Original Article

Clinical Assessment of Open Flap Debridement Using Magnifying Loupes and Surgical Operating Microscope: A Split-Mouth Randomized Controlled Clinical Trial

Open flap debridement using surgical operating microscope

Abstract

Objectives: To overcome the drawbacks of the conventional flap surgery, newer surgical techniques like minimally invasive surgery were evolved to optimize the primary closure of the flap. Using a surgical operating microscope is one such technique, enhancing precession with clinical benefits. The current study aimed to compare the efficacy of a surgical operating microscope versus surgical loupes regarding periodontal treatment outcomes.

Materials and Methods: In this split-mouth randomized controlled clinical trial, flap surgery was planned for sites with a pocket probing depth (PPD)≥5mm under a surgical operating microscope and surgical loupes. All clinical periodontal parameters were recorded at baseline, and 3, and 6 months. The patients’ perception of postoperative pain and wound healing were also assessed.

Results: The study comprised of 20 participants with mild to severe periodontitis. The reduction in the mean PPD was significantly greater at the test site than the control site at 3 months (P=0.05) and 6 months (P=0.005). At 3 months, there was a statistically significant difference in clinical attachment level (CAL) between the test and control sites (P=0.001). Flap surgery performed under a surgical operating microscope significantly enhanced early wound healing and caused less postoperative pain compared to flap surgery performed under surgical loupes (P<0.05).

Conclusion: All parameters improved at the test and control sites after the procedure. Nonetheless, the clinical parameters were noticeably better at the test site. Also, the test site had lower postoperative pain and enhanced wound healing compared with the test site.

1. Dadwal A, Kaur R, Jindal V, Jain A, Mahajan A, Goel A. Comparative evaluation of manual scaling and root planing with or without magnification loupes using scanning electron microscope: A pilot study. J Indian Soc Periodontol. 2018 Jul-Aug;22(4):317-321.
2. Farook SA, Stokes RJ, Davis AK, Sneddon K, Collyer J. Use of dental loupes among dental trainers and trainees in the UK. J Investig Clin Dent. 2013 May;4(2):120-3.
3. Hegde R, Hegde V. Magnification‑enhanced contemporary dentistry: Getting started. J Interdiscip Dent. 2016 May;6(2):91-100.
4. Yadav VS, Salaria SK, Bhatia A, Yadav R. Periodontal microsurgery: Reaching new heights of precision. J Indian Soc Periodontol. 2018 Jan-Feb;22(1):5-11.
5. Mohan R, Guddappa M. Magnification tools: surgical operating microscope and magnifying loupe in dental practice. Int J Eng Technol. 2013;2(8):78-81.
6. SILNESS J, LOE H. PERIODONTAL DISEASE IN PREGNANCY. II. CORRELATION BETWEEN ORAL HYGIENE AND PERIODONTAL CONDTION. Acta Odontol Scand. 1964 Feb;22:121-35.
7. Benamghar L, Penaud J, Kaminsky P, Abt F, Martin J. Comparison of gingival index and sulcus bleeding index as indicators of periodontal status. Bull World Health Organ. 1982;60(1):147-51.
8. Wachtel H, Schenk G, Böhm S, Weng D, Zuhr O, Hürzeler MB. Microsurgical access flap and enamel matrix derivative for the treatment of periodontal intrabony defects: a controlled clinical study. J Clin Periodontol. 2003 Jun;30(6):496-504.
9. Christodoulides N, Nikolidakis D, Chondros P, Becker J, Schwarz F, Rössler R, et al. Photodynamic therapy as an adjunct to non-surgical periodontal treatment: a randomized, controlled clinical trial. J Periodontol. 2008 Sep;79(9):1638-44.
10. Aboalshamat K, Daoud O, Mahmoud LA, Attal S, Alshehri R, Bin Othman D, et al Practices and Attitudes of Dental Loupes and Their Relationship to Musculoskeletal Disorders among Dental Practitioners. Int J Dent. 2020 Jul 30;2020:8828709.
11. Cohen J. A coefficient of agreement for nominal scales. Educational and Psychological Measurement. 1960 April;20(1), 37–46.
12. Penmetsa GS, Panda KD, Manthena AKR, Korukonda RR, Gadde P. Evaluating the efficacy of different magnification variables during root planing procedure under a surgical operating microscope in chronic periodontitis: A randomized clinical trial. J Indian Soc Periodontol. 2020 Jan-Feb;24(1):32-36.
13. Corbella S, Taschieri S, Cavalli N, Francetti L. Comparative evaluation of the use of magnification loupes in supragingival scaling procedures. J Investig Clin Dent. 2018 May;9(2):e12315.
14. Ribeiro FV, Casarin RC, Palma MA, Júnior FH, Sallum EA, Casati MZ. Clinical and patient-centered outcomes after minimally invasive non-surgical or surgical approaches for the treatment of intrabony defects: a randomized clinical trial. J Periodontol. 2011 Sep;82(9):1256-66.
15. Mamoun J. Use of high-magnification loupes or surgical operating microscope when performing prophylaxes, scaling or root planing procedures. N Y State Dent J. 2013 Aug-Sep;79(5):48-52.
16. Hegde R, Sumanth S, Padhye A. Microscope-enhanced periodontal therapy: a review and report of four cases. J Contemp Dent Pract. 2009 Sep 1;10(5):E088-96.
17. Bittencourt S, Del Peloso Ribeiro E, Sallum EA, Nociti FH Jr, Casati MZ. Surgical microscope may enhance root coverage with subepithelial connective tissue graft: a randomized-controlled clinical trial. J Periodontol. 2012 Jun;83(6):721-30.
18. Reddy S, Prasad MG, Bhowmik N, Priya S, Manasa D, Hiranmayi V. Open flap debridement using microsurgical loupes and modified widman flap approach-a case series. Int J Appl Dent Sci. 2019;5(02):96-9.
19. Chacko NL, Bhamare R, Rakhewar PS, Raje M. Microsurgical and conventional open flap debridement procedure in the management of periodontitis: A comparative clinical study. IOSR J Dent Med Sci. 2021;20:24-32.
20. Dhir R, Jayasheela M, Triveni MG, Shetru MN. Periodontal microsurgery: a boon for precision. Annals of Dental Sciences. 2022 Apr;2022.
21. Shah R, Zope S, Suragimath G, Varma S, Pisal A. Periodontal microsurgery: An advanced approach for minimal invasive periodontal therapy. Sch J Dent Sci. 2022 Jul;9:112-7.
22. Kumar PM, Sahitya S, Penmetsa GS, Supraja S, Kengadaran S, Chaitanya A. Assessment of knowledge, attitude, and practice related to ergonomics among the students of three different dental schools in India: An original research. J Educ Health Promot. 2020 Oct 30;9:266.
23.Yuvaraja M, Reddy NR, Kumar PM, Ravi KS, Alqahtani N. Thermoreversible gel for intrapocket delivery of green tea catechin as a local drug delivery system: An original research. J Adv Pharm Technol Res. 2016 Oct-Dec;7(4):139-143.
IssueVol 22 (Continuously Published Article-Based) QRcode
SectionOriginal Article
Keywords
Debridement Minimally Invasive Surgical Procedures Surgical Flaps

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How to Cite
1.
Vintha J, Pasupuleti MK, Penmetsa GS, Venkata Satya Gottumukkala SN, Santosh Venkata Konathala R, Eagala SV. Clinical Assessment of Open Flap Debridement Using Magnifying Loupes and Surgical Operating Microscope: A Split-Mouth Randomized Controlled Clinical Trial. Front Dent. 2025;22.