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Aim and objective: To report a case of surgical management and postsurgical rehabilitation COVID-19-related mucormycotic osteomyelitis of the maxilla. Background: Patients with the SARS-CoV-2 infection, also termed the COVID-19 illness, have been found to be afflicted with other associated bacterial and fungal diseases which have been termed as co-infections. In this regard, mucormycosis, a fungal infection, has been found to occur in these patients especially with a lowered immune response and has been found to cause osteomyelitis of the jaw bones. Case description: We present a case of mucormycosis in a COVID-19-affected patient that occurred in August 2020 denoted the first wave of disease in India, causing extensive osteomyelitis of the left maxilla. The patient presented clinically with odontalgia and tooth mobility in the upper anterior region. Clinical examination revealed the presence of abscesses in the attached gingiva in relation to tooth numbers 13,12, 11, 22, 23,24 and 25. A deep horizontal cleft was observed in the mucogingival junction in relation to 23 discharging pus. Computed tomography (CT) imaging revealed a diffuse radiolucency extending from the alveolar ridge of the upper anterior teeth to the left maxillary sinus, breaking the floor of the sinus. We have performed extensive medical and surgical management of this patient including postoperative prosthetic rehabilitation which is documented in the present case report. Clinical significance: Our observation of maxillary osteomyelitis secondary to mucormycosis in the first COVID wave in India makes our case extremely rare and important as this highlights that COVID-19 complications were significant but under-evaluated in the first wave of the disease. © Jaypee Brothers Medical Publishers. 2021.

This case series reports the various treatment modalities to treat the multiple recessions. Gingival recession is a widespread clinical manifestation affecting single or multiple root surfaces at all teeth types. Periodontal reconstructive surgery consists of various mucogingival procedures. The primary goal of these procedures is to benefit periodontal health through the reconstruction of lost hard and soft tissues, or by preventing its additional loss, and also enhancing the esthetic appearance. Platelet-rich fibrin is a second generation platelet concentrate and is defined as an autologous leukocyte and platelet-rich fibrin biomaterial. Care was taken not to extend the incisions till the tip of the interdental papilla. A full thickness mucoperiosteal flap was reflected, extending beyond the mucogingival junction. A wide range of surgical techniques has been proposed for the treatment of the gingival recessions, each with its advantages and disadvantages. To provide predictable and long-term results, it is of paramount importance that the surgical technique is individually selected, taking into account several crucial factors such as the size of the defect, the width of the keratinised gingiva apical to the defect and the thickness of the flap.

Background: Awareness about pink esthetics among dentists in general needs to be assessed as root coverage procedures are the mainstay of treatment for gingival recession. Concordance among the dentists in figuring out the esthetic outcomes after root coverage procedures is inconsistent. Hence, this study aims to evaluate inter- and intra-examiner reliability of root coverage esthetic scores (RES) between periodontists and nonperiodontists. Materials and Methods: The study was conducted using twenty baseline and 6-month posttreatment photographs of Miller's Class I and Class II gingival recessions. The participants that constituted ten periodontists and ten nonperiodontists were assembled in the seminar hall to receive training on protocol and procedures for RES by the investigator. All the participants were shown twenty projections of side-by-side baseline and 6-month outcomes of root coverage procedures. Each projection was shown for 30 s during which the participants were made to use RES system to evaluate the surgical outcomes. Results: Periodontists showed the highest reliability in the scores of marginal tissue contour with an overall intraexaminer reliability to be perfect among periodontists. Intraexaminer reliability among nonperiodontists was fair, and gingival margin was the parameter with the highest reliability among them. Interexaminer reliability between periodontists and nonperiodontists showed slight reliability concerning gingival margin, and fair reliability was found for marginal tissue contour, soft-tissue texture, mucogingival junction, and gingival color. Conclusion: Satisfying the esthetic component of gingiva is the duty of every dentist in general and not only the periodontists. Significant variability was found in esthetic scores between the groups, which can probably be attributed to the lack of sufficient knowledge regarding pink esthetics among the nonperiodontists, which needs to be improved.

The present clinical and histologic case reports describe the periodontal plastic approaches used for the correction of gingival deformities following free gingival grafting (FGG) procedures. Five patients with poor esthetic and functional outcomes following soft tissue grafting voluntarily requested corrective treatment due to differences in color, texture, thickness, and mucogingival junction (MGJ) alignment between grafted and adjacent tissue, or because of food retention apical to the grafted site. Plastic surgical approaches included eliminating the thick borders the graft, aligning the MGJ, and reducing the excessive apicocoronal dimension of the graft. Histologic images confirmed the morphologic differences between the graft and adjacent alveolar mucosa. After intervention, all treated sites achieved a satisfactory esthetic appearance and function, with a soft tissue anatomy indistinguishable from those of adjacent sites. All patients agreed that their goals for the treatment were completely fulfilled.

This article gives information regarding various etiological factors that can lead to recession, the pathogenesis behind the recession, under which type it can be classified, the diagnostic criteria for recession, how to assess the root coverage, rationale for the necessary treatment with suitable non-surgical and surgical treatment options, concluding with post-operative care which has to be given to the patients after surgical procedures.

Objectives To evaluate changes in the gingival thickness (GT) and keratinized gingival width (KGW) of the maxillary and mandibular central and lateral incisors and canines after fixed orthodontic treatment and their association with sagittal tooth movement (STM). Materials and Methods In this study of both arches, 60 periodontally healthy subjects who had completed fixed orthodontic treatment were included. Using pretreatment and posttreatment lateral cephalograms, STM of the maxillary (1-NA angle and distance, and 1-SN angle) and mandibular (1-NB angle and distance, and IMPA angle) incisors were evaluated to divide the subjects into protrusion and retrusion groups. Pretreatment and posttreatment GT was identified via transgingival probing, and KGW was calculated from the free gingival margin to the mucogingival junction. Results The intragroup pretreatment and posttreatment comparison results showed a significant decrease in the GT of the maxillary and mandibular anterior teeth in the protrusion and retrusion groups and a decrease in the KGW of the maxillary lateral incisors in the protrusion group. Pearson correlation coefficient analyses for maxillary and mandibular anterior teeth revealed that the GT changes were not significantly associated with STM. However, a positive correlation existed between the KGW of tooth numbers 13 and 41 and STM. Conclusions STM was not significantly associated with decreased GT of the maxillary and mandibular anterior teeth, but it was positively correlated with the KGW of tooth numbers 13 and 41.

Plasma cell gingivitis, an infrequent benign entity, is an inflammatory or reactive condition of the gingiva to certain allergens or to an unknown factor. It is clinically characterized by erythematous, edematous, granular/cobblestone appearance of gingival surfaces with clear demarcation from the mucogingival junction. It easily bleeds on manipulation and may be associated with a burning sensation to spicy food consumption. As the name suggests it is diffuse and massive infiltration of plasma cells into the sub-epithelial gingival tissue. It is a hypersensitivity reaction to some antigen, often flavouring agents or spices found in chewing gums, toothpastes and lorenzes. Plasma cell gingivitis is also known as atypical gingivostomatitis, allergic gingivostomatitis, unusual gingivostomatitis and idiopathic gingivostomatitis. Histologically, the lesion shows dense plasma cell infiltrate of the connective tissue. We report a case of a rarely seen mucosal pathology of a 51 yr old male patient with a chief complaint of bleeding swollen mass in the upper and lower front tooth region who presented with this rare condition and its histological diagnosis and its management.

Antemortem domestic pig (Sus scrofa domesticus) dental pathology literature is sparse. This observational descriptive study evaluated 23 client-owned pigs that while sedated/anesthetized for routine annual care had intraoral dental radiographs and an oral examination performed. Age, gender, weight, and breed for each pig were recorded. Oral examination and radiographic findings were reviewed to create a comprehensive list of dental abnormalities identified. Descriptive statistics were performed to summarize the data. The study population included 14 castrated males and 20 Vietnamese pot-bellied mini-pigs. The median age was 3 years (range 2-12 years), and the median weight was 39 kg (range 11-140 kg). The most common finding was missing teeth (21/23 pigs); the first premolar tooth was the most likely to be absent (64/106 missing teeth). Periodontal disease was common (20/23 pigs). Advanced stages primarily affected the first molar teeth frequently in the form of a mucogingival defect. Supernumerary roots were discovered on the maxillary canine teeth in female pigs only (10/25 teeth with supernumerary roots). The most common persistent deciduous tooth was the maxillary second incisor (15/19 persistent deciduous teeth). Non-age or gender related open apices were most likely associated with mandibular first and second incisor teeth (26/96 teeth with open apices). Tooth resorption was also identified (7/23 pigs). The study findings prove that pet pigs commonly have dental pathology; therefore, thorough oral examinations with intraoral radiographs should be included in porcine routine health care regimens.

Introduction The present study aimed to clinically evaluate and compare the variations in gingival thickness and width of keratinized gingiva according to the dental arch and location in pigmented and nonpigmented gingiva. Materials and Methods A total of 240 sites from systemically healthy subjects were selected and divided into two groups; Group 1(pigmented gingiva) and group 2 (nonpigmented gingiva). After the initial visit of scaling and root planning, the gingival thickness was evaluated mid-buccally in the attached gingiva, that is, the center of the mucogingival junction and free gingival groove, and at the base of the interdental papilla. Similarly, the gingival width was measured as the distance from the gingival margin to the mucogingival junction. A single calibrated examiner recorded the measurements using the digital vernier caliper with a resolution of 0.01 mm. Results Gingival thickness and width were found to be significantly higher in pigmented than nonpigmented gingiva. Also, the maxillary arch was found to have thicker and wider gingiva than the mandibular arch in both the groups. The gingival thickness was found to be maximum in central incisor and minimum in canine in both the groups. However, the width of keratinized gingiva was found to be maximum in lateral incisor in group 1 (pigmented) and central incisor in group 2 (nonpigmented) and minimum in canine in both the groups. Conclusion A significant positive correlation in gingival thickness and width was observed according to dental arch and location in both pigmented and nonpigmented gingiva.

Attached gingiva is the distance between the mucogingival junction to a projection of the external surface of the sulcus or the periodontal pocket. There are mainly 3 methods for evaluating attached gingiva functional method (roll technique), the visual method with or without histochemical staining, anesthesia method. This retrospective cross-sectional study was conducted to identify the most commonly used technique for measuring the width of attached gingiva among patients. The study group consists of Adult patients who attended the outpatient Department of Prosthodontics from June 2019-March 2020. 86,000 case sheets were reviewed and sampling was done using simple random sampling. A chi-square test was done to evaluate the correlation between age, gender and Profession with Technique for measurement of Attached gingiva. From the study, we can see that most of the students used Roll technique to find Attached gingiva and some used Balloon technique to find attached gingiva. However, there is no significant correlation between age, gender and Profession with Technique of width of attached gingiva.

Introduction: Attached gingiva aids in increased resistance to external injury and contribute in stabilisation of gingival margin against frictional forces as well as dissipates physiological forces exerted by the muscular fibers of the alveolar mucosa on gingival tissues. Objective: To assess width of attached gingiva in adults and correlate with oral hygiene maintenance and gingival inflammation. Methods: A cross-sectional study was conducted in patients aged 20-40 years visiting dental OPD with healthy periodontium. Plaque index (PI) and Gingival index (GI) were recorded. Mucogingival junction was determined by visual and functional method. Keratinised gingiva width (KGW) and probing pocket depth (PPD) was recorded and attached gingiva width (AGW) was calculated as (KGW–PPD). Results: Total 85 patients (43 males and 42 females) enrolled in this study. Among total, 48.23% had AGW

Purpose The health of peri-implant tissues is associated with the peri-implant soft tissue thickness (STT) and keratinized tissue width (KTW). Resorptive changes in the crestal bone around implant sites will be affected by the STT. The present randomized prospective study compared the effectiveness of titanium-prepared platelet-rich fibrin (T-PRF) with that of connective tissue graft (CTG) on peri-implant STT, KMW, and crestal bone level. Patients and Methods Through simultaneous augmentation of the soft tissue using T-PRF or CTG, 30 implants were placed in 30 patients. The implants were placed in thin, soft tissue areas and thickened simultaneously with a T-PRF membrane in the test group and a CTG in the control group. During surgery (T0) and at 3 months postoperatively (T1), the KTW and peri-implant STT were measured at 3 points: occlusal part of the alveolar crest (OAC), midbuccal mucosa level (MBML), and 1 mm above the mucogingival junction (MGJ1). The crestal bone changes were evaluated from a periapical radiograph at 3 months postoperatively. Results The baseline STT and KTW measurements showed no significant differences between the 2 groups (P .05). No crestal bone loss was observed in any of the dental implants. Conclusions Both groups experienced a greater increase in peri-implant STT at the OAC level, and T-PRF can be considered as an autogenous alternative to CTG. Also, peri-implant STT might prevent crestal bone resorption in the osseointegration period.

Purpose The aim of this study was to explore the effect of preventing first-stage wound dehiscence with new types of incision and flap design and to evaluate the effect of wound dehiscence on the bone resorption of the autogenous bone ring graft. Materials and methods In six beagle dogs, the second and fourth premolars on the bilateral mandible were extracted. After 3 months, on the left extraction sites, conventional alveolar crest incisions were made and the full-thickness flaps were elevated. However, on the right sites, the incisions were made at the mucogingival junction, the split-thickness flaps were elevated toward the lingual side, and the periosteum was elevated toward the buccal side. Then, Straumann implants (. 3.3, length 8 mm) were placed with simultaneous autogenous bone ring grafting. Next, the wounds on the left side were closed with periosteal releasing on buccal flaps conventionally, but the semi-thickness flaps on the right side were sutured with the elevated periosteum. After 3 months, the animals were euthanized, and the harvested samples were analyzed using microcomputed tomography and histology. Results The incidence rate of wound dehiscence in the new incision group was 16.7%, which was significantly lower than that in the conventional incision group (75%). There was hardly any vertical bone loss of the bone ring in the samples without wound dehiscence, but in wound dehiscence samples, severe bone loss, 2.47 ± 0.17 mm, was found on the buccal side of the bone ring, which was significantly higher than that on the lingual, mesial, and distal sides, 1.37 ± 0.14 mm, 1.00 ± 0.15 mm, and 1.03 ± 0.05 mm, respectively. Conclusion The use of a mucogingival junction incision and split-thickness flap design can effectively prevent first-stage wound dehiscence in autogenous bone ring grafting, which plays a key role in bone resorption of the graft.

The main objective of this study was to assess changes in the position of the gingival margin (GM) after performing an aesthetic crown lengthening (ACLP) by means of submarginal incisions, buccal osseous surgery, and a replaced flap after a healing period of 6 months. Twenty-one patients who needed a surgical crown lengthening in the maxillary anterior teeth were included. An individual stent was fabricated to record changes in the position of the GM. Clinical measurements were recorded pre-surgically; immediately post-surgically (baseline); and at 42, 90, and 180 days. After the ACLP, the GM displacement did not change significantly after 42, 90, and 180 days (4.32 ± 1.17 mm, 4.29 ± 1.14 mm, and 4.26 ± 1.11 mm, respectively). Tissue rebound seems to be related to the distance from the GM to the alveolar bone (AB) at the time of suturing (GM-AB(X)). When GM-AB(X) was ≤ 2 mm, 3 mm, and ≥ 4 mm, the GM rebound at 6 months was 0.94 ± 0.53 mm, 0.10 ± 0.28 mm, and − 0.26 ± 0.40 mm, respectively. These differences were statistically significant (P

Introduction Loss of the interdental papilla, leading to the formation of black triangular spaces just below the contact area of adjacent teeth, is one of the most challenging periodontal conditions to treat and often requires an interdisciplinary approach by the periodontist, restorative dentist, and orthodontist. Although these "black triangles" may appear quite small from a clinician's standpoint, they can have a significant impact on oral health satisfaction for patients. This case series illustrates a novel minimally invasive approach to restore interdental papilla deficiencies. Case presentation Four interdental papilla defects were treated in three females. No patients were lost to follow-up over 6 months. The surgery consisted of a horizontal incision placed apical to the area of papillary loss in the alveolar mucosa just beyond the mucogingival junction. An interdental subperiosteal tissue space was then created by tunneling toward and under the dental papilla. Once adequate release was achieved, dermal filler was administered into and underneath the deficient papilla. The papillary margins were then sealed with cyanoacrylate and additional dermal filler was injected as needed to achieve ideal papillary fill. Six months after treatment there was an improvement in patient-satisfaction regarding papilla fill demonstrated by a mean increase in visual analogue scale (VAS) measurements of 62.46%. Mean papilla fill was 1.75 mm. Conclusion This surgical technique demonstrates the restoration of deficient interdental papillae between teeth and implants, and perhaps as importantly, a considerable improvement in patient-based outcomes quantified through VASs.

We report the case of a non‐cirrhotic 25‐year‐old female patient with cryptogenic portal hypertension who underwent cyanoacrylate injection for acute gastroesophageal variceal bleeding with a subsequent embolic stroke via a previously unrecognised portopulmonary venous anastomosis., We report the case of a noncirrhotic 25‐year‐old female patient with cryptogenic portal hypertension who underwent cyanoacrylate injection for acute gastroesophageal variceal bleeding with a subsequent embolic stroke via a previously unrecognized portopulmonary venous anastomosis.

Buccal orthodontic tooth movement (OTM) of the anterior teeth out of the osseous envelope of the alveolar process incase of front teeth crowding may be associated with a higher tendency for developing gingival recessions. The aim ofthis case report is to present the effectiveness of a minimally invasive preorthodontic corticotomy combined with a buccalbone augmentation according to the rules of periodontally accelerated osteogenic orthodontics (PAOO). The maingoal of our therapy is to increase or maintain the buccal bone thickness, which could prevent the development of gingivalrecessions. Corticotomy possibly have an additional benefit throughout regional acceleratory phenomenon, reducingthe duration of OTM in the early treatment phases. A generally and periodontally healthy individual at the age of17 presenting crowding and thin bone morphotype in the mandibular y front area, who requiresting OTM with incisorproclination, was treated. Surgery was performed under local anesthesia. Three vertical incisions were performed onthe midline and on both sides between lateral incisors and canines, with preservation of the papilla integrity. Incisionswere connected by tunneling knifes in 2 layers, subperiosteally in the whole length and supraperiosteally apically fromthe mucogingival junction. Corticocisions were utilized by ultrasonic instrument penetrating through the cortical bone.“Sticky bone” plates, a combinations of platelet rich fibrin (PRF) and xenograft, were used subperiosteally for bone, andPRF membranes supraperiosteally for soft tissue augmentation. Initiation of OTM started 1 week postoperatively, andactivation of the multibond appliance was performed activated in 2 weeks. The extent of tooth movement measuredon the central incisor was compared followed-up on cephalometric radiographs made taken at the different treatmenttime appointments, while buccal bone thickness on the 6 front teeth was evaluated in CBCT before and after OTM. Thealignment phase ended up at the 20th week due to an initial arch wire sequence using light forces. The buccal bony wallthicknesses showed similar values compared to the initial ones, and there was no radiologically proven substantial verticalbone loss. The presented comprehensive treatment approach promised a good option in the prevention of the periodontalside effects during orthodontic treatment.

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

The aim of the present study was to re-visit the gingival dimension using digital scanning in a healthy Korean population. Forty-eight periodontally healthy volunteers (38 males and 10 females, mean age: 24.3 ± 2.2 years) were included. The mucogingival junction was highlighted using 2.5% diluted iodine solution. Then, the facial gingiva and mucosa of both jaws were digitally scanned using an intraoral digital scanner. Using computer software and periodontal probing, the heights and areas of keratinized gingiva (KG) and attached gingiva (AG) were measured. Similar distribution patterns in the gingival heights were noted in the maxilla and mandible. The maxilla showed substantially greater gingival values than the mandible. The heights of the KG and AG were notably smaller on the mandibular first premolar (2.37 mm and 1.07 mm, median value) and second molar (3.28 mm and 1.78 mm) than on the other teeth. The area of the KG was the largest in the canine (63.74 mm2 and 46.85 mm2) and first molar (64.14 mm2 and 58.82 mm2) in each jaw. Mandibular first and second molars, mandibular canine, and maxillary canine showed the highest value of the area under the receiver operation characteristics curve (&gt, 0.7) for differentiating between males and females. The gingival dimensions recorded using intraoral scanner demonstrated similar distribution patterns as in previous studies.

There is a need to modify the definition of attached gingiva (AG) as it applies to healthy and diseased teeth and implants. There are two parts to this new definition: Part A is when the biologic width is supracrestal (epithelial attachment and gingival fibers) and is attached to a healthy tooth or tissue-level implant, and the zone of AG is measured from the base of the sulcus to the mucogingival junction (MGJ); Part B is when the biologic width is subcrestal-as with infrabony defects on periodontally involved teeth, periodontally involved tissue-level implants, and bone-level implants placed at or below the bone crest-and the zone of AG is measured from the bone crest (not the base of the sulcus) to the MGJ. Further, what the AG is actually attached to around teeth and different types of implants, and the clinical significance of these differences, are thoroughly discussed.

Introduction This study aimed to evaluate the 3-dimensional (3D) mandibular dental changes over 42 years using the registration of digital models. Methods The sample comprised digital dental models of 8 untreated subjects (4 males and 4 females) with normal occlusion measured longitudinally at ages 17 years (T1) and 60 years (T2). Using 13 landmarks placed on the mucogingival junction, we registered the T2 model on the T1 model. Three-dimensional changes in the position of the landmarks on the buccal cusp tip of the posterior teeth and incisal edge of the central incisors were measured by 2 examiners. Registration and measurements were performed using SlicerCMF (version 3.1; http://www.slicer.org ) software. Intra- and interrater agreements were evaluated using intraclass correlation coefficients and the Bland-Altman method. One-sample t tests were used for evaluating interphase 3D dental changes (P Results Adequate intra- and interrater reproducibility was found. From T1 to T2, the mandibular teeth showed significant 3D positional changes. A significant dental eruption relative to the mucogingival junction was observed for the anterior and posterior teeth. Anteroposterior movements of mandibular teeth were not significant except for the right molar that drifted mesially. Transverse movements included slight lingual tipping at canines and premolars regions. Conclusions Dental changes in untreated normal occlusion were very slight from early to mature adulthood. The eruption of the mandibular teeth was the most consistent finding. A tendency for mesial movement of molars and lingual movement of first premolars and canines was observed in the mandible during the aging process.

Objective This outcome analysis study evaluated the actual positions of the orthodontic miniplate and miniplate anchoring screws (MPASs) and the risk factors affecting adjacent anatomic structures after miniplate placement in the mandibular incisal area. Methods Cone-beam computed tomographic images of 97 orthodontic miniplates and their 194 MPASs (diameter, 1.5 mm; length, 4 mm) in patients whose miniplates provided sufficient clinical stability for orthodontic treatment were retrospectively reviewed. For evaluating the actual positions of the miniplates and analyzing the risk factors, including the effects on adjacent roots, MPAS placement height (PH), placement depth (PD), plate angle (PA), mental fossa angle (MA), and root proximity were assessed using the paired t-test, analysis of variance, and generalized linear model and regression analyses. Results The mean PDs of MPASs at positions 1 (P1) and 2 (P2) were 2.01 mm and 2.23 mm, respectively. PA was significantly higher in the Class III malocclusion group than in the other groups. PH was positively correlated with MA and PD at P1. Of the 97 MPASs at P1, 49 were in the no-root area and 48 in the dentulous area; moreover, 19 showed a degree of root contact (19.6%) without root perforation. All MPASs at P2 were in the no-root area. Conclusions Positioning the miniplate head approximately 1 mm lower than the mucogingival junction is highly likely to provide sufficient PH for the P1- MPASs to be placed in the no-root area.

Purpose This study assessed a novel treatment protocol for immediate implant placement in defective fresh extraction sockets. Materials and methods A single-arm clinical study was conducted including 12 fresh extraction sockets divided into two groups: those with intact and those with a deficient facial plate of bone. Hopeless teeth were atraumatically extracted, a vestibular access horizontal incision was made 3 to 4 mm apical to the mucogingival junction, a mucoperiosteal tunnel was created from the labial orifice of the socket, a slowly resorbing membrane shield was stabilized under the tunnel, implants were placed using a surgical guide, and a subepithelial connective tissue graft was harvested and secured over the membrane shield. Definitive restorations were delivered at 3 months postoperatively. Cone beam computed tomography (CBCT) scans were taken at baseline and after 6 and 13 months to measure facial bone thickness and height. Pink esthetic score (PES) was recorded at 6 and 13 months. Results At 6 months, the mean ± SD facial bone thickness was 1.88 ± 0.73 mm for sockets with intact facial bone compared to 0.76 ± 0.42 at baseline and 2.34 ± 0.78 mm for sockets with deficient facial bone compared with 0 ± 0 at baseline, whereas at 13 months, the thickness was 1.84 ± 0.74 and 2.18 ± 0.73 mm, respectively. The facial bone crest coincided with the implant platform in sockets with an intact facial bone plate and those with a deficient facial bone plate at 6 months, whereas at 13 months, the distance for sockets with a deficient facial bone plate increased to 0.20 ± 0.13 mm. The mean PES at 6 and 13 months was 11.33 for both groups out of a maximum score of 14. Conclusion The proposed technique provided a minimally invasive treatment with predictable esthetic outcome allowing immediate implant placement in sockets with intact and with deficient facial plates.

Background It has been demonstrated in non-oral tissues that the locally evoked vasoconstriction could elicit remote vasoconstriction. This study aimed to investigate the spreading vasoconstrictor effects of epinephrine in the gingiva. Methods Gingival blood flow (GBF) was measured by laser speckle contrast imager in 21 healthy volunteers. In group A, two wells were fabricated from orthodontic elastic ligature and placed 2 mm apically to the free gingival margin at the mid buccal line of 12 (test side) and 21 (control side) teeth. The GBF was measured in the wells and tightly apical, coronal, distal and mesial to the wells. In group B, the wells were made on the buccal surface of the same teeth, including the gingival sulcus. Four regions were selected for measurement from the gingival margin reaching the mucogingival line (coronal, midway1, midway2 and apical). After the baseline recording, 3 µg epinephrine was applied into the test, and physiological saline into the control well. The GBF was recorded for 14 min. The gingival thickness was measured with a PIROP Ultrasonic Biometer. Results In group A, the GBF did not increase or decrease after the application of epinephrine. In group B, the GBF significantly decreased in all regions of the test side and remained low for the observation period. The vasoconstriction appeared with delays in more apical regions (at min 1 in the coronal and the midway1, at min 2 in the midway2, at min 4 in the apical region). Similarly, the amount of the decrease at 14 min was the largest close to sulcus (− 53 ± 2.9%), followed by the midway1 (− 51 ± 2.8%) and midway2 (− 42 ± 4.2%) and was the lowest in the apical region (− 32 ± 5.8%). No correlation was found between GBF and gingival thickness. Conclusion Epinephrine could evoke intense vasoconstriction propagating to the mucogingival junction, indicating the presence of spreading vasoconstriction in the human gingiva. The attached gingiva is impermeable to epinephrine, unlike the gingival sulcus. This trial was registered in ClinicalTrials.gov titled as Evidence of Spreading Vasoconstriction in Human Gingiva with the reference number of NCT04131283 on 16 October 2019. https://clinicaltrials.gov/show/NCT04131283

Background The active arterial-to-arterial collaterals are a significant factor in the prevention of ischemia and extensive tissue necrosis in the case of arterial blockage of various tissues. The present study investigates the mucogingival vasculature in the maxillary esthetic zone mucosa in human cadavers and functionally evaluates the area, which is supplied by the terminal arterioles, on the individual level. Methods In the human cadaver study, macroscopic arterial analyses of the anterior maxillary vestibule in 7 specimens were scrutinized by latex milk injection. The tracks of the mucosal branches in relation to the mucogingival junction were investigated. In the functional study, individual gingival blood flow (GBF) changes were measured by laser speckle contrast imaging (LSCI) in 31 young subjects with healthy gingiva before and during 30-s compressions. This was conducted with a ball-shaped condenser. The data was analyzed by the linear mixed model. Results The vertically aligned branches of the superior labial artery (SLA) divided into small, slightly deviating sub-branches near the mucogingival junction. These arteries created collateral plexuses and supplied the attached gingiva. The compression of these branches resulted in ischemia coronally with significant individual variation. The ischemia was either apico-mesial, apico-distal, or straight apical to the compression. A significant correlation was found between the ischemic area and the magnitude of the decrease in GBF (r = 0.81, p Conclusion The arcade anastomoses formed by the small arteries in the keratinized gingiva of the upper esthetic zone explain the consequences of vertical incisions. The considerable individual variations in ischemic responses might be the reason for unexpected surgical outcomes in some cases. Furthermore, there is increasing evidence that men have different vascular reactivity and/or regulation of collateral circulation than women, which may affect wound healing.

Background: To assess the soft tissue dimension following tooth extraction and alveolar ridge preservation in the posterior maxilla compared to spontaneous healing. Methods: Thirty-five patients randomly assigned to alveolar ridge preservation (ARP) and spontaneous healing (SH) after maxillary molar extraction. The crestal, buccal, and palatal gingival thickness at 6 months was measured around virtually placed implant fixtures using superimposed cone-beam computed tomography and intraoral scan taken at 6 months. Buccal mucogingival junction (MGJ) level change over 6 months was estimated using intraoral scans obtained at suture-removal and 6 months. Results: The crestal gingiva was significantly thinner in group ARP (&minus, 1.16 mm) compared to group SH (p &lt, 0.05). The buccal and palatal gingiva was significantly thinner at the implant shoulder (IS) level in group ARP (buccal: &minus, 0.75 mm, palatal: &minus, 0.85 mm) compared to group SH (p &lt, 0.05). The thickness at 2 mm below the IS of both sides and the buccal MGJ level change were similar in both groups (p &gt, 0.05). Conclusions: ARP in the posterior maxilla resulted in a thinner soft tissue on top of and at the prospective level of the implant shoulder at 6 months. The buccal MGJ level changed minimal for 6 months in both groups.

Gingival recession is a frequent mucogingival defect in the adult population. It affects the esthetics and is related to hypersensitivity and a high risk of periodontal attachment loss. The connection between orthodontic treatment and periodontal health has been debated for a long time. A healthy periodontium can be preserved during safe orthodontic tooth movement even in patients with poor mucogingival anatomy. This article aimed to review the strategies around managing the risks of mucogingival and apical root changes owing to maxillary canine impaction, with a special focus on gingival recession and impacted maxillary canine treatment. Maxillary canines are the second most frequently impacted teeth after the third molars. They can be located in the labial or buccal aspect of the alveolar bone. If interceptive procedures fail, the next step is the challenging and time-consuming comprehensive orthodontic-surgical treatment. Determining the exact impacted canine location, its relation to the adjacent teeth and structures, the least invasive surgical approach, and the best path for traction are all a part of the standard diagnostic process. It has also been suggested that orthodontists should evaluate periodontal risks to achieve the best possible results. Clinical examination and cone beam computed tomography provide valuable information for the treatment plan that yields good results with a healthy periodontium.

This clinical report describes the successful use of aesthetic crown lengthening, lip-repositioning technique as well as gingival depigmentation for the reduction of excessive gingival display and dark gums, respectively. Lip-repositioning technique was performed with the main objective of reducing gummy smile by limiting the retraction of elevator muscles (e.g., zygomaticus minor, levator anguli oris, orbicularis oris, and levator labii superioris) during smiling, thereby restricting the upper lip from shifting apically while smiling. This technique includes removing a strip of mucosa from the maxillary labial and buccal vestibule, creating a partial-thickness flap between mucogingival junction and upper lip musculature, and suturing the lip mucosa with mucogingival junction, resulting in a narrow vestibule and restricted muscle pull, thereby reducing gingival display. The results obtained with lip repositioning for the treatment of gummy smile are substantial and it is a simple and effective procedure, well accepted by patients. Proper case selection is important for using this procedure.

Bu vakanın amacıolgumuzda maksiller kanin dişlerdeki Miller Sınıf-I dişeti çekilmelerindekoronale kaydırılan flep (KKF) ve subepitelyal bağ dokusu grefti (SBDG)tedavisi ile KKF ve trombositten zengin fibrin (TZF) tedavisinin sonuçlarını karşılaştırmaktı. Sistemik açıdansağlıklı 31 yaşında bayan hasta, kliniğimize dişlerinde hassasiyet ve estetikşikayeti ile başvurdu. Maksiller sağ ve sol kanin dişinde Miller Sınıf-I dişetiçekilmesi mevcuttu. Hastadan alınan kandan TZF elde edildi. Dişetiçekilmelerinin tedavisi için her iki dişte önce tam kalınlık mukoperiostal flepkaldırıldıktan sonra mukogingival birleşimden itibaren yarım kalınlık flep kaldırıldı.Kök yüzeyi debridmanı gerçekleştirildikten sonra papil bölgesi deepitelizeedildi ve TZF interdental papile süture edildi. Sol kaninde ise SBDG papilleresüture edildi. Her iki mukoperiostal flep koronale kaydırılarak kök yüzeyikapatıldı. Operasyon bölgesi öjenolsüz bir pat ile korundu. Hastaya operasyonsonrası antienflamatuvar ve klorheksidin glukonat içeren gargara reçete edildi.Operasyon sonrası erken dönemde herhangi bir komplikasyon izlenmedi. Pat vesüturlar operasyondan 10 gün sonra alındı. Bir ay sonra sağ kaninde %100 kökkapanmasının sağlandığı görüldü. Sol kaninde ise 1.5 mm dişeti çekilmesimevcuttu ve keratinize dişeti kalınlığı TZF uygulanan dişe göre daha fazlaydı. On beşay sonraki dişeti çekilmesi her iki tarafta da 1 mm olarak ölçüldü.Lokalize Miller Sınıf-Ive sınıf-II dişeti çekilmelerinde TZF kullanılarak yapılan tedaviler hakkındabaşarılı klinik sonuçlar bulunmaktadır. İkinci bir cerrahi müdahaleninolmaması, daha az zaman alması, donör saha morbiditesininortadan kalkması ve post-operatif rahatsızlığın olmaması gibi avantajlarıylaTZF SBDG’yeiyi bir alternatif olarak görülmektedir.Anahtar Kelimeler: Bağ dokusu grefti, Diş eti çekilmesi, Trombositten zengin fibrinTHE COMPARISON OF CORONALLY ADVANCED FLAP WITHPLATELET RICH FIBRIN AND CORONALLY ADVANCED FLAP WITH SUBEPITHELIAL CONNECTIVETISSUE GRAFT IN THE TREATMENT OF LOCALIZED GINGIVAL RECESSION: A CASE REPORTABSTRACTThepurpose of this case was comparing the efficacy of coronally advanced flap (CAF) with subepithelial connective tissue graft (SCTG) treatment and CAF with platelet-rich fibrin (PRF) in the maxillary canine teeth with Miller Class-I gingival recessions.Systemicallyhealthy 31 year-old female patient was admitted to ourclinic witha complaint of aesthetic and hypersensitivity.Miller Class-I gingival recession was present in maxillary right and left canine teeth. PRF was obtained from the patient’sblood. Full thickness mucoperiosteal flap was reflected followed by a partial thickness flapbeyond the mucogingival junction forthe treatment of gingival recessions at both tooth. Thepapilla area was deepitelized after root surface debridement andPRF was sutured to the interdentalpapilla. SCTG was sutured to papilla at left canine. Root surface was closed by sliding the both mucoperiosteal flaps coronally.The surgical area was protected using a non-eugenol dres- sing. After surgery anti-inflammatory and chlorhexidinegluconate mouthwash was prescribed. There were no complications in the early period afterthe operation.The dressing and sutures were removed 10 days after the operation. 100% root coverage was maintained at right canine one month later. There was 1.5 mm gingival re- cession at left canine and keratinized gingival thickness was higher accordingto the PRF applied teeth. The gingi- val recession was 1 mm at both sides fifteen month later.Thereare successful clinical results​​ in thetreatment of localized Miller Class-I andClass-II gingival recessions using PRF. PRF is seen as a goodalternative to SCTG with advantages such as the absence of asecond surgical intervention, less time consuming, the elimination of donor site morbidity and the lack of post-operativediscomfort.Keywords: Connective tissue graft, Gingival recession, Platelet rich fibrin

Inflammation and/or infection around skeletal anchorage miniplates is a relatively common complication. The aim of this study was to assess potential predictive factors behind soft tissue infection associated with titanium miniplates used for orthodontic anchorage. A cross-sectional study enrolled 60 patients who had miniplates for at least 6 months. Infection around miniplates (dependent variable) was defined according to the presence of exudate and edema in the region and was used in a conditional multiple logistic regression model to investigate the possible role of several independent variables as predictive factors. A total of 20 men and 40 women used 139 miniplates. In all, 72.7% of miniplates were installed in female patients and 27.3% in male patients. Infection occurred in 24 (17.3%) of the 139 miniplates installed. This study showed that greatest impact for infection was the distance from the exposed link of the miniplate to the mucogingival junction, probing depth and oral hygiene frequency were also important to explain infection. However, age was the least factor to obtaining the infection around the miniplate.