Intrabony defect treatment with V-MIS technique

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Posted on By Jonathan Blansett In Periodontics

8mm probing depth mesial #19. Site accessed with line angle DB #20 to line angle MB #19 and sharp dissection. Debrided with ultrasonics and hand scalers. Conditioned root with EDTA, rinsed, dried, applied emd to root surface and mixed with fdba and condensed into defect. 4.0 chromic gut interrupted suture to close. Note fibrous attachment on buccal surface of root that was undisturbed.

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6 Comments

Jonathan... outstanding access and visibility for proper debridement. Critical components of sound periodontal treatment. Thanks for reminding us of foundational therapy.


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Thank u sir, it means a lot coming from giants like you and your brother, I appreciate the compliment! You guys are world class clinicians and people. In my experience this technique is extremely predictable with minimal/no post-op recession, sensitivity, pain, aesthetic changes. A game-changer in the field of surgical periodontal therapy.


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Your thoughts on laser detoxification and biostimulation? thanks Dr. Salama


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Hey Dr. Salama, my thoughts mirror Tom Wilson and SteveI Harrel (since I did my training in Dallas big shock right? haha...but I think it is very consistent in the perio literature)...calculus is always covered in plaque, is seen directly adjacent to areas of inflammation, and sterile calculus is not a realistic goal nor is sterile calculus non-antigenic (guinea pig study in the 1960s that used autoclaved sterile calculus injected into the peritoneal cavity...all developed foreign body reactions). The laser therapy and biostimulation are only as good as root debridement and calculus removal. This case as all cases we treat has already had initial therapy including s/rp so the majority of the calculus has already been removed, but we always see residual calculus even if it is tiny in these sites (imaging can view up to 60X). Certainly lasers help desensitize roots, reduce pro-inflammatory cytokines, and lead to a short term reduction on BOP, but if u eliminate the s/rp portion of the lanap protocols or photodynamic therapy protocols, I suspect U would not be successful in dealing w the etiology of the problem. Master clinicians like yourself and dr Nevins get dramatic improvements w lanap bc u can meticulously remove calculus w your s/rp techniques imo. The laser helps gain access to the root surface in a much better way than just s/rp does since the laser will cut all the way to bone, but an nd:yag wavelength cannot remove calculus so u must properly instrument the diseased root. We use an Er:YSGG laser in addition to local s/rp here for treatment of persistent 4-5mm pd's that bleed instead of the videoscope. But I certainly respect and realize the great results you have shown with localized LANAP procedures and am not discounting them at all...this is just another way to peel an orange and allows for phenomenal visualization of the defect in question. Thank u sir! -jb


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Hey Jon
Very nice approach ( visualization ) to get at the root for treatment. Do you have pre and post op films?
And is you choice of suture for perio surgery gut?

Nice job

Rocco


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Hey Dr. Mele, I just did this case a few days ago, so no post-op films or clinical measurements yet. The pre-op film is unremarkable as this was not visible on a radiographic series and was purely an intrabony/combination defect. 4.0 cg sutures are nice because the are large enough to where they won't 'cut' or 'bite' into the flap like a 6.0 nylon can tend to and it is easy to manipulate clinically and will resorb. I'll post some more of these cases with definite radiographic findings, this video editing software is nice and I finally have it :)


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KLS Martin
3Shape