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Thibault É, Dhalla S, Deporter D. Management of cervical external root resorption following connective tissue grafting. Clin Adv Periodontics 2024; 14:90-94. [PMID: 37366238 DOI: 10.1002/cap.10255] [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: 03/17/2023] [Revised: 05/25/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Cervical external root resorption (CERR) is not a common occurrence, but can result in a hopeless tooth prognosis. Its etiology is poorly understood and its management can be challenging. The present case report describes the late presentation and management of CERR at both maxillary first premolar teeth following connective tissue grafting (CTG) procedures including use of citric acid as a chemical root surface conditioner. METHODS AND RESULTS A 55-year-old female was diagnosed with bilateral external cervical root resorption of both maxillary first premolar teeth 28 years after CTG procedures that had included the use of citric acid root conditioning. As both teeth were asymptomatic, the patient opted for repair of the lesions via full-thickness flap elevation, meticulous removal of all granulation tissue, and restoration of the lesions with a resin-modified glass ionomer. A 2-year follow-up has been completed with no significant complications to report. CONCLUSIONS CERR usually develops asymptomatically and is found by chance in radiographs. Its etiology is unclear, but may appear some years after soft tissue grafting to manage gingival recession. Early detection is key to be able to repair the lesions with minimal intervention.
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Affiliation(s)
- Émilie Thibault
- Discipline of Periodontology, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Suraya Dhalla
- Discipline of Periodontology, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Douglas Deporter
- Discipline of Periodontology, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
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2
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Hande A, Kalmegh PP, Sonone AM, Patil SK, Sharma PN, Pakhale A. Peripheral Odontogenic Fibroma: A Report of a Rare Case and Review of Literature. Cureus 2024; 16:e58154. [PMID: 38741876 PMCID: PMC11089489 DOI: 10.7759/cureus.58154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
Peripheral odontogenic fibroma (POF) is described as a relatively rare, benign, extraosseous odontogenic tumor derived from odontogenic ectomesenchyme. It is characterized by a mature fibrous stroma with embedded inactive resting islands of odontogenic epithelium. In the category of peripheral/extraosseous neoplasms, odontogenic fibroma (OF) is one of the most prevalent tumors. The radiographic examination shows minimum bone loss in the alveolar crest area. It poses a diagnostic challenge for clinicians and pathologists because its clinical and radiological aspects are similar to other peripheral odontogenic as well as non-odontogenic tumors, and the differential diagnosis is predicated on histological assessment. Histopathological examination is the key to a final confirmed diagnosis. This article presents a case report of a 53-year-old male who reported a painless, pale pink mass in the maxillary anterior region. We emphasize the clinicopathological, radiographical, and histopathological aspects of the rare entity of POF.
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Affiliation(s)
- Alka Hande
- Oral Pathology and Microbiology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Padmashri P Kalmegh
- Oral and Maxillofacial Pathology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Archana M Sonone
- Oral Pathology and Microbiology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swati K Patil
- Oral Pathology and Microbiology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Preethi N Sharma
- Oral and Maxillofacial Pathology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Aayushi Pakhale
- Oral Pathology and Microbiology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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3
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Mazzotti C, Mounssif I, Rendón A, Mele M, Sangiorgi M, Stefanini M, Zucchelli G. Complications and treatment errors in root coverage procedures. Periodontol 2000 2023; 92:62-89. [PMID: 36594482 DOI: 10.1111/prd.12468] [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: 04/30/2022] [Revised: 07/08/2022] [Accepted: 07/26/2022] [Indexed: 01/04/2023]
Abstract
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.
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Affiliation(s)
- Claudio Mazzotti
- Periodontology Unit, Department of Biomedical and Neuromotor Sciences, Bologna University, Bologna, Italy
| | - Ilham Mounssif
- Periodontology Unit, Department of Biomedical and Neuromotor Sciences, Bologna University, Bologna, Italy
| | - Alexandra Rendón
- Periodontology Unit, Department of Biomedical and Neuromotor Sciences, Bologna University, Bologna, Italy
| | - Monica Mele
- Periodontology Unit, Department of Biomedical and Neuromotor Sciences, Bologna University, Bologna, Italy
| | - Matteo Sangiorgi
- Periodontology Unit, Department of Biomedical and Neuromotor Sciences, Bologna University, Bologna, Italy
| | - Martina Stefanini
- Periodontology Unit, Department of Biomedical and Neuromotor Sciences, Bologna University, Bologna, Italy
| | - Giovanni Zucchelli
- Periodontology Unit, Department of Biomedical and Neuromotor Sciences, Bologna University, Bologna, Italy
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
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Couso-Queiruga E, Gonzalez-Martin O, Stuhr S, Gamborena I, Chambrone L, Avila-Ortiz G. Comparative histological evaluation of intra- and extraorally de-epithelialized connective tissue graft samples harvested from the posterior palate region. J Periodontol 2022; 94:652-660. [PMID: 36582071 DOI: 10.1002/jper.22-0493] [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: 08/16/2022] [Revised: 12/20/2022] [Accepted: 12/25/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Autologous connective tissue graft (CTG) is generally considered the gold standard for peri-implant soft tissue phenotype modification and root coverage therapy. The presence of epithelial remnants in CTG has been associated with complications after soft tissue augmentation surgery. However, a specific method for de-epithelization that is patently superior has not been identified yet. This study aimed to evaluate the effectiveness of two different approaches to de-epithelialize CTG samples harvested from the posterior palate. METHODS Patients in need of periodontal or implant-related surgery that required harvesting a CTG from the posterior palate region were recruited. CTG samples harvested with an indirect approach were de-epithelialized using either an intraoral (IO group) or an extraoral (EO group) method. Tissue specimens were subsequently processed for histological analysis. The presence or absence of oral epithelial remnants was determined by two examiners using light microscopy. RESULTS Twenty-four patients, who provided a total of 46 analyzable CTG samples, were enrolled in this study. Histological assessment revealed that 19 out of 22 samples in the IO group were free of epithelial remnants. In the EO group, 20 out of 24 samples did not exhibit epithelial residues. These results translate into 86.4% and 83.3% of epithelium-free samples in the IO and EO groups, respectively. CONCLUSIONS Although the intraoral method may provide several practical advantages compared with the extraoral technique, both approaches for de-epithelialization of CTG samples harvested from the posterior palate region tested in this study were comparably effective. However, none of these methods ensured complete removal of the oral epithelium in a predictable manner, which should be considered in clinical practice.
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Affiliation(s)
- Emilio Couso-Queiruga
- Department of Oral Surgery and Stomatology, University of Bern School of Dental Medicine, Bern, Switzerland.,Formerly, Department of Periodontics, University of Iowa College of Dentistry, Iowa City, Iowa, USA
| | - Oscar Gonzalez-Martin
- Private Practice, Atelier Dental Madrid, Madrid, Spain.,Harvard School of Dental Medicine, Boston, Massachusetts, USA.,Department of Periodontology, Complutense University of Madrid, Madrid, Spain
| | - Sandra Stuhr
- Formerly, Department of Periodontics, University of Iowa College of Dentistry, Iowa City, Iowa, USA.,Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Iñaki Gamborena
- Private Practice, San Sebastian, Spain.,Department of Preventive and Restorative Sciences, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USA.,Department of Restorative Dentistry, University of Washington School of Dentistry, Seattle, Washington, USA
| | - Leandro Chambrone
- Evidence-Based Hub, Interdisciplinary Research Center Egas Moniz (CiiEM), Egas Moniz-Cooperative of Higher Education, CRL, Monte de Caparica, Portugal.,Unit of Basic Oral Investigations (UIBO), School of Dentistry, Universidad El Bosque, Bogotá, Colombia
| | - Gustavo Avila-Ortiz
- Department of Oral Surgery and Stomatology, University of Bern School of Dental Medicine, Bern, Switzerland.,Formerly, Department of Periodontics, University of Iowa College of Dentistry, Iowa City, Iowa, USA.,Private Practice, Atelier Dental Madrid, Madrid, Spain
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5
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Unusual complications at the recipient site following periodontal plastic surgery procedures: a systematic review. Clin Oral Investig 2022; 26:5595-5609. [PMID: 35809115 DOI: 10.1007/s00784-022-04596-6] [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: 01/23/2022] [Accepted: 06/20/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To identify and describe unusual soft tissue complications of periodontal plastic surgery procedures at the recipient site after periodontal grafts. MATERIALS AND METHODS Two independent reviewers performed a comprehensive search in MEDLINE, Cochrane, periodontics journals, reference lists, and grey literature for articles dated up to July 2021. Publications related to surgical interventions only around the teeth with an unusual complication at the recipient site were selected. No restrictions were made in the number of cases, follow-up period, or language. The Cochrane Collaboration's tool for assessing risk of bias, the Newcastle-Ottawa Scale (NOS), and two validated case report/series checklists were used to critically appraise the studies. RESULTS A total of 1434 articles were examined, of which 28 met the inclusion criteria: one RCT, two cohort studies, and twenty-five case reports/series. The periodontal plastic surgery procedures described in these articles were conducted to treat lack of attached gingiva and gingival recessions. The following unusual complications were found: bone exostosis, epithelial inclusion, root resorption, abscess, overgrowth, "liver clot" formation, and oroantral communication. CONCLUSION Bone exostosis and epithelial inclusions were the most prevalent unusual complications following treatment with subepithelial connective tissue graft, free gingival graft, and acellular dermal matrix allograft. Due to the nature of the reports, the clinical recommendations for diagnosis and treatment cannot be homogenized. Clinical studies reporting complications are required to develop management protocols (PROSPERO CRD42021230875). CLINICAL RELEVANCE Clinicians need to know the main complications that can occur in mucogingival surgeries as well as their clinical management to provide a successful and predictable treatment.
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Oda N, Ono M, Sonoyama W, Morimoto T, Tosa I, Nousho S, Nakano K, Kuboki T. White discharge formation following a subepithelial connective tissue graft for anterior fixed partial denture pontics: a case report based on clinical and histological findings. J Prosthodont Res 2021; 66:184-192. [PMID: 34053972 DOI: 10.2186/jpr.jpr_d_20_00115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PATIENT A 54-year-old woman presenting with anterior alveolar ridge resorption was submitted to a connective tissue graft (CTG) for esthetic improvement before rehabilitation with a fixed partial denture. Palate-harvested connective tissue was used as a graft after extra-oral removal of the epithelium. Unexpectedly, complete wound healing was not observed. Moreover, 6 months post-surgery, a white discharge was detected at the grafted site. The adjacent tooth showing a root fracture was initially associated with the symptoms and was then extracted. Concomitantly, the unhealed tissue at the grafted site was also excised, leading to temporary symptom resolution. However, the white discharge reappeared after 2 months. The excision area was expanded to remove the grafted tissue entirely, and the wound was completely healed. Since the alveolar ridge resorption had become larger compared to the preoperative condition, the patient was subjected to a second CTG, now using a connective tissue harvested from the palate by a single incision technique. The wound healed uneventfully, and the final prosthesis was delivered 6 months after soft tissu e stabilization. The patient has been followed-up for more than 28 months without any recurrence of white discharge. DISCUSSION Histopathological and cytological examination detected keratinized epithelial tissues and cells, respectively, in excised tissues and white discharge specimens. Consequently, a possible relationship between white discharge and residual epithelium in the harvested graft was strongly suspected. CONCLUSIONS Success of the CTG procedure requires careful method selection for tissue transplantation and treatment execution.
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Affiliation(s)
- Norimi Oda
- Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama
| | - Mitsuaki Ono
- Department of Molecular Biology and Biochemistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama
| | - Wataru Sonoyama
- Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama
| | | | - Ikue Tosa
- Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama
| | - Shuji Nousho
- Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama
| | - Keisuke Nakano
- Department of Oral Pathology and Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama
| | - Takuo Kuboki
- Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama
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Ripoll S, Fernández de Velasco-Tarilonte Á, Bullón B, Ríos-Carrasco B, Fernández-Palacín A. Complications in the Use of Deepithelialized Free Gingival Graft vs. Connective Tissue Graft: A One-Year Randomized Clinical Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094504. [PMID: 33922745 PMCID: PMC8123082 DOI: 10.3390/ijerph18094504] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 12/04/2022]
Abstract
In the treatment of gingival recession, different surgical options have been described: free gingival grafts (FGG), connective tissue Grafts (CTG), and a more recent technique, de-epithelialized free gingival graft (DFGG). They are not procedures exempt from the appearance of complications. Most publications refer to postoperative complications, and there is limited literature regarding the development of late complications (weeks or months). Our working group carried out a study to describe the development of late complications associated with the use of DFGG in comparison with CTG, providing an incidence rate and a classification. Sixty-eight patients with mucogingival problems were selected, and divided into two groups: the Test Group, for which we used DFGG + Coronal Advancement Flap (CAF), and the Control Group (CTG + CAF). All patients were treated at the University of Seville’s dental school to solve mucogingival problems for aesthetic and/or functional reasons. A classification is proposed based on its severity; Major and Minor. Major complications included reepithelialization of the graft, epithelial bands, cul-de-sac, epithelial cysts, and bone exostoses. Minor complications included the graft´s color changes and superficial revascularization. Late major complications were only associated with the use of the DFGG, and the late minor complications developed with the use of the DFGG were much higher than those associated with CTG. CTG appears to be a safer procedure than DFGG in terms of late complications.
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Affiliation(s)
- Silvestre Ripoll
- Clínica Dental Silvestre Ripoll, Marqués de Paradas 40 Local, 41001 Sevilla, Spain;
- Department of Periodontology, School of Dentistry, Universidad de Sevilla, C/Avicena S/N, 41009 Sevilla, Spain; (B.B.); (B.R.-C.)
| | - Ángela Fernández de Velasco-Tarilonte
- Department of Periodontology, School of Dentistry, Universidad de Sevilla, C/Avicena S/N, 41009 Sevilla, Spain; (B.B.); (B.R.-C.)
- Correspondence: ; Tel.: +34-670-438-872
| | - Beatriz Bullón
- Department of Periodontology, School of Dentistry, Universidad de Sevilla, C/Avicena S/N, 41009 Sevilla, Spain; (B.B.); (B.R.-C.)
| | - Blanca Ríos-Carrasco
- Department of Periodontology, School of Dentistry, Universidad de Sevilla, C/Avicena S/N, 41009 Sevilla, Spain; (B.B.); (B.R.-C.)
| | - Ana Fernández-Palacín
- Departamento de Ciencias Sociosanitarias, Universidad de Sevilla, 41004 Sevilla, Spain;
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8
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Cardoso MV, Lara VS, Sant'Ana ACP, Damante CA, Ragghianti Zangrando MS. Late complications after root coverage with two types of subepithelial connective tissue grafts, clinical and histopathological evaluation: A prospective cohort study. J Clin Periodontol 2021; 48:431-440. [PMID: 33340153 DOI: 10.1111/jcpe.13413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 12/07/2020] [Accepted: 12/12/2020] [Indexed: 01/15/2023]
Abstract
AIM This prospective cohort study evaluated late complications (LC) on recipient sites comparing two types of connective tissue grafts (CTG). MATERIALS AND METHODS Participants (n: 60) were treated with coronally advanced flap (CAF) plus CTG harvested by de-epithelialized technique (DE) (n:31) or two-parallel incision (PI) (n:29). Areas were evaluated to identify white discharge associated or not with gingival cul-de-sac. Patients were ordered in groups with (DE+and PI+) or without (DE- and PI-) LC. Biopsies for histopathological analysis in LC areas were proposed. RESULTS Six cases exhibited LC, 5 in DE graft (DE+) and 1 in PI graft (PI+) group; 2 were diagnosed at 3 months postoperatively, 3 at 6 months and one at 12 months. The relative risk for LC was 1.7 times greater for DE graft (p: 0.01; CI: 1.10 to 2.72; RR>1). Differences were not observed for clinical outcomes after both types of CTGs (p > 0.05). Biopsies showed deep invagination of the epithelial lining suggesting cyst-like area/ cavity with keratin content and consolidated in fibrous connective tissue. After 24 months biopsied areas presented no recurrence of LC, in non-biopsied patients the clinical condition remained unchanged. CONCLUSIONS Considering the limitations of this study, LC on recipient sites demonstrated no statistical difference between two types of CTG.
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Affiliation(s)
- Matheus Völz Cardoso
- Discipline of Periodontics, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - Vanessa Soares Lara
- Discipline of Pathology and Oral Pathology, Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | | | - Carla Andreotti Damante
- Discipline of Periodontics, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
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9
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Wang YS, Bissonnette C, Brett C, McNamara KK, Tatakis DN. Multiple Epithelial Origin Complications Following Subepithelial Connective Tissue Graft for Root Coverage. Clin Adv Periodontics 2021; 11:140-144. [PMID: 33393182 DOI: 10.1002/cap.10146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/23/2020] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The subepithelial connective tissue graft (SCTG) and flap combination is a highly predictable root coverage procedure, with low complication rates. To our knowledge, this article reports the first case of two late SCTG complications, epithelial cell discharge, and subsequent epidermal inclusion cyst (EIC) formation. CASE PRESENTATION A 35-year-old male presented with a 3-mm deep Miller Class II recession defect on the mandibular right canine and mesial root of mandibular right first molar. A mild discomfort was reported at 8 weeks after envelope flap+SCTG in #27. At 4 months after the procedure, the patient presented with persistent discomfort and minimally compressible recipient site diffuse swelling with discharge, which was cytologically diagnosed as normal epithelial cells. One year postoperatively, enlargement of the lesion was seen, and excisional biopsy was performed simultaneously with SCTG in #30. The lesion was diagnosed as EIC. At 8 months follow-up, the site healed uneventfully, the patient remained asymptomatic, and the site exhibited scar formation and no recurrence of the lesion. CONCLUSION This report highlights epithelial cell discharge and EIC formation as a rare yet possible SCTG complication and emphasizes the importance of an excisional biopsy as the means to obtain a definitive diagnosis and manage this complication.
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Affiliation(s)
- Ying S Wang
- Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, OH
| | - Caroline Bissonnette
- Division of Oral and Maxillofacial Pathology, College of Dentistry, The Ohio State University, Columbus, OH.,Current affiliation: Department of Oral Medicine, Atrium Health, Charlotte, NC
| | - Christopher Brett
- Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, OH.,Current affiliation: Private practice, Tulsa, OK
| | - Kristin K McNamara
- Division of Oral and Maxillofacial Pathology, College of Dentistry, The Ohio State University, Columbus, OH
| | - Dimitris N Tatakis
- Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, OH
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10
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Chambrone L, Tatakis DN. Periodontal soft tissue root coverage procedures: a systematic review from the AAP Regeneration Workshop. J Periodontol 2016; 86:S8-51. [PMID: 25644302 DOI: 10.1902/jop.2015.130674] [Citation(s) in RCA: 253] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND This paper aims to create a "bridge" between research and practice by developing a practical, extensive, and clinically relevant study that translates evidence-based findings on soft tissue root coverage (RC) of recession-type defects to daily clinical practice. METHODS This review is prepared in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement based on the proposed focused questions. A literature search with no restrictions regarding status or the language of publication was performed for MEDLINE and EMBASE databases up to and including June 2013. Systematic reviews (SRs), randomized clinical trials, controlled clinical trials, case series, and case reports evaluating recession areas that were treated by means of RC procedures were considered eligible for inclusion through the three parts of the study (part I, an overview of the base of SRs; part II, an alternative random-effects meta-analyses on mean percentage of RC and sites exhibiting complete RC; and part III, an SR of non-randomized trials exploring other conditions not extensively evaluated by previous SRs). Data on Class I, II, III, and IV recessions, type of histologic attachment achieved with treatment, recipient- and donor-site anatomic characteristics, smoking-related outcomes, root surface conditions, tooth type and location, long-term effectiveness outcomes, unusual conditions that may be reported during conventional daily practice, and patient-centered outcomes were assessed as well. RESULTS Of the 2,456 potentially eligible trials, 234 were included. Data on Class I, II, III, and IV gingival recessions, histologic attachment achieved after treatment, recipient- and donor-site anatomic characteristics, smoking-related outcomes, root surface conditions/biomodification, tooth type and location, long-term effectiveness outcomes and unusual conditions that may be reported during conventional daily practice, and patient-centered outcomes (i.e., esthetic, visual analog scale, complications, hypersensitivity, patients perceptions) were assessed. Subepithelial connective tissue (CT)-based procedures and coronally advanced flap plus acellular dermal matrix grafts, enamel matrix derivative, or collagen matrix led to the best improvements of recession depth, clinical attachment level (CAL) gain, and keratinized tissue (KT). Some conditions, such as smoking and use of magnification, may affect RC outcomes. CONCLUSIONS All RC procedures can provide significant reduction in recession depth and CAL gain for Miller Class I and II recession-type defects. Subepithelial CT graft-based procedures provided the best outcomes for clinical practice because of their superior percentages of mean and complete RC, as well as significant increase of KT.
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Affiliation(s)
- Leandro Chambrone
- UIBO (Unit of Basic Oral Investigation), Faculty of Dentistry, El Bosque University, Bogotá, Colombia
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11
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McGuire MK, Scheyer ET, Schupbach P. A Prospective, Case-Controlled Study Evaluating the Use of Enamel Matrix Derivative on Human Buccal Recession Defects: A Human Histologic Examination. J Periodontol 2016; 87:645-53. [PMID: 26832834 DOI: 10.1902/jop.2016.150459] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Connective tissue grafts (CTGs) and coronally advanced flaps (CAFs) do not regenerate periodontal attachment apparatus when used to treat gingival recessions (GRs). Instead of generating new bone, cementum, and inserting periodontal ligament fibers, CTG+CAF repairs through a long epithelial junction and connective tissue attachment. Enamel matrix derivatives (EMDs) have demonstrated proof-of-principle that periodontal regeneration can be achieved, although data are limited. METHODS Three patients, each requiring extraction of four premolars before orthodontic treatment, were enrolled in a randomized, open-label study. Two months after induction of Miller Class I and II GR, each patient received EMD+CAF for three teeth and CTG+CAF for one tooth for root coverage. Nine months after root coverage, all four premolars from each of the three patients were surgically extracted en bloc for histologic and microcomputed tomography (micro-CT) analysis, looking for evidence of periodontal regeneration. Standard clinical measurements, radiographs, and intraoral photographs were taken over prescribed time points. RESULTS Seven of the nine teeth treated with EMD+CAF demonstrated varying degrees of periodontal regeneration, detailed through histology with new bone, cementum, and inserting fibers. Micro-CT corroborated these findings. None of the three teeth treated with CTG+CAF showed periodontal regeneration. Clinical measurements were comparable for both treatments. One instance of root resorption and ankylosis was noted with EMD+CAF. CONCLUSIONS EMD+CAF continues to show histologic evidence of periodontal regeneration via human histology, this being the largest study (nine teeth) examining its effect when treating GR. The mechanism of action, ideal patient profile, and criteria leading to predictable regeneration are in need of further exploration.
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Affiliation(s)
| | | | - Peter Schupbach
- Laboratory for Applied Periodontal and Craniofacial Regeneration, The Dental College of Georgia, Institute for Regenerative and Reparative Medicine, Augusta University, Augusta Georgia
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12
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Zuhr O, Bäumer D, Hürzeler M. The addition of soft tissue replacement grafts in plastic periodontal and implant surgery: critical elements in design and execution. J Clin Periodontol 2014; 41 Suppl 15:S123-42. [DOI: 10.1111/jcpe.12185] [Citation(s) in RCA: 142] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 10/07/2013] [Accepted: 10/16/2013] [Indexed: 01/27/2023]
Affiliation(s)
- Otto Zuhr
- Private Practice Hürzeler/Zuhr; Munich Germany
- Department of Periodontology; Centre for Dental, Oral, and Maxillofacial Medicine (Carolinum); Johann Wolfgang Goethe-University Frankfurt/Main; Frankfurt Germany
| | | | - Markus Hürzeler
- Private Practice Hürzeler/Zuhr; Munich Germany
- Department of Operative Dentistry and Periodontology; University Dental School; University of Freiburg; Freiburg Germany
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13
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Parashis AO, Tatakis DN. Subepithelial Connective Tissue Graft for Root Coverage: A Case Report of an Unusual Late Complication of Epithelial Origin. J Periodontol 2007; 78:2051-6. [DOI: 10.1902/jop.2007.070099] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Griffin TJ, Cheung WS, Zavras AI, Damoulis PD. Postoperative complications following gingival augmentation procedures. J Periodontol 2007; 77:2070-9. [PMID: 17209793 DOI: 10.1902/jop.2006.050296] [Citation(s) in RCA: 239] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Postoperative pain, swelling, and bleeding are the most common complications following soft tissue grafting procedures; however, detailed documentation is sparse in the literature. The aims of this prospective study were as follows: 1) to compare the frequency of complication occurrence after free soft tissue grafting (FSTG) or subepithelial connective tissue grafting (SCTG) procedures; 2) to evaluate the use of an acellular dermal matrix (ADM) as the donor tissue alternative to an FSTG or SCTG; and 3) to identify possible predictors for these complications. METHODS Seventy-five FSTG and 256 SCTG procedures were performed in 228 patients by a single operator. In five free soft tissue and 84 bilaminar graft procedures, an ADM was used instead of autogenous tissue. Variables such as the duration and location of procedures, smoking history, gender, and age were recorded. Patients were asked to fill out a questionnaire 1 week after the surgeries regarding postoperative pain, swelling, and bleeding. Data were analyzed using the chi2 test and logistic regression analysis. Odds ratios were calculated for moderate and severe adverse outcomes grouped together. RESULTS The duration of surgical procedures was highly correlated with pain or swelling post-surgically (P = 0.001). Current smokers were three times more likely to experience post-surgical swelling (P = 0.01). Patients who underwent FSTG procedures were three times more likely to develop post-surgical pain (P = 0.002) or bleeding (P = 0.03) compared to those who received SCTG procedures. When an ADM was applied instead of autogenous tissue, the probability of swelling or bleeding was significantly reduced (odds ratio [OR] = 0.46, P = 0.02 and OR = 0.3, P = 0.001, respectively). CONCLUSIONS Long surgical procedures and smoking may increase the severity and frequency of certain post-surgical complications after gingival augmentation procedures. FSTG procedures incur a higher likelihood for postoperative pain or bleeding than SCTG procedures, whereas the application of an ADM may significantly reduce the probability of swelling and bleeding.
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Affiliation(s)
- Terrence J Griffin
- Department of Periodontology, Tufts University School of Dental Medicine, Boston, MA 02111, USA.
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Neely AL, Gordon SC. A Familial Pattern of Multiple Idiopathic Cervical Root Resorption in a Father and Son: A 22-Year Follow-Up. J Periodontol 2007; 78:367-71. [PMID: 17274728 DOI: 10.1902/jop.2007.060155] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The etiology of idiopathic cervical root resorption has not been elucidated clearly. However, the process has been linked to trauma, intracanal bleaching, and partial-thickness connective tissue grafts. METHODS This study describes a familial pattern of multiple idiopathic cervical root resorption in a father and son. RESULTS The father was a healthy 63-year-old white male who presented with the first resorption lesion in 1983. Twenty-seven additional lesions were identified on 16 teeth over 22 years. Five teeth were lost as a result of extensive resorption. The son was a healthy 43-year-old when a resorption lesion was identified in 1993. A lesion identified on another tooth 12 years later resulted in extraction. CONCLUSIONS Close relatives of those affected by multiple idiopathic cervical root resorption should be examined carefully for cervical resorption. This study also showed that early treatment can prevent or delay the need for extraction.
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Affiliation(s)
- Anthony L Neely
- Department of Periodontology and Dental Hygiene, School of Dentistry, University of Detroit Mercy, Detroit, MI 48219, USA.
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Wei PC, Geivelis M. A Gingival Cul-de-Sac Following a Root Coverage Procedure with a Subepithelial Connective Tissue Submerged Graft. J Periodontol 2003; 74:1376-80. [PMID: 14584873 DOI: 10.1902/jop.2003.74.9.1376] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The subepithelial connective tissue graft (SCTG) used as a submerged graft in combination with a partial thickness advanced flap or rotated flap is a predictable technique for achieving coverage of the denuded root surface and/or for increasing the width of attached gingiva in Miller's class I and II marginal tissue recessions. However, even with a successful result, complications may occasionally occur. METHODS A 4-mm marginal tissue recession with an insufficient zone of attached gingiva on the facial aspect of a mandibular left lateral incisor (#23) was covered with a submerged SCTG and an envelope partial thickness flap. The mucogingival defect was successfully corrected. Nevertheless, the facial gingiva, specifically between teeth #22 (mandibular left canine) and #23, remained bulky and was reshaped 6 months postoperatively. A 5-mm long gingival cul-de-sac with an intermittent thick white discharge was detected 3 months following the gingivoplasty procedure. RESULTS With a periodontal probe kept in the tract, the lining of the cul-de-sac was exposed to the oral cavity by making an incision on the facial gingiva, along the axis of the probe, through to the lumen. The gingival tissue was then removed with a rotary bur until only a thin layer of periosteum remained. The mucosal defect was subsequently repaired by grafting with a non-submerged SCTG. The gingival contour was significantly improved and no sign of recurrence was noted up to 4 years later. CONCLUSIONS The existence of a cyst cannot be verified without a histological evaluation. However, the development of a gingival cyst should be suspected with persistent tissue bulkiness and/or emergence of a thick white discharge from a site where a submerged SCTG procedure was performed. In addition, the ill-circumscribed border around the lesion makes complete elimination of the pathosis relatively hard to achieve by a "superficial" gingivoplasty procedure.
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Affiliation(s)
- Pein-Chi Wei
- Department of Periodontics, Division of Dentistry, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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