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Assimi S, Ismaili Z, Dghoughi S. Successful management of gingival recession with creeping attachment: A case report. Clin Case Rep 2024; 12:e8952. [PMID: 38756619 PMCID: PMC11096279 DOI: 10.1002/ccr3.8952] [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: 01/02/2024] [Revised: 04/07/2024] [Accepted: 05/03/2024] [Indexed: 05/18/2024] Open
Abstract
Key Clinical Message A successful management of a mandibular recession with creeping attachment using free gingival graft. This case highlights the "wait-and-see" approach in the treatment plan, emphasizing the root coverage. Abstract This clinical report describes the case of a 23-year-old female patient with gingival recession of the mandibular left central incisor. The patient's symptoms included hypersensitivity and cosmetic improvements. After thorough examination, the patient was diagnosed with plaque-induced gingivitis on a reduced periodontium with acquired mucogingival deformities. Gingival recession was classified as Miller class II or Cairo Recession Type 1. The treatment plan consisted of a nonsurgical phase, followed by a surgical phase using a free gingival graft. The surgical procedure involved harvesting the graft from the palatal mucosa and placing it in the recipient site. Post-operative care and instructions were provided and a comprehensive follow-up schedule was established. At the 12-month evaluation, the patient exhibited healthy periodontal conditions with creeping attachment and complete root coverage. The success of the treatment approach demonstrates its effectiveness in addressing hypersensitivity and cosmetic concerns, while improving periodontal health. Factors influencing the achievement of creeping attachment are discussed, including recession width, graft position, bone support, tooth position, patient hygiene, graft thickness, and root surface treatment.
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Affiliation(s)
- Sihame Assimi
- Department of Periodontology, Faculty of dentistryMohammed V University in RabatRabatMorocco
| | - Zouheir Ismaili
- Department of Periodontology, Faculty of dentistryMohammed V University in RabatRabatMorocco
| | - Saloua Dghoughi
- Department of Oral surgery, Faculty of DentistryMohammed V University in RabatRabatMorocco
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Oliveira JA, da Silveira MI, Soares LFF, Alves RDO, Carrera TMI, Azevedo MR, Oliveira GJPLD, Pigossi SC. Wound-healing agents for palatal donor area: A network meta-analysis. Clin Oral Implants Res 2024; 35:359-376. [PMID: 38315151 DOI: 10.1111/clr.14241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 12/18/2023] [Accepted: 01/13/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND The aim of this systematic review and network meta-analysis (NMA) was to assess the efficacy of different wound-healing agents for palatal donor area management after soft tissue graft harvesting. METHODS Electronic searches in six databases were conducted for publications up to October 2023. Studies with data from patients undergoing therapeutic approaches using agents for palatal healing after gingival graft harvesting were included. Data about postoperative pain, wound-healing and postoperative complications reported for each agent were extracted. Three different tools were used for the risk of bias within studies evaluation (Murad tool for case series and case report, RoB 2.0 tool for randomized studies and ROBINS-I tool for non-randomized studies). A Bayesian random effects NMA was conducted for postoperative pain levels and wound healing. RESULTS Eighty-four publications were included in the systematic review (qualitative analysis), with 14 of these subjected to NMA (quantitative analysis). The summarized results from the qualitative and quantitative analysis showed that all wound-healing agents evaluated promoted better pain control and wound healing compared to spontaneous healing and hemostatic sponges alone. The NMA outcomes reveal that leucocyte- and platelet-rich fibrin (L-PRF) was the most effective agent in reducing postoperative pain in all analyzed periods. Moreover, the L-PRF seems to accelerate wound healing and reduce postoperative complications compared to other agents. CONCLUSION In conclusion, the L-PRF was the most effective agent in reducing postoperative pain, accelerating wound healing and reducing postoperative complications after harvesting soft tissue grafts from the palatal area.
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Affiliation(s)
- Jovânia Alves Oliveira
- School of Dentistry, Alfenas Federal University (Unifal-MG), Alfenas, Minas Gerais, Brazil
- Department of Periodontology and Implantodontology, School of Dentistry, Federal University of Uberlandia - UFU, Uberlandia, Minas Gerais, Brazil
| | | | - Lélio Fernando Ferreira Soares
- Department of Diagnosis and Surgery, School of Dentistry at Araraquara, UNESP - São Paulo State University (FOAr/UNESP), Araraquara, São Paulo, Brazil
| | - Roberta de Oliveira Alves
- Department of Periodontology and Implantodontology, School of Dentistry, Federal University of Uberlandia - UFU, Uberlandia, Minas Gerais, Brazil
| | - Thaísa Macedo Iunes Carrera
- Department of Periodontology and Implantodontology, School of Dentistry, Federal University of Uberlandia - UFU, Uberlandia, Minas Gerais, Brazil
| | - Mayra Resende Azevedo
- Department of Periodontology and Implantodontology, School of Dentistry, Federal University of Uberlandia - UFU, Uberlandia, Minas Gerais, Brazil
| | | | - Suzane Cristina Pigossi
- Department of Periodontology and Implantodontology, School of Dentistry, Federal University of Uberlandia - UFU, Uberlandia, Minas Gerais, Brazil
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Sourvanos D, Zhu TC, Dimofte A, Busch TM, Lander B, Burrell JC, Neiva R, Fiorellini JP. A novel investigational preclinical model to assess fluence rate for dental oral craniofacial tissues. Photodiagnosis Photodyn Ther 2024; 46:104015. [PMID: 38373469 PMCID: PMC11139582 DOI: 10.1016/j.pdpdt.2024.104015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVE Photodynamic Therapy (PDT) and Photobiomodulation (PBM) are recognized for their potential in treating head and neck conditions. The heterogeneity of human tissue optical properties presents a challenge for effective dosimetry. The porcine mandible cadaver serves as an excellent model and has several similarities to human tissues of the dental oral craniofacial complex. This study aims to validate a novel modeling system that will help refine PDT and PBM dosimetry for the head and neck region. METHODS AND MATERIALS Light transmission was analyzed through several tissue combinations at distances of 2 mm to 10 mm. Maximum light fluence rates (mW/cm2) were compared across tissue types to reveal the effects of tissue heterogeneity. RESULTS The study revealed that light fluence is affected by tissue composition, with dentin/enamel showing reduced transmission and soft tissue regions exhibiting elevated values. The porcine model has proven to be efficient in mimicking human tissue responses to light, enabling the potential to optimize future protocols. CONCLUSION The porcine mandible cadaver is a novel model to understand the complex interactions between light and tissue. This study provides a foundation for future investigations into dosimetry optimization for PDT and PBM.
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Affiliation(s)
- Dennis Sourvanos
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, PA, USA; Center for Innovation and Precision Dentistry (CiPD), School of Dental Medicine, School of Engineering, University of Pennsylvania, PA, USA.
| | - Timothy C Zhu
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, PA, USA
| | - Andreea Dimofte
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, PA, USA
| | - Theresa M Busch
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, PA, USA
| | - Bradley Lander
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, PA, USA
| | - Justin C Burrell
- Center for Innovation and Precision Dentistry (CiPD), School of Dental Medicine, School of Engineering, University of Pennsylvania, PA, USA; Department of Oral and Maxillofacial Surgery, Hospital of the University of Pennsylvania and University of Pennsylvania School of Dental Medicine, University of Pennsylvania, PA, USA; Center for Neurotrauma, Neurodegeneration & Restoration, Corporal Michal J. Crescenz Veterans Affairs Medical Center, PA, USA
| | - Rodrigo Neiva
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, PA, USA
| | - Joseph P Fiorellini
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, PA, USA
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Silva ALM, de Souza JAC, Nogueira TE. Postoperative local interventions for the palate as a gingival graft donor area: a scoping review. Clin Oral Investig 2023; 27:6971-7006. [PMID: 37851129 DOI: 10.1007/s00784-023-05296-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/27/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVE This scoping review aimed to systematically identify evidence-based interventions to stimulate healing or protect the harvested palate of patients undergoing gingival grafting. MATERIAL AND METHODS The study followed guidelines from the Joanna Briggs Institute and PRISMA-ScR (protocol available at osf.io/zhafn). PubMed, Embase, and seven other databases were searched on November 2022, with additional monitoring until April 2023. The inclusion criteria focused on studies evaluating outcomes related to the donor area (palate) and interventions for healing or protecting it, regardless of publication year and language. Data from the included publications was extracted and presented through narrative text, tables, and figures. RESULTS Eighty-one studies (including 64 clinical trials, four case series, five theses, and eight systematic reviews) and 37 clinical trial records were included. The number of studies on this topic has significantly increased, reflecting a growing interest in the field. Thirty-six interventions with published results and 12 interventions with unpublished results from clinical trial registers were identified. Some promising interventions that showed potential for improving patient-reported outcomes include cyanoacrylate adhesive, platelet-rich fibrin (PRF), and the combination of palatal stents and healing agents. CONCLUSIONS Thirty-six interventions with published results were identified for postoperative use on the harvested palate, showing varying levels of evidence and conflicting effectiveness for specific outcomes. CLINICAL RELEVANCE Postoperative discomfort and pain in the palate are commonly experienced by patients undergoing grafting procedures using this region as the donor area. Awareness of the available options and their levels of evidence is crucial for informed decision-making.
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Affiliation(s)
- Ana Luiza Mustafé Silva
- Faculty of Dentistry, Postgraduate Program in Dentistry, Universidade Federal de Goiás, CEP, Goiânia, Goiás, 74605-220, Brazil
| | - João Antônio Chaves de Souza
- Faculty of Dentistry, Postgraduate Program in Dentistry, Universidade Federal de Goiás, CEP, Goiânia, Goiás, 74605-220, Brazil
| | - Túlio Eduardo Nogueira
- Faculty of Dentistry, Postgraduate Program in Dentistry, Universidade Federal de Goiás, CEP, Goiânia, Goiás, 74605-220, Brazil.
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Ameida FX, Cotrim KC, Kalil EC, Bechara K, Dalla R, Rovai ES, Shibli JA, Santos NCCD. Is there an effective way to control pain perception after free gingival graft removal? A systematic review and meta-analysis. Braz Dent J 2023; 34:10-29. [PMID: 38133083 PMCID: PMC10742360 DOI: 10.1590/0103-6440202305503] [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: 05/03/2023] [Accepted: 11/13/2023] [Indexed: 12/23/2023] Open
Abstract
The literature describes multiple ways to stimulate wound healing to reduce the patient's perception of pain. This systematic review aimed to evaluate if methods that enhance wound healing can reduce the patient's perception of pain after free gingival graft removal from the palate region compared to natural healing. A systematic review protocol was written following the PRISMA checklist. Electronic searches of five databases were performed to identify randomized clinical trials (RCTs) that assessed the patient's perception of pain after the removal of a free gingival graft from the palate. The primary outcome was the visual analog scale (VAS) score assessing the patient's perception of pain 7 days after the free gingival graft removal from the palate region. Of the 1,622 potentially relevant articles retrieved from the electronic databases, 16 RCTs were selected for qualitative analysis, and of these, 6 RCTs were included in the meta-analysis. RCTs showed a significant VAS reduction associated with the use of methods to enhance wound healing. The pooled estimates revealed a significant overall VAS reduction of 2.20 (95% CI 2.32, 2.07) 7 days after surgery. The methods that presented the greatest reduction in the perception of pain were platelet-rich fibrin, hyaluronic acid, and autologous fibrin glue. Methods that enhance wound healing, including platelet-rich fibrin, hyaluronic acid, and autologous fibrin glue, can reduce pain perception after free gingival graft removal in the palate region. However, only 1 RCT investigated each approach, which hinders the conclusion regarding the best procedure to reduce the perception of pain.
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Affiliation(s)
- Flavio X Ameida
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, SP, Brazil
| | - Khalila C Cotrim
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, SP, Brazil
| | - Eduardo C Kalil
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, SP, Brazil
| | - Karen Bechara
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, SP, Brazil
| | - Renan Dalla
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, SP, Brazil
| | - Emanuel S Rovai
- Department of Dentistry, Dental Research Division, University of Taubaté, Taubaté, São Paulo, Brazil
- Department of Periodontology, Institute of Science and Technology, São Paulo State University(UNESP), São José dos Campos, São Paulo, Brazil
| | - Jamil A Shibli
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, SP, Brazil
| | - Nidia C Castro Dos Santos
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, SP, Brazil
- The Forsyth Institute, The Forsyth InstituteCambridge, MA, United States
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