Insights into the Relationship between Periodontitis and Systemic Sclerosis Based on the New Periodontitis Classification (2018): A Cross-Sectional Study

(1) Background: This study aimed to assess the periodontitis burden in systemic sclerosis patients and the possible association between them, and the degree to which some potential risk factors and two potential diagnostic biomarkers may account for this association. (2) Methods: This cross-sectional study included a test group (systemic sclerosis patients) and a control group (non-systemic sclerosis patients). Both groups benefited from medical, periodontal examination and saliva sampling to determine the salivary flow rate and two inflammatory biomarkers (calprotectin, psoriasin). A systemic sclerosis severity scale was established. (3) Results: In the studied groups, comparable periodontitis rates of 88.68% and 85.85%, respectively, were identified. There were no significant differences in the severity of periodontitis among different systemic sclerosis severity, or in the positivity for anti-centromere and anti-SCL70 antibodies. Musculoskeletal lesions were significantly more common in stage III/IV periodontitis (n = 33, 86.84%) than in those in stage I/II (n = 1, 100%, and n = 3, 37.5%, respectively) (p = 0.007). Comparable levels of the inflammatory mediators were displayed by the two groups. There were no significant differences in calprotectin and psoriasin levels between diffuse and limited forms of systemic sclerosis. (4) Conclusions: Within the limitations of the current study, no associations between systemic sclerosis and periodontitis, or between their risk factors, could be proven.

Classifying Maxillary Sinuses of Polish Patients for Sinus Lift: A Pilot Study

To date, there is no systematic anatomical classification available that could help clinicians in choosing between the lateral and palatal approach in sinus lift procedures. The aim was to provide a simple-to-use and memorable classification of the maxillary sinus concerning the thickness of lateral and palatal walls to facilitate the most adequate choice for the window location during direct sinus floor elevation. Cone beam computed tomography scans were consecutively obtained for 200 maxillary sinuses of patients needing dental implant placement with potential maxillary sinus augmentation. The thickness and height of the alveolar bone of the lateral and palatal walls of the maxillary sinuses were assessed. Four variants were distinguished. Class 0: an adequate sub-sinus residual bone height; without the need for sinus floor augmentation. Classes 1-3 had a reduced sub-sinus residual bone height. Class 1: a thinner lateral than palatal sinus wall. Class 2 (the most frequent; 49%): the comparable thickness of both walls in which either lateral, palatal, or crestal window osteotomies can be applied. Class 3 (the least frequent; 3%): a thinner palatal sinus wall in comparison to the lateral wall. The presented anatomical classification simplifies the decision-making process of choosing the most adequate window location and osteotomy technique.

Coronally Advanced Entire Papilla Preservation (CA-EPP) Flap in the Treatment of an Isolated Intrabony Defect to Promote Buccal and Interproximal Soft Tissue Stability: Case Reports

Surgical treatment of infrabony defects may result in gingival recession of the neighboring teeth. The aim of this clinical report is to describe a surgical technique to promote gingival margin stability in the treatment of infrabony defects at sites with a thin or medium gingival phenotype. A coronally advanced entire papilla preservation (CA-EPP) flap with a connective tissue graft (CTG) was executed in two different clinical cases. This technique substantially improved interproximal clinical attachment level and pocket closure, with no gingival recession. A CA-EPP flap using a CTG may promote gingival margin stability and can be recommended in regenerative periodontal procedures.

3D vertical soft tissue augmentation of aesthetically compromised permanent submerged dental implants

CASE PRESENTATION

Midfacial peri-implant soft tissue recession poses a significant challenge to achieving satisfactory aesthetic outcomes and requires a comprehensive, multidisciplinary approach. The present study describes two challenging cases in which implants were aesthetically compromised. A predictable technique was employed to manage these cases by using the implant itself as a tent to achieve 3D horizontal and vertical soft tissue building, which resulted in improved patient satisfaction. The first case involved a deep, severely buccally placed implant situated adjacent to compromised tooth structure. Horizontal and vertical soft tissue augmentation were carried out using a healing abutment to maintain the connective tissue coronal to the implant. The final fixed prosthesis was then delivered on top of the permanent submerged implant, with excellent soft tissue outcomes and a high level of patient satisfaction. The second case involved two compromised, deep, buccally placed implants that were managed by performing a permanent implant submergence technique on the maxillary left central incisor implant and augmenting the soft tissue vertically and horizontally. The final fixed prosthesis was delivered between the maxillary left lateral incisor implant and the previously prepared maxillary right central incisor, resulting in an acceptable aesthetic outcome. The technique presented managed the peri-implant soft tissue dehiscence effectively and restored the previously deficient peri-implant papillae.

CONCLUSIONS

The key to treating challenging aesthetic complications encountered with implants is presurgical prosthetic preparation followed by use of a comprehensive surgical technique to optimise soft tissue thickness and height and address compromised aesthetics in a single surgical step. Use of a permanent implant submergence technique with remediation of associated defects may be a viable clinical approach that is not often explored for these types of defects.

Treatment of Mandibular Class III/IV Furcation Defects with a Combination Plastic Regenerative Technique: A Case Series

The aim of this present case series investigated the effect of a combination therapy utilizing connective tissue graft (CTG) in the treatment of periodontal regeneration of mandibular Class Ⅲ furcation involvement (FI). Six patients diagnosed with periodontitis stage Ⅲ or Ⅳ (grade A to C), presenting with Class Ⅲ or Ⅳ FI, were treated with fibroblast growth factor 2 and carbonate apatite in combination with CTG. The following clinical parameters were evaluated at baseline and after 6, 12 and 18 months: periodontal probing depth, clinical attachment level, furcation invasion, the radiographic vertical defect depth, and gingival phenotype. Significant improvements in clinical parameters were observed in all treated FI sites. Four Class Ⅲ Fls and one Class Ⅳ Fl obtained complete closure, and one Class Ⅳ furcation was improved to Class Ⅰ. This case series showed the potential of administering combination regenerative therapy for changing the prognosis of hopeless teeth with severe furcation defects.

The influence of interradicular anatomy on the predictability of periodontal regenerative therapy of furcation defects: a retrospective, multicenter clinical study

BACKGROUND

The relationship between the anatomy of the interradicular space and success in regenerative therapy of furcation defects is discussed in this paper. The goal of this retrospective, multicenter clinical study is to clinically evaluate the relationship between the interradicular conformation and regenerative therapy success with the use of a novel measurement method.

METHODS

One hundred thirty-eight radiographs of mandibular molars with furcation defects that had been treated with regenerative therapy were collected from six clinical centers. Data on the type of therapy and clinical parameters before and after treatment (follow-up of at least 12 months) were collected. The radiographs (before surgery and at least 12 months postoperatively) were measured with a visual evaluation method by a blind operator using graphics software.

RESULTS

Success, defined as a reduction in horizontal and vertical furcation involvement, decrease in probing depths, and increase in clinical attachment level, was statistically assessed on 138 regenerated molars sites and were related to clinical variables such as age, sex, center, and treatment. No correlation was found between success in regenerative therapy and the conformation of the interradicular space, measured with a visual ratio method and a standard linear measurement. At the univariate analysis, the parameters that had a correlation with success were center, extent of furcation involvement, treatment, and sex. The use of enamel matrix derivative (EMD) seemed to be the most favorable therapy, with increase in CAL gain and reduction of vertical or horizontal furcation involvement.

CONCLUSIONS

The regenerative outcome was not significantly influenced by the anatomy of furcation. The center, the degree of furcation involvement, sex, and treatment (EMD) were significantly associated with higher success of periodontal regeneration.

Involvement of the endocannabinoid system in current and recurrent periodontitis: A human study

OBJECTIVE

The aim of the present study was to assess if the endocannabinoid system is involved differently in patients with recurrent and non-recurrent periodontal disease and if in sites that have a predisposition for reactivation, levels of anandamide (AEA) change after periodontal therapy.

BACKGROUND

Periodontal disease (PD) may be due to a dysregulation of the endocannabinoid system.

METHODS

Periodontal patients were recruited, treated for PD and monitored. Gingival samples from these patients with recurrent (n = 10) and non-recurrent (n = 10) periodontal disease were harvested before and after treatment and compared to those of periodontally healthy (n = 10) subjects. Levels of CB1 and CB2, AEA and CBs receptor activation were assessed in healthy and inflamed samples using immunohistochemistry, chromatography and autoradiography. In healed sites, AEA levels were also assessed.

RESULTS

The number of CBs in inflamed sites of recurrent patients was significantly higher than in those with non-recurrent disease and also higher than those in healthy subjects. Inflamed sites of recurrent patients had significantly lower CBs receptor activation than those of healthy subjects. Levels of AEA in inflamed sites of non-recurrent patients were significantly higher than those found both in inflamed recurrent sites and in healthy sites. Otherwise, the amount of AEA in healthy subjects and recurrent inflamed sites was similar. After periodontal therapy, levels of AEA were significantly lower in both periodontal groups. In recurrent sites, they resulted significantly lower than in non-recurrent and even in healthy subjects.

CONCLUSIONS

The endocannabinoid system seems involved differently in subjects with recurrent and non-recurrent periodontal disease.

Radiographic ratios for classifying furcation anatomy: proposal of a new evaluation method and an intra-rater and inter-rater operator reliability study

OBJECTIVES

Even if it seems to be an important anatomical parameter for tissue regeneration, few studies in literature evaluate the "mean measure" of root divergence. Most of them are linear measurements, which hardly describe the dental furcation conformation in its entirety. It is left to the subjectivity of the operator deciding whether a furcation is convergent or divergent. The goal of this study is to create a visual evaluation method using specific measurements applied on endo-oral X-rays to overcome these problems, giving a conformation of the entire interradicular space and its divergence.

MATERIAL AND METHODS

A user-friendly software (Paint®, Windows10®) was used to take three different measurements on endo-oral radiographs of upper and lower molars. Three blind operators measured 20 radiographs, to analyze the intra- and inter-operator reproducibility of the measurements. Then, the technique was repeated on 250 radiographic images to identify an average value and define a main conformation of the interradicular space. The ratio of these three measurements allowed to develop a new visual evaluation method of the interradicular space.

RESULTS

Intra and inter-operator reproducibility was statistically confirmed on a sample of 20 anonymous endo-oral radiographs measured by 3 blind operators, indicating that the measurement technique was not operator dependent. Measurement made on 250 X-rays obtained with this technique permitted to subdivide in five groups the conformation of the interradicular space and define a mean value of the interradicular space.

CONCLUSIONS

A new anatomical evaluation of the interradicular space in its entirety, which could help the clinicians in diagnostic and decisional phase in the therapy of furcated molars, can be obtained.

CLINICAL RELEVANCE

A pre-operative evaluation of interradicular space conformation could affect therapy treatment choice.

Vertical soft tissue augmentation to treat implant esthetic complications: A prospective clinical and volumetric case series

INTRODUCTION

Challenging implant esthetic complications are often characterized by implant malpositioning and interproximal attachment loss of the adjacent teeth. However, limited evidence is available on the treatment of these conditions. The aim of this study was to evaluate the clinical, volumetric, and patient-reported outcome following treatment of peri-implant soft tissue dehiscences (PSTDs) exhibiting interproximal attachment loss on adjacent teeth, performed through vertical soft tissue augmentation with implant submersion.

METHODS

Ten subjects with isolated PSTD in the anterior maxilla characterized by adjacent dentition exhibiting interproximal attachment loss were consecutively enrolled and treated with horizontal and vertical soft tissue augmentation, involving crown and abutment removal, two connective tissue grafts, and submerge healing. Clinical outcomes of interest included mean PSTD coverage, mean PSTD reduction, clinical attachment level (CAL) gain at the implant and adjacent sites and soft tissue phenotype modifications at 1 year. Optical scanning was used for assessing volumetric changes. Professional assessment of esthetic outcomes was performed using the Implant Dehiscence coverage Esthetic Score (IDES), while patient-reported esthetic assessment involved a 0-10 visual analogue scale.

RESULTS

The mean PSTD depth reduction and mean PSTD coverage at 1 year were 2.25 mm, and 85.14%, respectively. A mean keratinized tissue width (KTW) gain of 1.15 mm was observed, while the mean gain in mucosal thickness (MT) was 1.58 mm. A mean CAL gain of 1.45 mm was obtained at the interproximal aspect of the adjacent dentition at 1 year. Greater linear dimensional (LD) changes were observed at the midfacial aspect of the implant compared to the interproximal sites. The mean final IDES was 6.90 points, while patient-reported esthetic evaluation was 8.83 points.

CONCLUSIONS

The present study demonstrated that vertical soft tissue augmentation with a submerged healing is an effective treatment approach for the treatment of challenging PSTDs with adjacent dentition exhibiting interproximal attachment loss. This technique can be effective in resolution of esthetic complications in most cases, providing a substantial gain in interproximal attachment levels at the adjacent dentition.

Clinical and patient-reported outcomes of tissue engineering strategies for periodontal and peri-implant reconstruction

Scientific advancements in biomaterials, cellular therapies, and growth factors have brought new therapeutic options for periodontal and peri-implant reconstructive procedures. These tissue engineering strategies involve the enrichment of scaffolds with living cells or signaling molecules and aim at mimicking the cascades of wound healing events and the clinical outcomes of conventional autogenous grafts, without the need for donor tissue. Several tissue engineering strategies have been explored over the years for a variety of clinical scenarios, including periodontal regeneration, treatment of gingival recessions/mucogingival conditions, alveolar ridge preservation, bone augmentation procedures, sinus floor elevation, and peri-implant bone regeneration therapies. The goal of this article was to review the tissue engineering strategies that have been performed for periodontal and peri-implant reconstruction and implant site development, and to evaluate their safety, invasiveness, efficacy, and patient-reported outcomes. A detailed systematic search was conducted to identify eligible randomized controlled trials reporting the outcomes of tissue engineering strategies utilized for the aforementioned indications. A total of 128 trials were ultimately included in this review for a detailed qualitative analysis. Commonly performed tissue engineering strategies involved scaffolds enriched with mesenchymal or somatic cells (cell-based tissue engineering strategies), or more often scaffolds loaded with signaling molecules/growth factors (signaling molecule-based tissue engineering strategies). These approaches were found to be safe when utilized for periodontal and peri-implant reconstruction therapies and implant site development. Tissue engineering strategies demonstrated either similar or superior clinical outcomes than conventional approaches for the treatment of infrabony and furcation defects, alveolar ridge preservation, and sinus floor augmentation. Tissue engineering strategies can promote higher root coverage, keratinized tissue width, and gingival thickness gain than scaffolds alone can, and they can often obtain similar mean root coverage compared with autogenous grafts. There is some evidence suggesting that tissue engineering strategies can have a positive effect on patient morbidity, their preference, esthetics, and quality of life when utilized for the treatment of mucogingival deformities. Similarly, tissue engineering strategies can reduce the invasiveness and complications of autogenous graft-based staged bone augmentation. More studies incorporating patient-reported outcomes are needed to understand the cost-benefits of tissue engineering strategies compared with traditional treatments.

Regenerative Surgery of Mandibular Class II Furcation Defects: A Comparison of Two Techniques in a Randomized Clinical Trial with 3D CBCT Measurements at 24 Months

The aim of the present study was to evaluate, clinically and via CBCT, the long-term efficacy of a bioresorbable polylactic acid membrane combined with deproteinized bovine bone graft (DBBM) and compare it to enamel matrix derivative (EMD) combined with DBBM graft in the treatment of class II furcation defects. Sites were randomly assigned to the test group (Guidor Matrix Barrier + Bio-Oss) or the control group (Emdogain + Bio-Oss). Probing pocket depth (PPD), clinical attachment level (CAL), gingival recession (REC), and keratinized tissue (KT) width were assessed at 12 and 24 months, and radiographic bone gain was investigated at 24 months via CBCT. Both groups showed a significant radiographic bone fill and clinical gain. The combination of Emdogain + Bio-Oss showed better clinical outcomes and less complications, though this difference was not statistically significant.

Radiographic protrusion of dental implants in the maxillary sinus and nasal fossae: A multidisciplinary consensus utilising the modified Delphi method

The aim of the present study was to generate an international and multidisciplinary consensus on the clinical management of implant protrusion into the maxillary sinuses and nasal fossae. A total of 31 experts participated, 23 of whom were experts in implantology (periodontologists, maxillofacial surgeons and implantologists), 6 were otolaryngologists and 2 were radiologists. All the participants were informed of the current scientific knowledge on the topic based on a systematic search of the literature. A list of statements was created and divided into three surveys: one for all participants, one for implant providers and radiologists and one for otolaryngologists and radiologists. A consensus was reached on 15 out of 17 statements. According to the participants, osseointegrated implants protruding radiographically into the maxillary sinus or nasal fossae require as much monitoring and maintenance as implants fully covered by bone. In the event of symptoms of sinusitis, collaboration between implant providers and otolaryngologists is required. Implant removal should be considered only after pharmacological and surgical management of sinusitis have failed.

Soft tissue phenotype modification predicts gingival margin long-term (10-year) stability: Longitudinal analysis of six randomized clinical trials

Aim

To assess the prognostic value of soft tissue phenotype modification following root coverage procedures for predicting the long‐term (10‐year) behaviour of the gingival margin.

Materials and Methods

Participants from six randomized clinical trials on root coverage procedures at the University of Michigan were re‐invited for a longitudinal evaluation. Clinical measurements were obtained by two calibrated examiners. A data‐driven approach to model selection with Akaike information criterion (AIC) was carried out via multilevel regression analyses and partial regression plotting for changes in the level of the gingival margin over time and interactions with the early (6‐month) results of soft tissue phenotypic modification.

Results

One‐hundred and fifty‐seven treated sites in 83 patients were re‐assessed at the long‐term recall. AIC‐driven model selection and regression analyses demonstrated that 6‐month keratinized tissue width (KTW) and gingival thickness (GT) influenced the trajectory of the gingival margin similarly in a concave manner; however, GT was the driving determinant that predicted significantly less relapse in the treatments, with stability of the treated gingival margin obtained beyond values of 1.46 mm.

Conclusions

Among a compliant patient cohort, irrespective of the rendered therapy, the presence of at least 1.5 mm KTW and 1.46 mm GT was correlated with the long‐term stability of the gingival margin.

Introduction of a Novel Anatomic Recession Ratio in the Treatment of Gingival Recession: A Proof-of-Principle Study

The present study introduces a novel "anatomic recession ratio" (ARR) and evaluates the clinical outcomes of using a tunnel technique (TUN) with a connective tissue graft (CTG) for root coverage (RC). Sixteen systemically healthy patients contributing a total of 33 recession types 1 and 2 were treated with TUN + CTG. The predictive value of a panel of baseline clinical parameters (ARR) on RC was evaluated 12 months postoperatively. At 12 months, mean recession depth decreased from 2.74 ± 0.22 mm to 0.46 ± 0.13 mm (P < .0001); 19 sites (58%) showed complete RC, and the mean RC rate was 88.85% ± 2.73%. The mean ARR value was 0.74 ± 0.3, revealing a positive correlation with RC (r²: 0.73, P < .0001). The 12-month esthetic evaluation resulted in a score of 8.52 ± 1.75 using the root coverage esthetic score. TUN + CTG is effective in reducing recession depth and obtaining good esthetic outcomes. Within the limits of the present study, it may be suggested that ARR has potential as an analytical baseline parameter for RC outcomes with TUN + CTG.

Supracrestal tissue esthetic management (STEM) technique and current approaches in restorative and surgical treatment of deep margins

Carious lesions with deep margins represent a challenge in daily clinical practice. The following key points are discussed in this article: how to manage a deep margin from a restorative point of view; when and how to perform a surgical procedure; and when it is favorable to carry out definitive restoration work after surgery. The restorative materials and adhesive procedures available today allow minimally invasive techniques to be used on dental tissue with a high preservation of tooth structure. These materials and techniques help to avoid adverse periodontal tissue reactions. Depending on the clinical situation, three treatment options are available when dealing with a subgingival margin. If the depth of the cavity margin is at a maximum distance of 1.5 mm below the gingival margin, isolation with rubber dam allows the performance of interproximal margin relocation, thereby facilitating optimal restoration and periodontal tissue integration. If the margin is located deeper than 1.5 mm below the gingival margin, surgery is necessary before any restorative work can take place. When the margin is within 2 mm above the bone crest, a supracrestal tissue esthetic management (STEM) procedure is undertaken, which means that no ostectomy is required and only osteoplasty is necessary to reshape the preexisting supracrestal attachment, thereby allowing the restorative work to proceed. When the margin is less than 2 mm above the bone crest, crown lengthening with minimal ostectomy and subsequent osteoplasty becomes necessary.

How efficacious is the combination of substitute bone graft with autogenous bone graft in comparison with substitute bone graft alone in the horizontal bone gain? A systematic review and meta-analysis

Background

A systematic review (SR) was conducted to answer the following focused question based on PICO strategy: In patients who were submitted to horizontal guided bone regeneration, “how efficacious is the combination of substitute bone graft with autogenous bone graft in comparison with substitute bone graft alone, in terms of bone gain?”

Material and Methods

MEDLINE (PubMed), Scopus, Embase, Web of Science databases were searched, and hand searches were made up to June 2021, to find randomized clinical trials comparing the clinical effects of autogenous bone graft + substitute bone graft versus substitute bone graft alone in the treatment of horizontal guided bone regeneration.

Results

Four trials representing 109 individuals were included. All studies included in this SR used allogeneic bone graft. The meta-analysis did not show any statistically significant difference between the groups, for horizontal bone gain at a distance of 0 mm (MD: -0.46; 95%CI: -1.03 – 0.11) or at a distance of 4 to 5 mm from the top of the crestal alveolar ridge (MD: 0.17; 95%CI: -1.08 – 1.42).

Conclusions

Within limitations of this systematic review, it was concluded that the addition of autogenous bone graft to the allogeneic bone graft did not significantly increase the quantity of regenerated bone.

Key words:Bone graft, bone regeneration, allograft.

Virucidal Activity of Different Mouthwashes Using a Novel Biochemical Assay

BACKGROUND

Saliva of patients with COVID-19 has a high SARS-CoV-2 viral load. The risk of spreading the virus is not insignificant, and procedures for reducing viral loads in the oral cavity have been proposed. Little research to date has been performed on the effect of mouthwashes on the SARS-CoV-2 virus, and some of their mechanisms of action remain unknown.

METHODS

SARS-CoV-2 positive nasopharyngeal swabs measured by RT-PCR were used for virucidal activity in a 1:1 ratio, with an incubation time of 1 min. The solutions used in this study were: iodopovidone (8 mg); * D-limonene, a terpene extracted from citrus peels (0.3%); † cetylpyridinium chloride (0.1%) (CPC); ‡ chlorhexidine gluconate (10%) (CHX); § a CPC (0.12%) and CHX (0.05%) containing formula; ** a formula containing essential oils; †† a CPC containing formula (0.07%); ‡‡ a D-limonene (0.2%) and CPC (0.05%) containing formula; §§ a solution containing sodium fluoride (0.05%) and CPC (0.075%); *** a solution containing CHX (0.12%) and; ††† a CHX (0.2%) containing formula. ‡‡‡ As a control reaction, saline solution or excipient solution (water, glycerin, citric acid, colorant, sodium citrate) was used.

CONCLUSION

Within the limitations of this study, we can conclude that a mouthwash containing both D-limonene and CPC reduced the virucidal activity in about 6 logs (>99.999% reduction). Hence, establishing a clinical protocol for dentists is suggested, where all patients to be treated rinse pre-operatively with a mouthwash containing both D-limonene and CPC to reduce the likelihood of infection with SARS-CoV-2 for dentists. This is a relatively inexpensive way to reduce viral transmission of SARS-CoV-2 from infected individuals within the community. It is also a simple way to decrease infections from asymptomatic and pre-symptomatic patients.

The Evolution of Surgical Techniques and Biomaterials for Periodontal Regeneration

The understanding of biological concepts in wound healing together with the evolution in biomaterials applied in periodontal regeneration allowed for improved, minimally invasive surgical techniques with a wider range of application and adapted to achieve multiple goals at the same time. Regenerating attachment was never the sole end point, but maintaining the patient's own natural dentition in health and esthetics is becoming a feasible goal even in cases considered challenging just a few years ago. In this article we report on the evolution of techniques and biomaterials and their application in esthetic and challenging cases.

Gingival Phenotype Modification as a Result of Root Coverage Procedure with Two Human Dermal Matrices: Long-Term Assessment of a Randomized Clinical Trial

The gingival thickness (GT) and keratinized tissue width (KTW) constitute the gingival phenotype, a concept that has received a great deal of appreciation in recent years. Gingival phenotype modification has been achieved via different surgical techniques and grafting materials. Despite the superiority of autogenous grafts, their increased patient morbidity and limited recourse has led to the development of graft substitutes. The human dermal matrix is a notable example that, depending on its processing method, can become freeze-dried or solvent-dehydrated acellular dermal matrix (FDADM and SDADM, respectively). This article reports the 9-year outcomes of a randomized clinical trial regarding gingival phenotype modification following root coverage with FDADM and SDADM. Twelve of the original 20 patients were available at the 9-year follow-up. Overall, the outcomes of gingival phenotype modification were maintained in both groups and at all sites after 9 years. For KTW, an incremental increase was observed over time in both groups, and minimal or no changes were noted in GT from the 1-year recall to the 9-year recall. However, the gingival margin level showed an apical shift for both groups.

Tunnel Technique with a Subperiosteal Bag for Ridge Augmentation: A Case Series

The present prospective case series evaluated the efficacy, the intra- and postsurgical complications, and the patient-related outcomes of a tunnel technique with a subperiosteal bag (TTSB) for horizontal ridge augmentation prior to implant placement. Twenty-five systemically healthy patients searching for implant rehabilitation and presenting with a horizontal ridge deficiency requiring bone augmentation before implant placement were included. Guided bone regeneration (GBR) was performed using the TTSB technique, involving the preparation of a collagen membrane that is perforated, folded, and sutured to form a bag that is then filled with a xenogeneic bone graft material. The bag is then inserted into a subperiosteal tunnel. Horizontal bone gain (HBG) was calculated 6 months after the surgery using CBCT. Healing was uneventful and with minimal morbidity. Average HBG was 3.7 ± 1.8 mm (P < .05), with a vertical component gain of 1.3 ± 1.7 mm (P > .05). In 12 patients, additional bone augmentation was required at the time of implant placement. A higher HBG was achieved in the maxilla than in the mandible (4.3 ± 1.3 mm vs 3.2 ± 1.8 mm, respectively; P < .05), and sites with an initial horizontal ridge width ≤ 3.5 mm were associated with a higher chance of requiring additional bone grafting at the time of implant placement compared to sites with an initial horizontal ridge width > 3.5 mm. The present case series demonstrated that TTSB is an effective approach for ridge augmentation prior to implant placement with minimal intra- and postoperative complications or patient morbidity.

Short-term effect of regular vs mini curettes on periodontal tissue according to phenotype: a randomized control clinical trial

AIM

The aim of this randomized control clinical trial was to compare the soft tissue response to mechanical root instrumentation procedures performed using periodontal curettes with different-sized working parts.

MATERIALS AND METHODS

Twenty patients affected by Stage 3 Grade B periodontitis - a total of 109 teeth - were treated with either Mini-Five Gracey Curettes (MFC) or Conventional Gracey Curettes (CGC). Measurements were performed by a blinded examiner at baseline and at 6 weeks. Outcome measurements included pocket depth (PD), recession depth (RD), and difference in RD (∆RD).

RESULTS

The use of MFC significantly reduced soft tissue shrinkage (1.5 ± 1 vs 2.4 ± 1.3; difference: -0.9 mm; P < 0.001). Patients in the MFC (test) group experienced lower gingival recession (GR), especially in both thin (2 ± 0.4 mm vs 3.1 ± 0.5 mm; difference: -1.1; P < 0.001) and medium (1.6 ± 0.5 mm vs 2.6 ± 0.6; difference: -1 mm; P = 0.010) periodontal phenotypes. Severe periodontal pockets (PD ≥ 7 mm) of patients in the MFC group experienced significantly lower soft tissue shrinkage than those in the CGC (control) group, regardless of periodontal phenotype.

CONCLUSION

The use of MFC resulted in a greater PD reduction and lower rate of GR in the short term. Nonsurgical periodontal treatment performed with CGC led to more soft tissue shrinkage, particularly when performed in patients with a thin periodontal phenotype.

A Novel Technique for the Estimation of Gingival Thickness: A Preliminary Study

This study aimed to evaluate the correlation between soft tissue thickness measured by CBCT and phenotype probing estimation and to assess the thickness cutoffs for each phenotype probing outcome. CBCT was performed with a lip retractor in order to isolate periodontal soft tissues in 10 consecutive patients. Using colored probes, the phenotype was evaluated for all present teeth and recorded as thin, medium, thick, or very thick. The overall correlation between tissue thickness and the phenotype probe score was r = 0.86 (CI: 0.80, 0.90). The correlation was r = 0.90 (CI: 0.81, 0.94) when only maxillary anterior teeth were considered. The obtained cutoffs were 0.83 mm between thin and medium phenotypes, 1.07 mm between medium and thick phenotypes, and 1.24 mm between thick and very thick phenotypes. Thus, a high correlation between tissue thickness and the phenotype probe score was found. Preliminary data on the use of phenotype probes as an evaluation method for gingival thickness were promising.

Autologous connective tissue graft or xenogenic collagen matrix with coronally advanced flaps for coverage of multiple adjacent gingival recession. 36-month follow-up of a randomized multicentre trial

AIM

To report the 36-month follow-up of a trial comparing the adjunct of a xenogenic collagen matrix (CMX) or connective tissue graft (CTG) to coronally advanced flaps (CAF) for coverage of multiple adjacent recessions.

MATERIAL AND METHODS

125 subjects (61 CMX) with 307 recessions in 8 centres from the parent trial were followed-up for 36 months. Primary outcome was change in position of the gingival margin. Multilevel analysis used centre, subject and tooth as levels and baseline parameters as covariates.

RESULTS

No differences were observed between the randomized and the follow-up population. Average baseline recession was 2.6 ± 1.0 mm. 3-year root coverage was 1.5 ± 1.5 mm for CMX and 2.0 ± 1.0 mm for CTG (difference of 0.32 mm, 95% CI from -0.02 to 0.65 mm). The upper limit of the confidence interval was over the non-inferiority margin of 0.25 mm. No treatment differences in position of the gingival margin were observed between 6- and 36-month follow-up (difference 0.06 mm, 95% CI -0.17 to 0.29 mm).

CONCLUSION

CMX was not non-inferior with respect to CTG in multiple adjacent recessions. No differences in stability of root coverage were observed between groups and in changes from 6 to 36 months. Previously reported shorter time to recovery, lower morbidity and more natural appearance of tissue texture and contour observed for CMX in this trial are also relevant in clinical decision-making.

Pedicle Flap Designs for Soft Tissue Conditioning in the Therapy of Peri-implantitis

Keratinized mucosa (KM) is regarded as a key factor in peri-implant health. A lack of KM has been associated with discomfort, higher plaque accumulation, and mucosal inflammation. Persistent inflammation might lead to progressive peri-implant bone loss. Several approaches to manage peri-implantitis have been advocated. Despite the effectiveness shown by surgical therapeutic modalities, soft tissue conditioning seems pivotal for long-term peri-implant health and stability. Free epithelial grafts have been demonstrated to efficiently augment the band of KM. Nevertheless, morbidity, dynamic soft tissue changes, and longer healing periods are shortcomings to be considered. The purpose of this technical note is to provide an alternative therapeutic modality for the surgical management of peri-implantitis combined with simultaneous soft tissue conditioning by means of pedicle flaps. Three main clinical scenarios are provided to conceive pedicle epithelial or connective tissue flaps, combined or not with collagen matrices, as predictable approaches to augment KM in the surgical therapy of peri-implantitis.

Gingival phenotype assessment methods and classifications revisited: a preclinical study

Objective

To compare gingival phenotype assessment methods based on soft tissue transparency on different backgrounds and assessor experience levels.

Methods

For this purpose, 24 gingival specimens were retrieved from pig jaws with tissue thicknesses from 0.2 to 1.25 mm. Three methods were assessed: periodontal probe PCP12 (thin/thick), double-ended periodontal probe DBS12 (thin/moderate/thick) and colour-based phenotype probe CBP (thin/moderate/thick/very thick). Each sample was photographed with each probe underneath and categorized whether the probe was visible or not using different coloured backgrounds. To measure experience level influence, dentists, dental undergraduate students and laypersons (n = 10/group) performed the evaluation.

Results

PCP12 probe showed a threshold between 0.4 and 0.5 mm. To distinct between thin and moderate thick gingiva, a comparable range for DBS12 was found while moderate thickness was between 0.5 and 0.8 mm and for thick above 0.8 mm. CBP also showed a comparable threshold of 0.5 mm for thin versus moderate as compared with the other methods; above 0.8 mm, predominantly a very thick tissue was measured. In general, the background colour had a minor impact on PCP12 and DBS12, and investigator experience showed no clear influence on GP assessment.

Conclusion

Based on probe transparency and within the limitation of a preclinical study, we suggest GP differentiation into three entities: thin (< 0.5 mm; high risk), moderate (0.5–0.8 mm; medium risk) and thick (> 0.8 mm; low risk).

Clinical relevance

All three GP assessment methods are easy to perform and seem to have a high predictive value with a three entities classification for DBS12 and CBP.

Implant soft tissue Dehiscence coverage Esthetic Score (IDES): A pilot within- and between-rater analysis of consistency in objective and subjective scores

OBJECTIVES

To introduce an esthetic index for assessing the outcomes of peri-implant soft tissue dehiscence/deficiency (PSTD) coverage and test its within- and between-reviewer reliability.

MATERIALS AND METHODS

Photographs of 51 single PSTDs at baseline and after treatment were provided to four periodontists from three centers. The examiners were asked to rate each case at two timepoints with the Implant soft tissue Dehiscence/deficiency coverage Esthetic Score (IDES) that involved the evaluation of the post-treatment level of the soft tissue margin, peri-implant papillae height, mucosa color, and mucosa appearance (summing up to a total score of 10). Variance components analysis was conducted using multilevel regression fit in a Bayesian framework for obtaining uncertainty intervals for fractional variance contributions and intraclass correlation values (ICC) of the IDES, and for each of its four clinical variables.

RESULTS

Regression models showed reproducible esthetic evaluation among the examiners (inter-reliability) and negligible intra-reviewer variability (assessment of the same case at different timepoints). The ICC for the variability in the assessment of the overall IDES was 0.86, and for the individual components ranged from 0.78 to 0.87. Additionally, there was a strong similarity between the raters' IDES values, and their subjective esthetic response, by the same raters.

CONCLUSION

The IDES showed persistent judgment among the 4 reviewers, and only a slight intra-reviewer variability across timepoints. Within its limitations, this study suggests that the proposed novel score can be a reliable tool for evaluating the esthetic outcomes of PSTD coverage, which can aid in standardization of esthetic assessments following the treatment of a PSTD.

Interproximal attachment gain: The challenge of periodontal regeneration

The new classification of periodontal diseases recognizes the key role of the interdental clinical attachment for defining the periodontal status and the extent of disease severity. Regenerating interdental clinical attachment not only improves the prognosis of the tooth, but it also lessens the severity of the disease condition. This manuscript provides a state-of-the-art review on surgical reconstructive approaches for treating papillary deficiency associated with soft and hard tissue interproximal defects. Combination therapy of papilla preservation, connective tissue grafting, and coronally advanced flaps may result in regeneration of the intrabony defect coupled with root coverage. Future research highlighted here may have the potential, especially in combination approaches, to repair challenging interproximal soft and hard tissue deficiencies.

Aesthetic-And patient-related outcomes following root coverage procedures: A systematic review and network meta-analysis

BACKGROUND

Aim of this systematic review (SR) of randomized controlled trials (RCTs) was to evaluate effect of different flap designs and graft materials for root coverage, in terms of aesthetics, patient satisfaction and self-reported morbidity (post-operative pain/discomfort).

MATERIAL AND METHODS

A comprehensive literature search was performed. A mixed-modelling approach to network meta-analysis was utilized to formulate direct and indirect comparisons among treatments for Root Coverage Esthetic Score (RES), with its individual components, and for subjective patient-reported satisfaction and post-operative pain/discomfort (visual analogue scale (VAS) of 100).

RESULTS

Twenty-six RCTs with a total of 867 treated patients (1708 recessions) were included. Coronally Advanced Flap (CAF) + Connective Tissue Graft (CTG) (0.74 (95% CI [0.24, 1.26], p = .005)), Tunnel (TUN) + CTG (0.84 (95% CI [0.15, 1.53]), p = .01) and CAF + Graft substitutes (GS) (0.55 (95% CI [0.006, 1.094], p = .04)) were significantly associated with higher RES than CAF. No significant difference between CAF + CTG and TUN + CTG was detected (0.09 (95% CI [-0.54, 0.72], p = .77)). Addition of CTG resulted in less natural tissue texture (-0.21 (95% CI [-0.34, -0.08]), p = .003) and gingival colour (-0.06 (95% CI [-0.12, -0.03], p = .03)) than CAF. CTG techniques were associated with increased morbidity.

CONCLUSIONS

Connective tissue graft procedures showed highest overall aesthetic performance for root coverage, although graft integration might impair soft tissue colour and appearance. Additionally, CTG-based techniques were also correlated with a greater patient satisfaction and morbidity.

Tunnel Technique with a Subperiosteal Bag for Horizontal Ridge Augmentation

Several approaches for horizontal ridge augmentation have been proposed, including guided bone regeneration (GBR), ridge split, and block grafts. Minimally invasive techniques for horizontal GBR have been introduced to reestablish an adequate bone volume, minimizing tissue trauma and patient morbidity. The present article describes a tunnel technique with a subperiosteal bag for horizontal GBR. A collagen membrane is partially perforated, folded, and sutured to form a bag that is filled with xenogeneic bone graft. The filled bag is inserted into a subperiosteal tunnel such that the perforated side faces the alveolar ridge and the nonperforated side faces the tunnel flap. The main advantage of this approach is the preservation of the periosteum and the enhanced blood supply to the flap, which may contribute to increased favorable wound healing and a reduced risk of flap dehiscence and membrane exposure. This novel tunnel approach for horizontal GBR using a customized bag made from a collagen membrane, specifically adapted and filled with deproteinized bovine bone, resulted in a significant ridge volume gain that allowed implant placement.

Correlation between facial growth patterns and cortical bone thickness assessed with cone-beam computed tomography in young adult untreated patients

Background

The vertical facial growth pattern is one of the most important issue in the orthodontic diagnosis and treatment. Previous studies investigated the association between interdental bone thickness and facial divergence using mainly bidimensional analysis. When two-dimensional dental radiographic views are not sufficient for diagnosis and measurements, cone-beam computed tomography (CBCT) images should be used to assess the alveolar bone structure three-dimensionally and with high accuracy and reliability.

The aim of the present study was to evaluate the correlation between alveolar bone thickness and facial divergence in young adults untreated patients using a three-dimensional method analysis with CBCT images.

Methods

Records of 30 untreated patients (mean age 16 ± 2 years) with Angle Class I and mild to moderate crowding were analyzed. Subjects were classified as hypodivergent (<39˚), normodivergent (41 ± 2˚), and hyperdivergent (>43°). according to the inter-maxillary angle between the sagittal maxillary plane (ANS-PNS) and the mandibular plane (GN-ME). The alveolar bone thickness measurements were taken for the buccal and palatal/lingual surfaces of maxillary and mandibular anterior teeth. Axial-guided navigation (AGN) was used to locate all landmarks using a specific software (Horos 3.0).

Results

The statistical analysis showed a significant difference between the hypodivergent and hyperdivergent group regarding buccal bone height (P = 0.005), buccal apical bone thickness (P = 0.003) and palatal mid-root bone thickness (P = 0.006). Moreover, buccal bone height (P = 0.006) was found to be statistically significant different in normodivergent compared with hypodivergent individuals.

Conclusions

Facial types were found to be correlated with alveolar bone thickness. The hyperdivergent subjects presented thinner alveolus bone in the anterior maxilla and at almost all sites in the mandible. Clinicians should be aware of the possibility of thin cortical bone plates in hyperdivergent patients, reducing antero-posterior movements to avoid fenestration and dehiscence.

Biologics-based regenerative technologies for periodontal soft tissue engineering

This manuscript provides a state-of-the-art review on the efficacy of biologics in root coverage procedures, including enamel matrix derivative, platelet-derived growth factor, platelet concentrates, and fibroblast-growth factor-2. The mechanism of action and the rationale for using biologics in periodontal plastic surgery, as well as their anticipated benefits when compared with conventional approaches are discussed. Although the clinical significance is still under investigation, preclinical data and histologic evidence demonstrate that biologic-based techniques are able to promote periodontal regeneration coupled with the provision of tooth root coverage.

Autogenous soft tissue grafting for periodontal and peri-implant plastic surgical reconstruction

This state-of-the-art review presents the latest evidence and the current status of autogenous soft tissue grafting for soft tissue augmentation and recession coverage at teeth and dental implant sites. The indications and predictability of the free gingival graft and connective tissue graft (CTG) techniques are highlighted, together with their expected clinical and esthetic outcomes. CTGs can be harvested from the maxillary tuberosity or from palate with different approaches that can have an impact on graft quality and patient morbidity. The influence of CTGs on soft tissue thickness and keratinized tissue width are also discussed.

Living cell-based regenerative medicine technologies for periodontal soft tissue augmentation

The cultivation of human living cells into scaffolding matrices has progressively gained popularity in the field of periodontal wound healing and regeneration. Living cellular constructs based on fibroblasts, keratinocytes alone or in combination have been developed and used as alternatives to autogenous soft tissue grafts in keratinized tissue augmentation and in root coverage procedures. Their promising advantages include reduced patient morbidity, unlimited graft availability, and comparable esthetics. This manuscript reviews soft tissue augmentation and root coverage procedures using bioengineered living cellular therapy and highlights their expected clinical, esthetic, and patient-related outcomes.

Extracellular matrix-based scaffolding technologies for periodontal and peri-implant soft tissue regeneration

The present article focuses on the properties and indications of scaffold-based extracellular matrix (ECM) technologies as alternatives to autogenous soft tissue grafts for periodontal and peri-implant plastic surgical reconstruction. The different processing methods for the creation of cell-free constructs resulting in preservation of the extracellular matrices influence the characteristics and behavior of scaffolding biomaterials. The aim of this review is to discuss the properties, clinical application, and limitations of ECM-based scaffold technologies in periodontal and peri-implant soft tissue augmentation when used as alternatives to autogenous soft tissue grafts.

The Effect of Time on Root Coverage Outcomes: A Network Meta-analysis

The stability of root coverage outcomes has gained a great deal of interest. However, insufficient evidence is available, mainly due to limited direct comparisons among different techniques and the small sample size among clinical trials. Therefore, the aim of this study was to propose a mixed-models network meta-analysis (NMA) that includes the novelty of assessing time on root coverage outcomes while simultaneously comparing different surgical approaches. A literature search was performed by 2 individual reviewers to identify randomized clinical trials (RCTs) reporting the outcomes of root coverage procedures of at least 2 time points to estimate the slopes of different treatment approaches. The primary outcomes were the changes in slopes for recession depth (REC), keratinized tissue width (KTW), and clinical attachment level. Sixty RCTs with a total of 2,554 gingival recessions (1,864 patients) were included in the NMA. Connective tissue graft (CTG) and enamel matrix derivative (EMD) approaches provided superior initial REC reduction compared to flap advancement alone. However, only CTG-based procedures were effective in maintaining the stability of the gingival margin over time, while EMD, acellular dermal matrix, collagen matrix, and flap alone showed a similar tendency for gingival recession recurrence. Baseline REC and KTW at the earliest postoperative recall were predictors for the stability of the gingival margin. In addition, a geographic center effect on the treatment slopes was observed for REC and KTW. While limitations of the present linear mixed-modeling approach should be considered as it refers to estimation and comparison of time slopes based on an examined while linear framework, the designed NMA showed to be an effective tool for the simultaneous comparison of multiple treatment approaches while taking into account the critical element of time.

Acellular dermal matrix and coronally advanced flap or tunnel technique in the treatment of multiple adjacent gingival recessions. A 12-year follow-up from a randomized clinical trial

AIM

To evaluate the long-term outcomes of Acellular Dermal Matrix (ADM) with Coronally Advanced Flap (CAF) or Tunnel technique (TUN) in the treatment of multiple adjacent gingival recessions (MAGRs).

MATERIAL AND METHODS

Nineteen of the original 24 patients contributing to a total number of 33 sites for CAF and 34 for TUN were available for the 12 years follow-up examination. Recession depth, mean root coverage (mRC), keratinized tissue width (KTW), gingival thickness (GT) were evaluated and compared with baseline values and 6-months results. Regression analysis was performed to identify factors related to the stability of the gingival margin.

RESULTS

A highly significant drop in mRC was observed for both groups from the 6 months timepoint to the 12 years recall (p < .001). While there were no statistically significant differences between the two groups in terms of Clinical Attachment Level (CAL), KTW, GT changes and Root Coverage Esthetic Score at each timepoint (p > .05). KTW ≥ 2 mm and GT ≥ 1.2 mm at 6-months were two predictors for stability of the gingival margin (p = .03 and p = .01, respectively).

CONCLUSIONS

A significant relapse of the gingival margin of MAGRs treated with CAF or TUN + ADM was observed after 12 years.

New Perspectives in the Use of Biomaterials for Periodontal Regeneration

Periodontitis is a disease with a high prevalence among adults. If not treated, it can lead to loss of teeth. Periodontal therapy aims at maintaining patient’s teeth through infection control and correction of non-maintainable anatomies including—when possible—regeneration of lost periodontal tissues. The biological regenerative potential of the periodontium is high, and several biomaterials can be utilized to improve the outcome of periodontal therapy. Use of different natural and synthetic materials in the periodontal field has been studied for many years. The main materials used today in periodontology analyzed in this review are: Resorbable and non-resorbable barrier membranes; autogenous, allogeneic, xenogeneic, and alloplastic bone substitutes; biological agents, such as amelogenins; platelet-derived growth factor; bone morphogenic proteins; rh fibroblast growth factor 2; teriparatide hormone; platelet concentrates; and 3D scaffolds. With the development of new surgical techniques some concepts on periodontal regeneration that were strictly applied in the past seem to be not so critical today. This can have an impact on the materials that are needed when attempting to regenerate lost periodontal structures. This review aims at presenting a rationale behind the use of biomaterials in modern periodontal regeneration

Minimizing Patient Morbidity Following Palatal Gingival Harvesting: A Randomized Controlled Clinical Study

This clinical study was conducted to evaluate the impact of different hemostatic treatments following palatal gingival harvesting on patient discomfort. Fifty patients who needed a mucogingival surgery requiring gingival graft harvesting were enrolled and randomly assigned to one of five groups: (1) a control group in which only sutures were applied; (2) a cyanoacrylate group; (3) a periodontal dressing material group; (4) a hemostatic gelatin sponge group; and (5) a group in which the gelatin sponge and cyanoacrylate were combined. In the 2 weeks following the procedures, perception of pain, healing, consumption of drugs, and willingness to repeat the procedure were recorded through visual analog scale (VAS) by patients. Over the 2 weeks, lower pain (VAS) was found in all test groups compared to the control group (P < .01, value for time-group interaction). Notably, the gelatin sponge combined with cyanoacrylate group had very low pain (VAS ≤ 0.5 points) throughout the 14 days. The lowest healing scores at day 10 were associated with the control group (6.8 VAS points) in contrast to the four test groups (8.2 to 9.0 VAS points, P = .0001). Pain was inversely correlated with age (P < .05). Pain also depended on the apicocoronal dimension of the graft: the higher the graft, the more pain was experienced by the participants (0.4 VAS points per 1 mm, P < .05). Within the limitations of this study, palatal coverage appears to result in better outcomes when compared to suture alone. In particular, a double-layered protection of the palatal wound with a gelatin sponge combined with cyanoacrylate appeared to be the best option in reducing pain and postoperative discomfort.

Impact of Dental Implant Surface Modifications on Adhesion and Proliferation of Primary Human Gingival Keratinocytes and Progenitor Cells

The success of dental implants depends mainly on osseointegration and gingival sealing. Therefore, early attachment and spreading of epithelial cells might be critical for a positive outcome. Research in dental implant materials has primarily focused on surface roughness, defined by the average roughness (Ra) index, as it promotes the process of osseointegration. This study explored its influence on soft tissue attachment by looking mainly at adhesion, proliferation, and spreading of primary human cells belonging to the epithelial lineage. Characterized human gingival keratinocytes, gingival and epithelial progenitor cells were seeded on machined (S1; Ra = 0.3 to 0.6 μm), Ti-Unite (S2; Ra = 1.2 μm), and SLA (S3; Ra = 2 μm) implants. Cell adhesion with early proliferation and spreading were evaluated by combining a biochemical vitality test with imaging analyses. Findings showed that adhesion was significantly higher on S1 (36% ± 2%) and S2 (44% ± 7%) than on S3 (23% ± 6%), while early proliferation was slightly improved on S1. The resulting data, obtained through an innovative and easily reproducible in vitro method, suggest that implant surface roughness affects epithelial cell adhesion and proliferation.

Predictor factors for long-term outcomes stability of coronally advanced flap with or without connective tissue graft in the treatment of single maxillary gingival recessions: 9 years results of a randomized controlled clinical trial

AIM

To assess the clinical outcomes 9 years after the surgical treatment of single maxillary gingival recessions and identify predictors for long-term gingival margin stability.

MATERIALS AND METHODS

Twenty-five gingival recessions (Miller Class I and II) were randomly treated with Coronally Advanced Flap (CAF) plus Connective Tissue Graft (CTG) or CAF alone. Outcomes included complete root coverage (CRC), recession reduction (REC), keratinized tissue (KT) gain and dentin hypersensitivity, and were evaluated at 6 months, 1 and 9 years. Multilevel analysis was performed to identify predictors for long-term gingival margin stability.

RESULTS

Baseline gingival recession was 2.4 ± 0.8 mm and 2.4 ± 1.0 mm in the CAF + CTG and in the CAF-treated sites, respectively (p = 0.693). The chance to gain and preserve CRC over time is equal to 70% in the CAF + CTG group (Relative Risk [RR] = 1.70, 95% CI [0.84-3.45]; adjusted RR = 1.48, 95% CI [0.61-3.62]). Using the CTG, an increase in KT was recorded 9 years after the surgery (p = 0.019). An OR of 0.12 (p = 0.022) of not achieving CRC was observed in cases with non-carious cervical lesions (NCCL) compared to cases without NCCL.

CONCLUSION

Both treatment modalities demonstrated stability over time. Additional use of CTG provided a greater increase in KT. The presence of NCCL negatively affected CRC and REC.