Comparative evaluation of clinical attachment and alveolar bone levels in patients with infrabony pockets treated by conventional and microsurgical approach - a randomized clinical trial.

Objectives: The aim of the present study is to evaluate and compare healing outcomes, probing pocket depth (PPD) reduction, clinical attachment, and alveolar bone level following Modified Widman Flap (MWF) with and without 4× prismatic loupe in infrabony pockets.

Methods: Patients having at least one infrabony pocket with PPD ≥5 mm and angular bone loss ≥3 mm bilaterally were randomly assigned to a microsurgical (test) group with MWF using 4× magnifying loupes and conventional (control) group by MWF only. At baseline, 3 and 6 months plaque index, bleeding index, PPD, and relative clinical attachment level were taken. The healing outcome was evaluated with a healing index by Landry. Pain score was assessed with Visual Analog Scale (VAS). The percentage of defect depth (DD) reduction was assessed by cone beam computed tomography (CBCT) and periapical radiograph. Continuous data between groups were analyzed using an unpaired "t" test. Within-group comparison was done using repeated measures analysis of variance followed by multiple pairwise comparisons and paired "t" test.

Results: There was a statistically significant (P = 0.004) reduction in intrabony DD in each group evaluated through CBCT. The mean VAS score after 1 week of surgical procedure was 3.67 at the conventional site compared to 2.9 at the microsurgical site, which was statistically significant (P = 0.004). Statistically significant (P ≤ 0.05) healing scores were observed for microsurgery group (84.6% after 1 week) compared to control group (15.4% after 1 week).

Conclusion: Although blinding of patients and surgeons was difficult and healing indices used are subjective, it can be concluded that microsurgery under 4× magnifying loupe is as effective as conventional MWF in the treatment of infrabony pockets but clinical parameters are greatly enhanced by microsurgery with improved healing and less patient discomfort.