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Background/Objectives: Autogenous palatal free gingival graft (FGG) harvesting presents challenges for patients due to the increased risk of postoperative morbidity related to a second intraoral surgical wound that heals with secondary intention. This parallel-group, randomized, controlled, open-label trial aimed to evaluate the efficacy of the application of leukocyte- and platelet-rich fibrin (L-PRF) membrane to the palatal donor site on wound healing, hemostasis, and pain control after FGG harvesting. Methods: Twenty-eight adult patients with insufficient attached gingiva underwent soft tissue augmentation using FGG harvested from the palate at the Department of Oral and Maxillofacial Surgery, Baskent University, Turkey. Patients were randomized to either an L-PRF group or a control group. In the L-PRF group, the L-PRF membrane was sutured to the donor sites, whereas in the control group, donor sites healed by secondary intention. Postoperative evaluations were conducted on days 1, 3, 5, and 7 and at weeks 2, 3, 4, 5, and 6. Donor sites were evaluated clinically for pain, burning sensation, bleeding, wound healing, and color match to adjacent tissues. Donor site wound areas were analyzed using digital images. Results: Two patients were excluded from the analysis due to loss of contact, leaving 26 (n = 13, n = 13) patients for analysis. Donor site pain and burning sensation were significantly lower in the L-PRF group compared to the control group during the first two postoperative weeks (p < 0.001). Bleeding was significantly lower in the L-PRF group on postoperative days 1 and 3 (p < 0.001). Clinical healing index scores were significantly higher in the L-PRF group at weeks 3 and 4 (p < 0.001). Additionally, palatal wound area reductions from baseline were significantly greater in the L-PRF group at all follow-up intervals (p < 0.001). Conclusions: The application of an L-PRF membrane to palatal donor wounds after FGG harvesting significantly reduces postoperative pain, decreases bleeding, and accelerates healing, providing a valuable autologous biomaterial for enhanced wound healing and improved patient comfort. [ABSTRACT FROM AUTHOR]

This study aims to mine and analyze adverse events (AEs) of Vedolizumab based on the FAERS database to better understand its safety and potential risks in the real world. Data from the second quarter of 2014 to the third quarter of 2023 were collected, employing various signal mining methods such as Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), and Empirical Bayesian Geometric Mean (EBGM). The study gathered 14,753,012 reports of AEs, of which 46,726 were related to Vedolizumab. Signal mining identified 401 Preferred Terms (PTs) involving 27 System Organ Classes (SOCs). There was an increasing trend in the number of reports, with a slightly higher proportion of reports from women compared to men, and the primary reporting group was adults, especially those aged between 18 and 65 years. New potential AE signals were identified, such as a higher incidence of Pregnancy, Haematochezia, and Clostridium difficile infection. Although less frequent, strong signals were noted for Incisional hernia, Intestinal fistula infection, Anastomotic complication, Drug metabolising enzyme increased, Gingival graft, Intestinal anastomosis complication, Anorectal infection, Perineal rash, and Abdominal hernia obstructive. Despite the positive prospects of Vedolizumab in the treatment of inflammatory bowel diseases, the AEs related to its use identified in this study, particularly the newly identified potential risks, suggest that even targeted therapies can have systemic effects beyond expectations. [ABSTRACT FROM AUTHOR]

Background and Objectives: The palate's morphological characteristics are of great importance, especially in periodontology, where the palatine tissue represents a source of tissue graft for multiple mucogingival surgeries. This study aimed to estimate the amount of donor tissue available through the average palatal height and average location of the greater palatine artery in the Saudi population according to age and gender. Materials and Methods: Digital casts for adult Saudi patients at the age of 18–60 years old with a mean age of 37.76 ± 12.68 years were collected and analyzed using EXOCAD software. The digital casts were evaluated, and measurements of arch width at molars and canines, palatal vault height (PVH), palatal height index (PHI), and extension of the palatal rugae were registered. Finally, the amount available for soft tissue graft harvesting was calculated. Results: Overall, 109 maxillary casts for Saudi patients, 52 (47.7%) males and 57 (52.3%) females, were analyzed. The maxillary inter-molar arch width, inter-canine width, and palatal vault height significantly differed between males and females (p < 0.05). The mean PHI was 45.51% ± 8.12%, and 27.5% were classified as orthostaphyline, while 72.5% were categorized as hypsistaphyline, with no significant difference between the genders. The mean maximum graft width was 11.45 mm, and the graft width was significantly different between males and females (p < 0.005), while the mean maximum graft length was 17.78 mm, and the graft length showed no significant difference. Conclusions: The results of this study provide specific clinical guidelines for periodontal procedures by emphasizing the importance of gender-specific anatomical considerations. Data on graft dimensions and palatal measurements will enable the exact planning of soft tissue harvesting to minimize surgical risks and optimize mucogingival surgery outcomes in the Saudi population. [ABSTRACT FROM AUTHOR]

Background: Post-extraction ridge resorption is an inevitable phenomenon that cannot be eliminated but is significantly reduced using additional surgical techniques known as socket preservation. They aim to create favorable conditions for implant placement and prosthetic restoration. This study aims to assess the effect of socket sealing (SS) with free gingival grafts on the vertical resorption of socket walls at the premolar and molar regions over 3 months. Methods: This randomized two-arm controlled trial with parallel groups (1:1 allocation) was conducted at the Department of Oral Surgery, Medical University-Varna, Bulgaria, from 27 June 2022 to 20 April 2023. Forty patients aged 30–65 were equally and randomly allocated to the SS or the control groups. Atraumatic tooth extraction was performed. In the control group, the socket was left on secondary wound healing. In the SS group, the socket orifice was "sealed" with an FGG harvested from the hard palate or maxillary tuberosity. Results: Data analysis demonstrated that SS with an FGG is a successful method for reducing the post-extraction resorption of the socket walls. In addition, this study confirms that the thickness of the buccal wall is a significant factor in its vertical resorption. Conclusions: Socket sealing with an FGG is a valuable method that eliminates the need for flap reflection and compensates for the soft tissue deficit when immediate implant placement or bone augmentation is required. Further research is necessary to determine the role of different factors influencing bone resorption and compare the effect of different socket preservation methods. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Clinical Considerations Conclusion Clinical Significance Gingival recession is a complication that can occur after orthodontic treatment, and its cause is still very controversial in the literature. The objective of this study was to report a clinical case of orthodontic retreatment conducted with in‐office aligners and root coverage using free gingival graft, connective tissue graft, and Emdogaim for a patient with severe gingival recession.This report presents a potential solution to correct a gingival recession with in‐office clear aligner. A mandibular left lateral incisor whose root was positioned buccally to the bone plate, likely due to improper bonding of a fractured orthodontic retainer. The treatment consisted of 10 in‐office aligners, which effectively repositioned the root within the alveolus. After the orthodontic retreatment, the patient underwent gingival grafting surgery, which was successful due to the accurate positioning of the root in the socket, influencing bone deposition in the area. Subsequent 4‐year follow‐up showed treatment stability, mainly in the soft tissue area.Within the limitations of this case report, the in‐office aligners facilitated individualized and precise movements, allowing for torque adjustments when necessary. Besides that, the improved root positioning facilitated successful surgical procedures for covering the gingival recession, including the free gingival graft (FGG) and connective tissue graft with Emdogain (CTG + Emdogain).This case report presents an orthodontic treatment alternative for the multidisciplinary correction of a gingival recession, meeting the esthetic and functional demands of an adult patient. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Materials and Methods Results Conclusions Trial Registration To compare the 5‐year outcomes of collagen matrix (CM) and free gingival graft (FGG) used to augment the keratinized mucosa (KM) around posterior dental implants.Thirty patients (44 implants) with inadequate KM (< 2 mm) on posterior dental implants were randomized into two groups that received KM augmentation with CM or FGG. Clinical measurements comprising the KM width (KMW), buccal mucosal thickness (MT), and clinical parameters were examined in a 5‐year follow‐up. Marginal bone loss (MBL) was evaluated with standardized radiographs using the paralleling technique. Patient‐reported outcomes (PROs) during the first week post‐surgery and at the 5‐year follow‐up were evaluated.KMW increased significantly during the follow‐up period in both groups. The FGG group had a significantly greater KMW than the CM group at the 1, 2‐month follow‐up and after the 6‐month follow‐up. KM shrinkage was observed, and was greatest within the first 2 months post‐surgery in both groups. At the 5‐year follow‐up, the KM shrinkage was significantly different between the groups (FGG: 47%; CM: 70%) (p < 0.01). The MT increased significantly in the FGG group. The clinical parameters and MBL were similar between the groups. The bleeding score in the FGG group was higher than that in the CM group (p < 0.05) within the first 2 days post‐surgery, while other PROs scores were similar between groups in the first week post‐surgery. At 5‐year follow‐up, all patients were highly satisfied with the treatments.FGG was superior to CM in terms of the KM augmentation and MT increase. Except for a slight difference in self‐reported bleeding during the first two post‐operative days, CM didn't demonstrate other significant advantages in PROMs.ChiCTR1800018285 (date of registration: 9/9/2018, retrospectively registered. URL: https://www.chictr.org.cn/showproj.html?proj=24156) [ABSTRACT FROM AUTHOR]

The current study utilized a green synthesis where microwave-assisted free radical technique was applied for economical synthesis of a novel biocompatible polymethyl methacrylate grafted moringa gum amphiphilic graft copolymer, focusing on optimization based on percentage yield, percentage grafting, and intrinsic viscosity was performed, and analytical characterizations confirmed successful grafting. The copolymer demonstrated surfactant-like properties, as evidenced by the determined critical micelle concentration (CMC). Evaluation of its impact on poorly water-soluble drugs, simvastatin, and metronidazole benzoate, revealed efficient release within 60 min. Safety assessments, including In vitro assessments like hemocompatibility, bactericidal activity, fish toxicity, and in vivo evaluations such as oral toxicity, and wound repair studies and cell toxicity studies indicated the safety profile of prepared graft copolymer and explored its potential as a biopolymer for pharmaceutical delivery and tissue regrowth platform. [ABSTRACT FROM AUTHOR]

Objectives: Platelet concentrates are biomaterials with significant potential in tissue regeneration, functioning as scaffolds with greater leukocyte inclusion and a flexible fibrin mesh. However these concentrates have different preparation methods and biological properties. The objective of this clinical investigation was to evaluate the effects of utilizing platelet-rich fibrin (PRF) materials (L-PRF and A-PRF) as a palatal bandage following free gingival graft (FGG) on patients' morbidity and oral health-related quality of life. Materials and methods: Thirty-nine participants received FGG to promote keratinized tissue and treat gingival recession. Participants were randomly assigned to L-PRF, A-PRF, and control groups, with 13 participants in each. They used a visual analog scale (VAS) to rate their pain, analgesic medication use, dietary changes, discomfort, and bleeding at 1–7 days, 14 days and 1 month during the healing process. Patients' quality of life was assessed using the Oral Health Impact Profile (OHIP-14) at baseline, 1–7 days, 14 days, 1 month, and 6 months. Results: There was no difference in anxiety levels between the all groups. (p > 0.05). The control group had higher OHIP-14 total scores than the other groups, but the differences were not statistically significant, especially in the first seven days (p > 0.05). In addition, the PRF groups showed an improvement in quality of life after 14 days, 1 month, and 6 months (p < 0.05). Patients' pain and suffering decreased with healing. The control group took more postoperative analgesics than PRF groups. In addition, there was a significant decrease in patient complaints about medicine intake, bleeding, pain, perceived sensitivity, and dietary modifications in all groups during follow-up. Conclusions: PRF palatal bandages may improve patient's quality of life, donor site healing, postoperative pain and morbidity. Clinical relevance: This study found that preserving the palate in FGG and employing PRF materials that speed palate healing reduce discomfort and morbidity. [ABSTRACT FROM AUTHOR]

Aim: Mandibular anterior deep gingival recessions are complex to manage in individuals who lack sufficient keratinized tissue. The aim of the present study was to evaluate the clinical and esthetic outcomes and tissue stability of mucogingival procedures performed by means of a free gingival graft (FGG) or subepithelial connective tissue graft (SCTG) 2to 5-years postoperatively and to identify the esthetic outcome perception of the patients at follow-up. Materials and methods: Individuals presenting RT1 and RT2 gingival recessions treated with an FGG or SCTG in the mandibular anterior sextant were recalled to evaluate clinical outcomes and patient satisfaction postoperatively. A visual analog scale (VAS) and recession esthetic score (RES) were used for the evaluation. Results: A total of 32 consecutive individuals, 16 in each group (FGG/SCTG), responding to the follow-up appointment, entered this study. RT2 recessions were prevalent (87.5% FGG; 68.8% SCTG). Mean recession depth (RD) at baseline was 4.68 ± 0.76 (range: 4 to 6 mm) and 5.31 ± 1.35 (range: 4 to 10 mm) for the SCTG and FGG groups, respectively, and 0.18 ± 0.34 and 0.43 ± 0.49, respectively, at follow-up. Keratinized tissue width (KTW) was significantly greater in FGG individuals at follow-up: 5.25 ± 0.84 vs 2.84 ± 1.12 (P < 0.0001; confidence interval [CI]: 1.70 to 3.12). The SCTG group showed a higher RES than the FGG group, but the difference was not significant (P = 0.067, CI: 0.007 to 1.94). The patients' perception (VAS) of satisfactory esthetics was statistically significantly higher than the professional RES assessment for FGG individuals (P = 0.007, CI: 0.36 to 2.01), but the difference between the VAS and RES values was not statistically significant for the SCTG group. Conclusions: Both SCTGs and FGGs provide satisfactory esthetics and tissue stability. Patients' esthetic perception of FGGs is significantly higher than the professional evaluation. Clinical relevance: When 100% root coverage is not achieved using an FGG, satisfactory esthetic outcomes with minimal residual recessions of < 1 mm can be accomplished on the more challenging RT2 defects. [ABSTRACT FROM AUTHOR]

Background: Advanced platelet-rich fibrin (A-PRF) is produced by centrifuging the patient's blood in vacuum tubes for 14 min at 1500 rpm. The most important component of A-PRF is the platelets, which release growth factors from their ⍺-granules during the clotting process. This process is believed to be the main source of growth factors. The aim of this paper was to systematically review the literature and to summarize the role of A-PRF in oral and maxillo-facial surgery. Materials and Methods: A systematic review was carried out, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO: CRD42024584161). Results: Thirty-eight articles published before 11 November 2024 were included in the systematic review. The largest study group consisted of 102 patients, and the smallest study group consisted of 10 patients. A-PRF was most often analyzed compared to leukocyte-PRF (L-PRF) or blood cloth. A-PRF was correlated with lower postoperative pain. Also, A-PRF was highlighted to have a positive effect on grafting material integration. A-PRF protected areas after free gingival graft very well, promoted more efficient epithelialization of donor sites and enhanced wound healing. Conclusions: Due to its biological properties, A-PRF could be considered a reliable addition to the surgical protocols, both alone and as an additive to bio-materials, with the advantages of healing improvement, pain relief, soft tissue management and bone preservation, as well as graft integration. However, to determine the long-term clinical implications and recommendations for clinical practice, more well-designed randomized clinical trials are needed in each application, especially those with larger patient cohorts, as well as additional blinding of personnel and long follow-up periods. [ABSTRACT FROM AUTHOR]

(1) Background: A free gingival graft (FGG) is a common technique used to reconstruct or enhance the area of keratinized mucosa, while a connective tissue graft (CTG) is utilized to boost soft tissue thickness, thereby promoting stability in interproximal marginal bone levels. Most reported complications following FGG procedure are associated with the donor site. In addition to a painful, open wound in the palate, the most frequent complications linked to FGG harvesting include excessive bleeding, postoperative bone exposure, and recurrent herpes lesions. Numerous methods for securing the donor site after a free gingival graft surgery have been documented in research publications. The main objective of this systematic review was to assess various techniques for protecting the palate after graft harvesting and their impact on patient experience, with a focus on pain management. The secondary objective was to evaluate these techniques in relation to donor site wound healing. (2) Methods: The search was performed across four databases: Medline (PubMed Central), Scopus, Web of Science, and Embase, in accordance with PRISMA guidelines and the recommendations set forth in the Cochrane Handbook for Systematic Reviews of Interventions. The initial search took place on 9 October 2023, followed by an update on 28 June 2024. The search utilized the following keywords: ("wound" OR "injury") AND ("graft" OR "free gingival graft" OR "graft harvesting") AND ("healing" OR "recovery") AND "palate". (3) Results: After conducting the follow-up search, a total of 958 papers were identified: 193 from PubMed, 314 from Scopus, 101 from Web of Science, and 350 from Embase. Ultimately, of the 49 papers that remained, 11 were excluded due to not fulfilling the inclusion criteria, leaving 38 full-text papers on free gingival grafts (FGG) for qualitative analysis. (4) Conclusions: Various methods for palatal protection after free gingival grafts (FGG) are described in the literature, stemming from biological, physical, or chemical sources. Most studies in this review examined platelet-rich fibrin and suggested that it provides no benefits for patients' subjective experiences or wound healing outcomes. While photobiomodulation appears to support wound epithelialization, it does not influence pain perception. Alternatives such as propolis, hyaluronic acid, and medicinal plant extracts show potential for palatal protection; however, further research is needed to thoroughly evaluate their effectiveness. [ABSTRACT FROM AUTHOR]

Objectives: This study evaluates the efficacy of polyvinylpyrrolidone–sodium hyaluronate (PVP‐SH) gel as a dressing material in enhancing both clinical and patient‐reported outcomes post‐free gingival graft (FGG) harvesting from the hard palate. Material and Methods: This randomized clinical trial included 18 patients and spanned from June 2022 to August 2023. Patients received an FGG procedure to manage a lack of attached gingiva. Following graft harvesting, patients were divided into two groups: the control group, which received Coe‐Pak, and the test group, which was treated with PVP‐SH gel. The primary outcome measured was complete epithelialization. Secondary outcomes included the Landry healing scale, post‐operative pain level, and patient willingness to receive the same treatment again. Results: The test group reported significantly lower analgesic use (p < 0.001) and reduced pain severity (p < 0.001) compared to the control group. Furthermore, test group patients indicated a higher level of satisfaction regarding the prospect of retreatment. In contrast, the control group showed significantly slower progress in wound healing and epithelization (p < 0.05) compared to the test group. Conclusions: The findings of this study suggest that PVP‐SH gel is a superior dressing material post‐FGG harvesting, yielding improved clinical and patient‐reported outcomes relative to Coe‐Pak. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate factors that influence the 12-month outcomes after the treatment of multiple gingival recessions (GRs) with a modified coronally advanced tunnel (MCAT) and a subepithelial connective tissue graft (SCTG), with cross-linked hyaluronic acid (HA, tests) or without (controls). Materials and Methods: Twenty-four patients with 266 GRs were treated. A logistic regression model was set to identify the baseline parameters that could predict the 12-month outcomes. The study protocol was registered at ClinicalTrials.gov (ID No. NCT05045586). Results: The evaluated clinical and esthetic parameters showed marked improvement in both groups without any statistically significant differences between the groups, with the exception of the soft tissue texture (STT). The STT was in favor of the HA group (0.96 versus 0.73, p = 0.0091). The likelihood of an MRC > 85%, of achieving CRC, and of gaining an RES = 10 was the highest for the incisors (reference group) and the lowest for the molars (OR = 0.046, p = 0.005). With each 1 mm increase in the baseline clinical attachment level, the odds of failure (MRC < 85%, not achieving CRC) increased, whereas each 1 mm increase in the baseline keratinized tissue width (KTW) improved the chances of an MRC > 85%, of achieving CRC, and of gaining an RES = 10. The application of HA increased the likelihood of a perfect RES more than twofold (OR = 2.683, p = 0.001). Conclusions: The application of HA improved the 12-month esthetic outcomes after the treatment of GRs with the MCAT technique. The baseline CAL, KTW, and tooth type predicted the 12-month MRC, CRC, and RES. An evaluation of the baseline characteristics of the surgical area might help clinicians develop individualized treatment plans. [ABSTRACT FROM AUTHOR]

Aim: To compare three-dimensional changes of aporcine derived collagen matrix (CM) and free gingival grafts (FGG) for increasing keratinized tissue (KT) at dental implants over a 24-month follow-up period. Materials and methods: This retrospective study enrolled 25 patients exhibiting 41 implants with deficient KT width (i.e., < 2 mm) who underwent soft tissue augmentation using either CM (11 patients/15 implants) or FGG (14 patients/26 implants). The primary outcome was tissue thickness change (mm) at treated implant sites between 1- (S0), 12- (S1), and 24-months (S2). Secondary outcome was the changes of KT width over a 24-month follow-up period. Results: Dimensional analyses from S0 to S1 and from S0 to S2 revealed a mean decrease in tissue thickness of -0.05 ± 0.35 mm and − 0.31 ± 0.41 mm in the CM group, and − 0.23 ± 0.38 mm and − 0.22 ± 0.81 mm in the FGG group, with no significant differences found between the groups (S0-S1: p = 0.14, S0-S2: p = 0.58). Within S1 and S2, the CM and FGG groups displayed comparable tissue thickness reduction (CM: -0.32 ± 0.53 mm, FGG: -0.02 ± 0.21 mm; p = 0.07). The FGG group exhibited a significantly greater KT gain 24-months compared to the CM group (CM: 1.50 ± 1.14 mm, FGG: 4.04 ± 1.65 mm; p < 0.001). Conclusions: CM and FGG were associated with comparable three-dimensional thickness changes over a period of 24 months. A significantly wider KT band could be established in the FGG group. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusions Key points Plain language summary Platelet concentrates have gained significant attention in periodontology due to their regenerative properties. This randomized clinical trial was aimed to compare the clinical efficacy of advanced platelet‐rich fibrin (A‐PRF) and connective tissue graft (CTG) in the management of recession defects. The objectives were to compare changes in recession height and root coverage percentage between the groups.Systemically healthy individuals presenting Cairo's RT1/RT2 gingival recession defects in the maxilla (n = 40) were treated with either A‐PRF or CTG in combination with coronally advanced flap (CAF). Clinical parameters were measured at baseline, 3 months, and 6 months. Mean and complete root coverage percentages were calculated at 3 and 6 months.In both the test (CAF + A‐PRF) and control (CAF + CTG) groups, a statistically significant reduction in mean recession height was seen from baseline values of 2.90 ± 0.55 mm and 3.15 ± 0.87 mm to 0.80 ± 0.95 mm and 0.15 ± 0.48 mm at 6 months, respectively (p < 0.001). In the test group, 10 sites had complete root coverage at 6 months with mean root coverage of 73.76 ± 29.58%. In the control group, 18 of 20 sites had complete root coverage with mean root coverage of 93.35 ± 23.1%. The control sites had a significantly greater reduction in recession height and higher mean and complete root coverage percentages at 6 months (p < 0.05).The study findings suggest that, the CTG had resulted in superior outcomes than A‐PRF along with CAF. Question: To compare the efficacy of advanced platelet‐rich fibrin (A‐PRF) with connective tissue graft (CTG) in the management of gingival recession defects. Finding: Both interventions showed satisfactory healing. At 6 months, the CTG group demonstrated superior results than the A‐PRF group. Meaning: CTG has a greater therapeutic potential than A‐PRF in the management of gingival recessions. Question: To compare the efficacy of advanced platelet‐rich fibrin (A‐PRF) with connective tissue graft (CTG) in the management of gingival recession defects.Finding: Both interventions showed satisfactory healing. At 6 months, the CTG group demonstrated superior results than the A‐PRF group.Meaning: CTG has a greater therapeutic potential than A‐PRF in the management of gingival recessions.Platelet‐derived membranes are widely used in various dental therapies due to their healing properties. Limited studies have been conducted using the novel platelet preparations in the management of receding gums. This study compared the effects of advanced platelet‐rich fibrin membrane with conventional soft tissue harvested from the palate in the treatment of gum recession. Twenty‐three patients requiring gum augmentation were recruited and treated with either platelet‐derived membrane (test group) or tissue harvested from their palate (control group). Clinical parameters were measured at baseline (before intervention), 3 months, and 6 months. Both treatment modalities resulted in significant gum coverage at the end of 6 months. On comparison, the control sites had significantly greater improvements in all the measured clinical parameters indicating that tissue obtained from the palate had superior therapeutic potential. [ABSTRACT FROM AUTHOR]

Connective tissue grafts for gingival recession treatment present significant challenges as they require an additional surgical site, leading to increased morbidity, extended operative times, and a more painful postoperative recovery for patients. Gelatin contains the arginine–glycine–aspartic acid (RGD) sequence, which supports cell adhesion and interactions. The development of gelatin hydrogels holds significant promise due to their biocompatibility, ease of customization, and structural resemblance to the extracellular matrix, making them a potential candidate for gingival regeneration. This study aimed to assess the physical and biological properties of crosslinked gelatin hydrogels using EDC/NHS with two crosslinker concentrations (GelCL12 and GelCL24) and compare these to non-crosslinked gelatin. Both groups underwent morphological, rheological, and chemical analysis. Biological assessments were conducted to evaluate human gingival fibroblast (HGF) proliferation, migration, and COL1 expression in response to the scaffolds. The crosslinked gelatin group exhibited greater interconnectivity and better physical characteristics without displaying cytotoxic effects on the cells. FTIR analysis revealed no significant chemical differences between the groups. Notably, the GelCL12 group significantly enhanced HGF migration and upregulated COL1 expression. Overall, GelCL12 met the required physical characteristics and biocompatibility, making it a promising scaffold for future gingival tissue regeneration applications. [ABSTRACT FROM AUTHOR]

Background: This study evaluated the influence of the adjunctive application of a cross‐linked hyaluronic acid (HA) in the treatment of multiple gingival recessions, using a modified coronally advanced tunnel (MCAT) technique and subepithelial connective tissue graft (SCTG) (MCAT+SCTG±HA). Methods: A randomized, split‐mouth, double‐masked comparison of the effects of MCAT+HA+SCTG (test) versus MCAT+SCTG (control) in the treatment of multiple, contralateral gingival recessions with clinical, esthetic, and histological evaluations was carried out. All samples were stained with hematoxylin and eosin, Masson's trichrome, Verhoeff–Van Gieson, and Alcian blue stain for semiquantitative evaluation. The primary outcome variable was 12‐month mean root coverage (MRC). Results: Twenty‐four patients with 266 gingival recessions received both control and test treatments (133 recessions per group). 12‐month MRC of the MCAT+HA+SCTG group was not significantly different from the MCAT+SCTG group with 84.32%± 34.46% and 85.71%± 36.43%, respectively (p = 0.991). Both treatment modes produced favorable esthetic outcomes (root coverage esthetic score [RES] 9.51± 1.01 tests vs. 9.26± 1.10 controls, p = 0.7292). However, the application of HA improved soft tissue texture (p = 0.0091). The remaining end point measures did not differ significantly between groups. Histological evaluation showed a significantly greater number of elastic fibers and a moderate increase in collagen fiber density in biopsy samples taken from the test sides when compared to the control sides (p = 0.0419 and p = 0.300, respectively). Conclusions: MCAT+SCTG is an effective procedure in the treatment of multiple recession Type 1 (RT1) and RT2 recessions. There were no statistically significant differences in evaluated clinical treatment outcomes in the MCAT+HA+SCTG group compared to the MCAT+SCTG group within a period of 12 months. The application of HA increased collagen and elastic fiber density. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Clinical Considerations Conclusion Treatment of gingival recession in the anterior mandible is more complex due to unique anatomic features including excessive tension due to frenal and muscle attachments, thin tissue, shallow vestibule, and narrow interdental space. These features are particularly limiting in the presence of deep recession and negatively impact the success most routine soft tissue grafting procedures. The recently proposed laterally closed tunnel combined the benefit of tension management from tunneling rather than incising papillae with lateral closure of deep recession to minimize the need for coronal advancement.This is an effective, although technically demanding procedure. This report presents a method of facilitating tunnel preparation by utilizing superficial papillary access incisions bilaterally in the papilla between the lateral incisor and canine. This papilla has the least tension and most robust interdental volume and blood supply. This incision creates a mini flap that facilitates tunnel dissection and graft placement.Because the mini flap is used for graft insertion, the suturing for lateral closure can be performed before graft insertion. The result is reduced technical difficulty. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Methods Results Conclusions The objective of this study is to investigate the effect of collagen matrix with polydeoxyribonucleotide (PDRN) at two concentrations on keratinized tissue (KT) regeneration for buccally positioned implants in canines.Four implants were placed in the edentulous mandible of five dogs simultaneously with KT removal. The implants were positioned buccally with respect to the ridge crest. After 2 months, KT augmentation was performed applying the following treatment modalities:(1) free gingival graft (FGG), (2) xenogeneic collagen matrix (XCM), (3) XCM loaded with 2 mg/mL PDRN (PDRN2), and (4) XCM loaded with 4 mg/mL PDRN (PDRN4). All animals were sacrificed 3 months later. Outcomes included clinical (KT height) and histomorphometric measurements (KT height/length, level of the mucosa, mucosal thickness, supracrestal soft tissue height).Clinical and histomorphometric KT formation at 3 months was greatest in groups with FGG (4.70 ± 1.00/3.94 ± 0.93 mm) and PDRN2 (4.85 ± 1.43/3.95 ± 0.87 mm). Group PDRN2 (1.87 ± 1.50 mm) showed a higher marginal mucosal level with respect to the implant platform compared to other groups (range: 0.57 ± 0.97–0.69 ± 1.14 mm). All groups presented a soft tissue thickness of < 2 mm on the buccal aspect of the implants.Based on the limitations of this pilot preclinical study, XCM with 2 mg/mL of PDRN demonstrated a potential for KT augmentation. [ABSTRACT FROM AUTHOR]

Background. Gingival recession is a common periodontal condition causing aesthetic issues, dental hypersensitivity, and cervical abrasion. Treatment involves periodontal plastic surgery with connective tissue grafts, LPRF. Aim. This systematic review and meta-analysis aimed to compare L-PRF with CTG in treating GR. Methods and materials. A systematic search of electronic databases found that randomized controlled trials (RCTs) involving patients with Miller class I or II gingival recessions treated with L-PRF and periodontal plastic surgery techniques compared to using CTG in combination with periodontal plastic surgery showed a primary gain in clinical attachment level. Statistical analysis used. The analysis of the dichotomous data involved calculating the risk ratio (RR) and 95% confidence interval (CI), whereas the continuous data was studied by calculating the mean difference (MD) and 95% CI. The I-squared (I2) statistic assessed the heterogeneity. The Egger's regression test was employed to evaluate the presence of publication bias. Results and conclusions. This meta-analysis of fourteen RCTs found no significant difference in CAL gain 6 months postoperatively between L-PRF and CTG. However, CTG was favored in increasing keratinized mucosa width and achieving more relative root coverage compared to L-PRF. There was no significant difference in gingival recession depth change between the two treatments. Both L-PRF and CTG are effective in treating gingival recession, but CTG may provide better improvements in KMW and rRC. [ABSTRACT FROM AUTHOR]

This article discusses the complex treatment of occlusal reconstruction in a patient who experienced facial trauma resulting in the loss of multiple maxillary teeth and a wide area of the maxillary anterior alveolar ridge. The treatment involved a combination of maxillary bone grafting, dental implants, and orthognathic surgery. The article provides a detailed account of the treatment process and highlights the importance of careful planning and consideration of various factors, such as the patient's general and local condition, in achieving satisfactory outcomes. The case report is valuable as there have been few reports on such complex treatments. The article concludes that anatomically correct reconstruction of teeth, periodontal tissues, and jaw bone, along with appropriate occlusal relationships, can lead to successful results. [Extracted from the article]

Background: In recent years, the utilization of blood concentrates in dentistry has become increasingly prevalent. In 2014, the development of injectable platelet-rich fibrin (i-PRF) was achieved. One of the key benefits of i-PRF is its ability to consistently release a range of growth factors. This review aimed to determine whether i-PRF could be used for gingival augmentation. Methods: The research involved a search of the PubMed, Embase, Scopus, and Google Scholar databases using the following search terms: ("microneedling" or "micro needling" or "injectable platelet-rich fibrin" or "i-PRF") and ("gingival augmentation" or "augmentation" or "attached gingiva" or "attached mucosa" or "soft tissue augmentation" or "KM" or "keratinized mucosa"). Results: Of the 668 results, 8 articles meeting the inclusion criteria were included in the article. The results of the studies analyzed indicated a significant increase in gingival thickness. Furthermore, some articles demonstrated an increase in keratinized tissue width. The augmentation of the gingival thickness with i-PRF yielded no inferior results in comparison to the free gingival graft, which is the current gold standard, resulting in a superior aesthetic outcome and a reduction in postoperative discomfort. Conclusions: This systematic review allowed the authors to conclude that the use of i-PRF or hyaluronic acid may be the first step towards developing a non-surgical method of gingival augmentation. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Key points Free gingival graft harvested from the palate is considered the most predictable method to augment the keratinized tissue (KT). However, the anatomical limitations of the palate, and associated patient morbidity and complications restrict clinicians from performing these procedures in adolescents. Color mismatch with the native tissues resulting in poor esthetic appearance is another concern. To overcome these limitations, this article reports a surgical approach known as labial gingival graft (LGG) as an alternative to palatal graft.Two adolescent patients presenting with absence of attached gingiva and shallow gingival recession in the mandibular incisor region were treated with LGG harvested from the labial KT of teeth adjacent to those requiring KT augmentation.The procedure was well tolerated by the patients. At the final follow‐up (3.5‐ and 2 years from baseline), a significant gain in KT with complete root coverage was achieved in both patients. Both professional and patient‐centered esthetic evaluations revealed excellent color match making the grafted area imperceptible from the adjacent mucosa.The proposed technique was found to be simple and predictable, and was associated with minimal morbidity and no complications. Clinicians may consider performing LGG procedure when sufficient KT can be harvested from adjacent donor site. The selection of such techniques is of particular relevance in children who are vulnerable to complications associated with more invasive procedures.Why are these cases new information? To the best of our knowledge, this article is the first to present the use of labial gingival graft harvested from adjacent keratinized mucosa in adolescent patients. What are the keys to successful management of these cases? Proper case selection in terms of sufficient amount of keratinized tissue to harvest as labial gingival graft from adjacent teeth. Use of smaller instruments, small‐sized needles, and sutures under magnification to minimize trauma to the tissues /graft. Preparation of an immobile periosteal bed and suturing protocol that minimizes the dead space and ensures revascularization of graft. What are the primary limitations to success in these cases? A prerequisite of the presence of thick gingiva and sufficient dimensions of KT around the adjacent teeth further limits its applicability in all cases. [ABSTRACT FROM AUTHOR]

Background: The importance of an adequate amount of peri‐implant keratinized tissue and attached mucosa has recently been emphasized. This manuscript presents preliminary findings of a novel approach for increasing the width of keratinized mucosa (KM) around dental implants using a mesh free gingival graft (mesh‐FGG). Methods: Two healthy adults were treated as part of this study. After implant placement, a large edentulous alveolar ridge with shallow vestibule and minimal amount of KM was treated in both subjects (one in the posterior mandible and the other in the anterior mandible) with the combination of an apically positioned flap and a mesh‐FGG. Clinical, esthetic and patient‐reported outcomes were observed at approximately 4‐month time points. Results: All sites healed uneventfully after the treatments. In both cases, increased vestibule depth, soft‐tissue thickness, and width of peri‐implant KM were obtained. The patients did not report any accessory discomfort. Four months following the grafting procedure, good overall esthetic outcome was observed with minimal color disparity and graft demarcation. Conclusions: Width of KM around dental implants can be increased using a mesh‐FGG. Randomized controlled clinical studies comparing mesh‐FGG to conventional FGG and other commonly applied techniques are required to assess the long‐term efficacy of this novel technique in terms of soft‐tissue thickness, width of peri‐implant KM, and patient‐reported outcomes. Key points: Principal Findings: Meshed‐FGG allowed an expansion of the length of the harvested graft. This results in coverage of large recipient sites, increase in height of KM and good aesthetic integration of the graft. [ABSTRACT FROM AUTHOR]

Background: A previous case study reported periimplantitis and concomitant perigraftitis of a second implant placed at a site that had alveolar ridge preservation three decades earlier. Infection at the site persisted 4 months after implant removal by flapless implant reversal. A flap was subsequently reflected, the grafted bone was removed, and a second alveolar ridge preservation was performed with a freeze‐dried bone allograft. The publication reported infection resolved, and the site healed uneventfully. However, it is unknown if placement of another implant at the site would be successful. The purpose of this paper is to report on the findings at surgical reentry and outcome of the third implant. Methods: Eleven months after the second alveolar ridge preservation, the site was reentered. The bone graft was found to be partially soft tissue encapsulated. All encapsulated graft materials and soft tissue were removed. An implant was placed, and the alveolar defect was grafted with a demineralized bone allograft. Seventeen months after implant placement, a buccal free gingival graft was performed during which the crestal bone adjacent to the implant was found to be hard and corticated. The implant was deemed to be osseointegrated and restored after soft tissue healing. Results: Twenty‐five months after implant placement, the third implant remained functional and asymptomatic with the peri‐implant bone exhibiting normal trabeculation. Conclusions: Implant therapy can be successful following treatment and resolution of perigraftitis. Key points: Perigraftitis may play a contributing role in the biologic complications of implants that have been placed into grafted bone.Perigraftitis may be successfully resolved by completely removing all grafted bone.Once perigraftitis has been eliminated, an implant may be successfully placed. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the dimensional changes in free gingival grafts (FGG) at implant sites in mandibular reconstruction patients. Methods: Patients who received FGG 4 months after implant placement in the reconstructed mandible with no keratinized mucosa (KM) present were invited for re-examination after 36.7 ± 16.8 months (3.06 ± 1.4 years). Immediately after graft extraction (T0), graft width (GW), graft length (GL), graft thickness (GT), graft dimension (GD), and vertical bone height were documented. Re-examination (T1) included clinical examinations (GW, GL, GD, peri-implant probing depths, and modified Sulcus Bleeding Index), radiographic examination (marginal bone level), and medical chart review. Results: Twenty patients and 62 implants (47 in fibula flaps and 15 in iliac flaps) were included. A significant decrease in GW (51.8%), GL (19.2%), and GD (60.2%), were found between T0 and T1 (p <.001). The univariate analysis showed that GW change was not significantly associated with reconstruction technique, baseline GL, baseline GT, baseline GD, implant location, or type of prosthesis. Implant survival rate of 100% was observed at follow-up. Conclusions: Within the limitations of the study, free gingival grafts at implant sites in the reconstructed mandible undergo dimensional change that result in a reduction of approximately 60% of the original graft dimension. Graft width decreased over 50%. Clinical relevance: FGG is the standard of care intervention for increasing the amount of KM around implants. This study was the first to evaluate the dimensional change in FGG at implant sites in mandibular reconstruction patients after a medium-term follow-up. Clinical trial registration: Clinical trial registration is not applicable as this study comprehends a retrospective analysis. [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. [ABSTRACT FROM AUTHOR]

The science of dental tissue grafting is evolving, with an increased understanding of factors influencing graft behavior. Despite the widespread clinical use of soft tissue grafts, the histological characteristics of different gingival harvesting sites are still underexplored. This study aimed to fill this gap by analyzing 50 tissue samples harvested from 25 patients across three sites: the hard palate, maxillary tuberosity, and palatal rugae. Each sample underwent thorough histological and histomorphometric analysis. Conventional statistical analysis was performed using SPSS, while predictive modeling was conducted with RapidMiner Studio. The study identified significant histological differences among the graft sites, with notable variations in total graft height, epithelial height, and interdigitation perimeter. These findings underscore the importance of donor site selection in influencing graft success. Pair plots and principal component analysis (PCA) further highlighted the distinct histological features of each tissue type. The random forest classifier identified total graft height, epithelial height, and perimeter as the most influential factors in predicting graft site behavior. This study offers valuable insights into the histological characteristics of soft tissue grafts, potentially leading to more predictable clinical outcomes. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate the viability of free gingival grafts (FGG) and assess clinical and radiographic changes in the alveolar ridge following socket seal surgery with or without freeze-dried bone allograft (FDBA). Materials and methods: Twenty-eight anterior and premolar tooth extractions were randomly allocated to 2 groups: socket graft of FDBA sealed with FGG (n = 15) and control with empty sockets sealed solely with FGG (n = 13). Photographs taken at 3, 7, 14, and 30 days post-surgery assessed FGG viability. Alveolar ridge volume was clinically evaluated via intraoral scanners before surgery and at 1 and 3 months post-surgery. CBCT scans taken immediately post-surgery and 3 months later assessed alveolar ridge dimensions. Results: FGG viability in both groups increased from day 3 and reached the maximum score on day 14. Alveolar ridge volume reduction at 3 months in the FDBA group was comparable to the control group. Buccal alveolar bone height reduction was significantly higher in the FDBA group than the control group, while palatal alveolar bone height was comparable. Alveolar bone width reduction was evident but not statistically significant between the groups. The FDBA group exhibited a significant alteration in bone volume compared to the control group. Conclusion: Viability of FGG was not affected by graft filling materials. Sealing the socket with FGG effectively preserved socket integrity and ridge volume in minor socket defects using either graft filling material or not. This study was registered on 4 January 2021 on Thai Clinical Trials Registry (TCTR20210104001). [ABSTRACT FROM AUTHOR]

Aim: This study aimed to assess the effectiveness of advanced platelet-rich fibrin (A-PRF) combined with the pinhole surgical technique (PST) for enhancing root coverage (RC) in individuals with Miller class I or II gingival recessions (GR). Additionally, it compared the clinical effect of A-PRF and resorbable collagen membrane (RCM). Materials and methods: A total of 18 patients, encompassing 36 treatment sides of 18 Miller class I or II, were randomly assigned to the PST + A-PRF side (18 sides) and the PST + RCM side (18 sides). Clinical assessments of various parameters, including plaque index (PI), clinical attachment level (CAL), keratinized tissue width (KTW), recession depth (RD), recession width (RW), and gingival thickness (GT) were conducted at baseline and three months after the surgical procedure. A numeric rating scale (NRS) was also evaluated during the 1st, 2nd, 3rd and 4th days. This study was formally recorded under the TCTR identification number TCTR20230613005 in the Thai Clinical Trials Register-Medical Research Foundation of Thailand (MRF) on 13/06/2023. Furthermore, it was ethically approved by Sana'a University's Ethical Committee for Medical Research. Results: When comparing the values of 3 months follow-up with the baseline values, intra-side comparison of the PST + A-PRF group showed significant improvements in PI (P = 0.02), CAL (P = 0.01), and RD (P = 0.04), and GT values (P < 0.01). The improvements in the PST + A-PRF group were through the reduction of baseline values of PI, CAL, and RD; the mean reductions in PI, CAL, and RD were 0.44 ± 0.71, 0.33 ± 0.45, and 0.22 ± 0.43 respectively, and a significant increase in GT value (0.44 ± 0.24). While there was an insignificant increase in KTW value with no change in RW values (4.50 ± 0.71, P = 1). In contrast, intra- side comparison of PST + RCM side showed only a significant reduction in PI value (0.44 ± 0.71, P = 0.02) and a significant increase in GT value (0.42 ± 0.26, P = < 0.01). Meanwhile, there were insignificant improvements in CAL (2.89 ± 0.95), KTW (3.97 ± 0.74), and RD (1.94 ± 0.87) values. Regarding inter-side comparison, there were no statistically significant among all variables (p > 0.05). The pain scores of the numeric rating scale were significantly lower on the PST + A-PRF sides compared with the PST + RCM sides, especially on the 1st, 2nd, and 3rd days (P < 0.001). Conclusion: Both A-PRF and RCM showed not wholly satisfactory outcomes in gingival recession treatment. Interestingly, the combination of PST with A-PRF has proven more effective than combining PST with RCM. Additionally, the localized application of A-PRF has been shown to reduce post-operative pain following the pinhole surgical technique. [ABSTRACT FROM AUTHOR]

Gingival recession is a common condition in adults, causing esthetic issues or tooth sensitivity in patients. Gingival recession in the lower incisors area after orthodontic treatment is often difficult to predict, due to anatomical factors such as thin phenotype, shallow vestibular depth, and low frenum attachment. A young male patient presented to the clinic with severe Cairo Class I gingival recession at tooth 41 after 2 years of orthodontic treatment. Surgery combining tunneling technique and multiple papilla full thickness flap was performed to treat the patient after endodontic treatment. The clinical case was followed up to monitor gingival margin recovery one year post-surgery. The clinical case introduces a treatment method for severe localized gingival recession in the lower anterior region of a single tooth. [ABSTRACT FROM AUTHOR]

Periodontitis is a severe bacterial infection that affects soft tissues around teeth. Periodontitis is caused by a Gram-negative anaerobic bacterium called Porphyromonas gingivalis (P. gingivalis), which promotes the expression of nuclear factor kappa β (NF-κβ). In recent years, medical herbs such as green tea containing Epigallocatechin-3-Gallate (EGCG) have been employed extensively in anti-inflammatory and antibacterial studies due to their low toxicity and strong efficacy based on their multitarget therapy. The mucoadhesive drug delivery system adheres to the surface of the oral mucosa, providing sustained release, enhancing local effects, bypassing first-pass metabolism, and minimizing systemic side effects. This study aimed to investigate the impact of an EGCG-loaded mucosal gingival patch on periodontitis caused by P. gingivalis. Periodontitis was induced in Wistar rats by administering 0.03 mL containing 1010 (CFU) in phosphate-buffered saline (PBS) into the incisive gingival sulcus of the mandible of the anterior teeth. The rats with induced periodontitis received the treatment as mucoadhesive gingival patches loaded with EGCG (GP-EGCG), doxycycline (GP-doxy), and blank patches for one hour daily over 3, 5, 7, 14, and 21 days. Immunohistochemical analysis was performed on the anterior inferior gingival sulcus after the treatment. Results showed that the treatment of periodontitis with GP-EGCG significantly lowered NF-κB expression compared to the control groups following treatment during 3, 5, 7, 14, and 21 days (p < 0.05). EGCG has effectively reduced inflammatory markers in P. gingivalis-induced periodontitis. These findings suggest that the treatment based on EGCG holds promising potential for managing periodontitis, providing an alternative approach to traditional therapies. [ABSTRACT FROM AUTHOR]

Objectives: There is a growing evidence to suggest augmenting peri‐implant keratinized mucosa in the presence of ≤ 2 mm of keratinized mucosa. However, the most appropriate surgical technique and augmentation materials have yet to be defined. The aim of this systematic review and meta‐analyses was to evaluate the clinical and patient‐reported outcomes of augmenting keratinized mucosa around implants using free gingival graft (FGG) versus xenogeneic collagen matrix (XCM) before commencing prosthetic implant treatment. Material and Methods: Electronic databases were searched to identify observational studies comparing implant sites augmented with FGG to those augmented with XCM. The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool. Results: Six studies with 174 participants were included in the present review. Of these, 87 participants had FGG, whereas the remaining participants had XCM. At 6 months, sites augmented with FGG were associated with less changes in the gained width of peri‐implant keratinized mucosa compared to those augmented with XCM (mean difference 1.06; 95% confidence interval −0.01 to 2.13; p = 0.05). The difference, however, was marginally significant. The difference between the two groups in changes in thickness of peri‐implant keratinized mucosa at 6 months was statistically significantly in favor of FGG. On the other hand, XCM had significantly shorter surgical time, lower postoperative pain score, and higher color match compared to FGG. Conclusions: Within the limitation of this review, the augmentation of keratinized mucosa using FGG before the placement of the final prosthesis may have short‐term positive effects on soft tissue thickness. XCM might be considered in aesthetically demanding implant sites and where patient comfort or shorter surgical time is a priority. The evidence support, however, is of low to moderate certainty; therefore, further studies are needed to support the findings of the present review. [ABSTRACT FROM AUTHOR]

After vertical bone augmentation (VBA) surgery, loss of both keratinized tissue (KT) and vestibule depth (VD) take place. This article evaluated KT gain, patient satisfaction, and aesthetic outcomes after a modified apically repositioned flap (ARF) in combination with a strip-free gingival graft (FGG) harvested from the palate and a xenogeneic collagen matrix (XCM) to correct mucogingival distortion (MGD) after VBA. This technique minimizes patient morbidity by reducing the need for extensive masticatory mucosa grafts. The study included 12 patients with ≤3 mm KT after vertical augmentation procedures. Keratinized tissue gain and tissue thickness were measured. Patient morbidity and aesthetic outcomes were also evaluated. Twenty-four months after surgery, significant VD gain was observed, obtaining a vertical KT augmentation of 5.38 ± 2.06 mm, although tissue thickness increase was only 0.42 ± 0.42mm. Regarding patient satisfaction, aesthetic results evaluating tissue color and texture were satisfactory; the pain was slight, obtaining a score of 2.10 ± 1.13 out of 10, measured using a Visual Analogue Scale (VAS). The present retrospective case series study shows that using an apically repositioned flap combined with a strip FGG and an XCM might offer a valid means of achieving KT gain. [ABSTRACT FROM AUTHOR]

AbstractGellan Gum (GG) grafted poly-acrylic acid (GG-g-pAAc) hydrogels of different composition were synthesized by changing the concentration of GG through free radical polymerization. The hydrogels were characterized through SEM, TGA, and FTIR. The FTIR spectra confirmed the grafting of GG into the network of polyacrylic acid and evidenced the GG-g-pAAc formation. The rough surface nature of the hydrogels was elaborated through SEM analysis provided the information about the materials to be utilized for removal purpose. The thermal stability was confirmed by TGA analysis and the hydrogels were found stable upto a high temperature range. With an efficiency of 96%, Basic Orange-2 dye (BO-2) was successfully removed from wastewater using synthesized hydrogels as an adsorbent. The adsorption parameters were calculated using a number of different kinetic models. According to the findings, the pseudo-second order kinetics model best suited to the kinetics data, while the Langmuir isotherm provided the most comprehensive explanation of the process of adsorption. BO-2 was removed to the greatest extent (257.5 mg/g). Additionally, the results showed that the adsorption process on synthesized hydrogels was exothermic with values of ΔH = −13.2, −219.4 and −12.9 kJ/mol for pAAc, 10%GG-g-pAAc, and 20%GG-g-pAAc respectively. The adsorption process is spontaneous, with negative values of ΔG = −8.2, −214.4 and −7.947 kJ/mol for pAAc, 10%GG-g-pAAc and 20%GG-g-pAAc at 293K, respectively. The adsorption process on synthesized hydrogels showed no dis-orderness with negative values of ΔS = −17.2, −461.16 and −16.42 kJ/mol for pAAc, 10%GG-g-pAAc and 20%GG-g-pAAc, respectively. [ABSTRACT FROM AUTHOR]

Objective: An ideal anatomical component for maintaining gingival health is the attached gingiva. Increasing the width of the attached gingiva can be achieved using the predictable surgical methods of the modified apically repositioned flap (MARF) and the free gingival graft (FGG). Methods: Fifteen (female) systemically and periodontally healthy patients were enrolled for this study. The treatment of a total of 21 teeth with recession in the lower jaw, absence of bone dehiscence, and attached gingiva ranging from a minimum of 0.5 mm to a maximum of 1.5 mm was conducted through FGG and modified apical positioned flap techniques. These procedures were randomly selected. Pocket depth on probing, gingival recession (GR), clinical attachment loss, bleeding index on probing, attached gingival width (AGW), keratinized tissue width and plaque index values were recorded before the surgical procedure and repeated at the 3rd month, 1st and 2nd years. Results: The changes in GR levels at baseline, 3 months, first and second year in both the FGG and MARF groups were statistically significant (p=0.001; p<0.05). The changes observed in AGW levels at baseline, 3 months, first and second year in both MARF and FGG groups were statistically significant (p=0.001; p<0.05). Conclusion: Both techniques have been shown to result in a statistically significant increase in the width of keratinized tissue and the amount of attached gingiva in the long term. [ABSTRACT FROM AUTHOR]

Introduction: Gingival recession is the exposure of the root surface of the tooth, characterised by the displacement of the gingival margin apically from the Cementoenamel Junction (CEJ). Various techniques have been suggested for treating recession, such as Free Gingival Graft (FGG), Connective tissue grafts, laterally or Coronally Advanced Flaps (CAF), and Guided Tissue Regeneration (GTR)-based procedures. Different membranes have been used for GTR, one of which is the amnion membrane. Aim: To evaluate root coverage using Coronally Advanced Flap (CAF) with and without amniotic membrane in the treatment of localised gingival recession. Materials and Methods: A randomised controlled trial was conducted at Pandit Deendayal Upadhyay Dental College and Hospital, Solapur, Maharashtra, India from March 2017 to February 2018. In this study, 30 teeth were treated, with 15 teeth undergoing CAF with amniotic membrane (Group IITest Group) and 15 teeth treated with CAF without amniotic membrane (Group I-Control Group). Probing Depth (PD), Clinical Attachment Level (CAL), Relative Attachment Level (RAL), Recession Width (RW), Recession Depth (RD), Width of Keratinised Gingiva (WKG), Width of Attached Gingiva (WAG), and gingival biotype were assessed between baseline and after three months. Statistical analysis was performed using paired t-test, independent t-test, and Mann-Whitney U-Test. Statistical Package for Social Sciences (SPSS) software version 20.0 was used for analysis. The α error of 5% (p-value=0.05) and β error of 20% were taken into consideration. Results: The mean age of the study population was 30.36±4.55 years, with 18 males and 12 females. There was a decrease in RD, RW, PD, and a gain in CAL and RAL in both groups after three months compared to the baseline values. Additionally, there was an increase in WKG, WAG, and a significant change in the thickness of the gingival biotype from thin to thick in both groups at the end of three months. On inter group comparison, the changes in PD (p-value=1.00), RD (p-value=1.00), RW (0.176), CAL (0.664), RAL (1.00), WKG (p-value=0.313) were not statistically significant at the end of three months. WAG was higher in Group II compared to Group I (p-value=0.014*), and the mean root coverage was greater in Group II (15.62%) than in the control group (11.642%) (p-value=0.005) at the end of three months. There was a statistically significant difference (p-value=0.005*) in Group II (15.62%) compared to the control group (11.642%). Conclusion: Amniotic membrane in combination with CAF proves to be a successful option for root coverage in localised recession defects. However, histological evidence and a greater number of future longitudinal studies are necessary to study the efficacy of this approach. [ABSTRACT FROM AUTHOR]

The interaction between the recipient area and the graft is one of the key factors in the success of periodontal plastic surgery. This randomized controlled, split-mouth, double-blinded clinical trial aimed to compare the clinical and aesthetic outcomes of epithelialized palatal graft (EPG) and gingival unit graft (GUG) in achieving root coverage in localized (Recession Type 1) RT1 recession defects. Twenty participants with forty bilateral recession defects randomly received EPG or GUG surgical treatment modalities for each of the recession defects. Clinical measurements recorded at baseline and after six months included recession depth (RD), recession width (RW), probing depth (PD), clinical attachment level (CAL), keratinized tissue width (KTW), and the average width of mesial and distal interdental papilla (aWIDP). There was a statistically significant greater mean root coverage (MRC) percentage at GUG sites (80.68 ± 16.12%) in comparison to EPG sites (71.05 ± 17.23%) (p = 0.01). The treatment satisfaction (p = 0.009) and aesthetic satisfaction (p < 0.001) experienced were significantly better for GUG as compared to EPG. The regression model (R 2 = 0.56) significantly predicted MRC percentage in GUG sites with baseline RD (β = −12.49; p = 0.02) and aWIDP (β = −9.31; p = 0.02). GUG showed a better MRC, aesthetics and increased KTW. Root coverage procedures often need to suffice the dual objective of coverage and aesthetics at the same time. GUG is a simple modification of the conventional EPG that can provide better clinical and aesthetic outcomes. [ABSTRACT FROM AUTHOR]

Vestibular Incision Subperiosteal Tunnel Access (VISTA) root coverage technique has experienced a surge in popularity in recent times. The methodology employed in this study is characterized by its minimally invasive nature, utilizing a single incision. The primary objective of this systematic review was to assess the effectiveness of the VISTA approach for achieving root coverage. The protocol was registered with PROSPERO and included randomized controlled clinical trials where gingival recessions were managed with VISTA technique or its modifications. Among the total of 416 records, a mere 14 studies were initially deemed eligible for consideration. Ultimately, only eight pieces of research were included in the final analysis. There were six studies that exhibited heterogeneity, while two studies showed homogeneity and were therefore included in the meta-analysis. All of the studies considered in the analysis exhibited a moderate to low risk of bias. The majority of the research included in the analysis focused on selective root coverage outcome indicators, while neglecting to incorporate patient-reported outcome measures and patient experienced outcome measures. The VISTA procedure is commonly acknowledged as the most efficacious approach for managing gingival recession. The current literature provides support for the recommendation of the procedure, with evidence of intermediate certainty. The findings of this systematic review indicates that the available data are restricted due to several methodological limitations observed in the included studies. These limitations include, small sample sizes, selective reporting of outcomes, and very short follow-up periods. [ABSTRACT FROM AUTHOR]

Failures of soft tissue grafting are relatively common and can be stressful when encountered for both the clinicians and patients. Soft tissue grafting has predictable success most of the time when proper selection and implementation of surgical procedure is done. This case report describes management of soft-tissue surgery failure after multiple mucogingival grafting for enhancing the soft-tissue quality, quantity, and aesthetic outcomes. Augmentation by free gingival graft using periodontal microsurgical principle resulted complete coverage of the defect suggesting that careful treatment planning, immaculate execution by skillful technique definitely helped to achieve a successful result. Simultaneous use of photobiomodulation (PBM) helped in faster and better healing of the grafted area. [ABSTRACT FROM AUTHOR]

It has been said, 'Bone sets the tone, but tissue is the issue.' In the field of implantology, while significant breakthroughs have been achieved in hard tissue regeneration, clinicians find it more challenging to handle soft tissue complications around dental implants. Successfully managing soft tissue around dental implants requires clinicians to have comprehensive knowledge of proper implant placement, prosthetic design and tissue management, and a high level of surgical skills for soft tissue augmentation and grafting. Autogenous gingival grafts can be utilized in various clinical situations, providing surgeons with great potential and freedom to enhance the quality and quantity of peri-implant soft tissue. Emerging trends, such as digital tools for treatment planning, minimally invasive surgical approaches, and innovative biomaterials, can also contribute to a more pleasing outcome. By elucidating these multifaceted considerations, this review will serve as a valuable resource for clinicians aiming to achieve functional and aesthetic excellence in implant-based oral rehabilitation. [ABSTRACT FROM AUTHOR]

Background.: The importance of peri-implant soft tissues in maintaining tissue health and aesthetics has been recognized. A thickness of at least 2 mm is considered a protective factor against peri-implantitis. This study assessed clinical outcomes and complications at implant sites following soft tissue augmentation with either palatal free gingival graft (FGG) or palatal pedicle graft (PPG). Methods.: In this randomized controlled clinical trial, 42 patients with inadequate keratinized tissue width (KTW) were randomly assigned to two intervention groups: Group 1 received FGGs, while group 2 underwent PPGs. The KTW, vestibular depth, and surface shrinkage were recorded preoperatively and one and three months after the operation. Patient-reported outcome measurements were recorded at a two-week follow-up. Results.: Thirty-five patients completed the study (FGG group, n=17; PPG group, n=18). Group 2 demonstrated a higher increase in KTW and vestibular depth at 1 and 3 months (P <0.05).>P>0.05). The number of analgesics in each group was not significantly different two weeks after the operation; however, the Numeric Pain Rating Scale (NPRS) showed significantly higher pain scores on days 3 to 8 in group 1 patients. Conclusion.: The use of PPG in soft tissue augmentation demonstrated more KTW formation and less postoperative morbidity. There was no difference between the methods used to compare surface shrinkage. [ABSTRACT FROM AUTHOR]

Purpose: The goal of the study was to examine the efficacy of collagen membrane or free connective tissue graft in conjunction with growth factor-enhanced matrix (GEM) for treating Miller class two gingival recession. Patients and methods: Twenty sites in 10 patients, with class II Miller gingival recession were allocated randomly to be treated by (GEM21s) with free connective tissue graft (group I) or GEM21s with collagen membrane (group II). Recession width, recession depth, height of keratinized tissue and digital measurements were recorded at baseline, 1, 3, and 6 months. Probing pocket depth, clinical attachment level, gingival thickness, and radiographic parameters were recorded at baseline and 6 months. Root coverage percentage were recorded 6 months postoperative and wound healing index were recorded at 1, 3, and 6 months postoperative. Results: Both groups showed significant improvement in all clinical parameters and increase in bone level was observed after 6 months compared to baseline measures. There was no statistically significant difference between both groups except for recession depth at 1 and 3 months after surgery and height of keratinized tissue at 1, 3, and 6 months in favor of group I. Radiographically there was a statistically significant difference (P ≤ 0.05) in amount of labial bone gain and bone density in favor of group I compared to group II. Conclusion: GEM21s combined either with free connective tissue graft or collagen membrane led to favorable gingival coverage and radiographical results with better results for free connective tissue graft with GEM21s. [ABSTRACT FROM AUTHOR]

The amount of keratinized gingiva around teeth/prostheses is a crucial factor to consider before placing the crowns and bridges around implants or edentulous teeth. Keratinized gingiva around teeth, edentulous sites or implants is an important as it improves aesthetics, helps to maintain good oral hygiene around prosthesis, and prevents postoperative exposure of implant threads. The presence of adequate keratinized tissue around implants/prostheses is vital for good peri-implant health and should be augmented before implant treatment to improve the overall prognosis of the implants. The attached gingiva can be augmented using a free gingival graft (FGG) or AlloDerm®. However, procurement of FGG is surgically demanding as it requires procurement of the tissue graft from the palate. Moreover, it creates a second surgical site with an increased risk of post-operative discomfort and bleeding. To overcome these limitations, this case report presents a novel non-invasive simple, surgical technique to augment keratinized tissue using partially excised pedicled gingivectomy tissue for augmentating attached gingiva before prosthetic rehabilitation. [ABSTRACT FROM AUTHOR]

Background: The primary purpose of this two‐arm, parallel design, randomized controlled study is to compare healing of the palatal tissue donor site when platelet‐rich fibrin (PRF) is used as a wound dressing compared to the use of a hemostatic agent. Secondary outcomes of patient pain perception and analgesic intake were also evaluated. Methods: Seventy‐four patients receiving free gingival grafts were randomized to receive either PRF (test) or hemostatic agent (control) as a palatal wound dressing by patients selecting a sealed envelope containing their group assignment (initially 37 envelopes for PRF group and 37 for hemostatic agent group). Patient pain assessment and analgesic consumption were documented using a 21‐point numerical scale (NMRS‐21) at 24, 48, and 72 hours post‐surgery. At 1‐, 2‐, 3‐, and 4‐week follow‐up appointments palatal early healing index (PEHI) scores including wound color, epithelialization, presence or absence of swelling, granulation tissue, and bleeding on gentle palpation were generated by direct intraoral examination by a blinded examiner unaware of the patients' treatment group. Results: NMRS‐21 pain scores showed a significant reduction in pain over time in both groups, with no significant difference between groups at any time point. No significant between‐group difference was found in the amount of analgesics taken by patients at 24, 48, and 72 hours. There was significant improvement in PEHI scores over the 4‐week time period in both groups, but there was no significant difference in PEHI score at each time point (1, 2, 3, 4 weeks) between groups. Conclusions: Study findings suggest that there is no difference in early palatal wound healing, patient pain perception, or analgesic consumption between use of PRF or a hemostatic agent as donor‐site wound dressings. [ABSTRACT FROM AUTHOR]

The tunnel technique is an up-to-date technique that is actively used in the treatment of multiple gingival recessions. The use of a connective tissue graft in addition to the coronally displaced subperiosteal flap, which is freed without disrupting the papillary integrity, provides an increase in keratinized tissue, treatment of gingival recession and thickening of gingival tissue. The aim of this study is to evaluate the results of connective tissue graft placed with tunnel technique. A systemically healthy 26-year-old female patient with gingival recession in her lower right canine and premolar teeth underwent tunnelled connective tissue graft placement and the results of the operation were evaluated at a 2-year follow-up. As a result, the modified tunnel technique and connective tissue graft were found to be very successful in root surface closure. [ABSTRACT FROM AUTHOR]

Background: Even though the natural polymers are biodegradable, non-toxic and cost effective, but these suffer with some of drawbacks like uncontrolled drug release, enzymatic degradation, reduction in viscosity on long term storage, thermal instability etc. The aforesaid limitations can be overcome by grafting of natural polymers to obtain high performance biomaterials for drug delivery system. Materials and Methods: Purified fenugreek and mesquite gums were grafted with acrylamide using Ceric Ammonium Nitrate (CAN) as free radical initiator. Confirmation of grafting was done by elemental analysis and FT-IR spectroscopy. Grafted copolymers were tested for its biodegradability in microorganisms and toxicity in Drosophila melanogaster. Nine batches of mebendazole tablets (F1 to F9) were prepared using mixture of acrylamide grafted fenugreek and mesquite gum polymer by 32 factorial designs. Compressed tablets were tested for post-compression compendia parameters. Results: FT-IR confirmed the grafting and compatibility between drug and synthesized copolymers. Synthesised graft copolymers showed significant swelling index, water retention capacity, viscosity, hydration capacity than the pure gum polymers. Compressed tablets showed hardness (5.5 to 6.6 kg/cm2 ), friability (less than 1%). thickness (3 mm) and complied weight variation test as per compendial standards. Further tablets were coated with Eudragit RS 100 demonstrated small amount of drug release in 5 hr and maximum amount of drug released in colonic region. Hence, after reaching colonic region drug release extended upto 12 hr due to satisfactory drug release by copolymers. Conclusion: Grafted copolymers were biodegradable, non-toxic and showed higher swelling index then pure polymers. These copolymers can be used as drug release retardant in the tablet formulation. [ABSTRACT FROM AUTHOR]