Optimising periodontal surgery: the challenge of tissue hypoxia

The surgical treatment of stage II chronic generalised periodontitis (CGP), although based on modified flap surgery, frequently encounters an unfavourable biological environment. The instability of postoperative outcomes and the risk of complications are closely linked to microcirculation disorders and local oxidative stress. These phenomena create tissue hypoxia which hinders the regeneration and stabilisation of the pathological process.

The objective of this clinical study conducted by I. M. Futrak and A. V. Bambulyak is to evaluate the efficacy of an innovative postoperative rehabilitation protocol combining photodynamic therapy (PDT) with the local application of an antihypoxant agent (Actovegin gel). The researchers are testing the hypothesis that a combined action on microbial decontamination and tissue oxygenation can overcome the limitations of traditional pharmacological treatments. The ultimate goal is to demonstrate whether this synergy optimises reparative osteogenesis and guarantees a lasting clinical remission for patients with stage II GCP.

Methodology: a combined post-surgical protocol

This clinical study was conducted on 33 patients suffering from stage II chronic generalised periodontitis. In order to optimise tissue response following the surgical procedure, all subjects underwent modified flap surgery before being allocated to two distinct groups for the rehabilitation phase:

• Experimental group (n = 21): protocol including local applications of an antihypoxant gel (Actovegin) combined with photodynamic therapy (PDT) sessions.
• Control group (n = 12): conventional postoperative pharmacological management.

The evaluation of healing dynamics, a crucial parameter for the practitioner in the practice, spanned a period of 6 months (follow-ups at 5-7 days, 1, 3 and 6 months). The researchers analysed the evolution of inflammation and hygiene via the PMA, PBI (Papilla Bleeding Index) and OHI-S indices, as well as epithelial attachment loss (EAL).

Bone support stability and reparative osteogenesis were quantified by the Fuchs radiological index. Statistical analysis was based on the Student's t-test, with a significance level set at p < 0.05.

Study results: Healing kinetics and periodontal indices

The study conducted on 33 patients shows a clear divergence between the two therapeutic protocols from the early postoperative phase. The results highlight the efficacy of the combination of photodynamic therapy (PDT) and an antihypoxant (Actovegin) in reducing inflammation and stabilising tissues.

Early postoperative phase (5 to 7 days)

In the main group (n = 21), the resolution of oedema and pain syndrome was significantly faster than in the control group. At 5-7 days, 80.95% of the patients in the main group no longer presented any clinical complaints, marking an accelerated functional recovery compared to traditional pharmacological treatment.

Evolution of clinical indices at 6 months

Long-term measurements reveal a statistical superiority of the combined protocol for all evaluated periodontal markers. The following table summarises the observed reductions compared to baseline values:

Clinical indicator (at 6 months)	Main Group (PDT + Actovegin)	Control Group (Traditional)	Significance (p)
Reduction of the PMA index	- 75.95%	- 19.36%	p < 0.01
Reduction in attachment loss (VEP)	- 48.98%	Data not specified (%)	p < 0.01
Fuchs index (Radiological)	1.2-fold increase	Reduced stabilisation	p < 0.05

Qualitative and radiological observations

The analysis of the study data highlights several key points regarding the quality of tissue repair:

• Bone stabilisation: The increase in the Fuchs radiological index by a factor of 1.2 in the main group demonstrates a stabilisation of the bone structure of the alveolar process and an optimisation of reparative osteogenesis.
• Clinical remission: The authors report a more stable and durable remission in the PDT-treated group, attributed to improved local microcirculation and reduced post-surgical oxidative stress.
• Epithelial attachment: The reduction by almost half in epithelial attachment loss (48.98%) confirms better preservation of the tooth-supporting tissues compared to the conventional protocol.

Clinical analysis of results and perspectives

This study demonstrates that the integration of photodynamic therapy (PDT) combined with an antihypoxant agent (Actovegin gel) radically transforms the outcomes of flap surgery. The most striking result for the clinician is the 75.95% reduction in the PMA index at 6 months in the test group, compared to only 19.36% in the control group. This disparity suggests that conventional treatment struggles to stabilise inflammation in the long term without active management of oxidative stress and local hypoxia.

In terms of regeneration, the 48.98% gain in epithelial attachment loss (VEP) and the improvement in the Fuchs index (multiplied by 1.2) indicate a stabilisation of the alveolar bone. In clinical practice, this means that this protocol not only disinfects the root surface via PDT, but also optimises the tissue metabolism necessary for reparative osteogenesis. The early resolution of pain and oedema in 80.95% of patients as early as the 7th day is a strong indicator of accelerated microcirculatory recovery.

However, the limitations of this study must be noted: the sample size remains modest (n=33) and the distribution between the test group (21) and the control group (12) is asymmetrical. Although the p-values are significant (p < 0.01), these results should be confirmed in larger cohorts to generalise this protocol in daily practice.

In practical terms, these data highlight that the success of periodontal surgery depends as much on post-operative metabolic management as on the surgical technique itself. For the implantologist or periodontist, addressing tissue hypoxia is a serious avenue to secure clinical outcomes.

Summary of results

This clinical study conducted on 33 patients with stage II periodontitis demonstrates that the combination of photodynamic therapy (PDT) and a local antihypoxant (Actovegin) following flap surgery reduces inflammation (PMA index) by 75.95% and epithelial attachment loss by 48.98% at 6 months. This protocol ensures symptom resolution in 80.95% of subjects from the 7th day and significant bone stabilisation (Fuchs index multiplied by 1.2) compared to conventional treatment.

In practical terms, for the practitioner:

• Accelerating post-operative comfort: The combined use eliminates oedema and pain in over 80% of patients in less than a week.
• Securing bone regeneration: The local antihypoxant promotes reparative osteogenesis, offering superior radiological stability compared to conventional medications.
• Maintaining remission: Favour the addition of PDT to achieve a substantial reduction in gingival inflammation and better long-term preservation of the periodontal support.

The management of healing following periodontal surgery remains a major clinical challenge, particularly given the risk of complications related to microcirculation disorders and oxidative stress. A study conducted by Futrak and Bambulyak (2026) proposes a combined approach to secure postoperative outcomes for stage II generalised periodontitis.

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