A longitudinal study comparing scaling, osseous surgery and modified Widman procedures : results after 5 years

Aim of the study

To compare the results after 5 years of 3 different treatments : scaling and root planing (SRP), modified Widman flap (MWF) and bone surgery (BS).

Materials and methods

Sixteen patients suffering from moderate to advanced chronic periodontitis received SRP and were then randomly divided into 3 groups : SRP only, MWF and BS. After the active treatment, maintenance visits were programmed every 3 months. Clinical evaluations were undertaken at 8 weeks, 6 months and then at 1, 3, 4, and 5 years. The data were stratified according to probing depths (< 3 mm, 4-6 mm and > 7 mm).

Results

The plaque index remained low during the study for all 3 groups (0.38 maximum). Bone surgery produced greater reduction in mean probing depths up to 4 years but there was no difference at 5 years. Both BS and MWF caused greater reduction in probing depths of more than 7 mm than did SRP (mean values 4.87, 4.66 and 6.17 mm respectively) but the SRP group had a lower percentage of sites of 7 mm by the end of the study.

Conclusion

A small loss of attachment was observed at sites of less than 3 mm (from 0.5 to 1.0 mm), whereas a significant gain in attachment was not recorded for the medium and deep pockets by the end of the study. There were no differences between the three procedures.

Finally, no matter how deep the pocket, the three treatments caused recession that was not significantly different between the three groups, except for BS compared with SRP for pockets of less than 3 mm.

Commentary

This study showed results in accordance with other comparable studies in the literature. Even if the probing depths are reduced after treatment, gain of attachment is minimal and not significant.