Comparing the efficacy of scaling with root planing and modified widman flap in patients with chronic periodontitis.

The present study was aimed to compare non-surgical treatment (scaling and root planing) with surgical (Modified Widman Flap procedure) treatment for chronic periodontitis. Modified Widman Flap procedure was chosen in our study because it results in removal of pocket epithelium to allow direct approximation of connective tissue with the tooth surface, less mechanical trauma than closed curettage, minimal bone removal, maximal conservation of periodontal tissue, facilitation of oral hygiene, and less root exposure with less sensitivity. The study was performed for a six month period .At initial examination, oral prophylaxis was performed and meticulous oral hygiene instructions were given. The patients were recalled after 21 days. At baseline, 15 subjects were selected with 5-7 mm periodontal pocket in at least 2 quadrants of the mouth. It was a split mouth design, with one quadrant of mouth as Control Group and another quadrant as Test Group. In the Control group, Scaling and Kirmani M, Saima S, Behal R, Jan SM, Yousuf A, Shah AF. Comparing the efficacy of scaling with root planing and modified widman flap in patients with chronic periodontitis. IAIM, 2016; 3(4): 168-174. Page 169 root planning was carried out and in test group modified widman flap procedure was carried out. Sutures were removed after 1 week. Oral hygiene instructions and professional tooth cleaning were repeated once every 2 weeks during study period for both selected quadrants. The clinical assessment was carried out from baseline to 3 months and 6 months to evaluate the respective treatments and to compare between Non surgical mechanical treatment (control group) and surgical treatment (test group).This study demonstrated that both surgical and nonsurgical methods of treatment are effective in eliminating gingivitis and reducing probing depths provided the subgingival plaque is eliminated and reinfection prevented following active therapy. The investigation demonstrated that active therapy including meticulous subgingival debridement resulted in low frequency of gingival sites which showed bleeding on probing, a high frequency of sites with shallow pockets 4 mm and disappearance of pockets with probing depth of > 6 mm.

The clinical efficacy of laser assisted modified Widman flap: A randomized split mouth clinical trial.

Objective: The objective of the study was to compare the clinical efficacy of use of a diode laser (DL) (810 nm) as an adjunct to modified Widman flap (MWF) surgery to that of MWF alone. Materials and Methods: Twenty‑five patients between the ages of 20 and 50 years with generalized chronic periodontitis were selected for the study. Control sites (Group A) were randomly selected to receive an MWF, and the contralateral test sites (Group B) received MWF in conjunction with low‑level laser therapy. The energy density of 4 J/cm2 was applied to the gingival surface after periodontal treatment. The study tooth/site was treated along with any additional teeth in the quadrant in which the site was located if needed. Randomization was done using a coin flip. The DL was used to de‑epithelialize the inner part of the periodontal flap and photo‑biostimulate the surgical area. Plaque index (PI), papillary bleeding index (PBI), probing depth (PD), and clinical attachment level (CAL) scores were recorded at baseline and at 6 and 9 months. Statistical Analysis: Data were expressed as the mean ± standard deviation. Statistical analyzes were performed using paired Student’s t‑test for intragroup comparisons and unpaired Student’s t‑test for intergroup comparisons. Results: No significant difference was observed in PI scores between the two groups at baseline, 6 and 9 months. PBI scores were significantly lower in Group B versus Group A at 6 months (P < 0.01). However, no significant difference was observed between the two groups in PBI scores at the end of 9 months. PD reduction in Group B versus Group A was statistically significant at the end of 9 months (P < 0.01). Gains in CAL were significantly greater in Group B versus Group A at 6 and 9 months. Conclusion: The use of an 810 nm DL provided additional benefits to MWF surgery in terms of clinical parameters.

A comparative study on the bite force after modified Widman's flap / 대한치주과학회지

The masticatory function of tooth is maintained by the periodontal health, and periodontal health is also maintained by the masticatory function. Bite forces are withstanded by the PDL, and this thought to be through the viscoelastic theory. Mobility test and Bite force test are used to evaluate the viscoelastic theory of the PDL. In this study, the bite force test was used. In the same conditions of quantity of the supporting tissue, the maximum bite force according to the quality of the supporting tissue was evaluated. The study was conducted on 40 patients with moderate adult periodontitis, who were indications to the modified widman flap treatment. The maximum bite force in the premolar and molar regions were tested before treatment, 3weeks and 4 weeks after treatment. and the results were as follows. 1. In the premolar region, 3 weeks and 4 weeks after treatment showed higher maximum bite force than before treatment. And in the molar region the maximum bite force decreased 3 weeks after treatment, but increased after 4 weeks, compared to before treatment. 2. In the 1st premolar, there were only significant difference between before and 3 weeks after treatment, and between and 4 weeks after treatment. 3. In the 2nd premolar, there were only significant difference between before and 3 weeks after treatment, and between and 4 weeks after treatment. 4. In the 1st molar, there were no significant difference between before, 3 weeks after treatment, 4 weeks after treatment. 5. In the 2nd molar, there were no significant difference between before, 3 weeks after treatment, 4 weeks after treatment. From the results above, it shows that there were improvements in the maximum bite force through specific periodontal treatments, and thus it can be considered in clinical situations, that selection of the prosthodontic material, decisions of extraction, evaluation of the prognosis after periodontal treatment is a helpful method.

Comparative Study on the Tooth Mobility after Modified Widman Flap / 대한치주과학회지

Tooth mobility is an important part of a periodontal examination and represents a function of the persisting height of the alveolar bone and the width of the periodontal ligament. The purpose of this study was to evaluate the changes of the tooth mobility over 4 week-period following surgical therapy on the periodontal disease. Thirty five patients presenting with moderate periodontal pockets were selected and tooth mobility was measured at weekly intervals using Periotest (Siemens Co., Germany) beginning at the pre-operation examination and ending four weeks following the modified Widman Flap. All data were statistically analyzed using the one-way ANOVA test. The results were obtained as follows; 1. All teeth exhibited the greatest change in mobility at 1 week post-op, mobility generally decreasing with time. 2. Comparison of the weekly tooth mobility data regarding the 1st premolars showed significant differences only between weeks 1 (9.94) and 4 (6.14) (p<0.05). 3. Comparison of the weekly tooth mobility data regarding the 1st molar showed significant changes in the intervals between pre-op (6.49) and week 1 (11.22), pre-op and week 2 (9.37), weeks 1 and 3 (7.65), weeks 1 and 4 (5.62), and weeks 2 and 4 (p<0.05). 4. Comparison of the weekly tooth mobility data regarding the 2nd premolar and 2nd molar showed significant differences between pre-op (6.91, 8.60) and week 1 (11.02, 12.62), weeks 1 and 3 (8.00, 8.05), weeks 3 ad 4 (6.22, 6.71), and weeks 2 (9.34, 11.01) and 4 (p<0.05).