Olsen CT Ammons, WF and Van Belle G. A longitudinal study comparing apically positioned flaps with and without osseous surgery. Int J Perio Rest Dent, 4:11, 1985.

Aims

Materials and Methods

12 patients having bilateral similar periodontal destruction participated in the study. Split mouth design was employed. Half of the mouth received apically positioned flap with osseous recontouring and half apically positioned flaps alone. Patients were placed in a 6 month recall basis for 2 years and in a 3 month recall basis afterwards.

Results

• Plaque and gingival inflammation were reduced at the first 6 months and came back to presurgical levels at 6 mo. for both groups. The width of attached keratinized gingiva is essentially the same for both procedures, although the width of keratinized gingiva seems to be slightly greater for the non-osseous group (osseous group had scalloped). The level of the gingival margin was more apical for the osseous group.
• Interproximal pocket depth was significantly higher for the non-osseous group at five years; buccal and lingual pocket depth was the same. Pocket depth tends to rebound to baseline values for the non-osseous group but the reduction seems to be sustained in the osseous group.
• If only 4 or more mm pockets are analyzed, bleeding points were noted 2.3 times more frequently for the non-osseous group.
• Pockets of 1-3 mm: were 1-3 mm post-surgically
• Pockets of 4 mm: 85% were 1-3 mm for osseous and 65% were for non-osseous
• Pockets of 5 mm: 85% were 2-3 mm for osseous and 47% for non-osseous
• Pockets of 6-8 mm: 5% went back to preop values for osseous and 30% for non-osseous. Osseous reduced 6-8 mm to 2-4 mm 95% of time was opposed to 70% non-osseous
• No differences were found between osseous and non-osseous in regard to length of attachment during the 5 years.
• Bone margin was located more apically in the osseous group.
• Areas with loss of attachment of more than 4 mm: the margin of gingiva is more apical for the osseous surgery group but level of attachment is not. The pocket depths are even greater than the preop values for flap curettage.

Conclusions

Osseous surgery is more effective than flap curettage in reducing 4-8 mm pockets.

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