Different Surgical Modalities in the Treatment of Periodontitis

• Change from Baseline in Periodontal Probing Depths (PPD) [ Time Frame: 3, 6 and 12 months ] [ Designated as safety issue: No ]
  A clinical measure of resolution of disease
  
  
• Change from Baseline of EuroQol-5D-3L and Condition Specific Oral Impacts on Daily Performance Questionnaire [ Time Frame: 3, 6, 9 and 12 months ] [ Designated as safety issue: No ]
  To assess impact on quality of life.
  
  

• Incremental cost per quality-adjusted life year gained [ Time Frame: 3, 6, 9 and 12 months ] [ Designated as safety issue: No ]
  To determine cost-effectiveness from an NHS perspective
  
  
• Clinical attachment level (CAL) change [ Time Frame: 3, 6 and 12 months ] [ Designated as safety issue: No ]
  
• Radiographic bone change [ Time Frame: 12 months ] [ Designated as safety issue: No ]
  As determined from standardized peri-apical radiographs
  
  
• Change in subgingival microbiota [ Time Frame: 3, 6 and 12 months ] [ Designated as safety issue: No ]
  Assessed via pooled samples and analyzed via Q-PCR
  
  

Periodontal diseases (PD) are highly prevalent chronic diseases, and may be associated with loss of gum and bone tissue surrounding the tooth. Among adults (with 2 or more teeth remaining) in England, 54% experienced gum bleeding and 45% had periodontal (gum) disease of which 9% was severe. Bacterial in origin, the high prevalence of PD, together with increased retention of teeth at older ages, has considerable implications for the population's future treatment needs and the associated costs to the health system. It is therefore important to ensure interventions delivered are those proven to be most efficient and cost effective. The investigators study question will therefore be, "In an adult population with moderate to severe chronic periodontitis, how will 3 different treatment approaches; simplified papilla preservation flap (SPPF), resective periodontal flap with osseous recontouring (RPFO) and subgingival debridement (SD), differ in regard to healing and resolution of disease, patient reported outcomes and cost effectiveness?" The aim of this study is to find the most efficient way to treat chronic periodontitis, through a randomised controlled trial of 3 established forms of treatment.

Research will be carried out at the Eastman Dental Institute and Hospital, specifically in the Eastman Clinical Investigation Centre (ECIC), a dedicated clinical research centre. A total of 117 participants will be recruited in order to provide the necessary power to discriminate between the 3 treatment approaches. Eligible patients, who fit the inclusion criteria, will be drawn from hospital referrals and once informed consent is gained, will be randomised to one of the 3 approaches. Two surgical approaches (SPPF, RPFO) will be compared with a non-surgical (SD) approach, and followed up over a 12 month period. Among other things, the investigators will compare clinical parameters of wound healing (including bacterial changes), patient's quality of life and cost-effectiveness.