Page 105 - GTM-4-3

Global Translational Medicine Comparative analysis of MIF and CF techniques

1. Introduction as the experience level increased, the rate of complications
and the operative time decreased.
Periodontal regeneration (PR) is a valuable treatment
modality for managing isolated furcation and intrabony There are currently no reports in the literature assessing
defects (IBD). Several systemic and localized the efficacy of technique-sensitive procedures, such as
1,2
factors are considered well-evidenced risk factors and MIF, compared to more straightforward procedures,
predictors of periodontal and peri-implant therapy such as CFs for PR in inexperienced clinicians. Therefore,
success. In addition, numerous clinical studies have the study aims to evaluate the outcomes of using MIF
3-5
explored the impact of various membranes, bone grafts, incisions compared to CF in PR procedures performed by
and biological agents on PR success. Despite these less experienced periodontal residents while considering
6-8
variables, the clinician’s skill in several aspects of the systemic risk factors/predictors of included subjects,
procedure—such as case selection, incision and flap hypothesizing that MIF should result in more predictable
design optimization, supra-crestal tissue compartment outcomes compared to CF, consistent with the available
management, materials selection, membrane literature. 15,16
manipulation, and type of suturing techniques—directly 2. Methodology
influences the healing process. Ultimately, these skills
impact the outcomes of the PR procedure. Therefore, 2.1. Study population
9
ongoing refinement of skills and adopting technological Patient data of those who underwent periodontal
innovations are essential for achieving the best possible therapy from January 2012 to January 2023 at the School
results for patients. 10
of Dentistry, University of Michigan, in Ann Arbor,
The conventional flap (CF) technique, involving buccal Michigan, United States, were retrieved from electronic
and lingual/oral flap reflection beyond the limits of IBD, health records. The research received ethical clearance
11
is commonly used due to its convenience and ease of from the Institutional Review Board of the University of
execution. 12,13 However, recognizing the importance of Michigan (IRBMED: HUM00248789).
effective access to the interdental blood supply, wound
closure, and optimal tissue/bone regeneration, various 2.2. Data collection
surgical approaches have been developed. Minimally 2.2.1. Inclusion criteria
14
invasive flap (MIF) techniques aim to limit tissue reflection, The inclusion criteria are as follows:
thereby reducing surgical trauma and lowering the risk of (i) Individuals aged ≥18 years
post-operative complications, the most common of which (ii) Individuals diagnosed with IBD ≥ 5 mm probing
is membrane exposure. 15-20 Notable examples include the depth (PD) of vital anterior, pre-molar, or molar, with
papilla-preserving flap technique introduced by Takei in or without furcation involvement, treated with PR
1985, its modifications by Cortellini in 1995 and 1999, 15,16 in the post-graduate periodontics department at the
21
the minimally invasive surgical technique (MIST), 22-24 and University of Michigan.
its later modification, the modified MIST (M-MIST). (iii) Individuals with baseline and follow-up periodontal
18
In treating deep IBD, using an MIF is crucial to optimize charts with complete clinical parameters (clinical
wound stability, maintain flap integrity, and promote attachment level [CAL], PD, bleeding on probing
primary intention healing in molars. 25,26 [BOP]) and comprehensive clinical notes describing

Studies have investigated the outcome of surgical and the PR procedure in detail, indicating the type of flap
non-surgical procedures performed by inexperienced used and the materials utilized.
clinicians, such as university-based periodontal (iv) Patients compliant with supportive periodontal
residents. 27-29 Brayer et al. reported that root debridement therapy following surgeries.
27
performed by 2 -year periodontal residents compared to
nd
fully trained American board-certified, experienced level 2.2.2. Exclusion criteria
1 clinicians was less effective. In a retrospective analysis, The exclusion criteria are as follows:
Kozlovsky et al. concluded that the operator’s experience (i) Individuals with hopeless teeth (Based on the
28
level will affect the outcome and the patient’s compliance. definition provided by Sanz et al. ).
30
Similarly, Ozcan et al. compared the reported clinical and (ii) Individuals with systemic conditions that were
29
esthetic results of coronally advanced flap procedures for generally considered to be contraindications to
the treatment of gingival recession (GR). The 6-month periodontal surgery, but not limited to severe
results showed that an advanced surgical experience level osteoporosis, uncontrolled diabetes, and blood
results in higher percentages of root coverage. In addition, dyscrasias.

Volume 4 Issue 3 (2025) 97 doi: 10.36922/GTM025080015