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Sabri H, Alhachache S, Saxena P, Dubey P, Nava P, Rufai SH, Sarkarat F. Microsurgery in periodontics and oral implantology: a systematic review of current clinical applications and outcomes. Evid Based Dent 2024:10.1038/s41432-024-01024-4. [PMID: 38867104 DOI: 10.1038/s41432-024-01024-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/03/2024] [Indexed: 06/14/2024]
Abstract
OBJECTIVES The aim of this systematic review was to comprehensively explore the current trends and therapeutic approaches in which an operating microscope (OM) is used in periodontics and dental implant surgeries. MATERIALS AND METHODS A systematic search strategy was built to detect studies including various surgical techniques performed under an OM. PubMed, EMBASE, and SCOPUS databases were searched. No limitations in terms of time and language were applied. The data regarding the study design, type of procedure, treatment groups, and surgical outcomes were collected and analyzed descriptively. In addition, a bibliometric analysis was performed concerning the co-authorship and keyword co-occurrence network. RESULTS Out of 1985 articles, finally, 55 met the inclusion criteria. Current periodontal and implant microsurgery trends consist of: periodontal therapy, dental implant microsurgery, soft tissue grafting and periodontal plastic surgery, bone augmentation, ridge preservation, and ortho-perio microsurgery. The bibliometric analysis revealed "guided tissue regeneration", "periodontal regeneration" and "root coverage" being the most repeated keywords (landmark nodes). 132 authors within 29 clusters were identified, publishing within the frameworks of "periodontal and implant microsurgery". CONCLUSION Within its limitations, this systematic review provides an overview of the latest trends in periodontal and implant microsurgery when considering the use of an OM as the magnification tool. Also, it discusses the reported success and outcomes of the mentioned procedures.
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Affiliation(s)
- Hamoun Sabri
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.
| | - Sara Alhachache
- Department of Periodontics, University of Louisville School of Dental Medicine, Louisville, KY, USA
| | - Pramiti Saxena
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Prerana Dubey
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Paolo Nava
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Syed Hanan Rufai
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Farzin Sarkarat
- Department of Oral and Maxillofacial Surgery, Gulf Medical University, Ajman, United Arab Emirates
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Ardila CM, González-Arroyave D, Vivares-Builes AM. A Systematic Review of Randomized Clinical Trials Evaluating the Efficacy of Minimally Invasive Surgery for Soft Tissue Management: Aesthetics, Postoperative Morbidity, and Clinical Results. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050924. [PMID: 37241156 DOI: 10.3390/medicina59050924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: The necessity for less invasive and patient-friendly surgical therapies guided the development of the "minimally invasive surgical technique" (MIST). The aim of this systematic review was to evaluate the efficacy of MIST for soft tissue management considering aesthetic results, postoperative morbidity, and clinical outcomes. Materials and Methods: Several databases were used to conduct a thorough analysis of the scientific evidence. To investigate randomized clinical trials (RCTs), MeSH terms and keywords were provided. Results: Eleven RCTs were chosen. These experiments included 273 patients. The trials that explored MIST for papilla preservation presented greater efficacy in increasing papillary height (p < 0.05). MIST showed stable clinical outcomes for the management of excessive gingival display and with a flapless technique for single implant placement. Considering the treatment of gingival recessions, some RCTs presented greater root coverage with MIST (p < 0.05), while other trials did not show differences between groups. Regarding aesthetic perception, five RCTs indicated high patient satisfaction with MIST (p < 0.05). Similarly, six RCTs reported that patients in the MIST group presented significantly less post-surgical pain and lower wound healing scores (p < 0.01). Conclusions: It was concluded that using MIST resulted in more clinical studies reporting better clinical outcomes. Considering aesthetic appearance, slightly more than half of the clinical trials also showed improved results with MIST. Likewise, regarding postoperative morbidity, 60% of the clinical trials also described better scores with MIST. All of this indicates that MIST is a good alternative for the management of soft tissues.
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Affiliation(s)
- Carlos M Ardila
- Basic Studies Department, School of Dentistry, Universidad de Antioquia UdeA, Medellín 050010, Colombia
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3
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Öngöz Dede F, Bozkurt Doğan Ş, Çelen K, Çelen S, Deveci ET, Seyhan Cezairli N. Comparison of the clinical efficacy of concentrated growth factor and advanced platelet-rich fibrin in the treatment of type I multiple gingival recessions: a controlled randomized clinical trial. Clin Oral Investig 2023; 27:645-657. [PMID: 36401070 DOI: 10.1007/s00784-022-04775-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/06/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The purpose of this randomized controlled clinical trial was to compare and evaluate the clinical effects of concentrated growth factor (CGF) and advanced platelet-rich fibrin (A-PRF) applied together with coronally advanced flap (CAF) technique using a microsurgical approach in the treatment of type I multiple gingival recessions (GR). MATERIALS AND METHODS Sixteen patients with multiple recession defects (Cairo type I) were included in this randomized and controlled study. Forty-five gingival recession defects were randomly equally divided into three groups (n = 15): CAF + CGF (test site); CAF + A-PRF (test site), and CAF alone (control site). Clinical attachment level (CAL), vertical gingival recession (VGR), horizontal gingival recession (HGR), gingival thickness (GT), width of keratinized gingiva (KGW), percentages of the mean (MRC), and complete root coverage (CRC), patient esthetic score (PES), and hypersensitivity score (HS) were recorded at baseline and 6 months after surgery. Patient comfort score (PCS) was evaluated at the day of surgery. RESULTS Significant improvements were determined in CAL, VGR, HGR, KGW, and GT at 6 months when compared to baseline levels in intra-group comparisons for all groups, and also GT was increased in CAF + A-PRF and CAF + CGF compared to CAF alone at 6 months in intergroup comparisons (p < 0.05). At 6 months, MRC was detected 85.66 ± 22.68% in the CAF + CGF, 90.88 ± 20.87% in the CAF + A-PRF, and 75.10 ± 32,37% in the CAF alone, and a significant increase was detected in the CAF + A-PRF group compared to CAF alone (p < 0.05). CRC in CAF + CGF was 66.66%, in CAF + A-PRF 80% and in CAF alone was 53.33% (p > 0.05). PES and HS values showed significant improvement from baseline to 6 months for all groups and also in CAF + CGF and CAF + A-PRF compared to CAF alone at 6 months in intergroup comparisons (p < 0.05). CONCLUSIONS The present study showed that the use of A-PRF and CGF membranes in GR therapy may have an additional benefit in GT increase and also A-PRF may increase the percentages of MRC. The use of A-PRF and CGF membranes may be beneficial in terms of improving patient-related parameters. CLINICAL RELEVANCE A-PRF and CGF may be superior to CAF alone in terms of patient-related parameters and GT increase in multiple recession defects. TRIAL REGISTRATION NUMBER 17578e02-00a9-4a41-8c8d-42a637143531.
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Affiliation(s)
- Figen Öngöz Dede
- Faculty of Dentistry, Department of Periodontology, Ordu University, 52100, Altınordu. Ordu, Turkey.
| | - Şeyma Bozkurt Doğan
- Faculty of Dentistry, Department of Periodontology, Yıldırım Beyazıt University, Ankara, Turkey
| | - Kübra Çelen
- Faculty of Dentistry, Department of Periodontology, Ordu University, 52100, Altınordu. Ordu, Turkey
| | - Selman Çelen
- Faculty of Dentistry, Department of Periodontology, Ordu University, 52100, Altınordu. Ordu, Turkey
| | - Emre Taha Deveci
- Faculty of Dentistry, Department of Periodontology, Ordu University, 52100, Altınordu. Ordu, Turkey
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Cairo F, Burkhardt R. Minimal invasiveness in gingival augmentation and root coverage procedures. Periodontol 2000 2023; 91:45-64. [PMID: 36694255 DOI: 10.1111/prd.12477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/30/2022] [Accepted: 07/20/2022] [Indexed: 01/26/2023]
Abstract
Minimally invasive surgical procedures aim at optimal wound healing, a reduction of postoperative morbidity and, thus, at increased patient satisfaction. The present article reviews the concept of minimal invasiveness in gingival augmentation and root coverage procedures, and critically discusses the influencing factors, technical and nontechnical ones, and relates them to the underlying biological mechanisms. Furthermore, the corresponding outcomes of the respective procedures are assessed and evaluated in relation to a possible impact of a minimized surgical invasiveness on the clinical, aesthetic, and patient-related results.
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Affiliation(s)
- Francesco Cairo
- Head Research Unit in Periodontology and Periodontal Medicine, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Rino Burkhardt
- Private Practice, Zurich, Switzerland.,Center of Dental Medicine, University of Zurich, Zurich, Switzerland.,Prince Philip Dental Hospital, The University of Hong Kong, Hong Kong, Hong Kong, SAR.,Department of Periodontics & Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Durgapal S, Shetty M. Magnification in Periodontics: An Overview. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2022. [DOI: 10.1055/s-0042-1747911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AbstractA plethora of changes in the concept and the techniques in dental sciences and an increase in patient awareness have spawned demand in advanced dental treatment encompassing elimination of disease with more precision and less discomfort. The use of magnification systems like microscopes is widespread in the medical field, and now it has successfully spread its wings in dentistry. Visual enhancement by using loupes or surgical microscopes can render refinement in the basic surgical procedures. Magnification periodontics refers to the wide range of procedures performed by the use of magnification systems like loupes and microscopes that allow convergence of ideas and efforts, which can make a huge impact on patients. Periodontal procedures are being increasingly performed nowadays that have enabled enhanced outcomes, which were difficult to achieve with the macrosurgery procedures when wound healing and tissue trauma are in consideration. The surgical operating microscope works within the microsurgical triad that includes illumination increased precision and magnification. The incorporation of smaller instruments and sutures and better visualization of the operating site enhance the surgical skills of the clinician. In the past decade, various periodontal procedures from the removal of calculus to the placement of dental implants have been performed using the surgical microscope, which have invariably provided favorable results. It is a topic of interest in the future of periodontal therapy.
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Affiliation(s)
- Surabhi Durgapal
- Department of Periodontics, A B Shetty Memorial Institute of Dental Sciences, Nitte Deemed to be University, Mangalore, Karnataka, India
| | - Mamatha Shetty
- Department of Periodontics, A B Shetty Memorial Institute of Dental Sciences, Nitte Deemed to be University, Mangalore, Karnataka, India
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Robotic and Microrobotic Tools for Dental Therapy. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:3265462. [PMID: 35222881 PMCID: PMC8881140 DOI: 10.1155/2022/3265462] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/02/2022] [Accepted: 01/18/2022] [Indexed: 12/04/2022]
Abstract
Robotic and microrobotic tools such as dental operating microscopes and dental endoscopes are being used extensively in dental therapy, which have a significant impact on dental therapy and education. Herein, this paper reviews the state of the art of robotic and microrobotic tools for dental therapy. This article starts with a brief introduction of current robotic and microrobotic tools for dental therapy and then displays their applications in various dental problems; strengths and weaknesses are also surveyed. Lastly, the conclusion and outlook are discussed, referring to the emerging dental clinic problems and demands. This review is expected to provide guidelines for the therapeutic application of robotic and microrobotic tools and to promote the development of robots in dentistry.
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7
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Savithri N, Subramanian S, Prakash PG, Appukuttan D. Effect of microsurgical technique for root coverage using modified coronally advanced flap with connective tissue graft- Randomized controlled clinical trial. Dent Res J (Isfahan) 2022. [DOI: 10.4103/1735-3327.359324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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8
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The comparison of the efficacy of gingival unit graft with connective tissue graft in recession defect coverage: a randomized split-mouth clinical trial. Clin Oral Investig 2021; 26:2761-2770. [PMID: 34787718 DOI: 10.1007/s00784-021-04252-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 10/23/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Gingival unit graft (GUG) is defined as the modified form of free gingival graft. The aim of this study is to compare the clinical efficacy of GUG with connective tissue graft (SCTG) with respect to clinical periodontal parameters and patient comfort scores in gingival recessions. MATERIALS AND METHODS Sixteen patients with bilateral recession type 1 (RT1) gingival recessions participated in this randomized and split-mouth study. Thirty-two defects received surgical treatment with SCTG or GUG. The recession defect coverage, periodontal measurements, and patient-reported outcomes (intra- and post-operative patient comfort, aesthetic satisfaction, and hypersensitivity) were evaluated at baseline and post-operative months 1, 3 and 6. RESULTS The favorable results were obtained in both study groups in gingival recession depth (RD), gingival recession width (RW), clinical attachment level (CAL), and keratinized tissue width (KTW). The average percentages of the recession defect coverage (RC) for GUG and SCTG group treatments after 6 months were 68.2 ± 33% and 76.4 ± 30.2%, respectively (p > 0.05). Although there was no significant difference between groups at post-operative 6 months (p > 0.05) in terms of RD, RW, CAL, RC, patient comfort, aesthetic satisfaction, and hypersensitivity parameters, the increase in KTW was significantly higher in GUG group (p < 0.05). CONCLUSIONS It was concluded that although both techniques were effective, GUG can be a convenient method for treatment of RT1 gingival recessions with inadequate KTW and (or) shallow vestibule depth. CLINICAL RELEVANCE According to the results of this study, GUG may be a preferred choice in localized gingival recessions with a lack of keratinized tissue. The trial registration number: NCT04637451.
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Di Gianfilippo R, Wang IC, Steigmann L, Velasquez D, Wang HL, Chan HL. Efficacy of microsurgery and comparison to macrosurgery for gingival recession treatment: a systematic review with meta-analysis. Clin Oral Investig 2021; 25:4269-4280. [PMID: 33928441 DOI: 10.1007/s00784-021-03954-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Microsurgical principles, techniques, and armamentarium have made significant contributions to the periodontal plastic surgery. The present meta-analysis aimed to investigate the overall efficacy of microsurgery on root coverage, and its clinical outcomes when compared to traditional macrosurgery. MATERIAL AND METHODS Electronic searches on PubMed, Embase, and CINAHL were used to retrieve prospective clinical trials. Primary outcomes were the mean root coverage (mRC) and probability of achieving complete root coverage (cRC), with secondary outcomes as other periodontal parameters and patient-reported outcome measures (PROMs). RESULTS Nineteen studies were included in the quantitative analysis. Microsurgery was estimated to achieve 83.3% mRC and 69.3% cRC. From a subgroup of 9 comparative studies, it was estimated microsurgery increased mRC by 6.6% (p<0.001) and cRC by 27.9% (p<0.01) compared to macrosurgical control treatments. Operating microscope (OM) yielded a significantly 6.7% higher mRC than the control group (p=0.002), while using loupes showed 6.16% increase in mRC with a borderline significance (p=0.09). OM and loupes-only had a 31.05% (p=0.001) and 25.54% (p=0.001) increases in achieving cRC compared to control, respectively. As for PROMs, microsurgery reduced postoperative pain (p<0.001) and enhanced esthetics (p= 0.05). CONCLUSIONS Microsurgery significantly improved mean root coverage, probability of achieving complete root coverage, esthetics, and post-surgical recovery. Microsurgery enhances not only subclinical healing but also clinical outcomes, possibly owing to its minimally invasive approach and surgical precision. CLINICAL RELEVANCE Periodontal plastic microsurgery is minimally invasive, inducing less surgical trauma and ultimately resulting in improved clinical outcomes, patient's satisfaction, and quality of life.
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Affiliation(s)
- Riccardo Di Gianfilippo
- Department of Periodontics and Oral Medicine, University of Michigan - School of Dentistry, 1011 North University Avenue, Ann Arbor, MI, USA
| | - I-Ching Wang
- Department of Periodontics and Oral Medicine, University of Michigan - School of Dentistry, 1011 North University Avenue, Ann Arbor, MI, USA
| | - Larissa Steigmann
- Department of Periodontics and Oral Medicine, University of Michigan - School of Dentistry, 1011 North University Avenue, Ann Arbor, MI, USA
| | - Diego Velasquez
- Department of Periodontics and Oral Medicine, University of Michigan - School of Dentistry, 1011 North University Avenue, Ann Arbor, MI, USA.,Private Practice, 415 North Alloy Drive, Fenton, MI, 48430, USA
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan - School of Dentistry, 1011 North University Avenue, Ann Arbor, MI, USA
| | - Hsun-Liang Chan
- Department of Periodontics and Oral Medicine, University of Michigan - School of Dentistry, 1011 North University Avenue, Ann Arbor, MI, USA.
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KAYAR NA, AYTEKİN Z. IMPACT OF TOOTH LOCATION ON THE TREATMENT OF MULTIPLE GINGIVAL RECESSIONS WITH CONNECTIVE TISSUE GRAFT ASSOCIATED WITH A CORONALLY ADVANCED FLAP. CUMHURIYET DENTAL JOURNAL 2021. [DOI: 10.7126/cumudj.884369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Goyal L, Chawla K. Efficacy of microsurgery in treatment of localized or multiple gingival recession: A systematic review. J Oral Biol Craniofac Res 2021; 11:237-244. [PMID: 33665073 DOI: 10.1016/j.jobcr.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 01/30/2021] [Accepted: 02/01/2021] [Indexed: 10/22/2022] Open
Abstract
Objective To address the clinical question whether microsurgery hold an advantage in terms of clinical and patient oriented outcome over conventional macrosurgical procedures in the treatment of gingival recession. Material and methods A Literature search on MEDLINE, SCOPUS, EMBASE (Excerpta Medica Database) via Ovid and Cochrane library was conducted in order to investigate clinical studies on efficacy of microsurgery in the treatment of localized or multiple gingival recession as compared to conventional macrosurgical procedures. Publications before May 2020 and grey literature was searched without any language restrictions. Primary outcome considered was change in recession depth and mean root coverage. Whereas, change in clinical attachment level, Change in keratinized tissue, patient oriented outcome like esthetics, pain and discomfort were the secondary outcome. Based on inclusion criteria ten studies were included in systematic review. Data was extracted and analyzed. Results and conclusion All the included studies showed improvement in the mean percentage of root coverage or mean root coverage (primary outcome) when microsurgical approach was used. Predictability of complete root coverage is better with microsurgical instrumentation but results are not statistically significant. As far as patient centered outcome is concerned, there is no evidence for recommendation of microsurgery.
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Affiliation(s)
- Lata Goyal
- Department of Dentistry (Periodontology), All India Institute of Medical Sciences, Bathinda, India
| | - Kirti Chawla
- Department of Periodontics, Jamia Millia Islamia, New Delhi, India
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Ma L, Fei B. Comprehensive review of surgical microscopes: technology development and medical applications. JOURNAL OF BIOMEDICAL OPTICS 2021; 26:JBO-200292VRR. [PMID: 33398948 PMCID: PMC7780882 DOI: 10.1117/1.jbo.26.1.010901] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/04/2020] [Indexed: 05/06/2023]
Abstract
SIGNIFICANCE Surgical microscopes provide adjustable magnification, bright illumination, and clear visualization of the surgical field and have been increasingly used in operating rooms. State-of-the-art surgical microscopes are integrated with various imaging modalities, such as optical coherence tomography (OCT), fluorescence imaging, and augmented reality (AR) for image-guided surgery. AIM This comprehensive review is based on the literature of over 500 papers that cover the technology development and applications of surgical microscopy over the past century. The aim of this review is threefold: (i) providing a comprehensive technical overview of surgical microscopes, (ii) providing critical references for microscope selection and system development, and (iii) providing an overview of various medical applications. APPROACH More than 500 references were collected and reviewed. A timeline of important milestones during the evolution of surgical microscope is provided in this study. An in-depth technical overview of the optical system, mechanical system, illumination, visualization, and integration with advanced imaging modalities is provided. Various medical applications of surgical microscopes in neurosurgery and spine surgery, ophthalmic surgery, ear-nose-throat (ENT) surgery, endodontics, and plastic and reconstructive surgery are described. RESULTS Surgical microscopy has been significantly advanced in the technical aspects of high-end optics, bright and shadow-free illumination, stable and flexible mechanical design, and versatile visualization. New imaging modalities, such as hyperspectral imaging, OCT, fluorescence imaging, photoacoustic microscopy, and laser speckle contrast imaging, are being integrated with surgical microscopes. Advanced visualization and AR are being added to surgical microscopes as new features that are changing clinical practices in the operating room. CONCLUSIONS The combination of new imaging technologies and surgical microscopy will enable surgeons to perform challenging procedures and improve surgical outcomes. With advanced visualization and improved ergonomics, the surgical microscope has become a powerful tool in neurosurgery, spinal, ENT, ophthalmic, plastic and reconstructive surgeries.
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Affiliation(s)
- Ling Ma
- University of Texas at Dallas, Department of Bioengineering, Richardson, Texas, United States
| | - Baowei Fei
- University of Texas at Dallas, Department of Bioengineering, Richardson, Texas, United States
- University of Texas Southwestern Medical Center, Department of Radiology, Dallas, Texas, United States
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Holtzman LP, Blasi G, Rivera E, Herrero F, Downton K, Oates T. Gingival Thickness and Outcome of Periodontal Plastic Surgery Procedures: A Meta-regression Analysis. JDR Clin Trans Res 2020; 6:295-310. [PMID: 32718265 DOI: 10.1177/2380084420942171] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To evaluate the impact of soft tissue thickness (STT) on root coverage achieved with different periodontal plastic surgery procedures. BACKGROUND Gingival recession has been managed successfully through various surgical approaches, with great variability in outcomes. Anatomic characteristics of the recipient site and selected technique account in part for this variability. Gingival flap thickness is one of the most critical site-related characteristics. METHODS An electronic search was conducted on the major databases (PubMed, Embase, Web of Science). Human prospective studies with at least 6 mo of follow-up and with a numeric baseline measurement for gingival thickness were eligible. Only studies including nonsmoking patients were considered. Variables included surgical approach, participant characteristics, local anatomic factors, and follow-up time. Primary outcome was mean percentage root coverage (%RC) achieved, and complete root coverage was a secondary outcome. RESULTS A total of 42 studies were included (35 randomized controlled trials, 5 case series, 1 prospective cohort study, and 1 controlled clinical trial). Across studies, the pooled %RC was 81.9% (95% CI, 79.1% to 84.7%). The %RC was not significantly associated (P = 0.267) with baseline soft tissue thickness; however there was a significant (P = 0.031) inverse relationship between STT and %RC after 12-mo follow-up. Subgroup analysis showed that for no graft, there was a significant (P = 0.025) positive relationship between STT and %RC with the exclusion of the single outlier study based on STT. CONCLUSIONS STT plays a limited role in predicting root coverage across all approaches; when flaps are performed with no graft, the effect of STT is most critical. The length of time following surgery appears to influence outcomes, with 12-mo follow-up offering greater insight. KNOWLEDGE TRANSFER STATEMENT The results of this study can suggest to clinicians which periodontal plastic surgery technique to employ when treating challenging cases. In particular, it can be helpful when selecting the treatment approach to treat thin phenotype sites. This study could help clinicians provide a more appropriate treatment decision in such cases.
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Affiliation(s)
- L Paternò Holtzman
- Department of Periodontology and Prosthodontics, G. Eastman Dental Hospital, Rome, Italy.,Private practice, Rome, Italy.,Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD, USA
| | - G Blasi
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD, USA.,Department of Periodontology, International University of Catalonia, Barcelona, Spain
| | - E Rivera
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD, USA
| | - F Herrero
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD, USA.,Private practice, San Juan, Puerto Rico
| | - K Downton
- Health Sciences and Human Services Library, University of Maryland, Baltimore, Baltimore, MD, USA
| | - T Oates
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD, USA
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Minimally Invasive Surgery for Clinical Crown Lengthening Using Piezoelectric Ultrasound. Case Rep Dent 2020; 2020:7234310. [PMID: 32181022 PMCID: PMC7066419 DOI: 10.1155/2020/7234310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 01/18/2020] [Indexed: 11/17/2022] Open
Abstract
This case report is aimed at describing a flapless, minimally invasive clinical crown lengthening with an osteotomy performed using a piezoelectric ultrasound. A female patient complained about the amount of gum that was exposed when she smiled, which caused aesthetic discomfort. After a clinical examination, it was confirmed that the patient had excessive gum exposure in the upper arch of the dental region for teeth 14 to 24 when she smiled. The tomographic exam showed that bone tissue was at the level of the enamel-cementum junction, and gingival tissue covered a part of the anatomic crown. Virtual analysis using digital smile design (DSD) demonstrated that enlarging the clinical crowns would provide better aesthetics. The excess gingival tissue was removed from the gingival margin region with the aid of a mockup without interference to the interdental papillae. Then, osteotomy was performed using piezoelectric ultrasound until there was a 2.5 mm distance from the top of the bone crest to the new gingival margin. In the postoperative period, good repositioning of the gingival margin, absence of postoperative complications, and rapid healing of the gingival tissue were verified. After 6 months, a good aesthetic outcome was observed with stability in the level of the periodontal tissues obtained via the crown-lengthening technique. It can be concluded that the minimally invasive clinical crown-lengthening technique was effective in repositioning the gingival margin with no postoperative complications.
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15
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Moro MG, Souto MLS, Rovai ES, Cesar Neto JB, Holzhausen M, Pannuti CM. Effect of magnification on root coverage surgery. BRAZILIAN JOURNAL OF ORAL SCIENCES 2020. [DOI: 10.20396/bjos.v19i0.8658221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Root coverage surgery can be performed in patients with gingival recession to cover the exposed root aiming to control hypersensitivity and promotes better aesthetic. Optical magnification has been proposed as a refinement in this surgical technique to increase root coverage. This approach may lead to enhanced soft tissue stability, less post-operative discomfort, better predictability and esthetic appearance. Aim: This systematic review aimed to evaluate the effectiveness of magnification on root coverage surgery when compared to procedures performed without magnification. Methods: Randomized controlled trials with a follow-up of at least 6 months that compared surgeries for root coverage performed under optic magnification versus conventional (macro) root coverage surgery were screened. The primary outcome was mean root coverage (mm) (MRC) and secondary outcomes were percentage of root coverage (PRC) and complete root coverage (CRC). Results: Of 569 papers relevant to this review, seven were included. Meta-analysis showed that the use of magnification may favor greater PRC (7.38%, 95% CI 3.66-11.09). Conclusion: Magnification can increase PRC in root coverage surgeries. More randomized trials with the use of magnification may be necessary to verify if this benefit is clinically relevant, in order to justify the use of this device.
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Novaes AB, Palioto DB. Experimental and clinical studies on plastic periodontal procedures. Periodontol 2000 2019; 79:56-80. [PMID: 30892770 DOI: 10.1111/prd.12247] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We have compiled, in this Periodontology 2000 review, all Latin American literature on experimental and clinical studies of periodontal plastic procedures. The body of literature on this subject has led to a discussion of the features and treatment outcomes of root-coverage procedures. Over time, knowledge on periodontal plastic procedures has become less empirical and more supportive of the clinical management of recession-type defects. Gingival recession etiology, animal studies, free gingival grafts, pedicle flaps (semilunar, laterally positioned, and coronally positioned), and subepithelial connective tissue grafts are extensively reviewed. The use of allografts as an alternative to subepithelial connective tissue grafts, the treatment of multiple gingival recessions, and the rationale for use of guided tissue regeneration and enamel matrix derivative in plastic periodontal procedure is discussed. We also assess how smoking can affect the treatment outcomes in plastic surgery procedures. Minimally invasive procedures are of great value in improving the features of the final tissues. The following aspects identified in this compilation were of great interest: (a) some factors, anatomical in nature, favor the formation of root recessions, but it is the inflammatory process (caused by the presence of biofilm and/or by traumatic toothbrushing) that is responsible for the development of root recessions; and (b) pedicle flap procedures (especially the coronally positioned flap) are extremely versatile and have the most predictable outcome of all root-coverage procedures, especially when combined with subepithelial connective tissue grafting and/or allogeneic grafts. In summary: subepithelial connective tissue grafting is considered as the first option to augment gingival width and thickness, and it may provide better long-term results; the same principles of root-coverage procedures in individual sites appear be used in clinical practice also for multiple-recession type defects; an allograft is an efficient alternative to a subepithelial connective tissue graft and, when it is the treatment option of choice, the use of wide, extended flaps should be considered; because of the superiority of plastic periodontal procedures over guided tissue regeneration and the technical difficulty of the latter, guided tissue regeneration has become obsolete for root-coverage procedures; there is rather a large body of evidence attesting that smoking negatively influences root-coverage procedures, especially subepithelial connective tissue grafts; and minimally invasive techniques may be of great value for improving the results obtained with plastic periodontal procedures, but these techniques need to be better addressed in clinical trials, both in terms of the quality and quantity of the new tissue generated.
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Affiliation(s)
- Arthur Belém Novaes
- Department of Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Daniela Bazan Palioto
- Department of Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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Chambrone L, Castro Pinto RCN, Chambrone LA. The concepts of evidence‐based periodontal plastic surgery: Application of the principles of evidence‐based dentistry for the treatment of recession‐type defects. Periodontol 2000 2019; 79:81-106. [DOI: 10.1111/prd.12248] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Leandro Chambrone
- M.Sc. Dentistry Program Ibirapuera University Sao Paulo SP Brazil
- Unit of Basic Oral Investigation (UIBO) School of Dentistry El Bosque University Bogota Colombia
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Yadav D, Singh S, Roy S. Periodontal microsurgery for management of multiple marginal tissue recession using Zucchelli's modification of coronally advanced flap and pericardium membrane in an esthetic zone. J Indian Soc Periodontol 2019; 23:284-289. [PMID: 31143012 PMCID: PMC6519094 DOI: 10.4103/jisp.jisp_107_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Marginal tissue recession (MTR) by definition is an apical shift of gingival margin, which leads to exposure of root surface. Patients affected with MTR often complain of sensitivity to cold on exposed root surfaces apart from esthetic concerns. In this article, a case of multiple Miller's class I MTR who presented with sensitivity to cold in relation to maxillary anterior teeth region was treated using Zucchelli's coronally advanced flap with pericardium membrane under operating microscope. The application of principles of periodontal microsurgery and guided tissue regeneration results in significant root coverage with reduction/elimination of sensitivity. Long-term success of root coverage procedures depends on the removal of etiology and maintenance therapy.
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Affiliation(s)
- Dinesh Yadav
- Department of Periodontology, Army Dental Centre (Research and Referral), New Delhi, India
| | - Sangeeta Singh
- Department of Periodontology, Army Dental Centre (Research and Referral), New Delhi, India
| | - Subrata Roy
- Department of Periodontology, Army Dental Centre (Research and Referral), New Delhi, India
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Mounssif I, Stefanini M, Mazzotti C, Marzadori M, Sangiorgi M, Zucchelli G. Esthetic evaluation and patient-centered outcomes in root-coverage procedures. Periodontol 2000 2018; 77:19-53. [DOI: 10.1111/prd.12216] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Zuhr O, Rebele SF, Cheung SL, Hürzeler MB. Surgery without papilla incision: tunneling flap procedures in plastic periodontal and implant surgery. Periodontol 2000 2018; 77:123-149. [PMID: 29493018 DOI: 10.1111/prd.12214] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Diverse clinical advancements, together with some relevant technical innovations, have led to an increase in popularity of tunneling flap procedures in plastic periodontal and implant surgery in the recent past. This trend is further promoted by the fact that these techniques have lately been introduced to a considerably expanded range of indications. While originally described for the treatment of gingival recession-type defects, tunneling flap procedures may now be applied successfully in a variety of clinical situations in which augmentation of the soft tissues is indicated in the esthetic zone. Potential clinical scenarios include surgical thickening of thin buccal gingiva or peri-implant mucosa, alveolar ridge/socket preservation and implant second-stage surgery, as well as soft-tissue ridge augmentation or pontic site development. In this way, tunneling flap procedures developed from a technique, originally merely intended for surgical root coverage, into a capacious surgical conception in plastic periodontal and implant surgery. The purpose of this article is to provide a comprehensive overview on tunneling flap procedures, to introduce the successive development of the approach along with underlying ideas on surgical wound healing and to present contemporary clinical scenarios in step-by-step photograph-illustrated sequences, which aim to provide clinicians with guidance to help them integrate tunneling flap procedures into their daily clinical routine.
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21
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Tatarakis N, Gkranias N, Darbar U, Donos N. Blood flow changes using a 3D xenogeneic collagen matrix or a subepithelial connective tissue graft for root coverage procedures: a pilot study. Clin Oral Investig 2017; 22:1697-1705. [PMID: 29080078 DOI: 10.1007/s00784-017-2261-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 10/17/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The study investigated the early healing process following the treatment of single Miller class I and II recessions with a 3D xenogeneic collagen matrix (CMX) or connective tissue graft (CTG). METHODS This pilot investigation was designed as a single-center randomized controlled parallel trial. A total of eight subjects (four per group) were treated with either CMX or CTG in the anterior maxilla. Vascular flow changes were assessed by laser Doppler flowmetry (LDF) before and after surgery and at days 1, 2, 3, 7, 14, and 30 while clinical evaluations took place at baseline and at days 60 and 180. Pain intensity perception was evaluated by the short-form McGill pain questionnaire (SF-MPQ), at days 1 and 14. RESULTS The vascular flow fluctuated similarly in both groups pre- and post-operatively, but the CTG exhibited a more homogeneous pattern as opposed to CMX that showed a second phase of increased blood flow at 14 days. Clinically, the CTG led to greater change in mean root coverage and keratinized tissue gain but CMX was associated with lower early pain intensity scores. CONCLUSIONS Within the limits of the study, the vascular flow alterations during the early healing of both graft types followed a similar pattern. The CMX was associated with a second peak of increased blood flow. CLINICAL RELEVANCE The vascular flow changes after the application of CMX for single tooth recession root coverage did not show major differences from those observed after the use of a CTG. A trend for better clinical performance in terms of root coverage and keratinized tissue gain was noted for the CTG, but the initial patient morbidity was less for CMX.
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Affiliation(s)
- Nikolaos Tatarakis
- Centre for Oral Clinical Research, Institute of Dentistry, Barts & The London School of Medicine & Dentistry, Queen Mary University of London (QMUL), Turner Street, London, E1 2AD, UK
| | - Nikolaos Gkranias
- Centre for Oral Clinical Research, Institute of Dentistry, Barts & The London School of Medicine & Dentistry, Queen Mary University of London (QMUL), Turner Street, London, E1 2AD, UK
| | - Ulpee Darbar
- Department of Restorative Dentistry, Eastman Dental Hospital, University College London Hospital, London, UK
| | - Nikolaos Donos
- Centre for Oral Clinical Research, Institute of Dentistry, Barts & The London School of Medicine & Dentistry, Queen Mary University of London (QMUL), Turner Street, London, E1 2AD, UK.
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Santamaria MP, Neves FLDS, Silveira CA, Mathias IF, Fernandes‐Dias SB, Jardini MAN, Tatakis DN. Connective tissue graft and tunnel or trapezoidal flap for the treatment of single maxillary gingival recessions: a randomized clinical trial. J Clin Periodontol 2017; 44:540-547. [DOI: 10.1111/jcpe.12714] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Mauro Pedrine Santamaria
- Department of Periodontology College of Dentistry – FOSJC UNESP – São Paulo State University São Paulo Brazil
| | - Felipe Lucas da Silva Neves
- Department of Periodontology College of Dentistry – FOSJC UNESP – São Paulo State University São Paulo Brazil
| | - Camila Augusto Silveira
- Department of Periodontology College of Dentistry – FOSJC UNESP – São Paulo State University São Paulo Brazil
| | - Ingrid Fernandes Mathias
- Department of Restorative Dentistry College of Dentistry – FOSJC UNESP – São Paulo State University São Paulo Brazil
| | | | | | - Dimitris N. Tatakis
- Division of Periodontology College of Dentistry The Ohio State University Columbus OH USA
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Kumar A, Bains VK, Jhingran R, Srivastava R, Madan R, Rizvi I. Patient-centered Microsurgical Management of Gingival Recession using Coronally Advanced Flap with Either Platelet-rich Fibrin or Connective Tissue Graft: A Comparative Analysis. Contemp Clin Dent 2017; 8:293-304. [PMID: 28839418 PMCID: PMC5551337 DOI: 10.4103/ccd.ccd_70_17] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose: To evaluate autologous platelet-rich fibrin (PRF) and autogenous connective tissue graft (CTG) in gingival recession defects in conjunction with coronally advanced flap (CAF) using a microsurgical technique. Materials and Methods: Forty-five Class I and II recession defects were randomly equally (n = 15) divided into three groups: Group I sites treated with CAF with PRF, Group II sites treated with CAF with CTG, and Group III sites treated with CAF alone using microsurgical approach. Parameters recorded were vertical gingival recession (VGR) and horizontal gingival recession (HGR), % complete root coverage (CRC), patient comfort score (PCS), patient esthetic score (PES), and hypersensitivity score (HS) at 10 days, 3 months, and 6 months. Results: CAF surgery alone and in combination with PRF or CTG are effective procedures to cover denuded roots with mean VGR values of 1.26 ± 0.70 mm (74.4%), 1.26 ± 0.59 mm (58%), and 1.06 ± 0.79 mm (53.3%) for Groups I, II, and III, respectively. In terms of CRC achieved at 6 months, results showed that 100% CRC was obtained in 60% sites of Group I, 20% sites of Group II, and 27% sites of Group III. Patient response and acceptance for surgical treatment modality in terms of PCS and PES were highest for Group I (PRF and CAF) followed by Group III and Group II, and there was decrease in HS for Group I (PRF and CAF) while no significant changes in HS were observed for Group II and Group III. At the end of 6 months follow-up, there was a significant increase in gingival thickness measurements using transgingival probing in Group II, whereas nonsignificant changes were observed in Group I and Group III. Conclusions: A long-term multicenter randomized controlled clinical study may be necessary to evaluate the clinical outcome for autologous PRF in comparison to CTG and CAF alone.
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Affiliation(s)
- Archana Kumar
- Department of Periodontology, Saraswati Dental College, Lucknow, Uttar Pradesh, India
| | - Vivek Kumar Bains
- Department of Periodontology, Saraswati Dental College, Lucknow, Uttar Pradesh, India
| | - Rajesh Jhingran
- Department of Periodontology, Saraswati Dental College, Lucknow, Uttar Pradesh, India
| | - Ruchi Srivastava
- Department of Periodontology, Saraswati Dental College, Lucknow, Uttar Pradesh, India
| | - Rohit Madan
- Department of Periodontology, Saraswati Dental College, Lucknow, Uttar Pradesh, India
| | - Iram Rizvi
- Department of Periodontology, Saraswati Dental College, Lucknow, Uttar Pradesh, India
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Expression of Pentraxin 3 and Thrombospondin 1 in Gingival Crevicular Fluid during Wound Healing after Gingivectomy in Postorthodontic Patients. J Immunol Res 2016; 2016:4072543. [PMID: 27403446 PMCID: PMC4923607 DOI: 10.1155/2016/4072543] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 04/17/2016] [Accepted: 05/10/2016] [Indexed: 12/16/2022] Open
Abstract
Background. Wound healing is a tissue repair process after an injury, and two of its main components are inflammation and angiogenesis, in which course a cascade of mediators is involved. The aim of this research was to evaluate the involvement of Pentraxin 3 and Thrombospondin 1 in wound healing after periodontal surgery (gingivectomy) for gingival overgrowth during orthodontic treatment with or without magnification devices, by assessing their levels in GCF. Methods. From 19 patients with gingival overgrowth as a result of fixed orthodontic treatment, the overgrown gingiva was removed by gingivectomy, from one half of the mandibular arch without magnification and from the other under magnification. Pentraxin 3 and Thrombospondin 1 were determined from gingival crevicular fluid by ELISA tests. Results. Statistically significant differences (p < 0.05) and correlations between levels of the two biomarkers were analyzed. Statistically significant differences were established between levels of the two biomarkers at different time points, with significant positive correlation at the point of 24 hours. Conclusions. Within the limitations of this study, the results seem to sustain the involvement of Pentraxin 3 and Thrombospondin 1 in the processes of inflammation and angiogenesis in wound healing of patients with postorthodontic gingivectomy. The dynamics of Pentraxin 3 and Thrombospondin 1 levels could suggest a reduced inflammation and a faster angiogenesis using microsurgery.
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25
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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: 249] [Impact Index Per Article: 31.1] [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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Gobbato L, Nart J, Bressan E, Mazzocco F, Paniz G, Lops D. Patient morbidity and root coverage outcomes after the application of a subepithelial connective tissue graft in combination with a coronally advanced flap or via a tunneling technique: a randomized controlled clinical trial. Clin Oral Investig 2016; 20:2191-2202. [DOI: 10.1007/s00784-016-1721-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 01/12/2016] [Indexed: 02/04/2023]
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Agarwal SK, Jhingran R, Bains VK, Srivastava R, Madan R, Rizvi I. Patient-centered evaluation of microsurgical management of gingival recession using coronally advanced flap with platelet-rich fibrin or amnion membrane: A comparative analysis. Eur J Dent 2016; 10:121-133. [PMID: 27011751 PMCID: PMC4784142 DOI: 10.4103/1305-7456.175686] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of coronally advanced flap (CAF) procedure under microsurgical approach for the management of Miller's Class I and II gingival recession defects with the use of either platelet-rich fibrin (PRF) or amnion membrane (AM) in comparison to CAF alone. MATERIALS AND METHODS A total of 45 sites with Miller's Class I or II gingival recession defect were randomly distributed for: Experimental Group I (CAF with PRF) sites (n = 15) which were treated with the microsurgical approach using CAF along with PRF; experimental Group II (CAF with AM) sites (n = 15) were treated with the microsurgical approach using CAF along with AM; control Group III (CAF alone) sites (n = 15) were treated with the microsurgical approach using CAF alone. Vertical gingival recession (VGR), horizontal gingival recession (HGR), gingival thickness (GT) (using transgingival probing [TGP] and ultrasonography [USG]) and patients' response and acceptance were documented at baseline, 3 months and 6 months after surgical interventions. RESULTS CAF alone and in combination with PRF or AM, were effective techniques for root coverage with average VGR values of 1.47 ± 0.92 mm (56%), 0.67 ± 1.23 mm (36%) and 0.60 ± 1.06 mm (33%) in Group I (CAF with PRF), Group II (CAF with AM), and Group III (CAF alone), respectively. Complete coverage (100%) was obtained in 33.3% sites of Group I (CAF with PRF), 26.6% sites of Group II (CAF with AM) and 13.3% in Group III (CAF alone). Patients' response and acceptance for surgical treatment modality in terms of patient esthetic score and decrease in hypersensitivity score was highest for Group I (CAF with PRF), whereas patient comfort score was highest for Group II (CAF with AM). At 6 months follow-up, significant increase in GT measurements (using TGP and USG) in Group I (CAF with PRF), whereas, nonsignificant increase for Group II (CAF with AM) and no change or decrease for Group III (CAF alone) as compared to baseline was observed. CONCLUSION The present study observed enhancement in root coverage when PRF or AM are used in conjunction with CAF as compared to CAF alone. These results are based on 6-month follow-up. Therefore, the long-term evaluation may be necessary to appreciate the clinical effect of autologous PRF and AM.
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Affiliation(s)
- Sumit Kumar Agarwal
- Department of Periodontology, Saraswati Dental College, Lucknow, Uttar Pradesh, India
| | - Rajesh Jhingran
- Department of Periodontology, Saraswati Dental College, Lucknow, Uttar Pradesh, India
| | - Vivek Kumar Bains
- Department of Periodontology, Saraswati Dental College, Lucknow, Uttar Pradesh, India
| | - Ruchi Srivastava
- Department of Periodontology, Saraswati Dental College, Lucknow, Uttar Pradesh, India
| | - Rohit Madan
- Department of Periodontology, Saraswati Dental College, Lucknow, Uttar Pradesh, India
| | - Iram Rizvi
- Department of Periodontology, Saraswati Dental College, Lucknow, Uttar Pradesh, India
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Abstract
Objective: To evaluate whether microsurgery gains better result in root coverage compared to conventional surgical techniques. Methods: A number of databases were searched to identify eligible studies from January 1992 to January 2015. The following outcomes were evaluated: number of sites exhibiting complete root coverage and patients’ esthetic satisfaction. Results: Four Randomized Clinical Trials (RCTs) fulfilled the inclusion criteria. A pooled estimate from the two RCTs regarding sub-epithelial connective tissue grafts (SCTG) showed significant achievement in complete root coverage in the microsurgical group [relative risk (RR):1.63; 95% confidence interval (CI): 1.12 to 2.36; P=0.01] with acceptable heterogeneity. The other two studies were about coronal advanced flap (CAF) with enamel matrix derivative or free rotated papilla autograft and did not qualify for meta-analysis. Patients’ esthetic satisfaction was analyzed only by one study. Conclusions: Using microsurgical technique for treating gingival recessions may be effective in achieving complete root coverage for SCTG.
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Affiliation(s)
- Jian Kang
- Jian Kang, DDS, State Key Laboratory of Oral Diseases, Dept. of Periodontics, Dept. of Periodontics, Tianjin Stomatological Hospital, Tianjin, China. West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Shu Meng
- Shu Meng, DDS, State Key Laboratory of Oral Diseases, Dept. of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Chunjie Li
- Chunjie Li, DDS, Department of Evidence-Based Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Zhenhua Luo
- Zhenhua Luo, DDS, State Key Laboratory of Oral Diseases, Dept. of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Shujuan Guo
- Shujuan Guo, DDS, State Key Laboratory of Oral Diseases, Dept. of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yafei Wu
- Yafei Wu, DDS, State Key Laboratory of Oral Diseases, Dept. of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
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Nizam N, Bengisu O, Sönmez Ş. Micro- and macrosurgical techniques in the coverage of gingival recession using connective tissue graft: 2 years follow-up. J ESTHET RESTOR DENT 2014; 27:71-83. [PMID: 25393983 DOI: 10.1111/jerd.12124] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The aim was to evaluate the clinical results of micro- and macrosurgical approaches in the coverage of gingival recession using connective tissue graft. MATERIAL AND METHODS Twenty-one teeth in microsurgical group (test group) and 21 in macrosurgical group (control group) were treated using coronally positioned flap and subgingival connective tissue graft. Recession depth (RD), recession width (RW), root surface area (RSA), keratinized tissue width (KTW), probing depth, clinical attachment level, pain level during healing, and aesthetic results were evaluated for 24 months. RESULTS RD, RW, and RSA were significantly lower at 1, 3, 6, and 24th months compared with baseline in both groups. RD was also significantly lower in the 1st month compared with 24th month in control group. RD and RSA at 24th month were significantly lower in microsurgical group. KTW significantly and similarly increased by 6th month in both groups. The pain levels in the donor and the recipient area decreased earlier in the microsurgical group, and aesthetic scores improved similarly in both groups. CONCLUSION A microsurgical approach to root coverage with gingival recession is likely to preserve the clinical outcomes longer than macrosurgical approach, at least for 24 months. Healing appears to be faster using microsurgery, but aesthetic outcomes are similar. CLINICAL SIGNIFICANCE This study evaluated the clinical results of microsurgical versus macrosurgical approaches to root coverage in cases of gingival recession. Based on the results of the study, pain levels in the donor and the recipient areas decreased earlier in the microsurgical group, and microsurgical approach resulted in significantly greater amount of root coverage at 24 months.
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Affiliation(s)
- Nejat Nizam
- Department of Periodontology, School of Dentistry, Ege University, Izmir, Turkey
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30
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Zuhr O, Rebele SF, Schneider D, Jung RE, Hürzeler MB. Tunnel technique with connective tissue graft versus
coronally advanced flap with enamel matrix derivative for root coverage: a RCT using 3D digital measuring methods. Part I. Clinical and patient-centred outcomes. J Clin Periodontol 2013; 41:582-92. [DOI: 10.1111/jcpe.12178] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Otto Zuhr
- Private Office Huerzeler/Zuhr; Munich Germany
- Department of Periodontology; Center for Dental, Oral and Maxillofacial Medicine (Carolinum); Johann Wolfgang Goethe-University; Frankfurt/Main Germany
| | - Stephan F. Rebele
- Private Office Huerzeler/Zuhr; Munich Germany
- Department of Operative Dentistry and Periodontology; University School of Dentistry; Albert-Ludwigs-University; Freiburg Germany
| | - David Schneider
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | - Rony E. Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | - Markus B. Hürzeler
- Private Office Huerzeler/Zuhr; Munich Germany
- Department of Operative Dentistry and Periodontology; University School of Dentistry; Albert-Ludwigs-University; Freiburg Germany
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Douglas de Oliveira DW, Marques DP, Aguiar-Cantuária IC, Flecha OD, Gonçalves PF. Effect of Surgical Defect Coverage on Cervical Dentin Hypersensitivity and Quality of Life. J Periodontol 2013; 84:768-75. [DOI: 10.1902/jop.2012.120479] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Douglas de Oliveira DW, Oliveira-Ferreira F, Flecha OD, Gonçalves PF. Is Surgical Root Coverage Effective for the Treatment of Cervical Dentin Hypersensitivity? A Systematic Review. J Periodontol 2013; 84:295-306. [DOI: 10.1902/jop.2012.120143] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Roman A, Soancă A, Kasaj A, Stratul SI. Subepithelial connective tissue graft with or without enamel matrix derivative for the treatment of Miller class I and II gingival recessions: a controlled randomized clinical trial. J Periodontal Res 2013; 48:563-72. [DOI: 10.1111/jre.12039] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2012] [Indexed: 11/30/2022]
Affiliation(s)
- A. Roman
- Department of Periodontology; Iuliu Hatieganu University of Medicine and Pharmacy; Str. Victor Babes 8 400012 Cluj-Napoca Romania
| | - A. Soancă
- Department of Periodontology; Iuliu Hatieganu University of Medicine and Pharmacy; Str. Victor Babes 8 400012 Cluj-Napoca Romania
| | - A. Kasaj
- Department of Conservative Dentistry and Periodontology; Johannes Gutenberg University; Augustusplatz 2 Mainz Germany
| | - S.-I. Stratul
- Department of Periodontology; Victor Babes University of Medicine and Pharmacy; Bv. Revolutiei nr.9 300014 Timisoara Romania
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