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Statement of problem Porcelain laminate veneers without tooth preparation (no-prep veneers) might represent a convenient and conservative option for the esthetic rehabilitation of anterior teeth. However, controversy exists about their predictability. Purpose The purpose of this clinical study was to retrospectively evaluate the performance of no-prep porcelain veneers placed as per the recently proposed “CH no-prep” protocol, which claimed to overcome many of the drawbacks of previous no-prep veneer solutions. Material and methods One hundred eight no-prep porcelain laminate veneers based on the CH no-prep protocol were placed in 21 patients between 2015 and 2017. All participants were contacted, and 15 received a recall examination: a total of 78 veneers were evaluated as per the Clinical-Photographic-Micromorphologic coding. Plaque and gingival indexes and any increase in gingival recession were recorded. Pulp vitality was verified. A survival rate based on the count of absolute failures and a success rate summarizing the effect of both absolute and relative failures were calculated. Results The mean observation period was 43.1 months, with an observation interval of 36 to 60 months and a survival rate of 97.4%. From the 5 relative failures (3 minimal fractures or chips and 2 limited marginal discolorations) and the 2 absolute failures (unrepairable fractures), an overall success rate of 91.0% was recorded, with 71 restorations that were judged excellent in terms of clinical acceptance after the recall examination. From the Clinical-Photographic-Micromorphologic evaluation, 5 restorations (6.4%) showed minimal issues for marginal integrity, while a limited porcelain overhang was identified on 2 restorations (2.8%). Micromorphologic analyses confirmed the clinical evaluations. No periodontal recession was observed, and plaque and gingival indexes appeared stable. Conclusions Porcelain laminate veneers placed as per the CH no-prep protocol demonstrated excellent performances after 36 to 60 months of clinical service. The achieved outcomes, in terms of color match and overall esthetic and anatomic integration, confirmed that a prepless approach may be safely adopted provided that strict rules for patient selection and finish line placement are adopted.

The frenulum is an anatomical structure in the oral cavity. Its formed folds of mucosa membranes attach the lip and the cheek to the alveolar mucosa, the gingiva, and the underlying periosteum. Abberansia frenulum is one of the causes of aesthetic and functional problems such as gingival recession, which occurs either due to plaque control or muscle pull issues. One of the treatment options for the anomaly of the frenulum case is by performing a frenectomy procedure. This paper aimed to explain using the z-plasty technique in abberansia frenulum treatment with hypertrophy frenum associated with midline diastema and short vestibule. A 36-year-old female patient came to Periodontic Clinic in Oral dan Dental Hospital, Universitas Padjajaran, Bandung, Indonesia, with chief complaint pain in 41 teeth, and clinically the gingiva appears recession and short vestibule. This situation is alarming in terms of aesthetics and functionality. The treatment of frenectomy with the z-plasty technique is an indication for this case. The frenectomy with the z-plasty method has shown favorable results in aesthetics and functional appearance. The z-plasty technique helped in reducing soft tissue tension so that it can minimize scar formation

Item does not contain fulltext AIM: To investigate the prevalence of non-carious cervical lesions (NCCLs) and their association with individual and tooth-related factors in adults from the 1982 Pelotas Birth Cohort. MATERIALS AND METHODS: Participants were interviewed and clinically examined at the age of 31. NCCL was defined as loss of dental tissue without bacterial involvement in the cervical region. Independent variables were the socioeconomic, demographic, behavioural, and clinical characteristics. Associations were tested using a multilevel Poisson regression model. RESULTS: Five-hundred and thirty-nine participants were clinically examined, with a 26% prevalence of NCCLs, which were more prevalent in the maxilla (56.5%) and in premolars (72.9%). In the multilevel analysis, women presented lower prevalence than men [prevalence ratio (PR) 0.59 (0.48-0.73)]; those who reported smoking at both 22 and 30 years of age had more NCCLs than those who never smoked [PR 1.65 (1.31-2.07)]; and high-frequency brushers presented higher prevalence than low-frequency brushers [PR 1.26 (1.03-1.55)]. Gingival recession increased 10 times the prevalence of NCCLs [PR 10.03 (8.15-12.35)], while the presence of periodontal pockets (≥4 mm) reduced the prevalence of NCCLs [PR 0.43 (0.28-0.66)]. CONCLUSIONS: NCCLs were more prevalent in males, smokers, and those with higher frequency of toothbrushing. While the presence of periodontal pockets was associated with a lower prevalence of NCCLs, gingival recession was a strong clinical indicator for the presence of NCCLs.

The understanding of biological concepts in wound healing together with the evolution in biomaterials applied in periodontal regeneration allowed for improved, minimally invasive surgical techniques with a wider range of application and adapted to achieve multiple goals at the same time. Regenerating attachment was never the sole end point, but maintaining the patient's own natural dentition in health and esthetics is becoming a feasible goal even in cases considered challenging just a few years ago. In this article we report on the evolution of techniques and biomaterials and their application in esthetic and challenging cases.

Periodontitis is a multifactorial inflammatory condition associated with an oral microbiome dysbiosis that results in gingival inflammation and clinical attachment loss. Periodontal therapies are based on scaling and root planing to disturb the bacterial biofilm mechanically and remove calculus and contaminated cementum. Research does not support the use of root modifiers for decontamination and biomodification of periodontally affected root surfaces. Standardized clinical trials in large populations, assessing biological and patient-reported outcome measures, are necessary to evaluate candidate biomaterials for decontamination and biomodification of periodontally affected root surfaces.

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

Objective Assess the clinical effects, 3D radiographic results and patient-reported outcome measures (PROMs) of buccal bone regeneration combined with piezocision. Methods Ten patients presenting roots prominence with a thin buccal bone thickness or buccal bone dehiscence in the lower front region were enrolled. Patients received orthodontic treatment assisted by piezocison which was combined with a buccal alveolar bone regeneration using a tunneling approach. A comparison between pre- and post-treatment alveolar bone measurements based on CBCT was performed. Periodontal parameters such as recession scores and root resorption were recorded before and after treatment. The PROMs were also investigated. Results An overall significant buccal bone gain of 2.7 ± 2.7% was found after the treatment. The apical region reached the highest gain of 8.9 ± 5.5% whereas the most coronal region showed no significant increase of the bone envelope (1.2 ± 2.7%). No adverse event such as the appearance of recession or root resorption were observed. However, in 2 patients, the biomaterial was not properly integrated and seemed to be encapsulated. The pain level and the paracetamol consumption were equivalent to those after the placement of the orthodontic appliance except on the day of the surgery. Conclusions Within the limitation of this study, piezocision combined with buccal bone regeneration using a tunneling technique seems to be effective to augment bone and did not lead to gingival recession. However, in 2 cases the biomaterial seemed encapsulated, and therefore the predictability of the integration of the material can be questioned. ClinicalTrials.gov registration : NCT03655938.

Gingival recession is usually characterized by the apical displacement of the gingival margin, exposing the root surface when related to cemento-enamel junction. It has turned out to be one of the most common perturbations for the patients, apart from esthetic, root sensitivity, progression of periodontal diseases and root caries are the major fields of concern. The goal of periodontist is not only to treat gingival recession but also to rectify the functional and esthetic deficiencies to further combat the periodontal destruction. Semilunar flap is one of the procedures followed to cover recession, being a simple, minimally invasive and effective technique with higher patient acceptance and provides satisfactory results for Miller’s class I recession. Semilunar flap when combined with EDTA, as root conditioner provides a biocompatible cell surface for tissue attachment. Here we are presenting a case report where semilunar coronally advanced flap was used for treatment of Miller’s Class I recession in maxillary central incisor. Keywords: EDTA, Esthetics, Gingival Recession, Semilunar Flap.

Apical migration of the gingival fiber attachment and marginal gingiva leads to gingival recession and can be caused due to many factors such as faulty tooth brushing, masochistic habits, periodontal disease etc. This causes dentinal hypersensitivity, aesthetic problems, root caries, cervical abrasion, and difficulty in maintaining oral hygiene and often possess a challenging situation for the clinician to deliver best care to the patients. This case reports about the use of SCTG along with coronally advanced flap. To report a case of RT2 recession, older term – Millers Class II recession which showed promising result when root coverage procedure was done using sub-epithelial connective tissue and coronally advancing the flap. A 62-year-old male patient was referred to the Department of Periodontology, with a chief complaint of hypersensitivity and downward shifting of gum in upper front left teeth region which was progressive in nature with no obvious medical history.After achieving profound anaesthesia over the concerned region the recipient site was prepared. After which the donor tissue was retrieved from the palatal area using trap door method and placed over the recipient site. No root biomodification agents were used. The graft was stabilised using interrupted suture and then criss-cross suturing was done, and non-eugenol periodontal dressing was given. The follow up results showed good outcome with predictable root coverage achieved using Sub-epithelial Connective Tissue Graft (SCTG) and coronally advanced flap in the canine region which is often the most difficult one to achieve complete root coverage because of canine prominence. SCTG can be used successfully along with coronally advanced flap and clinicians must opt for such treatment modalities for patients benefit.

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: Previous history of periodontitis associated with smoking and poor oral hygiene are considered as one the risk factor for peri-implantitis which in-turn leads to implant failure. Periodontitis is regarded as the most prevalent infectious diseases with around 75% of adults being affected. A similarity between the pathogenesis of periodontitis and peri-implantitis is as a result of intra-oral translocation of periodontal pathogen from teeth showing periodontitis to the peri-implant niche. Aim: The main aim of the study is to evaluate the prevalence of peri-implantitis in patients suffering from periodontitis. Material and Methodology: A retrospective study was conducted in the department of periodontology on 30 patients suffering from periodontitis and with dental implant insertions. In all the patients, periodontal and bone conditions were evaluated. Probing depth, gingival recession, clinical attachment levels, and radiographic bone loss was calculated around the implants, adjacent teeth and contra- lateral teeth to evaluate correlation between periodontitis and implant failures. Results: On evaluation of results with 30 patients, periodontal depth, clinical attachment levels, and gingival recession showed statistically significant around implants when compared with the periodontal parameters around the adjacent teeth and contra-lateral teeth. Non significant results were obtained when radiographic bone loss was evaluated. Conclusion: Within the limitations of the study, it was concluded that dental implant therapy is strongly affected by the periodontal health and health of adjacent teeth plays an important role in determining the failure or success of the implant while contra-lateral teeth have no or minimal relationship between periodontitis and implant failure. Keywords: Implant, Oral Health, Peri-Implantitis, Periodontitis, Translocation.

Background: Periodontal diseases are a group of inflammatory diseases causing alveolar bone loss and eventually leading to loss of teeth. The present study was evaluated the effectiveness of platelet-rich fibrin (PRF) in the treatment of intrabony defects with or without bone graft. Materials and Methods: Thirty subjects with the presence of intrabony defects were enrolled. All subjects were included irrespective of age and gender. A questionnaire was prepared for extracting demographic and personal details of all the patients. William probe and moth mirror-tweezers set was used for carrying out clinical examination of all subjects. Random and unbiased division of all the subjects was done with ten patients in each group as follows: Group I: Subjects in which treatment was carried out using PRF with demineralized bone matrix, Group II: Subjects in which treatment was carried out using PRF alone, and Group III: Subjects in which treatment was carried in the form of open flap debridement (OFD). Pretreatment and posttreatment clinical variables were assessed which included plaque index (PI), gingival index (GI), probing depth (PD), relative attachment level (RAL), and gingival recession (GR) were assessed at baseline and 9 months postoperatively were calculated. Results: Mean PI among Group 1, Group 2, and Group 3 at baseline was 0.78, 0.8, and 0.84, respectively. Mean PI among Group 1, Group 2, and Group 3 at 9 months follow-up was 0.56, 0.55, and 0.72, respectively. Significant results were obtained while comparing the PI among the three study groups at follow-up. Mean GI among Group 1, Group 2, and Group 3 at baseline was 0.78, 0.8, and 0.84, respectively. Mean GI among Group 1, Group 2, and Group 3 at 9 months follow-up was 0.56, 0.55, and 0.72, respectively. Significant results were obtained while comparing the GI among the three study groups at follow-up. Significant difference was seen in PD, RAL, and GR from baseline to 9 months in all groups (P < 0.05). Conclusion: PRF leads to significantly better improvement in the clinical parameters on follow-up in comparison to OFD alone in patients with the presence of intrabony defects.

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.

Certain bone morphologies and soft tissue thickness (ie, phenotype) are considered to be risk factors for the development of gingival recessions following orthodontic tooth movement. Preoperative evaluation of the periodontal phenotype, in the frame of orthodontic treatment plan, identify teeth at high risk for mucogingival complications related to orthodontic therapy. The new surgical technique is illustrated in a clinical case. A patient with a thin phenotype without visible gingival recession had bone dehiscences in the anterior mandible. Prior to orthodontic treatment, simultaneous bone and soft tissue augmentation was performed using the combination of a highly cross-linked ribose porcine type I collagen membrane and a subepithelial palatal connective tissue graft. Two years after augmentation surgery and initiation of orthodontic treatment, a thick buccal tissue with a wide band of attached gingiva was observed without any clinical signs of root prominences, indicating a substantial change in periodontal phenotype. The clinical findings were corroborated by the 3D analysis, demonstrating substantial bone apposition on the buccal aspect of all roots in the treated area. The described surgical technique offers a valuable approach for regenerating hard and soft tissues in deficient areas prior to orthodontic therapy, thus preventing the development of gingival recessions.

Smoking is considered as the major environmental risk factor for periodontal diseases. Smokers have a higher risk for severe periodontitis with more periodontal tissue destruction, more gingival recession, and more susceptibility for tooth loss. The aim of this narrative review is to provide up-to-date evidence on the clinical outcomes of periodontal treatment in smokers. Electronic databases were searched for studies that compare the clinical outcomes in smokers and non-smokers following non-surgical and surgical periodontal treatment modalities and also during the supportive periodontal treatment. Clinical studies published before May 2021 were included in the review. Smokers have a higher risk for recurrence of periodontal disease and the response to non-surgical as well as surgical periodontal treatment is not as good as that of non-smokers. Moreover, there is a dose-response effect in the adverse effects of smoking on periodontal health. Compared to non-smokers, smoker patients with periodontitis tend to respond less favorably to non-surgical and surgical periodontal treatment, and exhibit recurrence more frequently during supportive periodontal treatment. Along with the periodontal treatment, smokers may be encouraged to quit. Long follow-up and the communication between the dentist and the patient give a great opportunity for such counseling.

OBJECTIVES This study aimed to assess the outcomes of bifocal transport distraction osteogenesis (BTDO) for closure of a wide or previously failed unilateral alveolar cleft. METHODS Patient in this study had a large alveolar cleft that had not healed with bone grafts. Bone-borne distraction was used under general anesthesia. Intraoperative complications as bleeding and trauma to neighboring teeth were documented. Postoperative complications as wound dehiscence, paresthesia, infection, and bleeding were recorded. Complications including changes in bone segment movement, activation force loss, and occlusal interferences were observed during the activation phase. During the consolidation phase, problems including gingival recession, pulpal vitality, and cosmetic concerns were evaluated. Postoperative, periapical, occlusal, and orthopantomograms were used to evaluate bone gain and bone generation in the distracted area. RESULTS Ten patients (6 males and 4 females) with unilateral alveolar cleft were included, with mean age of 9.5 ± 2.5 years. Average cleft width was 12.25 ± 2.54 mm. There was no intraoperative or postoperative bleeding. Only 1 patient had a wound dehiscence (10%). All patients had mild postoperative pain and edema in upper lip. Only 1 patient complained of numbness in infraorbital nerve's innervated region. Radiographs revealed bone formation in cleft area and bone healing in distracted chamber. CONCLUSIONS Bifocal transport distraction osteogenesis improves success rate of an alveolar cleft treatment especially a wide or previously failed one. This technique associated with minimal complications when careful planning and cooperation from a patient are combined. It can be recommended when other modalities for alveolar cleft are failed. Patients also tolerate the device well.

Objective: to evaluate the efficacy of non-invasive procedures through biomimetic mineralization of a fluoride gel, bioactive glass materials with and without fluoride and self-organizing biomimetic peptides in the treatment of dentinal hypersensitivity due to early non-carious cervical lesions. Materials and methods: Twenty-eight patients with self-reported history of dentin hypersensitivity were evaluated sequentially for evidence of erosion, abrasion or gingival recession at facial cervical region. Patients were randomly distributed into four treatment groups of seven patients each according to the type of the treatment (group I: Elmex Gele'e, group II: BioMin™ F, group III: BioMin™ C group IV: CurodontTM D’senz). The teeth were subjected to five follow up periods (baseline, after 3,6,9 and 12 weeks) and assessed in response to evaporative air-blast stimulus utilizing Schiff Sensitivity and Visual Analogue Scales. Electrical test was performed utilizing electrical pulp tester. The extent of tubule occlusion was examined under scanning electron microscope using negative replica of randomly selected patients. Results: All the tested groups showed different degrees of relieving dentinal hypersensitivity symptoms. The difference between the studied groups was statistically significant. Under SEM, group II, III and IV showed complete tubule occlusion. However, group I showed partial tubule occlusion. Conclusions: Elmex® gelee, BioMin™ F, BioMin™ C and Curodont™ D’senz were effective to manage dentin hypersensitivity related to early non-carious cervical lesions based on the biomimetic mineralization concept that has focused on permanent management of dentin hypersensitivity. Keywords: Fluoride, Bioactive glass, self-organizing biomimetic peptides, non-carious cervical lesions, dentin hypersensitivity.

The aim of this retrospective study was to assess the outcomes of non-surgical and surgical mechanical root debridement for the treatment of infrabony defects and explore potential prognostic factors. Treated infrabony defects followed for at least 1 year were selected. All data pertaining to the clinical outcomes were recorded. Multi-level regression analysis and Cox Proportional-Hazards Models were used to assess the immediate (3–6 months) clinical outcomes, survival of the treated teeth, and factors influencing these results. 132 patients were included in the analysis. The analysis showed 1.42 ± 1.71 and 2.23 ± 1.64 mm in pocket depth (PD) reduction, 0.13 ± 1.83 and 0.08 ± 1.76 mm in clinical attachment level (CAL) gain, and 1.29 ± 1.56 and 2.15 ± 1.33 mm increase in gingival recession (REC) for the non-surgical and surgical groups, respectively. The 5-year survival rates were 93% for the non-surgically and 90% for the surgically treated teeth. Several factors affected clinical outcomes and tooth survival. Within its limitations, the treatment of infrabony defects with non-surgical and surgical mechanical root debridement was found to result in moderate but significant PD reduction, nevertheless, this may also be attributable to the resultant REC.

Background Individual studies conducted in Asian countries have reported higher risk of periodontitis among smokeless tobacco (SLT) users in comparison to non-users. Therefore, a systematic review was conducted to summarize the available evidence on this topic. Methods Prominent electronic databases were searched using pre-decided MeSH terms and keywords. Screening of titles and abstracts, full text reading, quality assessment and data extraction was done by two investigators independently. The Newcastle-Ottawa scale was used for risk of bias assessment of eligible studies. Meta-analysis was performed for four periodontal outcomes (periodontal pocket depth, loss of attachment, clinical attachment level and gingival recession). A sensitivity analysis was also performed. Results Of the 546 citations, 367 were screened for eligibility. Finally, 89 studies were shortlisted for full text reading, of which, 36 were found eligible for qualitative analysis. Most of the studies were conducted in India (n=22), were of cross-sectional design (n=33), utilized purposive sampling and 24 studies were included for meta-analysis (n=28) and done on hospital-based population (n=26). Only 13 (37.1%) studies achieved a score of more than 50% (5/10 stars) on quality assessment scale. SLT users had higher odds of greater periodontal pocket depth greater than 4 mm (OR=3.64), gingival recession (OR=1.71) and loss of attachment 4-5 mm (OR=2.83) and mean difference of 1.7 mm for Clinical Attachment Level compared to non-users. Conclusion The studies included in this review suggests that SLT users have poorer periodontal health in comparison to non-users. But most of this evidence comes from cross-sectional studies. Longitudinal studies with rigorous methodology are required to support this elucidation. Registration: This systematic review protocol has been registered in PROSPERO (CRD42019122964).

Objective: This clinical trial evaluates the effect of erbium, chromium:yttrium–scandium–gallium–garnet (Er,Cr:YSGG) root surface biomodification and laser harvesting of de-epithelialized gingival ...

Gingival recession is a common dental condition causing esthetic and functional problems to the patients. In the present case report gingival recession Miller class III is treated with bilaminar technique and subepithelial connective tissue graft where the tooth root surface is modified by Er:YAG laser and the case is observed for 5 months. There were no complications or side effects during the surgery and the healing period. The patient was stable after 5 months of follow-up. It could be concluded that the Er:YAG laser could be used in addition to mucogingival surgery, but longer observation and more studies are needed to clarify and prove its adjunctive application.

Objective: To determine efficacy of casein phosphopeptide amorphous calcium phosphate and sodium fluoride varnish in managing dentine hypersentivity. Study Design: Quasi-experimental study. Place and Duration of Study: Foundation University College of Dentistry, Islamabad, from Jun to Nov 2020. Methodology: Patients of both gender 20-60 years of age with ASA “American Society of Anesthesiologists physical status classification” status I (completely healthy fit patient) or status II (patient has mild systemic disease) diagnosed with dentine hypersensitivity of incisors, canines, premolars with clinical evidence of erosion, abrasion, gingival recession not requiring restorative treatment were enrolled in the study. At first visit baseline, dentine hypersentivity was recorded by means of tactile and evaporative stimuli, response was quantified using visual analogue scale. Patients were randomly divided in two groups 1-casein phosphopeptide amorphous calcium phosphate, 2-sodium fluoride varnish desensitizing agent was applied conferring to manufacturer instructions. Visual analogue scale readings were assessed at base line and post treatment valueswas recorded at 7th, 15th, 30th day. Results: Total 80 patients enrolled in the study with a mean age of 36.26 ± 8.91 years and age-range of 21-60 years. Visual analogue scale results of group-1 (n=40) were recorded at baseline as 5.9 ± 0 .94, 7th day 1.9 ± 0.92, 15th day 1.4 ± 0 .81 and 30th day 1.0 ± 0.71. In case of group-2 Visual Analogue Score recorded to be 6.2 ± 1.24,3.2 ± 0.81, 3.0 ± 0.52 and 2.7 ± 1.12 at baseline, 7th, 15th, and 30th day respectively. Conclusion: Casein phosphopeptide amorphous..................

Objectives The goal of this study was to evaluate the impact of enamel matrix derivative (EMD) on periodontal healing after root coverage (RC) surgery, involving CAF in combination with SCTG, and to assess the molecular profile, verifying the inflammation level in early stage (1 and 2 weeks).Materials and methods Thirty-two recessions (RT1) were submitted to periodontal surgery with (test) or without (control) EMD. The clinical parameters analyzed on the day of surgery and 6 months after the surgical procedure were as follows: recession height and width, keratinized tissue height, percentual root coverage, and the gingival thickness of keratinized tissue. Moreover, the main inflammatory biomarkers and growth factors (IL-1β, IL-6, IL-8, FGF, MIP-1α and β, PDGF, TNF-α, and VEGF) were evaluated at baseline, 7, and 14 days after procedures.Results The average root coverage was significantly higher in the test group as compared to the control group (86% vs. 66%, p = 0.008). The test side had significantly lesser final RH compared to the control side (p = 0.01). Also, there was a significant reduction of RW in both groups, with more significant results in the test group. KTH and GT were not significantly different at any time and group. After 14 days, the immunological analysis showed an increase of VEGF (p = 0.03) on the test group compared to the control side.Conclusion The use of EMD in RC surgeries resulted in a significantly higher RC, as well as a significant increase in VEGF expression, suggesting that EMD may contribute to the angiogenic and healing process.Clinical relevance EMD provided better results in root coverage treatment when associated with CAF and SCTG, beyond a greater releasing of angiogenic growth factor (VEGF), which enhanced the result.

Aim: Our aim was to present the regenerative-reconstructive surgical treatment of a complex periodontal defect. Surgicaltreatment planning was carried out on realistic virtual hybrid models, containing all relevant anatomical structures (teeth,alveolar bone and gingiva). Additional aim was to evaluate the outcome of the surgical treatment, by the superimpositionof pre- and postoperative cone-beam computed tomography (CBCT) scans.Materials and methods: Utilizing a semi-automatic segmentation method, the 3D model of teeth and alveolar bonewas generated from the CBCT scan using the open source radiographic image processing software, 3D Slicer. Spatialregistration of the hard tissue model acquired from the CBCT scan and the digital model acquired with an intraoralscanner was performed based on anatomical landmarks. First step of the planned stepwise surgical treatment was theextraction and simultaneous alveolar ridge preservation of tooth 26. Surgery was carried out according to the extractionsite development (XSD) technique. Second step was the regenerative treatment of the horizonto-vertical periodontal defectinvolving tooth 24 and 25. Superimposition of the pre- and postoperative CBCT scans allowed to validate the volumetricand linear changes.Results: In the surgical area the cumulative hard tissue gain was 0.44 cm3. Crestal bone resorption of 0.11 cm3 occurredat the palatal and buccal aspects. Linear measurements were performed to evaluate the hard tissue fill of the periodontaldefect around tooth 24 and 26. On average the intrabony component showed a 53.88 ± 36.84% of hard tissuefill, with minor crestal bone resorption. On average a 1.22 ± 0.87 mm of gingival recession occurred around the teeth.Conclusion: It can be concluded that hybrid models acquired with the aforementioned technique allowed detailed planningof the surgical procedures. With the application of the postoperative volumetric and linear evaluation, the healingdynamics of the complex defect could be demonstrated thoroughly.

Aims: To determine the pattern of chewable tobacco habits, to assess the oral hygiene habits among patients visiting dental OPD and to determine the association of oral health maintenance and chewable tobacco with severity of periodontal disease. Study Design: It was a comparative cross sectional study. Place and Duration of Study: Dental Outpatient Department, Liaquat University Hospital Hyderabad and Jamshoro for six months from 1st February 2020 to 31st July 2020. Methodology: A total of 362 subjects were selected by non-probability sampling technique. A pre-designed questionnaire was used to collect the data. Questionnaire forms was close and open ended. The investigator checked the patients, under the supervision of the OPD specialist and classified the periodontal health status. Statistical package for social sciences (SPSS v.22) was used for data analysis. Results: A total of 362 subjects, (84.5%) male and (15.5%) females were included in the study with the mean age 34.9 and SD ± 11.7. A highly significant association was found between chewable tobacco consumption and oral hygiene habits on periodontal health (p=

Objectives Minimally invasive flap designs have been introduced to enhance blood clot stability and support wound healing. Limited data appear to suggest, that in intrabony defects, better clinical outcomes can be achieved by means of minimally invasive flap compared to more extended flaps. The aim of this study was to evaluate the healing of intrabony defects treated with either minimally invasive surgical flaps or with modified or simplified papilla preservation techniques in conjunction with the application of an enamel matrix derivative (EMD). Materials and methods Forty-seven subjects were randomly assigned to either test (N = 23) or control (N = 24) procedures. In the test group, the intrabony defects were accessed by means of either minimally invasive surgical technique (MIST) or modified minimally invasive surgical technique (M-MIST) according to the defect localization while the defects in the control group were treated with either the modified or simplified papilla preservation (MPP) or the simplified papilla preservation technique (SPP). EMD was used as regenerative material in all defects. The following clinical parameters were recorded at baseline and after 12 months: full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), probing depths (PD), clinical attachment level (CAL), and gingival recession (GR). Early healing index (EHI) score was assessed in both groups 1 week following the surgery. CAL gain was set as primary outcome. Results After 12 months follow-up, the CAL gain was 4.09 ± 1.68 mm in test group and 3.79 ± 1.67 mm in control group, while the PD reduction was 4.52 ± 1.34 mm and 4.04 ± 1.62 mm for test and control sites. In both groups, a minimal GR increase (0.35 ± 1.11 mm and 0.25 ± 1.03 mm) was noted. No residual PDs ≥ 6 mm were recorded in both groups. CAL gains of 4–5 mm were achieved in 30.4% and in 29.2% of test and control group, respectively. Moreover, CAL gains ≥ 6 mm were recorded in 21.7% of experimental sites and in 20.8% of control sites. No statistically significant differences in any of the evaluated parameters were found between the test and control procedures (P > 0.05). After 1 week post-surgery, a statistically significant difference (P Conclusions Within the limits of this pilot RCT, the results have failed to show any differences in the measured parameters following treatment of intrabony defects with EMD, irrespective of the employed surgical technique. Clinical relevance In intrabony defects, the application of EMD in conjunction with either MIST/M-MIST or M-PPT/SPPT resulted in substantial clinical improvements.

BACKGROUND: The long-term stability for both the patient and periodontist remains an important priority after connective tissue graft to manage the gingival recession cases. The goal of this analysis was to assess and compare the connective tissue graft with Pouch/Tunnel technique versus connective tissue graft with coronally advanced tunnel flap for the treatment of maxillary recession cases in severe periodontitis. METHODS: The total sample size was comprised of 200 subjects. The control group, coronally advanced flap along with connective tissue graft (CTG) was comprised of 100 samples and test group, pouch/tunnel technique with connective tissue graft (POT + CTG) was also comprised of 100 samples. The clinical findings included medium root coverage (MRC) and absolute root (CRC) coverage, gingival (GT) distribution and keratinized tissue (KT) gain. Esthetic findings were also evaluated. All findings analyzed initially after 6th months and have been expanded to 4 years. RESULTS: There were no major variations between the MRC and CRC patient classes with non significant values. In the POT + CTG category, GT and KT improvements were slightly greater at 4 years, with a substantial improvement in texture in control group. CONCLUSION: Pouch/Tunnel technique along with connective tissue graft allows for the clinical coverage of gingival recessions that is equivalent to Coronally advanced flap with CTG, however this may improves the gingival thickness, KT and esthetic performance.

The objective of this prospective randomized controlled single-center clinical trial was to prove the efficacy of adjunctive photobiomodulation in improving selected outcomes following the use of laterally closed tunnel technique for the management of isolated gingival recession. Nineteen participants (with isolated gingival recession) each treated by laterally closed tunnel technique were randomized to either add on treatment with control (sham laser application) or test group (photobiomodulation with 660 nm diode, 3.5 J/cm2 per point of application). The primary outcome variable was change in recession depth and secondary variables included recession width, width of keratinized gingiva, periodontal biotype, and VAS score for pain assessment and EHS index for early wound healing assessment. Analysis was performed using a linear mixed effects model. There were no significant differences in the gingival recession depth (p = 0.8324) and recession width (p-0.969) at 3-month follow-up. The VAS scores were significantly lower for the test (laterally closed tunnel technique + photobiomodulation) group as compared to control (laterally closed tunnel technique + sham laser) over time (p =

Aim of study: The aim of this study was to Compare the effectiveness of Non-pedicled buccal fat pad versus Platelet rich fibrin in treatment of Miller class II gingival recession using vistubular Incision Subperiosteal Tunnel Access TechniquePatients and methods:This study was conducted on 40 patients with class II gingival recession in anterior or premolar segment. The entire patients were selected from the out patient clinic of the Oral Medicine, Oral Diagnosis, and Periodontology Department. Faculty of Dentistry, Minya University.Forty patients with gingival recession class II were divided randomly into two groups:Group I: (20 defect) using VISTA technique with Non- pedicled buccal fat pad (NPBFP), Group II: (20 defect) using VISTA technique with platelet rich fibrin (PRF).Results: In both groups all clinical parameters were statistically significant from pre-operative period till 6 months follow up period. In the comparison between the two groups after 6 months follow up period, there were no statistically significant difference between two groups regarding all clinical parameters except percentage of root coverage; there was significant increase in percentage of root coverage after 3 and 6 months follow up period in group II with p value was less than 0.05.Conclusion: Both PRF membrane and NPBFP are effective in the management of Class II gingival recession defects using VISTA technique. PRF group has better results regarding percentage of root coverage than NPBPF group after 3 and 6 months follow up.

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

Background: Gingival recession (GR) is a challenging condition especially with the increasing esthetic demand of patients today. Hence, there is a need to assess the prevalence of GR and to investigate possible associations with this condition.Methods:A cross-sectional observational study design was used where a sample of 500 patients,within the age range of 18-60 years,was drawn from Department of Dentistry, GMERS Medical College and Hospital, Himatnagar. The collected data included demographic and periodontal variables, and the significance level was set at P ≤ 0.05. Statistical analysis was performed using the Chi-square and Fisher exact test.Results:The overall prevalence of GR was 69.4%.Statistical analysis indicated a significant association between gender and GR (significant male predilection,P ≤ 0.05), and between GR and plaque biofilm due to periodontitis with 90.8% of recession cases having periodontitis. A significant association was also found between the cause and distribution of GR,where mandibular incisors showed the highest prevalence of GR.Conclusion: Gingival recession is a highly prevalent condition amongst the people in North Gujarat,with periodontitis being the fundamental cause.Frenal pull is the most prominent local factor in inducing GR in the North Gujarat population.This information can be applied by educating the population and initiating new preventive programs and awareness campaigns.

Subject. A review of the literature devoted to the current problem of dentistry - mucogingival anomalies (small vestibule of the mouth, short frenulum of the lips, tongue, muco-alveolar cords) is presented. Purpose of the study — study the materials of publications devoted to mucogingival anomalies as etiopathogenetic factors in the development of gingival recession. Methodology. In detail, in the light of modern ideas described mucogingival anomalies (shallow vestibule of the mouth, short frenulum of the lips, tongue, mucous-alveolar cords) and their effect on the development of gum recession. Results. It has been established that a large role in the occurrence and development of gingival recession is played by the ratio of the size of the attached and free gums, which is normally equal to 5: 1, and in pathology — 1: 1. The pathogenetic mechanism of the negative impact of mucogingival abnormalities is associated with the absence, first of all, of a sufficient width of the attached gums with a shallow vestibule of the mouth, which is a factor of constant chronic trauma to the gums with, leading to disturbances in microcirculation and tissue metabolism, resulting in resorption of bone structures, etermined radiographically. In the mechanism of gum recession, a significant role is also played by the pulling mucous-alveolar cords, shortened and massive frenum of the lips and tongue. The main signs of arising ischemic disorders are anemization and mobility of the marginal gums when the lower or upper lip, cheeks, and tongue are abducted. To prevent severe destructive lesions, it is necessary to timely identify and eliminate, with the help of vestibulo- or frenuloplasty operations, conditions conducive to functional chronic traumatization of the periodontal tissues. Conclusions. The results of the review indicate that knowledge of the anatomical and topographic parameters of the vestibule and oral mucosa is necessary to prevent the development of gingival recession, prescribe timely and adequate treatment, predict and prevent complications. However, it should be recognized that this problem, in our opinion, continues to remain relevant to this day due to the lack of an integrated approach to the prevention, diagnosis and treatment of gum recession.

Background Erbium-doped yttrium aluminum garnet (ER:YAG) lasers have been used to treat peri-implant, but there are some disputes. To dispel these negative views, our study aims to compare the efficacy and safety of Er:YAG lasers versus conventional mechanical debridement in the treatment of peri-implantitis. Methods Seven databases were used to search for relevant studies and full-text articles which evaluate the comparisons of Er:YAG lasers and mechanical debridement for patients with peri-implantitis. Review Manager 5.4 was employed to assess the effects of the results among the selected studies. Forest plots, subgroup analyses, and on the included articles were also completed. Cochrane risk of bias assessment tool was used to assess the risk of bias. Results Our study focused on 10 previously conducted studies which included 294 patients with peri-implantitis and a total of 461 implants. No significant differences in clinical attachment level (CAL) (MD =0.17, P=0.25, at 6 months; MD =0.23, P=0.15, at 12 months), reduction in bleeding on probing (BOP) (MD =9.54%, P=0.18, at 6 months; MD =11.28%, P=0.24, at 12 months), or plaque index (PI) (MD =-0.02, P=0.75, at 6 months; MD =-0.07, P=0.66, at 12 months) were observed between the Er:YAG laser group and the mechanical debridement group. However, in reducing probing depth (PD) (MD =0.28, P=0.03, at 6 months; MD =0.35, P=0.002, at 12 months) and gingival recession (GR) changes (MD =-0.12, P=0.04, at 6 months; MD =-0.16, P=0.03, at 12 months), the Er:YAG laser group showed some advantages at 6-month and 12-month intervals following treatment. No significant publication bias existed in our meta-analysis by using funnel plot and Egger's test (PD: P=0.65; CAL: P=0.73). Discussion Our research supported the premise that Er:YAG lasers offer health benefits to patients with peri-implantitis and can effectively reduce PD and GR. Due to the limitations of the included studies, further studies should be carried out to validate our findings.

In this report, we demonstrate the effectiveness of the Invisalign® system in the treatment of severe gingival recession and bone dehiscence through torque, translation, and intrusion movements in a young woman. Cone-beam computed tomography was used to assess bone parameters and check the teeth during treatment. The root of the mandibular right central incisor, which was buccally positioned and exhibited bone dehiscence of 9.4 mm, was moved toward the center of the alveolar process by using the Invisalign® system and SmartForce® features. The patient was monitored by a periodontist throughout the orthodontic treatment period. Her gingival recession reduced, while the bone dehiscence reduced from 9.40 mm to 3.14 mm. Thus, movement of the root into the alveolus promoted bone neoformation and treated the gingival recession. The findings from this case suggest that orthodontic treatment using the Invisalign® system, along with periodontal monitoring, can aid in the treatment of gingival recession and alveolar defects.

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.

Gingival recession is a dramatic soft tissue finding in teeth affected by periodontal disease and remains one of the most common aesthetic concerns associated with periodontal tissue. The etiology of the condition is multifactorial but is commonly associated with alveolar morphology, tooth brushing, mechanical trauma and periodontal disease. With greater understanding of the dynamics of healing along with an awareness of aesthetics various periodontal procedures have been introduced to deal with problems of gingival recession. The long-term stability of the outcomes obtained with the surgical treatment of single and multiple gingival recessions has been evaluated in a few studies. Of the vast repertoire of mucogingival procedures for gingival recession management, long term studies of more than 5 years is present only for coronally advanced flap with or without connective tissue grafts. There are many other novel techniques in literature with little or no evidence to prove its long term efficacy. Various studies published during the last 30 years were identified through a search of the PubMed/Medline, Science Direct and Cochrane Library databases. “Follow up”, “root coverage”, root coverage procedures, root coverage techniques were the key words used for the search. In this review we have grouped the efficacy of various root coverage techniques based on their short and long term follow up. The review emphasises the value of meticulous follow up in order to validate efficacy of root coverage techniques. It also discusses the factors responsible for stability of results. Keywords: Gingival recession, Long term stability, Root coverage

Background. Tobacco smoke is an established risk factor for periodontitis. However, few studies have evaluated the periodontal status of smokeless tobacco (SLT) users, while that of individuals with dual habits has largely been unexplored. Therefore, the current study aimed to find if the periodontal status in individuals with dual habits of smoking and SLT use is different from those with any single habit.Methods. Four groups (A: exclusive smokers, B: exclusive tobacco chewers, C: individuals with dual habits, and D: non-users of tobacco), each comprising 75 males in the age group of 20 to 35 years, were selected. Along with the history of tobacco use, a modified oral hygiene index (OHI), gingival index (GI), probing depth (PD), and the number of teeth with gingival recession (GR) were recorded. The data were assessed using the Chi-squared test, one-way ANOVA, and logistic regression. Statistical significance was set at P3.0). The prevalence of severe gingivitis (GI>2.0) was significantly lower among exclusive smokers (group A) and those with dual habits (group C) compared to the other two groups. As much as 60% of group C participants had average PD in the range of 4-6 mm, while deeper average PD (>6 mm) was most common among smokers. The highest risk of having a tooth with GR was also associated with the dual habit (OR = 4.33, 95% CI = 3.24 - 5.76) compared with the non-users.Conclusion. While both forms of tobacco were associated with poor periodontal status, the additive effect of smoking and SLT use was evident in almost all the parameters, more so with poor oral hygiene and the prevalence of gingival recession. These findings emphasize that individuals with dual habits have an additional risk for periodontal destruction.

Objectives To investigate factors that influence 12-month outcomes after treatment of multiple gingival recessions (GR) with modified coronally advanced tunnel (MCAT) and subepithelial connective tissue graft (SCTG) with enamel matrix derivative (EMD) (tests) or without (controls). Materials and methods Twenty patients with 150 GR were treated. Logistic regression models were used to identify baseline parameters that could predict 12-month average root coverage (ARC), complete root coverage (CRC), root esthetic coverage score (RES), gain in keratinized tissue width (KTW), and gain in gingival thickness (GT). Results The likelihood of ARC > 85% increased sevenfold (odds ratio [OR] = 7.33; 95% confidence interval [CI] = 2.43–12.12), of achieving CRC: 21-fold (OR = 21.23; 95% CI = 10.21–45.32), and of gaining RES = 10: tenfold (OR = 10.23; 95% CI = 5.78–32.23) in favor of EMD-treated sites. With each 1-mm2 increase in baseline avascular exposed root surface area (AERSA), the odds of failure (ARC ≤ 85%, not achieving CRC and postoperative GT ≤ 2 mm) increased almost fourfold (OR = 3.56; 95% CI = 1.98–10.19), fourfold (OR = 4.23; 95% CI = 1.11–9.02), and nearly sixfold (OR = 5.76; 95% CI = 2.43–12.87), respectively. The greater the baseline GT, the more likely the chance of achieving CRC (OR = 10.23; 95% CI = 8.37–16.23) and RES = 10 (OR = 5.50; 95% CI = 3.34–16.43). All models exhibited fair to excellent discrimination and satisfactory calibration. Conclusions Based on logistic regression, EMD application improved postoperative ARC, CRC and RES; baseline AERSA predicted 12-month ARC, CRC, and GT gain, whereas baseline GT was a predictor of achieving CRC and perfect RES. Clinical relevance Additional use of EMD, lower baseline AERSA, and greater baseline GT significantly increase the odds of obtaining better outcomes 12 months after MCAT + SCTG technique.

Background: Gingival recession is associated with dentin hypersensitivity, unesthetic appearance, and carious or noncarious cervical lesions. Orthodontic treatment, gingival thickness (GT), and keratinized tissue width (KTW) play roles in gingival recession etiology. The study is aimed to compare the prevalence of gingival recession in the mandibular incisor region of orthodontically-treated females with untreated controls, and to identify if there is any correlation among the GT, KTW, and gingival recession. Subjects and Methods: A total of 150 Saudi females were enrolled in this study. They were categorized into the treatment group (n = 75) and control group (n = 75). Background characteristics and clinical periodontal parameters including the plaque index, gingival index, GT, KTW, gingival recession length (GRL), and gingival recession width (GRW) were recorded and compared between groups, and any associations were identified. Results: Among the orthodontically-treated females, 31 (41.33%) had at least one mandibular incisor with gingival recession, in contrast to 18 (24%) of the controls. Pearson's correlation analysis indicated a significant positive correlation between the GT and KTW and between the GRL and GRW (P < 0.001). In addition, a significant negative correlation was observed between the KTW and GRL and between the KTW and GRW (P < 0.001). However, no significant correlation was found between the GT and GRL or between the GT and GRW. Conclusions: Our findings indicated that orthodontic treatment is a predisposing factor for the development or progression of gingival recession, particularly in females with a narrow KTW.

Bone exostosis is defined as a benign overgrowth of bone tissue of unclear origin. Rarely, bone exostosis might develop following soft tissue graft procedures like mucogingival surgical interventions (eg, FGG or subepithelial CTG). This aberration has been mainly associated with surgical trauma or fenestration of the periosteum but is still a matter of debate. The present paper (1) presents a clinical case with clinical, radiographic, and histologic findings at 30 years following application of an FGG to increase the gingival width and (2) provides a short literature review on this particular clinical condition. At the clinical examination, the FGG was firm to palpation, and the 3D images showed an area of increased radiopacity. Histologic analysis revealed localized thickening of the bone with an overlaying connective tissue covered by keratinized epithelium. The bony tissue was vital, had a convex shape, and contained many osteocytes and resting lines, demonstrating some moderate signs of bone remodeling. The connective tissue and keratinized epithelium displayed a regular thickness without any signs of inflammation. Taken together, the histologic findings failed to reveal any pathologic signs except for the presence of vital bone formed outside the bony envelope. It can be concluded that: (1) the development of a bone exostosis following a mucogingival procedure is a rare clinical sequela of uncertain etiology, and (2) surgical removal of the exostosis may be indicated accordingly with patient symptoms.

Prolonged treatment duration is one of the main concerns of patients undergoing orthodontic treatment. In addition to the longer duration, there are several drawbacks such as increased predisposition to root resorption, caries, and gingival recession. Thus, clinicians are always on the lookout for better solutions or alternatives. This is where the technique of corticotomy came in. In the present study, two cases where a piezosurgical corticotomy was done for rapid tooth movement have been discussed. The entire treatment duration was about 7–8 months without any relapse or posttreatment complications.

Gingival recession accounts for apical migration of the gingival margin, resulting in exposure of the cementoenamel junction and root surface, with exposure of the root surface linked to deteriorated esthetic appearance and increased dentinal hypersensitivity. Various surgical techniques have been used to correct labial gingival recession defects. The present study evaluated and compared the results of semilunar coronally positioned flap (SCPF) alone and in conjunction with free gingival graft (FGG) for the treatment of Miller Class I and II gingival recession defects in maxillary anterior teeth. A total of 20 bilateral Miller Class I and II gingival recession sites were included and randomly allocated (n = 10 sites/group) to either the semilunar coronally positioned flap technique alone (SCPF group; control) or with FGG (SCPF+FGG group; test). Longitudinal alterations in probing depth (PD), recession width (RW), recession height (RH), width of keratinized tissue (WKT), and clinical attachment level (CAL) were measured and analyzed for both groups at 1-, 3-, 6-, and 12-month follow-ups. Both groups saw a significant decrease in RH, RW, and CAL and a significant increase in WKT. No statistically significant difference was observed in the final root coverage outcome between both groups in terms of RH, RW, and CAL, but a significant increase in WKT was seen with SCPF+FGG. Both techniques demonstrated optimal results without significant differences in the final root coverage outcomes except for WKT, which had a statistically significant increase in the SCPF+FGG group.

Introduction: This case report demonstrated a challenging clinical case addressed within a multidisciplinary approach to achieve its maintenance, even though had a poor prognosis. It was associated with the endodontic treatment with mucogingival techniques, including periodontal microsurgery and connective tissue graft. Case presentation: A patient presented a deep gingival recession with the apex-exposed non-vital tooth with interproximal bone loss (RT2) and without mobility. The treatment involved an initial endodontic approach and periodontal therapy (scaling and root planing), microsurgical techniques with coronally advanced flap (CAF), root preparation with PrefGel® (24% EDTA), enamel matrix derivatives (Emdogain®), and connective tissue graft. As a clinical result, it was verified an increase of keratinized tissue width and gingival thickness, and root coverage, reaching good esthetics and a stable result after 17 months. Conclusion: The correct diagnosis and technique selection may affect directly the outcome, especially in challenging cases. Even though there was a poor prognosis, an adequate treatment plan, patient cooperation, and technique mastery help to achieve a high level of root coverage, esthetic recovering, and successful outcome.

Relevance. It is currently relevant to study and compare the effectiveness of the autologous connective tissue grafts and the combination of collagen-based and autologous platelet-rich plasma in the surgical treatment of Miller Class I gingival recessions.Materials and methods. We examined and treated 48 (20 male (41.67%) and 28 female (58.33%)) patients aged from 25 to 40 years with Miller Class I gingival recessions. All gingival recessions were treated surgically using a modified twolayer tunnel technique. The patients were divided into two groups according to the graft type. Group I (24 patients (50%) had a connective tissue graft from the hard palate. Group II (24 patients (50%) used the combination of the autologous platelet-rich plasma and 3D collagen matrix Fibromatrix for the regeneration of oral soft tissues. We removed the sutures on the 14th day. The patients were followed up on the 7th and 14th days and in 1.3 months.Results. 48 Miller Class I gingival recessions were treated between 2018 and 2020. The depth of gingival recessions averaged 3.5 ± 1.13 mm before treatment. The level of the attached keratinized gingiva regarding the cementoenamel junction significantly (p < 0.001) improved in both groups after the surgery. The width and thickness of the keratinized gingiva best increased in group II. The mean effectiveness of gingival recession treatment was 84% in study group I and 96% – in study group II. Pain syndrome, fibrinous plaque and soft tissue edema were insignificant in group II.Conclusion. The combination of the autologous platelet-rich plasma and Fibromatrix, collagen 3D matrix, for the regeneration of the oral soft tissues is a more effective technique for the treatment of Miller Class I gingival recessions. This technique has several advantages. It is minimally invasive, less painful, soft tissue postoperative swelling is less and the received volume of the attached keratinized gums is larger than with a connective tissue graft.

Implant related biological complications include peri-implant mucositis and peri-implantitis. The main clinical symptoms ofperi-implant mucositis is bleeding on gentle probing. In case of peri-implantitis, bleeding on probing and increased probingdepth are leading signs. Treatments of peri-implant inflammation are divided into conservative and surgical therapies.The prerequisite for both approaches is the proper professional cleaning of supracrestal implant surfaces. According tothe literature, air-abrasive technique is suitable for decontamination of contaminated implant surfaces. Silicate-basedpowders that are suitable for cleaning supramucosal parts are not soluble in aqueous medium, so their use is not recommendedsubmucosally as the small particles cannot be completely eliminated. Using Varios Combi Pro (NSK/NakanishiInc., Shimohinata Kanuma, Japan), water-soluble glycine powder can be applied to the implant surface at an adjustablepressure through a disposable special plastic nozzle. During use, the amount of water cooling can be adjusted. Glycinepowder air-abrasive technique cleans the surface of implants more efficiently than cleaning with conventional hand curettewithout damaging supracrestal implant surfaces. Three patients in this case report underwent clinical and radiologicalexaminations. The peri-implant status was recorded by recording the following parameters: plaque index (PI), calculusindex (CI), probing pocket depth (PPD), bleeding on probing (BoP), gingival recession (GR), keratinized mucosa width (KW)and radiological bone loss. Status was also registered at baseline and six months after surgical therapy. Treatment plansof the patients were set up individually, but each treatment involved surgical preparation and air-abrasive debridementwith glycine powder with Varios Combi Pro (NSK/Nakanishi Inc., Shimohinata Kanuma, Japan). In two cases, in additionto surgical therapy, free gingival graft (FGG) transplantation was also performed. Peri-implant inflammation was treatedsuccessfully in all three cases.