48. Miron RJ, Sculean A, Cochran DL, Froum S, Zucchelli G, Nemcovsky C, et al. Twenty years of enamel matrix derivative: the past, the present and the future. J Clin Periodontol. 2016;43(8):668–83.
49. Lee JH, Park YS, Kim YT, Kim DH, Jeong SN. Assessment of early discomfort and wound healing outcomes after periodontal surgery with and without enamel matrix derivative: an observational retrospective case-control study. Clin Oral Investig. 2020;24(1):229–37.
50. Zhou S, Sun C, Huang S, Wu X, Zhao Y, Pan C, et al. Efficacy of Adjunctive Bioactive Materials in the Treatment of Periodontal Intrabony Defects: A Systematic Review and Meta-Analysis. Biomed Res Int. 2018;2018.
51. Sculean A, Alessandri R, Miron R, Salvi GE, Bosshardt DD. Enamel Matrix Proteins and Periodontal Wound Healing and Regeneration. Clin Adv Periodontics. 2011;1(2):101–17.
52. Esposito M, Grusovin MG, Papanikolaou N, Coulthard P, Worthington H V. Enamel matrix derivative (Emdogain®) for periodontal tissue regeneration in intrabony defects. A Cochrane systematic review. Eur J Oral Implantol. 2009;2(4):247–66.
53. Kao RT, Nares S, Reynolds MA. Periodontal Regeneration – Intrabony Defects: A Systematic Review from the AAP Regeneration Workshop. J Periodontol. 2015;86(2-s):S77–104.
54. Rojas MA, Marini L, Pilloni A, Sahrmann P. Early wound healing outcomes after regenerative periodontal surgery with enamel matrix derivatives or guided tissue regeneration: A systematic review. BMC Oral Health. 2019;19(1):1–16.
55. Liu S, Hu B, Zhang Y, Li W, Song J. Minimally invasive surgery combined with regenerative biomaterials in treating intra- bony defects: A meta-analysis. PLoS One. 2016;11(1):1–13.
56. Aimetti M, Fratini A, Manavella V, Giraudi M, Citterio F, Ferrarotti F, et al. Pocket resolution in regenerative treatment of intrabony defects with papilla preservation techniques: A systematic review and meta-analysis of randomized clinical trials. J Clin Periodontol. 2021;48(6):843–58.
57. Liu B, Ouyang X, Kang J, Zhou S, Suo C, Xu L, et al. Efficacy of periodontal minimally invasive surgery with and without regenerative materials for treatment of intrabony defect: a randomized clinical trial. Clin Oral Investig 2021;(0123456789). https://doi.org/10.1007/s00784-021-04134-w