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Objective: The present study aimed to determine the gingival biotype in Chinese subjects with and without a history of periodontal disease., Material and Methods: Thirty periodontally healthy subjects and 20 subjects with treated chronic periodontitis were recruited. The mid-buccal gingival thickness of upper central and lateral incisors was measured by a customized caliper in all subjects. The crown length and crown width of these teeth were recorded in the healthy group, while gingival recession was measured in the periodontitis group. These outcome measures were compared among the groups and sub-groups, and the correlation of gingival biotypes with clinical parameters was analyzed., Results: The mean thickness of gingiva in the 30 periodontally healthy subjects was 1.05±0.31 mm (0.47-1.57 mm). The males exhibited a greater crown length than the females (P<.05). No significant correlation was found between gingival thickness and the crown width to crown length ratio. The mean gingival thickness at the 80 sites measured in the 20 periodontitis subjects was 0.89±0.29 mm (0.33-1.56 mm). Overall, gingival biotype as measured by gingival thickness was significantly correlated with gingival recession (r=-.240, P=.032), while a stronger correlation was found among the 42 sites with bleeding on probing prior to periodontal treatment (r=-.382, P=.013)., Conclusion: This study shows that gingival biotype measured by gingival thickness in subjects with treated periodontitis is significantly correlated with gingival recession. Further study could clarify the clinical implications of gingival biotype in the management of periodontal patients., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background and Objective: Tissue engineering by using recombinant human (rh) growth factor technology may offer a promising therapeutic approach for treatment of gingival recession. Fibroblast growth factor-2 (FGF-2) has shown the ability to promote periodontal regeneration. Gelatin/beta-tricalcium phosphate (gelatin/β-TCP) sponges have been developed to control the release of growth factors. The present study evaluated the periodontal regenerative efficacy of rhFGF-2 by comparing gelatin/β-TCP sponges incorporated with rhFGF-2 to the scaffolds alone in artificially created recession-type defects in dogs., Material and Methods: Critically sized buccal gingival recession defects were surgically created on maxillary canine teeth of five dogs. In each animal, defects were randomized to receive either a gelatin/β-TCP sponge soaked with rhFGF-2 (gelatin/β-TCP/rhFGF-2) or phosphate-buffered saline (gelatin/β-TCP). Eight weeks after surgery, biopsy specimens were obtained and subjected to microcomputed tomography and histological analyses., Results: Complete root coverage was achieved in both groups. Microcomputed tomography revealed significantly greater new bone volume in the gelatin/β-TCP/rhFGF-2 group. Histologically, both groups achieved periodontal regeneration; however, gelatin/β-TCP/rhFGF-2 sites exhibited more tissue regeneration, characterized by significantly larger amounts of new cementum and new bone. Gelatin/β-TCP sites featured increased long junctional epithelium and connective tissue attachment. In the gelatin/β-TCP/rhFGF-2 sites, new bone exhibited many haversian canals and circumferential lamellae as well as remarkably thick periosteum with blood vascularization and hypercellularity., Conclusion: Within the limitations of this study, rhFGF-2 in gelatin/β-TCP sponges exhibits an increased potential to support periodontal wound healing/regeneration in canine recession-type defects., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background and Objective: The objective of this study was to evaluate the levels of MMP-8, MMP-9, TIMP-1 and interleukin-1beta (IL-1β) in gingival crevicular fluid during the early and late stages of healing in gingival recession sites treated with coronally advanced flap plus platelet-rich fibrin (CAF+PRF) compared with CAF plus connective tissue graft (CAF+CTG)., Material and Methods: Twenty-four nonsmoking patients with Miller Class I or Class II localized gingival recession defects in bilateral sites received treatment with either CAF+PRF (PRF group) or CAF+CTG (CTG group). Gingival crevicular fluid samples were collected at baseline and at 10 d and 1 mo, 3 mo and 6 mo after surgery. The levels of MMP-8, MMP-9, TIMP-1 and IL-1β in gingival crevicular fluid were measured using a time-resolved immunofluorometric assay and ELISAs., Results: Gingival crevicular fluid levels of IL-1β were significantly elevated in the CTG group at 10 d compared with baseline (p < 0.05). At 10 d after surgery, the levels of TIMP-1 in gingival crevicular fluid showed a significant decrease in the CTG group compared with the PRF group (p < 0.05). The levels of IL-1β and MMP-8 in gingival crevicular fluid were significantly lower in the PRF group than in the CTG group at 10 d (p < 0.05). No significant differences were found in all clinical and biochemical parameters at 1, 3, and 6 mo between study groups (p > 0.05)., Conclusion: Root coverage with CAF+PRF has a significant effect on increasing gingival crevicular fluid TIMP-1 levels and suppressing gingival crevicular fluid MMP-8 and IL-β levels at 10 d. Gingival crevicular fluid levels of MMP-8, MMP-9, TIMP-1 and IL-1β did not seem to be affected by the technique at later phases of wound healing., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background and Objective: The effects of tobacco smoking on the prevalence and severity of periodontal disease have been well documented. However, very few studies have assessed the effects of oral smokeless tobacco (ST) on the periodontium. Considering the widespread use of ST products globally, the effects of such products on the periodontal tissues may be important. The present study was performed to compare retrospectively the patterns of periodontal destruction among oral ST users and never-users with periodontitis., Material and Methods: Data from 149 patients with periodontitis (60 ST users and 89 never-users) were compared for mean scores of probing depth, recession (REC) and clinical attachment loss (CAL) and the mean percentage of sites with different ranges of probing depth, REC and CAL., Results: For full-mouth scores, mean REC and CAL were significantly higher in ST users than in never-users (p < 0.001 and p = 0.008, respectively). For different regions of the dentition, mean scores of REC were significantly higher among ST users than among never-users (p < 0.001 for all regions), and mean scores of CAL were significantly higher for ST users in mandibular (p < 0.001), buccal (p = 0.008), lingual (p = 0.022), anterior (p = 0.012) and molar (p = 0.009) sites. Generally, there were higher percentages of sites with shallow pockets (0-3 mm), REC of ≥ 1 mm and CAL of ≥ 3 mm in ST users than in never-users. However, only differences for REC categories were significant for all regions (p < 0.001). ST users had a significantly higher proportion of sites with CAL of ≥8 mm for full-mouth sites (p = 0.003), mandibular teeth (p < 0.001), buccal sites (p = 0.002), anterior teeth (p = 0.040) and molars (p = 0.007)., Conclusion: ST users tend to have more severe REC and CAL and a greater proportion of sites with higher values of REC and CAL compared with never-users. The greatest increase in severity of CAL was found to be localized to sites on mandibular teeth, buccal surfaces, anteriors and molars, which may be a result of the retention of the ST product in the oral cavity., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background and Objective: The presence of citrullinated proteins, and peptidylarginine deiminase types -2 (PAD-2) and -4 (PAD-4) in periodontal tissues, determine the presence of anti-cyclic citrullinated protein antibodies (anti-CCP) in gingival crevicular fluid (GCF) and compare the expression of these proteins between inflamed and non-inflamed sites., Material and Methods: Tissue sections were stained using antibodies against citrullinated proteins, PAD-2 and PAD-4. RT-PCR was performed to investigate PAD-2 and PAD-4 mRNA in inflamed and non-inflamed gingival tissues. Anti-CCP antibodies in gingival crevicular fluid were detected by ELISA., Results: Citrullinated proteins, PAD-2 and PAD-4 were detected in gingiva. There was a correlation between inflammation and expression of these proteins. mRNAs for PAD-2 and PAD-4 were detected in both inflamed and non-inflamed gingival tissues. Antibodies to CCP were found mostly in the GCF of individuals with periodontitis., Conclusion: PAD-2 and PAD-4 (protein and mRNA) as well as citrullinated proteins are present in inflamed gingiva, and anti-CCP antibodies can be detected in the GCF of some patients. Tissue expression of citrullinated proteins and PAD increased with the severity of inflammation. The presence of anti-CCP antibodies in GCF was almost exclusive to a subset of patients with periodontitis. Increased expression of these proteins in inflamed gingiva lends support to the notion that periodontal inflammation contributes to the inflammatory burden in a similar way to rheumatoid arthritis., (© 2012 John Wiley & Sons A/S.)

Background and Objective: This study is a systemic review of coronally positioned flap, coronally positioned flap+chemical root surface conditioning, or coronally positioned flap+enamel matrix derivative (EMD) for the treatment of Miller class I and II gingival recession., Material and Methods: All studies available through the Medline database by the end of October 2005 were used. Each study provided mean clinical attachment level, keratinized tissue, probing pocket depth, gingival recession depth and root coverage percentage before and after treatment with coronally positioned flap alone, coronally positioned flap+chemical root surface conditioning, or coronally positioned flap+EMD. Effectiveness was evaluated by comparing the weighted mean average in gingival recession depth, probing pocket depth, clinical attachment level, keratinized tissue and root coverage percentage achieved with the three treatments., Results: Seven studies for the coronally positioned flap+EMD group, four studies for the coronally positioned flap+chemical root surface conditioning group, and seven studies for the coronally positioned flap group were retrieved for this weighted mean analysis. The results of clinical attachment level, gingival recession depth, and root coverage percentage in the coronally positioned flap+EMD group were statistically significantly better than the changes in the coronally positioned flap and coronally positioned flap+chemical root surface conditioning group at 6 and 12 mo (p<0.001). There was no significant difference at the 6-mo comparison among clinical attachment level, keratinized tissue, probing pocket depth, and gingival recession depth, except in the root coverage percentage for coronally positioned flap and coronally positioned flap+chemical root surface conditioning groups., Conclusion: The results suggest that root coverage by the coronally positioned flap and coronally positioned flap+chemical root surface conditioning procedures were unpredictable but became more predictable when the coronally positioned flap procedure was improved by the modification of adding EMD.