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Background: The mucogingival conditions associated with the recession defects at the mandibular anterior region, not only make plaque control difficult to be performed by the patient but also pose a problem in passively advancing the tissues at the recipient site. This surgical technique is used to treat multiple recession defects in the mandibular anterior region. Materials and Methods: Twenty-five sites in 17 subjects (11 women and 6 men) underwent modified bridge flap and de-epithelized gingival unit graft (d-GUG) as a single-step treatment modality to cover the denuded root surface, as well as increase the width of keratinized gingiva in recession type 1 gingival recession defects in the mandibular anterior region. Results: Nearly 60% of sites in our study showed complete root coverage, with a mean root coverage percentage of 88.08%. Furthermore, keratinized tissue width, keratinized tissue thickness as well as vestibular depth showed statistically significant increases as compared to baseline levels. Conclusion: Thus, the modified bridge flap technique using d-GUG within the limitations of our study design, showed promising results in terms of recession coverage as well as management of the difficult mucogingival conditions at the mandibular anterior region.

Innovations in surgical techniques have improved the esthetic outcome and predictability of root coverage procedures in recent years. A free gingival graft (FGG) augments the attached gingiva, but the compromised blood supply precludes its use in root coverage. In the surgical technique described in this case report, the FGG kept over a laterally placed periosteal flap enhanced the outcome. A laterally flipped periosteal flap was adapted over the root surface using resorbable sutures. The free graft was secured at the recipient site with cyanoacrylate adhesive, and adaptation was ensured with suspensory sutures. Satisfactory root coverage was appreciated and maintained at 6 months with excellent functional outcomes. Adequate width of the attached gingiva and vestibular depth were also noticed at the recipient site. The patient was highly satisfied with the obtained results, which were maintained until the 1-year postoperative period.

The importance of esthetics is increasing for the patients as well as for the dentist. With a high incidence that rises with age and a complicated soft-tissue pathology caused by a wide variety of factors, gingival recessions are a common but troublesome dental problem. They are characterized by the exposure of the root surface of the teeth due to the apical migration of the gingival border beyond the cemento-enamel junction, and they cause both functional and cosmetic disruptions. Many different surgical approaches have been offered over the years to address gingival recession, all with the goal of providing enough root coverage and achieving aesthetically pleasing results. No matter the amount of defects, Zucchelli's method is beneficial in terms of root coverage and keratinized tissue gain when treating many neighboring recessions. In this case study, Zucchelli's coronally advanced flap is used to treat numerous neighboring gingival recessions.

Gingival recession (GR) is considered a public health problem which is highly prevalent across different populations. Accuracy of psychometric properties of prevalence estimates of GR reported in epidemiological studies is important to facilitate setting public health goals, planning of public health programs, implementation of best practices and thereby developing public health policy. However, the reported prevalence estimates are influenced by the methodological variations among different studies, as observed in our recently published systematic review and meta-analysis on the global prevalence of GR. It substantially limits the comparability between studies and inferences about the true global variation in the prevalence of GR are difficult to establish. To address these issues, this commentary suggests to follow the standardized principles related to study design, clinical examination protocol, and characteristics of study subjects in future epidemiological studies on prevalence estimates of GR. Furthermore, the inclusion of additional domains in the reporting data is suggested for a deeper insight into the patterns of GR in different populations. Our suggestions are derived from a pragmatic approach and their consistent implementation would improve the reporting quality and achieve uniformity in future studies, thus benefitting the research in this area.

Rough surfaces of dental implants, when exposed to the oral environment, are conducive to biofilm colonization and can predispose the affected implant to periimplantitis. Recession coverage using soft-tissue grafts is one of the treatment modalities used for the treatment of exposed implant threads. Recession coverage on the palatal aspect of maxillary implants is difficult due to the firm nature of the palatal mucosa and, consequently has not been widely documented in the literature. This case report documents a novel double-pedicle technique for palatal recession coverage on a dental implant. Two pedicle grafts were obtained from either side of the implant with the mucosal recession: a full-thickness lateral-pedicle graft from the distal aspect and a subepithelial connective tissue pedicle from the mesial aspect. The connective tissue pedicle was stabilized first on the area of mucosal recession and was then covered with the distal full-thickness lateral pedicle. Complete recession coverage was obtained, and the result was observed to be clinically stable after 18 months of follow-up. The technique demonstrated in this report can be a useful tool for the treatment of localized palatal recessions on dental implants.

Background: Root coverage using subepithelial connective tissue graft (SCTG) is gold standard with few drawbacks such as requirement of second surgical site, reduced donor tissue availability, and increased surgical complications and pain. Periosteal pedicle graft (PPG) due to its rich source of pluripotent stem cells and nonrequirement of second surgical site could be a successful alternative for invasive SCTG. Therefore, current research aims to compare the amount of root coverage obtained with PPG to SCTG. Materials and Methods: Fifty-two single gingival recessions were included in the sample, with 26 patients allocated to the SCTG (control) and PPG (test) groups at random. At baseline, 3, and 6 months after surgery, clinical measurements of probing depth, clinical attachment level (CAL), recession depth (RD), recession width (RW), and width of keratinized tissue were taken. Results: Both procedures, i.e., SCTG and PPG, resulted in root coverage to a variable extent and a significant decrease in RD (1.69, 1.38 mm in SCTG and PPG groups, respectively) and RW, CAL gain is found in both the groups without any intergroup statistical variance. Complete root coverage (CRC) was obtained in 14 out of 26, i.e., 53.8% defects in both SCTG and PPG groups. A better comfort level is found in the group treated with PPG. Conclusion: Gingival recessions can be successfully treated with PPG, which has predictability comparable to SCTG and does not require a second surgical site.

About half of the cases of gingival recession are associated with the noncarious cervical lesion (NCCL), resulting in combined defects (CDs). NCCL negatively affects the root coverage outcomes. In addition, considering the morbidity associated with graft harvesting, soft-tissue substitutes (STSs) appeared as a suitable option for connective tissue grafts for surgical root coverage. Currently, the literature addressing the therapy of CDs employing STSs is scarce. Thus, the present review aimed to update the literature and outline the future perspectives about root coverage of CDs using STSs. A detailed literature search was conducted on MEDLINE, Web of Science, EMBASE, LILACS, Scopus, and Google Scholar databases using keywords and Boolean operators. Randomized clinical trials (2) and case reports (6) were included. None of the selected studies reported any adverse effect using STSs. Based on the limited evidence available, we cannot state that STSs may benefit the periodontal clinical and patient-centered outcomes. Randomized controlled trials are needed to assess the long-term outcomes, surgical approaches, and restorative protocols.

Background: Gingival recession (GR) has become a common problem among patients. GR is associated with increased accumulation of plaque, root caries, abrasion and cervical wear, and dentinal hypersensitivity. The present study aimed to examine the correlation between gingival biotypes and the occurrence of GR. Methods: The study initially recruited 94 subjects; however, 54 of them did not have any recession sites, and hence were discarded. Therefore, the analysis was performed on 40 subjects. The study particularly compared the relationship between the recession length (RL) and width along with the gingival thickness (GT). As such, different clinical parameters were analyzed, namely, RL, recession width (RW), keratinized gingival width (KGW), and GT. Results: Based on the statistical analysis (descriptive statistics and Pearson's correlation) conducted on the collected data, the study established that the gingival RL has a significant negative relationship with GT, which implied that the amount of thickness is inversely proportional to the RL. The study also found a significant positive correlation between RW and RL as well as between GT and KGW. Conclusion: Based on the findings, the study thus concluded that the gingival biotype (thickness) significantly determines the occurrence and extent of GR.

Aim: The present study aimed to assess the clinical outcome of root coverage following coronally advanced flap with or without amniotic membrane in Miller's class I or class II localized gingival recession in relation to anteriors. Methods: Five patients with bilaterally symmetrical Miller's class I or class II localized gingival recession were included in the study. Each patient was divided into control (without amniotic membrane) and test sites (with amniotic membrane) arbitrarily. Clinical parameters including plaque index, probing pocket depth (PPD), clinical attachment level (CAL), and depth and width of the gingival recession were recorded in a pro forma at baseline and in the 2nd, 4th, 12th week. The results were tabulated and subjected to statistical analysis using analysis of variance (ANOVA). Results: A 0.600-mm, 0.400-mm, 2.630-mm, and 2.616-mm reduction in PPD and gain in CAL were observed at control and test sites in the 12th week postoperatively and was found to be statistically insignificant (P = 0.580 and P = 0.871, respectively). Changes in depth and width of the gingival recession were observed and found to be maximum between base line (2.28 mm, 3.01 mm, 2.71, and 3.09 mm) and 2nd week (0.00, 0.00 mm, 0.23, and 0.20 mm) but without statistical significance. Conclusion: From the above results of the study, it could be concluded that the use of amniotic membrane as a barrier along with coronally advanced flap did not influence the clinical outcome of root coverage procedure.

Background: Gingival recession is defined as the apical migration of gingival margin to the cementoenamel junction. Recently, amnion membrane, the third-generation membrane which is a placental-derived tissue, has been introduced. Materials and Methods: Study included 45 subjects with age group of 20–60 years of both genders. Patients with Miller's Class I and Class II gingival recession were selected for the study. The progress was assessed at baseline one, three, and six months observation interval through clinical parameters RD, RW, PD, and CAL at the end of six months. Results: Recession depths in the first, third, and sixth month were 1.82 ± 0.442, 1.31 ± 0.47 mm, and 0.91 ± 0.29, respectively, which showed a significant reduction from the baseline. Recession widths in the first, second, and third weeks were 3.04 ± 0.442 mm, 1.31 ± 0.47 mm, and 1.49 ± 0.59 mm, respectively. There was a statistically significant reduction (P > 0.005) when compared to the baseline. Pocket depths in the first, third, and sixth month were 0.93 ± 0.447, 0.42 ± 0.50, and 0.24 ± 0.43 (P > 0.005) which is significant when compared to baseline. Clinical attachment levels in the first, third, and sixth month were 2.73 ± 0.751, 1.78 ± 0.70, and 1.18 ± 0.53 (P > 0.005) which is significant compared to six months. Conclusion: Within the limitations of the present study, the data obtained by periodic assessment of the clinical parameters indicate the use of amnion membrane and hyaluronic acid, and proper technique may thus be the panacea for root coverage procedure.

Background: The vestibular depth (VD) varies to a great extent among individuals and at different points of reference. The normal range of depth of the vestibule at different areas in the mouth remains to be established. Aim: The primary objective of this study is to assess the average VD around different teeth in the maxilla and the mandible. Furthermore, an attempt has been made to identify the various ranges of VD and understand what could be suggestive of a normal VD. Materials and Methods: The participants included were divided into four age groups, i.e., 6–14 years (Group 1), 15–30 years (Group 2), 31–50 years (Group 3), and >50 years (Group 4). Further, the subjects were grouped into subgroup A, periodontally healthy and subgroup B, gingival recession (GR). Group 1, 2, and 3 included 30 subjects each in subgroup A, while Group 4 subgroup B had 18 subjects. In case of subgroup B, Group 2 included 9 subjects, Group 3–31 subjects, and Group 4–30 subjects. Measurements included the depth of vestibule from 2 reference point, i.e., gingival margin (GM) and incisal edge (IE). Results: In subgroup A, the average VD from GM was found to be the least in the Group 1 i.e., 6–14 years (9.2 mm ± 4.26 in maxilla and 7.01 mm ± 3.14 in the mandible) and the highest in the Group 4 i.e., >50 years (12.06 mm ± 2.73 in maxilla and 10.08 mm ± 2.58 in the mandible). In the case of subgroup B, the least depth from GM was found in the Group 3 i.e., >30–50 years (9.44 mm ± 2.73 in the maxilla and 8.32 mm ± 1.7 in the mandible) and the maximum depth in the Group 4 (>50 years) (11.28 ± 2.31 in maxilla and 9.42 ± 2.87 in the mandible). Conclusion: The study provides a range of VD s in different areas of the mouth in periodontally healthy and individuals with GR, which will contribute to constitute a normal range of VD.

Introduction: Gingival recession was treated with gum drop technique (GDT) along with pericardial membrane, advanced platelet rich fibrin (A-PRF) and injectable platelet rich fibrin (i-PRF) in the defect sites for regeneration of soft tissue. Patient Concerns: Several 3-4 mm of recession sites in the maxillary right and left canine and premolar region. These sites were selected and divided into two groups: A and B based on the application with A-PRF and pericardium, respectively. Probing pocket depth (PPD), clinical attachment level (CAL), recession height (RH), recession width (RW) and keratinized tissue width (KTW) were assessed. The keratinized tissue width (KTW) was measured as the distance between the marginal gingiva and the mucogingival junction. Treatment: The defects were treated with the GDT following irrigation with i-PRF and followed up for 6 months. Both groups achieved significant root coverage which was stable even after 6 months post operatively. Keratinized tissue showed a 1 mm gain with pericardial membrane.

Mucogingival problems are associated with recession of gingival margin, shallow vestibular depth, and gingival margin pull by aberrant frenum. Till now, various individualistic and successful surgical techniques have been described in the literature for mucogingival problems. These case series enumerate the gingival recession cases, managed by bridge flap technique using diode laser which is a single-step procedure to cover the earlier exposed root surfaces and extend the width of the attached gingiva. Postsurgical parameters were recorded at 6 months and 1 year.

Objectives: Gingival recession is a major concern as it causes unesthetic appearance during smiling, dentinal hypersensitivity, and root caries. Several surgical procedures have been undertaken to cover these exposed root surfaces, with the most predictable and effective being coronally advanced flap (CAF) with subepithelial connective tissue graft. Because amniotic membrane (AM) contains embryonic stem cells, it can be utilized as a possible autograft/periodontal-guided tissue regeneration substitute. Magnification improves visibility and causes less tissue trauma during surgery. Therefore, the goal of this study was to evaluate the efficacy of root coverage with AM utilizing a conventional macrosurgical technique (MaT) versus microsurgical technique (MiT) employing loupes. Materials and Methods: This randomized clinical trial included 24 patients, 12 of whom were treated using MaT and 12 utilizing MiT with 4x magnification loupes. Clinical parameters such as amount of root coverage in terms of vertical gingival recession (VGR), horizontal gingival recession (HGR), increase in width of keratinized gingiva (WKG), clinical attachment loss, and patient satisfaction analysis for the evaluation of discomfort, dentinal hypersensitivity, and esthetics were recorded at baseline and 3 and 6 months after surgery. Results: Both the groups demonstrated improvement in all clinical parameters. However, the test group showed a significant reduction in VGR and HGR with a mean difference of 0.95 mm (P = 0.007) and 2.167 mm (P = 0.002) at 6 months, respectively. There was no significant difference in the mean WKG and hypersensitivity scores between the two groups. Conclusion: Both treatment approaches, i.e., MaT and MiT with the use of AM, were effective in improving the clinical parameters and the amount of root coverage. However, the test group showed a better reduction in discomfort and hypersensitivity postoperatively with enhanced esthetic outcomes. Clinical Relevance: Magnification-assisted root coverage attained predictable outcome.

Gingival recession is an exposure of root surface due to the apical migration of the marginal periodontal tissues apical to cementoenamel junction. Many therapeutic options are available for the treatment of gingival recession, among these techniques, Vestibular Incision Subperiosteal Tunnel Access (VISTA) technique in combination with collagen membrane (BIO-GIDE) was used in the present study for the treatment of multiple gingival recession defects in the maxillary anterior region. In the VISTA technique, a single vestibular incision provides broader access to the entire surgical area which reduces the possibility of traumatizing the gingiva, with little or no scar formation. And the use of collagen membrane offers several advantages over other techniques as it is biocompatible, there is no need for donor site or secondary surgical procedure there by reducing post-harvesting morbidity and patient discomfort. In this case report VISTA technique in combination with collagen membrane was found to be a reliable treatment method for multiple gingival recession defects.

Context: Gingival recessions are commonly seen in the dentally cognizant population as well as those with limited access to dental attention. When root coverage is planned, the ultimate goal is to obtain complete root coverage, thus restoring the lost gingival unit covering the root. Aims: To determine the efficacy of sticky bone and concentrated growth factor (CGF) membrane along with a coronally advanced flap (CAF) as compared to CAF alone in treating Miller's Class I and Class II gingival recessions (Cairo RT1). Settings and Design: The current study was a randomized double-blind controlled trial on 15 subjects using a split-mouth design. Materials and Methods: Fifteen subjects who were systemically healthy and had recession sites (30 sites) were randomly assigned to two groups: Group A (test group = CAF + CGF + sticky bone) and Group B (control group = CAF alone). Clinical outcome was assessed with parameters such as recession depth, recession width, keratinized gingival width, gingival mucosal thickness, and relative attachment level (RAL), and these were assessed at baseline and 1, 3, and 6 months. Results: A distinct improvement was observed in the depth and width of recession, RAL, keratinized gingival width, and mucosal thickness of the gingiva in the two groups from baseline to 6 months. Statistical significance was not seen on intergroup comparisons. Conclusions: Thus, clinical outcomes revealed noticeable improvement for both the groups. However, statistically, the efficacy of CGF and sticky bone was not perceived to be superior to that of CAF alone.

Objective: The objective of this study is to assess the prevalence of gingival recession (GR) and associated etiological factors among school children. Methodology: The study sample consisted of 2095 children from the Nellore region divided into three groups of age ranges from primary dentition (12 years) respectively, attending the department of pediatric and preventive dentistry and the school dental health programs organized by the department. The clinical examination involved measuring GR using William's periodontal probe and evaluating associated etiological factors. Data were statistically analyzed using the Chi-square test. Results: The GR among the study population was 7.9% (n = 165). Among them, males were 46% and females were 54% (P > 0.05). The GR was more in children in the 7–12 years age group (75%), followed by 12 years (4%) age groups. The associated factors include malocclusion (69%), deleterious habits (5%), and anomalies (26%). Anomalies showed an association with GR (P < 0.05) compared to malocclusion and deleteriousness habits (P > 0.05). Conclusion: The prevalence of GR is 7.9%, and GR is more prevalent in males and the 7–12 years age group. GR is associated with transient malocclusion, deleterious habits, and anomalies.

Aim: The main focus of the study is to determine the difference between the efficacy of xenogeneic collagen matrix (XCM) versus platelet-rich fibrin (PRF) adjunct to coronally advanced flap to treat the gingival recession.Background: Because of esthetic concerns or root hypersensitivity, typical necessity dictates for buccal gingival recession treatment. This study was planned to evaluate and compare the efficacy of XCM with PRF in the treatment of the recessed gingiva. Materials and Methods: Thirty-four sites with Cairo's RT1 and RT2 gingival recessions were taken, out of which 17 sites received XCM (test) and 17 sites received PRF (control). A periodontal treatment was performed first, followed by a re-evaluation. All clinical measurements, including recession height (RH), recession width (RW), clinical attachment level (CAL), keratinized tissue width, and keratinized tissue thickness, were taken before surgery (baseline) and at a 6-month interval following periodontal surgery. Landry's healing index was also measured at the 1st and 2nd weeks after surgery. Results: None of the acquired data implies a significant difference statistically for CAL, RW, RH, thickness, and width of keratinized tissue (WKT) at 6-month interval between both the groups. Comparison of healing at the 1st and 2nd week intervals among both the groups showed no statistical significance. No significant difference among both Groups A and B was seen according to the intergroup analysis in terms of periodontal parameters such as CAL (P = 0.374), RW (P = 0.542), RH (P = 0.890), WKT (P = 0.877) and thickness of keratinized tissue (P = 0.547), and Landry's healing index (P = 0.429). Conclusion: In consideration of the patient's comfort and the method's simplicity, it can be concluded that PRF or XCM can be employed as an alternative.

Aims: The purpose of this randomized controlled clinical trial was to clinically assess soft tissue augmentation and compare patients' morbidity and root coverage outcomes of coronally advanced flap (CAF) with subepithelial connective tissue graft (SCTG) versus de-epithelialized free gingival graft (DFGG) in the management of Miller Class I and II gingival recession. Materials and Methods: Twenty-eight patients with Miller's Class I or II gingival recession (GR) defects were randomly assigned into two equal parallel groups treated with either CAF + SCTG, harvested using single-line incision technique (control), or CAF + DFGG (test). Gingival thickness (GT), recession depth, recession width, percentage of root coverage, keratinized tissue width, pocket depth, and clinical attachment level were measured at baseline and 3 and 6 months postoperatively. Patient-reported outcomes were assessed postoperatively, including pain, stress, bleeding, and inability to chew. Patients' overall satisfaction and root coverage esthetic scores were recorded at 6 months. Results: Both groups demonstrated a statistically significant improvement in all clinical outcomes after 3 and 6 months compared to baseline. DFGG showed a statistically significant increase in GT after 6 months. No statistically significant difference was detected in other clinical outcomes between both groups at different time intervals. Both treatments achieved 92.9% complete root coverage. Patients treated with CAF + DFGG reported significantly higher stress and inability to chew scores after 2 weeks than those treated with SCTG. There were no significant differences in patient satisfaction between both groups. Conclusions: CAF + SCTG and CAF + DFGG were both effective and can be applied safely in treating Miller Class I and II GRs.

Aims: The aim of the study was to compare the clinical efficacy of platelet-rich fibrin (PRF) and connective tissue grafting in the treatment of gingival recession (GR) using pouch and tunnel (P and T) technique. Materials and Methods: A total of 40 Class I or Class II GR defects in 17 patients were randomized treated with P and T with PRF (Group I, n = 20) and P and T with CTG (Group II, n = 20). The parameters measured were plaque index (PI), gingival index (GI), probing pocket depth (PPD), clinical attachment level (CAL), horizontal gingival recession (HGR), vertical gingival recession (VGR), width of attached gingiva (WAG), width of keratinised gingiva (WKG), gingival thickness-mid buccal (GTMB), and gingival thickness interdental papilla (GTIP). Postsurgical discomfort level (PSDL), hypersensitivity score (HS), and patient esthetic score (PES) were recorded using visual analog scale (VAS). The PI, GI, PPD, CAL, HGR, VGR, WAG, WKG, GTMB, and GTIP were assessed at pretreatment (baseline) and 1-, 3-, and 6-month posttreatment. The PSDL, HS, and PES were assessed at baseline, day 10, 1, 3, and 6-month posttreatment. Results: P and T with PRF and CTG resulted in root coverage of 73.75% ± 7.80% and 70.83% ±8.26%, respectively. Patient response and acceptance for the surgical treatment modality showed less discomfort and better esthetics in Group I as compared to Group II. Conclusions: PRF treated sites were comparable to the gold standard CTG with better patient acceptance and a lesser invasive approach in terms of graft procurement.

Context: The mucogingival junction (MGJ) is one of the important anatomical entities which mark the apical termination of attached gingiva, except that at palatal side. Its position is genetically determined like other organs and tissues in our body. There are certain anatomic aberrations such as abnormal teeth eruption or high frenal attachments and pathologies, such as periodontitis, leading to its absence. There are no studies on the prevalence of teeth having no clinically detectable MGJ. There is a resurgence of importance of attached gingiva, reflected by the definite presence of MGJ, through the field of dental implantology. Aims: We aim to evaluate the prevalence of teeth without clinically detectable MGJ on the buccal aspect of dentate alveolar processes. Settings and Design: This cross-sectional observational clinical study was conducted in the department of periodontology which was approved by the institutional ethical committee. Materials and Methods: Periodontally healthy as well as diseased patients of age 18–50 years were included in the study. The detection of MGJ was carried out by visual method, tension test, rolling probe method, and Lugol's iodine solution, and confirmation from any two methods was considered for the absence of MGJ. The etiology of MGJ absence (gingival recession, pocket till MGJ, trauma, abnormal frenal attachment, malposition of tooth, abnormal habits, severe abrasion, etc.,) was also evaluated. Statistical Analysis Used: Simple statistics in the form of averages and percentages were used for calculations. Results: A total of 130 subjects (3637 teeth) were examined out of which 32 (24.6%) subjects showed no clinically detectable MGJ. In all subjects, on an average, every subject has 28 teeth and out of the total 3637 teeth analyzed, only 91 (2.5%) teeth were without detectable MGJ. Conclusion: Almost 25% of the population may show a tooth or few teeth without a clinically detectable MGJ. The prevalence of teeth without clinically detectable MGJ per mouth is very low at 0.7 (approximately 1 tooth/subject).

Although techniques such as subepithelial connective tissue graft are now widely used for root coverage procedures, free gingival graft (FGG) continues to be a common mucogingival procedure used to increase keratinized tissue dimensions. However, the palatal donor site heals with secondary intention and requires a longer healing time causing more discomfort and pain to the patient. A healthy 22-year-old female patient presented with Miller's class II recession in relation to the tooth 31 with high frenal attachment and a shallow vestibule, which was treated using FGG, and the donor site was bandaged with advanced-platelet-rich fibrin (A-PRF). This report evaluates the healing of the donor site over a 12-month period and assesses the root coverage as well as the postoperative discomfort after the harvesting of graft. In terms of healing, the use of A-PRF membrane as a palatal bandage appears to accelerate healing at the donor site, thereby reducing postoperative complications.

Background: Gingival recession leads to root surface exposure devoid of periodontal attachment. Recession defects with interdental attachment loss (RT2, RT3), further increase the avascular area which is critical for survival of soft-tissue grafts. Nonsubmerged grafts such as free gingival grafts and gingival unit grafts (GUGs) rely primarily on plasmatic circulation from the recipient area during the initial stages of healing for its survival. Methods: Nineteen isolated RT2 recession defects, in the mandibular anterior region, were treated using GUG. The clinical parameters of recession depth (RD), recession width (RW), interdental clinical attachment levels (iCAL) were measured at baseline. Percentage of mean root coverage (MRC) was calculated at 3 months and 6 months. Results: The percentage of mean root coverage (MRC) achieved at the end of 6 months was 81.79% ± 6.16%. Further, Simple linear regression analysis to predict MRC at 6 months using baseline RW revealed, for every 1 mm decrease in RW, the percentage of root coverage significantly increased by 5.25% (P = 0.04). Conclusion: GUG can be used as an alternative treatment modality to achieve successful root coverage in RT2 recession defects. Baseline RW can be used to predict the outcome of root coverage at the end of 6 months.

Gingival recession is a commonly encountered chief complaint in a dental office, most commonly presenting as pain or sensitivity on intake of food or sometimes just seen as an esthetic concern which may present in a localized or generalized form. Such interest toward dental esthetics has encouraged clinicians to formulate newer minimally invasive surgical techniques which are short but still deliver predictable long-term benefits in restoring the patient's smile. One such method was evaluated in the present short communication where a commercially available, biodegradable, and volume-stable collagen membrane was used to manage gingival recession instead of donor grafts. The clinical parameters which were assessed after a period of 9 months demonstrated an increased width of attached gingiva and overall tissue thickness after surgical intervention. These findings along with successful mean root coverage of the upper left canine would seem to challenge the results obtained while using similar procedures and donor grafts, the age-old gold standard bio-filler. The dawn of esthetic dentistry is here with more emphasis on how physical appearance bolsters confidence and morale among younger individuals. Among the various complaints concerned with patient's esthetic, periodontal plastic surgery is one of the more challenging procedures. The real obstacle while performing such procedures is achieving complete or partial root coverage over an avascular bed, whereas multiple variables seem to affect the overall clinical outcome.

Background: Oral diseases are among the most common diseases which could not dissociate from general conditions with regards to impacts on quality of life (QoL). The present study is aimed to assess the impact of the severity of periodontal disease on oral health QoL using oral health-related quality of life (OHQoL)-UK questionnaire. Materials and Methods: The OHQoL-UK questionnaire consists of 16 variables within four domains made up of symptoms, psychological, social dimensions, and physical dimensions. Summing up the responses produce overall OHQoL-UK scores ranging from 16 to 80. Internal consistency was assessed using Cronbach's reliability coefficient. Each patient underwent a periodontal examination including periodontal attachment levels with Williams' periodontal probe as part of his or her routine assessment by one clinician collaborating on the study. Results: Within 200 patients participating in this study, 51% were < diploma, 32% were < bachelor's degree, and 17% were bachelor's degree and higher. Patients with higher educational level have a higher mean QoL score (P = 0.0001) which was statistically significant in regard to all aspects. Conclusion: The mean QoL score was significantly lower in patients with severe periodontitis when compared to patients with mild periodontitis, patients with better academic qualification have higher mean QoL score. According to the effect of severity of periodontal condition and educational level on QoL, required intervention should be done for treatment to improve QoL as a result.

Chronic periodontitis is precipitated as periodontal pockets, gingival recession (GR), decreased keratinized gingiva, and vestibular depth (VD). In the mandibular anterior region, it is frequently seen as GR and decreased VD. The development of high frenal attachment due to loss of periodontal support further increases the rate of progression of the disease and compromises the condition of the incisors. As mandibular incisors have short roots, they usually tend to become mobile early during the progression of periodontal disease. In this case report, a single-step surgery was done, which included periodontal flap surgery with bone augmentation in relation to mandibular anterior teeth. Following this, the width of keratinized tissue was increased using Diode laser by deepening the vestibule. This combined procedure can cover the exposed roots and increase the width of keratinized gingiva.

Background: Multiple gingival recession (MGR) coverage, especially in esthetic area, demands a high patient satisfaction. Coronally advanced flap modifications, namely Zucchelli's technique (ZT) and vestibular incision subperiosteal tunnel access (VISTA), are techniques, recommended in the correction of MGR. Aim: The purpose was to comparatively analyze the ZT and VISTA technique reinforced with the platelet-rich fibrin membrane in the management of MGR. Materials and Methods: This split-mouth, randomized study comprised 16 consenting, systemically healthy participants. The bilateral Miller's multiple class I and II lesions were managed with ZT and VISTA technique and had a follow-up period of 18 months. Gingival thickness (GT), mean percentage of root coverage, and patient-centered outcome scales, including patient comfort score, patient esthetic score, and hypersensitivity score, were the primary outcome measures. Further clinical parameters assessed were gingival index, probing depth, clinical attachment level, and width of keratinized gingiva. Statistical Analysis and Results: Paired t-test and unpaired t-test were used for intragroup comparison and intergroup analysis, respectively. While both the techniques exhibited high root coverage percentage (VISTA: 93.95% and ZT: 96.84%), statistically significant difference was noted with patient esthetic score and surgical mortality score in VISTA. Conclusion: Both ZT and VISTA were effective in terms of root coverage and GT augmentation in MGR management. From the patient's perspective, they preferred VISTA technique over ZT, stating its minimal postoperative morbidity and improved esthetic outcome. Hence, within the limitations of this study, the VISTA technique was found to be a superior alternative compared to that of ZT in MGR management.

Gingival recession predisposes to functional and aesthetic concerns, for which many surgical procedures are available. Among these, till now subepithelial connective graft is considered as the gold standard technique for its higher predictability of achieving recession coverage. However, it does not heal by new attachment, thus many techniques to promote new attachment such as root biomodification are done. This case enumerates the use of Er, Cr: YSGG laser for root biomodification to treat a wide and deep gingival recession defect by subpedicle connective tissue graft. Six months results show better recession coverage inspite of a wide and deeper defect. Thus, Er, Cr: YSGG laser can be an adjunctive tool to enhance the recession coverage.

Background: Autologous platelet concentrate (APC)/platelet-rich fibrin (PRF) of second and third generations has increased use in periodontics to optimize wound healing. Few systematic reviews (SRs) have reported improved clinical outcomes, while other studies reported significantly better results for the connective tissue graft (CTG). There is still unclear clinical evidence about APC/PRF use to treat gingival recession (GR) defects. Then, the purpose of this SR was to evaluate the use of APC/PRF membranes (2nd and 3rd generations) in root coverage (RC) procedures and assess its efficacy as a substitute biomaterial. Materials and Methods: An electronic search was conducted in PubMed, Cochrane Central, Web of Science, Google Scholar, BookSC databases, and gray literature. The search strategy, without date restriction up to April 2020, included keywords as “platelet-rich fibrin,” “autologous platelet concentrates,” “blood,” “systematic review,” “periodontics,” “surgery,” “tissue,” “gingiva,” “gingival recession,” “connective tissue,” “graft,” and “root coverage.” The methodological quality was evaluated through the AMSTAR2, and a population, index test, comparator, outcome strategy was used to assess specific clinical parameters such as recession depth, clinical attachment levels, and RC outcomes. Results: Nine SRs were included. Only three articles described the technique of APC/PRF production. Three studies reported unfavorable outcomes using APC, while six reported favorable results and postoperative discomfort reduction. Articles included in this SRs that provided information about APC/PRF membranes (n = 13) showed no significant difference between APC/PRF and the control group for the parameters analyzed. Conclusions: This implies that APC/PRF may be considered a feasible substitute biomaterial for treating GR defects, although the CTG still provides superior outcomes. Further long-term and controlled studies are needed to verify this finding.

Background: The most common technique for gingival augmentation is free gingival graft (FGG). The aim of this study is to clinically compare the efficacy of FGG harvested with erbium: yttrium-aluminum-garnet (Er: YAG) laser stabilized with 5-0 silk suture in comparison to N-butyl-2-cyanoacrylate tissue adhesive in increasing the width of keratinized gingiva (WK) for the management of Miller's Class I and II gingival recession. Methodology: Forty-eight gingival recession defects were divided into two Groups I and II. Group I sites were treated with FGG harvested using Er: YAG laser stabilized with 5-0 silk suture and Group II sites were treated with FGG harvested using Er: YAG laser stabilized with N-butyl-2-cyanoacrylate tissue adhesive. Clinical parameters such as gingival recession depth, clinical attachment level (CAL), gain in gingival tissue thickness, and WK were recorded at baseline and 3 and 6 months postoperatively. Results: A significant reduction in gingival recession defects, gain in CAL, increase in WK, and gain in gingival tissue thickness were observed in both the groups. Intergroup comparison of gingival recession defects, CAL, WK, and gingival tissue thickness yielded nonsignificant differences. Conclusion: Within the limits of this study, it can be concluded that both 5-0 silk suture and n-butyl-2-cyanoacrylate were equally efficacious in the stabilization of FGG. N-butyl-2-cyanoacrylate was easy to apply, consumed less operating time, and had no adverse effect. Hence, cyanoacrylate can be used as an alternative to suture in stabilization of FGG.

Background: The aim of this study was to compare the effectiveness of root coverage through vestibular incision subperiosteal tunnel access (VISTA) technique using platelet rich fibrin (PRF) or subepithelial connective tissue graft (SCTG) in multiple gingival recessions. Materials and Methods: A total of 20 patients with multiple gingival recessions were included, and 10 subjects were randomly allocated to test group (VISTA with PRF) and 10 patients to control group (VISTA with SCTG). Clinical parameters were recorded at baseline, 3 months, and 6 months. Patient's response toward the treatment was also assessed by questionnaire. Results: All the clinical parameters in the study have showed better results in test group when compared to control group after a follow up period of 6 months with statistical significance. Conclusion: The results of the present study suggested that multiple gingival recessions can be successfully treated with both procedures, but better root coverage and a greater increase in keratinized tissue were achieved with the VISTA technique with SCTG. All the patients in both groups felt it was worth undergoing the treatment.

Background: Prognosis in the management of Millers Class III or IV gingival recession is often fair to poor, which is further decreased by factors such as inadequate keratinized gingiva. Very few modalities show long-term success in the management of gingival recession with inadequate keratinized gingiva, free gingival graft (FGG) being one such technique. Materials and Methods: Ten individuals with Millers Class III or IV recession and inadequate keratinized gingiva were recruited for the study. The first surgical procedure involved the FGG procedure to increase the width of keratinized gingiva (WOKG). Patients were recalled after 3 months for the second surgical procedure, where the flap was coronally advanced. They were recalled 9 months after the second surgery. WOKG was examined at baseline and 3 months (before the second surgical procedure). Recession depth (RD) and clinical attachment level (CAL) was examined at baseline, at 3 months (before the second surgical procedure) and at 12 months (9 months after the second surgical procedure). The percentage of root coverage was measured at 12 months from baseline. Results: Significant increase in WOKG was seen at 3 months. Significant decrease in RD and CAL was observed at 12 months from baseline. The percentage of root coverage was 76.4%. Conclusion: Two-stage FGG procedure can be a successful modality in the management of Millers Class III or IV recession with inadequate keratinized gingiva. This technique improves the prognosis of such compromised cases.

Aims: This study was a single-arm trial to obtain preliminary data on the efficacy of collagen membranes impregnated with recombinant human fibroblast growth factor-2 (rhFGF-2) in the treatment of Miller's Class I and II gingival recessions. Materials and Methods: Twenty-one individuals (34 sites) presenting with localized Miller's Class I and II gingival recessions were included in this study. Following a standard surgical protocol, rhFGF-2-impregnated membranes were placed in sites with gingival recession. Clinical parameters such as width of keratinized gingiva (wKG), recession depth (RD), and probing depth were measured at baseline and after therapy completion at 3 and 6 months. Results: Most of the sites exhibited favorable clinical healing; the most common complications were persistent edematous and inflamed gingivae beyond 1 week (n = 3), development of residual periodontal pockets (n = 2), and no reduction in RDs (n = 2). Significant improvements in wKG and RD were noted from baseline to 6 months. Conclusion: rhFGF-2-impregnated collagen membranes showed promising results in terms of increasing the wKG and recession coverage. A comparison with other standard therapies and agents in subsequent trials may shed more light on the clinical efficacy of this material.

Introduction: One of the most common aesthetic concerns associated with the periodontal tissue is gingival recession. Covering the root surface exposed during the disease process with soft and hard tissue surgeries may decrease these problems. The aim of the study was to compare the clinical outcome of coronally advanced flap (CAF) procedure in root coverage with platelet-rich fibrin (PRF) or subepithelial connective tissue graft (SCTG) for the treatment of Miller's Class-I gingival recession. Materials and Methods: The split mouth design consisted of 15 patients with a total of 30 sites with bilateral Miller's Class-I recession on anterior teeth. They were randomly assigned into PRF group (test) or SCTG group (control). Statistical Analysis: The values obtained were tabulated and analyzed using Mann--Whitney U-test and repeated measure ANOVA test. All the statistical tests were carried out using SPSS software. Results: It was observed that both the autogenous grafts healed without any complications and at the end of 6 months the grafts were stable and recession coverage between 88-100% was achieved. Conclusion: CAF procedure with either PRF or SCTG were both effective in the treatment of Miller's Class-I gingival recessions. CAF with SCTG showed better root coverage than CAF with PRF. Use of PRF offered additional benefit of avoiding second surgical site. Therefore, PRF can be considered as a viable alternative to SCTG in certain cases.

Aims: The aim of this study was to compare outcomes of lateral osteoperiosteal flap (OPF) and lateral pedicle flap (LPF) in the treatment of Miller's Class III gingival recession. Materials and Methods: Twenty-two anterior maxillary and mandibular sites from 16 participants requiring mucogingival surgery for Miller's Class III gingival recession were included in the study. Eleven sites each were assigned to two groups. OPF: sites treated with lateral OPF and LPF: sites treated with LPF. Recession depth (RD) and bone level (BL) were the primary outcome variables, and probing pocket depth, clinical attachment level (CAL), and keratinized tissue width (KTW) were the secondary variables. All the variables were recorded at baseline (on the day of surgery), 3 months, and 6 months postsurgery. Results: OPF and LPF resulted in similar reduction in RD at the end of the study period (P ≤ 0.001). There was no statistically significant difference in RD between OPF and LPF at 6 months (P = 0.862). OPF-treated sites showed greater gain in BL at 3 months (P = 0.0004) and 6 months (P = 0.0002). No significant differences were seen between OPF and LPF in measures of PD, CAL, and KTW. Conclusion: Data from this 6-month trial seem to suggest that OPF can be used as an alternative procedure for treating Miller's class III recessions with adjacent edentulous sites or wide interproximal spaces. Long-term effects of OPF on the stability of root coverage outcomes are an exciting direction for future research.

Background: Gingival recession (GR) is a common clinical feature of periodontal disease and is an undesirable condition. More than 50% of the population has one or more sites with GR ≥ 1 mm. Material and Methods: In this study 15 subjects were subjected to initial periodontal therapy such as ultrasonic scaling and root planning with hand instruments and curettes. Patient is motivated for home care. The buccal fat pad is harvested and sutured in the gingival recession area and followed up for 6 months and root coverage was calculated. Results: At baseline mean recession of 5.60 ± 1.18 mm, probing depth of 0.73 ± 0.59 mm, clinical attachment loss of 6.40 ± 1.18 mm were recorded. At the end of 6 months, the mean recession was reduced from 5.60 ± 1.18 mm to 2.87 ± 0.74 mm, probing depth was increased from 0.73 ± 0.59 mm to 1.73 ± 0.70 mm and clinical attachment loss was decreased from 6.40 ± 1.18 mm to 4.53 ± 0.83 mm.The difference between baseline score and six months score for all three parameters are statistically significant. Conclusion: Buccal fat pad is a predictable procedure to cover Miller's class III and class IV gingival recession defects. There was a definitive improvement in clinical parameters (reduction in gingival recession, increased probing depth, gain in clinical attachment) after 6 months. There was 46.78% improvement in root coverage which was statistically significant.

Background: According to the American Association of Periodontology, subepithelial connective tissue graft (SCTG) is one the most reliable surgical technique available for the treatment of gingival recession (GR) with Miller's Class I defect. However, due to its various disadvantages, alternate grafts such as acellular dermal matrix (ADM) grafts have been introduced for recession coverage. The present study compares the clinical outcome of these two grafts in treating Miller's Class I GR. Materials and Methods: All the 15 patients participated in the study who had totally 30 bilateral Miller's Class I GR were divided randomly into SCTG group and ADM group each containing 15 defects. In the SCTG group, coronally advanced flap (CAF) with SCTG was performed, and in ADM group, CAF with ADM was done. Clinical parameters were measured on the day of surgery (baseline) and after 6 months. Data collected were statistically analyzed using paired and unpaired t-tests. Results: The analysis of the data collected at the baseline and 6 months later showed that there were no statistically significant differences in the recorded clinical parameters such as probing pocket depth, clinical attachment loss, and GR depth. ADM group showed a better color match than the SCTG group, while SCTG group achieved more keratinized tissue width than ADM group. Conclusion: From the outcome of the current study, we can conclude that ADM is an efficient substitute for SCTG for treating Miller's Class I GR. However, additional studies with greater number of samples and lengthier follow-up periods are necessary to validate the present inference.

Gingival recessions are one of the most prevalent periodontal diseases. Hypersensitivity and esthetics are the major concerns associated with recession defects. There are various treatment modalities for its management, but recently, minimally invasive techniques have gained much importance because of lower patient morbidity and comparable results when compared to conventional techniques. This case series represents a 6-month follow-up of a recently introduced pinhole surgical technique where the percentage of root coverage was found to be statistically significant.

Background: Malocclusion is known to cause plaque accumulation and periodontal breakdown. However, no previous study from Saudi Arabia has assessed this relationship in patients seeking orthodontic treatment for esthetics. Objective: The objective of this study was to investigate the relationship between malocclusion and periodontal disease in terms of gingival inflammation, probing pocket depth (PPD) and recession in patients seeking orthodontic treatment for esthetic improvement. Materials and Methods: This prospective cross-sectional study was conducted at the Outpatient Division of Periodontics, College of Dentistry, King Khalid University, Saudi Arabia, among consecutive new patients seeking orthodontic treatment for esthetic improvement between June and August 2018. Angle's class of malocclusion, various malalignments, plaque index (PI), gingival index (GI), adequacy of width of attached gingiva (WAG), response to fremitus test, PPD and gingival recession (GR) were recorded.P < 0.05 was considered statistically significant. Results: A total of 410 consecutive patients were included. Of these, 314 patients had Class I, 57 had Class II (division I), 25 had Class II (division II) and 14 had Class III malocclusions. In patients with all types of malocclusion, the majority had a PI and GI of score 2 (74.1% and 83.7%, respectively). Most of the patients (85.9%) had adequate WAG; similarly, 94.9% had a negative fremitus test, which shows the absence of trauma from occlusion. Mean PPD and GR in the maxillary and mandibular arches showed varying results. Conclusion: This study demonstrates a relationship between malocclusion and presence of periodontal disease in patients seeking orthodontic treatment for esthetic improvement in the southwestern region of Saudi Arabia. Therefore, in patients seeking orthodontic treatment, careful evaluation of gingival and oral hygiene along with adequacy of attached gingiva should be considered.

Saddle flap technique, a modified coronally advanced flap approach for isolated gingival recession management was introduced and assessed in terms of clinical efficacy and patient satisfaction. A total of 10 systemically healthy subjects with isolated gingival recession defect (Miller Class I and II) were enrolled in the study. The primary endpoint measure was patient satisfaction in terms of esthetics and percentage root coverage. The secondary outcome measures comprised clinical attachment level change, gingival thickness variation, width of keratinized tissue alteration, and postoperative healing. At 1 year postoperative, 80% of the treated sites achieved 100% root coverage. Based on clinical results, saddle flap technique could be considered as one of the possible treatment options for isolated gingival recession with good esthetic and patient satisfaction.

INTRODUCTION: To evaluate the effect of orthodontic retraction force on thick and thin gingival biotypes of anterior teeth having grade I and II gingival recession with D1 and D2 alveolar bone densities by assessing the displacement of teeth and deformation in gingival tissue, along with evaluating the amount of equivalent stress on teeth and gingiva in finite element model. MATERIALS AND METHOD: Based on cone-beam computed tomography datasets, eight models (LC01–LC08) of maxilla with appliance assembly were created. A retraction load of 150 gm was applied on each model during the finite element analysis (FEA), and then values of teeth displacement, gingival deformation, and von Mises stress were evaluated. RESULT: All the models with D1 bone density (LC01–04) were showing gingival deformation, whereas models with D2 bone quality (LC05–08) give no significant outcome. The amount of von Mises stress for teeth and gingival tissue in each model was the same for both central and lateral incisors. CONCLUSION: All the models having D1 bone quality showed greater gingival deformation after applying retraction force, whereas in models with D2 bone density, deformation was not significant. Changes in gingival tissue are brought about by orthodontic treatment, which also helps to correct the periodontal defects; however, bone density plays a significant role in improving gingival recession.

Background: Xenogeneic grafts have gained attention due to advantages in compare of autografts. This study aimed to compare Xeno (ostrich) Acellular Dermal Matrix (XADM) with the free gingival graft (FGG) to increase the width of Keratinized gingiva (KGW) in dogs. Materials and Methods: This split mouth animal study was performed on 10 mixed breed dogs. The upper second premolar sites were randomly selected for grafting by XADM (test) or FGG (control). Measurements of KGW were recorded before surgery, 1, 3, and 6 months after surgery. Biopsies from grafted sites for histologic and histomorphometric evaluations were harvested 6 months after surgery. Data were analyzed by repeated measured, paired samples t-test, and Wilcoxon Signed rank test. P < 0.05 was considered statistically significant. Results: KGW increased in the two study groups after surgery with no significant statistical difference between them at any time intervals (P > 0.05). The graft shrinkage was 23% and 21% for the test and control groups, respectively, without statistically significant difference (P > 0.05). Histomorphometric evaluation showed no significant difference between the two study groups. Foreign body reaction was not seen in any of the study groups. Conclusion: Increased KWG was similar between the two study groups. With regard to FGG limitations, XADM may be assumed as a suitable alternative for FGG. It should be noted that this research was an animal study and clinical trials on human should be performed to approve the efficacy and safety of this material.

Gingival recession may cause aesthetic challenge for affected individuals, which may be the reason for definitive treatment. Other possible side effect is that because of the exposure of the root surface, it may predispose to root caries and dentinal hypersensitivity. Many surgical procedures have been described as part of the options for the management of gingival recession, the use of subgingival connective tissue is one of such surgical methods. This report describes a case of a gingival recession managed with the use of subepithelial connective tissue graft. The main reason for the surgical intervention was the concern of the patient and the tendency for progression of the recession. Connective tissue was sourced from the palate and sutured in the recipient site with a 4.0 vicryl suture. The case had been followed up for 4 years with good root coverage (100%) and colour match. The resulting improved aesthetics has enhanced the selfimage of the patient.

Gingival recession is defined as apical migration of marginal gingival tissue causing the exposure of root surface. Abnormal brushing techniques, trauma, anatomical presence of tooth, caries, and improper oral hygiene measures are some of the problems leading to gingival recession. Several treatment modalities such as coronary advanced flaps and free gingival grafts have been used for the treatment of gingival recession defects and showed good results. However, while treating multiple gingival recessions, some new treatment modalities were introduced in literature. Vestibular incision subperiosteal tunnel access (VISTA) as a minimally invasive technique for root coverage was introduced with various advantages such as no secondary surgical site needed for harvestment of donor tissue and it provides excellent esthetic results with decreased patient morbidity. The present case report emphasizes on the treatment of multiple gingival recessions in the maxillary anterior teeth region using VISTA with titanium-prepared platelet-rich fibrin.

Marginal tissue recession (MTR) by definition is an apical shift of gingival margin, which leads to exposure of root surface. Patients affected with MTR often complain of sensitivity to cold on exposed root surfaces apart from esthetic concerns. In this article, a case of multiple Miller's class I MTR who presented with sensitivity to cold in relation to maxillary anterior teeth region was treated using Zucchelli's coronally advanced flap with pericardium membrane under operating microscope. The application of principles of periodontal microsurgery and guided tissue regeneration results in significant root coverage with reduction/elimination of sensitivity. Long-term success of root coverage procedures depends on the removal of etiology and maintenance therapy.

Connective tissue graft (CTG) is considered the gold standard for soft-tissue correction and augmentation surgeries, but involves a secondary donor area and its associated complications. The techniques to harvest CTG have undergone a large number of modifications over a period of 44 years since the time it was introduced by Edel in 1974 to increase the width of keratinized gingiva. This review compiles all the techniques of graft harvest from the palate and their modifications which have been introduced in the last 44 years till date. This review is based on systematic reviews, comparative human studies, and case reports describing any new technique of graft harvest. Publications till April 2018 were selected and further reviewed. In addition, specific related journals and books were searched upon. In order to minimize the pain, bleeding, and morbidity associated with donor site, several researchers proposed harvesting of the connective tissue by means of different techniques, each precisely different from others in terms of design, incisions, and procedure of harvest. Although the latest techniques are minimally invasive with reduced incision lines, less compromised blood supply, accelerated healing, and no sloughing of the overlying flap, they are technique sensitive which requires higher expertise to execute.

Background: Root coverage procedures have gained much popularity in recent years, due to increasing esthetic demands of patients. Coronally advanced flap (CAF) is a predictable technique for treating gingival recessions. Platelet-rich fibrin (PRF), an autologous platelet concentrate, has properties to enhance soft-tissue wound healing. A current method in dentistry is the use of human chorion membrane, a placental derivative, having biologic properties that help in healing and regeneration. Thus, the aim of the study was evaluation and comparison of the efficacy of chorion membrane and PRF membrane in the treatment of Miller's Class I and Class II recession defects. Materials and Methods: This was a randomized controlled clinical study. Totally 30 sites with Miller's Class I and Class II recession were taken and randomly allocated to chorion membrane (test) PRF membrane (control) group. The clinical parameters recorded were clinical attachment level (CAL), recession height (REC-HT), recession width (REC-WD), width of keratinized gingiva (WKG) and gingival tissue thickness (GTH). Results: Significant differences were seen from baseline to 6 months in test group regarding gain in CAL (P < 0.001), reduction in REC-HT (P < 0.001), decrease in REC-WD (P = 0.02), increase in WKG (P < 0.001), and increase in GTH (P < 0.001). In the control group also, significant difference was noted at the end of 6 months i regarding gain in CAL (P < 0.001), reduction in REC-HT (P < 0.001), decrease in REC-WD (P = 0.029), increase in WKG (P < 0.001), and increase in GTH (P < 0.001). Intergroup analysis showed significant differences between test and control groups at the end of 6 months, with CAL, REC-HT, WKG, and GTH showing statistically significant differences with P = 0.002, 0.001, 0.001, and 0.026, respectively. No significant difference was seen regarding REC-WD (P = 0.39). Conclusions: Both are effective materials in root coverage, but chorion membrane showed better and more stable results at the end of 6 months as compared to PRF membrane in treating gingival recession.

Background: The objective of our study was to evaluate and compare the effectiveness of coronally advanced flap (CAF) with or without the use of platelet-rich fibrin (PRF) membrane in the treatment of multiple adjacent recession defects (MARD) clinically and by cone-beam computed tomography (CBCT). Materials and Methods: Twenty healthy patients having 75 MARD were allocated randomly to CAF with orthodontic button group (CAFB) or CAFB + PRF membrane group (CAFB + PRF). Clinical parameters such as gingival recession depth (GRD), probing depth (PD), and keratinized tissue width (KTW) were calculated at baseline, 3 months, and 6 months. The distance from the facial alveolar crest of bone to gingival margin bone and gingival thickness (GT) at three different points were assessed by CBCT at baseline and 6-month postsurgery. Esthetic outcome and postoperative discomfort were evaluated using root coverage esthetic score and visual analog scale, respectively. Results: Percent root coverage achieved in CAFB category was 93.17% ± 13.23% and that in CAFB + PRF group was 95.68% ± 10.13% at 6 months, with no notable difference. Similarly, no difference was found in either group in GRD reduction, PD, and CAL postoperatively. Use of PRF resulted in statistically highly significant (P < 0.001) increased GT at 6 months' time point as compared to participants treated with CAF without PRF, which indicates clinical and esthetic benefits achieved through the procedure. Conclusions: CAFB can be used successfully to treat MARD with predictable outcome. Additional benefit in terms of gain in KTW and GT can be achieved when PRF membrane is used as an adjunct.

Background: Currently, the leading theme in mucogingival surgery is the correction of gingival recession defects. Free gingival graft (FGG) has been successfully in use in this category of reconstructive therapeutic modality. Objectives: The aim of this systematic review was to evaluate the literature with respect to efficacy of FGG in the management of Miller Class I and II localized gingival recessions. Data Sources: Search strategies were performed via electronic database which included Pubmed-Medline, Google scholar and manual search using University library resources. Two reviewers assessed the eligibility of the studies. Study Eligibility Criteria: Controlled clinical trials, randomized clinical trials and longitudinal studies evaluating recession areas treated by FGG with minimum of 6 months follow up were included. In-vitro and animal studies, studies mainly done on Miller Class III and IV gingival recession defect, studies on multiple gingival recessions and case series and case reports were excluded from the search. Results: The electronic and manual search identified a total of 557 articles. A final screen consisted of 39 articles out of which 17 articles were selected for full-text assessment. Finally, 7 articles were selected for detailed evaluation for this systematic review. FGG has shown significant results in all the studies except for one study. Conclusion: FGG produces substantial results, however, highly depends on the case selection and operator's skill and experience. FGG gives an impression of being the best alternative option in zones where gingival recession presents with inadequate width of attached gingiva and depth of vestibular fornix.

The management of gingival recession associated with esthetic concerns and root hypersensitivity is challenging and its sequelae are 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 second-generation platelet concentrate, platelet rich fibrin (PRF) has been widely used. Lately, concentrated growth factor (CGF) has evolved as a promising regenerative material, wherein it also acts as a scaffold and accelerates wound healing due to its dense fibrin meshwork. A 21-year-old male patient presented with bilateral multiple gingival recessions due to faulty tooth brushing. Coronally advanced flap with Zuchelli's technique was planned as a treatment modality. Platelet concentrates PRF and CGF were placed bilaterally during the procedure, and the outcome of the treatment was compared. The percentage of root coverage was clinically evaluated, and histological evaluation was also done to assess the density of fibrin meshwork in the platelet concentrates. Nearly 100% of root coverage was achieved with both PRF and CGF membrane 3 months postoperatively. However, CGF showed satisfactory wound healing by the 10th-day postoperatively compared to PRF. As CGF operates on varying centrifugation to separate cells in the venous blood, thereby resulting in fibrin-rich blocks that are much larger, denser, and richer in growth factors as also shown histologically.