Clinical and radiographic outcomes of entire papilla preservation versus open flap debridement using bovine-derived xenograft and leukocyte- and platelet-rich fibrin in the treatment of isolated intrabony defects.

OBJECTIVE: This study aimed to compare the short-term clinical and radiographic outcomes of the Entire Papilla Preservation (EPP) technique versus Open Flap Debridement (OFD) in the treatment of isolated intrabony periodontal defects, with both approaches performed using bovine-derived xenograft and a leukocyte- and platelet-rich fibrin (L-PRF) membrane. MATERIALS AND METHODS: This retrospective study included 28 patients diagnosed with Stage 3 Grade B periodontitis, who underwent either EPP (n = 14) or OFD (n = 14) using bovine-derived xenograft and L-PRF following initial non-surgical periodontal therapy. Clinical parameters-including clinical attachment level (CAL) and probing depth (PD)-were recorded as primary outcomes at baseline and 6 months postoperatively. Early wound healing index (EHI), and patient-reported pain using a visual analogue scale (VAS) were considered secondary outcomes and were assessed within the first postoperative week. Standardized periapical radiographs were used to evaluate defect resolution. Statistical analysis was performed using Student's t-test, paired sample t-test, and chi-square test, with the significance level set at p < 0.05. RESULTS: Both groups showed significant CAL gain postoperatively. The EPP group demonstrated a higher mean CAL gain (4.64 ± 1.10 mm) compared to the OFD group (3.43 ± 1.32 mm). A statistically significant difference in the distribution of CAL gain categories between the groups was observed (p = 0.006). PD reduction was observed in both groups with no significant difference (p = 0.62). REC increased significantly in the OFD group (p < 0.05), whereas changes in the EPP group were not statistically significant (p > 0.05). EPP resulted in significantly lower postoperative VAS scores and higher EHI scores (p < 0.001), indicating better patient comfort and faster early healing. CONCLUSION: The EPP technique resulted in greater CAL gain and reduced postoperative discomfort than OFD when both were performed with bovine-derived xenograft and L-PRF. These findings suggest that EPP may serve as a minimally invasive and effective alternative for managing isolated intrabony defects, particularly when preservation of the interdental papilla is desired. CLINICAL RELEVANCE: The EPP technique, designed to preserve the interdental papilla and support primary closure, may be considered a minimally invasive alternative to OFD in suitable cases of isolated intrabony defects. TRIAL REGISTRATION: Trial registration is also available at ClinicalTrials.gov. Clinical Trials-ID: NCT06687785 Registration Date: 07.11.2024.