Minimally Invasive Non-Surgical Periodontal Treatment

Periodontitis is a chronic inflammatory disease characterized by the destruction of the tooth-supporting tissues. Conventional non-surgical periodontal therapy based on scaling and root planing (SRP) is considered the first-line treatment for periodontal pockets. However, complete removal of subgingival biofilm and calculus may be difficult in deep pockets, furcation areas, and root concavities because of limited access.

Minimally Invasive Non-Surgical Therapy (MINST) has been introduced to improve access to deep periodontal defects while minimizing soft tissue trauma. The technique combines magnification loupes with Mini-Five Gracey curettes to allow more precise instrumentation and preservation of soft tissues during periodontal debridement.

This prospective, single-center, split-mouth randomized controlled clinical trial will include 23 patients diagnosed with Stage III/IV periodontitis. Bilateral molar teeth with probing pocket depth ≥5 mm and bleeding on probing will be randomly assigned to either the test or control intervention within each participant.

The control sites will receive conventional subgingival scaling and root planing using ultrasonic instruments. The test sites will receive conventional ultrasonic instrumentation followed by MINST performed with Mini-Five Gracey curettes under magnification loupes.

All participants will receive oral hygiene instructions and full-mouth supragingival periodontal therapy before subgingival treatment. Scaling and root planing will be completed over two treatment sessions separated by one week. Professional supportive periodontal therapy will be provided during follow-up according to the study protocol.

Clinical evaluations will be performed at baseline, 3 months, and 6 months. The primary clinical variables include Plaque Index (PI), Gingival Index (GI), Bleeding on Probing (BOP), Probing Pocket Depth (PPD), and Clinical Attachment Level (CAL). Microbiological evaluation using the benzoyl-DL-arginine naphthylamide (BANA) assay will also be performed at the same follow-up intervals.

The objective of the study is to determine whether MINST provides improved clinical periodontal outcomes compared with conventional non-surgical periodontal therapy in molar teeth affected by Stage III/IV periodontitis.

Inclusion criteria

• Adults aged 18 to 35 years.
• Diagnosed with Stage III or Stage IV periodontitis.
• Systemically healthy.
• Presence of at least two bilateral molar teeth with probing pocket depth (PPD) ≥5 mm and bleeding on probing (BOP).
• At least 20 remaining teeth.
• Radiographic evidence of periodontal bone loss.
• Non-smokers and non-users of tobacco or alcohol.
• Not pregnant or breastfeeding.
• Not receiving medications known to affect periodontal healing.
• Willing and able to provide written informed consent and comply with study procedures.

Exclusion criteria

• Individuals who do not meet the inclusion criteria.
• Pregnancy or breastfeeding.
• Presence of systemic diseases or medical conditions affecting periodontal status or healing.
• Current use of medications that may influence periodontal healing.
• Current smokers or users of tobacco or alcohol.
• Individuals unwilling or unable to provide informed consent.