Transforming Subgingival Scaling: Short-Term Efficacy of No-Incision Micro-Flap Technique in Periodontal Treatment

Summary

This study demonstrates that the no-incision micro-flap technique (NMFT) enhances short-term subgingival scaling efficacy in moderate periodontal pockets by improving visualization, achieving superior probing depth reduction and bleeding control compared to conventional scaling.

Abstract

Conventional subgingival scaling and root planing (SRP) is typically performed without direct visualization, relying solely on tactile feedback, which limits the efficacy of calculus removal—particularly in deeper periodontal pockets. This study aimed to introduce and evaluate the no-incision micro-flap technique (NMFT), a four-handed, non-surgical modification designed to enhance subgingival visibility without requiring additional equipment such as a periodontal endoscope. In this split-mouth randomized controlled trial, 20 patients with generalized chronic periodontitis (Stage II–III) underwent NMFT-aided SRP on one side and conventional SRP on the contralateral side. Periodontal parameters, including probing depth (PD), clinical attachment loss (CAL), and bleeding on probing (BOP), were assessed at baseline, 6 weeks, and 3 months post-treatment. A total of 1,629 sites with baseline PD ≥ 4 mm were analyzed. At 3 months, the NMFT group demonstrated a significantly greater mean PD reduction compared to the control group (between-group difference: 0.5 mm; 95% CI: 0.26–0.81; P = 0.007, with the most pronounced effect observed in moderate pockets (4–6 mm), where an additional 0.7 mm reduction was achieved (P < 0.001). BOP rates were also significantly lower in the NMFT group in both 6 weeks (between-group difference = 7.2%, P = 0.028) and 3 months (between-group difference = 9.1%, P = 0.003). However, no significant inter-group differences in CAL gain were found. These findings indicate that NMFT enhances short-term SRP efficacy by improving visualization and debridement thoroughness, particularly in shallow-to-moderate pockets, offering a practical and accessible alternative to conventional blind SRP in resource-limited settings. Larger-scale validation is warranted to support its broader clinical adoption.

Introduction

Periodontal disease is a chronic inflammatory disorder triggered by microbial biofilms that leads to progressive destruction of the supporting periodontal tissues. Severe periodontitis represents a major cause of tooth loss worldwide¹. The primary goals of periodontal therapy include plaque control, inflammation resolution, and restoration of periodontal tissue function². Non-surgical periodontal therapy, a well-established approach, aims to control microbial infection through the removal of bacterial biofilms, calculus, and endotoxins from periodontally affected root surfaces³. As a cornerstone o....

Protocol

This study is a single-center, split-mouth controlled, randomized controlled trial, reported in accordance with the CONSORT (Consolidated Standards of Reporting Trials) guidelines. The study was approved by the Medical Ethics Committee of Dongyang People's Hospital (Approval No.: 2024-YX-081) and registered on the Chinese Clinical Trial Registry (ChiCTR) number: ChiCTR2600124289. All participants provided written informed consent prior to enrollment. The study was conducted in compliance with the principles of the Declaration of Helsinki. We conducted a clinical study to evaluate and compare the effectiveness of NMFT-assisted SRP and conventional SRP. A total of 2....

Results

In this study, 20 participants were included, randomized, and assigned to the treatments (Figure 2). All 20 participants completed the full course of treatment. At the 6-week follow-up, 16 participants were evaluated (2 only attended the 6-week follow-up, and 2 were lost to follow-up). At the 3-month follow-up, 15 participants were evaluated (1 only attended the 3-month follow-up, and 3 were lost to follow-up). All 20 participants were included in the final intention-to-treat analysis. In th.......

Discussion

Traditional SRP is typically performed using a closed approach, relying primarily on tactile sensation rather than direct visualization. This "blind" technique may lead to either incomplete debridement or excessive removal of root structure⁵. To overcome these limitations, periodontal endoscopy has been developed as an adjunctive tool, providing magnification of 24 to 48 times, which enables direct visualization of subgingival calculus and root morphology¹¹

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
4% Articaine with 1:100,000 epinephrine	Pierre Roland, France	Articaine-4%	Local anesthetic for patient comfort during SRP procedures.
11/12 Dental Explorer	Hu-Friedy, Chicago, IL, USA	EXD-11/126	Used for tactile detection of calculus and root surface smoothness verification.
Gracey Curettes (5/6, 7/8, 11/12, 13/14)	Hu-Friedy, Chicago, IL, USA	GRA-5/6, etc.	Manual instruments for root planing after ultrasonic debridement.
High-definition Intraoral Mirror	Hanenkratt GmbH & Co. KG, Königsbach-Stein, Germany	REF-7115, etc.	Used for reflection and visualization of subgingival calculus during NMFT procedure.
High-suction Dental Ejector	Dong Guan Li Gang Medical Treatment Equipment Co., Ltd. Guangdong, China	N/A	Assistant-operated suction device for maintaining a clear operative field.
IBM SPSS Statistics	IBM Corporation, Armonk, NY, USA	Version 26.0	Statistical software for data analysis.
Ultrasonic Subgingival Scaler Tip	Sirona Dental Systems GmbH, Bensheim, Germany	SIROPERIO PE1, etc.	Ultrasonic insert used for calculus removal and gingival displacement.
UNC-15 Periodontal Probe	Hu-Friedy, Chicago, IL, USA	PCPUNC15	Standard probe for measuring PD, CAL, and BOP.