Videoscope-Assisted Minimally Invasive Surgery (VMIS) for Bone Regeneration
The concept and relevant literature related to minimally invasive periodontal surgery is reviewed. The original MIS procedure for bone regeneration is described as well as the modification of MIS for the MIST and M-MIST procedure. The development and intr
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Videoscope-Assisted Minimally Invasive Surgery (VMIS) for Bone Regeneration Stephen Harrel
Minimally invasive surgery was first defined in a 1990 editorial in the British Journal of Surgery as the ability to perform a standard surgical procedure through a much smaller opening than had been used previously [1]. The need for this definition was based on the growing popularity of medical surgical procedures that were being introduced at the time that used various forms of improved lighting and magnification. These visualization improvements included surgical loops with headlights, surgical microscopes, and hard (non-flexible) endoscopes. Prior to the introduction of the term “minimally invasive surgery,” the instrument used for magnification often defined many of these procedures. Examples would be microsurgery when a surgical microscope was used or endoscope surgery when an endoscope was used. In the process of introducing the concept of minimally invasive surgery to medicine in 1993, Hunter and Sackier made the point that the procedure had to accomplish the same beneficial end point that was obtained with larger surgical openings [2]. This was to counter the fact that in some cases surgeons were performing a surgical procedure using smaller incisions and using new technology but were not obtaining the positive results that were obtained with traditional larger incisions. Periodontal procedures have faced a somewhat similar dilemma with the words “minimally invasive” being applied to many procedures that are not significantly smaller or as effective as more traditional procedures using a larger access approach. In the periodontal literature, the first description of a minimally invasive procedure was in 1995 by Harrel and Rees [3]. Following the original description, a detailed minimally invasive procedure for periodontal bone regeneration (MIS) was described by Harrel in 1999–2001 [4–6]. This procedure used much smaller incisions than are traditionally used for bone grafting. At that time either surgical
S. Harrel (*) Department of Periodontology, Texas A&M College of Dentistry, Dallas, TX, USA e-mail: [email protected] © Springer Nature Switzerland AG 2020 S. Nares (ed.), Advances in Periodontal Surgery, https://doi.org/10.1007/978-3-030-12310-9_6
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magnification loops or a surgical microscope was utilized for visualization. Several case series using this technique were published showing results that were similar or improved when compared to traditional bone regeneration procedures. In 2005, Harrel and Wilson published a case series that described the use of enamel matrix derivative (EMD) used in conjunction with the then current minimally invasive bone grafting procedure. Improved results from MIS were reported at 1 year postoperatively [7]. In 2009, a 6-year long-term report of this same group of patients showed that the favorable results originally reported were stable or improved over time [8]. This was felt to establish the fact that a minimally invasive surgical approach yielded long-ter
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