The effect of systematic plaque control on bone regeneration in infrabony pockets

Periocampus Journal Club - November 06, 2020

A series of articles published in the 70s and 80s by a group of researchers, Lindhe, Yoneyama, Nyman, Liljenberg and Rosling, reported the results of studies that are of fundamental importance for all periodontists. An article discussed in this issue of the Herald demonstrates a crucial concept in periodontology: surgical therapy cannot be successful if there is not excellent plaque control.

In the study "The effect of systematic plaque control on bone regeneration in infrabony pockets" the outcomes of two groups of patients were compared. After periodontal surgery, modified Widman flap, one group was enrolled in supportive therapy and was re-called every two weeks for professional tooth cleaning; the second group of patients was re-called once a year. Both groups were followed for two years.

Following these two years, the results of the first group of patients were remarkable! From the bone point of view, all the angular defects treated with an open flap debridement were closed. This demonstrates and further reiterates that if we remove the subgingival biofilm effectively and if at the same time the patient can control the supragingival biofilm properly, the biological healing of the pocket over time leads to complete closure, the reformation of the connective tissue attachment and the regeneration of the bone, regardless of the use of a regenerative treatment.
The control group patients, however, weren't successful at maintenance of proper oral hygiene - at follow-up they failed to present bone regeneration and the  periodontal indices indicated gradual recurrence of the disease.

This and the studies discussed in the previous issues of the Herald truly are a cornerstone of modern periodontology. They demonstrate the fundamental importance of supragingival plaque control. Although they are dated and subjected to criticism regarding some of the methodologies adopted (statistical analysis and randomization, which were not performed according to the standards we adopt today), they still have an extraordinary impact because they demonstrate fundamental concepts, with a very clear and linear methodology.

Enjoy the reading!