ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Videoscope-Assisted Minimally Invasive Surgery Might Minimize Post-Operative Pain and Gingival Recession in Periodontal Surgery
Clinical Question In healthy adult patients with residual periodontal defects that require periodontal surgery, does videoscope-assisted minimally invasive surgery (V-MIS) cause less post-operative pain and gingival recession?
Clinical Bottom Line V-MIS may be a suitable alternative in localized periodontal defects in patients with residual pocket depth/clinical attachment loss following initial non-surgical therapy. This surgical technique improves soft tissue height and reduces patient discomfort.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 27100806Harrel/ 201630 systemically healthy patients with residual periodontal defects following initial non-surgical therapyBlinded clinical cohort study
Key resultsThirty patients were enrolled in the study. Probing depth, clinical attachment level, soft tissue height and radiographs were obtained before and after the surgical procedure. The V-MIS protocol was followed with split thickness reflection of the papilla in order to maintain blood supply. Defects were debrided using direct visualization with the videoscope, treated with EDTA, and then grafted with the combination of enamel matrix derivative (EMD) and freeze-dried bone allograft (FDBA). A single vertical mattress suture was used at the base of the papilla. Patients were evaluated at 1, 2, 4 weeks, 6 months and 1 year, following treatment for clinical and patient centered outcomes as well as VAS pain scale. Results for 30 patients were reported through 6 months and 18 patients were reported at 12 months. There was statistically significant improvement in the amount of gingival recession comparing baseline to 12 months measurements (mean improvement 0.48 ± 0.65mm, P = 0.006). Three patients reported slight pain; mean pain level on the day of surgery, at 1 week, and at 12 months post-op were 0.9 mm, 0.5 mm and 0 mm respectively (on a 100-mm visual analog scale). All stated that they were satisfied with the treatment.
Evidence Search (Videoscope-assisted[All Fields] AND ("minimally invasive surgical procedures"[MeSH Terms] OR ("minimally"[All Fields] AND "invasive"[All Fields] AND "surgical"[All Fields] AND "procedures"[All Fields]) OR "minimally invasive surgical procedures"[All Fields] OR ("minimally"[All Fields] AND "invasive"[All Fields] AND "surgery"[All Fields]) OR "minimally invasive surgery"[All Fields])) AND (("patients"[MeSH Terms] OR "patients"[All Fields] OR "patient"[All Fields]) AND Discomfort[All Fields])
Comments on
The Evidence
A total of 30 patients were enrolled with a 60% completion rate. The study included all one-, two- and three-walled defects; however, the authors took this into consideration and recorded the clinical measurements separately for each type of defect. This study included a small number of subjects with only a 1-year follow-up. Videoscope-assisted technique provided better visualization in minimally invasive surgery and showed promising results. However, a controlled clinical trial with a good sample size is needed to determine if there are clinically meaningful results when the videoscope is used.
Applicability Practitioners might consider V-MIS as an alternative treatment option for localized periodontal defects in patients with residual pocket depth/clinical attachment loss following initial non-surgical therapy to minimize patient discomfort and post-operative gingival recession. However, they need to keep in mind that there has not been a significant amount of published information on this technique.
Specialty/Discipline (Periodontics)
Keywords Videoscope, Minimally Invasive Surgery
ID# 3127
Date of submission: 11/26/2016spacer
E-mail duongm@uthscsa.edu
Author Mylinh Duong, DDS
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Richard S. Finlayson, DDS
Faculty mentor/Co-author e-mail Finlaysonr@uthscsa.edu
Basic Science Rationale
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