Periodontal Endoscopy-Assisted Minimally Invasive Nonsurgical Therapy Versus Regenerative Surgery for the Treatment of Intrabony Defects: A Narrative Review

Background: The aim of the present narrative review is to synthesize the available scientific evidence comparing periodontal endoscopy-assisted therapy with established surgical regenerative procedures for the treatment of intrabony periodontal defects. While regenerative surgery—including papilla-preserving techniques—remains the standard approach for achieving predictable clinical attachment gain, these procedures may potentially compromise papillary integrity and healing dynamics. Periodontal endoscopy enables enhanced visualization and debridement without surgical access. This review evaluates available studies and discusses whether endoscopy-assisted therapy can achieve outcomes comparable to surgical regeneration while reducing tissue trauma and preserving interdental anatomy. Methods: A comprehensive literature search was conducted using the electronic databases PubMed, Web of Science, The Cochrane Library, and Scopus, supplemented by manual searching. The search was performed up to 1 November 2025. Results: Two studies were included. Overall, there is a substantial lack of RCTs directly comparing periodontal endoscopy-assisted therapy with surgical regenerative procedures. However, EASD (Endoscopic- assisted subgingival debridement) was found not to be inferior to papilla-preservation surgery (PPFS) for treating residual pockets in intrabony defects. Both PPFS and EASD were effective, although PPFS showed more consistent microbial modulation. Conclusions: Periodontal endoscopy-assisted therapy may be considered a promising minimally invasive approach for selected intrabony defects, potentially reducing surgical morbidity and preserving interdental tissues. Although early data suggest that endoscopy-guided approaches may offer comparable clinical improvements with less invasiveness, the evidence base is too small to support definitive recommendations. Robust, well-designed randomized trials are needed to define its clinical indications and compare it directly with established regenerative procedures.