The etiology and prevalence of gingival recession

An esthetic flap design for surgical endodontics in the anterior zone

OBJECTIVE

To describe an esthetic flap design for surgical endodontics in the anterior zone and to discuss the treatment outcome.

CLINICAL SIGNIFICANCE

Traditional flaps used in apical surgery in the anterior region are created with horizontal and vertical incisions. These incisions do not completely avoid scarring, and may sometimes cause esthetic defects. We describe an envelope flap with no vertical incision for apical surgery in anterior that mainly consists of oblique incision in interproximal papilla. The approach achieve rapid would healing while avoiding scar formation.

CONCLUSIONS

The present report describes successfully treated cases of surgical endodontics in the esthetic zone using an envelope flap that the author recommend in order to achieve better esthetic results.

Biofabrication Strategies for Oral Soft Tissue Regeneration

Gingival recession, a prevalent condition affecting the gum tissues, is characterized by the exposure of tooth root surfaces due to the displacement of the gingival margin. This review explores conventional treatments, highlighting their limitations and the quest for innovative alternatives. Importantly, it emphasizes the critical considerations in gingival tissue engineering leveraging on cells, biomaterials, and signaling factors. Successful tissue-engineered gingival constructs hinge on strategic choices such as cell sources, scaffold design, mechanical properties, and growth factor delivery. Unveiling advancements in recent biofabrication technologies like 3D bioprinting, electrospinning, and microfluidic organ-on-chip systems, this review elucidates their precise control over cell arrangement, biomaterials, and signaling cues. These technologies empower the recapitulation of microphysiological features, enabling the development of gingival constructs that closely emulate the anatomical, physiological, and functional characteristics of native gingival tissues. The review explores diverse engineering strategies aiming at the biofabrication of realistic tissue-engineered gingival grafts. Further, the parallels between the skin and gingival tissues are highlighted, exploring the potential transfer of biofabrication approaches from skin tissue regeneration to gingival tissue engineering. To conclude, the exploration of innovative biofabrication technologies for gingival tissues and inspiration drawn from skin tissue engineering look forward to a transformative era in regenerative dentistry with improved clinical outcomes.

Donor site wound healing following free gingival graft surgery using platelet rich fibrin: A randomized controlled trial

BACKGROUND

The primary purpose of this two-arm, parallel design, randomized controlled study is to compare healing of the palatal tissue donor site when platelet-rich fibrin (PRF) is used as a wound dressing compared to the use of a hemostatic agent. Secondary outcomes of patient pain perception and analgesic intake were also evaluated.

METHODS

Seventy-four patients receiving free gingival grafts were randomized to receive either PRF (test) or hemostatic agent (control) as a palatal wound dressing by patients selecting a sealed envelope containing their group assignment (initially 37 envelopes for PRF group and 37 for hemostatic agent group). Patient pain assessment and analgesic consumption were documented using a 21-point numerical scale (NMRS-21) at 24, 48, and 72 hours post-surgery. At 1-, 2-, 3-, and 4-week follow-up appointments palatal early healing index (PEHI) scores including wound color, epithelialization, presence or absence of swelling, granulation tissue, and bleeding on gentle palpation were generated by direct intraoral examination by a blinded examiner unaware of the patients' treatment group.

RESULTS

NMRS-21 pain scores showed a significant reduction in pain over time in both groups, with no significant difference between groups at any time point. No significant between-group difference was found in the amount of analgesics taken by patients at 24, 48, and 72 hours. There was significant improvement in PEHI scores over the 4-week time period in both groups, but there was no significant difference in PEHI score at each time point (1, 2, 3, 4 weeks) between groups.  CONCLUSIONS: Study findings suggest that there is no difference in early palatal wound healing, patient pain perception, or analgesic consumption between use of PRF or a hemostatic agent as donor-site wound dressings.

Predictors of survival of large non-occlusal non-incisal glass-ionomer restorations in older adults

PURPOSE

This study aimed to investigate the predictors of survival of non-occlusal non-incisal glass-ionomer restorations as a surrogate for root surface restorations among older adults.

METHODS

In a retrospective cohort analysis using the University of Iowa College of Dentistry electronic dental records, we included 721 patients aged 65+ who received 2+ surface non-occlusal non-incisal glass ionomer restorations placed from January 2005 - December 2011. Restorations were followed until September 2017 or until they were deemed to have failed.

RESULTS

At baseline, participants' mean age was 77.6 ± 8.2 years, and 45.8% were females. Most patients were self-pay (65.2%). Most restorations were placed by residents and dental students (82.7%) and included only two surfaces (95.6%). About half (49.1%) failed during follow-up, with a median survival time of 3.7 years. The time ratio for lower incisors compared to other teeth was 0.6 (p = .006), for three-and-four-surface restorations compared to two was 0.7 (p = .007), for faculty as providers compared to residents and students was 1.4 (p = .039), and for the Geriatric & Special Needs Clinic compared to others was 0.8 (p = .013). Time ratios less than one indicate association with shorter durations for restorations, and time ratios greater than one indicate association with longer durations for restorations.

CONCLUSION

Tooth type, number of restored surfaces, provider type, and clinic were all significant factors associated with survival of these restorations.

The wingspan suspension approach: A modified semilunar technique for multiple areas of recession

BACKGROUND

Gingival recession can be considered an undesirable condition that results in the exposure of the root surface. There are many techniques that can be employed to address gingival recession; however, they frequently involve a second surgical site. Other approaches have been introduced in the past to address this concern, and this case study discusses the use of a modified technique to achieve root coverage.

METHODS

A patient presented to the periodontics clinic with concerns regarding gingival recession. A modification to the semilunar technique was employed to address the recession, whereas double sling sutures were utilized to maintain the coronal repositioning of the flap.

RESULTS

Maxillary central incisors initially presented with 2-3 mm of facial recession and root coverage was achieved by use of a modified surgical semilunar approach. No rebound noted over a 6-month period, newly established gingival margin deemed clinically stable.

CONCLUSIONS

This case study provides an alternative to addressing gingival recession in the maxillary anterior region, when <3 mm of recession is noted. Avoidance of a second surgical procedure and/or donor site is of particular benefit, as well as maintenance of the blood supply.

KEY POINTS

Why is this case new information? There is insufficient evidence on the use of a modified wingspan incision design Phenotype modification with elimination of a second surgical site is most ideal for the patient. What are the keys to successful management of this case? Comprehensive diagnosis and proper case selection Meticulous flap management and adequate release to allow for repositioning without tension Appropriate use ofsuture and suturing technique. What are the primary limitations to success in this case? Thin periodontal phenotype Poor oral hygiene and plaque accumulation postoperatively Loss to follow-up.

Effect of a powered and a manual toothbrush in subjects susceptible to gingival recession: A 36-month randomized controlled clinical study

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.

The effect of an antioxidant gel compared to chlorhexidine during the soft tissue healing process: An animal study

BACKGROUND

Prolonged inflammation and oxidative stress can impede healing. To enhance healing efficiency, many solutions have been employed. This is an in vivo study comparing chlorhexidine (CHX) to a commercial antioxidant gel (AO).

METHODS

Envelope flaps were created in the lower incisor gingival region of 60 Sprague-Dawley rats, and acellular dermal matrix (ADM) was inserted. Animals were randomly assigned to postsurgical treatment application of AO gel or 0.12% CHX twice daily. A control group received no postsurgical treatment. Data collected (before surgery, 24 h, and 72 h) included surgical images, tissue samples, and weights. Blinded scorers assessed images using a wound healing scale. Real-time polymerase chain reaction (RT-PCR) was used for gene expression of tumor necrosis factor-alpha (TNFα), interleukin-1 (IL-1), myeloperoxidase (MPO), and superoxide dismutase (SOD).

RESULTS

The AO group scored higher than the CHX and control groups in clinical evaluation (p < 0.05). At 24 h, TNFα expression was upregulated in the AO group compared to CHX (p = 0.027) and controls (p = 0.018). The AO group had significantly higher expression of antioxidant enzyme (SOD) at 24 h compared to CHX (p = 0.021). All animals lost weight in the first 24 h. Animals treated with AO or CHX regained more weight at 72 h than control animals (p = 0.034 and 0.003, respectively).

CONCLUSION

Animals treated with AO healed faster. AO led to earlier upregulation of TNFα and antioxidant enzyme SOD. We hypothesized that AO promoted an earlier inflammatory process while counteracting oxidative stress by increasing antioxidant responses via SOD.

Relationship Between Cone-Beam CT Evaluation and Clinical Evaluation Before and After Orthodontic Treatment and the Rate of Gingival Recession: A Systematic Review

A systematic review was conducted to investigate the correlation between gingival recession and orthodontic treatment analysis using cone-beam CT (CBCT) dental images to provide an accurate overview of the factors that can influence gingival recession. The literature was searched across several databases (PubMed, Scopus, Web of Science, etc.) for studies using CBCT dental images. Four full-text articles describe how CBCT is used to evaluate gingival recession during orthodontic treatment. The Risk-of-Bias VISualization tool was used to assess the risk of bias. In dentistry, CBCTs are used for various imaging modalities. An accurate assessment of gingival recession was made using CBCT. There were only 35 (22.5%) cases of retraction of the gingival margin after orthodontic treatment. In most studies, various types of malocclusions were treated successfully with fixed orthodontic treatment without gingival recession. Among the studies, 50% had a low risk of bias in all four areas, while one study (25%) had an unclear risk of bias. Only one study (25%) had a high risk of bias. CBCT systems have been extensively studied to show their wide application potential in preventing gingival recession. CBCT systems should be further investigated to address limitations associated with methodology and application. Dental applications of CBCT can be enriched by overcoming these challenges.

Adjunctive use of hyaluronic acid in the treatment of gingival recessions: a systematic review and meta-analysis

OBJECTIVES

To explore the efficacy of Hyaluronic acid as an adjunctive in treatment of gingival recessions (GR).

MATERIALS AND METHODS

A systematic literature search was performed in several electronic databases, including Medline/ PubMed, Embase, CENTRAL and LILACS. Recession improvement was evaluated through multiple outcome variables. The Cochrane Risk of Bias tool and the ROBINS-I tool were used to assess the quality of the included trials. Weighted Mean Differences (WMDs) and 95% confidence intervals (CIs) between test and control sites were estimated through meta-analysis using a random-effect model for the amount of Relative Root Coverage (RRC).

RESULTS

A total of 3 randomised studies were deemed as eligible for inclusion. Their data were also used for pooling the effect estimates. Overall analysis of RRC (3 studies) presented a WMD of 7.49% (p = 0.42; 95% CIs -10.88, 25.86) in favour of adjunctive use of hyaluronic acid during Coronally Advanced Flap (CAF) technique, although statistical significance was not reached. Statistical heterogeneity was found to be high (I2 = 80%).

CONCLUSIONS

Within their limitations, the present data indicate that the local application of Hyaluronic acid does not lead to additional clinical benefits when used as an adjunctive to the treatment of GR with CAF. However, due to the high heterogeneity among the studies, additional well-designed RCTs are needed to provide further evidence on this clinical indication for the use of Hyaluronic acid.

CLINICAL RELEVANCE

In the frame of the current review, the adjunctive use of Hyaluronic acid does not additionally improve the clinical outcomes obtained during treatment of GR with CAF.

Periosteum for Root Coverage in an Isolated Gingival Recession as an Autogenous Graft: A Case Report

In periodontal care, where patient results are crucial in guiding the development of surgical techniques, gingival recession management is a critical issue. The periosteum eversion technique (PET) emerges as a modern strategy that leverages the intrinsic regenerative capabilities of the periosteum to attain root coverage. A detailed case study showcases the effectiveness of PET in managing a Miller Class I gingival recession alongside an adjunctive platelet-rich fibrin (PRF) procedure. This approach entailed the deliberate elevation and eversion of the periosteal flap to encompass the recession area, securing it meticulously through suturing. Across a six-month observation period, this method exhibited successful root coverage, augmentation of keratinized tissue, and enhanced patient comfort, as reported, with no significant complications observed. These outcomes provide support for the incorporation of PET into standard periodontal protocols, underscoring its capacity to reshape the treatment landscape for gingival recession.

A long-term longitudinal study of gingival recession in dentists: A 15-year follow-up

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.

Enhancing root coverage and esthetic outcomes in isolated gingival recession using orthodontic intervention and lateral closed tunnel technique: An interdisciplinary prospective case series

BACKGROUND

Gingival recession (GR) in malposed tooth in association with bone dehiscence and/or fenestration poses a challenge for successful root coverage treatment. Lateral closed tunnel (LCT) technique is particularly useful in isolated GR in mandibular anterior region, where the shallow vestibular depth prevents tension-free coronal mobilization of tissues.

METHODS

Twenty patients with GR associated with tooth malposition were treated using a combined orthodontic-periodontic approach with a torquing auxiliary spring followed by LCT technique.

RESULTS

The two techniques resulted in a combined recession depth reduction from 3.75 ± 1.14 mm to 0.40 ± 0.50 mm at the end of 6-month study period. The orthodontic intervention led to an increase in labial marginal bone levels, as assessed through cone beam computed tomography (CBCT), while the LCT achieved closure of residual recession defect. Also, an increase of keratinized tissue width from 0.81 ± 0.88 mm at baseline to 3.30 ± 0.67 mm at 6 months was achieved. Mean root coverage percentage (MRC%) of 91.40% + 10.25% was seen, with 11 out of 20 sites (55%) showing complete root coverage (CRC).

CONCLUSIONS

Single tooth orthodontic repositioning followed by LCT technique proved effective in successfully managing isolated recession defects in the mandibular anterior gingival region, which often presents challenging mucogingival conditions. The precise single tooth repositioning resulted in labial marginal bone augmentation, while the LCT surgical approach allowed residual defect closure.

KEY FINDINGS

Why are these cases new information? Correction of single tooth malposition is achieved before recession coverage treatment to achieve a favorable environment for graft uptake. The reduction in denuded root surface along with the bone remodeling results in increasing the ratio of vascular to avascular region, thus improving the overall prognosis of the treatment. What are the keys to successful management of these cases? The lateral closed tunnel technique involves creating a mucoperiosteal tunnel to close the recession site. Precision is crucial to avoid damage to surrounding tissues. The recipient site should be wider than the width of recession to improve graft vascularity. What are the primary limitations to success in these cases? Limitations may arise when dealing with complex cases, such as multiple teeth involvement or teeth with significant vertical or horizontal bone loss.

Orthodontic retention: Rationale and periodontal implications

Post-treatment change in the form of true relapse and physiological and maturational effects is common following orthodontics. The unpredictable nature of these manifestations dictates a conservative, near-universal approach to retention. Both fixed and removable forms of retention are popular with the latter constrained by variable levels of adherence particularly in the medium- to long-term. Fixed retention may offer a more predictable means of preservation of orthodontic outcomes; however, this advantage is offset by the requirement for prolonged supervision and the potential for adverse changes including periodontal breakdown. Nevertheless, while examples of severe complications are common, a clear causal relationship between intact, passive retainers and periodontal issues does not appear to exist. Nevertheless, the importance of diligent maintenance and careful supervision during fixed retention, in particular, cannot be disregarded.

Effects of different patterns of movement for correcting a deep curve of Spee with clear aligners on the anterior teeth: a finite element analysis

OBJECTIVE

To analyse the anterior teeth effects of clear aligners on five different patterns of mandibular molar movement and to define the most effective configuration to be implemented with clear aligners through finite element analysis.

METHODS

A three-dimensional mandibular model with a deep overbite in the mandible was constructed using cone beam computerized tomography (CBCT) data. The model included the mandibular dentition, mandibular periodontal ligaments, attachments, and aligners. Five models were created: (1) configuration A: second molar distalization (0.25 mm); (2) configuration B: second molar distalization (0.25 mm), first molar extrusion (0.15 mm); (3) configuration C: second molar distalization (0.25 mmm), first and second premolar extrusion(0.15 mm); (4) configuration D: second molar distalization (0.25 mm), first molar and first/second premolar extrusion(0.15 mm); and (5) configuration E: second molar distalization (0.25 mm), first molar and first/second premolar extrusion (0.15 mm), first molar and first/second premolar expansion (0.15 mm).

RESULTS

In all configurations, the anterior teeth exhibited labial tipping and the mandibular central incisor of configuration E showed the highest labial tipping. Configuration E demonstrated a relatively minor impact on mandibular molars distalization compared with configuration A. Configuration A showed the highest distal displacement value, and configuration E produced the lowest displacement value. Configuration E caused the highest periodontal ligament (PDL) pressure of the central and lateral incisors. The differences in the canines between configurations C and D,were not significant, and the stress distribution differed among the five groups.

CONCLUSIONS

All patterns utilizing clear aligners facilitated mandibular molar distalization. Extruding the premolars and second molar distalization at the same time had little impact on second molar distalization; When expansion and extrusion were simultaneously performed during the distalization of mandibular molars, our prime consideration was the alveolar bone on the labial side of the anterior teeth to prevent the occurrence of gingival recession, dehiscence, and fenestration. Due to the lack of consideration for periodontal tissues in this study, clinical protocols should be designed based on the periodontal status of the mandibular anterior teeth.

Clinical Evaluation of Coronally Advanced Flap with or without a Platelet-Rich Fibrin Membrane for the Root Coverage

Aim

To evaluate "coronally advanced flap" with or without "a platelet-rich fibrin membrane for the root coverage."

Materials and Methods

All the clinical parameters were assessed at different time intervals (at baseline, 1, 3, and 6 months) in both experimental and control group. Following "clinical parameters" were recorded using "UNC-15" "Probe-Plaque Index (PI)" (Silness and Loe, 1964), "Gingival Index" (GI) (Loe and Silness, 1963), "Recession depth (RD)," "Recession width (RW)," "Clinical attachment level (CAL)," and "Width of keratinized gingiva (WKG)".

Results

At final evaluation (i.e., mean change from baseline to 6 months), "the decrease in Plaque Index was 2.5% higher in Group B (66.0%) as compared to Group A (63.5%). The decrease in Gingival Index was 6.1% higher in Group B (91.4%) as compared to Group A (85.3%), and the decrease in recession width was 4.0% higher in Group B (75.2%) as compared to Group A (71.2%). The decrease in clinical attachment level was 4.4% higher in Group B (53.2%) as compared to Group A (48.4%). The increase in width of keratinized gingiva was 1.9% higher in Group A (28.8%) as compared to Group B (26.9%)."

Conclusion

The controlled, randomized, split mouth design showed that CAF surgery, either by alone or in combination with PRF, is an efficient treatment method for covering denuded roots. "This design was used to treat bilateral isolated Miller's class I and II recessions in gingival part. When compared to the CAF approach, the results from a combination of CAF and PRF after a 6-month period showed additional advantages in addition to mean root coverage in the treatment of Miller's classes I and II recessions in gingival part."

Advances in the Application of Microneedles in the Treatment of Local Organ Diseases

In recent years, microneedles (MNs) have attracted a lot of attention due to their microscale sizes and high surface area (500-1000 µm in length), allowing pain-free and efficient drug delivery through the skin. In addition to the great success of MNs based transdermal drug delivery, especially for skin diseases, increasing studies have indicated the expansion of MNs to diverse nontransdermal applications, including the delivery of therapeutics for hair loss, ocular diseases, and oral mucosal. Here, the current treatment of hair loss, eye diseases, and oral disease is discussed and an overview of recent advances in the application of MNs is provided for these three noncutaneous localized organ diseases. Particular emphasis is laid on the future trend of MNs technology development and future challenges of expanding the generalizability of MNs.

Efficacy of amniotic membrane with coronally advanced flap in the treatment of gingival recession: an updated systematic review and meta-analysis

OBJECTIVES

This systematic review aims to evaluate the efficacy of combining the amniotic membrane (AM) with the coronally advanced flap (CAF) in the treatment of Miller class I and II gingival recession (GR).

METHODS

The protocol of this updated PRISMA-compliant systematic review was registered in PROSPERO (CRD42023431501). The following treatment outcomes were recorded; recession depth (RD), recession width (RW), width of keratinized gingiva (WKG), and clinical attachment level (CAL). We searched the following databases: MEDLINE, Cochrane Library, Google Scholar, EMBASE, Web of Science, and Science Direct.

RESULTS

Two independent reviewers screened the selected articles. Twenty-two eligible articles were extracted, with 689 sites of GR in 481 patients. No statistically significant difference was found in RD, RW, WKG, and CAL between (AM&CAF) in comparison to control groups. However, the subgroup analysis showed statistically significant differences in RD between the (AM & CAF) group v/s (CAF) alone (P = 0.004). Moreover, the subgroup analysis of the WKG showed statistically significant differences between (AM & CAF) v/s (CAF&CM) (p = 0.04). Additionally, a statistically significant difference was found in the subgroup analysis of CAL between both (AM & CAF) group v/s (CAF) alone (p = 0.0009).

CONCLUSION

With the limitations of this meta-analysis due to short follow-up periods (6 months), the AM can be considered a viable treatment option for GR defects with satisfactory treatment outcomes comparable to other previously investigated treatment modalities.

CLINICAL SIGNIFICANCE

While AM showed various beneficial properties as an ideal membrane for the coverage of GR, future studies are required to completely understand the potential application of AM in the treatment of GR.

Assessing the Reliability of Miller's Classification and Cairo's Classification in Classifying Gingival Recession Defects: A Comparison Study

Background and Objectives: Gingival recession results in adverse aesthetics and root sensitivity, and there is a need to treat and prevent its further progression. To overcome these problems, various advances have been made by clinicians in treating gingival recession based on the type of gingival recession. Miller's classification has been used for a long time to classify the type of recession. However, certain limitations have been found with use of Miller's classification such as a lack of clarity in the method for measuring soft and hard tissue loss in the interproximal area. Cairo classification was proposed to overcome limitations of Miller's classification to classify gingival recession. Cairo's classification is a treatment-oriented classification based on buccal and interproximal attachment loss. Therefore, the study was conducted to assess and compare the reliability of Miller's and Cairo's classifications in determining gingival recession. Material and methods: A total of 220 buccal gingival recession defects were included in the study based on the inclusion and exclusion criteria. Four examiners were included in the study. Two examiners classified the recession defects according to Miller's classification and the other two examiners classified recession defects according to Cairo's classification at baseline and at a 1-week interval. Statistical analysis was conducted using SPSS software version 25.0 using Cohen's kappa correlation coefficient and Chi-square test statistics to determine the intra- and inter-rater agreement among the examiners for the two gingival recession classification systems. A p value of <0.05 was considered statistically significant. Results: The intra-rater agreement for Cairo's classification was 0.86 and 0.82, whereas for Miller's classification, it was found to be 0.68. The inter-rater reliability agreement for Cairo's classification was 0.82 and 0.8, whereas for the Miller's classification, it was 0.56 and 0.67. Conclusions: Within the limitations of the study, it was found that Cairo's classification is clearer and more reliable than Miller's classification in the assessment of gingival recession.

Electrospun methacrylated natural/synthetic composite membranes for gingival tissue engineering

New functional materials for engineering gingival tissue are still in the early stages of development. Materials for such applications must maintain volume and have advantageous mechanical and biological characteristics for tissue regeneration, to be an alternative to autografts, which are the current benchmark of care. In this work, methacrylated gelatin (GelMa) was photocrosslinked with synthetic immunomodulatory methacrylated divinyl urethanes and defined monomers to generate composite scaffolds. Using a factorial design, with the synthetic monomers of a degradable polar/hydrophobic/ionic polyurethane (D-PHI) and GelMa, composite materials were electrospun with polycarbonate urethane (PCNU) and light-cured in-flight. The materials had significantly different relative hydrophilicities, with unique biodegradation profiles associated with specific formulations, thereby providing good guidance to achieving desired mechanical characteristics and scaffold resorption for gingival tissue regeneration. In accelerated esterase/collagenase degradation models, the new materials exhibited an initial rapid weight loss followed by a more gradual rate of degradation. The degradation profile allowed for the early infiltration of human adipose-derived stromal/stem cells, while still enabling the graft's structural integrity to be maintained. In conclusion, the materials provide a promising candidate platform for the regeneration of oral soft tissues, addressing the requirement of viable tissue infiltration while maintaining volume and mechanical integrity. STATEMENT OF SIGNIFICANCE: There is a need for the development of more functional and efficacious materials for the treatment of gingival recession. To address significant limitations in current material formulations, we sought to investigate the development of methacrylated gelatin (GelMa) and oligo-urethane/methacrylate monomer composite materials. A factorial design was used to electrospin four new formulations containing four to five monomers. Synthetic immunomodulatory monomers were crosslinked with GelMa and electrospun with a polycarbonate urethane resulting in unique mechanical properties, and resorption rates which align with the original design criteria for gingival tissue engineering. The materials may have applications in tissue engineering and can be readily manufactured. The findings of this work may help better direct the efforts of tissue engineering and material manufacturing.

In Vitro Investigation of Gelatin/Polycaprolactone Nanofibers in Modulating Human Gingival Mesenchymal Stromal Cells

The aesthetic constancy and functional stability of periodontium largely depend on the presence of healthy mucogingival tissue. Soft tissue management is crucial to the success of periodontal surgery. Recently, synthetic substitute materials have been proposed to be used for soft tissue augmentation, but the tissue compatibility of these materials needs to be further investigated. This study aims to assess the in vitro responses of human gingival mesenchymal stromal cells (hG-MSCs) cultured on a Gelatin/Polycaprolactone prototype (GPP) and volume-stable collagen matrix (VSCM). hG-MSCs were cultured onto the GPP, VSCM, or plastic for 3, 7, and 14 days. The proliferation and/or viability were measured by cell counting kit-8 assay and resazurin-based toxicity assay. Cell morphology and adhesion were evaluated by microscopy. The gene expression of collagen type I, alpha1 (COL1A1), α-smooth muscle actin (α-SMA), fibroblast growth factor (FGF-2), vascular endothelial growth factor A (VEGF-A), transforming growth factor beta-1 (TGF-β1), focal adhesion kinase (FAK), integrin beta-1 (ITG-β1), and interleukin 8 (IL-8) was investigated by RT-qPCR. The levels of VEGF-A, TGF-β1, and IL-8 proteins in conditioned media were tested by ELISA. GPP improved both cell proliferation and viability compared to VSCM. The cells grown on GPP exhibited a distinct morphology and attachment performance. COL1A1, α-SMA, VEGF-A, FGF-2, and FAK were positively modulated in hG-MSCs on GPP at different investigation times. GPP increased the gene expression of TGF-β1 but had no effect on protein production. The level of ITG-β1 had no significant changes in cells seeded on GPP at 7 days. At 3 days, notable differences in VEGF-A, TGF-β1, and α-SMA expression levels were observed between cells seeded on GPP and those on VSCM. Meanwhile, GPP showed higher COL1A1 expression compared to VSCM after 14 days, whereas VSCM demonstrated a more significant upregulation in the production of IL-8. Taken together, our data suggest that GPP electrospun nanofibers have great potential as substitutes for soft tissue regeneration in successful periodontal surgery.

Implant-supported crowns on maxillary laterals and canines-a long-term follow-up of aesthetics and function

OBJECTIVES

To assess the long-term aesthetic and functional aspects of implant-supported crowns in lateral (ISC-L) and canine positions (ISC-C).

MATERIALS AND METHODS

Thirty-two patients (14 males, 18 females, mean age: 23.1, SD:2.0) with an ISC-L or ISC-C participated in this prospective cohort study at baseline (T0) and in the long-term follow-up (T1, mean years: 11.1, SD: 1.0). Twenty-four patients (11 males, 13 females) participated in T1. Patient-reported outcomes (PROM) were rated using surveys with questions related to aesthetics and function. The colour of the implant crown and the buccal gingiva, the appearance of the papilla, periodontal health and temporomandibular disorder (TMD) outcomes were assessed in a clinical examination. The Mann-Whitney, Chi-square and Signed Rank tests were performed.

RESULTS

Patients with an ISC-L and ISC-C were equally satisfied with the crown shape and colour at T0 and T1. No differences in TMD outcomes were reported by the patients and no clinical signs of TMD were observed. At T1, ISC-C had more bleeding on probing and a three mm greater pocket depth than ISC-L (p = 0.03, p = 0.01, respectively). At T0, operators graded the crown colour of ISC-L as being too dark (35%) and ISC-C as being too light (40%). At T1, no difference was seen between the two groups regarding crown colour, gingiva colour and the papilla (p = 0.2749, p = 0.2099, p = 0.8053, respectively).

CONCLUSIONS

The PROM and clinical examination show that ISC-L and ISC-C are equivalent with regard to aesthetics and function in the long term.

CLINICAL RELEVANCE

Although ISC-L and ISC-C are aesthetically and functionally comparable in the long term, ISC-Cs are more likely to impact periodontal health.

Clinical evaluation of root coverage in Miller class III/RT2 labial gingival recession treated with interdisciplinary periodontal-orthodontic therapy: a randomized controlled clinical trial

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.

Modification of titanium orthopedic implants with bioactive glass: a systematic review of in vivo and in vitro studies

Bioactive glasses (BGs) are ideal biomaterials in the field of bio-restoration due to their excellent biocompatibility. Titanium alloys are widely used as a bone graft substitute material because of their excellent corrosion resistance and mechanical properties; however, their biological inertness makes them prone to clinical failure. Surface modification of titanium alloys with bioactive glass can effectively combine the superior mechanical properties of the substrate with the biological properties of the coating material. In this review, the relevant articles published from 2013 to the present were searched in four databases, namely, Web of Science, PubMed, Embase, and Scopus, and after screening, 49 studies were included. We systematically reviewed the basic information and the study types of the included studies, which comprise in vitro experiments, animal tests, and clinical trials. In addition, we summarized the applied coating technologies, which include pulsed laser deposition (PLD), electrophoretic deposition, dip coating, and magnetron sputtering deposition. The superior biocompatibility of the materials in terms of cytotoxicity, cell activity, hemocompatibility, anti-inflammatory properties, bioactivity, and their good bioactivity in terms of osseointegration, osteogenesis, angiogenesis, and soft tissue adhesion are discussed. We also analyzed the advantages of the existing materials and the prospects for further research. Even though the current research status is not extensive enough, it is still believed that BG-coated Ti implants have great clinical application prospects.

Global prevalence of gingival recession: A systematic review and meta-analysis

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.

Presence of host and bacterial-derived collagenolytic proteases in carious dentin: a systematic review of ex vivo studies

Introduction and aim

The presence of host collagenases in the degradation of the protein matrix at later stages of carious dentin lesions development, as well as the potential involvement of bacterial collagenases, have been suggested but lack conclusive evidence. This study aims to conduct a systematic review to comprehensively assess the profile of host and bacterial-derived collagenolytic proteases in both root and coronal dentin carious lesions.

Methods

The search was performed in eight databases and the grey literature. Studies evaluating ex vivo dentin, extracted teeth, or biofilms from natural caries lesions were included. The methodological quality of studies was assessed using the Joanna Briggs Institute tool. Synthesis of the results and the certainty of evidence were performed following the Synthesis without Meta-analysis (SWiM) checklist and GRADE approach for narrative synthesis, respectively.

Results

From 935 recovered articles, 18 were included. Although the evidence was very uncertain, it was possible to suggest that 1) MMP-2, MMP-9, MMP-13, and CT-B may be increased in carious dentin when compared to sound dentin; 2) there is no difference in MMP-2 presence, while MMP-13 may be increased in root when compared to coronal carious dentin; 3) there is no difference of MMP-2 and MMP-9 expression/activity before and after cavity sealing; 4) MMP-8 may be increased in the dentin before cavity sealing compared to dentin after cavity sealing; 5) there is no difference of MMP-20 in irradiated vs. non-irradiated carious dentin. MMP-20 probably reduces in carious outer dentin when compared to carious inner dentin (moderate certainty). Genes encoding bacterial collagenolytic proteases and protein-degrading bacteria were detected in coronal and root carious lesions.

Conclusion

Trends in the direction of the effect were observed for some collagenolytic proteases in carious dentin, which may represent a potential target for the development of new treatments. (Protocol register-PROSPERO: CRD42020213141).

Current and Potential Applications of Monoterpenes and Their Derivatives in Oral Health Care

Plant products have been employed in medicine for centuries. As the world becomes more health-conscious, there is a growing interest in natural and minimally processed products for oral health care. This has led to an increase in research into the bioactive compounds found in plant products, particularly monoterpenes. Monoterpenes are known to have beneficial biological properties, but the specific mechanisms by which they exert their effects are not yet fully understood. Despite this, some monoterpenes are already being used in oral health care. For example, thymol, which has antibacterial properties, is an ingredient in varnish used for caries prevention. In addition to this, monoterpenes have also demonstrated antifungal, antiviral, and anti-inflammatory properties, making them versatile for various applications. As research continues, there is potential for even more discoveries regarding the benefits of monoterpenes in oral health care. This narrative literature review gives an overview of the biological properties and current and potential applications of selected monoterpenes and their derivatives in oral health care. These compounds demonstrate promising potential for future medical development, and their applications in future research are expected to expand.

Evaluation of mid-buccal gingival recessions and occlusal interferences

BACKGROUND

Dental malocclusions may cause disruption in occlusal harmony, and destructive interferences during mandibular functional movements can be seen. Ideal occlusal contacts during dynamic mandibular movements may be crucial for preventing the occurrence of mid-buccal gingival recession (mbGR). While determining mbGR risk factors in young adults, the effect of occlusal interferences on mbGR has not yet been focused on. Based on this gap, this field needs to be clarified with new studies.

OBJECTIVE

The aim of this case-control study was to evaluate the relationships between the presence, extent and severity of mbGRs to dental malocclusions, occlusal interferences in anterior (AG) and lateral guidance (LG) and to determine the potential risk indicators in a young population.

METHODS

A total of 149 dental students were comprised and 70 of them presented mbGR(s) and 79 did not (18-25 years, 4553 teeth). Periodontal status was assessed with full mouth bleeding (FMBS) and plaque score (FMPS), probing depth, clinical attachment level, recession depth and keratinised tissue width (KTW) by a periodontist. Malocclusions and occlusal interferences were evaluated by an orthodontist. Logistic regression analyses provided data on the effect of occlusal interferences and the other indicators towards mbGR.

RESULTS

The mean of the number of teeth with mbGR(s) per subject was 4.3. The mean of the overall extent of teeth with mbGR(s) was 14.2%. FMBS, decreased KTW, self-reported bruxism, group function occlusion, increased contact number of all teeth and only premolars/molars in AG or LG and Class III malocclusions were significantly associated with the presence of mbGR. Decreased KTW presenting mbGR in the mandible and non-carious cervical lesion adjunct to mbGR significantly increased the odds of the severity of mbGR. Group function occlusion revealed higher mbGRs in premolar/molars than canine guided occlusion.

CONCLUSION

Increase in the occlusal interferences in premolars/molars during lateral and anterior guidance may have an effect on the presence and severity of mbGR. Further studies should be designed to confirm these findings.

Liquid platelet-rich fibrin in root surface biomodification during gingival recession treatment: Randomized, controlled, split-mouth, clinical trial

BACKGROUND AND OBJECTIVE

Free gingival graft (FGG) has been successfully used in the treatment of gingival recessions, as it is the most predictable technique for increasing the attached gingiva. This study aimed to evaluate the effect of liquid platelet-rich fibrin (PRF) with FGG on root surface coverage as root surface biomodification.

MATERIALS AND METHODS

The research sample consisted of 32 surgical sites in 16 patients, they had 2 bilateral recessions in the incisor area of the same dental arch, the sample was divided into 2 groups randomly, and liquid PRF was applied in the first group with the FGG (experimental group), and in the second group the FGG was applied alone (control group). Gingival recession depth (RD) and width of attached gingiva (WAG) were measured before starting, after 1, 3, and 6 months. The percentage of root coverage (RC) was calculated after 6 months. Healing Index (HI) was recorded after 1 week, 2 weeks, and 1 month.

RESULTS

Both groups showed a reduction in gingival RD during all follow-up periods but the difference between both groups was not statistically significant (p > 0.05) at 1 and 3 months, whereas there were significant differences at 6 months (p = 0.001). RC was better in the liquid PRF group than in the control group, but this difference was not statistically significant (p > 0.05). The postoperative 7th and 14th days HI scores of the liquid PRF group were significantly better than the control group (p = 0.000 and p = 0.004, respectively), whereas there were no significant differences in HI scores between both groups at first month (p > 0.05).

CONCLUSIONS

According to the results, the addition of liquid PRF to the root surface with FGG showed further development in terms of decreasing RD, increasing WAG, and accelerated wound-healing.

Comparison of Gingival Recession of Mandibular Incisors of Class III Patients Immediately after Compensatory or Surgical Orthodontic Treatment

OBJECTIVE

 This study aimed to compare gingival recession in mandibular anterior teeth in patients with Class III malocclusion, immediately after compensatory or surgical orthodontic treatment.

MATERIALS AND METHODS

 The sample consisted of 40 patients with Class III malocclusion, divided into two groups: Group 1 (compensatory), 20 patients treated with compensatory orthodontics, with a mean initial age of 20.26 years (standard deviation [SD] . = 7.44), mean final age of 23.07 years (SD = 7.32), and mean treatment time of 2.81 years (SD =0.84). Group 2 (surgical), who undergone orthodontic-surgical treatment, with a mean initial age of 23.08 years (SD =5.48), mean final age of 25.43 years (SD =5.12), and mean treatment time of 2.35 years (SD =1.56). Intraoral photographs taken before and after removal of the fixed orthodontic appliance were used to measure the gingival recession, from the cervical of the mandibular incisors from the most cervical point of the gingival margin to the cementoenamel junction. In the initial and final cephalograms, the position of the mandibular incisors was measured. The intergroup comparison was performed using the independent t-test.

RESULTS

 The results showed that there was no statistically significant difference in the gingival recession at the beginning, at the end, and of changes with treatment between the compensatory and surgical groups.

CONCLUSION

 It was concluded that the compensatory and surgical orthodontic treatments for Class III malocclusion showed similar results regarding the gingival recession of the mandibular incisors.

Risk factors for gingival recessions after orthodontic treatment: a systematic review

BACKGROUND/OBJECTIVES

To systematically review the available evidence concerning the risk factors for gingival recessions (GR) after orthodontic treatment (OT).

DATA COLLECTION AND ANALYSIS

Data was obtained and collected by systematically searching 3 data bases: Pubmed, EMBASE, and Web of Science until 20 April 2023. Controlled trials, cohort, case-control or cross-sectional studies describing GR or clinical crown height (CCH) after OT were included. The risk of bias in the selected studies was evaluated with the methodological index for non-randomized studies.

RESULTS

Forty-eight articles were included, investigating the following six risk factors for GR: 1. OT (n = 21), 2. Type of orthodontic intervention (n = 32), 3. Patient's baseline occlusal and skeletal characteristics (n = 14), 4. Mucogingival characteristics (n = 10), 5. Oral hygiene (n = 9), and 6. Others (n = 12). Significantly higher prevalence, severity and extent of GR were found in orthodontic patients by 10/15, 4/10, and 2/2 articles respectively. 10/16 articles reported significantly more GR and increased CCH in patients where orthodontic incisor proclination was performed. The evidence surrounding maxillary expansion and orthodontic retention was too heterogeneous to allow for? definitive conclusions. Pre-treatment angle classification, ANB, overjet, overbite, arch width and mandibular divergence were found not to be associated with GR (9/14), while pre-treatment crossbite, symphysis height and width were (5/7 studies). A thin gingival biotype, presence of previous GR, baseline width of keratinized gingiva and facial gingival margin thickness were correlated with increased risk of GR after OT by nine articles, while pocket depth was not. Oral hygiene, sex, treatment duration, and oral piercings were found not to be linked with GR in orthodontic patients, while GR was reported to increase with age in orthodontic patients by 50 per cent of the articles investigating this factor. The mean risk of bias for comparative and not comparative studies was 14.17/24 and 9.12/16.

LIMITATIONS

The selected studies were quite heterogeneous regarding study settings, variables reported and included very limited sample sizes.

CONCLUSION

Although studies regarding the risk factors for GR are relatively abundant, they are very heterogeneous concerning design, studied factors, methodology and reporting, which often leads to contradictory results. Uniform reporting guidelines are urgently needed for future research.

PROSPERO REGISTRATION

CRD42020181661.

FUNDING

This research received no funding.

The Effect of Three Desensitizing Toothpastes on Dentinal Tubules Occlusion and on Dentin Hardness

There are two main methods used for dentin hypersensitivity (DH) treatment: dentinal tubule occlusion and blockage of nerve activity. Dentifrices are the most common vehicles for active ingredients used for DH treatment. The aim of this study was to evaluate the efficacy of three toothpastes on dentinal tubule occlusion, mineral acquisition, and dentin hardness. Forty human dentin disks were submerged in 40% citric acid for 30 s and then exposed to tooth brushing for 2 min twice a day for 14 days using three toothpastes: Dontodent Sensitive (group 1), Dr. Wolff's Biorepair (group 2), and Sensodyne Repair and Protect (group 3). In the control group (group 4), the samples were brushed with water. All of the samples were evaluated using scanning electron microscopy (SEM), energy-dispersive X-ray (EDX), and Vickers dentin hardness determination. On SEM images, the degree of dentinal tubule occlusion was assessed using a five-grade scale. The mean score values in groups 1-4 were 3.60 ± 0.69, 2.20 ± 0.91, 2.30 ± 1.16, and 5.00 ± 0.00, significantly higher in study groups when compared to the control group (Kruskal Wallis test p < 0.05). EDX evaluation showed significantly higher calcium and phosphorus concentrations in groups 1 and 3 when compared to control group d. The mean values of Vickers dentin hardness numbers in groups 1-4 were 243.03 ± 10.014, 327.38 ± 56.65, 260.29 ± 37.69, and 225.83 ± 29.93, respectively. No statistically significant results were obtained when comparing the hardness mean values in groups (Kruskal-Wallis statistical test, p = 0.372 > 0.05). All three toothpastes tested demonstrated significant occlusion of dentinal tubules. Dontodent Sensitive and Sensodyne Repair and Protect toothpastes enhanced the calcium and phosphorus content of the dentin surface. None of the toothpastes increased dentin hardness as a result of mineral acquisition.

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

Introduction

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

Objective

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

Materials and Methods

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

Results

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

Conclusion

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

Complications and treatment errors involving periodontal tissues related to orthodontic therapy

In this review, typical clinical complications involving periodontal tissues are illustrated that can be encountered in conjunction with orthodontic therapy (OT). Special considerations are given for various clinical scenarios, such as the patient presenting in periodontal health, with periodontitis, or with mucogingival conditions. While some of the complications are seen as common side effects of OT, other, more severe, problems that could have been avoided may be viewed as treatment errors. Recommendations are made on how to prevent these complications, based on the currently available evidence, on clinical practice guidelines, and on expert opinion. In conclusion, while there are several areas in which OT can have unwanted adverse effects on periodontal/mucogingival conditions, there is also great potential for synergies, offering opportunities for close cooperation between the two specialties (periodontics and orthodontics) for the benefit of patients affected by tooth malpositioning and/or periodontal or mucogingival problems.

Complications and treatment errors in root coverage procedures

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

Evaluation of the Effect of Injectable Platelet-rich Fibrin on Palatal Wound Healing: A Two-arm Randomized Controlled Clinical Trial

AIM

This study aimed to evaluate the effect of injectable platelet-rich fibrin (i-PRF) as a potential catalyst for the acceleration of palatal wound healing after subepithelial connective tissue graft (SCTG) harvesting.

MATERIALS AND METHODS

Referred patients to the Department of Periodontology with the complication of the gingival recession were examined. Thirty participants were chosen for root coverage surgeries with SCTGs, and randomly distributed into two groups; the study group (n = 15) with i-PRF was applied, and the control group (n = 15) without i-PRF. The wound healing index was evaluated on the 7th, 14th, and 30th days of the treatment. Palatal tissue thickness was measured before the treatment and at the 1st, 2nd, and 3rd months after the treatment.

RESULTS

The study group improved significantly the early healing over the control group on days 7 and 14 (p < 0.01), whereas no difference in the first month (p > 0.05) between the groups. Moreover, the study group showed higher tissue thickness mean in the first and second month (p < 0.01), but in the third month, there were no significant differences (p > 0.05) between both groups.

CONCLUSION

The i-PRF has favorable effects on the healing process by enhancing wound healing and increasing the tissue thickness in the palate after SCTG harvesting.

CLINICAL SIGNIFICANCE

For clinicians, it is important to know that we can use biological materials to accelerate healing in general, such as i-PRF. In this study, we used it in the palate, which may accelerate the healing so that we can repeatedly use the same area of the patient's palate for more than one occasion faster.

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

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).

Histological and histomorphometric study of human palatal mucosa: Implications for connective tissue graft harvesting

AIMS

To analyse the histological structure and histomorphometric characteristics of human hard palatal mucosa in order to determine the donor site of choice for connective tissue grafts from a histological point of view.

MATERIALS AND METHODS

Palatal mucosa samples from six cadaver heads were harvested at four sites: incisal, premolar, molar and tuberosity. Histological and immunohistochemical techniques were performed, as was histomorphometric analysis.

RESULTS

In the current study, we found that the density and size of cells were higher in the superficial papillary layer, whereas the thickness of the collagen bundles increased in the reticular layer. Excluding the epithelium, the mean percentage of lamina propria (LP) and submucosa (SM) was 37% and 63%, respectively (p < .001). LP thickness showed similar values in the incisal, premolar and molar regions, and a significantly greater thickness in tuberosity (p < .001). The thickness of SM increased from incisal to premolar and molar, disappearing in the tuberosity (p < .001).

CONCLUSIONS

As dense connective tissue of LP is the tissue of choice for connective tissue grafts, the best donor site from a histological point of view is tuberosity because it is composed only of a thick LP without the presence of a loose submucosal layer.

Role of dental training and distance of the observer on the perception of apically shifted gingival margin with increased vertical tooth size in the esthetic zone

OBJECTIVES

To evaluate the influence of the gingival contour on the smile esthetics. The influence of size, symmetry, teeth involved in apically shifted gingival margins, and the distance and clinical training of the observer were investigated.

MATERIALS AND METHODS

Two groups were identified: 33 first-year dental students (inexperienced) and 40 last-year students (trained). Each observer expressed four evaluations on four different images assigning a score from 0 to 10. Using a picture of an "ideal" female smile, 10 variants were virtually created by shifting (2 and 4 mm) the gingival contour apically at different sites of the upper incisors and canines. A total of 292 evaluations were collected.

RESULTS

Considering a score >6 for a "pleasant smile," only one 4 mm single alteration at the canine gingival contour obtained an insufficient score. "Observational distance" and "clinical training" did not influence the final score, while size and symmetry of alterations displayed a significant role.

CONCLUSIONS

The dental training of the observer and a close interpersonal distance seemed to be irrelevant in the esthetic perception of gingival margin alterations.

Efficacy of periodontal soft tissue augmentation prior to orthodontic treatment on preventing gingival recession: study protocol for a randomised controlled trial

INTRODUCTION

In adult patients with thin phenotype, gingival recession is obvious in the mandibular incisors after a large amount of lingual tooth movement. A systematic review indicated that soft tissue augmentation before orthodontic treatment might yield satisfactory results with respect to the progression of gingival recession. However, the studies included had a low-to-moderate level of evidence. This study was designed to investigate the efficacy of soft tissue augmentation prior to orthodontic treatment on the prevention of gingival recession.

METHOD AND ANALYSIS

This is a single-centre, single-blind, randomised controlled, double-armed parallel group comparison trial. This study was initiated in December 2021 and end in December 2025 (anticipated). Patients with mild crowding in the lower arch and a thin gingival type was enrolled and randomly assigned in a 1:1 ratio to either group A (having soft tissue augmentation prior to orthodontic treatment) or group B (having orthodontic treatment only). The planned number of enrolled patients was 48 (24 patients × 2 groups). The primary endpoint was the mean change in recession of the gingival margin. Secondary endpoints included the probing depth, gingival phenotype, frequency of complete root coverage, gingival thickness, width of the keratinised gingiva, clinical attachment level, gingival recession class, full-mouth plaque score, alveolar bone thickness in the faciolingual dimension of the lower anterior teeth and lower incisor inclination.

ETHICS AND DISSEMINATION

The study protocol was approved by the Ethical Committee of the Shanghai Stomatological Hospital (certificate number (2021)016). The study was conducted in accordance with the Declaration of Helsinki, the Clinical Trials Act and other current legal regulations in China. Written informed consent was obtained from all the participants. The results of this study will be reported in journal publications.

TRIAL REGISTRATION NUMBER

ChiCTR2100050892.

Periodontal and Dentition Status among Psychiatric Patients in Indore: A Descriptive Cross-sectional Study

AIM

To assess and record periodontal and dentition status among psychiatric patients using modified WHO Oral Health Assessment form 1997.

MATERIALS AND METHODS

A descriptive cross-sectional study was conducted at Sri Aurobindo Institute of Medical Sciences and PG Institute, Indore, among the inpatients and outpatients. Ethical approval for the study was obtained from Institutional Review Board of Sri Aurobindo College of Dentistry. Statistical analysis was done using SPSS, IBM version 20.0. Descriptive statistics was used to find the frequencies, mean, and standard deviation of variables considered in the study.

RESULTS

Among all the disorders, schizophrenia subjects had shallow pockets 28 (25.2%) and deep pockets 55 (49.5%). Only 2 (2.6%) study subjects who had major depressive disorder had more than 12 mm loss of attachment (LOA). The highest mean DMFT score was recorded for schizophrenia patients (13.0 ± 7.09).

CONCLUSION

The results reveal an unmet need of projecting effective planning and implementation strategies toward the improvement of periodontal and dentition status health of the psychiatric patients.

CLINICAL SIGNIFICANCE

The study highlights the importance of incorporating dental health education to psychiatric rehabilitation programs.

Clinical applications of mucogingival therapies utilizing adjunctive autologous blood products

BACKGROUND

Mucogingival deformities are prevalent oral conditions and can result in esthetic compromise, dentinal hypersensitivity, and an increase in radicular caries rates. Mucogingival treatments address thin periodontal phenotype and/or gingival recession defects. Although many of these grafting procedures are predictable in improving soft-tissue quality and quantity around teeth and dental implants, patients often complain of discomfort at both the donor and recipient sites. Free gingival grafts and coronally advanced flaps alone or in combination with subepithelial connective tissue graft and/or acellular dermal matrix are among the most common surgical procedures employed to achieve root coverage and enhance periodontal phenotype. Autologous blood products (ABPs) contain platelets, growth factors, leukocytes, and stem cells that contribute to cell mitosis, collagen production, and angiogenesis, leading to the healing and regeneration of hard and soft tissue. Evaluation of the adjunctive role of ABPs in mucogingival surgery and their impacts on clinical and patient-centered data is critical to achieve optimal patient-reported outcome measures based upon the current scientific evidence.

METHODS

We present exemplar cases in which adjunctive ABPs were utilized in mucogingival treatment to enhance treatment outcomes.

RESULTS

No adverse events were noted. Satisfactory treatment outcomes were achieved in patients with local and/or systemic compromise when mucogingival therapies were used in combination with ABPs.

CONCLUSIONS

Adjunctive use of ABPs may enhance outcomes of mucogingival therapy. Utilization of adjunctive ABPs may be particularly advantageous in situations where the predictability of clinical and esthetic outcomes is limited due to anatomical and/or patient factors.

Clinical outcomes of the biologically oriented preparation technique (BOPT) in fixed dental prostheses: A systematic review

STATEMENT OF PROBLEM

The biologically oriented preparation technique is a concept with a vertical tooth preparation, gingitage, an immediate interim restoration preserving the clot, and a specific laboratory technique aiming to adapt the marginal periodontal tissue to a remodeled emergence profile of the crown. However, the published scientific evidence on this subject is limited.

PURPOSE

The purpose of this systematic review was to analyze whether using the biologically oriented preparation technique leads to improved clinical outcomes in terms of probing depth, gingival inflammation index, gingival marginal stability, and fewer mechanical and biological complications.

MATERIAL AND METHODS

Recommendations from the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were used in this systematic review. An electronic search of the MEDLINE/PubMed, EMBASE, Science Direct, Wiley Online Library, Cochrane, and ProQuest databases was made for articles published between March 2010 and July 2021 using keywords. Three reviewers selected and analyzed all articles that mentioned the biologically oriented preparation technique and met the inclusion criteria.

RESULTS

A total of 6 articles met the inclusion criteria: 1 prospective randomized clinical study, 1 randomized clinical study, 1 prospective clinical study, and 3 case series. According to these studies, of all the teeth treated with the biologically oriented preparation technique, probing depth (greater than 3 mm) increased in only 2.3%, gingival inflammation was present in 22.8%, gingival recession occurred in 1.7% (decreased gingival stability), and mechanical and biological failures occurred in 4.4% of the teeth.

CONCLUSIONS

Fixed dental prosthesis treatments performed following the concept of the biologically oriented preparation technique did not increase probing depth and showed a moderate rate of gingival inflammation, lower recession rates, and lower mechanical and biological failures at the 5-year follow-up. The biologically oriented preparation technique appears to be a viable alternative technique for obtaining satisfactory and stable clinical results up to 5 years. Long-term randomized clinical trials are recommended to reach more conclusions about this protocol.

Hyaluronic Acid as an Adjunct to Coronally Advanced Flap Procedures for Gingival Recessions: A Systematic Review and Meta—Analysis of Randomized Clinical Trials

Previous systematic reviews have reported that coronally advanced flap (CAF) + connective tissue graft (CTG) are the gold standard in root coverage procedures (RCP). Nevertheless, adjunctive treatment with hyaluronic acid (HA) has been proposed to aim at improving clinical outcomes and reducing patient morbidity. The aim of this systematic review and meta-analysis is to compare the use of HA as an adjunctive treatment to CAF procedures in Miller class I and II (recession type 1; RT1) gingival recession (GR) defects treatment with no adjunctive/other treatments. MEDLINE, The Cochrane Central Register of Controlled Trials, Web of Science, Scopus databases and gray literature were searched up to April 2022. The primary outcome variables were mean recession coverage (MRC) and reduction of the recession depth (RecRed). Weighted mean differences and 95% confidence intervals between treatments were estimated using a random-effect mode. From 264 titles identified, 3 RCTs reporting 90 GR defects in 60 patients were included. Overall analysis of MRC and RecRed were 0.27% (p = 0.01) and 0.40 mm (p = 0.45) in favor of CAF + HA compared to CAF alone/CAF + subepithelial connective tissue graft (SCTG), respectively, with a statistically significant difference only for MRC values. Nevertheless, due to the limited number and heterogeneity of the included studies, well-performed RCTs are needed to clarify a potential advantage of HA in RCPs in the future.

Kuronale Kaydırılan Flep ve Bağ Doku Grefti ile Tedavi Edilen Dişeti Çekilmelerinin Retrospektif Analizi

Aim: The aim of this retrospective study was to evaluate the effectiveness of coronally advanced flap and connective tissue graft (CAF+CTG) in the treatment of gingival recessions (GR).Method: Periodontal records of 32 single and multiple GR in 11 patients treated with CAF+CTG were selected for the study. According to Cairo’s classification, recession type 1 defects were included. Recession depth (RD), probing depth (PD) and clinical attachment level (CAL) were assessed at baseline and follow-ups. Mean root coverage (MRC) and complete root coverage (CRC) were evaluated. Compliance with supportive periodontal therapy (SPT) was also determined.Results: Mean age of 11 patients was 29.6±4.4 years. The mean observation time of 32 recessions was 37.6±24.2 months. All clinical parameters showed an improvement between baseline and the latest follow-up. After treatment with CAF+CTG, MRC was 92.6±13.1% and CRC was achieved in 75% of the recessions. Compliance to SPT was calculated at 83.3%.Conclusion: The use of CAF+CTG yielded positive outcomes in terms of all clinical parameters and complete root coverage in Cairo recession type 1 defects with a mean observation period of &gt;3 years. The results of the present study confirm the use of CAF+CTG as a gold standard for the treatment of gingival recessions.

Investigation of the palatal soft tissue volume: a 3D virtual analysis for digital workflows and presurgical planning

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.

Clinical comparison between different surgical techniques used to manage advanced gingival recession (Miller's class III & IV)

Advanced gingival recession is considered a complex soft tissue problem, which is increased in severity with age, and has multiple etiological factors. Therefore, the treatment is very complicated with low predictability. However, in the last decade, many clinical trials have shown highly predictable results when managing advanced recession cases by surgical intervention.

The present review shows different surgical techniques with their clinical outcomes in order to choose the most suitable technique required by the clinical condition. Although there are relatively few studies, modified tunnel technique and coronal advanced flap (CAF) showed the highest percentage of root coverage (%RC) during the first year (up to 86%). These techniques are primarily indicated to manage advanced recession in the esthetic zone. Pedicle buccal fat pad (PBFP) also had a good percentage of root coverage when used in the maxillary posterior area, as it has a high blood supply with minimal risk for infection and necrosis. Free gingival graft (FGG) can be used in the mandibular anterior area, as it creates a band of keratinized tissue that can resist recession with a fair percentage of root coverage. However, color match and graft shrinkage are the main problems of this procedure.

Patient and professional use of the root coverage esthetic score (RES) and how it relates to patient satisfaction following periodontal plastic surgery

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.

Gingival recession in mandibular anterior teeth in patients with Class II malocclusion treated with elastics and Twin Force appliance

INTRODUCTION

This study aimed to compare the early results of gingival recession in patients with Class II malocclusion treated with Class II intermaxillary elastics and the Twin Force appliance.

METHODS

The sample comprised 55 patients with Class II malocclusion treated without extraction and divided into 2 groups. Group 1 consisted of 23 patients treated with fixed appliances and Class II elastics, with mean initial age of 15.41 ± 5.65 years and a mean treatment time of 3.11 ± 0.91 years. Group 2 consisted of 32 patients treated with fixed appliances and the Twin Force mandibular protraction appliance, with a mean initial age of 18.45 ± 6.63 years and a mean treatment time of 3.17 ± 1.59 years. Dolphin software measured gingival recession in initial and final intraoral photographs. Initial and final lateral cephalograms were used to measure the position of the mandibular incisors. Intragroup and intergroup comparisons were performed by dependent and independent t tests, respectively.

RESULTS

In both groups, there was no significant increase in gingival recession with orthodontic treatment, and there was significant protrusion and buccal inclination of the mandibular incisors. When changes with treatment were compared between the groups, there was no statistically significant difference in gingival recession and mandibular incisor position.

CONCLUSIONS

There was no significant increase in gingival recession immediately after orthodontic treatment performed with intermaxillary elastics and the Twin Force appliance.

Comparison between connective tissue graft and xenogeneic acellular dermal matrix to treat single gingival recession: A data reanalysis of randomized clinical trials

OBJECTIVES

There are few studies comparing xenogeneic acellular dermal matrixes (XDMs) with connective tissue graft (CTG) to treat single gingival recession (GR). The present study involved a reanalysis of previous studies and comparison of CTG or XDM to treat single RT1/GR.

MATERIALS AND METHODS

Fifty patients from three previous randomized clinical trials treated either by CTG (n = 25) or XDM (n = 25) were evaluated after 6-month. Clinical, patient-centered, and esthetic parameters were assessed. Pearson's correlation and regression analyses were also performed.

RESULTS

Greater recession reduction (RecRed), percentage of root coverage (%RC), and complete root coverage (CRC) were observed in the CTG group (p ≤ 0.02). Gingival thickness (GT) and keratinized tissue width (KTW) gains were higher in the CTG group. The CTG group showed better esthetic at 6-month. Logistic analyses reported that GT([OR] = 1.647³ ) and papilla height (PH) (OR = 8.20) are predictors of CRC. GT*XDM interaction was a negative predictor of CRC (OR = 7.105^-5 ). GT at baseline acted as a predictor of RecRed in both groups (p = 0.03). The XDM graft impacted RecRed and %RC negatively. Baseline PH was a predictor of %RC for both grafts.

CONCLUSION

CTG was superior for treating RT1/GR, providing better root coverage outcomes and tissue gains over time. GT, PH, and graft type were classified as predictors of CRC.

CLINICAL SIGNIFICANCE

CTG presented better outcomes to treat single RT1 gingival recession when compared to the XDM.