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Di Gianfilippo R, Pini Prato G, Franceschi D, Castelluzzo W, Barbato L, Bandel A, Di Martino M, Pannuti CM, Chambrone L, Cairo F. Diagnostic reproducibility of the 2018 Classification of Gingival Recessions: Comparing photographic and in-person diagnoses. J Periodontol 2024. [PMID: 39185680 DOI: 10.1002/jper.24-0173] [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: 03/11/2024] [Revised: 07/01/2024] [Accepted: 07/30/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND To assess how the diagnostic reproducibility of the 2018 Classification of Gingival Recession Defects (GRD) could be applied when comparing in-person chairside measurements with photographic measurements. METHODS Thirty-four GRD were photographed and evaluated by 4 masked operators. For each case, the operators measured twice recession type (RT), recession depth (RD), keratinized tissue width (KTW), gingival thickness (GT), detectability of the cemento-enamel junction (CEJ), and presence of root steps (RSs), chairside, and on photographs. Intraclass correlation coefficient (ICC) with 95% confidence intervals (CI) was calculated for RD and KTW; Kappa with 95% CI was used for GT, CEJ, and RS; quadratic weighted Kappa with 95% CI was used for RT. RESULTS RD, KTW, and RT showed excellent overall intra-operator agreement (> 0.93), and from good to excellent overall inter-operator agreement (> 0.80), for both clinical and photographic measurements. Agreements were lower for GT, CEJ, and RS. Overall clinical and photographic agreements were within 0.1 difference for every variable, except for inter-operator agreement for RS which was 0.72 for clinical measurements and 0.45 for photographic measurements. The lowest overall agreement between clinical versus photographic measurements existed for CEJ (0.28) and RS (0.35). CONCLUSIONS Variables composing the 2018 Classification of GRD are reproducible, both clinically and on photographs, with comparable agreements. The overall agreement was higher for KTW, RD, and RT, and lower for GT, CEJ, and RS, for both clinical and photographic measurements. The comparison between chairside and photographic evaluations indicated fair to excellent agreement for most variables, with CEJ and RS showing fair agreement. PLAIN LANGUAGE SUMMARY As digital diagnostics evolve to facilitate clinical diagnostic measurement, we aimed to assess the effectiveness of intraoral photography for diagnosing gingival recession defects (GRD) according to the 2018 Classification of GRD, compared to traditional clinical examination. Standardized photographs of thirty-four GRD cases were captured. Four masked operators evaluated the same gingival recessions twice in a clinical setting and twice using photographs. Measurement repeatability within and between operators was calculated for both clinical and photographic settings, and the two settings were compared. Continuous measurements such as recession depth and keratinized tissue width, as well as the evaluation of interproximal attachment height (recession type), showed excellent agreement both clinically and photographically. Agreement was lower for gingival thickness and the detectability of tooth anatomical landmarks, such as the cemento-enamel junction and the presence of root steps. Overall, the agreement between chairside and photographic evaluations was generally good, but lower when evaluating tooth anatomical landmarks. The variables composing the 2018 Classification of GRD are reproducible in both clinical and photographic settings, with comparable levels of agreement. However, there was consistently worse agreement for gingival thickness and when evaluating tooth anatomical landmarks.
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Affiliation(s)
- Riccardo Di Gianfilippo
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Pacific Academy of Periodontal and Implant Research, Bellevue, Washington, USA
- Foundation for Oral Rehabilitation, Lucerne, Switzerland
| | | | - Debora Franceschi
- Department of Experimental and Clinical Medicine, The University of Florence, Florence, Italy
| | - Walter Castelluzzo
- Unit in Periodontology and Periodontal Medicine, The University of Florence, Florence, Italy
| | - Luigi Barbato
- Unit in Periodontology and Periodontal Medicine, The University of Florence, Florence, Italy
| | - Alessandra Bandel
- Unit in Periodontology and Periodontal Medicine, The University of Florence, Florence, Italy
| | - Maria Di Martino
- Unit in Periodontology and Periodontal Medicine, The University of Florence, Florence, Italy
| | - Claudio M Pannuti
- Discipline of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Leandro Chambrone
- Evidence-Based Hub, Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz-Cooperativa de Ensino Superior, Caparica, Portugal
- Department of Periodontics, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Unit of Basic Oral Investigation, Universidad El Bosque, Bogota, Colombia
| | - Francesco Cairo
- Head Research Unit in Periodontology and Periodontal Medicine, The University of Florence, Florence, Italy
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Malhotra S, Tewari S, Sharma R, Sharma RK, Tanwar N, Arora R. Clinical evaluation of root coverage in Miller class III/RT2 labial gingival recession treated with interdisciplinary periodontal-orthodontic therapy: a randomized controlled clinical trial. J Periodontal Implant Sci 2024; 54:265-279. [PMID: 38290996 PMCID: PMC11377891 DOI: 10.5051/jpis.2204100205] [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: 10/13/2022] [Revised: 03/21/2023] [Accepted: 04/30/2023] [Indexed: 02/01/2024] Open
Abstract
PURPOSE The aim of current study was to evaluate percentage root coverage (RC%) in isolated Miller class III/RT2 labial gingival recession (GR) associated with malaligned mandibular anteriors, using interdisciplinary periodontal-orthodontic treatment as compared to mucogingival surgery alone. METHODS Thirty-six systemically healthy patients having isolated Miller class III/RT2 GR with respect to malaligned mandibular anteriors, were randomly divided into test group: mucogingival surgery using subepithelial connective tissue graft followed by orthodontic treatment and control group: mucogingival surgery alone. Primary clinical parameters included (RC%), recession depth, keratinized tissue width, mid-labial clinical attachment level, interdental clinical attachment level (iCAL), periodontal phenotype (PP), gingival thickness (GT), root coverage esthetics score (RES) and hypersensitivity. Total duration of follow up was 12 months. RESULTS Mean RC% was significantly more achieved in test group (66.67%±40.82%) in comparison to control group (39.93%±31.41%) at the end of study (P=0.049). Further, complete root coverage was attained in 5/8 cases of test group versus 1/2 cases of control group after 3/12 months respectively. RES and hypersensitivity, showed statistically significant improvement after complete follow up period in both the groups. An ideal RES score of 10 was achieved in 4/7 cases of test group while in 1/2 cases of control group after 3/12 months respectively. Correlation analysis revealed significant negative correlation between RC% and iCAL. Correlation of RC% with GT and PP was non-significant. CONCLUSIONS Interdisciplinary periodontal-orthodontic approach may be more beneficial in terms of achieving improved RC%, esthetic and resolution of hypersensitivity in the management of Miller class III/RT2 GR in malaligned mandibular anteriors. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04255914.
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Affiliation(s)
- Sakshi Malhotra
- Department of Periodontics, Post Graduate Institute of Dental Sciences, Rohtak, India
| | - Shikha Tewari
- Department of Periodontics, Post Graduate Institute of Dental Sciences, Rohtak, India.
| | - Rekha Sharma
- Department of Orthodontics and Dentofacial Orthopaedics, Post Graduate Institute of Dental Sciences, Rohtak, India
| | - Rajinder Kumar Sharma
- Department of Periodontics, Post Graduate Institute of Dental Sciences, Rohtak, India
| | - Nishi Tanwar
- Department of Periodontics, Post Graduate Institute of Dental Sciences, Rohtak, India
| | - Ritika Arora
- Department of Periodontics, Post Graduate Institute of Dental Sciences, Rohtak, India
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Sutor S, Graetz C, Geiken A, Straßburger M, Löwe C, Holtmann B, Conrad J, Sälzer S, Dörfer CE. Effect of a powered and a manual toothbrush in subjects susceptible to gingival recession: A 36-month randomized controlled clinical study. Int J Dent Hyg 2024. [PMID: 38863249 DOI: 10.1111/idh.12834] [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: 09/19/2023] [Revised: 05/07/2024] [Accepted: 05/11/2024] [Indexed: 06/13/2024]
Abstract
OBJECTIVE The objective of this long-term clinical study was to evaluate the influence of a newly developed powered toothbrush (PT) on the size and number of pre-existing gingival recessions (GR) in comparison to a manual toothbrush (MT). METHODS This was a prospective, single-blind, parallel-group, randomized controlled clinical study. Participants without periodontitis, but with at least two teeth (index teeth) showing GR ≥2 mm were randomized to brush either twice daily with a MT or with a PT with a linear magnetic drive causing the round brush head to produce gentle micro vibrations along with oscillating-rotating movements. Primary outcome parameter was the mean change of GR at the index teeth over 36 months. RESULTS Totally 87 out of 92 participants completed the study (MT/PT: n = 42/n = 45). At the 36-month evaluation the mean (standard deviation) change of GR at index teeth differed significantly between MT 0.17 (0.77) and PT -0.10 (0.63) (p = 0.013). Furthermore, the amount of GR sites which improved ≥1 mm or remained stable during the study period did not differ between MT and PT, but the number of sites worsened ≥1 mm was significantly in favour for PT (MT 23 (25.5%) versus PT 10 (10.6%); p = 0.009). A binary logistic regression identified tooth type (OR = 2.991 for pre-/molar (1.096 [95% CI 1.002-8.933]; p = 0.050)) and manual brushing (OR = 3.341 (1.206 [95% CI 1291-8648]; p = 0.013)) as risk factors for recession impairment at the index teeth. There were no differences between groups for adverse events. CONCLUSION In a population with pre-existing gingival recessions and consequently a high risk of developing further recession the PT seems to be favourable with regard to further development of GR.
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Affiliation(s)
- Simone Sutor
- Clinic of Conservative Dentistry and Periodontology, University of Kiel, Kiel, Germany
| | - Christian Graetz
- Clinic of Conservative Dentistry and Periodontology, University of Kiel, Kiel, Germany
| | - Antje Geiken
- Clinic of Conservative Dentistry and Periodontology, University of Kiel, Kiel, Germany
| | - Martin Straßburger
- Clinic of Conservative Dentistry and Periodontology, University of Kiel, Kiel, Germany
| | - Carolin Löwe
- Clinic of Conservative Dentistry and Periodontology, University of Kiel, Kiel, Germany
| | - Bernhard Holtmann
- Clinic of Conservative Dentistry and Periodontology, University of Kiel, Kiel, Germany
| | - Jonas Conrad
- Clinic of Conservative Dentistry and Periodontology, University of Kiel, Kiel, Germany
| | - Sonja Sälzer
- Clinic of Conservative Dentistry and Periodontology, University of Kiel, Kiel, Germany
- Zahnarztpraxis Poststraße, Hamburg, Germany
| | - Christof E Dörfer
- Clinic of Conservative Dentistry and Periodontology, University of Kiel, Kiel, Germany
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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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Matas F, Mendieta C. A long-term longitudinal study of gingival recession in dentists: A 15-year follow-up. Int J Dent Hyg 2024; 22:339-348. [PMID: 37680082 DOI: 10.1111/idh.12745] [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: 10/15/2022] [Revised: 08/04/2023] [Accepted: 08/06/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVES To assess the prevalence, distribution pattern, and development/progression of gingival recession in a population of dentists, followed up over an additional 15 years, after an initial and previously published follow-up of 10 years. METHODS This 25-year longitudinal gingival recession investigation started in 1994 at the Dental School with 60 final-year dental students; among them, 40 were re-examined in 2004, and 27 of those 40 were further examined in 2019 by the same examiner. A questionnaire session provided information on toothbrushing habits at each appointment. RESULTS In this study, 27 individuals aged 31-44 years (724 teeth) were followed up. The prevalence of gingival recession was 100% after 15 years. A total of 204 and 317 recessions found in 2004 and 2019, respectively, were valid for the longitudinal evaluation. The highest recession incidence was observed in the molars during both examinations (p < 0.0001). The mean recession heights were 1.66 ± 0.87 mm and 1.85 ± 1.08 mm, respectively (p = 0.024). The difference between the means was 0.19 mm after 15 years. The mean probing depth and bleeding on probing at the point of the maximum recession decreased (p < 0.0001). A multiple regression analysis on the tooth level was performed and indicated that the keratinized gingival width was negatively associated with the severity of the buccal recession height. CONCLUSIONS Fifteen years after the initial follow-up, the mean number of gingival recessions per dentist and the mean recession height increased, while toothbrushing habits remained nearly unchanged.
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Affiliation(s)
| | - Carlos Mendieta
- Periodontology Unit, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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Elena RDGP, Miren VF, Ana-María GDLF, Xabier MM, Luis-Antonio AZ. Analysis of the treatment of RT2 recessions with a xenogeneic collagen matrix vs. connective tissue graft combined with a coronally advanced flap. A double-blinded randomized clinical trial. Clin Oral Investig 2024; 28:215. [PMID: 38489063 PMCID: PMC10943151 DOI: 10.1007/s00784-024-05602-9] [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: 12/08/2023] [Accepted: 03/05/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVES To compare the clinical efficacy in terms of mean root coverage in RT2 recession treated with a coronally advanced flap combined with a xenogeneic collagen matrix versus a connective tissue graft. MATERIALS AND METHODS A total of 20 patients were randomized to receive one of two treatments: coronally advanced flap + xenogeneic collagen matrix (test group) and coronally advanced flap + connective tissue graft (control group). Patient-related outcomes measures and professional aesthetic assessment by root esthetic score were performed. A descriptive and analytical statistical analysis of the variables was performed. RESULTS At 12 months, the mean root coverage was 56.48% in the test group and 69.72% in the control group (p = 0.048), with a 35% and 40% complete root coverage in the xenogeneic collagen matrix and connective tissue graft, respectively. Test group presented less pain (3.65 vs. 5.2 VAS units) (p = 0.015) and less surgical time (45 vs. 49.15 min) (p = 0.004) than control group. CONCLUSION The use of xenogeneic collagen matrix in RT2 recessions was effective for recession reduction to those obtained using autologous grafts; with the advantage that the duration of surgery and patient morbidity decreased. Therefore, xenogeneic collagen matrix in RT2 recessions could be an alternative to autologous grafts. CLINICAL RELEVANCE The use of xenogeneic collagen matrix decreases the surgery time and patient morbidity but connective tissue graft results in significantly better mean root coverage and complete root coverage. Xenogeneic collagen matrix can be used in the treatment of RT2 gingival recessions. STUDY REGISTRATION NCT03344315.
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Affiliation(s)
| | | | - García-De-La-Fuente Ana-María
- Research Group: GIU21/042. Department of Stomatology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Barrio Sarriena s/n, Biscay, Leioa, 48940, Spain.
- Research Group: GIU21/042. Department of Stomatology, University of the Basque Country (UPV/EHU), Biscay, Spain.
| | - Marichalar-Mendía Xabier
- Research Group: GIU21/042. Department of Nursery I. Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Biscay, Spain
| | - Aguirre-Zorzano Luis-Antonio
- Research Group: GIU21/042. Department of Stomatology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Barrio Sarriena s/n, Biscay, Leioa, 48940, Spain
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Fernández-Jiménez A, García-De-La-Fuente AM, Marichalar-Mendia X, Aguirre-Zorzano LA, Estefanía-Fresco R. Treatment of deep single RT2 and RT3 antero-mandibular gingival recessions with a combination of surgical techniques: A case series study. J ESTHET RESTOR DENT 2024; 36:363-372. [PMID: 37594747 DOI: 10.1111/jerd.13120] [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: 03/29/2023] [Revised: 06/18/2023] [Accepted: 07/29/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVE To evaluate root coverage (RC) in deep single antero-mandibular RT2 and RT3 gingival recessions (GR) and to investigate the influence of several factors in RC. MATERIALS AND METHODS Fifteen single antero-mandibular GR with a minimum depth of 3 mm were consecutively treated with a new one-stage technique (laterally positioned flap with a tunnel access and a connective tissue graft). At baseline and at 12-month follow-up, the percentage of mean root coverage (%MRC), the recession reduction (RecRed), complete root coverage (CRC) and the gain of keratinized tissue width (KTW) were assessed. Descriptive, intergroup comparative and correlation analyses were performed. RESULTS At 12 months, a %MRC of 77.29 ± 21.48% with a mean RecRed of 4.10 ± 1.51 mm was achieved. The %MRC was 84.71 ± 21.08% in RT2, and 62.43 ± 14.17% in RT3. The mean gain of KTW was 2.10 ± 0.89 mm, with a mean gain of 2.0 ± 1.03 mm for RT2 and 2.3 ± 0.57 mm for RT3. CRC was observed in six cases, all of them being RT2. A positive association was found between the %MRC and the initial position of the tooth and of both papillae. CONCLUSIONS This technique might be a valuable approach for the treatment of deep single antero-mandibular RT2 and RT3 recessions, even in malpositioned teeth. CLINICAL SIGNIFICANCE A combination of different surgical techniques could provide greater vascularization to the CTG especially in malpositioned teeth in sextant V with a large avascular area to be covered.
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Affiliation(s)
- A Fernández-Jiménez
- Research Group: GIU21/042, Department of Stomatology II, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - A M García-De-La-Fuente
- Research Group: GIU21/042, Department of Stomatology II, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - X Marichalar-Mendia
- Research Group: GIU21/042, Department of Nursing I, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - L A Aguirre-Zorzano
- Research Group: GIU21/042, Department of Stomatology II, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
- Clínica Dr. Aguirre, Bilbao, Spain
| | - R Estefanía-Fresco
- Research Group: GIU21/042, Department of Stomatology II, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
- Clínica Dr. Aguirre, Bilbao, Spain
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Romandini P, Marruganti C, Romandini WG, Sanz M, Grandini S, Romandini M. Are periodontitis and dental caries associated? A systematic review with meta-analyses. J Clin Periodontol 2024; 51:145-157. [PMID: 38084804 DOI: 10.1111/jcpe.13910] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 01/19/2024]
Abstract
AIM The epidemiological relationship between periodontitis and caries remains controversial, and evidence synthesis is currently lacking. Therefore, this systematic review was designed to answer the following PECO question: 'In human adults (P), do subjects suffering from periodontitis (E) have higher presence/number of untreated carious lesions and caries experience (O) than subjects not suffering from periodontitis (C)?'. MATERIALS AND METHODS Observational studies that met specific inclusion criteria established to answer to the PECO question were included. Two review authors independently searched for eligible studies, screened the titles and abstracts, carried out the full text analysis, extracted the data and performed the risk of bias assessment. In case of disagreement, a third review author took the final decision during ad hoc consensus meetings. Data synthesis was carried out through random-effects meta-analyses. RESULTS A total of 18 studies on 21 cohorts, involving 135,018 participants, were included. Meta-analyses showed a significant association between periodontitis and the presence of at least one tooth with either untreated carious lesions (odds ratio [OR] = 1.63; 95% confidence interval [CI]: 1.32-2.01; p <.00; I2 = 83.0%) or caries experience (decayed and filled teeth ≥ 1) (OR = 1.27; 95% CI: 1.01-1.59; p = .038; I2 = 90.0%). Moreover, subjects with periodontitis exhibited a higher number of surfaces (difference in means [MD] = 0.86; 95% CI: 0.46-1.27; p <.001; I2 = 0.0%) and teeth (MD = 0.35; 95% CI: 0.28-0.42; p <.001; I2 = 69.6%) with untreated carious lesions, as well as a higher number of teeth with caries experience (standardized difference in means [SMD] = 1.46; 95% CI: 0.15-2.78; p = .029; I2 = 98.9%) compared with those without periodontitis. Sensitivity analyses focusing on severe periodontitis as exposure mostly showed consistent results. Estimates for caries experience were only slightly attenuated in adjusted models compared with crude models. Subgroup analyses by caries location also indicated that periodontitis was associated only with root caries, while it was not with caries affecting the anatomical crown. CONCLUSIONS Periodontitis was found to be associated with the presence and number of treated/untreated root carious lesions. Therefore, caries-specific preventive measures (e.g., fluorides) should be considered for individuals with periodontitis.
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Affiliation(s)
- Pierluigi Romandini
- Unit of Periodontology, Endodontology and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
- Division of Fixed Prosthodontics and Biomaterials, University of Geneva, Geneva, Switzerland
| | - Crystal Marruganti
- Unit of Periodontology, Endodontology and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | | | - Mariano Sanz
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, Madrid, Spain
- Department of Periodontology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Simone Grandini
- Unit of Periodontology, Endodontology and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Mario Romandini
- Department of Periodontology, Faculty of Dentistry, University of Oslo, Oslo, Norway
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Mancini L, Mancini V. Parodontgel® on Wound Healing and Patient-Reported Outcome Measures (PROMs) after Tunneled Coronally Advanced Flap (TCAF). Case Rep Dent 2024; 2024:5571545. [PMID: 38304282 PMCID: PMC10834094 DOI: 10.1155/2024/5571545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 02/03/2024] Open
Abstract
The adjunctive use of healing gels following periodontal plastic surgery is not common in clinical practice, and no definitive benefits have yet been demonstrated. Case Presentation. A 33-year-old male patient with a central lower incisor class RT1 recession sought treatment due to sensitivity and dissatisfaction with the appearance of his smile. The patient had no history of periodontal disease; however, he was under orthodontic treatment contributing to the gingival recession and irregular gum contours. Treatment. The patient underwent two sequential surgical procedures. Initially, an apically repositioned flap (APF) was performed to correct the frenulum reducing flap tension and improving the gum line aesthetics. Subsequently, after 8 weeks, a tunneled coronally advanced flap (TCAF) was executed to further refine the gum contours and achieve root coverage. Postoperative Healing Protocol. To enhance the healing process and alleviate postoperative discomfort, a healing gel containing hyaluronic acid as the active molecule was applied to the surgical sites. The gel was expected to reduce pain perception and minimize the need for painkiller intake during the critical first week of recovery. The patient was asked to fill a pain chart for the initial 7 days, recording pain levels on a visual analogue scale (VAS 0-10) and the number of paracetamol tablets taken as painkillers. Results. After both the APF and TCAF surgeries, the patient reported pain levels with a mean VAS score of 4.33 and 4.25, respectively. The painkiller intake during the first week was noted to be 3 tablets for the APF and 2 tablets for the TCAF. Notably, the application of the healing gel with hyaluronic acid did not cause any adverse reactions, indicating its potential safety and efficacy in this context. Conclusion. The application of a healing gel containing hyaluronic acid after periodontal plastic surgery showed promising results in reducing postoperative pain and the need for painkillers during the initial week of recovery. However, further investigations through randomized clinical trials are required to establish the potential benefits and broader applicability of such healing gel applications in the context of periodontal plastic surgery.
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Affiliation(s)
- Leonardo Mancini
- Center for Clinical Research and Evidence Synthesis in Oral Tissue Regeneration (CRITERION), Boston, Massachusetts, USA
- Clinic of Reconstructive Dentistry, Centre of Dental Medicine, University of Zurich, Zurich, Switzerland
- Private Practice, Avezzano, Italy
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El Kholti W, Boubdir S, Al Jalil Z, Rhalimi L, Chemlali S, Mound A, Aboussaouira T, Kissa J. Prevalence and risk indicators of buccal gingival recessions in a Moroccan periodontitis patients: A retrospective study. Saudi Dent J 2024; 36:117-122. [PMID: 38375373 PMCID: PMC10874803 DOI: 10.1016/j.sdentj.2023.10.008] [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: 06/20/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 02/21/2024] Open
Abstract
Background This study investigates the prevalence, distribution and risk indicators of buccal gingival recessions (GRs) in periodontitis patients. Methods A retrospective examination of 400 periodontitis patients files was performed using an operating sheet. Univariate logistic regression analysis was performed to identify risk indicators of GRs. Multivariate regression analysis was conducted for selected variables with p < 0.05. Results 354/400 (88.5 %) patients have at least one GR ≥ 1 mm. The prevalence of recession type (RT) at the patient level was 0.5 %, 2.25 % and 85.75 % for RT1, RT2 and RT3 respectively. Lower incisors are the most affected teeth (79.8 %). Upper canines present the lowest frequency (41.8 %). The univariate logistic regression showed that age (SE = 0.021; 95 % CI 1.01-1.10; p = 0.006), plaque index (SE = 0.50; 95 % CI 1.49-10.50; p = 0.006), level of plaque control (SE = 0.529; 95 % CI 0.90-0.72; p = 0.010) and periodontitis stage (SE = 0.41; 95 % CI 1.41-7.07; p = 0.005) were significantly associated with the presence of GR. In the multivariate regression model, significant results were confirmed only for age (SE = 0.021; 95 % CI 1.02-1.17; p = 0.006) and periodontitis stage (SE = 0.41; 95 % CI 1.35-6.75; p = 0.007). Conclusion The cross-sectional study showed a high prevalence of GRs. Lower incisors were the most affected teeth. Most patients have GRs with advanced interproximal attachment loss (RT3 GRs). Age, plaque index, level of plaque control and periodontitis stage resulted as risk indicators of GRs.
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Affiliation(s)
- Wafa El Kholti
- University of Hassan II of Casablanca, Faculty of Dentistry of Casablanca Morocco, Department of Periodontics, Casablanca, Morocco
| | - Safaa Boubdir
- University of Hassan II of Casablanca, Faculty of Dentistry of Casablanca Morocco, Department of Periodontics, Casablanca, Morocco
| | - Zineb Al Jalil
- University of Hassan II of Casablanca, Faculty of Dentistry of Casablanca Morocco, Laboratory of Community Health, Epidemiology and Biostatistics, Casablanca, Morocco
| | - Loubna Rhalimi
- University of Hassan II of Casablanca, Faculty of Dentistry of Casablanca Morocco, Department of Periodontics, Casablanca, Morocco
| | - Sihame Chemlali
- University of Hassan II of Casablanca, Faculty of Dentistry of Casablanca Morocco, Department of Periodontics, Casablanca, Morocco
| | - Abdallah Mound
- University of Hassan II of Casablanca, Faculty of Medicine and Pharmacy of Casablanca Morocco, Department of Biology, Casablanca, Morocco
| | - Touria Aboussaouira
- University of Hassan II of Casablanca, Faculty of Medicine and Pharmacy of Casablanca Morocco, Department of Biology, Casablanca, Morocco
| | - Jamila Kissa
- University of Hassan II of Casablanca, Faculty of Dentistry of Casablanca Morocco, Department of Periodontics, Casablanca, Morocco
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Pini Prato G, Di Gianfilippo R. Challenges and success in periodontal plastic surgery. J Clin Periodontol 2023; 50:1572-1581. [PMID: 37661329 DOI: 10.1111/jcpe.13869] [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: 05/25/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 09/05/2023]
Abstract
To truly understand a field of study, one must delve into its past and examine the challenges and successes that have shaped its current practices. In the case of periodontal plastic surgery, recognizing how challenges induced changes over the last 70 years-from the 1950s to today-is essential to fully comprehend its evolution. This editorial provides a perspective on the field, highlighting the interrelationships between influential surgical techniques and advancements in research methodology. With each event building upon the last, the evolution of periodontal plastic surgery is a story of scientific progress and ongoing research, fostering a sense of community and shared knowledge.
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Affiliation(s)
| | - Riccardo Di Gianfilippo
- Department of Periodontics and Oral Medicine, The University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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12
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Baima G, Shin HS, Arrica M, Laforí A, Cordaro M, Romandini M. The co-occurrence of the two main oral diseases: periodontitis and dental caries. Clin Oral Investig 2023; 27:6483-6492. [PMID: 37714978 PMCID: PMC10630193 DOI: 10.1007/s00784-023-05253-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 09/09/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVES Limited studies are available testing through multiple regression models the association between the two main oral diseases: dental caries and periodontitis. The aim of this cross-sectional population-based study was to verify whether dental caries and periodontitis co-occur in a representative sample of the South Korea population. MATERIALS AND METHODS A total of 23,405 subjects representative of 36.2 million of adults (KNHANES) were examined. Univariate and multiple regression analyses using 7 different models were applied, controlling for age, gender, smoking status, frequency of toothbrushing, use of interproximal toothbrushes and flossing, educational level, income, gum diseases treatment and tooth filling in the previous year, BMI, Vitamin D serum levels, alcoholism, diabetes status, stress and carbohydrates dietary intake. RESULTS In the fully adjusted model, participants with periodontitis had, respectively, a mean of 0.82 (95% CI: 0.41-1.23) and of 0.36 (95% CI: 0.22-0.50) more untreated decayed surfaces and teeth than participants without periodontitis, with an OR to have at least one untreated decayed surface of 1.96 (95% CI: 1.66-2.32). However, cumulative caries experience (DF scores) and periodontitis were not associated. CONCLUSIONS In this large nationally representative population, periodontitis and untreated dental caries co-occur. However, when considering cumulative caries experience (DF scores), the two diseases do not appear related. CLINICAL RELEVANCE In light of their possible co-occurrence, clinicians should implement integrative diagnostic, preventive and treatment strategies for both diseases.
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Affiliation(s)
- Giacomo Baima
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Hye-Sun Shin
- Department of Dental Hygiene, Dongnam Health University, Suwon-Si, Gyeonggi-Do, Korea
| | - Mariantonietta Arrica
- Department of Medical, Surgical and Experimental Sciences, School of Dentistry, University of Sassari, Sassari, Italy
| | - Andreina Laforí
- Division of Fixed Prosthodontics and Biomaterials, Clinic of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Massimo Cordaro
- Institute of Dentistry and Maxillofacial Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Mario Romandini
- Department of Periodontology, Faculty of Dentistry, University of Oslo, 69, 0455, Geitmyrsveien, Oslo, Norway.
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13
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Yadav VS, Gumber B, Makker K, Gupta V, Tewari N, Khanduja P, Yadav R. Global prevalence of gingival recession: A systematic review and meta-analysis. Oral Dis 2023; 29:2993-3002. [PMID: 35735236 DOI: 10.1111/odi.14289] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/11/2022] [Accepted: 06/18/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to estimate the global prevalence of gingival recession (GR) in the general population. MATERIALS AND METHODS Population-based observational studies reporting the prevalence of GR and published from 1991 to 2021 were identified from five electronic databases and manual searches. Risk of bias was assessed using the Joanna Briggs Institute's Critical Appraisal Checklist for Prevalence Studies. The pooled prevalence of GR was calculated by using a random-effect model. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to summarize the overall certainty of evidence. RESULTS A total of 15 studies involving 37,460 participants were included. The overall pooled prevalence was 78.16% at the minimal reported threshold values and 84.92% at ≥1 mm "cut-off" with high heterogeneity among studies. A separate analysis for the buccal GR revealed a pooled prevalence of 75.42%. The risk of bias was found to be high for 10 and low for 5 studies. The overall certainty of the evidence was assessed to be very low. CONCLUSION More than two-thirds of the population worldwide was found to be affected by GR. Studies with standard case definition and less heterogeneity are required to accurately estimate the prevalence of GR.
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Affiliation(s)
- Vikender Singh Yadav
- Division of Periodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Bhumika Gumber
- Division of Periodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Kanika Makker
- Division of Periodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Vandana Gupta
- Division of Periodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Nitesh Tewari
- Division of Pedodontics and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Puneet Khanduja
- Public Health Consultant, MicroSave Consulting, New Delhi, India
| | - Renu Yadav
- Department of Prosthodontics, Surendera Dental College and Research Institute, Sri Ganganagar, India
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Strauss FJ, Marruganti C, Romandini M, Cavalla F, Neira P, Jiménez FJ, Jung RE, Sanz M, Gamonal Aravena J. Epidemiology of mid-buccal gingival recessions according to the 2018 Classification System in South America: Results from two population-based studies. J Clin Periodontol 2023; 50:1336-1347. [PMID: 37430409 DOI: 10.1111/jcpe.13847] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 05/18/2023] [Accepted: 06/23/2023] [Indexed: 07/12/2023]
Abstract
AIM The aim of this investigation was to estimate the prevalence, severity and extent of mid-buccal gingival recessions (GRs; classified according to the 2018 Classification System) and to identify their risk indicators in the South American population. MATERIALS AND METHODS Epidemiological data from two cross-sectional studies-performed on 1070 South American adolescents and 1456 Chilean adults-were obtained. All participants received a full-mouth periodontal examination by calibrated examiners. GR prevalence was defined as the presence of at least one mid-buccal GR ≥ 1 mm. GRs were also categorized into different recession types (RTs) according to the 2018 World Workshop Classification System. Analyses for RT risk indicators were also performed. All analyses were carried out at the participant level. RESULTS The prevalence of mid-buccal GRs was 14.1% in South American adolescents and 90.9% in Chilean adults. In South American adolescents, the prevalence of RTs was 4.3% for RT1 GRs, 10.7% for RT2 GRs and 1.7% for RT3 GRs. In Chilean adults, the prevalence of RT1 GRs was 0.3%, while the prevalence of RT2 and RT3 GRs was 85.8% and 77.4%, respectively. Full-Mouth Bleeding Score (FMBS; <25%) was associated with the presence of RT1 GRs in adolescents. The risk indicators for RT2/RT3 GRs mainly overlapped with those for periodontitis. CONCLUSIONS Mid-buccal GRs affected 14.1% of South American adolescents, whereas they affected most of the Chilean adult population (>90%). While RT1 GRs are more commonly observed in a non-representative cohort of South American adolescents (when compared to Chilean adults), the majority of Chilean adults exhibit RT2/RT3 GRs.
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Affiliation(s)
- Franz Josef Strauss
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
- Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile
- Center for Surveillance and Epidemiology of Oral Diseases, Aconcagua Clinical Research Unit, San Felipe, Chile
| | - Crystal Marruganti
- Unit of Periodontology, Endodontology and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Mario Romandini
- Department of Periodontology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Franco Cavalla
- Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile
- Center for Surveillance and Epidemiology of Oral Diseases, Aconcagua Clinical Research Unit, San Felipe, Chile
| | - Patricio Neira
- Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile
- Center for Surveillance and Epidemiology of Oral Diseases, Aconcagua Clinical Research Unit, San Felipe, Chile
| | - Francisco J Jiménez
- Department of Surgical Sciences and Diagnosis, Faculty of Dentistry, University of Costa Rica, San José, Costa Rica
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Mariano Sanz
- Department of Periodontology, Faculty of Dentistry, University of Oslo, Oslo, Norway
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - Jorge Gamonal Aravena
- Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile
- Center for Surveillance and Epidemiology of Oral Diseases, Aconcagua Clinical Research Unit, San Felipe, Chile
- Center for Surveillance and Epidemiology of Oral Diseases, Faculty of Dentistry, University of Chile, Santiago, Chile
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Yadav VS, Monga N, Jose NK, Priya H. Evidence-based suggestions to improve the methodological issues in reporting of prevalence studies on gingival recession. J Indian Soc Periodontol 2023; 27:461-464. [PMID: 37781332 PMCID: PMC10538512 DOI: 10.4103/jisp.jisp_400_22] [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: 09/05/2022] [Revised: 03/05/2023] [Accepted: 03/12/2023] [Indexed: 10/03/2023] Open
Abstract
Gingival recession (GR) is considered a public health problem which is highly prevalent across different populations. Accuracy of psychometric properties of prevalence estimates of GR reported in epidemiological studies is important to facilitate setting public health goals, planning of public health programs, implementation of best practices and thereby developing public health policy. However, the reported prevalence estimates are influenced by the methodological variations among different studies, as observed in our recently published systematic review and meta-analysis on the global prevalence of GR. It substantially limits the comparability between studies and inferences about the true global variation in the prevalence of GR are difficult to establish. To address these issues, this commentary suggests to follow the standardized principles related to study design, clinical examination protocol, and characteristics of study subjects in future epidemiological studies on prevalence estimates of GR. Furthermore, the inclusion of additional domains in the reporting data is suggested for a deeper insight into the patterns of GR in different populations. Our suggestions are derived from a pragmatic approach and their consistent implementation would improve the reporting quality and achieve uniformity in future studies, thus benefitting the research in this area.
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Affiliation(s)
- Vikender Singh Yadav
- Division of Periodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Nitika Monga
- Division of Non-Communicable Diseases, Indian Council of Medical Research Headquarters, New Delhi, India
| | - Nisha K. Jose
- Division of Non-Communicable Diseases, Indian Council of Medical Research Headquarters, New Delhi, India
| | - Harsh Priya
- Division of Public Health Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
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Mandil O, Sabri H, Manouchehri N, Mostafa D, Wang H. Root coverage with apical tunnel approach using propolis as a root conditioning agent: A case report with 2-year follow-up and review of the literature. Clin Exp Dent Res 2023; 9:568-573. [PMID: 37338508 PMCID: PMC10441594 DOI: 10.1002/cre2.751] [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: 02/14/2023] [Revised: 04/28/2023] [Accepted: 05/08/2023] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVES One of the main challenges in performing root coverage is patient discomfort and donor site morbidity. This case report presents a minimally invasive apical tunnel surgical technique, with propolis for root conditioning, to correct gingival recession defects without harvesting donor grafts, flap elevation, or sutures. Propolis is a natural anti-infective, anti-inflammatory, and antioxidant agent. MATERIAL AND METHODS A 58-year-old woman with no significant medical history was presented for root coverage of her upper left canine and first premolar with recession type (RT)1A (+). Propolis was used as a root conditioning agent to promote soft tissue coverage via an apical tunnel approach. During the apical tunnel approach, a small apical hole was made 6 mm below the mucogingival junction, and the mucosa and associated attached gingiva was away from the tooth so the flap could be repositioned coronally. Collagen matrix was used as a soft tissue graft material. RESULTS At the 2-month, 6-month, 8-month, and 2-year follow-up, complete root coverage was achieved for both teeth. No bleeding on probing was noticed nor recurrent GRs at the treated sites. CONCLUSION Without incisions, donor site reflection, or flaps, the apical tunnel approach can be successfully used to cover the exposed roots. Additionally, propolis is a potential root conditioning agent during soft tissue graft procedure due to its anti-inflammatory and antioxidant properties.
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Affiliation(s)
- Obada Mandil
- Department of Periodontics and Oral Medicine, School of DentistryUniversity of MichiganAnn ArborMichiganUSA
| | - Hamoun Sabri
- Department of Periodontics and Oral Medicine, School of DentistryUniversity of MichiganAnn ArborMichiganUSA
- Center for Clinical Research and Evidence Synthesis In Oral Tissue Regeneration (CRITERION)Ann ArborMichiganUSA
| | - Neshatafarin Manouchehri
- Department of Periodontics and Oral Medicine, School of DentistryUniversity of MichiganAnn ArborMichiganUSA
| | - Diana Mostafa
- Department of Periodontics and Oral Medicine, School of DentistryAlexandria UniversityAlexandriaEgypt
| | - Hom‐Lay Wang
- Department of Periodontics and Oral Medicine, School of DentistryUniversity of MichiganAnn ArborMichiganUSA
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Xue F, Zhang R, Liu J, Duan J, Zhang Y, Cai Y. Digitally measured exposed root surface area for predicting the effectiveness of modified coronally advanced tunnel combined de-epithelialized gingival grafting in the treatment of multiple adjacent gingival recessions. Clin Oral Investig 2023; 27:4503-4512. [PMID: 37227498 DOI: 10.1007/s00784-023-05072-5] [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: 02/15/2023] [Accepted: 05/17/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVES To assess the predictive value of baseline digitally measured exposure root surface area (ERSA) on the effectiveness of modified coronally advanced tunnel and de-epithelialized gingival grafting (MCAT + DGG) technique for the treatment of multiple adjacent gingival recessions (MAGRs). MATERIALS AND METHODS A total of 96 gingival recessions (48 RT1 and 48 RT2) from 30 subjects were included. ERSA was measured on the digital model obtained by intraoral scanner. Generalized linear model was used to analyze the possible correlation of ERSA, Cairo recession type (RT), gingival biotype, keratinized gingival width (KTW), tooth type, and cervical step-like morphology on the mean root coverage (MRC) and complete root coverage (CRC) at 1-year after MCAT + DGG. The predictive accuracy of CRC is tested using receiver-operator characteristic curves. RESULTS At 1-year postoperatively, the MRC for RT1 was 95.14 ± 10.25%, which was significantly higher than 78.42 ± 22.57% for RT2 (p < 0.001). ERSA (OR:1.342, p < 0.001), KTW (OR:1.902, p = 0.028) and lower incisors (OR:15.716, p = 0.008) were independent risk factors for predicting MRC. ERSA and MRC showed significant negative correlation in RT2(r = -0.558, p < 0.001), but not in RT1(r = 0.220, p = 0.882). Meanwhile, ERSA (OR:1.232, p = 0.005) and Cairo RT (OR:3.740, p = 0.040) were independent risk factors for predicting CRC. For RT2, the area under curve was 0.848 and 0.898 for ERSA without or with other correction factors, respectively. CONCLUSIONS Digitally measured ERSA may provide strong predictive values for RT1 and RT2 defects treated with MCAT + DGG. CLINICAL RELEVANCE This study demonstrates that digitally measured ERSA is a valid outcome predictor for root coverage surgery, especially applicable for predicting RT2 MAGRs.
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Affiliation(s)
- Fei Xue
- First Clinical Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, 100081, People's Republic of China
| | - Rui Zhang
- Third Clinical Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, 100081, People's Republic of China
| | - Jia Liu
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, No.22 South Avenue Zhongguancun, Beijing, 100081, People's Republic of China
| | - Jinyu Duan
- First Clinical Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, 100081, People's Republic of China
| | - Yong Zhang
- First Clinical Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, 100081, People's Republic of China.
| | - Yu Cai
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, No.22 South Avenue Zhongguancun, Beijing, 100081, People's Republic of China.
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Mahajan A, Goyal L, Asi KS, Walhe MS, Chandel N. Clinical effectiveness of periosteal pedicle graft for the management of gingival recession defects-a systematic review and meta-analysis. Evid Based Dent 2023; 24:93-94. [PMID: 37286696 DOI: 10.1038/s41432-023-00898-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/19/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The purpose of this systematic review and meta-analysis was to evaluate the effectiveness of periosteal pedicle graft (PPG) in terms of root coverage and patient related outcomes. To the best of our knowledge this is the first systematic review with meta-analysis on PPG. MATERIAL AND METHODS A comprehensive search was performed using electronic and hand searches upto January 2023. Primary outcomes were Recession depth Reduction (Rec Red), mean root coverage (mRC) and complete root coverage (CRC). Secondary outcomes were gain in width of keratinized gingiva (WKG) and patient reported outcome measures (PROMs). Meta-analysis was performed when possible. The risk bias assessment was done using RevMan5.4.1 and Joanna Briggs institute scale for the included RCTs and case series respectively. RESULTS A total of 8 RCTs and 2 case series (538 recession sites) were included based upon the predefined inclusion and exclusion criteria. The follow up period ranged from 6 months to 18 months. Results demonstrated that mRC of PPG + Coronally advanced flap (CAF) was 87.7% for localized gingival recession defects (GRDs) and 84.83% for multiple GRDs. An overall gain in WKG (Weighted Mean =1.49 ± 0.27 mm) was observed among all the included studies in the PPG + CAF group with mean difference (-0.10 (95% CI [-0.52, 0.33], p = 0.66)). Sub-group meta-analysis comparing PPG + CAF with sub-epithelial connective tissue graft (SCTG) + CAF resulted in similar outcomes in terms of Rec Red (0.10 (95% CI [-0.56 to 0.77], p = 0.76)) and gain in WKG (-0.03 (95% CI [-0.25 to 0.18], p = 0.76)). In terms of PROMs systematic review revealed better patient satisfaction with PPG + CAF than SCTG + CAF. CONCLUSION PPG + CAF is a viable treatment modality for management of GRDs. The primary and secondary outcomes achieved utilizing PPG + CAF were found to be comparable to other conventional techniques including the gold standard i.e., SCTG.
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Affiliation(s)
- Ajay Mahajan
- Department of Periodontology, H.P. Government Dental College and Hospital, Shimla, Himachal Pradesh, India.
| | - Lata Goyal
- All India Institute of Medical Sciences (AIIMS), Bathinda, Punjab, India
| | - Kanwarjit Singh Asi
- Department of Periodontology, H.P. Government Dental College and Hospital, Shimla, Himachal Pradesh, India
| | - Monika Shekhar Walhe
- Department of Periodontology, H.P. Government Dental College and Hospital, Shimla, Himachal Pradesh, India
| | - Nidhi Chandel
- Department of Periodontology, H.P. Government Dental College and Hospital, Shimla, Himachal Pradesh, India
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Kofina V, Wang YS, Fial A, Tatakis DN. Intra-marrow penetrations and root coverage outcomes: a systematic review. BMC Oral Health 2023; 23:256. [PMID: 37138270 PMCID: PMC10157995 DOI: 10.1186/s12903-023-02964-6] [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: 01/26/2023] [Accepted: 04/12/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Intra-marrow penetrations (IMPs) have been performed during guided tissue regeneration (GTR) procedures with reported clinical benefits. The aim of this systematic review was to investigate the use and effect of IMPs during root coverage procedures. METHOD A broad search for human and animal studies was performed on PubMed, Cochrane Database of Systematic Reviews and Cochrane Central Registry of Controlled Trials and Web of Science, following a registered review protocol (PROSPERO). All prospective study designs, case series and case reports on gingival recession treatment (follow-up ≥ 6 months) that employed IMPs were included. Root coverage, complete root coverage prevalence, and adverse effects were recorded, and risk of bias was assessed. RESULTS Of 16,181 screened titles, 5 articles (all of them human studies) met inclusion criteria. All studies (including two randomized clinical trials) treated Miller class I and II recession defects, using coronally advanced flap with IMPs alone or in conjunction with GTR protocols. Therefore, all treated defects received IMPs and no studies compared protocols with and without IMPs. Outcomes were indirectly compared with existing root coverage literature. Mean root coverage was 2.7 mm and 68.5% at 6.8 months (median: 6 months, range 6-15 months) for sites treated with IMPs. CONCLUSION IMPs are rarely used during root coverage procedures, have not been associated with intra-surgical or wound healing adverse effects and have not been investigated as independent factor. Future clinical studies are needed to directly compare treatment protocols with and without IMPs and investigate the potential benefits of IMPs for root coverage.
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Affiliation(s)
- Vrisiis Kofina
- Department of Surgical Sciences, School of Dentistry, Marquette University, P.O. Box 1881, Milwaukee, WI, 53201-1881, USA
| | - Ying S Wang
- Division of Periodontology, College of Dentistry, The Ohio State University, 4121 Postle Hall, 305 W. 12th Ave, Columbus, OH, 43210, USA
- Department of Periodontics, School of Dentistry, Texas A&M University, 3302 Gaston Avenue, Dallas, TX, 75246, USA
| | - Alissa Fial
- Raynor Memorial Libraries, Marquette University, P. O. Box 3141, Milwaukee, WI, 53201-3141, USA
| | - Dimitris N Tatakis
- Division of Periodontology, College of Dentistry, The Ohio State University, 4121 Postle Hall, 305 W. 12th Ave, Columbus, OH, 43210, USA.
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20
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González-Febles J, Romandini M, Laciar-Oudshoorn F, Noguerol F, Marruganti C, Bujaldón-Daza A, Zabalegui I, Sanz M. Tunnel vs. coronally advanced flap in combination with a connective tissue graft for the treatment of multiple gingival recessions: a multi-center randomized clinical trial. Clin Oral Investig 2023:10.1007/s00784-023-04975-7. [PMID: 36988824 DOI: 10.1007/s00784-023-04975-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVE To evaluate the efficacy of the partial-thickness non-advanced tunnel technique (TUN) versus the coronally advanced flap (CAF), both combined with a connective tissue graft, in the treatment of multiple gingival recessions. MATERIALS AND METHODS Twenty-nine patients (83 teeth) affected by multiple gingival recessions were treated in two clinical centers with either the test (TUN) or the control (CAF) intervention combined with a connective tissue graft. Outcomes at 3 and 6 months after surgery included complete root coverage (CRC-primary outcome), mean root coverage (mRC), changes in recession depth (RD), probing pocket depth (PPD), and keratinized tissue height (KT). Root sensitivity and root coverage esthetic score (RES) were also evaluated at 6-month examination. Surgery duration, wound healing index (WHI), and patient-reported outcome measures (PROMs) were additionally considered. RESULTS At 6 months, CRC was observed in 80.9% and 79.5% of the teeth treated with TUN and CAF, respectively (odds ratio = 1.2; p = 0.802). No differences between groups were also observed in terms of mRC (TUN = 94.0%; CAF = 91.1%), RD and PPD reductions, root sensitivity, RES, and WHI. KT increase was significantly higher in teeth treated with TUN (Difference in Means - MD = - 1.0 mm; p = 0.001). Surgery duration was shorter (MD = - 19.3 min; p = 0.001), and patients reported less intra-surgical pain (MD = - 16.4; p = 0.028) as well as postoperative morbidity in TUN compared with CAF. CONCLUSIONS Both surgical interventions showed a similar efficacy in terms of root coverage, albeit TUN was associated with a higher increase in KT and with a milder patient's surgical experience. CLINICAL RELEVANCE Both techniques have shown similar efficacy for the coverage of exposed root surfaces, although clinicians may consider TUN as less invasive. TRIAL REGISTRATION Clinicaltrials.gov (NCT05122468).
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Affiliation(s)
- Jerián González-Febles
- Section of Post-Graduate Periodontology, Faculty of Odontology, Department of Dental Clinical Specialties, University Complutense, Plaza Ramón Y Cajal, 3, 28040, Madrid, Spain
- Clínica Periodontal Antonio Bujaldón, Almería, Spain
| | - Mario Romandini
- Section of Post-Graduate Periodontology, Faculty of Odontology, Department of Dental Clinical Specialties, University Complutense, Plaza Ramón Y Cajal, 3, 28040, Madrid, Spain.
| | - Florencia Laciar-Oudshoorn
- Section of Post-Graduate Periodontology, Faculty of Odontology, Department of Dental Clinical Specialties, University Complutense, Plaza Ramón Y Cajal, 3, 28040, Madrid, Spain
| | - Fernando Noguerol
- Section of Post-Graduate Periodontology, Faculty of Odontology, Department of Dental Clinical Specialties, University Complutense, Plaza Ramón Y Cajal, 3, 28040, Madrid, Spain
| | - Crystal Marruganti
- Unit of Periodontology, Endodontology and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Antonio Bujaldón-Daza
- Section of Post-Graduate Periodontology, Faculty of Odontology, Department of Dental Clinical Specialties, University Complutense, Plaza Ramón Y Cajal, 3, 28040, Madrid, Spain
- Clínica Periodontal Antonio Bujaldón, Almería, Spain
| | - Ion Zabalegui
- Section of Post-Graduate Periodontology, Faculty of Odontology, Department of Dental Clinical Specialties, University Complutense, Plaza Ramón Y Cajal, 3, 28040, Madrid, Spain
| | - Mariano Sanz
- Section of Post-Graduate Periodontology, Faculty of Odontology, Department of Dental Clinical Specialties, University Complutense, Plaza Ramón Y Cajal, 3, 28040, Madrid, Spain
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21
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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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22
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Tunnel technique with cross-linked hyaluronic acid in addition to subepithelial connective tissue graft, compared with connective tissue graft alone, for the treatment of multiple gingival recessions: 6-month outcomes of a randomized clinical trial. Clin Oral Investig 2023; 27:2395-2406. [PMID: 36735090 DOI: 10.1007/s00784-023-04887-6] [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: 11/29/2022] [Accepted: 01/29/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The aim of this study was to investigate differences in clinical and esthetic outcomes in the treatment of multiple gingival recession types 1 and 2, using the modified coronally advanced tunnel technique (MCAT) combined with subepithelial connective tissue graft (SCTG), with or without cross-linked hyaluronic acid (HA). MATERIALS AND METHODS A total of 24 patients with 266 multiple gingival recessions (GR) were enrolled in the study (133 recessions per group). MCAT was combined with SCTG and HA on the test side, while MCAT with SCTG was used on the control side. Clinical parameters were measured at baseline and 6 months post-operatively. Visual analogue scales (VAS) and questionnaires were used to assess patient-rated outcomes, and the root coverage esthetic score (RES) was used for professional esthetic evaluation. RESULTS No significant improvement in root coverage was observed as a result of adding HA. After 6 months, mean root coverage (MRC) was 85% for SCTG + HA group and 83% for SCTG group (p = 0.9819). Complete root coverage (CRC) was observed in 91% (test) and 93% (control) of the cases (p = 0.9001). Professional assessment of soft tissue texture (STT) using RES showed a significant difference (0.94 versus 0.69, p = 0.0219) in favor of the experimental group. CONCLUSIONS Both treatments were similarly effective in treating multiple GRs and led to comparable improvements in clinical parameters. However, application of HA improved the appearance of soft tissue texture. CLINICAL RELEVANCE Adjunctive application of HA in the MCAT + SCTG procedure may improve STT results.
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23
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Stefanini M, Barootchi S, Tavelli L, Marzadori M, Mazzotti C, Mounssif I, Sangiorgi M, Sabri H, Wang HL, Zucchelli G. Difficulty score for the treatment of isolated gingival recessions with the coronally advanced flap: a preliminary reliability study. Clin Oral Investig 2023; 27:559-569. [PMID: 36220955 DOI: 10.1007/s00784-022-04750-0] [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: 04/09/2022] [Accepted: 10/01/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The treatment of gingival recessions (GRs) is operator-sensitive and dependent upon several local anatomical factors. The aim of this study was to introduce a difficulty score for the treatment of localized GRs with the coronally advanced flap (CAF) and to test its consistency among different operators. MATERIALS AND METHODS A rubric (difficulty score) consisting of the assessment and grading of 8 anatomical parameters (anatomical papilla, apical and lateral keratinized tissue width, apical and lateral frenum, vestibulum depth, scar tissue, and mucosal invagination) is described based on the available evidence and the authors' experience. Inter-examiner agreement, with the score, was tested on 32 localized GRs among four different experienced practitioners. RESULTS Minor discrepancies were observed in the total scores between the reviewers (intraclass correlation coefficient [ICC] 0.95). A good reproducibility, with ICCs ranging from 0.56 to 0.98, was found for the individual parameters. All models showed high absolute variance contribution conveying true differences among the cases, and small examiner variance, demonstrating minor systematic variability among the four reviewers and reproducible evaluations. CONCLUSIONS The proposed difficulty score for the treatment of GRs with CAF was reproducible among different operators. Clinical interventional studies are the next step to validate the clinical magnitude of the present score. CLINICAL RELEVANCE A novel tool for evaluating the difficulty of the treatment of isolated gingival recession using CAF was described. Clinicians can benefit from this score when assessing the expected level of complexity of the surgical case.
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Affiliation(s)
- Martina Stefanini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Shayan Barootchi
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, 1011 N University Avenue, Ann Arbor, MI, USA.
| | - Lorenzo Tavelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, 1011 N University Avenue, Ann Arbor, MI, USA.,Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, MA, USA
| | - Matteo Marzadori
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Claudio Mazzotti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Ilham Mounssif
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Matteo Sangiorgi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Hamoun Sabri
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, 1011 N University Avenue, Ann Arbor, MI, USA
| | - Hom-Lay Wang
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, 1011 N University Avenue, Ann Arbor, MI, USA
| | - Giovanni Zucchelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, 1011 N University Avenue, Ann Arbor, MI, USA
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24
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Stähli A, Duong HY, Imber JC, Roccuzzo A, Salvi GE, Katsaros C, Ramseier CA, Sculean A. Recession coverage using the modified coronally advanced tunnel and connective tissue graft with or without enamel matrix derivative: 5-year results of a randomised clinical trial. Clin Oral Investig 2023; 27:105-113. [PMID: 36002594 PMCID: PMC9402279 DOI: 10.1007/s00784-022-04691-8] [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: 04/18/2022] [Accepted: 08/15/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To evaluate the 5-year results of single and multiple recession type (RT) 1 and 2 (Miller I to III) recessions treated with the modified coronally advanced tunnel (MCAT) and connective tissue graft (CTG) with or without an enamel matrix derivative (EMD). The main outcome variable was the stability of obtained root coverage from 6 months to 5 years. MATERIALS AND METHODS In 24 patients, both complete and mean root coverage (CRC and MRC) and gain of keratinised tissue (KT) were assessed at 6 months and 5 years after recession coverage by means of MCAT and CTG with or without EMD. Aesthetic outcomes after 5 years were evaluated using the root coverage aesthetic score (RES). RESULTS At 5 years, 24 patients with a total of 43 recessions were evaluated. Eight patients (57.14%) of the test and 6 (60.0%) of the control group showed complete root coverage. MRC revealed no statistically significant differences between the two groups, with 73.87 ± 26.83% (test) and 75.04 ± 22.06% (control), respectively. KT increased from 1.14 ± 0.57 mm to 3.07 ± 2.27 mm in the test group and from 1.24 ± 0.92 mm to 3.02 ± 1.55 mm in the control group, respectively. CONCLUSION Treatment of single and multiple RT 1 and 2 recessions by means of MCAT and CTG with or without EMD yielded comparable clinical improvements which could be maintained over a period of 5 years. The additional use of EMD did not influence the clinical outcomes. CLINICAL RELEVANCE The use of MCAT + CTG yielded successful coverage of single and multiple RT 1 and 2 gingival recessions, while the additional application of EMD did not seem to influence the results.
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Affiliation(s)
- A. Stähli
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010 Bern, Switzerland
| | - H. Y. Duong
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010 Bern, Switzerland
| | - J. C. Imber
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010 Bern, Switzerland
| | - A. Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010 Bern, Switzerland
| | - G. E. Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010 Bern, Switzerland
| | - C. Katsaros
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010 Bern, Switzerland
| | - C. A. Ramseier
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010 Bern, Switzerland
| | - A. Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010 Bern, Switzerland
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25
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Barootchi S, Giannobile WV, Tavelli L. PDGF-BB-enriched collagen matrix to treat multiple gingival recessions with the tunneled coronally advanced flap. Clin Adv Periodontics 2022; 12:224-232. [PMID: 35665500 DOI: 10.1002/cap.10211] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/01/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND With technological advancements in reconstructive periodontology, traditional protocols for the treatment of gingival recessions (GRs) can be challenged. This manuscript presents preliminary findings of a novel minimally-invasive approach for the regenerative treatment of multiple adjacent GR defects. METHODS Two healthy adults were treated as part of this study. Multiple adjacent GRs in both subjects (1 in the mandible, and 1 in the maxilla) were treated employing a tunneled coronally advanced flap (TCAF) design, with the application of a cross-linked collagen matrix (CCM) that was enriched with recombinant human platelet-derived growth factor-BB (PDGF-BB) that was also applied on the prepared root surfaces. Clinical, ultrasonographic, esthetic, and patient-reported outcomes were observed at approximately 6- and 18-month time points. RESULTS All sites healed uneventfully after the treatments. Complete root coverage was achieved and maintained throughout the follow-up observations, from 6 to 18 months. Patients reported minimal discomfort and reduction of dentinal hypersensitivity at the augmented sites. The areas augmented with CCM + PDGF-BB revealed an increased soft tissue thickness relative to baseline (pretreatment) measures, as well as reduction in the level of the facial bone dehiscences. CONCLUSION This article describes the success of two cases of a novel minimally invasive regenerative approach for the treatment of multiple adjacent GR defects by the TCAF, using a CCM loaded with PDGF-BB. This approach offers potential as a minimally-invasive method to repair multiple adjacent GRs.
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Affiliation(s)
- Shayan Barootchi
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA.,Center for clinical Research and evidence synthesis In oral TissuE RegeneratION (CRITERION), Ann Arbor, Michigan, USA.,Center for clinical Research and evidence synthesis In oral TissuE RegeneratION (CRITERION), Boston, Massachusetts, USA
| | - William V Giannobile
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Lorenzo Tavelli
- Center for clinical Research and evidence synthesis In oral TissuE RegeneratION (CRITERION), Ann Arbor, Michigan, USA.,Center for clinical Research and evidence synthesis In oral TissuE RegeneratION (CRITERION), Boston, Massachusetts, USA.,Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
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26
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Tavelli L, Barootchi S, Rodriguez MV, Mancini L, Majzoub J, Travan S, Sugai J, Chan H, Kripfgans O, Wang H, Giannobile WV. Recombinant human platelet-derived growth factor improves root coverage of a collagen matrix for multiple adjacent gingival recessions: A triple-blinded, randomized, placebo-controlled trial. J Clin Periodontol 2022; 49:1169-1184. [PMID: 35871600 PMCID: PMC9796054 DOI: 10.1111/jcpe.13706] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 07/10/2022] [Accepted: 07/16/2022] [Indexed: 12/30/2022]
Abstract
AIM To evaluate the efficacy of recombinant human platelet-derived growth factor (rhPDGF)-BB combined with a cross-linked collagen matrix (CCM) for the treatment of multiple adjacent gingival recession type 1 defects (MAGRs) in combination with the coronally advanced flap (CAF). MATERIALS AND METHODS Thirty patients were enrolled in this triple-blind, randomized, placebo-controlled trial and treated with either CAF + CCM + rhPDGF, or CAF + CCM + saline. The primary outcome was mean root coverage (mRC) at 6 months. Complete root coverage, gain in gingival thickness (GT), keratinized tissue width, volumetric and ultrasonographic changes, and patient-reported outcome measures were also assessed. Mixed-modelling regression analyses were used for statistical comparisons. RESULTS At 6 months, the mRC of the CCM + rhPDGF and CCM alone groups were 88.25% and 77.72%, respectively (p = .02). A significant gain in GT was consistently observed for both treatment arms, and more so for the patients receiving the matrix containing rhPDGF through time (0.51 vs. 0.80 mm, on average, p = .01). The rhPDGF + CCM treated patients presented greater volume gain, higher soft tissue thickness, and a superior aesthetic score. CONCLUSION rhPDGF enhances the clinical, volumetric, and aesthetic outcomes of MAGRs above the results achieved with CAF + CCM alone (ClinicalTrials.gov NCT04462237).
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Affiliation(s)
- Lorenzo Tavelli
- Department of Oral Medicine, Infection, and Immunity, Division of PeriodontologyHarvard School of Dental MedicineBostonMassachusettsUSA,Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA,Center for clinical Research and evidence synthesis In oral TissuE RegeneratION (CRITERION)BostonMassachusettsUSA
| | - Shayan Barootchi
- Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA,Center for clinical Research and evidence synthesis In oral TissuE RegeneratION (CRITERION)BostonMassachusettsUSA
| | - Maria Vera Rodriguez
- Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA,Postgraduate Periodontics, Division of PeriodonticsColumbia University College of Dental MedicineNew YorkNew YorkUSA
| | - Leonardo Mancini
- Department of Life, Health and Environmental SciencesUniversity of L'AquilaL'AquilaItaly
| | - Jad Majzoub
- Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA
| | - Suncica Travan
- Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA
| | - Jim Sugai
- Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA
| | - Hsun‐Liang Chan
- Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA
| | - Oliver Kripfgans
- Biointerfaces Institute and Department of Biomedical EngineeringCollege of EngineeringAnn ArborMichiganUSA,Department of RadiologyUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Hom‐Lay Wang
- Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA
| | - William V. Giannobile
- Department of Oral Medicine, Infection, and Immunity, Division of PeriodontologyHarvard School of Dental MedicineBostonMassachusettsUSA,Center for clinical Research and evidence synthesis In oral TissuE RegeneratION (CRITERION)BostonMassachusettsUSA
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27
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Skierska I, Wyrębek B, Górski B. Clinical and Aesthetic Outcomes of Multiple Gingival Recessions Coverage with Modified Coronally Advanced Tunnel and Subepithelial Connective Tissue Graft in Maxilla and Mandible: A 2-Year Retrospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11024. [PMID: 36078740 PMCID: PMC9518086 DOI: 10.3390/ijerph191711024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/29/2022] [Accepted: 08/31/2022] [Indexed: 06/15/2023]
Abstract
Limited long-term data are available when analyzing gingival recession coverage between the maxillary and mandibular sites. Therefore, the aim of this study was to evaluate the influence of location (maxilla versus mandible) of multiple gingival recessions on 24 months clinical and aesthetic outcomes of modified coronally advanced tunnel with subepithelial connective tissue graft. Forty patients with multiple gingival recessions (GR) located at maxillary or mandibular teeth were treated between January 2018 and December 2019. Reduction in GR, average root coverage (ARC), complete root coverage (CRC), increase in keratinized tissue width (KTW), increase in gingival thickness (GT), and aesthetic evaluation with the root coverage esthetic score (RES) were evaluated after 24 months. Thirty patients with 270 recessions in the upper teeth and ten patients with 90 recessions in the lower teeth completed the 2-year recall. The differences between preoperative and postoperative clinical parameters showed statistical significance only within but not between groups. ARC at 2 years was 93.31% for maxillary teeth and 93.06% for mandibular teeth (p = 0.7906). Mean RES values were comparable for upper and lower teeth (9.25 versus 8.92, respectively, p = 0.6733). However, upper teeth achieved significantly higher scores for marginal tissue contour (MTC), muco-gingival junction alignment (MGJ), and gingival color (GC). Lower teeth had decreased chances of receiving better RES (OR = 0.49, CI 0.24-0.99, p = 0.0457) in regression analysis, when compared with upper teeth. MCAT + SCTG achieved comparably favorable 2-year outcomes for the treatment of multiple GR in upper and in lower teeth. However, the individual RES components were higher in maxillary teeth, and upper teeth had higher odds of receiving better RES.
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28
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Seidel A, Schmitt C, Matta RE, Buchbender M, Wichmann M, Berger L. Investigation of the palatal soft tissue volume: a 3D virtual analysis for digital workflows and presurgical planning. BMC Oral Health 2022; 22:361. [PMID: 35999531 PMCID: PMC9400256 DOI: 10.1186/s12903-022-02391-z] [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: 07/05/2022] [Accepted: 08/11/2022] [Indexed: 12/04/2022] Open
Abstract
Background In mucogingival and implant surgery, an autologous soft tissue graft from the palate is the gold standard for reconstructing missing keratinised soft tissue and volume. Previously, presurgical measurements of the graft harvesting site were described with two-dimensional (2D) linear measurements. The present observational clinical study aimed to evaluate a three-dimensional (3D) measurement method for determining the present palatal soft tissue volume for each patient individually. Methods Pre-existing cone beam computed tomography (CBCT) scans of 20 patients were converted into 3D Standard Tessellation Language models of the bone surface. Intraoral impressions of the maxilla were taken and digitised to visualise the gingival surface. The resulting virtual models of bone (reference value) and gingival (actual value) surfaces were merged, with tooth surfaces used for registration. The region between the central incisors and the hard palate was subdivided into 5 regions of interest (ROIs). The distance between palatal bone and gingival surface was analysed both volumetrically and linearly, and the results were statistically evaluated for the ROIs.
Results The average gingival surface area on the palate was 19.1 cm2, and the mean volume was 58.2 cm3 (± 16.89). Among the ROIs, the mean linear value was highest in the most distal region, from the second molar to the hard palate (4.0 ± 1.09 mm) and lowest in the canine region (1.9 ± 0.63 mm). For mean distance, significant differences were found for the anterior palate and the most posterior palate in comparison with all other ROIs (p < 0.01). The volume measurements also declined significantly and steadily between the posterior (1.9 ± 1.0 cm3) and anterior palates (0.4 ± 0.2 cm3). Conclusions By merging digital data, palatal soft tissue could be quantified virtually. The results were reliable and comparable to previous findings with linear measurement methods. This 3D soft tissue volume analysis method fully exploited the diagnostic potential of data that are frequently collected for presurgical planning in oral surgery (i.e., CBCT + surface scans). This evaluation method might be useful for volumetric and linear measurements in other applications in anatomy and for determining palatal soft tissue dimensions in the planning stage before surgical interventions. Trial registration This observational clinical trial was retrospectively registered in the German Clinical Trials Register, reference number: DRKS00023918.
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Affiliation(s)
- Anna Seidel
- Department of Prosthodontics, University Hospital Erlangen of Friedrich-Alexander University Erlangen-Nürnberg (FAU), Glueckstrasse 11, 91054, Erlangen, Germany.
| | - Christian Schmitt
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen of Friedrich-Alexander University Erlangen-Nürnberg (FAU), Glueckstrasse 11, 91054, Erlangen, Germany
| | - Ragai Edward Matta
- Department of Prosthodontics, University Hospital Erlangen of Friedrich-Alexander University Erlangen-Nürnberg (FAU), Glueckstrasse 11, 91054, Erlangen, Germany
| | - Mayte Buchbender
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen of Friedrich-Alexander University Erlangen-Nürnberg (FAU), Glueckstrasse 11, 91054, Erlangen, Germany
| | - Manfred Wichmann
- Department of Prosthodontics, University Hospital Erlangen of Friedrich-Alexander University Erlangen-Nürnberg (FAU), Glueckstrasse 11, 91054, Erlangen, Germany
| | - Lara Berger
- Department of Prosthodontics, University Hospital Erlangen of Friedrich-Alexander University Erlangen-Nürnberg (FAU), Glueckstrasse 11, 91054, Erlangen, Germany
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Patient and professional use of the root coverage esthetic score (RES) and how it relates to patient satisfaction following periodontal plastic surgery. BMC Oral Health 2022; 22:295. [PMID: 35850680 PMCID: PMC9290205 DOI: 10.1186/s12903-022-02326-8] [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: 03/06/2022] [Accepted: 07/07/2022] [Indexed: 11/22/2022] Open
Abstract
Background Following periodontal plastic surgery in the treatment of recession defects, previous studies have reported that patients rate the esthetic outcomes more favorable than dental professionals. The root coverage esthetic score has been developed and suggested to serve as a comprehensive assessment instrument as it addresses several esthetic outcomes following root coverage procedures. However, no study has yet reported on patient use of this instrument. In the present study clinical, esthetic and patient-reported outcomes following periodontal plastic surgery were assessed. The primary objective was to compare the esthetic/clinical outcome as judged by the patient and by one dentist by using the root coverage esthetic score. The secondary objective was to evaluate the correlation between patient-reported outcomes, root coverage esthetic score and clinical parameters following treatment of recession defects. Materials and methods Subjects that had undergone periodontal plastic surgery were invited to score the treatment outcome according to the root coverage esthetic score, which subsequently also was professionally scored by a dentist. Thereafter, the subjects answered a questionnaire on patient satisfaction. All types of surgical root coverage procedures in canine or incisor teeth were included. Results A total of 34 subjects were included, presenting 46 treated recessions. No statistically significant different score was found comparing the root coverage esthetic score by the patient and the professional. The majority of subjects was satisfied with the treatment outcome, and most would have undergone the treatment again. Conclusion The root coverage esthetic score assessment can be conducted by patients and was not statistically significant different to that of the professional. Patient satisfaction is not always dependent on complete root coverage or the other clinical parameters included in the root coverage esthetic score.
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Romano F, Perotto S, Baima G, Macrì G, Picollo F, Romandini M, Mariani GM, Aimetti M. Estimates and multivariable risk assessment of mid-buccal gingival recessions in an Italian adult population according to the 2018 World Workshop Classification System. Clin Oral Investig 2022; 26:4769-4780. [PMID: 35301598 PMCID: PMC9276566 DOI: 10.1007/s00784-022-04441-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/04/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this cross-sectional study was to provide estimate of mid-buccal gingival recession (GR) according to the 2018 World Workshop Classification System and to explore GR risk indicators in a representative urban population in North-West of Italy. MATERIAL AND METHODS This is a secondary analysis using data collected in an epidemiological study enrolling a representative sample of 736 adults, living in Turin. GR prevalence was defined as the presence of at least one mid-buccal GR ≥ 1 mm. GRs were categorized according to the 2018 classification system (RT1, RT2, RT3) and to different severity cutoffs. Logistic regression analysis was performed to identify RT GR risk indicators. RESULTS Mid-buccal GR ≥ 1 mm affected 57.20% of subjects and 14.56% of teeth. When considering RT1 GRs, their prevalence was 40.90% and 6.29% at the patient and tooth level. RT2 and RT3 GRs affected 25.82% and 36.68% of the study population, respectively. RT1 GRs occurred mostly on maxillary and mandibular premolars and maxillary canines, while RT2 and RT3 GRs on maxillary molars and mandibular incisors. Older age, high education, and full-mouth plaque score (FMPS) < 30% were risk indicators for RT1 GRs, while older age, poor education, periodontitis, and FMPS > 60% were significant contributors to RT2 and RT3 GRs. CONCLUSIONS RT1 and RT3 are fairly common findings in this Italian population and are significantly associated to different contributing factors and tooth type distribution pattern. CLINICAL RELEVANCE Prevention strategies should target different socio-demographic, behavioral, and clinical risk indicators based on the RT classes.
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Affiliation(s)
- Federica Romano
- Periodontology Unit, C.I.R. Dental School, Department of Surgical Sciences, University of Turin, Via Nizza 230, 10126, Turin, Italy.
| | - Stefano Perotto
- Postgraduate Program in Periodontology, C.I.R. Dental School, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Giacomo Baima
- Periodontology Unit, C.I.R. Dental School, Department of Surgical Sciences, University of Turin, Via Nizza 230, 10126, Turin, Italy
| | - Gianfranco Macrì
- Periodontology Unit, C.I.R. Dental School, Department of Surgical Sciences, University of Turin, Via Nizza 230, 10126, Turin, Italy
| | - Fabrizio Picollo
- Periodontology Unit, C.I.R. Dental School, Department of Surgical Sciences, University of Turin, Via Nizza 230, 10126, Turin, Italy
| | - Mario Romandini
- Section of Graduate Periodontology, Faculty of Odontology, University Complutense, Madrid, Spain
| | - Giulia Maria Mariani
- Periodontology Unit, C.I.R. Dental School, Department of Surgical Sciences, University of Turin, Via Nizza 230, 10126, Turin, Italy
| | - Mario Aimetti
- Periodontology Unit, C.I.R. Dental School, Department of Surgical Sciences, University of Turin, Via Nizza 230, 10126, Turin, Italy
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Gingival Recessions and Periodontal Status after Minimum 2-Year-Retention Post-Non-Extraction Orthodontic Treatment. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12031641] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The objectives of this study were to assess gingival recessions (GR) and periodontal status in patients previously treated with non-extraction orthodontic treatment and retention at a follow-up of a minimum of two years after the end of treatment. Data from patients aged between 16 and 35 years with a previous non-extraction orthodontic treatment and at least 2 years of retention and full records before and after treatment were collected. The casts were digitalized using the 3Shape TRIOS® intraoral scanner and the Viewbox4 software was used for the measurements. The following parameters were scored: inclination of the lower and upper incisors (IMPA and I^SN) and anterior crowding (Little index). The included patients were recalled for a clinical periodontal follow-up examination and the following parameters were evaluated: buccal and lingual GR (mm) of incisors and canines, bleeding of probing score, plaque score, and gingival phenotype. The digital cast analysis showed a mean Little index of 7.78 (SD 5.83) and 1.39 (SD 0.79), respectively, before and after treatment. The initial and final cephalometric analyses showed an I^SN of 103.53° and 105.78°(SD 7.21) and IMPA of 91.3°and 95.1°, respectively. At the follow-up periodontal visits, the patients showed an overall low oral hygiene with bleeding at probing in 66.6% and plaque in the anterior area in 76.2% of patients. From the total examined 240 teeth of the frontal sextants, three patients had GR (from 1 to 6.5 mm): in the upper arch two at canines and one at central incisor, whereas in the lower arch two at central and one at lateral incisors. The gingival phenotype was thick in 55% of cases. The lingual-to-lingual retainers at follow-up were present in 61.9% of patients. A slight increased risk for buccal GR development was found only in correlation with the presence of fixed retainer and thin gingival phenotype mainly in patients with gingivitis. Thus, non-extraction orthodontic treatment performed with controlled forces and biomechanics seems to not affect the development of GR or the periodontal health after retention.
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Tadepalli A, Chekurthi S, Kavassery Balasubramanian S, Parthasarathy H, Ponnaiyan D. Comparative Evaluation of Clinical Efficacy of Leukocyte-Rich Platelet-Rich Fibrin with Advanced Platelet-Rich Fibrin in Management of Gingival Recession Defects: A Randomized Controlled Trial. Med Princ Pract 2022; 31:376-383. [PMID: 35728577 PMCID: PMC9485915 DOI: 10.1159/000525560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 05/29/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The aim of this research was to determine and compare the clinical efficacy of leukocyte platelet-rich fibrin (L-PRF) and advanced platelet-rich fibrin (A-PRF) in combination with coronally advanced flap (CAF) in the treatment of gingival recession defects. METHODS Systemically healthy subjects presenting with 30 Miller's class I or II gingival recession defects in maxillary anteriors and premolars, were treated with either CAF + L-PRF or CAF + A-PRF. Clinical parameters such as recession height (RH), width, probing pocket depth, clinical attachment level (CAL), keratinized tissue height (KTH), and width of attached gingiva (WAG) were measured at baseline, 3, and 6 months. Gingival biotype was evaluated at baseline and 6 months post-surgery. Mean root coverage percentage (MRC%) was evaluated at 3 and 6 months. RESULTS Statistically significant reduction in mean RH was observed from baseline (2.53 ± 0.74 mm, 2.63 ± 0.82 mm) to 6 months (0.87 ± 0.83 mm, 0.53 ± 0.91 mm) in CAF + L-PRF and CAF + A-PRF groups, respectively. The MRC% achieved at 6 months was 67.20 ± 32.81 in the CAF + L-PRF group and 81.66 ± 28.21 in the CAF + A-PRF group. Statistically significant gain in CAL, WAG, and KTH was observed in both therapeutic groups (p < 0.05). Intergroup analysis revealed no statistically significant differences among study parameters between groups at any time point (p > 0.05). CONCLUSION Based on the findings of this study, both L-PRF and A-PRF may be suggested as viable treatment options for the management of gingival recession in maxilla.
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Morales A, Strauss FJ, Hämmerle CHF, Romandini M, Cavalla F, Baeza M, Sanz M, Gamonal J. Performance of the 2017 AAP/EFP case definition compared to the CDC/AAP definition in population-based studies. J Periodontol 2021; 93:1003-1013. [PMID: 34625960 DOI: 10.1002/jper.21-0276] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/08/2021] [Accepted: 09/26/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Classification of the periodontal conditions is indispensable for epidemiological data in order to guide situational awareness and therapeutic strategies. The new classification of periodontal diseases and conditions introduced by the American Academy of Periodontology and the European Federation of Periodontology (AAP/EFP), however, has not yet been applied to population-based studies. The aim of the present study was to compare the prevalence of periodontitis between the AAP/EFP and the CDC/AAP classification system and to evaluate the accuracy of the new AAP/EFP classification system against the CDC/AAP case definition for population-based studies. METHODS Epidemiological data from two cross-sectional studies were obtained. One of them was a population-based study on Chilean adults (1.456 individuals; 35-44 years; 65-74 years) and the other one a sample of adolescents (1.070 individuals; 15-19 years) from 5 countries; Argentina, Chile, Colombia, Ecuador and Uruguay. All participants had undergone full-mouth periodontal examination by calibrated examiners. Epidemiological datasets were analyzed according to the AAP/EFP and the CDC/AAP case definitions. The accuracy of the AAP/EFP definition was examined by assessing the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the receiver operating curve (ROC) using the CDC/AAP case definition as the reference standard. RESULTS According to the AAP/EFP, the prevalence of periodontitis in adolescents was 75.6%. The majority of the adolescents were classified either as stage I (39.2%) or stage II (28.2%). By using the CDC/AAP classification the prevalence of periodontitis in adolescents was 27.2%. The most common form of periodontitis with the CDC/AAP classification was moderate periodontitis (15.3%) followed by mild periodontitis (11.4%). The AAP/EFP revealed high sensitivity in moderate (95.7%) and severe periodontitis (100%) as well as a moderate (75%) to high specificity (92%) in moderate and severe periodontitis, respectively. The PPV was 41.6% in moderate and 5.7% in severe periodontitis while the NPV was high in both categories (moderate = 99%; severe = 100%). The AUC was 0.912 (95% CI = 0.89 - 0.93). In adults, the prevalence of periodontitis was 99% according to the AAP/EFP. The majority of adults were classified as stage IV (81.3%) whereas stage III amounted to 12.8%. By using the CDC/AAP classification, the prevalence of periodontitis in adults was 88.3% and the most common form of periodontitis was moderate periodontitis (57.2%) followed by severe periodontitis (29.7%). In adults, the AAP/EFP revealed high sensitivity in moderate (99.7%) and severe periodontitis (100%) but low specificity in both categories (moderate = 6.8%; severe = 8.3%). The PPV was 88.7% in moderate and 31.7% in severe periodontitis. The NPV was high in both categories (moderate = 76.5%; severe = 100%). The AUC was 0.573 (95% CI = 0.53 - 0.62). CONCLUSIONS This study revealed a clear discrepancy in the prevalence of periodontitis between the AAP/EFP and the CDC/AAP classification when using epidemiological data. The 2017 AAP/EFP classification system performs well compared to the CDC/AAP case definition in identifying adolescents with periodontitis. The AAP/EFP system seems less accurate in adults with high prevalence of periodontitis. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Alicia Morales
- Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile.,Center for Surveillance and Epidemiology of Oral Diseases, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Franz J Strauss
- Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile.,Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.,Department of Oral Biology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Christoph H F Hämmerle
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Mario Romandini
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - Franco Cavalla
- Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile.,Center for Surveillance and Epidemiology of Oral Diseases, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Mauricio Baeza
- Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile.,Center for Surveillance and Epidemiology of Oral Diseases, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Mariano Sanz
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - Jorge Gamonal
- Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile.,Center for Surveillance and Epidemiology of Oral Diseases, Faculty of Dentistry, University of Chile, Santiago, Chile
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Górski B, Szerszeń M, Kaczyński T. Effect of 24% EDTA root conditioning on the outcome of modified coronally advanced tunnel technique with subepithelial connective tissue graft for the treatment of multiple gingival recessions: a randomized clinical trial. Clin Oral Investig 2021; 26:1761-1772. [PMID: 34431001 PMCID: PMC8816759 DOI: 10.1007/s00784-021-04151-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/16/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate effects of root conditioning with 24% ethylenediaminetetraacetic acid (EDTA) on the 12-month outcomes after treatment of multiple gingival recessions (GR) with modified coronally advanced tunnel (MCAT) and subepithelial connective tissue graft (SCTG). MATERIALS AND METHODS Twenty patients with 142 GR were treated (72 test sites: SCTG + EDTA and 70 control sites: SCTG). Average and complete root coverage (ARC, CRC), gain in keratinized tissue width (KTW), gain in gingival thickness (GT), root esthetic coverage score (RES), and patient-reported outcome measures (PROMs) were evaluated at 12 months post-operatively. RESULTS Differences between pre- and post-operative values were statistically significant only within but not between treatment modalities. At 12 months, ARC was 86.0% for SCTG + EDTA-treated and 84.6 for SCTG-treated defects (p = 0.6636). CRC was observed in 90.2% (tests) and 91.4% (controls) of all cases (p = 0.9903). Professional assessment of esthetic outcomes using RES showed highly positive results reaching the value of 8.9 in case of test sites and 8.7 for control sites (p = 0.3358). Severity of pain and swelling did not differ between sites, regardless of whether EDTA was used. CONCLUSIONS Test and control sites presented similarly positive outcomes related to root coverage, periodontal and esthetic parameters, and patient satisfaction and self-reported morbidity with no statistical differences between them 12 months after surgery. No significant differences in evaluated variables were observed between sites treated with and without 24% EDTA. Clinical relevance Considering the limitations of the present study, the use of 24% EDTA for root conditioning did not improve 12-month outcomes after treatment of multiple RT1 and RT2 gingival recessions with MCAT and SCTG. Trial registration ClinicalTrials.gov identifier: NCT03354104.
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Affiliation(s)
- Bartłomiej Górski
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Warsaw, Stanisława Binieckiego St 6, 02-097, Warsaw, Poland.
| | - Marcin Szerszeń
- Department of Dental Prosthetics, Medical University of Warsaw, Stanisława Binieckiego St 6, 02-097, Warsaw, Poland
| | - Tomasz Kaczyński
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Warsaw, Stanisława Binieckiego St 6, 02-097, Warsaw, Poland
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Laterally Positioned Flap with Subepithelial Connective Tissue Graft Modified One-Stage Procedure for the Treatment of Deep Isolated Gingival Recessions in Mandibular Incisors. Case Rep Dent 2021; 2021:2326152. [PMID: 34394995 PMCID: PMC8363451 DOI: 10.1155/2021/2326152] [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: 04/19/2021] [Revised: 07/02/2021] [Accepted: 07/12/2021] [Indexed: 11/28/2022] Open
Abstract
The laterally positioned flap (LPF) has been proposed as a promising treatment for isolated gingival recessions (GRs) in mandibular incisors. Several modifications have been proposed to reduce the risk of gingival recession (GR) at the donor tooth site. Therefore, the aim of this was to describe a modified one-stage procedure of performing the LPF associated with the subepithelial connective tissue graft (LPF + SCTG) with the modifications for the treatment of deep isolated GR in mandibular incisors. The modified one-stage technique (LPF + SCTG) is unique because it was presented being bilaminar with tunneled connective tissue graft (CTG) in the adjacent tooth and extended to the flap donor site, without a submarginal incision in the adjacent tooth, taking the entire band of the keratinized tissue (KT) into the flap. In addition, 3 clinical cases were described using this surgical technique. Three healthy patients with Cairo RT1 or RT2 GRs on teeth 31 or 41 were treated with the LPF + SCTG technique. Probing depth (PD), clinical attachment level (CAL), complete root coverage (CRC), mean root coverage (MRC), recession depth (RD), and keratinized tissue width (KTW) were assessed at baseline and in the follow-up periods of 18, 24, and 48 months, in the cases 1, 2, and 3, respectively. The LPF + SCTG with the modifications presented is a predictable approach for the treatment of deep isolated RT1 and RT2 GRs in mandibular incisors that are well positioned in the bone envelope with the presence of KTW adjacent to GR and adequate vestibule depth in the donor area of the flap.
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Górski B, Górska R, Szerszeń M, Kaczyński T. Modified coronally advanced tunnel technique with enamel matrix derivative in addition to subepithelial connective tissue graft compared with connective tissue graft alone for the treatment of multiple gingival recessions: prognostic parameters for clinical treatment outcomes. Clin Oral Investig 2021; 26:673-688. [PMID: 34218303 PMCID: PMC8791902 DOI: 10.1007/s00784-021-04045-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/21/2021] [Indexed: 12/27/2022]
Abstract
Objectives To investigate factors that influence 12-month outcomes after treatment of multiple gingival recessions (GR) with modified coronally advanced tunnel (MCAT) and subepithelial connective tissue graft (SCTG) with enamel matrix derivative (EMD) (tests) or without (controls). Materials and methods Twenty patients with 150 GR were treated. Logistic regression models were used to identify baseline parameters that could predict 12-month average root coverage (ARC), complete root coverage (CRC), root esthetic coverage score (RES), gain in keratinized tissue width (KTW), and gain in gingival thickness (GT). Results The likelihood of ARC > 85% increased sevenfold (odds ratio [OR] = 7.33; 95% confidence interval [CI] = 2.43–12.12), of achieving CRC: 21-fold (OR = 21.23; 95% CI = 10.21–45.32), and of gaining RES = 10: tenfold (OR = 10.23; 95% CI = 5.78–32.23) in favor of EMD-treated sites. With each 1-mm2 increase in baseline avascular exposed root surface area (AERSA), the odds of failure (ARC ≤ 85%, not achieving CRC and postoperative GT ≤ 2 mm) increased almost fourfold (OR = 3.56; 95% CI = 1.98–10.19), fourfold (OR = 4.23; 95% CI = 1.11–9.02), and nearly sixfold (OR = 5.76; 95% CI = 2.43–12.87), respectively. The greater the baseline GT, the more likely the chance of achieving CRC (OR = 10.23; 95% CI = 8.37–16.23) and RES = 10 (OR = 5.50; 95% CI = 3.34–16.43). All models exhibited fair to excellent discrimination and satisfactory calibration. Conclusions Based on logistic regression, EMD application improved postoperative ARC, CRC and RES; baseline AERSA predicted 12-month ARC, CRC, and GT gain, whereas baseline GT was a predictor of achieving CRC and perfect RES. Clinical relevance Additional use of EMD, lower baseline AERSA, and greater baseline GT significantly increase the odds of obtaining better outcomes 12 months after MCAT + SCTG technique.
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Affiliation(s)
- Bartłomiej Górski
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Warsaw, Stanisława Binieckiego St 6, 02-097, Warsaw, Poland.
| | - Renata Górska
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Warsaw, Stanisława Binieckiego St 6, 02-097, Warsaw, Poland
| | - Marcin Szerszeń
- Department of Dental Prosthetics, Medical University of Warsaw, Stanisława Binieckiego St 6, 02-097, Warsaw, Poland
| | - Tomasz Kaczyński
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Warsaw, Stanisława Binieckiego St 6, 02-097, Warsaw, Poland
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Lim HC, Lee J, Kang DY, Cho IW, Shin HS, Park JC. Digital Assessment of Gingival Dimensions of Healthy Periodontium. J Clin Med 2021; 10:jcm10081550. [PMID: 33917248 PMCID: PMC8068027 DOI: 10.3390/jcm10081550] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/30/2021] [Accepted: 04/05/2021] [Indexed: 11/18/2022] Open
Abstract
The aim of the present study was to re-visit the gingival dimension using digital scanning in a healthy Korean population. Forty-eight periodontally healthy volunteers (38 males and 10 females, mean age: 24.3 ± 2.2 years) were included. The mucogingival junction was highlighted using 2.5% diluted iodine solution. Then, the facial gingiva and mucosa of both jaws were digitally scanned using an intraoral digital scanner. Using computer software and periodontal probing, the heights and areas of keratinized gingiva (KG) and attached gingiva (AG) were measured. Similar distribution patterns in the gingival heights were noted in the maxilla and mandible. The maxilla showed substantially greater gingival values than the mandible. The heights of the KG and AG were notably smaller on the mandibular first premolar (2.37 mm and 1.07 mm, median value) and second molar (3.28 mm and 1.78 mm) than on the other teeth. The area of the KG was the largest in the canine (63.74 mm2 and 46.85 mm2) and first molar (64.14 mm2 and 58.82 mm2) in each jaw. Mandibular first and second molars, mandibular canine, and maxillary canine showed the highest value of the area under the receiver operation characteristics curve (>0.7) for differentiating between males and females. The gingival dimensions recorded using intraoral scanner demonstrated similar distribution patterns as in previous studies.
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Affiliation(s)
- Hyun-Chang Lim
- Department of Periodontology, Periodontal-Implant Clinical Research Institute, School of Dentistry, Kyung Hee University, Seoul 02447, Korea;
| | - Jaemin Lee
- Department of Periodontology, College of Dentistry, Dankook University, Cheonan-si 31116, Korea; (J.L.); (D.-Y.K.); (I.-W.C.); (H.-S.S.)
| | - Dae-Young Kang
- Department of Periodontology, College of Dentistry, Dankook University, Cheonan-si 31116, Korea; (J.L.); (D.-Y.K.); (I.-W.C.); (H.-S.S.)
| | - In-Woo Cho
- Department of Periodontology, College of Dentistry, Dankook University, Cheonan-si 31116, Korea; (J.L.); (D.-Y.K.); (I.-W.C.); (H.-S.S.)
| | - Hyun-Seung Shin
- Department of Periodontology, College of Dentistry, Dankook University, Cheonan-si 31116, Korea; (J.L.); (D.-Y.K.); (I.-W.C.); (H.-S.S.)
| | - Jung-Chul Park
- Department of Periodontology, College of Dentistry, Dankook University, Cheonan-si 31116, Korea; (J.L.); (D.-Y.K.); (I.-W.C.); (H.-S.S.)
- Correspondence: ; Tel.: +82-41-550-1931; Fax: +82-303-3442-7364
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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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Romandini M, Pedrinaci I, Lima C, Soldini MC, Araoz A, Sanz M. Prevalence and risk/protective indicators of buccal soft tissue dehiscence around dental implants. J Clin Periodontol 2021; 48:455-463. [PMID: 33378079 DOI: 10.1111/jcpe.13417] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/08/2020] [Accepted: 12/23/2020] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the prevalence of buccal peri-implant soft tissue dehiscence (PISTD) in anterior implants and to identify the risk/protective indicators of PISTD in implants not suffering peri-implantitis. MATERIALS AND METHODS 240 randomly selected patients from a university clinic database were invited to participate in the present cross-sectional study. Those who accepted, after the evaluation of their medical and dental records, were clinically examined to assess the prevalence of buccal PISTD in non-molar implants. Multilevel multivariate logistic regression analyses were then carried out to identify those factors associated either positively (risk) or negatively (protective) with buccal PISTD in implants without peri-implantitis. RESULTS 92 patients with a total of 272 dental implants were analysed. At implant-level, the prevalence of buccal PISTD was 16.9%, while when selecting only implants without peri-implantitis it was 12.0%. Buccal PISTD was present in 26.7% of the implants diagnosed with peri-implantitis. The following factors were identified as risk/protective indicators of buccal PISTD in implants without peri-implantitis: malposition (too buccal vs. correct: OR=14.67), thin peri-implant phenotype (OR=8.31), presence of at least one adjacent tooth (OR=0.08) and presence of abutment (OR=0.12). CONCLUSIONS PISTD are highly prevalent among patients with dental implants in this university-based population, and several factors were identified as risk and protective indicators of PISTD in implants not suffering peri-implantitis.
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Affiliation(s)
- Mario Romandini
- Section of Graduate Periodontology, Faculty of Odontology, University Complutense, Madrid, Spain
| | - Ignacio Pedrinaci
- Section of Graduate Periodontology, Faculty of Odontology, University Complutense, Madrid, Spain
| | - Cristina Lima
- Section of Graduate Periodontology, Faculty of Odontology, University Complutense, Madrid, Spain
| | | | - Ana Araoz
- Section of Graduate Periodontology, Faculty of Odontology, University Complutense, Madrid, Spain
| | - Mariano Sanz
- Section of Graduate Periodontology, Faculty of Odontology, University Complutense, Madrid, Spain.,ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, Madrid, Spain
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Gil S, de la Rosa M, Mancini E, Dias A, Barootchi S, Tavelli L, Mendoza-Azpur G. Coronally advanced flap achieved higher esthetic outcomes without a connective tissue graft for the treatment of single gingival recessions: a 4-year randomized clinical trial. Clin Oral Investig 2020; 25:2727-2735. [PMID: 32974775 DOI: 10.1007/s00784-020-03587-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/14/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Limited long-term data are available when comparing the esthetic outcomes of coronally advanced flap (CAF) with or without a connective tissue graft (CTG). The aim of this study was to compare the 4-year esthetic outcomes of CAF vs CAF + CTG for the treatment of isolated maxillary gingival recessions. MATERIAL AND METHODS Forty-eight patients were randomly assigned for treatment either with CAF (control; N = 24) or to CAF + CTG (test group; N = 24). Patients were followed after the surgery until the final evaluation. A professional esthetic evaluation was performed using the Root coverage Esthetic Score (RES). Recession reduction, mean root coverage, and complete root coverage were also evaluated. RESULTS Forty-two patients completed the study at the 4-year recall. A significant recession reduction was evident at 4 years, without significant intergroup differences. The CAF group showed a statistically significant higher final RES compared with the CAF + CTG group (9.14 ± 1.08 vs 7.25 ± 1.29, respectively, p < 0.001). Regarding the individual components of RES, gingival margin and marginal tissue contour were significantly higher in the CAF group compared with that in the CAF + CTG group. CONCLUSIONS CAF presented with a significantly higher overall esthetic score than CAF + CTG, and in the individual RES components of marginal tissue contour and gingival margin after 4 years. CLINICAL RELEVANCE CAF without the addition of CTG provided higher esthetic outcomes for the treatment of isolated gingival recessions.
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Affiliation(s)
- Stephany Gil
- Department of Periodontology, School of Dentistry, Universidad Científica del Sur, Calle Cantuarias 398, Miraflores, 15074, Lima, Peru
| | - Manuel de la Rosa
- Department of Periodontics, AME University Monterrey, Monterrey, Mexico
| | | | - Antonio Dias
- Department of Periodontology, School of Dentistry, Universidad Científica del Sur, Calle Cantuarias 398, Miraflores, 15074, Lima, Peru
| | - 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
| | - Gerardo Mendoza-Azpur
- Department of Periodontology, School of Dentistry, Universidad Científica del Sur, Calle Cantuarias 398, Miraflores, 15074, Lima, Peru.
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