Abstract
OBJECTIVES: This study evaluates the changes in subgingival periodontopathogens following access flap surgery (AFS) in Stage III Grade B periodontitis patients. MATERIALS AND METHODS: This randomized clinical split-mouth study included 20 systemically healthy periodontitis patients. Participants' right and left quadrants were randomly assigned to the control (nonsurgery) or test (AFS) group. Quantities of subgingival periodontopathogens (Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia) and periodontal measurements (gingival index [GI], plaque index [PI], bleeding on probing [BOP], probing depth [PD], and clinical attachment level [CAL]) were evaluated before and 4 weeks after surgery. Quantitative polymerase chain reaction was utilized for detecting and quantifying periodontopathogens. RESULTS: A significant reduction in periodontopathogens was observed in the test group, while levels increased in the control group (p < 0.05). A significant difference was noted between the groups in changes in the quantities of periodontopathogens (p < 0.05). The reduction in periodontal parameters was significantly greater in the test group 1-month post-AFS (p < 0.05). Positive correlations were observed between decreases in P. gingivalis levels and reductions in T. denticola and T. forsythia (p < 0.05). CONCLUSIONS: AFS effectively reduces subgingival periodontopathogens and enhances periodontal health in the early healing phase. It demonstrates significant benefits for patients with advanced periodontitis and deep residual pockets. CLINICAL RELEVANCE: AFS is an effective treatment option for managing deep residual pockets, as it promotes periodontal health and significantly reduces bacterial burden during the critical early healing phase. These results are particularly valuable for clinicians aiming to prevent disease progression, thereby enhancing patient care and treatment outcomes. Trial Registration: ClinicalTrials.gov identifier: NCT06684288.