Histological and morphometric study of the periodontal granulation tissue after minimally invasive surgical technique
Yomna Elsaka, Mohamed Nassar, Lobna Elgammal, Manal Elbermawy, Ahmed BadrIntroduction
Minimal invasive surgical techniques (MIST) aim to limit the size of incision needed to access periodontal surgical defects, thereby reducing wound healing time and increasing patient satisfaction.
Aim
The aim of the present study was to evaluate radiographically the outcome of the MIST in conjunction with beta-tricalcium phosphate and hyaluronic acid gel (HA) with and without preservation of the periodontal granulation tissue.
Patients and methods
A randomized controlled trial was carried out on 28 infrabony defects in 28 systemically healthy patients with stage III grade B periodontitis based on radiographic evaluation. Four weeks following phase I therapy, sites were randomly divided as follows: test group (group I), 14 sites treated by MIST with periodontal granulation tissue preservation, and control group (group II), 14 sites treated by MIST with standard removal of periodontal granulation tissue. The radiographic parameter of bone level was recorded using cone beam computed tomography, recorded at baseline and after 6 months. Histological examination combined with histomorphometrical analysis was performed on the periodontal granulation tissues using a transmission electron microscope using ultrathin sections and semithin sections to reveal the presence of mesenchymal stem cells (MSCs) in the granulation tissues.
Results
Cone beam computed tomography analysis showed statistically significant differences in the bone level in the two studied groups at 6 months as compared to the mean baseline value. But, when comparing the two groups at baseline and after 6 months, there were no statistically significant differences recorded. The granulation tissue specimens were divided into two parts: coronal and apical parts. The histological examination of these tissues revealed the presence of an abundance of MSCs in the coronal part. The histomorphometrical analysis of the coronal part of the periodontal granulation tissues showed the presence of an increased number of apparent MSCs than in the apical part.
Conclusion
MIST in adjunct with hyaluronic acid gel and beta-tricalcium phosphate resulted in improvements of the radiographic parameter with evidence of bone fill. The preservation of the coronal part of the granulation tissue is essential for periodontal regeneration, as it revealed the presence of MSCs, which help in the regeneration.