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This case report describes the use of the modified laterally positioned flap (LPF) technique associated with a subepithelial connective tissue graft (SCTG) for root coverage of homologous mandibular molars with deep gingival recession (GR). A 25-year-old woman with deep GR affecting the mandibular right and left second molars (teeth 31 and 18, respectively) reported bilateral dentinal hypersensitivity. The defect in tooth 31 was 5 mm deep and 4 mm wide. In tooth 18, the defect was 6 mm deep and 5 mm wide. There was 1 mm of keratinized tissue at tooth 31, and no keratinized tissue was present at tooth 18. The modified LPF-SCTG technique with mesial to distal positioning of the flap was selected to treat the defects. The flap was modified by a submarginal incision in the tooth farthest from the GR to preserve the integrity of the donor site. One year postsurgery, tooth 31 had 80.0% coverage, a 66.6% gain in clinical attachment, and a 5-mm increase in keratinized tissue width. Tooth 18 had 83.3% root coverage, a 71.4% gain in clinical attachment, and a 5-mm increase in keratinized tissue width. The patient's complaints of hypersensitivity were resolved, and the tissue gain provided better access and more comfort during cleaning of the teeth. The flap donor sites demonstrated no clinical signs of GR. Based on the 1-year follow-up assessments, the modified LPF-SCTG technique was effective for the treatment of deep single-tooth GR in mandibular molars without causing adverse affects on the flap donor sites. [ABSTRACT FROM AUTHOR]

The interaction between the recipient area and the graft is one of the key factors in the success of periodontal plastic surgery. This randomized controlled, split-mouth, double-blinded clinical trial aimed to compare the clinical and aesthetic outcomes of epithelialized palatal graft (EPG) and gingival unit graft (GUG) in achieving root coverage in localized (Recession Type 1) RT1 recession defects. Twenty participants with forty bilateral recession defects randomly received EPG or GUG surgical treatment modalities for each of the recession defects. Clinical measurements recorded at baseline and after six months included recession depth (RD), recession width (RW), probing depth (PD), clinical attachment level (CAL), keratinized tissue width (KTW), and the average width of mesial and distal interdental papilla (aWIDP). There was a statistically significant greater mean root coverage (MRC) percentage at GUG sites (80.68 ± 16.12%) in comparison to EPG sites (71.05 ± 17.23%) (p = 0.01). The treatment satisfaction (p = 0.009) and aesthetic satisfaction (p < 0.001) experienced were significantly better for GUG as compared to EPG. The regression model (R 2 = 0.56) significantly predicted MRC percentage in GUG sites with baseline RD (β = −12.49; p = 0.02) and aWIDP (β = −9.31; p = 0.02). GUG showed a better MRC, aesthetics and increased KTW. Root coverage procedures often need to suffice the dual objective of coverage and aesthetics at the same time. GUG is a simple modification of the conventional EPG that can provide better clinical and aesthetic outcomes. [ABSTRACT FROM AUTHOR]

Vestibular Incision Subperiosteal Tunnel Access (VISTA) root coverage technique has experienced a surge in popularity in recent times. The methodology employed in this study is characterized by its minimally invasive nature, utilizing a single incision. The primary objective of this systematic review was to assess the effectiveness of the VISTA approach for achieving root coverage. The protocol was registered with PROSPERO and included randomized controlled clinical trials where gingival recessions were managed with VISTA technique or its modifications. Among the total of 416 records, a mere 14 studies were initially deemed eligible for consideration. Ultimately, only eight pieces of research were included in the final analysis. There were six studies that exhibited heterogeneity, while two studies showed homogeneity and were therefore included in the meta-analysis. All of the studies considered in the analysis exhibited a moderate to low risk of bias. The majority of the research included in the analysis focused on selective root coverage outcome indicators, while neglecting to incorporate patient-reported outcome measures and patient experienced outcome measures. The VISTA procedure is commonly acknowledged as the most efficacious approach for managing gingival recession. The current literature provides support for the recommendation of the procedure, with evidence of intermediate certainty. The findings of this systematic review indicates that the available data are restricted due to several methodological limitations observed in the included studies. These limitations include, small sample sizes, selective reporting of outcomes, and very short follow-up periods. [ABSTRACT FROM AUTHOR]

Failures of soft tissue grafting are relatively common and can be stressful when encountered for both the clinicians and patients. Soft tissue grafting has predictable success most of the time when proper selection and implementation of surgical procedure is done. This case report describes management of soft-tissue surgery failure after multiple mucogingival grafting for enhancing the soft-tissue quality, quantity, and aesthetic outcomes. Augmentation by free gingival graft using periodontal microsurgical principle resulted complete coverage of the defect suggesting that careful treatment planning, immaculate execution by skillful technique definitely helped to achieve a successful result. Simultaneous use of photobiomodulation (PBM) helped in faster and better healing of the grafted area. [ABSTRACT FROM AUTHOR]

This document summarizes a study on the esthetic effectiveness of Invisalign therapy in treating palatally impacted canines. The study found that clear aligner treatment, when used with auxiliary appliances, can result in acceptable gingival esthetics. However, the study had limitations, such as a small sample size and the use of photographs that may have shown gingival irritation. Further research is needed to compare the efficiency of Invisalign and conventional fixed appliances in treating impacted canines. [Extracted from the article]

This article explores the use of in-house 3D-printed aligners for retreatment after fixed retainer failure. It discusses the advancements in materials science and CAD/CAM technology that have made clear aligners a popular alternative to fixed appliances. The article presents a case study where 3D-printed aligners were successfully used to treat a patient with misaligned teeth. While the article acknowledges the limited research on the efficacy of 3D-printed aligners, it highlights their potential benefits and suggests they may become a transformative option in orthodontic treatment. [Extracted from the article]

Background: To evaluate the risk indicators associated with midfacial gingival recessions (GR) in the natural dentition esthetic regions. Methods: Cone‐beam computed tomography (CBCT) results of thirty‐seven subjects presenting with 268 eligible teeth were included in the cross‐sectional study. Clinical measurements included presence/absence of midfacial GR; the depth of the midfacial, mesial, and distal gingival recession; the recession type (RT); keratinized tissue width (KT); and attached gingiva width (AG). Questionnaires were utilized to capture patient‐reported esthetics and dental hypersensitivity for each study tooth. Buccal bone dehiscence (cBBD) and buccal bone thickness (cBBT) were measured on the CBCT scans. High‐frequency ultrasonography was performed to assess gingival thickness (GT) and buccal bone dehiscence (uBBD). Intraoral optical scanning was obtained to quantify the buccolingual position of each study site (3D profile analysis). Multilevel logistic regression analyses with generalized estimation equations were performed to assess the factors associated with the conditions of interest. Results: The presence of midfacial GR was significantly associated with the history of periodontal treatment for pocket reduction (OR 7.99, p = 0.006), KT (OR 0.62, p < 0.001), cBBD (OR 2.30, p = 0.015), GT 1.5 mm from the gingival margin (OR 0.18, p = 0.04) and 3D profile 1 mm from the gingival margin (OR 1.04, p = 0.001). The depth of midfacial GR was significantly correlated to previous history of periodontal treatment (OR 0.96, p = 0.001), KT (OR −0.18, p < 0.001), presence of bone fenestration (OR 0.24, p = 0.044), and cBBD (OR 0.43, p < 0.001). The depth of midfacial GR was also the only factor associated with patient‐reported esthetics (OR −3.38, p = 0.022), while KT (OR 0.77, p = 0.018) and AG (OR 0.82, p = 0.047) were significantly correlated with patient‐reported dental hypersensitivity. Conclusions: Several risk indicators of midfacial and interproximal GR in the esthetic region were identified. The use of imaging technologies allowed for detection of parameters associated with the conditions of interest, and, therefore, their incorporation in future clinical studies is advocated. Ultrasonography could be preferred over CBCT for a noninvasive assessment of periodontal phenotype. [ABSTRACT FROM AUTHOR]

Gingival recession of lower incisors is a periodontal condition that mostly develops in young adults as a result of various etiological factors, such as mechanical trauma, bacterial associated gingival inflammation, viral infection or a mixture of the above. Several predisposing factors contribute to its occurrence, including thin gingival biotype, reduced alveolar bone thickness, the presence of dehiscence and fenestrations, frenum pull, root malposition due to crowding or previous orthodontic treatment, as well as distorted fixed orthodontic retainers. The treatment approaches vary from supportive periodontal therapy alone to different surgical root coverage procedures. In situations where the root is in close proximity to or beyond the cortical bone, orthodontic repositioning of the root within the bone prior to surgical root coverage has been shown to be beneficial. Historically, such orthodontic correction required insertion of fixed orthodontic devices over an extended period, which posed challenges to patients who may have already undergone orthodontic treatment in the past and are therefore reluctant to undergo retreatment. This case series illustrates that, in contrast to certain beliefs, clear aligners are an effective tool for repositioning the lower incisors' roots before surgical root coverage procedures. The article provides guidelines for treatment planning and aligners' design to achieve the best outcome in the shortest duration. [ABSTRACT FROM AUTHOR]

Enamel interproximal reduction (IPR), also known as stripping, is an orthodontic procedure used by many clinicians, especially in non-extraction cases. It aims to reduce the mesiodistal diameter of teeth by removing interproximal enamel. This therapeutic option allows to obtain space in the dental arch to achieve tooth alignment, in case of mild or moderate crowding, and to preserve the papilla avoiding the onset of black triangles. IPR is an irreversible procedure, and it requires an accurate case examination to avoid damage, such as demineralization of the enamel or periodontal complications, that can compromise both aesthetics and oral health. When performing IPR, orthodontists can change the contact point between the teeth and move it closer to the alveolar crest, thus improving esthetics by reducing the black triangles. However, there is also a risk for worsening periodontal health due to root proximity although, according to the literature, periodontal indices, such as clinical attachment loss (CAL) and bleeding on probing (BOP), seem to be not significantly affected by IPR. [ABSTRACT FROM AUTHOR]

This narrative review synthesizes the available evidence that assesses the potential link between orthodontic treatment and gingival/periodontal health. It is believed that excessive mandibular incisor proclination associated with thin labial bone and gingival phenotype is a significant risk factor for developing gingival recession. This review will focus on available gingival phenotypes assessment methods and the portrayed association between craniofacial morphology and periodontal characteristics. The impact of these topics on orthodontic treatment is discussed. The various methods for determining gingival phenotypes tested in the literature demonstrate the benefits of direct measurements. Using ultrasound to identify gingival phenotype is a promising diagnostic tool for evaluating dental soft tissues. However, the practical limitations of direct methods have led to the continued use of indirect methods, which may not provide reliable results when used by themselves. Although studies have examined and confirmed a relationship between alveolar bone thickness and craniofacial morphology, this review has found limited knowledge of the association between craniofacial and gingival morphology. Nevertheless, as part of the treatment planning process before orthodontic or combined orthodontic-orthognathic treatment, it is always important to consider the individual's gingival phenotype. [ABSTRACT FROM AUTHOR]

this review aims to explore key aspects related to the treatment of gingival recession defects (GRD) and sites lacking keratinized gingiva in orthodontic patients. It focuses on five crucial core aspects: 1) risk assessment for GRD development; 2) diagnosis, characteristics, and the dilemma surrounding GRD treatment necessity; 3) the evolution of root coverage procedures and the significance of modifying soft tissue phenotype for gingival margin stability; 4) the development and progression of gingival recessions in orthodontic patients; and 5) the staging of orthodontic and periodontal therapies; specifically, the consideration of preemptive soft tissue phenotype modification (STPM) or treatment of GRD. the management of GRD and sites lacking gingiva or with a thin mucosal phenotype, as well as the staging of periodontal and orthodontic treatment, should be guided by the positioning of the tooth within the alveolar bone envelope and the periodontal phenotype. In cases where the gingival phenotype is thin (< 1 mm), with or without GRD, it is advisable to perform preemptive soft tissue augmentation (PMT) prior to orthodontic treatment if the tooth is located within the alveolar bone envelope. Conversely, if the tooth is positioned outside the alveolar bone housing, orthodontic tooth movement should be employed to reposition the tooth within the bone housing before any soft tissue augmentation procedure is performed. Research has demonstrated a negative correlation between tooth position and periodontal root coverage, whereas tooth repositioning has shown a two-fold positive effect: 1) improving the surrounding soft tissues by reducing or eliminating the defect, and 2) enhancing the implementation and wound healing dynamics of root coverage procedures. [ABSTRACT FROM AUTHOR]

The soft and hard tissue healing of open wounds in immediate implant placement are yet to be explored. The aim of this study was to compare the clinical outcomes of open wound healing using reactive soft tissue (RST) and absorbable collagen sponge (ACS). Forty implants placed immediately in posterior sockets were included; autologous RST was used in 20 and ACS substitute was used in 20. Soft tissue healing was primarily assessed through a novel scoring system and the evaluation of gingival recession. The horizontal bone width (HBW) and interproximal marginal bone level (MBL) were measured on radiographs to observe the hard tissue healing. No significant difference in total soft tissue healing score was observed at 2 weeks postoperatively. Notably, the ACS group showed better tissue colour (P = 0.016) but worse fibrous repair (P = 0.043) scores than the RST group. Gingival recession levels were comparable in the two groups, both before tooth extraction and after placement of the restoration. Regarding hard tissue, HBW and MBL changes showed no intergroup differences. Within the limitations of this study, both RST and ACS seemed effective for open wound closure, achieving ideal soft and hard tissue healing in immediate implant placement. [ABSTRACT FROM AUTHOR]

Copyright of Clinical Orthodontics is the property of Dental Press International and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Oral piercing habits are associated with various degrees of complications. Tongue piercing increases the risk of gingival recession and infrabony defects, subsequently leading to localized periodontitis. In the case presented, the patient had persistent swelling and suppuration around her mandibular anterior teeth attributed to tongue piercing jewelry that was placed approximately 12 years prior. Intraoral examinations revealed a localized deep pocket, purulent discharge, swelling, plaque accumulation, bleeding on probing, gingival recession, and teeth mobility. The patient was diagnosed with localized stage III, grade C periodontitis. Following full-mouth debridement and the placement of an extracoronal lingual splint, minimally invasive, papillae-sparing incisions were made, and regenerative therapy with bone allograft and collagen membrane was used to manage the infrabony defects. During the 18-month postoperative follow-up, complete soft-tissue healing was observed along with a significant reduction in pocket depth and the absence of bleeding on probing or suppuration. Radiographic evaluation showed evidence of bone fill. The reported case demonstrates how careful diagnosis and treatment planning are crucial for managing different periodontal defects and emphasizes the importance of proficient periodontal management, which can save teeth that would otherwise be extracted and replaced with implant therapy or fixed bridgework. [ABSTRACT FROM AUTHOR]

This article provides a literature review on minimally invasive mucogingival surgical techniques for the treatment of periodontal disease and intraosseous defects. It compares the effectiveness of various surgical procedures and emphasizes the importance of accurate diagnosis and comprehensive treatment planning. The review includes 34 selected articles and discusses techniques such as Entire Papilla Preservation and the Single Flap approach. The article aims to provide evidence-based information to guide clinicians in choosing regenerative periodontal surgical techniques. [Extracted from the article]

Gingival hyperpigmentation is a change in the color of the gingiva that becomes darker than its normal color that could be an aesthetic problem to a person’s appearance. Gingival depigmentation is a periodontal plastic surgery procedure in which gingival hyperpigmentation is removed. This study aimed to compare the evaluation of gingival hyperpigmentation treatment using 2 commonly used techniques, namely conventional surgical scalpel and diode laser techniques. This scoping review was carried out according to the PICO (Population, Intervention, Comparison, Outcome) framework. Article searches were performed in 4 databases. Articles were selected using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). The number of articles that met the inclusion criteria in this study was 12 articles. The 4 most frequently used parameters in the 12 articles were postoperative pain, intra and postoperative bleeding, wound healing, and gingival repigmentation. Diode lasers produced minimal postoperative pain and intra and postoperative bleeding compared to scalpel. Healing of depigmented wounds with the conventional scalpel technique was better than diode laser, and both techniques were equally effective in healing depigmented wounds. Gingival repigmentation could occur after gingival depigmentation using both scalpel and diode laser. [ABSTRACT FROM AUTHOR]

Root surface biomodification has been used to treat gingival recession and periodontitis. For example, to improve treatment efficacy of gingival recessions (GR), chemical preparation of the exposed root surface is advocated. The principle for this procedure is to remove the smear layer from the root surfaces, which leads to exposition of surface collagen fibers and improved healing. The aim of present article is to evaluate the importance of root surface biomodification after scaling and root planing (SRP) and a comparative review of various root conditioning agents. The review was written during the search for English-language literature in the Google Scholar and PubMed databases. 104 literary sources were identified during the literature review. After excluding publications that did not meet the inclusion search criteria, the total number of included articles has become 55. The instrumented root surface is always covered by a smear layer, containing remnants of dental calculus, contaminated root cementum, bacterial endotoxin and subgingival plaque after the scaling and root planning procedure. The root conditioning agents, described in this study, were found to be effective in the removal of the smear layer, able to produce uncovering and widening the dentin tubules, and unmasking the dentin collagen matrix. Within the limits of this study, the most frequently used conditioning agents are tetracycline, EDTA, and citric acid; among them Tetracycline HCL is the most reliable agent. [ABSTRACT FROM AUTHOR]

This is the second article in a two-part series on gingival recession. The first article covered the aetiology and prevalence of gingival recession, while this article focuses on the factors affecting decision making and the management, including treatment of gingival recession alongside the evidence base. With more than half of the population suffering from gingival recession, the clinician should be aware of the different options and treatment modalities available to manage gingival recession. This will enable them to engage with the patient, giving them the necessary and required information to make a patient-centred decision about the most suitable treatment option that will address their concerns. CPD/Clinical Relevance: The clinician should be aware of the different options and treatment modalities available to manage gingival recession. [ABSTRACT FROM AUTHOR]

This article presents a case report on the treatment of a labially impacted canine using orthodontic and surgical techniques. The authors describe the use of a closed-eruption or tunnel technique to expose the impacted tooth and guide its eruption into the center of the alveolus. The treatment involved the use of archwires, elastics, and various appliances to align the canine. After 30 months of treatment, the impacted canine was successfully brought into the arch, resulting in improved occlusion, alignment, and periodontal health. [Extracted from the article]

Gingival recession affects more than half of the population and has a multifactorial aetiology. Despite this, the knowledge and awareness of the factors that predispose sites to recession remains limited, with most people associating it with poor oral hygiene. As patients retain their teeth for longer, the risk of recession is likely to grow, thus increasing the need to establish a greater understanding of this very common condition. This two-part series provides a contemporary overview of the condition with the first article discussing its prevalence, aetiology and classification, and the second covering the different management options. CPD/Clinical Relevance: It is important to establish the aetiology of gingival recession to manage the condition effectively. [ABSTRACT FROM AUTHOR]

This article discusses a custom-made spring appliance that can correct excessive root torque in cases with buccally erupted ectopic canines. It provides case studies and demonstrates the successful repositioning of ectopic canines using the appliance. The treatment involves the use of torquing auxiliary springs and sectional wires to correct the torque and alignment of the canines. The authors emphasize the importance of well-planned biomechanics in achieving successful tooth movements and avoiding complications. The article provides detailed descriptions of the treatment procedures and includes radiographs and images to illustrate the cases. [Extracted from the article]

Background: This study aimed to determine the effects of smoking on early (≤3 months) clinical outcomes and relevant molecular biomarkers following root coverage surgery. Methods: Eighteen smokers and 18 nonsmokers, status biochemically verified, with RT1 gingival recession defects were recruited and completed study procedures. All patients received coronally advanced flap plus connective tissue graft. Baseline and 3 month recession depth (RD), recession width (RW), keratinized tissue width (KTW), clinical attachment level (CAL), and gingival phenotype (GP) were recorded. Root coverage (RC) percentage and complete root coverage (CRC) were calculated. Recipient (gingival crevicular fluid) and donor (wound fluid) site VEGF‐A, HIF‐1α, 8‐OHdG, and ANG levels were determined. Results: There were no significant intergroup differences for any baseline or postoperative clinical parameters (P > 0.05), except for whole mouth gingival index (increased in nonsmokers at 3 months; P < 0.05). Compared to baseline, RD, RW, CAL, KTW, and GP significantly improved postoperatively, without significant intergroup differences. There were no significant intergroup differences for RC (smokers = 83%, nonsmokers = 91%, P = 0.069), CRC (smokers = 50%, nonsmokers = 72%, P = 0.177), and CAL gain (P = 0.193). The four biomarker levels significantly increased postoperatively (day 7; P ≤ 0.042) in both groups and returned to baseline (day 28) without significant intergroup differences (P > 0.05). Similarly, donor site parameters were not different between groups. Strong correlations, consistent over time, were found between biomarkers implicated in angiogenesis (VEGF‐A, HIF‐1α, and ANG). Conclusions: The early (3 month) clinical and molecular changes after root coverage surgery utilizing a coronally advanced flap plus connective tissue graft are similar between smokers and nonsmokers. [ABSTRACT FROM AUTHOR]

Background: Along the years, a remarkable variety of periodontal surgical protocols has been proposed, the focus of which has shifted from the mere resolution of a soft tissue defect to the performance of predictable and minimally invasive procedures. Initially, the free gingival graft was used. Subsequently, many different techniques were experimented, including those using soft tissue substitutes, such as the Alloderm membrane. Nowadays, the association of the connective tissue graft with the coronally advanced flap is considered the gold standard. Finally, the Pinhole technique, being a more conservative method in terms of tissue preservation and aesthetic outcome, was proposed. Objectives: The aim of this review was the comparison of the updated techniques for the treatment of multiple periodontal recessions, affecting both maxilla and mandible. The procedure outcome was assessed in terms of complete root coverage, recession reduction, gain in height and volume, aesthetic outcome, patient's post-operative pain and morbidity of donor and recipient sites. Material and methods: Electronic and hand searches were performed to collect split- mouth studies, randomized controlled clinical trials, case series, pilot studies, periodontal books, case studies, systematic reviews and meta-analysis, including maxillary and mandibular multiple gingival recession defects of all four Miller's classes, for its extensive evidence. Results: Thirty-four publications were included and data regarding the surgical techniques outcome were extracted from eighteen articles. The clinical evaluation analyzed the amount of complete root coverage, recession reduction and gain in height and volume, while the patient's perspective was expressed in terms of aesthetic satisfaction and possible postoperative complications. Procedures in the last ten years showed better results in all the above-mentioned factors. Conclusion: Procedural predictability and long-lasting treatment stability embody the factors driving the technique election process and adding value to more updated procedures. Progress was observed both at an aesthetic level, by reducing the discrepancies between the surgical region and the surrounding tissue, and at a postoperative level, by reducing patient discomfort. The challenges inherent to this branch could soon find answers thanks to its prompt evolution, which allows for further advances to be conceived. [ABSTRACT FROM AUTHOR]

Copyright of Revista Odontología Vital is the property of Universidad Latina de Costa Rica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Decreased adaptive capacity of periodontium enhances susceptibility to injury from occlusal forces. This study aimed to identify the association between bone loss severity and signs of occlusal trauma in teeth with reduced periodontal support. Periodontal assessment, radiographic examination and relative maximum force in chewing movements using T-scan III occlusal analysis system were determined in 312 teeth from 15 periodontitis subjects, who received non-surgical periodontal therapy. Comparison of periodontal parameters and occlusal trauma indicators was performed between groups with and without > 60% proximal bone loss. The correlation was investigated among each assessed parameter and signs of occlusal trauma including fremitus, advanced tooth mobility and widened periodontal ligament space. Bleeding on probing, gingival recession and clinical attachment loss in the group with > 60% bone loss were more severe than those with less bone loss (p<0.05). Fremitus, advanced mobility, and widened periodontal ligament space were different between groups (p<0.05) although distribution of relative maximum force was not different. The extent of proximal bone loss was found to correlate with fremitus, advanced mobility, and widened periodontal ligament space at r= 0.219, 0.418, 0.318 respectively (p<0.05). In conclusion, all significant signs of occlusal trauma were significantly associated with > 60% proximal bone loss. [ABSTRACT FROM AUTHOR]

This article discusses the issue of indiscriminate alignment in orthodontic treatment for severe mandibular crowding. It explores the potential causes of this problem, such as dentoskeletal discrepancies and improper use of orthodontic devices. The article presents a case study of a 24-year-old female patient with dental crowding and asymmetrical arches, discussing the treatment plan and outcomes. It emphasizes the importance of preventing and managing indiscriminate alignment to avoid permanent damage. Additionally, the article addresses the controversy surrounding the relationship between orthodontic tooth movement and gingival recession, highlighting the importance of proper management and control of lower incisor positions in treatment planning. Strategies such as extraction spaces and sequential bonding protocols are suggested to prevent and address these issues. The article concludes that with immediate and precise intervention, stable results can be achieved over time. [Extracted from the article]

New functional materials for engineering gingival tissue are still in the early stages of development. Materials for such applications must maintain volume and have advantageous mechanical and biological characteristics for tissue regeneration, to be an alternative to autografts, which are the current benchmark of care. In this work, methacrylated gelatin (GelMa) was photocrosslinked with synthetic immunomodulatory methacrylated divinyl urethanes and defined monomers to generate composite scaffolds. Using a factorial design, with the synthetic monomers of a degradable polar/hydrophobic/ionic polyurethane (D-PHI) and GelMa, composite materials were electrospun with polycarbonate urethane (PCNU) and light-cured in-flight. The materials had significantly different relative hydrophilicities, with unique biodegradation profiles associated with specific formulations, thereby providing good guidance to achieving desired mechanical characteristics and scaffold resorption for gingival tissue regeneration. In accelerated esterase/collagenase degradation models, the new materials exhibited an initial rapid weight loss followed by a more gradual rate of degradation. The degradation profile allowed for the early infiltration of human adipose-derived stromal/stem cells, while still enabling the graft's structural integrity to be maintained. In conclusion, the materials provide a promising candidate platform for the regeneration of oral soft tissues, addressing the requirement of viable tissue infiltration while maintaining volume and mechanical integrity. There is a need for the development of more functional and efficacious materials for the treatment of gingival recession. To address significant limitations in current material formulations, we sought to investigate the development of methacrylated gelatin (GelMa) and oligo-urethane/methacrylate monomer composite materials. A factorial design was used to electrospin four new formulations containing four to five monomers. Synthetic immunomodulatory monomers were crosslinked with GelMa and electrospun with a polycarbonate urethane resulting in unique mechanical properties, and resorption rates which align with the original design criteria for gingival tissue engineering. The materials may have applications in tissue engineering and can be readily manufactured. The findings of this work may help better direct the efforts of tissue engineering and material manufacturing. [Display omitted] [ABSTRACT FROM AUTHOR]

This study investigates the prevalence, distribution and risk indicators of buccal gingival recessions (GRs) in periodontitis patients. 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 < 0.05. 354/400 (88.5 %) patients have at least one GR ≥ 1 mm. The prevalence of recession type (RT) at the patient level was 0.5 %, 2.25 % and 85.75 % for RT1, RT2 and RT3 respectively. Lower incisors are the most affected teeth (79.8 %). Upper canines present the lowest frequency (41.8 %). The univariate logistic regression showed that age (SE = 0.021; 95 % CI 1.01–1.10; p = 0.006), plaque index (SE = 0.50; 95 % CI 1.49–10.50; p = 0.006), level of plaque control (SE = 0.529; 95 % CI 0.90–0.72; p = 0.010) and periodontitis stage (SE = 0.41; 95 % CI 1.41–7.07; p = 0.005) were significantly associated with the presence of GR. In the multivariate regression model, significant results were confirmed only for age (SE = 0.021; 95 % CI 1.02–1.17; p = 0.006) and periodontitis stage (SE = 0.41; 95 % CI 1.35–6.75; p = 0.007). The cross-sectional study showed a high prevalence of GRs. Lower incisors were the most affected teeth. Most patients have GRs with advanced interproximal attachment loss (RT3 GRs). Age, plaque index, level of plaque control and periodontitis stage resulted as risk indicators of GRs. [ABSTRACT FROM AUTHOR]

Decubital lesions or traumatic ulcers caused by dentures usually appear one or two day(s) after new dentures placement due to mismatch of the microrelief of the tissue and the microrelief of the gingival surface of the prosthesis. The study aimed to analyze factors that could influence the healing of ulcers during a one-week period after the placement of new partial and complete dentures. The prospective cohort study included 60 patients with new denture-induced traumatic ulcers. Traumatic ulcers were treated with denture adjustment, or combination of adjustment with 0.2% or 0.3% hyaluronic acid gels respectively for seven days. Healing of ulcers were observed through measurement of perimeter, area, maximum and minimum diameters on digital photographs. Multivariate logistic regression was used to predict other factors that could affect healing process. Perimeter, area, maximum and minimum diameters of denture-related ulcers were significant decreased after application of gels on the fifth and seventh day. The fifth day ulcers were not healed if dentures were only adjusted, while healed lesion was 40% for the other two groups. On the seventh day, the percent of healed lesion in the group with dentures adjustment was 20%, while it was increased to 75% healed lesions for combination of denture adjustment and hyaluronic acid gels. Anticoagulant/anti-aggregation drugs also had positive impact on ulcer healing; antihypertensives that included diuretics slowed ulcer healing, other monitored factors in the study did not show a significant impact. Hyaluronic acid in combination with the dentures adjustment for seven days leads to higher healing rate, and reduction in size of ulcers that did not heal until this time point. [ABSTRACT FROM AUTHOR]

To compare the treatment outcome of laser and its effectiveness in the management of gingival hyperpigmentation over scalpel surgical method. The patients were selected and were divided into two groups by the split-mouth design. Group A : Right half upper and lower central incisors to premolars were treated using the laser technique. GROUP B : Left half upper and lower central incisors to premolars were treated by Scalpel technique. This study was a comparative, split-mouth analytical study, and the results were observed for a period of 9 months. Diode laser technique gave better results in this perio-esthetics procedure as compared to scalpel technique. However, recurrence of pigmentation has been reported even after this duration. Diode laser was superior over the scalpel technique in the aspect of operator convenience, reduced postoperative bleeding, and reducing the incidence of repigmentation in terms of intensity and extent of pigmentation. Patient comfort was more in scalpel technique. Laser can be used for better periodontal esthetic procedure over the standard scalpel technique, although repigmentation was reported in both groups. But delayed healing occurred on the laser side due to the thermal effect of the laser on the adjacent tissues. Provision of such advanced instruments to dental surgery can give better satisfaction to patient clientele in terms of good esthetic results. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study is to determine if there is a difference in dimensional change of a free soft tissue autograft (FSTA) with epithelium compared to without epithelium. The secondary aim is to determine the patient and professional evaluation of color match and graft texture between the two groups. Methods: Patients with ≤2 mm keratinized tissue indicated for a FSTA were randomly assigned to control group (FSTA with epithelium) or test group (de‐epithelialized FSTA). The vertical and horizontal measurements of the grafts were taken at surgery, and 1, 3, and 6 months postoperatively. Patients were asked to evaluate the color match at each postoperative time point on a 21‐step Numeric Rating Scale (NRS‐21). Professional assessment of color match and graft texture were evaluated on images at the same time points. Results: Forty‐six patients and 55 grafts were included in the study. For change in graft height, width, and area, there were no significant differences between the treatment groups at any time point. Graft height and area in both groups decreased significantly from baseline to month 1 (p <.001), but no other difference was significant over time. When patients and professionals used the NRS‐21 for evaluation of color match between the graft site and the surrounding soft tissue, there was no significant difference between the treatment groups. Similarly, evaluation of texture match on color images and black‐and‐white images revealed no significant differences between or within groups. Conclusion: De‐epithelialized FSTA showed no difference in dimensional change or color and texture match compared to FSTA with epithelium. [ABSTRACT FROM AUTHOR]

Purpose: This systematic review explored dental complications associated with metal ion release from oral piercings using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Methods: Item retrieval from October 2022 to December 2022 from databases, such as Cochrane Central Register of Controlled Trials, Medline, PubMed, Embase, Scopus and Web of Science, using predefined search terms was undertaken by two independent reviewers. Data were extracted and risk of bias was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. From 1509 identified studies, 25 were included for analysis. Results: Of the 25 studies, 20 included both clinical examination and questionnaire-based data. The remaining five studies were deemed low quality based on the Joanna Briggs Institute criteria. The average time piercings were worn ranged between 5 and 48 months. Most studies did not investigate complications from metal ion release. Only two studies examined the direct effects of metal ion release and showed that metal ions may cause hypersensitivity reactions and mucosal changes. Other soft tissue complications were reported, with gingival recession noted in 16 out of 25 studies, especially due to lip piercings. Studies reporting other complications were as follows: swelling (9), pain (8), infection (6), bleeding (6), inflammation (5), alterations to speech, eating and/or swallowing (5), changes to taste or metallic taste (5), and mucosal changes (4). Ten studies reported tooth chipping from tongue piercings. Conclusion: Oral piercings leach metal ions into surrounding tissues which may cause local mucosal changes. Furthermore, oral piercings cause damage to both soft and hard oral tissues, particularly gingival recession for lip piercings and tooth chipping for tongue piercings. Thus, to prevent such adverse injuries, dental professionals should discourage patients against oral piercings. [ABSTRACT FROM AUTHOR]

Gingival retraction is commonly employed in dentistry. There are several methods that may be used, which fall into mechanical, chemo-mechanical and surgical techniques. The application of these methods depends on the clinical activity the clinician is performing, and there are advantages and disadvantages to each method. This review reflects on the current literature available on gingival retraction methods to provide clinicians with guidance on which methods to consider when undertaking the three most common clinical scenarios: master impression taking; cementation of indirect restorations whether tooth or implant retained; and for direct adhesive dentistry. CPD/Clinical Relevance: Selecting an appropriate gingival retraction method, for example for master impression taking, cementation of restorations and in adhesive dentistry is of value. [ABSTRACT FROM AUTHOR]

Background: A 13‐year follow‐up was conducted of a short‐term investigation of the use of living cellular construct (LCC) versus free gingival graft (FGG) for keratinized tissue width (KTW) augmentation in natural dentition, to evaluate the long‐term outcomes and assess the changes occurring since the end of the original 6‐month study. Methods: Twenty‐four subjects out of the original 29 enrolled participants were available at the 13‐year follow‐up. The primary endpoint was the number of sites demonstrating stable clinical outcomes from 6 months to 13 years (defined as KTW gain, stability, or ≤0.5 mm of KTW loss, together with reduction, stability, or increase of probing depth, and recession depth [REC] ≤0.5 mm). Secondary outcomes included the assessment of KTW, attached gingiva width (AGW), REC, clinical attachment level, esthetics, and patient‐reported outcomes at the 13‐year visit, assessing the changes from baseline to 6 months. Results: Nine sites per group (42.9%) were found to have maintained stable (≤0.5 mm or improved) clinical outcomes from 6 months to 13 years. No significant differences were observed for the clinical parameters between LCC and FGG from 6 months to 13 years. However, the longitudinal mixed model analysis showed that FGG delivered significantly better clinical outcomes over 13 years (p < 0.01). LCC‐treated sites exhibited superior esthetic outcomes compared to FGG‐treated sites at 6 months and 13 years (p < 0.01). Patient‐evaluated esthetics were significantly higher for LCC over FGG (p < 0.01). Patient overall treatment preference was also in favor of LCC (p < 0.01). Conclusions: A similar stability of the treatment outcomes from 6 months to 13 years was found for LCC‐ and FGG‐treated sites, with both approaches shown to be effective in augmenting KTW and AGW. However, superior clinical outcomes were found for FGG over 13 years, while LCC was associated with better esthetics and patient‐reported outcomes than FGG. [ABSTRACT FROM AUTHOR]

The article discusses gingival phenotype and thickness through visual, probing, and ultrasound methods in orthodontic patients, finding limited agreement between probing and ultrasound measurements. Topics include the importance of gingival characteristics in dental outcomes, challenges in accurate visual assessment of phenotype by clinicians, and the need for further research to enhance diagnostic methods for gingival health.

Background: The purpose of the present study was to prospectively evaluate the 3‐year changes in the gingival dimensions following multiple coronally advanced flap (MCAF) with selective use of connective tissue graft (CTG). In addition, the secondary aim was to histologically identify the factors related to phenotype changes. Methods: Twenty patients treated with MCAF and site‐specific application of a CTG were available for the 3‐year follow‐up. Outcome measures included complete root coverage (CRC), recession reduction, keratinized tissue width (KTW), marginal tissue thickness changes, and primary flap position. Biopsies were harvested at one of the sites treated with the adjunct of CTG. All sections were stained with hematoxylin and eosin, Masson trichrome, Verhoeff‐van Gieson, tenascin, and alcian blue stain for semiquantitative evaluation. Results: At 3 years, CRC was detected in 86% of sites treated with MCAF alone and 81% of sites treated with MCAF + CTG. The 47% of sites treated with MCAF + CTG presented an apical shift of primary flap from its original position. Linear regression showed a significant association between KTW change and the initial KTW in MCAF‐treated sites, while both initial KTW and position of primary flap were statistically significantly associated factors with KTW changes in the MCAF + CTG group. In all the biopsies examined, there is always a marked and clear separation between the connective tissue of the gingival flap and the palatal connective tissue of the graft. Conclusions: The selective use of CTG is an effective treatment for multiple gingival recessions. Only a limited increase in KTW can be expected in a bilaminar technique if, during the healing phases, the connective tissue is maintained completely covered. [ABSTRACT FROM AUTHOR]

The final goal of periodontal treatment is to achieve functional and anatomical tissue regeneration. Numerous techniques have illustrated favorable effects on anatomical and functional periodontal regeneration, but long-term results are highly variable. In addition, techniques for closure of class I-II recessions have results up to 100% with high predictability, in contrast to Miller class III-IV recessions, according to the literature. This systematic review aims to define the different techniques for closure of Miller class III-IV recessions and to identify their characteristics in different clinical situations. A study of publications in the electronic databases PubMed, Google Scholar and eLIBRARY was performed through a literature review. Articles concerning various techniques for closure of class III-IV recessions were included. A total of 100 articles were reviewed during the revision process. After analyzing the literature according to the inclusion criteria, the final number of articles had become 46. The features of the various techniques as well as long-term surgical outcomes were reviewed. Many techniques should be further investigated, due to insufficient clinical data and a few number of cases. [ABSTRACT FROM AUTHOR]

Gingival phenotype (GP) has been reported to influence the treatment planning and clinical outcomes in several dental specialties. This study aimed to investigate optimal cutoff values for gingival thickness (GT) measurement at different landmarks to determine GP. The correlations between GT and bone thickness (BT) of buccal alveolar crest were also analyzed. A total of 600 teeth were included. GP was clinically determined by the transparency of a periodontal probe through the gingival margin (TRAN). Measurements for free gingival thickness (GT1), cementoenamel junction gingival thickness (GT2), supracrestal gingival thickness (GT3), subcrestal 1 mm gingival thickness (GT4) and BT at 1, 3 mm apical from the alveolar crest edge (BT1 and BT2) were assessed on cone-beam computed tomography (CBCT) images. Spearman's correlation coefficient was used to evaluate correlations between GT and BT. The optimal cutoff values of GT using CBCT method to discriminate GP were 0.75 mm for GT1, 0.85 mm for GT2, 1.15 mm for GT3 and 0.45 mm for GT4. There was significantly positive correlation between GT and BT at all levels (r: 0.375–0.903). The correlations between GT3 and BT (r: 0.789–0.903) were strong, while correlations between GT4 and BT were weak (r: 0.375–0.467). The optimal cutoff values of gingival thickness using CBCT method to discriminate gingival phenotype at each gingival landmark were determined. The supracrestal gingival thickness might be an indicator of buccal alveolar crest bone thickness, which could provide valuable perspectives on clinical diagnosis, treatment planning and decision-making. [ABSTRACT FROM AUTHOR]

Retrospective studies have found conflicting results regarding the relationship between lower incisor inclination and the development of gingival recession (GR) after orthodontic treatment. 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. 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. Men had a significantly thicker MS than women at T0 and T1 (p < 0.0004). There was a significant reduction of approximately 10% in AP between T0 and T1 (p < 0.0001). Among subjects without GR at T0, 70.4% presented a stable gingival situation at T1. For subjects with 1 lower incisor with GR at T0, 50% showed improvement in the gingival situation at T1, 21.4% remained stable, and 28.6% experienced worsening. Sixteen lateral incisors presented a worsening gingival situation, representing an increase of 129% compared to the central incisors. No relationship was found between lower incisor inclination and the thickness of the AP and MS in the development of GR. [ABSTRACT FROM AUTHOR]

Immediate implant placement in the anterior maxilla remains a complex procedure, particularly when the cortical bone plate of the socket is not intact and a gingival recession is present. The reconstruction of both hard and soft tissues increases the complexity of these clinical scenarios. This case report describes a novel, minimally invasive technique to reconstruct class III sockets with simultaneous implant placement. Four incisions are made with a scalpel blade to create, or “draw,” a square outline instead of raising a flap at the tuberosity to harvest a hard- and soft-tissue block. In addition, a tunneling approach is described to graft the site while preserving the recipient area’s vascularity. Harvesting a hard- and soft-tissue block from the tuberosity in a minimally invasive manner preserves the donor site and helps to reconstruct a class III alveolus in one single appointment, thereby reducing morbidity, costs, and treatment time. [ABSTRACT FROM AUTHOR]

Aim is to consider and analyze the possible causes of the development of localized gingival recession on the lingual surface, which can come to the aid of preventing this pathology so that reduce the risk of its occurrence. The publications in the electronic databases Google Scholar and PubMed were studied during a review of the literature, authors have selected articles the content of which concerns the study of the etiopathogenesis of gingival recession on the lingual surface. 134 articles we reviewed during the review. After analyzing the literature for inclusion criteria, the total number of publications has become 55. Conforming to the studied literature, gingival recession from lingual surface was determined to be a late complication caused by tongue piercing, ankyloglossia and orthodontic treatment including lingual orthodontic appliances. [ABSTRACT FROM AUTHOR]

Predicting root coverage after surgery is the major therapeutic endpoint of gingival recession treatment. Acellular dermal matrix has been used as a substitution to graft connective tissue in such treatment. This clinical study aimed to evaluate the results of treating gingival recession using an acellular dermal matrix of human skin to cover the surface of the premolar root. Male and female patients aged 23-38 years, presenting with problems due to exposure of recession defects when smiling, were recruited. A total of 13 patients with 42 sites of Miller Class I or II gingival recession were treated by grafting the acellular dermal matrix from January 2018 to June 2020. In total, 42 maxillary premolar sites with gingival recession were grafted with the acellular dermal matrix. The average levels of coverage were 94.24% and 91.87% at the end of the 3rd and 6th months, respectively. Acellular dermal matrix can be successfully used to treat gingival recession, as we can predict the full coverage of the exposed root surface. Dermoid membrane graft surgery to cover gingival recession is highly effective. [ABSTRACT FROM AUTHOR]