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Aim: To evaluate the non-inferiority of the adjunct of a xenogeneic collagen matrix (CMX) or connective tissue graft (CTG) to coronally advanced flaps (CAF) for coverage of multiple adjacent recessions and compare superiority in patient-reported outcomes (PROM)., Material and Methods: One hundred and eighty-seven subjects (92 CMX) with 485 recessions in 14 centres were randomized and followed up for 6 months. Patients filled daily diaries for 15 days to monitor patient-reported experience. The primary outcome was changed in position of the gingival margin. Multilevel analysis used centre, subject and tooth as levels and baseline parameters as covariates., Results: Average baseline recession was 2.5 ± 1.0 mm. The surgery was 15.7 min shorter (95%CI from 11.9 to 19.6, p < .0001) and perceived lighter (11.9 VAS units, 95%CI from 4.6 to 19.1, p = .0014) in CMX subjects. Time to recovery was 1.8 days shorter in CMX. Six-month root coverage was 1.7 ± 1.1 mm for CMX and 2.1 ± 1.0 mm for CTG (difference of 0.44 mm, 95%CI from 0.25 to 0.63 mm). The upper limit of the confidence interval was over the non-inferiority margin of 0.25 mm. Odds of complete root coverage were significantly higher for CTG (OR = 4.0, 95% CI 1.8-8.8)., Conclusion: Replacing CTG with CMX shortens time to recovery and decreases morbidity, but the tested generation of devices is probably inferior to autologous CTG in terms of root coverage. Significant variability in PROMs was observed among centres., (© 2017 The Authors. Journal of Clinical Periodontology Published by John Wiley & Sons Ltd.)

The aim of this clinical case series was to evaluate the clinical performance of the modified tunnel technique for treatment of multiple gingival recessions in the anterior mandible. A total of 20 patients with 63 Miller Class I and II defects were treated via a modified tunnel technique with subepithelial connective tissue graft. At baseline and 6 months postoperative, recession depth, probing pocket depth, width of keratinized tissue, and gingival tissue thickness were assessed. At 6 months, the results revealed a mean recession coverage of 93.87%. Complete recession coverage was achieved in 74.60%. The mean reduction of recession depth was 2.79 ± 0.12 mm. The modified tunnel technique showed successful mean root coverage in the delicate anterior mandible and was able to increase the amount of keratinized tissue.

Aims and Background: Primary wound closure has been advocated to be indispensable for a successful outcome of guided tissue regeneration-procedures. Yet narrow inter-proximal spaces often lack sufficient tissue quantity in order to facilitate a tension free re-adaptation of periodontal flaps. In order to maintain an uneventful healing process, the concept of layer-wise wound closure is applied to periodontal surgery., Material and Method: This article describes the introduction of a modified flap design, the double split flap., Results and Conclusion: By preparation of a second, internal flap and a wound in a layer-wise fashion, it is assumed that primary healing will be more predictable to achieve.

Objectives: The aim of the following study was to assess contour changes after socket preservation techniques., Material and Methods: In five beagle dogs, the distal root of the third and fourth mandibular premolars was extracted. The following treatments (Tx) were randomly assigned for the extraction socket. Tx 1: BioOss Collagen. Tx 2: BioOss Collagen and a free soft tissue graft. Tx 3: No treatment. Tx 4: The internal buccal aspect was covered with an experimental collagen membrane, the extraction socket was filled with BioOss Collagen and the membrane folded on top of the graft. Impressions were obtained at baseline, 2 and 4 months after surgery. Bucco-lingual measurements were performed using digital imaging analysis., Results: All groups displayed contour shrinkage at the buccal aspect. Only the differences between the two test groups (Tx 1, Tx 2) and the control group (Tx 3) were significant at the buccal aspect (p< or =0.001). No measurements of the Tx 4 group could be performed., Conclusion: Socket preservation techniques, used in the present experiment, were not able to entirely compensate for the alterations after tooth extraction. Yet, incorporation of BioOss Collagen seems to have the potential to limit but not avoid the post-operative contour shrinkage.

Purpose: The purpose of this prospective clinical trial was to evaluate over a 5-year period the treatment outcomes for immediately loaded full-arch fixed prostheses supported by two axially inclined and two tilted implants used to rehabilitate edentulous arches. This report presents preliminary 1-year results. Materials and Methods: Thirty-seven patients were recruited for treatment with either mandibular or maxillary full-arch fixed prostheses supported by four implants. Within 24 hours, the implants were immediately loaded with screw-retained full-arch acrylic resin provisional restorations. Definitive reconstructions were delivered 6 months later. Complete full-arch prostheses were supported by metal frameworks combined with high-density acrylic resin. Follow-up visits were scheduled for 6 and 12 months after initial prosthetic loading and then annually for up to 5 years. Digital radiographs were obtained immediately, 6 months after surgery, and at each annual follow-up visit. Marginal periimplant bone levels were assessed using digital image analysis. Results: The 1-year implant survival rates were 96.0% for axially positioned implants and 94.6% for tilted implants. The survival rates were 96.6% for maxillary implants and 98.7% for mandibular implants. The prosthetic survival rate was 100%. No significant differences were found in the results for tilted versus axially positioned implants. One year after loading, the mean marginal bone loss was 0.82 ± 0.31 mm around the axially oriented implants and 0.76 ± 0.49 mm around the tilted implants (P ≤ .05). Conclusions: Preliminary data from this clinical trial show high implant survival rates for immediately loaded full-arch prostheses supported by four implants. Immediate loading of tilted implants may be considered a viable treatment option for the rehabilitation of edentulous patients. [ABSTRACT FROM AUTHOR]

Recent advances in periodontal plastic surgery have encouraged reassessment of the envelope technique and its modified version, the tunnel technique, for root coverage. This article describes alterations in the technique-sensitive tunnel approach, which include an undermining split flap preparation of the buccal tissues with newly developed instruments to minimize trauma and ensure a better blood supply for the connective tissue graft. The use of a microsurgical concept, including microsurgical blades and suture material, improves wound healing and establishes a better esthetic result. Because these modifications simplify the tunnel approach, the spectrum of indications for the tunnel technique may be expanded and a broader application achieved. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to evaluate whether tooth extraction without the elevation of a muco-periosteal flap has advantageous effects on the resorption rate after tooth extraction. Material and Methods: In five beagle dogs polyether impressions were taken before the surgery. The roots of the first and second pre-molars (P1 and P2) were extracted and the sites were assigned to one of the following treatments: treatment group (Tx) 1, no treatment; Tx 2, surgical trauma (flap elevation and repositioning); Tx 3, the extraction socket was filled with BioOss Collagen® and closed with a free soft-tissue graft; Tx 4, after flap elevation and repositioning, the extraction socket was treated with BioOss Collagen® and a free soft-tissue graft. Impressions were taken 2 and 4 months after surgery. The casts were scanned, matched together with baseline casts and evaluated with digital image analysis. Results: The “flapless groups” demonstrated significant lower resorption rates both when using socket-preservation techniques and without. Furthermore, socket-preservation techniques yielded better results compared with not treating the socket. Conclusion: The results demonstrate that leaving the periosteum in place decreases the resorption rate of the extraction socket. Furthermore, the treatment of the extraction socket with BioOss Collagen® and a free gingival graft seems beneficial in limiting the resorption process after tooth extraction. [ABSTRACT FROM AUTHOR]