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Xenograft bone substitutes are commonly used to increase bone volume and height in the deficient posterior maxilla. The addition of enamel matrix derivate (Emdogain) could increase the efficiency of the bone healing process. The aim of this prospective randomized, controlled split-mouth design study was to compare the percentage of newly formed bone in sinus floor augmentation with deproteinized bovine bone mineral with or without the addition of enamel matrix derivative after 6 months of healing. Sixteen bilateral sinus floor augmentation procedures were performed. Deproteinized bovine bone mineral combined with enamel matrix derivative (test) and deproteinized bovine bone mineral alone (control) groups were randomly allocated within each patient. Six months after augmentation and concurrent to implant placement, bone biopsies were taken for histomorphometric analysis. Additionally, implant survival and peri-implant bone levels were radiographically assessed at baseline and 24 months after functional loading. Histomorphometric analysis revealed a significantly higher amount of newly formed bone in the test group compared with the control group (22.6% and 15.5%, respectively; P = .033). No significant differences in the amount of remaining graft or connective tissue was found. Enamel matrix derivative added to deproteinized bovine bone mineral particles significantly increased new bone formation in sinus lift procedures in edentulous or partially edentulous patients with deficient bilateral posterior alveolar ridges requiring augmentation for implant placement.

Background The mechanism of gingival growth that may occur during fixed orthodontic treatment is not yet fully understood and the amount of dental plaque is often incriminated. The objective of this study was to evaluate the prevalence of gingival growth during multi-attachment orthodontic treatment and to prioritize its associated factors. Methods: This comprehensive cross-sectional descriptive study was conducted on orthodontic patients aged 9 to 30 years, in good general health, treated by a fixed appliance. Periodontal clinical parameters such as plaque index, gingival index, probing pocket depth, periodontal phenotype and gingival enhancement index were recorded. Likewise, the brushing habits and the date of the last scaling were noted. The orthodontic parameters studied were the duration of the treatment, the type of attachment, the alloys used for the arches and the type of ligatures. Descriptive statistics were carried out, and variables presenting p value < 0.05 were included in a multivariate analysis to calculate the Odds Ratio (OR) of gingival enlargement". Results: A total of 193 patients were included (16.38 ± 4.89 years). Gingival growth occurred for 49.7% of patients included. The associated factors for this pathology during fixed orthodontic treatment were conventional metal brackets (OR = 3.5), mouth breathing (OR = 3), male gender (OR = 2.2), thick periodontal phenotype (OR = 2) and elastomeric ligations (OR = 2). After achievement of the logistic regression, the amount of plaque would not be directly related to the development of this gingival increase. Conclusions Among the associated factors that underlie gingival growth during multi-attachment therapy, the amount of plaque is not found. The qualitative assessment of the plaque and its evolution during treatment could clarify the role of the biofilm in the occurrence of gingival overgrowth.

Purpose The aim of this study was to compare the efficacy of the tunnel technique for root coverage using a new xenogeneic acellular dermal matrix vs. connective tissue grafting (CTG) for the treatment of multiple maxillary adjacent recessions (recession type 1) at 12 months postoperatively. Methods This study enrolled 12 patients with at least 3 contiguous, bilateral, symmetrical maxillary gingival recessions (i.e., at least 6 recessions per patient). In total, 74 recessions were treated using the modified coronally advanced tunnel (MCAT) technique combined with a novel porcine-derived acellular dermal matrix (PADM) at 37 test sites or CTG at 37 control sites. The following clinical parameters were measured: recession height, clinical attachment level, width of keratinized tissue, probing depth, recession width, gingival thickness, mean root coverage (MRC), and complete root coverage (CRC). Comparisons between test and control groups were made for pain visual analog scale scores at 14 days. Results At 12 months, the MCAT with PADM (test) yielded a statistically significant improvement in all clinical parameters studied. MRC was significantly higher on the control sides (80.6%±23.7%) than on the test sides (68.8%±23.4%). Similarly, CRC was 48.7%±6.8% on the control sides (CTG), in contrast to 24.3%±8.2% on the test sides (PADM). Statistically significant differences were observed in favor of the control sides for all clinical parameters studied. Nevertheless, the MCAT in adjunction with PADM was clearly superior at reducing mean and maximum patient-reported postoperative pain intensity and pain duration in the first week after surgery. Conclusions The use of PADM to treat multiple recessions improved clinical parameters at 12 months, but these outcomes were nevertheless poorer than those observed for CTG. However, PADM reduced morbidity, particularly the pain experienced by patients. Trial Registration ClinicalTrials.gov Identifier: NCT03162016, Graphical Abstract

Objective To evaluate the treatment of maxillary Miller Class I and II multiple adjacent gingival recessions using the modified coronally advanced tunnel technique (MCAT) combined with a new porcine acellular dermal matrix (PADM). Materials and Methods Twelve patients exhibiting at least six adjacent maxillary Miller Class I and II gingival recessions were consecutively treated by means of MCAT and a PADM. Recession depth (RD), recession width (RW), probing pocket depth (PD), keratinized tissue height (KT), clinical attachment level (CAL), mean root coverage (RC), and complete root coverage (CRC) were recorded. Results At 12 months, CRC was obtained in 43% of the 100 gingival recessions, while the mean RC measured 84.35%. Mean RD reduction was 3.16 ± 0.75 mm (P

Background: The mechanism of gingival growth that may occur during fixed orthodontic treatment is not yet fully understood and the amount of dental plaque is often incriminated. The objective of this study was to evaluate the prevalence of gingival growth during multi-attachment orthodontic treatment and to prioritize its predicting factors, especially the quantity of biofilm. Methods: This comprehensive cross-sectional descriptive study was conducted on orthodontic patients aged 9 to 30 years, in good health, treated by a fixed appliance. Periodontal clinical parameters such as plaque index, gingival index, probing pocket depth, periodontal phenotype and gingival enhancement index were recorded. Likewise, the brushing habits and the date of the last scaling were noted. The orthodontic parameters studied were the duration of the treatment, the type of bracket, the alloys used for the arches and the type of ligatures. Descriptive statistics were carried out, and variables presenting p value < 0.25 were included in a multivariate analysis to calculate the Odds Ratio (OR) of gingival enlargement".Results: A total of 193 patients were included (16.38 ± 4.89 years). Gingival growth occurred for 49.7% of patients included. The predisposing factors for this pathology during fixed orthodontic treatment were conventional metal brackets (p = 0.021), mouth breathing (p = 0.040), male gender (p = 0.035), thick periodontal phenotype (p = 0.043), elastomeric ligations (p = 0.007), duration of treatment (p = 0.022) and presence of plaque (p = 0.004). After achievement of the logistic regression, only two factors remained related to gingival enlargement: metallic brackets (OR:3.5, 95% CI:1.1- 10.55) and duration of treatment (OR:2.03, 95% CI:1.01-4.08). The amount of plaque would not be directly related to the development of gingival increase during orthodontic treatment. Conclusions: Among the predisposing factors that underlie gingival growth during multi-attachment therapy, the amount of plaque is not found. The qualitative assessment of the plaque and its evolution during treatment could clarify the role of the biofilm in the occurrence of gingival overgrowth.Trial registration: Cross-sectional study.

L’osteoradionecrosi (ORN) e una complicanza legata alla radioterapia della cavita orale o dell’orofaringe. Il rischio di ORN e piu frequentemente post-traumatico sulla mandibola che sulla mascella e persiste anche dopo molti anni dall’irradiazione. Questo rischio dipende dalla dose e persiste nonostante i cambiamenti nelle tecniche di irradiazione e il loro potenziale di preservazione della secrezione salivare e di limitazione della dose trasmessa all’osso di sostegno. La prevenzione consiste nell’evitare terapie dentarie invasive e nell’attuare una fluoroprofilassi finche resta insufficiente il recupero salivare. Il trattamento medico precoce viene realizzato a scopo antifibrosante, anti-infiammatorio e anti-infettivo e si associa a tecniche di detersione dei tessuti necrotici, ma non deve, comunque, ritardare il ricorso a un trattamento radicale.

L’osteonecrosi dei mascellari (ONM) sotto bifosfonati (BP) e secondaria a una sostanza farmacologica che modifica il rimodellamento osseo. L’incidenza di ONM in pazienti trattati con BP per affezioni maligne varia dall’1% al 10%, e dallo 0,001% allo 0,1% in caso di affezione benigna. Questo rischio e maggiore per via endovenosa che per via orale e aumenta con la durata della somministrazione. Tutto cio richiede di ridurre l’infiammazione e l’infezione locale attraverso misure di detersione parodontale (rimozione del tartaro, lucidatura) preliminarmente alla realizzazione di interventi chirurgici (con collutorio e antibioticoprofilassi). Il posizionamento di impianti dentari non e raccomandato nei pazienti in terapia con BP per via endovenosa nel quadro di patologie maligne. Il posizionamento di impianti e possibile nei pazienti con osteoporosi trattata con BP orali, dopo un’attenta valutazione del rischio. La gestione dei pazienti a rischio di sviluppare ONM da BP richiede una stretta collaborazione del medico che prescrive BP con il dentista, cosi come un rigoroso controllo dentario prima della terapia durante e dopo.

Growing evidence supports that the Epstein-Barr virus (EBV) is a putativeperiodontal pathogen, but little is known regarding EBV behavior inperiodontitis. Here, EBV infection was monitored in saliva andperiodontal pocket(PP), at baseline and 3 months after periodontal non-surgical therapy (p-NST) in 20 patients diagnosed with periodontitis. After the treatment, the patients with the improved periodontal condition (good responders) showed a significant decrease in salivary EBV load. In contrast, in poor responders, EBV load was slightly increased. Moreover, after the therapy, most patients showed clear signs of EBV infection in a deep PP (≥5mm) selected as a study site. To investigate how EBV can persist in a PP, we further investigate cellular sites of viral replication in PP. We identified large amounts of infiltrated EBV-infected cells, mostly overlapping with CD138+plasma cells (PC). EBV-infected PCs formed high-density clusters within the infiltrate and along the periodontal epithelium which were commonly associated with CD3+T-cells andCD20+B-cells to evoke diffuse ectopic lymphoid-like structures. Taking together, this study provides new insights to support a model where the periodontal condition may play a major role in oral EBV shedding. Since PC harbors the late productive phases of EBV replication, the periodontal condition may favor B-cell differentiation with possible amplification of periodontal EBV infection and viral spreading. PCs have long been recognized as pathogenic markers in inflammatory lesions. Our finding sheds new light on the role of EBV infection and PC in periodontitis.

Purpose Gingival recession is a significant problem in the esthetic zone. Connective tissue grafts have been considered the gold standard, but they need a donor site that increases morbidity and discomfort for the patient.The purpose of the present study was to evaluate the clinical results of a modified tunnel technique that consists of replacing the connective tissue graft by enamel matrix derivative, in the treatment of Miller Class I recession defects. Materials and Methods Twenty-six teeth in 14 subjects with Miller Class I recessions were treated using the tunnel procedure plus enamel matrix derivative. The gingival recession, probing depth, clinical attachment level, and the width of the keratinized gingival tissue were recorded. Results There was a statistically significant reduction in gingival recession (88% of root coverage) and a gain in clinical attachment level (3.1 mm) between baseline and 24 months post-operatively, whereas the change in width of keratinized tissue and in probing depth was not statistically significant. All patients were satisfied with the esthetic appearance and would undergo the same surgery again. Conclusion This technique could be successfully used as an alternative to connective tissue grafts, with the advantage of avoiding the discomfort and morbidity of connective tissue harvesting. Clinical Significance This modified tunnel technique using enamel matrix derivative potentially represents a clinically and esthetically satisfactory treatment of Miller Class I recession defects.

The oral cavity contributes to overall health, psychosocial well-being and quality of human life. Oral inflammatory diseases represent a major global health problem with significant social and economic impact. The development of effective therapies, therefore, requires deeper insights into the etiopathogenesis of oral diseases. Epstein–Barr virus (EBV) infection results in a life-long persistence of the virus in the host and has been associated with numerous oral inflammatory diseases including oral lichen planus (OLP), periodontal disease and Sjogren’s syndrome (SS). There is considerable evidence that the EBV infection is a strong risk factor for the development and progression of these conditions, but is EBV a true pathogen? This long-standing EBV paradox yet needs to be solved. This review discusses novel viral aspects of the etiopathogenesis of non-tumorigenic diseases in the oral cavity, in particular, the contribution of EBV in OLP, periodontitis and SS, the tropism of EBV infection, the major players involved in the etiopathogenic mechanisms and emerging contribution of EBV-pathogenic bacteria bidirectional interaction. It also proposes the involvement of EBV-infected plasma cells in the development and progression of oral inflammatory diseases. A new direction for preventing and treating these conditions may focus on controlling pathogenic EBV with anti-herpetic drugs.

Gingival recession is a significant problem in the esthetic zone. Connective tissue grafts have been considered the gold standard, but they need a donor site that increases morbidity and discomfort for the patient.The purpose of the present study was to evaluate the clinical results of a modified tunnel technique that consists of replacing the connective tissue graft by enamel matrix derivative, in the treatment of Miller Class I recession defects.Twenty-six teeth in 14 subjects with Miller Class I recessions were treated using the tunnel procedure plus enamel matrix derivative. The gingival recession, probing depth, clinical attachment level, and the width of the keratinized gingival tissue were recorded.There was a statistically significant reduction in gingival recession (88% of root coverage) and a gain in clinical attachment level (3.1 mm) between baseline and 24 months post-operatively, whereas the change in width of keratinized tissue and in probing depth was not statistically significant. All patients were satisfied with the esthetic appearance and would undergo the same surgery again.This technique could be successfully used as an alternative to connective tissue grafts, with the advantage of avoiding the discomfort and morbidity of connective tissue harvesting.This modified tunnel technique using enamel matrix derivative potentially represents a clinically and esthetically satisfactory treatment of Miller Class I recession defects.

International audience; An amplifying role for oral epithelial cells (ECs) in Epstein-Barr Virus (EBV) infection has been postulated to explain oral viral shedding. However, while lytic or latent EBV infections of oro/nasopharyngeal ECs are commonly detected under pathological conditions, detection of EBV-infected ECs in healthy conditions is very rare. In this study, a simple non-surgical tissue sampling procedure was used to investigate EBV infection in the periodontal epithelium that surrounds and attaches teeth to the gingiva. Surprisingly, we observed that the gingival ECs of the periodontium (pECs) are commonly infected with EBV and may serve as an important oral reservoir of latently EBV-infected cells. We also found that the basal level of epithelial EBV-infection is significantly increased in chronic periodontitis, a common inflammatory disease that undermines the integrity of tooth-supporting tissues. Moreover, the level of EBV infection was found to correlate with disease severity. In inflamed tissues, EBV-infected pECs appear to be prone to apoptosis and to produce larger amounts of CCL20, a pivotal inflammatory chemokine that controls tissue infiltration by immune cells. Our discovery that the periodontal epithelium is a major site of latent EBV infection sheds a new light on EBV persistence in healthy carriers and on the role of this ubiquitous virus in periodontitis. Moreover, the identification of this easily accessible site of latent infection may encourage new approaches to investigate and monitor other EBV-associated disorders.

La temporisation immédiate par un pilier de cicatrisation anatomique ou sealing socket abutment (pilier SSA) à la suite d’une extraction-implantation immédiate permettrait d’optimiser la cicatrisation des tissus mous péri-implantaires, en assurant la fermeture hermétique de l’alvéole post-extractionnelle et en stabilisant des tissus environnants. Le profil d’émergence anatomique dicté par le pilier SSA favorise l’intégration biologique, prothétique et esthétique de la future prothèse supra implantaire.La conception du pilier SSA a d’abord été décrite par le Dr G. Finelle au travers de deux protocoles faisant intervenir la Conception et fabrication assistée par ordinateur (CFAO). Plus récemment, un troisième protocole ne nécessitant pas l’utilisation de la CFAO et permettant la conception en per-opératoire d’un pilier SSA a été décrit : c’est la technique directe, que nous avons particulièrement étudiée dans ce travail de thèse.Après des rappels fondamentaux sur la cicatrisation du tissu osseux et gingival après la pose d’un implant, l’objectif a été, à partir de la réalisation du protocole clinique de confection du SSA en technique directe, d’analyser les bénéfices sur le profil d’émergence et sur les tissus mous péri-implantaires, enfin de discuter de l’apport et des limites de ce protocole en comparaison à celui du pilier SSA usiné par CFAO.

L’enseignement de parodontologie a une place centrale dans le cursus des étudiants en odontologie. Sa particularité est d'être une formation double, à la fois théorique pour maîtriser l'ensemble des connaissances nécessaires mais aussi techniques pour acquérir les compétences chirurgicales. Aujourd’hui l’État favorise la création d’outils numériques innovants pour répondre aux besoins de cette nouvelle génération d’étudiants connectés dit « génération Z ». De plus, dans une dynamique de restructuration de l’enseignement, nous avons interrogé les étudiants de 5ème année (promotion 2015 – 2020) afin d’obtenir leurs avis sur la création d’un outil pédagogique. Ainsi 70% des étudiants ressentent le besoin d’avoir accès à des vidéos pour améliorer la compréhension des différentes techniques de chirurgie parodontale enseignées. Par conséquent, nous avons réalisé des vidéos pédagogiques illustrant 5 techniques considérées comme le socle de la chirurgie parodontale. Elles ont été diffusées en fin d’année à cette même promotion, et un second questionnaire a été transmis dans le but d’évaluer la qualité et l’intérêt de la mise à disposition de ces films aux prochaines promotions de la faculté d’Odontologie de Nice. Malgré un enseignement de qualité, l’ensemble des étudiants met en avant la précision des vidéos, leur permettant une meilleure compréhension des étapes cliniques. Ces vidéos sont donc complémentaires à un enseignement théorique. Elles sont actuellement disponibles sur plusieurs plateformes dont Jalon et YouTube®.

Le recours à des tissus autologues présente de nombreux avantages et est considéré comme le gold standard.Cependant, le recours à des matrices acellulaires d’origine xénogénique en chirurgie plastique parodontale nous a permis de s’affranchir d’un site donneur, avec les avantages qui en découlent. De plus, la disponibilité illimitée de ces produits permet de traiter des récessions multiples, étendues à un quadrant, voire un maxillaire complet, ce qui semblerait être leur indication majeure. Enfin, ces alternatives majorent la satisfaction et le confort du patient.Le manque de recul clinique sur ces nouvelles matrices xénogéniques nous a incité à initier un projet de recherche clinique comparant la greffe de tissu autologue à la matrice Mucoderm® dans le cadre de récessions de classe I et II de Miller. Cette étude clinique prospective randomisée en bouche divisée a démontré des résultats semblables en termes de recouvrement avec néanmoins de meilleurs résultats pour la greffe conjonctive en termes de recouvrement complet. On obtient, dans les 2 cas, un gain de tissu kératinisé en hauteur et en épaisseur équivalent. Cependant lorsque l’on intègre des critères subjectifs tels que la douleur, les données sont en faveur de la matrice en raison de l’absence de prélèvement. Enfin, la stabilité des résultats à long terme reste encore à définir. Ce sont des procédés nouveaux qui nécessitent d’autres investigations pour conclure sur leur efficacité réelle. De plus, les résultats prometteurs qui se dessinent au sujet de ces substituts doivent être validés scientifiquement par les études de bons niveaux de preuve qui sont en cours, menées sur des échantillons de patients importants.

Une alvéolyse plus ou moins sévère est inévitable après la perte d’une dent. La reconstruction tridimensionnelle de ces défauts osseux peut être résolue par les greffes pré-implantaires, utilisant essentiellement de l’os autogène ou un substitut osseux allogénique. Pratiquées dans le monde entier, elles permettent une réhabilitation implanto-portée parfaitement intégrée du point de vue esthétique et fonctionnel.Cependant, la chirurgie pré-implantaire « conventionnelle » impose bien souvent un deuxième site opératoire dans le cas de greffes autogènes, ainsi qu’un deuxième temps chirurgical nécessaire à la mise en place de l’implant. Des inconvénients non négligeables pour le patient comme pour le praticien, qui entrainent un risque de morbidité accrue.La recherche s’est donc employée à proposer d’autres alternatives, tant au niveau de la technique opératoire que du biomatériau utilisé.Se basant sur la technique de la greffe osseuse autogène en anneau (ou ring technique) avec pose d’implant simultanée, un nouveau procédé de greffe osseuse allogénique d’augmentation verticale péri-implantaire a vu le jour : le Maxgraft® Bone Ring. Cet anneau d’os allogénique vise à reconstruire de façon tridimensionnelle le défaut osseux, avec pose de l’implant en un seul temps chirurgical. Ce protocole inédit permet ainsi de réduire la durée du traitement – par rapport à une technique classique de greffe par bloc osseux allogène – ; mais également d’éliminer le risque de morbidité liée au prélèvement d’os autogène – comme dans le cas d’une ring technique. Les résultats cliniques sont encourageants, à condition d’avoir une parfaite maîtrise du geste chirurgical.Toutefois, cette technique novatrice n’est qu’à l’aube de son développement. Le recul clinique et le nombre de publications de haut niveau de preuve lui font encore défaut pour pouvoir conclure de son efficacité à moyen et long-terme.

L’évolution récente des biomatériaux et les avancées en matière d’ingénierie tissulaire ont permis de voir apparaitre des nouvelles techniques. Celles-ci évitent alors le prélèvement conjonctif au niveau d’un site donneur, dont les suites douloureuses postopératoires représentent un inconvénient majeur. Ainsi certains praticiens se sont attachés à décrire des techniques utilisant toutes sortes de biomatériaux en alternative au greffon conjonctif.Le PRF est un caillot de fibrine concentrant une part importante des plaquettes et leucocytes issues du prélèvement sanguin originel. Sa composition, ainsi que l’architecture toute particulière de son réseau de fibrine lui confèrent des propriétés biologiques favorisant la cicatrisation des tissus gingivaux. Utilisé sous forme de membranes associées aux techniques de chirurgie plastique parodontale, il permet une réduction de la profondeur de récession. Le gain d’attache et le gain en épaisseur gingivale sembleraient améliorés. Cependant, la greffe de tissu conjonctif reste le « Gold Standard ».Les sociétés scientifiques ne considèrent pas le PRF® comme un substitut éventuel au greffon conjonctif, s’accordant sur le manque d’études histologiques et d’essais cliniques à long terme.

De nos jours, l’essor de l’implantologie a permis d’élargir de façon considérable notre éventail thérapeutique et d’apporter à nos patients un confort, une fonction et de l’esthétique. Par contre, certains écueils anatomiques de la sphère orale, sont des obstacles à la pose implantaire. Il nous faut alors envisager un aménagement tissulaire. Au maxillaire, avec la perte des dents postérieures ainsi que la pneumatisation des sinus, la hauteur osseuse résiduelle devient trop faible pour permettre la pose d’implant. Il nous faut alors contourner cet obstacle grâce aux techniques de soulevé du plancher sinusien.Les substituts osseux doivent avoir les capacités suivantes : ostéo-conducteur, ostéogénique et ostéo-inducteur. Même si le matériau de choix reste l'os autogène, les quantités intra-buccales sont limitées et nécessitent un deuxième site chirurgical. Nous avons donc associé les propriétés angiogéniques et pro-collagéniques des dérivés de protéines d’émail au Bio-Oss®. Dans notre étude, des comblements sous sinusiens bilatéraux ont été effectués avec du BioOss® seul et BioOss® + Emdogain®. Avec les dérivés des protéines d’émail, les résultats histomorphométriques, montrent que le mélange BioOss® + Emdogain®, augmente de moitié le pourcentage d’os vital (22.5% par rapport à 15.5%)Ces données sont satisfaisantes mais restent encore éloignées du pourcentage d’os vital obtenu avec l’os allogénique.

La greffe épithélio-conjonctive n’a plus à faire ses preuves en matière de gain de tissu kératinisé sur le long terme. Cette technique est un acte courant de chirurgie dentaire et est réalisée depuis des années par les parodontologistes.Cependant, les inconvénients de cette intervention font consensus : un résultat final peu esthétique, une plaie palatine douloureuse pour le patient, le risque de nécrose du greffon et enfin et surtout un risque hémorragique lié au prélèvement palatin.Aujourd’hui, l’ingénierie tissulaire se met au service de la parodontologie et tente de mettre au point des matériaux capables de suppléer la greffe épithélio-conjonctive en évinçant les inconvénients de cette dernière.Cette thèse a pour but de faire le point sur ces nouveaux matériaux de substitution, de déterminer quelle est leur place actuelle dans notre arsenal thérapeutique et d’aider le chirurgien dentiste dans ses choix en synthétisant les résultats connus à ce jour sur les substituts.