Prevalence of oral soft and hard tissue lesions related to mechanical toothcleansing procedures

Effectiveness of restorative materials on combined periodontal-restorative treatment of gingival recession with cervical lesion: A systematic review

Introduction

Gingival recession associated with non-carious cervical lesions (NCCL) is a common finding in the majority of the population. Sometimes, periodontal surgery using connective tissue graft (CTG), which is the gold standard in the treatment of gingival recession, needs to be combined with adhesive restoration to restore sufficient convergence profile. Thus, this systematic review aims to evaluate periodontal-restorative therapy using CTG combined restorative material to treat gingival recession with NCCL.

Methods

This study, following PRISMA guidelines, involved a literature search across PubMed, Scopus, Embase, and Google Scholar for articles from 2014 to June 2023 using keywords related to connective tissue grafts, cervical lesions, and gingival recession combined using AND/OR as Boolean operator. It included randomized controlled trials (RCTs), prospective studies, case series, or reports involving adult subjects with gingival recession and non-carious cervical lesions treated with CTG and restorative care, with at least 6 months of follow-up. Data were independently extracted by two reviewers, with discrepancies resolved by consensus. Risk of bias was assessed using the Cochrane RoB 2.0 tool, ROBINS-I, and the JBI Critical Appraisal tool.

Results

8 out of 1175 publications were selected for final analysis. Selected publications consist of randomized clinical trials, prospective studies, case series, and a case report. The restorative materials used include resin composite, resin-modified glass ionomer (RMGI), and giomers. It has been reported that the restoration showed no negative effect on the surrounding gingival tissue after surgical treatment. Resin composites and RMGI showed similar clinical results as restorative materials whereas giomers was reported to be less effective for the combined treatment of gingival recession associated with NCCL.

Conclusion

Therefore, the combination of surgical and restorative treatment provides stable clinical outcome and good emergence profile in gingival recession associated with NCCL. Root coverage with CTG is successful on teeth with cervical fillings.

Self-Reported Oral Hygiene Performance of Patients in Albania: A Questionnaire-Based Survey

Background/Objectives: Oral hygiene is a key factor for dental and periodontal diseases and the prognosis of any treatment to restore their consequences. The present survey aimed to evaluate how well informed patients in Albania are on oral hygiene, given the scarce evidence on this topic. Methods: This survey was performed using a Google Forms questionnaire on oral hygiene habits, type and technique of instruments used, and frequency of dental recall visits. Results: A total of 1006 questionnaires were filled in a one-month time period (January 2020) from a population of 75.2% females and 24.8% males, 32.7 ± 11.3 years of age, from whom 94.6% reported a lack of systemic diseases and 80% were non-smokers. All of the population brushed their teeth at least once daily. The most used type of toothbrush was a manual one (91.1%) with medium-bristle hardness in 71% of cases. The most prevalent way of using the toothbrush was through circular movements (36.7%) with a duration of 2-3 min in 72% of the population. Only 77.1% of the population used interdental instruments, mainly interdental floss. Conclusions: Within the limits of this study, it could be concluded that the present population seemed to be mostly appropriately informed, but the information needs further revision and promotion by dentists.

The mucosal released-coronally advanced flap: A novel surgical approach-A case report

BACKGROUND

The coronally advanced flap (CAF) can be a predictable surgical technique for the treatment of gingival recessions. However, the characteristics of the defect (e.g., limited amount of keratinized gingiva or flap tension, etc.) may limit the use of the CAF with a possible requirement of additional surgical interventions (i.e., the use of a tissue graft to be harvested from donor sites or connective tissue substitutes).

METHODS

A 28-year-old woman patient, with no history of periodontal disease, came for referral presenting receding gums as a chief complaint, poor esthetics, and dentinal hypersensitivity at the buccal surface of teeth 11, 12, and 13. Clinically, she presented a thick phenotype with gingival recession type, RT1, with detectable cemento-enamel junction (A‒) in the second quadrant. To reduce the need of harvesting soft tissue grafts, the amount of cutting of muscles and vessels from the inner portion of the flap and mitigate the postoperative discomfort associated with the CAF, a novel surgical approach is described here using an advanced flap that incorporates an external incision along the mucogingival junction.

RESULTS

The average root coverage achieved with the novel procedure presented in this case report was 95%, along with an increased amount of keratinized gingiva and minimal postoperative patient's discomfort.

CONCLUSIONS

The mucosal released CAF is a promising technique in which the CAF technique alone may not be an indication.

KEY POINTS

This technique has the following advantages: Reduce the need of harvesting soft tissue grafts. Reduce the amount of cutting of muscles and vessels from the inner portion of the flap. Minimal postoperative discomfort for the patient.

Evaluation of oral health among people with multimorbidity in the marginalized population of Karachi, Pakistan: A multicenter cross-sectional study

Background

Oral health is linked to physical and mental well-being. Oral disease is common among poor and socioeconomically disadvantaged people in developing and industrialized countries.

Objectives

This study assessed the oral health disease burden among people with multimorbidity in marginalized populations.

Methods

This cross-sectional study was conducted across 16 locations in the slums of Karachi, Pakistan, to assess oral health disease problems among adults aged 18 to 70 with comorbidity or multimorbidity. The questionnaire covered the socioethnic, demographic, and disease status of people with oral health status. Data analyses were performed using SAS version 9.4.

Results

Of the 16 designated slum locations, 870 individuals were considered for oral health screening. Gingivitis was highly prevalent, 29% among slum dwellers with multimorbidity of diabetes, hepatitis, and hypertension. Dandasa was widely used as a tooth-cleansing agent in 35% of the study population. By contrast, 45.4% of people showed unsatisfactory oral hygiene conditions. Pathan ethnicity showed the highest prevalence (i.e., 29.8% of dental problems with disease multimorbidity in 26.8% of Baldia Town residents of Karachi). Of the 870 individuals, the highest frequency of dental problems was found in the age group of 18-38 years (28-42.9%) and among female participants (53.8%).

Conclusion

There is an urgent need for the global enhancement of public health programs, specifically focusing on implementing effective strategies to prevent oral illnesses, promote oral health, and address other chronic diseases in basic healthcare settings. Enhancing oral health poses significant difficulties, especially in less developed nations.

Treatment of Multiple RT1 Gingival Recessions Using a Coronally Advanced Flap Associated with L-PRF or Subgingival Connective Tissue Graft from Maxillary Tuberosity: A Randomized, Controlled Clinical Trial

The goal of plastic periodontal surgery is to obtain complete root coverage, increasing gingival thickness (GT), a positive prognostic factor for gingival margin stability over time. The aim of this study was to compare the effectiveness of the Coronally Advanced Flap (CAF) in RT1 (GR; gingival recession with no loss of interproximal attachment) when associated with a connective tissue graft from the maxillary tuberosity (tCTG) or with leukocyte and platelet-rich fibrin (L-PRF) membranes in obtaining root coverage and increasing the thickness and width of the keratinized tissue, along with aesthetic improvement, taking into account a number of patient-related outcomes. Thirty patients with two adjacent RT1 GRs (GRs with no loss of interproximal attachment) were each treated using CAF associated with tCTG (15 patients) or L-PRF. The main outcome was a GT increase; secondary outcomes were keratinized tissue width (KT), gingival recession (GR), probing depth (PD), clinical attachment level (CAL), root coverage percentage (RC%), complete root coverage (CRC), and root coverage esthetic score (RES). Patient-reported outcomes were discomfort (D), dentine hypersensitivity (DH), patient-related esthetic score (PRES), and overall treatment satisfaction (OTS). After 12 months, clinical and patient-reported parameters did not show significant differences between groups, with the only exception being a GT gain, which was significantly greater in the CAF + tCTG group. Our results showed that both techniques were effective in treating RT1 GRs, with comparable patient-related outcomes. However, the use of tCTG produces significantly thicker tissue, covering the exposed root surface.

Mechanical plaque removal in step-1 of care

Maintaining a regular oral hygiene routine is essential for taking care of our mouths, ensuring healthy teeth, and achieving fresh breath. Patient education on oral hygiene is an important component of their overall treatment. Firstly, patients should be informed about the direct connection between bacteria in dental plaque and oral diseases. It is important for patients to understand that these conditions can be treated, but the success of treatment greatly depends on their level of oral hygiene. This journey begins by selecting the appropriate toothbrush and mastering the correct brushing technique to effectively remove dental plaque while avoiding any potential damage to the gums. In addition to toothbrushes, there are other devices available for comprehensive dental cleaning, such as floss, interdental sticks, interdental brushes, and oral irrigators. These aids are particularly beneficial for eliminating dental plaque from hard-to-reach areas. Moreover, tongue brushing or tongue scraping can effectively reduce breath odor and tongue coating. Currently, self-care recommendations for dental implants are primarily based on existing knowledge regarding natural teeth cleaning. Evidence-based recommendations are derived from comprehensive systematic evaluation of various oral hygiene aids.

Lower incisor inclination and thickness of the alveolar process and mandibular symphysis in the development of gingival recession: A retrospective cohort study

Introduction

Retrospective studies have found conflicting results regarding the relationship between lower incisor inclination and the development of gingival recession (GR) after orthodontic treatment.

Objective

This study aimed to investigate the relationship between lower incisor inclination and alveolar process (AP) and mandibular symphysis (MS) thickness in the development of GR.

Materials and Methods

Frontal intraoral photography and cephalometric radiography were conducted before (T0) and after (T1) orthodontic treatment of 62 subjects. The presence of GR was considered when the cementoenamel junction was visible in the lower incisor on the frontal intraoral photograph. The circumstances for improvement, stability, and worsening of the gingival situation were based on the reduction, maintenance, and increase in the number of lower incisors with GR before and after treatment. To measure the incisor-mandibular plane angle (IMPA) and the thickness of the AP and the MS were used the cephalometric radiographs.

Results

Men had a significantly thicker MS than women at T0 and T1 (p < 0.0004). There was a significant reduction of approximately 10% in AP between T0 and T1 (p < 0.0001). Among subjects without GR at T0, 70.4% presented a stable gingival situation at T1. For subjects with 1 lower incisor with GR at T0, 50% showed improvement in the gingival situation at T1, 21.4% remained stable, and 28.6% experienced worsening. Sixteen lateral incisors presented a worsening gingival situation, representing an increase of 129% compared to the central incisors.

Conclusion

No relationship was found between lower incisor inclination and the thickness of the AP and MS in the development of GR.

Complications and treatment errors in root coverage procedures

Root coverage procedures have become very common in clinical dental practice. Even though these techniques are considered safe, the clinician may face several issues during the therapy due to their surgical nature. Some of these issues can be defined strictly as complications inherent to the procedure, whereas others are medical errors or treatment errors. This review will focus on describing treatment errors and complications that may arise during different phases of the root coverage therapeutic process and on how to prevent and manage them.

Comparative study of the modified VISTA technique (m-VISTA) versus the coronally advanced flap (CAF) in the treatment of multiple Miller class III/RT2 recessions: a randomized clinical trial

OBJECTIVES

To compare the percentage of mean root coverage (MRC%) obtained in the treatment of multiple Miller class III/RT2 gingival recessions using the modified VISTA (m-VISTA) technique versus the coronally advanced flap (CAF) technique, using a connective tissue graft (CTG) in both cases.

MATERIALS AND METHODS

Twenty-four patients were randomly treated with m-VISTA (test group (TG) = 12) or CAF (control group (CG) = 12). A calibrated, experienced, and blinded examiner collected data related to multiple periodontal clinical variables, especially the recession (REC) in order to calculate the MRC% at 6 and 12 months, which was the primary outcome of the study. Also, the radiological bone level, the characteristics of the CTG, and postsurgical incidences were assessed. Finally, a descriptive and an analytical statistical analysis of the variables and their associations was performed.

RESULTS

The recessions (n = 84) were located mainly in the mandible (n = 65) and in posterior sectors (premolars: n = 35; molars: n = 8). At 6 months, the MRC% was 61% (2 mm) for both study groups, and at 12 months, it increased to 73.26% (2.11 mm) in the TG and decreased to 56.49% (1.78 mm) in the CG.

CONCLUSION

When approaching multiple Miller class III/RT2 recessions, there were no statistically significant differences in the MRC% at 6 and 12 months between the group treated with the m-VISTA technique and the group treated with the CAF.

CLINICAL RELEVANCE

The characteristics of the m-VISTA technique, such as the closed approach, the mobilization of the papilla, and the coronal stabilization of the CTG, could facilitate the maturation of the tissues in the treatment of Miller class III/RT2 recessions. This would favor better root coverage.

TRIAL REGISTRATION

NCT03258996.

Prevalence of gingival recession and associated etiological factors among the school children

OBJECTIVE

The objective of this study is to assess the prevalence of gingival recession (GR) and associated etiological factors among school children.

METHODOLOGY

The study sample consisted of 2095 children from the Nellore region divided into three groups of age ranges from primary dentition (<7 years), mixed dentition (7-12 years), and permanent dentition (>12 years) respectively, attending the department of pediatric and preventive dentistry and the school dental health programs organized by the department. The clinical examination involved measuring GR using William's periodontal probe and evaluating associated etiological factors. Data were statistically analyzed using the Chi-square test.

RESULTS

The GR among the study population was 7.9% (n = 165). Among them, males were 46% and females were 54% (P > 0.05). The GR was more in children in the 7-12 years age group (75%), followed by <7 years (21%) and >12 years (4%) age groups. The associated factors include malocclusion (69%), deleterious habits (5%), and anomalies (26%). Anomalies showed an association with GR (P < 0.05) compared to malocclusion and deleteriousness habits (P > 0.05).

CONCLUSION

The prevalence of GR is 7.9%, and GR is more prevalent in males and the 7-12 years age group. GR is associated with transient malocclusion, deleterious habits, and anomalies.

Rethinking the decision-making process to treat gingival recession associated with non-carious cervical lesions

The presence of a tooth-surface defect, such as a non-carious cervical lesion (NCCL), associated with sites of gingival recession (GR) defects creates a combined soft tissue/tooth defect (CD) that requires a different treatment plan. This study aimed to critically review the literature regarding the available treatment protocols for CDs and suggest a new decision-making process. NCCLs were classified as Class A-: the cementoenamel junction (CEJ) was visible and the root surface discrepancy was < 0.5 mm (no step); Class A+: CEJ was visible and the root surface discrepancy was > 0.5 mm (with a step); Class B-: unidentifiable CEJ without a step; Class B+: unidentifiable CEJ with a step. NCCLs affecting both root and crown surfaces (Class B) lead to CEJ destruction and consequently eliminate an important landmark used before and after root coverage procedures. The depth of the root surface discrepancy is vital owing to its possible impact on soft tissue adaptation after healing, which, in turn, may influence the treatment options, namely the use of graft and/or composites to compensate for the discrepancy. Clinically, a step with horizontal depth greater than 0.5 mm should be recognized as the minimum threshold value to define this condition. Extremely deep defects tend to assume a V-shaped topography. Therefore, extremely deep V-shaped defects were classified into subclasses A+V, a V-shaped defect, and B+V, a V-shaped defect with loss of CEJ, for management considerations. The treatment options, supported by the literature, and a decision-making process to deal with each condition are presented.

The use of medium bristle toothbrushes is associated with the incidence of gingival fissures

OBJECTIVES

The objective of this study was to compare the incidence of gingival fissures (GF) associated with the use of soft and medium bristle toothbrushes over three months.

MATERIAL AND METHODS

A blind randomized crossover clinical trial was conducted with 20 high school students (14 females, 14-24 years old) using both toothbrushes type (soft and medium bristle) during 3 months each. Periodontal examinations and photographs of premolars and molars were recorded on days 0, 30, 60, and 90 of 1st phase. Following a 10-day washout period, the 2nd phase was carried out with the participants changing the assigned brush type. Toothbrushing perception was evaluated at the end of study through a questionnaire. A calibrated and blind examiner analyzed the photographs for GF presence. Differences in the GF incidence between toothbrushes type were analyzed by McNemar test, while factors associated with GF incidence were investigated by Poisson regression.

RESULTS

Sixty-five percent (n = 13) of participants had at least one GF throughout the study, with 40% (n = 8) of them while using medium brushes only (p = 0.039). GF occurrence was significantly associated with medium brushes (IRR, 3.582; 95% CI 1.459-8.795; p = 0.005). 58.8% of participants reported gingival soreness or bleeding with medium brushes.

CONCLUSIONS

Both toothbrushes led to the GF occurrence. Nonetheless, medium bristles toothbrushes determined a 3.58 times greater risk of developing these lesions. Clinical relevance The use of medium bristle brush is associated with greater incidence of gingival fissures. The presence of gingival fissures should be considered by the clinician when evaluating the toothbrushing habits of patients.

Treatment of Gingival Recession: When and How?

Gingival recession is a common finding in daily clinical practice. Several issues may be associated with the apical shift of the gingival margin such as dentine hypersensitivity, root caries, non-carious cervical lesions (NCCLs), and compromised aesthetics. The first step in an effective management and prevention program is to identify susceptibility factors and modifiable conditions associated with gingival recession. Non-surgical treatment options for gingival recession defects include establishment of optimal plaque control, removal of overhanging subgingival restorations, behaviour change interventions, and use of desensitising agents. In cases where a surgical approach is indicated, coronally advanced flap and tunnelling procedures combined with a connective tissue graft are considered the most predictable treatment options for single and multiple recession defects. If there is a contraindication for harvesting a connective tissue graft from the palate or the patient wants to avoid a donor site surgery, adjunctive use of acellular dermal matrices, collagen matrices, and/or enamel matrix derivatives can be a valuable treatment alternative. For gingival recession defects associated with NCCLs a combined restorative-surgical approach can provide favourable clinical outcomes. If a patient refuses a surgical intervention or there are other contraindications for an invasive approach, gingival conditions should be maintained with preventive measures. This paper gives a concise review on when and how to treat gingival recession defects.

Contemporary practices for mechanical oral hygiene to prevent periodontal disease

It is well established that dental plaque on teeth leads to gingivitis and periodontitis, and that several mechanical and chemical methods of plaque control can prevent gingivitis. The aim of the current review is to summarize and synthesize the available scientific evidence supporting practices for mechanical oral hygiene to prevent periodontal diseases. Evidence for contemporary practices of mechanical oral hygiene to prevent periodontal disease relies on studies of gingivitis patients. General recommendations concerning the ideal oral hygiene devices and procedures are still inconclusive. However, toothbrushing and interdental cleaning remain the mainstays of prevention of periodontal diseases. The primary approach requires individually tailored instruction for implementation of a systematic oral hygiene regimen.

Evaluation of root coverage with pedicled buccal fat pad in class III and class IV gingival recession defects

Background:

Gingival recession (GR) is a common clinical feature of periodontal disease and is an undesirable condition. More than 50% of the population has one or more sites with GR ≥ 1 mm.

Material and Methods:

In this study 15 subjects were subjected to initial periodontal therapy such as ultrasonic scaling and root planning with hand instruments and curettes. Patient is motivated for home care. The buccal fat pad is harvested and sutured in the gingival recession area and followed up for 6 months and root coverage was calculated.

Results:

At baseline mean recession of 5.60 ± 1.18 mm, probing depth of 0.73 ± 0.59 mm, clinical attachment loss of 6.40 ± 1.18 mm were recorded. At the end of 6 months, the mean recession was reduced from 5.60 ± 1.18 mm to 2.87 ± 0.74 mm, probing depth was increased from 0.73 ± 0.59 mm to 1.73 ± 0.70 mm and clinical attachment loss was decreased from 6.40 ± 1.18 mm to 4.53 ± 0.83 mm.The difference between baseline score and six months score for all three parameters are statistically significant.

Conclusion:

Buccal fat pad is a predictable procedure to cover Miller's class III and class IV gingival recession defects. There was a definitive improvement in clinical parameters (reduction in gingival recession, increased probing depth, gain in clinical attachment) after 6 months. There was 46.78% improvement in root coverage which was statistically significant.

The Clinical Evaluation of the Effects of Low-Level Laser Therapy on the Donor and Recipient Sites of the Free Gingival Graft: A Case Series

Introduction: Free gingival grafting is among the most foreseeing procedures for increasing the zone of keratinized attached gingiva and enhancing soft tissue around the teeth and dental implants. Nowadays low-level laser therapy (LLLT) is a promising approach in providing patients with more pleasing results in terms of esthetics and comfort. This study aims to investigate the effects of LLLT on gingival recessions treated with free gingival graft (FGG). Methods: This case series was conducted on 12 individuals requiring a bilateral gingival graft in the mandibular region. There was a 30-day interval between the two operations. The test side was selected randomly and irradiated by a low-level laser (LLL) just before surgery. The patients did not know which side was irradiated. LLLT was applied to the donors' as well as recipients' site immediately after the operation and 48 hours later. The patients were instructed to record their post-operative pain in a visual analogue scale (VAS) 3 and 24 hours and 7 days after the surgical procedure. The clinical photographs were taken immediately and 30 days after surgical treatment were graded by three experienced periodontists for color matching to adjacent tissues. Results: Ten individuals could finish the study. The test group presented significantly better shade matching and wound healing at the palatal donor site on days 7, 14 and 21. There was a significant reduction in post-operative pain after 24 hours (P = 0.007). No statistically significant difference was found between both groups in terms of clinical periodontal indices. Conclusion: LLLT could reduce post-operative pain 24 hours after surgical treatment. Furthermore, the application of LLLT could improve the donors' site healing and the recipients' site color matching.

[Modified tunnel technique applied in the treatment of gingival recessions with non-carious cervical lesion]

OBJECTIVE

This study aimed to investigate the clinical effect of modified tunnel technique (MTUN) in the treatment of gingival recession with non-carious cervical lesion (NCCL).

METHODS

Forty-two teeth with Miller I degree gingival recession were divided into the NCCL group or control group depending on whether NCCL was present. Both groups were treated with MTUN plus subepithelial connective tissue. The periodontal probing depth (PD), gingival recession height (GRH), gingival recession width (GRW), attached gingival width (AGW), and clinical attachment loss (CAL) were recorded before and at 3 and 6 months after operation. The mean root coverage (MRC) at 6 months after operation was calculated and analyzed. A root coverage esthetic scoring system was used to record aesthetic scores.

RESULTS

GRH, GRW, and CAL of the two groups after surgery were significantly lower than those before surgery, and no significant changes in PD and AGW were observed. The MRC in the NCCL group was 63.40%±28.02%, whereas that in the control group was 67.00%±21.72%; no significant difference between the two groups was found. In terms of aesthetic outcomes, no significant difference between groups was reported.

CONCLUSIONS

MTUN can effectively improve gingival recession, and the presence of shallow NCCL (≤1 mm) will not affect the surgical effect of MTUN.

Root coverage with coronally advanced flap:6-year follow-up

AIM

The aim of this study was to evaluate the long-term stability of root coverage without a regular control programme after coronally advanced flap (CAF) procedures in isolated gingival recessions.

MATERIAL AND METHODS

Recession defects were treated with CAF using microsurgery technique. Probing depth, clinical attachment level, keratinized gingival width, plaque index, papilla bleeding index, recession depth, recession width and root surface area was evaluated at baseline, and then postoperative 6-month and 6-year follow-up sessions. Percentages of root coverage and complete root coverage rates were also calculated.

RESULTS

In total, 12 defects in 12 patients of the 36 defects in 30 patients were available for analysis at the 6-year follow-up examination (66.7% of the initial sites could be reached). Percentage of mean root coverage was 95.06% at 6-month and 69.27% at 6-year and the difference was statistically significant (P < 0.05). Complete root coverage rate decreased from 75% (at 6-month) to 50% (at 6-year), but the difference was not statistically significant (P > 0.05).

CONCLUSION

Within the limits of this long-term follow-up study, there seems to be a rather high risk for relapse after root coverage with CAF possibly due to the lack of regular recalls and persistent traumatic tooth brushing habits.

Are bristle stiffness and bristle end-shape related to adverse effects on soft tissues during toothbrushing? A systematic review

BACKGROUND

Toothbrushing might be associated with the development of soft tissue lesions. This systemic review aimed to examine soft tissue lesions caused by different bristle stiffnesses and bristle end-shapes in manual toothbrushes in adult individuals.

MATERIALS AND METHODS

Scopus, EMBASE and PubMed databases were searched to find controlled trials that evaluated manual toothbrush bristle stiffness and/or end-shape in regard to soft tissue safety. The grey literature was also included in the search strategy. Two reviewers independently performed the screening, final selection and data extraction. To be included, studies had to have been performed using at least two manual toothbrushes differing in bristle stiffness and/or end-shape, and had to report any adverse effects on oral soft tissues after at least 7 days of follow-up. A meta-ethnography strategy was used for qualitative data synthesis. The Cochrane Collaboration tool was assessed to evaluate the risk of bias.

RESULTS

Thirteen studies were included from the 1,945 initially retrieved. Toothbrush bristle end-shape was investigated in six studies, bristle stiffness in two, and both features were investigated in five studies. Hard-bristle toothbrushes produced more gingival lesions than medium- and soft-bristle brushes. A slight gingival recession width increase was identified in the end-rounded group, compared with the tapered group. Only four studies presented adverse effects as the primary outcome.

CONCLUSION

Soft and extra-soft toothbrushes tend to be safer. Oral soft tissue injuries are similar for both tapered and end-rounded bristles. Further studies investigating adverse effects as a primary outcome are recommended.

Periodontal clinical evaluation before and after surgically assisted rapid maxillary expansion

Introduction:

The surgically assisted rapid maxillary expansion is a procedure that reduces the resistance of the sutures correcting the posterior crossbite in adults.

Objective:

The aim of this study was to evaluate the periodontal status of 17 adults submitted to this procedure.

Methods:

The clinical attachment level (CAL), gingival recession, attached gingiva and bleeding were evaluated in maxillary first premolars and molars, central and lateral incisors of right and left sides before surgery, 5 days and 6 months after. Means, standard deviation, medians, minimum and maximum values were compared among the evaluations using the Friedman and McNemar tests.

Results:

There was a statistically significant increase in CAL in the right central incisor, right and left premolars and right and left molars. There was a statistically significant increase in gingival recession in the right and left premolars and molars. The amount of attached gingiva significantly decreased in right premolars and right and left molars. There was increase in bleeding in most of the teeth.

Conclusion:

Results indicated that the surgically assisted rapid maxillary expansion might cause alterations in periodontal tissue.

Exploring the Gingival Recession Surgical Treatment Modalities: A Literature Review

Gingival recessions present complex soft tissue pathology, with a multiple aetiology and a high prevalence which increases with age. They are defined as an exposure of the root surface of the teeth as a result of the apical migration of the gingival margin beyond the cementum-enamel junction, causing functional and aesthetic disturbances to the affected individuals. Aiming to ensure complete root coverage and satisfying aesthetic outcomes, a wide range of surgical techniques have been proposed through the decades for the treatment of the gingival recessions. The following literature review attempts to provide a comprehensive, structured and up-to-date summary of the relevant literature regarding these surgical techniques, aiming to emphasise for each technique its indications, its long-term success and predictability, its advantages and disadvantages about each other.

Fifteen-Year Follow-Up of a Case of Surgical Retreatment of a Single Gingival Recession

Purpose

The aim of the present case report was to describe the retreatment of the single gingival recession in aesthetic area, in the presence of scar formation and consequent impairment of aesthetic appearance.

Methods

A young patient with one single recession of 4 mm of 2.1 was treated with coronally advanced flap and subepithelial connective tissue graft, through a microsurgical approach that aimed at the removal of the scarred fibrous tissue. The intervention was performed using a surgical microscope as a magnification device.

Results

Fifteen years after the surgical treatment, a substantial stable resolution of the gingival recession could be observed. Moreover, a further improvement of the aesthetic appearance could be observed.

Conclusions

This case report suggests that periodontal microsurgery could be an effective approach for the retreatment of gingival recessions and, in long-term evaluation, to reduce the aesthetic problem due to the presence of scar formation. Further studies with a larger sample size are needed to better evaluate its efficacy.

Association between oral health behavior and periodontal disease among Korean adults: The Korea national health and nutrition examination survey

This study was performed to assess the association between oral health behavior and periodontal disease using nationally representative data.This study involved a cross-sectional analysis and multivariable logistic regression analysis models using the data from the Korean National Health and Nutrition Examination Survey. A community periodontal index greater than or equal to code 3 was used to define periodontal disease.Adjusted odds ratios and their 95% confidence intervals of periodontitis for the toothbrushing after lunch group and the toothbrushing before bedtime group were 0.842 (0.758, 0.936) and 0.814 (0.728, 0.911), respectively, after adjustments for age, sex, body mass index, drinking, exercise, education, income, white blood cell count, and metabolic syndrome. Adjusted odds ratios and their 95% confidence intervals of periodontitis for the floss group and the powered toothbrush group after adjustment were 0.678 (0.588, 0.781) and 0.771 (0.610, 0.974), respectively.The association between oral health behavior and periodontitis was proven by multiple logistic regression analyses after adjusting for confounding factors among Korean adults. Brushing after lunch and before bedtime as well as the use of floss and a powered toothbrush may be considered independent risk indicators of periodontal disease among Korean adults.

Coronally advanced flap with or without porcine collagen matrix for root coverage: a randomized clinical trial

OBJECTIVES

The objective of this study is to clinically evaluate the outcomes following treatment of single gingival recessions with either coronally advanced flap technique (CAF) alone or combined with a porcine collagen matrix graft (CM).

MATERIALS AND METHODS

This is a randomized parallel design clinical trial, including forty patients with single Miller Class I or II gingival recession, with a depth ≥ 2 mm and located at upper canines or premolars. The patients were randomly assigned to receive either CAF or CAF + CM. The primary outcome variable was gingival recession reduction (Rec Red).

RESULTS

Baseline recession depth was 3.14 ± 0.51 mm for CAF group and 3.16 ± 0.65 mm for CAF + CM group (p > 0.05). Both groups showed significant Rec Red (p < 0.05), up to 6 months. Rec Red for CAF + CM was 2.41 ± 0.73 mm and was 2.25 ± 0.50 mm for CAF alone (p > 0.05). Root coverage was 77.2 % in the CAF + CM group and 72.1 % in the CAF group (p > 0.05). Complete root coverage (CRC) was found in 40 % of the cases in the CAF + CM group and in 35 % of the sites treated with CAF. Keratinized tissue thickness (KTT) was 0.26 mm higher in CAF + CM group (p < 0.05).

CONCLUSIONS

It can be concluded that CAF + CM does not provide a superior recession reduction when compared to CAF; however, it may offer a small gain in KTT after 6 months.

CLINICAL RELEVANCE

CAF + CM can be suggested as a valid therapeutic option to achieve root coverage and some increase in soft tissue thickness after 6 months.

Comparative evaluation of enamel abrasivity by toothbrush and velcro: An in vitro scanning electron microscope study

Context:

Plaque control has been shown to be pivotal in maintaining the optimal periodontal health. Mechanical plaque control is the most popular option for establishing the optimal oral health. Toothbrushes have been the novel tool for mechanical cleansing. However, the abrasive potential of the toothbrushes on the enamel surface is an area in gray.

Aims:

The aim of this in vitro study is to evaluate the abrasivity of the toothbrush versus the velcro fasteners.

Materials and Methods:

The mounted teeth of both the groups were subjected to abrasion test, and the tooth surfaces were observed for the possible abrasions from the oscillating strokes (toothbrush) and frictional contacts (hook and loop velcro) and examined under the scanning electron microscope.

Results:

Comparative assessment of both velcro (hook and loop) and toothbrush bristles did not reveal any evidence of abrasion on the tooth specimens.

Conclusions:

Veclro fasteners are safe and qualitatively at par to the manual toothbrush for their efficacy and efficiency in teeth cleansing

Comparative evaluation of envelope type of advanced flap with and without type I collagen membrane (NEOMEM™) in the treatment of multiple buccal gingival recession defects: A clinical study

BACKGROUND

The aim of this study is to compare and evaluate the clinical outcome of the envelope-type of coronally advanced flap (CAF) alone versus envelope type of coronally advanced flap plus type I collagen membrane (NEOMEM) in the treatment of multiple buccal gingival recessions, using the split mouth study.

MATERIALS AND METHODS

Ten patients in the age group of 20-50 years showing bilateral gingival recessions were treated. The defects in each patient were randomly assigned as Group A, which were treated with the envelope type of CAF, and those in Group B were treated with envelope type of CAF along with the Type I collagen membrane (NEOMEM). The recession depth (RD), probing depth (PD), clinical attachment level (CAL), and width of the keratinized tissue (KT) were measured at baseline, at three and six month intervals.

RESULTS

Forty-six Miller's class I and II gingival recessions were treated. In the CAF + Type I collagen membrane (NEOMEM)-treated (Group B) sites the baseline gingival recession was 2.34 ± 0.48 mm, while in the CAFtreated (Group A) sites it was 2.52 ± 0.84 mm. Both the treatments resulted in significant recession depth reduction (P < 0.001), but the reduction was significantly greater (P < 0.01) for Group B than Group A. The probing depth changes were significant (P < 0.01) for both groups, but the difference was nonsignificant. Similarly, a significant gain of CAL was seen in Group B (2.23 ± 0.75 mm, P < 0.001) as well as in group A (1.60 ± 0.86 mm, P < 0.001) showing a significant difference (P < 0.01) between the two groups. The width of keratinized tissue was also significantly (P < 0.001) increased in both groups, but the increase was significantly greater (P < 0.001) in group B (2.30 ± 1.06 mm) than in group A (1.21 ± 0.67 mm).

CONCLUSION

The envelope type of CAF along with Type I collagen membrane (NEOMEM) was more effective than envelope type of CAF alone, in producing root coverage in multiple gingival recession defects, associated with gain in CAL as also in the width of KT.

Gingival abrasion and recession in manual and oscillating-rotating power brush users

OBJECTIVE

To assess gingival recession (GR) in manual and power toothbrush users and evaluate the relationship between GR and gingival abrasion scores (GA).

METHODS

This was an observational (cross-sectional), single-centre, examiner-blind study involving a single-brushing exercise, with 181 young adult participants: 90 manual brush users and 91 oscillating-rotating power brush users. Participants were assessed for GR and GA as primary response variables. Secondary response variables were the level of gingival inflammation, plaque score reduction and brushing duration. Pearson correlation was used to describe the relationship between number of recession sites and number of abrasions. Prebrushing (baseline) and post-brushing GA and plaque scores were assessed and differences analysed using paired tests. Two-sample t-test was used to analyse group differences; ancova was used for analyses of post-brushing changes with baseline as covariate.

RESULTS

Overall, 97.8% of the study population had at least one site of ≥1 mm of gingival recession. For the manual group, this percentage was 98.9%, and for the power group, this percentage was 96.7% (P = 0.621). Post-brushing, the power group showed a significantly smaller GA increase than the manual group (P = 0.004); however, there was no significant correlation between number of recession sites and number of abrasions for either group (P ≥ 0.327).

CONCLUSIONS

Little gingival recession was observed in either toothbrush user group; the observed GR levels were comparable. Lower post-brushing gingival abrasion levels were seen in the power group. There was no correlation between gingival abrasion as a result of brushing and the observed gingival recession following use of either toothbrush.

Reliability study of Mahajan's classification of gingival recession: A pioneer clinical study

BACKGROUND

Gingival recession defects (GRD) are one of the most commonly encountered conditions for which periodontal treatment is required. Several attempts have been made to classify GRD. Among all the classifications Millers classification for gingival recessions is the most accepted. Recently, several limitations and drawbacks have been pointed out in Miller's classification system. The aim of the present study is to test the reliability of the recently proposed Mahajan's Modification of the Miller's Classification for GRD.

MATERIALS AND METHODS

All 15 males and 11 females between the ages of 22 and 55 years (mean age, 37.15 year) with at least one buccal gingival recession were consecutively recruited by the same periodontist in order to test the reliability of the new classification of GRD. The classification was tested by two examiners blinded to the data collected by the other examiner. Intra-rater and inter-rater agreement was assessed.

RESULTS

The new classification system of gingival recessions was tested in a total of 175 gingival recessions in 26 patients. The intraclass correlation coefficient for inter-rater agreement was 0.90, showing an almost perfect agreement between the examiners.

CONCLUSION

The newly proposed classification system eliminates the drawbacks and limitations associated with Miller's classification system and can be used to classify GRD reliably.

Root caries: a periodontal perspective

BACKGROUND AND OBJECTIVE

A prevailing dental problem in the periodontal patient is root caries. Specifically, periodontal involvement often results in root surfaces becoming exposed and at risk for this condition. Periodontal therapy often leads to increased gingival recession as well, and the associated increased root caries risk may compromise the long-term success and survival of periodontally treated teeth.This narrative review will address the topic of root caries in the periodontal patient, focusing on unmet research needs.

MATERIAL AND METHODS

The Medline database was searched to identify items dealing with root caries, in terms of clinical features, diagnosis, pathogenic mechanisms and histopathology, as well as epidemiology, focusing then on the relationship between root caries and periodontal disorders.

RESULTS

Although there is extensive literature on root caries, consensus is lacking regarding certain aspects, such as diagnostic criteria, prevalence within populations and indisputable risk factors. Advancing age could be an aggravating factor in susceptibility to root caries for the periodontal patient; however, definitive evidence in this regard is still missing. Similarly, full awareness of the increased risk of root caries in patients with periodontal disease or long-term periodontal treatment appears to be still lacking.

CONCLUSION

Research regarding root caries in age-specific (elderly) periodontal patients is needed. Improved oral hygiene practices, locally applied preventive measures, good dietary habits and regular dental check-ups are crucial approaches to prevent both periodontal disease progression and root caries. Periodontal patients with root exposure should follow a strict root caries prevention protocol, as an integral component of their periodontal maintenance therapy.

Coronally advanced flap and combination therapy for root coverage. Clinical strategies based on scientific evidence and clinical experience

During the past three decades, several surgical techniques have been proposed to treat single and multiple gingival recessions. Evidence indicates that coronally advanced flap-based approaches result in the best clinical results. Among all the different techniques, the use of a graft under a coronally advanced flap results in the best short- and long-term outcomes in terms of root coverage and gain in keratinized tissue. The use of a coronally advanced flap + connective tissue graft would appear to be the best choice for root coverage. However, harvesting a graft from the palate adds morbidity, surgical chair-time and requires increased surgical skills. A potential alternative could be the use of enamel matrix derivatives under a coronally advanced flap, and this achieves similar clinical outcomes and is less invasive, but adds economic costs to the treatment. Evidence shows that a coronally advanced flap alone in many instances results in complete root coverage and is stable over time. A coronally advanced flap is less invasive for the patient, requires less chair-time and probably less surgical skill. It would therefore be desirable to use a coronally advanced flap approach when indicated. It has been hypothesized that a coronally advanced flap approach alone could be successfully applied when the residual gingiva is thick and wide, although existing evidence does not support this hypothesis in full. Accordingly, the adjunctive use of a graft or enamel matrix derivatives could be restricted to sites at which there is thin and narrow residual gingiva.

Gingival recession: prevalence, extension and severity in adults

The gingival recession was assessed in 380 adult individuals aged more than 20 years and comprised both subjects being treated and looking for treatment at Bauru Dental School. Clinical evaluation was conducted by a single examiner in all teeth and involved analysis of four dental aspects (mesial, buccal, distal and lingual). The gingival recession was regarded as present whenever more than 1mm of root surface was exposed, and its vertical width was measured in millimeters from the cementoenamel junction to the gingival margin. The recessions were further scored following the criteria suggested by Miller in 1985. Gingival recession was observed in at least one dental surface in about 89% of the individuals analyzed. The prevalence, extension and severity of this clinical aspect increased with age. Class I recessions were the most frequent, yet there was a gradual increase of Class III and IV recessions as older subjects were evaluated. The mandibular teeth displayed more surfaces with gingival recession than the maxillary teeth and the mandibular incisors were the most affected teeth. Such high prevalence of gingival recession in adult patients demonstrates that dental professionals should provide attention to the clinical relevance of such alterations, as well as to the diagnosis of the etiologic factors.