This article describes the development of a new surgical approach to periodontal treatment. Twenty patients who suffered from bone defects without existing bony walls due to adult periodontitis were treated in three different groups using methods of bone tissue engineering. At that time no surgical technique existed that could be applied to those patients to generate new bone. The periodontal surgeries were performed between 2004 and 2008. All patients received follow-up examinations at 6, 12, and 24 months after surgical procedure. Measured parameters were compared to baseline. The surgical approach and the augmentation material have been improved based on the results of the previous group. This strategy was applied because of the ethical fact that a medical treatment of patients has to be carried out with the knowledge and experience of previous settings. All groups received recombinant human bone morphogenetic protein 2 and platelet-rich plasma. The above-mentioned procedure had been approved in other indications in the field of oral and maxillofacial surgery. The first group underwent conventional muco-periosteal flap technique and obtained an augmentation with absorbable collagen sponge (ACS). The second and third groups were treated using endoscopically assisted microsurgery due to wound healing disturbances that appeared in the first group. The augmentation was carried out with demineralized bone matrix (DBM) instead of ACS (group 2) or tricalciumphosphate as a further development instead of DBM (group 3). The radiological control 12 months (group 1), 18 months (group 2), and 2 years (group 3) after surgery proved the following results—first group: 1.7 mm (average) vertical bone development (VBD); second group: 2.5 mm (average) VBD; third group: 3.2 mm (average) VBD. These results of single patient treatment open new ways into periodontal surgery. They have to be confirmed by prospective case series and multicenter studies.
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