OBJECTIVES: This case series evaluated the clinical efficacy of the novel "lateral approach" combined with an enamel matrix derivative (EMD) and bone grafting in the regenerative surgical treatment of intrabony defects associated with an edentulous ridge. MATERIAL AND METHODS: The innovative flap, called the "lateral approach," is explicitly designed for regeneration of unchallenged isolated intrabony defects associated with edentulous alveolar ridges. The flap is defined by a curved vertical incision on the buccal side opposite the treated defect and a sulcular incision on the buccal and defect-associated sides, promoting uneventful healing and regeneration while minimizing complications. Seven intrabony defects (one per patient) distal to the lower second molar were treated using the "lateral approach" combined with EMD and grafting with deproteinized bovine bone mineral. The primary outcome was clinical attachment level (CAL) change. As additional parameters, pocket probing depth (PPD) reduction and complication rate were analyzed. All the outcomes were assessed 6 months post-surgery and compared with the baseline values. RESULTS: Primary wound healing occurred in 100% of cases, and no complications were reported. At the 6-month re-evaluation, the initial median CAL of 6 mm (interquartile range 5-8 mm) was reduced to 3 mm (3-5 mm). The corresponding median PPD was reduced from 6 mm (IQR 6-8 mm) to 4 mm (IQR 3-5 mm). These differences were statistically significant (p < 0.05). CONCLUSIONS: The "lateral approach" is a technique for the surgical treatment of intrabony defects associated with the edentulous ridge. Within the limitations of the study, this method seems to be suitable for distal intrabony defects in the lower second molars, which frequently develop after third molar extraction.

Clinic of Stomatology St Anne's University Hospital Faculty of Medicine Masaryk University Brno Czechia

See more in PubMed

Aslan, S. , Buduneli N., and Cortellini P.. 2017. “Entire Papilla Preservation Technique: A Novel Surgical Approach for Regenerative Treatment of Deep and Wide Intrabony Defects.” International Journal of Periodontics & Restorative Dentistry 37, no. 2: 227–233. PubMed

Aslan, S. , Buduneli N., and Cortellini P.. 2020. “Clinical Outcomes of the Entire Papilla Preservation Technique With and Without Biomaterials in the Treatment of Isolated Intrabony Defects: A Randomized Controlled Clinical Trial.” Journal of Clinical Periodontology 47, no. 4: 470–478. PubMed

Carvalho Dutra, B. , Oliveira A. M. S. D., Oliveira P. A. D., Miranda Cota L. O., Silveira J. O., and Costa F. O.. 2019. “Effects of Topical Application of 1% Sodium Alendronate Gel in the Surgical Treatment of Periodontal Intrabony Defects: A 6‐month Randomized Controlled Clinical Trial.” Journal of Periodontology 90, no. 10: 1079–1087. PubMed

Chapple, I. L. C. , Mealey B. L., Van Dyke T. E., et al. 2018. “Periodontal Health and Gingival Diseases and Conditions on an Intact and a Reduced Periodontium: Consensus Report of Workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri‐Implant Diseases and Conditions.” Journal of Periodontology 89, no. Suppl 1: S74–S84. PubMed

Cortellini, P. , Pini Prato G., Baldi C., and Clauser C.. 1990. “Guided Tissue Regeneration With Different Materials.” International Journal of Periodontics & Restorative Dentistry 10, no. 2: 136–151. PubMed

Cortellini, P. , and Tonetti M. S.. 2011. “Clinical and Radiographic Outcomes of the Modified Minimally Invasive Surgical Technique With and Without Regenerative Materials: A Randomized‐Controlled Trial in Intra‐Bony Defects.” Journal of Clinical Periodontology 38, no. 4: 365–373. PubMed

Cortellini, P. , and Tonetti M. S.. 2015. “Clinical Concepts for Regenerative Therapy in Intrabony Defects.” Periodontology 2000 68, no. 1: 282–307. PubMed

Graziani, F. , Karapetsa D., Mardas N., Leow N., and Donos N.. 2018. “Surgical Treatment of the Residual Periodontal Pocket.” Periodontology 2000 76, no. 1: 150–163. PubMed

Hromčík, F. , and Halusková A.. 2023. “Lateral Approach for the Regenerative Treatment of Intrabony Defects Associated With Edentulous Spaces. A Pilot Case.” Poster session presented at the International Symposium on Soft Tissue Management around Teeth and Implants, Florence, Italy, May 26–27. https://www.researchgate.net/publication/370465469_Lateral_approach_for_the_regenerative_treatment_of_intrabony_defects_associated_with_edentulous_spaces_A_pilot_case.

Huang, H.‐L. , Ma Y.‐H., Tu C.‐C., and Chang P.‐C.. 2022. “Radiographic Evaluation of Regeneration Strategies for the Treatment of Advanced Mandibular Furcation Defects: A Retrospective Study.” Membranes 12, no. 2: 219. PubMed PMC

Jeffcoat, M. K. , Reddy M. S., Magnusson I., et al. 1996. “Efficacy of Quantitative Digital Subtraction Radiography Using Radiographs Exposed in a Multicenter Trial.” Journal of Periodontal Research 31, no. 3: 157–160. PubMed

Jepsen, K. , Sculean A., and Jepsen S.. 2023. “Complications and Treatment Errors Related to Regenerative Periodontal Surgery.” Periodontology 2000 92, no. 1: 120–134. PubMed

Kan, K. W. , Liu J. K. S., Lo E. C. M., Corbet E. F., and Leung W. K.. 2002. “Residual Periodontal Defects Distal to the Mandibular Second Molar 6–36 Months After Impacted Third Molar Extraction.” Journal of Clinical Periodontology 29, no. 11: 1004–1011. PubMed

Kugelberg, C. F. , Ahlström U., Ericson S., Hugoson A., and Thilander H.. 1991. “The Influence of Anatomical, Pathophysiological and Other Factors on Periodontal Healing After Impacted Lower Third Molar Surgery: A Multiple Regression Analysis.” Journal of Clinical Periodontology 18, no. 1: 37–43. PubMed

Kyung, N. , Estrin N. E., Sze J., Saragossi J., Iacono V. J., and Bassir S. H.. 2021. “Long‐Term Outcomes of Periodontal Regenerative Procedures for the Treatment of Intrabony Periodontal Defects: A Systematic Review and Meta‐Analysis.” Journal of International Academy of Periodontology 23, no. 3: 180–210.

Machtei, E. E. 2001. “The Effect of Membrane Exposure on the Outcome of Regenerative Procedures in Humans: A Meta‐Analysis.” Journal of Periodontology 72, no. 4: 512–516. PubMed

Mathew, G. , Sohrabi C., Franchi T., Nicola M., Kerwan A., and Agha R.. 2023. “Preferred Reporting of Case Series in Surgery (PROCESS) 2023 Guidelines.” International Journal of Surgery 109, no. 12: 3760–3769. PubMed PMC

Matuliene, G. , Pjetursson B. E., Salvi G. E., et al. 2008. “Influence of Residual Pockets on Progression of Periodontitis and Tooth Loss: Results After 11 Years of Maintenance.” Journal of Clinical Periodontology 35, no. 8: 685–695. PubMed

Nibali, L. , Koidou V. P., Nieri M., Barbato L., Pagliaro U., and Cairo F.. 2019. “Regenerative Surgery Versus Access Flap for the Treatment of Intrabony Periodontal Defects. A Systematic Review and Meta‐Analysis.” Journal of Clinical Periodontology 47, no. S22: 320–351. PubMed

Nibali, L. , Sultan D., Arena C., Pelekos G., Lin G. H., and Tonetti M.. 2021. “Periodontal Infrabony Defects: Systematic Review of Healing by Defect Morphology Following Regenerative Surgery.” Journal of Clinical Periodontology 48, no. 1: 101–114. PubMed

Passarelli, P. C. , Lajolo C., Pasquantonio G., et al. 2019. “Influence of Mandibular Third Molar Surgical Extraction on the Periodontal Status of Adjacent Second Molars.” Journal of Periodontology 90, no. 8: 847–855. PubMed

Saito, A. , Bizenjima T., Takeuchi T., et al. 2019. “Treatment of Intrabony Periodontal Defects Using rhFGF‐2 in Combination With Deproteinized Bovine Bone Mineral or rhFGF‐2 Alone: A 6‐month Randomized Controlled Trial.” Journal of Clinical Periodontology 46, no. 3: 332–341. PubMed PMC

De Sanctis, M. , Zucchelli G., and Clauser C.. 1996. “Bacterial Colonization of Barrier Material and Periodontal Regeneration.” Journal of Clinical Periodontology 23, no. 11: 1039–1046. PubMed

Sanz, M. , Jepsen K., Eickholz P., and Jepsen S.. 2015. “Clinical Concepts for Regenerative Therapy in Furcations.” Periodontology 2000 68, no. 1: 308–332. PubMed

Sanz, M. , Tonetti M. S., Zabalegui I., et al. 2004. “Treatment of Intrabony Defects With Enamel Matrix Proteins or Barrier Membranes: Results From a Multicenter Practice‐Based Clinical Trial.” Journal of Periodontology 75, no. 5: 726–733. PubMed

Schincaglia, G. P. , Hebert E., Farina R., Simonelli A., and Trombelli L.. 2015. “Single Versus Double Flap Approach in Periodontal Regenerative Treatment.” Journal of Clinical Periodontology 42, no. 6: 557–566. PubMed

Singh, S. , Sruthima Gottumukkala N., Konathala S., Penmetsa S., Doraisami D., and Bypalli V.. 2022. “Periodontal Status of Mandibular Second Molar After Extraction of Impacted Mandibular Third Molars – A Prospective Clinical Trial.” European Oral Research 56, no. 3: 110–116. PubMed PMC

Stavropoulos, A. , Bertl K., Sculean A., and Kantarci A.. 2022. “Regenerative Periodontal Therapy in Intrabony Defects and Long‐Term Tooth Prognosis.” Dental Clinics of North America 66, no. 1: 103–109. PubMed

Trombelli, L. , Simonelli A., Pramstraller M., Wikesjö U. M. E., and Farina R.. 2010. “Single Flap Approach With and Without Guided Tissue Regeneration and a Hydroxyapatite Biomaterial in the Management of Intraosseous Periodontal Defects.” Journal of Periodontology 81, no. 9: 1256–1263. PubMed

Windisch, P. , Iorio‐Siciliano V., Palkovics D., Ramaglia L., Blasi A., and Sculean A.. 2022. “The Role of Surgical Flap Design (Minimally Invasive Flap vs. Extended Flap With Papilla Preservation) on the Healing of Intrabony Defects Treated With an Enamel Matrix Derivative: A 12‐Month Two‐Center Randomized Controlled Clinical Trial.” Clinical Oral Investigations 26, no. 2: 1811–1821. PubMed PMC

Yang, Y. , Tian Y., Sun L.‐J., et al. 2023. “The Impact of Anatomic Features of Asymptomatic Third Molars on the Pathologies of Adjacent Second Molars: A Cross‐Sectional Analysis.” International Dental Journal 73, no. 3: 417–422. PubMed PMC