***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Eighty-two periodontally involved patients were treated in a split mouth design such that one quadrant received coronal scaling ( CS ) , root planing ( RP ) , modified Widman surgery ( MW ) , and flap with osseous resection surgery ( FO ) . The therapy was performed in three phases : Phase I : the teeth previously design ated to receive RP , MW , and FO were thoroughly root planed and the teeth design ated to receive CS were scaled with no subgingival instrumentation , plaque control was initiated and reinforced for the entire mouth ; Phase II : the design ated teeth received MW or FO surgery ; and Phase III : maintenance therapy every three months . The CS teeth received coronal scaling and polishing during maintenance appointments , while RP , MW , and FO teeth received supragingival instrumentation , subgingival instrumentation and polishing .  Clinical measurements were taken initially , four weeks post-Phase I , 10 weeks post-Phase II , and after each of two years of maintenance care . All therapy modalities result ed in a decrease of mean probing depth with the FO producing the greatest decrease followed by MW , RP , and CS . The deeper the initial probing depth , the greater was the mean reduction of probing depth . FO created a loss of mean probing attachment in the 1 to 4 mm category . RP and MW produced the greatest gain of mean probing attachment in the 5 to 6 mm category . RP , MW , and FO produced similar gains in the greater than or equal to 7 mm category . FO created the most gingival recession followed by MW , RP , and CS AIMS This paper describes a modified surgical approach of the minimally invasive surgical technique ( modified minimally invasive surgical technique , M-MIST ) and preliminarily evaluates its applicability and clinical performances in the treatment of isolated deep intrabony defects in combination with amelogenins . MATERIAL AND METHODS Twenty deep isolated intrabony defects in 20 patients were studied . Fifteen were surgically accessed with the M-MIST , while in five sites , which presented a lingual intrabony component , the conventional MIST had to be applied . The M-MIST consisted of a buccal incision of the defect-associated papilla , according to the principles of the papilla preservation techniques . Only a buccal flap was raised while the interdental papilla was left in situ . The granulation tissue filling the defect was dissected and removed , leaving the interdental and palatal tissues untouched . Root instrumentation and application of the regenerative material were performed before suturing . Primary closure of the flaps was attained with a single internal modified mattress suture . Surgery was performed with the aid of an operating microscope and microsurgical instruments . RESULTS The surgical chair-time of the M-MIST-treated sites ( N=15 ) was 56+/-8.64 min . Early wound healing was uneventful : primary wound closure was attained and maintained in all sites . No oedema or haematoma was noted . Patients did not report pain or discomfort . The 1-year clinical attachment level ( CAL ) gain was 4.5+/-1.4 mm in defects 6+/-1.5 mm deep . Residual probing depths ( PDs ) were 3.1+/-0.6 mm . A minimal increase of 0.1+/-0.3 mm in gingival recession between baseline and 1 year was observed . CONCLUSIONS M-MIST was applicable on 15 isolated interproximal defects out of 20 selected ones . It result ed in very limited patient morbidity and excellent clinical improvements . These outcomes should be confirmed in a larger study The purpose of this study was to compare the long term effectiveness of scaling and root planing alone to scaling and root planing followed by periodontal surgery .  Seventeen subjects with moderate to advanced periodontitis received through scaling and root planing as well as oral hygiene instruction . A modified Widman flap was then r and omly performed for one-half of each subject 's dentition . Recall prophylaxis and oral hygiene reinforcement were administered for 4 years after completion of therapy . Shallow crevices ( 1 - -3 mm)subjected to either procedure tended to increase slightly in depth and exhibit a slight loss of attachment when compared to pretreatment measurements . Moderately deep pockets ( 4 - -6 mm ) treated by either procedure were reduced and demonstrated a sustained gain or maintenance of attachment level . Pockets initially greater than or equal to 7 mm exhibited the greatest reduction in depth and attachment gain . Gingivitis was reduced following either procedure for moderate and deep pockets . No difference in supragingival plaque retention was noted and both procedures reduced calculus . The results indicate that both procedures were effective in treating moderate to advanced periodontitis . However , the additional flap procedure tended to result in greater pocket reduction and attachment gain for deeper pockets Eleven highly susceptible periodontitis patients volunteered for a one-year prospect i ve study of surgical and non-surgical periodontal therapy . The patients had high oral hygiene st and ards and had not received antimicrobial therapy within six months . This study suggests that both types of therapy are equally effective in treating recurrent lesions Three methods for treatment of periodontal pockets  ( subgingival curettage , modified Widman flap surgery , and pocket elimination ) were applied as a clinical trial to 82 patients . Follow up results over one to five years after the initial treatment are reported . The variations in attachment levels and pocket depth were analyzed statistically as related to methods of treatment and yearly time intervals following the initial treatment . The most favorable results regarding gain or maintenance of attachment levels and reduction of pocket depth were observed interproximally . Subgingival curettage provided the greatest gain in attachment level up to three years postoperatively , but after four to five years there was no significant difference in results following the three methods . The most significant loss of attachment and return of pocket depth occurred on the buccal aspects of the teeth , and the results were not significantly different for the three methods except at the first year of follow up when the attachment level was maintained best after curettage This study evaluated the effects of 4 types of periodontal therapy ( coronal scaling ( CS ) , root planning ( RP ) , modified Widman surgery ( MW ) , and flap with osseous resectional surgery ( FO ] and subsequent maintenance care upon bleeding on probing ( BOP ) .  75 individuals completed split mouth therapy and 2 years of maintenance followup .  Data were obtained by 1 calibrated examiner prior to the initiation of therapy , following the hygienic phase and surgical phase of active therapy and yearly during maintenance care . All types of therapy reduced the prevalence of BOP . At the end of 2 years of maintenance therapy , regions greater than 5 mm treated by CS demonstrated a significantly ( p less than 0.05 ) greater prevalence of BOP sites than regions treated by the other modalities . Generally , sites associated with deeper probing depths exhibited a greater tendency to bleed and sites with associated plaque accumulation bled more frequently . RP result ed in a significantly ( p less than 0.05 ) higher % of bleeding sites that stopped following active therapy than did CS . Throughout the study , BOP was extremely dynamic , with 15 - 88 % of sites converting to a new status between any 2 examination periods . This dynamic nature may explain the inability of previous investigations to establish BOP as a reliable predictor of periodontal breakdown Limited information is available comparing the relative longitudinal effectiveness with respect to tooth type of scaling and root planing alone and scaling and root planing followed by flap procedures . The purpose of this study was to investigate these treatment methods as applied to molar and nonmolar teeth on a longitudinal basis in humans . Seventeen subjects with chronic periodontitis received thorough scaling and root planning as well as oral hygiene instruction . A modified Widman flap was then r and omly performed for one-half of each subject 's dentition . Routine recall prophylaxis and oral hygiene reinforcement were administered postsurgically every 3 to 4 months . Pocket depth and clinical attachment levels were recorded by a single calibrated examiner before therapy and at intervals up to 61/2 years following active treatment . Ten subjects remained as participants after 61/2 years . A paired t test was used to test for the mean difference in pocket depth and clinical attachment level between molar and nonmolar teeth for each treatment method . For pockets initially 4 to 6 mm , the results indicated greater pocket depth and more apical clinical attachment level on molars than nonmolars treated by either method of therapy . For pockets initially greater than or equal to 7 mm there was no difference between pocket depth on molar and nonmolar teeth following scaling and root planing alone . However , there was less overall pocket depth on nonmolars than molars following the flap procedure , indicating a greater effect of pocket reduction on nonmolar than molar teeth with the flap procedure . No difference between tooth types was found for clinical attachment level in pockets initially greater than or equal to 7 mm with either treatment method . Both treatment methods result ed in at least maintenance of pretreatment attachment levels adjacent to molar and nonmolar teeth BACKGROUND Scaling and root planing , osseous surgery , and modified Widman procedures are effective methods for treating periodontal diseases . Studies have been carried out to determine if these procedures are more effective than others in reducing clinical probing depths , while maintaining clinical attachment levels . The purpose of this report is to present 5-year results from a longitudinal study comparing scaling and root planing ( SRP ) , osseous surgery ( OS ) , and modified Widman ( MW ) therapies . The study has been completed for 12 years . METHODS Sixteen adult patients with moderate to advanced periodontal disease were treated with initial scaling and oral hygiene procedures in a private practice . Posthygiene data were used to compare changes in plaque and gingival indices , probing depth ( PD ) , clinical attachment levels ( CAL ) , and recession . Frequency distributions were used to compare changes at individual sites . The first published report was from baseline to one year . This follow-up report is from baseline through 5 years . RESULTS At 5 years , there were significant decreases in gingival and plaque scores . For the 3 procedures , there were significant decreases in baseline 4 to 6 mm PD ( P<0.0001 ) ; however , there were no differences between the methods . Similar findings were noted for PD initially greater than 7 mm . At 5 years , OS had the greatest number of 1 to 3 mm sites ( 332 sites , 73.2 % ) , while MW had the fewest number of 4 to 6 mm PD ( 98 sites , 21.8 % ) . SRP had the fewest 7 mm and greater sites ( 15 sites , 3.4 % ) . At 5 years , CAL loss for 1 to 3 mm PD was statistically significant for the 3 procedures . There were slight gains in CAL for 4 to 6 mm probing depths . These gains were not significant . Similar findings were seen for CAL for probing depths greater than 7 mm . OS had the greatest number of sites losing more than 2 mm of CAL ( 64 sites ) , followed by SRP ( 21 sites ) and MW ( 34 sites ) , respectively . CONCLUSIONS This 5-year clinical trial demonstrates that with good patient maintenance excellent clinical results can be achieved with various methods of treatment . Within the limits of this study , SRP , OS , and MW were effective at reducing probing depths with slight changes in clinical attachment levels The CONSORT ( Consoli date d St and ards of Reporting Trials ) statement is used worldwide to improve the reporting of r and omized , controlled trials . Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating experience . This investigation compared a traditional periodontal surgical method with a non-surgical treatment of scaling and root planing by an ultrasonic device ( Odontoson M ) using irrigation with an iodised solution .  8 adult patients with periodontal disease were each treated at 2 r and omly chosen quadrants by a Widman flap type surgical technique , and the remaining non-surgically . The patients then attended bi-monthly oral hygiene sessions over a period of 1 year . At that stage , clinical evaluation revealed that the Odontoson M plus an ionized irrigant solution achieved a statistically comparable outcome to that of surgical treatment , even in the pockets initially up to 7 mm in depth Eighty-two periodontal patients were treated in a split mouth design with coronal scaling ( CS ) , root planing ( RP ) , modified Widman surgery ( MW ) , and flap with osseous resection surgery ( FO ) which were r and omly assigned to various quadrants in the dentition . Therapy was performed in 3 phases : non-surgical , surgical , and supportive periodontal treatment ( SPT ) < or = 7 years . Clinical data consisted of probing depth ( PD ) , clinical attachment level ( CAL ) , gingival recession ( REC ) , bleeding on probing ( BOP ) , suppuration ( SUP ) , and supragingival plaque ( PL ) . Because of the necessity to exit many CS treated sites due to breakdown , data for CS were reported only up to 2 years . All therapies produced mean PD reduction with FO > MW > RP > CS following the surgical phase for all probing depth severities . By the end of year 2 there were no differences between the therapies in the 1 to 4 mm sites . There were no differences in PD reduction between MW and RP treated sites by the end of year 3 in the 5 to 6 mm sites and by the end of year 5 in the > or = 7 mm sites . FO produced greater PD reduction in > or = 5 mm sites through year 7 of SPT . Following the surgical phase , FO produced a mean CAL loss and CS and RP produced a slight gain in 1 - 4 mm sites . RP and MW produced a greater gain of CAL than CS and FO following the surgical phase in 5 to 6 mm sites , but the magnitude of difference decreased during SPT . Similar CAL gains were produced by RP , MW , and FO in sites > or = 7 mm . These gains were greater than that produced by CS and were sustained during SPT . Recession was produced with FO > MW > RP > CS . This relationship was maintained throughout SPT . The pre 
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CONCLUSIONS Surgical therapy had significantly more CAL loss  than non-surgical therapy in shallow PD .
In moderate PD , MWF had significantly more PD reduction than SRP , and there was significantly less CAL gain with surgical therapy .
In deep PD , OS had significantly higher PD reduction than SRP