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Awareness about root coverage is increasing in day-to-day clinical practice. Patients are more motivated and concerned about aesthetics nowadays along with the issues of sensitivity of teeth. The conventional flap designs and techniques including lateral sliding flaps, coronally advanced flap, subepithelial connective tissue grafts and free gingival grafts are being adopted for root coverage. The newer material including resorbable and non-resorbable guided tissue regenerative membranes, amniotic membrane, platelet-rich fibrin membrane, enamel matrix derivative protein, xenogenic collagen matrix graft along with the soft tissue substitute like acellular dermal matrix allograft are also being used for recession coverage. The present case report describes a case of 22-year-old female patient with the chief complaint of denudation of gums exposing the root surface over the mandibular left central incisor. The soft tissue substitute acellular dermal matrix allograft was used for root coverage as the patient was not willing to procure an autogenous palatal graft. The results were satisfactory with complete root coverage.

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.

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.

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.

A 21-year-old woman presented with a 13-year history of a linear lesion on the lip. She experienced no pain and only had an esthetic complaint. Her personal and family history was otherwise unremarkable. She had no history of photosensitivity, Raynaud's phenomenon, arthralgias, dry eyes, fever, trauma, or exposure to irradiation. (

The objective of this study is to assess the prevalence of gingival recession (GR) and associated etiological factors among school children.The study sample consisted of 2095 children from the Nellore region divided into three groups of age ranges from primary dentition (7 years), mixed dentition (7-12 years), and permanent 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.The GR among the study population was 7.9% (n = 165). Among them, males were 46% and females were 54% (P0.05). The GR was more in children in the 7-12 years age group (75%), followed by7 years (21%) and12 years (4%) age groups. The associated factors include malocclusion (69%), deleterious habits (5%), and anomalies (26%). Anomalies showed an association with GR (P0.05) compared to malocclusion and deleteriousness habits (P0.05).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.

Objective: To evaluate the gingival condition due to adult orthodontic treatment using the clinical crown height (CCH) as an index. Design: Retrospective study. Setting: Department of Orthodontics at a university. Participants: A total of 21 adult female patients with healthy periodontal tissue were treated by means of the multi-bracket appliance with extraction of four first premolars. Methods: Three-dimensional (3D) digital dental models were reconstructed to assess the vertical movement of the free gingival margin caused by adult orthodontic treatment. Pre- and post-treatment CCH were measured, and changes in CCH due to treatment were examined. Results: The change in CCH by orthodontic treatment was able to be assessed objectively using 3D digital models of the dental casts. In the upper dentition, a significant reduction in CCH was found on the labial and lingual sides of the central incisor, with a mean of –0.28 mm and –0.34 mm, respectively ( P < 0.001). In contrast, a significant increase in CCH was found on the labial side of the lateral incisor with a mean of 0.75 mm ( P < 0.001). In the lower dentition, CCH on the lingual side of the canine, the second premolar and the first molar increased significantly ( P < 0.001), with a mean of 0.41 mm, 0.45 mm and 0.50 mm, respectively. For the buccal side, the second premolar showed a significant increase in CCH with a mean of 0.61 mm ( P < 0.001). Conclusion: By using the CCH as an index, it was possible to assess the gingival condition after active orthodontic treatment.

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

Objective. To investigate the correlation of periodontal parameters and bite force in different stages of periodontitis after phase I periodontal therapy. Methods. Periodontal clinical parameters such as mobility, attachment loss, gingival recession, and percentage of bone remaining were recorded at the mandibular first molar region after phase I therapy in subjects categorized according to the stage of periodontitis. Corresponding bite force was recorded at the first mandibular molar region using a bite force device after phase I therapy. ANOVA test was used to assess the significant difference among different groups. Pearson correlation coefficient was used to assess the correlation between measured variables. Results. The ANOVA test represents that there is no statistical significant difference between the bite force in stage I, stage II, and stage III type of periodontitis. A strong positive correlation was found ( r = 0.537 ) between bite force and percentage of remaining alveolar bone support whereas negative correlation was observed in measured parameters such as mobility ( r = − 0.0181 ), attachment loss ( r = − 0.608 ), and gingival recession ( r = − 0.435 ). Conclusion. Among all periodontal clinical parameters, the percentage of remaining alveolar bone is the strong predictor of bite force and mobility; attachment loss and gingival recession cannot predict the bite force in the first molar region. Bite force is variable in different stages of periodontitis.

This study investigated the prevalence of and risk factors for alveolar fenestration and dehiscence in the anterior teeth of Chinese patients with skeletal Class III malocclusion.This study included clinical and radiographic examinations and intraoperative observations of 460 anterior teeth from 54 patients who underwent corticotomy and periodontal regenerative surgery before orthodontic treatment. Fenestration and dehiscence were detected and recorded during open-flap surgery. Univariate and multivariate analyses were performed to assess relationships between fenestration and dehiscence and age, sex, history of previous orthodontic treatment, mandibular plane angle, dentition, tooth position, sagittal root position, periodontal biotype, gingival recession, width of keratinized gingiva, and width of the basal bone.The prevalence of buccal alveolar bone defects was 16.1% (fenestration) and 20.7% (dehiscence) at the tooth level. Multivariate logistic regressions showed that fenestration was significantly associated with tooth position (canine vs central incisor, odds ratio [OR] = 3.324; P = 0.006; lateral incisor vs central incisor, OR = 5.588; P 0.001), and sagittal root position (buccally positioned vs centrally positioned, OR = 5.865; P = 0.025). Dehiscence was significantly associated with dentition (mandible vs maxilla, OR = 11.685; P 0.001), tooth position (canine vs central incisor, OR = 3.863; P = 0.007), age (OR = 1.227; P = 0.010), sex (male vs female, OR = 5.530; P = 0.026), and history of orthodontic treatment (yes vs no, OR = 4.773; P = 0.028).Buccally positioned teeth in the osseous housing, lateral incisors, and canines were more likely to exhibit alveolar fenestration. Mandibular teeth and canines, patients who were older, were male, and had a history of orthodontic treatment, were more likely to exhibit alveolar dehiscence.

Background Gingival recession is a common finding in the adult population. It is considered a challenge for clinicians to obtain a complete root coverage of Miller class III recession. The aim of this case series was to assess the outcomes achieved with the use of modified VISTA technique (m-VISTA) in patients having multiple Miller class III recessions after 6 months. Methods Ten patients (six women and four men; mean age: 53 years), who showed multiple Miller class III recessions (depth ≥ 2 mm) and who met the established inclusion and exclusion criteria, were treated by postgraduate students with the use of m-VISTA technique. Results A total of 38 recessions were performed. The recessions were mainly located in the mandible (80%), which included six molars. The mean baseline recession was 3.12 mm. Post the intervention, a mean root coverage of 58.72% was achieved, with complete root coverage observed in 29% of the recessions. Conclusions m-VISTA may offer several advantages in the treatment of Miller class III gingival recession. Nevertheless, more clinical trials with a longer follow-up period are needed to arrive at a concrete conclusion about its advantages. Trial registration: NCT03258996. Data registration: 08/18/2017.

Aim of this study is the evaluation of the periodontal status of impacted canines treated by closed approach with ultrasonic surgery and orthodontic treatment compared with contralateral spontaneously erupted teeth. The periodontal conditions of the teeth adjacent to the canines (lateral incisors and first premolar) were also considered. 17 patients (9 females and 8 males; mean age: 15.2 years) with unilateral palatal impaction of maxillary canine were selected. All patients were treated by closed-flap surgery with ultrasonic instruments. Periodontal status was evaluated by assessing probing depth (PD), gingival recession and width of keratinized tissue (KT) 4.6 months after the end of the orthodontic treatment, on average. Test group was composed by impacted elements and adjacent teeth and control group by contralateral spontaneously erupted canines and adjacent teeth. Student's t-test was used to compare test and control group values of PD and width of KT. Significance threshold for Student's t-test was set at p p

The aim of the present study was to retrospectively evaluate the longevity of teeth and implants during a long-term period in a cohort of periodontally compromised patients, treated and maintained in a private specialist periodontal practice, and to analyze the associated risk factors. Fifty-eight patients (30 men, 28 women) who had received active periodontal therapy (APT) and regular periodontal maintenance (PM) ≥ 10 years were included and evaluated. The following were evaluated: (1) statistically significant differences of clinical parameters assessed at six tooth or implant sites (plaque scores, bleeding score, periodontal probing depth, bleeding on probing, and gingival recession) and radiographic parameters (mesial and distal bone crest loss) between patients with and without tooth/implant loss during PM; and (2) associations between the number of teeth and implants lost and potential risk factors. During PM, the overall average tooth loss was 0.07 teeth/patient/year (0.04 teeth/patient/year for periodontal reasons), while the overall average implant loss was 0.4 implants/patient/year. The overall implant failure was 10.08%, and the rate of implant failure due to biologic reasons was 9.8%. Incidence of implant failures in patients with vs without recurrent periodontal disease was 83.3% vs 16.7% (P < .05). Results showed that in chronic periodontitis patients, ATP followed by long-term PM is successful in keeping the majority of periodontally compromised teeth. In the same patients, a higher tendency for implant loss than tooth loss was found.

Background Epithelioid hemangioendothelioma (EHE) is an especially rare, low-grade malignant vascular tumor that, according to WHO classification, is described as locally aggressive tumor with possible metastasis and makes up 1% of all vascular tumors. EHE is characterized by the accumulation of round, eosinophil-infiltrated endothelium cells; with vacuolation of their cytoplasm; frequent angiocentric inflammation; and myxohyaline stroma. This tumor is usually found in the liver, lungs, and bones and is especially rare in the mouth. Case presentation We present an 18-year-old Caucasian female whose oral cavity lesion had been misdiagnosed as marginal periodontitis. The patient was treated improperly for 2 years until she was referred to a maxillofacial surgeon. The patient complained only about gingival recession in the palatal area of her upper-right-side 13th, 14th, and 15th teeth. The lesion’s clinical appearance was of locally ulcerated painless lesion that affect the underlying bone as seen in X-rays in the palatal side of the right canine and the first and second premolars. Patient underwent surgery for her present defect and reconstruction using allogenic bone transplant. The diagnosis of EHE was based on the bony destruction as seen in x-rays and in the accumulation of tumor cells that were 100% positive to CD31; CD34 and ERG to endothelial markers. During the 31-month follow-up period, the patient exhibited no clinical and radiographic complications. Conclusions With this clinical case, we demonstrate that this rare tumor must be included in differential diagnoses of periodontal pathologies to perform histomorphological examination in a timely manner, which could lead to correct diagnosis and adequate treatment.

INTRODUCTION Esthetic and functional root coverage procedures using a variety of techniques and materials allow for predictable outcomes in Miller Class I and II defects, but may be accompanied by high levels of postoperative discomfort and lengthy intrasurgical time. Current techniques may also require a steep practitioner learning curve, cumbersome intrasurgical steps, and their use in challenging clinical situations, e.g. multiple adjacent recession defects, limited vestibular depth, and anatomical limitations can prove difficult. This report introduces the side access mucosal releasing incision (SAMRI) technique as an innovative and simplified method to perform mucosal-access root coverage procedures. CASE PRESENTATION A 42-year-old female presents with 3 to 4 mm of gingival recession at #9-11 and opts for treatment with a vestibular approach and acellular dermal matrix graft to avoid a secondary surgical site. CONCLUSION SAMRI procedure allows for optimal root coverage and esthetic results while limiting intrasurgical time and postoperative patient morbidity.

AIM Evaluation of long-term results after connective tissue graft (CTG) using the envelope technique and the effect on patient-centred outcomes (Oral Health Impact Profile: OHIP) in a private practice setting. MATERIALS AND METHODS Fifteen patients (11 female, mean age: 45.0 ± 8.88 years) underwent root coverage procedure using a CTG involving maxillary Miller class I teeth. Pre-operatively, 3 and 120 ± 12 months after surgery, all patients were examined, completed OHIP questionnaire, and were asked to assess improvement and their satisfaction with the results of surgery. All procedures were performed by the same investigator. RESULTS Recession depth at 3 months of 1.19 ± 0.93 mm was reduced to that of 0.63 ± 0.64 mm at 120 ± 12 months after surgery (p = .117). Recession width (-1.23 ± 2.27 mm) decreased as well (p = .117), while relative root coverage increased from 48.46 ± 32.18% at 3 months to 71.22 ± 30.86% at 120 months (p = .011). The number of cases with complete root coverage increased from two (15.4%) to six (40.0%) from 3 to 120 months (p = .046). OHIP score (12.07 ± 10.15) did not change after 10 years (12.13 ± 9.86, p = .889). Ten years after surgery, 12 patients (80%) reported they would make the decision again to undergo CTG transplantation. CONCLUSIONS Within the limitations of the study design with a high risk of bias in a practice setting, long-term stability of recession reduction, OHIP and patient-perceived satisfaction remained stable over 10 years.

Background/Aim: To report cases in which we achieved sufficient width of the keratinized gingiva using a coronally advanced flap in combination with a subepithelial connective tissue graft (SCTG) obtained by the ‘CO(2) laser de-epithelization technique’ (CODE). Patients and Methods: Eleven patients with 21 Miller Class I, II, and III gingival recessions had surgery. To prepare SCTG, free gingival grafts were harvested and de-epithelialized extra-orally. De-epithelialization was conducted by irradiation of CO(2) laser. Postoperative examinations were performed at 12 months. Results: At 12 months, statistically highly significant root coverage was achieved in all recessions. Complete root coverage was obtained in 7 of the 21 recessions. The treatment yielded mean root coverage of 41.0%, and was associated with a mean gain of keratinized gingiva of 2.9±0.3 mm. Conclusion: The use of CODE allows harvesting grafts of excellent quality and quantity and increases the keratinization of the overlying mucosal epithelium.

Objective: The objective of this study was to determine orthodontists’, periodontists’, and laypersons’ perception of smile esthetics, regarding the presence of different levels of gingival recession on the maxillary left canine. Material and Methods: Two close-up smile images (frontal and oblique) of a white female were selected for this study. The images were digitally altered to create different levels of gingival recession on maxillary left canine, in 0.5-mm increments. They were randomly arranged into a photo album that was shown to 135 evaluators: 45 orthodontists, 45 periodontists, and 45 laypersons. Each evaluator was asked to rate the smile attractiveness, using to a visual analog scale. Data were analyzed statistically using ANOVA, Tukey’s post-hoc test, and Student t-test. Results: According to the orthodontists and periodontists, all levels of recession were considered as unesthetic in both types of images. According to the laypersons, gingival recession > 1.5 mm in the frontal image and > 1.0 mm in the oblique image were considered unesthetic. Conclusion: The results showed that the presence of unilateral gingival recession on maxillary canines may negatively influence smile attractiveness, depending on the evaluator type and the level of the recession.

Background Coronally advanced flap combined with connective tissue graft is considered as the golden standard of root coverage. Although Miller class I recession is considered to get complete root coverage, there are some uncommon conditions in different cases. This case reported a maxillary lateral incisor with a gingival recession, a stillman’s cleft, a bony exostosis and a denture stomatitis. Case presentation A 27-year-old female with a gingival recession, a stillman’s cleft and a bony exostosis was treated by coronally advanced flap combined with connective tissue graft technique, and the complete coverage was achieved. Later a denture stomatitis occurred when an acrylic removable partial denture was used, however the gingival margin was not affected. The denture stomatitis disappeared when a new denture with casting palatal plane was produced. In this case of 3-year follow-up, the gingival contour remained stable and the outcome was satisfactory. Conclusion Coronally advanced flap combined with connective tissue graft technique is a classic manner to treat gingival recession especially for a long term stability, even when there is a gingival stillman’s cleft, a bony exostosis and a denture stomatitis.

There is no clear evidence that immediate implant placement can be applied to cases with dehiscence in the facial alveolar bone prior to extraction.To evaluate the results of immediate implant placement in the anterior maxilla with facial alveolar bone dehiscence.We super positioned pre- and post-operative cone-beam computed tomography (CBCT) three-dimensional reconstruction images. A CBCT was taken before tooth extraction (T0), when the definitive restoration was placed (T1), and 1 year after placing the definitive restoration (T2). The depth and width of the dehiscence at T0, and the height and width of the facial hard and soft tissues are measured at the implant site at T1 and T2. We calculated the change in the amount of hard and soft tissues from T1 to T2 and determined the correlation between preoperative facial alveolar bone morphology and postoperative gingival recession.13 women and 7 men were recruited. A total of 20 implants were evaluated. The implant survival rate was 100%. The mean facial alveolar bone dehiscence width was 3.9 ± 1.6 mm, and the mean depth from platform level was 2.9 ± 1.7 mm. The mean implant body exposure on the buccal was 4.8 ± 1.7 mm, and the mean socket width gap was 2.1 ± 0.8 mm. At T1, the mean facial hard tissue width was 2.1 ± 0.7 mm, and the mean height was 2.0 ± 0.7 mm. The mean change in vertical gingival recession from T1 to T2 was 0.5 ± 0.5 mm. We found a positive correlation between facial alveolar bone dehiscence width and gingival recession (r = 0.46, p-value = 0.04) and between dehiscence depth and gingival recession (r = 0.48, p-value = 0.03).The results of our CBCT superposition method indicated that immediate implant placement can be considered in patients with facial alveolar bone dehiscence. However, there may be a higher risk of gingival recession with wide or deep dehiscence.

OBJECTIVE The aim of the present systematic review and meta-analysis was to assess the clinical efficacy of regenerative periodontal surgery of intrabony defects using a combination of enamel matrix derivative (EMD) and bone graft compared with that of EMD alone. MATERIALS AND METHODS The Cochrane Oral Health Group specialist trials, MEDLINE, and EMBASE databases were searched for entries up to February 2014. The primary outcome was gain of clinical attachment (CAL). Weighted means and forest plots were calculated for CAL gain, probing depth (PD), and gingival recession (REC). RESULTS Twelve studies reporting on 434 patients and 548 intrabony defects were selected for the analysis. Mean CAL gain amounted to 3.76 ± 1.07 mm (median 3.63 95 % CI 3.51-3.75) following treatment with a combination of EMD and bone graft and to 3.32 ± 1.04 mm (median 3.40; 95 % CI 3.28-3.52) following treatment with EMD alone. Mean PD reduction measured 4.22 ± 1.20 mm (median 4.10; 95 % CI 3.96-4.24) at sites treated with EMD and bone graft and yielded 4.12 ± 1.07 mm (median 4.00; 95 % CI 3.88-4.12) at sites treated with EMD alone. Mean REC increase amounted to 0.76 ± 0.42 mm (median 0.63; 95 % CI 0.58-0.68) at sites treated with EMD and bone graft and to 0.91 ± 0.26 mm (median 0.90; 95 % CI 0.87-0.93) at sites treated with EMD alone. CONCLUSIONS Within their limits, the present results indicate that the combination of EMD and bone grafts may result in additional clinical improvements in terms of CAL gain and PD reduction compared with those obtained with EMD alone. The potential influence of the chosen graft material or of the surgical procedure (i.e., flap design) on the clinical outcomes is unclear. CLINICAL RELEVANCE The present findings support the use of EMD and bone grafts for the treatment of intrabony periodontal defects.

This study aimed to evaluate the oral health status of individuals with obsessive-compulsive disorder (OCD).Ninety-two participants, aged 18 years and older from which 46 had OCD symptoms, were included in this comparative cross-sectional study. Data on age, sex, smoking habit, educational level, and potential mediators including brushing frequency (BF) and brushing duration (BD) were collected. Clinical examinations determined outcome measures including decayed-missing-filled teeth (DMFT), presence of root caries (PoRC), gingival recession (GR), plaque index (PI), and papillary bleeding index (PBI). Pathway analysis was used for data analysis.Individuals with OCD had significantly lower DMFT (p.01), higher BF (p = .01), and lower PI (p = .01); however, there were no significant differences regarding BD, GR, PBI, and PoRC (p.05). While BD did not have a mediating role, BF mediated the effect of OCD on DMFT (B = -0.31, CI = -0.60 to -0.06) and PI (B = -0.15, CI = -0.36 to -0.03). Males had less PI (B = -1.03, CI = -1.81 to -0.24) and PBI (B = -1.14, CI = -2.09 to 0.20) than females. Except for OCD and sex, other predictors were not significant.Individuals with OCD had lower caries experience and similar gingival health compared to controls. Part of the impact of OCD was mediated through brushing habits.

In forensic science, the information that teeth provide to the age estimation process is very important. In adults, one of the most widely used indicators of skeletal age is the Root Dentin Translucency (RDT), mainly through the Lamendin technique, which is used in various Latin American contexts. Recently, Parra et al. (2020) have developed a Bayesian regression model using the Lamendin technique to establish standardized criteria for estimating age-at-death in adults in various forensic contexts. In this study, we evaluate the applicability of this proposal together with the proposal by Lamendin et al. (1992) and Prince and Ubelaker (2002) in Latin American contexts. A sample of single-rooted teeth belonging to 805 individuals from six Latin American countries was used. The results of the three proposals considered were analyzed taking into account factors such as age, sex, origin, and the tooth surface on which the variables were surveyed. Of the factors that would affect the estimates, it was found that the age of the individuals had the greatest influence. However, it was confirmed that the sex and surface of the teeth on which the measurements were taken did not influence the final result. On the other hand, as we expected, the application of the analyzed proposals would also be possible in other forensic contexts, as shown by the results obtained according to the origin. This research expands the FIDB with more information on Latino contexts.

This research aimed to develop a new digital evaluation protocol to objectively quantify the volumetric changes of root coverage periodontal plastic surgery when combined with connective tissue graft. Consecutive patients with Cairo recession type 1 (RT1) or Cairo recession type 2 (RT2) were treated. Accurate study models obtained at baseline and follow-ups were optically scanned. Healing dynamics were measured by calculating volume differences between time points. Nineteen patients were treated between December 2014 and January 2019. At 3-month follow-up, root coverage was 95.6% (± 14.5%) with tunnel and connective tissue graft (TUN + CTG) technique, and 88.9% (± 20.5%) with the vestibular incision subperiosteal tunnel access and connective tissue graft (VISTA + CTG) technique. Recession decreased 1.33 (± 0.86) mm and 1.42 (± 0.92) mm, respectively (p = 0.337). At 6-month follow-up, root coverage was 96.5% (± 10.4%) with the TUN + CTG and 93.9% (± 10.3%) with the VISTA + CTG. Recession decreased 1.35 (± 0.85) mm and 1.45 (± 0.82) mm, respectively (p = 0.455). Complete root coverage was achieved in 86.7% (± 0.4%) with TUN + CTG and 70.6% (± 0.5%) with VISTA + CTG. No statistically significant differences were found between techniques. The digital protocol presented proved to be a non-invasive technique for accurate measurements of clinical outcomes. Both techniques reduce gingival recessions, with no statistically significant differences.

Numerous surgical procedures are used to correct gingival recession, like free gingival graft, pedicle graft, and connective tissue graft. Our study aimed to compare and clinically evaluate root coverage using a coronally advanced flap (CAF) with and without Biomesh

Partial-thickness double pedicle flap and connective tissue graft (CTG) is a procedure to treat single gingival recession in the anterior mandible. However, long-term data have not been reported. Patients who had been treated by the same periodontist in a private practice in Belgium between 2002 and 2009 were invited to return for a clinical examination in 2017. Seventeen patients (15 females, 2 males; mean age: 34.6 years) with a total of 23 treated single recessions were reexamined after 8 to 15 years of follow-up. Between 1 and 8 to 15 years of follow-up, mean and complete root coverage did not differ and amounted to 75% and 44% at study termination, respectively (P = .204). The esthetic outcome was mediocre, given a final mean root coverage esthetic score of 6.52. The Mucosal Scarring Index demonstrated a significant reduction in scarring between 1 and 8 to 15 years of follow-up; however, 31% of the cases still demonstrated some scarring in the end. Patients were less critical than clinicians, as they expressed high esthetic (mean: 81) and low scarring (mean 14) scores on visual analog scales. Partial-thickness double pedicle flap and CTG is an effective root-coverage procedure. However, alternative techniques may need to be considered for esthetically demanding patients.

A 9-year-old female was referred by her general dentist for an evaluation of an impacted maxillary left central incisor. Her maxillary left primary incisors showed crossbites and her right central incisor showed an edge-to-edge bite which caused gingival recession on the mandibular right central incisor. After treatment, the impacted maxillary central incisor erupted successfully. An optimal overbite and overjet were also achieved, and her gingival recession was improved.

Objective To investigate risk indicators associated with root caries among the Hong Kong older adults who attended long-term care facilities regularly. Methods Nonfrail older adults with at least six natural teeth from 10 long-term social or residential care facilities were examined. The clinical examinations were conducted by two calibrated dentists in the institutions. Portal dental chairs, intra-oral LED lights, disposable mouth mirrors, periodontal probes and CPI probes were used in the examinations. Negative binomial regression analyses were performed to identify the risk indicators associated with root caries. Multilevel logistic regression analyses were conducted to detect the associations between DF-root and D-root, and selected person-level and tooth surface-level factors. Results A total of 353 older adults (mean age 74.9 years) were examined. The prevalence of DF-root and D-root was 43.1% and 30.0%, respectively. The mean DF-root and D-root scores were 1.3 and 0.7, respectively. Relative to participants without DF-root, those with root caries experience were older and had more exposed root surfaces, and a higher proportion were partial denture wearers. There was a positive correlation between the DF-root score and the age of the participant, and with the numbers of exposed root surfaces, missing teeth and teeth with coronal caries. Higher prevalence of DF-root was observed among the older participants, and caries experience of root surfaces with greater gingival recession and visible plaque was higher. Lingual root surfaces and roots in the mandibular anterior region had the lowest rates of DF-root. Conclusions People who are older have a higher prevalence and severity of root caries. Coronal caries experience, maxillary teeth, buccal root surfaces, gingival recession and plaque on the root surface are positively associated with root caries in older adults.

Made available in DSpace on 2019-10-06T17:15:44Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-09-01 Introduction: Residual pockets represent a risk factor for periodontal disease progression. Diabetes Mellitus (DM) may impair prognosis after cause-related therapy, mainly due to the chronic hyperglycemia that negatively influences tissue repair. This study evaluated the clinical efficacy of antimicrobial photodynamic therapy (aPDT) with curcumin (CUR) solution (100 mg/L) and LED irradiation (465–485 nm), as an adjunctive therapy to scaling and root planing (SRP), in the treatment of residual pockets in type 2 diabetic patients. Methods: Individuals with type 2 DM and chronic periodontitis presenting at least one residual pocket per quadrant were selected (n = 25). In each patient, all residual pockets with probing depth (PD) ≥5 mm and bleeding on probing (BOP) were allocated to receive, according to quadrant: 1) SRP (SRP group); 2) SRP and irrigation with CUR solution (100 mg/L) (CUR group); 3) SRP and LED irradiation (InGaN, 465–485 nm, 0.78 cm², 78 mW, 100 mW/cm², 60 s) (LED group); 4) SRP, irrigation with CUR solution (100 mg/L), one minute of pre-irradiation, and LED irradiation (InGaN, 465–485 nm, 60 s) (aPDT group). Clinical parameters of PD, gingival recession (GR), clinical attachment level (CAL), BOP and visible plaque index (PI) were evaluated at baseline, three and six months post-therapies. Differences between the examination periods in each group were analyzed by Friedman's test for non-parametric data, while parametric data were submitted to analysis of variance (One-way ANOVA), followed by Tukey's test. Intergroup comparisons were performed by Kruskal-Wallis test. Results: In an intergroup comparison, the mean values for PD, GR, CAL, BOP and PI were not different at baseline, three and six months (p > 0.05). The intragroup comparison evidenced reduction in PD and BOP in all treatment groups at three and six months (p < 0.05). Significant CAL gain was notable only for the aPDT and LED groups at three months in comparison to baseline data (p < 0.05). Conclusion: Treatment of residual pockets in patients with type 2 DM through association of SRP with aPDT (CUR solution 100 mg/L and LED irradiation) or LED irradiation may yield short-term (three months) clinical benefits regarding CAL gain. Department of Surgery and Integrated Clinic Division of Periodontology São Paulo State University (Unesp) School of Dentistry Department of Surgery and Integrated Clinic Division of Periodontology São Paulo State University (Unesp) School of Dentistry

Maxillary midline diastema is a common aesthetic concern of dental patients. Various treatment modalities have been employed to close diastemas. This case report describes an unusual orthodontic treatment approach for a 25-year-old African American female patient with a large maxillary midline diastema of 5mm, bialveolar dental protrusion and unilateral Class III malocclusion. The treatment included one mandibular incisor extraction, followed by retraction of the incisors. At the end of the 16-month active treatment period, favourable aesthetic and occlusal outcomes were attained. Closure of midline diastema, good overjet and overbite with Class I molar relationships were achieved. CLINICAL SIGNIFICANCE: Fixed orthodontic treatment with single mandibular incisor extraction can be an effective treatment choice for a large maxillary midline diastema. With careful selection of the case and treatment planning, successful results can be obtained.

This study evaluated clinical outcomes of acellular dermal matrix (ADM) allograft compared with autogenous free gingival graft (FGG) for gingival augmentation after 15 years. Twenty-two patients were originally included and evaluated by de Resende et al. (Clin Oral Investig 23:539–550, 2019), and 12 accepted to participate in this longitudinal evaluation. Clinical parameters evaluated were recession depth (RD), probing depth (PD), clinical attachment level (CAL), keratinized tissue width (KTW), and soft tissue thickness (TT). In addition, esthetic perception was evaluated by patients and by a calibrated periodontist. Data were evaluated by ANOVA complemented by Tukey tests (p

To evaluate periodontal health and oral health behaviors in a cohort of subjects with type 1 diabetes (T1D), 50 persons with T1D (30 males and 20 females; mean age: 35.2 years) were recruited from the Diabetology Unit of the Geneva University Hospitals; 50 nondiabetic persons matched for gender, age, and smoking status comprised the control group. We assessed periodontal health using the gingival index (GI), plaque index, probing depth (PD), bleeding on probing (BOP), and clinical attachment level (CAL) and recorded self‐reported attitudes and behaviors regarding dental care. The two groups were compared using conditional logistic regression. With respect to the mean PD, CAL, and the mean number of sites with PD >4 mm that bled upon probing, there were no significant differences between the groups. However, subjects with diabetes had significantly more plaque and gingival inflammation and presented more sites with BOP compared with control subjects. Further analysis of the subjects in younger (40 years) cohorts revealed a marked difference in GI between younger healthy and controls, which was also present in older patients and controls but much reduced in magnitude and significance. This marked difference in the gingival health of young versus old diabetic patients to matched controls may provide diagnostic advantages and screening and prevention opportunities to exploit. In spite of similar self‐reported oral hygiene habits and frequency of dental visits, patients with T1D presented more plaque and more inflammation than healthy controls, particularly in the younger subjects. Gingivitis in young T1D patients may be an early indicator for more complicated diabetes and periodontitis in the future. Thus, patients with T1D mellitus should be screened for signs of periodontal disease early and should be motivated and instructed in good oral hygiene practices.

Background The objective was to evaluate the efficiency of indocyanine green (ICG)-based adjunctive antimicrobial photodynamic therapy (aPDT) in a prospective clinical study regarding non-surgical treatment of chronic periodontitis. Methods Affected teeth of twenty patients were treated with scaling and root planing (control group). Using a split-mouth design, two quadrants received additional ICG-based (perio green®, 0.1 mg/ml) aPDT (test group) with a diode laser at 808 nm (100 mW at 2 kHz). Clinical assessment of bleeding on probing (BOP), sulcus fluid flow rate (SFFR) and microbiological analysis were performed at baseline, two weeks, three and six months after treatment. Relative attachment level (RAL), probing depths (PD) and gingival recession (GR), were also analyzed. Results At baseline, none of the assessed parameters showed significant differences between the test and control groups. Median values for BOP, RAL, PD, decreased significantly in both groups after three months of treatment (p ≤ 0.05) without significant difference between the groups. Two weeks after treatment, the SFFR showed significantly lower mean values in the test group (aPDT). Conclusion Within the study limits, the only significant difference between the control group and the aPDT group was a transient smaller amount of SFFR in the latter during the first follow-up. With the applied parameters, this study does not conclusively support ICG-based aPDT, though it is promising because no adverse effects occurred. The precise modes of action of ICG must be elucidated, and further clinical trials are needed.

Introduction Gingival recession (GR) is an unhealthy root exposure that could result in sensitivity, abrasion, root caries and higher chance of plaque collection. The prevalence of GR is higher on the facial surfaces but could also affect the lingual tooth surfaces. Despite the etiology and location of GR, treatment is warranted to improve the long-term periodontal stability around the affected teeth. This case report describes the use of partly deepithelialized free gingival graft (PE-FGG) to augment lingual GR post orthodontic treatment. Case presentation The current report evaluates the results of PG-FGG to correct lingual recession in a 21-year-old female. The patient presented with 5 mm lingual recession on a previously orthodontically rotated tooth (#21). The recession was treated using a PE-FGG to increase keratinized gingiva (KG) and reduce root exposure. Follow-up at 24 months showed adequate root coverage and KG. Conclusion The use of PE-FGG can be used to enhance KG for lingual recession with adequate root coverage.

INTRODUCTION There is limited evidence related to the long-term treatment outcomes of acellular dermal matrix graft (ADMG) plus coronally advanced flap (CAF) for the treatment of multiple recession defects. The aim of this case report is to assess the short- and long-term clinical outcomes of Miller Class I multiple gingival recession-type defects in the maxilla treated with ADMG plus CAF. CASE PRESENTATION A 36-year-old female patient smoking < five cigarettes per day presented multiple adjacent Miller Class I gingival recession in the left maxilla and was referred for treatment with chief complaints of dental hypersensitivity and esthetics. Root coverage was achieved by ADMG + CAF and the patient underwent a 10-year follow-up. CONCLUSIONS Within the limits of this case report, mean root coverage obtained at 6 months could not be maintained in the long term. A significant relapse was detected after 10 years, from 80% complete root coverage (CRC) at 6 months to 40% at 10 years. Monitoring, compliance, and reinstructions in oral hygiene techniques seem mandatory for minimizing relapse of gingival recessions after root coverage procedures.

Background Peripheral caries may cause significant oral pain and pathology and is very prevalent within the Western Australia horse population. Associations with periodontal disease have been indicated; however, further work is needed to assess the anatomical and histological aspects of the conditions, to better understand the pathophysiology. Objectives To assess the anatomical and histopathological changes associated with equine cheek teeth peripheral caries and disease of the periodontium to better understand the pathogenesis and any association between the conditions. Study design Cross-sectional epidemiological and histological study. Methods A survey of 500 Western Australia horses was performed to assess the prevalence of peripheral caries and associations with other dental pathologies within the Western Australia horse population. Histopathological assessment was also performed on four extracted cheek teeth affected by peripheral caries and on three interdental areas from an abattoir specimen affected by peripheral caries and interdental feed accumulation. Results There was a significant association between peripheral caries and cheek teeth interdental feed accumulation and gingival recession. This association was significantly stronger in the mandibular cheek teeth than the maxillary cheek teeth and also in horses with moderate or severe peripheral caries compared to horses with mild peripheral caries. Histopathological examination found caries lesions consistent with those found in humans above the gingival margin. Sub-gingivally, however, the cementum and periodontal structures were normal. In the samples with concurrent peripheral caries and deep feed-pocketing, there was significant gingival recession; however, only mild or no histopathological changes occurred in the gingiva. Main limitations Small sample size for histopathological assessment. Conclusion Horses with peripheral caries, and in particular, horses with mandibular cheek teeth with peripheral caries are significantly more likely to also be affected by disease of the periodontium than horses without peripheral caries.

This report describes a minimally invasive surgical approach using the vestibular incision subperiosteal tunnel access and a suture called the subperiosteal sling (SPS) to stabilize the connective tissue graft (CTG) for periodontal plastic surgery. The SPS suture engages only the CTG and stabilizes the CTG against the tooth independent of the overlying tissue, which minimizes the risk of graft mobility caused by muscle movement.

The objectives of this study were to clinically and histologically assess the capacity of bilaminar subepithelial connective tissue grafts (SCTGs) alone or in combination with gingivoplasty (Gv) to increase the keratinized gingiva width (KGW) in contralateral mandibular sites lacking KG (10 patients, 42 sites). The effects of Gv timing (1 vs 2 months) and technique (blade vs laser) were also evaluated. SCTGs alone resulted in mean KGW increase of 0.1 to 0.7 mm. Laser-Gv significantly increased KGW by an additional 1.9 mm at 4 months postabrasion as opposed to 0.9 mm achieved with blade-Gv. Histologically, laser-treated sites displayed parakeratinization with more pronounced rete pegs than observed in blade-abraded sites.

Introduction In recent years, several methods have been described for the treatment of deep Miller Class II recessions. Most of these techniques concentrate on single recessions or one deep recession accompanied by just slight neighboring root denudations. A modified technique is presented for treating two or more deep recessions beyond the mucogingival margin combining a subepithelial connective tissue graft (SCTG), enamel matrix derivative, and a multiple pedicle coronally advanced flap. To the best of our knowledge, this is the first report to describe the treatment of multiple deep Miller Class II recessions exceeding beyond the mucogingival junction using a pedicled advanced flap. Case presentation A 29-year-old woman was referred to the periodontal practice of JT for the treatment of progressive deep Miller Class II recessions. The root coverage procedure was performed by a modified multiple pedicle flap combined with a connective tissue graft harvested from the palate and enamel matrix derivative. The case was followed up for 2 years. Conclusions This modified technique of a multiple pedicled flap is a feasible and useful method for treating several deep neighboring recessions. Due to the improved incision techniques, scar tissue formation might be reduced not to interfere with the esthetic result.

The purpose of this study was to identify the prevalence and predisposing and etiologic factors of dentin hypersensitivity (DH), as well as the demographic characteristics of patients.The 1210 patients were examined. The research was based on a two-step investigation: questionnaire and clinical examination. DH was evaluated by the response of the patient to tactile and air-blast stimuli. Loss of attachment and gingival recession of sensitive teeth was measured on the buccal and lingual surfaces. Also, the tooth wear of sensitive teeth was graded on the buccal and lingual surfaces. Comparisons of nonnormally distributed continuous variables were performed using the Mann-Whitney U test and Kruskal-Wallis one-way analysis of variance (ANOVA) and Dunn's post hoc test. Comparisons of categorical variables were performed using Pearson's chi-square, Fisher's exact chi-square, Yates's chi-square, and the Monte Carlo chi-square test.One hundred twenty-four patients reported DH, showing a prevalence for self-reported DH of 10.2%. Eight hundred forty teeth were diagnosed as having DH, giving a clinical diagnosis rate of DH of 29.4%. Females (76.8%), the 31-40 years age group (26%), housewives (36.8%), and high school education level (38%) had the highest prevalence of DH as demographic properties. A cold stimulus was the most common stimuli trigger for hypersensitivity (97.1%). Occasional pain (55.5%) showed the highest prevalence in terms of frequency of DH. A higher rate of DH was found with the use of medium brushes (47.4%) and brushing twice per day (59.4%) for 1-2 min (56.2%) with the circular method (33.8%) as oral hygiene habits. The buccal surface of the lower right central incisors (5.7%) had the highest prevalence. The most affected teeth by DH were incisors (38.4%). The buccal surfaces (86.3%) of teeth showed a higher high prevalence of DH compared with the lingual surface (52.7%), similar to gingival recession (40.9% vs. 15.7%) and loss of attachment (68.3% vs. 42.6%).Clinically diagnosed DH was more common than self-reported DH. Some factors related to patients such as sex (female), the 31-40 years age group, housewives, high school students, using medium brushes, brushing twice per day, and the circular brushing method were more likely to have a risk for DH. Also, buccal surfaces of teeth, gingival recession, and loss of attachment on the buccal surface of teeth should be considered as predisposing factors for DH.To control and prevent DH, clinicians should consider patients' demographics, predisposing factors, and etiologic factors.

Background The aim of the study was to clinically evaluate the healing of intrabony defects after treatment with a new generation of platelet-rich fibrin (A-PRF+) respect to enamel matrix derivative (EMD). Methods Thirty (30) intrabony defects of 18 patients (9 males, 9 females) were randomly treated with A-PRF+ (test, n = 15) or EMD (control, n = 15). The following clinical parameters were recorded at baseline and 6 months after surgery: pocket depth (PD), gingival recession (GR) and clinical attachment level (CAL). After debridement the intrabony defects were filled with A-PRF+ in the test group, respectively with EMD in the control group, and fixed with sutures to ensure wound closure and stability. Results Both treatment methods resulted in statistically significant PD reductions, respectively CAL gains six months post-operatively. No statistically significant differences were found between the two groups as the mean CAL gain was 2.33 ± 1.58 mm in the A-PRF+ group, respectively 2.60 ± 1.18 mm in the EMD group (p Conclusion Within the limits of this study the new-generation platelet-rich fibrin seems to be as clinically effective as EMD during surgical treatment of intrabony defects. Treatment with A-PRF+ or EMD resulted in reliable clinical outcomes. The use of A-PRF+ as a human autologous product can give a positive impact on periodontal healing. Clinical Relevance A-PRF+ may be suitable for the treatment of intrabony periodontal defects. Trial registration number (TRN) NCT04404374 (ClinicalTrials.gov ID).

Introduction: implant supported prosthesis has become a viable treatment option for missing teeth. An important tool to detect early changes around implants is the standardized assessment of peri-implant hard and soft tissue parameters. The purpose of this prospective study was to clinically and radiographically assess the soft and hard tissues around implants.Methods: ten (10) patients with 13 implant supported prosthesis were included in the study. Clinical parameters plaque index (PI), gingival index (GI), modified sulcus bleeding index (mSBI), peri-implant Probing Depth (PD), gingival margin Level, width of keratinized mucosa (WKM) and implant mobility were measured at loading and at 3 and 6 months. The radiographic crestal bone loss and peri-apical implant radiolucencies were also evaluated at loading and at 3 and 6 months. Student paired t test and correlation and regression analysis was done to evaluate the effect of clinical variables over bone loss.Results: there was decrease in the site specific PI, GI, mSBI and peri-implant PD and an increase in the gingival recession from baseline to 6 months. The WKM remained stable throughout the study. Significant crestal bone loss was observed around implants more on the distal as compared to the mesial aspect. No mobility or peri-apical implant radiolucency was observed. Regression analysis of the confounding variables with bone loss showed no significant effect.Conclusion:the occlusal loading of implants after 6 months showed significant bone loss (

To describe the step-by-step procedure of a novel surgical technique consisting of a combination of the laterally closed tunnel (LCT) and the modified coronally advanced tunnel (MCAT) (ie, LCT/MCAT), designed to treat multiple mandibular adjacent gingival recessions (MAGR) and to present the clinical outcomes obtained in 11 consecutively treated patients.Eleven systemically and periodontally healthy patients (7 females, mean ± SD 33.62 ± 14.6 years, min. 19 years max. 67 years) with a total of 40 adjacent mandibular RT1 (ie, Miller Class 1 and 2) gingival recessions with a minim um depth ≥ 3 mm, were consecutively treated with LCT/MCAT, in conjunction with an enamel matrix derivative (EMD) and subepithelial palatal connective tissue graft (SCTG). Treatment outcomes were assessed at baseline and at 12 months postoperatively. Prior to surgery and at 12 months postoperatively, recession depth (RD) and recession width (RW) were evaluated. The primary outcome variable was complete root coverage (CRC, ie 100% root coverage), the secondary outcome was mean root coverage (MRC).Postoperative pain and discomfort were low and the healing was uneventful in all cases without any complications. At 12 months, statistically significant (P.05) root coverage (RC) was obtained in all patients. CRC was obtained in five patients with a total of 21 recessions, while MRC measured 92.9% (ie, 3.75 mm). In seven patients (ie, 63.6%), RC amounted to93% while the minim um RC per patient measured 83.76%.The results of the present case series suggest that the LCT/MCAT is a valuable technique for the treatment of mandibular RT1 MAGR.

Introduction Root coverage of gingival recessions in the anterior mandible has limited predictability. Mandibular incisors often offers a thin phenotype, a lack of keratinized tissue and moreover a shallow vestibule with high labial frenum attachment. These conditions induce tensions on the surgical site in conventional coronally advanced flap (CAF) procedures and may compromise the complete root coverage. The purpose of this case report is to present a novel surgical technique for deep labial recessions on mandibular incisors, based on a modified tunnel technique with subepithelial connective tissue graft (CTG) in combination with simultaneous frenuloplasty. Case presentation A 20-year-old female patient was referred to the office for treatment of an isolated RT1 in Cairo classification buccal recession on #24 with a shallow vestibule. The design of the recipient site consisted of a full-thickness modified tunnel preparation extending 4 mm bilaterally to the recession and beyond the crestal bone. A CTG was harvested from the palate and properly adapted to the root surface. The graft and flap were secured with single-interrupted sutures and double-crossed sutures to achieve complete root coverage. Frenuloplasty was then performed with a single incision in the bottom of the vestibule and careful sectioning of frenum fibers to release vestibular tensions. Complete root coverage was maintained at 5 years with completely satisfactory esthetic outcomes. Conclusion Treatment of single deep mandibular anterior recessions with a combined tunneled CTG approach in addition to frenuloplasty appears to lead to complete long-term root coverage in one surgery with lasting esthetics results.

The objective of the present study was to investigate the effects of various types of fixed prostheses on periodontal tissues and explore the association of gingival biotype and gum recession in relation to prosthesis types. The study participants (N = 95) were divided into three groups based on the type of dental prosthesis: Group-I: cobalt-chrome (Co-Cr) ceramic prosthesis fabricated by the conventional method (n = 35), Group-II: consisted of patients with Co-Cr ceramic prostheses fabricated by a computer-aided design and computer aided manufacturing (CAD/CAM) technique (n = 30), and Group-III: zirconia-based prostheses fabricated by the CAD/CAM technique (n = 30). Following the use of prostheses, periodontal examinations were performed using the Community Periodontal Index (CPI) and Modified Approximal Plaque Index (MAPI). In addition, the gingival biotype was examined using a probe transparency method. The Statistical Package for the Social Sciences (SPSS), Version 20 (IBM Company, Chicago, IL, USA), was used to analyze the results, and the significance level was set at p = 0.05. It showed the MAPI results after the use of prosthetic rehabilitation for 12 months of periodontitis in 87.9% ± 15.4 of patients in Group-I, in 80.6% ± 17.97 in those in Group-II, and in 62.5% ± 21.4 in those in Group-III (p &lt, 0.01). The CPI index results indicated a high prevalence of periodontal disease in all groups. The number of people with healthy periodontium constituted 17.1% of patients in Group-I, 24.2% in Group-II, and 37.1% in Group-III. Our study concluded that prosthetic treatment with periodontal diseases showed better outcomes while using dental prostheses fabricated by the CAD/CAM technique compared to the conventionally fabricated dental prostheses. The thin gingival biotype is more often associated with gingival recession than the thick biotype.

Objective The current cross‐sectional study aimed to investigate the prevalence of gingival recession (REC) in a sample of young individuals. In addition, the association with several risk factors was examined. Materials & methods A 104 subjects, aged 18–30 years old, were randomly enrolled in the study. Participants were requested to fill in a simple structured questionnaire in order to provide information on dental hygiene habits, educational level, smoking and history of orthodontic treatment. Afterwards, all the included individuals were subjected to a thorough clinical periodontal examination including gingival recession (REC), gingival biotype, plaque levels and gingival bleeding index (GBI) assessment. Results The mean prevalence of REC in the studied population surpassed 50% with an equal distribution among females and males. The most common teeth associated with REC were the lower left canine and left 1st premolar. Among the examined variables, only the bleeding index was found to be associated with the presence of REC. Conclusions Gingival recession was a prevalent condition among young individuals. Gingival inflammation was found to be the most significant factor affecting the incidence of REC.