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Abstract: Introduction: Miniscrew Assisted Rapid Palatal Expanders (MARPE) have been recently utilized in adult patients to correct maxillary transverse deficiency. Clinical research on the effect of different MARPE designs on periodontium of neighbouring teeth has been limited. The aim of this research was to compare the Moon expander and the Dresden appliance in terms of their respective effects on periodontium of neighbouring teeth. Changes in risk factors attributed to gingival recession was also analyzed. Methods: In this retrospective study, Cone Beam Computer Tomography (CBCT) records, intraoral scan records (STL), and intraoral photographs were taken from patients undergoing expansion with either Moon or Dresden appliances. Records were taken at T1 (pre-expansion) and T2 (post-expansion) timepoints. Maxillary first molars (mid-mesiobuccal root), first premolars (mid-buccal root) and second premolars (mid-buccal root) were analyzed. Changes in buccal bone marginal level, buccal bone thickness at 3 and 6 mm from CEJ, buccal gingival level, and gingival thickness at 2mm from CEJ were analyzed using CBCT and superimposed STL data. To assess for changes in risks for further recession, photo-analysis was performed on the photographs taken at T1 and T2. Changes in gingival recession, keratinized tissue thickness, gingival inflammation, and keratinized tissue width were scored. Data were compared between the two groups and analyzed. Results: Data obtained from nine adult patients treated using the Dresden appliance and eleven adult patients treated with the Moon expander were analyzed. The results showed that after maxillary expansion, the buccal bone thickness at 6mm from the CEJ was reduced by 0.31mm around the first maxillary molars (p-value

Introduction. Mandibular anterior teeth are most frequently affected by gingival recessions. However, data regarding mucogingival treatment aimed at root coverage in this specific location is limited. Aim. To systematically review the literature addressing the focused question: “What is the effectiveness, efficacy and efficiency of different surgical approaches on clinical and patient-related outcomes in the treatment of buccal gingival recessions on mandibular anterior teeth?” Material methods. Electronic (Medline, Scopus, and Cochrane databases) and hand literature searches were performed for studies including at least one arm involving the use of pedicle flaps and/or free soft tissue grafts in the treatment of RT1 and RT2 gingival recessions located on the buccal aspects of mandibular centrals, laterals and canines. A Bayesian single-arm network meta-analysis was performed, and a treatment hierarchy of different surgical technique was based on a 3-12-month follow-up. Results. Sixteen studies, with a total of 23 arms, were included in the quantitative analysis. The greatest mean root coverage is associated with LPF+CTG (91.2%) and TUN+CTG (89.4%), whereas LPF alone, CAF+CTG and FGG showed lower mRC (79.1%, 78.9% and 68.5% respectively). TUN+CTG provides significantly greater mean root coverage compared to CAF+CTG. No difference among the procedures could be observed in terms of keratinized tissue width gain. Conclusions. Treatment hierarchy generated by an arm-based network meta-analysis model indicated in tunnel and laterally positioned flap, both in combination with connective tissue graft, the greatest results in the treatment of mandibular anterior recessions.

The connective tissue graft (CTG) procedure is among the most predictable and frequently used periodontal surgical procedures, indicated primarily for coverage of exposed root surfaces, i.e., the treatment of gingival recession defects. However, the need to improve CTG periodontal outcomes in challenging clinical situations has not been met. The “surgical delay” or “ischemic preconditioning” or “pre-wounding” technique, which has been used in general plastic surgery, leads to improved clinical outcomes. The aim of this randomized, parallel arm, clinical trial was to examine the feasibility of the “pre-wounding” technique in improving CTG outcomes in deep gingival recession defects. Adult non-smokers with 3mm or greater recession defects were recruited. Following IRB-approved informed consent, subjects were randomly assigned to receive on a single tooth either a routine CTG (rCTG) or a surgically delayed CTG (pwCTG). In the pwCTG group pre-wounding was performed by means of 2 parallel incisions 1mm apart and the graft was harvested 5 days later. The recipient bed flap design was the same for both CTG types. Each subject contributed one test (rCTG or pwCTG) and one control (contralateral) site. 30-second gingival crevicular (GCF) samples were collected using paper strips immediately pre-operatively, immediately following graft placement, 3 days, and 1, 2, and 3 weeks post-operatively (PO). GCF samples were analyzed with ELISA for the presence of angiogenin (ANG) and hypoxia-inducible factor 1α (HIF-1α). Recipient and donor sites clinical parameters were assessed immediately pre-operatively, 2, 3, and 6 months PO. Questionnaires completed by subjects were used to evaluate post-operative pain and discomfort, using visual analog scores (VAS) and pain effect scales.19 subjects (9 rCTG, 10 pwCTG) completed the study. There were no statistically significant intergroup differences regarding pre-operative or PO periodontal clinical parameters.The achieved root coverage (RC) 180 days (D) PO was 89.8+13.1% for the pwCTG group and 85.6+14.9% for the rCTG group with no statistically significant difference between the two groups. Both pwCTG and rCTG showed an intragroup statistically significant difference regarding RC at D180 PO compared to D60 PO. 50% of pwCTG subjects had 100% RC at the D180 PO. 44.4% of the rCTG subjects had 100% RC at D180 PO. GCF analysis did not show an intergroup statistically significant difference in ANG and HIF-1α levels at any of the predetermined GCF sampling. Regarding pain in the donor and recipient sites, there were no intergroup statistically significant differences at any of the predetermined PO visits.This is the first study to test “pre-wounding” in a CTG procedure. The present study was able to demonstrate that pre-wounding the palate does not have adverse effects on clinical outcomes of CTGs. Additionally, from the patients’ prospective there are no adverse effects by the application of the “pre-wounding” technique. The present study was not able to prove the clinical or biochemical superiority of the tested technique versus the routine CTG procedure. Further studies on subpopulations with a reduced healing capacity and/or more severe gingival recession are necessary to elucidate the potential of the surgical delay or pre-wounding technique in oral plastic surgery.