Er：YAG激光应用于种植体周围炎治疗的临床效果评估

目的：探讨Er：YAG激光( erbium-doped： yttrium aluminium garnet)与机械刮治治疗种植体周围炎的有效性。方法22例种植体周围炎患者,按照单盲随机分组对照原则将种植体分成2组,试验组采用Er：YAG激光照射,激光能量设定为100 mJ/脉冲、频率10 Hz;对照组采用塑料刮治器和0.2%洗必泰抗菌治疗。在基线、3个月和6个月时进行临床牙周指标的检查测定,包括菌斑指数、出血指数、临床附着水平和探诊深度。结果基线时试验组和对照组间各项临床牙周指标的差异无统计学意义(P>0.05)。治疗后3个月(P<0.01)和6个月(P<0.05),试验组出血指数、菌斑指数和对照组比较差异具有统计学意义;2组探诊深度在治疗后3个月和6个月均有降低,且2组探诊深度的差异均有统计学意义(P<0.05);然而2组临床附着水平差异无统计学意义(P>0.05)。结论 Er：YAG激光治疗后能显著改善种植体周围炎炎症水平,控制种植体周围炎的有效性优于机械刮治治疗。     

根面平整术一次法和四分法治疗慢性牙周炎的疗效比较

目的比较根面平整术一次法和四分法治疗慢性牙周炎的疗效。方法选取18例慢性牙周炎患者,龈上洁治术后随机分为两组：试验组和对照组,分别采用一次法和四分法进行根面平整术治疗。治疗前和治疗结束后1个月、2个月和6个月检测菌斑指数、龈沟出血指数和探诊深度。结果术后1个月,比较两组的菌斑指数、龈沟出血指数和探诊深度,差异均有统计学意义（P〈0.05）;2个月时,两组间菌斑指数和龈沟出血指数差异无统计学意义,探诊深度差异有统计学意义（P〈0.05）;6个月时两组间菌斑指数、龈沟出血指数和探诊深度差异均无统计学意义。结论根面平整术一次法和四分法对慢性牙周炎的治疗均有效,治疗后1个月一次法疗效优于四分法,治疗后6个月两种方法的疗效无显著差异。     

龈下刮治和根面平整术联合Nd: YAG激光治疗慢性牙周炎的疗效评价

目的 研究龈下刮治和根面平整术（SRP）联合Nd: YAG激光治疗对慢性牙周炎患者的疗效。方法 选择口内有4颗及以上牙齿,探诊深度为4~8 mm的慢性牙周炎患者,研究位点为分布在口内4个不同象限的互不毗邻的单根牙。随机分成4组:对照组（不治疗）、SRP组（单纯SRP）、SRP+L组（SRP后行激光治疗）、L+SRP组（激光治疗后行SRP）。观测时间点为基线（临床处理前）和临床处理后1周、1个月、3个月,比较不同组在不同观测点牙周临床指标和龈下菌群中红色复合体（包括牙龈卟啉单胞菌、福赛斯坦纳菌、齿垢密螺旋体）的组成变化。结果 牙周临床指标:SRP、SRP+L、L+SRP组的各项临床指标变化均优于对照组;3个治疗组组间比较,探诊出血、探诊深度和临床附着丧失量之间无明显差异（P>0.05）,但在3个月时,L+SRP和SRP+L组的菌斑指数百分比下降较SRP组明显（P<0.05）。微生物检测结果:SRP、SRP+L、L+SRP组龈下菌斑中牙龈卟啉单胞菌、福赛斯坦纳菌、齿垢密螺旋体百分比均较基线下降,3个治疗组间也存在一定差异（P<0.05）,但在不同观测时间点的差异不完全相同。结论 慢性牙周炎治疗中,Nd: YAG激光联合SRP治疗较单纯SRP治疗未见明显优势,且Nd: YAG激光和SRP的治疗先后对临床效果也无明显影响;但激光联合SRP治疗可能较单纯SRP更有利于局部菌斑的控制。     

透明质酸在慢性牙周炎治疗中的作用

目的　观察局部应用外源性透明质酸(HA)对慢性牙周炎的临床疗效。方法　采用口内自身对照的研究方法。选择20例慢性牙周炎患者的患牙306颗,其中150颗患牙为对照组,156颗为实验组。对照组患牙仅作洁刮治和根面平整(SRP)。实验组患牙在行SRP后,龈下辅助给予0·2%透明质酸凝胶。观察两组患牙的菌斑指数、龈沟液流速、龈沟出血指数、牙周探诊深度和临床附着水平等临床指标的动态变化。结果　对照组和实验组患牙的各临床指标在治疗后均显著改善,实验组患牙龈沟液流速的下降显著快于对照组(P=0·001),但其余临床指标两组间的差异无显著性。结论　本研究未发现HA结合SRP对治疗慢性牙周炎在牙周组织修复再生中有促进作用; HA能迅速减轻牙周组织的炎症反应。     

Er:YAG激光治疗慢性牙周炎临床疗效观察

目的 比较单独应用Er:YAG激光与常规牙周基础治疗治疗慢性牙周炎的临床疗效.方法 纳入22例慢性牙周炎患者,采用单盲、随机和自身对照设计,患者一侧用Er:YAG激光治疗,另一侧用超声联合手工刮治.分别于基线、治疗后6周、3个月和6个月进行牙周临床指标检查,内容包括菌斑指数、探诊深度、牙龈出血指数和附着丧失;并对基线时探诊深度≥4mm的位点进行统计和比较.结果 2组探诊深度、牙龈出血指数和附着丧失在治疗后6周、3个月和6个月时与基线比较均有明显下降,2组菌斑指数在基线及治疗后各时间点均无明显变化.且同一时间点2组间各项临床指标均无显著性差异.结论 Er:YAG激光作为治疗慢性牙周炎的方法可行有效,可取得与常规牙周基础治疗相似的临床疗效.     

Er∶YAG激光治疗慢性牙周炎对龈沟液中Dickkopf-1水平和ALP活性的影响

目的:检测龈沟液中Dickkopf-1 (DKK1)水平和碱性磷酸酶(alkaline phosphatase,ALP)活性,比较Er∶YAG激光辅助超声龈下刮治联合根面平整术(scaling and root planing,SRP)与单纯SRP对慢性牙周炎(chronic periodontitis,CP)疗效的影响.方法:采取半口对照设计方案,纳入11例CP患者,19对38颗患牙,以超声洁治后1周作为基线.按照随机原则,一侧(实验侧)应用Er:YAG激光辅助SRP,另一侧(对照侧)仅采用SRP.分别在基线、治疗完成后1周、1个月、3个月收集龈沟液并通过酶联免疫吸附法检测龈沟液中DKK1水平及磷酸苯二钠法检测ALP活性;并于基线、刮治后1个月、刮治后3个月记录受试牙出血指数(bleeding index,BI)、牙周探诊深度(probing depth,PD)、临床附着丧失(clinical attachment loss,CAL).采用SPSS19.0软件包对实验数据进行统计学分析.结果:无论是激光组还是对照组,治疗后1个月及治疗后3个月,BI、PD、CAL较基线均明显下降,但2组之间临床指标比较无显著差异(P＞0.05).实验组基线、治疗1周、治疗后1个月和治疗后3个月龈沟液中ALP活性逐渐下降,分别为(396.19±150.55)、(386.69±146.42)、(341.22±171.62)、(249.27±98.72) U/L;DKK1浓度亦逐渐下降,分别为(307.12:±45.63)、(297.32±91.34)、(265.87±41.40)、(244.43±43.09)μg/L.对照组同期ALP活性分别为(394.09±±120.25)、(374.72±131.27)、(344.42±127.80)、(252.36±90.4)U/L,DKK1浓度分别为(305.33±47.40)、(310.34±±84.68)、(270.04±±55.14)、(247.31±56.99) μg/L,ALP及DKK1均呈下降趋势,但2组同期ALP活性及DKK1水平无显著差异(P＞0.05).DKK1与CAL呈显著正相关(r=0.675,P=0.00).结论:Er:YAG激光作为非手术方法辅助SRP治疗慢性牙周炎安全有效,远期疗效有待进一步观察.     

根面平整术一次法与四分法治疗慢性牙周炎的疗效比较

目的 比较根面平整一次法和四分法治疗慢性牙周炎的临床疗效.方法 选取16例慢性牙周炎患者,龈上洁治术后随机分为2组,实验组和对照组,分别采用一次法和四分法进行根面平整术治疗.于治疗前和治疗后1个月和2个月检测牙周探诊深度、菌斑指数和龈沟出血指数.结果 术后1个月和2个月重度探诊位点(PD≥7mm)的牙周探诊深度2组间比较均具有统计学意义(P＜0.05),中度探诊位点(4mm≤PD＜7mm)的牙周探诊深度组间比较均无统计学意义(P＞0.05).术后1个月的菌斑指数和龈沟出血指数实验组与对照组比较均有统计学意义;2个月复查时,两组间菌斑指数和龈沟出血指数比较无统计学意义.结论 一次法和四分法根面平整术对慢性牙周炎的治疗均有效,一次法的短期疗效优于四分法,对深袋的改变尤为显著.     

P.gingivalis level in gingival crevicular fluid before and after supragingival scaling by electrochemical method

目的 观察龈上洁治术后临床指标及龈沟液中牙龈卟啉单胞菌含量的变化.方法 选取30例慢性龈炎患者,采集洁治术前、后患牙的龈沟液,以健康的第一磨牙为对照,应用电化学测菌法分别检测治疗前后龈沟液中牙龈卟啉单胞菌的数量,同时记录临床指标,包括菌斑指数、牙龈指数、探诊深度.结果 龈上洁治术前患牙与健康对照牙龈沟液牙龈卟啉单胞菌的绝对数量有显著差异性(P<0.05);龈上洁治术后慢性龈炎患者临床指标菌斑指数、牙龈指数、探诊深度均有明显下降(P<0.05);龈上洁治术后龈沟液中牙龈卟啉单胞菌的绝对数量亦有明显下降(P<0.05).结论 龈沟液内牙龈卟啉单胞菌含量变化临床指标一致,可以反映洁治效果.     

米诺环素对慢性牙周炎的辅助治疗作用

目的 :探讨米诺环素对慢性牙周炎的辅助治疗作用。方法 :将 2 0个病例中患中度及重度慢性牙周炎的患牙 80个随机分成 4组 :①米诺环素 +刮治组 (SRP +M ) ;②单纯刮治组 (SRP) ;③单纯用米诺环素组 (M ) ;④未处理组 (U)。分别在基线、1周 ,4周时检测菌斑指数 (PI)、牙龈指数 (GI)、探诊出血指数 (BOP)、探诊深度 (PD)、附着丧失 (AL)等牙周病临床指标。结果 :SRP +M组在 1周和 4周时探诊深度和探诊出血率显著低于其它 3组 (P <0 .0 5 )。结论 :龈下局部应用米诺环素联合刮治术和根面平整术在降低探诊深度和探诊出血方面比单纯实施刮治术和根面平整术组效果明显。     

半导体激光辅助治疗中重度慢性牙周炎的临床疗效分析

目的评价半导体激光辅助治疗中重度慢性牙周炎的临床疗效。方法采用随机、自身对照、单盲法。将10位中重度慢性牙周炎患者的左右侧牙列随机分为实验组和对照组,每个象限选取探诊深度(Probing depth,PD)≥6 mm的两个位点,共80个位点。初诊时进行龈上洁治,2周后,实验组龈下刮治(Scaling and root planing,SRP)+半导体激光(980 nm,2 W)照射30 s,对照组只进行SRP,比较治疗前及治疗后3个月PD、临床附着丧失(Clinical attachment loss,CAL)和探诊出血(Bleeding on probing,BOP)的变化。结果治疗前,两组各临床指标均无明显差异(P>0.05)。治疗后3个月,两组各临床指标均较治疗前明显降低(P<0.05),实验组PD(4.15±0.24)mm,CAL(5.45±0.28)mm,BOP阳性率20%,对照组PD(4.13±0.28)mm,CAL(5.15±0.30)mm,BOP阳性率42.5%。其中,实验组BOP阳性率明显低于对照组(P<0.05),两组PD和CAL的变化值无明显差别(P>0.05)。结论半导体激光辅助治疗中重度慢性牙周炎可以有效改善牙龈炎症,其长期疗效有待进一步研究。     

Short-term clinical and immunologic effects of scaling and root planing with Er:YAG laser in chronic periodontitis

BACKGROUND: Recently, the erbium-doped:yttrium, aluminum, and garnet (Er:YAG) laser has been used for periodontal therapy. This study compared Er:YAG laser irradiation (100 mJ/pulse, 10 Hz, 12.9 J/cm(2)) with or without conventional scaling and root planing (SRP) to SRP only for the treatment of periodontal pockets affected with chronic periodontitis. METHODS: Twenty-one subjects with pockets from 5 to 9 mm in non-adjacent sites were studied. In a split-mouth design, each site was randomly allocated to a treatment group: SRP and laser (SRPL), laser only (L), SRP only (SRP), or no treatment (C). The plaque index (PI), gingival index (GI), bleeding on probing (BOP), and interleukin (IL)-1beta levels in crevicular fluid were evaluated at baseline and at 12 and 30 days postoperatively, whereas probing depth (PD), gingival recession (GR), and clinical attachment level (CAL) were evaluated at baseline and 30 days after treatment. A statistical analysis was conducted (P <0.05). RESULTS: Twelve days postoperatively, the PI decreased for SRPL and SRP groups (P <0.05); the GI increased for L, SRP, and C groups but decreased for the SRPL group (P <0.05); and BOP decreased for SRPL, L, and SRP groups (P <0.01). Thirty days postoperatively, BOP decreased for treated groups and was lower than the C group (P <0.05). PD decreased in treated groups (P <0.001), and differences were found between SRPL and C groups (P <0.05). CAL gain was significant only for the SRP group (P <0.01). GR increased for SRPL and L groups (P <0.05). No difference in IL-1beta was detected among groups and periods. CONCLUSION: Er:YAG laser irradiation may be used as an adjunctive aid for the treatment of periodontal pockets, although a significant CAL gain was observed with SRP alone and not with laser treatment.     

Comparison of Nd:YAG laser versus scaling and root planing in periodontal therapy

BACKGROUND: The Nd:YAG laser has recently been used in the treatment of periodontal disease. However, although a clinical reduction of probing depth and gingival inflammation to this new approach has been reported, it has not been fully evaluated. Interleukin-1 beta (IL- 1beta), a potent stimulator of bone resorption, has been identified in gingival crevicular fluid (GCF), which is closely associated with periodontal destruction. The aim of this study was to compare the effects of Nd:YAG laser treatment versus scaling/root planing (SRP) treatment on crevicular IL-1beta levels in 52 sampled sites obtained from 8 periodontitis patients. METHODS: One or 2 periodontitis-affected sites with a 4 to 6 mm probing depth and horizontal bone loss from 3 adjacent single-root teeth in each of 4 separate quadrants were selected from patients for clinical documentation and IL-1beta assay. Sampling site(s) from each diseased quadrant was randomly assigned to one of the following groups: 1) subgingival laser treatment (20 pps, 150 mJ) only; 2) SRP only; 3) laser treatment first, followed by SRP 6 weeks later; or 4) SRP first, followed by laser therapy 6 weeks later. The GCF was collected and the amount of IL-1beta was assayed by enzyme-linked immunosorbent assay (ELISA). Clinical parameters and GCF were measured at baseline and biweekly after therapy for 12 weeks. RESULTS: An obvious clinical improvement (marked decrease in the number of diseased sites with gingival index > or =2) and reduction of crevicular IL- 1beta were found in all groups. The level of IL- 1beta was significantly lower in the SRP group (P = 0.035) than in the laser therapy group for the duration of the 12 weeks. The laser combined SRP therapy group showed a further reduction of IL- 1beta (6 to 12 weeks after treatment) than either laser therapy alone or SRP combined laser therapy. CONCLUSIONS: Our data suggest that laser therapy appeared to be less effective than traditional SRP treatment. Of the 4 treatment modalities, inclusion of SRP was found to have a superior IL- 1beta response, when compared to other therapies without it. In addition, no additional benefit was found when laser treatment was used secondary to traditional SRP therapy.     

Clinical evaluation of an Er:YAG laser combined with scaling and root planing for non-surgical periodontal treatment. A controlled,prospective clinical study

OBJECTIVES: The purpose of the present controlled clinical trial was to compare the treatment of advanced periodontal disease with a combination of an Er:YAG laser (KEY II, KaVo, Germany) and scaling and root planing with hand instruments (SRP) to laser alone. MATERIAL AND METHODS: Twenty healthy patients with moderate to advanced periodontal destruction were randomly treated in a split-mouth design with a combination of an Er:YAG laser and SRP (test) or with laser (control) alone. The used energy setting for laser treatment was 160 mJ/pulse at a repetition rate of 10 Hz. Prior to treatment and 3, 6 and 12 months later the following parameters were evaluated by a blinded examiner: Plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR) and clinical attachment level (CAL). Subgingival plaque samples were taken at each appointment and analysed using darkfield microscopy for the presence of cocci,-non-motile rods, motile rods and spirochetes. No statistical significant differences in any of the investigated parameters between both groups were observed at baseline. RESULTS: Initially, the plaque index was 1.0 +/- 0.6 in both groups. At the 3-month examination the plaque scores were markedly reduced and remained low throughout the study. A significant reduction of the GI and BOP occurred in both groups after 3, 6 and 12 months (P < 0.05, P < 0.05, respectively). The mean PD decreased in the test group from 5.2 +/- 0.8 mm at baseline to 3.2 +/- 0.8 mm after 12 months (P < 0.05) and in the control group from 5.0 +/- 0.7 mm at baseline to 3.3 +/- 0.7 mm after 12 months (P < 0.05). The mean CAL decreased in the test group from 6.9 +/- 1.0 mm at baseline to 5.3 +/- 1.0 mm after 12 months (P < 0.05) and in the control group from 6.6 +/- 1.1 mm at baseline to 5.0 +/- 0.7 after 12 months (P < 0.05). Both groups showed a significant increase of cocci and-non-motile rods and a decrease in the amount of motile rods and spirochetes. Conclusion: In conclusion, the present results have indicated that: (i) non-surgical periodontal therapy with both an Er:YAG laser + SRP and an Er:YAG laser alone may lead to significant improvements in all clinical parameters investigated, and (ii) the combined treatment Er:YAG laser + SRP did not seem to additionally improve the outcome of the therapy compared to Er:YAG laser alone.     

Adjunctive controlled topical application of tetracycline HCl in the treatment of localized persistent or recurrent periodontitis

Abstract 35 patients receiving regular supportive periodontal therapy (SPT) and showing signs of localized persistent or recurrent periodontitis were enrolled in the study. Within 1 week after SPT, each patient had a tetracycline HCl loaded ethylene vinyl acetate co-polymer fiber placed into the periodontal pocket of 1 randomly selected tooth with persistent or recurrent periodontitis (test); the fiber was removed after 9.5±2.0 days. A non-adjacent tooth with persistent or recurrent periodontitis in a separate quadrant, which received no further treatment, served as a control. A total of 28 patients completed the 6-month study. Compared to control teeth, in test teeth at 6 months significantly (p < 0.01) lower scores were found for gingival index, pocket probing depths, and PMN elastase-α₁-proteinase inhibitor concentrations in gingival crevicular fluid. With the exception of plaque index scores, test teeth demonstrated significant reductions from baseline to 6 months in all parameters (p < 0.05). Conversely, all parameter measurements in control teeth, except bleeding on probing, showed no significant difference between baseline and 6-month values. The results suggest that the use of controlled topical application of tetracycline HCl may improve periodontal health and reduce the risk of disease progression in localized persistent or recurrent periodontitis. Moreover, the effects of this application appear to be sustained for at least 6 months.     

氯己定薄片辅助牙周治疗的疗效观察

目的评价控释药氯己定薄片(chip)辅助牙周刮治(scaling and root planing, SRP)治疗牙周炎的疗效和安全性.方法 65例成人牙周炎患者经全口SRP后,左右侧象限均至少有一个牙位探诊深度(probing depth, PD)≥5 mm且探诊出血(bleeding on probing, BOP),选此种牙为受试牙,检查和记录其临床指标,并随机选择一侧的受试牙刮治后放药,另一侧受试牙刮治后不做处理,临床观察6个月.结果用药组在第6个月时的PD减少(1.32 mm)以及附着增加(0.91 mm)均显著高于对照组(0.77 mm,0.40 mm),差异有非常显著性(P<0.001),第6个月用药组的BOP阳性率(79.4%)明显低于对照组(92.4%)(P<0.001);两组的牙面着色指数无统计学差别.44.6%的患者反映用药部位不适,主要为牙龈轻度胀痛.结论 SRP+氯己定薄片组在减少PD、增加牙周附着和减轻牙周组织炎症方面优于单纯SRP组,是一种适于牙周维护治疗的有效且安全的局部用药.     

Progressive periodontal disease has a simultaneous incremental elevation of gingival crevicular fluid and serum CRP levels

Aim: Increased C‐reactive protein levels have been found in all active inflammations, including periodontitis. This study aims to assess the C‐reactive protein levels in periodontal disease progression. Methods: Forty‐five patients were divided into the following three groups (n = 15) based on gingival index, probing pocket depth, and clinical attachment level: healthy (group I), gingivitis (group II), and chronic periodontitis (group III). Gingival crevicular fluid and serum samples were quantified for C‐reactive protein using enzyme‐linked immunosorbent assay. Results: The mean C‐reactive protein concentration in gingival crevicular fluid and serum was found to be highest in group III (1233.33 ng/mL for gingival crevicular fluid, 5483.33 ng/mL for serum), and least in group I (60 ng/mL and 413 ng/mL for gingival crevicular fluid and serum, respectively) The mean C‐reactive protein concentration in group II (453.33 ng/mL for gingival crevicular fluid and 3565.33 ng/mL for serum) was found to be intermediate. Conclusions: C‐reactive protein levels in gingival crevicular fluid and serum increased proportionately with the severity of periodontal disease. They correlated positively with clinical parameters, including gingival index, probing pocket depth, and clinical attachment level. Thus, it can be considered as a periodontal inflammatory biomarker and deserves further consideration.     

牙周洁治对人牙周炎袋底微生物和龈沟液量的影响

目的:探讨牙周洁治对人牙周炎袋底微生物和龈沟液量的影响,为研究牙周洁治机制提供依据。方法:选60例牙周炎患者,随机分为2组,每组30例,洁治组作牙周洁治,对照组用常规漱口液漱口,分别在治疗前、治疗后1周和治疗后1月用刚果红负性染色法观察袋底微生物的变化,并测定牙周探诊深度(PD)、龈指数(GI)和龈沟液量(GCF)的变化。结果:洁治组在洁治后1周时牙周袋底的球菌比率明显增加,杆菌和螺旋体比率及PD和GCF明显降低;对照组GI轻度降低,但PD和GCF以及袋底的球菌、杆菌、螺旋体比率无明显变化;洁治组和对照组的球菌、杆菌和螺旋体比率及PD、GI和GCF均有显著性差异。洁治后1月时PD、GI和GCF量及袋底的微生物比率与洁治1周时无显著性差异。结论:牙周洁治对人牙周炎袋底微生物有明显的改善作用,可通过减少袋底致病菌比率和降低PD以减轻牙周炎症和减少龈沟液的分泌。     

Clinical evaluation of periodontal surgical treatment with an Er:YAG laser: 5-year results

BACKGROUND: The aim of the present study was to evaluate and compare the long-term clinical outcomes of erbium-doped:yttrium, aluminum, and garnet (Er:YAG) laser-assisted periodontal flap surgery versus conventional treatment with the modified Widman flap procedure. METHODS: A total of 146 single-rooted periodontally involved teeth from 25 patients were included in this study. In each patient, left or right maxillary single-rooted teeth were assigned randomly to one of two groups: group A (Er:YAG laser) and group B (modified Widman flap surgery). Er:YAG laser was used to debride the bone pockets, scale the root surface, and trim the periodontal flap. Recession, probing depth (PD), clinical attachment level (CAL), plaque index (PI), gingival index (GI), and bleeding on probing (BOP) scores were recorded at baseline and at 3, 6, 12, 24, 36, 48, and 60 months. RESULTS: Both treatments resulted in decreases in PD, PI, GI, and BOP, increases in gingival recession, and gains in CAL. PD reduction in group A versus group B was statistically significant at 6, 12, 24, and 36 months (P < 0.05). Gains in CAL were significantly greater in group A versus group B at 6, 12, 24, and 36 months. BOP scores were significantly lower in group A versus group B at 3 and 6 months (P < 0.05). All other differences between treatment groups were not statistically significant. CONCLUSIONS: Surgical treatment of single-rooted teeth with chronic periodontitis using the Er:YAG laser yields greater PD reduction and gains in CAL for up to 3 years compared to conventional Widman flap surgery. The short-term results obtained with both treatments can be maintained over 5 years.