Short term effects of apically repositioned flaps on the sub-gingival bacterial flora

Aim of the study

This study examines the short term effects of apically repositioned flaps on the clinical parameters of periodontal disease and on the composition of the subgingival flora with the aid of hybrid DNA technique.

Materials and methods

Scaling, polishing and instruction in oral hygiene was carried out on 11 subjects. After 3 months, sites with pockets of 4 mm were treated with apically repositioned flaps. Clinical indices were recorded at the beginning, after initial therapy and 3 months after surgery. DNA probes for 29 bacterial species were taken. Subgingival plaque samples were taken from 28 sites at each follow-up visit.

Results

At a clinical level, after surgery, there were significant reductions in mean pocket depth, the percentage of erythematous sites, the percentage of sites with an attachment level of less than 4 mm and a significant increase in the percentage of sites with a level of attachment of 4 to 6 mm, were observed.

After scaling and root planning, the total bacterial counts were significantly reduced for all species tested. P. gingivalis et B. forsythus were practically eliminated by the mechanical treatments, with further improvement after the surgery.

Conclusion

For some bacteria, surgery produced further benefits compared with scaling and root planning alone. Surgery, by modifying the environment and the composition of the subgingival plaque and by reducing the depths of the pockets altered the host-parasite balance in favour of the host and so inhibited the progression of periodontal disease.

Commentary

There was a strict protocol for this work which produced large volumes of clinical and microbiological data. Each table and figure merits a detailed examination and several readings in order to extract all the information provided.