Comparative Evaluation of Single-Flap Approach and Open-Flap Debridement with Calcium Phosphosilicate Bone Graft in the Treatment of Intrabony Defects - A Clinico-Radiographic Study

Sep 30, 2026

Periodontal intrabony defects represent a major therapeutic challenge in chronic periodontitis. This randomized clinical trial compares a minimally invasive single-flap approach (SFA) with conventional open-flap debridement (OFD), with both techniques combined with calcium phosphosilicate (CPS) bone graft. Twenty-four systemically healthy patients were followed for 12 months, with clinical parameters assessed up to 12 months and CBCT used at baseline and 12 months to quantify percentage bone fill. Both methods improved outcomes, while SFA showed superior PPD reduction and attachment gain. SFA also produced significantly greater bone fill at 12 months.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages4

Reading Time10 min

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Abstract

Background

Aim

Materials and Methods

Results

Conclusion

Introduction

Materials and Methods

Study population and design

Surgical Procedure

Postoperative care

Clinical evaluation

Radiographic evaluation

Statistical analysis

Original Research Comparative Evaluation of Single‑Flap Approach and Open‑Flap Debridement with Calcium Phosphosilicate Bone Graft in the Treatment of Intrabony Defects: A Clinico‑Radiographic Study Dimple Bhati, Amit Wadhawan, Prashant Tyagi, Manini Singh, Nidhi Yadav Department of Periodontology, Shree Bankey Bihari Dental College and Research Centre, Ghaziabad, Uttar Pradesh, India Submitted: 04‑Aug‑2025 Revised: 12‑Aug‑2025 Accepted: 25‑Aug‑2025 Published: 17‑Dec‑2025 Abstract Background: Periodontal intrabony defects pose a significant therapeutic challenge in periodontitis management. The single‑flap approach (SFA) is a minimally invasive alternative to conventional open‑flap debridement (OFD), aiming to improve healing outcomes and reduce surgical trauma. Aim: To compare the clinical and radiographic outcomes of SFA and OFD, both combined with calcium phosphosilicate (CPS) bone graft in the treatment of intrabony defects. Materials and Methods: This randomized clinical trial included 24 systemically healthy patients with chronic periodontitis and comparable intrabony defects. Patients were allocated into two groups: Group A (SFA + CPS putty) and Group B (OFD + CPS putty) . Clinical parameters, including plaque index (PI), gingival index (GI), oral hygiene index‑simplified (OHI‑S), probing pocket depth (PPD), and relative attachment level (RAL), were measured at baseline, 3, 6, 9, and 12 months. Radiographic assessment using CBCT was conducted at baseline and 12 months to determine percentage bone fill. Results: Both techniques resulted in significant improvements. However, SFA showed superior reductions in PPD and better clinical attachment gain. Radiographically, the SFA group demonstrated significantly greater bone fill at 12 months (P = 0.043) . Conclusion: SFA combined with CPSgraft provides a less invasive and effective alternative to OFD, offering enhanced clinical outcomes and faster healing. Keywords: Bone regeneration, CBCT, CPS putty, intrabony defect, open‑flap debridement, periodontitis, single‑flap approach Introduction eriodontitis is a chronic inflammatory condition that Pdestroys tooth‑supporting structures, including the periodontal ligament, alveolar bone, and cementum.[1] Alveolar bone loss, particularly in the form of intrabony defects, is a hallmark of the disease and poses a complex regenerative challenge. While traditional open‑flap debridement (OFD) provides effective access fordebridement, it may compromise soft tissue architecture and prolong healing.[2] The single‑flap approach (SFA), introduced as a minimally invasive surgical technique, limits flap elevation to one side (typically buccal), preserving papillary integrity and promoting better wound stability.[3] | Access this article online | | | --- | --- | | Quick Response Code:
| Website: [https://journals.lww.com/jpbs](https://journals.lww.com/jpbs) | | | DOI: 10.4103/jpbs.jpbs_1357_25 | Bone grafts play a pivotal role in regenerative periodontal therapy. Calcium phosphosilicate (CPS) putty is a bioactive, osteostimulative material that enhances healing by releasing ions that support osteogenesis. It provides a moldable, self‑retentive scaffold without requiring additional membranes, making it a suitable graft for minimally invasive approaches.[4] This study was designed to compare SFA and OFD, both combined with CPS putty, for the treatment of intrabony periodontal defects over a 12‑month period. | Address for correspondence: Dr. Dimple Bhati, Department of Periodontology, Shree Bankey Bihari Dental College and Research Centre, Ghaziabad, Uttar Pradesh - 201 302, India.
E-mail: [iamdimplebhati@gmail.com](iamdimplebhati@gmail.com) | | --- | | This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 Licvense, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the n

FAQs

What is the main objective of the study?

To compare the clinical and radiographic outcomes of the single-flap approach (SFA) versus open-flap debridement (OFD), both combined with calcium phosphosilicate (CPS) putty, for intrabony defects.

How were the patients grouped and treated?

Twenty-four systemically healthy patients with chronic periodontitis were randomized into Group A (SFA + CPS putty) and Group B (OFD + CPS putty). After Phase I therapy, Group A received a single buccal flap, while Group B received full-thickness buccal and lingual flaps.

Which technique showed better radiographic and clinical results?

Both improved significantly, but the SFA group showed greater reductions in probing pocket depth (PPD), better relative attachment level (attachment gain), and significantly greater bone fill at 12 months.

Sep 30, 2026

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