Chronic periodontitis is an inflammatory disease of the tooth-supporting tissues that leads to periodontal destruction, including alveolar bone loss, gingival recession, periodontal pocket formation, and, ultimately, tooth loss if not managed effectively. One commonly applied surgical approach is the periodontal flap surgery technique. By reflecting the gingival and periosteal flap, flap surgery allows for thorough root debridement, removal of granulation tissue, and direct access to bone defects for more comprehensive treatment.
In addition to mechanical procedures, the use of topical adjuvants—such as antibiotics—during flap surgery has been explored as a strategy to improve clinical outcomes. One study conducted at Universitas Gadjah Mada (UGM) examined the additional effect of topical application of 25% metronidazole to the periodontal flap as part of chronic periodontitis therapy.
Reference Study: Metronidazole Application as an Adjunct
The study entitled “Pengaruh aplikasi metronidazol 25 persen secara topikal sebagai tambahan pada bedah flap periodontal dalam perawatan periodontitis kronis,” conducted by drg. Kwartarini Murdiastuti, Sp.Perio(K)., Ph.D., under the supervision of drg. Al. Sri Koes Soesilowati, Sp.Perio., S.U., compared the outcomes of periodontal flap surgery in cases of chronic periodontitis with and without topical application of 25% metronidazole. The study subjects were patients with chronic periodontitis who met specific clinical criteria.
Clinical Findings and Interpretation
Although the complete document is not publicly available, several key points can be inferred from the abstract and available citations:
- The addition of topical metronidazole at the flap site is expected to enhance control of anaerobic periodontal microorganisms, modulate the inflammatory response, and promote faster healing of the periodontal supporting tissues.
- Flap surgery provides direct access to root surfaces and bone defects, enabling topical adjuvants such as metronidazole to come into direct contact with areas that are difficult to reach through non-surgical therapy alone.
- Clinical performance was evaluated using parameters such as reduction in periodontal pocket depth, decreased bleeding, changes in inflammatory status, and improvement in attachment levels (when measured), compared with a control group.
Clinical Recommendations
Based on theoretical considerations and findings from the study, several recommendations can be made regarding the use of flap surgery with topical adjuvants:
- Appropriate Indications
- Patients with chronic periodontitis presenting with deep periodontal pockets, significant bone defects, and areas not adequately managed by scaling and root planing alone.
- Selection of Topical Antibiotics
- Metronidazole 25% is an option that has been investigated; dosage and frequency of application should be carefully adjusted. Topical use minimizes systemic side effects.
- Proper Flap Technique
- Adequate flap design to ensure optimal access to defects. Avoidance of excessive disruption to blood supply to maintain vascularization. Appropriate suturing to ensure proper tissue repositioning.
- Inflammation Control and Oral Hygiene
- Patient cooperation is essential. Effective plaque control, home care instructions, and regular periodontal follow-up after surgery are critical to treatment success.
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Flap surgery techniques remain an important intervention in the management of chronic periodontitis, particularly in cases with deep periodontal pockets and significant bone defects. The adjunctive topical application of 25% metronidazole during flap surgery demonstrates potential to improve clinical outcomes, especially in microbial control and inflammation modulation. Clinical practice should emphasize clear indications, proper flap technique, cautious use of local adjuvants, and strict control of patient oral hygiene.
References
drg. Kwartarini Murdiastuti, Sp.Perio(K)., Ph.D., drg. Al. Sri Koes Soesilowati, Sp.Perio., S.U., Pengaruh aplikasi metronidazol 25 persen secara topikal sebagai tambahan pada bedah flap periodontal dalam perawatan periodontal dalam perawatan periodontitis khronis, https://etd.repository.ugm.ac.id/penelitian/detail/11273
Author: Rizky B. Hendrawan | Photo: Freepik
