1
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Mascardo KC, Tomack J, Chen CY, Mancini L, Kim DM, Friedland B, Barootchi S, Tavelli L. Risk indicators for gingival recession in the esthetic zone: A cross-sectional clinical, tomographic, and ultrasonographic study. J Periodontol 2024; 95:432-443. [PMID: 38196327 DOI: 10.1002/jper.23-0357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 12/09/2023] [Accepted: 12/13/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND To evaluate the risk indicators associated with midfacial gingival recessions (GR) in the natural dentition esthetic regions. METHODS Cone-beam computed tomography (CBCT) results of thirty-seven subjects presenting with 268 eligible teeth were included in the cross-sectional study. Clinical measurements included presence/absence of midfacial GR; the depth of the midfacial, mesial, and distal gingival recession; the recession type (RT); keratinized tissue width (KT); and attached gingiva width (AG). Questionnaires were utilized to capture patient-reported esthetics and dental hypersensitivity for each study tooth. Buccal bone dehiscence (cBBD) and buccal bone thickness (cBBT) were measured on the CBCT scans. High-frequency ultrasonography was performed to assess gingival thickness (GT) and buccal bone dehiscence (uBBD). Intraoral optical scanning was obtained to quantify the buccolingual position of each study site (3D profile analysis). Multilevel logistic regression analyses with generalized estimation equations were performed to assess the factors associated with the conditions of interest. RESULTS The presence of midfacial GR was significantly associated with the history of periodontal treatment for pocket reduction (OR 7.99, p = 0.006), KT (OR 0.62, p < 0.001), cBBD (OR 2.30, p = 0.015), GT 1.5 mm from the gingival margin (OR 0.18, p = 0.04) and 3D profile 1 mm from the gingival margin (OR 1.04, p = 0.001). The depth of midfacial GR was significantly correlated to previous history of periodontal treatment (OR 0.96, p = 0.001), KT (OR -0.18, p < 0.001), presence of bone fenestration (OR 0.24, p = 0.044), and cBBD (OR 0.43, p < 0.001). The depth of midfacial GR was also the only factor associated with patient-reported esthetics (OR -3.38, p = 0.022), while KT (OR 0.77, p = 0.018) and AG (OR 0.82, p = 0.047) were significantly correlated with patient-reported dental hypersensitivity. CONCLUSIONS Several risk indicators of midfacial and interproximal GR in the esthetic region were identified. The use of imaging technologies allowed for detection of parameters associated with the conditions of interest, and, therefore, their incorporation in future clinical studies is advocated. Ultrasonography could be preferred over CBCT for a noninvasive assessment of periodontal phenotype.
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Affiliation(s)
- Kathleen Chloe Mascardo
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Justin Tomack
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Chia-Yu Chen
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Leonardo Mancini
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Center for Clinical Research and Evidence Synthesis in Oral Tissue Regeneration (CRITERION), Boston, Massachusetts, USA
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - David M Kim
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Bernard Friedland
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Shayan Barootchi
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Center for Clinical Research and Evidence Synthesis in Oral Tissue Regeneration (CRITERION), Boston, Massachusetts, USA
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Lorenzo Tavelli
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Center for Clinical Research and Evidence Synthesis in Oral Tissue Regeneration (CRITERION), Boston, Massachusetts, USA
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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2
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Zaaya S, Elbattawy W, Yusri S, Fawzy El-Sayed KM. Micro-needling versus acellular dermal matrix in RT1 gingival recession coverage: A randomized clinical trial. J Periodontal Res 2024. [PMID: 38660934 DOI: 10.1111/jre.13271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 04/05/2024] [Accepted: 04/07/2024] [Indexed: 04/26/2024]
Abstract
AIMS This randomized trial assessed for the first time the efficacy of coronally advanced flap (CAF) followed by micro-needling (MN) in contrast to CAF with acellular dermal matrix (ADM) on gingival thickness (GT, primary outcome), keratinized tissue width (KTW), clinical attachment level (CAL), probing depth (PD), recession depth (RD), recession width (RW), recession reduction (Rec-Red), complete root coverage (CRC) and percentage of root coverage (all secondary outcomes) in management of RT1 gingival recession in patients with thin gingival phenotype. METHODS A total of 24 patients (n = 24) with a thin gingival phenotype and single RT1 gingival recession in the aesthetic zone were randomly allocated to test- (CAF + MN; n = 12) or control group (CAF + ADM; n = 12). All clinical parameters were evaluated at baseline, 3 and 6 months. RESULTS Both groups independently demonstrated significant gain in GT, RW, RD, CAL, PD, Rec-Red, CRC and percentage of root coverage, with reduced PI and BOP (p < .05) at 3 and 6 months, without intergroup differences (p > .05). At 6 months, KTW gain was significantly higher in CAF + MN (5.08 ± 0.9 mm) than in CAF + ADM-group (4.25 ± 1.06 mm; p < .05). Stepwise linear regression model with GT as dependent variable showed that base-line GT was the only statistically significant predictor for GT with a direct correlation between base-line GT and GT after 6 months. CONCLUSION CAF followed by MN could represent a promising graft-less approach for increasing gingival thickness, comparable to CAF with ADM, with superior keratinized tissue width improvement, in the treatment of RT1 recession defects in patients with thin gingival phenotype.
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Affiliation(s)
- Salma Zaaya
- Oral Medicine and Periodontology Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Weam Elbattawy
- Oral Medicine and Periodontology Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Sarah Yusri
- Oral Medicine and Periodontology Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Karim M Fawzy El-Sayed
- Oral Medicine and Periodontology Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
- Clinic for Conservative Dentistry and Periodontology, School of Dental Medicine, Christian Albrechts University, Kiel, Germany
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3
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Dentoalveolar Surgery. J Oral Maxillofac Surg 2023; 81:E51-E74. [PMID: 37833029 DOI: 10.1016/j.joms.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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4
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Nandkeoliar T, Kumar A, Chungkham S, Singh SS. Estimation of vestibular depth: An observational cross-sectional study. J Indian Soc Periodontol 2023; 27:320-327. [PMID: 37346864 PMCID: PMC10281317 DOI: 10.4103/jisp.jisp_293_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 01/17/2023] [Accepted: 01/22/2023] [Indexed: 06/23/2023] Open
Abstract
Background The vestibular depth (VD) varies to a great extent among individuals and at different points of reference. The normal range of depth of the vestibule at different areas in the mouth remains to be established. Aim The primary objective of this study is to assess the average VD around different teeth in the maxilla and the mandible. Furthermore, an attempt has been made to identify the various ranges of VD and understand what could be suggestive of a normal VD. Materials and Methods The participants included were divided into four age groups, i.e., 6-14 years (Group 1), 15-30 years (Group 2), 31-50 years (Group 3), and >50 years (Group 4). Further, the subjects were grouped into subgroup A, periodontally healthy and subgroup B, gingival recession (GR). Group 1, 2, and 3 included 30 subjects each in subgroup A, while Group 4 subgroup B had 18 subjects. In case of subgroup B, Group 2 included 9 subjects, Group 3-31 subjects, and Group 4-30 subjects. Measurements included the depth of vestibule from 2 reference point, i.e., gingival margin (GM) and incisal edge (IE). Results In subgroup A, the average VD from GM was found to be the least in the Group 1 i.e., 6-14 years (9.2 mm ± 4.26 in maxilla and 7.01 mm ± 3.14 in the mandible) and the highest in the Group 4 i.e., >50 years (12.06 mm ± 2.73 in maxilla and 10.08 mm ± 2.58 in the mandible). In the case of subgroup B, the least depth from GM was found in the Group 3 i.e., >30-50 years (9.44 mm ± 2.73 in the maxilla and 8.32 mm ± 1.7 in the mandible) and the maximum depth in the Group 4 (>50 years) (11.28 ± 2.31 in maxilla and 9.42 ± 2.87 in the mandible). Conclusion The study provides a range of VD s in different areas of the mouth in periodontally healthy and individuals with GR, which will contribute to constitute a normal range of VD.
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Affiliation(s)
- Tanya Nandkeoliar
- Department of Periodontics, Dental College, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - Ashish Kumar
- Department of Periodontics, Dental College, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - Sachidananda Chungkham
- Department of Periodontics, Dental College, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - Sinam Subhaschandra Singh
- Department of Periodontics, Dental College, Regional Institute of Medical Sciences, Imphal, Manipur, India
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5
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Fawzy M, Hosny M, El-Nahass H. Evaluation of esthetic outcome of delayed implants with de-epithelialized free gingival graft in thin gingival phenotype with or without immediate temporization: a randomized clinical trial. Int J Implant Dent 2023; 9:5. [PMID: 36781590 PMCID: PMC9925631 DOI: 10.1186/s40729-023-00468-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 01/31/2023] [Indexed: 02/15/2023] Open
Abstract
AIM The current study investigates the effect of immediate temporization on the pink esthetics of delayed implants in patients with thin gingival phenotype in combination with a De-epithelialized Free Gingival Graft in the maxillary premolar area. METHODOLOGY The study population was randomly assigned into two groups. The two groups were treated with delayed implants with simultaneous placement of a de-epithelialized free gingiva graft. The test group was immediately temporized while the control group had no temporization. The pink esthetic score was assessed as the primary outcome. Additional secondary outcomes were assessed such as the keratinized tissue width and the soft tissue thickness. RESULTS Twenty implants were placed in the current study, split into 10 implants per group. The results showed that the Pink Esthetic Score of the IT group was 11.88 ± (1.13) and 11.33 ± (1.25) for the CTG group, which showed no statistical difference between the groups after 1 year of follow-up. There was also no significant difference between the two groups at 12 months regarding the keratinized tissue width and the soft tissue thickness. CONCLUSIONS Immediate and delayed temporizations have no effect on the Pink Esthetics of the delayed implants; however, immediate temporization allowed earlier provisional crown delivery. Soft tissue augmentation of the thin gingival phenotype improved esthetics for both groups. Trial registration Name of the registry: clinicaltrials.gov; trial registration number: NCT03792425. Date of registration: January 3, 2019. URL of trial registry record: https://clinicaltrials.gov/ct2/show/NCT03792425?term=NCT03792425&draw=2&rank=1.
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Affiliation(s)
- Maha Fawzy
- grid.7776.10000 0004 0639 9286Department of Oral Medicine and Periodontology, Faculty of Dentistry, Cairo University, 11 El-Saraya St. – Manial, Cairo, Egypt
| | - Manal Hosny
- grid.7776.10000 0004 0639 9286Department of Oral Medicine and Periodontology, Faculty of Dentistry, Cairo University, 11 El-Saraya St. – Manial, Cairo, Egypt
| | - Hani El-Nahass
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Cairo University, 11 El-Saraya St. - Manial, Cairo, Egypt.
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6
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Tavelli L, Zucchelli G, Stefanini M, Rasperini G, Wang HL, Barootchi S. Vertical soft tissue augmentation to treat implant esthetic complications: A prospective clinical and volumetric case series. Clin Implant Dent Relat Res 2023; 25:204-214. [PMID: 36759964 DOI: 10.1111/cid.13188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/23/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Challenging implant esthetic complications are often characterized by implant malpositioning and interproximal attachment loss of the adjacent teeth. However, limited evidence is available on the treatment of these conditions. The aim of this study was to evaluate the clinical, volumetric, and patient-reported outcome following treatment of peri-implant soft tissue dehiscences (PSTDs) exhibiting interproximal attachment loss on adjacent teeth, performed through vertical soft tissue augmentation with implant submersion. METHODS Ten subjects with isolated PSTD in the anterior maxilla characterized by adjacent dentition exhibiting interproximal attachment loss were consecutively enrolled and treated with horizontal and vertical soft tissue augmentation, involving crown and abutment removal, two connective tissue grafts, and submerge healing. Clinical outcomes of interest included mean PSTD coverage, mean PSTD reduction, clinical attachment level (CAL) gain at the implant and adjacent sites and soft tissue phenotype modifications at 1 year. Optical scanning was used for assessing volumetric changes. Professional assessment of esthetic outcomes was performed using the Implant Dehiscence coverage Esthetic Score (IDES), while patient-reported esthetic assessment involved a 0-10 visual analogue scale. RESULTS The mean PSTD depth reduction and mean PSTD coverage at 1 year were 2.25 mm, and 85.14%, respectively. A mean keratinized tissue width (KTW) gain of 1.15 mm was observed, while the mean gain in mucosal thickness (MT) was 1.58 mm. A mean CAL gain of 1.45 mm was obtained at the interproximal aspect of the adjacent dentition at 1 year. Greater linear dimensional (LD) changes were observed at the midfacial aspect of the implant compared to the interproximal sites. The mean final IDES was 6.90 points, while patient-reported esthetic evaluation was 8.83 points. CONCLUSIONS The present study demonstrated that vertical soft tissue augmentation with a submerged healing is an effective treatment approach for the treatment of challenging PSTDs with adjacent dentition exhibiting interproximal attachment loss. This technique can be effective in resolution of esthetic complications in most cases, providing a substantial gain in interproximal attachment levels at the adjacent dentition.
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Affiliation(s)
- Lorenzo Tavelli
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA.,Center for clinical Research and evidence synthesis In oral TissuE RegeneratION (CRITERION), Boston, Massachusetts, USA.,Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Giovanni Zucchelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Martina Stefanini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giulio Rasperini
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.,IRCCS Foundation Polyclinic Ca' Granda, Milan, Italy
| | - Hom-Lay Wang
- Center for clinical Research and evidence synthesis In oral TissuE RegeneratION (CRITERION), Boston, Massachusetts, USA
| | - Shayan Barootchi
- Center for clinical Research and evidence synthesis In oral TissuE RegeneratION (CRITERION), Boston, Massachusetts, USA.,Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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7
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Stepanov AG, Tkachenko ED, Apresyan SV, Batov RV. [Evaluation of the clinical effectiveness of the use of a navigational surgical template in the vestibuloplasty protocol in patients with periodontal diseases]. STOMATOLOGIIA 2022; 101:38-46. [PMID: 35943499 DOI: 10.17116/stomat202210104138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
THE AIM OF THE STUDY Was to evaluate the clinical effectiveness of the use of a navigational surgical template in the vestibuloplasty protocol in patients with periodontal diseases. MATERIALS AND METHODS There were 48 people selected to participate in the study and randomly divided into 2 equal groups. The patients of the main group underwent vestibuloplasty procedure using a free gingival graft modeled using the developed protocol and a navigational surgical template. Patients in the control group underwent a similar operation using classical technology. The study assessed postoperative pain, the index of early wound healing, Doppler fluometry of the transplanted flap and flap morphometric measurements. RESULTS The results of all conducted studies confirmed the effectiveness of the developed clinical protocol. CONCLUSION According to objective and subjective assessments, the use of a surgical navigation template can reduce the time and invasiveness of vestibuloplasty surgery, make it more comfortable for the patient and get a more predictable clinical result.
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Affiliation(s)
- A G Stepanov
- Peoples' Friendship University of Russia, Moscow, Russia
| | - E D Tkachenko
- Peoples' Friendship University of Russia, Moscow, Russia
| | - S V Apresyan
- Peoples' Friendship University of Russia, Moscow, Russia
| | - R V Batov
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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8
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Panda S, Khijmatgar S, Arbildo-Vega H, Das AC, Kumar M, Das M, Mancini L, Del Fabbro M. Stability of biomaterials used in adjunct to coronally advanced flap: A systematic review and network meta-analysis. Clin Exp Dent Res 2021; 8:421-438. [PMID: 34845864 PMCID: PMC8874057 DOI: 10.1002/cre2.461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/23/2021] [Accepted: 05/05/2021] [Indexed: 12/26/2022] Open
Abstract
AIM The objective of this network meta-analysis was to rank different biomaterials used in adjunct to coronally advanced flap (CAF), based on their performance in root-coverage for Miller's Class I and II gingival recessions. MATERIALS AND METHODS An electronic database search was carried out in PUBMED, CENTRAL, SCOPUS, and EMBASE to identify the eligible articles and compiled into the citation manager to remove the duplicates. The primary outcome was keratinized gingival tissue width (KGW) and percentage of root coverage (%RC). The treatment effect of different biomaterials was estimated using predictive interval plots and ranked based on biomaterials performance, using multidimensional scale ranking. RESULTS CAF + connective tissue graft (CTG), CAF + platelet concentrate matrix (PCM) and acellular dermal matrix (ADM) ranked at the top positions in performance in improving KGW. The highest ranked materials in improving percentage of root coverage in gingival recession were CAF + collagen matrix (CM) + gingival fibroblasts (GF), CAF + ADM + platelet rich plasma (PRP) and CAF + ADM, as compared to CAF alone. CONCLUSION CTG, ADM, platelet concentrates, and CM + GFs, when used in adjunct to CAF, showed improved stability over ≥12 months of follow-up, better percentage of root coverage, and improved keratinized gingival width.
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Affiliation(s)
- Sourav Panda
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha O Anusandhan (Deemed to be) University, Bhubaneswar, Odisha, India.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Shahnawaz Khijmatgar
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.,Department of Oral Biology and Genomic Studies, Nitte (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences, Mangalore, India
| | - Heber Arbildo-Vega
- Department of General Dentistry, Dentistry School, Universidad San Martín de Porres, Chiclayo, Peru
| | - Abhaya Chandra Das
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha O Anusandhan (Deemed to be) University, Bhubaneswar, Odisha, India
| | - Manoj Kumar
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha O Anusandhan (Deemed to be) University, Bhubaneswar, Odisha, India
| | - Mohit Das
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha O Anusandhan (Deemed to be) University, Bhubaneswar, Odisha, India
| | - Leonardo Mancini
- Department of life health and environmental sciences, University of L'Aquila, Italy
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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9
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Tavelli L, Barootchi S, Majzoub J, Chan HL, Stefanini M, Zucchelli G, Kripfgans OD, Wang HL, Urban IA. Prevalence and risk indicators of midfacial peri-implant soft tissue dehiscence at single site in the esthetic zone: A cross-sectional clinical and ultrasonographic study. J Periodontol 2021; 93:857-866. [PMID: 34787892 DOI: 10.1002/jper.21-0402] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/23/2021] [Accepted: 11/08/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Esthetic complications of dental implants in the esthetic zone can have a major negative impact on patients' quality of life and perception of implant therapy. The aim of the present study was to evaluate the prevalence of peri-implant soft tissue dehiscence (PSTD) and the clinical and ultrasonographic risk indicators for this condition. METHODS Subjects with one or more healthy single dental implants in the esthetic area were identified and recruited. Clinical and ultrasonographic measurements, including PSTD class and subclass, pocket depth, keratinized mucosa width (KMW), mucosal thickness (MT) at 1 mm and 3 mm, buccal bone distance (BBD) and buccal bone thickness, were evaluated in healthy implants and implants with PSTD. RESULTS 153 subjects with a total of 176 dental implants were included. The prevalence of PSTD was 54.2% and 56.8% on a patient and implant level, respectively. The most frequent type of PSTD was the one characterized by having both an implant-supported crown longer than the clinical crown of the homologous tooth and a visible abutment/implant fixture exposed to the oral cavity. The multi-variate analysis showed that the presence of an adjacent implant, a longer time of the implant in function, limited MT, reduced KMW and increased BBD were significantly associated with the presence of a PSTD. CONCLUSIONS PSTDs are common findings in the esthetic region. Several risk indicators for this condition, such as presence of an adjacent implant, increased time in function of the implant, higher BBD, lower KMW and MT were identified. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Lorenzo Tavelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, MA, USA.,Doctoral School of Medicine, University of Szeged, Szeged, Hungary.,Center for clinical Research and evidence synthesis In oral TissuE RegeneratION (CRITERION), Ann Arbor, MI, USA
| | - Shayan Barootchi
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Center for clinical Research and evidence synthesis In oral TissuE RegeneratION (CRITERION), Ann Arbor, MI, USA
| | - Jad Majzoub
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Hsun-Liang Chan
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Martina Stefanini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giovanni Zucchelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Oliver D Kripfgans
- Biointerfaces Institute and Department of Biomedical Engineering, College of Engineering, Ann Arbor, MI, USA.,Department of Radiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Hom-Lay Wang
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Istvan A Urban
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Doctoral School of Medicine, University of Szeged, Szeged, Hungary.,Urban Regeneration Institute, Budapest, Hungary
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10
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Azab E, Youssef AR. Biocompatibility Evaluation of Human and Porcine Acellular Dermal Matrix on Human Primary Gingival Fibroblasts: In Vitro Comparative Study. Eur J Dent 2021; 15:563-567. [PMID: 34144630 PMCID: PMC8382466 DOI: 10.1055/s-0041-1727551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective
Allogeneic and xenogeneic acellular dermal matrix (ADM) grafts have been used to treat periodontal soft tissue defects. The purpose of the current study was to compare the effect of human ADM (AlloDerm) and porcine ADM (Derma) on human primary gingival fibroblasts
in vitro
regarding the biocompatibility test.
Materials and Methods
Gingival fibroblasts were obtained from healthy adult gingiva and seeded on AlloDerm or Derma ADM in 96-well plate. The control cells were grown on a surface-treated polystyrene cell-culture plate without matrix. The cells were cultured for 3, 7, and 14 days. The fibroblasts morphology was examined using inverted microscopy, and the cell viability of fibroblasts adherent to the dermal matrix was evaluated using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) cell viability assay after 3, 7, and 14 days in culture. The data were statistically evaluated by one-way analysis of variance.
p
-Value of 0.05 was considered significant.
Results
Gingival fibroblasts adjacent to the AlloDerm and Derma matrices were healthy, attached to the well, and did not exhibit any cytopathic changes similar to control. There were no statistically significant differences in the cell viability between the gingival fibroblasts attached to Derma and AlloDerm on day 3 (
p
= 0.841), day 7 (
p
= 0.198), and day 14 (
p
= 0.788).
Conclusion
Considering this
in vitro
study’s limitations, both human and porcine ADM were compatible with the surrounding human primary gingival fibroblasts. No significant differences were observed in the cell viability between the gingival fibroblasts that were attached to Derma and AlloDerm.
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Affiliation(s)
- Ehab Azab
- Department of Basic and Clinical Oral Sciences, Division of Periodontology, Faculty of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Abdel-Rahman Youssef
- Department of Basic and Clinical Oral Sciences, Division of Basic Medical Science, Faculty of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia.,Department of Microbiology and Immunology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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11
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Jasser RA, AlSarhan M, Alotaibi D, Aloraini S, Koppolu P, Andreana S. Evaluation of clinical performance and survival rate of Straumann dental implants in Saudi Population based on cross-sectional study. Sci Rep 2021; 11:9526. [PMID: 33947951 PMCID: PMC8097015 DOI: 10.1038/s41598-021-89112-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 04/21/2021] [Indexed: 11/21/2022] Open
Abstract
Risk indicators of peri-implantitis is still contradictory and somehow unclear in present literature therefore efforts should be done for better understanding of the exact etiology of peri-implant disease progression. The present study aimed to assess risk indicators associated with peri-implantitis by observing the changes in several periodontal parameters after implant placement. This cross-sectional study included 213 female and 271 male patients aged 26–87 years, who received 484 titanium implants (Straumann, Switzerland) at King Saud University’s Dental College, Saudi Arabia. Patients were called for dental visits. During these visits; full clinical and radiographic assessment of implants were done. The periodontal pocket depth (PPD) was greater around implants placed at grafted sites than non-grafted sites and around bone-level implants than tissue-level implants. The plaque index (PI) was associated with poor oral hygiene. There was a strong association between graft (yes/no) and bleeding on probing (BOP). Patients with good oral hygiene showed high radiographic bone stability. Keratinized tissue width < 2 mm was associated with a higher PPD, higher PI, higher BOP, more edematous gingiva, and more exposed implant threads on radiography. In patients receiving implants, poor oral hygiene status and inadequate keratinized tissue level can be proposed as risk indicators for developing periimplantitis due to strong association found between them and developments of peri-implantitis.
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Affiliation(s)
- Reham Al Jasser
- Department of Periodontics and Community Dentistry, Dental College, King Saud University, Riyadh, Kingdom of Saudi Arabia.
| | - Mohammed AlSarhan
- Department of Periodontics and Community Dentistry, Dental College, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Dalal Alotaibi
- Department of Periodontics and Community Dentistry, Dental College, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Saleh Aloraini
- Department of Periodontics and Community Dentistry, Dental College, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Pradeep Koppolu
- Department of Preventive Dental Sciences, College of Dentistry, Dar Al Uloom University, Riyadh, Kingdom of Saudi Arabia
| | - Sebastiano Andreana
- Department of Restorative Dentistry, State University of New York at Buffalo School of Dental Medicine, Buffalo, New York, USA
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12
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Han Z, Wei Y, Wang C, Yang G, Hu W, Chung KH. Clinical evaluations of free gingival grafting before implant placement to increase keratinized tissue width in molar regions: A retrospective case series. Clin Oral Implants Res 2021; 32:799-807. [PMID: 33755996 DOI: 10.1111/clr.13748] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 02/17/2021] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To evaluate the dimensional changes of the keratinized tissue width (KTW) in molar regions after augmentation by free gingival grafts (FGG) before implant placement. MATERIAL AND METHODS In seventeen patients, twenty implant sites in molar regions with KTW ≤3 mm at the buccal aspect received FGG 2 months before implant placement. KTW at the buccal aspect was measured before FGG (T0), immediately before implant placement (T1), at the time of impression taking for final prosthesis fabrication (T2), and at the end of the follow-up period after loading (T3, 12-48 months). Changes in KTW before and after FGG, as well as the alterations during the follow-up period after loading, were analyzed. Shapiro-Wilk test, paired Student's t test, and Wilcoxon signed-rank test were used for the data analysis at α = 0.05. RESULTS KTW at the buccal aspect of the alveolar ridge was observed with a significant gain of 5.9 ± 1.3 mm at T1 (p < .001). The shrinkage of KTW from T2 to T3 was 8.5%, which was limited but statistically significant (p = .008). KTW at the buccal aspect of implant restorations was 5.0 ± 1.5 mm at T3. CONCLUSIONS Within the limitations of the present study, our data suggest that using FGG to increase KTW in molar regions before implant placement had a predictable result. The buccal KTW had a limited reduction and was ≥3 mm with more than 12 months of follow-up after loading.
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Affiliation(s)
- Ziyao Han
- Department of Periodontology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yiping Wei
- Department of Periodontology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Cui Wang
- Department of Periodontology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Gang Yang
- Department of Periodontology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Wenjie Hu
- Department of Periodontology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Kwok-Hung Chung
- Department of Restorative Dentistry, University of Washington, Seattle, WA, USA
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Hartlev J, Schou S, Isidor F, Nørholt SE. A clinical and radiographic study of implants placed in autogenous bone grafts covered by either a platelet-rich fibrin membrane or deproteinised bovine bone mineral and a collagen membrane: a pilot randomised controlled clinical trial with a 2-year follow-up. Int J Implant Dent 2021; 7:8. [PMID: 33554323 PMCID: PMC7868310 DOI: 10.1186/s40729-021-00289-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 01/08/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose To compare the survival and clinical performance of implants placed in sites previously augmented with autogenous bone grafts covered by either a platelet-rich fibrin (PRF) membrane (PRF group) or a standard procedure (gold standard) involving coverage of the autogenous bone graft with deproteinised bovine bone mineral and a resorbable collagen membrane (control group). Methods A total of 27 partially edentulous patients (test n = 14, control n = 13) with indication for staged lateral bone block augmentation and dental implant placement were included. Twenty-four months after crown placement (range: 14–32 months), patients were recalled for a final clinical and radiographic follow-up. Outcome measures were implant survival, implant crown survival, clinical parameters of the implant, peri-implant marginal bone level, marginal bone level of adjacent tooth surfaces, biological and technical complications and patient-related outcome measures. Results Two implants were lost in the control group (85% survival rate); none were lost in the PRF group (100% survival rate). None of the 26 initially placed implant crowns were lost, but one implant and therefore one implant crown were lost after 20 months. Consequently, the definitive implant crown survival was 92% (95% confidence interval (CI): 73–110%) in the control group and 100% in the PRF group. No statistical difference in implant survival rate (p = 0.13) or implant crown survival was seen between the groups (p = 0.28). The mean marginal bone level at the follow-up was 0.26 mm (95% CI: 0.01–0.50 mm) in the PRF group and 0.68 mm (95% CI: 0.41–0.96 mm) in the control group. The difference between the groups was − 0.43 mm (95% CI: − 0.80 to − 0.05 mm, p = 0.03), which was statistically significant (p = 0.03). Both groups demonstrated similar healthy peri-implant soft tissue values at the final follow-up. Conclusion Although the current study is based on a small sample of participants, the findings suggest that the methodology of the PRF and the control group approach can both be used for bone augmentation with a similar outcome. A significant, but clinically irrelevant, higher peri-implant marginal bone level was registered in the PRF group than in the control group. Patients in both groups were highly satisfied with the treatment. Trial registration ClinicalTrials.gov Identifier: NCT04350749. Registered 17 April 2020. Retrospectively registered.
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Affiliation(s)
- Jens Hartlev
- Section for Oral Surgery and Oral Pathology, Department of Dentistry and Oral Health, Health, Aarhus University, Vennelyst Boulevard 9, DK-8000, Aarhus C, Denmark.
| | - Søren Schou
- Department of Periodontology, School of Dentistry, Faculty of Health Sciences, University of Copenhagen, Noerre Alle 20, DK-2200, Copenhagen N, Denmark
| | - Flemming Isidor
- Section for Prosthetics, Department of Dentistry and Oral Health, Health, Aarhus University, Vennelyst Boulevard 9, DK-8000, Aarhus C, Denmark
| | - Sven Erik Nørholt
- Section for Oral Surgery and Oral Pathology, Department of Dentistry and Oral Health, Health, Aarhus University, Vennelyst Boulevard 9, DK-8000, Aarhus C, Denmark.,Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark
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Mancini L, Tarallo F, Quinzi V, Fratini A, Mummolo S, Marchetti E. Platelet-Rich Fibrin in Single and Multiple Coronally Advanced Flap for Type 1 Recession: An Updated Systematic Review and Meta-Analysis. ACTA ACUST UNITED AC 2021; 57:medicina57020144. [PMID: 33562581 PMCID: PMC7915928 DOI: 10.3390/medicina57020144] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 01/25/2021] [Accepted: 02/02/2021] [Indexed: 12/23/2022]
Abstract
Background and Objectives: The aim of the present systematic review and meta-analysis was to investigate the efficacy of leukocyte–platelet-rich fibrin (L-PRF) in addition to coronally advanced flap (CAF) for the treatment of both single and multiple gingival recessions (GRs) compared to the CAF alone and to the adjunct of connective tissue graft (CTG). Root coverage outcomes using platelet concentrates have gained increased interest. In particular, it has been suggested that adding L-PRF to CAF may provide further benefits in the treatment of GRs. Materials and Methods: An electronic and manual literature search was conducted to identify randomized controlled trials (RTCs) investigating root coverage outcomes with CAF + L-PRF. The outcomes of interest included mean root coverage (mRC), recession reduction, keratinized tissue width (KTW) gain, gingival thickness (GT) gain, and patient-reported outcome measures (PROms) such as pain perception and discomfort. Results: A total of 275 patients and 611 surgical sites were analyzed. L-PRF in adjunct to single CAF seems to show statistically significant results regarding clinical attachment level (CAL) with a weighted means (WM) 0.43 95% CI (−0.04, 0.91), p < 0.0001, GT (WM 0.17 95% CI (−0.02, 0.36), p < 0.0001, and mRC (WM 13.95 95% CI (−1.99, 29.88) p < 0.0001, compared to single CAF alone. Interesting results were obtained from the adjunct of PRF to multiple CAF with respect to multiple CAF alone with an increase in the mRC WM 0.07 95% CI (−30.22, 30.35), p = 0.0001, and PPD change WM 0.26 95% CI (−0.06, 0.58), p < 00001. On the other hand, no statistically significant data were obtained when L-PRF was added to single or multiple CAF combined with CTG according to the included outcomes such as mRC (p = 0.03 overall). Conclusions: L-PRF is a valid alternative to CAF alone. L-PRF compared to CTG in single and multiple CAF showed statistically significant results regarding pain perception and discomfort PROms (p < 0.0001). However, CTG remains the gold standard for treating gingival recession.
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15
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Wang ICI, Barootchi S, Tavelli L, Wang HL. The peri-implant phenotype and implant esthetic complications. Contemporary overview. J ESTHET RESTOR DENT 2021; 33:212-223. [PMID: 33459483 DOI: 10.1111/jerd.12709] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/04/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To provide a contemporary and comprehensive overview of the hard and soft tissue biological structures surrounding an osseointegrated dental implant (peri-implant referred to as the peri-implant phenotype), in the context of peri-implant esthetic complications. OVERVIEW The individual components of the peri-implant phenotype (keratinized mucosa width, mucosal thickness, supracrestal tissue height, and the peri-implant buccal bone) have been linked to different aspects of implant esthetics, as well as health-related aspects. At the time of implant therapy, respecting the biology of the peri-implant hard and soft tissues, and anticipating their remodeling patterns can alleviate future esthetic complications. CONCLUSIONS While the current literature may not allow for a point-by-point evidence based-recommendation for the required amount of each peri-implant structure, bearing in mind the proposed values for the components of the peri-implant phenotype, at the time of and prior to implant therapy can lead to more predictable treatment outcomes, and the avoidance of esthetic complications. CLINICAL SIGNIFICANCE Knowledge of hard and soft tissue components surrounding and osseointegrated dental implant, and their underlying biological remodeling process is crucial for carrying out a successful therapy and alleviating possible future esthetic challenges.
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Affiliation(s)
- I-Ching Izzie Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Shayan Barootchi
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Lorenzo Tavelli
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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16
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Deeb JG, Deeb GR. Oral Soft Tissue Grafting. Oral Maxillofac Surg Clin North Am 2020; 32:611-630. [PMID: 32912774 DOI: 10.1016/j.coms.2020.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The presence of healthy soft tissue at the tooth and implant interface correlates to long-term success and stability in function and esthetics. Grafting procedures utilizing various techniques can be performed during any stage of the implant or restorative therapy. Materials of autogenous, allogeneic, and xenogeneic sources are available for oral soft tissue grafting. This article describes the classifications of soft tissue defects, treatment modalities, and materials used to enhance soft tissue quality and quantity and to achieve optimal esthetics and function around teeth and implants.
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Affiliation(s)
- Janina Golob Deeb
- Department of Periodontics, School of Dentistry, Virginia Commonwealth University, 521 North 11th Street, Richmond, VA 23298, USA
| | - George R Deeb
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Virginia Commonwealth University, 521 North 11th Street, Richmond, VA 23298, USA.
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17
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Barootchi S, Tavelli L, Gianfilippo RD, Eber R, Stefanini M, Zucchelli G, Wang HL. Acellular dermal matrix for root coverage procedures: 9-year assessment of treated isolated gingival recessions and their adjacent untreated sites. J Periodontol 2020; 92:254-262. [PMID: 32729954 DOI: 10.1002/jper.20-0310] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/23/2020] [Accepted: 06/23/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND The long-term outcomes of acellular dermal matrix (ADM) for the treatment of isolated gingival recessions has not yet been evaluated. Thus, the aim of this study was to observe the root coverage outcomes of coronally advanced flap with ADM over time, and compare them with their adjacent untreated sites. METHODS Twelve patients (from 20) were available at the 9-year recall. Clinical parameters (recession depth, mean root coverage [mRC], keratinized tissue width [KTW], and gingival thickness) were evaluated and compared with the 1-year results, and the ADM-adjacent untreated sites (on mesial and distal) via mixed-modeling regression analyses. RESULTS From 1 to 9 years, the ADM-treated isolated recessions showed a relapse from 77% to 62% mRC (P <0.05). A similar pattern toward apical shift of the gingival margin was noticed for the ADM-adjacent untreated sites without baseline recession. However, ADM-adjacent untreated sites which had presented with recession at baseline but were not treated showed a significantly more apical shift of the gingival margin (almost two-fold). A significant increase in KTW was noted for all sites. Baseline KTW ≥2 mm was a significant predictor for the stability of the gingival margin at the ADM-treated, and the ADM-adjacent sites with baseline recession. CONCLUSIONS ADM-treated sites displayed recession relapse from 1 to 9 years. The untreated adjacent sites with a recession at baseline, showed a higher apical displacement of the gingival margin compared with the ADM-treated sites, and ADM-adjacent sites without a recession at baseline.
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Affiliation(s)
- Shayan Barootchi
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Lorenzo Tavelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Riccardo Di Gianfilippo
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Robert Eber
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Martina Stefanini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giovanni Zucchelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Hom-Lay Wang
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
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18
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Tavelli L, Barootchi S, Avila-Ortiz G, Urban IA, Giannobile WV, Wang HL. Peri-implant soft tissue phenotype modification and its impact on peri-implant health: A systematic review and network meta-analysis. J Periodontol 2020; 92:21-44. [PMID: 32710810 DOI: 10.1002/jper.19-0716] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/20/2020] [Accepted: 05/06/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The peri-implant soft tissue phenotype (PSP) encompasses the keratinized mucosa width (KMW), mucosal thickness (MT), and supracrestal tissue height (STH). Numerous approaches to augment soft tissue volume around endosseous dental implants have been investigated. To what extent PSP modification is beneficial for peri-implant health has been subject of debate in the field of implant dentistry. The aim of this systematic review was to analyze the evidence regarding the efficacy of soft tissue augmentation procedures aimed at modifying the PSP and their impact on peri-implant health. METHODS A comprehensive search was performed to identify clinical studies that involved soft tissue augmentation around dental implants and reported findings on KMW, MT, and/or STH changes. The effect of the intervention on peri-implant health was also assessed. Selected articles were classified based on the general type of surgical approach to increase PSP, either bilaminar or an apically positioned flap (APF) technique. A network meta-analysis including only randomized-controlled trials (RCTs) reporting on PSP outcomes was conducted to assess and compare different techniques. RESULTS A total of 52 articles were included in the qualitative analysis, and 23 RCTs were included as part of the network meta-analysis. Sixteen RCTs reported the outcomes of PSP modification therapy with bilaminar techniques, whereas 7 involved the use of APF. The analysis showed that bilaminar techniques in combination with soft tissue grafts (connective tissue graft [CTG], collagen matrix [CM], and acellular dermal matrix [ADM]) resulted in a significant increase in MT compared to non-augmented sites. In particular, CTG and ADM were associated with higher MT gain as compared to CM and non-augmented sites. However, no significant differences in KMW were observed across different bilaminar techniques. PSP modification via a bilaminar approach utilizing either CTG or CM showed beneficial effects on marginal bone level stability. APF-based approaches in combination with free gingival graft (FGG), CTG, CM, or ADM showed a significant KMW gain compared to non-augmented sites. However, compared to APF alone, only FGG exhibited a significantly higher KMW gain. APF with any evaluated soft tissue graft was associated with with reduction of probing depth, soft tissue dehiscence and plaque index compared to non-augmented sites compared to non-augmented sites. The evidence regarding the effect of PSP modification via APF-based approaches on peri-implant marginal bone loss or preservation is inconclusive. CONCLUSIONS Bilaminar approach involving CTG or ADM obtained the highest amount of MT gain, whereas APF in combination with FGG was the most effective technique for increasing KMW. KMW augmentation via APF was associated with a significant reduction in probing depth, soft tissue dehiscence and plaque index, regardless of the soft tissue grafting material employed, whereas bilaminar techniques with CTG or CM showed beneficial effects on marginal bone level stability.
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Affiliation(s)
- Lorenzo Tavelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Shayan Barootchi
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Gustavo Avila-Ortiz
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, Iowa, USA
| | - Istvan A Urban
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Private practice, Budapest, Hungary
| | - William V Giannobile
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Department of Biomedical Engineering & Biointerfaces Institute, College of Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Hom-Lay Wang
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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Barootchi S, Tavelli L, Zucchelli G, Giannobile WV, Wang H. Gingival phenotype modification therapies on natural teeth: A network meta‐analysis. J Periodontol 2020; 91:1386-1399. [DOI: 10.1002/jper.19-0715] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/07/2020] [Accepted: 03/15/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Shayan Barootchi
- Department of Periodontics & Oral Medicine University of Michigan School of Dentistry Ann Arbor MI USA
| | - Lorenzo Tavelli
- Department of Periodontics & Oral Medicine University of Michigan School of Dentistry Ann Arbor MI USA
| | - Giovanni Zucchelli
- Department of Periodontics & Oral Medicine University of Michigan School of Dentistry Ann Arbor MI USA
- Department of Biomedical and Neuromotor Sciences University of Bologna Bologna Italy
| | - William V. Giannobile
- Department of Periodontics & Oral Medicine University of Michigan School of Dentistry Ann Arbor MI USA
- Department of Biomedical Engineering & Biointerfaces Institute College of Engineering University of Michigan Ann Arbor MI USA
| | - Hom‐Lay Wang
- Department of Periodontics & Oral Medicine University of Michigan School of Dentistry Ann Arbor MI USA
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20
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Moraschini V, Guimarães HB, Cavalcante IC, Calasans-Maia MD. Clinical efficacy of xenogeneic collagen matrix in augmenting keratinized mucosa round dental implants: a systematic review and meta-analysis. Clin Oral Investig 2020; 24:2163-2174. [DOI: 10.1007/s00784-020-03321-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 05/01/2020] [Indexed: 12/13/2022]
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21
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Dhingra A, Taylor T, Flinton R. Digital Custom Impression Technique to Record Emergence Profile and Fabrication of an Esthetic Implant Supported Restoration. J Prosthodont 2020; 29:636-639. [PMID: 32406151 DOI: 10.1111/jopr.13200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/05/2020] [Accepted: 05/11/2020] [Indexed: 11/29/2022] Open
Abstract
One of the challenges in esthetic implant supported restorations is to replicate the emergence profile of soft tissue contours created by provisional restorations. Various analog techniques have been used to achieve the most esthetic and natural emergence profile in final restorations. The evolution of digital dentistry has made dentistry easier and efficient albeit with a learning curve. The technique described here uses digital technology to describe a complete digital workflow from the provisional stage to the final restoration.
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Affiliation(s)
- Ajay Dhingra
- Department of Reconstructive Sciences, School of Dental Medicine, University of Connecticut, Farmington, CT
| | - Thomas Taylor
- Department of Reconstructive Sciences, School of Dental Medicine, University of Connecticut, Farmington, CT
| | - Robert Flinton
- Restorative Dentistry, Rutgers School of Dental Medicine, Newark, NJ
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22
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Long-term predictability of allogenic dermal matrix for root coverage: Three years observation period on 15 consecutive cases. Saudi Dent J 2020; 33:99-104. [PMID: 33551623 PMCID: PMC7848796 DOI: 10.1016/j.sdentj.2020.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 01/05/2020] [Indexed: 11/23/2022] Open
Abstract
Gingival recession is an apical migration of gingival margin that is a common finding on patients with meticulous oral hygiene and periodontitis patients. Several surgical treatment techniques of gingival recession have been described. The most challenging situation is the presence of multiple adjacent recession defects. 15 patients with total of 53 recession defects have been treated with Acellular Dermal Matrix (ADM). The following clinical parameters were evaluated recession depth (RD), probing depth (PD); and the width of the keratinized tissue (KT). Upon completion of the study; there was statistically significant (P-value = 0.00) reduction in recession depth from baseline, one and three years after the surgery (2.6 mm, 0.32 mm, and 0.17 mm, respectively). There was statistically significant (P-value = 0.00) increase in the width of keratinized tissue from baseline to one year and three years (3.47 mm, 5.02 mm, and 5.40 mm, respectively). Based on this study the use of ADM with the coronally advanced flap resulted in a significant increase in keratinized tissue and percentage of root surface coverage.
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23
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Liu P, Li Q, Yang Q, Zhang S, Lin C, Zhang G, Tang Z. Three-dimensional cell printing of gingival fibroblast/acellular dermal matrix/gelatin–sodium alginate scaffolds and their biocompatibility evaluation in vitro. RSC Adv 2020; 10:15926-15935. [PMID: 35493638 PMCID: PMC9052548 DOI: 10.1039/d0ra02082f] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/15/2020] [Indexed: 11/21/2022] Open
Abstract
3D cell printing of gingival fibroblast/acellular dermal matrix/gelatin–sodium alginate scaffolds showed satisfactory biological properties.
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Affiliation(s)
- Peng Liu
- Second Clinical Division
- Peking University School and Hospital of Stomatology
- Beijing
- P. R. China
- National Engineering Laboratory for Digital and Material Technology of Stomatology
| | - Qing Li
- Second Clinical Division
- Peking University School and Hospital of Stomatology
- Beijing
- P. R. China
- Center of Digital Dentistry
| | - Qiaolin Yang
- Department of Orthodontics
- Peking University School and Hospital of Stomatology
- Beijing
- P. R. China
| | - Shihan Zhang
- Second Clinical Division
- Peking University School and Hospital of Stomatology
- Beijing
- P. R. China
| | - Chunping Lin
- Second Clinical Division
- Peking University School and Hospital of Stomatology
- Beijing
- P. R. China
| | - Guifeng Zhang
- State Key Laboratories of Biochemical Engineering
- Institute of Process Engineering
- Beijing
- P. R. China
| | - Zhihui Tang
- Second Clinical Division
- Peking University School and Hospital of Stomatology
- Beijing
- P. R. China
- National Engineering Laboratory for Digital and Material Technology of Stomatology
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Zucchelli G, Tavelli L, Stefanini M, Barootchi S, Mazzotti C, Gori G, Wang HL. Classification of facial peri-implant soft tissue dehiscence/deficiencies at single implant sites in the esthetic zone. J Periodontol 2019; 90:1116-1124. [PMID: 31087334 DOI: 10.1002/jper.18-0616] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/06/2018] [Accepted: 01/14/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The incidence of a peri-implant soft tissue dehiscence/deficiency (PSTD) is not a rare finding. Despite multiple previous attempts aimed at correcting the PSTDs, a classification of these conditions has not yet been proposed. This lack in the literature may also lead to discrepancies in the reported treatment outcomes and thus misinform the clinician or the readers. The aim of the present article was therefore to present a classification of peri-implant PSTD at a single implant site. METHODS Four classes of PSTDs were discussed based on the position of the gingival margin of the implant-supported crown in relation to the homologous natural tooth. In addition, the bucco-lingual position of the implant head was also taken into consideration. Each class was further subdivided based on the height of the anatomical papillae. RESULTS Subsequently, for each respective category a surgical approach (including bilaminar techniques, the combined prosthetic-surgical approach or soft tissue augmentation with a submerged healing) was also suggested. CONCLUSION This paper provides a new classification system for describing PSTDs at single implant sites, with the appropriate recommended treatment protocol.
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Affiliation(s)
- Giovanni Zucchelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Lorenzo Tavelli
- Department of Periodontics & Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Martina Stefanini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Shayan Barootchi
- Department of Periodontics & Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Claudio Mazzotti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | | | - Hom-Lay Wang
- Department of Periodontics & Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
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Abstract
In the review we analyze the basic surgical techniques applied to increase the volume of a keratinized gum and materials used for this procedure, such as dermal and collagen matrices. The results of clinical trials are presented on the effectiveness of collagen matrices, including Mucograft. The analysis of the literature highlights the main advantages and disadvantages of these methods and materials, as well as the most significant and promising areas for the further clinical research.
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Lin CY, Chen Z, Pan WL, Wang HL. Impact of timing on soft tissue augmentation during implant treatment: A systematic review and meta-analysis. Clin Oral Implants Res 2018; 29:508-521. [PMID: 29603808 DOI: 10.1111/clr.13148] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND To achieve a predictable esthetic and functional outcome, soft tissue augmentation has become popular in implant treatment. OBJECTIVES The aim of this systematic review and meta-analysis was to assess the influence of different timing for soft tissue augmentation during implant treatment on soft tissue conditions and its stability. MATERIAL AND METHODS Electronic and manual searches for articles written in English up to September 2017 were performed by two independent reviewers. Human clinical studies with the purpose of evaluating outcomes (at least 3-month follow-up) of autogenous soft tissue graft for augmentation during implant treatment, either simultaneous or after implant placement (staged), were included. Cumulative changes of keratinized tissue width (KTW), soft tissue thickness (STT), and mid-buccal mucosal recession (MR) data were analyzed with a random-effects model to compare the postoperative outcomes. RESULTS Twenty-nine human studies (eight randomized clinical trials, six cohort studies, and 15 case series) that met the inclusion criteria were included. For the overall data, the weighted mean STT gain (1 year after surgery) was 1.03 mm (95% CI: 0.78-1.29 mm), among which the simultaneous group was 1.12 mm (95% CI: 0.75-1.49 mm) and staged group (3-6 months after implant placement) was 0.95 mm (95% CI: 0.58-1.31 mm). There was no statistically significant difference in KTW and MR between 3 months and more than 3 months after surgery. CONCLUSIONS This review revealed that the stability of soft tissue, in terms of KTW and mid-buccal MR, can be obtained 3 months after surgery. There is no difference between simultaneous and staged soft tissue augmentation during implant treatment, and both procedures significantly enhance KTW and STT.
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Affiliation(s)
- Cho-Ying Lin
- Department of Periodontics, Chang Gung Memorial Hospital, Taipei, Taiwan
- Chang Gung University, Taoyuan City, Taiwan
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Zhaozhao Chen
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
- State Key Laboratory of Oral Diseases, Department of Prosthodontics, National Clinical Research Center for Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Whei-Lin Pan
- Department of Periodontics, Chang Gung Memorial Hospital, Taipei, Taiwan
- Chang Gung University, Taoyuan City, Taiwan
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
- State Key Laboratory of Oral Diseases, Department of Prosthodontics, National Clinical Research Center for Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Zucchelli G, Sharma P, Mounssif I. Esthetics in periodontics and implantology. Periodontol 2000 2018; 77:7-18. [DOI: 10.1111/prd.12207] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Mazzotti C, Stefanini M, Felice P, Bentivogli V, Mounssif I, Zucchelli G. Soft-tissue dehiscence coverage at peri-implant sites. Periodontol 2000 2018; 77:256-272. [DOI: 10.1111/prd.12220] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Clinical Outcomes of Comparing Soft Tissue Alternatives to Free Gingival Graft: A Systematic Review and Meta-Analysis. J Evid Based Dent Pract 2017; 17:370-380.e3. [DOI: 10.1016/j.jebdp.2017.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 05/17/2017] [Accepted: 05/19/2017] [Indexed: 11/20/2022]
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Abstract
PURPOSE Oral soft tissue augmentation or grafting procedures are often necessary to achieve proper wound closure after deficits resulting from tumor excision, clefts, trauma, dental implants, and tooth recessions. MATERIALS AND METHODS Autologous soft tissue grafts still remain the gold standard to acquire a functionally adequate zone of keratinized attached gingiva. However, soft tissue substitutes are more commonly used because they minimize morbidity and shorten surgical time. RESULTS This review aimed to assess soft tissue grafting techniques and materials used in the oral cavity from existing literature. There are a large variety of materials and techniques, including grafts, local flaps, allogenic derived matrices such as acellular dermal allograft, xenogenic tissue matrices from animal origin, and synthetic materials. CONCLUSIONS Tissue engineering of oral mucosa represents an interesting alternative to obtain sufficient autologous tissue for reconstructing oral wounds using biodegradable scaffolds, and may improve vascularization and epithelialization, which are critical for successful outcomes.
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Lima RSRE, Peruzzo DC, Napimoga MH, Saba-Chujfi E, Dos Santos-Pereira SA, Martinez EF. Evaluation of the Biological Behavior of Mucograft® in Human Gingival Fibroblasts: An In Vitro Study. Braz Dent J 2017; 26:602-6. [PMID: 26963203 DOI: 10.1590/0103-6440201300238] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 09/08/2015] [Indexed: 02/17/2023] Open
Abstract
Mucograft(r) is a resorbing porcine matrix composed of type I and type III collagen, used for soft tissue augmentation in guided tissue bony regeneration procedures. This in vitro study aimed to evaluate the biological behavior of Mucograft(r) in human gingival fibroblasts, as well as the ability of the matrix to induce production of extracellular matrix. Six resorbing Mucograft(r) matrices (MCG) were cut into 3 x 2 mm rectangles and 5 x 5 mm squares and were placed in 96- and 24-well plates, respectively. The control group (CTRL) consisted of cells plated on polystyrene without the MCG. After one, two, three and seven days, cell proliferation and viability were assessed using the Trypan exclusion method and MTT test, respectively. Type III collagen (COL 3A1) and vimentin (VIM) expression were also evaluated at 10 and 14 days, using Western blotting. Statistical analysis, using ANOVA with post hoc Bonferroni test, revealed that human gingival fibroblasts from MCG showed similar results (p>0.05) for proliferation and viability as the cells cultured on CTRL. After 14 days, a significant decrease in COL 3A1 expression (p<0.05) was observed when cultured with the MCG. VIM expression showed no significant difference at any time period (p>0.05). Although no increase in extracellular matrix secretion was observed in this in vitro study, Mucograft(r) presented cellular compatibility, being an option for a scaffold whenever it is required.
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Affiliation(s)
- Rafaela S R E Lima
- Department of Periodontology, SLMANDIC - São Leopoldo Mandic Institute and Research Center, Campinas, SP, Brazil
| | - Daiane C Peruzzo
- Department of Periodontology, SLMANDIC - São Leopoldo Mandic Institute and Research Center, Campinas, SP, Brazil
| | - Marcelo H Napimoga
- Department of Immunology, SLMANDIC - São Leopoldo Mandic Institute and Research Center, Campinas, SP, Brazil
| | - Eduardo Saba-Chujfi
- Department of Periodontology, SLMANDIC - São Leopoldo Mandic Institute and Research Center, Campinas, SP, Brazil
| | | | - Elizabeth F Martinez
- Department of Pathology and Cell Biology, SLMANDIC - São Leopoldo Mandic Institute and Research Center, Campinas, SP, Brazil
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Evaluation of Light-Activated Provisional Resin Materials for Periodontal Soft Tissue Management. BIOMED RESEARCH INTERNATIONAL 2016; 2016:1209705. [PMID: 27672651 PMCID: PMC5031816 DOI: 10.1155/2016/1209705] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 08/17/2016] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to determine mechanical properties using a compressive test with cylinder specimen (h = 6 mm and ϕ = 4 mm) as well as cytotoxicity using elutes from disk specimen (ϕ = 10 mm and h = 2 mm) against human gingival fibroblasts and oral keratinocytes with light-activated provisional resin materials (Revotek LC and Luxatemp Solar) compared to chemically activated counterpart (Snap, Trim II, and Jet). Significantly increased compressive strength (210~280 MPa) was detected in light-activated products compared to chemically activated ones (20~65 MPa, P < 0.05) and similar compressive modulus was detected in both types (0.8~1.5 and 0.5~1.3 GPa). Simultaneously, the light-activated products showed less adverse effects on the periodontal soft tissue cells in any polymerization stage compared to the chemically activated products. Particularly, chemically activated products had significantly greater adverse effects during the “polymerizing” phase compared to those that were “already set” (P < 0.05), as shown in confocal microscopic images of live and dead cells. In conclusion, light-activated provisional resin materials have better mechanical properties as well as biocompatibility against two tested types of oral cells compared to the chemically activated counterpart, which are considered as more beneficial choice for periodontal soft tissue management.
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Use of Transalveolar Sutures in Conjunction With Grafting to Preserve Vestibular Depth and Augment Gingival Thickness Around Mandibular Implants. J Oral Maxillofac Surg 2016; 74:940-4. [DOI: 10.1016/j.joms.2015.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 12/04/2015] [Accepted: 12/04/2015] [Indexed: 11/20/2022]
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Halperin-Sternfeld M, Zigdon-Giladi H, Machtei EE. The association between shallow vestibular depth and peri-implant parameters: a retrospective 6 years longitudinal study. J Clin Periodontol 2016; 43:305-10. [PMID: 26718112 DOI: 10.1111/jcpe.12504] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2015] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study was to retrospectively evaluate the association between shallow vestibular depth (VD) and peri-implant parameters. MATERIAL AND METHODS Peri-implant parameters were evaluated in 61 periodontal patients under regular supportive periodontal therapy. Clinical parameters included gingival index (GI), plaque index (PI), bleeding on probing (BOP), peri-implant pocket depths (PPD), mucosal recession (MR), relative attachment level (RAL), width and thickness of keratinized mucosa (KMW, KMT) and VD. Radiographic bone level (RBL) was measured on peri-apical radiographs. RESULTS Sites with shallow VD (≤ 4 mm) were associated with higher MR (0.91 mm versus 0.47 mm, p ≤ 0.009), higher RAL (4.23 mm versus 3.59 mm, p ≤ 0.0001) and higher RBL (2.18 mm versus 1.7 mm, p = 0.05) when compared with adequate vestibular depth sites (VD > 4 mm). Moreover, sites with shallow VD presented lower KMW compared with sites with adequate VD (1.24 mm versus 2.38 mm, respectively, p ≤ 0.0001). Slightly greater BOP, and GI were recorded for the shallow VD compared with adequate sites. According to multivariate analysis, factors that could predict RAL included: VD, GI, age, supporting periodontal therapy, implant type and design. CONCLUSIONS Based on this study, inadequate vestibular depth around dental implants may be associated with increased peri-implant bone loss and mucosal recession. Further prospective and intervention studies will be required to fully understand this phenomenon.
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Affiliation(s)
- Michal Halperin-Sternfeld
- Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus, Haifa, Israel
| | - Hadar Zigdon-Giladi
- Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus, Haifa, Israel.,Bruce Rappaport Faculty of Medicine- Technion, Israel Institute of Technology, Haifa, Israel
| | - Eli E Machtei
- Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus, Haifa, Israel.,Bruce Rappaport Faculty of Medicine- Technion, Israel Institute of Technology, Haifa, Israel
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Sareen S, Pathak AK, Singhal D, Dixit J, Purwar P. Coverage of denuded labial bone resulting from post space preparation with a free gingival autograft: lessons learnt. BMJ Case Rep 2015; 2015:bcr-2015-211427. [PMID: 26290565 DOI: 10.1136/bcr-2015-211427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Rehabilitation of endodontically treated teeth by post and core preparation is a common procedure in day to day dental practice. However, in some instances, post space preparation can produce excessive frictional heat leading to significant damage to the attachment apparatus of the tooth as well as to the overlying soft tissue. This report describes a case of mucosal dehiscence arising due to trauma induced by inadvertent post space preparation. The denuded mucosa was restored to its physiological position with the help of free gingival autograft obtained from the palatal donor site. The aesthetic results obtained were excellent and have been stable for a period of 2 years.
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Affiliation(s)
- Sagar Sareen
- Faculty of Dental Sciences, Department of Periodontology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | | | - Divya Singhal
- Faculty of Dental Sciences, Department of Periodontology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Jaya Dixit
- Faculty of Dental Sciences, Department of Periodontology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Parth Purwar
- Faculty of Dental Sciences, Department of Periodontology, King George's Medical University, Lucknow, Uttar Pradesh, India
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Poskevicius L, Sidlauskas A, Galindo-Moreno P, Juodzbalys G. Dimensional soft tissue changes following soft tissue grafting in conjunction with implant placement or around present dental implants: a systematic review. Clin Oral Implants Res 2015; 28:1-8. [DOI: 10.1111/clr.12606] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Lukas Poskevicius
- Department of Maxillofacial Surgery; Lithuanian University of Health Sciences; Kaunas Lithuania
| | - Antanas Sidlauskas
- Department of Orthodontics; Lithuanian University of Health Sciences; Kaunas Lithuania
| | - Pablo Galindo-Moreno
- Department of Oral Surgery and Implant Dentistry; School of Dentistry; University of Granada; Granada Spain
| | - Gintaras Juodzbalys
- Department of Maxillofacial Surgery; Lithuanian University of Health Sciences; Kaunas Lithuania
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Travassos R, Soares B, Bhandi SH, Silva MBD, Bandéca MC, Mouchrek JCE, Silva VCD, Benatti BB. Multidisciplinary Treatment of a Fenestration-type Defect. J Contemp Dent Pract 2015; 16:329-34. [PMID: 26067739 DOI: 10.5005/jp-journals-10024-1685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The case report aimed at treating a fenestration-type defect with multidisciplinary conventional and advanced surgical techniques. Fenestrations are isolated areas in which the exposed root surface is covered only by the periosteum and gingiva, but the remaining cortical bone remains intact. Root coverage is indicated in cases of root hypersensitivity, treatment of shallow caries lesions, cervical abrasions, and esthetic and cosmetic needs. In this case report, after proper hygiene instruction and dental biofilm control, a fenestration-type defect was treated using guided tissue regeneration (anorganic bovine matrix and resorbable membrane) and a connective tissue grafts, associated to an endodontic apicoectomy. After reevaluation, the remaining gingival recession was treated with a second gingival connective tissue graft covered with q double papillae type in order to reconstruct the periodontal tissues of the involved tooth. In this clinical case, the interaction between the different areas of dentistry has made it possible to correct a fenestration-type defect, following procedures based on scientific evidence, restoring periodontal health, esthetics, self-esteem, and meeting the patient's expectations regarding her initial complaint. This case report shows the important role of interdisciplinary approach to treating a patient with a complex periodontal defect that required different types of knowledge and abilities to achieve the best results based on the current status of dentistry possibilities.
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Affiliation(s)
- Rafael Travassos
- Department of Dentistry, School of Dentistry, Federal University of Maranhão Avenida dos Portugueses S/N Campus do Bacanga, São Luis, Maranhao, Brazil
| | - Bruno Soares
- Department of Dentistry, School of Dentistry, Federal University of Maranhão Avenida dos Portugueses S/N Campus do Bacanga, São Luis, Maranhao, Brazil
| | - Shilpa H Bhandi
- Department of Conservative Dentistry and Endodontics MS Ramaiah Dental College and Hospital, Bengaluru Karnataka, India
| | - Monica Barros da Silva
- Department of Postgraduate Program in Dentistry, School of Dentistry, CEUMA University, Rua Josué Montello 1 Renascença II, São Luís, Maranhao, Brazil
| | - Matheus Coelho Bandéca
- Department of Postgraduate Program in Dentistry, School of Dentistry, CEUMA University, Rua Josué Montello 1 Renascença II, São Luís, Maranhao, Brazil
| | - José Carlos Elias Mouchrek
- Department of Postgraduate Program in Dentistry, School of Dentistry, CEUMA University, Rua Josué Montello 1 Renascença II, São Luís, Maranhao, Brazil
| | - Vanessa Camila da Silva
- Department of Dentistry, School of Dentistry, Federal University of Maranhão Avenida dos Portugueses S/N Campus do Bacanga, São Luis, Maranhao, Brazil
| | - Bruno Braga Benatti
- Professor, Department of Dentistry, School of Dentistry, Federal University of Maranhão Avenida dos Portugueses S/N Campus do Bacanga, São Luis, Maranhao 65085-580, Brazil, e-mail:
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Novelli C. Esthetic treatment of a periodontal patient with prefabricated composite veneers and fiber-reinforced composite: clinical considerations and technique. J ESTHET RESTOR DENT 2014; 27:4-12. [PMID: 24975164 DOI: 10.1111/jerd.12116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
UNLABELLED The advances in periodontal therapy and the clinical success of adhesive dentistry have changed the way dentists treat periodontal patients. As more teeth are saved, the demand for functional and esthetic restoration of periodontally involved teeth grows. Once, these teeth were restored with full-coverage splinted restorations, whereas today, adhesive techniques provide less invasive and less complicated treatment options. This paper presents a novel adhesive combination of fiber-reinforced composite and prefabricated composite veneers to restore function and esthetics in a periodontal patient with severe bone and attachment loss. After successful completion of the periodontal treatment, fiber-reinforced composite has been bonded to the buccal surface of the maxillary anterior teeth in order to control teeth mobility. At the same appointment, prefabricated composite veneers have been bonded to the splinted teeth in order to restore esthetics. The final result shows full integration of contemporary adhesive techniques for single-appointment, minimally invasive treatment of a periodontal patient. CLINICAL SIGNIFICANCE This paper describes the use of fiber-reinforced composite and prefabricated composite veneers for the treatment of severe periodontal patients with a minimally invasive, single-appointment technique.
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Cairo F, Nieri M, Pagliaro U. Efficacy of periodontal plastic surgery procedures in the treatment of localized facial gingival recessions. A systematic review. J Clin Periodontol 2014; 41 Suppl 15:S44-62. [DOI: 10.1111/jcpe.12182] [Citation(s) in RCA: 203] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 10/06/2013] [Accepted: 10/13/2013] [Indexed: 12/11/2022]
Affiliation(s)
- Francesco Cairo
- Department of Periodontology and Implant Dentistry; Tuscan School of Dental Medicine; University of Florence; Florence Italy
- Department of Periodontology and Implant Dentistry; Tuscan School of Dental Medicine; University of Siena; Siena Italy
| | - Michele Nieri
- Department of Periodontology and Implant Dentistry; Tuscan School of Dental Medicine; University of Florence; Florence Italy
- Department of Periodontology and Implant Dentistry; Tuscan School of Dental Medicine; University of Siena; Siena Italy
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Askin SB, Aksu AE, Calis M, Tulunoğlu İ, Safak T, Tözüm TF. Report of multidisciplinary treatment of an extensive mandibular ameloblastoma with free iliac crest bone flap, dental implants, and acellular dermal matrix graft. J ORAL IMPLANTOL 2013; 41:107-11. [PMID: 23506101 DOI: 10.1563/aaid-joi-d-13-00003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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