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Objective: To evaluate the impact of soft tissue thickness (STT) on root coverage achieved with different periodontal plastic surgery procedures.Background: Gingival recession has been managed successfully through various surgical approaches, with great variability in outcomes. Anatomic characteristics of the recipient site and selected technique account in part for this variability. Gingival flap thickness is one of the most critical site-related characteristics.Methods: An electronic search was conducted on the major databases (PubMed, Embase, Web of Science). Human prospective studies with at least 6 mo of follow-up and with a numeric baseline measurement for gingival thickness were eligible. Only studies including nonsmoking patients were considered. Variables included surgical approach, participant characteristics, local anatomic factors, and follow-up time. Primary outcome was mean percentage root coverage (%RC) achieved, and complete root coverage was a secondary outcome.Results: A total of 42 studies were included (35 randomized controlled trials, 5 case series, 1 prospective cohort study, and 1 controlled clinical trial). Across studies, the pooled %RC was 81.9% (95% CI, 79.1% to 84.7%). The %RC was not significantly associated (P= 0.267) with baseline soft tissue thickness; however there was a significant (P= 0.031) inverse relationship between STT and %RC after 12-mo follow-up. Subgroup analysis showed that for no graft, there was a significant (P= 0.025) positive relationship between STT and %RC with the exclusion of the single outlier study based on STT.Conclusions: STT plays a limited role in predicting root coverage across all approaches; when flaps are performed with no graft, the effect of STT is most critical. The length of time following surgery appears to influence outcomes, with 12-mo follow-up offering greater insight.Knowledge Transfer Statement: The results of this study can suggest to clinicians which periodontal plastic surgery technique to employ when treating challenging cases. In particular, it can be helpful when selecting the treatment approach to treat thin phenotype sites. This study could help clinicians provide a more appropriate treatment decision in such cases.

Cardiovascular disease is one of the leading causes of death worldwide. Controlled prospective studies and randomized clinical studies have shown that inflammation plays a major role in the pathogenesis of atherosclerosis, and that a chronic inflammatory systemic reaction increases the risk of cardiovascular, and cerebrovascular attacks. In recent years, many researchers have focused on defining a correlation between cardiovascular and periodontal diseases. The aim of the present study was to observe the effects of periodontal causal therapy on the level of specific inflammatory markers, such as C-reactive protein (CRP) and interleukin-6 (IL-6) levels, before and after non-surgical periodontal therapy. A total of 64 patients were enrolled in the present study. Among these, 26 patients were affected by cardiovascular disease and periodontal disease, (MCV-Perio test group), whereas 38 patients were only affected by cardiovascular disease, without periodontal disease, (MCV control group). The MCV-Perio group was then sub-divided into two additional groups: Treated MCV-Perio test group, treated with non-surgical phase I periodontal therapy; Not-Treated MCV-Perio test group, not treated with any periodontal therapy. A comprehensive periodontal treatment was carried out at baseline. The non-surgical therapy treatment was conceived according to Full Mouth Therapy (FMT) treatment protocol, consisting of various phases delivered in a very short time. Blood samples were collected at baseline and re-evaluated in order to assess periodontal and inflammation marker changes. All values were registered as an average ± standard deviation (x ± SD) and Wilcoxon-Mann-Whitney test was used. It is interesting to observe that the serum concentrations of IL-6 and hs-CRP were higher in the group with cardiovascular and periodontal disease compared to the group with cardiovascular disease alone. Non-surgical periodontal treatment determined a dramatic improvement in the levels of the systemic inflammatory markers. The results of the present study show that non-surgical periodontal therapy performed according to the Full Mouth Therapy protocol may prove beneficial in reducing the levels of inflammatory markers typically associated with heart disease. Because the two pathologies share a certain number of common risk factors, this may be a hindrance in the correct interpretation of the results. Therefore, further evidence, represented preferably with a randomized controlled clinical design is necessary to interpret the results correctly.

A conservative approach to endodontic treatment of a maxillary canine with dens invaginatus is presented. Pulp involvement and periapical abscess subsequent to contamination through the invagination space occurred at an early dental age before root completion. Treatment was initially to achieve apical closure before the completion of root canal treatment. Apexification with calcium hydroxide was performed to provide favorable conditions for healing and eventually for successful obturation. Difficulties and entanglements posed by the complex internal morphology and the root developmental stage are presented. Clinical considerations are discussed and a treatment approach used to overcome those obstacles described.