Gingivectomy versus flap surgery: the effect of the treatment of infrabony defects

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Abstract
The aim of this paper was to compare the short-term results of gingivectomy (GV) and modified Widman flap (MWF) surgery in the treatment of infrabony defects. 14 patients with 68 bilateral infrabony defects were selected. At baseline, and 3 and 6 months postoperatively, assessments of oral hygiene, gingival conditions, bleeding on probing, probing pocket depth and attachment level, were recorded. Conventional radiograps were obtained in a way that assured a reproducible projection geometry. In a split-mouth design, one jaw quadrant was randomly treated with GV, while the contralateral with a MWF. The changes of the bone tissue were assessed by means of conventional and subtraction images by 2 observers. The interobserver agreement of the conventional and subtraction technique was studied. The majority of the sites demonstrated a significant improvement in gingival conditions and a reduction in bleeding. For both treatments, probing depths were reduced by an average of 3 mm, while a mean of 1.22-1.35 mm of probing attachment gain was obtained. The GV resulted in slightly more gingival recession (1.90 mm) than the MWF (1.60 mm). The radiographic examination demonstrated gain of bone in 7 defects treated with GV and in 9 defects treated with MWF. This study demonstrated that pockets associated with infrabony defects can be successfully treated by both treatment modalities. Furthermore, bone gain can occur after treatment but not in a predictable manner.