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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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Fernández-Jiménez A, García-De-La-Fuente AM, Marichalar-Mendia X, Aguirre-Zorzano LA, Estefanía-Fresco R. Treatment of deep single RT2 and RT3 antero-mandibular gingival recessions with a combination of surgical techniques: A case series study. J ESTHET RESTOR DENT 2024; 36:363-372. [PMID: 37594747 DOI: 10.1111/jerd.13120] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/18/2023] [Accepted: 07/29/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVE To evaluate root coverage (RC) in deep single antero-mandibular RT2 and RT3 gingival recessions (GR) and to investigate the influence of several factors in RC. MATERIALS AND METHODS Fifteen single antero-mandibular GR with a minimum depth of 3 mm were consecutively treated with a new one-stage technique (laterally positioned flap with a tunnel access and a connective tissue graft). At baseline and at 12-month follow-up, the percentage of mean root coverage (%MRC), the recession reduction (RecRed), complete root coverage (CRC) and the gain of keratinized tissue width (KTW) were assessed. Descriptive, intergroup comparative and correlation analyses were performed. RESULTS At 12 months, a %MRC of 77.29 ± 21.48% with a mean RecRed of 4.10 ± 1.51 mm was achieved. The %MRC was 84.71 ± 21.08% in RT2, and 62.43 ± 14.17% in RT3. The mean gain of KTW was 2.10 ± 0.89 mm, with a mean gain of 2.0 ± 1.03 mm for RT2 and 2.3 ± 0.57 mm for RT3. CRC was observed in six cases, all of them being RT2. A positive association was found between the %MRC and the initial position of the tooth and of both papillae. CONCLUSIONS This technique might be a valuable approach for the treatment of deep single antero-mandibular RT2 and RT3 recessions, even in malpositioned teeth. CLINICAL SIGNIFICANCE A combination of different surgical techniques could provide greater vascularization to the CTG especially in malpositioned teeth in sextant V with a large avascular area to be covered.
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Affiliation(s)
- A Fernández-Jiménez
- Research Group: GIU21/042, Department of Stomatology II, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - A M García-De-La-Fuente
- Research Group: GIU21/042, Department of Stomatology II, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - X Marichalar-Mendia
- Research Group: GIU21/042, Department of Nursing I, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - L A Aguirre-Zorzano
- Research Group: GIU21/042, Department of Stomatology II, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
- Clínica Dr. Aguirre, Bilbao, Spain
| | - R Estefanía-Fresco
- Research Group: GIU21/042, Department of Stomatology II, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
- Clínica Dr. Aguirre, Bilbao, Spain
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Phull T, Garg A, Jyoti D, Yamini R, Natso V, Sapra J. Esthetic Management of Multiple Gingival Recession - A Case Report and Review of Literature. J Pharm Bioallied Sci 2024; 16:S966-S968. [PMID: 38595465 PMCID: PMC11000867 DOI: 10.4103/jpbs.jpbs_700_23] [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: 08/19/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 04/11/2024] Open
Abstract
The importance of esthetics is increasing for the patients as well as for the dentist. With a high incidence that rises with age and a complicated soft-tissue pathology caused by a wide variety of factors, gingival recessions are a common but troublesome dental problem. They are characterized by the exposure of the root surface of the teeth due to the apical migration of the gingival border beyond the cemento-enamel junction, and they cause both functional and cosmetic disruptions. Many different surgical approaches have been offered over the years to address gingival recession, all with the goal of providing enough root coverage and achieving aesthetically pleasing results. No matter the amount of defects, Zucchelli's method is beneficial in terms of root coverage and keratinized tissue gain when treating many neighboring recessions. In this case study, Zucchelli's coronally advanced flap is used to treat numerous neighboring gingival recessions.
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Affiliation(s)
- Tanvi Phull
- Department of Oral and Maxillofacial Surgery, Gian Sagar Dental College, Rajpura, Patiala, Punjab, India
| | - Anamika Garg
- Department of Periodontology, Government Dental College and Hospital, Patiala, Punjab, India
| | - Divya Jyoti
- Department of Oral Health Sciences (Periodontics), Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - R Yamini
- Department of Periodontology, Government Dental College and Hospital, Patiala, Punjab, India
| | - Vizoto Natso
- Department of Periodontology, Government Dental College and Hospital, Patiala, Punjab, India
| | - Jatin Sapra
- Department of Periodontology, Government Dental College and Hospital, Patiala, Punjab, India
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4
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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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Bertoldi C, Consolo U, Lalla M, Zaffe D, Tanza D, Cairo F, Cortellini P. Long-term stability (21-30 years) of root coverage outcomes using sub-epithelial connective tissue grafts at single or multiple gingival recessions: A longitudinal case series. J Clin Periodontol 2024; 51:2-13. [PMID: 37794814 DOI: 10.1111/jcpe.13882] [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: 12/15/2022] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 10/06/2023]
Abstract
AIM To evaluate outcomes and predictive factors for the long-term stability of root coverage using a sub-epithelial connective tissue graft. MATERIALS AND METHODS One-hundred and two healthy subjects (221 gingival recessions, GRs) were treated from 1987 to 1996. Keratinized tissue width (KTW), GR depth (RD), GR width (RW) and GR area (RA) were evaluated at baseline (M0) and at 1 month (M1), 1 year (M2), 11 years (M3), 21 years (M4) and 27 years (M5) after surgery. Primary outcomes consisted of complete root coverage (cRC) and relative dimensional changes in recession depth (measured in mm [c%-RD]), recession width (measured in mm [c%-RW]) and recession area (measured in mm2 [c%-RA]). RESULTS cRC was 88.7% at 1 year (M2), 59.8% at M3, 44.4% at M4 and 51.9% at M5. Average c%-RD was 95.2% at 1 year, 81.9% at M3, 71.5% at M4 and 81.7% at M5. KTW increased after surgery and over time and was positively correlated with favourable outcomes. Increased baseline RA was associated with less favourable clinical outcomes. CONCLUSIONS The sub-epithelial connective tissue graft is effective in the treatment of GRs and facilitates long-term stability of clinical outcomes. Wider baseline RA was a strong predictor of unfavourable short- and long-term RC outcomes.
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Affiliation(s)
- Carlo Bertoldi
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Modena, Italy
| | - Ugo Consolo
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Modena, Italy
| | - Michele Lalla
- Department of Economics Marco Biagi, University of Modena and Reggio Emilia, Modena, Italy
| | - Davide Zaffe
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Donato Tanza
- Department of Neurosciences - Head and Neck, Modena General Hospital, Modena, Italy
| | - Francesco Cairo
- Department of Experimental and Clinical Medicine, Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
| | - Pierpaolo Cortellini
- European Research Group on Periodontology (ERGOPERIO), Bern, Switzerland
- Department of Oral Health Sciences, KU Leuven and Dentistry (Periodontology), University Hospitals Leuven, Leuven, Belgium
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Ekşi C. Two Cases Demonstrating the Role of Creeping Attachment in the Treatment of Keratinized Gingival Deficiency With Free Gingival Graft: A 12-Month Follow-Up. Cureus 2023; 15:e49537. [PMID: 38156128 PMCID: PMC10753146 DOI: 10.7759/cureus.49537] [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] [Accepted: 11/27/2023] [Indexed: 12/30/2023] Open
Abstract
After free gingival graft procedure, partial or complete coverage of exposed root surfaces due to coronal migration of the gingival margin is called "creeping attachment." This case report aimed to evaluate the results of the free gingival graft procedure performed on two patients with keratinized gingival deficiency in the mandibular anterior region and to present the creeping attachment formation process with a 12-month follow-up in light of current literature. Free gingival graft treatment was applied after the initial periodontal treatments were completed for two patients who visited the periodontology clinic complaining of gingival recession. Although the postoperative recovery was completed without any problems, it was observed that there were still root exposures in the relevant areas. Patient motivation was provided by giving oral hygiene training to the patients. After the 12-month follow-up, it was reported that denuded root surfaces were completely covered with creeping attachment formation. Complete coverage of denuded root surfaces is possible through the formation of creeping attachment, with the help of oral care and follow-up procedures, without requiring repeated surgical procedures. So, after relevant procedures, dentists must provide patients with sufficient information and awareness on this issue.
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Affiliation(s)
- Cemre Ekşi
- Periodontology, Eskişehir Osmangazi University, Faculty of Dentistry, Eskişehir, TUR
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Park WB, Park W, Kang P, Lim HC, Han JY. Submerged Technique of Partially De-Epithelialized Free Gingival Grafts for Gingival Phenotype Modification in the Maxillary Anterior Region: A Case Report of a 34-Year Follow-up. Medicina (Kaunas) 2023; 59:1832. [PMID: 37893551 PMCID: PMC10608273 DOI: 10.3390/medicina59101832] [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] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023]
Abstract
A coronally advanced flap combined with a subepithelial connective tissue graft is considered the gold standard for achieving root coverage on exposed root surfaces. Nevertheless, challenges arise when this technique is applied to multiple teeth and when the palatal soft tissue is very thin. Several surgical modifications have been reported to simultaneously achieve both single or multiple root coverage and widening of the keratinized gingiva. In this context, there have been no reported cases utilizing the submerged technique with partially de-epithelialized free gingival grafts. We intend to introduce a submerged technique involving partially de-epithelialized free gingival grafts for the modification of soft tissue phenotypes in the maxillary anterior region.
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Affiliation(s)
- Won-Bae Park
- Department of Periodontology, School of Dentistry, Kyung Hee University, Seoul 02447, Republic of Korea
- Private Practice in Periodontics and Implant Dentistry, Seoul 02771, Republic of Korea
| | - Wonhee Park
- Department of Prosthdontics, Division of Dentistry, College of Medicine, Hanyang University, 222-1 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea
| | - Philip Kang
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, NY 10027, USA
| | - Hyun-Chang Lim
- Department of Periodontology, Periodontal-Implant Clinical Research Institute, School of Dentistry, Kyunghee daero 23, Dongdaemoon-gu, Seoul 02447, Republic of Korea
| | - Ji-Young Han
- Department of Periodontology, Division of Dentistry, College of Medicine, Hanyang University, 222-1 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea
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Chen Z, Zhong J, Xie Y, Fan K, Zhou S, Ouyang X. Does vestibular incision improve the outcomes of vestibular incision subperiosteal tunnel technique: A randomized clinical trial for treatment of multiple adjacent type 1 gingival recession. J ESTHET RESTOR DENT 2023; 35:1131-1138. [PMID: 37078417 DOI: 10.1111/jerd.13051] [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: 01/04/2023] [Revised: 03/27/2023] [Accepted: 03/31/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE The purpose of this study was to compare the clinical outcomes of vestibular incision subperiosteal tunnel technique (VISTA) and tunnel approach combined with connective tissue graft (CTG) for treatment of type 1 (RT1) multiple gingival recession. MATERIALS AND METHODS Twenty-four patients with a total of 59 nonmolar recession teeth were randomly allocated to VISTA + CTG or Tunnel + CTG group. Recession depth and width, probing depth, clinical attachment level, width of keratinized tissue, gingival thickness, flap tension, mean root coverage (MRC), complete root coverage (CRC), patient-centered, and esthetic outcomes (root coverage esthetic scores, RES) were assessed at baseline and 12 months after surgery. RESULTS At 12 months, MRC of 91.13 ± 16.96% and 91.40 ± 13.53%, CRC of 70.97% and 67.86% were observed for VISTA + CTG and Tunnel + CTG group respectively, with no significant difference between the two groups (p > 0.05). High RES of 8.52 ± 1.46 and 8.82 ± 1.44 was obtained in VISTA + CTG and Tunnel + CTG group respectively, without showing a significant difference (p = 0.245), while less scar formation was observed in Tunnel + CTG group (p < 0.01). CONCLUSIONS Both procedures were effective for root coverage in RT1 multiple gingival recession at 12 months. Better esthetic result with less scar formation was obtained in tunnel approach combined with CTG without vestibular incision. (Registration number: ChiCTR-INR-16007845, registered on 19/12/2015, http://www.chictr.org.cn). CLINICAL SIGNIFICANCE VISTA + CTG and Tunnel + CTG were both effective for root coverage in RT1 multiple gingival recession, with satisfying esthetic outcomes. However, it is suggested in critical esthetic areas, treatment options of making vertical incisions should be carefully considered.
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Affiliation(s)
- Ziyuan Chen
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Second Clinical Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Jinsheng Zhong
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Ying Xie
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Keang Fan
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Third Clinical Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Shuangying Zhou
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Xiangying Ouyang
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
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Blasi G, Vilarrasa J, Abrahamian L, Monje A, Nart J, Pons R. Influence of immediate postoperative gingival thickness and gingival margin position on the outcomes of root coverage therapy: A 6 months prospective case series study using 3D digital measuring methods. J ESTHET RESTOR DENT 2023; 35:1039-1049. [PMID: 37021694 DOI: 10.1111/jerd.13042] [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: 02/03/2023] [Revised: 03/13/2023] [Accepted: 03/22/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND To assess linear and volumetric changes following the treatment of gingival recessions (GRs) by means of a modified coronally advanced tunnel technique combined with acellular dermal matrix (MTUN + ADM). MATERIALS AND METHODS Patients presenting GR type 1 (RT1) GRs underwent root coverage surgery consisting of MTUN + ADM. Clinical measurements were made, and intraoral scans were obtained at baseline, postoperatively, and 6 weeks, 3 and 6 months after surgery, to evaluate changes in probing depth (PD), keratinized tissue width (KTW), recession depth (RD), recession area (RA), marginal gingival thickness (MGT), and mucosal volume (MV). The impact of patient-level and surgical-site variables upon percentage root coverage (% RC) and the likelihood of achieving complete root coverage (CRC) were explored. RESULTS A total of 20 patients (n = 47 teeth) were treated. After 6 months, RD and RA decreased, while KTW, MGT, and MV increased. The mean % RC was 93% at 6 months and CRC was found on 72.3% of the sites at 6 months. The postoperative MGT changes at 1.5 and 3 mm were significantly correlated to % RC and CRC at 6 months. Each additional mm of postoperative gain of gingival thickness resulted in a 4-fold increase in the probability of achieving CRC. Additionally, gingival margin positioned ≥0.5 mm coronal to the cementoenamel junction immediately after surgery was a strong predictor of CRC. CONCLUSIONS The MGT gain at 1.5 and 3 mm achieved in the immediate postoperative period is a significant predictor of CRC at 6 months when treating multiple GRs via MTUN + ADM. CLINICAL SIGNIFICANCE The Scientific rationale for the study relies on the lack of 3D digital measuring tools in the assessment of soft tissue healing dynamics after root coverage therapy. The principal findings of this study can be summarized as follows: tooth type, tooth position, and post-operative gingival margin position and gingival thickness and volume changes are predictors of CRC. Therefore, the practical implications are that the more thickness and more coronal advancement achieved immediately after root coverage surgery, the higher chance of achieving CRC.
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Affiliation(s)
- Gonzalo Blasi
- Department of Periodontology, School of Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, Baltimore School of Dentistry, University of Maryland, Baltimore, Maryland, USA
| | - Javi Vilarrasa
- Department of Periodontology, School of Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Lory Abrahamian
- Department of Periodontology, School of Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Alberto Monje
- Department of Periodontology, School of Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - José Nart
- Department of Periodontology, School of Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Ramón Pons
- Department of Periodontology, School of Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain
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Galarraga-Vinueza ME, Barootchi S, Nevins ML, Nevins M, Miron RJ, Tavelli L. Twenty-five years of recombinant human growth factors rhPDGF-BB and rhBMP-2 in oral hard and soft tissue regeneration. Periodontol 2000 2023. [PMID: 37681552 DOI: 10.1111/prd.12522] [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: 05/18/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 09/09/2023]
Abstract
Contemporary oral tissue engineering strategies involve recombinant human growth factor approaches to stimulate diverse cellular processes including cell differentiation, migration, recruitment, and proliferation at grafted areas. Recombinant human growth factor applications in oral hard and soft tissue regeneration have been progressively researched over the last 25 years. Growth factor-mediated surgical approaches aim to accelerate healing, tissue reconstruction, and patient recovery. Thus, regenerative approaches involving growth factors such as recombinant human platelet-derived growth factor-BB (rhPDGF-BB) and recombinant human bone morphogenetic proteins (rhBMPs) have shown certain advantages over invasive traditional surgical approaches in severe hard and soft tissue defects. Several clinical studies assessed the outcomes of rhBMP-2 in diverse clinical applications for implant site development and bone augmentation. Current evidence regarding the clinical benefits of rhBMP-2 compared to conventional therapies is inconclusive. Nevertheless, it seems that rhBMP-2 can promote faster wound healing processes and enhance de novo bone formation, which may be particularly favorable in patients with compromised bone healing capacity or limited donor sites. rhPDGF-BB has been extensively applied for periodontal regenerative procedures and for the treatment of gingival recessions, showing consistent and positive outcomes. Nevertheless, current evidence regarding its benefits at implant and edentulous sites is limited. The present review explores and depicts the current applications, outcomes, and evidence-based clinical recommendations of rhPDGF-BB and rhBMPs for oral tissue regeneration.
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Affiliation(s)
- Maria Elisa Galarraga-Vinueza
- Tufts University School of Dental Medicine, Boston, Massachusetts, USA
- School of Dentistry, Universidad de las Américas (UDLA), Quito, Ecuador
| | - Shayan Barootchi
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Center for Clinical Research and Evidence Synthesis in Oral Tissue Regeneration (CRITERION), Boston, Massachusetts, USA
| | - Marc L Nevins
- Division of Periodontology, Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Myron Nevins
- Division of Periodontology, Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Richard J Miron
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Lorenzo Tavelli
- Center for Clinical Research and Evidence Synthesis in Oral Tissue Regeneration (CRITERION), Boston, Massachusetts, USA
- Division of Periodontology, Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
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11
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Chacón G, Saleh MHA, Fleming C, Leon N, Wang HL. Papilla reconstruction for an iatrogenic RT3 gingival defect using a tuberosity soft tissue graft: A case report. Clin Adv Periodontics 2023; 13:163-167. [PMID: 36636761 DOI: 10.1002/cap.10233] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/08/2022] [Accepted: 12/29/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Orthognathic surgery is a reliable and safe method to improve maxillo-mandibular malformations. However, it is a complex procedure that can affect deeper structures and the terminal blood supply of specific areas, thereby affecting the results. Occasionally, despite careful digital planning and diagnosis, esthetic complications may occur, such as scarring or mucogingival alterations, including localized aseptic necrosis with associated recessions. In more severe cases, larger fragments of necrosis may be involved. METHODS AND RESULTS The aim of this case report was to present a case, including diagnosis, treatment plan, periodontal plastic surgical technique, and follow-up for a recession type 3 (RT3) defect. This RT3 gingival defect was associated with necrotic crestal bone exposure in the anterior esthetic area resulting from a complication after orthognathic surgery. CONCLUSIONS Partial reconstruction of the interdental papilla can be possible through consideration of the defect characteristics, use of microsurgical principles, and utilization of a suitable connective tissue grafting technique. KEY POINTS Why is this case new information? To the authors' knowledge, there is very limited clinical and scientific evidence regarding the management of esthetic complications associated with ischemic necrosis resulting from orthognathic surgeries. This case study identified the management of papillary reconstructions of these mucogingival defects. What are the keys to the successful management of this case? For an ideal case management, adequate plaque and infection control and timely notice of the defect appearance are critical. Additionally, proper surgical soft tissue management of the affected papillae and surrounding area is required. Finally, the type of connective tissue graft to be used, its management and fixation, and proper postoperative protocols are needed for case success. What are the primary limitations to success in this case? Despite the limitations of this study, the authors consider that the treatment of mucogingival complications related to orthognathic surgeries is possible, using microsurgical concepts and connective tissue grafts to reconstruct papillae.
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Affiliation(s)
| | - Muhammad H A Saleh
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Christina Fleming
- Department of Periodontics, University of Louisville, Louisville, Kentucky, USA
| | | | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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Kumari K, Nath B, Kumar A, Chhabada AK, Kumari R, Prakash G. Comparison of Root Coverage by the Subepithelial Connective Tissue Graft With and Without Root Biomodification: A Comprehensive Clinical Study. Cureus 2023; 15:e44758. [PMID: 37809257 PMCID: PMC10556792 DOI: 10.7759/cureus.44758] [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: 09/28/2022] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND Being an autologous graft, a subepithelial connective tissue (SECT) graft shows more predictable root coverage better than other techniques. Hence, it is most likely to be widely used for recession treatment. During root planing, a smear layer forms on the root surface that cannot be removed by water or saline rinsing. To remove this smear layer, root biomodification agents are widely used. The present study was conducted to assess the efficacy of an SECT graft for root coverage with and without root biomodification. METHODS This study included 20 patients with no gender predilection, with an age range of 24-36 years and a mean age of 27.6 ± 4.24 years. The chosen range facilitated the acquisition of data in a relatively homogeneous population, minimizing the confounding effects of factors such as aging-related tissue changes or early-onset periodontal issues. All 40 sites were treated with the SECT and coronally advanced flap. Root conditioning in controls was done with distilled saline and tested using 24% ethylenediaminetetraacetic acid (EDTA) gel (Maquira; STM Meditech, Kerala). At baseline and at one, three, and six months postoperatively, pocket depth (PD) and clinical attachment levels (CALs) were assessed at four sites using a UNC-15 probe, and from the gingival margin to the cementoenamel junction (CEJ), the vertical recession was assessed. RESULTS For the buccal surface, CALs were reduced significantly (p < 0.001). Following root conditioning with 24% EDTA, no difference was seen in the CAL in the control and test group either buccally or interproximally with a p-value of greater than 0.05. For PD, following a SECT graft or root conditioning, no significant change was observed in the buccal or interproximal region (p > 0.05). The vertical recession was significantly reduced with a p-value of less than 0.001 and depth coverage of 97.5%. The difference between the two groups was statistically non-significant (p > 0.05). The root surface coverage decreased significantly from 16.6 ± 2.8 to 0.45 ± 0.4 from baseline to six months, which was statistically significant (p < 0.001). This intergroup difference was non-statistical (p > 0.05). CONCLUSION The present study concludes that the use of an SECT graft in root coverage can significantly improve the CAL, root surface area, and vertical recession both with and without root biomodification. We conclude that there is a significant decrease in the probing depth following SECT grafting and with root biomodification.
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Affiliation(s)
- Khushboo Kumari
- Department of Oral Pathology, Buddha Institute of Dental Sciences and Hospital, Patna, IND
| | - Barsha Nath
- Department of Periodontology and Implantology, Buddha Institute of Dental Sciences and Hospital, Patna, IND
| | - Amrit Kumar
- Department of Periodontology and Implantology, Buddha Institute of Dental Sciences and Hospital, Patna, IND
| | | | - Rosy Kumari
- Department of Periodontology and Implantology, Buddha Institute of Dental Sciences and Hospital, Patna, IND
| | - Gyan Prakash
- Department of Periodontology and Implantology, Buddha Institute of Dental Sciences and Hospital, Patna, IND
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Cheng X, Tang R, Ge Z. Comparison of the efficacy and long-term stability of tunnel technique and coronally advanced flap in the treatment of gingival recession: a Meta-analysis. Hua Xi Kou Qiang Yi Xue Za Zhi 2023; 41:450-462. [PMID: 37474478 PMCID: PMC10372530 DOI: 10.7518/hxkq.2023.2023045] [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: 07/22/2023]
Abstract
OBJECTIVES This study aimed to evaluate the efficacy and long-term stability of tunnel technique (TUN) and coronally advanced flap (CAF) combined with connective tissue graft (CTG) in treating gingival recession. METHODS Databases including PubMed, Web of Science, Embase, and CNKI were electronically searched to collect randomized controlled trial (RCT) of CAF+CTG compared to TUN+CTG in the treatment of Miller class Ⅰ or Ⅱ gingival recession on September 1, 2022. RESULTS There were 8 RCTs with 305 patients (454 recession sites) participating. The results of the Meta-analysis revealed that, in terms of mean root coverage (MRC) of main indicators, no significant difference was found between the CAF group and the TUN group in both short- and long-term results, which were [MD: 1.45%, 95%CI (-2.93%, 5.82%), P=0.52] and [MD: -0.70%, 95%CI (-6.41%, 5.00%), P=0.81]. However, the CAF group outperformed the TUN group in the long term [MD: 5.69%, 95%CI (0.87%, 10.50%), P=0.02], and the results of complete root coverage (CRC) analysis were similar to those of MRC. In the short term, the TUN group grew keratinized gingiva significantly faster than the CAF group [MD: -0.38 mm, 95%CI (-0.67 mm, -0.10 mm), P=0.008]. Long-term findings revealed no significant difference between the two groups [MD: -0.26 mm, 95%CI (-0.94 mm, 0.43 mm), P=0.46]. The TUN group's secondary index root coverage esthetic score (RES) was statistically significantly higher than the CAF group's [MD: 0.62, 95%CI (0.28, 0.96), P=0.000 3]. Given that there were few results included in the literature and the heterogeneity was too great, no significant difference was observed in the postoperative VAS pain index score [MD: 0.53, 95%CI (-1.96, 3.03), P=0.68]. CONCLUSIONS This study discovered that both CAF+CTG and TUN+CTG can achieve good root coverage in treating gingival recession, with CAF outperforming TUN and both groups achie-ving good long-term stability. After the operation, the TUN group had a higher RES than the CAF group. Given the limitations of this study, more high-quality studies are needed in the future to demonstrate the efficacy of TUN in gingival retraction surgery.
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Affiliation(s)
- Xiaoming Cheng
- Dept. of Stomatology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
- Dept. of Stomatology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Rui Tang
- Dept. of Stomatology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Zili Ge
- Dept. of Stomatology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
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Mandil O, Sabri H, Manouchehri N, Mostafa D, Wang H. Root coverage with apical tunnel approach using propolis as a root conditioning agent: A case report with 2-year follow-up and review of the literature. Clin Exp Dent Res 2023; 9:568-573. [PMID: 37338508 PMCID: PMC10441594 DOI: 10.1002/cre2.751] [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: 02/14/2023] [Revised: 04/28/2023] [Accepted: 05/08/2023] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVES One of the main challenges in performing root coverage is patient discomfort and donor site morbidity. This case report presents a minimally invasive apical tunnel surgical technique, with propolis for root conditioning, to correct gingival recession defects without harvesting donor grafts, flap elevation, or sutures. Propolis is a natural anti-infective, anti-inflammatory, and antioxidant agent. MATERIAL AND METHODS A 58-year-old woman with no significant medical history was presented for root coverage of her upper left canine and first premolar with recession type (RT)1A (+). Propolis was used as a root conditioning agent to promote soft tissue coverage via an apical tunnel approach. During the apical tunnel approach, a small apical hole was made 6 mm below the mucogingival junction, and the mucosa and associated attached gingiva was away from the tooth so the flap could be repositioned coronally. Collagen matrix was used as a soft tissue graft material. RESULTS At the 2-month, 6-month, 8-month, and 2-year follow-up, complete root coverage was achieved for both teeth. No bleeding on probing was noticed nor recurrent GRs at the treated sites. CONCLUSION Without incisions, donor site reflection, or flaps, the apical tunnel approach can be successfully used to cover the exposed roots. Additionally, propolis is a potential root conditioning agent during soft tissue graft procedure due to its anti-inflammatory and antioxidant properties.
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Affiliation(s)
- Obada Mandil
- Department of Periodontics and Oral Medicine, School of DentistryUniversity of MichiganAnn ArborMichiganUSA
| | - Hamoun Sabri
- Department of Periodontics and Oral Medicine, School of DentistryUniversity of MichiganAnn ArborMichiganUSA
- Center for Clinical Research and Evidence Synthesis In Oral Tissue Regeneration (CRITERION)Ann ArborMichiganUSA
| | - Neshatafarin Manouchehri
- Department of Periodontics and Oral Medicine, School of DentistryUniversity of MichiganAnn ArborMichiganUSA
| | - Diana Mostafa
- Department of Periodontics and Oral Medicine, School of DentistryAlexandria UniversityAlexandriaEgypt
| | - Hom‐Lay Wang
- Department of Periodontics and Oral Medicine, School of DentistryUniversity of MichiganAnn ArborMichiganUSA
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Meenakshi RP, Kiruba R, Arun KV, Sivaram G, Arumuganainar D, Kaveri K. Cell-based therapy in the management of Class III Miller's recession - A case report with 45-month follow-up. J Indian Soc Periodontol 2023; 27:437-442. [PMID: 37593550 PMCID: PMC10431218 DOI: 10.4103/jisp.jisp_436_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: 09/22/2022] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 08/19/2023] Open
Abstract
Miller's Class III gingival recessions (GRs) have always posed a challenge to the clinicians in terms of achieving complete root coverage (CRC). In the present case, a cell-based therapy with autologous fibroblasts seeded onto a Type 1 collagen membrane, through an in-vitro culturing method was utilized. The fibroblasts-seeded membrane was surgically placed under a laterally repositioned flap. The patient presented with a CRC, which was stable even at the postoperative period of 45 months. In addition, a 3-mm substantial gain in the width of keratinized tissue was achieved and maintained throughout the postoperative period. Hence, the results of the cell-seeded therapy emphasize that it can serve as an effective alternative method for the management of Miller's Class III GRs.
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Affiliation(s)
| | - R. Kiruba
- Department of Virology, Kings Institute of Preventive Medicine and Research, Chennai, Tamil Nadu, India
| | - K. V. Arun
- Department of Periodontics, Ragas Dental College and Hospital, Chennai, Tamil Nadu, India
| | - G. Sivaram
- Department of Periodontics, Ragas Dental College and Hospital, Chennai, Tamil Nadu, India
| | | | - K. Kaveri
- Department of Virology, Kings Institute of Preventive Medicine and Research, Chennai, Tamil Nadu, India
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Güler K, Görgün EP. An alternative method for esthetic and functional management of oral pyogenic granuloma. Clin Adv Periodontics 2023. [PMID: 37226321 DOI: 10.1002/cap.10251] [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: 02/27/2023] [Revised: 05/08/2023] [Accepted: 05/17/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Pyogenic granuloma are gingival enlargements which cause esthetic and functional problems that hinder chewing and maintaining oral hygiene. In this series consisting of six cases, we report the rehabilitation of pyogenic granuloma using partly de-epithelialized gingival grafts. METHODS Following documentation of clinical measurements, a concurrent treatment plan of excision and reconstruction with partly de-epithelialized gingival grafts was followed for all the cases. 6 months following procedures, clinical parameters were measured again and a short patient-reported outcome measures consisting of three questions were applied. RESULTS In histological evaluations, pyogenic granuloma features were observed. In the fourth postoperative week, interdental papilla and attached gingiva were restored. 6 months follow-up showed reduction in plaque and gingival indices, clinical attachment loss, and mobility. Mean keratinized tissue height was increased from 2.58±2.20 to 6.66±1.66 in the 6th month of operation. Oldest case was stable after 12 months of follow-up and no infection was found at grafting sites. Papillary coverage was achieved. CONCLUSION If the pyogenic granuloma is not completely removed due to esthetic reservations, a recurrence may occur. Within our limitations, we can suggest that the immediate esthetic rehabilitation with P-DGG presents a compatible approach in the treatment of mucogingival defects after aggressive excision of pyogenic granuloma. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Kübra Güler
- Department of Periodontology, Faculty of Dentistry, Uskudar University, İstanbul, Türkiye
| | - Emine Pirim Görgün
- Department of Periodontology, Faculty of Dentistry, Sivas Cumhuriyet University, Sivas, Türkiye
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17
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Guimarães DM, de Andrade PF, Rebollal J, Neves AMD, Granjeiro JM. A modified tunnel technique to treat multiple gingival recessions: Case Series. Braz Dent J 2023; 34:136-145. [PMID: 37466521 PMCID: PMC10355267 DOI: 10.1590/0103-6440202305502] [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: 03/29/2023] [Accepted: 05/22/2023] [Indexed: 07/20/2023] Open
Abstract
This case series reports a modified tunnel technique with connective tissue graft for the root coverage of multiple Miller Class I, II, and III gingival recessions. The modified approach presents an innovative suture technique to improve the stability and position of the graft. Ten patients with multiple gingival recessions (n=85 teeth) received surgical root coverage treatment. The gingival recession height and width were measured and presented as median, minimum, and maximum values. The percentage of the root coverage after at least 12 months expressed the treatment effectiveness. The Shapiro-Wilk test evaluated the normality; pared Wilcoxon test determined the exact P-value for the differences in the height of the gingival recession before and after surgical treatment (α = 0.05). An average of 97.9% (± 5.6%, p < 0.0001) root coverage after treatment occurred, and 73 out of 85 recessions presented complete root coverage after 12 months. Treatment of Miller class I and II gingival recessions resulted in root coverage higher than 99 and class III higher than 95% (p < 0.0001). The presented case series report the efficacy of a modified surgical technique promoting more than 95% of root coverage after 12 months in multiple Miller Class I, II, and III gingival recessions. Well-designed blind randomized controlled trials are needed to validate the proposed technique.
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Affiliation(s)
- Dennis Malta Guimarães
- Latin American Institute of Dental Research and Education (ILAPEO),
Department of Implantology, Curitiba, Paraná, Brazil
| | | | - Julio Rebollal
- Latin American Institute of Dental Research and Education (ILAPEO),
Department of Implantology, Curitiba, Paraná, Brazil
| | - André Martins das Neves
- School of Dentistry, Federal University of Minas Gerais, Belo
Horizonte, Minas Gerias, Brazil
| | - José Mauro Granjeiro
- Latin American Institute of Dental Research and Education (ILAPEO),
Department of Implantology, Curitiba, Paraná, Brazil
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Cairo F, Cortellini P, Barbato L, Masseti L, Mervelt J, Nieri M, Pini Prato GP, Tonetti MS. Long-term comparison of root coverage procedures at single RT2 maxillary gingival recessions: Ten-year extension results from a randomized, controlled clinical trial. J Clin Periodontol 2023; 50:511-519. [PMID: 36644804 DOI: 10.1111/jcpe.13778] [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: 10/09/2022] [Revised: 01/04/2023] [Accepted: 01/10/2023] [Indexed: 01/17/2023]
Abstract
AIM The purpose of the present study was to assess root coverage outcomes 10 years after connective tissue graft plus coronally advanced flap (CTG + CAF) or CAF alone, at single RT2 maxillary gingival recession. MATERIALS AND METHODS Twenty-one of the original 29 patients (11 treated with CAF + CTG and 10 with CAF alone) were available for the 10-year follow-up. A blinded and calibrated examiner performed all the measurements. Outcome measures included complete root coverage (CRC), recession reduction (RecRed), root coverage aesthetic score (RES), and keratinized tissue (KT) gain. A visual analogue scale was used to evaluate patient satisfaction. RESULTS CRC was maintained in 63% of the test group and 20% of the control group after 10 years, with a significant difference favouring CAF + CTG (p = .030). Furthermore, the addition of CTG was associated with greater KT gain (p = .0002) and greater papilla tip recession (p = .023) than with CAF at the last follow-up. No difference was detected regarding RecRed, RES, and patient satisfaction. CONCLUSIONS Adding CTG under CAF improved the probability of maintaining complete root coverage 10 years after single maxillary RT2 recession treatment.
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Affiliation(s)
- Francesco Cairo
- Department of Experimental and Clinical Medicine, Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
| | - Pierpaolo Cortellini
- Accademia Toscana di Ricerca Odontostomatologica (ATRO), Florence, Italy
- Private Practice, Florence, Italy
| | - Luigi Barbato
- Department of Experimental and Clinical Medicine, Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
| | - Lorenzo Masseti
- Department of Experimental and Clinical Medicine, Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
| | - Jana Mervelt
- Department of Experimental and Clinical Medicine, Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
| | - Michele Nieri
- Department of Experimental and Clinical Medicine, Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
| | - Giovan Paolo Pini Prato
- Accademia Toscana di Ricerca Odontostomatologica (ATRO), Florence, Italy
- Private Practice, Florence, Italy
| | - Maurizio S Tonetti
- Shanghai PerioImplant Innovation Center, Department of Oral and Maxillofacial Implantology, Shanghai Ninth People Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center of Oral Diseases, National Center of Stomatology, College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- European Research Group on Periodontology (ERGOPerio), Genoa, Italy
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Saleh MHA, Urban IA, Alrmali A, Ravidà A. Papilla reconstruction using a vertical interproximal tunnel approach. Int J Oral Implantol (Berl) 2023; 16:55-64. [PMID: 36861681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
INTRODUCTION Papilla reformation is one of the most difficult and elusive surgical techniques for clinicians. Although it involves similar tenets to those applied for soft tissue grafting at recession defects, crafting a small tissue in restricted space remains unpredictable. Numerous grafting techniques have been developed to correct interproximal and buccal recession, but so far, only a limited number of techniques have been prescribed for interproximal remediation. CASE PRESENTATION This report describes in detail a modern technique (the vertical interproximal tunnel approach) for reforming the interproximal papilla and treating interproximal recession. It also documents three challenging cases of papilla loss. The first case presented Class II papilla loss and a recession type 3 gingival defect adjacent to a dental implant, managed using the vertical interproximal tunnel approach through a short vertical incision. A 6-mm increase in attachment level and almost complete papilla fill were observed in this case with this surgical technique for papilla reconstruction. The second and third cases presented Class II papilla loss between two adjacent teeth, managed using the vertical interproximal tunnel approach through a semilunar incision and achieving full papilla reconstruction. CONCLUSION Both described incision designs for the vertical interproximal tunnel approach require technical meticulousness. When executed carefully and using the most beneficial pattern of blood supply, predictable reconstruction of the interproximal papilla can be achieved. It also helps alleviate concerns associated with inadequate flap thickness, blood supply and flap retraction.
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Abu-Ta'a M, Adler JR. Advanced Platelet-Rich Fibrin and Connective Tissue Graft for Treating Marginal Tissue Recessions: A Randomized, Controlled Split-Mouth Study. Cureus 2023; 15:e35761. [PMID: 36879584 PMCID: PMC9985511 DOI: 10.7759/cureus.35761] [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] [Accepted: 03/04/2023] [Indexed: 03/07/2023] Open
Abstract
OBJECTIVES This study aimed to evaluate and compare the clinical outcomes of advanced platelet-rich fibrin (A-PRF) and connective tissue graft (CTG) in treating marginal tissue recessions. MATERIALS & METHODS Fifteen patients with isolated bilateral maxillary gingival recessions were recruited for the study, with 30 defects. The defects were classified as Miller's class I/II gingival recession on the canine or premolar region. Patients were randomly divided into two groups, each receiving one of the two treatment techniques (A-PRF or CTG) on a different side of the maxilla in a split-mouth design. Clinical parameters such as recession height (RH), recession width (RW), probing pocket depth (PPD), clinical attachment level (CAL), a width of attached gingiva (WAG), and keratinized tissue height (KTH) were evaluated at baseline, 3, and 6 months. Changes in biotype, Recession Esthetic Score (RES), and Visual Analogue Score-Esthetics (VAS-E) were also evaluated at 6 months. TRIAL REGISTRATION Ethics approval number (Helsinki): PHRC/HC/877/21 and registered at the Clinical Trials Registry under the number NCT05267015 Results: At the end of 6 months, there was a statistically significant reduction in RH and RW in both groups, with the mean RC% of 69.2±22.91, and 88.66±33.18 in Groups I and II, respectively. Intergroup analysis showed statistically significant differences in recession parameters between groups at 3 and 6 months, with better outcomes for the CTG group. CONCLUSIONS This study demonstrates that A-PRF and CTG effectively manage gingival recession defects. However, CTG resulted in better clinical outcomes in terms of reduction in recession height and width.
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Affiliation(s)
| | - John R Adler
- Dentistry, Arab American University, Ramallah, PSE
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21
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Cairo F, Burkhardt R. Minimal invasiveness in gingival augmentation and root coverage procedures. Periodontol 2000 2023; 91:45-64. [PMID: 36694255 DOI: 10.1111/prd.12477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/30/2022] [Accepted: 07/20/2022] [Indexed: 01/26/2023]
Abstract
Minimally invasive surgical procedures aim at optimal wound healing, a reduction of postoperative morbidity and, thus, at increased patient satisfaction. The present article reviews the concept of minimal invasiveness in gingival augmentation and root coverage procedures, and critically discusses the influencing factors, technical and nontechnical ones, and relates them to the underlying biological mechanisms. Furthermore, the corresponding outcomes of the respective procedures are assessed and evaluated in relation to a possible impact of a minimized surgical invasiveness on the clinical, aesthetic, and patient-related results.
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Affiliation(s)
- Francesco Cairo
- Head Research Unit in Periodontology and Periodontal Medicine, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Rino Burkhardt
- Private Practice, Zurich, Switzerland.,Center of Dental Medicine, University of Zurich, Zurich, Switzerland.,Prince Philip Dental Hospital, The University of Hong Kong, Hong Kong, Hong Kong, SAR.,Department of Periodontics & Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
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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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Blasi G, Monje A, Muñoz-Peñalver J, Oates TW, Avila-Ortiz G, Nart J. Influence of vestibular depth on the outcomes of root coverage therapy: A prospective case series study. J Periodontol 2022; 93:1857-1866. [PMID: 35482935 DOI: 10.1002/jper.21-0638] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 11/10/2021] [Revised: 04/01/2022] [Accepted: 04/16/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the influence of vestibular depth (VD) on the outcomes of root coverage therapy. METHODS Patients presenting gingival recession defects (GRD) with a minimum depth of 2 mm underwent root coverage therapy consisting of a coronally advanced flap plus a connective tissue graft (CAF + CTG). Clinical examinations were performed, and intraoral scans were obtained at baseline, 3 and 6 months after surgery to assess changes in probing depth (PD), keratinized tissue width (KTW), recession depth (RD), GRD area, marginal gingival thickness (MGT), and VD. The influence of VD on percentage of root coverage (%RC) and the likelihood of achieving complete root coverage (CRC) were explored. RESULTS A total of 20 patients were enrolled, and 44 teeth were treated. RD decreased and MGT increased in all treated sites. At 6 months, mean %RC was 87.47 ± 18.37 and CRC was observed in 61.4% of sites. Mean baseline VD was 7.33 ± 2.67 mm. Mean VD reduction from baseline to 6 months was 1.98 ± 1.27 mm. %RC and CRC were significantly correlated with baseline VD. Each additional 1 mm of baseline VD implied a gain of 6.58% for %RC and increased 2.75 times the probability of achieving CRC. Narrow baseline KTW and mandibular arch location were associated with inferior treatment outcomes. CONCLUSION Lower %RC and likelihood of achieving CRC can be expected after root coverage therapy via CAF + CTG in sites presenting a shallow vestibulum.
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Affiliation(s)
- Gonzalo Blasi
- Department of Periodontology, School of Dentistry, International University of Catalonia, Barcelona, Spain.,Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, Baltimore School of Dentistry, Baltimore, Maryland, USA
| | - Alberto Monje
- Department of Periodontology, School of Dentistry, International University of Catalonia, Barcelona, Spain.,Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Jesus Muñoz-Peñalver
- Department of Periodontology, School of Dentistry, International University of Catalonia, Barcelona, Spain
| | - Thomas W Oates
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, Baltimore School of Dentistry, Baltimore, Maryland, USA
| | - Gustavo Avila-Ortiz
- Department of Periodontics, College of Dentistry, University of Iowa, Iowa City, Iowa, USA
| | - Jose Nart
- Department of Periodontology, School of Dentistry, International University of Catalonia, Barcelona, Spain
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Mehta V, Kaçani G, Moaleem MMA, Almohammadi AA, Alwafi MM, Mulla AK, Alharbi SO, Aljayyar AW, Qeli E, Toti Ç, Meto A, Fiorillo L. Hyaluronic Acid: A New Approach for the Treatment of Gingival Recession-A Systematic Review. Int J Environ Res Public Health 2022; 19:14330. [PMID: 36361208 PMCID: PMC9658310 DOI: 10.3390/ijerph192114330] [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] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
This systematic review aimed to investigate the effectiveness of hyaluronic acid (HA) on the clinical treatment outcomes of patients with gingival recession. A systematic search was performed in PubMed, Cochrane Central Register of Controlled Trials, Embase, Scopus, and Google Scholar for studies up to 15 August 2022. Two reviewers separately selected the papers for eligibility after conducting a thorough search. The study includes randomized controlled clinical trials in which participants were given HA in addition to periodontal treatment surgical procedures. The changes following the treatment protocol were evaluated for complete and mean root coverage as a primary outcome and gingival recession gain as the secondary outcome. Three articles met the eligibility criteria out of 557 titles. In periodontal surgery, HA exhibited better results in complete root coverage and mean root coverage when compared to the control group. Gingival recession reduction, clinical attachment level, and keratinized tissue gain were significantly increased compared to the control groups. However, the comparison presented in the following study might show heterogeneity among the studies and risk of bias in general. Given the scope of this analysis, results suggest that adjunctive treatment with HA gel for root coverage could be clinically beneficial.
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Affiliation(s)
- Vini Mehta
- Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune 411018, India
| | - Gerta Kaçani
- Department of Prosthetic, Faculty of Dental Medicine, University of Medicine, 1005 Tirana, Albania
| | - Mohammed M. Al Moaleem
- Department of Prosthetic Dental Science, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia
- Faculty of Dentistry, University of Ibn Al-Nafis for Medical Sciences, Sana’a 4337, Yemen
| | | | - Malak Mohammed Alwafi
- College of Dentistry, Taibah University, Al Madinah Al Munawwarah, Medina 41311, Saudi Arabia
| | | | - Shahad Owaidh Alharbi
- College of Dentistry, Taibah University, Al Madinah Al Munawwarah, Medina 41311, Saudi Arabia
| | | | - Etleva Qeli
- Department of Conservative, Faculty of Dental Medicine, University of Medicine, 1005 Tirana, Albania
| | - Çeljana Toti
- Department of Prosthetic, Faculty of Dental Medicine, University of Medicine, 1005 Tirana, Albania
| | - Agron Meto
- Department of Dentistry, University of Aldent, 1007 Tirana, Albania
| | - Luca Fiorillo
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98100 Messina, Italy
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania “Luigi Vanvitelli”, 80121 Naples, Italy
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Tavelli L, Barootchi S, Rodriguez MV, Mancini L, Majzoub J, Travan S, Sugai J, Chan H, Kripfgans O, Wang H, Giannobile WV. Recombinant human platelet-derived growth factor improves root coverage of a collagen matrix for multiple adjacent gingival recessions: A triple-blinded, randomized, placebo-controlled trial. J Clin Periodontol 2022; 49:1169-1184. [PMID: 35871600 PMCID: PMC9796054 DOI: 10.1111/jcpe.13706] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 12/19/2021] [Revised: 07/10/2022] [Accepted: 07/16/2022] [Indexed: 12/30/2022]
Abstract
AIM To evaluate the efficacy of recombinant human platelet-derived growth factor (rhPDGF)-BB combined with a cross-linked collagen matrix (CCM) for the treatment of multiple adjacent gingival recession type 1 defects (MAGRs) in combination with the coronally advanced flap (CAF). MATERIALS AND METHODS Thirty patients were enrolled in this triple-blind, randomized, placebo-controlled trial and treated with either CAF + CCM + rhPDGF, or CAF + CCM + saline. The primary outcome was mean root coverage (mRC) at 6 months. Complete root coverage, gain in gingival thickness (GT), keratinized tissue width, volumetric and ultrasonographic changes, and patient-reported outcome measures were also assessed. Mixed-modelling regression analyses were used for statistical comparisons. RESULTS At 6 months, the mRC of the CCM + rhPDGF and CCM alone groups were 88.25% and 77.72%, respectively (p = .02). A significant gain in GT was consistently observed for both treatment arms, and more so for the patients receiving the matrix containing rhPDGF through time (0.51 vs. 0.80 mm, on average, p = .01). The rhPDGF + CCM treated patients presented greater volume gain, higher soft tissue thickness, and a superior aesthetic score. CONCLUSION rhPDGF enhances the clinical, volumetric, and aesthetic outcomes of MAGRs above the results achieved with CAF + CCM alone (ClinicalTrials.gov NCT04462237).
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Affiliation(s)
- Lorenzo Tavelli
- Department of Oral Medicine, Infection, and Immunity, Division of PeriodontologyHarvard School of Dental MedicineBostonMassachusettsUSA,Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA,Center for clinical Research and evidence synthesis In oral TissuE RegeneratION (CRITERION)BostonMassachusettsUSA
| | - Shayan Barootchi
- Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA,Center for clinical Research and evidence synthesis In oral TissuE RegeneratION (CRITERION)BostonMassachusettsUSA
| | - Maria Vera Rodriguez
- Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA,Postgraduate Periodontics, Division of PeriodonticsColumbia University College of Dental MedicineNew YorkNew YorkUSA
| | - Leonardo Mancini
- Department of Life, Health and Environmental SciencesUniversity of L'AquilaL'AquilaItaly
| | - Jad Majzoub
- Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA
| | - Suncica Travan
- Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA
| | - Jim Sugai
- Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA
| | - Hsun‐Liang Chan
- Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA
| | - Oliver Kripfgans
- Biointerfaces Institute and Department of Biomedical EngineeringCollege of EngineeringAnn ArborMichiganUSA,Department of RadiologyUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Hom‐Lay Wang
- Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA
| | - William V. Giannobile
- Department of Oral Medicine, Infection, and Immunity, Division of PeriodontologyHarvard School of Dental MedicineBostonMassachusettsUSA,Center for clinical Research and evidence synthesis In oral TissuE RegeneratION (CRITERION)BostonMassachusettsUSA
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26
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Barootchi S, Tavelli L, Di Gianfilippo R, Shedden K, Oh TJ, Rasperini G, Neiva R, Giannobile WV, Wang HL. Soft tissue phenotype modification predicts gingival margin long-term (10-year) stability: Longitudinal analysis of six randomized clinical trials. J Clin Periodontol 2022; 49:672-683. [PMID: 35561034 PMCID: PMC9325391 DOI: 10.1111/jcpe.13641] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [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: 01/28/2022] [Revised: 03/27/2022] [Accepted: 04/26/2022] [Indexed: 11/30/2022]
Abstract
Aim To assess the prognostic value of soft tissue phenotype modification following root coverage procedures for predicting the long‐term (10‐year) behaviour of the gingival margin. Materials and Methods Participants from six randomized clinical trials on root coverage procedures at the University of Michigan were re‐invited for a longitudinal evaluation. Clinical measurements were obtained by two calibrated examiners. A data‐driven approach to model selection with Akaike information criterion (AIC) was carried out via multilevel regression analyses and partial regression plotting for changes in the level of the gingival margin over time and interactions with the early (6‐month) results of soft tissue phenotypic modification. Results One‐hundred and fifty‐seven treated sites in 83 patients were re‐assessed at the long‐term recall. AIC‐driven model selection and regression analyses demonstrated that 6‐month keratinized tissue width (KTW) and gingival thickness (GT) influenced the trajectory of the gingival margin similarly in a concave manner; however, GT was the driving determinant that predicted significantly less relapse in the treatments, with stability of the treated gingival margin obtained beyond values of 1.46 mm. Conclusions Among a compliant patient cohort, irrespective of the rendered therapy, the presence of at least 1.5 mm KTW and 1.46 mm GT was correlated with the long‐term stability of the gingival margin.
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Affiliation(s)
- Shayan Barootchi
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA.,Center for Clinical Research and Evidence Synthesis in Oral Tissue Regeneration (CRITERION), Ann Arbor-Boston, Michigan, USA
| | - Lorenzo Tavelli
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA.,Center for Clinical Research and Evidence Synthesis in Oral Tissue Regeneration (CRITERION), Ann Arbor-Boston, Michigan, USA.,Department of Oral Medicine, Infection, and Immunity, School of Dental Medicine, Harvard University, Boston, Michigan, USA
| | - Riccardo Di Gianfilippo
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Kerby Shedden
- Department of Statistics and Biostatistics, University of Michigan, Ann Arbor, Michigan, USA.,Consulting for Statistics, Computing and Analytics Research (CSCAR), University of Michigan Office of Research, Ann Arbor, Michigan, USA.,Rogel Cancer Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Tae-Ju Oh
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Giulio Rasperini
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA.,Department of Biomedical, Surgical and Dental Sciences, Foundation IRCCS Ca' Granda Polyclinic, University of Milan, Milan, Italy
| | - Rodrigo Neiva
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - William V Giannobile
- Department of Oral Medicine, Infection, and Immunity, School of Dental Medicine, Harvard University, Boston, Michigan, USA
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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27
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Quispe-López N, Sánchez-Santos J, Delgado-Gregori J, López-Malla Matute J, López-Valverde N, Zubizarreta-Macho Á, Flores-Fraile J, Gómez-Polo C, Montero J. Double Lateral Sliding Bridge Flap versus Laterally Closed Tunnel for the Treatment of Single Recessions in the Mandibular Anterior Teeth: A Pseudorandomized Clinical Trial. J Clin Med 2022; 11:jcm11102918. [PMID: 35629044 PMCID: PMC9147998 DOI: 10.3390/jcm11102918] [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: 03/29/2022] [Revised: 05/10/2022] [Accepted: 05/20/2022] [Indexed: 11/18/2022] Open
Abstract
(1) Background: This study compared the clinical and esthetic results of the double lateral sliding bridge flap (DLSBF) and the laterally closed tunnel (LCT) techniques, with a subepithelial connective tissue graft (SCTG), for the treatment of single Miller class II-III recessions in the mandibular anterior teeth. (2) Methods: This pseudorandomized clinical trial evaluated 14 patients, 7 of whom were part of the DLSBF + SCTG group, with an average follow-up of 58.7 ± 24.0 months, and 7 of whom were in the LCT + SCTG group, with an average follow-up of 16.7 ± 3.3 months. Clinical and esthetic evaluations of the following parameters were performed and the results for the two groups were compared: gingival recession depth, probing depth, keratinized tissue width, gingival thickness, percentage of root coverage and root coverage esthetic score. (3) Results: After the follow-up period, each technique provided evidence of a reduction in recession depth and clinical attachment level, as well as increased keratinized tissue width and gingival thickness, with statistically significant differences (p < 0.05). The analysis showed that gingival recession depth decreased less in the DLSBF group (4.3 ± 1.2 mm to 0.6 ± 1.1 mm) than it did in the LCT group (4.9 ± 1.1 mm to 0.1 ± 0.4 mm), but no significant difference was found between the two groups. Similarly, a greater reduction in the clinical attachment level parameter was observed in the LCT group, while a greater increase in gingival thickness was observed in the DLSBF group. The presence of scars was the only parameter for which statistically significant differences (p < 0.05) between the two study groups were found. (4) Conclusions: Within the limitations of the study, it indicates that the LCT + SCTG technique may be considered an optimal technique in terms of reducing gingival recession depth, complete root coverage and esthetic results for the treatment of single gingival recessions in the mandibular anterior teeth.
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Affiliation(s)
- Norberto Quispe-López
- Department of Surgery, Faculty of Medicine, Dental Clinic, University of Salamanca, Miguel de Unamuno Campus, 37007 Salamanca, Spain; (Á.Z.-M.); (J.F.-F.); (C.G.-P.); (J.M.)
- Department of Surgery, Salamanca Biomedical Research Institute (IBSAL), University of Salamanca, 37007 Salamanca, Spain;
- Correspondence:
| | - Juan Sánchez-Santos
- Department of Surgery, Implants and Periodontics, Faculty of Health Sciences, Alfonso X El Sabio University, 28691 Madrid, Spain; (J.S.-S.); (J.D.-G.); (J.L.-M.M.)
| | - Joaquín Delgado-Gregori
- Department of Surgery, Implants and Periodontics, Faculty of Health Sciences, Alfonso X El Sabio University, 28691 Madrid, Spain; (J.S.-S.); (J.D.-G.); (J.L.-M.M.)
| | - Joaquín López-Malla Matute
- Department of Surgery, Implants and Periodontics, Faculty of Health Sciences, Alfonso X El Sabio University, 28691 Madrid, Spain; (J.S.-S.); (J.D.-G.); (J.L.-M.M.)
| | - Nansi López-Valverde
- Department of Surgery, Salamanca Biomedical Research Institute (IBSAL), University of Salamanca, 37007 Salamanca, Spain;
| | - Álvaro Zubizarreta-Macho
- Department of Surgery, Faculty of Medicine, Dental Clinic, University of Salamanca, Miguel de Unamuno Campus, 37007 Salamanca, Spain; (Á.Z.-M.); (J.F.-F.); (C.G.-P.); (J.M.)
| | - Javier Flores-Fraile
- Department of Surgery, Faculty of Medicine, Dental Clinic, University of Salamanca, Miguel de Unamuno Campus, 37007 Salamanca, Spain; (Á.Z.-M.); (J.F.-F.); (C.G.-P.); (J.M.)
- Department of Surgery, Salamanca Biomedical Research Institute (IBSAL), University of Salamanca, 37007 Salamanca, Spain;
| | - Cristina Gómez-Polo
- Department of Surgery, Faculty of Medicine, Dental Clinic, University of Salamanca, Miguel de Unamuno Campus, 37007 Salamanca, Spain; (Á.Z.-M.); (J.F.-F.); (C.G.-P.); (J.M.)
| | - Javier Montero
- Department of Surgery, Faculty of Medicine, Dental Clinic, University of Salamanca, Miguel de Unamuno Campus, 37007 Salamanca, Spain; (Á.Z.-M.); (J.F.-F.); (C.G.-P.); (J.M.)
- Department of Surgery, Salamanca Biomedical Research Institute (IBSAL), University of Salamanca, 37007 Salamanca, Spain;
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Sanchez N, Vignoletti F, Sanz-Martin I, Coca A, Nuñez J, Maldonado E, Sanz-Esporrin J, Hernando-Pradíes I, Santamaría S, Herrera D, Garcia-Sanz JA, Sanz M. Cell Therapy Based on Gingiva-Derived Mesenchymal Stem Cells Seeded in a Xenogeneic Collagen Matrix for Root Coverage of RT1 Gingival Lesions: An In Vivo Experimental Study. Int J Mol Sci 2022; 23:ijms23063248. [PMID: 35328670 PMCID: PMC8950013 DOI: 10.3390/ijms23063248] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/12/2022] [Accepted: 03/15/2022] [Indexed: 12/05/2022] Open
Abstract
(1) Background: To investigate the effect of a xenogeneic collagen matrix (CMX) seeded with autologous gingiva-derived mesenchymal cells (GMSCs) when combined with a coronally advanced flap (CAF) in the treatment of localized gingival recession type 1 (RT1). (2) Methods: Dehiscence-type defects were created in seven dogs. GMSCs were isolated, transfected with a vector carrying green fluorescent protein (GFP) and expanded. Once chronified, the defects were randomly treated with (1) CAF plus the combination of CMX and GFP+ GMSCs, (2) CAF plus CMX with autologous fibroblasts, (3) CAF plus CMX and (4) CAF alone. Histological and clinical outcomes at 2- and 6-week healing periods were analyzed and compared among groups. (3) Results: Histologically, the addition of autologous cells to the CMX resulted in reduced inflammation and a variable degree of new cementum/bone formation. CMX plus GMSCs resulted in greater mean recession reduction (1.42; SD = 1.88 mm) and percentage of teeth with recession reduction of ≥2 mm (57%) when compared to the other groups, although these differences were not statistically significant. (4) Conclusions: The histometric and clinical results indicated a positive trend favouring the combination of CMX and GMSCs with the CAF when compared to the groups without cells, although these differences were not statistically significant.
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Affiliation(s)
- Nerea Sanchez
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, School of Dentistry, University Complutense, 28040 Madrid, Spain; (N.S.); (F.V.); (I.S.-M.); (A.C.); (J.N.); (J.S.-E.); (I.H.-P.); (D.H.)
| | - Fabio Vignoletti
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, School of Dentistry, University Complutense, 28040 Madrid, Spain; (N.S.); (F.V.); (I.S.-M.); (A.C.); (J.N.); (J.S.-E.); (I.H.-P.); (D.H.)
| | - Ignacio Sanz-Martin
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, School of Dentistry, University Complutense, 28040 Madrid, Spain; (N.S.); (F.V.); (I.S.-M.); (A.C.); (J.N.); (J.S.-E.); (I.H.-P.); (D.H.)
| | - Alejandro Coca
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, School of Dentistry, University Complutense, 28040 Madrid, Spain; (N.S.); (F.V.); (I.S.-M.); (A.C.); (J.N.); (J.S.-E.); (I.H.-P.); (D.H.)
| | - Javier Nuñez
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, School of Dentistry, University Complutense, 28040 Madrid, Spain; (N.S.); (F.V.); (I.S.-M.); (A.C.); (J.N.); (J.S.-E.); (I.H.-P.); (D.H.)
| | - Estela Maldonado
- Department of Anatomy and Embryology, Faculty of Medicine, University Complutense, 28040 Madrid, Spain;
| | - Javier Sanz-Esporrin
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, School of Dentistry, University Complutense, 28040 Madrid, Spain; (N.S.); (F.V.); (I.S.-M.); (A.C.); (J.N.); (J.S.-E.); (I.H.-P.); (D.H.)
| | - Irene Hernando-Pradíes
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, School of Dentistry, University Complutense, 28040 Madrid, Spain; (N.S.); (F.V.); (I.S.-M.); (A.C.); (J.N.); (J.S.-E.); (I.H.-P.); (D.H.)
| | - Silvia Santamaría
- Margarita Salas Center for Biological Research (CIB-CSIC), 28040 Madrid, Spain; (S.S.); (J.A.G.-S.)
| | - David Herrera
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, School of Dentistry, University Complutense, 28040 Madrid, Spain; (N.S.); (F.V.); (I.S.-M.); (A.C.); (J.N.); (J.S.-E.); (I.H.-P.); (D.H.)
| | - Jose A. Garcia-Sanz
- Margarita Salas Center for Biological Research (CIB-CSIC), 28040 Madrid, Spain; (S.S.); (J.A.G.-S.)
| | - Mariano Sanz
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, School of Dentistry, University Complutense, 28040 Madrid, Spain; (N.S.); (F.V.); (I.S.-M.); (A.C.); (J.N.); (J.S.-E.); (I.H.-P.); (D.H.)
- Correspondence:
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Tazegül K, Doğan ŞB, Ballı U, Dede FÖ, Tayman MA. Growth factor membranes in treatment of multiple gingival recessions: a randomized clinical trial. Quintessence Int 2022; 53:288-297. [PMID: 34881843 DOI: 10.3290/j.qi.b2407765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to assess the clinical effects of concentrated growth factor (CGF) in combination with coronally advanced flap (CAF) compared with platelet rich fibrin (PRF)+CAF for the treatment of multiple adjacent gingival recessions (GRs). METHOD AND MATERIALS 18 subjects with total of 76 Type I GRs in the maxilla were included. Recessions were randomly treated according to a split-mouth design by means of CGF+CAF (39 defects, CGF side), or PRF+CAF (37 defects, PRF side). Clinical outcomes were evaluated at 6 months. RESULTS The mean root coverage was 86.32% and 80.86%, and complete root coverage was 61.53% (24/39) and 51.35% (19/37) for CGF side and PRF side, respectively, at 6 months. Statistically significant gains were observed in the terms of clinical attachment level, recession depth, keratinized gingiva width, gingival thickness, and recession width in the both sides at 6 months compared to baseline values; no statistically significant difference was observed in these parameters between the two sides at 6 months. CONCLUSIONS According to results, the use of CGF+CAF was not superior to PRF+CAF in providing additional benefits in clinical parameters. Keratinized gingiva width and gingival thickness significantly increased with the use of CGF and PRF membranes together with CAF.
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30
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Panda S, Khijmatgar S, Arbildo-Vega H, Das AC, Kumar M, Das M, Mancini L, Del Fabbro M. Stability of biomaterials used in adjunct to coronally advanced flap: A systematic review and network meta-analysis. Clin Exp Dent Res 2021; 8:421-438. [PMID: 34845864 PMCID: PMC8874057 DOI: 10.1002/cre2.461] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/23/2021] [Accepted: 05/05/2021] [Indexed: 12/26/2022] Open
Abstract
AIM The objective of this network meta-analysis was to rank different biomaterials used in adjunct to coronally advanced flap (CAF), based on their performance in root-coverage for Miller's Class I and II gingival recessions. MATERIALS AND METHODS An electronic database search was carried out in PUBMED, CENTRAL, SCOPUS, and EMBASE to identify the eligible articles and compiled into the citation manager to remove the duplicates. The primary outcome was keratinized gingival tissue width (KGW) and percentage of root coverage (%RC). The treatment effect of different biomaterials was estimated using predictive interval plots and ranked based on biomaterials performance, using multidimensional scale ranking. RESULTS CAF + connective tissue graft (CTG), CAF + platelet concentrate matrix (PCM) and acellular dermal matrix (ADM) ranked at the top positions in performance in improving KGW. The highest ranked materials in improving percentage of root coverage in gingival recession were CAF + collagen matrix (CM) + gingival fibroblasts (GF), CAF + ADM + platelet rich plasma (PRP) and CAF + ADM, as compared to CAF alone. CONCLUSION CTG, ADM, platelet concentrates, and CM + GFs, when used in adjunct to CAF, showed improved stability over ≥12 months of follow-up, better percentage of root coverage, and improved keratinized gingival width.
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Affiliation(s)
- Sourav Panda
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha O Anusandhan (Deemed to be) University, Bhubaneswar, Odisha, India.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Shahnawaz Khijmatgar
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.,Department of Oral Biology and Genomic Studies, Nitte (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences, Mangalore, India
| | - Heber Arbildo-Vega
- Department of General Dentistry, Dentistry School, Universidad San Martín de Porres, Chiclayo, Peru
| | - Abhaya Chandra Das
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha O Anusandhan (Deemed to be) University, Bhubaneswar, Odisha, India
| | - Manoj Kumar
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha O Anusandhan (Deemed to be) University, Bhubaneswar, Odisha, India
| | - Mohit Das
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha O Anusandhan (Deemed to be) University, Bhubaneswar, Odisha, India
| | - Leonardo Mancini
- Department of life health and environmental sciences, University of L'Aquila, Italy
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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谢 成, 廖 阳, 童 方, 方 静, 王 勤, 余 慧. [Efficacy of tunnel technique for treatment of gingival recession of upper adjacent teeth with noncarious cervical defect]. Nan Fang Yi Ke Da Xue Xue Bao 2021; 41:1680-1685. [PMID: 34916194 PMCID: PMC8685711 DOI: 10.12122/j.issn.1673-4254.2021.11.12] [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] [Received: 04/08/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate the efficacy of tunnel technique (TUN) in treatment of teeth with adjacent gingival regression (GR) combined with noncarious cervical lesions (NCCL). METHODS We collected data from 21 patients (79 teeth) undergoing TUN surgery for GR combined with NCCL. According to GR depth (GRD) and lesion depth (LD) of NCCL, the teeth were divided into group 1 with GRD≤3 mm and LD≤1 mm; group 2 with GRD≤3 mm and LD>1mm; group 3 with GRD>3 mm and LD≤1 mm; and group 4 with GRD>3 mm and LD>1 mm. The mean root coverage (MRC) rate, complete root coverage (CRC) rate, keratinized gingival width, and keratinized gingival thickness were compared among the 4 groups after TUN surgery. RESULTS The keratinized gingival width and thickness were significantly improved after the surgery in the 4 groups. When the GRD was below 3 mm, the MRC was not significantly different between group 1 and group 2 (8.55% vs 95.45%, P>0.05); When the GRD was beyond 3 mm, the MRC and CRC rates were both decreased in group 3 and group 4, especially in group 4, where the CRC rate (25%) was significantly lower than those in the other 3 groups (P < 0.01). CONCLUSION In patients with GR combined with NCCL, TUN surgery can obviously improve keratinized gingival width and thickness. GRD has a greater effect on the outcome of root coverage than LD, suggesting that NCCL restoration before TUN surgery may not be necessary. Both GRD and LD should be considered in the evaluation of the clinical efficacy of TUN surgery.
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Affiliation(s)
- 成婕 谢
- />南方医科大学口腔医院//广东省口腔医院,广东 广州 510280Stomatology Hospital, Southern Medical University, Guangzhou 510280, China
| | - 阳阳 廖
- />南方医科大学口腔医院//广东省口腔医院,广东 广州 510280Stomatology Hospital, Southern Medical University, Guangzhou 510280, China
| | - 方丽 童
- />南方医科大学口腔医院//广东省口腔医院,广东 广州 510280Stomatology Hospital, Southern Medical University, Guangzhou 510280, China
| | - 静娴 方
- />南方医科大学口腔医院//广东省口腔医院,广东 广州 510280Stomatology Hospital, Southern Medical University, Guangzhou 510280, China
| | - 勤 王
- />南方医科大学口腔医院//广东省口腔医院,广东 广州 510280Stomatology Hospital, Southern Medical University, Guangzhou 510280, China
| | - 慧敏 余
- />南方医科大学口腔医院//广东省口腔医院,广东 广州 510280Stomatology Hospital, Southern Medical University, Guangzhou 510280, China
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Jain KS, Vaish S, Gupta SJ, Sharma N, Khare M, Nair MM. Minimally invasive treatment of gingival recession by vestibular incision subperiosteal tunnel access technique with collagen membrane and advanced platelet-rich fibrin: A 6-month comparative clinical study. J Indian Soc Periodontol 2021; 25:496-503. [PMID: 34898915 PMCID: PMC8603801 DOI: 10.4103/jisp.jisp_590_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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 05/08/2021] [Accepted: 05/09/2021] [Indexed: 11/24/2022] Open
Abstract
AIM The study aimed to assess the minimally invasive Vestibular Incision Subperiosteal Tunnel Access (VISTA) technique for treatment of Millers Class I or Class II buccal gingival recession defects and to compare the effectiveness of a bioresorbable collagen membrane or advanced platelet rich fibrin (A-PRF). METHODS AND MATERIAL 20 sites with Millers Class I or II gingival recession were recruited and allocated into 2 groups with 10 sites each. Group 1: VISTA with A-PRF, Group 2: VISTA with with bioresorbable collagen membrane (Healiguide)®. STANDARDIZED CLINICAL PARAMETERS Plaque Index (PI), Gingival Index (GI), Clinical attachment level (CAL )Pocket Probing Depth (PPD) Recession Height (RH ) and width of keratinized gingiva (WKG) were measured at baseline 3 months and 6 months. RESULTS Both groups showed significant improvement in clinical parameters. However reduction in recession height and mean root coverage percentage was greater in A-PRF group after 6 months. CONCLUSIONS VISTA with both A-PRF and Healiguide showed good clinical outcomes but better results were obtained when A-PRF was used.
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Affiliation(s)
- Kavya Sangal Jain
- Department of Periodontology and Oral Implantology, ITS-Centre for Dental Studies and Research Center, Ghaziabad, Uttar Pradesh, India
| | - Shubhra Vaish
- Department of Periodontology and Oral Implantology, ITS-Centre for Dental Studies and Research Center, Ghaziabad, Uttar Pradesh, India
| | - Swyeta Jain Gupta
- Department of Periodontology and Oral Implantology, ITS-Centre for Dental Studies and Research Center, Ghaziabad, Uttar Pradesh, India
| | - Nikhil Sharma
- Department of Periodontology and Oral Implantology, ITS-Centre for Dental Studies and Research Center, Ghaziabad, Uttar Pradesh, India
| | - Medhavee Khare
- Department of Periodontology and Oral Implantology, ITS-Centre for Dental Studies and Research Center, Ghaziabad, Uttar Pradesh, India
| | - Meera M. Nair
- Department of Periodontology and Oral Implantology, ITS-Centre for Dental Studies and Research Center, Ghaziabad, Uttar Pradesh, India
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Bhatia A, Yadav VS, Tewari N, Kumar A, Sharma RK. Efficacy of modified coronally advanced flap in the treatment of multiple adjacent gingival recessions: a systematic review and meta-analysis. Acta Odontol Scand 2021; 79:562-572. [PMID: 33900132 DOI: 10.1080/00016357.2021.1908594] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE This systematic review (SR) aims to evaluate the efficacy of modified coronally advanced flap (mCAF) on clinical and patient-reported outcomes in the treatment of multiple adjacent gingival recessions (MAGRs). MATERIALS AND METHODS Randomized controlled trials (RCTs), case-series and prospective clinical studies on treatment of Miller class I/II or RT1 MAGRs with ≥ 6 months follow-up were identified from the electronic databases and hand-searched journals. Complete root coverage (CRC) was the primary outcome variable. To evaluate treatment effects, meta-analysis was conducted, wherever appropriate. RESULTS A total of 1395 recessions in 408 patients were evaluated in SR and meta-analysis was performed for four RCTs. Overall CRC achieved with mCAF was 70% and mean root coverage (MRC) ranged from 51.58 to 97.27%. Meta-analysis showed that combination of mCAF with connective tissue graft (CTG) or collagen matrix (CM) demonstrated significantly higher CRC% and recession reduction than mCAF alone. Limited evidence is available to support the use of platelet rich fibrin or enamel matrix derivative or acellular dermal matrix graft along with mCAF to further enhance its efficacy. CONCLUSIONS mCAF is an effective procedure for treating MAGRs and in terms of achieving CRC and MRC. Additional use of CTG or CM further enhances treatment outcomes.
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Affiliation(s)
- Anu Bhatia
- Division of Periodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Vikender Singh Yadav
- Division of Periodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Nitesh Tewari
- Division of Pedodontics and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Kumar
- Department of Periodontics, Dental College, Regional Institute of Medical Sciences, Imphal, India
| | - Rajinder Kumar Sharma
- Department of Periodontics and Implantology, Post Graduate Institute of Dental Sciences, Rohtak, India
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Fernandes GVDO, Santos NBM, Siqueira RACD, Wang HL, Blanco-Carrion J, Fernandes JCH. Autologous Platelet Concentrate of 2 nd and 3 rd generations efficacy in the surgical treatment of gingival recession: an overview of systematic reviews. J Indian Soc Periodontol 2021; 25:463-479. [PMID: 34898911 PMCID: PMC8603797 DOI: 10.4103/jisp.jisp_515_20] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 03/21/2021] [Accepted: 07/21/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Autologous platelet concentrate (APC)/platelet-rich fibrin (PRF) of second and third generations has increased use in periodontics to optimize wound healing. Few systematic reviews (SRs) have reported improved clinical outcomes, while other studies reported significantly better results for the connective tissue graft (CTG). There is still unclear clinical evidence about APC/PRF use to treat gingival recession (GR) defects. Then, the purpose of this SR was to evaluate the use of APC/PRF membranes (2nd and 3rd generations) in root coverage (RC) procedures and assess its efficacy as a substitute biomaterial. MATERIALS AND METHODS An electronic search was conducted in PubMed, Cochrane Central, Web of Science, Google Scholar, BookSC databases, and gray literature. The search strategy, without date restriction up to April 2020, included keywords as "platelet-rich fibrin," "autologous platelet concentrates," "blood," "systematic review," "periodontics," "surgery," "tissue," "gingiva," "gingival recession," "connective tissue," "graft," and "root coverage." The methodological quality was evaluated through the AMSTAR2, and a population, index test, comparator, outcome strategy was used to assess specific clinical parameters such as recession depth, clinical attachment levels, and RC outcomes. RESULTS Nine SRs were included. Only three articles described the technique of APC/PRF production. Three studies reported unfavorable outcomes using APC, while six reported favorable results and postoperative discomfort reduction. Articles included in this SRs that provided information about APC/PRF membranes (n = 13) showed no significant difference between APC/PRF and the control group for the parameters analyzed. CONCLUSIONS This implies that APC/PRF may be considered a feasible substitute biomaterial for treating GR defects, although the CTG still provides superior outcomes. Further long-term and controlled studies are needed to verify this finding.
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Affiliation(s)
- Gustavo Vicentis De Oliveira Fernandes
- Faculty of Dental Medicine at Universidade Católica Portuguesa, Ann Arbor, Michigan, USA,
- Center for Interdisciplinary Research in Health, Institute of Health Sciences, Universidade Católica Portuguesa, Viseu, Portugal
- Department of Periodontics and Oral Medicine at the University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | | | | | - How-Lay Wang
- Department of Periodontics and Oral Medicine at the University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Juan Blanco-Carrion
- Department of Stomatology, Santiago de Compostela University, Santiago De Compostela, Spain
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Kuralt M, Gašperšič R, Fidler A. Methods and parameters for digital evaluation of gingival recession: a critical review. J Dent 2021; 118:103793. [PMID: 34481931 DOI: 10.1016/j.jdent.2021.103793] [Citation(s) in RCA: 4] [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: 05/06/2021] [Revised: 08/14/2021] [Accepted: 08/26/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES The aim of the present review was to find, compare, and critically discuss digital methods for quantitative evaluation of gingival recessions dimensions. DATA Collection of articles and classification related to digital evaluation of gingival recessions. SOURCES A search of PubMed, Web of Science, Scopus, and reference lists of articles was conducted up to April 2021 STUDY SELECTION: Twenty-two articles used digital evaluation of gingival recessions dimensions. The methods in the included articles were extracted, compared, and categorized. RESULTS Digital measurements were performed on 2D intraoral photographs, 3D models, or cross-sections obtained from 3D models. Baseline measurement were performed for diagnostic and treatment planning and categorised into distance and area measurements. Follow-up evaluation of treatment was based either on repeating the "baseline" measurements and calculating differences or measuring differences directly on composite images, composed from two superimposed images obtained at two time-points. Direct measurements were categorised into distance, area, and volume measurements. CONCLUSIONS Digital evaluation predominantly means just digitalization of the established evaluation methods; therefore, increasing measurements accuracy and maintaining comparability with past studies. At present, a large variability of digital evaluation workflow among the included studies renders the comparison among different studies difficult if not impossible. The potential of digital evaluation seems not to have been fully exploited as only a few novel measurements and parameters introduced, i.e., volumetric evaluation of soft tissue dynamics. For reproducible and comparable studies in the future, the research should be aimed at evaluation, optimization and standardization of all phases of the digital evaluation. CLINICAL SIGNIFICANCE Digital evaluation, based on 3D image superimposition is a promising approach as it increases measurements accuracy, maintains compatibility with past studies and simultaneously introduces novel evaluation possibilities.
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Affiliation(s)
- Marko Kuralt
- Department of Restorative Dentistry and Endodontics, University Medical Centre Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Slovenia
| | - Rok Gašperšič
- Department of Oral Medicine and Periodontology, Faculty of Medicine, University of Ljubljana, Slovenia; Department of Oral Medicine and Periodontology, University Medical Centre Ljubljana, Slovenia
| | - Aleš Fidler
- Department of Restorative Dentistry and Endodontics, University Medical Centre Ljubljana, Slovenia; Department of Endodontics and Operative Dentistry, Faculty of Medicine, University of Ljubljana, Slovenia.
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Agroya A, Khanna SS, Chhabra P, Sheth AM, Vattikunta N, Kaur N. Esthetic Root Coverage by Subepithelial Connective Tissue Graft with Management of Repeated Rupture of Palatal Arterial Bleeding: A Rare Case Report. J Pharm Bioallied Sci 2021; 13:S861-S864. [PMID: 34447216 PMCID: PMC8375926 DOI: 10.4103/jpbs.jpbs_550_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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 09/25/2020] [Accepted: 09/27/2020] [Indexed: 11/30/2022] Open
Abstract
Nowadays, patients are much concerned about esthetics of the oro-facial region. Gingival recession is considered as one of the major esthetic problems creating complex situations by compromising oral esthetics. This can be treated successfully by means of several mucogingival surgical procedures which can be used to accomplish satisfactory root coverage without any loss of interdental soft- and hard-tissue height. Grafts are also very useful in such scenarios. Our case reports the connective tissue graft technique used in the treatment of gingival recession. The objective of this case was to evaluate the efficacy of connective tissue graft (CTG) and also to mention the management of complications on the donor site.
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Affiliation(s)
- Archana Agroya
- Department of Periodontics and Implantology, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India
| | - Shilpa Sunil Khanna
- Department of Oral and Maxillofacial Surgery, Sri Ramakrishna Dental College and Hospital, Coimbatore, Tamil Nadu, India
| | - Parul Chhabra
- Department of Periodontics and Implantology, Seema Dental College and Hospital, Rishikesh, Uttarakhand, India
| | | | - Naresh Vattikunta
- Department of Orthodontics and Dentofacial Orthopaedics, Dr's Sudha and Nageswara Rao Siddhartha Institute of Dental Sciences, Vijayawada, Andhra Pradesh, India
| | - Navneet Kaur
- Department of Oral and Maxillofacial Surgery, Guru Nanak Dev Dental College and RI, Sunam, Punjab, India
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Tunkel J, Hofmann F, de Stavola L. The multiple pedicle coronally advanced flap for multiple deep Miller-Class-II-recessions: A case report. Clin Adv Periodontics 2021; 11:176-182. [PMID: 34250744 DOI: 10.1002/cap.10177] [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: 05/19/2021] [Accepted: 06/26/2021] [Indexed: 11/09/2022]
Abstract
INTRODUCTION In recent years, several methods have been described for the treatment of deep Miller-Class-II-recessions. Most of these techniques concentrate on single recessions or one deep recession accompanied by just slight neighboring root denudations. A modified technique is presented for treating two or more deep recessions beyond the mucogingival margin combining a subepithelial connective tissue graft (SCTG), enamel matrix derivative, and a multiple pedicle coronally advanced flap. To the best of our knowledge, this is the first report to describe the treatment of multiple deep Miller-Class-II-recessions exceeding beyond the mucogingival junction using a pedicled advanced flap. CASE PRESENTATION A 29-year-old woman was referred to the periodontal practice of JT for the treatment of progressive deep Miller-Class-II-recessions. The root coverage procedure was performed by a modified multiple pedicle flap combined with a connective tissue graft harvested from the palate and enamel matrix derivative. The case was followed up for 2 years. CONCLUSIONS This modified technique of a multiple pedicled flap is a feasible and useful method for treating several deep neighboring recessions. Due to the improved incision techniques, scar tissue formation might be reduced not to interfere with the esthetic result.
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Martin-Cabezas R, Deschamps-Lenhardt S, Huck O. Optimization of connective tissue graft length by graft splitting: A case series. Clin Adv Periodontics 2021; 11:165-170. [PMID: 34231331 DOI: 10.1002/cap.10175] [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: 09/07/2020] [Accepted: 06/30/2021] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The aim of this case series was to assess the feasibility of a graft modification to increase its length when treating multiple adjacent gingival recessions with only one harvesting site at the palate and respecting the safety zone. CASE SERIES Nineteen recessions were treated in four consecutive patients with a modified coronally advanced tunnel and a modified connective tissue graft. An 8-mm height connective tissue graft was harvested by the single-incision technique, the graft was split longitudinally, achieving 4-mm height and double the length. Changes in recession depth, keratinized tissue height, mean and complete root coverage, and esthetic score were analyzed at 6 months. The technique allows to harvest a connective tissue graft up to 58-mm length with a single palatal site. Complete root coverage was achieved in 15/19 recessions (78.94%), with a mean root coverage of 82.90%. The mean recession depth was reduced by 1.31 mm and the keratinized tissue increased by 0.69 mm. The esthetic outcome score was 9.26/10. CONCLUSION This graft modification technique allows increasing significantly the graft length up to 58 mm without any modification of the surgical harvesting procedure. Therefore, it can be suggested to reduce the morbidity.
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Affiliation(s)
| | | | - Olivier Huck
- Department of Periodontology, Dental Faculty, University of Strasbourg, Strasbourg, France
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Rajeswari SR, Triveni MG, Kumar ABT, Ravishankar PL, Rajula MPB, Almeida L. Patient-centered comparative outcome analysis of platelet-rich fibrin-reinforced vestibular incision subperiosteal tunnel access technique and Zucchelli's technique. J Indian Soc Periodontol 2021; 25:320-329. [PMID: 34393403 PMCID: PMC8336766 DOI: 10.4103/jisp.jisp_187_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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 01/26/2021] [Accepted: 03/07/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Multiple gingival recession (MGR) coverage, especially in esthetic area, demands a high patient satisfaction. Coronally advanced flap modifications, namely Zucchelli's technique (ZT) and vestibular incision subperiosteal tunnel access (VISTA), are techniques, recommended in the correction of MGR. Aim: The purpose was to comparatively analyze the ZT and VISTA technique reinforced with the platelet-rich fibrin membrane in the management of MGR. Materials and Methods: This split-mouth, randomized study comprised 16 consenting, systemically healthy participants. The bilateral Miller's multiple class I and II lesions were managed with ZT and VISTA technique and had a follow-up period of 18 months. Gingival thickness (GT), mean percentage of root coverage, and patient-centered outcome scales, including patient comfort score, patient esthetic score, and hypersensitivity score, were the primary outcome measures. Further clinical parameters assessed were gingival index, probing depth, clinical attachment level, and width of keratinized gingiva. Statistical Analysis and Results: Paired t-test and unpaired t-test were used for intragroup comparison and intergroup analysis, respectively. While both the techniques exhibited high root coverage percentage (VISTA: 93.95% and ZT: 96.84%), statistically significant difference was noted with patient esthetic score and surgical mortality score in VISTA. Conclusion: Both ZT and VISTA were effective in terms of root coverage and GT augmentation in MGR management. From the patient's perspective, they preferred VISTA technique over ZT, stating its minimal postoperative morbidity and improved esthetic outcome. Hence, within the limitations of this study, the VISTA technique was found to be a superior alternative compared to that of ZT in MGR management.
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Affiliation(s)
- S Raja Rajeswari
- Department of Periodontics, SRM Kattankulathur Dental College, SRM Institute of Science and Technology, SRM Nagar, Kattankulathur, Kanchipuram, Chennai, TN, India
| | - M G Triveni
- Department of Periodontics, Bapuji Dental College and Hospital, Davanagere, Karnataka, India
| | - A B Tarun Kumar
- Department of Periodontics, Bapuji Dental College and Hospital, Davanagere, Karnataka, India
| | - P L Ravishankar
- Department of Periodontics, SRM Kattankulathur Dental College, SRM Institute of Science and Technology, SRM Nagar, Kattankulathur, Kanchipuram, Chennai, TN, India
| | - M Prem Blaisie Rajula
- Department of Periodontics, SRM Kattankulathur Dental College, SRM Institute of Science and Technology, SRM Nagar, Kattankulathur, Kanchipuram, Chennai, TN, India
| | - Lydia Almeida
- Department of Periodontics, Bapuji Dental College and Hospital, Davanagere, Karnataka, India
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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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Tonetti MS, Cortellini P, Bonaccini D, Deng K, Cairo F, Allegri M, Conforti G, Graziani F, Guerrero A, Halben J, Malet J, Rasperini G, Topoll H. Autologous connective tissue graft or xenogenic collagen matrix with coronally advanced flaps for coverage of multiple adjacent gingival recession. 36-month follow-up of a randomized multicentre trial. J Clin Periodontol 2021; 48:962-969. [PMID: 33817812 DOI: 10.1111/jcpe.13466] [Citation(s) in RCA: 4] [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: 01/18/2021] [Revised: 02/22/2021] [Accepted: 03/19/2021] [Indexed: 11/26/2022]
Abstract
AIM To report the 36-month follow-up of a trial comparing the adjunct of a xenogenic collagen matrix (CMX) or connective tissue graft (CTG) to coronally advanced flaps (CAF) for coverage of multiple adjacent recessions. MATERIAL AND METHODS 125 subjects (61 CMX) with 307 recessions in 8 centres from the parent trial were followed-up for 36 months. Primary outcome was change in position of the gingival margin. Multilevel analysis used centre, subject and tooth as levels and baseline parameters as covariates. RESULTS No differences were observed between the randomized and the follow-up population. Average baseline recession was 2.6 ± 1.0 mm. 3-year root coverage was 1.5 ± 1.5 mm for CMX and 2.0 ± 1.0 mm for CTG (difference of 0.32 mm, 95% CI from -0.02 to 0.65 mm). The upper limit of the confidence interval was over the non-inferiority margin of 0.25 mm. No treatment differences in position of the gingival margin were observed between 6- and 36-month follow-up (difference 0.06 mm, 95% CI -0.17 to 0.29 mm). CONCLUSION CMX was not non-inferior with respect to CTG in multiple adjacent recessions. No differences in stability of root coverage were observed between groups and in changes from 6 to 36 months. Previously reported shorter time to recovery, lower morbidity and more natural appearance of tissue texture and contour observed for CMX in this trial are also relevant in clinical decision-making.
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Affiliation(s)
- Maurizio S Tonetti
- Department of Oral and Maxillofacial Implantology, Shanghai Key Laboratory of Stomatology, National Clinical Research Centre for Stomatology, Shanghai Ninth People Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,European Research Group on Periodontology, Genova, Italy
| | | | | | - Ke Deng
- Division of Periodontology and Implant Dentistry, Hong Kong University, Hong Kong, China
| | - Francesco Cairo
- European Research Group on Periodontology, Genova, Italy.,Unit of Periodontology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Mario Allegri
- European Research Group on Periodontology, Genova, Italy
| | | | - Filippo Graziani
- European Research Group on Periodontology, Genova, Italy.,Department of Periodontology, University of Pisa, Pisa, Italy
| | | | - Jan Halben
- European Research Group on Periodontology, Genova, Italy
| | - Jacques Malet
- European Research Group on Periodontology, Genova, Italy.,U.F.R. of Odontology, Paris 5 - Descartes University Paris, Paris, France
| | - Giulio Rasperini
- European Research Group on Periodontology, Genova, Italy.,Department of Biomedical, Surgical and Dental Sciences, University of Milano, Milan, Italy
| | - Heinz Topoll
- European Research Group on Periodontology, Genova, Italy
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Bakhishov H, Isler SC, Bozyel B, Yıldırım B, Tekindal MA, Ozdemir B. De-epithelialized gingival graft versus subepithelial connective tissue graft in the treatment of multiple adjacent gingival recessions using the tunnel technique: 1-year results of a randomized clinical trial. J Clin Periodontol 2021; 48:970-983. [PMID: 33751615 DOI: 10.1111/jcpe.13452] [Citation(s) in RCA: 4] [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: 03/29/2020] [Revised: 02/14/2021] [Accepted: 02/24/2021] [Indexed: 11/27/2022]
Abstract
AIM To compare the clinical efficacy and postoperative morbidity of de-epithelialized gingival graft (DGG) with subepithelial connective tissue graft (SCTG) on treatment of multiple adjacent gingival recessions (MAGRs) with tunnel technique (TUN) and to evaluate histological characteristics of the palatal grafts. MATERIALS AND METHODS Twenty-seven patients with MAGRs affecting at least 2 adjacent teeth were treated with either DGG + TUN or SCTG + TUN. Recession depth(RD) and width(RW), probing depth(PD), clinical attachment level(CAL), keratinized tissue height(KTH), gingival thickness(GT), and complete and mean root coverage(CRC, MRC) were evaluated at 6 and 12 months postoperatively. Multilevel analysis was performed to identify patient- and tooth/site-related predictors for the 12-month MRC outcomes. Postoperative patient morbidity and histological characteristics of palatal graft samples obtained during harvesting were investigated. RESULTS At the 12-month follow-up, MRC was 91.72% ± 16.59% and 84.72% ± 19.72% in DGG + TUN and SCTG + TUN groups (p = .001). Multilevel regression analysis identified RD, KTH and GT as variables associated with MRC. No significant difference between the groups was observed regarding postoperative patient morbidity parameters. Cellularity was found significantly higher in the SCTG samples compared to the DGG samples (p < .05). CONCLUSIONS Although DGG + TUN presented higher MRC and CRC compared to SCTG + TUN in the treatment of MAGRs, treatment method was not a significant predictive factor for the amount of MRC outcomes while RD, KTH and GT were significant predictive factors.
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Affiliation(s)
- Hikmat Bakhishov
- Department of Periodontology, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Sila Cagri Isler
- Department of Periodontology, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Bejna Bozyel
- Department of Periodontology, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Benay Yıldırım
- Department of Oral Pathology, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Mustafa Agah Tekindal
- Faculty of Medicine Deparment of Biostatistics, Izmir Katip Celebi Universitesi, İzmir, Turkey
| | - Burcu Ozdemir
- Department of Periodontology, Faculty of Dentistry, Gazi University, Ankara, Turkey
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43
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Sebaoun A, Meir H, Slutzkey GS, Nemcovsky CE, Beitlitum I. Effect of root surface conditioning on gingival recession coverage with a connective tissue graft. A retrospective comparative study of three different agents. J ESTHET RESTOR DENT 2021; 33:679-684. [PMID: 33817964 DOI: 10.1111/jerd.12730] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 03/20/2021] [Accepted: 03/25/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Different root modifiers have been proposed in the literature with an attempt to improve the healing process and the success rate of root coverage procedures. The aim of the present retrospective study was to evaluate the effect of three different types of root surface conditioning, namely, tetracycline (TTC), ethylene-di-amino-tetra-acetic acid (EDTA) and saline, on the outcome of root coverage procedures applying the same surgical technique. MATERIALS AND METHODS Twenty-nine patients with 60 Classes I, II, or III recession defects were treated using connective tissue with a partial-thickness double-pedicle graft. In 21 recession defects root surface was treated with TTC and, in other 21, with EDTA, while in the remaining, saline solution was applied. Statistical analysis consisted of descriptive statistics and Kruskal-Wallis, Mann-Whitney, and chi-square tests. RESULTS Differences between pre- and postoperative values were statistically significant only within but not between groups. Mean root coverage was 73.25%, 69.19%, and 82.17% in the TTC, the EDTA, and the saline groups, respectively. The study revealed no statistically significant differences for all evaluated parameters between groups. CONCLUSION Within the limits of this study, root conditioning, prior to root coverage procedures, does not significantly affect their outcome. CLINICAL SIGNIFICANCE Clinical outcome of root coverage procedures is not related to the type of root surface conditioning.
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Affiliation(s)
- Alon Sebaoun
- Department of Periodontology and Dental Implantology, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haya Meir
- Department of Periodontology and Dental Implantology, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil S Slutzkey
- Department of Periodontology and Dental Implantology, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Carlos E Nemcovsky
- Department of Periodontology and Dental Implantology, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilan Beitlitum
- Department of Periodontology and Dental Implantology, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
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Clark-Perry D, Mikitanov S I, Levin L. Do root coverage procedures affect the longevity of teeth? A systematic review. Quintessence Int 2021; 52:284-291. [PMID: 33655740 DOI: 10.3290/j.qi.b967613] [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: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to systematically review the literature regarding the effect of root coverage procedures on tooth survival and periodontal outcomes. DATA SOURCES A systematic search of the literature was performed according to the PRISMA guidelines. A PICO-based search strategy was performed in six databases. Eligibility criteria included studies comparing tooth survival and periodontal outcomes of teeth treated with root coverage procedures versus teeth that had no treatment. The search resulted in 3,646 articles; 212 articles were downloaded for review, and six articles (three studies) were included. Only a single study reported on tooth survival and found no difference between teeth that underwent root coverage procedures versus those that did not. Although the surgeries described in each study were mostly successful in reducing recession and increasing keratinized gingiva, teeth which did not undergo surgery did not seem to have a clinically significant change in recession. The study with the longest follow-up (18 to 35 years) showed an average increase in recession of 0.5 ± 0.9 mm and a decrease in keratinized tissue of 0.3 ± 0.8 mm in the control group. CONCLUSION This systematic review highlights the need for randomized controlled trials to assess the influence of root coverage surgeries on tooth longevity in order to better inform evidence-based practice. When compared to no surgical intervention, there is presently no evidence to suggest that root coverage surgeries increase tooth longevity. Furthermore, the amount of recession does not appear to increase a clinically significant amount over time without surgical intervention in the presence of proper maintenance and home care.
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Agrawal E, Chopra R, Sharma N. Treatment of lingual gingival recession on mandibular lateral incisor using minimally invasive full-thickness tunneling technique and subepithelial palatal connective tissue graft. J Indian Soc Periodontol 2021; 25:78-82. [PMID: 33642747 PMCID: PMC7904009 DOI: 10.4103/jisp.jisp_91_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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/14/2020] [Accepted: 05/29/2020] [Indexed: 12/03/2022] Open
Abstract
Gingival recession on the lingual aspect of teeth may cause dentinal hypersensitivity problems in patients. Treatment of such recessions is not a regular procedure owing to its anatomical restraints, difficulty in isolation as well as lack of esthetic importance. The present case describes the use of connective tissue graft (CTG) in the treatment of isolated lingual recession on mandibular lateral incisor using minimally invasive tunneling technique. Six-month posttreatment follow-up showed a root coverage of 3.5 mm with enhanced width of keratinized tissue. This report encourages the application of CTG along with tunneling technique in the treatment of lingual recession to achieve root coverage as well as alleviate patient's dentinal hypersensitivity issues.
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Affiliation(s)
- Eiti Agrawal
- Department of Periodontology and Implantology, ITS - Centre for Dental Studies and Research, Ghaziabad, Uttar Pradesh, India
| | - Rahul Chopra
- Department of Periodontology and Implantology, ITS - Centre for Dental Studies and Research, Ghaziabad, Uttar Pradesh, India
| | - Nikhil Sharma
- Department of Periodontology and Implantology, ITS - Centre for Dental Studies and Research, Ghaziabad, Uttar Pradesh, India
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Shirakata Y, Nakamura T, Kawakami Y, Imafuji T, Shinohara Y, Noguchi K, Sculean A. Healing of buccal gingival recessions following treatment with coronally advanced flap alone or combined with a cross-linked hyaluronic acid gel. An experimental study in dogs. J Clin Periodontol 2021; 48:570-580. [PMID: 33513277 PMCID: PMC8248173 DOI: 10.1111/jcpe.13433] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 09/10/2020] [Revised: 12/14/2020] [Accepted: 01/22/2021] [Indexed: 01/13/2023]
Abstract
Aim To clinically and histologically evaluate in dogs the healing of gingival recessions treated with coronally advanced flap (CAF) with or without cross‐linked hyaluronic acid (HA). Materials and methods Gingival recession defects were surgically created on the vestibular side of both maxillary canines in 8 dogs. After 8 weeks of plaque accumulation, the 16 chronic defects were randomly treated with either CAF alone or CAF and HA‐gel (CAF/HA). Clinical and histological outcomes were evaluated at 10 weeks post‐surgically. Results Compared to baseline, the clinical measurements at 10 weeks revealed a statistically significant decrease in gingival recession for both CAF (p < 0.01) and CAF/HA (p < 0.001) groups. Statistically significant differences were found in clinical attachment level (p < 0.05) and width of gingival recession (p < 0.01) favouring the CAF/HA group. Bone formation was statistically significantly greater in the CAF/HA group than in the CAF group (1.84 ± 1.16 mm vs., 0.72 ± 0.62 mm, respectively, p < 0.05). Formation of cementum and connective tissue attachment were statistically significantly higher in the CAF/HA group compared with the CAF group (i.e. 4.31 ± 1.78 mm versus 2.40 ± 1.35 mm and 1.69 ± 0.98 mm versus 0.74 ± 0.68 mm, respectively (p < 0.05)). Conclusions The present data have for the first time provided histologic evidence for periodontal regeneration of gingival recession defects following treatment with CAF and HA. Clinical relevance The use of HA in conjunction with CAF may represent a novel modality for treating gingival recession defects.
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Affiliation(s)
- Yoshinori Shirakata
- Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Toshiaki Nakamura
- Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yoshiko Kawakami
- Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Takatomo Imafuji
- Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yukiya Shinohara
- Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kazuyuki Noguchi
- Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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Bertl K, Spineli LM, Mohandis K, Stavropoulos A. Root coverage stability: A systematic overview of controlled clinical trials with at least 5 years of follow-up. Clin Exp Dent Res 2021; 7:692-710. [PMID: 33565266 PMCID: PMC8543486 DOI: 10.1002/cre2.395] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 12/18/2020] [Indexed: 12/25/2022] Open
Abstract
Objectives To systematically assess the long‐term outcome (≥5 years) of root coverage procedures reported in controlled clinical trials. Material and Methods Literature search was performed according to the PRISMA guidelines with the following eligibility criteria: (a) English or German language; (b) controlled (CT) or randomised controlled clinical trials (RCT); (c) root coverage procedure with ≥5 years follow‐up; and (d) clinical treatment effect size and/or patient‐related outcome measures (PROMs) reported. Results Four CT and 14 RCT with a follow‐up of 5–20 years fulfilled the eligibility criteria; sample size per study ranged from 8 to 70 patients contributing with 18–149 sites. Coronally advanced flap (CAF) and CAF + connective tissue graft (CTG) were the prevalent treatments (i.e., in 24 and 38% of the groups, respectively), while other flap designs and adjuncts (i.e., enamel matrix derivative, bone graft, collagen membrane) were represented only once. For single Miller class I/II gingival recessions (GR), CAF + CTG appeared advantageous compared to other techniques, and provided low residual recession depths (i.e., ≤0.5 mm), and complete root coverage in ≥2/3 of the patients; similar tendency was observed for multiple GR. No data on Miller class III/IV GR is available. No meta‐analysis was feasible due to lack of similarity in the clinical and methodological characteristics across the trials and observed comparisons of interventions. Conclusions CAF + CTG appears to be the ‘gold standard’ technique for the treatment of single and multiple Miller class I/II GR also in regard to long‐term (i.e., ≥5 years of follow‐up) treatment outcomes. There is little information regarding the performance, on the long‐term, of other techniques and adjuncts.
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Affiliation(s)
- Kristina Bertl
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden.,Division of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Loukia M Spineli
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Khalid Mohandis
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden
| | - Andreas Stavropoulos
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden.,Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria.,Division of Regenerative Dentistry and Periodontology, University Clinics of Dental Medicine (CUMD), University of Geneva, Geneva, Switzerland
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48
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Mancini L, Tarallo F, Quinzi V, Fratini A, Mummolo S, Marchetti E. Platelet-Rich Fibrin in Single and Multiple Coronally Advanced Flap for Type 1 Recession: An Updated Systematic Review and Meta-Analysis. ACTA ACUST UNITED AC 2021; 57:medicina57020144. [PMID: 33562581 PMCID: PMC7915928 DOI: 10.3390/medicina57020144] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 01/25/2021] [Accepted: 02/02/2021] [Indexed: 12/23/2022]
Abstract
Background and Objectives: The aim of the present systematic review and meta-analysis was to investigate the efficacy of leukocyte–platelet-rich fibrin (L-PRF) in addition to coronally advanced flap (CAF) for the treatment of both single and multiple gingival recessions (GRs) compared to the CAF alone and to the adjunct of connective tissue graft (CTG). Root coverage outcomes using platelet concentrates have gained increased interest. In particular, it has been suggested that adding L-PRF to CAF may provide further benefits in the treatment of GRs. Materials and Methods: An electronic and manual literature search was conducted to identify randomized controlled trials (RTCs) investigating root coverage outcomes with CAF + L-PRF. The outcomes of interest included mean root coverage (mRC), recession reduction, keratinized tissue width (KTW) gain, gingival thickness (GT) gain, and patient-reported outcome measures (PROms) such as pain perception and discomfort. Results: A total of 275 patients and 611 surgical sites were analyzed. L-PRF in adjunct to single CAF seems to show statistically significant results regarding clinical attachment level (CAL) with a weighted means (WM) 0.43 95% CI (−0.04, 0.91), p < 0.0001, GT (WM 0.17 95% CI (−0.02, 0.36), p < 0.0001, and mRC (WM 13.95 95% CI (−1.99, 29.88) p < 0.0001, compared to single CAF alone. Interesting results were obtained from the adjunct of PRF to multiple CAF with respect to multiple CAF alone with an increase in the mRC WM 0.07 95% CI (−30.22, 30.35), p = 0.0001, and PPD change WM 0.26 95% CI (−0.06, 0.58), p < 00001. On the other hand, no statistically significant data were obtained when L-PRF was added to single or multiple CAF combined with CTG according to the included outcomes such as mRC (p = 0.03 overall). Conclusions: L-PRF is a valid alternative to CAF alone. L-PRF compared to CTG in single and multiple CAF showed statistically significant results regarding pain perception and discomfort PROms (p < 0.0001). However, CTG remains the gold standard for treating gingival recession.
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Cardoso MV, Lara VS, Sant'Ana ACP, Damante CA, Ragghianti Zangrando MS. Late complications after root coverage with two types of subepithelial connective tissue grafts, clinical and histopathological evaluation: A prospective cohort study. J Clin Periodontol 2021; 48:431-440. [PMID: 33340153 DOI: 10.1111/jcpe.13413] [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: 06/25/2020] [Revised: 12/07/2020] [Accepted: 12/12/2020] [Indexed: 01/15/2023]
Abstract
AIM This prospective cohort study evaluated late complications (LC) on recipient sites comparing two types of connective tissue grafts (CTG). MATERIALS AND METHODS Participants (n: 60) were treated with coronally advanced flap (CAF) plus CTG harvested by de-epithelialized technique (DE) (n:31) or two-parallel incision (PI) (n:29). Areas were evaluated to identify white discharge associated or not with gingival cul-de-sac. Patients were ordered in groups with (DE+and PI+) or without (DE- and PI-) LC. Biopsies for histopathological analysis in LC areas were proposed. RESULTS Six cases exhibited LC, 5 in DE graft (DE+) and 1 in PI graft (PI+) group; 2 were diagnosed at 3 months postoperatively, 3 at 6 months and one at 12 months. The relative risk for LC was 1.7 times greater for DE graft (p: 0.01; CI: 1.10 to 2.72; RR>1). Differences were not observed for clinical outcomes after both types of CTGs (p > 0.05). Biopsies showed deep invagination of the epithelial lining suggesting cyst-like area/ cavity with keratin content and consolidated in fibrous connective tissue. After 24 months biopsied areas presented no recurrence of LC, in non-biopsied patients the clinical condition remained unchanged. CONCLUSIONS Considering the limitations of this study, LC on recipient sites demonstrated no statistical difference between two types of CTG.
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Affiliation(s)
- Matheus Völz Cardoso
- Discipline of Periodontics, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - Vanessa Soares Lara
- Discipline of Pathology and Oral Pathology, Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | | | - Carla Andreotti Damante
- Discipline of Periodontics, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
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50
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Poornima R, Meena A. Contemporary minimally invasive VISTA approach for gingival recession coverage: a case series. Gen Dent 2021; 69:58-61. [PMID: 33350957] [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: 06/12/2023]
Abstract
Gingival recession is a common problem that requires periodontal surgery to restore esthetics. The vestibular incision subperiosteal tunnel access (VISTA) technique is a minimally invasive recession coverage method that has gained popularity. This case series reviews the treatment outcomes in 10 patients with a total of 28 Miller Class I or Class II recession defects in the maxillary anterior region. The defects were treated with the VISTA technique alone without any grafting material. The clinical parameters measured at baseline and at 3- and 6-month follow-up examinations were probing depth, clinical attachment level, Gingival Index, width and thickness of attached gingiva, and height of gingival recession. Statistical analysis (repeated-measures analysis of variance with a post hoc Bonferroni test) revealed that all clinical parameters except probing depth and thickness of attached gingiva showed statistically significant improvement from baseline to the follow-up examinations (P < 0.001). A mean root coverage of 78.99% was achieved. Even when performed without any grafting material, the VISTA technique is a reliable method to obtain recession coverage in the maxillary anterior region.
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