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Aim: To describe the microbiological composition of subgingival dental plaque and molecular profile of gingival crevicular fluid (GCF) of periodontal furcation‐involved defects. Materials and Methods: Fifty‐seven participants with periodontitis contributed with a degree II–III furcation involvement (FI), a non‐furcation (NF) periodontal defect and a periodontally healthy site (HS). Subgingival plaque was analysed by sequencing the V3–V4 region of the 16S rRNA gene, and a multiplex bead immunoassay was carried out to estimate the GCF levels of 18 GCF biomarkers. Aiming to explore inherent patterns and the intrinsic structure of data, an AI‐clustering method was also applied. Results: In total, 171 subgingival plaque and 84 GCF samples were analysed. Four microbiome clusters were identified and associated with FI, NF and HS. A reduced aerobic microbiota (p =.01) was detected in FI compared with NF; IL‐6, MMP‐3, MMP‐8, BMP‐2, SOST, EGF and TIMP‐1 levels were increased in the GCF of FI compared with NF. Conclusions: This is the first study to profile periodontal furcation defects from a microbiological and inflammatory standpoint using conventional and AI‐based analyses. A reduced aerobic microbial biofilm and an increase of several inflammatory, connective tissue degradation and repair markers were detected compared with other periodontal defects. [ABSTRACT FROM AUTHOR]

Common challenges encountered for atrophic maxilla rehabilitation are the inadequate width and height of attached keratinized mucosa (AKM) and shallow vestibular depth. This study presents a buccally displaced palatal (BDP) flap technique to increase the tissue thickness and AKM width at the second-stage surgery and reestablish the correct fornix depth. The peri-implant pocket depths, modified Plaque Index score, modified sulcus Bleeding Index score, and soft tissue recession were evaluated 6 and 12 months after prostheses loading. A total of 52 implants were placed and analyzed, and no implant failures were found. No significant changes in peri-implant parameters were observed between 6 and 12 months, and mean recession was less than 0.2 mm after 12 months. Though this change was statistically significant, it was clinically irrelevant. The results demonstrate that adequately healthy peri-implant soft tissues and substantial dimensional stability of vestibular soft tissues at the 1-year follow-up were achieved with the BDP flap technique. The BDP flap could represent a viable option for increasing the width and the height of AKM and establishing the correct maxillary fornix depth. [ABSTRACT FROM AUTHOR]

Aims: Oral lichen planus (OLP) is a chronic immune disease. In this paper, we evaluated the overall characters, clinical presentation, and outcome of gingival lesions in OLP Italian patients. Methods and Results: A retrospective cohort study was accomplished: a total of 1319 charts were investigated, of whom 922 were female (69.9%): 617 patients (46.8%) manifested white lesions and 702 red ones (53.2%). While most patients had several oral sites of involvement, the gingiva was the unique location in 103 cases. Symptoms were reported in 480 patients (36.4%): 286 patients with erosive OLP, 103 with atrophic form, and 91 with a white form. Long‐lasting surveillance showed that only 40 patients (3.03%) had a total clinical signs remission. Regarding OLP medical treatment provided, patients attending less frequently a dental office underwent more often a specific therapy. Conclusions: To the best of our knowledge, this is the biggest collections of patients with gingival OLP ever described; exclusive gingival lesions are, however, rare and unlikely to undergo a malignant transformation. Moreover, gum lesions seemed to anticipate the appearance of oral lesions and a higher rate of OLP therapy was observed in patients with less frequent dental check‐ups and oral hygiene instructions. [ABSTRACT FROM AUTHOR]

The aim of the study was to assess modifications of gingival morphology at the end of Phase I treatment with Invisalign First. Eighteen subjects (ten females, eight males, mean age nine years) treated with Invisalign First were selected. The following parameters were measured on intraoral photographs before treatment (T0) and after the first set of aligners (T1) at level of permanent incisors, deciduous canines and molars: gingival margin height (GMH) and deciduous canine inclination (DCI). A paired t-test was used to evaluate T1-T0 changes. The level of significance was established at 5%. Deciduous canines' GMH showed a major reduction between T1 and T0 accounting for 0.87 mm and 0.86 mm, respectively on the right and left sides. DCI increased for all patients in the interval T0–T1 on both sides, +7.11° on the right and +7.5° on the left. Tooth movement during Invisalign First induced significant modifications of gingival contour resulting in a more harmonious smile. [ABSTRACT FROM AUTHOR]

Background and Objectives : The influence of the quantity and quality of peri-implant soft tissue on implant health and long-term maintenance is controversial. This consensus aimed to assess the importance of peri-implant soft tissue by analyzing four aspects: the role of keratinized mucosa (KM), the efficacy of specific collagen matrix, the influence of abutment material, and soft-tissue thickness. Materials and Methods : Active members of the Italian Academy of Osseointegration (IAO) participated in the consensus. Four systematic reviews were conducted, and their results were discussed to provide guidelines on the importance of soft tissue around implants. The first review evaluated the effect of KM on soft-tissue health, peri-implant bone loss, and patient-related variables. The second one analyzed if there was a specific type of matrix that provided better results in terms of peri-implant buccal soft-tissue thickness and keratinized mucosa width compared to autogenous soft-tissue graft. The third review evaluated the influence of different abutment materials on the soft tissues, and the fourth assessed the effect of soft-tissue thickness on peri-implant marginal bone loss (MBL). Results and Conclusions : The agreements reached by the assembly were as follows: the presence of supra-periosteal keratinized tissue is considered to favorably influence peri-implant health and aesthetics but had no relation to preventing bone crest resorption unrelated to infection. It facilitates patient cleaning around implants and reduces patient-reported pain. The free gingival graft (FGG) is considered the best in terms of supra-periosteal KM increase. Connective tissue grafts (CTG) perform better than volume-stable collagen matrices to increase soft-tissue thickness. Collagen matrices reduce surgical time and patient morbidity and can give better camouflaging. The influence of abutment material (titanium or zirconia) on MBL remains controversial, and no conclusion could be reached on this issue. Peri-implant soft-tissue health and recession seem not to be influenced by abutment material, but data are limited to zirconia and titanium. Although this systematic review highlighted the absence of a correlation between soft-tissue thickness and MBL, the assembly failed to find a consensus on this issue.

The article describes the case of a 34-year-old healthy woman presented with diffuse and painful oral lesions, which appeared two days after the first administration of Pfizer BioNTech SARS-CoV-2 vaccine. Topics discussed include finding on clinical examination, possibility that SARS-CoV-2 can infect and replicate in oral kieratinocytes and fibroblasts, causing oral manifestations, and the use of polysorbate 80 to make the m-RNA fat-soluble.

The aim of this prospective randomized clinical study was to evaluate, by means of an image analysis system, the efficacy of two different surgical procedures for the treatment of Miller Class I and II maxillary gingival recession. Patients treated for maxillary gingival recession were recruited and randomly divided into two groups: patients who received a coronally advanced flap with connective tissue graft (CAF + CTG) or CAF alone. Outcome parameters included complete root coverage, recession reduction, and keratinized tissue amount. Twenty-five patients completed the 12-month follow-up period. Patients in the CAF + CTG group showed a better primary outcome— gingival recession at 12 months—than CAF patients (P = .0001). Gingival recession at 12 months had a median of 0.5 (interquartile range [IQR] 0.5 to 0.6) in the CAF + CTG group and a median of 1.0 (IQR 0.9 to 1.1) in the CAF group. CAF + CTG and CAF groups had similar complete root coverage at 6 and 12 months. Recession and keratinized tissue width significantly decreased over time (P < .0001), with no effect of treatment or of treatment over time. Buccal probing depth had similar values over time (P = .28) and in the two groups (P = .52). Buccal clinical attachment level had similar values in the two groups (P = .87); moreover, mesial and distal clinical attachment levels did not show any variation over time (P = .88 and P = .68, respectively). By means of a computerized image analysis system better outcomes in terms of recession reduction after 12 months of follow-up were measured for maxillary gingival recessions treated with CAF and CTG. Adjunctive application of a CTG under a CAF increased the probability of achieving complete root coverage in maxillary Miller Class I and II defects (61.5% versus 83.3%; P = .38). Both treatments were equally effective in providing a consistent reduction of the baseline recession. [ABSTRACT FROM AUTHOR]

In the maxillary arch from premolar to premolar, 26 single dental implants were inserted in fresh extraction sockets and immediately provisionalized. The bone-to-implant gap was grafted with a bovine bone mineral. After 3 months, definitive ceramic crowns were placed. At baseline and after 1 year, the soft tissue horizontal width, mesiodistal papillary level, midfacial gingival level, and pink esthetic score were evaluated. No statistical differences were found between baseline and 1 year for all parameters. Immediate singletooth implants, with immediate restoration, are capable of maintaining the soft tissue contour and esthetics compared to the pretreatment status. [ABSTRACT FROM AUTHOR]

Objective: The aim of this randomized, single-blind, split-mouth design, clinical trial was to evaluate the effectiveness in plaque removal of two brushing methods, the vertical and the horizontal, in a sample of healthy young adults. Method and Materials: Forty-nine subjects were enrolled and 43 completed the study. All subjects abstained from oral hygiene practices for 48 hours. Plaque and gingival abrasions were recorded according to the Rustogi Modified Navy Plaque Index (RMNPI) and the van der Weijden method by one calibrated examiner before and immediately after the brushing session. A dental hygienist performed the two brushing methods using a randomized split-mouth design. The average plaque scores from the whole mouth, interproximal surfaces, and gingival margin were obtained before and after brushing, and the differences were evaluated using one-way analysis of variance. Results: The differences in mean plaque scores between pre- and postbrushing were statistically significant for both methods. Considering the interbrushing differences, the vertical method produced lower plaque scores compared to the horizontal for the whole mouth (P = .02). In the interproximal surfaces, the vertical method removed more plaque compared to the horizontal one (P < .01). In the gingival margin no statistically significant differences in plaque scores were recorded. Only 10 gingival abrasions were registered, mainly produced by the horizontal method. Conclusion: Results suggest that both toothbrushing methods are effective in plaque removal; nevertheless, the vertical brushing method has demonstrated to remove more plaque from the interproximal surfaces than the horizontal method. [ABSTRACT FROM AUTHOR]

Most of the histologic studies found in the literature on the peri-implant soft tissues have been done in animals and usually have been confined to mandibular implants fitted with healing or standard abutments. Few studies have investigated human peri-implant soft tissues. Moreover, the structure and dimensions of the peri-implant soft tissues in immediately loaded implants have not been investigated in depth. Human histologic data are valuable to validate animal models. This histologic and histomorphometric study evaluated the peri-implant soft tissues around three immediately loaded implants in humans. The implants were retrieved using a trephine and treated to obtain thin, ground sections. The sulcular epithelium was composed of approximately four to five layers of parakeratinized epithelial cells and had a length of approximately 1.2 to 1.3 mm. The junctional epithelium was composed of approximately three to four layers of epithelial cells and had a length of approximately 1.0 to 1.5 mm. Connective tissue attachment had a width of between 400 and 800 µm. Peri-implant collagen fibers, in the form of bundles (1- to 5-µm thick), began at the crestal bone and were oriented perpendicular to the abutment surface until 200 µm from the surface, where they became parallel running in several directions. Collagen fibers appeared to form a three-dimensional network around the abutment. No acute or chronic inflammatory cell infiltrate was present. Collagen fibers oriented in a perpendicular manner and in direct contact with the abutment surface were not observed in any of the specimens. This differentiated network of fibers may have clinical relevance as a mechanical protection of the underlying bone. These human histologic data are extremely valuable to validate and confirm those obtained from studies performed on animal models. Moreover, immediate loading of the implants did not compromise soft tissue integration. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate whether the use of enamel matrix derivative (EMD) improves clinical results of the coronally advanced flap (CAF) procedure in the treatment of multiple gingival recession defects. Ten patients presenting at least two adjacent buccal gingival recession defects affecting symmetric teeth on both sides of the maxilla were included in this study. Each set of multiple recession defects was assigned randomly to the test or control group. A bilateral simultaneous CAF procedure with vertical releasing incisions, with the adjunct of EMD for test sites, was performed. Clinical measurements (recession length, keratinized tissue, probing depth, and clinical attachment level) were assessed at baseline and 6 and 24 months after surgery by a blinded examiner. At the 6-month evaluation, both treatment procedures displayed good results with significant root coverage gain (CAF, 80.7% ± 20%; CAF + EMD, 82.8% ± 14%). A similar amount of relapse was noted at the 24-month evaluation when compared with the 6-month results (CAF, 71.0% ± 22%; CAF + EMD, 74.8% ± 16%). The use of EMD does not seem to significantly improve the results of the CAF procedure for root coverage in treatment of multiple recessions. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study was to transfer the provisional restoration emergence profile to the final implant-supported restoration and to buccal gingival margin ( BGM) stability after 2 years of function. Materials and Methods A total of 33 patients were recruited for treatment of single gaps by means of 33 implant-supported restorations. Fixed provisional crowns were screwed to the fixture and adjusted until the complete peri-implant soft tissue maturation was achieved. After 12 weeks, a second fixture impression was taken by means of a pick-up customization technique in order to transfer the clinical aspect of the peri-implant soft tissues to the master cast. A definitive restoration was delivered. A standardized method from digital photographs was used to assess the gingival margin modification ( BGM) from the provisional ( P) to the definitive prosthesis installation at baseline ( D0), and after 1 ( D1) and 2 years ( D2) of function. Also, marginal bone loss ( MBL) was calculated after 1 ( D1) and 2 years ( D2) of definitive restoration function. Results The BGM index at the time of the final restoration installation ( D0) was 0.12 ± 0.33 mm if compared with the BGM position of the provisional restoration ( P); it was of 0.12 ± 0.46 mm after 1-year of follow-up ( D1) and of 0.31 ± 0.21 after 2 years of function ( D2). No significant difference was calculated between measurements in different follow-up visits ( p > 0.05). No significant MBL was measured between the baseline ( D0) and the 1-year follow-up ( p = 0.816) with a mean MBL value of 0.2 ± 0.1 mm. Similar result was calculated after 2 years ( p = 0.684) with a mean MBL value of 0.3 ± 0.2. Conclusion A modified impression pick-up may be helpful to reproduce the gingival margin position from the provisional to the definitive restoration. Moreover, the gingival zenith position during the follow-up period seemed to be stable. Clinical Significance The modification of the standard impression pick-up technique may contribute to reproducing a natural emergence profile of esthetic implant prosthetic restorations (from the provisional to the definitive restoration.) With this technique, implant soft tissues stability around CAD-CAM (computer aided design - computer aided manufacturing) abutments can be easily obtained, and the customized abutment shape may better support the scalloped peri-implant soft tissues architecture, especially in anterior areas. [ABSTRACT FROM AUTHOR]

Background and Objective: In spite of four decades of studies on gingival crevicular fluid, no data have been reported on the repeatability of gingival crevicular fluid collection and the subsequent quantification procedures. The present study reports, for the first time, on the repeatability and method error of gingival crevicular fluid collection and quantification, as determined through its alkaline phosphatase (ALP) activity. Diagnostic considerations are then explored. Material and Methods: Twenty-seven healthy subjects (17 women and 10 men; mean age ± SD, 21.2 ± 4.8 years) with optimal periodontal status were enrolled according to a blind prospective design. The gingival crevicular fluid was collected at baseline, and after 1 d, 1 wk and 3 mo. At each clinical session, two consecutive rounds of gingival crevicular fluid collection were made from each of the four maxillary incisors, allowing the recovery of resting and flow gingival crevicular fluid. The total ALP activities were determined spectrophotometrically, and repeatability and method errors for the resting, flow and overall (resting + flow) gingival crevicular fluid ALP activities were calculated, relative to the corresponding baseline levels. Results: No significant differences were seen over time, although the flow gingival crevicular fluid ALP activity was generally lower than that for the resting gingival crevicular fluid. The method errors ranged from 40 to 58%, with the flow and overall gingival crevicular fluid activities showing the highest and lowest errors, respectively. Conclusion: Reliable use of the gingival crevicular fluid ALP collection and quantification, both in research and diagnosis on an individual basis, should take into account relevant errors, and variations are to be considered as true only above relevant thresholds. [ABSTRACT FROM AUTHOR]

Aim Adenosine receptors modulate inflammation in periodontal tissues. No data are available regarding the effects of adenosine A2A receptor stimulation in experimental periodontitis ( EPD). The aim of this study was to investigate the effects of polynucleotides (also known as polydeoxyribonucleotide, PDRN), a ligand of A2A receptor, in EPD in rats. Materials and Methods EPD was induced ligating the cervix of the lower left first molar. Sham- EPD had no ligature. After 7 days, EPD animals were randomized to a daily treatment with vehicle gel or 0.75% PDRN gel or PDRN gel with a specific A2A antagonist ( DMPX). Treatments lasted 7 days. Animals were then euthanized and the periodontium and surrounding gingival tissue were excised for histological evaluation and bio-molecular analysis of inflammatory (p- JNK, p- ERK, TNF-α, IL-6, HMGB-1) and apoptotic proteins ( BAX and Bcl-2). Results Vehicle-treated EPD rats showed severe inflammatory infiltrate in both gingival and periodontal ligament, as well as an enhanced expression of p- JNK, p- ERK, TNF-α, IL-6, HMGB-1 and BAX and a reduction in Bcl-2. PDRN gel restored the histological features, blunted inflammatory and apoptotic proteins expression and preserved Bcl-2 expression. DMPX abrogated PDRN positive effects. Conclusion Our data suggest that adenosine receptor stimulation by PDRN might represent a new therapeutic strategy for periodontitis. [ABSTRACT FROM AUTHOR]

Aim Comparing the efficacy of photoablative and photodynamic diode laser in adjunct to scaling -root planing ( SRP) and SRP alone for the treatment of chronic periodontitis. Materials and Methods Twenty-six patients were studied. Maxillary left or right quadrants were randomly assigned to sham-laser treatment + SRP or laser + SRP. This consisted of photoablative intra/extra-pocket de-epithelization with diode laser (λ = 810 nm), followed by single SRP and multiple photodynamic treatments (once weekly, 4-10 applications, mean ± SD: 3.7 ± 2.4) using diode laser (λ = 635 nm) and 0.3% methylene blue as photosensitizer. The patients were monitored at days 0 and 365 by clinical assessment (probing depth, PD; clinical attachment level, CAL; bleeding on probing, BOP) and at days 0, 15, 30, 45, 60, 75, 90, 365 by cytofluorescence analysis of gingival exfoliative samples taken in proximity of the teeth to be treated (polymorphonuclear leukocytes, PMN; red blood cells, RBC; damaged epithelial cells, DEC; bacteria). Results At day 365, compared with the control quadrants, the laser + SRP therapy yielded a significant ( p < 0.001) reduction in PD (−1.9 mm), CAL (−1.7 mm) and BOP (−33.2% bleeding sites), as well as in bacterial contamination - especially spirochetes - and PMN and RBC shedding in the gingival samples ( p < 0.001). Conclusions Diode laser treatment (photoablation followed by multiple photodynamic cycles) adjunctive to conventional SRP improves healing in chronic periodontitis patients. [ABSTRACT FROM AUTHOR]

Purpose: The present clinical study aimed to investigate the safety and feasibility of cervical marginal relocation (CMR) procedures in cases of deep caries involving supracrestal tissue attachment (STA)., Materials and Methods: Fifteen patients were selected from those attending the Studio Ghezzi Dental Clinic, Settimo Milanese, Milan, Italy. After following an oral hygiene program with specific counseling sessions, the selected patients were included in a periodic supportive periodontal therapy program. Depending on the treatment they received, the patients were divided into three groups according to a new classification system: a) Class 1: Nonsurgical CMR; b) Class 2a: Surgical CMR (gingival approach); c) Class 2b: Surgical CMR (osseous approach). The primary and secondary outcomes were pocket depth (PD) on probing and residual bleeding on probing (BOP) after 1 year., Results: No differences were found among the three CMR approaches for PD (overall mean value after 1 year: 2.5 ± 0.64 mm; overall mean value after 5.7 years: 2.3 ± 0.49 mm) or residual BOP (40% of the cases after 1 year)., Conclusion: Based on the study results, the authors can conclude that CMR procedures do not negatively affect the periodontal health status of patients when the connective compartment of the STA is not violated.