Early Wound Healing Score: a system to evaluate the early healing of periodontal soft tissue wounds

The Efficacy of Ozonated Olive Oil in Crown Lengthening Procedures for Anterior Teeth: A Case Report

Ensuring the health of the gums and supporting structures (periodontium) is crucial during dental restoration procedures to achieve optimal function and appearance of the teeth. Understanding the anatomy, the impact of restorative materials, and their interaction with the periodontium is essential for successful treatment outcomes. Crown lengthening is a surgical procedure that involves the removal of gingiva and bone tissue to expose more of the tooth structure, thereby increasing the visible portion of the tooth (clinical crown height). To protect the wound from mechanical trauma and stability of the surgical site during the healing process, periodontal dressing can be applied after surgery. Ozone therapy has demonstrated its effectiveness in promoting the healing of various types of wounds, including chronic and difficult-to-heal wounds, as an antibacterial agent and in modulating the immune system. Thus, this study aimed to compare, evaluate, and assess the use of periodontal dressing with that of ozonated olive oil after the crown lengthening procedure.

Early wound healing at 1 week postoperatively in periodontal tissue regeneration therapy: enamel matrix derivative versus recombinant human fibroblast growth factor

PURPOSE

Recombinant human fibroblast growth factor-2 (rhFGF-2) has demonstrated positive effects on wound healing at 2 weeks after periodontal surgery relative to enamel matrix derivative (EMD). However, the effects at earlier postoperative stages have not been reported. This retrospective study compared the early wound healing outcomes 1 week after surgery using the modified papilla preservation technique (mPPT) with either EMD or rhFGF-2 therapy.

METHODS

We compiled a list of all mPPT sites treated with EMD or rhFGF-2 during the survey period (September 2011 to March 2022). Early wound healing was assessed using the early wound healing score (EHS) and the modified early wound healing index (mEHI). Inter-rater reliability for the EHS and mEHI was established using intraclass correlation coefficients. Factors influencing mPPT were identified by analyzing the correlation coefficients between the EHS items, mEHI items, and potential influencing factors. After adjusting for factors impacting EHS, mEHI, and mPPT, we compared the EHS and mEHI between EMD and rhFGF-2 groups.

RESULTS

In total, 72 sites were evaluated. The scores for incision line, step, and dehiscence were significantly higher in those receiving rhFGF-2 (n=42) compared to those treated with EMD (n=30). The EHS item scores did not differ significantly between groups. Among patients aged ≥50 years, but not those <50 years, significantly higher step and dehiscence scores were found in the rhFGF-2 group than the EMD group (P<0.01). Additionally, for patients exhibiting a clinical attachment level (CAL) ≥8 mm, the step score was significantly higher in the rhFGF-2 group than in the EMD group (P<0.05), but this trend was not reflected in those with a CAL <8 mm.

CONCLUSIONS

In this study, early wound closure at mPPT sites was more effectively achieved with rhFGF-2 than with EMD. Nevertheless, biochemical assessments are required to compare the re-epithelialization effects of these therapies.

Posterior open wound healing in immediate implant placement using reactive soft tissue versus absorbable collagen sponge: a retrospective cohort study

The soft and hard tissue healing of open wounds in immediate implant placement are yet to be explored. The aim of this study was to compare the clinical outcomes of open wound healing using reactive soft tissue (RST) and absorbable collagen sponge (ACS). Forty implants placed immediately in posterior sockets were included; autologous RST was used in 20 and ACS substitute was used in 20. Soft tissue healing was primarily assessed through a novel scoring system and the evaluation of gingival recession. The horizontal bone width (HBW) and interproximal marginal bone level (MBL) were measured on radiographs to observe the hard tissue healing. No significant difference in total soft tissue healing score was observed at 2 weeks postoperatively. Notably, the ACS group showed better tissue colour (P = 0.016) but worse fibrous repair (P = 0.043) scores than the RST group. Gingival recession levels were comparable in the two groups, both before tooth extraction and after placement of the restoration. Regarding hard tissue, HBW and MBL changes showed no intergroup differences. Within the limitations of this study, both RST and ACS seemed effective for open wound closure, achieving ideal soft and hard tissue healing in immediate implant placement.

Oral Wound Healing: A Scoping Review and Proposal of a New Index for Palatal Mucosa

Purpose

The aim of this scoping review was to evaluate the wound healing indices available in literature and propose a new intra-oral wound healing index to assess the healing of palatal mucosa.

Materials and Methods

A PubMed database search was conducted to identify relevant studies using the search strategy: ('Oral Wound healing') OR ('Palatal tissue healing') OR ('Healing indices in Oral and Maxillofacial Surgery') OR ('Palatal wound healing') OR ('Complications in wound healing'). A qualitative and quantitative synthesis of the results was done and data was presented following the PRISMA-ScR guidelines.

Results

The search resulted in 9 articles published between 2019 and 2022, which were eligible for inclusion in the study. The data revealed that the indices currently available for the assessment of intra-oral healing were limited and primarily concerned with the assessment of gingival and periodontal tissues.

Conclusion

The healing indices devised for gingival and periodontal tissues cannot be applied to palatal healing due to the differences in clinical and histological aspects. Therefore, a new index to monitor the healing response specifically for the soft tissues in the palate has been proposed. This maybe particularly useful in cleft palate repair and other procedures performed over the palatal tissues.

Immediate Implant Placement with Different Interradicular Osteotomies in the Mandible: A Randomized Clinical Study

AIM

To assess the implant stability and amount of marginal bone loss in immediate implant placement (IIP) in mandibular molars by using pre-extractive interradicular implant bed preparation vs conventional post-extractive interradicular implant bed preparation.

MATERIALS AND METHODS

This randomized clinical trial was conducted on fourteen patients who had an immediate dental implant at the mandibular molar area by two different techniques. All patients were divided randomly into two equal groups: Group I (control) was treated with conventional post-extractive interradicular implant bed preparation, and group II (test) was treated by pre-extractive interradicular implant bed preparation All surgeries were performed by the same surgeon. All patients were followed up clinically at immediate post-surgery (T0), 7 days (T1), 3 weeks (T2), 90 days (T3), and 3 months after loading (T6) for healing and to evaluate the marginal bone loss radiographically at T0, T3 and T6. Descriptive and bivariate statistics were computed using the SPSS version (SPSS, IBM Inc., Chicago, IL), and p ≤ 0.05 was considered an indicator of statistical significance.

RESULTS

A total of 7 female and 7 male patients with a mean age of 32.07 ± 5.87 years. Radiographically, there is no significant statistical difference in comparing between two groups for the marginal bone loss. However, there was a highly significant statistical difference (p < 0.001) in each group between different interval periods (T0, T3, T6) with mean start 5.27 ± 0.53, and 5.19 ± 0.72 at (T0) reaching 7.60 ± 0.89 and 7.09 ± 0.96 at (T3) and slightly decrease of 7.52 ± 0.79 and 7.02 ± 0.79 in (T6) with radiographic evaluation, and it represented clinically in each group with mean 3.57 ± 0.313 and 4.0 ± 0.58 at (T0) increase to 6.55 ± 0.395 and 6.52 ± 0.45 at (T6) for both group respectively. There is no statistically significant difference in soft tissue healing with an average mean of 4.57 ± 0.24 and 3.57 ± 0.509 (p = 0.001) when comparing between both groups respectively.

CONCLUSION

Both techniques seem useful for dental implant placement in badly decayed mandibular molars. However, pre-extracted interradicular implant bed preparation for IIP might offer advantages in terms of primary implant stability and bone preservation. However, further studies are needed to confirm these findings.

CLINICAL SIGNIFICANCE

Both techniques are alternative methods for the treatment of badly decayed mandibular molars by immediate dental implant except for minor complications that do not interfere with dental implant placement. How to cite this article: Alzaibak LMA, Abdel-Monem TM, Elgohary NM, et al. Immediate Implant Placement with Different Interradicular Osteotomies in the Mandible: A Randomized Clinical Study. J Contemp Dent Pract 2024;25(4):303-312.

Comparative Assessment of Gingival Depigmentation Using Scalpel Versus Microneedling With Ascorbic Acid: A Randomized Controlled Trial

Background Gingival pigmentation (GP), characterized by the presence of melanin in the gingival tissues, is a common aesthetic concern in dental practice. While it poses no inherent health risks, the visible discoloration may cause psychological distress for individuals seeking optimal dental aesthetics. Understanding the efficacy of various methods is essential for refining treatment strategies and enhancing patient satisfaction in the realm of gingival depigmentation (GD). Aim The objective of the study was to compare the effectiveness of scalpel and microneedling (MN) with ascorbic acid in the treatment of GD. Materials and methods Sixteen patients who had a complaint of GP were included in the study, of whom eight were allocated for depigmentation with a scalpel, and the other eight patients were treated with the MN technique with ascorbic acid. Postoperative wound healing scores were evaluated on the first and seventh days, respectively. The intensity of depigmentation was assessed at baseline, in the first month, and at the end of the third month, respectively. Results The mean Dummett-Gupta Oral Pigmentation Index (DOPI) score at baseline was 2.65±0.16 and 2.61±0.17 in the surgical and microneedling groups with ascorbic acid, respectively. The mean DOPI score at the end of the third month was 1.67±0.39 and 0.87±0.17 in the scalpel and MN with ascorbic acid groups, respectively. There was a statistically significant difference between the scalpel and MN with ascorbic acid groups at the end of the first and third months, respectively, where MN with ascorbic acid showed aesthetically pleasing outcomes. Patients treated with the scalpel technique showed incomplete healing and ulceration on the first and seventh days after the procedure when compared to the MN technique with ascorbic acid. The healing index scores were statistically significant in the MN with ascorbic acid group. Conclusion The MN technique with ascorbic acid is a successful technique for treating GD. It showed aesthetically gratifying outcomes when compared to the conventional surgical technique.

Evaluation of clinical and serological responses after full-mouth implantation in single-visit versus multiple-session surgery

Background

This research aimed to evaluate the clinical characteristics of pain and wound healing and serological inflammatory markers after full-mouth implantation in one session compared to several sessions.

Methods

A single-masked clinical trial was conducted on 20 patients (n=10) receiving full-mouth implants. Patients were randomly divided into two groups. The first group was operated under general anesthesia in one session and the second group in multi-sessions. Inflammation level was evaluated through white blood cell (WBC) and serum C-reactive protein (CRP) before and after surgery by a blood test. Pain and early wound healing (EHS) assessment was conducted after surgery with VAS and EHS indicators, respectively. Serological and clinical parameters were compared by repeated-measures ANOVA and Sidak and Man-Whitney U tests, respectively, using SPSS 20.

Results

The CRP level 48 hours postoperatively was not different in the two groups; however, seven days after treatment, it was higher in the multi-session group than in the single-session approach. The WBC was not different between the two groups at evaluated intervals. Serum levels of WBC and CRP increased 48 hours postoperatively and decreased seven days later. EHS showed no difference between the two groups at the three investigated intervals. The amount of VAS 24 and 48 hours and 7 days postoperatively was higher in multi-session surgery than in the one-session approach. In both groups, VAS was not different at 24 and 48 hours postoperatively and decreased over seven days.

Conclusion

Full-mouth implant surgery under general anesthesia in one session caused less inflammation and pain postoperatively while presenting the same wound-healing process as the multi-session surgery.

A systematic review of oral wound healing indices

Wound healing monitoring for abnormality identification and intervention is crucial to securing a successful surgical outcome. Indices have been used to summarize the degree of healing. Given the increasing frequency of regenerative procedures which preserve dentition and implant stability, and the higher esthetic demands, an appraisal of the available indices is needed to identify the current knowledge gap. This study aimed to systematically review published oral wound healing indices and scores.

MATERIALS AND METHODS

A complete literature electronic search in 5 databases was conducted by two reviewers. A combination of keywords related to oral wound healing was used.

RESULTS

A total of 11 articles were included in the evaluation of various procedures (conventional periodontal procedures, guided tissue regeneration, soft tissue reconstruction procedures, and tooth extractions), at different time points (1 day to 12 weeks), with a focus on diverse clinical signs and symptoms. Frequently evaluated parameters included wound dehiscence/epithelialization (91%), tissue color (redness) (73%), suppuration (55%), swelling/edema (55%), and hemostasis (55%). Other less commonly used parameters include esthetics-related and patient-centered outcomes.

CONCLUSION

The available indices evaluate a diverse group of subjective clinical signs and symptoms to estimate the underlying biological healing events and assess the degree of clinical success. The majority of the included indices are not validated. Quantitative and objective subclinical parameters including blood perfusion, biomaterial stability, and completeness of epithelialization, are needed for customized wound healing care and better outcome prediction.

A novel technique to detect cover screw location at stage two uncovery surgery over conventional technique - A randomized controlled trial

AIM

The conventional technique of implant uncovery using a blade and scalpel is associated with various drawbacks, including profuse bleeding, soft-tissue trauma, delayed healing, and patient noncompliance. Therefore, there is a need to explore the alternative approaches that offer improved accuracy and time efficiency during the cover screw location at the second stage of recovery. This study aims to assess the accuracy and time efficiency of a novel technique that utilizes an apex locator in comparison to conventional locating techniques for implant uncovery.

SETTINGS AND DESIGN

The study employed a simple randomized controlled trial with a sample size of 161.

MATERIALS AND METHODS

The study employed apex locator (Woodpecker Woodpex III Gold 5th generation) in conjunction with a K-file (Mani k-file #10, 21 mm) for detecting the implant location. The accuracy of the novel technique was determined based on the values measured on the apex locator, with positive values indicating soft-tissue response and negative values indicating the cover screw (metal). The accuracy was cross-verified using radiovisiography (RVG). The clinician-based scoring was also done, considering RVG evaluation, amount of incision given, and ease of the procedure. The time required to locate the cover screw was recorded using a timer for both the novel technique and the conventional method.

STATISTICAL ANALYSIS USED

All the recorded values were statistically analyzed using the independent t-test (P < 0.005) with the SPSS software (version 23).

RESULTS

The results revealed a significant difference in terms of incision given, ease of treatment, and time taken for the procedure (P < 0.05), while the accuracy of the novel technique was not disturbed (P > 0.05).

CONCLUSION

Based on the findings of this in vivo study, the use of an apex locator as an alternative to conventional methods for detecting cover screw location at the second stage of recovery is recommended. The novel technique demonstrated faster uncovering of implants without posing any risks to the surrounding tissues or implants.

Knotless barbed suture versus conventional polydioxanone suture material for intraoral surgical incisions - A randomized controlled trial

Purpose

To evaluate and compare the perioperative wound management and healing of intraoral surgical incisions between the conventional and knotless barbed Polydioxanone suture materials.

Materials and methods

A Randomized Controlled Trial was conducted with well-constructed inclusion and exclusion criteria. 46 participants were allotted into the control and test groups based on a computer-generated randomization sequence. The materials used were 3-0 Stratafix™ knotless barbed PDS suture and conventional 3-0 Ethicon PDSTMII suture materials. Parameters assessed included intraoperative time taken for closure and assessment with Early Wound Healing Score (EHS) on postoperative day 1 and Landry, Turnbull, and Howley (LTH) Healing index on postoperative days 3 and 7. Statistical analyses were done using the Chi-square test and student's t-test with a p-value less than 0.05 indicating statistical significance.

Results

32 patients had surgical intervention for maxillofacial fracture management and 14 patient for orthognathic osteotomies. Surgical sites (n = 60) included maxillary and mandibular vestibules. Intraoperative closure time was better in the test group with statistical significance (p-value = 0.0472). The healing scores on the 3rd and 7th postoperative days were compared between the control and test groups exhibiting statistical significance favouring the test group. The p-values were 0.0479 and 0.0393 respectively.

Conclusion

To conclude, our study concurred with the existing literature in terms of reduced operating time, and better wound healing observed with the knotless barbed suture. Along with statistical significance, all the variables exhibited clinical relevance and better wound management in the test group.

Success rate of infrazygomatic crest mini-implants used for en-masse retraction of maxillary anterior teeth in first premolar extraction cases: A three-dimensional comparative prospective clinical trial between adolescents and young adults

BACKGROUND

The purpose of this study was to compare the success rate of infrazygomatic mini-implants between adolescents and young adults.

METHODS

A total of 60 subjects of different age groups ie, (group I [adolescents]: 12-18 years, mean age: 14.9 ± 2.9 years; group II [young adults]: 19-25 years, mean age = 21.9 ± 3.1 years) were assessed in the study. En-masse retraction of maxillary anterior teeth was carried out with extraction of upper first premolars with infrazygomatic crest (IZC) mini-implants as anchorage units. Clinical parameters such as success rate, soft tissue thickness, maximum insertion torque, maximum removal torque, pain response, soft tissue response, and cone-beam computed tomography parameters such as embedded angulation, penetration depth, thickness of bone on buccal and palatal aspect of mini-implant, and peri-implant bone density were evaluated.

RESULTS

The success rate of IZC mini-implants in adolescents was found to be 96.6% and 98.3% in young adults respectively. There was no significant difference in success rate between the two groups. Intergroup comparison showed a significant difference (P < 0.05) in terms of maximum insertion torque, maximum removal torque, soft tissue thickness, cortical bone thickness, and peri-implant bone density values. Comparison between right and left side revealed a significant difference (P < 0.05) with regards to soft tissue response, soft tissue thickness, total bone thickness, cortical bone thickness, and peri-implant bone density.

CONCLUSIONS

There was no significant difference in the success rate of IZC mini-implants between adolescents and young adults. Thus, the use of IZC mini-implants can be recommended in adolescents for successful orthodontic treatment.

Use of Injectable Platelet-Rich Fibrin Accompanied by Bone Graft in Socket Endurance: A Radiographic and Histological Study

Background Ridge preservation became a crucial dental health issue and strategy to keep away from ridge defacement after post-tooth loss. The recent scientific evolution of platelet-rich fibrin (PRF) comprises a parenteral formulation of PRF. The combined allograft for socket preservation gives benefits. In this study, bone allografts, demineralized freeze-dried bone allografts (DFDBA) and freeze-dried bone allografts (FDBA) are used in a 30:70 ratio alone or in combination with injectable PRF (I-PRF) for socket preservation. Methods This study is a radiographic and histological examination conducted on 60 participants aged between 19-65 years. Participating patients agreed voluntarily that they would not bear any fixed prosthesis for the next nine months and plan for implanted teeth placement, including multi-rooted mandibular molars denticles. Both groups received atraumatic extraction; then, the socket was preserved with bone allograft alone in the control group and bone allograft mixed with I-PRF, forming sticky bone, in the experimental group. Clinical, radiological, and histological assessments were taken at the inception stage, three months, six months, and nine months. A multivariate regression model and a generalized estimating equation (GEE) model were used to analyse the effects of these changes on outcomes. Results In all the parameters, the test group indicated a good amount of bone growth with increasing intervals of time for bone height radiographically with statistically significant difference present (p<0.05) and histologically after nine months when socket site grafted with bone graft in combination with I-PRF. Conclusion This study's results demonstrated that I-PRF possesses the potential to regenerate and heal in the tooth-extracted socket. This study further recommends the implementation of I-PRF in safeguarding and conserving the raised rim of the tooth. Future research should take place on the osteogenic capability of I-PRF in more comprehensive ridge accession surgical procedures and additional expanding and improving capacities in periodontal reconstruction.

Unusually isolated Staphylococcus arlettae in intra-oral sutures - Case series

Introduction

The human oral cavity comprises various niches such as teeth, gingiva, tongue, soft and hard palate, and various dental prostheses, all inhabited by different bacterial species. Although more than 600 taxa belong to the oral cavity, identifying Staphylococcus arlettae , an incompletely understood bacterium, has been rare.

Methods

Three patients who underwent periodontal flap surgeries were reported with the incidental finding of S. arlettae associated with the intra-oral sutures placed. Environmental sampling was performed, to establish the exact source of this bacterium.

Results

Staphylococcus arlettae was isolated in three patients' intra-oral sutures. All environmental samples were negative for the presence of the bacterium.

Conclusion

. To this date, no studies have identified such an occurrence of Staphylococcus arlettae with intra-oral sutures. Its identification in association with foreign materials, such as sutures, can be considered a potential for surgical site infections and requires further investigation.

Titanium Dioxide Nano-Formulation: Characterization, Antimicrobial Activity, and Wound Healing in Animals

The use of metal oxide nanoparticles as an alternative antimicrobial agent has gained attention due to the increasing problem of antimicrobial resistance. Understanding its properties and potential benefits can contribute to the development of more effective and sustainable treatments in veterinary medicine. The aim of this study was to characterize TiO2-NP formulations and evaluate their antibacterial and wound healing abilities. The diameters and zeta potentials were determined using the Zetasizer in conjunction with dynamic light scattering. The agar-well diffusion method, time-kill kinetic assay and crystal violet assay were used to evaluate their antimicrobial activities. Wound healing assays were conducted both in vitro and in vivo. The study demonstrated that TiO2-NP formulations exhibit significant antimicrobial properties against various bacterial strains such as S. aureus and E. coli. No measurable E. coli growth was observed within a 15-min period following exposure to TiO2-NP formulations. The TiO2-NP formation can improve wound healing by enhancing cell migration and collagen formation in both in vitro and in vivo conditions. In summary, our study suggests that TiO2-NP has the potential for use as an antimicrobial agent for animal wound treatment due to its ability to suppress bacterial growth and biofilm formation, as well as to enhance wound healing.

Overview of Ultrasound in Dentistry for Advancing Research Methodology and Patient Care Quality with Emphasis on Periodontal/Peri-implant Applications

BACKGROUND

Ultrasound is a non-invasive, cross-sectional imaging technique emerging in dentistry. It is an adjunct tool for diagnosing pathologies in the oral cavity that overcomes some limitations of current methodologies, including direct clinical examination, 2D radiographs, and cone beam computerized tomography. Increasing demand for soft tissue imaging has led to continuous improvements on transducer miniaturization and spatial resolution. The aims of this study are (1) to create a comprehensive overview of the current literature of ultrasonic imaging relating to dentistry, and (2) to provide a view onto investigations with immediate, intermediate, and long-term impact in periodontology and implantology.

METHODS

A rapid literature review was performed using two broad searches conducted in the PubMed database, yielding 576 and 757 citations, respectively. A rating was established within a citation software (EndNote) using a 5-star classification. The broad search with 757 citations allowed for high sensitivity whereas the subsequent rating added specificity.

RESULTS

A critical review of the clinical applications of ultrasound in dentistry was provided with a focus on applications in periodontology and implantology. The role of ultrasound as a developing dental diagnostic tool was reviewed. Specific uses such as soft and hard tissue imaging, longitudinal monitoring, as well as anatomic and physiological evaluation were discussed.

CONCLUSIONS

Future efforts should be directed towards the transition of ultrasonography from a research tool to a clinical tool. Moreover, a dedicated effort is needed to introduce ultrasonic imaging to dental education and the dental community to ultimately improve the quality of patient care.

Clinical, histological, immunohistochemical, and biomolecular analysis of hyaluronic acid in early wound healing of human gingival tissues: A randomized, split-mouth trial

BACKGROUND

Hyaluronic acid (HA) exerts a fundamental role in tissue repair. In vitro and animal studies demonstrated its ability to enhance wound healing. Nevertheless, in vivo human studies evaluating mechanisms involved in oral soft tissue repair are lacking. The aim of this study was to evaluate the in vivo effect of HA on early wound healing of human gingival (G) tissues.

METHODS

In the present randomized, split-mouth, double-blind, clinical trial, G biopsies were obtained in eight patients 24 h post-surgery after HA application (HA group) and compared with those obtained from the same patients without HA application (no treatment; NT group). Clinical response was evaluated through the Early Wound Healing Score (EHS). Microvascular density (MVD), collagen content and cellular proliferation were evaluated through sirius red and Masson trichrome staining, and Ki-67 immunohistochemistry, respectively. To assess collagen turnover, MMP-1, MMP-2, MMP-9, TGF-β1 protein levels and LOX, MMP1, TIMP1, TGFB1 gene expression were analyzed by western blot and real time polymerase chain reaction.

RESULTS

Twenty-four hours after surgery, the EHS was significantly higher in the HA group. MVD, collagen content, and cell proliferation were not affected. LOX mRNA, MMP-1 protein, and TIMP1 gene expression were significantly upregulated in the HA compared to the NT group.

CONCLUSIONS

The additional use of 0.8% HA gel does not modify new blood vessel growth in the early phase of gingival wound healing. Concerning the secondary outcomes, HA seems to enhance extracellular matrix remodeling and collagen maturation, which could drive early wound healing of G tissues to improve clinical parameters.

Effect of fibrin-rich plasma and collagen sponge on healing of the palatal mucosa

Background

The purpose was to evaluate the variation in thickness and early healing of the donor area of the palate with the placement of a collagen sponge and the use of fibrin-rich plasma (L-PRF).

Material and Methods

Thirty patients who required mucogingival surgery treatment were selected and distributed into 2 groups. After obtaining the free palate graft, L-PRF was placed in Group A, and a collagen sponge was placed in Group B. The healing process of the palate was evaluated at 24 hours and 7, 14, 21 and 28 days postsurgery. The thickness of the donor area (palate) was evaluated using an acrylic splint. These measurements were made before and 4 months after surgery.

Results

In the collagen sponge group, less gain of the palatal mucosa was observed, with a mean difference of 0.1 ± 0.8 mm (CI: -0.341-0.518) (p=0.691), whereas in the fibrin-rich plasma group, a mean difference of 0.0 ± 0.5 mm (CI: -0.229-0.229) (p=0.934) was found; however, when comparing the gain of the palatal mucosa in both groups, no significant difference was observed (p=0.932). The healing index at 24 hours indicated the presence of clots, on Day 28 vascularisation and total epithelialisation (100.0%), and finally, the collagen sponge group on Day 14 presented 93.3% partial vascularisation of connective tissue and 33.3% L-PRF (p=0.001).

Conclusions

There was no statistically significant difference in the thickness of the palatal mucosa after the use of L-PRF and the collagen sponge. Key words:Palate thickness, connective tissue graft, fibrin-rich plasma, collagen sponge, palate healing.

Management of Aberrant Frenal Attachments in Adults by Scalpel Method and 980 nm Diode Laser

Treatment modalities like electrosurgery and lasers have emerged as effective painless alternatives to scalpel methods for a frenectomy. The present case series involves ten patients, diagnosed with abnormal frenal attachments. Frenectomy was performed by 980 nm diode laser and scalpel methods. Scalpel frenectomy was performed as described by Archer and Kruger. Laser-assisted frenectomy was performed by a hemostat-guided incision using a 980 nm diode laser tip in a paintbrush motion. It was observed that Visual Analogue Scale (VAS) pain scores in patients who underwent scalpel frenectomy were comparatively higher than the laser-treated patients. In contrast, wound healing scores were higher in the scalpel group, suggesting early wound healing in the scalpel-treated patients.

A rare incidence and management of complex odontoma and surgical dehiscence in maxillary anterior region: A case report

Odontoma is a benign odontogenic tumour, which is rather considered hamartoma. Hamartoma is not a true neoplasm, rather a growth of abnormal mixture of cells found in the body area they normally grows. Fully developed odontomas generally consist of enamel, dentin and pulpal tissues, in an unorganised manner. Some of them may contain cementum too. These are further grouped into compound and complex, depending on their clinical, radiographic and histologic features. Odontomas are generally asymptomatic and slow growing, but may cause bone expansion and hinderance in tooth eruption. These lesions are generally diagnosed by coincidence in radiograph. We are presenting a case and surgical management of complex odontoma and post-operative dehiscence in the anterior right maxillary region of a 38-year-old male.

Assessment of early wound healing, pain intensity, quality of life and related influencing factors during periodontal surgery: a cross-sectional study

BACKGROUND

This cross-sectional study assessed early wound healing, pain intensity, quality of life, surgical satisfaction, and related factors during periodontal surgery.

METHODS

A total of 369 patients completed the questionnaire before undergoing periodontal surgery (baseline), immediately after the operation (phase I), on the day of suture removal (phase II), and one month later (phase III). The Early Wound Healing Score (EHS) was assessed, and the short-form McGill Pain Questionnaire (SF-MPQ), tooth hypersensitivity visual analog scale (VAS), oral health-related quality of life measure (OHQoL-UK), and surgical satisfaction VAS were administered and analysed.

RESULTS

The EHS was 8.41 ± 2.74 and was influenced by disease severity and surgical factors. Scores on the SF-MPQ, pain intensity scores, and OHQoL-UK scores were significantly increased in phase I and decreased later. Tooth sensitivity decreased significantly one month after periodontal surgery. Psychological factors were positively related to SF-MPQ, pain intensity, OHQoL-UK and tooth sensitivity VAS scores in all phases, while disease severity and surgical factors were only related to these scores at baseline or in phases I/II/III. Surgical acceptance and reoperation willingness continuously decreased after surgery, and all these scores were related to surgical satisfaction.

CONCLUSIONS

EHS, pain intensity and quality of life were closely related to disease severity, psychological factors and surgical factors in phase I (i.e., immediately after surgery). The findings suggest that surgical details should be enhanced and that behavioural and psychological interventions measures should be implemented to improve outcomes during periodontal operation and during the early postoperative period as well as to improve patient-oriented periodontal surgery experiences. Trial registration This cross-sectional study did not include interventions with human participants, and all the experimental procedures involving humans in this study were approved by the Ethics Committee of West China College of Stomatology, Sichuan University (WCHSIRB-D-2020-284).

Comparison between conventional and micro-assisted periodontal surgery: Case series

Microsurgery is a minimally invasive procedure that uses a surgical microscope, specially designed equipment, and suture materials. Even though this equipment and expertise of numerous surgeries are required to meet patient esthetic reckoning, doctors must be ready to invest time and effort into becoming familiar with novel surgical methods and devices. The ambition of this case series is to compare conventional macro surgery and microsurgery in terms of clinical approach. This study included four cases, two flap surgery, and two root coverage. Clinical parameters for root coverage, increase in keratinized tissue (KT), gain in clinical attachment level (CAL) and complete root coverage (CRC), dentin hypersensitivity index-Schiff's index and for flap surgery, probing depth, clinical attachment level. Healing and pain analysis were done. There was no significant difference seen between conventional and clinical outcomes of a microsurgical technique such as clinical attachment level, probing depth, increase in KT, gain in clinical attachment level (CAG), and CRC, dentin hypersensitivity index-Schiff's index. When patient-based outcomes such as healing index and Visual Analog Scale, a significant difference was seen. If a microsurgical method is used instead of a traditional macroscopic approach, the early healing index can be significantly improved and there will be less postoperative pain.

Peripheral mononuclear cells composition in platelet-rich fibrin in canines with chronic conditions

Platelet-rich fibrin (PRF) is a hot research topic because of its regenerative effect in humans. However, data reporting about its application in companion animals is lacking. The study aimed to supplement currently available data on PRF cell composition in canine patients by isolating peripheral blood mononuclear cells (PBMC), namely T cells, matured B cells, monocytes and macrophages, and adapting current protocols of cell flow cytometry for PRF analysis. The canine patient population was divided into three subgroups: animals with periodontitis only, animals with neoplasia and periodontitis, and healthy controls. Individual clinical parameters of the patients and evaluation of the wound healing quality were included in the research. In the present study, canine PRF cell composition was analyzed for the first-time using cell flow cytometry protocol. A higher proportion of PBMC cells related to wound healing (CD3+, CD3+ CD4+ CD8-, CD14+) were found in the PRF of control, periodontitis and neoplasia groups compared to the respective blood samples, which implies a positive outcome associated with clinical PRF usage in canine patients. Proportions of monocytes and macrophages were higher in PRF samples compared to the blood of healthy patients and periodontitis-affected patients. However, inflammatory and neoplastic processes do not affect the distribution of PBMC.

Comparison of the effects of Diplen LX membrane and Coe-Pak on pain, wound healing, and patient preference after the periodontal flap surgery in patients with moderate to severe chronic periodontitis

Background. After periodontal surgery, in most cases, the surgical area is covered with a surgical pack. It has been suggested that these packs might minimize complications. This study aimed to compare the effects of Diplen LX membrane and Coe-Pak on pain, wound healing, and patient preference after a periodontal flap surgery in patients with moderate to severe chronic periodontitis. Methods. In this randomized clinical trial, 26 patients were evaluated. Pain scores were assessed using visual analog scale (VAS) on the 3rd and 7th days postoperatively and compared between the two dressings. On the 7th and 14th days after both flap surgeries, surgical site healing was evaluated using the wound healing index (WHI). Results. The mean age of the patients was 31. It was observed that the severity of pain in the studied patients on the 3rd and 7th days postoperatively was significantly lower in the intervention group than in the control group. It was also observed that the value of WHI in the studied patients on the 7th and 14th days postoperatively was significantly higher in the intervention group than in the control group. Conclusion. The pain was less severe in both groups using periodontal dressing and also lower in the Diplen LX membrane group. In addition, based on WHI, wound healing score in patients was also higher and more favorable in the Diplex LX membrane group. Due to the above factors, the majority of patients preferred the use of the Diplen LX membrane.

Clinical evaluation and biological understanding of the early step-by-step healing after periodontal microsurgery: A case report with PES analysis comparing initial and 31-day result

Microsurgery has evolved, permitting faster vascularization and healing than macro-interventions, reducing tissue trauma and obtaining precise wound closure. Therefore, this study aimed to detail the initial healing steps after the periodontal microsurgical procedure. A -26 year-old female had a localized recession (anterior lower tooth, recession type1-), with the absence of local keratinized tissue width (KTW) and adjacent gingival thickness (GT)<1 mm. After oral prophylaxis and occlusal adjustments, the pink esthetic score was performed (5 points), followed by the microsurgery procedure. Prior to inserting the subepithelial connective tissue graft (SCTG), the epithelial layer was removed, and the root surface was biomodified. Two days postoperatively, it was possible to observe a white layer from the SCTG in the gingival margin, decreasing after 4 days. In 6 days, the sutures were removed; no graft and volume loss was observed. For 9 days, the volume was the maintenance. Nevertheless, there was a reduction in tissue volume in the facial zone. After 11 and 13 days, an improved healing process was found, whereas, after 16 days, it was possible to report stable tissues, which was confirmed after 31 days, with a significant GR reduction and an increase in KTW and GT. Moreover, the final pink esthetic score (PES) was 9. Microsurgery had a faster healing and predictable outcome, suggesting reduced trauma, which may allow a quicker suture removal without jeopardizing the outcomes.

Comparison of Pulsed and Continuous Wave Diode Laser at 940 nm on the Viability and Migration of Gingival Fibroblasts

Gingival fibroblasts have critical roles in oral wound healing. Photobiomodulation (PBM) has been shown to promote mucosal healing and is now recommended for managing oncotherapy-associated oral mucositis. This study examined the effects of the emission mode of a 940 nm diode laser on the viability and migration of human gingival fibroblasts. Cells were cultured in a routine growth media and treated with PBM (average power 0.1 W/cm² , average fluence 3 J/cm² , every 12h for 6 sessions) in one continuous wave (CW) and two pulsing settings with 20 % and 50 % duty cycles. Cell viability was assessed using MTT, and digital imaging quantified cell migration. After 48 and 72 hours, all treatment groups had significantly higher viability (n = 6, p < 0.05) compared to the control. The highest viability was seen in the pulsed (20% duty cycle) group at the 72-hour time point. PBM improved fibroblast migration in all PBM-treated groups, but differences were not statistically significant (n = 2, p > 0.05). PBM treatments can promote cell viability in both continuous and pulsed modes. Further studies are needed to elucidate the optimal setting for PBM-evoked responses for its rationalized use in promoting specific phases of oral wound healing.

A Retrospective Evaluation of Secondary Wound Healing for Extraction of the Maxillary First Molar in Dogs

Oral surgery and exodontia can present challenges in veterinary patients, with a particular area of challenge being extraction and closure of the maxillary first molar (M1) in dogs. This retrospective assessment evaluated patients that had the maxillary first molar extracted with placement of a cruciate suture across the alveolus to achieve partial closure and secure the blood clot. Patients that had teeth extracted adjacent to M1 (maxillary fourth premolar [PM4] or second molar [M2]) were excluded from the study. Three groups of patients were assessed: Group A - at the time of extraction of M1, both the maxillary PM4 and M2 were still present in the oral cavity. Group B - at the time of M1extraction only PM4 or M2 was present, but not both. The tissue was completely intact at the location of the missing tooth. Group C - at the time of M1 extraction neither PM4 or M2 were present, but tissue in these locations was intact. In a three-and-a half-year time period (2015-2018), 179 dogs with 213 solitary M1 extractions were performed. Of these 213 extraction sites, 127 sites (60%) had follow up examination within a two-week postoperative period. Of these 127 sites, 126 (99.2%) appeared appropriately healed without complication. The results of this retrospective evaluation demonstrate that primary closure of a maxillary first molar extraction site may not be required for appropriate soft tissue wound healing in canine patients.

Clinical Comparison of Diode Laser Assisted “v-Shape Frenectomy” and Conventional Surgical Method as Treatment of Ankyloglossia

(1) Background: Ankyloglossia, or tongue-tie is a condition, in which the tip of tongue cannot protrude beyond the lower incisor teeth because of short frenulum linguae, often containing scar tissue. Limitations of movement are the most important clinical symptoms of this condition, together with feeding, speech, and mechanical problems. (2) Methods: the present study included two groups of patients (group A and group B) including, respectively, 29 and 32 patients (61 patients total), aged from 8 to 12 and presenting ankyloglossia classified according to the Kotlow’s classification. The patients in group A underwent a common surgical procedure. For the patients of group B, a diode laser device (K2 mobile laser, Dentium, Korea) with a micro-pulsed wavelength of 980 ± 10 nm and power of 1.2 watts was used. The post-surgical discomfort of the patients (recording the pain perceived immediately after the end of the anesthesia and during the following week, using the Numeric Rating Scale (NRS) system) and healing characteristics (recorded using the Early Wound Healing Score or EHS) were evaluated. (3) Results: The results shows that the pain in the patients who underwent laser-assisted frenectomy is significantly reduced (p < 0.001) when compared to those who underwent conventional surgical frenectomy, both immediately after surgery (with a reduction in the average NRS of 80.6%) and after the first week (with a reduction in the average NRS of 86.58%). Additionally, in the same patients, an augmentation in the average value of the EHS of 45% was recorded, highlighting significantly (p < 0.001) better quality in the healing of the wound within the 24 h after surgery. Moreover, other advantages observed in the use of laser assisted-frenectomy are the absence of bleeding and, consequently, a clear operative field; no need to use sutures; no need to take painkillers or antibiotics after surgery; and having a faster recovery and less time needed to perform the operation. (4) Conclusions: within the limits of the present study, it seems possible to assert that the laser frenectomy performed using the v-shape technique presents a series of advantages if compared to the conventional surgical method.

Effectiveness of platelet rich fibrin versus demineralized bone xenograft in periodontally accelerated osteogenic orthodontics: A pilot comparative clinical study

OBJECTIVES

To compare the rate of extraction space closure between periodontally accelerated osteogenic orthodontics (PAOO) using platelet-rich fibrin (PRF) (Group 1) and PAOO using demineralized bone xenograft (DMBM) (Group 2) and to compare the level of wound healing between the PRF group vs the DMBM group after PAOO.

MATERIALS AND METHODS

A two-arm prospective single blind pilot study with a split-mouth design was used in which 14 patients requiring premolar extraction were divided into two groups: PRF and DMBM. En-masse space closure was carried out with using mini implants after the PAOO procedure. The amount of space closure was measured at five time points with 2-week intervals within 2 months. The gingival healing levels were assessed using early wound healing scores on the first postoperative day.

RESULTS

The rate of extraction space closure was faster in the experimental quadrant at all time points (T1-T4) in the PRF group and at time points (T3, T4) in the DMBM group. Comparison between experimental quadrants showed a significant increase in the rate of space closure in the PRF group T1 to T3 (P < .05). The PRF group showed higher total early healing scores than the DMBM group.

CONCLUSIONS

PRF, when used in the PAOO procedure, produces a faster rate of space closure with better early wound healing than DMBM.

Effect of Chlorhexidine Digluconate in Early Wound Healing of Human Gingival Tissues. A Histological, Immunohistochemical and Biomolecular Analysis

Chlorhexidine digluconate (CHX) is considered the gold standard for oral cavity antiseptic treatment. Nevertheless, several in vitro studies have reported detrimental effects in oral tissue repair. The aim of the present study was to evaluate the in vivo effect of post-surgical CHX mouth rinse on gingival tissue (G) 24 h after injury. G biopsies were obtained in three patients 24 h after surgery with the indication of post-surgical 0.12% CHX use and were compared with those obtained from the same patients without any antiseptic use. Changes in collagen production, cell proliferation, and apoptosis were examined by histological and Ki-67/P53 immunohistochemical analysis. Fibrotic markers (COL1A1, αSMA), proapoptotic protein (BAX) expression, and wound healing-related gene modulation (RAC1, SERPINE1, TIMP1) were analyzed by quantitative real-time PCR analysis. CHX was able to reduce cellular proliferation and increase collagen deposition, proapoptotic molecule and fibrotic marker expression, and myofibroblast differentiation, reduce expression of RAC1 and trigger expression of SERPINE1 and TIMP1, showing “scar wound healing response” pattern. This study assessed for the first time the in vivo effects of CHX on gingival tissue. The demonstration of a CHX-induced fibrotic transformation, leading to scar repair, supports the need for new post-surgical clinical protocols based on a strategic and personalized use of CHX.

Laterally closed tunnel technique with and without adjunctive photobiomodulation therapy for the management of isolated gingival recession-a randomized controlled assessor-blinded clinical trial

The objective of this prospective randomized controlled single-center clinical trial was to prove the efficacy of adjunctive photobiomodulation in improving selected outcomes following the use of laterally closed tunnel technique for the management of isolated gingival recession. Nineteen participants (with isolated gingival recession) each treated by laterally closed tunnel technique were randomized to either add on treatment with control (sham laser application) or test group (photobiomodulation with 660 nm diode, 3.5 J/cm² per point of application). The primary outcome variable was change in recession depth and secondary variables included recession width, width of keratinized gingiva, periodontal biotype, and VAS score for pain assessment and EHS index for early wound healing assessment. Analysis was performed using a linear mixed effects model. There were no significant differences in the gingival recession depth (p = 0.8324) and recession width (p-0.969) at 3-month follow-up. The VAS scores were significantly lower for the test (laterally closed tunnel technique + photobiomodulation) group as compared to control (laterally closed tunnel technique + sham laser) over time (p =  < 0.0001) as well as per site (p = 0.0006) The Early Wound Healing Index scores were significantly higher in the test (laterally closed tunnel technique + photobiomodulation) group as compared to control (laterally closed tunnel technique + sham laser) group (p < 0.0001). The adjunctive use of photobiomodulation did not show a better outcome concerning recession depth but appears to provide faster healing of the surgical wounds and better patient comfort. The result needs further evaluation in particular with respect to long-term effect and due to limitation in sample size. Clinical Trial Registry of India: CTRI/2019/11/022012.

Mesenchymal Stromal Cells Enhance Vascularization and Epithelialization within 7 Days after Gingival Augmentation with Collagen Matrices in Rabbits

Soft gingival tissue deficiency remains a severe problem leading to postoperative recession, peri-implantitis, and bone resorption. The use of collagen matrices does not always lead to complete rebuilding of the gingiva volume. The application of mesenchymal stromal cells (MSCs) simultaneously with collagen materials represents a promising approach for the restoration of soft gingival tissues. However, short-term effects of MSCs-enriched collagen grafts after gingival augmentation have not yet been studied properly. Mucograft and Mucoderm matrices were implanted in rabbits (n = 12) simultaneously with the intraoperative injection of rabbit bone marrow-derived mesenchymal stromal cells (BM-MSCs) or without cells. Collagen matrices were implanted under the flap or by the surface technique without intentional primary closure. The samples were harvested seven days after implantation, histological staining with hematoxylin and eosin, and immunohistochemical staining for VEGF, IGF1, and TGF were performed. The use of Mucoderm led to better augmentation outcomes on day 7 compared with Mucograft (p < 0.0001). Gingival augmentation in combination with the local administration of BM-MSCs led to better regeneration of the soft gingival tissues independently of the type of implanted collagen matrices (p < 0.0001). Furthermore, injection of BM-MSCs significantly enhanced gingival vascularization and epithelization with a clear positive correlation between vascular growth and epithelial response. Administration of BM-MSCs in combination with various collagen materials may potentially improve gingiva regeneration.

Gene expression profiles of oral soft tissue-derived fibroblast from healing wounds: correlation with clinical outcome, autophagy activation and fibrotic markers expression

AIM

Our aim was to evaluate gene expression profiling of fibroblasts from human alveolar mucosa (M), buccal attached gingiva (G) and palatal (P) tissues during early wound healing, correlating it with clinical response.

MATERIALS AND METHODS

M, G and P biopsies were harvested from six patients at baseline and 24 hr after surgery. Clinical response was evaluated through Early wound Healing Score (EHS). Fibrotic markers expression and autophagy were assessed on fibroblasts isolated from those tissues by Western blot and qRT-PCR. Fibroblasts from two patients were subjected to RT² profiler array, followed by network analysis of the differentially expressed genes. The expression of key genes was validated with qRT-PCR on all patients.

RESULTS

At 24 hr after surgery, EHS was higher in P and G than in M. In line with our clinical results, no autophagy and myofibroblast differentiation were observed in G and P. We observed significant variations in mRNA expression of key genes: RAC1, SERPINE1 and TIMP1, involved in scar formation; CDH1, ITGA4 and ITGB5, contributing to myofibroblast differentiation; and IL6 and CXCL1, involved in inflammation.

CONCLUSIONS

We identified some genes involved in periodontal soft tissue clinical outcome, providing novel insights into the molecular mechanisms of oral repair (ClinicalTrial.gov-NCT04202822).

Early Wound Healing Score (EHS): An Intra- and Inter-Examiner Reliability Study

The early wound healing score (EHS) was introduced to assess early wound healing of periodontal soft tissues after surgical incision. The purpose of this study is to evaluate the intra- and inter-examiner reliability of the EHS. Six examiners with different levels of training and clinical focus were enrolled. Each examiner was trained on the use of the EHS before starting the study. Thereafter, 63 photographs of three different types of surgical incisions taken at day 1, 3 or 7 post-operatively were independently evaluated according to the proposed assessment method. A two-way random intra-class correlation coefficient (ICC) and 95% confidence interval (CI) were used to analyze the intra- and inter-examiner reliability for the EHS. The inter-examiner reliability for the EHS was 0.828 (95% CI: 0.767–0.881). The intra-examiner reliability ranged between 0.826 (95% CI: 0.728–0.891) and 0.915 (95% CI: 0.856–0.950). The results therefore show an “almost perfect agreement” for intra- and inter-examiner reliability. The EHS provides a system for reproducible repeated ratings for the early healing assessment of incisions of periodontal soft tissues. Even when used by examiners with different clinical experience and specialty, it shows a high correlation coefficient.

Early wound healing outcomes after regenerative periodontal surgery with enamel matrix derivatives or guided tissue regeneration: a systematic review

BACKGROUND

Proper wound healing after regenerative surgical procedures is an essential issue for clinical success. Guided tissue regeneration (GTR) and application of enamel matrix derivatives (EMD) are common means to regenerate periodontal tissues. Both methods bear considerable advantages due to their special characteristics, but also go along with certain disadvantages. Today, there is no consensus in the literature whether GTR or EMD show better results regarding early wound healing, which is considered a crucial stage in periodontal regeneration. Therefore, the aim of the present systematic review was to compare the early wound healing after regenerative periodontal surgery with either EMD or GTR treatment.

METHODS

An electronic literature search in PubMed was performed to identify randomized clinical trials (RCTs) or clinical trials (CTs) comparing regenerative surgery employing EMD and/or GTR in patients with chronic periodontitis. Among the finally included studies, a qualitative and quantitative data extraction regarding early wound healing parameters was performed. Primary outcome parameters were early wound healing index (EWH), flap dehiscence, membrane exposure, suppuration and abscess formation during the first 6 weeks. As secondary parameters, swelling and allergic reactions were assessed.

RESULTS

Seven studies reporting 220 intrabony periodontal defects in 199 patients were analysed. Flap dehiscence was observed in two studies in 12% of the GTR treated sites and in 10.3% of those treated with EMD. Membrane exposure was evaluated in five studies and was registered in the 28.8% of the defects, while no dehiscence was reported on the EMD group. Swelling was reported only in one study in 8/16 GTR sites and 7/16 EMD sites. Due to considerable heterogeneity of parameters no meta-analysis was possible.

CONCLUSIONS

Due to considerable heterogeneity of the published studies a clear beneficial effect of the EMD on the early wound healing outcomes after surgical treatment of periodontal intrabony defects cannot be confirmed. Standardized RCT studies are needed in order to allow for proper comparison of early wound healing after both types of surgical approaches.