The purpose of the present study was to describe a novel protocol for a minimally invasive pocket elimination surgery (MI-PES) in the posterior maxilla and mandible, which consists of the combined use of i) an access flap based on an internally-beveled gingivectomy with minimal to no papilla mobilization at the buccal aspect and ii) a resective procedure with an apically-positioned flap on the oral aspect. The interproximal bone defects were accessed with a single (oral) flap and the bone architecture was modified by the adoption of piezoelectric inserts for a controlled bone recontouring associated with fiber retention. Mean probing depth (PD) was 5.5 ± 0.8 pre-surgery and shifted to 2.7 ± 0.6 mm at 6-month re-evaluation. All treated pockets showed a post-surgery PD < 4mm. Gingival recession (REC) was 0.3 ± 0.5 mm at baseline, and increased to 1.6 ± 0.8 mm. When buccal and oral pockets were separately analyzed, a trend towards a similar PD reduction, less REC increase and greater CAL gain was recorded for buccal pockets. These preliminary observations seem to support the use of MI-PES as a valuable option for pocket elimination at least when residual pockets are associated with a shallow interproximal osseous crater in the posterior maxilla/mandible.
