The effects of vertically coronally advanced flap and free gingival graft techniques on shallow vestibule: a randomized comparative prospective trial

OBJECTIVES

The present study aimed to compare the influence of vertically coronally advanced flap (V-CAF) and free gingival graft (FGG) techniques on shallow vestibule depth (VD).

MATERIALS AND METHODS

Parallel-arm randomized clinical trial was conducted on 38 sites treated with either FGG or V-CAF. Periodontal variables (VD, recession depth and width, probing depth, clinical attachment level, keratinized tissue height (KTH), and tissue thickness (TT)), clinician- and patient-based subjective variables were assessed.

RESULTS

All periodontal variables showed significant improvements in both groups at all follow-up intervals compared to baseline (p < 0.05). Both groups increased VD compared to baseline. RC and CRC were similar after treatment for both techniques. FGG provided a greater increase in KTH (p < 0.001) and VD (VD1, p = 0.02 and VD2, p < 0.001) while V-CAF exhibited more TT gain (p = 0.002). Except overall tissue appearance that was better in V-CAF (p < 0.001), no inter-group significant difference existed in patient-based variables.

CONCLUSIONS

Both techniques were significantly effective in VD increasing. While both techniques were equally successful in RC, V-CAF provided higher TT gain and better tissue appearance. V-CAF can be chosen instead of FGG in the treatment of recessions with shallow VD.

CLINICAL RELEVANCE

It can be recommended to prefer V-CAF instead of FGG in the treatment of shallow vestibule.

TRIAL REGISTRATION NUMBER

NCT05777811 (clinicaltrials.gov).

Cyanoacrylate and hyaluronic acid combination on palatal donor site management after de‐epithelialized graft harvesting

BACKGROUND

Although soft tissue substitutes showed promising improvement in the past decade, epithelialized gingival graft (EGG) is still widely used in periodontal plastic surgery applications. Donor site management after EGG harvesting has been challenging for clinicians. This study aimed to compare the effectiveness of cyanoacrylate, hyaluronic acid, and their combination in palatal donor site management after EGG harvesting.

METHODS

Data from 89 patients were included and categorized as gelatin sponge (GS), gelatin sponge with either cyanoacrylate (GS + CY), hyaluronic acid (GS + HA), or both (GS + CY + HA). The data of pain perception (PP), quantity of analgesics (QA), secondary bleeding (SB), epithelization level (EL), and color match (CM) were assessed retrospectively.

RESULTS

The GS + CY and GS + HA + CY groups showed lower PP scores compared to the GS and GS + HA groups (p < 0.05). The QA was higher in the GS group compared to the GS + CY and GS + HA + CY groups (p < 0.001). All study groups showed greater EL than GS group on day 7 (p < 0.001). On day 14, full EL was present in 81% of the patients in the GS + HA + CY group, which was higher than the other groups (p < 0.001). All study groups reported lower SB in the first 3 days, which was lower compared to the GS group (p < 0.001) and showed higher CM scores than the GS group on days 7 and 14 (p < 0.001).

CONCLUSIONS

CY application reduces pain and analgesic intake and HA may support the wound healing with increased EL. Using the CY-HA combination provides additional benefits for donor site management.

Comparison of two techniques in gingival recession treatment: A randomized one-year clinical follow-up study

BACKGROUND

Gingival recession (GR) is highly prevalent in the general population and represents a significant concern for patients and clinicians. Various surgical techniques have been proposed to treat gingival recession. Well-designed trials with clinicianand patient-based parameters, evaluating the envelope connective tissue graft (E-CTG) and semilunar coronally advanced flap (SCAF) techniques are still needed.

OBJECTIVES

The aim of this trial was to compare the effectiveness of E-CTG and SCAF in the treatment of GR during a 1-year follow-up.

MATERIAL AND METHODS

A total of 42 patients with GR were treated with E-CTG (n = 20) or SCAF (n = 22). Clinician-based recordings of recession depth (RD), recession width (RW), probing depth (PD), clinical attachment level (CAL), keratinized tissue width (KTW), tissue thickness (TT), clinical attachment gain (CAG), root coverage (RC), keratinized tissue change (KTC), and wound healing index (WHI), as well as patient-based parameters of dentine hypersensitivity (DH), tissue appearance, patient expectations, and esthetics were collected at baseline (BL), 6 weeks (T 1 ), 6 months (T 2 ), and 1 year (T 3 ).

RESULTS

After the treatment, E-CTG demonstrated better outcomes than SCAF in terms of CAG (50.70% vs. 33.33%), RC (85.60% vs. 35.60%) and KTC (1.70 ±1.49 mm vs. 0.36 ±0.96 mm) at T 3 . Similar findings were detected in terms of WHI, tissue appearance, patient expectations, and esthetics. Although inconvenient surgical experience was recorded, better results were obtained after E-CTG in terms of DH and meeting the RC expectations.

CONCLUSIONS

Despite it being more difficult surgical experience and the risk of keloid formation, E-CTG was superior to SCAF in terms of RC percentage, reducing DH and obtaining satisfactory RC. However, it is still necessary to improve patient comfort in the case of E-CTG.

An Unusual Case of Early Dental Implant Failure in an Otherwise-Healthy Patient due to Actinomycosis

Actinomyces spp. are members of normal oral flora that may give rise to a rare disease- oral actinomycosis . Here we present a case of early implant failure associated with actinomycosis in an otherwise -healthy 43-year-old female and the treatment adopted following explantation. Clinically, one month after the implant placement, the peri-implant soft tissues were hyperplastic and associated with an excessive tissue reaction, bleeding, suppuration, deep probing depth , and implant mobility at #19 and #20 implants. Both implants were removed and all granulomatous tissues were thoroughly debrided. Histopathological examination revealed signs of acute ulcerative inflammatory reaction and Actinomyces colonies. The patient was prescribed short-term oral penicillins. After six months following explantation, the deficient bone was augmented with using a combination of absorbable collagen membrane, autogenous block and xenograft. The patient was followed up for one year ; and subsequently, two implants were reinserted at the same positions. The patient was followed up and no recurrences were observed. Implant failure due to actinomycosis is an extremely rare condition , and a definitive diagnosis is therefore essential for successful treatment.