Comparison of Microsurgical versus Macrosurgical Technique of Periodontal Flap with and without Adjunctive Diode Laser Ablation: A Randomized Clinical Study

IntroductIonPeriodontitis is a chronic, multifactorial inflammatory disease characterized by the progressive destruction of the periodontal supporting structures, primarily driven by a dysbiotic subgingival biofilm and the host immune-inflammatory response. 1The persistent presence of pathogenic bacteria within subgingival plaque, particularly gram-negative anaerobes, initiates and perpetuates an inflammatory cascade that leads to the loss of connective tissue attachment and alveolar bone.Among these pathogens, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola-collectively referred to as the "red complex"-are recognized as key contributors to the etiology of chronic periodontitis. 2 Effective periodontal therapy focuses on the disruption of this pathogenic biofilm through mechanical debridement and long-term plaque control.In cases with deep periodontal pockets, furcation involvement, or complex intrabony defects, surgical intervention becomes necessary to achieve adequate debridement and promote healing.Periodontal flap surgeries are commonly indicated for sites with probing depths 5 mm. 3 The use of magnification systems during surgery enhances visualization and precision during debridement and suturing.Microsurgical and minimally invasive approaches-such as minimally invasive surgical technique (MIST), modified MIST (M-MIST),