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The aim of this systematic review was to assess the efficacy of three biologics, namely autologous blood-derived products (ABPs), enamel matrix derivatives (EMD) and recombinant human platelet-derived growth factor BB (rhPDGF-BB), in root coverage and gingival augmentation therapy.The protocol of this PRISMA 2020-compliant systematic review was registered in PROSPERO (CRD42021285917). After study selection, data of interest were extracted. A network meta-analysis (NMA) was conducted to assess the effect of different surgical interventions on the main clinical outcomes of interest (i.e., mean root coverage [MRC%], complete root coverage [CRC%], keratinized tissue width [KTW], gingival thickness [GT] change, and recession depth [RD] reduction).A total of 48 trials reported in 55 articles were selected. All studies reported on the treatment of gingival recession defects for root coverage purposes. Forty-six treatment arms from 24 trials were included in the NMA. These arms consisted of treatment with coronally advanced flap (CAF) alone, EMD + CAF, platelet-rich fibrin (PRF) + CAF, and subepithelial connective tissue graft (SCTG) + CAF. Regarding MRC%, SCTG+CAF was associated with a significant higher estimate (13.41%, 95% CI [8.06-18.75], P 0.01), while EMD+CAF (6.68%, 95% CI [-0.03 to 13.4], P = 0.061) and PRF+CAF (1.03%, 95% CI [-5.65 to 7.72], P = 0.71) failed to show statistically significant differences compared with CAF alone (control group) or with each other. Similarly, only SCTG+CAF led to a significantly higher CRC% (14.41%, 95% CI [4.21 to 24.61], P 0.01), while treatment arms EMD + CAF (13.48%, 95% CI [-3.34 to 30.32], P = 0.11) and PRF+CAF (-0.91%, 95% CI [-15.38, 13.57], p = 0.81) did not show significant differences compared with CAF alone or with each other. Differences in the CI of PRF+CAF (symmetrical around a zero adjunctive effect) and EMD+CAF (non-symmetrical) suggest that EMD could have some additional value compared with PRF. Treatment with SCTG+CAF led to a statistically significant higher RD reduction (-0.39 mm, 95% CI [-0.55 to 0.22], P 0.01), however EMD+CAF (-0.13 mm, 95% CI [-0.29 to 0.01], P = 0.08) and PRF+CAF (-0.06 mm, 95% CI [-0.23 to 0.09], P = 0.39) failed to show significant differences compared with CAF or with each other. While SCTG+CAF was associated with a statistically significant higher gain of KTW (0.71 mm, 95% CI [0.48 to 0.93], P 0.01), EMD+CAF (0.24 mm, 95% CI [-0.02 to 0.51], P = 0.08) and PRF+CAF (0.08 mm, 95% CI [-0.23 to 0.41], P = 0.58) did not result into significant changes compared with CAF alone or with each other. Regarding the use of rhPDGF-BB+CAF, although available studies have reported equivalent results compared with SCTG+CAF, evidence is very limited.The use of ABPs, EMD, or rhPDGF-BB in conjunction with a CAF for root coverage purposes is safe and generally promotes significant improvements respective to baseline clinical parameters. However, the adjunctive use of ABPs and EMD does not provide substantial additional improvements in terms of clinical outcomes and patient-reported outcome measures to those achieved using CAF alone, when baseline KTW is2 mm. Both PRF+CAF and EMD+CAF rendered inferior MRC%, CRC%, RD reduction, and KTW gain compared with SCTG+CAF, which should still be considered the gold-standard in root coverage therapy. Although some studies have reported equivalent results for rhPDGF-BB+CAF compared with the gold-standard intervention, limited evidence precludes formal comparisons with CAF or SCTG+CAF that could be extrapolated to guide clinical practice.

There are few studies comparing xenogeneic acellular dermal matrixes (XDMs) with connective tissue graft (CTG) to treat single gingival recession (GR). The present study involved a reanalysis of previous studies and comparison of CTG or XDM to treat single RT1/GR.Fifty patients from three previous randomized clinical trials treated either by CTG (n = 25) or XDM (n = 25) were evaluated after 6-month. Clinical, patient-centered, and esthetic parameters were assessed. Pearson's correlation and regression analyses were also performed.Greater recession reduction (RecRed), percentage of root coverage (%RC), and complete root coverage (CRC) were observed in the CTG group (p ≤ 0.02). Gingival thickness (GT) and keratinized tissue width (KTW) gains were higher in the CTG group. The CTG group showed better esthetic at 6-month. Logistic analyses reported that GT([OR] = 1.647CTG was superior for treating RT1/GR, providing better root coverage outcomes and tissue gains over time. GT, PH, and graft type were classified as predictors of CRC.CTG presented better outcomes to treat single RT1 gingival recession when compared to the XDM.

The aim of the present study was to compare repeated applications of antimicrobial photodynamic therapy (aPDT) to open flap debridement (OFD) in the treatment of residual periodontal pockets in non-furcation sites.Forty-six subjects with a diagnosis of Stage III or IV Grade C periodontitis, that had been previously treated, participated in the study. Residual pockets were divided between two groups: (1) aPDT group: received ultrasonic periodontal debridement followed by immediate application of aPDT, and repeated on1st, 2nd, 7th, and 14th days; and (2) OFD group: treated by modified papilla preservation technique, where granulation tissue and visible calculus were removed with hand curettes and an ultrasonic device. Clinical, immunological, and microbiological parameters were evaluated before and after treatment.Both treatments were effective reducing clinical parameters of disease. OFD resulted in a greater mean probing pocket depths (PPD) reduction in deep pockets (p = 0.001). However, aPDT resulted in a lower occurrence of gingival recession (GR), dentin hypersensitivity (DH) and analgesic intake. Reduction in Porphyromonas gingivalis was observed in both groups. Only the OFD group had a significant reduction in Aggregatibacter actinomycetemcomitans. aPDT group had greater increase in interleukin 10 (IL-10) levels and a greater reduction of interleukin 1 beta (IL-1β) at 14 days when compared to the OFD group (p 0.05).OFD was superior in reducing PPD in deep pockets compared to the aPDT. However, OFD resulted in greater GR. Both treatments lowered P. gingivalis levels but only OFD reduced levels of A. actinomycemtemcomitans.

The purpose of this study was to investigate the influence of vestibular depth (VD) on the outcomes of root coverage therapy.Patients presenting gingival recession defects (GRD) with a minimum depth of 2 mm underwent root coverage therapy consisting of a coronally advanced flap plus a connective tissue graft (CAF + CTG). Clinical examinations were performed, and intraoral scans were obtained at baseline, 3 and 6 months after surgery to assess changes in probing depth (PD), keratinized tissue width (KTW), recession depth (RD), GRD area, marginal gingival thickness (MGT), and VD. The influence of VD on percentage of root coverage (%RC) and the likelihood of achieving complete root coverage (CRC) were explored.A total of 20 patients were enrolled, and 44 teeth were treated. RD decreased and MGT increased in all treated sites. At 6 months, mean %RC was 87.47 ± 18.37 and CRC was observed in 61.4% of sites. Mean baseline VD was 7.33 ± 2.67 mm. Mean VD reduction from baseline to 6 months was 1.98 ± 1.27 mm. %RC and CRC were significantly correlated with baseline VD. Each additional 1 mm of baseline VD implied a gain of 6.58% for %RC and increased 2.75 times the probability of achieving CRC. Narrow baseline KTW and mandibular arch location were associated with inferior treatment outcomes.Lower %RC and likelihood of achieving CRC can be expected after root coverage therapy via CAF + CTG in sites presenting a shallow vestibulum.

To assess the prognostic value of soft tissue phenotype modification following root coverage procedures for predicting the long-term (10-year) behaviour of the gingival margin.Participants from six randomized clinical trials on root coverage procedures at the University of Michigan were re-invited for a longitudinal evaluation. Clinical measurements were obtained by two calibrated examiners. A data-driven approach to model selection with Akaike information criterion (AIC) was carried out via multilevel regression analyses and partial regression plotting for changes in the level of the gingival margin over time and interactions with the early (6-month) results of soft tissue phenotypic modification.One-hundred and fifty-seven treated sites in 83 patients were re-assessed at the long-term recall. AIC-driven model selection and regression analyses demonstrated that 6-month keratinized tissue width (KTW) and gingival thickness (GT) influenced the trajectory of the gingival margin similarly in a concave manner; however, GT was the driving determinant that predicted significantly less relapse in the treatments, with stability of the treated gingival margin obtained beyond values of 1.46 mm.Among a compliant patient cohort, irrespective of the rendered therapy, the presence of at least 1.5 mm KTW and 1.46 mm GT was correlated with the long-term stability of the gingival margin.

The prosthetic emergence profile design might be an important factor in postsurgical mucosal recession etiology. Therefore, a restorative buccal emergence profile designed correctly might reduce gingival margin recession.To compare the marginal gingival level and the width/height (W/H) ratio between two profile configurations of single implant-supported restorations at molar sites.Twenty-one patients requiring a single mandibular molar tooth replacement with supracrestal mucosal thickness ≥2 mm were recruited and randomly assigned to a prosthesis buccal emergence profile design based on the buccal mucosal W/H ratio (Test Group) or maintained the original emergence profile of the healing abutment (Control Group). Assessments were made before delivery of the definitive restoration (T0), at prosthesis placement (T1), one (T2), and 12 (T3) months after loading. The gingival margin level change (△GM), initial emergence angle, buccal mucosal W/H ratio, marginal bone loss (MBL), implant failure, and complications were assessed.The gingival recession in the test group (0.13 ± 0.32 mm) was significantly lower than in the control group (0.63 ± 0.38 mm) at T3 (p = 0.006). The initial emergence angle in the test group (31.4 ± 7.22 degrees) was significantly lower than the control group (40.0 ± 7.60 degrees) (p = 0.025). The W/H ratio in the test group at T2 was significantly higher than at T0 but remained stable thereafter. The W/H ratio presented a continued rising trend in the control group.When the initial supracrestal soft tissue thickness was ≥2 mm, a restorative emergence profile based on the W/H ratio significantly reduced gingival margin recession. An emergence angle of 32.4 degrees showed better behavior in maintaining the gingival margin than 40 degrees.ChiCTR190002210.

Tissue regeneration within the periodontally involved furcation area is one of the most challenging aspects of periodontal surgery. The aim of this study was to evaluate the additional benefit of leukocyte and platelet-rich fibrin (L-PRF) to autogenous bone grafts (ABGs) in the treatment of mandibular molar degree II furcation involvement, comparing the clinical outcomes with those from open flap debridement (OFD)+ABG and OFD alone treatments.Fifty-four patients, exhibiting one buccal or lingual mandibular molar furcation defect, were randomly assigned to three treatment groups: OFD+ABG+L-PRF (n = 18); OFD+ABG (n = 18); and OFD (n = 18). Clinical (probing depth [PD], horizontal clinical attachment level [HCAL], vertical clinical attachment level [VCAL], gingival recession [GR]) and radiographic (vertical bone level [VBL]) parameters were evaluated at baseline and 6 months after treatment. HCAL change was the primary outcome.No significant differences within each group were reported for GR changes, but statistically significant improvements in HCAL, VCAL, PD, and VBL were observed in all groups, except for VBL in the OFD group. At 6 months, the mean HCAL gain was 2.29 ± 0.18 mm in the OFD+ABG+L-PRF group, which was significantly greater than that in the OFD+ABG (1.61 ± 0.18 mm) and OFD (0.86 ± 0.18 mm) groups. Both OFD+ABG+L-PRF and OFD+ABG therapies produced a significantly greater clinical and radiographic improvement than OFD.The addition of L-PRF to ABG produces a significantly greater HCAL gain and PD reduction as compared with OFD+ABG treatment in mandibular degree II furcation involvements.

Made available in DSpace on 2022-04-28T17:30:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-12-28 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Introduction: Gingival recession (GR) is a relevant clinical condition due to its high prevalence worldwide, which leads to aesthetic demands and dentin hypersensitivity. Collagen matrices have been associated with different designs of coronally advanced flaps (CAFs) to treat GR defects. However, the literature lacks long-term follow-up of this treatment option. The aim of this study is to present the long-term follow-up (up to 7 years) of two GR defects (associated or not with noncarious cervical lesion) treated with a CAF and a collagen matrix (CM). Case presentation Case 1 underwent a CAF associated with a CM to treat a single GR defect. After 7 years, Case 1 presented with 3 mm of recession reduction, which corresponds with the 85.7% of root coverage. Case 2 presented two GR defects associated with noncarious cervical lesions (NCCLs). The NCCLs were partially restored with resin composite and then underwent a modified CAF for multiple defects and a CM. After 5 years of follow-up, Case 2 presented with 1.5 and 2.5 mm of recession reduction, which corresponds with the average 83.3% defect coverage. Conclusion These two cases may show that CMs can provide long-term stable outcomes in the treatment of GR defects. Fed Univ Pernambuco UFPE, Dept Prosthesis & Surg Orofacial, Recife, PE, Brazil Sao Paulo State Univ, Inst Sci & Technol, Div Periodont, UNESP, Av Engn Francisco Jose Longo 777, BR-12245000 Sao Jose Dos Campos, SP, Brazil Private Educ Inst, Sao Paulo, Brazil Sao Paulo State Univ, Inst Sci & Technol, Div Periodont, UNESP, Av Engn Francisco Jose Longo 777, BR-12245000 Sao Jose Dos Campos, SP, Brazil CAPES: 001 CNPq: 304269/2019-0

Made available in DSpace on 2022-05-01T10:19:02Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Background: Xenogeneic matrices (XMs) have been increasingly used for root coverage procedures. This study compared the use of two types of XM (collagen matrix [CM] and xenogeneic acellular dermal matrix [XDM]) associated with the coronally advanced flap technique (CAF) to treat single gingival recessions. Methods: Seventy-five patients presenting single RT1 gingival recession were treated by CAF (control group, n = 25), CAF+CM (test group 1, n = 25), or CAF+XDM (test group 2, n = 25) and completed 6-month follow-up. Clinical, patient-centered, and esthetic assessments were performed and intra- and intergroup differences were analyzed. Results: At 6 months, the mean recession reduction for CAF, CAF+CM, and CAF+XDM was 2.4 ± 0.8 mm, 2.4 ± 0.9 mm and 2.1 ± 0.8 mm, respectively (P > 0.05). The corresponding mean percentage of root coverage was 78.9% ± 26.2% for CAF, 78.0% ± 28.5% for CAF+CM, and 65.6% ± 26.9% for CAF+XDM (P > 0.05). Dentin hypersensitivity and esthetic conditions showed significantly improvements in all groups. Test groups presented significant gains in gingival thickness (GT; CAF+CM: 0.4 ± 0.3 mm; CAF+XDM: 0.4 ± 0.2 mm) compared to the control group (CAF: 0.0 ± 0.1 mm; P

BACKGROUND The autogenous connective tissue graft (CTG) with coronally advanced flap (CTG+CAF) is the "gold standard" for recession defect coverage; however, researchers continue to pursue lower morbidity, more convenient and unlimited supply harvest graft substitutes, including those that could provide soft tissue volume augmentation. METHODS A randomized, controlled, double-masked comparison of a volume-stable collagen matrix (VCMX) versus CTG was conducted at four clinical investigation sites. Single, contralateral, within patient matched-pair, RT1 recession defects were treated with VCMX+CAF (test) and CTG+CAF (control). The primary efficacy end point was percent root coverage at 6 months. Secondary efficacy end points included clinical measures such as soft tissue volume, attachment level, and keratinized tissue width. Patient-reported outcomes included measures such as discomfort, esthetics, and overall satisfaction; 6-month end point results were followed for 1 year. RESULTS Thirty patients received control and test therapies, and all patients were available for follow-up measures. Average percent root coverage for CTG+CAF was 90.5% ± 14.87% versus 70.7% ± 28.26% for VCMX+CAF, P

Introduction The aim of this case series was to assess the feasibility of a graft modification to increase its length when treating multiple adjacent gingival recessions with only one harvesting site at the palate and respecting the safety zone. Case series Nineteen recessions were treated in four consecutive patients with a modified coronally advanced tunnel and a modified connective tissue graft. An 8-mm height connective tissue graft was harvested by the single-incision technique, the graft was split longitudinally, achieving 4-mm height and double the length. Changes in recession depth, keratinized tissue height, mean and complete root coverage, and esthetic score were analyzed at 6 months. The technique allows to harvest a connective tissue graft up to 58-mm length with a single palatal site. Complete root coverage was achieved in 15/19 recessions (78.94%), with a mean root coverage of 82.90%. The mean recession depth was reduced by 1.31 mm and the keratinized tissue increased by 0.69 mm. The esthetic outcome score was 9.26/10. Conclusion This graft modification technique allows increasing significantly the graft length up to 58 mm without any modification of the surgical harvesting procedure. Therefore, it can be suggested to reduce the morbidity.

Introduction The purpose of this case report is to document the 8.5 years result of treatment of a mandibular incisor having a buccal Cairo Recession Type 2 (RT2) gingival recession defect (GRD) using a double-layer technique using an acellular dermal matrix (ADM) with a coronally advanced flap (CAF). To the author's knowledge, no long-term results of this treatment modality in the mandibular incisor area have been reported. Case presentation A 65-year-old non-smoking female presented with an RT2 GRD on the buccal aspect of tooth #25 (International Standards Organization, ISO #41). Her overall periodontal status was healthy. This GRD was treated using a double-layer of an ADM with a CAF. Tension-free flap advancement was permitted by eliminating a frenum pull. Improved root coverage and stable gingival margins were found after 8.5 years. Conclusion This report provides evidence to support the use of a double-layer technique using an ADM with a CAF to treat a mandibular incisor with an RT2 GRD.

Introduction Numerous techniques have been reported in the literature for the reconstruction of gingival recession defects. The purpose of this case series was to evaluate clinically and radiographically the efficacy of sticky bone with i-PRF coated collagen membrane in the treatment of gingival recession. Case presentation Sixteen patients exhibiting isolated Miller's Class I or II recession in the maxillary esthetic zone were treated using sticky bone [i-PRF + Freeze-dried bone allograft] with i-PRF coated collagen membrane using the coronally advanced flap. Clinical parameters including Probing Depth (PD), Width of Keratinized Gingiva (WKG), Gingival Thickness (GT), and Recession Depth (RD) were recorded at baseline and six months post-surgery. The radiographic (ST-CBCT) measurements computed were labial plate thickness (OT1, OT3, and OT5) and gingival thickness (GT1, GT3, and GT5) at baseline and six months post-treatment. Twelve out of sixteen treated cases achieved complete root coverage. An increase in gingival thickness was observed in all the cases. Conclusions Within the limitations of this case series, sticky bone with i-PRF coated collagen membrane showed promising results in the treatment of isolated maxillary Miller's Class I or II gingival recession and serves as an altered approach for root coverage procedure. However, histological analysis and larger sample size are needed to establish definitive proof of soft and hard tissue regeneration. This article is protected by copyright. All rights reserved.

Aim To report the 36-month follow-up of a trial comparing the adjunct of a xenogenic collagen matrix (CMX) or connective tissue graft (CTG) to coronally advanced flaps (CAF) for coverage of multiple adjacent recessions. Material and methods 125 subjects (61 CMX) with 307 recessions in 8 centres from the parent trial were followed-up for 36-months. Primary outcome was change in position of the gingival margin. Multilevel analysis used centre, subject, and tooth as levels and baseline parameters as covariates. Results No differences were observed between the randomized and the follow-up population. Average baseline recession was 2.6 ± 1.0 mm. 3-year root coverage was 1.5 ± 1.5 mm for CMX and 2.0 ± 1.0 mm for CTG (difference of 0.32 mm, 95%CI from -0.02 to 0.65 mm). The upper limit of the confidence interval was over the non-inferiority margin of 0.25 mm. No treatment differences in position of the gingival margin were observed between 6- and 36-month follow-up (difference 0.06 mm, 95%CI -0.17 to 0.29 mm). Conclusion CMX was not non-inferior with respect to CTG in multiple adjacent recessions. No differences in stability of root coverage were observed between groups and in changes from 6 to 36 months. Previously reported shorter time to recovery, lower morbidity and more natural appearance of tissue texture and contour observed for CMX in this trial are also relevant in clinical decision making.

Aim: Comparison of the clinical efficacy (digitally volumetric, aesthetic, patient-centred outcomes) of tunnel technique (TUN) with subepithelial connective tissue graft (CTG) versus coronally advanced flap (CAF) with enamel matrix derivate (EMD) 5 years after gingival recession therapy. Materials and methods: In 18 patients contributing 36 RT1 recessions, study models were collected at baseline and follow-ups. Optical scans assessed recessions computer-assisted [recession depth, recession reduction (RECred), complete root coverage (CRC), percentage of root coverage (RC), pointwise (pTHK) and mean areal (aTHK) marginal soft tissue thickness]. Root coverage aesthetic Score (RES) was used for aesthetic evaluation and visual analogue scales for patient-centred data collection applied. Results: Sixty months after surgery, 50.0% (TUN+CTG) and 0.0% (CAF+EMD) of sites showed CRC (p = 0.0118), 82.2% (TUN+CTG) and 32.0% (CAF+EMD) achieved RC, respectively (p = 0.0023). CTG achieved significantly better RECred (TUN+CTG: 1.75±0.74 mm; CAF+EMD: 0.50 ± 0.39 mm; p = 0.0009) and aTHK (TUN+CTG: 0.95 ± 0.41 mm; CAF+EMD: 0.26 ± 0.28 mm; p = 0.0013). RES showed superior outcomes (p = 0.0533) for TUN+CTG (6.86 ± 2.31) compared to CAF+EMD (4.63 ± 1.99). The study failed to find significant differences related to patient-centred outcomes (TUN+CTG: 8.30 ± 2.21; CAF+EMD: 7.50 ± 1.51; p = 0.1136). Conclusions: Five years after treatment, CTG resulted in better clinical and aesthetic outcomes than CAF+EMD. Increased THK was associated with improved outcomes for RECred and RC.

INTRODUCTION The purpose of this case series is to evaluate the clinical efficacy of advanced platelet-rich fibrin (A-PRF) in combination with coronally advanced flap (CAF) in the management of gingival recession defects and its first of its kind. CASE SERIES Fourteen systemically healthy patients presenting with 35 RT1 recession defects were treated with A-PRF + CAF. Recession height (RH), recession width (RW), probing pocket depth (PPD), clinical attachment level (CAL), keratinized tissue height (KTH), and width of attached gingiva (WAG) were measured at baseline, 3, and 6 months. Gingival thickness (GTH) and phenotype were evaluated at baseline and 6 months postsurgery. Mean root coverage percentage (MRC%) was estimated at 3 and 6 months. At the end of 6 months, esthetics was measured on the scale of visual analogue scale (VAS) and recession esthetic scale (RES). Statistically significant reduction in mean RH was observed from baseline (2.49 ± 0.65 mm) to 6 months (0.66 ± 0.80 mm). At 6 months, the MRC% attained was 75.94 ± 26.72. Complete root coverage was achieved in 18 sites. At 6 months, there was a significant gain in GTH, CAL, WAG, and KTH (p ≤ 0.001). The mean RES and VAS esthetic scores were 8.54 ± 1.57 and 8.83 ± 1.17, respectively. CONCLUSION Based on the findings of this study, A-PRF may be suggested as a viable treatment option for the management of recession in maxillary anteriors and premolars.

Introduction Paresthesia is a common cause of dental malpractice litigation. Symptoms range from minimal to severely affecting the quality of life. Effective treatments of post-traumatic paresthesias are scarce. This case report documents the first reported use of laser biostimulation to reverse a long-standing paresthesia of the infraorbital nerve, resulting from a root coverage procedure of the maxillary right canine. Case presentation A coronally repositioned flap with enamel matrix derivative was used to treat gingival recession on the buccal surface of tooth #6 of a 35-year-old Caucasian female. One week later the patient reported lip numbness. The patient declined further treatment, and the paresthesia remained unchanged for the next 13 months. The patient then consented to laser biostimulation with a 1064 nm neodymium:yttrium aluminum garnet laser. A single laser biostimulation treatment resulted in an immediate and dramatic improvement of lip sensation. The patient's symptoms improved over the next 2½ years without further treatment. Conclusion The cause of the paresthesia and the exact mechanism of its reversal remain unknown, although speculated causes and the possible mechanisms of action of low-level laser therapy are discussed. Laser biostimulation for treatment of peripheral nerve injury is noninvasive and may eliminate the need for corticosteroids or other more invasive treatment modalities. It may not be effective in all paresthesia cases, but when used properly, laser therapy offers a safe treatment alternative for an often troubling problem.

Despite the considerable experience in mechanical force‐induced tooth movement, there still exist several persisting controversies and conflicting opinions about issues crucial for the attainment of excellent results within a reasonable time period for most or all patients. Such controversies embrace the features of (optimal) orthodontic force, its best magnitude and duration, the biology of tooth movement (inflammation and mechanotransduction), biomarkers in oral fluids, best methods for acceleration of tooth movement, and long‐term (deleterious) effects of orthodontic treatment. Scientists are discovering that medical care is proving to be as individualized as faces. Each of us is defined by a unique genetic and molecular makeup. This realization is modifying the way diseases are defined and treated and is the basis of a growing movement toward precision medicine, whereby diagnosis and treatment plans are tailored according to a patient’s individual needs. Orthodontists are keenly cognizant of the individual variability of their patients, at least functionally and morphologically, and have begun discovering molecular, genetic, and environmental factors that appear to affect the outcome of mechanotherapy. Thus, the way ahead in terms of identifying the biological determinants of tooth movement is clear.

Introduction Restoring function and esthetics are essential aspects of periodontology and restorative dentistry. Depending on their extension and the tissues involved, the treatment of non-carious cervical lesions (NCCLs) associated with gingival recessions may require a multidisciplinary approach, and different periodontal and restorative techniques have been described. Case presentation This case report presents an innovative approach to treat a deep NCCL combined with a gingival recession in a canine region of a female patient. A Computer Aided Design - Computer Aided Manufacturing (CAD/CAM) chairside ceramic restorations in combination with mucogingival surgery procedures are described. A comprehensive analysis of the selected approach and its clinical implications is presented based on a 60-month follow-up. Conclusions After 60-month follow-up, clinical condition maintained stable, and a successful esthetic outcome was accomplished. Complete root coverage was achieved and kept throughout the whole period of tracing.

Accidental contact of various chemicals in dentistry may cause damage to the gingiva. A male patient presented for a full mouth rehabilitation with ceramic crowns. The patient underwent the steps of ceramic crown preparation uneventfully. At the time of crown delivery, cotton rolls were placed in several vestibular areas for isolation. They were regularly changed during different steps of etching and cementation process, which included the use of Multilink Primer B (Ivoclar Vivadent™). On removal of the cotton roll in the area of upper right canine, the gingival tissues appeared blanched and grayish white. The cotton roll was found to have absorbed some etching material in it. As the patient was asymptomatic, he was dismissed. Two weeks later, the patient presented with inflammation and gingival recession in the same area. Initially, he was treated palliatively, and subsequently, he received a connective tissue graft on the upper right canine. This case report showed that acid etching material used during the prosthodontic cementation may have caused a gingival recession, which was successfully treated with tunnel flap and connective tissue graft. Optimal isolation of the operative field should be performed to avoid this problem.

Objective To provide a contemporary and comprehensive overview of the hard and soft tissue biological structures surrounding an osseointegrated dental implant (peri-implant referred to as the peri-implant phenotype), in the context of peri-implant esthetic complications. Overview The individual components of the peri-implant phenotype (keratinized mucosa width, mucosal thickness, supracrestal tissue height, and the peri-implant buccal bone) have been linked to different aspects of implant esthetics, as well as health-related aspects. At the time of implant therapy, respecting the biology of the peri-implant hard and soft tissues, and anticipating their remodeling patterns can alleviate future esthetic complications. Conclusions While the current literature may not allow for a point-by-point evidence based-recommendation for the required amount of each peri-implant structure, bearing in mind the proposed values for the components of the peri-implant phenotype, at the time of and prior to implant therapy can lead to more predictable treatment outcomes, and the avoidance of esthetic complications. Clinical significance Knowledge of hard and soft tissue components surrounding and osseointegrated dental implant, and their underlying biological remodeling process is crucial for carrying out a successful therapy and alleviating possible future esthetic challenges.

Made available in DSpace on 2021-06-25T22:23:35Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-12-16 Introduction: Gingival recession (GR) is a prevalent problem that is related to esthetic demands and dentin hypersensitivity. Frequently, GR is associated with non-carious cervical lesion (NCCLs) forming a combined defect (CD), which requires restorative and surgical treatment. Connective tissue graft procedures allow predictable root coverage but can result in patient discomfort. Case Presentation: This first case report describes multiple GRs associated with B+ NCCL at teeth #4 and #6 of a 27-year-old patient with a thin periodontal phenotype. The aim of this report was to evaluate the 6-month outcome of a new volume-stable collagen matrix (VCMX) combined with modified coronally advanced flap (MCAF) and partial restoration to treat CDs. After 6 months, significant improvement was observed regarding CD coverage (69.05%), recession reduction (2.25 mm), gingival thickness gain (0.74 mm), and keratinized tissue width gain (0.75 mm). In addition, excellent esthetic evaluation and patient comfort were achieved by using the biomaterial. Conclusion: VCMX associated with MCAF and partial restoration may be an option to treat multiple recession defects plus B+ NCCLs. Sao Paulo State Univ UNESP, Inst Sci & Technol, Div Periodont, Ave Eng Francisco Jose Longo 777, Sao Jose Dos Campos, SP, Brazil Sao Paulo State Univ UNESP, Inst Sci & Technol, Div Periodont, Ave Eng Francisco Jose Longo 777, Sao Jose Dos Campos, SP, Brazil

Purpose To search the literature and to critically evaluate the findings on the periodontal outcomes of restorations and tooth-supported fixed prostheses. Materials and methods PubMed was searched according to a systematic methodology, previously reported, but updated to include a larger database. Filters applied were: Case reports, clinical trial, review, guideline, randomized controlled trial, meta-analysis, systematic reviews, and English. A narrative review was then synthesized to discuss periodontal outcomes related to restorations and tooth-supported fixed prostheses. Relevant data was organized into four sections: Direct restorations, indirect restorations, biologic width or supracrestal tissue attachment and tooth preparation/finish line design. Results While increased gingival index, bleeding on probing, probing depth and clinical attachment loss have been associated with subgingival restorations, intracrevicular margins do not cause periodontal diseases. Inflammation and bone loss occur, for both direct and indirect restorations, only with large overhangs. Different restorative materials are associated with different clinical responses when placed in the gingival sulcus or within the epithelial and connective tissue attachments. When the connective tissue attachment is removed, histological changes occur causing its apical shift and subsequent re-establishment. Gingival displacement during impression procedures can cause gingival recession. Emergence profile can have a range of values, not associated with periodontal diseases. Periodontal response appears to be clinically not different when compared among different finish line designs. Conclusions Contemporary procedures and materials used for the placement and fabrication of tooth-supported restorations and fixed prostheses are compatible with periodontal health when adequate patient education and motivation in self-performed oral hygiene are present. Periodontal diagnostic criteria should be thoroughly reviewed before fixed restorative treatments are planned and executed.

Introduction The increasing esthetic demands from patients have required that clinicians sharpen their skills and adopt newer and more novel techniques to satisfy these demands. In periodontal therapy, periodontal plastic surgery poses a substantial challenge to the clinician, both because it is technique sensitive and also because it includes a wide array of procedures and their variations. Conventional plastic procedures have provided satisfactory results in the treatment of gingival recession but there is, presently, a greater need for more advanced procedures that cause less surgical morbidity as also provide improved results. Minimally invasive surgery has been harnessed in periodontics for this purpose and has been extensively used in multiple indications, including root coverage. Modified-Vestibular Incision Supra-periosteal Tunnel Access (M-VISTA) applies the principles of minimally invasive surgery to provide satisfactory results in root coverage. Case presentation A 28-year-old male patient presented with multiple Miller Class I/II buccal recession defects and associated high labial frenum on right maxillary anterior teeth. M-VISTA technique allowed coronal repositioning of gingival margin, which was then stabilized by orthodontics bracket assisted suturing technique. The V-shaped incision in the region of the frenal attachment allowed for conducting both the M-VISTA and frenectomy techniques simultaneously. Connective tissue graft was inserted in the supra-periosteal tunnel and vertical incision was sutured. Complete root coverage was achieved and maintained at 9 months with excellent esthetic outcomes. Conclusions The use of connective tissue graft along with M-VISTA technique allows the clinician to successfully treat multiple recession defects.

The new classification of periodontal diseases recognizes the key role of the interdental clinical attachment for defining the periodontal status and the extent of disease severity. Regenerating interdental clinical attachment not only improves the prognosis of the tooth, but it also lessens the severity of the disease condition. This manuscript provides a state-of-the-art review on surgical reconstructive approaches for treating papillary deficiency associated with soft and hard tissue interproximal defects. Combination therapy of papilla preservation, connective tissue grafting, and coronally advanced flaps may result in regeneration of the intrabony defect coupled with root coverage. Future research highlighted in this review may have the potential especially in combination approaches to repair challenging interproximal soft and hard tissue deficiencies.

The 2017 World Workshop completely restructured knowledge in periodontology with a series of official consensus statements jointly agreed upon by the American Academy of Periodontology and the European Federation of Periodontology. Among them, the 2017 classification of phenotype and gingival recession successfully incorporated the most relevant previous classifications into a treatment-oriented diagnostic matrix. Despite the significant advantages related with the implementation of this new classification of gingival recessions, recent articles still report data based on previous outdated systems. Therefore, the present commentary aimed to dive into the key advantages of the 2017 classification of phenotype and gingival recession, and to stress why it should be fully integrated into research and practice settings.

BACKGROUND This split-mouth randomized clinical trial compared two different types of subepithelial connective tissue grafts (SCTG) considering clinical parameters and patient-centered outcomes in patients with bilateral recession type 1 multiple gingival recessions after 6 months postoperatively. METHODS A total of 21 patients were surgically treated with coronally advanced flap (CAF) associated with SCTG harvested by: double blade scalpel (DBS) and de-epithelialized (DE) SCTG. Periodontal clinical parameters and esthetics were evaluated by a calibrated periodontist at baseline and after 6 months. Patient-centered outcomes related to pain/discomfort and esthetics were assessed with visual analogue scale after 7 days and 6 months, respectively. RESULTS All clinical parameters, with the exception of probing depth, demonstrated differences in intragroup evaluation, comparing baseline to 6-month evaluation (P

Background To determine if there is a difference in the amount of shrinkage during healing of free soft tissue autografts (FSTAs) using different surgical techniques-suturing the vestibular flap margin apically to the base of the recipient bed versus leaving the flap margin free and unsutured. Methods Twenty-eight patients with mucogingival defects requiring FSTAs were recruited and enrolled in the study. Patients were randomized into test and control groups (14 per group) and received ≥1 FSTAs on non-molar mandibular teeth. In the test group the mucosal flap margin was sutured apically to the periosteum at the base of the graft; whereas, the mucosal flap margin in the control group was left free. Graft dimensional measurements were taken at time of surgery, then at 1, 3, and 6 months post-surgery. Results Thirty-five grafts were performed (15 test, 20 control). All FSTAs experienced vertical shrinkage after 6 months, but there was no significant difference (P = 0.51) in the mean amount of shrinkage after 6 months between the test (23.20% ± 20.88%) and control (21.10% ± 21.88%) groups. There was significantly greater horizontal shrinkage in the test (loss of 7.59% ± 10.20%) compared with the control (small gain of 0.32% ± 4.20%) group (P = 0.01). Conclusions The findings suggest that there is similar vertical shrinkage when performing FSTA surgery when the mucosal flap margin is left free and unsutured when compared with leaving the flap margin free.

BACKGROUND/AIM This study evaluated marginal soft tissue recession at implants with simultaneous lateral guided bone regeneration (GBR), at least five years after prosthetic loading. MATERIAL AND METHODS Patients treated with GBR at the time of implant placement and adherent to supportive periodontal therapy (SPT) program with at least 5 years of follow-up were re-examined in 5 clinical centers. At the last follow-up, clinical and radiographic data on peri-implant hard and soft tissue were collected. Multilevel analysis considering center, patient, and implant (brand, length, diameter, position) was performed. RESULTS A total of 96 patients and 195 augmented implants were included. The mean duration of SPT was 8.3 ± 3.1 years, while mean recall frequency was 4.5 ± 1.3 months. Sixty-five (33%) implants received soft tissue graft before prosthetic delivery. Twenty-one (11%) implants developed biological complications during the follow-up. No implant failure was reported. Mean difference in bone levels (ΔBL) was -0.7 ± 0.9 mm, while mean difference in keratinized tissue (ΔKT) was -0.4 ± 0.9 mm. Eighty-five (44%) implants showed recession (REC) of soft tissue margin (mean 0.6 ± 0.8 mm). The presence of REC was associated with use of non-resorbable membrane (p

Introduction Guided tissue regeneration (GTR) has been well documented with combination of bone graft substitutes and biologic modifiers to improve the outcomes of periodontal regenerative procedures. Amnion-chorion allograft membrane (ACM) is a placenta-derived resorbable allograft membrane which contains growth factors found in the placenta. The primary purpose of the barrier membranes for GTR was to exclude the epithelial down-growth along with the root surface, however, the ACM can be used as an additional biologic modifier because of the release of growth factors from the ACM after placement. The aim of this case report is to evaluate the efficacy and the application of ACM on the previously diseased root surface to treat periodontal intrabony defect. Case presentation A 60-year-old Caucasian male with deep and wide intrabony defect on mesial #19 was treated with a regenerative procedure with combination of application of ACM on the root surface and filling the intrabony defect with the corticocancellous freeze-dried bone allograft. The bone substitute was covered with another layer of ACM and primary closure was achieved. Wound healing process was uneventful, and the clinical and radiographic outcomes were favorable up to 18 months after the surgical procedure. Conclusion This case report demonstrated that the application of ACM on the root surface with a combination of bone substitute might enhance to the radiographic bone fill and the clinical attachment level gain and minimize the risk of post-operative gingival recession.

Made available in DSpace on 2020-12-12T02:48:41Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-01-01 Background: This study was conducted to assess the clinical, immunological, and patient-centered outcomes of microcurrent electrotherapy on palatal wound healing. Methods: This was a parallel, double-masked randomized clinical trial, in which 53 patients with ridge preservation indications were selected and randomly assigned to one of two groups. In the control (sham) group (n = 27), palatal wounds, after free gingival grafts (FGG) harvest, received sham application of electrotherapy. In the test (electrotherapy treatment [EE]) group (n = 26), palatal wounds, after FGG harvest, received application of microcurrent electrotherapy protocol. Clinical parameters, patient-centered outcomes, and inflammatory markers were evaluated, up to 90 days postoperatively. Results: The EE group achieved earlier wound closure (P

Introduction The management of gingival recession associated with esthetic concerns and root hypersensitivity is challenging, and its sequelae is based on the assessment of etiological factors and the degree of tissue involvement. Procedures using pedicle flaps, free soft tissue grafts, combination of pedicle flaps with grafts, barrier membranes, and the use of platelet concentrates are all effective for this purpose. The use of the third-generation platelet concentrate, advanced platelet-rich fibrin (A-PRF), has evolved as a promising regenerative material for root coverage procedure wherein it acts as a scaffold and also accelerates wound healing due to its dense fibrin meshwork. Case presentation This case report, discusses treating an isolated maxillary Miller Class I recession in a 25-year-old male patient by a periosteal inversion method along with the A-PRF membrane. A partial thickness flap was reflected; periosteum was inverted; and an A-PRF membrane was placed over the denuded root surface which aided in enhanced regeneration; 100% root coverage was obtained as seen in follow-up visits. Conclusion The periosteal inversion technique along with an A-PRF membrane seems to be a novel approach in managing an isolated Miller Class I maxillary gingival recession.

Background: The long-term outcomes of acellular dermal matrix (ADM) for the treatment of isolated gingival recessions has not yet been evaluated. Thus, the aim of this study was to observe the root coverage outcomes of coronally advanced flap with ADM over time, and compare them with their adjacent untreated sites. Methods: Twelve patients (from 20) were available at the 9-year recall. Clinical parameters (recession depth, mean root coverage [mRC], keratinized tissue width [KTW], and gingival thickness) were evaluated and compared with the 1-year results, and the ADM-adjacent untreated sites (on mesial and distal) via mixed-modeling regression analyses. Results: From 1 to 9 years, the ADM-treated isolated recessions showed a relapse from 77% to 62% mRC (P&nbsp

Objective To assess the clinical efficacy and esthetic outcome of porcine-derived dermal collagen matrix in comparison with connective tissue graft in the treatment of multiple adjacent gingival recessions (MAGR), 6 and 12 months after the surgery. Materials and methods Twenty patients with bilateral type I MAGR were treated randomly with porcine-derived dermal collagen matrix (test site) or connective tissue graft (control site) in combination with a modified coronally advanced tunnel technique. The primary objectives were to evaluate the mean and complete root coverage. The secondary objectives were to assess keratinized tissue width, gingival thickness gain, and root coverage esthetic score. Results Six and 12 months postoperatively, both groups achieved significant improvements in all clinical parameters compared to baseline, with no statistically significant differences between the groups. Mean root coverage change (Δ12m - 6 m) was statistically significant between the groups in favor of connective tissue graft, and twice as many patients exhibited a complete coverage of all recessions in the control group than the test group. Conclusion The porcine-derived dermal collagen matrix combined with a modified coronally advanced tunnel technique resulted in satisfactory clinical and esthetic outcomes, which were similar to connective tissue graft. Clinical significance Porcine-derived dermal collagen matrix (XDM) may be proposed as a substitute for connective tissue graft in multiple adjacent recession treatment due to successful root coverage, a significant increase of gingival thickness, and high esthetic outcomes. The clinical benefits for the use of XDM could be: (a) second surgical wound avoidance, (b) patient discomfort decrease, and (c) lower complications' rate.

AIM The aim of this randomized clinical trial was to compare clinical and volumetric outcomes of tunnel technique (TUN) with subepithelial connective tissue graft (CTG) versus coronally advanced flap (CAF) with enamel matrix derivate (EMD) 2 years after gingival recession (GR) treatment. MATERIALS AND METHODS Twenty-three patients contributed 45 Miller class I or II GR. At baseline and follow-up examinations, study models were collected. Their three-dimensional scans allowed precise computer-assisted measurement of recession depth (REC), complete root coverage (CRC), percentage of root coverage (RC), pointwise (pTHK) and mean areal (aTHK) marginal soft tissue thickness. Clinical examination delivered probing depths (PPD) and height of keratinized tissue. RESULTS 24 months after surgery, digitally evaluated CRC was present in 60.0% of the TUN + CTG and 0.0% of the CAF + EMD-treated sites (p

Introduction Papilla reconstruction relies on similar principles as those applied to soft tissue grafting for recession defects; however, it is uniquely challenging from a surgical perspective because of the small size and lack of a blood supply. Several techniques have been used to reconstruct lost papilla; however, there are no prescribed techniques for this specific application. Case presentation This report describes a novel technique, herein called, the "tube technique" for treating interproximal recession and reconstructing the interproximal papilla, and documents two cases using the tube technique. An increase in attachment levels was observed in Case 1 (5 mm) and in Case 2 (4 mm) after using this surgical technique for papilla reconstruction. Conclusion The tube grafting technique requires technical precision. Although when executed carefully, it results in predictable reconstruction of the interproximal papilla. Use of the tube technique helps mitigate issues associated with inadequate flap thickness, blood supply, and flap retraction.