Endoscopic-assisted non surgical periodontal therapy: radiographic evaluation of infrabony defect response. A pilot study.

The goal of non surgical therapy is to remove subgingival biofilm and a minimally invasive endoscopic treatment of subgingival areas allows a significant improvement of deposits removal. The aim of this study is to analyze the radiographic response of infrabony defects after non surgical periodontal therapy performed with a periodontal endoscope. Twenty-three sites, belonging to 13 patients (7 females and 6 males, mean ± SD = 50±11 years), were analyzed after endoscopic-assisted* non surgical periodontal therapy. All patients were affected by chronic periodontitis, with moderate (probing depth – PD: 5-6 mm) or deep (PD:≥7mm) pockets and vertical infrabony defects affecting single – rooted teeth. All sites were treated with endoscopic-assisted scaling and root planing (S-RP) and standardized x-rays were taken before and one year after the treatment. Radiographs were scanned and evaluated using an image analyzer. The following measurements were taken: the distance between interproximal cementoenamel junction (CEJ) and base of the defect (BD), the distance between bone crest (BC) and BD, the angle of the defect and the Infrabony Defect Fill (IDF) (measured as the difference between initial and final vertical distance from CEJ to BD). Results, one year after the procedure, show a statistically significant (p=0.0001) mean reduction of CEJ-BD and BC-BD distances, respectively 1.13 (0.68-1.59) mm and 0.82 (0.42-1.22) mm, and a statistically significant (p=0.03) mean increase of the defect angle: 6.29 mm (0.67-11.92). Moreover, the mean value of IDF fill was 1.14 ± 0.22 mm, denoting an infrabony defect fill. Bone remodeling, occurred after non surgical endoscopic-assisted periodontal therapy, led to a partial fill of the defect and an increase of the defect angle, due to a remineralization of the most apical part of the defect. Taking advantage of the regenerative potential present in the area, the vertical defect partially turned into a horizontal defect. This procedure brings predictable improvements in the radiographic parameters of infrabony defects versus S-RP alone. Periodontal endoscopic-assisted non surgical therapy achieves a statistically significant decrease of the vertical component of the bony defects and the opening of the defect angle. This procedure seems to be a reliable treatment for patients with a medical history or other psychological/economical concerns limiting a surgical approach.