Search

Gingival recession is defined as the apical migration of the gingival margin from its normal position leading to exposure of the root surface. It not only poses problems in maintaining good oral hygiene but also simultaneously hampers the esthetics. In the present case, the patient came up with a complaint of a denuded root surface due to apical migration of the gingival margin and also a complaint of sensitivity in the same. The case was diagnosed as chronic generalized gingivitis with localized periodontitis in relation to 31. Based on the clinical outcomes, the lateral pedicle graft (LPG) technique was performed. A complete coverage of the exposed root surface was achieved. This case report shows that a simple technique of root coverage like LPG can result in the successful coverage of the denuded root surface.

Background The combination of the coronally positioned flap with connective tissue grafting in treating gingival recession defects has been shown to demonstrate the highest success rate. Aim The aim of the present study was to compare and evaluate the efficiency between autologous fibrin glue (AFG) and conventional absorbable sutures in the treatment of marginal tissue recessions using connective tissue grafts (CTGs) and the coronally advanced flap (CAF) technique. Methods Twenty Miller’s class I and II recession sites in maxillary or mandibular areas in chronic periodontitis patients were treated as group I (test): CTG + CAF + AFG; and group II (control): CTG + CAF with conventional absorbable sutures. Clinical parameters in both groups were recorded at baseline (t0) and six months (t1) postoperatively in terms of gingival recession height (RH), root coverage esthetic score (RCES), visual analogue scale (VAS), and healing index (HI). Results The RH, RCES, VAS, and HI were significantly reduced at the end of six months compared to baseline (P < 0.005) in both groups; however, there was no statistical difference between the groups, indicating the equivalent efficacy of AFG and conventional sutures in healing. Conclusion All the treated sites were found to have appreciable root coverage with satisfactory post-operative healing. Hence, it may be suggested that both AFG and absorbable sutures are equally efficient in post-surgical soft tissue healing.

Background: The mucogingival conditions associated with the recession defects at the mandibular anterior region, not only make plaque control difficult to be performed by the patient but also pose a problem in passively advancing the tissues at the recipient site. This surgical technique is used to treat multiple recession defects in the mandibular anterior region. Materials and Methods: Twenty-five sites in 17 subjects (11 women and 6 men) underwent modified bridge flap and de-epithelized gingival unit graft (d-GUG) as a single-step treatment modality to cover the denuded root surface, as well as increase the width of keratinized gingiva in recession type 1 gingival recession defects in the mandibular anterior region. Results: Nearly 60% of sites in our study showed complete root coverage, with a mean root coverage percentage of 88.08%. Furthermore, keratinized tissue width, keratinized tissue thickness as well as vestibular depth showed statistically significant increases as compared to baseline levels. Conclusion: Thus, the modified bridge flap technique using d-GUG within the limitations of our study design, showed promising results in terms of recession coverage as well as management of the difficult mucogingival conditions at the mandibular anterior region.

This case report describes the 20-year outcomes of multidisciplinary treatment in a patient with severe gingival recession, inadequate attached gingiva, and severe midline diastema. Following phase 1 periodontal treatment, mucogingival surgery was performed to create an adequate gingival area in a systematically healthy 20-year-old female patient, followed by orthodontic treatment 3 months postoperatively. The width of the keratinized gingiva increased, the gingival margin moved coronally, and the formation of a new papilla was successful. After 20 years, clinical improvement has remained steady.

Abstract Aim This study aimed to assess the effectiveness of advanced platelet-rich fibrin (A-PRF) combined with the pinhole surgical technique (PST) for enhancing root coverage (RC) in individuals with Miller class I or II gingival recessions (GR). Additionally, it compared the clinical effect of A-PRF and resorbable collagen membrane (RCM). Materials and methods A total of 18 patients, encompassing 36 treatment sides of 18 Miller class I or II, were randomly assigned to the PST + A-PRF side (18 sides) and the PST + RCM side (18 sides). Clinical assessments of various parameters, including plaque index (PI), clinical attachment level (CAL), keratinized tissue width (KTW), recession depth (RD), recession width (RW), and gingival thickness (GT) were conducted at baseline and three months after the surgical procedure. A numeric rating scale (NRS) was also evaluated during the 1st, 2nd, 3rd and 4th days. This study was formally recorded under the TCTR identification number TCTR20230613005 in the Thai Clinical Trials Register-Medical Research Foundation of Thailand (MRF) on 13/06/2023. Furthermore, it was ethically approved by Sana’a University’s Ethical Committee for Medical Research. Results When comparing the values of 3 months follow-up with the baseline values, intra-side comparison of the PST + A-PRF group showed significant improvements in PI (P = 0.02), CAL (P = 0.01), and RD (P = 0.04), and GT values (P 0.05). The pain scores of the numeric rating scale were significantly lower on the PST + A-PRF sides compared with the PST + RCM sides, especially on the 1st, 2nd, and 3rd days (P

Abstract Background Patients with skeletal angle Class III malocclusion usually have inadequate hard and soft tissue volume at the mandibular anterior teeth. The labial proclination at the teeth may lead to gingival recession. The purpose of this study was to explore whether periodontal phenotype modification therapy with soft tissue augmentation (PhMT-s) can prevent gingival recession in these patients. Methods Four patients with skeletal Class III malocclusion and a thin periodontal phenotype underwent surgical-orthodontic treatment. Prior to tooth movement, they underwent a minimally invasive vestibular incision with subperiosteal tunnel access combined with autogenous connective tissue grafts for periodontal phenotype modification with soft tissue augmentation (PhMT-s). The labial gingival thickness of the anterior mandibular teeth was measured at three distinct levels: at the cementoenamel junction (GT0), 3 mm apical to the CEJ (GT3), and 6 mm apical to the CEJ (GT6). These measurements were taken at baseline, three months following PhMT-s, and after tooth decompensation. Additionally, a biopsy sample was obtained from the PhMT-s site of one patient. All sections were subsequently stained using hematoxylin and eosin, Masson trichrome, Sirius Red, and immunohistochemistry. Results The thickness of the labial gingiva was increased about 0.42 to 2.00 mm after PhMT-s. At the end of pre-orthognathic surgical orthodontic treatment, the thickness of the labial gingiva was increased about − 0.14 to 1.32 mm compared to the baseline and no gingival recession occurred after the pre-orthognathic surgical orthodontic treatment. The histologic results demonstrated that the grafts obtained from the PhMT-s site exhibited increased deposition of collagen fibers. Moreover, the proportion of type III collagen increased and the grafts displayed significantly reduced positive expression of CD31 and OCN. Conclusions PhMT-s increased the thickness of the soft tissue, stabilizing the gingival margin for teeth exhibiting a thin periodontal phenotype and undergoing labial movement. This is attributed to the increased deposition of collagen fibers.

Abstract Objective This systematic review evaluates the efficacy of buccal pad fat (BPF) as an autologous graft in the treatment of gingival recession (GR). Thus, the research question explores if the BPF can serve as a viable alternative to the gold standard connective tissue graft. Materials and methods Only seven studies met the inclusion criteria were critically appraised including the randomized controlled clinical trials, and case series. The inclusion criteria were systemically healthy individuals in the age range (18–65 years old) with Miller’s classification of GR either class I, II, III, or IV while exclusion criteria were patients with poor oral hygiene, pregnant and lactating patients, teeth with caries, any prior surgery in the relevant regions, and use of medications. Results The review included 117 patients with 136 GR defects. The age of participants ranges from 20 to 65 years old with the higher percentage of root coverage (%RC) at 6 months in the pedicled BPF group which was 89.30%while the lowest (%RC) at 6 months in the same group was 46.78%. The BPF group’s width of keratinized gingiva (WKG) values indicate a notable improvement, suggesting a positive impact on WKG compared to the control group. Conclusions BPF can be considered as a promising graft to augment gingival tissues at different sites in the oral cavity with different Miller’s classes of GR providing a new era in GR treatment.

Innovations in surgical techniques have improved the esthetic outcome and predictability of root coverage procedures in recent years. A free gingival graft (FGG) augments the attached gingiva, but the compromised blood supply precludes its use in root coverage. In the surgical technique described in this case report, the FGG kept over a laterally placed periosteal flap enhanced the outcome. A laterally flipped periosteal flap was adapted over the root surface using resorbable sutures. The free graft was secured at the recipient site with cyanoacrylate adhesive, and adaptation was ensured with suspensory sutures. Satisfactory root coverage was appreciated and maintained at 6 months with excellent functional outcomes. Adequate width of the attached gingiva and vestibular depth were also noticed at the recipient site. The patient was highly satisfied with the obtained results, which were maintained until the 1-year postoperative period.

Background: Parry-Romberg Syndrome (PRS), characterized by progressive hemifacial atrophy, presents unique challenges in oral health management due to its rare nature and varied clinical manifestations. While cutaneous and craniofacial features are well-documented, gingival involvement is less commonly recognized. Case Presentation: We present a case of gingival manifestation of PRS in a 26-year-old female, emphasizing the progressive nature of the condition and its impact on oral health. Clinical examination revealed significant gingival recession on the affected side, leading to tooth sensitivity and compromised periodontal health. Diagnosis: The diagnosis of PRS was established based on characteristic facial asymmetry, radiographic findings, and absence of systemic involvement. Gingival recession was confirmed through periodontal assessment. Management: Management strategies included symptomatic relief with desensitizing toothpaste, preservation of periodontal health through oral hygiene instructions and periodontal therapy, and supportive care tailored to the patient's needs. Multidisciplinary collaboration was essential to optimize patient care and address the complex clinical manifestations of PRS. Outcome: While complete resolution of gingival recession was not achieved due to the progressive nature of PRS, symptomatic relief and preservation of periodontal health were achieved through comprehensive management strategies. Long-term follow-up is essential to monitor disease progression and adjust treatment as needed. Conclusion: Gingival involvement in PRS underscores the importance of a multidisciplinary approach to oral health management. Recognition of gingival manifestations and implementation of individualized treatment plans are crucial for optimizing oral health outcomes and enhancing the quality of life for affected individuals. Update Dent. Coll. j: 2024; 14(2): 27-30

Objective To determine the prevalence of gingival recessions in students of the faculty of odontology at Universidad de Los Andes and the factor associated with its presence. Methods In this cross-sectional study, a randomized stratified sampling was used to select the students. The sample included 311 undergraduate students evaluated between March and December 2022. The year spectrum was from 17 to 29 years old. Two calibrated examiners intra e interoperator completed a clinical evaluation with a periodontal probe, where the purpose was to diagnose gingival recessions and identify if there were any related factors such as smoking, braces, bruxism, marginal insertion frenulum, fine phenotype, and malposition. The total prevalence was described with each trust interval of 95%. The association between categorical variables was analyzed with the chi-square test, and the t-student test of the Mann-Whitney test analyzed the difference between continuous variables and recession prevalence. Results 93,56% of the students presented at least one gingival recession. The highest prevalence related to teeth occurred in pieces 1.6, 3.4, 2.6, and 4.1, and the most severe were 3.3, 4.3, and 1.3. The most associated factor related to recessions was orthodontics, with a prevalence of 75,2%. Bruxism showed a positive association with the number of recessions, with a prevalence of 60,7%. Conclusions Buccal gingival recessions were very prevalent in undergraduate students at the dental school of Universidad de los Andes during 2022, and they were strongly associated with the history of orthodontics.

Mucogingival surgery encompasses any procedure designed to correct defects in the morphology, position, or enhance the dental gingival junction. The lack of keratinized gingiva and the presence of gingival recession can be an esthetic and functional problem for the patient. This paper will review the gingival dimensions of the periodontium in health and address the prevalence, etiology, and predisposing factors related to defects in the quality and quantity of gingiva.Gingival augmentation techniques and indications will be reviewed, including root coverage and non-root coverage procedures. Autogenous soft tissue grafts will be described, as well as several non-autogenous graft materials.Ultimately, careful diagnosis, realistic expectations, clear goals, and correct technique selection are essential for the most successful clinical results.

Abstract Background Dentin hypersensitivity (DH) is one of the most challenging and persistent dental complaints characterized by transient, intense pain triggered by various stimuli. It affects a significant portion of the global population, predominantly those aged 20–40. This study aims to evaluate the desensitizing efficacy of seventh-generation dentin bonding agents (Single Bond Universal by 3 M ESPE and Xeno-V + by Dentsply) against a control group using Bifluorid 12 by Voco in mitigating DH within a month of the follow-up period. Methods This was a single-center, parallel-group, double-blind, controlled randomized clinical trial conducted at Dow University of Health Sciences, Karachi, Pakistan. A total of 105 patients with DH were allocated into three groups for this study. The patients were divided into three groups (Single Bond Universal by 3 M ESPE and Xeno-V + by Dentsply) and the control group containing fluoride varnish (Bifluorid 12 by Voco). Discomfort Interval Scale scores and Schiff Cold Air Sensitivity Scale scores were recorded at baseline, immediately after the intervention, after 01 weeks, and after 01 month. Results All the materials demonstrated a statistically significant reduction in discomfort and sensitivity (DIS scores p-value 0.01) immediately after 01 week and over a period of 01 month after treatment compared with the baseline scores before application, with no single material proving superior over the one-month observation period. The study also provided insights into dental hygiene practices, with a significant majority using a toothbrush and sensitivity patterns, with cold stimuli being the most common cause of sensitivity. Conclusion The study demonstrates that Single Bond Universal, Xeno V+, and Bifluorid 12 are equally effective in reducing dentin hypersensitivity, with no distinct superiority observed over a one-month period. The findings highlight the potential of fluoride varnishes as a less technique-sensitive and cost-effective option for treating DH, offering valuable insights for future research and clinical practice. Trial registration NCT04225247 ( https://clinicaltrials.gov/study/NCT04225247 ), Date of Registration: 13/01/2020. (Retrospectively registered).

This systematic review aimed to identify, evaluate, and summarize the results of relevant studies on radicular prominence and its relationship with gingival recessions. This review was conducted according to the PRISMA (Preferred Reporting Reviews and Meta-Analysis) guidelines, and the focused PICO question was “In teeth with vestibular site-specific root or alveolar bone prominence, what are the chances that this will lead to gingival recession or difficulty in root coverage procedures, compared to teeth correctly positioned in the alveolar bone or without anatomical root prominence?”. A search was carried out on three databases: Embase, PubMed/MedLine, and Wiley Library. This initial search was complemented with manual research. It included any clinical study, such as a randomized clinical trial, controlled clinical trial, prospective/retrospective clinical study, case series, or case report, published in English from January 2012 to December 2023, which reported any involvement of the root/bone prominence approach. The exclusion criteria were clinical studies without report results/details of the case(s), studies based on questionnaires, editorial letters, any review, in vitro/in silica and animal studies, and interviews. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement was applied for quality assessment. A total of 163 articles were found, but only three articles were included (k = 0.98). The included studies observed negative correlations when comparing the variables root prominence with linear root coverage, root surface area covered, and linear tissue thickness gain. It suggested a significant reduction in root coverage for prominences greater than 1 mm; therefore, relevant keratinized tissue gains can be achieved in gingival recession treatment after the application of the odontoplasty. The STROBE checklist evaluated 22 items, and all the included studies had a high-quality assessment (greater than 75%) with values greater than 85%. Then, it was not possible to draw conclusions due to the number of articles included, even though they had high-quality assessments. Otherwise, it is possible to suggest that the root prominence may impact gingival recession. Therefore, new and well-designed studies must be developed to establish a significant conclusion about this condition.

ABSTRACTThe aim of this study is to evaluate the performance of the restorations and soft tissues at 2 years using direct composite resin with injection molding technique to solve open gingival embrasures, also known as black triangles.Materials and Method An observational study of a case series was conducted for the treatment of black triangles. The criteria evaluated in each of the restorations were: color stability, polishing, maintenance of surface gloss, staining in the tooth/restoration margins, secondary caries, radiographic appearance of the restored emergence profile, probing depth and bleeding on probing (of the restored proximal surface), presence of plaque (of the restored proximal surface), detachment, delamination, and fracture of the restoration. The following patient satisfaction criteria were evaluated using the visual analog scale (VAS): aesthetic, functional and overall satisfaction.Results A total of 36 restorations were performed in the anterior aesthetic area between canines (24 upper and 12 lower). The mechanical and biological survival rate of restorations were both 100% (95%CI: 90.3–100%). Regarding mechanical complications, there were no restorations showing secondary caries, alteration of color, staining in the tooth/restoration interface, detachment, delimitation or fracture during the entire follow-up (0%; 95%CI: 0–9.7%). Regarding biological complications, there were no restorations measuring probing depth higher than 3 mm or showing an unusual radiographic appearance during the entire follow up (0%; 95%CI: 0–9.7%).Conclusions The composite injection technique using anatomical matrices is a cost-effective, minimally traumatic, predictable, and reproducible approach to achieve anterior black triangles closure and creation of pseudopapillas.

Background: To assess the alterations in gingival thickness and the occurrence gingival recession subsequent to orthodontic-orthognathic treatment of mandibular incisors in skeletal Class III and identify risk factors associated with gingival recession. Methods: In this retrospective cohort study, we enrolled 33 patients exhibiting skeletal Class III malocclusion, totaling 131 mandibular incisors, who were undergoing orthodontic- orthognathic treatment that did not involve extraction of mandibular teeth. The subjects were categorized into surgery group (S; n = 17; ANB = −5.55 ± 3.26; IOFTN = 4.60 ± 0.51, scores ranging: 4.3–5.3) and non-surgery group (NS; n = 16; ANB = −3.00 ± 4.08; IOFTN = 4.63 ± 0.50, scores ranging: 4.3–5.4), based on if they had history of Periodontally Accelerated Osteogenic Orthodontics surgery (S) or not (NS). Patients in S group received orthognathic surgery about 1–1.5 years after Periodontally Accelerated Osteogenic Orthodontics surgery. Alterations in gingival thickness, gingival recession, and keratinized gingival width were compared before and after orthodontic-orthognathic treatment. Logistic regression analysis was used to construct a gingival recession prediction model and draw nomograms. Results: After orthodontic-orthognathic treatment, the gingival thickness and keratinized gingival width in NS group decreased by 0.15 ± 0.21 mm and 0.74 ± 0.91 mm, whereas those in the S group increased by 0.32 ± 0.28 mm and 2.09 ± 1.51 mm (P

This review assesses evolving landscape of mucogingival surgery for treatment of gingival recession and peri-implant mucosal defects, highlighting an increased awareness of the role of soft tissue and advancements in treatment modalities. In response to diverse mucogingival defects, various treatment approaches have been proposed, with ongoing updates in considerations, prognostic factors, as well as the introduction of novel techniques. A comprehensive and up-to-date exploration of the existing literature is therefore required to consolidate the current understanding of mucogingival surgery.Among all treatment modalities, coronally advanced flap (CAF) and tunneling (TUN) techniques were evaluated for treating gingival recessions and peri-implant mucosal defects, acknowledging challenges due to limited direct comparisons and heterogeneous study groups. While some evidence favored CAF for achieving higher complete root coverage, recent meta-analyses suggest comparable outcomes for both techniques, underscoring the need for better-designed studies.In conclusion, both CAF and TUN exhibit versatility in mucogingival surgery, with considerations for specific clinical scenarios. Future studies should explore surgical duration, post-operative experiences, and comprehensive outcomes such as patient satisfaction, long-term stability, and esthetic results for a more thorough evaluation of these techniques.

This review highlights the use of optical scanning-based digital technologies in assessing volumetric changes following root coverage therapy. A comprehensive search was conducted in different databases to identify interventional studies reporting on volumetric changes after root coverage surgery using various approaches. 12 articles from 10 studies meeting the inclusion criteria were included in the qualitative synthesis. The documented volumetric outcomes encompassed changes in volume (Vol) measured in mm³, mean distance between surfaces (ΔD) in mm, and linear dimensional changes (LD) in mm. A notable divergence was observed in determining the Region of Interest (ROI). The observed variability in methodologies and outcomes underscores the necessity for standardized approaches and reporting guidelines, enabling volumetric comparisons across different studies and treatments.

Abstract Objective Aim of this randomized clinical controlled trial was to evaluate the influence of fixed orthodontic steel retainers on gingival health and recessions of mandibular anterior teeth. Materials and methods After end of the orthodontic treatment, patients were randomly assigned into the test (fixed steel retainer) or control group (modified removable vacuum-formed retainer). Periodontal parameters (periodontal probing depth: PPD; recession: REC; bleeding on probing: BOP) as well as plaque and gingival index were assessed on mandibular anterior teeth directly before attaching/handing over the retainer (baseline: BL), 6 and 12 months after orthodontic treatment. Results 37 patients (test: n = 15, mean age: 16.1±4.2 years; control: n = 17, mean age: 17.1±5.4 years) completed the study. REC and PPD failed to show significant pairwise differences. The number of patients showing gingival health in the area of the mandibular anterior teeth (test: BL n = 10, 6 months n = 9, 12 months n = 11; control: BL n = 10, 6 months n = 16, 12 months n = 15) revealed a significant difference for the intra-group comparison between BL and 6 months in the control group (p = 0.043). The inter-group comparisons failed to show significant differences. Conclusion Young orthodontically treated patients with fixed steel retainers show in 73.3% healthy gingival conditions after one year which are comparable to the control group (88.2%). Gingival recessions were in a clinically non-relevant range at any time of the examination. Clinical trial number DRKS00016710.

Abstract Objectives This systematic review aims to evaluate the efficacy of combining the amniotic membrane (AM) with the coronally advanced flap (CAF) in the treatment of Miller class I and II gingival recession (GR). Methods The protocol of this updated PRISMA-compliant systematic review was registered in PROSPERO (CRD42023431501). The following treatment outcomes were recorded; recession depth (RD), recession width (RW), width of keratinized gingiva (WKG), and clinical attachment level (CAL). We searched the following databases: MEDLINE, Cochrane Library, Google Scholar, EMBASE, Web of Science, and Science Direct. Results Two independent reviewers screened the selected articles. Twenty-two eligible articles were extracted, with 689 sites of GR in 481 patients. No statistically significant difference was found in RD, RW, WKG, and CAL between (AM&CAF) in comparison to control groups. However, the subgroup analysis showed statistically significant differences in RD between the (AM & CAF) group v/s (CAF) alone (P = 0.004). Moreover, the subgroup analysis of the WKG showed statistically significant differences between (AM & CAF) v/s (CAF&CM) (p = 0.04). Additionally, a statistically significant difference was found in the subgroup analysis of CAL between both (AM & CAF) group v/s (CAF) alone (p = 0.0009). Conclusion With the limitations of this meta-analysis due to short follow-up periods (6 months), the AM can be considered a viable treatment option for GR defects with satisfactory treatment outcomes comparable to other previously investigated treatment modalities. Clinical significance While AM showed various beneficial properties as an ideal membrane for the coverage of GR, future studies are required to completely understand the potential application of AM in the treatment of GR.

Background: This study investigates the prevalence, distribution and risk indicators of buccal gingival recessions (GRs) in periodontitis patients. Methods: A retrospective examination of 400 periodontitis patients files was performed using an operating sheet. Univariate logistic regression analysis was performed to identify risk indicators of GRs. Multivariate regression analysis was conducted for selected variables with p

This study evaluates the preferences of dentists regarding the interdisciplinary treatment of patients with gingival recession (GR) and a thin periodontal phenotype, based on their specialization. A cross-sectional study was conducted among Polish dentists, between May and October 2022, using an online survey. The dentists were first asked to provide details regarding their specialization and the length of their professional career. In the second part of the survey, they responded to questions about the preferred timing of a consultation and soft tissue augmentation in patients who planned to undertake orthodontic treatment (OT). Moreover, factors undermining the decision-making process regarding soft tissue augmentation and the methods used for the evaluation of periodontal tissues were assessed. In total, 554 dentists completed the survey, among whom 328 were orthodontists and 226 were periodontists/oral surgeons. A third of the surveyed periodontists/oral surgeons (33%) reported that they receive referrals from orthodontists prior to OT and 39% of orthodontists indicated that they refer patients for soft tissue augmentation before commencing OT. The majority of periodontists/oral surgeons (51%) and the most significant proportion of orthodontists (45%) agreed that the ideal timing of soft tissue augmentation is dependent on each specific case. Both groups of surveyed dentists considered “planned tooth movement” as the most important factor in clinical decision-making. Among the periodontists/oral surgeons, the most popular methods to assess periodontal tissues were: 3D radiological examination, the visual method, and gingival transparency with the use of a periodontal probe. On the other hand, the surveyed orthodontists preferred the visual method, followed by 2D radiological examination, and then by 3D radiological examination. The majority of surveyed periodontists/oral surgeons and orthodontists agreed that the ideal timing of soft tissue augmentation in patients undertaking orthodontic treatment should be decided on a case-by-case basis, with planned tooth movement being the determining factor.

Key Clinical Message A successful management of a mandibular recession with creeping attachment using free gingival graft. This case highlights the “wait‐and‐see” approach in the treatment plan, emphasizing the root coverage. Abstract This clinical report describes the case of a 23‐year‐old female patient with gingival recession of the mandibular left central incisor. The patient's symptoms included hypersensitivity and cosmetic improvements. After thorough examination, the patient was diagnosed with plaque‐induced gingivitis on a reduced periodontium with acquired mucogingival deformities. Gingival recession was classified as Miller class II or Cairo Recession Type 1. The treatment plan consisted of a nonsurgical phase, followed by a surgical phase using a free gingival graft. The surgical procedure involved harvesting the graft from the palatal mucosa and placing it in the recipient site. Post‐operative care and instructions were provided and a comprehensive follow‐up schedule was established. At the 12‐month evaluation, the patient exhibited healthy periodontal conditions with creeping attachment and complete root coverage. The success of the treatment approach demonstrates its effectiveness in addressing hypersensitivity and cosmetic concerns, while improving periodontal health. Factors influencing the achievement of creeping attachment are discussed, including recession width, graft position, bone support, tooth position, patient hygiene, graft thickness, and root surface treatment.

The importance of esthetics is increasing for the patients as well as for the dentist. With a high incidence that rises with age and a complicated soft-tissue pathology caused by a wide variety of factors, gingival recessions are a common but troublesome dental problem. They are characterized by the exposure of the root surface of the teeth due to the apical migration of the gingival border beyond the cemento-enamel junction, and they cause both functional and cosmetic disruptions. Many different surgical approaches have been offered over the years to address gingival recession, all with the goal of providing enough root coverage and achieving aesthetically pleasing results. No matter the amount of defects, Zucchelli's method is beneficial in terms of root coverage and keratinized tissue gain when treating many neighboring recessions. In this case study, Zucchelli's coronally advanced flap is used to treat numerous neighboring gingival recessions.

The article is a literature review concerning certain aspects of the history of Russian dentistry. In this regard, minimally invasive methods are discussed, including air-abrasive, laser, sonic and ultrasonic preparation, as well as atraumatic restorative treatment without mechanical preparation. Indications for minimally invasive methods, assessment of caries activity and prognosis, causes and mechanisms of the accelerated restoration cycle are discussed. The need to preserve dental tissues has been undervalued in the past. Non-selective preparation to hard dentin is currently considered hypertherapy. The concept of minimally invasive dentistry is also applied in endodontics and periodontology. In patients with gingival recession, it is important to protect atrophic tissues from further damage. After a tooth extraction, excessive socket curettage should be avoided. The research in dentistry should be protected from conflicts of interest. Patients should be objectively informed about treatment options, given recommendations based on clinical indications, wishes and possibilities. It is also necessary to develop economic measures in order to reorient private dental clinics to receive patients with compulsory medical insurance and the use of minimally invasive methods.

Abstract Background and Objective Free gingival graft (FGG) has been successfully used in the treatment of gingival recessions, as it is the most predictable technique for increasing the attached gingiva. This study aimed to evaluate the effect of liquid platelet‐rich fibrin (PRF) with FGG on root surface coverage as root surface biomodification. Materials and Methods The research sample consisted of 32 surgical sites in 16 patients, they had 2 bilateral recessions in the incisor area of the same dental arch, the sample was divided into 2 groups randomly, and liquid PRF was applied in the first group with the FGG (experimental group), and in the second group the FGG was applied alone (control group). Gingival recession depth (RD) and width of attached gingiva (WAG) were measured before starting, after 1, 3, and 6 months. The percentage of root coverage (RC) was calculated after 6 months. Healing Index (HI) was recorded after 1 week, 2 weeks, and 1 month. Results Both groups showed a reduction in gingival RD during all follow‐up periods but the difference between both groups was not statistically significant (p > 0.05) at 1 and 3 months, whereas there were significant differences at 6 months (p = 0.001). RC was better in the liquid PRF group than in the control group, but this difference was not statistically significant (p > 0.05). The postoperative 7th and 14th days HI scores of the liquid PRF group were significantly better than the control group (p = 0.000 and p = 0.004, respectively), whereas there were no significant differences in HI scores between both groups at first month (p > 0.05). Conclusions According to the results, the addition of liquid PRF to the root surface with FGG showed further development in terms of decreasing RD, increasing WAG, and accelerated wound‐healing.

Introduction, aim: This article provides an overview of current knowledge on the relationship between orthodontic treatment and the emergence of gingival recession. It summarises the results of available studies published since 1973. The views of various authors are different. Gingival recession is multifactorial in origin, with the following cited as risk factors: dehiscence of the alveolar bone, gingival phenotype, thin biotype of the bone of the alveolar process, the shape of symphysis, dental malposition, the articulation of the dentition, inappropriate oral hygiene technique, tension of the mucosal folds and many others.Methodology: The scientific databases PubMed, Science Direct, Google Scholar, Embase, and Web of Science were used for the research. Key words (gingival recession, orthodontic treatment, incisor protrusion, symphysis, gingival biotype) were entered into the search and articles were studied. Important facts and results of individual studies were written down. Conclusion: The issue of recessions is complex and multifactorial. It is important to correctly assemble a treatment plan with regard to the condition of the periodontium, gingival phenotype, bone biotype of the alveolar process, facial skeleton (shape of the symphysis), level of dental hygiene as well as regular check-ups in the retention phase of treatment in order to avoid possible complications of fixed retainers.

Root exposure generates major concerns regarding aesthetics and other problems like hypersensitivity and root caries. Gingival recession has traditionally been treated by periodontal plastic surgery, often using soft tissue grafts to fill the defect with excellent clinical results. Advancements in root coverage procedures in the aesthetic zone have led to increasing the ability of clinicians to harness a treatment modality that delivers better outcomes with less surgical morbidity. Collagen membrane is most commonly used for guided tissue regeneration (GTR). On the other hand, platelet-rich fibrin (PRF) has gained popularity due to its simple method of acquisition, low cost and the presence of growth factors. Therefore, this case report describes the treatment of a 38-year-old patient with bilateral multiple Miller’s class I recession defects extending from central incisors to canines by using the vestibular incision subperiosteal tunnel access (VISTA) with PRF and collagen membrane. Clinical parameters such as recession height (RH) and width of keratinised gingiva (WKG) were measured at 6-month and 1-year follow up intervals. The 6-month follow-up revealed optimum root coverage with excellent outcomes for both sites, with an increase in the width of keratinised gingiva and a decrease in the recession height, and less discomfort in the site treated with a PRF membrane. These clinical parameters were maintained at the 1-year follow up. The increase in the width of keratinised gingiva and the decrease in the recession height in both groups and the patient compliance due to this minimally invasive procedure suggests its potential use when aesthetics and patient comfort are of paramount concern.

Introduction: Retrospective studies have found conflicting results regarding the relationship between lower incisor inclination and the development of gingival recession (GR) after orthodontic treatment. Objective: This study aimed to investigate the relationship between lower incisor inclination and alveolar process (AP) and mandibular symphysis (MS) thickness in the development of GR. Materials and Methods: Frontal intraoral photography and cephalometric radiography were conducted before (T0) and after (T1) orthodontic treatment of 62 subjects. The presence of GR was considered when the cementoenamel junction was visible in the lower incisor on the frontal intraoral photograph. The circumstances for improvement, stability, and worsening of the gingival situation were based on the reduction, maintenance, and increase in the number of lower incisors with GR before and after treatment. To measure the incisor-mandibular plane angle (IMPA) and the thickness of the AP and the MS were used the cephalometric radiographs. Results: Men had a significantly thicker MS than women at T0 and T1 (p

This study aims to evaluate the influence of the additional use of enamel matrix derivate (EMD) in the treatment of gingival recession defects using a coronally advanced flap (CAF) and a xenogeneic dermal matrix (XDM) by means of digital and clinical assessment methods. In this prospective randomized controlled study, recession height and area, width and thickness of keratinized gingiva, pocket probing depth, and clinical attachment levels were measured at the baseline and followed up for one year. Fifteen patients (n = 15) with 24 gingival recession defects were treated between 2019 and 2021. On average, the digitally assessed root coverage of the control group (CAF + XDM) was not significantly different compared to the test group (CAF + XDM + EMD), with 69 ± 28% and 36 ± 32%, respectively (p = 0.094). One year postoperatively, there were no differences found regarding keratinized tissue width (KTW) between the control group and test group (p = 0.690). However, the control group showed superior results in the thickness of keratinized gingiva (p = 0.044). The present study showed that there were no statistically significant differences in the root coverage results in the CAF + XDM + EMD group compared to the CAF + XDM group. The adjunctive use of EMD to a CAF and XDM in the treatment of gingival recession defects does not appear to have any clinical benefit.

Abstract Background Recently, there is increased demand for periodontal plastic surgery and development of new surgical approaches for aesthetic purposes. Gingival recession (GR) is the exposure of the root surfaces leading to esthetic problems, hypersensitivity, caries of the roots and teeth loss. Coronally advanced flap is considered a predictable treatment of GR but it needs a filler like subperiosteal connective tissue graft (CTG) which is considered as the gold standard treatment approach. The aim of the present study is to compare the clinical benefits and effectiveness of a xenogenic collagen matrix (mucoderm, botiss, dental, Berlin, Germany) to CTG for treatment of GR. Results Regarding clinical parameters, mean preoperative values for attached gingiva, probing depth, clinical attachment loss and gingival recession for group I were (1.8 ± 0.7 mm, 1.2 ± 0.3 mm, 6.6 ± 0.4 mm and 5.4 ± 0.2 mm) respectively. While mean postoperative values were (2.3 ± 0.9 mm, 1.1 ± 0.4 mm, 3.4 ± 0.5 mm and 2.7 ± 0.7 mm For group two preoperative mean values were (1.9 ± 0.3 mm, 1.1 ± 0.5 mm, 6.8 ± 0.5 mm and 5.4 ± 0.2 mm) respectively. While mean for postoperative values of attached gingiva, probing depth, clinical attachment loss and gingival recession for group tow were (2.5 ± 0.6 mm, 0.8 ± 0.3 mm, 3.7 ± 0.2 mm and 3.1 ± 0.3 mm) respectively All of the clinical parameters measured showed a significant difference between pre ad postoperative measurements while there was no significant differences between the two groups (test and control group). Regarding the patients satisfaction the percentage was greater in test group but the difference was not statistically significant. Conclusions In general, all of the parameters measured showed a significant difference between pre and postoperative measurements for each group but there is no significant difference between the two groups using (two treatment approaches. Both treatment procedures are considered efficient in increasing zone of attached gingiva and decreasing its clinical attachment loss. Mucoderm is considered as an efficient alternative to CTG for treatment of gingival recession.

Abstract Objectives One of the main challenges in performing root coverage is patient discomfort and donor site morbidity. This case report presents a minimally invasive apical tunnel surgical technique, with propolis for root conditioning, to correct gingival recession defects without harvesting donor grafts, flap elevation, or sutures. Propolis is a natural anti‐infective, anti‐inflammatory, and antioxidant agent. Material and Methods A 58‐year‐old woman with no significant medical history was presented for root coverage of her upper left canine and first premolar with recession type (RT)1A (+). Propolis was used as a root conditioning agent to promote soft tissue coverage via an apical tunnel approach. During the apical tunnel approach, a small apical hole was made 6 mm below the mucogingival junction, and the mucosa and associated attached gingiva was away from the tooth so the flap could be repositioned coronally. Collagen matrix was used as a soft tissue graft material. Results At the 2‐month, 6‐month, 8‐month, and 2‐year follow‐up, complete root coverage was achieved for both teeth. No bleeding on probing was noticed nor recurrent GRs at the treated sites. Conclusion Without incisions, donor site reflection, or flaps, the apical tunnel approach can be successfully used to cover the exposed roots. Additionally, propolis is a potential root conditioning agent during soft tissue graft procedure due to its anti‐inflammatory and antioxidant properties.

The aim of this systematic scoping review was to provide scientific evidence on the efficacy and methods of application of hyaluronic acid (HA) in the coverage of gingival recessions in terms of recession depth (RD) reduction, clinical attachment level (CAL) gain and probing depth (PD). An electronic search of the literature on the main databases was conducted. Initially, 405 articles were identified. Finally, four studies were included after the review process. It was not possible to perform a meta-analysis of the articles selected because of the differences among the surgical treatments and commercial formulations and compositions of HA. Both randomized controlled trials in this research examined type 1 gingival recessions treated with a coronally advanced flap. In the selected case series, recessions were treated with either a modified coronally advanced tunnel or laterally closed tunnel combined with a subepithelial connective tissue graft and HA. No significant variation was found in terms of PD. Modifications of CAL are connected to variations of RD; however, RD reduction is similar to the control group. HA seems to improve the clinical outcomes of gingival recession coverage in the short term, but the magnitude is limited. Formulations, surgical techniques and application methods are heterogeneous.

Background: Gingival recession is a characteristic indicator of periodontitis and one of the factors that contributes to increased tooth clinical crown length. Patients with root exposure frequently undergo periodontal surgical procedures in addition to adjunctive therapy to increase root coverage area and soft tissue stability. Purpose: This study aimed to evaluate fibroblast-root surface adhesion and determine whether periodontitis-damaged root surface microstructure can be restored using ethylenediaminetetraacetic acid (EDTA) and an enamel matrix derivative (EMD), individually or in combination. Material and methods: Teeth extracted from patients with periodontal disease were used to create 60 samples, with each group containing six specimens. The test groups were provided root planing or root condition-specific materials (hyaluronic acid [HA], 24% EDTA, EMD, or EDTA/EMD) for varying treatment time periods. In contrast, the control group did not undergo any surface modifications. The samples and fibroblast cells were incubated for 72 h. The number of living cells on the root surface in each group was calculated using a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay (cell viability assessment). Results: The control, root planing, and EMD groups showed that the root surfaces treated with EDTA for 4 min had significantly better cell adhesion. Surface EDTA treatment for 2 min significantly promoted cell attachment compared to root planing treatment. The root surfaces modified with EDTA/EMD for 2 and 4 min showed significantly improved cellular migration and adhesion compared to the root surface treated with root planing. Conclusion: EDTA and EDTA/EMD substantially affected the root surface, which was related to the length of the treatment process. This effect shifts the surface properties, alters fibroblast interactions with the root surface, and recruits more cells to cover a larger area.

Abstract Aim This study sought to determine the prevalence of dentine hypersensitivity (DH) among adults in Turkey. Also, to ascertain the association between DH and both etiological predictors and demographic patient characteristics. Material method Using a questionnaire and thermal and evaporative tests, 259 women and 209 men in the age range of 18 to 72 were analyzed. Individually, a clinical evaluation of DH signs was conducted. The DMFT index, gingival index, and gingival bleeding were reported for each subject. The gingival recession and tooth wear of sensitive teeth were also evaluated. Pearson Chi-square test was used to compare categorical data. Logistic Regression Analysis was used to examine the risk factors of DH. Data with dependent categorical variables were compared using the McNemar-Browker test. The significance level was p

Abstract Background Smokeless tobacco (SLT) products of several different types are widely used in several South Asian countries including Pakistan. These products are consumed in different forms and with different names. The study aims to determine adverse effects of the SLT consumption on periodontal tissues. Methods This cross sectional study was conducted in Karachi, Pakistan. It recruited 377 users of (SLT) with 231 males (61.3%) and 146 females (38.7%) of age 15 to 45 years. After obtaining informed consent, quantitative data were collected via a questionnaire followed by intra oral clinical examination to determine presence of periodontal diseases using community periodontal index (CPI). To determine the association between periodontal diseases and smokeless tobacco consumption habits, Chi Square test was conducted. Results Gingival recession (Class II-IV) (65.8%) was the most prevalent periodontal disease among SLT users. CPI score was high (CPI score 3 and 4) in 31.3% participants, whereas tooth loss was found in 21%. Among types of SLT products, gutka (28.6%) and betel quid (23.3%) were most commonly used. Using SLT for five or more years was found to be associated with a high CPI score, gingival recession (Class II-IV), moderate to severe tooth mobility, and presence of tooth loss. Conclusions The study found statistically significant association between duration in years of using SLT and periodontal disease including gingival recession, tooth mobility and tooth loss. However, no significant results were found between retention during single use and frequency of SLT use per day. However, the link of these factors with the periodontal disease cannot be eliminated.

Noncarious cervical lesions (NCCL) have a multifactorial etiology. The terms abfraction, abrasion, and erosion are also used to describe the same lesion. NCCLs can lead to gum recession which is one of the most frequent gingival defects. NCCLs generally also involve loss of tooth structure. Therefore, treatments should be planned and performed in an interdisciplinary manner. When NCCL is minimal, the choise to use simple direct restorations is the main therapeutic option. If it is serious, microsurgical treatment or, more precisely, interdisciplinary treatment might be necessary. Root coverage by microsurgical methods is the most challenging esthetic procedure. There are many techniques available of which we must always choose the method that can ensure and control root coverage in the long term.

Abstract Background Intra-marrow penetrations (IMPs) have been performed during guided tissue regeneration (GTR) procedures with reported clinical benefits. The aim of this systematic review was to investigate the use and effect of IMPs during root coverage procedures. Method A broad search for human and animal studies was performed on PubMed, Cochrane Database of Systematic Reviews and Cochrane Central Registry of Controlled Trials and Web of Science, following a registered review protocol (PROSPERO). All prospective study designs, case series and case reports on gingival recession treatment (follow-up ≥ 6 months) that employed IMPs were included. Root coverage, complete root coverage prevalence, and adverse effects were recorded, and risk of bias was assessed. Results Of 16,181 screened titles, 5 articles (all of them human studies) met inclusion criteria. All studies (including two randomized clinical trials) treated Miller class I and II recession defects, using coronally advanced flap with IMPs alone or in conjunction with GTR protocols. Therefore, all treated defects received IMPs and no studies compared protocols with and without IMPs. Outcomes were indirectly compared with existing root coverage literature. Mean root coverage was 2.7 mm and 68.5% at 6.8 months (median: 6 months, range 6–15 months) for sites treated with IMPs. Conclusion IMPs are rarely used during root coverage procedures, have not been associated with intra-surgical or wound healing adverse effects and have not been investigated as independent factor. Future clinical studies are needed to directly compare treatment protocols with and without IMPs and investigate the potential benefits of IMPs for root coverage.

Abstract Background Autogenous soft tissue grafting is indicated in thin gingival biotypes before orthodontic proclination or labial movements to increase the keratinized gingiva and prevent gingival recession. However, its effect on local alveolar bone remodeling is unclear. The aim of this study was to investigate the effects of autogenous soft tissue grafting on local alveolar bone after orthodontic proclination or labial movements. Methods Sixteen patients with a thin scalloped gingival biotype, narrow keratinized gingiva, or thin cortical bone requiring orthodontic proclination or labial movement of teeth were included. Cone-beam computed tomography (CBCT) images were obtained before grafting and at least 6 months after surgery. Sixty mandibular teeth were included, and the vertical bone level and horizontal labial bone thickness were measured. The results were compared using paired t-tests or Wilcoxon signed-rank test. Results The horizontal labial bone thickness increased, especially at 6 mm below the cementoenamel junction (CEJ) in the mandibular central and lateral incisors (P 0.05). Conclusions New bone regeneration was observed on the labial (pressure) side after autogenous soft tissue grafting, which may represent a mechanism to effectively prevent gingival recession and maintain periodontal health. IRB approval All the experimental procedures involving humans in this study were approved by the Medical Ethics Committee of Xiangya Stomatological Hospital, Central South University ( No. 20190048).

Objective To evaluate the clinical effect of enamel matrix derivative(EMD) assisted with connective tissue graft(CTG) in the treatment of gingival recession. Methods Search The Cochrane Library, PubMed, EMbase, Web of Science, Wanfang Public Database,VIP database and CNKI to search for randomized controlled trials of EMD in the treatment of gingival recession. The search period is from the establishment of the databases to October 3, 2022. The test group was treated with EMD+CTG, while the control group was treated with CTG alone. Meta-analyses were performed using Review Manager 5.4.1 and Stat12.0. Results Meta analysis results showed that only 12 months after treatment, there was a statistically significant difference in the PD and CAL outcome indicators between the EMD assisted treatment group and the control group [MDPD=-0.10, 95% CI (-0.19, -0.01), P = 0.03], [MDCAL=-0.38, 95% CI(-0.71, -0.04), P = 0.03]. There was no significant difference between the test group and the control group in other indicators. Conclusion EMD assisted CTG in the treatment of gingival recession may be beneficial to the reduction of PD and CAL.

The goal of plastic periodontal surgery is to obtain complete root coverage, increasing gingival thickness (GT), a positive prognostic factor for gingival margin stability over time. The aim of this study was to compare the effectiveness of the Coronally Advanced Flap (CAF) in RT1 (GR; gingival recession with no loss of interproximal attachment) when associated with a connective tissue graft from the maxillary tuberosity (tCTG) or with leukocyte and platelet-rich fibrin (L-PRF) membranes in obtaining root coverage and increasing the thickness and width of the keratinized tissue, along with aesthetic improvement, taking into account a number of patient-related outcomes. Thirty patients with two adjacent RT1 GRs (GRs with no loss of interproximal attachment) were each treated using CAF associated with tCTG (15 patients) or L-PRF. The main outcome was a GT increase; secondary outcomes were keratinized tissue width (KT), gingival recession (GR), probing depth (PD), clinical attachment level (CAL), root coverage percentage (RC%), complete root coverage (CRC), and root coverage esthetic score (RES). Patient-reported outcomes were discomfort (D), dentine hypersensitivity (DH), patient-related esthetic score (PRES), and overall treatment satisfaction (OTS). After 12 months, clinical and patient-reported parameters did not show significant differences between groups, with the only exception being a GT gain, which was significantly greater in the CAF + tCTG group. Our results showed that both techniques were effective in treating RT1 GRs, with comparable patient-related outcomes. However, the use of tCTG produces significantly thicker tissue, covering the exposed root surface.

Background: Different extracellular matrix (ECM)-based technologies in periodontal and peri-implant soft tissue augmentation have been proposed in the market. The present review compared the efficacy of soft tissue substitutes (STSs) and autogenous free gingival grafts (FGGs) or connective tissue grafts (CTGs) in mucogingival procedures to increase keratinized tissue (KT) width around teeth and implants. Methods: Two independent examiners performed an electronic search on MEDLINE and the Cochrane Library based on the following PICOS format: (P) adult patients; (I) soft tissue substitutes and FGGs/CTGs; (C) STSs vs. CTGs; STSs vs. FGGs; STSs vs control; (O) KT width gain; (S) systematic reviews, randomized controlled trials. Studies published before November 2023 were included. Results: Around teeth, all biomaterials showed superior performance compared to a coronally advanced flap (CAF) alone for treating gingival recessions. However, when compared to CTGs, acellular dermal matrices (ADMs) yield the most similar outcomes to the gold standard (CTGs), even though in multiple recessions, CTGs continue to be considered the most favorable approach. The use of STSs (acellular matrix or tissue-engineered) in combination with apically positioned flaps (APF) resulted in significantly less gain in KT width compared to that achieved with FGGs and APFs. Around dental implants, free gingival grafts were deemed more effective than soft tissue substitutes in enhancing keratinized mucosa width. Conclusions: Based on the available evidence, questions remain about the alternative use of soft tissue substitutes for conventional grafting procedures using free gingival grafts or connective tissue grafts around teeth and implants.

Abstract: This study aimed to compare the use of connective tissue grafts (CTG) and platelet-rich fibrin (PRF) associated with the tunnel technique (TT) for the treatment of multiple gingival recessions (GR). Fourteen patients with multiple bilateral GR [type 1 recession (RT 1)] in the maxillary incisors, canines, and/or premolars were included. The TT was performed on both sides (split-mouth model); CTG (36 GR) was used on one side, and on the other, PRF (36 GR) was used. Clinical parameters, including recession depth (RD), probing depth, clinical attachment level (CAL), and keratinized gingiva thickness/width (GT/KTW), were obtained at baseline and after 1, 3, 6, and 16 months. Lower RD (0.81 ± 0.68 vs. 1.23 ± 0.71 mm) and CAL (2.54 ± 0.63 vs. 2.73 ± 0.82 mm) were observed for CTG compared to PRF after 16 months. Higher GT was obtained for CTG compared to PRF after 3 (1.81 ± 0.56 vs 1.43 ± 0.47 mm) and 6 months (1.67 ± 0.61 vs. 1.38 ± 0.55 mm, p < 0.05). The recession coverage (RC) was higher for CTG (55.42% ± 37.14) in comparison to PRF (29.53% ± 34.08) after 16 months (p < 0.05). Similarly, CTG presented a more complete coverage of the recession (15; 41.66%) than PRF (9; 24.32%). There were no significant differences between the groups in terms of surgery time, postoperative pain, or healing patterns. Greater esthetic satisfaction was obtained with CTG. It was concluded that CTG combined with TT showed clinical and esthetic results superior to those of PRF in multiple GR treatments.

Objectives: Modified form of VISTA (MVISTA), a novel surgical procedure, aims at comprehensive root coverage that maintains the inner continuity of the periosteum and papilla. This technique incorporates any regenerative graft material within the tunnel. The objective of study is to compare the MVISTA for treating multiple adjacent gingival recessions and chorion membranes or grafts of connective tissues. Materials and methods: This is a split-mouth type randomized trial. In this trial total of 18 patients were considered. The patients in this trial had multiple adjacent, gingival recessions of Miller's Classes I/II, and they were randomized to either the MVISTA with chorion membrane (test) or connective tissue graft (CTG) (control) group. A baseline and one year after surgery were considered for recording to mean root coverage (MRC), complete root coverage (CRC), and clinical periodontal parameters. An intragroup comparison was made. Results: The intragroup comparison of recession depth baseline and 12 months after-surgery record found a significant difference between the two groups (P = 0.00). In the postoperative condition, the depth of recession reduction was higher in the test group than in the control group. However, from a statistical perspective, the difference was insignificant (P > 0.05). At the end of the year, it was found that the width of the keratinized tissue had increased significantly (P 000). At the end of 1 year, the test group showed 66.67 % CRC compared to 44.44 % in the control group. The gingival phenotype displayed statistically significant improvement in the test group (p = 0.004). PD and CAL showed statistically nonsignificant outcomes (P > 0.05). Conclusions: As far as multiple adjacent gingival recession treatment is concerned, MVISTA with chorion membrane treatment enhanced the gingival phenotype, restored complete root coverage (66.6%), and increased the width of keratinized tissue. CTG and CM demonstrated good root coverage results; the latter might be used as a substitute graft to treat multiple recessions.

Abstract Objectives To evaluate the influence of the gingival contour on the smile esthetics. The influence of size, symmetry, teeth involved in apically shifted gingival margins, and the distance and clinical training of the observer were investigated. Materials and Methods Two groups were identified: 33 first‐year dental students (inexperienced) and 40 last‐year students (trained). Each observer expressed four evaluations on four different images assigning a score from 0 to 10. Using a picture of an “ideal” female smile, 10 variants were virtually created by shifting (2 and 4 mm) the gingival contour apically at different sites of the upper incisors and canines. A total of 292 evaluations were collected. Results Considering a score >6 for a “pleasant smile,” only one 4 mm single alteration at the canine gingival contour obtained an insufficient score. “Observational distance” and “clinical training” did not influence the final score, while size and symmetry of alterations displayed a significant role. Conclusions The dental training of the observer and a close interpersonal distance seemed to be irrelevant in the esthetic perception of gingival margin alterations.

Objective: To compare the effectiveness of the conventional technique and cordless technique in gingival displacement. Materials and Methods: A bibliographic search was carried out until August 2023, in the biomedical databases: Pubmed/Medline, Cochrane Library, Scielo, Scopus and Google Scholar. Included studies reporting the gingival displacement of vital teeth using the cordless and con-ventional techniques comprised clinical trials, articles in English and without time limits. The RoB 2.0 tool was used to assess the risk of the included studies and the GRADEPro GDT tool to assess the quality of the evidence and the strength of recommendation of the results. Results: The preliminary search yielded a total of 489 articles, discarding those that did not meet the selection criteria, leaving only 15 articles. A total of fourteen articles entered a meta-analysis. It was found that the conventional technique caused better gingival (width) displacement than the cordless techniques, however, it caused more bleeding. Furthermore, among the wireless techniques, the one using polyvinylsiloxane obtained better results. Conclusions: The literature reviewed suggests that the conventional technique resulted in a better gingival displacement (width) than the cordless techniques, however, it causes a greater periodontal injury.

Gingival recession (GR) is considered a public health problem which is highly prevalent across different populations. Accuracy of psychometric properties of prevalence estimates of GR reported in epidemiological studies is important to facilitate setting public health goals, planning of public health programs, implementation of best practices and thereby developing public health policy. However, the reported prevalence estimates are influenced by the methodological variations among different studies, as observed in our recently published systematic review and meta-analysis on the global prevalence of GR. It substantially limits the comparability between studies and inferences about the true global variation in the prevalence of GR are difficult to establish. To address these issues, this commentary suggests to follow the standardized principles related to study design, clinical examination protocol, and characteristics of study subjects in future epidemiological studies on prevalence estimates of GR. Furthermore, the inclusion of additional domains in the reporting data is suggested for a deeper insight into the patterns of GR in different populations. Our suggestions are derived from a pragmatic approach and their consistent implementation would improve the reporting quality and achieve uniformity in future studies, thus benefitting the research in this area.

Rough surfaces of dental implants, when exposed to the oral environment, are conducive to biofilm colonization and can predispose the affected implant to periimplantitis. Recession coverage using soft-tissue grafts is one of the treatment modalities used for the treatment of exposed implant threads. Recession coverage on the palatal aspect of maxillary implants is difficult due to the firm nature of the palatal mucosa and, consequently has not been widely documented in the literature. This case report documents a novel double-pedicle technique for palatal recession coverage on a dental implant. Two pedicle grafts were obtained from either side of the implant with the mucosal recession: a full-thickness lateral-pedicle graft from the distal aspect and a subepithelial connective tissue pedicle from the mesial aspect. The connective tissue pedicle was stabilized first on the area of mucosal recession and was then covered with the distal full-thickness lateral pedicle. Complete recession coverage was obtained, and the result was observed to be clinically stable after 18 months of follow-up. The technique demonstrated in this report can be a useful tool for the treatment of localized palatal recessions on dental implants.

Background: Root coverage using subepithelial connective tissue graft (SCTG) is gold standard with few drawbacks such as requirement of second surgical site, reduced donor tissue availability, and increased surgical complications and pain. Periosteal pedicle graft (PPG) due to its rich source of pluripotent stem cells and nonrequirement of second surgical site could be a successful alternative for invasive SCTG. Therefore, current research aims to compare the amount of root coverage obtained with PPG to SCTG. Materials and Methods: Fifty-two single gingival recessions were included in the sample, with 26 patients allocated to the SCTG (control) and PPG (test) groups at random. At baseline, 3, and 6 months after surgery, clinical measurements of probing depth, clinical attachment level (CAL), recession depth (RD), recession width (RW), and width of keratinized tissue were taken. Results: Both procedures, i.e., SCTG and PPG, resulted in root coverage to a variable extent and a significant decrease in RD (1.69, 1.38 mm in SCTG and PPG groups, respectively) and RW, CAL gain is found in both the groups without any intergroup statistical variance. Complete root coverage (CRC) was obtained in 14 out of 26, i.e., 53.8% defects in both SCTG and PPG groups. A better comfort level is found in the group treated with PPG. Conclusion: Gingival recessions can be successfully treated with PPG, which has predictability comparable to SCTG and does not require a second surgical site.

About half of the cases of gingival recession are associated with the noncarious cervical lesion (NCCL), resulting in combined defects (CDs). NCCL negatively affects the root coverage outcomes. In addition, considering the morbidity associated with graft harvesting, soft-tissue substitutes (STSs) appeared as a suitable option for connective tissue grafts for surgical root coverage. Currently, the literature addressing the therapy of CDs employing STSs is scarce. Thus, the present review aimed to update the literature and outline the future perspectives about root coverage of CDs using STSs. A detailed literature search was conducted on MEDLINE, Web of Science, EMBASE, LILACS, Scopus, and Google Scholar databases using keywords and Boolean operators. Randomized clinical trials (2) and case reports (6) were included. None of the selected studies reported any adverse effect using STSs. Based on the limited evidence available, we cannot state that STSs may benefit the periodontal clinical and patient-centered outcomes. Randomized controlled trials are needed to assess the long-term outcomes, surgical approaches, and restorative protocols.

Background: Gingival recession (GR) has become a common problem among patients. GR is associated with increased accumulation of plaque, root caries, abrasion and cervical wear, and dentinal hypersensitivity. The present study aimed to examine the correlation between gingival biotypes and the occurrence of GR. Methods: The study initially recruited 94 subjects; however, 54 of them did not have any recession sites, and hence were discarded. Therefore, the analysis was performed on 40 subjects. The study particularly compared the relationship between the recession length (RL) and width along with the gingival thickness (GT). As such, different clinical parameters were analyzed, namely, RL, recession width (RW), keratinized gingival width (KGW), and GT. Results: Based on the statistical analysis (descriptive statistics and Pearson's correlation) conducted on the collected data, the study established that the gingival RL has a significant negative relationship with GT, which implied that the amount of thickness is inversely proportional to the RL. The study also found a significant positive correlation between RW and RL as well as between GT and KGW. Conclusion: Based on the findings, the study thus concluded that the gingival biotype (thickness) significantly determines the occurrence and extent of GR.