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Jung HJ, Karimbux N, Dragan IF. Correcting mucogingival deformities for pescatarian patients: A clinical case study. Clin Adv Periodontics 2024. [PMID: 38646856 DOI: 10.1002/cap.10289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 03/11/2024] [Accepted: 03/23/2024] [Indexed: 04/23/2024]
Abstract
AIM This clinical case study is to highlight the improvement of periodontal health of mandibular canines using a soft tissue alternative of fish origin, a piscine graft. METHODS A 37-year-old female patient was referred to a periodontal practice for evaluation of mucogingival deformities around teeth #22 and #27 that were also diagnosed with recession, lack of keratinized tissue (KT), and bilateral high frenum attachment. Multiple soft tissue treatment options were presented to the patient, including autogenous, allograft, or xenograftporcine or piscine. RESULTS Given the patient's dietary preference, piscine option was preferred. The procedures were completed one at a time, first #22 and later #27, using the standard of care procedures for correcting mucogingival deformities using soft tissue alternatives. Post-surgical visits were scheduled at regular intervals (2, 4, 12, 24, 52 weeks) to evaluate the clinical outcomes. Healing was uneventful and clinical outcomes reveal correction of the mucogingival deformities. The amount of KT at the 52 weeks healing time, measured using an intraoral scanner was 2.12 mm on #22 and 1.78 mm on #27. CONCLUSION Within this clinical case's scope, piscine xenograft demonstrates to be a safe and effective soft tissue alternative to correct mucogingival deformities, increasing the KT width and achieving recession coverage. In addition, integration of patient's preference may lead to increased case acceptance and patient compliance. KEY POINTS What new information is this case providing? The use of a soft tissue alternative of piscine origin that was selected based on the patient's preference to correct bilateral combined mucogingival deformities (recession, lack of KT, and aberrant frenum attachment) around teeth. What is a key step to integrating this soft tissue alternative in clinical practice? The pre-hydration of the soft tissue alternative is preferred, compared to other soft tissue alternatives that might not require hydration (xenograft bovine origin). What are the limitations to success in this case? Confirming with the patient no pre-existing fish allergies.
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Affiliation(s)
- Hyung Jae Jung
- Tufts University School of Dental Medicine, Boston, Massachusetts, USA
| | - Nadeem Karimbux
- Tufts University School of Dental Medicine, Boston, Massachusetts, USA
| | - Irina F Dragan
- Tufts University School of Dental Medicine, Boston, Massachusetts, USA
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Private Practice Limited to Periodontology and Implant Dentistry, Brookline Periodontal Associates, Brookline, Massachusetts, USA
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Zheng K, Zhang Y. Modified coronally advanced flap technique in the treatment of fibrous epulis: A case report with 1-year follow-up. Clin Adv Periodontics 2024. [PMID: 38523464 DOI: 10.1002/cap.10286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/02/2024] [Accepted: 03/03/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Currently, the treatment of epulis is primarily surgical excision, which would greatly affect the aesthetics of patients if happened in the anterior region. It's challenging for clinicians to balance the aesthetic after surgery and less surgical trauma. To overcome this disadvantage, the authors propose the modified coronally advanced flap technique which applies the principles of minimally invasive surgery to provide satisfactory therapeutic results in fibrous epulis. METHODS We report a case of an 18-year-old female with the chief complaint of a gingival swelling in the right upper anterior region. After the initial periodontal therapy, the modified surgical approach was applied to this patient. Unlike conventional coronally advanced flap technique, an additional incision was made, and the free portion was rotated into the adjacent space to completely cover the trauma, which avoided the use of the second operative zone. RESULTS The gingiva recovered with normal color, contour, and consistency after surgery, the papilla filled up the proximal space well and was in good harmony with the adjacent papillae. The surgical results remained stable during the follow-up period. CONCLUSIONS The use of modified coronally advanced flap technique allows the clinician to successfully resume the natural appearance of gingiva in the treatment of fibrous epulis, as well as simplify the surgical approach, shorten the operative time, and demonstrate no tendency of recurrence. KEY POINTS Why is this case new information? This novel technique not only removes the epulis, but also takes into account the postoperative aesthetics of the surgery at the same time. This minimally invasive surgical technique reduces operative time and increases patient comfort. Keys to successful management of this case are as follows: (i) Adequate preoperative assessment of the location of the additional incision; (ii) tension-free coronal flap advancement. What are the primary limitations to success in this case? Clinical studies with long-term outcomes of this approach are needed. This procedure may be limited to larger gingival tumors.
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Affiliation(s)
- Kaixin Zheng
- Department of Oral Medicine, Hangzhou Normal University, Hangzhou, China
| | - Yuan Zhang
- Department of Stomatology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
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Gisotti M, Valente NA. Palatal shield technique: a novel approach for improved donor site healing in mucogingival procedures - report of two cases. Quintessence Int 2024; 55:160-165. [PMID: 38224104 DOI: 10.3290/j.qi.b4867835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
OBJECTIVE Mucogingival surgery involving tissue grafts is commonly employed for cosmetic procedures like root coverage, and is increasingly applied in implant therapy to modulate peri-implant soft tissues and enhance implant survival. These procedures involve harvesting autologous connective or epithelial connective tissue, often from the palate or tuber maxillae. However, this can cause patient morbidity due to postoperative pain. Substitute materials, including animal-derived and xenografts, have been developed but lack qualities of autologous grafts. METHOD AND MATERIALS To address postoperative discomfort, a novel technique, named "palatal shield," using composite resin stabilized on adjacent teeth's palatal surface is proposed as an aid to donor site healing after mucogingival procedures. Two cases are reported where this technique was successfully applied. The first case involves a 53-year-old woman undergoing free gingival graft surgery for peri-implant treatment. The second case features a 58-year-old man receiving subepithelial connective tissue graft surgery for root sensitivity. RESULTS Ten days post surgery, both patients reported excellent postoperative comfort. The technique's effectiveness is highlighted in these cases, demonstrating its applicability in various surgical cases involving free gingival graft or connective tissue graft harvesting. CONCLUSION The proposed "palatal shield" technique offers several advantages, including enhanced patient comfort, ease of application, and cost-effectiveness, making it a promising addition to mucogingival surgical procedures.
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Chawla K, Goyal L. Root coverage with the restoration of non-carious cervical lesions: A systematic review and meta-analysis. Dent Med Probl 2024; 61:99-119. [PMID: 38445442 DOI: 10.17219/dmp/155338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/12/2022] [Indexed: 03/07/2024] Open
Abstract
The progression of non-carious cervical lesions (NCCLs) leads to gingival recession (GR), which is restored with restorative materials, using different periodontal plastic surgery procedures. There is no consensus on which technique is superior to others. Therefore, the present systematic review aimed to assess the effectiveness of root coverage (RC) procedures in the restored and unrestored NCCLs in terms of clinical and patient-centered outcomes.We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) while searching 5 databases in addition to the gray literature. The Medical Subject Headings (MeSH) terms and keywords in the title and abstract fields, as well as in headings, were used to search the existing literature for the relevant publications on the effectiveness of RC procedures with the restoration of NCCLs over the past 3 decades (January 1990-July 2021). After applying the inclusion and exclusion criteria, 13 articles were read in full and critically analyzed. The quality analysis was performed using the Cochrane RevMan software.A total of 222 potentially relevant titles and abstracts were found after the initial electronic and manual search, and after removing duplicates. Applying the inclusion and exclusion criteria yielded 23 publications that were further analyzed for relevance and applicability. Following critical analysis, 13 publications were used for validity assessment and data extraction.In the teeth with NCCLs and GR, the restoration of NCCLs does not affect the percentage RC. However, it significantly decreases dentin hypersensitivity, and the patients' perception of esthetics and satisfaction.
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Affiliation(s)
- Kirti Chawla
- Department of Periodontology, Faculty of Dentistry, Jamia Millia Islamia, New Dehli, India
| | - Lata Goyal
- Department of Periodontology, Faculty of Dentistry, Jamia Millia Islamia, New Dehli, India
- Department of Dentistry, All India Institute of Medical Sciences (AIIMS), Bhatinda, India
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Rodriguez AB, Chan HL, Velasquez D. Anatomy-driven complexity classification for soft-tissue tunneling procedures. Clin Adv Periodontics 2023. [PMID: 37812141 DOI: 10.1002/cap.10267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 08/01/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND The tunnel technique (TUN) preserves the integrity of the papilla by creating envelope flaps that allow for the insertion of a connective tissue graft, and/or biomaterials. METHODS (1) A comprehensive overview of tunneling flap procedures in the treatment of gingival recessions (GRs) for soft tissue coverage is presented and (2) A classification system for soft and hard tissue anatomy of GR sites which may aid the clinician in determining the surgical complexity is being introduced. RESULTS A novel clinical classification system is proposed to illustrate complexity levels determined by soft and hard tissue anatomy of GR sites such as the mucogingival junction proximity to the gingival margin, bone morphotype, and mucosal margin thickness. CONCLUSIONS TUN is highly effective in treating single/multiple GRs. Its limitations are related to variability in surgical site anatomy and operator expertise. A classification system based on anatomical soft and hard tissue variations has been proposed to help identify complexity levels encountered during tunneling procedures. KEY POINTS Site-related factors directly impact the surgical variables related to tissue trauma, flap tension, soft tissue management, muscle pull, and wound stability during the healing of gingival recessions (GRs). The achievement of expedited and favorable wound healing is crucial to obtaining quantitative and qualitative success in the treatment of GR and the long-term stability of root coverage. A classification system based on anatomical soft and hard tissue variations has been proposed to facilitate tunneling procedures while respecting surgical principles.
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Affiliation(s)
- Amanda B Rodriguez
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Hsun-Liang Chan
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Diego Velasquez
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Seven Lakes Periodontics, Private Practice, Fenton, Michigan, USA
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Kulkarni MR, Bhatavadekar NB, Setty SB, Bakshi PV. A double lateral pedicle graft technique for palatal recession coverage on dental implants. J Indian Soc Periodontol 2023; 27:536-540. [PMID: 37781328 PMCID: PMC10538518 DOI: 10.4103/jisp.jisp_379_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 01/13/2023] [Accepted: 03/05/2023] [Indexed: 10/03/2023] Open
Abstract
Rough surfaces of dental implants, when exposed to the oral environment, are conducive to biofilm colonization and can predispose the affected implant to periimplantitis. Recession coverage using soft-tissue grafts is one of the treatment modalities used for the treatment of exposed implant threads. Recession coverage on the palatal aspect of maxillary implants is difficult due to the firm nature of the palatal mucosa and, consequently has not been widely documented in the literature. This case report documents a novel double-pedicle technique for palatal recession coverage on a dental implant. Two pedicle grafts were obtained from either side of the implant with the mucosal recession: a full-thickness lateral-pedicle graft from the distal aspect and a subepithelial connective tissue pedicle from the mesial aspect. The connective tissue pedicle was stabilized first on the area of mucosal recession and was then covered with the distal full-thickness lateral pedicle. Complete recession coverage was obtained, and the result was observed to be clinically stable after 18 months of follow-up. The technique demonstrated in this report can be a useful tool for the treatment of localized palatal recessions on dental implants.
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Affiliation(s)
- Mihir Raghavendra Kulkarni
- Department of Periodontics, SDM College of Dental Sciences and Hospital, Shri Dharmasthala Manjunatheshwara University, Dharwad, Karnataka, India
| | - Neel Bhalachandra Bhatavadekar
- Department of Periodontology, University of North Carolina, Chapel Hill, NC, USA
- Department of Periodontology, University of Texas Health Science Center, Houston, Texas, USA
| | - Swati Badrinarayan Setty
- Department of Periodontics, SDM College of Dental Sciences and Hospital, Shri Dharmasthala Manjunatheshwara University, Dharwad, Karnataka, India
| | - Purva Vijay Bakshi
- Department of Periodontics, SDM College of Dental Sciences and Hospital, Shri Dharmasthala Manjunatheshwara University, Dharwad, Karnataka, India
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Schincaglia GP, Agusto M, Thacker S, Thomas Simpson K, Salman A. Gingival pedicle with split-thickness tunnel technique: A retrospective case series for single mandibular anterior recessions. Clin Adv Periodontics 2023; 13:137-143. [PMID: 35412668 DOI: 10.1002/cap.10197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 02/24/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Gingival recessions in the mandibular anterior sextant are a common clinical finding, but mucogingival treatment in this location is particularly challenging, due to several anatomical and surgical difficulties. In the present case series, a novel technique, called gingival pedicle with split-thickness tunnel (GPST), was retrospectively evaluated. CASE SERIES Fifteen patients presenting with a single buccal RT1 or RT2 gingival recession of a depth of ≥3 mm in the mandibular anterior sextant were treated by means of the GPST technique. Clinical periodontal parameters at baseline and at the last follow-up evaluation visit (6-84 months) were compared. Early healing was uneventful in all cases, and no complications such as flap dehiscence or loss of connective tissue graft were observed. Mean root coverage (mRC) was 98.1% ± 7.38%, corresponding to a statistically significant recession reduction (ΔRD) of 4.53 ± 1.19 mm. Complete root coverage was achieved in 14 of 15 cases. The gain in keratinized tissue width amounted to 3.13 ± 0.99 mm and was statistically significant, whereas no significant change in periodontal probing depth was observed after treatment. CONCLUSION In conclusion, treatment with GPST technique seems to achieve a favorable and predictable clinical improvement in gingival recessions on mandibular anterior teeth. Why are these cases new information? Limited information is available about the management of isolated deep labial recessions in the mandibular anterior teeth. A novel surgical approach, called GPST technique, is described in a case series to specifically address this type of defect. What are the keys to successful management of these cases? Horizontal incision ≥ RECwidth Cut-back preparation helps to mobilize the flap without tension. CTG width ≥ 3 times RECwidth CTG height ≥ RECdepth Proper graft and flap stabilization need to be achieved. What are the primary limitations to success in these cases? Limited mesio-distal dimensions, which do not allow to obtain a pedicle with adequate horizontal width Very thin biotype may not be suitable because of the risk of inadequate flap vascularization.
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Affiliation(s)
- Gian Pietro Schincaglia
- Department of Periodontics, Case Western Reserve University School of Dental Medicine, Cleveland, Ohio, USA
- Department of Periodontics, School of Dentistry, West Virginia University, Morgantown, West Virginia, USA
| | - Michele Agusto
- Department of Periodontics, School of Dentistry, West Virginia University, Morgantown, West Virginia, USA
| | - Sejal Thacker
- Division of Periodontics, University of Connecticut School of Dental Medicine, Farmington, Connecticut, USA
| | - Kerri Thomas Simpson
- Department of Periodontics, School of Dentistry, West Virginia University, Morgantown, West Virginia, USA
| | - Arif Salman
- Department of Periodontics, School of Dentistry, West Virginia University, Morgantown, West Virginia, USA
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Geisinger ML, Kaur M, Abou Arraj RV, Basma H, Geurs NC. Clinical applications of mucogingival therapies utilizing adjunctive autologous blood products. Clin Adv Periodontics 2022; 12:233-240. [PMID: 36134542 DOI: 10.1002/cap.10227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/30/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Mucogingival deformities are prevalent oral conditions and can result in esthetic compromise, dentinal hypersensitivity, and an increase in radicular caries rates. Mucogingival treatments address thin periodontal phenotype and/or gingival recession defects. Although many of these grafting procedures are predictable in improving soft-tissue quality and quantity around teeth and dental implants, patients often complain of discomfort at both the donor and recipient sites. Free gingival grafts and coronally advanced flaps alone or in combination with subepithelial connective tissue graft and/or acellular dermal matrix are among the most common surgical procedures employed to achieve root coverage and enhance periodontal phenotype. Autologous blood products (ABPs) contain platelets, growth factors, leukocytes, and stem cells that contribute to cell mitosis, collagen production, and angiogenesis, leading to the healing and regeneration of hard and soft tissue. Evaluation of the adjunctive role of ABPs in mucogingival surgery and their impacts on clinical and patient-centered data is critical to achieve optimal patient-reported outcome measures based upon the current scientific evidence. METHODS We present exemplar cases in which adjunctive ABPs were utilized in mucogingival treatment to enhance treatment outcomes. RESULTS No adverse events were noted. Satisfactory treatment outcomes were achieved in patients with local and/or systemic compromise when mucogingival therapies were used in combination with ABPs. CONCLUSIONS Adjunctive use of ABPs may enhance outcomes of mucogingival therapy. Utilization of adjunctive ABPs may be particularly advantageous in situations where the predictability of clinical and esthetic outcomes is limited due to anatomical and/or patient factors.
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Affiliation(s)
- Maria L Geisinger
- Department of Periodontology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Maninder Kaur
- Department of Periodontology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ramzi V Abou Arraj
- Department of Periodontology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Hussein Basma
- Department of Periodontology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Nicolaas C Geurs
- Department of Periodontology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Scheyer ET, Gomes P, Rossi A. The treatment of multiple gingival recession defects with connective tissue grafting and enamel matrix derivative in a private practice setting: Two case reports. Clin Adv Periodontics 2022; 12:241-250. [PMID: 36282493 DOI: 10.1002/cap.10226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/02/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Dentofacial esthetics has become a mainstay treatment in periodontics. For a periodontal private practice to succeed in a referral-based environment, predictability and stability in treatment results are crucial. The scientific literature provides a guide to successfully treating multiple recession defects with non-carious cervical lesions and lingual recession. These case reports show how the use of biologic mediators, proper case selection, and proper surgical technique may provide a better treatment outcome for our patients. METHODS Two patients with multiple gingival recession defects were treated with autogenous tissue grafting in conjunction with the application of enamel matrix derivative (EMD) to attempt root coverage. Based on the Cairo classification, the recession defects were classified as type I in the maxillary buccal and lingual recession in the mandibular anterior. There were areas of no attached gingiva, loss of enamel, and the presence of non-carious cervical lesions. RESULTS At 3-month post-treatment in case #1 and 6-month post-treatment in case #2, satisfactory esthetic results for the patients and clinician were achieved. These short-term follow-ups were favorable for root coverage and soft tissue healing, especially at the 1-week visit. There was noticeably less edema and erythema. Additionally, dental hypersensitivity was no longer reported for both patients. CONCLUSION By using biologic mediators, such as an EMD combined with connective tissue grafting, both multiple recession defects with non-carious cervical lesions, and lingual recession cases, can be treated successfully in a private practice setting. Using an EMD provides no additional risks to patients, may result in faster healing, and would afford stability of long-term success by influencing true periodontal regeneration.
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Miguel MMV, Ferraz LFF, Rossato A, Cintra TMF, Mathias-Santamaria IF, Santamaria MP. Comparison between connective tissue graft and xenogeneic acellular dermal matrix to treat single gingival recession: A data reanalysis of randomized clinical trials. J ESTHET RESTOR DENT 2022; 34:1156-1165. [PMID: 35670134 DOI: 10.1111/jerd.12936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/05/2022] [Accepted: 05/22/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES There are few studies comparing xenogeneic acellular dermal matrixes (XDMs) with connective tissue graft (CTG) to treat single gingival recession (GR). The present study involved a reanalysis of previous studies and comparison of CTG or XDM to treat single RT1/GR. MATERIALS AND METHODS Fifty patients from three previous randomized clinical trials treated either by CTG (n = 25) or XDM (n = 25) were evaluated after 6-month. Clinical, patient-centered, and esthetic parameters were assessed. Pearson's correlation and regression analyses were also performed. RESULTS Greater recession reduction (RecRed), percentage of root coverage (%RC), and complete root coverage (CRC) were observed in the CTG group (p ≤ 0.02). Gingival thickness (GT) and keratinized tissue width (KTW) gains were higher in the CTG group. The CTG group showed better esthetic at 6-month. Logistic analyses reported that GT([OR] = 1.6473 ) and papilla height (PH) (OR = 8.20) are predictors of CRC. GT*XDM interaction was a negative predictor of CRC (OR = 7.105-5 ). GT at baseline acted as a predictor of RecRed in both groups (p = 0.03). The XDM graft impacted RecRed and %RC negatively. Baseline PH was a predictor of %RC for both grafts. CONCLUSION CTG was superior for treating RT1/GR, providing better root coverage outcomes and tissue gains over time. GT, PH, and graft type were classified as predictors of CRC. CLINICAL SIGNIFICANCE CTG presented better outcomes to treat single RT1 gingival recession when compared to the XDM.
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Affiliation(s)
- Manuela Maria Viana Miguel
- Division of Periodontics, Institute of Science and Technology, São Paulo State University (UNESP), São Paulo, Brazil
| | - Laís Fernanda Ferreira Ferraz
- Division of Periodontics, Institute of Science and Technology, São Paulo State University (UNESP), São Paulo, Brazil
| | - Amanda Rossato
- Division of Periodontics, Institute of Science and Technology, São Paulo State University (UNESP), São Paulo, Brazil
| | - Tuana Mendonça Faria Cintra
- Division of Periodontics, Institute of Science and Technology, São Paulo State University (UNESP), São Paulo, Brazil
| | | | - Mauro Pedrine Santamaria
- Division of Periodontics, Institute of Science and Technology, São Paulo State University (UNESP), São Paulo, Brazil.,University of Kentucky, College of Dentistry, Lexington, Kentucky, USA
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Karmakar S, Kamath DSG, Shetty NJ, Natarajan S. Treatment of Multiple Adjacent Class I and Class II Gingival Recessions by Modified Microsurgical Tunnel Technique and Modified Coronally Advanced Flap Using Connective Tissue Graft: A Randomized Mono-center Clinical Trial. J Int Soc Prev Community Dent 2022; 12:38-48. [PMID: 35281688 PMCID: PMC8896580 DOI: 10.4103/jispcd.jispcd_117_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 08/25/2021] [Accepted: 09/16/2021] [Indexed: 11/04/2022] Open
Abstract
Background Complete and uneventful recession coverage should be the aim of gingival recession treatment. Systematic reviews have said that coronally advanced flap with connective tissue graft (CTG) is the gold standard for gingival recession treatment. Minimally invasive procedures with optical magnification allow minimal tissue manipulation and precise adaptation of wound edges helping in faster and uneventful healing, thus bringing about a satisfactory clinical and patient outcome. Thus, the following study compares the clinical- and patient-related outcomes of modified microsurgical tunnel technique (MMTT) and modified coronally advanced flap (MCAF) using CTG in the coverage of multiple adjacent Miller's class I and II gingival recessions. Materials and Methods Gingival recession patients were selected and were assigned randomly to either MMTT+CTG or MCAF+CTG. Clinical parameters were evaluated at 1, 3, and 6 months. Patient's satisfaction level was assessed by measuring root coverage esthetic score, hypersensitivity, and morbidity. The statistical analysis was performed using commercially available software SPSS version 14. Descriptive statistics were expressed as mean±standard deviation for each parameter. Intragroup comparison was done by using the paired T-test. Intergroup comparison was done using the independent Student's T-test. The significance level was set at P = 0.05. Results MMTT+CTG showed a statistically significant greater clinical- and patient-related outcome. Conclusion MMTT+CTG, being a closed procedure, preserves the blood supply, helps in faster healing, and does not compromise the esthetics. All these lead to decreased morbidity and increased patient satisfaction which makes MMTT a superior technique than the conventional procedure in gingival recession treatment.
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Affiliation(s)
- Sayantan Karmakar
- Department of Periodontology, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Deepa Sai Giridhar Kamath
- Department of Periodontology, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Neetha J Shetty
- Department of Periodontology, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Srikanth Natarajan
- Department of Oral Pathology and Microbiology, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Mashaly M, Ghallab NA, Elbattawy W, Elarab AE. Soft Tissue Augmentation Using De-Epithelialized Free Gingival Graft Compared to Single-line Incision Subepithelial Connective Tissue Graft in the Management of Miller Class I and II Gingival Recession: A Randomized Controlled Clinical Trial. Contemp Clin Dent 2022; 13:227-235. [PMID: 36213850 PMCID: PMC9533386 DOI: 10.4103/ccd.ccd_763_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 09/29/2020] [Accepted: 10/18/2020] [Indexed: 11/04/2022] Open
Abstract
Aims The purpose of this randomized controlled clinical trial was to clinically assess soft tissue augmentation and compare patients' morbidity and root coverage outcomes of coronally advanced flap (CAF) with subepithelial connective tissue graft (SCTG) versus de-epithelialized free gingival graft (DFGG) in the management of Miller Class I and II gingival recession. Materials and Methods Twenty-eight patients with Miller's Class I or II gingival recession (GR) defects were randomly assigned into two equal parallel groups treated with either CAF + SCTG, harvested using single-line incision technique (control), or CAF + DFGG (test). Gingival thickness (GT), recession depth, recession width, percentage of root coverage, keratinized tissue width, pocket depth, and clinical attachment level were measured at baseline and 3 and 6 months postoperatively. Patient-reported outcomes were assessed postoperatively, including pain, stress, bleeding, and inability to chew. Patients' overall satisfaction and root coverage esthetic scores were recorded at 6 months. Results Both groups demonstrated a statistically significant improvement in all clinical outcomes after 3 and 6 months compared to baseline. DFGG showed a statistically significant increase in GT after 6 months. No statistically significant difference was detected in other clinical outcomes between both groups at different time intervals. Both treatments achieved 92.9% complete root coverage. Patients treated with CAF + DFGG reported significantly higher stress and inability to chew scores after 2 weeks than those treated with SCTG. There were no significant differences in patient satisfaction between both groups. Conclusions CAF + SCTG and CAF + DFGG were both effective and can be applied safely in treating Miller Class I and II GRs.
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Affiliation(s)
- Mohamed Mashaly
- Department of Periodontology, Faculty of Dentistry, Cairo University, Cairo, Egypt,Address for correspondence:Dr. Mohamed Mashaly, 27A Baghdad Street, Heliopolis, Cairo, Egypt. E-mail:
| | - Noha A. Ghallab
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Weam Elbattawy
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Azza Ezz Elarab
- Department of Oral Medicine and Periodontology, Vice Dean for Postgraduate Affairs and Research, Faculty of Dentistry, Cairo University, Cairo, Egypt
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13
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Monje A, Blasi G, Amerio E, Sanz-Martin I, Nart J. Dimensional Changes in Free Epithelialized Gingival/Mucosal Grafts at Tooth and Implant Sites: A Prospective Cohort Study. J Periodontol 2021; 93:1014-1023. [PMID: 34970744 DOI: 10.1002/jper.21-0521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/20/2021] [Accepted: 12/20/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND A study was made of the dimensional changes in free epithelialized gingival/mucosal grafts (FEGs) used to augment keratinized tissue (KT) at tooth and implant sites, and of the confounders influencing the dynamic changes over 6 months of follow-up. MATERIAL AND METHODS A prospective cohort interventional study was made of implant and tooth sites needing keratinized tissue augmentation by means of an apically positioned flap and FEG. Six intraoperative variables were recorded at baseline (T0). In addition, graft width (GW), graft length (GL) and graft dimension (GD) were assessed at three weeks (T1), three months (T2) and 6 months of follow-up (T3). Univariate and multivariate analyses were performed to explore associations between the demographic and intraoperative variables and the outcomes over the study period. RESULTS Based upon an a priori power sample size calculation, a total of 56 consecutive patients were recruited, of which 52 were available for assessment. A total of 73 graft units were included in 122 sites. At T3, the mean change in GD in FEG was 40.21%. In particular, the mean changes in GL and GW were 12.13% and 33.06%, respectively. Statistically significant changes in GD were recorded from T0 to T1 (p<0.0005) and from T1 to T2 (p<0.0005), but not from T2 to T3 (p = 0.13). The change in GD at T3 was 33.26% at tooth and 43.11% at implant site level (p = 0.01). Age and GW assessed at T0 proved to be related to the changes in GD and GW in the univariate and multivariate analyses. The univariate analysis showed the avascular area (AA) to be related to the changes in GD and GW at the implant sites, while graft thickness (GT) was associated to changes in GD and GW at the tooth sites in the univariate and multivariate analyses. CONCLUSIONS Free epithelialized grafts are exposed to dimensional changes that result in a reduction of approximately 40% of the original graft dimension - the changes being approximately 10% greater at the implant sites than at the tooth sites (NCT04410614). This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Alberto Monje
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Gonzalo Blasi
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain.,Division of Periodontology, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - Ettore Amerio
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Ignacio Sanz-Martin
- Section of Graduate Periodontology, Faculty of Odontology, Universidad Complutense, Madrid, Spain
| | - José Nart
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
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14
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Eltayeb TM, Ghali RM, Elashiry SG, Eldemerdash FH, Shaker IS, Gamal AY, Romanos GE. Erbium, Chromium:Yttrium-Scandium-Gallium-Garnet Laser for Root Conditioning and Reduction of Postoperative Morbidity in the Treatment of Gingival Recession Defects: A Randomized Controlled Clinical Trial. Photobiomodul Photomed Laser Surg 2021; 39:665-673. [PMID: 34115953 DOI: 10.1089/photob.2020.4918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objective: This clinical trial evaluates the effect of erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) root surface biomodification and laser harvesting of de-epithelialized gingival graft (DGG) on root coverage clinical outcomes and postoperative morbidity, and compares this to the conventional blade-harvested DGG method without Er,Cr:YSGG root surface biomodification in treatment of Miller's class I, II gingival recessions (GR). Background: The application of laser technology to enhance tooth root coverage clinical outcomes as well as the impact of laser on postoperative morbidity after harvesting autogenous soft tissue grafts requires further research. Methods: This study is a randomized, single-blinded controlled trial, including 24 volunteers with isolated GR defects. They were allocated into three treatment groups to receive one of the following three interventions: blade-harvested DGG (control group: B-DGG); Er,Cr:YSGG-harvested DGG and root surface biomodified [test 1 group: L-laser-harvested DGG (L-DGG)/laser root biomodification (LRB)]; and B-DGG and Er,Cr:YSGG root surface biomodification (test 2 group: B-DGG/LRB). Clinical and radiographic parameters were recorded at baseline (1 week before surgery) and 3, 6, and 9 months postoperatively. Results: Root coverage did not show a statistically significant difference between control and test groups. Statistically significant differences were found for Visual Analog Scale on the day of surgery and day 3 and 4 postoperatively, as well as pain medication on the day of surgery favoring the L-DGG group. Conclusions: The use of Er,Cr:YSGG laser in root surface biomodification improved root coverage outcomes at 9 months. Even these changes were not statistically significant from the control group; the L-DGG technique was associated with decreased postoperative morbidity in the palatal donor site.
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Affiliation(s)
- Tarek M Eltayeb
- Department of Oral Medicine and Peridontology, Faculty of Oral and Dental Medicine, Misr International University, Cairo, Egypt
| | - Rami M Ghali
- Department of Prosthodontics, Ain Shams University Faculty of Dentistry, Cairo, Egypt
| | - Shahinaz G Elashiry
- Department of Oral Medicine and Peridontology, Faculty of Oral and Dental Medicine, Misr International University, Cairo, Egypt
| | - Fatma H Eldemerdash
- Department of Oral Medicine and Peridontology, Faculty of Oral and Dental Medicine, Misr International University, Cairo, Egypt
| | - Islam S Shaker
- Department of Oral and Maxillofacial Radiology, Faculty of Oral and Dental Medicine, Misr International University, Cairo, Egypt
| | - Ahmed Y Gamal
- Department of Periodontology, Ain Shams University and October 6th University, Faculty of Dentistry, Cairo, Egypt
| | - Georgios E Romanos
- Department of Periodontology, School of Dental Medicine, Stony Brook University, Stony Brook, New York, USA
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15
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Kawar NI, Alrayyes SM, Khuzam M, Haddad JR, Tilwani SK. Gingival Sculpting-A Simple Gingival Depigmentation Technique using Bur Abrasion and Scalpel Combined: A Case Report. Clin Adv Periodontics 2021; 11:145-149. [PMID: 33538102 DOI: 10.1002/cap.10148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/15/2021] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Dentofacial esthetics demands have increased tremendously in the past decade. Psychological impact of unsatisfactory esthetic appearance can manifest in decreased sense of self-esteem and can negatively affect social and professional interactions. Esthetic awareness of dental patients has extended to include requests of gingival color modification. Gingival pigmentation can be physiological due to ethnic pigmentation or can be a result of various pathological processes. Different surgical modalities, tools and materials have been used in management of gingival pigmentation. This case report is introducing a simple, cost effective, minimally invasive technique of gingival sculpting for the purpose of significantly reducing gingival pigmentation. CASE PRESENTATION A healthy 32-year-old male patient presented with a chief complaint of gingival pigmentation that is causing him distress and low self-esteem. Gingival sculpting technique was used. This simple technique uses a combination of two methods, bur abrasion and scalpel blade with copious irrigation. The procedure resulted in minimal intra and postoperative complications and excellent esthetic results achieved instantly and maintained at 3 months postoperatively. High patient esthetic satisfaction was achieved. CONCLUSION Gingival sculpting is minimally invasive procedure that can be performed at any dental office. It renders excellent esthetic results using minimal chair time and down time for the patient. It is well tolerated by the patient with minimal bleeding, postoperative pain, and rapid healing time. Long-term follow-up is needed to ensure stability and lack of recurrence.
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Affiliation(s)
- Nadia I Kawar
- College of Dentistry, Periodontics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sahar M Alrayyes
- Department of Pediatric Dentistry, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Maher Khuzam
- College of Liberal Arts, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jacob R Haddad
- College of Liberal Arts, Benedictine University, Lisle, Illinois, USA
| | - Sunny K Tilwani
- College of Dentistry, Periodontics, University of Illinois at Chicago, Chicago, Illinois, USA
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16
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Chowdary PC, Pavankumar YS, Murthy KRV, Kishore D T. A Novel Modified-Vista Technique With Connective Tissue Graft in the Treatment of Gingival Recession-A Case Report. Clin Adv Periodontics 2020; 12:75-79. [PMID: 33216473 DOI: 10.1002/cap.10135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/22/2020] [Indexed: 11/09/2022]
Abstract
INTRODUCTION The increasing esthetic demands from patients have required that clinicians sharpen their skills and adopt newer and more novel techniques to satisfy these demands. In periodontal therapy, periodontal plastic surgery poses a substantial challenge to the clinician, both because it is technique sensitive and also because it includes a wide array of procedures and their variations. Conventional plastic procedures have provided satisfactory results in the treatment of gingival recession but there is, presently, a greater need for more advanced procedures that cause less surgical morbidity as also provide improved results. Minimally invasive surgery has been harnessed in periodontics for this purpose and has been extensively used in multiple indications, including root coverage. Modified-Vestibular Incision Supra-periosteal Tunnel Access (M-VISTA) applies the principles of minimally invasive surgery to provide satisfactory results in root coverage. CASE PRESENTATION A 28-year-old male patient presented with multiple Miller Class I/II buccal recession defects and associated high labial frenum on right maxillary anterior teeth. M-VISTA technique allowed coronal repositioning of gingival margin, which was then stabilized by orthodontics bracket assisted suturing technique. The V-shaped incision in the region of the frenal attachment allowed for conducting both the M-VISTA and frenectomy techniques simultaneously. Connective tissue graft was inserted in the supra-periosteal tunnel and vertical incision was sutured. Complete root coverage was achieved and maintained at 9 months with excellent esthetic outcomes. CONCLUSIONS The use of connective tissue graft along with M-VISTA technique allows the clinician to successfully treat multiple recession defects.
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Affiliation(s)
- P Charishma Chowdary
- Department of Periodontics and Oral Implantology, GITAM Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Y Sandhya Pavankumar
- Department of Periodontics and Oral Implantology, GITAM Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India
| | - K Raja V Murthy
- Department of Periodontics and Oral Implantology, GITAM Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Trinath Kishore D
- Department of Periodontics and Oral Implantology, GITAM Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India
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17
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Kumar S, Hirani T, Shah S, Mehta R, Bhakkand SR, Shishoo D. Treating Public Health Dilemma of Gingival Recession by the Dehydrated Amnion Allograft: A 5-Year Longitudinal Study. Front Oral Health 2020; 1:540211. [PMID: 35047979 PMCID: PMC8757781 DOI: 10.3389/froh.2020.540211] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 09/16/2020] [Indexed: 11/22/2022] Open
Abstract
Aim: This study aimed to evaluate the efficacy of dehydrated amnion allograft with coronally positioned flap procedure in paired Miller's class I recession defects. Methods: A total of 51 subjects were included in the study with bilateral Miller's class I gingival recession defects. In the test group, patients were treated with an amniotic membrane (AM) with a coronally positioned flap, while in the control group, patients were treated with coronally positioned flap alone. Clinical parameters such as recession depth, recession width (RW), probing depth (PD), relative attachment level (RAL), width of keratinized gingiva (WKG), and thickness of keratinized gingiva (TKG) were recorded at baseline and after 5 years of follow-up. Result: The mean baseline recession was 2.95 ± 0.89 in the test group and 2.70 ± 0.85 in the control group, and both were statically non-significant. At the end of 6 months, all the parameters, when compared with the baseline, showed a significant improvement. Intergroup comparison showed the non-significant difference in all settings except the TKG. Conclusion: AM proved to help improve the TKG. This increase in thickness helps in the long-term maintenance of the gingival margin in Miller's class I recession defect.
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Affiliation(s)
- Santosh Kumar
- Department of Periodontology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, India
| | - Tanvi Hirani
- Department of Periodontology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, India
| | - Sujay Shah
- Department of Periodontology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, India
| | - Rupal Mehta
- Department of Periodontology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, India
| | - Susmita R Bhakkand
- Department of Periodontology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, India
| | - Deepak Shishoo
- Department of Physiology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, India
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18
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Merijohn GK, Chambrone L, Brodsky AI, Xenoudi P. Mandibular Anterior Lingual Recession: Keratinized Tissue Grafting and Minimally Invasive Harvesting. Clin Adv Periodontics 2020; 11:201-207. [PMID: 33067880 DOI: 10.1002/cap.10132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/31/2020] [Indexed: 11/07/2022]
Abstract
INTRODUCTION The mandibular anterior lingual (MAL) keratinized tissue (KT) band is often insufficient in dimension: <2 mm height of which <1 mm is attached gingiva (AG). Its gingival phenotype is commonly characterized as thin (<1 mm) gingival thickness (GT) and having inadequate (<1 mm) AG width. When surgical treatment is indicated, prevention of significant apical displacement of the gingival margin and improvement of long-term gingival stability are enhanced by KT increase and phenotype modification in order to establish thick GT and adequate AG. The aim of this case report is to describe a bilaminar surgical approach, the modified coronally advanced flap (mCAF) and connective tissue graft with retained KT band (mCAF + CTGkt). It is an outcomes-driven surgical approach for KT increase and phenotype modification in order to predictably establish thick GT and adequate AG. The mCAF + CTGkt procedure is minimally invasive, predictable, well-tolerated and addresses both the unique features of MAL anatomy and normal oral functioning movement during the postoperative healing phase. CASE PRESENTATION A 48-year old female presented with chief complaint of MAL progressive gingival recession (GR). Attachment loss of 3-4 mm and lack of both KT and AG were documented. Primary treatment outcomes objectives were GR cessation, establish KT, increase GT and AG. A secondary outcome was decreasing GR. CONCLUSION The mCAF + CTGkt procedure resulted in KT increase, phenotype modification to establish thick GT and adequate AG, and decreased GR. It addressed unique features of MAL anatomy. Postoperative healing outcomes were not negatively impacted by normal oral functioning.
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Affiliation(s)
- George K Merijohn
- Department of Periodontology, University of Washington, Seattle, WA.,Division of Periodontology, University of California San Francisco, San Francisco, CA
| | - Leandro Chambrone
- School of Dentistry, Ibirapuera University (Unib), Sao Paulo, Brazil.,Unit of Basic Oral Investigation (UIBO), School of Dentistry, Universidad El Bosque, Bogota, Colombia.,Evidence-Based Hub, Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Caparica, Almada, Portugal
| | | | - Pinelopi Xenoudi
- Division of Periodontology, University of California San Francisco, San Francisco, CA.,College of Dental Medicine, California Northstate University, Sacramento, CA
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19
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Singh AK, Mali DK. Periosteum eversion technique versus subpedicle connective tissue graft technique for root coverage of gingival recessions: A randomized split-mouth study. Natl J Maxillofac Surg 2020; 11:81-88. [PMID: 33041582 PMCID: PMC7518482 DOI: 10.4103/njms.njms_32_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 10/14/2019] [Accepted: 10/16/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction: The connective tissue graft (CTG) with pedicle flap as subpedicle CTG technique (SPCTGT) is considered the gold standard technique in the treatment of gingival recessions. The aim of this study was to compare periosteum eversion technique (PET) with SPCTGT for root coverage of gingival recessions. Materials and Methods: Ten patients having bilateral gingival recessions of Miller class I and II were selected. The left or right side was randomly assigned into PET group and SPCTGT group. Before and after 1 year of surgery, depth of gingival recession (DGR), width of keratinized gingiva (WKG), width of attached gingiva (WAG), and probing depth (PD) were measured and compared. Pre- and post-groups were compared by paired t-test. Two independent groups were compared by independent Student's t-test. A two-tailed (α =2) P < 0.05 was considered statistically significant. Results: Comparing the pre to post mean of PET and SPCTGT showed decrease (net improvement) in DGR (−5.80 ± 0.42 vs. −4.65 ± 0.39, mean difference = −1.15 ± 0.57, t = 2.02, P = 0.058) and in PD (−1.05 ± 0.12 vs. −0.60 ± 0.12, mean difference = −0.45 ± 0.17, t = 2.64, P = 0.017); and increase (net improvement) in WKG (5.80 ± 0.42 vs. 4.80 ± 0.41, mean difference = 1.00 ± 0.58, t = 1.71, P = 0.104) and in WAG (5.60 ± 0.32 vs. 4.90 ± 0.24, mean difference = 0.70 ± 0.41, t = 1.73, P = 0.101). PET showed 19.8% and 42.9% higher decrease in DGR and PD; and 17.2% and 12.5% higher increase in WKG and WAG, respectively, than SPCTGT. Conclusions: The study found that both the modalities were effective in the management of root coverage of gingival recessions. However, PET was found more effective than SPCTGT.
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Affiliation(s)
- Awadhesh Kumar Singh
- Department of Periodontology, Chandra Dental College and Hospital, Barabanki, Uttar Pradesh, India
| | - Dhananjay Kumar Mali
- Department of Periodontology, Chandra Dental College and Hospital, Barabanki, Uttar Pradesh, India
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20
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Carranza N, Rojas MA. Bilaminar Palatal Connective Tissue Grafts Obtained With the Modified Double Blade Harvesting Technique: Technical Description and Case Series. Clin Adv Periodontics 2020; 10:186-194. [PMID: 32862553 DOI: 10.1002/cap.10124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 08/08/2020] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The purpose of this case series is to present a technique to harvest palatal connective tissue grafts (CTGs) that concurrently provides several advantages over previously described techniques when applied to treat gingival recessions. CASE SERIES Twenty patients were treated with root coverage procedures using CTGs harvested with the modified double blade harvesting technique (MDBHT). A double blade knife with two surgical blades set 1 mm apart was used in this case series. The palatal connective tissue was accessed through a horizontal incision and an envelope flap that was closed by primary intention. The grafts were measured immediately after harvesting with a periodontal probe. The overall mean length was 28.8 ± 7.8 mm and graft thickness was homogeneous and near to 1 mm in all the cases. Graft mean apicocoronal height was 5.0 ± 0.8 mm and 5.3 ± 1 mm at the molar and premolar levels, respectively. Clinical wound healing was evaluated at 7 days post-surgically and showed a modified early-wound healing index mean value of 3.0 ± 1.0. CONCLUSIONS The introduced MDBHT consistently rendered grafts of uniform thickness and sufficient dimensions, while excluding epithelial tissue and the deeper aspects of the submucosa, thus avoiding rich fatty and glandular tissues. MDBHT allowed for donor site healing with minimal discomfort and without complications.
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Affiliation(s)
- Nelson Carranza
- Private practice, Carranza Institute, Buenos Aires, Argentina.,Section of Periodontics, Department of Oral and Maxillofacial Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Mariana A Rojas
- Section of Periodontics, Department of Oral and Maxillofacial Sciences, "Sapienza" University of Rome, Rome, Italy
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21
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Miguel MMV, Mathias-Santamaria IF, Rossato A, Ferraz LFF, Figueiredo-Neto AM, de Marco AC, Casarin RCV, Wallet SM, Tatakis DN, Mathias MA, Santamaria MP. Microcurrent electrotherapy improves palatal wound healing: Randomized clinical trial. J Periodontol 2020; 92:244-253. [PMID: 32783220 DOI: 10.1002/jper.20-0122] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/07/2020] [Accepted: 05/31/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND This study was conducted to assess the clinical, immunological, and patient-centered outcomes of microcurrent electrotherapy on palatal wound healing. METHODS This was a parallel, double-masked randomized clinical trial, in which 53 patients with ridge preservation indications were selected and randomly assigned to one of two groups. In the control (sham) group (n = 27), palatal wounds, after free gingival grafts (FGG) harvest, received sham application of electrotherapy. In the test (electrotherapy treatment [EE]) group (n = 26), palatal wounds, after FGG harvest, received application of microcurrent electrotherapy protocol. Clinical parameters, patient-centered outcomes, and inflammatory markers were evaluated, up to 90 days postoperatively. RESULTS The EE group achieved earlier wound closure (P <0.001) and epithelialization (P <0.05; P = 0.03) at 7 and 14 days after harvest when compared with the sham group. Painful symptomatology was reported less frequently in the EE group than in the sham group at 3-day follow-up (P = 0.008). Likewise, an improvement in Oral Health Impact Profile was reported 2 days after the procedure by the EE group (P = 0.04). In addition, favorable modulation of inflammatory wound healing markers occurred when electrotherapy was applied. CONCLUSION Within the limits of the present study, it can be concluded that the use of a low-intensity electrotherapy protocol may accelerate palatal wound healing and decrease patient discomfort after FGG harvest.
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Affiliation(s)
- Manuela Maria Viana Miguel
- Division of Periodontics, Unesp - São Paulo State University, Institute of Science and Technology, São José dos Campos, São Paulo, Brazil
| | - Ingrid Fernandes Mathias-Santamaria
- Division of Periodontics, Unesp - São Paulo State University, Institute of Science and Technology, São José dos Campos, São Paulo, Brazil.,National Institute of Science and Technology-Complex Fluids, São Paulo, Brazil
| | - Amanda Rossato
- Division of Periodontics, Unesp - São Paulo State University, Institute of Science and Technology, São José dos Campos, São Paulo, Brazil
| | - Laís Fernanda Ferreira Ferraz
- Division of Periodontics, Unesp - São Paulo State University, Institute of Science and Technology, São José dos Campos, São Paulo, Brazil
| | | | - Andrea Carvalho de Marco
- Division of Periodontics, Unesp - São Paulo State University, Institute of Science and Technology, São José dos Campos, São Paulo, Brazil
| | - Renato Corrêa Viana Casarin
- Department of Prosthodontics and Periodontics, Division of Periodontics, University of Campinas Piracicaba Dental School Piracicaba, São Paulo, Brazil
| | | | - Dimitris N Tatakis
- College of Dentistry, Division of Periodontology, The Ohio State University, Columbus, OH, USA
| | - Marcio Antonio Mathias
- FEI University, Department of Electrical Engineering, São Bernardo do Campo, São Paulo, Brazil
| | - Mauro Pedrine Santamaria
- Division of Periodontics, Unesp - São Paulo State University, Institute of Science and Technology, São José dos Campos, São Paulo, Brazil
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22
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Barakat H, Dayoub S. Treatment of miller type I and II gingival recession defects using three-dimensional porcine collagen matrix with coronally advanced flap: A randomized clinical split-mouth trial (a 1-year follow-up). Indian J Dent Res 2020; 31:209-216. [PMID: 32436899 DOI: 10.4103/ijdr.ijdr_897_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction The main goal of periodontal plastic surgery is obtaining complete root coverage (CRC) and an optimal appearance. Aim The aim of this study was to evaluate the effectiveness of a three-dimensional porcine collagen matrix (PCM) with coronally advanced flap (CAF) in treating of Miller type I and II gingival recession (GR). Materials and Methods Twenty patients were enrolled in this study, presenting 40 Miller type I and II GR. Patients were randomized into test group (PCM + CAF) and control group [connective tissue graft (CTG + CAF)]. Clinical parameters such as recession depth (RD), probing depth, clinical attachment level (CAL), and width of keratinized gingiva (WKG) were evaluated at baseline and 12 months later. Root coverage percentage (RC%) and CRC were assessed at 12 months post surgically. Statistical analysis was performed using independent t-test for intergroup comparison. Statistical significance was set at 0.05. Results The mean RD at 12 months was 0.20 mm for the test group and 0.12 mm for the control group, whereas the mean RC% was 94.22% for PCM + CAF and 96.48% for CTG + CAF. CRC was higher in CTG + CAF with 80%. CAL gain was 2.05 and 2.07 mm in the test and control sites, respectively. The gain of WKG was 1.35 and 1.30 mm in the test and control sites, respectively. Patient esthetic satisfaction at 12 months post surgically in both groups was equivalent. Conclusion Within the limits of this study, using of PCM + CAF in treating GR is a successful and effective treatment option and could serve as an alternative to CTGs.
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Affiliation(s)
- Haydar Barakat
- Department of Periodontology, Dental Faculty, Damascus University, Damascus, Syria
| | - Suleiman Dayoub
- Department of Periodontology, Dental Faculty, Damascus University, Damascus, Syria
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23
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Tanik A, Cicek Y. Evaluation of the distance between the central teeth after frenectomy: a randomized clinical study. Eur Oral Res 2020; 55:99-103. [PMID: 34250477 PMCID: PMC8244937 DOI: 10.26650/eor.20210030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/27/2020] [Accepted: 01/10/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose: The present study aimed to evaluate the periodontal status and the distance
between the teeth one year after frenectomy in patients with abnormal frenums in
the maxillary and mandibular midline. Materials and methods: This study included 50 patients (24 men and 26 women) between the ages of 13
and 53 who have frenum-induced diastemas between the incisors. The abnormal
frenums were removed via conventional frenectomy. The distances between
the teeth before and one year after the surgery were measured with a caliper. To
determine the periodontal status, the pocket depth, plaque index, and bleeding
on probing were measured from four surfaces. In addition, the amount of attached
gingiva and degree of gingival recession were recorded and were statistically
analysed. Results: A significant decrease in the distance between teeth before and after frenectomy
was observed (p<0.05). There was a statistically significant difference in the amount
of gingival attachment, pocket depth, degree of gingival recession, plaque index,
and bleeding on probing (p<0.05). Conclusion: The removal of abnormal frenums with frenectomy can contribute to the reduction
in the distance between the teeth. In addition, frenectomy increases the amount
of gingiva and decreases the depth of the pocket, gingival recession, amount of
plaque, and bleeding.
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Affiliation(s)
- Abdulsamet Tanik
- Department of Periodontology, Faculty of Dentistry, Adıyaman University, Adıyaman,Turkey
| | - Yasin Cicek
- Department of Periodontology, Faculty of Dentistry, Adıyaman University, Adıyaman,Turkey
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Maldonado-Alfandari K, Chong CH. Pinwheel Pedicle Flap Technique for Increasing Keratinized Tissue at Stage 2 Implant Surgery. Clin Adv Periodontics 2019; 10:60-63. [PMID: 31855315 DOI: 10.1002/cap.10088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 06/19/2019] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The goal of stage 2 implant surgery is to uncover implants while maintaining or augmenting the peri-implant keratinized tissue. Although the absolute requirement for keratinized tissue around natural teeth can be debated, implants appear to have consistently improved postoperative clinical parameters and health when there is an adequate keratinized peri-implant tissue. CASE PRESENTATION This article presents a new technique to optimize the keratinized tissue around implants during stage 2 surgery. Although there are many treatment options that can be considered at the time of surgery, the technique presented here has the advantage of increasing the keratinized tissue circumferentially around the implant without using a second donor site. The technique, called the "pinwheel," is presented in two cases with the same clinical presentation. Two mandibular overdenture patients with ≤3 mm of keratinized tissue over implant sites, stage 2 surgery was performed using the "pinwheel technique" to increase the keratinized tissue on the facial and lingual surfaces. CONCLUSION The use of the pinwheel technique to augment keratinized tissue around implants is effective and is a viable treatment option during stage 2 implant surgery.
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25
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Balderrama ÍDF, Ferreira R, Rezende DRB, Nogueira ALRN, Greghi SLA, Zangrando MSR. Root coverage stability with acellular dermal matrix in multiple gingival recessions in esthetic zone: A clinical case report with 12-year follow-up. J Indian Soc Periodontol 2019; 23:584-588. [PMID: 31849407 PMCID: PMC6906899 DOI: 10.4103/jisp.jisp_582_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The importance of surgical intervention for the maintenance of long-term results by root coverage of multiple gingival recessions in an esthetic area treated with a tissue substitute (acellular dermal matrix [ADM]-Alloderm®) is widely required. The present case report highlights the effectiveness of the ADM for the treatment of multiple recession defects in a female patient with Class I and II gingival recession in relation to maxillary anterior associated with esthetics and dentin hypersensitivity demands. The root coverage rate for the anterior area showed greater value with 70% of coverage; at 90 days and 2 and 12 years of follow-up, it showed 70.5%, 79%, and 77%, respectively. Conversely, for the posterior area, these rates were 68.5%, 63%, and 57% for the same follow-up periods. Results regarding gain of keratinized tissue demonstrated superior values for the anterior area, namely 3.92, 3.34 and 3.22 mm at 90 days and 2 and 12 years. These values for the posterior area were 0.54 mm, 2.41, and 1.87 mm, respectively. These findings suggest that the tissue substitute Alloderm® showed excellent long-term results for areas of multiple recessions, providing root coverage and stability of keratinized tissue gain. After this long period of evaluation, some local factors associated with recurrence of gingival recessions were detected, and a lack of proper periodontal maintenance care was observed. However, esthetic and functional outcomes achieved with surgical procedure were maintained.
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Affiliation(s)
- Ísis De Fátima Balderrama
- Department of Prosthodontics and Periodontics, Division of Periodontics, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Rafael Ferreira
- Department of Prosthodontics and Periodontics, Division of Periodontics, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | | | | | - Sebastião Luiz Aguiar Greghi
- Department of Prosthodontics and Periodontics, Division of Periodontics, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Mariana Schutzer Ragghianti Zangrando
- Department of Prosthodontics and Periodontics, Division of Periodontics, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
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26
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Jepsen S, Caton JG, Albandar JM, Bissada NF, Bouchard P, Cortellini P, Demirel K, de Sanctis M, Ercoli C, Fan J, Geurs NC, Hughes FJ, Jin L, Kantarci A, Lalla E, Madianos PN, Matthews D, McGuire MK, Mills MP, Preshaw PM, Reynolds MA, Sculean A, Susin C, West NX, Yamazaki K. Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol 2019; 89 Suppl 1:S237-S248. [PMID: 29926943 DOI: 10.1002/jper.17-0733] [Citation(s) in RCA: 203] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 02/07/2018] [Accepted: 02/12/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND A variety of systemic diseases and conditions can affect the course of periodontitis or have a negative impact on the periodontal attachment apparatus. Gingival recessions are highly prevalent and often associated with hypersensitivity, the development of caries and non-carious cervical lesions on the exposed root surface and impaired esthetics. Occlusal forces can result in injury of teeth and periodontal attachment apparatus. Several developmental or acquired conditions associated with teeth or prostheses may predispose to diseases of the periodontium. The aim of this working group was to review and update the 1999 classification with regard to these diseases and conditions, and to develop case definitions and diagnostic considerations. METHODS Discussions were informed by four reviews on 1) periodontal manifestions of systemic diseases and conditions; 2) mucogingival conditions around natural teeth; 3) traumatic occlusal forces and occlusal trauma; and 4) dental prostheses and tooth related factors. This consensus report is based on the results of these reviews and on expert opinion of the participants. RESULTS Key findings included the following: 1) there are mainly rare systemic conditions (such as Papillon-Lefevre Syndrome, leucocyte adhesion deficiency, and others) with a major effect on the course of periodontitis and more common conditions (such as diabetes mellitus) with variable effects, as well as conditions affecting the periodontal apparatus independently of dental plaque biofilm-induced inflammation (such as neoplastic diseases); 2) diabetes-associated periodontitis should not be regarded as a distinct diagnosis, but diabetes should be recognized as an important modifying factor and included in a clinical diagnosis of periodontitis as a descriptor; 3) likewise, tobacco smoking - now considered a dependence to nicotine and a chronic relapsing medical disorder with major adverse effects on the periodontal supporting tissues - is an important modifier to be included in a clinical diagnosis of periodontitis as a descriptor; 4) the importance of the gingival phenotype, encompassing gingival thickness and width in the context of mucogingival conditions, is recognized and a novel classification for gingival recessions is introduced; 5) there is no evidence that traumatic occlusal forces lead to periodontal attachment loss, non-carious cervical lesions, or gingival recessions; 6) traumatic occlusal forces lead to adaptive mobility in teeth with normal support, whereas they lead to progressive mobility in teeth with reduced support, usually requiring splinting; 7) the term biologic width is replaced by supracrestal tissue attachment consisting of junctional epithelium and supracrestal connective tissue; 8) infringement of restorative margins within the supracrestal connective tissue attachment is associated with inflammation and/or loss of periodontal supporting tissue. However, it is not evident whether the negative effects on the periodontium are caused by dental plaque biofilm, trauma, toxicity of dental materials or a combination of these factors; 9) tooth anatomical factors are related to dental plaque biofilm-induced gingival inflammation and loss of periodontal supporting tissues. CONCLUSION An updated classification of the periodontal manifestations and conditions affecting the course of periodontitis and the periodontal attachment apparatus, as well as of developmental and acquired conditions, is introduced. Case definitions and diagnostic considerations are also presented.
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Affiliation(s)
- Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Jack G Caton
- University of Rochester, Periodontics, Eastman Institute for Oral Health, Rochester, NY, USA
| | - Jasim M Albandar
- Department of Periodontology and Oral Implantology, Temple University School of Dentistry, Philadelphia, PA, USA
| | | | - Philippe Bouchard
- U.F.R. d'Odontologie, Université Paris Diderot, Hôpital Rothschild AP-HP, Paris, France
| | - Pierpaolo Cortellini
- Private practice, Firenze, Italy; European Research Group on Periodontology, Bern, Switzerland
| | - Korkud Demirel
- Department of Periodontology, Istanbul University, Istanbul, Turkey
| | - Massimo de Sanctis
- Department of Periodontology, Università Vita e Salute San Raffaele, Milan, Italy
| | - Carlo Ercoli
- University of Rochester, Prosthodontics & Periodontics, Eastman Institute for Oral Health, Rochester, NY, USA
| | - Jingyuan Fan
- University of Rochester, Periodontics, Eastman Institute for Oral Health, Rochester, NY, USA
| | - Nicolaas C Geurs
- Department of Periodontology, University of Alabama at Birmingham, School of Dentistry, Birmingham, AL, USA
| | | | - Lijian Jin
- Discipline of Periodontology, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, Hong Kong SAR, China
| | | | - Evanthia Lalla
- Columbia University College of Dental Medicine, Division of Periodontics, New York, NY, USA
| | - Phoebus N Madianos
- Department of Periodontology, School of Dentistry, National and Kapodistrian University of Athens, Greece
| | - Debora Matthews
- Faculty of Dentistry, Dalhousie University, Halifax, Nova Scotia
| | | | - Michael P Mills
- Department of Periodontics, University of Texas Health Science Center at San Antonio, TX, USA
| | - Philip M Preshaw
- Centre for Oral Health Research and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Mark A Reynolds
- University of Maryland, School of Dentistry, Department of Advanced Oral Sciences and Therapeutics, Baltimore, MD, USA
| | - Anton Sculean
- Department of Periodontology, University of Bern, Switzerland
| | - Cristiano Susin
- Department of Periodontics, Augusta University Dental College of Georgia, Augusta, GA, USA
| | - Nicola X West
- Restorative Dentistry and Periodontology, School of Oral and Dental Sciences, Bristol Dental School & Hospital, Bristol, UK
| | - Kazuhisa Yamazaki
- Research Unit for Oral-Systemic Connection, Division of Oral Science for Health Promotion, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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27
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Jepsen S, Caton JG, Albandar JM, Bissada NF, Bouchard P, Cortellini P, Demirel K, de Sanctis M, Ercoli C, Fan J, Geurs NC, Hughes FJ, Jin L, Kantarci A, Lalla E, Madianos PN, Matthews D, McGuire MK, Mills MP, Preshaw PM, Reynolds MA, Sculean A, Susin C, West NX, Yamazaki K. Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Clin Periodontol 2019; 45 Suppl 20:S219-S229. [PMID: 29926500 DOI: 10.1111/jcpe.12951] [Citation(s) in RCA: 174] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 02/07/2018] [Accepted: 02/12/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND A variety of systemic diseases and conditions can affect the course of periodontitis or have a negative impact on the periodontal attachment apparatus. Gingival recessions are highly prevalent and often associated with hypersensitivity, the development of caries and non-carious cervical lesions on the exposed root surface and impaired esthetics. Occlusal forces can result in injury of teeth and periodontal attachment apparatus. Several developmental or acquired conditions associated with teeth or prostheses may predispose to diseases of the periodontium. The aim of this working group was to review and update the 1999 classification with regard to these diseases and conditions, and to develop case definitions and diagnostic considerations. METHODS Discussions were informed by four reviews on 1) periodontal manifestions of systemic diseases and conditions; 2) mucogingival conditions around natural teeth; 3) traumatic occlusal forces and occlusal trauma; and 4) dental prostheses and tooth related factors. This consensus report is based on the results of these reviews and on expert opinion of the participants. RESULTS Key findings included the following: 1) there are mainly rare systemic conditions (such as Papillon-Lefevre Syndrome, leucocyte adhesion deficiency, and others) with a major effect on the course of periodontitis and more common conditions (such as diabetes mellitus) with variable effects, as well as conditions affecting the periodontal apparatus independently of dental plaque biofilm-induced inflammation (such as neoplastic diseases); 2) diabetes-associated periodontitis should not be regarded as a distinct diagnosis, but diabetes should be recognized as an important modifying factor and included in a clinical diagnosis of periodontitis as a descriptor; 3) likewise, tobacco smoking - now considered a dependence to nicotine and a chronic relapsing medical disorder with major adverse effects on the periodontal supporting tissues - is an important modifier to be included in a clinical diagnosis of periodontitis as a descriptor; 4) the importance of the gingival phenotype, encompassing gingival thickness and width in the context of mucogingival conditions, is recognized and a novel classification for gingival recessions is introduced; 5) there is no evidence that traumatic occlusal forces lead to periodontal attachment loss, non-carious cervical lesions, or gingival recessions; 6) traumatic occlusal forces lead to adaptive mobility in teeth with normal support, whereas they lead to progressive mobility in teeth with reduced support, usually requiring splinting; 7) the term biologic width is replaced by supracrestal tissue attachment consisting of junctional epithelium and supracrestal connective tissue; 8) infringement of restorative margins within the supracrestal connective tissue attachment is associated with inflammation and/or loss of periodontal supporting tissue. However, it is not evident whether the negative effects on the periodontium are caused by dental plaque biofilm, trauma, toxicity of dental materials or a combination of these factors; 9) tooth anatomical factors are related to dental plaque biofilm-induced gingival inflammation and loss of periodontal supporting tissues. CONCLUSION An updated classification of the periodontal manifestations and conditions affecting the course of periodontitis and the periodontal attachment apparatus, as well as of developmental and acquired conditions, is introduced. Case definitions and diagnostic considerations are also presented.
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Affiliation(s)
- Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Jack G Caton
- University of Rochester, Periodontics, Eastman Institute for Oral Health, Rochester, NY, USA
| | - Jasim M Albandar
- Department of Periodontology and Oral Implantology, Temple University School of Dentistry, Philadelphia, PA, USA
| | | | - Philippe Bouchard
- U.F.R. d'Odontologie, Université Paris Diderot, Hôpital Rothschild AP-HP, Paris, France
| | - Pierpaolo Cortellini
- Private practice, Firenze, Italy; European Research Group on Periodontology, Bern, Switzerland
| | - Korkud Demirel
- Department of Periodontology, Istanbul University, Istanbul, Turkey
| | - Massimo de Sanctis
- Department of Periodontology, Università Vita e Salute San Raffaele, Milan, Italy
| | - Carlo Ercoli
- University of Rochester, Prosthodontics & Periodontics, Eastman Institute for Oral Health, Rochester, NY, USA
| | - Jingyuan Fan
- University of Rochester, Periodontics, Eastman Institute for Oral Health, Rochester, NY, USA
| | - Nicolaas C Geurs
- Department of Periodontology, University of Alabama at Birmingham, School of Dentistry, Birmingham, AL, USA
| | | | - Lijian Jin
- Discipline of Periodontology, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, Hong Kong SAR, China
| | | | - Evanthia Lalla
- Columbia University College of Dental Medicine, Division of Periodontics, New York, NY, USA
| | - Phoebus N Madianos
- Department of Periodontology, School of Dentistry, National and Kapodistrian University of Athens, Greece
| | - Debora Matthews
- Faculty of Dentistry, Dalhousie University, Halifax, Nova Scotia
| | | | - Michael P Mills
- Department of Periodontics, University of Texas Health Science Center at San Antonio, TX, USA
| | - Philip M Preshaw
- Centre for Oral Health Research and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Mark A Reynolds
- University of Maryland, School of Dentistry, Department of Advanced Oral Sciences and Therapeutics, Baltimore, MD, USA
| | - Anton Sculean
- Department of Periodontology, University of Bern, Switzerland
| | - Cristiano Susin
- Department of Periodontics, Augusta University Dental College of Georgia, Augusta, GA, USA
| | - Nicola X West
- Restorative Dentistry and Periodontology, School of Oral and Dental Sciences, Bristol Dental School & Hospital, Bristol, UK
| | - Kazuhisa Yamazaki
- Research Unit for Oral-Systemic Connection, Division of Oral Science for Health Promotion, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Carranza N, Rojas MA. Treatment of an Advanced Gingival Recession Involving the Apex of the Tooth: Periodontal Plastic, Endodontic Surgical Approach With a Laterally Stretched Flap and a Connective Tissue Graft. Clin Adv Periodontics 2019; 9:70-76. [PMID: 31498574 DOI: 10.1002/cap.10054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 09/10/2018] [Indexed: 11/10/2022]
Abstract
INTRODUCTION This case report presents the successful multidisciplinary treatment of a maxillary lateral incisor with a deep and narrow recession involving the root apex associated with pulpal necrosis. The tooth initially considered with a hopeless prognosis, was treated with a combined periodontal plastic, regenerative, and endodontic surgical procedure. CASE PRESENTATION A recently reported technique, the laterally stretched (LAST) flap with a connective tissue graft (CTG) technique for root coverage, was combined with enamel matrix derivative (EMD) for periodontal regeneration of the periapical lesion, that complemented an apicoectomy with retrograde sealing. The 6-year follow-up evidenced root coverage (RC) of 91.6% and increased keratinized tissue. Clinical and radiographic evaluation showed resolution of the periapical process. CONCLUSIONS A severe gingival recession with endodontic involvement can be repaired if adequate control of the endodontic infection is obtained. The LAST flap, originally described for lower anterior teeth, was used successfully in a maxillary tooth, under extreme circumstances.
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Affiliation(s)
- Nelson Carranza
- Private practice, Carranza Institute, Buenos Aires, Argentina
| | - Mariana A Rojas
- Department of Periodontics, University of Buenos Aires, Buenos Aires, Argentina
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29
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Tavelli L, Ravidà A, Lin GH, Del Amo FSL, Tattan M, Wang HL. Comparison between Subepithelial Connective Tissue Graft and De-epithelialized Gingival Graft: A systematic review and a meta-analysis. J Int Acad Periodontol 2019; 21:82-96. [PMID: 31522155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
AIM Sup-epithelial connective tissue graft (SCTG) and de-epithelialized gingival graft (DGG) approaches have been investigated with a focus on post-operative morbidity but not from a clinical outcome standpoint. The aim of this systematic review was to systematically investigate the literature for coronally advanced flaps (CAFs) combined with SCTG or DGG. MATERIALS AND METHODS Electronic and hand searches were performed to identified randomized controlled trials (RCTs) investigating the treatment of gingival recession (GRs) using CAF, with at least a 1-year of follow-up. The primary outcome was the mean root coverage (mRC), while the secondary outcomes included recession reduction (Rec Red), keratinized tissue (KT) gain, probing depth (PD) change, and clinical attachment level (CAL) gain. RESULTS Ten RCTs with a total of 408 gingival recessions were included. The meta-analysis demonstrated that CAF + DGG is associated with superior mRC, Rec Red, KT gain, PD reduction and CAL gain. The mRC for SCTG and DGG at 1-year was 89.3% and 94.0% respectively, while the mean difference of the other clinical parameters between the two approaches was within 1 mm in favor of the DGG group. CONCLUSIONS Limited evidence is available when comparing the two techniques, however the usage of DGG may be considered as the preferred technique of choice for autologous CTG harvesting when incorporated with a CAF.
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Affiliation(s)
- Lorenzo Tavelli
- Department of Periodontics and Oral Medicine, University of Michigan, School of Dentistry, Ann Arbor, MI, USA
| | - Andrea Ravidà
- Department of Periodontics and Oral Medicine, University of Michigan School, of Dentistry, Ann Arbor, MI, USA
| | - Guo-Hao Lin
- Department of Orofacial Sciences, University of California San Francisco, School of Dentistry, San Francisco, CA, USA
| | | | - Mustafa Tattan
- Department of Periodontics and Oral Medicine, University of Michigan, School of Dentistry, Ann Arbor, MI, USA
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan, School of Dentistry, Ann Arbor, MI, USA;
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30
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Xu CM, Zhang JM, Wu YF, Zhao L. [Research progress on substitutes for autogenous soft tissue grafts in mucogingival surgery]. Hua Xi Kou Qiang Yi Xue Za Zhi 2019; 37:208-213. [PMID: 31168989 DOI: 10.7518/hxkq.2019.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Mucogingival surgery is a general term for periodontal surgeries that correct aberrant periodontal soft tissues. Conventional mucogingival surgeries with pedicle flap or autologous soft tissue graft for treatment of gingival recession and insufficient keratinized tissues are always related to disadvantages such as need for a second surgery site, limited supplies, and complaints for postoperative discomfort. In this regard, research and application of soft tissue substitutes have gained increasing attention. Various kinds of soft tissue substitutes, including acellular dermal matrix and xenogeneic collagen matrix, have been developed and applied to clinical treatment. This review aims to summarize advances in research of the characteristics and clinical effectiveness of several soft tissue substitutes and provide references for clinical application.
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Affiliation(s)
- Chun-Mei Xu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Jin-Mei Zhang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Ya-Fei Wu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Lei Zhao
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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Abstract
Introduction: The occurrence of gingival recessions (GRs) is multifactorial, mainly due to trauma induced by traumatic toothbrushing, orthodontic tooth movement, as well as anatomical factors such as bone dehiscence, teeth malposition, and muscle pull. Fat tissue in the oral cavity is widely available and easily accessed. The use of pedicled buccal fat pad (BFP) graft is well known in maxillofacial surgery and has been shown promising results, becoming safe and effective graft for several clinical applications. However the use of fat tissue harvested from the buccal fat pad as a free graft (BFFP) is less common, but recently, it has been described by the author for different intraoral clinical applications. The aim of this study is to present additional application using the BFFG for coverage of severe muco-GRs and to discuss the promising outcomes of this procedure. Patients and Methods: A technique for harvesting intraoral BFFG for the use in mucogingival surgery is presented. A total of 10 patients (age: 38.3 ± 6.8 years) with 17 teeth presenting severe GRs (4.8 ± 1.8 mm) were included in the study. Recessions treated using BFFGs were recorded at baseline and 12 months after surgery. Results: A total of 17 GRs were treated using BFFG. At 12 months, significant reduction of recession occurred. Initial recession was reduced from 4.8 ± 1.8 mm to 1.7 ± 0.9 mm. A mean of 3.1-mm reduction in GR was achieved compared to baseline. Conclusions: The new, simple, technique for treatment of severe GRs using BFFG resulted in significant reduction of GRs.
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Affiliation(s)
- Fares Kamal Kablan
- Department of Oral and Maxillofacial Surgery, The Galilee Medical Center, Nahariya, Israel
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32
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Deo SD, Shetty SK, Kulloli A, Chavan R, Dholakia P, Ligade S, Dharmarajan G. Efficacy of free gingival graft in the treatment of Miller Class I and Class II localized gingival recessions: A systematic review. J Indian Soc Periodontol 2019; 23:93-99. [PMID: 30983778 PMCID: PMC6434727 DOI: 10.4103/jisp.jisp_102_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Currently, the leading theme in mucogingival surgery is the correction of gingival recession defects. Free gingival graft (FGG) has been successfully in use in this category of reconstructive therapeutic modality. Objectives The aim of this systematic review was to evaluate the literature with respect to efficacy of FGG in the management of Miller Class I and II localized gingival recessions. Data Sources Search strategies were performed via electronic database which included Pubmed-Medline, Google scholar and manual search using University library resources. Two reviewers assessed the eligibility of the studies. Study Eligibility Criteria Controlled clinical trials, randomized clinical trials and longitudinal studies evaluating recession areas treated by FGG with minimum of 6 months follow up were included. In-vitro and animal studies, studies mainly done on Miller Class III and IV gingival recession defect, studies on multiple gingival recessions and case series and case reports were excluded from the search. Results The electronic and manual search identified a total of 557 articles. A final screen consisted of 39 articles out of which 17 articles were selected for full-text assessment. Finally, 7 articles were selected for detailed evaluation for this systematic review. FGG has shown significant results in all the studies except for one study. Conclusion FGG produces substantial results, however, highly depends on the case selection and operator's skill and experience. FGG gives an impression of being the best alternative option in zones where gingival recession presents with inadequate width of attached gingiva and depth of vestibular fornix.
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Affiliation(s)
- Sukhada Dileep Deo
- Department of Periodontics, Dr. D. Y. Patil Vidyapeeth, Dr. D. Y. Patil Dental College and Hospital, Pune, Maharashtra, India
| | - Sharath Kumara Shetty
- Department of Periodontics, Dr. D. Y. Patil Vidyapeeth, Dr. D. Y. Patil Dental College and Hospital, Pune, Maharashtra, India
| | - Anita Kulloli
- Department of Periodontics, Dr. D. Y. Patil Vidyapeeth, Dr. D. Y. Patil Dental College and Hospital, Pune, Maharashtra, India
| | - Ruchira Chavan
- Department of Periodontics, Dr. D. Y. Patil Vidyapeeth, Dr. D. Y. Patil Dental College and Hospital, Pune, Maharashtra, India
| | - Poonam Dholakia
- Department of Periodontics, Dr. D. Y. Patil Vidyapeeth, Dr. D. Y. Patil Dental College and Hospital, Pune, Maharashtra, India
| | - Shruti Ligade
- Department of Periodontics, Dr. D. Y. Patil Vidyapeeth, Dr. D. Y. Patil Dental College and Hospital, Pune, Maharashtra, India
| | - Gopalakrishnan Dharmarajan
- Department of Periodontics, Dr. D. Y. Patil Vidyapeeth, Dr. D. Y. Patil Dental College and Hospital, Pune, Maharashtra, India
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33
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Ughabharathy R, Balu P, Muthu J, Saravanakumar R, Vineela K, Karthikeyan I. Clinical Evaluation of Increase in the Width of Attached Gingiva using Modified Apically Repositioned Flap: A 9-Month Follow-up Study. Contemp Clin Dent 2018; 9:200-204. [PMID: 29875561 PMCID: PMC5968683 DOI: 10.4103/ccd.ccd_806_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIM The purpose of this study is to evaluate the increase in the width of attached gingiva (AG) in single/multiple adjacent teeth using variation of modified apically repositioned flap (MARF). MATERIALS AND METHODS A total of 20 systemically healthy controls with inadequate width of AG were recruited for the study based on inclusion and exclusion criteria. In all the individuals, variation of MARF technique was performed to increase the width of AG. Outcomes of the surgical techniques were measured in terms of probing pocket depth, clinical attachment level, width of AG, and width of keratinized gingiva (KG). The results were followed up at 3 months and continued till 9 months to confirm the stability of results. RESULTS Treatment with this procedure resulted in a significant increase in the width of the KG and AG. The increase in KG ranged from baseline (2.0 mm) to 3.85 mm at 3rd month and the results were stable till 9th month (P < 0.001), and the increase in AG ranged from baseline (1.0 mm) to 2.85 mm at 3rd month and the results were stable till 9th month (P < 0.001). CONCLUSION MARF is an effective technique in increasing the width of the keratinized tissue and AG around teeth and also offers considerable advantages over other mucogingival surgery techniques.
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Affiliation(s)
- R. Ughabharathy
- Department of Periodontology, Indira Gandhi Institute of Dental Sciences, Puducherry, India
| | - Pratebha Balu
- Department of Periodontology, Indira Gandhi Institute of Dental Sciences, Puducherry, India
| | - Jananni Muthu
- Department of Periodontology, Indira Gandhi Institute of Dental Sciences, Puducherry, India
| | - R. Saravanakumar
- Department of Periodontology, Indira Gandhi Institute of Dental Sciences, Puducherry, India
| | - K. Vineela
- Department of Periodontology, Indira Gandhi Institute of Dental Sciences, Puducherry, India
| | - I. Karthikeyan
- Department of Periodontology, Indira Gandhi Institute of Dental Sciences, Puducherry, India
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Chopra A, Sivaraman K, Bhat SG. "United Pedicle Flap" for management of multiple gingival recessions. J Indian Soc Periodontol 2016; 20:344-8. [PMID: 27563212 PMCID: PMC4976559 DOI: 10.4103/0972-124x.183100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Numerous surgical procedures have evolved and are being modified with time to treat gingival recession by manipulating gingival or mucosal tissues in various ways. However, the decision to choose the most appropriate technique for a given recession site still remains a challenging task for clinicians. Mucogingival deformities such as shallow vestibule, frenal pull, or inadequate attached gingiva complicate the decision and limit the treatment options to an invasive procedure involving soft tissue grafts. The situation is further comprised if there is a nonavailability of adequate donor tissue and patients' unwillingness for procedures involving a second surgical site. In such situations, the recession either remains untreated or has poor treatment outcomes. This case report presents a modified pedicle graft technique for treatment of multiple gingival recessions with shallow vestibule and inadequate attached gingiva. The technique is a promising therapeutic alternative to invasive surgical procedures such as soft tissue grafts for treatment of multiple gingival recessions.
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Affiliation(s)
- Aditi Chopra
- Department of Periodontology, Manipal College of Dental Sciences, Manipal University, Manipal, Karnataka, India
| | - Karthik Sivaraman
- Department of Prosthodontics, Manipal College of Dental Sciences, Manipal University, Manipal, Karnataka, India
| | - Subraya Giliyar Bhat
- Department of Periodontology, Manipal College of Dental Sciences, Manipal University, Manipal, Karnataka, India
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Huang YS, Lin YC, Hung CY, Lai YL. Surgical considerations and management of bilateral labially impacted canines. J Dent Sci 2016; 11:202-206. [PMID: 30894972 PMCID: PMC6395172 DOI: 10.1016/j.jds.2013.02.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 03/16/2011] [Indexed: 11/05/2022] Open
Abstract
Canines are among the most commonly impacted teeth. When a canine is positioned labially, the untoward soft-tissue responses following surgical exposure may cause unfavorable esthetic outcomes. Therefore, decision making as to the choice of a proper surgical technique to uncover labially impacted teeth is critical. This case presentation describes two different surgical approaches for two maxillary impacted canines in a 12-year-old girl. A sequential approach included a first stage of surgical exposure using apically positioned flaps and orthodontic extrusion of both impacted teeth. A successive laterally positioned flap was used for the left maxillary canine to achieve a harmonious soft-tissue contour. In this case, close monitoring and cooperation during the various treatment phases led to proper canine positioning and a successful esthetic result, with good periodontal health and functional occlusion.
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Affiliation(s)
- Yu-Shan Huang
- Dentistry Division, National Yang-Ming University Hospital, Ilan, Taiwan.,Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan.,Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Chun Lin
- Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan.,Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Yuan Hung
- Dentistry Division, National Yang-Ming University Hospital, Ilan, Taiwan.,Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan.,Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Lin Lai
- Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan.,Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan
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Pandit N, Pandit IK, Bali D, Jindal S. Semilunar vestibular technique: A novel procedure for multiple recession coverage (a report of two cases). J Indian Soc Periodontol 2016; 19:694-7. [PMID: 26941524 PMCID: PMC4753718 DOI: 10.4103/0972-124x.162204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The procedures for root coverage have been greatly refined over the past few decades. Still as compared to the other periodontal surgical procedures, predictability of mucogingival procedures remains uncertain which is more in patients who present with multiple recessions or recession complicated with periodontal involvement. Techniques which claim success almost always involve a second surgical site. A novel technique avoiding second surgical site and good predictability for multiple recessions was described by Dr. P.D. Miller in a conference at Pune in 2011. A semilunar vestibular incision technique described by Dr. P.D Miller was performed on two patients who presented with multiple recessions in the maxillary anterior teeth. About 90-100% root coverage was observed when the patients were on a follow-up for 1-year with a significant increase in the vestibular depth. The semilunar vestibular incision technique used in two cases resulted in predictable root coverage with a good color blend, an esthetic marginal morphology and most importantly the avoidance of the second surgical site.
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Affiliation(s)
- Nymphea Pandit
- Department of Periodontology and Oral Implantology, D. A. V. (C) Dental College and Hospital, Yamunanagar, Haryana, India
| | - Inder Kumar Pandit
- Department of Pedodontics and Preventive Dentistry, D. A. V. (C) Dental College and Hospital, Yamunanagar, Haryana, India
| | - Deepika Bali
- Department of Periodontology and Oral Implantology, D. A. V. (C) Dental College and Hospital, Yamunanagar, Haryana, India
| | - Shaifi Jindal
- Department of Periodontology and Oral Implantology, Swami Devi Dayal Dental College and Hospital Barwala, Panchkula, Haryana, India
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Ozcelik O, Seydaoglu G, Haytac CM. Diode laser for harvesting de-epithelialized palatal graft in the treatment of gingival recession defects: a randomized clinical trial. J Clin Periodontol 2016; 43:63-71. [PMID: 26660000 DOI: 10.1111/jcpe.12487] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2015] [Indexed: 12/30/2022]
Abstract
AIMS The aim of present randomized controlled clinical study was to evaluate the effects of the use of diode laser for graft harvesting and palatal wound irradiation on post-operative morbidity and root coverage outcomes after a coronally advanced flap (CAF) with de-epithelialized gingival grafts (DGG). METHODS Fifty-two patients with isolated recessions were treated. The CTG resulted from the de-epithelialization of a free gingival graft (FGG) with blade (control group:DGG-B) or diode laser (DL) (test group:DGG-L). The DL was used to de-epithelialize the outer part of the FGG and photo-biostimulate the palatal wound area. Post-operative morbidity was evaluated by using Oral Health-related Quality of Life (OHQoL) and Visual Analogue Scale-discomfort (VAS). Root coverage outcomes were also evaluated 6 months after operation. RESULTS Statistically significant differences were found for OHQoL (p = 0.0001) and VAS (p = 0.0001) at the 7th day post-operatively favouring test sites. Root coverage results did not show a statistically significant difference. CONCLUSIONS While both techniques were effective with regard to root coverage at 6 months, the DGG-L technique decreased post-operative morbidity associated with palatal donor-site surgery.
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Affiliation(s)
- Onur Ozcelik
- Department of Periodontology, Cukurova University, Adana, Turkey
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Ozcelik O, Seydaoglu G, Haytac MC. Prediction of root coverage for single recessions in anterior teeth: a 6-month study. J Clin Periodontol 2015; 42:860-867. [PMID: 26297634 DOI: 10.1111/jcpe.12449] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the predictive values of baseline inter-dental papilla height (IPH), loss of inter-dental papilla height (LPH), avascular exposed root surface area (AERSA) and inter-dental clinical attachment level (ICAL) measurements on complete root coverage (CRC) of single recession defects treated with coronally advanced flap and connective tissue graft technique (CAF+CTG). MATERIAL & METHODS A total of 122 patients with one isolated gingival recession were enrolled. All recession defects without loss of ICAL (ID-CAL) (RT1) and with an amount of ID-CAL equal or smaller to the buccal attachment loss (RT2), located at upper and lower anterior teeth were treated with CAF+CTG. IPH, LPH, AERSA and ICAL parameters were analysed for possible correlation with CRC after 6 months. RESULTS The CRC was 86.7% for RT1, 74.2% for RT2 groups. The ROC analyses revealed acceptable cut-off points for baseline AERSA, IPH and LPH for achieving CRC. The results of logistic regression analyses showed that having baseline AERSA≥19 mm(2) (OR:23.7), IPH lower ≤1 mm (OR:97.3) and belonging to RT2 group (OR:15.0) were found to be independent risk factors related with not achieving final CRC. CONCLUSION This study indicates that AERSA and IPH may be used to predict the final CRC outcomes in RT1 and RT2 defects treated with CAF+CTG.
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Affiliation(s)
- Onur Ozcelik
- Department of Periodontology, Cukurova University, Adana, Turkey
| | | | - M Cenk Haytac
- Department of Periodontology, Cukurova University, Adana, Turkey
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Jindal U, Pandit N, Bali D, Malik R, Gugnani S. Comparative evaluation of recession coverage with sub-epithelial connective tissue graft using macrosurgical and microsurgical approaches: A randomized split mouth study. J Indian Soc Periodontol 2015; 19:203-7. [PMID: 26015673 PMCID: PMC4439632 DOI: 10.4103/0972-124x.148641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 10/08/2014] [Indexed: 11/30/2022] Open
Abstract
Aims: The aim was to compare the recession coverage outcomes when done macrosurgically and microsurgically. Background: Increasing interest in esthetics and the related problems such as hypersensitivity and root caries have favored the development of many root coverage procedures. Recession coverage up to a certain extent has solved these problems, but these procedures need good maintenance after the surgery for long-term benefits. With increasing advances in the field of recession coverage, microscope has added another dimension in undertaking the surgical procedure. Materials and Methods: Thirty Miller's Class I and II recession were treated using the sub-epithelial connective tissue graft from the palate. In 15 sites, the graft was placed at the recipient site with unaided eye (Group A) and in other 15 sites the graft was placed using surgical microscope (Group B). Clinical evaluation was done at baseline, 12 weeks and 24 weeks postoperatively using plaque index, gingival index, vertical recession (VR), probing depth, clinical attachment level (CAL), width of attached gingiva, papilla height (PH) and width, malalignment index (MI) and esthetic appearance. Statistical Analysis Used: Paired and unpaired Student's t-test along with Wilcoxon Z-test were used to analyze the results and probability of P < 0.05 were accepted to reject the null hypothesis. Pearson correlation was used to correlate two parameters such as VR and CAL and MI and VR. Results: Both the techniques demonstrated predictable mean root coverage (Group A 61.78% and Group B 67.58%) at 6 months postsurgery. CAL gain was slightly better in Group B patients when compared to Group A patients. A moderate positive correlation for Group A while a mild correlation in Group B was seen between the MI and VR. Conclusion: The use of the microscope enhances the results, but obtaining an expertise in using needs a lot of practice. The periodontal healing by both techniques should be evaluated histologically.
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Affiliation(s)
- Uditi Jindal
- Department of Periodontology and Oral Implantology, DAV(C) Dental College and Hospital, Yamuna Nagar, Haryana, India
| | - Nymphea Pandit
- Department of Periodontology and Oral Implantology, DAV(C) Dental College and Hospital, Yamuna Nagar, Haryana, India
| | - Deepika Bali
- Department of Periodontology and Oral Implantology, DAV(C) Dental College and Hospital, Yamuna Nagar, Haryana, India
| | - Rajvir Malik
- Department of Periodontology and Oral Implantology, DAV(C) Dental College and Hospital, Yamuna Nagar, Haryana, India
| | - Shalini Gugnani
- Department of Periodontology and Oral Implantology, DAV(C) Dental College and Hospital, Yamuna Nagar, Haryana, India
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Abstract
OBJECTIVES Various coronally repositioned flap (CRF) techniques have been proposed for coverage of gingival recession defects. Although CRF has several modifications all of them needs vertical or oblique external releasing incisions for treatment of localized gingival recession defects. The aim of present article was to evaluate the effectiveness of a modification of the new CRF procedure without any releasing incision for treatment of shallow localized gingival recession defects. CONCLUSION Shallow localized gingival recession defects can be treated with modified coronally repositioned flap technique successfully.
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Affiliation(s)
- Murat Akkaya
- Department of Periodontology, Faculty of Dentistry, University of Ankara, Ankara, Turkiye
| | - Fatma Böke
- Department of Periodontology, Faculty of Dentistry, University of Ankara, Ankara, Turkiye
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Abstract
The purpose of this article is to limelight the benefit of periodontal microsurgery in the surgical disciplines. It reviews the benefits and potential applications of magnification and microsurgery in the specialty of periodontics and a case report on microsurgical approach for free gingival graft surgery in the treatment of gingival recession. The increased demand for mucogingival esthetics has required the optimization of periodontal procedures. Microsurgery is a minimally invasive technique that is performed with the surgical microscope and adapted instruments and suture materials. Although this hardware and knowledge of various operations are necessary to achieve patient esthetic expectations, clinicians must be willing to undergo an extended period of systematic training to become familiar with novel operating procedures and instruments. This article describes the application of the surgical microscope to provide enhanced perioplastic treatment.
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Affiliation(s)
- Janak Anil Kapadia
- Department of Periodontics and Implantology, Vasantdada Patil Dental College and Hospital, Kavalapur, Sangli, Maharashtra, India
| | - Surekha Y Bhedasgoankar
- Department of Periodontics and Implantology, Vasantdada Patil Dental College and Hospital, Kavalapur, Sangli, Maharashtra, India
| | - Saurabh Dilip Bhandari
- Department of Periodontics and Implantology, Vasantdada Patil Dental College and Hospital, Kavalapur, Sangli, Maharashtra, India
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Abstract
Shallow vestibule, gingival recession, inadequate width of attached gingiva (AG) and aberrant frenum pull are an array of mucogingival problems for which several independent and effective surgical solutions are reported in the literature. This case series reports the effectiveness of the bridge flap technique as a single-step surgical entity for increasing the depth of the vestibule, root coverage, increasing the width of the AG and solving the problem of abnormal frenum pull. Eight patients with 18 teeth altogether having Millers class I, II or III recession along with problems of shallow vestibule, inadequate width of AG and with or without frenum pull underwent this surgical procedure and were followed-up till 9 months post-operatively. The mean root coverage obtained was 55% and the mean average gain in width of the AG was 3.5 mm. The mean percentage gain in clinical attachment level was 41%. The bridge flap technique can be an effective single-step solution for the aforementioned mucogingival problems if present simultaneously in any case, and offers considerable advantages over other mucogingival surgical techniques in terms of simplicity, limited chair-time for the patient and the operator, single surgical intervention for manifold mucogingival problems and low morbidity because of the absence of palatal donor tissue.
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Affiliation(s)
- Vivek Gupta
- Department of Periodontology, Saraswati Dental College and Hospital, Lucknow, India
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Manimegalai AG. A comparative study on the efficacy of a commercial fibrin adhesive (Tisseel) vis-à-vis silk suture on wound closure following periodontal surgical procedures. J Indian Soc Periodontol 2011; 14:231-5. [PMID: 21731248 PMCID: PMC3118073 DOI: 10.4103/0972-124x.76925] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 12/08/2010] [Indexed: 11/04/2022] Open
Abstract
AIMS AND OBJECTIVES To evaluate the efficacy of fibrin adhesive sealant (Tisseel(®)), a human biological tissue adhesive, as compared to conventional suture placement in pocket elimination and mucogingival surgical procedures. MATERIALS AND METHODS The study sample consisted of 25 patients (10 male and 15 female patients), in the age group of 25-40 years, with localized periodontitis in relation to the anterior region of the maxilla and mandible. They were divided into three surgical groups: Group I, Group II and Group III. Each of these groups was further divided into control and experimental groups. In all the control groups, the flaps/grafts were approximated with 4-0 black braided silk. In the experimental groups, the flaps/grafts were approximated with fibrin adhesive sealant (Tisseel(;)). Clinical parameters were taken pre-operatively.operatively and post-operatively on the 1(st), 2(nd), 3(rd), 7(th), and 10(th), day. RESULTS The Fibrin Adhesive System (FAS) showed superior results in all the parameters measured, i.e., hemostasis, fixation of tissues, reduction in plaque and gingival index and probing depth postoperatively. CONCLUSION The results of this study indicate that periodontal surgery using FAS enhances various periodontal regenerative surgical procedures.
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Affiliation(s)
- A G Manimegalai
- Department of Periodontology & Implantology, Priyadarshini Dental College, Pandur, Thiruvallur District, Tamil Nadu, India
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Soolari A, Soolari E, Shumaker ND. Palatal Tissue Enlargement After Subepithelial Connective Tissue Graft Harvest Associated With Anabolic Steroid Abuse. Clin Adv Periodontics 2011; 1:23-28. [PMID: 32698551 DOI: 10.1902/cap.2011.100004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Accepted: 01/27/2011] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Healing complications associated with androgenic anabolic steroid (AAS) abuse have received minimal attention in the periodontal literature. This case report describes an adverse healing event after palatal subepithelial connective tissue graft (SECTG) harvest associated with AAS abuse. CASE PRESENTATION A 35-year-old white male was treated with an SECTG procedure to address gingival recession on the facial aspect of teeth #24 and #25. Donor tissue was harvested from the left hard palate via a single incision technique. The procedure was completed without complication. One week postoperatively, the patient presented with a large asymptomatic overgrowth of tissue from the palatal harvest site. Over the following 5 weeks of continued observation, the lesion demonstrated progressive, spontaneous resolution. Investigation of possible etiology revealed the subject was a recreational bodybuilder with admitted AAS abuse. CONCLUSIONS Post-surgical healing can be influenced by AAS abuse. Alterations in connective tissue metabolism and fibroblast activity are known sequelae of AAS abuse; however, patients may be reluctant to admit to steroid abuse during the presurgical interview. Surgeons should suspect the possibility of AAS abuse when postoperative complications present in a patient of muscular body type.
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Affiliation(s)
- Ahmad Soolari
- Private practice, Silver Spring, MD.,Department of Periodontics, Naval Postgraduate Dental School, Bethesda, MD
| | - Ehsan Soolari
- College of Chemical and Life Sciences, University of Maryland, Adelphi, MD
| | - Nicholas D Shumaker
- Currently, private practice, Fort Collins, CO; previously, Naval Health Clinic Quantico, Quantico, VA, and Department of Periodontics, Naval Postgraduate Dental School
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Rasperini G, Acunzo R, Limiroli E. Decision Making in Gingival Recession Treatment: Scientific Evidence and Clinical Experience. Clin Adv Periodontics 2011; 1:41-52. [PMID: 32698553 DOI: 10.1902/cap.2011.100002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Accepted: 02/01/2011] [Indexed: 12/20/2022]
Abstract
Focused Clinical Question: What are the key considerations for selecting the best surgical approach in mucogingival plastic surgery? Summary: Treatment of gingival recession has become an important therapeutic issue due to the increasing number of cosmetic requests from patients. The dual goals of mucogingival treatment include complete root coverage, up to the cemento-enamel junction, and blending of tissue color between the treated area and non-treated adjacent tissues. Even though the connective tissue graft is commonly considered the "gold standard" for treatment of recession defects, it may not always be the best surgical option for every case. Conclusions: Under non-experimental conditions, all root coverage procedures may be effective in terms of complete root coverage and excellent esthetics. Careful analyses of patient- and defect-related factors, however, are key considerations prior to selecting an appropriate surgical technique.
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Affiliation(s)
- Giulio Rasperini
- Unit of Periodontology, Dental Clinic, Department of Surgical, Reconstructive and Diagnostic Science, Foundation IRCCS, Ca' Granda Policlinico, University of Milan, Milan, Italy
| | - Raffaele Acunzo
- Unit of Periodontology, Dental Clinic, Department of Surgical, Reconstructive and Diagnostic Science, Foundation IRCCS, Ca' Granda Policlinico, University of Milan, Milan, Italy
| | - Enrico Limiroli
- Unit of Periodontology, Dental Clinic, Department of Surgical, Reconstructive and Diagnostic Science, Foundation IRCCS, Ca' Granda Policlinico, University of Milan, Milan, Italy
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