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Tommasato G, Del Fabbro M, Oliva N, Khijmatgar S, Grusovin MG, Sculean A, Canullo L. Autogenous graft versus collagen matrices for peri-implant soft tissue augmentation. A systematic review and network meta-analysis. Clin Oral Investig 2024; 28:300. [PMID: 38704784 DOI: 10.1007/s00784-024-05684-5] [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: 11/20/2023] [Accepted: 04/24/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE The primary objective of this review is to compare autogenous soft tissue grafts (connective tissue graft - CTG and free gingival graft-FGG) with different type of matrices (acellular dermal matrix-ADM, xenograft collagen matrix-XCM, volume-stable collagen matrix-VCMX) used to increase peri-implant soft tissues. MATERIALS AND METHODS A search on electronic databases was performed to identify randomized and non-randomized controlled trials (RCTs and CCTs, respectively) with either parallel or split-mouth design, and treating ≥ 10 patients. A network meta-analysis (NMA) was used to compare different matrices. Soft tissue thickness dimensional changes and keratinized width (KMW) changes were the primary outcome measures. The secondary outcomes were to evaluate: a) PROMs; b) volumetric changes; c) surgical operating time; and d) different periodontal measurements. RESULTS A total of 23 studies were included in the qualitative analysis, and 16 studies (11 RCTs and 5 CCTs) in the quantitative analysis. A total of N = 573 sites were evaluated for NMA. CTG resulted the best material for increasing peri-implant soft tissue thickness, at 180 and 360 days after surgery. The use of an ADM showed good results for buccal thickness increase, primarily in the first three months after surgery. Vestibuloplasty + FGG resulted in the most effective technique for peri-implant KMW augmentation, after 180 days. CONCLUSIONS While CTG demonstrated better performance in all the comparison and FGG showed to be the best graft to increase keratinized mucosa up to 90 days, ADM and VCMX may be used to increase soft tissue horizontal thickness with lower patients' morbidity. LIMITATIONS The limits of this NMA are the following: a) limited number of included studies; b) high heterogeneity among them (number of patients, treatment sites, surgical techniques, outcome measures, and follow-ups). CLINICAL RELEVANCE Many studies compared the efficacy of autogenous and non-autogenous grafts in terms of gingival thickness, volume, and keratinized width increase. However, there is still not clear overall evidence on this topic. This NMA helps clinicians to choose the right material in different peri-implant soft tissue procedures. Recommendations for future studies are mandatory.
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Affiliation(s)
- Grazia Tommasato
- Department of Biomedical, Surgical and Dental Sciences, Università Degli Studi Di Milano, Milan, Italy.
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, Università Degli Studi Di Milano, Milan, Italy
| | - Nadim Oliva
- Department of Biomedical, Surgical and Dental Sciences, Università Degli Studi Di Milano, Milan, Italy
| | - Shahnawaz Khijmatgar
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Policlinico of Milan (Policlinico Di Milano Ospedale Maggiore | Fondazione IRCCS Ca' Granda), Milan, Italy.
| | | | - Anton Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Luigi Canullo
- Department of Surgical Sciences (DISC), Division of Prosthodontics and Implant Prosthodontics, University of Genoa, Rome, Italy
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Kassis J, Aboud ME. The Effect of Connective Tissue Graft Compared to Concentrated Growth Factor Graft on Buccal Peri-Implant Gingival Thickness: A 12-month Randomized Controlled Clinical Trial. J Oral Maxillofac Surg 2024; 82:563-571. [PMID: 38432641 DOI: 10.1016/j.joms.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Attached gingival phenotype has a crucial impact on the implant's durability and its future success. PURPOSE This study aims to measure and compare buccal peri-implant gingival thickness following grafting with connective tissue graft (CTG) and the concentrated growth factor (CGF) graft. STUDY DESIGN, SETTING, SAMPLE This is a split-mouth designed randomized controlled clinical study in which a total of 20 aged 18 to 55 have bilateral missing teeth in the maxillary premolar region with less than 2 mm of healthy peri-implant gingival thickness. Patients were excluded if they were smokers, had poor oral hygiene, had uncontrolled widespread periodontal disease, or had a history of radiation treatment. The same surgical protocol was followed for each study participant, where an independent blinded medical practitioner assigned the first stage side to be treated with CTG, while the second stage side with CGF 2 weeks later. EXPOSURE VARIABLE The primary exposure variable of this study was the gingival grafting technique; CTG or CGF. OUTCOME VARIABLE The primary outcome variable was the buccal peri-implant gingival thickness. Gingival thickness was measured at six different times; immediately before the procedure (T0), after 30 days (T1), after 45 days (T2), after 3 months (T3), after 6 months (T4), and after 12 months (T5). COVARIATES The covariates were age, sex general health, and periodontal status. ANALYSIS The statistical analysis; repeated measures analysis of variance test was used to compare the gingival thickness between the studied follow-up times within each group. The level of significance was set at ≤ 0.05. RESULTS The sample was composed of 40 treatment sites of 20 patients. The mean age of the sample was 32 years and 45% were male. The mean gingival thickness value of the CTG group was 1.62 mm with a (standard deviation = 0.18) compared to 1.28 mm for the CGF group with (standard deviation = 0.20) and an overall P value (0.001) at T5. CONCLUSIONS AND RELEVANCE CTG showed to have better gingival thickness than CGF in managing peri-implant buccal gingival thickness deficiency.
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Affiliation(s)
- Joul Kassis
- Researcher at the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Damascus University, Damascus, Syria.
| | - Magd Esber Aboud
- Implantologist at the Department of Implantology, The National Dental Center of Syrian Board and Specialization, Damascus, Syria
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Lim HC, Strauss FJ, Shin SI, Jung RE, Jung UW, Thoma DS. Augmentation of keratinized tissue using autogenous soft-tissue grafts and collagen-based soft-tissue substitutes at teeth and dental implants: Histological findings in a pilot pre-clinical study. J Clin Periodontol 2024; 51:665-677. [PMID: 38268024 DOI: 10.1111/jcpe.13949] [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: 10/11/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 01/26/2024]
Abstract
AIM To histomorphometrically assess three treatment modalities for gaining keratinized tissue (KT) at teeth and at dental implants. MATERIALS AND METHODS In five dogs, the distal roots of the mandibular second, third and fourth premolars were extracted. Dental implants were placed at the distal root areas 2 months later. After another 2 months, KT augmentation was performed at both distal (implants) and at mesial root (teeth) areas in the presence (wKT groups) or absence (w/oKT groups) of a KT band at the mucosal/gingival level. Three treatment modalities were applied randomly: apically positioned flap only (APF), free gingival grafts (FGGs) and xenogeneic collagen matrices (XCMs). A combination of the above produced six groups. Two months later, tissue sections were harvested and analysed histomorphometrically. RESULTS The median KT height and length were greatest at implants with FGG in both wKT (3.7 and 5.1 mm, respectively) and w/oKT groups (3.7 and 4.6 mm), and at teeth with FGG in wKT groups (3.7 and 6.1 mm) and with APF in the w/oKT groups (3.9 and 4.4 mm). The XCM and APF produced more favourable results at teeth than at implants. CONCLUSIONS FGG was advantageous in gaining KT, especially at implants.
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Affiliation(s)
- Hyun-Chang Lim
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
- Department of Periodontology, Kyung Hee University, College of Dentistry, Periodontal-Implant Clinical Research Institute, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Franz J Strauss
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
- Faculty of Dentistry, Universidad Finis Terrae, Santiago, Chile
| | - Seung-Il Shin
- Department of Periodontology, Kyung Hee University, College of Dentistry, Periodontal-Implant Clinical Research Institute, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
| | - Ui-Won Jung
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Daniel S Thoma
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
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Moreno Rodríguez JA, Ortiz Ruiz AJ. A Surgical Approach to Root Coverage and Correction of Mucogingival Conditions and Deformities in Mandibular Incisors with Isolated Gingival Recession: Free Mucogingival Graft. A Pilot Prospective Cohort Study. INT J PERIODONT REST 2024; 44:167-175. [PMID: 37552176 DOI: 10.11607/prd.6481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
The aim of this study was to present a periodontal plastic surgery approach to treat gingival recessions (GRs) and correct mandibular incisor mucogingival conditions and deformities. Isolated deep GRs (≥ 3 mm) in the mandibular incisors (n = 24 teeth) were treated: 66.6% of sites were recession types 2 or 3, and 58.3% of teeth were malpositioned. Recessions were treated using free mucogingival grafts (FMGs) harvested from the buccal aspect of donor teeth with altered passive eruption or healthy periodontal support, with < 3 mm between the cementoenamel junction and the buccal alveolar crest. Clinical parameters (GR, clinical attachment level, interproximal papilla tip location, keratinized tissue, vestibule depth) and root coverage esthetic score were evaluated at 9 months. FMG significantly reduced GR (P < .001) and increased keratinized tissue (P < .001) without loss of vestibule depth (P > .05). Mean root coverage was 94.37% ± 10.60%, mean residual GR was 0.08 ± 0.65 mm, and the mean root coverage esthetic score was 8.9 ± 1.24. Recession types 2/3 showed significant interproximal clinical attachment gain (P < .05). The interproximal papilla was significantly augmented at sites with papilla loss (P < .001). No clinical attachment loss (P = .346) was detected at donor sites. These results suggest that FMG is a promising root coverage approach for recession types 1, 2, and 3, correcting mucogingival conditions and deformities and reconstructing the interproximal papilla.
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Sabri H, Barootchi S, Padbury AJ, Chan HL. Considerations for Selecting Root Coverage Techniques in the Anterior Mandible. INT J PERIODONT REST 2024; 44:145-152. [PMID: 37819858 DOI: 10.11607/prd.6429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
The anterior mandible is the most challenging anatomical site for performing periodontal plastic surgeries. Increased demands for optimal root coverage and esthetic outcomes contribute to the development of pedicle flap-based surgical solutions, in contrast to the predominantly used free gingival graft. The aims of this study were to (1) summarize the current literature to identify the mostused techniques, indications, and their efficacy, and (2) provide a decision table for surgeons to navigate through the selection of appropriate techniques. Four main approaches were identified: free gingival graft, lateral sliding, tunneling, and coronally advanced flap. The flap approaches are mostly combined with a connective tissue graft. The decision table considers the patient's chief complaint, local anatomical factors, and technique sensitivity. The table provides a framework for supporting an evidence-based selection of surgical techniques and for studying novel methods to achieve predictable root coverage in the anterior mandible.
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de Almeida JM, de Sá DP, Furquim EMDA, Matheus HR. Modified one-stage technique of laterally positioned flap with subepithelial connective tissue graft for the treatment of peri-implant soft tissue dehiscence in the esthetic zone: A 5-year follow-up. Clin Adv Periodontics 2024; 14:15-19. [PMID: 36704873 DOI: 10.1002/cap.10237] [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: 10/25/2022] [Accepted: 01/19/2023] [Indexed: 01/28/2023]
Abstract
BACKGROUND The state of art of tissue grafting allows significant improvements in the soft tissue phenotype. The importance of appropriate soft tissue phenotype around implants is supported by recent literature. The present case report aims to describe the application of a modified one-stage technique of laterally positioned flap with subepithelial connective tissue graft (CTG) for the treatment of peri-implant soft tissue dehiscence in the esthetic zone. METHODS AND RESULTS A 38-year-old female presented 4 years following prosthetic restoration, with a localized soft tissue defect in height and thickness at the buccal aspect of the implant at #11, and the abutment exposed to the oral cavity. Incisions with internal and external bevels were performed in the medial and distal margins of the dehiscence, respectively, toward the alveolar mucosa. After intrasulcular incision, the area was de-epithelialized and a split thickness flap from mesial #11 to distal #14 was elevated. A tunnel was prepared at #21. CTG was stabilized mesially, within the tunnel prepared, and distally, through simple interrupted sutures. Vertical compressive sutures were performed on the CTG. The flap was laterally positioned and secured by means of suspended sutures. Healing was uneventful, increased thickness and height of the peri-implant mucosa were observed, with great esthetic outcome. The soft tissue margin was stable at the 5-year follow-up. CONCLUSION The technique described in this case report showed promising results for covering exposed implant abutment in the esthetic zone, as well as for modification of the soft tissue phenotype around dental implants. KEY POINTS Why is this case new information A modified one-stage technique that allows coverage of exposed metallic displays of titanium implants while modifying the soft tissue phenotype in the esthetic zone. What are the keys to successful management of this case? Meticulous incisions and internal and external bevels. Adequate elevation to allow repositioning without tension. Adequate graft size that extends through all the recipient bed; and tension-free suture. What are the primary limitations to success in this case? Presence of an implant installed in a non-satisfactory three-dimensional position. And poor hygiene and plaque accumulation postoperatively.
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Affiliation(s)
- Juliano Milanezi de Almeida
- Department of Diagnosis and Surgery - Periodontics Division, São Paulo State University (Unesp), School of Dentistry, Araçatuba, São Paulo, Brazil
- Nucleus of Study and Research in Periodontics and Implantology (NEPPI), São Paulo State University (Unesp),School of Dentistry, Araçatuba, São Paulo, Brazil
| | - Daniela Pereira de Sá
- Department of Diagnosis and Surgery - Periodontics Division, São Paulo State University (Unesp), School of Dentistry, Araçatuba, São Paulo, Brazil
| | - Elisa Mara de Abreu Furquim
- Department of Diagnosis and Surgery - Periodontics Division, São Paulo State University (Unesp), School of Dentistry, Araçatuba, São Paulo, Brazil
- Nucleus of Study and Research in Periodontics and Implantology (NEPPI), São Paulo State University (Unesp),School of Dentistry, Araçatuba, São Paulo, Brazil
| | - Henrique Rinaldi Matheus
- Department of Diagnosis and Surgery - Periodontics Division, São Paulo State University (Unesp), School of Dentistry, Araçatuba, São Paulo, Brazil
- Nucleus of Study and Research in Periodontics and Implantology (NEPPI), São Paulo State University (Unesp),School of Dentistry, Araçatuba, São Paulo, Brazil
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Gisotti M, Valente NA. Palatal shield technique: a novel approach for improved donor site healing in mucogingival procedures - report of two cases. Quintessence Int 2024; 55:160-165. [PMID: 38224104 DOI: 10.3290/j.qi.b4867835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
OBJECTIVE Mucogingival surgery involving tissue grafts is commonly employed for cosmetic procedures like root coverage, and is increasingly applied in implant therapy to modulate peri-implant soft tissues and enhance implant survival. These procedures involve harvesting autologous connective or epithelial connective tissue, often from the palate or tuber maxillae. However, this can cause patient morbidity due to postoperative pain. Substitute materials, including animal-derived and xenografts, have been developed but lack qualities of autologous grafts. METHOD AND MATERIALS To address postoperative discomfort, a novel technique, named "palatal shield," using composite resin stabilized on adjacent teeth's palatal surface is proposed as an aid to donor site healing after mucogingival procedures. Two cases are reported where this technique was successfully applied. The first case involves a 53-year-old woman undergoing free gingival graft surgery for peri-implant treatment. The second case features a 58-year-old man receiving subepithelial connective tissue graft surgery for root sensitivity. RESULTS Ten days post surgery, both patients reported excellent postoperative comfort. The technique's effectiveness is highlighted in these cases, demonstrating its applicability in various surgical cases involving free gingival graft or connective tissue graft harvesting. CONCLUSION The proposed "palatal shield" technique offers several advantages, including enhanced patient comfort, ease of application, and cost-effectiveness, making it a promising addition to mucogingival surgical procedures.
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Yang H, Ni J, Lu W, Li XJ, He FM. [Timing and surgery option of keratinized mucosa augmentation around implant site]. Zhonghua Kou Qiang Yi Xue Za Zhi 2024; 59:182-190. [PMID: 38280739 DOI: 10.3760/cma.j.cn112144-20230806-00058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
In recent years, clinicians have paid more attention to the biological and esthetic effects of the 2 mm keratinized mucosa width (KMW) around dental implant. How to increase the keratinized mucosa is the focus of clinicians. While the free gingival graft (FGG) is still the gold standard of keratinized mucosa augmentation, alveolar ridge preservation (ARP), connective tissue graft (CTG) and apically positioned flap (APF) can also be used to obtain more than 2 mm keratinized mucosa width when they are used before implantation, with implantation, within the implant-healing phase, with second stage of implantation or after rehabilitation according to different indications. This article comprehensively summarizes the influencing factors of timing and surgical procedures for keratinized mucosa augmentation, providing guidance for clinicians to treat peri-implant keratinized mucosa deficiencies.
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Affiliation(s)
- H Yang
- Department of Prosthodontics, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine & Clinical Research Center for Oral Diseases of Zhejiang Province & Key Laboratory of Oral Biomedical Research of Zhejiang Province & Cancer Center of Zhejiang University, Hangzhou 310006, China
| | - J Ni
- Department of Periodontology, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine & Clinical Research Center for Oral Diseases of Zhejiang Province & Key Laboratory of Oral Biomedical Research of Zhejiang Province & Cancer Center of Zhejiang University, Hangzhou 310006, China
| | - W Lu
- Department of Periodontology, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine & Clinical Research Center for Oral Diseases of Zhejiang Province & Key Laboratory of Oral Biomedical Research of Zhejiang Province & Cancer Center of Zhejiang University, Hangzhou 310006, China
| | - X J Li
- Department of Periodontology, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine & Clinical Research Center for Oral Diseases of Zhejiang Province & Key Laboratory of Oral Biomedical Research of Zhejiang Province & Cancer Center of Zhejiang University, Hangzhou 310006, China
| | - F M He
- Department of Prosthodontics, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine & Clinical Research Center for Oral Diseases of Zhejiang Province & Key Laboratory of Oral Biomedical Research of Zhejiang Province & Cancer Center of Zhejiang University, Hangzhou 310006, China
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Li R, Meng Z, Zhang Y, Xu M, He Y. Digitally designed stent-assisted soft-tissue management after jaw reconstruction: a prospective cohort study. Clin Oral Investig 2024; 28:93. [PMID: 38217671 DOI: 10.1007/s00784-024-05502-y] [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: 11/27/2023] [Accepted: 01/08/2024] [Indexed: 01/15/2024]
Abstract
OBJECTIVES A digitally designed stent was invented to assist vestibuloplasty and free gingival graft (FGG) after jaw reconstruction. This study aimed to compare the effects of conventional soft-tissue management comprising vestibuloplasty combined with FGG and modified soft-tissue management using a digitally designed stent on the vestibular sulcus depth (VD), keratinised-tissue width (KTW) and peri-implant tissue health in patients undergoing jaw reconstruction. MATERIALS AND METHODS This prospective cohort study enrolled patients who underwent jaw reconstruction using a fibular flap, iliac flap, or onlay bone graft followed by implant-supported rehabilitation at the Peking University School and Hospital of Stomatology between May 2019 and July 2022. Patients in the stent group received digitally designed stents following vestibuloplasty combined with FGG for peri-implant soft-tissue management. Patients in the control group underwent a conventional vestibuloplasty combined with FGG. VD and KTW were evaluated immediately after implant loading (T2) and 1 year after implant loading (T3), and the atrophy rates of VD and KTW were calculated. Peri-implant clinical parameters were evaluated at T3. Comparisons between the groups were performed using the Mann-Whitney U test. The effects of age, sex, primary disease, reconstruction type, reconstructed jaw and the number and location of implants on VD and KTW were evaluated using linear regression analysis. RESULTS There were no significant differences in the atrophy rates of VD and KTW between the stent and control groups at T2 and T3 (both P ≥ 0.05). There were no significant differences in peri-implant clinical parameters between the stent and control groups at T3 (P ≥ 0.05). Reconstruction type, location of implants and primary disease influenced VD, and reconstruction type and age influenced KTW. CONCLUSIONS There was no significant difference in the maintenance of VD and KTW after jaw reconstruction between soft-tissue management using a digitally designed stent and the conventional method. Further, digitally designed stents do not affect peri-implant tissue health. CLINICAL RELEVANCE Digitally designed stents can simplify clinical procedures without adverse effects on peri-implant tissue health, but they do not promote keratinized mucosa augmentation and vestibuloplasty.
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Affiliation(s)
- Ruiliu Li
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Zhaoqiang Meng
- Special Dental Care Clinic, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yi Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Mingming Xu
- Special Dental Care Clinic, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yang He
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
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Rasperini G, Kazarian E, Aslan S. Coronally Advanced Entire Papilla Preservation (CA-EPP) Flap in the Treatment of an Isolated Intrabony Defect to Promote Buccal and Interproximal Soft Tissue Stability: Case Reports. INT J PERIODONT REST 2024; 44:9-16. [PMID: 37655976 DOI: 10.11607/prd.6851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Surgical treatment of infrabony defects may result in gingival recession of the neighboring teeth. The aim of this clinical report is to describe a surgical technique to promote gingival margin stability in the treatment of infrabony defects at sites with a thin or medium gingival phenotype. A coronally advanced entire papilla preservation (CA-EPP) flap with a connective tissue graft (CTG) was executed in two different clinical cases. This technique substantially improved interproximal clinical attachment level and pocket closure, with no gingival recession. A CA-EPP flap using a CTG may promote gingival margin stability and can be recommended in regenerative periodontal procedures.
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Lacy JA, Palaiologou AA, Kotsakis GA, Deas DE, Diogenes A, Mealey BL. A randomized controlled trial evaluating the effect of epithelial removal on free soft tissue autograft healing. J Periodontol 2023; 94:1397-1404. [PMID: 37032496 DOI: 10.1002/jper.23-0022] [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: 01/10/2023] [Revised: 02/27/2023] [Accepted: 03/31/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND The purpose of this study is to determine if there is a difference in dimensional change of a free soft tissue autograft (FSTA) with epithelium compared to without epithelium. The secondary aim is to determine the patient and professional evaluation of color match and graft texture between the two groups. METHODS Patients with ≤2 mm keratinized tissue indicated for a FSTA were randomly assigned to control group (FSTA with epithelium) or test group (de-epithelialized FSTA). The vertical and horizontal measurements of the grafts were taken at surgery, and 1, 3, and 6 months postoperatively. Patients were asked to evaluate the color match at each postoperative time point on a 21-step Numeric Rating Scale (NRS-21). Professional assessment of color match and graft texture were evaluated on images at the same time points. RESULTS Forty-six patients and 55 grafts were included in the study. For change in graft height, width, and area, there were no significant differences between the treatment groups at any time point. Graft height and area in both groups decreased significantly from baseline to month 1 (p < .001), but no other difference was significant over time. When patients and professionals used the NRS-21 for evaluation of color match between the graft site and the surrounding soft tissue, there was no significant difference between the treatment groups. Similarly, evaluation of texture match on color images and black-and-white images revealed no significant differences between or within groups. CONCLUSION De-epithelialized FSTA showed no difference in dimensional change or color and texture match compared to FSTA with epithelium.
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Affiliation(s)
- Julia A Lacy
- Department of Periodontics, UT Health Science Center at San Antonio, School of Dentistry, San Antonio, TX, USA
| | - Archontia A Palaiologou
- Department of Periodontics, UT Health Science Center at San Antonio, School of Dentistry, San Antonio, TX, USA
| | - Georgios A Kotsakis
- Department of Periodontics, UT Health Science Center at San Antonio, School of Dentistry, San Antonio, TX, USA
| | - David E Deas
- Department of Periodontics, UT Health Science Center at San Antonio, School of Dentistry, San Antonio, TX, USA
| | - Anibal Diogenes
- Department of Endodontics, UT Health Science Center at San Antonio, School of Dentistry, San Antonio, TX, USA
| | - Brian L Mealey
- Department of Periodontics, UT Health Science Center at San Antonio, School of Dentistry, San Antonio, TX, USA
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Lim HC, Kim CH, Yoon H, Lee S, Chung JH, Shin SY. Keratinized tissue augmentation using collagen-based soft tissue substitute with/without epidermal growth factor on buccally positioned implants: a pilot preclinical study. Clin Oral Investig 2023; 27:7899-7908. [PMID: 37989966 DOI: 10.1007/s00784-023-05382-8] [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: 05/06/2023] [Accepted: 11/11/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVES To investigate the effect of epithelial growth factor (EGF) with collagen matrix (CM) on the gain of KT for buccally positioned implants in dogs. MATERIALS AND METHODS In five dogs, four implants were placed buccally with the whole part of KT excision on the buccal side (two implants per each hemi-mandible). After one month, KT augmentation was performed: 1) free gingival grafts (FGG), 2) collagen matrix (CM) only, 3) CM soaked with 1 μg/g of EGF, and 4) CM soaked with 10 μg/g of EGF (n = 5 in each group). The experimental animals were sacrificed three months post-KT augmentation. Clinical, histologic, and histomorphometric analyses were performed. RESULTS The clinical KT zone was the highest in group FGG (5.16 ± 1.63 mm). Histologically, all groups presented buccal bony dehiscence. Regarding newly formed KT, no specific difference was found among the groups, but robust rete pegs formation in some specimens in group FGG. Histomorphometric KT height (4.66 ± 1.81 mm) and length (5.56 ± 2.25 mm) were the highest in group FGG, whereas similar increases were noted in the rest. The buccal soft tissue thickness at the coronal part of the implant did not exceed 2 mm in all groups. CONCLUSION All groups presented increased KT zone, but FGG treatment was more favored. The addition of EGF to CM appeared not to enhance KT formation. CLINICAL RELEVANCE FGG treatment was more favorable to re-establish the KT zone than other treatment modalities.
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Affiliation(s)
- Hyun-Chang Lim
- Department of Periodontology, Periodontal Implant Clinical Research Institute, Kyung Hee University College of Dentistry, Kyung Hee University Medical Center, Seoul, Korea.
| | - Chang-Hoon Kim
- Department of Dentistry, Graduate School, Kyung Hee University, Seoul, Korea
| | - Heejun Yoon
- Department of Periodontology, Periodontal Implant Clinical Research Institute, Kyung Hee University College of Dentistry, Kyung Hee University Medical Center, Seoul, Korea
| | - Sunmin Lee
- Department of Dentistry, Graduate School, Kyung Hee University, Seoul, Korea
| | - Jong-Hyuk Chung
- Department of Periodontology, Periodontal Implant Clinical Research Institute, Kyung Hee University College of Dentistry, Kyung Hee University Medical Center, Seoul, Korea
| | - Seung-Yun Shin
- Department of Periodontology, Periodontal Implant Clinical Research Institute, Kyung Hee University College of Dentistry, Kyung Hee University Medical Center, Seoul, Korea
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Silva ALM, de Souza JAC, Nogueira TE. Postoperative local interventions for the palate as a gingival graft donor area: a scoping review. Clin Oral Investig 2023; 27:6971-7006. [PMID: 37851129 DOI: 10.1007/s00784-023-05296-5] [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: 06/02/2023] [Accepted: 09/27/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVE This scoping review aimed to systematically identify evidence-based interventions to stimulate healing or protect the harvested palate of patients undergoing gingival grafting. MATERIAL AND METHODS The study followed guidelines from the Joanna Briggs Institute and PRISMA-ScR (protocol available at osf.io/zhafn). PubMed, Embase, and seven other databases were searched on November 2022, with additional monitoring until April 2023. The inclusion criteria focused on studies evaluating outcomes related to the donor area (palate) and interventions for healing or protecting it, regardless of publication year and language. Data from the included publications was extracted and presented through narrative text, tables, and figures. RESULTS Eighty-one studies (including 64 clinical trials, four case series, five theses, and eight systematic reviews) and 37 clinical trial records were included. The number of studies on this topic has significantly increased, reflecting a growing interest in the field. Thirty-six interventions with published results and 12 interventions with unpublished results from clinical trial registers were identified. Some promising interventions that showed potential for improving patient-reported outcomes include cyanoacrylate adhesive, platelet-rich fibrin (PRF), and the combination of palatal stents and healing agents. CONCLUSIONS Thirty-six interventions with published results were identified for postoperative use on the harvested palate, showing varying levels of evidence and conflicting effectiveness for specific outcomes. CLINICAL RELEVANCE Postoperative discomfort and pain in the palate are commonly experienced by patients undergoing grafting procedures using this region as the donor area. Awareness of the available options and their levels of evidence is crucial for informed decision-making.
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Affiliation(s)
- Ana Luiza Mustafé Silva
- Faculty of Dentistry, Postgraduate Program in Dentistry, Universidade Federal de Goiás, CEP, Goiânia, Goiás, 74605-220, Brazil
| | - João Antônio Chaves de Souza
- Faculty of Dentistry, Postgraduate Program in Dentistry, Universidade Federal de Goiás, CEP, Goiânia, Goiás, 74605-220, Brazil
| | - Túlio Eduardo Nogueira
- Faculty of Dentistry, Postgraduate Program in Dentistry, Universidade Federal de Goiás, CEP, Goiânia, Goiás, 74605-220, Brazil.
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14
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Parlak HM, Yilmaz BT, Durmaz MH, Toz H, Keceli HG. The effects of vertically coronally advanced flap and free gingival graft techniques on shallow vestibule: a randomized comparative prospective trial. Clin Oral Investig 2023; 27:7425-7436. [PMID: 37855920 DOI: 10.1007/s00784-023-05332-4] [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: 08/23/2023] [Accepted: 10/10/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVES The present study aimed to compare the influence of vertically coronally advanced flap (V-CAF) and free gingival graft (FGG) techniques on shallow vestibule depth (VD). MATERIALS AND METHODS Parallel-arm randomized clinical trial was conducted on 38 sites treated with either FGG or V-CAF. Periodontal variables (VD, recession depth and width, probing depth, clinical attachment level, keratinized tissue height (KTH), and tissue thickness (TT)), clinician- and patient-based subjective variables were assessed. RESULTS All periodontal variables showed significant improvements in both groups at all follow-up intervals compared to baseline (p < 0.05). Both groups increased VD compared to baseline. RC and CRC were similar after treatment for both techniques. FGG provided a greater increase in KTH (p < 0.001) and VD (VD1, p = 0.02 and VD2, p < 0.001) while V-CAF exhibited more TT gain (p = 0.002). Except overall tissue appearance that was better in V-CAF (p < 0.001), no inter-group significant difference existed in patient-based variables. CONCLUSIONS Both techniques were significantly effective in VD increasing. While both techniques were equally successful in RC, V-CAF provided higher TT gain and better tissue appearance. V-CAF can be chosen instead of FGG in the treatment of recessions with shallow VD. CLINICAL RELEVANCE It can be recommended to prefer V-CAF instead of FGG in the treatment of shallow vestibule. TRIAL REGISTRATION NUMBER NCT05777811 (clinicaltrials.gov).
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Affiliation(s)
- Hanife Merva Parlak
- Department of Periodontology, Faculty of Dentistry, Hacettepe University, Sihhiye, 06100, Ankara, Turkey
| | - Birtan Tolga Yilmaz
- Private Practice, İzmir, Turkey
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
- Department of Dental Biomaterials, Institute of Health Science, Dokuz Eylul University, İzmir, Turkey
| | - Murat Haktan Durmaz
- Department of Periodontology, Faculty of Dentistry, Hacettepe University, Sihhiye, 06100, Ankara, Turkey
| | - Havanur Toz
- Department of Periodontology, Faculty of Dentistry, Hacettepe University, Sihhiye, 06100, Ankara, Turkey
| | - H Gencay Keceli
- Department of Periodontology, Faculty of Dentistry, Hacettepe University, Sihhiye, 06100, Ankara, Turkey.
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Danskin Y, Chu S, Simmonds T. Minimally invasive tunneling of a de-epithelialized connective tissue graft to improve gingival phenotype of lingual recession defects: A case report. Clin Adv Periodontics 2023; 13:235-240. [PMID: 36269197 DOI: 10.1002/cap.10230] [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: 07/13/2022] [Accepted: 10/16/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND This case report describes a minimally invasive technique to increase the functional resistance of mandibular anterior lingual recession defects to inflammation. There are only a few case reports that describe the soft tissue augmentation of lingual gingival recession, of which none describe a tunneling technique without coronal advancement of the flap to treat a long span of multiple recession defects. Soft tissue augmentation of lingual recession defects is challenging due to the proximity to the tongue, frenum, vital structures, pre-existing thin phenotype, and limited access during surgery. METHODS AND RESULTS A 30-year-old male was referred for the treatment of gingival recession on the lingual surfaces of teeth #22-27, with a diagnosis of recession type 2 (RT2). Mucogingival surgery included the preparation of the recipient site with a tunneling protocol, where apical muscular attachment was left undisturbed to isolate the flap from the movement of the tongue during normal function. As the goal was to not coronally advance the tunneled flap, the interdental papillae were not elevated and left intact, further optimizing blood supply. A free gingival graft was harvested, de-epithelialized extra-orally, and the resulting connective tissue graft (CTG) was fed through the tunnel and stabilized with sling sutures. Partial root coverage was achieved ranging from 50% to 90% at 4 months, consistent with the initial diagnosis of RT2. There was also a visually appreciable increase in gingival thickness and in the vestibular depth. CONCLUSION A de-epithelialized CTG via tunneling without disturbing the deeper muscular attachment is a conservative method to improve phenotype of lingual recession defects. KEY POINTS Why is this case new information? There are only a few case reports that describe soft tissue augmentation of lingual recession defects, of which none describe a tunneling technique without coronal advancement of the flap to treat a long span of multiple recession defects. This case report introduces a minimally invasive technique to increase the functional resistance of mandibular anterior lingual recession defects to plaque and calculus. What are the keys to successful management of this case? Control of gingival inflammation before and after surgery, with regular maintenance visits and oral hygiene instructions. Precise tunneling, leaving deeper muscular attachment on the floor of the mouth undisturbed. Connective tissue graft of even thickness that is fibrous in quality. What are the primary limitations to success in this case? A shallow lingual vestibule will not allow the clinician to leave deeper muscular attachment apical to tunneling undisturbed.
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Affiliation(s)
- Yoonah Danskin
- New York Harbor Healthcare System, US Department of Veterans Affairs, New York, NY, USA
| | - Stephanie Chu
- New York Harbor Healthcare System, US Department of Veterans Affairs, New York, NY, USA
- Private Practice, New York, NY, USA
| | - Trevor Simmonds
- New York Harbor Healthcare System, US Department of Veterans Affairs, New York, NY, USA
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16
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Watanabe M, Tanimura R. Treatment of peri-implant soft tissue dehiscence around implants placed in calvarial bone graft maxilla and mandible 20 years ago: A case report. Clin Adv Periodontics 2023; 13:209-216. [PMID: 35699320 DOI: 10.1002/cap.10213] [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: 03/28/2022] [Accepted: 06/06/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Despite tissue augmentation and management prior implantation, long-term observation can reveal a change in peri-implant phenotype with some lack of keratinized mucosa (KM). The treatment approach of peri-implant dehiscence in multiple implants is not clearly defined. This report describes the different periodontal surgical approaches undertaken to promote the gingival margin stability and to prevent the peri-implant mucosal inflammation over time. CASE PRESENTATION A 64-year-old woman with peri-implant tissue dehiscence regarding implants placed 20 years ago in a calvarial bone grafted maxilla and mandible was treated. Right maxillary and mandible peri-implants soft tissue were treated with a large apically positioned partial-thickness flap (APPTF) combined to a free gingival graft (FGG) simultaneously. For the left maxillary, where a frenum was in tension associated with infection and pockets, a large APPTF followed by a FGG 4 months later were performed. The KM width (KMW) increased in three operated sites with a gain average of 2.2 mm. The plaque control record decreased from 68% to 21%. All the probing depths were lower than 3 mm. Bleeding on probing was significantly reduced. The gingival index (GI) went from 1.5 to 0.25. CONCLUSION In a multiple implants soft tissue dehiscence case, an APPTF associate to a FGG, delayed or not, seems to be a safety primary approach to improve the KMW and to stabilize the peri-implants soft tissue. Further, a connective tissue graft in a bilaminar approach could be an option to enhance soft tissue thickness and esthetic outcomes. KEY POINTS Why is this case new information? To the best of the authors' knowledge, there are very limited studies regarding multi-implant soft tissue dehiscence treatment. Relevant guidelines are not clearly defined. Despite peri-implant hard and soft tissue augmentation, after a long-term observation (20 years of function), we can observe a change in peri-implant soft tissue phenotype (PISTP) with periodontal complication. What are the keys to successful management of this case? Removal of peri-implant infection and tissue tension (frenum) by a large apically positioned partial-thickness flap (APPTF) before soft tissue augmentation procedure. In case of very thin peri-implant soft tissue, caution is needed to preserve the blood supply from the supra-periosteal plexus. Large APPTF and sufficient amount of keratinized mucosa (KM) should be grafted to compensate for the tissue shrinkage. What are the primary limitations to success in this case? High esthetic demand. A secondary bilaminar approach with a connective tissue graft (CTG) should be necessary to improve the esthetic outcomes. Patient compliance.
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Affiliation(s)
- Martha Watanabe
- Department of Periodontology, Nihon University School of Dentistry, Tokyo, Japan
- Private Practice, Yokohama, Japan
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17
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Tavelli L, Barootchi S, Rodriguez MV, Travan S, Oh TJ, Neiva R, Giannobile WV. Living cellular constructs for keratinized tissue augmentation: A 13-year follow-up from a split-mouth randomized, controlled, clinical trial. J Periodontol 2023; 94:1302-1314. [PMID: 37133977 DOI: 10.1002/jper.23-0040] [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: 01/18/2023] [Revised: 04/09/2023] [Accepted: 04/22/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND A 13-year follow-up was conducted of a short-term investigation of the use of living cellular construct (LCC) versus free gingival graft (FGG) for keratinized tissue width (KTW) augmentation in natural dentition, to evaluate the long-term outcomes and assess the changes occurring since the end of the original 6-month study. METHODS Twenty-four subjects out of the original 29 enrolled participants were available at the 13-year follow-up. The primary endpoint was the number of sites demonstrating stable clinical outcomes from 6 months to 13 years (defined as KTW gain, stability, or ≤0.5 mm of KTW loss, together with reduction, stability, or increase of probing depth, and recession depth [REC] ≤0.5 mm). Secondary outcomes included the assessment of KTW, attached gingiva width (AGW), REC, clinical attachment level, esthetics, and patient-reported outcomes at the 13-year visit, assessing the changes from baseline to 6 months. RESULTS Nine sites per group (42.9%) were found to have maintained stable (≤0.5 mm or improved) clinical outcomes from 6 months to 13 years. No significant differences were observed for the clinical parameters between LCC and FGG from 6 months to 13 years. However, the longitudinal mixed model analysis showed that FGG delivered significantly better clinical outcomes over 13 years (p < 0.01). LCC-treated sites exhibited superior esthetic outcomes compared to FGG-treated sites at 6 months and 13 years (p < 0.01). Patient-evaluated esthetics were significantly higher for LCC over FGG (p < 0.01). Patient overall treatment preference was also in favor of LCC (p < 0.01). CONCLUSIONS A similar stability of the treatment outcomes from 6 months to 13 years was found for LCC- and FGG-treated sites, with both approaches shown to be effective in augmenting KTW and AGW. However, superior clinical outcomes were found for FGG over 13 years, while LCC was associated with better esthetics and patient-reported outcomes than FGG.
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Affiliation(s)
- Lorenzo Tavelli
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Department of Periodontics & 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
| | - Shayan Barootchi
- Department of Periodontics & 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
| | - Maria Vera Rodriguez
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Postgraduate Periodontics, Division of Periodontics, Columbia University College of Dental Medicine, New York City, New York, USA
| | - Suncica Travan
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Tae-Ju Oh
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Rodrigo Neiva
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Department of Periodontics, University of Pennsylvania, School of Dental Medicine, Philadelphia, Pennsylvania, USA
| | - William V Giannobile
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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Oliveira JA, da Silveira MI, de Oliveira Alves R, Bezerra FJB, de Oliveira GJPL, Pigossi SC. Effect of a gel containing green tea extract and hyaluronic acid on palate pain scores and wound healing after free gingival graft: a quasi-randomized controlled clinical trial. Clin Oral Investig 2023; 27:6735-6746. [PMID: 37775584 DOI: 10.1007/s00784-023-05282-x] [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: 07/03/2023] [Accepted: 09/24/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the effect of a gel containing green tea extract and hyaluronic acid (HA) on pain scores and wound healing in donor sites after free gingival graft (FGG). MATERIALS AND METHODS Forty-two patients requiring FGG were included in three groups: (1) control group (n = 14), no material was placed in the donor area; only the clot was kept in position by sutures; (2) placebo group (n = 14), vehicle gel applied 3 times a day for 7 days; and (3) test group (n = 14), gel containing green tea extract and HA applied 3 times a day for 7 days. The wound size by clinical measurement (WS-CM) and photographic image (WS-PI), complete wound epithelialization (CWE), and palatal mucosa color were evaluated after 3 days and 1, 2, and 4 weeks postoperatively. The visual analog scale (VAS) for pain and analgesic consumption were used to assess participant's perception in the same postoperative periods. RESULTS A similar progressive reduction in the wound size, associated with an improvement in the color pattern, was observed in all groups (p > 0.05). No significant differences were found for CWE and pain assessment between the examined groups (p > 0.05). CONCLUSION The gel containing green tea extract and HA application in palatal wounds after FGG removal does not provide clinical healing benefits using this investigated protocol. CLINICAL RELEVANCE This is the first clinical study evaluating the effect of gel containing green tea extract and HA on the palate postoperative pain control and wound healing after FGG. TRIAL REGISTRATION http://clinicaltrials.gov : NCT05270161.
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Affiliation(s)
- Jovânia Alves Oliveira
- School of Dentistry, Alfenas Federal University (Unifal-MG), Alfenas, Minas Gerais, Brazil
| | | | - Roberta de Oliveira Alves
- Department of Periodontology and Implantodontology, School of Dentistry, Federal University of Uberlandia-UFU, School of Dentistry, Umuarama Campus, Bloco UMU4L, Pará Avenue, 1720, Uberlandia, MG, 38405-320, Brazil
| | | | - Guilherme José Pimentel Lopes de Oliveira
- Department of Periodontology and Implantodontology, School of Dentistry, Federal University of Uberlandia-UFU, School of Dentistry, Umuarama Campus, Bloco UMU4L, Pará Avenue, 1720, Uberlandia, MG, 38405-320, Brazil
| | - Suzane Cristina Pigossi
- Department of Periodontology and Implantodontology, School of Dentistry, Federal University of Uberlandia-UFU, School of Dentistry, Umuarama Campus, Bloco UMU4L, Pará Avenue, 1720, Uberlandia, MG, 38405-320, Brazil.
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Alan R, Ercan E, Firatli Y, Firatli E, Tunali M. Innovative i-PRF semisurgical method for gingival augmentation and root coverage in thin periodontal phenotypes: a preliminary study. Quintessence Int 2023; 54:734-743. [PMID: 37609837 DOI: 10.3290/j.qi.b4328831] [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: 08/24/2023]
Abstract
OBJECTIVES The aim of the study was to evaluate the effect of injectable platelet-rich fibrin (i-PRF) on gingival thickness and gingival recession in individuals with thin periodontal phenotypes. METHOD AND MATERIALS In this prospective study, i-PRF was applied via a semisurgical method to augment 53 tooth regions with thin periodontal phenotypes. In order to ensure that sufficient blood clot formed on the side of the gingiva facing the bone and that i-PRF reached the area, a minimal incision was made with the help of a scalpel in the apical region of the relevant region, and the periosteum was elevated with a microsurgical instrument. To ensure sustained exposure to angiogenetic growth factors and enhance the histoconductive properties, i-PRF injection was applied to the relevant areas in four sessions at 10-day intervals. RESULTS An increase in gingival thickness was achieved in 92.5% of the areas treated with i-PRF, and the desired gingival thickness (0.8 mm) was achieved in 44.9% of these areas. In addition, significant reductions in the amount of recession were observed in 83.3% of the 12 gingival recession areas (P = .005). Moreover, complete coverage was achieved in 60% of these regions. CONCLUSION With the new i-PRF semisurgical method, it was shown that gingival thickness can be increased in tooth regions with thin gingiva, and that areas of gingival recession can be covered. Further comprehensive studies are needed to fully understand the role of i-PRF in enhancing angiogenesis and the histoconductive properties of this fully autogenous blood concentrate.
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20
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Di Domenico GL, Di Martino M, Arrigoni G, Aroca S, de Sanctis M. Multiple coronally advanced flap with a selective use of connective tissue graft: A 3-year prospective clinical and histological study. J Periodontol 2023; 94:1200-1209. [PMID: 37036093 DOI: 10.1002/jper.22-0632] [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: 10/24/2022] [Revised: 02/15/2023] [Accepted: 03/29/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND The purpose of the present study was to prospectively evaluate the 3-year changes in the gingival dimensions following multiple coronally advanced flap (MCAF) with selective use of connective tissue graft (CTG). In addition, the secondary aim was to histologically identify the factors related to phenotype changes. METHODS Twenty patients treated with MCAF and site-specific application of a CTG were available for the 3-year follow-up. Outcome measures included complete root coverage (CRC), recession reduction, keratinized tissue width (KTW), marginal tissue thickness changes, and primary flap position. Biopsies were harvested at one of the sites treated with the adjunct of CTG. All sections were stained with hematoxylin and eosin, Masson trichrome, Verhoeff-van Gieson, tenascin, and alcian blue stain for semiquantitative evaluation. RESULTS At 3 years, CRC was detected in 86% of sites treated with MCAF alone and 81% of sites treated with MCAF + CTG. The 47% of sites treated with MCAF + CTG presented an apical shift of primary flap from its original position. Linear regression showed a significant association between KTW change and the initial KTW in MCAF-treated sites, while both initial KTW and position of primary flap were statistically significantly associated factors with KTW changes in the MCAF + CTG group. In all the biopsies examined, there is always a marked and clear separation between the connective tissue of the gingival flap and the palatal connective tissue of the graft. CONCLUSIONS The selective use of CTG is an effective treatment for multiple gingival recessions. Only a limited increase in KTW can be expected in a bilaminar technique if, during the healing phases, the connective tissue is maintained completely covered.
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Affiliation(s)
| | - Maria Di Martino
- Department of Periodontology, Vita-Salute San Raffaele University, Milan, Italy
| | - Gianluigi Arrigoni
- Department of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sofia Aroca
- 26K Center for Clinical Research, Paris, France
- Department of Periodontology, Bern University, Bern, Switzerland
| | - Massimo de Sanctis
- Department of Periodontology, Vita-Salute San Raffaele University, Milan, Italy
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Limmeechokchai S, Kan JYK, Rungcharassaeng K, Chen JT, Goodacre B, Lozada J. Facial Contour Preservation of Anterior Immediate Single-Tooth Replacement With the Socket Shield Technique Versus Connective Tissue Graft: A Case Report. J ORAL IMPLANTOL 2023; 49:495-500. [PMID: 37776256 DOI: 10.1563/aaid-joi-d-23-00009] [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] [Indexed: 10/02/2023]
Abstract
The socket shield technique and subepithelial connective tissue graft following immediate implant placement with provisionalization had been advocated for peri-implant facial contour and gingival architecture preservation. This case report used three-dimensional volumetric analysis to longitudinally assess the peri-implant facial contour change before and after these procedures. The results demonstrated comparable and acceptable preservation of peri-implant facial contour between the two procedures after 2 years of function.
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Affiliation(s)
| | - Joseph Y K Kan
- Loma Linda University School of Dentistry, Loma Linda, Calif
| | | | - Joey T Chen
- Loma Linda University School of Dentistry, Loma Linda, Calif
| | - Brian Goodacre
- Loma Linda University School of Dentistry, Loma Linda, Calif
| | - Jaime Lozada
- Loma Linda University School of Dentistry, Loma Linda, Calif
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22
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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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Alkaya B, Kayhan HG, Temmerman A, Haytac MC, Teughels W. Pre-operative, chair-side Zn-containing surgical stents affect morbidity and wound healing after free gingival graft harvesting: a randomized clinical trial. Clin Oral Investig 2023; 27:5519-5527. [PMID: 37468598 DOI: 10.1007/s00784-023-05171-3] [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: 04/11/2023] [Accepted: 07/13/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To compare a pre-operatively, chair-side made, zinc-containing surgical stent (ZN) and suturing of a gelatin-based hemostatic agent (HA) on palatal wound healing and patient morbidity after free gingival graft surgery (FGG). MATERIALS AND METHODS Sixty patients requiring FGG were randomly divided into two groups to receive either a ZN or a sterile HA sutured on the surgical area. Patients were evaluated at 1st, 3rd, 7th, 14th, 28th, and 56th days following surgery. Overall surgical time, donor site surgical time, postoperative pain (PP), delayed bleeding (DB), changes in dietary habits (DH), burning sensation (BS), completion of re-epithelialization (CE), and patients' discomfort (PD) were evaluated. RESULTS Donor site surgical time, PP, DB, DH, BS were statistically significantly lower in the ZN group together with faster completion of re-epithelialization compared to the HA group. CONCLUSION Pre-operatively, chair-side made, zinc-containing surgical stents provided significant benefits for wound healing parameters and patients' postoperative morbidity after FGG harvesting. CLINICAL RELEVANCE The results show that using Zn-containing palatal stent after free gingival graft surgery significantly reduces pain and patient morbidity during the postoperative period.
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Affiliation(s)
- Bahar Alkaya
- Department of Periodontology Faculty of Dentistry, Cukurova University, Adana, Turkey
| | - Hamza Gokhan Kayhan
- Department of Periodontology Faculty of Dentistry, Cukurova University, Adana, Turkey
| | - Andy Temmerman
- Department of Oral Health Sciences, KU Leuven & Dentistry (Periodontology), University Hospitals Leuven, Louvain, Belgium
| | - Mehmet Cenk Haytac
- Department of Periodontology Faculty of Dentistry, Cukurova University, Adana, Turkey
| | - Wim Teughels
- Department of Oral Health Sciences, KU Leuven & Dentistry (Periodontology), University Hospitals Leuven, Louvain, Belgium
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Gabusi A, Stefanini M, Gissi DB, Rossi R, Sangiorgi M, Loi C, Filippi F, Montebugnoli L, Zucchelli G, Bardazzi F. Surgical management of gingival recessions in patients with refractory gingival pemphigus vulgaris: A multidisciplinary challenge. Clin Adv Periodontics 2023; 13:168-173. [PMID: 36733218 DOI: 10.1002/cap.10238] [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: 12/07/2022] [Accepted: 01/29/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Mucogingival surgery for root coverage of gingival recessions (GRs) is usually performed in patients with unremarkable periodontal and systemic health. However, the predictable results of surgical procedures and increasingly high aesthetic expectations of patients necessitate optimal management of GR also in patients with systemic conditions that affect the oral cavity. In patients with pemphigus vulgaris (PV), mucosal fragility and complicated surgical management of inflamed soft tissues are major challenges. METHODS AND RESULTS A 36-year-old female patient with PV and deep GR on the mandibular incisors is presented. After initial unresponsiveness to steroids and immunosuppressants, complete clinical remission was achieved through repeated rituximab infusions and topical platelet-rich plasma. After > 1 year of stable clinical remission off therapy the patient successfully underwent surgical procedures for vertically coronally advanced flap with connective tissue graft. CONCLUSIONS To the best of our knowledge, no studies have described the surgical management of GR in PV patients. Although controlled studies are required to confirm present results, complete and stable clinical remission is necessary to avoid complications. Collaboration among dermatologists, oral medicine specialists, and periodontologists is essential to determine whether mucogingival surgery for root surface exposure is indicated for PV patients. KEY POINTS Why are these cases new information? This is the first report of root coverage in a patient with oral PV What are the keys to the successful management of these cases? The achievement of complete and stable clinical remission from oral PV Multidisciplinary collaboration among dermatologists, oral medicine specialists, and periodontologists What are the primary limitations to success in these cases? The refractoriness of gingival lesions induced by PV Poor mucogingival conditions of inflamed gingival tissues exacerbated by PV.
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Affiliation(s)
- Andrea Gabusi
- Section of Oral Sciences, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Martina Stefanini
- Section of Oral Sciences, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Davide Bartolomeo Gissi
- Section of Oral Sciences, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Roberto Rossi
- Section of Oral Sciences, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Matteo Sangiorgi
- Section of Oral Sciences, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Camilla Loi
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
- Division of Dermatology, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Federica Filippi
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
- Division of Dermatology, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lucio Montebugnoli
- Section of Oral Sciences, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giovanni Zucchelli
- Section of Oral Sciences, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Federico Bardazzi
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
- Division of Dermatology, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Schincaglia GP, Agusto M, Thacker S, Thomas Simpson K, Salman A. Gingival pedicle with split-thickness tunnel technique: A retrospective case series for single mandibular anterior recessions. Clin Adv Periodontics 2023; 13:137-143. [PMID: 35412668 DOI: 10.1002/cap.10197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 02/24/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Gingival recessions in the mandibular anterior sextant are a common clinical finding, but mucogingival treatment in this location is particularly challenging, due to several anatomical and surgical difficulties. In the present case series, a novel technique, called gingival pedicle with split-thickness tunnel (GPST), was retrospectively evaluated. CASE SERIES Fifteen patients presenting with a single buccal RT1 or RT2 gingival recession of a depth of ≥3 mm in the mandibular anterior sextant were treated by means of the GPST technique. Clinical periodontal parameters at baseline and at the last follow-up evaluation visit (6-84 months) were compared. Early healing was uneventful in all cases, and no complications such as flap dehiscence or loss of connective tissue graft were observed. Mean root coverage (mRC) was 98.1% ± 7.38%, corresponding to a statistically significant recession reduction (ΔRD) of 4.53 ± 1.19 mm. Complete root coverage was achieved in 14 of 15 cases. The gain in keratinized tissue width amounted to 3.13 ± 0.99 mm and was statistically significant, whereas no significant change in periodontal probing depth was observed after treatment. CONCLUSION In conclusion, treatment with GPST technique seems to achieve a favorable and predictable clinical improvement in gingival recessions on mandibular anterior teeth. Why are these cases new information? Limited information is available about the management of isolated deep labial recessions in the mandibular anterior teeth. A novel surgical approach, called GPST technique, is described in a case series to specifically address this type of defect. What are the keys to successful management of these cases? Horizontal incision ≥ RECwidth Cut-back preparation helps to mobilize the flap without tension. CTG width ≥ 3 times RECwidth CTG height ≥ RECdepth Proper graft and flap stabilization need to be achieved. What are the primary limitations to success in these cases? Limited mesio-distal dimensions, which do not allow to obtain a pedicle with adequate horizontal width Very thin biotype may not be suitable because of the risk of inadequate flap vascularization.
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Affiliation(s)
- Gian Pietro Schincaglia
- Department of Periodontics, Case Western Reserve University School of Dental Medicine, Cleveland, Ohio, USA
- Department of Periodontics, School of Dentistry, West Virginia University, Morgantown, West Virginia, USA
| | - Michele Agusto
- Department of Periodontics, School of Dentistry, West Virginia University, Morgantown, West Virginia, USA
| | - Sejal Thacker
- Division of Periodontics, University of Connecticut School of Dental Medicine, Farmington, Connecticut, USA
| | - Kerri Thomas Simpson
- Department of Periodontics, School of Dentistry, West Virginia University, Morgantown, West Virginia, USA
| | - Arif Salman
- Department of Periodontics, School of Dentistry, West Virginia University, Morgantown, West Virginia, USA
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Stähli A, Párkányi L, Aroca S, Stavropoulos A, Schwarz F, Sculean A, Bosshardt DD. The effect of connective tissue graft or a collagen matrix on epithelial differentiation around teeth and implants: a preclinical study in minipigs. Clin Oral Investig 2023; 27:4553-4566. [PMID: 37300738 PMCID: PMC10415429 DOI: 10.1007/s00784-023-05080-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 12/18/2022] [Accepted: 05/19/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES This study aimed to histologically evaluate the healing at 8 weeks after coronally advanced flap (CAF) with either a superficial (SCTG) or deep palatal connective tissue graft (DCTG), or a collagen matrix (CM) to cover recession defects at teeth and implants. MATERIAL AND METHODS One mandibular side of 6 miniature pigs received each 3 titanium implants 12 weeks after extraction. Eight weeks later, recession defects were created around implants and contralateral premolars and 4 weeks later randomly subjected to CAF + SCTG, CAF + DCTG, or CAF + CM. After 8 weeks, block biopsies were histologically analyzed. RESULTS For the primary outcome, i.e., keratinization of the epithelium, all teeth and implants exhibited a keratinized epithelium with no histological differences among them also not in terms of statistically significant differences in length (SCTG 0.86 ± 0.92 mm, DCTG 1.13 ± 0.62 mm, and Cm, 1.44 ± 0.76 mm). Pocket formation was histologically seen at all teeth, around most implants with SCTG and DCTG, however not in the CM implant group. The connective tissue grafts showed hardly signs of degradation, whereas the CM was partly degraded and integrated in connective tissue. The mean gain in gingival height was similar in all experimental groups (SCTG 3.89 ± 0.80 mm, DCTG 4.01 ± 1.40 mm, CM 4.21 ± 0.64 mm). Statistically significant differences were found in the height of the junctional epithelium between the control teeth and the connective tissue groups (p = 0.009 and 0.044). CONCLUSIONS In this animal model, the use of either a superficial or deep connective tissue graft or a collagen membrane did not seem to have any impact on the epithelial keratinization around both teeth and implants. All procedures (CAF + SCTG/DCTG/CM) resulted in a long JE that was even longer at implants. CLINICAL RELEVANCE Deep/superficial palatal connective tissue graft yielded similar keratinization around teeth/implants. Given the absence of pocket formation and inflammatory processes at implants when using a CM, CAF + CM might bear potential clinical benefits.
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Affiliation(s)
- Alexandra Stähli
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland.
| | - László Párkányi
- Department of Periodontology, Faculty of Dentistry, University of Szeged, 6720 Tisza Lajos Körút 64, Szeged, Hungary
| | - Sofia Aroca
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - Andreas Stavropoulos
- Department of Periodontology, Faculty of Odontology, Malmö University, Carl Gustafs Väg 34, 20506, Malmo, Sweden
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Goethe University, Theodor-Stern-Kai 7, 60596, Frankfurt, Germany
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - Dieter D Bosshardt
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
- Robert K. Schenk Laboratory of Oral Histology, School of Dental Medicine, University of Bern, Freiburgstrasse 3, 3010, Bern, Switzerland
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Sundaresan Iii P, Paramashivaiah R, Prabhuji MLV. Comparative Evaluation of Recession Coverage Obtained Using the Pinhole Surgical Technique With and Without Platelet-Rich Fibrin: A Randomized Clinical Trial. INT J PERIODONT REST 2023; 43:e181-e188. [PMID: 37552198 DOI: 10.11607/prd.5953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
This randomized controlled clinical trial evaluated the pinhole surgical technique (PST) combined with platelet-rich fibrin (PRF) for the management of multiple recession defects compared to PST alone. Ten patients with 51 Miller Class I/ II or III gingival recessions were selected. Control sites were treated with PST alone, whereas test sites were treated with PST with PRF. Gingival recession depth (GRD), gingival recession width (GRW), probing depth (PD), clinical attachment level (CAL), keratinized tissue width (KTW), total soft tissue gain (TSTG), Plaque Index (PI), Gingival Index (GI), and gingival bleeding index (GBI) were measured at baseline and at 1, 3, and 6 months posttreatment. Both groups showed statistically significant root coverage. The mean recession coverage was 60.25% in the test group and 49.6% in the control group. The recession reduction from baseline was 2.50 mm for the test group and 1.88 mm for the control group. At the end of 6 months, all sites achieved adequate root coverage. PRF is a feasible alternative to connective tissue grafts as an adjunct to PST for the treatment of multiple recession defects.
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Ramanauskaite A, Obreja K, Müller KM, Schliephake C, Wieland J, Begic A, Dahmer I, Parvini P, Schwarz F. Three-dimensional changes of a porcine collagen matrix and free gingival grafts for soft tissue augmentation to increase the width of keratinized tissue around dental implants: a randomized controlled clinical study. Int J Implant Dent 2023; 9:13. [PMID: 37326686 PMCID: PMC10275822 DOI: 10.1186/s40729-023-00482-2] [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: 01/31/2023] [Accepted: 05/29/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Emerging clinical data points to the relevance of the presence of keratinized tissue (KT). Although apically positioned flap/vestibuloplasty along with free gingival graft (FGG) is considered as a standard intervention for augmenting KT, substitute materials appear to be a viable treatment alternative. So far, there is a lack of data investigating the dimensional changes at implant sites treated with soft-tissue substitutes or FGG. AIM The present study aimed at comparing three-dimensional changes of a porcine derived collagen matrix (CM) and FGG for increasing KT at dental implants over a 6-month follow-up period. MATERIALS AND METHODS The study enrolled 32 patients exhibiting deficient KT width (i.e., < 2 mm) at the vestibular aspect who underwent soft tissue augmentation using either CM (15 patients/23 implants) or FGG (17 patients/31 implants). The primary outcome was defined as tissue thickness change (mm) at treated implant sites between 1- (S0), 3- (S1), and 6-months (S2). Secondary outcomes considered changes of KT width over a 6-month follow-up period, surgical treatment time, and patient-reported outcomes. RESULTS Dimensional analyses from S0 to S1 and from S0 to S2 revealed a mean decrease in tissue thickness of - 0.14 ± 0.27 mm and - 0.04 ± 0.40 mm in the CM group, and - 0.08 ± 0.29 mm and - 0.13 ± 0.23 mm in the FGG group, with no significant differences noted between the groups (3 months: p = 0.542, 6 months: p = 0.659). Likewise, a comparable tissue thickness decrease was observed from S1 to S2 in both groups (CM: - 0.03 ± 0.22 mm, FGG: - 0.06 ± 0.14 mm; p = 0.467). The FGG group exhibited a significantly greater KT gain after 1, 3 and 6 months compared to the CM group (1 month: CM: 3.66 ± 1.67 mm, FGG: 5.90 ± 1.58 mm; p = 0.002; 3 months: CM: 2.22 ± 1.44; FGG: 4.91 ± 1.55; p = 0.0457; 6 months: CM: 1.45 ± 1.13 mm, FGG: 4.52 ± 1.40 mm; p < 0.1). Surgery time (CM: 23.33 ± 7.04 min.; FGG: 39.25 ± 10.64 min.; p = 0.001) and postoperative intake of analgesics were significantly lower in the CM group (CM: 1.2 ± 1.08 tablets; FGG: 5.64 ± 6.39 tablets; p = 0.001). CONCLUSIONS CM and FGG were associated with comparable three-dimensional thickness changes between 1 and 6 months. While a wider KT band could be established with FGG, the use of CM significantly reduced surgical time and patients´ intake of analgesics.
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Affiliation(s)
- Ausra Ramanauskaite
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt an Main, Germany
| | - Karina Obreja
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt an Main, Germany
| | - Katharina Melissa Müller
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt an Main, Germany
| | - Carla Schliephake
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt an Main, Germany
| | - Johanna Wieland
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt an Main, Germany
| | - Amira Begic
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt an Main, Germany
| | - Iulia Dahmer
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt an Main, Germany
| | - Puria Parvini
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt an Main, Germany
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt an Main, Germany
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George TP, Tadepalli A, Parthasarathy H, Ponnaiyan D, Ramachandran L, Cholan P. Comparison of Clinical Efficacy of Bio-Resorbable Xenogeneic Peritoneal Membrane with Connective Tissue Graft in the Management of Gingival Recession Defects: A Randomized Controlled Clinical Trial. INT J PERIODONT REST 2023; 43:s244-s254. [PMID: 37307509 DOI: 10.11607/prd.6232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This randomized controlled trial was aimed to determine the clinical efficacy of xenogeneic collagen membrane derived from porcine peritoneum (XCM) in combination with a coronally advanced flap (CAF) in the management of gingival recession defects and to compare the outcomes to those of connective tissue graft (CTG). 12 systemically healthy individuals presenting with 30 isolated/multiple Cairo's RT 1/2 gingival recession defects in maxillary canines and premolars, were randomly treated either with CAF+XCM or CAF+CTG. Recession height (RH), gingival biotype (GB), gingival thickness (GT), width of keratinized gingiva (WKG) and attached gingiva (WAG) were recorded at baseline, 3, 6 and 12 months. Patient perception for pain, esthetics and modification of root coverage esthetic score (MRES) were also documented. From baseline to 12 months, both groups showed a significant reduction in mean RH (CAF+CTG: 2.73±0.79mm to 0.33±0.61mm and CAF+XCM: 2.73±0.88mm to 1.20±0.77mm). At 12 months, CAF+CTG sites had a MRC of 85.60±28.74%, whereas CAF+XCM sites had a MRC of 55.13±31.22%. CAF+CTG treated sites had significantly better outcomes, with greater number of sites achieving complete root coverage (n=11) and higher MRES scores than porcine peritoneal membrane group (P<0.05). Int J Periodontics Restorative Dent. doi: 10.11607/prd.6232.
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Mahajan A, Goyal L, Asi KS, Walhe MS, Chandel N. Clinical effectiveness of periosteal pedicle graft for the management of gingival recession defects-a systematic review and meta-analysis. Evid Based Dent 2023; 24:93-94. [PMID: 37286696 DOI: 10.1038/s41432-023-00898-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/19/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The purpose of this systematic review and meta-analysis was to evaluate the effectiveness of periosteal pedicle graft (PPG) in terms of root coverage and patient related outcomes. To the best of our knowledge this is the first systematic review with meta-analysis on PPG. MATERIAL AND METHODS A comprehensive search was performed using electronic and hand searches upto January 2023. Primary outcomes were Recession depth Reduction (Rec Red), mean root coverage (mRC) and complete root coverage (CRC). Secondary outcomes were gain in width of keratinized gingiva (WKG) and patient reported outcome measures (PROMs). Meta-analysis was performed when possible. The risk bias assessment was done using RevMan5.4.1 and Joanna Briggs institute scale for the included RCTs and case series respectively. RESULTS A total of 8 RCTs and 2 case series (538 recession sites) were included based upon the predefined inclusion and exclusion criteria. The follow up period ranged from 6 months to 18 months. Results demonstrated that mRC of PPG + Coronally advanced flap (CAF) was 87.7% for localized gingival recession defects (GRDs) and 84.83% for multiple GRDs. An overall gain in WKG (Weighted Mean =1.49 ± 0.27 mm) was observed among all the included studies in the PPG + CAF group with mean difference (-0.10 (95% CI [-0.52, 0.33], p = 0.66)). Sub-group meta-analysis comparing PPG + CAF with sub-epithelial connective tissue graft (SCTG) + CAF resulted in similar outcomes in terms of Rec Red (0.10 (95% CI [-0.56 to 0.77], p = 0.76)) and gain in WKG (-0.03 (95% CI [-0.25 to 0.18], p = 0.76)). In terms of PROMs systematic review revealed better patient satisfaction with PPG + CAF than SCTG + CAF. CONCLUSION PPG + CAF is a viable treatment modality for management of GRDs. The primary and secondary outcomes achieved utilizing PPG + CAF were found to be comparable to other conventional techniques including the gold standard i.e., SCTG.
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Affiliation(s)
- Ajay Mahajan
- Department of Periodontology, H.P. Government Dental College and Hospital, Shimla, Himachal Pradesh, India.
| | - Lata Goyal
- All India Institute of Medical Sciences (AIIMS), Bathinda, Punjab, India
| | - Kanwarjit Singh Asi
- Department of Periodontology, H.P. Government Dental College and Hospital, Shimla, Himachal Pradesh, India
| | - Monika Shekhar Walhe
- Department of Periodontology, H.P. Government Dental College and Hospital, Shimla, Himachal Pradesh, India
| | - Nidhi Chandel
- Department of Periodontology, H.P. Government Dental College and Hospital, Shimla, Himachal Pradesh, India
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Jiang H, Liu L, Dong Y, Yu M, Yuan Y, Tian L. Study on short-term clinical observation of the effect of apically repositioned flap combined with free gingival graft to widen keratinized tissue in implant area. Afr Health Sci 2023; 23:346-352. [PMID: 38223652 PMCID: PMC10782318 DOI: 10.4314/ahs.v23i2.38] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
Objective To analyse the short-term clinical results of the effect of apically repositioned flap combined with free gingival graft to widen keratinized tissue in implant area, so as to provide a basis for its clinical application. Methods Fifteen patients with intraoral single or multiple missing teeth, who did not undergo implant restoration or who re-examined after implant restoration completed were included, along with KW less than 1-2 mm on the buccal side of the median line of the alveolar ridge crest in the implant area, or KW less than 1-2 mm on the buccal side of the abutments and dental crown margins. All underwent apically repositioned flap combined with free gingival graft, which were reviewed. Results Fifteen patients with missing keratinized gingivae underwent free gingival flap graft, survived with all grafted gingival flaps. Compared with before implantation, significant keratinized tissue widening and area gain were obtained at 1 and 3 months postoperatively. Conclusion The free gingival flap graft can significantly widen the buccal keratinized mucosa of the implant, and to some extent maintains the health status of the implant, which is worthy of clinical promotion and application.
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Affiliation(s)
- HuanHuan Jiang
- Department of Dental Implantology, Wuxi Stomatological Hospital, No.6 Jiankang Road, Liangxi District, Wuxi, China
| | - LinXiang Liu
- Department of Dental Implantology, Wuxi Stomatological Hospital, No.6 Jiankang Road, Liangxi District, Wuxi, China
| | - Yan Dong
- Department of Dental Implantology, Wuxi Stomatological Hospital, No.6 Jiankang Road, Liangxi District, Wuxi, China
| | - MeiNa Yu
- Department of Dental Implantology, Wuxi Stomatological Hospital, No.6 Jiankang Road, Liangxi District, Wuxi, China
| | - Yue Yuan
- Department of Dental Implantology, Wuxi Stomatological Hospital, No.6 Jiankang Road, Liangxi District, Wuxi, China
| | - Lei Tian
- Department of Dental Implantology, Wuxi Stomatological Hospital, No.6 Jiankang Road, Liangxi District, Wuxi, China
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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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Anegundi RV, Shenoy SB, Chandran T, Pampani P. Clinical efficacy of subepithelial connective tissue graft and A-PRF in the treatment of gingival recession. Quintessence Int 2023; 54:134-141. [PMID: 36421044 DOI: 10.3290/j.qi.b3512389] [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: 02/11/2023]
Abstract
OBJECTIVE The current study was designed to clinically compare and evaluate subepithelial connective tissue graft (SCTG) and advanced platelet-rich fibrin (A-PRF) membrane-based root coverage in the treatment of gingival recession type 1 (RT1). METHOD AND MATERIALS The current study involved 17 patients with bilateral gingival recession (RT1). Thirty-four sites were randomly allocated to test (A-PRF) and control (SCTG) sites and all the procedures were performed by a single operator. A single blinded observer evaluated the test and control sites at baseline, 3 months, and 6 months. The clinical parameters such as recession depth, recession width, width of keratinized gingiva, clinical attachment level, and percentage of root coverage were recorded. P < .05 was considered statistically significant. RESULTS The mean recession depth at baseline for control and test groups was 3.06 ± 0.56 mm and 2.35 ± 0.49 mm, respectively (P < .001). At the end of the study period, the mean recession depth was 0.53 ± 0.62 mm in the control group and 1.12 ± 0.49 mm in the test group (P < .05). No complications were associated with both the groups. The mean percentage of root coverage was 84.31 ± 17.89% in the control group and 51.96 ± 15.45% in the test group (P < .001). CONCLUSION In conclusion, the study results suggest that both SCTG and A-PRF can be used in treating gingival recessions. However, SCTG is a better material in achieving root coverage and increasing keratinized tissue width. (Quintessence Int 2023;54:134-141; doi: 10.3290/j.qi.b3512389).
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Wang M, Zhan Y, Liu F. Modified Suture Technique for Stabilization of Connective Tissue Graft in Immediate Implant Placement and Provisionalization: A Short Technical Report. INT J PERIODONT REST 2023; 43:e11-e18. [PMID: 36661875 DOI: 10.11607/prd.4909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Immediate implant placement and provisionalization with subepithelial connective tissue graft is considered the reference therapy for achieving a good esthetic outcome, especially in cases with a thin periodontal phenotype. Positioning sutures are usually required to maintain graft stability. This article describes the use of a modified suture technique involving vertical/horizontal double-parallel mattress sutures in immediate implant placement to achieve stable passive fixation of the graft in the appropriate position and to provide a more equal distribution of tension in the wound. A novel, simplified, reproducible technique is described in two cases of immediate implant placement and provisionalization with subepithelial connective tissue grafting and double-parallel mattress sutures.
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Skurska A, Milewski R, Pietruska M. Long-Term Clinical Assessment of Two Modifications of Tunnel Technique in Treatment of Cairo Recession Type 1 in Lower Jaw. Int J Environ Res Public Health 2022; 19:16444. [PMID: 36554325 PMCID: PMC9778240 DOI: 10.3390/ijerph192416444] [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: 11/02/2022] [Revised: 11/30/2022] [Accepted: 12/03/2022] [Indexed: 06/17/2023]
Abstract
AIM The aim of this study is to compare long-term results after using an MCAT (Modified Coronally Advanced Tunnel) with an SCTG (Subepithelial Connective Tissue Graft) or an MCAT with CM (Collagen Matrices) in the treatment of Cairo recession Type 1 in mandibular single-rooted teeth. MATERIAL AND METHOD The study encompassed 80 recessions in 18 patients for whom an MCAT was combined with CM on one side of the mandible and with an SCTG on the contralateral one. The following clinical parameters were measured: gingival recession height (GR) and width (RW), probing depth (PD), clinical attachment level (CAL), width of keratinized tissue (KT), gingival thickness (GT), and mean (MRC). RESULTS The MRC on the CM- and SCTG-treated sides was 55.25% and 82.35%, respectively. The SCTG side had a significantly greater improvement in MRC, GR, RW, KT, and GT compared to the CM side. The five-year results were stable relative to one-year observations. CONCLUSIONS Both methods of treatment enable the achievement of stable long-term clinical results. Application of subepithelial connective tissue grafts is more effective relative to clinical parameters.
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Affiliation(s)
- Anna Skurska
- Department of Periodontal and Oral Mucosa Diseases, Medical University of Białystok, ul. Waszyngtona 13, 15-269 Białystok, Poland
| | - Robert Milewski
- Department of Biostatistics and Medical Informatics Medical University of Białystok, ul. Szpitalna 37, 15-295 Białystok, Poland
| | - Małgorzata Pietruska
- Department of Periodontal and Oral Mucosa Diseases, Medical University of Białystok, ul. Waszyngtona 13, 15-269 Białystok, Poland
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Bednarz W, Majer J, Pakuszyńska-Błaszczyk J, Dominiak M, Gedrange T, Zielińska-Pałasz A. Laterally Positioned Flap Procedure with Augmented or Nonaugmented Palatal Connective Tissue Grafts in the Treatment of Multiple Adjacent Gingival Recessions: A Two-Year Follow-Up Study. Int J Environ Res Public Health 2022; 19:12208. [PMID: 36231511 PMCID: PMC9566521 DOI: 10.3390/ijerph191912208] [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: 08/22/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
The most commonly used technique for covering gingival recessions is the coronally advanced flap (CAF) technique due to its high success rate. In clinical situations where there is less keratinized tissue apical to the defect due to unfavorable anatomical conditions, a more advantageous technique for this situation should be considered, specifically the laterally positioned flap (LPF). The aim of this study was to compare the gingival thickness after gingival recession coverage using the laterally positioned flap supported by an augmented and non-augmented connective tissue graft (CTG). Thirty-four patients with 105 gingival recessions of Miller's class I and/or II were enrolled in this study. The method of choice was the laterally positioned flap. The test group was treated with previously augmented CTG harvested from the palatal mucosa while the control group was treated with a non-augmented CTG. Clinical measurements were recorded at baseline, 6, 12 and 24 months after intervention. Clinical results showed a statistically more significant percentage of average and complete gingival recession coverage in the test group. The LPF in combination with an augmented CTG proves to be an effective alternative to the CAF. Greater improvement in gingival thickness was observed in the LPF with augmented CTG than in non-augmented CTG.
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Affiliation(s)
- Wojciech Bednarz
- Specialist Outpatient Medical Clinic MEDIDENT, Okulickiego 19 Str., PL 38-300 Gorlice, Poland
| | - Jennifer Majer
- Department of Orthodontics, Carl Gustav Carus Campus, Technische Universität Dresden, Fetscherstr. 74, D-01309 Dresden, Germany
| | | | - Marzena Dominiak
- Department of Dental Surgery, Medical University in Wroclaw, Krakowska 26 str., PL 50-425 Wroclaw, Poland
| | - Tomasz Gedrange
- Department of Orthodontics, Carl Gustav Carus Campus, Technische Universität Dresden, Fetscherstr. 74, D-01309 Dresden, Germany
- Department of Dental Surgery, Medical University in Wroclaw, Krakowska 26 str., PL 50-425 Wroclaw, Poland
| | - Agata Zielińska-Pałasz
- Specialist Outpatient Medical Clinic MEDIDENT, Okulickiego 19 Str., PL 38-300 Gorlice, Poland
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Skierska I, Wyrębek B, Górski B. Clinical and Aesthetic Outcomes of Multiple Gingival Recessions Coverage with Modified Coronally Advanced Tunnel and Subepithelial Connective Tissue Graft in Maxilla and Mandible: A 2-Year Retrospective Study. Int J Environ Res Public Health 2022; 19:11024. [PMID: 36078740 PMCID: PMC9518086 DOI: 10.3390/ijerph191711024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/29/2022] [Accepted: 08/31/2022] [Indexed: 06/15/2023]
Abstract
Limited long-term data are available when analyzing gingival recession coverage between the maxillary and mandibular sites. Therefore, the aim of this study was to evaluate the influence of location (maxilla versus mandible) of multiple gingival recessions on 24 months clinical and aesthetic outcomes of modified coronally advanced tunnel with subepithelial connective tissue graft. Forty patients with multiple gingival recessions (GR) located at maxillary or mandibular teeth were treated between January 2018 and December 2019. Reduction in GR, average root coverage (ARC), complete root coverage (CRC), increase in keratinized tissue width (KTW), increase in gingival thickness (GT), and aesthetic evaluation with the root coverage esthetic score (RES) were evaluated after 24 months. Thirty patients with 270 recessions in the upper teeth and ten patients with 90 recessions in the lower teeth completed the 2-year recall. The differences between preoperative and postoperative clinical parameters showed statistical significance only within but not between groups. ARC at 2 years was 93.31% for maxillary teeth and 93.06% for mandibular teeth (p = 0.7906). Mean RES values were comparable for upper and lower teeth (9.25 versus 8.92, respectively, p = 0.6733). However, upper teeth achieved significantly higher scores for marginal tissue contour (MTC), muco-gingival junction alignment (MGJ), and gingival color (GC). Lower teeth had decreased chances of receiving better RES (OR = 0.49, CI 0.24-0.99, p = 0.0457) in regression analysis, when compared with upper teeth. MCAT + SCTG achieved comparably favorable 2-year outcomes for the treatment of multiple GR in upper and in lower teeth. However, the individual RES components were higher in maxillary teeth, and upper teeth had higher odds of receiving better RES.
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Fu X, Tian J, Wang Y, Zhang Y, Lin Y. Clinical Effect of Free Gingival Grafts on the Increase in Keratinized Mucosa Width at the Buccal Aspect of Implants in Adjacent Mandibular Molars: A Retrospective Study. INT J PERIODONT REST 2022; 42:649-656. [PMID: 36044697 DOI: 10.11607/prd.5706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The aim of this retrospective study was to evaluate the effect of free gingival grafts (FGGs) at adjacent mandibular molar implants and to compare the clinical outcomes between the first molar (M1) and second molar (M2) sites. Twenty-one patients with 44 implants were included. At the 3-year follow-up, the mean increase in the keratinized mucosa width (KMW) was 2.35 ± 1.33 mm, and the mean KMW shrinkage rate was 58% ± 23%. M1 sites showed a significantly greater increase of KMW and less graft shrinkage than M2 sites (M1: 2.87 ± 1.40 mm and 49% ± 24%, M2: 1.83 ± 1.06 mm and 66% ± 19%, P < .05). The results show that using FGG to increase KMW in mandibular molar implants was a predictable treatment method, and M1 sites were associated with a greater KMW increase than M2 sites.
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Carvelli G, Caton JG, Barmak AB, Tsigarida A. Comparison of Coronally Advanced Flap and Connective Tissue Graft With or Without Enamel Matrix Derivative for Gingival Recession Treatment: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. INT J PERIODONT REST 2022; 42:e121-e131. [PMID: 36044689 DOI: 10.11607/prd.6265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The aim of this systematic review and meta-analysis was to assess whether the addition of enamel matrix derivative (EMD) to a coronally advanced flap (CAF) combined with a connective tissue graft (CTG) resulted in a greater amount of root coverage in patients treated for gingival recessions, as compared to CAF+CTG alone. The search for clinical trials on root coverage procedures comparing CAF+CTG+EDM vs CAF+CTG was completed on online databases and gray literature, and it included studies published up to January 2022. The risk of bias was assessed using the Cochrane bias assessment tool, and the quantitative analysis was performed using a random effects model. A total of 1,917 articles were identified, and 12 underwent full-text review. Three studies were excluded, and 9 were selected for full analysis. The meta-analysis showed that there is a statistically significant difference (P = .04) in favor of CAF+CTG+EMD compared to CAF+CTG alone for the amount of root coverage (mean difference: 0.30 mm; 95% CI: 0.01, 0.58 mm). According to the results of this systematic review and meta-analysis, the addition of EMD to CAF+CTG results in a greater amount of root coverage in teeth treated for gingival recessions.
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Ashurko I, Tarasenko S, Esayan A, Kurkov A, Mikaelyan K, Balyasin M, Galyas A, Kustova J, Taschieri S, Corbella S. Connective tissue graft versus xenogeneic collagen matrix for soft tissue augmentation at implant sites: a randomized-controlled clinical trial. Clin Oral Investig 2022; 26:7191-7208. [PMID: 36029335 DOI: 10.1007/s00784-022-04680-x] [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: 03/15/2022] [Accepted: 08/10/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The purpose of this randomized clinical trial (RCT) is to compare xenogeneic collagen matrix (XCM) versus subepithelial connective tissue graft (SCTG) to increase soft tissue thickness at implant site. MATERIALS AND METHODS The study was a randomized, parallel-group controlled investigation. Thirty patients underwent buccal soft tissue thickness augmentation at the stage of implant placement by two different methods: SCTG (control group) and XCM (test group). Primary outcome was the amount of buccal soft tissue thickness gain, 3 months after the intervention. Secondary outcomes were the operation time, the amount of keratinized mucosa (KM), pain syndrome (PS), and patients' quality of life (QL). Histologic evaluation was also performed. RESULTS The amount of soft tissue thickness gain was 1.55±0.11 mm in SCTG group, and 1.18±0.11mm in XCM group. The difference between the SCTG and XCM was -0.366 (-0.66 to -0.07; p=0.016). Operation time with XCM was 8.4 (3.737 to 13.06) min shorter than that with the SCTG (p=0.001). KT, PS, and QL for both groups were not statistically significantly different at any time point (p>0.05). At histological examination, the general picture in both groups was similar. No significant differences between the studied groups in most indices, except for the average and maximum formation thickness, cellularity of the basal, mitotic activity and also maximum length of rete ridges. CONCLUSION Within limitations, this study demonstrates that the use of SCTG provides a statistically significant superior soft tissue thickness gain than XCM for soft tissue augmentation procedures around implants. CLINICAL RELEVANCE XCM can be used as the method of choice for increasing the thickness of soft tissues.
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Affiliation(s)
- Igor Ashurko
- Department of Oral Surgery of the Institute of Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 11 Mozhaisky Val Street, Moscow, 119048, Russian Federation.
| | - Svetlana Tarasenko
- Department of Oral Surgery of the Institute of Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 11 Mozhaisky Val Street, Moscow, 119048, Russian Federation
| | - Aleksandr Esayan
- Department of Oral Surgery of the Institute of Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 11 Mozhaisky Val Street, Moscow, 119048, Russian Federation
| | - Alexandr Kurkov
- Department of Oral Surgery of the Institute of Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 11 Mozhaisky Val Street, Moscow, 119048, Russian Federation
| | - Karen Mikaelyan
- Department of Oral Surgery of the Institute of Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 11 Mozhaisky Val Street, Moscow, 119048, Russian Federation
| | - Maxim Balyasin
- Peoples Friendship University of Russia, Moscow, Russian Federation
| | - Anna Galyas
- Department of Oral Surgery of the Institute of Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 11 Mozhaisky Val Street, Moscow, 119048, Russian Federation
| | - Julia Kustova
- Department of Oral Surgery of the Institute of Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 11 Mozhaisky Val Street, Moscow, 119048, Russian Federation
| | - Silvio Taschieri
- Department of Oral Surgery of the Institute of Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 11 Mozhaisky Val Street, Moscow, 119048, Russian Federation
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedica, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - Stefano Corbella
- Department of Oral Surgery of the Institute of Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 11 Mozhaisky Val Street, Moscow, 119048, Russian Federation
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedica, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
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Penmetsa GS, Raju M. Soft and Hard Tissue Revision Around an Implant: Case Report with a 10-Year Follow-up. INT J PERIODONT REST 2022; 42:e85-e90. [PMID: 35472119 DOI: 10.11607/prd.5701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Dental implants are the most promising modality of tooth replacement in the modern era. Of late, peri-implant architecture has gained significant importance and forms the basic foundation for success of an implant restoration, with both the hard and soft tissue components around an implant playing vital roles in the osseointegration process. A 23-year-old man reported with a titanium membrane exposure around tooth site 16 (FDI tooth-numbering system) along with decreased attached gingival width and thickness. To gain soft tissue thickness, a rotated connective tissue graft was harvested, as was a "sticky bone" graft to gain bone volume. Connective tissue is one of the most promising modalities for soft tissue augmentation around both the natural tooth and implants. "Sticky bone," which is a more advanced form of bone grafting techniques, was implemented to achieve the benefits of injectable platelet-rich fibrin. This case report describes the hard and soft tissue augmentation procedure and successful results at the 10-year follow-up, as well as fabrication of an implant-supported fixed partial denture.
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Alasqah M, Alrashidi A, Alshammari N, Alshehri A, Gufran K. Effect of honey dressing material on palatal wound healing after harvesting a free gingival graft: a prospective randomized case control study. Eur Rev Med Pharmacol Sci 2022; 26:2662-2668. [PMID: 35503610 DOI: 10.26355/eurrev_202204_28595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The aim of this prospective randomized case-control study was to understand the clinical benefits and effect of honey as a dressing material on palatal wound healing after harvesting free gingival graft (FGG). PATIENTS AND METHODS This prospective randomized case-control study was conducted on a sample of 20 patients with 10 patients in each group. Medihoney dressing material was applied to the donor site in the test group, whereas no dressing material was applied to the control group. All the patients received the same medication (Ibuprofen 600 mg) and post-operative instructions straight away after the surgical procedure. Patients were given the follow-up appointment at first, second and fourth week after the surgery during which the length and the width of the donor site was measured and recorded. RESULTS At first week, a significant difference in the proportion of patients showing the healing of donor site percentage was found to be 56% (both in width and length) for test group vs. 44% (both in width and length) for the control group (p=0.001). At 4-week, the healing of donor site percentage was found to be 86% (in width) and 91% (in length) for test group vs. 14% (in width) and 9% (in length) for the control group, the difference being statistically significant (p=0.001). CONCLUSIONS The result of this current study suggests that the honey dressing material accelerated the wound healing process of the palatal wound after harvesting FGG. It also showed a shorter recovery period along with less post-operative morbidity.
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Affiliation(s)
- M Alasqah
- Department of Preventive Dental Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University Alkharj, Saudi Arabia.
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43
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Tavelli L, Barootchi S. A Minimally Invasive Approach for the Treatment of Multiple Adjacent Gingival Recessions with a Volume-Stable Collagen Matrix: A Case Series. INT J PERIODONT REST 2022; 42:155-162. [PMID: 35353081 DOI: 10.11607/prd.5747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Several soft tissue graft materials have been utilized over the years as alternatives to the autogenous connective tissue graft for reducing patient morbidity. In particular, a novel volume-stable xenogeneic collagen matrix (VXCM) has recently been introduced for soft tissue augmentation at implant sites. The VXCM is porous in nature, and its mechanical properties suggest utilizing a specific flap approach when treating multiple adjacent gingival recessions (MAGRs). Herewith, a minimally invasive surgical technique is described in combination with VXCM for treatment of MAGRs. Five patients with 16 MAGRs were treated with this approach. All sites healed uneventfully, and patients reported minimal discomfort. At 6 months, the technique resulted in a mean root coverage of 94.73%, and complete root coverage was achieved in 13 sites (81.25%). The proposed minimally invasive approach may have potential to enhance flap blood supply and graft vascularization, promoting rapid healing with minimal postoperative discomfort. In addition, this approach can result in satisfactory clinical, esthetic, and patient-reported outcomes. Future adequately powered clinical trials are needed to validate the findings of this preliminary report.
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Agrawal P, Katti N, Mohanty D, Pradhan SS, Raj SC, Satyarup D, Mahopatra A, Srivani P. Treatment of Localized Gingival Recession Using Gingival Unit Grafts: An 18-month Follow-up Study. J Contemp Dent Pract 2022; 23:49-55. [PMID: 35656657] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
AIM The study aimed to longitudinally evaluate the efficacy of gingival unit grafts (GUGs), a modification of free gingival grafts, in the management of Miller's class I and class II recession defects in mandibular anterior region, over a period of 18 months. MATERIALS AND METHODS 17 subjects with 21 recession defects in mandibular anterior region were treated using GUG. Clinical parameters of recession depth (RD), clinical attachment levels (CALs), and keratinized tissue width (KTW) were recorded at baseline, 1, 6, and 18 months. Patient-centered outcomes were measured using a visual analog scale (VAS) for pain and discomfort on 14th postoperative day and for treatment satisfaction at the end of 18 months. RESULTS There was a statistically significant improvement in RD, CAL, and KTW at 18 months when compared to baseline levels. A mean root coverage (MRC) percentage of 84.76 ± 11.79% was achieved at the end of 18 months. Patient-related outcomes for VAS for pain and discomfort as well as treatment satisfaction showed favorable results. CONCLUSION GUG can be used as a predictable treatment modality for Miller's class I and class II recession defects in mandibular anterior region. The results obtained can be well maintained over 18-month period with optimal maintenance care. CLINICAL SIGNIFICANCE The advantage of involving marginal gingiva in GUG results in a well-contoured graft, which increases the ease of adaptation and suturing. The biological characteristic of intact marginal vasculature results in early integration of graft into the recipient area and greater success in graft survival over denuded root surface, causing better long-term RC outcomes.
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Affiliation(s)
- Poonam Agrawal
- Department of Periodontics, SCB Dental College and Hospital, Cuttack, Odisha, India
| | - Neelima Katti
- Department of Periodontics, SCB Dental College and Hospital, Cuttack, Odisha, India
| | - Devapratim Mohanty
- Department of Periodontics, SCB Dental College and Hospital, Cuttack, Odisha, India, Phone: +91 9338013446, e-mail:
| | - Shib Shankar Pradhan
- Department of Periodontics, SCB Dental College and Hospital, Cuttack, Odisha, India
| | - Subash Chandra Raj
- Department of Periodontics, SCB Dental College and Hospital, Cuttack, Odisha, India
| | - Dharmashree Satyarup
- Department of Public Health Dentistry, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India
| | - Annuroopa Mahopatra
- Department of Periodontics, SCB Dental College and Hospital, Cuttack, Odisha, India
| | - Peri Srivani
- Department of Periodontics, SCB Dental College and Hospital, Cuttack, Odisha, India
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Edranov SS, Matveeva NY, Kalinichenko SG. On-Bone Fixation of Free Gingival Graft Induces an Osteoinductive Effect in Human Alveolar Bone. Bull Exp Biol Med 2021; 172:276-281. [PMID: 34855081 DOI: 10.1007/s10517-021-05375-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Indexed: 12/26/2022]
Abstract
We examined alveolar bone samples in the area of on-bone fixation of a free gingival graft performed during surgery in patients aged 37-55 years with a diagnosis of secondary partial adentia of the upper and lower jaws. Six months after fixation of the graft in the alveolar bone, foci of neoosteogenesis were found in the contact zone. They were characterized by the appearance of appositional lines, cords of basophilic osteoblasts, and growing osteons. An immunohistochemical study revealed an increase in the number of CD44+, CD29+, and osteocalcin+ cells in the layer of the outer circumferential lamellae, primary osteons, and the lining of the Haversian canals. TGF-β1+ cells were located in the intertrabecular reticular tissue and wall of microvessels. The results indicate activation of mesenchymal stem cells in the area of localization of the graft and differentiating osteoblasts. The observed osteoinductive effect of free gingival graft is associated with its participation in reorganization in MSC and induction of morphogenetic molecules.
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Affiliation(s)
- S S Edranov
- Department of Histology, Embryology, and Cytology, Pacific State Medical University, Ministry of Health of the Russian Federation, Moscow, Russia
| | - N Yu Matveeva
- Department of Histology, Embryology, and Cytology, Pacific State Medical University, Ministry of Health of the Russian Federation, Moscow, Russia.
| | - S G Kalinichenko
- Department of Histology, Embryology, and Cytology, Pacific State Medical University, Ministry of Health of the Russian Federation, Moscow, Russia
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Veríssimo AH, Ribeiro AKC, Martins ARLDA, Gurgel BCDV, Lins RDAU. Comparative analysis of the hemostatic, analgesic and healing effects of cyanoacrylate on free gingival graft surgical wounds in donor and recipient areas: a systematic review. J Mater Sci Mater Med 2021; 32:98. [PMID: 34406492 PMCID: PMC8373739 DOI: 10.1007/s10856-021-06573-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 06/14/2021] [Indexed: 06/13/2023]
Abstract
UNLABELLED To analyze the hemostatic, Dsurgical wounds in donor and recipient areas of free gingival grafts (FGG). Five databases (PubMed, Scopus, Science Direct, Cochrane and Web of Science) were searched up to March 2021 (PROSPERO CRD42019134497). The focus of the study (cyanoacrylate) was combined with the condition (periodontal surgery OR free gingival graft OR free soft tissue graft OR autografts), and outcome (healing OR epithelialization OR pain OR analgesia OR bleeding OR hemostasis OR hemostatic). Studies reporting cyanoacrylate isolated or associated with another substance in FGG stabilization and closure were investigated and assessed for the quality and risk of bias through the Cochrane Manual. Six studies with 323 participants were included. Evaluation of the quality and risk of bias highlighted a low risk for four articles, intermediate for one and unclear for another. The use of cyanoacrylate associated or not with the hemostatic sponge or the platelet-rich fibrin was more effective in healing (three studies), analgesia (four studies), and hemostasis in one study (p < 0.05). However, groups with the association in cyanoacrylate showed superior healing, and analgesic action to the isolated cyanoacrylate group. In addition, two studies demonstrated that cyanoacrylate use reduces surgery duration, one study showed that it reduces postoperative sensibility, and another present hemostatic effect (p < 0.05). There is scarce literature for the use of cyanoacrylate in FGG wounds indicates that it can promote a minor inflammatory response, reduce operation time, does not interfere with healing, relieves postoperative discomfort, and suggests the possibility immediate hemostasis. Its use presents an alternative to suturing in FGG surgeries. But, the limited number of cases and the relative heterogeneity of the included studies suggest caution in generalizing the indication. CLINICAL RELEVANCE Cyanoacrylate seems to present analgesic effects and less pain when applied to wound closure and covering donor and recipient areas reducing the need for postoperative analgesic medication; and has a healing effect in the closure of the donor area on the palate. In addition, it can reduce bleeding time after surgery, and prevents late bleeding during the first postsurgical week. Scientific justification: To evaluate the hemostatic, analgesic and healing actions of cyanoacrylate compared to the suture thread and other agents when used to close surgical wounds from periodontal free gingival graft surgical wounds in both the donor and recipient areas of the graft. MAIN FINDINGS The use of cyanoacrylate individually or in association with wound dressing agents presents analgesic effects because the patient reports less pain experienced when cyanoacrylate is applied to the wound closure and covering, thereby reducing the need for postoperative analgesic medication. In addition, a healing effect is observed in the closure of the donor area on the palate; as well as it seems to present hemostatic effects, reducing the bleeding time after surgery, and preventing late bleeding during the first postsurgical week. PRACTICAL IMPLICATIONS Dentists may cautiously apply cyanoacrylate after periodontal surgeries for free gingival graft in both the donor and recipient areas of the graft. However, they must consider the limitations of the surgery, tension-free positioning, the patient's dyscrasia and postoperative care, constituting a set of predictors for adequate clinical decision-making. Widespread use of such material for all patients and surgical configurations may not be recommended.
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Affiliation(s)
- Aretha Heitor Veríssimo
- Department of Dentistry, Federal University of Rio Grande do Norte (UFRN), Av. Salgado Filho, 1787, Lagoa Nova, Natal, 59056-000, Brazil.
| | - Anne Kaline Claudino Ribeiro
- Department of Dentistry, Federal University of Rio Grande do Norte (UFRN), Av. Salgado Filho, 1787, Lagoa Nova, Natal, 59056-000, Brazil
| | - Ana Rafaela Luz de Aquino Martins
- Department of Dentistry, Federal University of Rio Grande do Norte (UFRN), Av. Salgado Filho, 1787, Lagoa Nova, Natal, 59056-000, Brazil
| | - Bruno Cesar de Vasconcelos Gurgel
- Department of Dentistry, Federal University of Rio Grande do Norte (UFRN), Av. Salgado Filho, 1787, Lagoa Nova, Natal, 59056-000, Brazil
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Kang J, Yi M, Chen J, Peng M. Comparative assessment between bio-adhesive material and silk suture in regard to healing, clinical attachment level and width of keratinized gingiva in gingival recession defects cases. Sci Prog 2021; 104:368504211011868. [PMID: 33940998 PMCID: PMC10454994 DOI: 10.1177/00368504211011868] [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] [Indexed: 11/15/2022]
Abstract
The objective of this study was to compare the silk suture with a cyanoacrylate adhesive to stabilize the free gingival graft in conjunction with Er: YAG laser-assisted recipient site preparation to augment the keratinized tissue in gingival recession cases. This randomized trial comprised of 300 recession defects patients. All the included patients were diagnosed using Miller class I and II gingival recession defects classification. Group I sites were treated with a free gingival graft (FGG) harvested using an Er: YAG laser and further sutured with silk. Group II sites were stabilized with isoamyl 2 cyanoacrylate bio-adhesive material. Clinical parameters, such as gingival recession depth, clinical attachment level, gain in gingival tissue thickness, and width of keratinized gingiva were recorded at baseline, and at third month, sixth month, and 12th month postoperatively. The mean changes in gingival recession from months 3 to 6 and months and 6 to 12 were significant (p < 0.05) in both groups. However, the improvement in recession depth was better in group II than in group I. The mean change in clinical attachment level did not differ significantly between the groups at the different time intervals. However, values tended to be higher in group II than in group I. The width of the keratinized gingiva tended to be higher from baseline to 3 months, baseline to 6 months, baseline to 12 months, 3 to 6 months, and from 6 to 12 months in group II as compared with group I (p > 0.05). Cyanoacrylate could be used as a substitute to silk sutures to stabilize FGGs. Cyanoacrylate was easy to apply, consumed less operating time, and was considered equally efficacious for stabilizing FGGs.
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Affiliation(s)
- Jing Kang
- Department of Orthodontics, Shanghai Huangpu District 2nd Dental Disease Prevention and Treatent Institute, Shanghai, China
| | - Min Yi
- Department of Periodontal, Shanghai Huangpu District 2nd Dental Disease Prevention and Treatment Institute, Shanghai, China
| | - Jie Chen
- Department of Radiology, Shanghai Huangpu District 2nd Dental Disease Prevention and Treatment Institute, Shanghai, China
| | - Minghui Peng
- Department of Orthodontics, Shanghai Huangpu District 2nd Dental Disease Prevention and Treatent Institute, Shanghai, China
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Iwanaga J, Tanaka T, Ibaragi S, Okui T, Hamaguchi J, Min S, Tubbs RS. Revisiting major anatomical risk factors of maxillary sinus lift and soft tissue graft harvesting for dental implant surgeons. Surg Radiol Anat 2020; 42:1025-1031. [PMID: 32277256 DOI: 10.1007/s00276-020-02468-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/31/2020] [Indexed: 11/25/2022]
Abstract
The anatomical variations of the maxillary sinus septa, greater palatine artery, and posterior superior alveolar arteries might cause unexpected complications when they are damaged. Dentists who know these structures well might hope to learn more practical knowledge to avoid and assess injury preoperatively. Therefore, this review paper aimed to review the reported anatomy and variations of the maxillary sinus septa, greater palatine artery/nerve, and posterior superior alveolar artery, and to discuss what has to be assessed preoperatively to avoid iatrogenic injury. To assess the risk of injury of surgically significant anatomical structures in the maxillary sinus and hard palate, the operator should have preoperative three-dimensional images in their mind based on anatomical knowledge and palpation. Additionally, knowledge of the average measurement results from previous studies is important.
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Affiliation(s)
- Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 S. Robertson St. Suite 1300, New Orleans, LA`, 70112, USA.
- Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
| | - Tsuyoshi Tanaka
- Department of Periodontology, University of Florida, Gainesville, FL, USA
| | - Soichiro Ibaragi
- Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Tatsuo Okui
- Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Junya Hamaguchi
- Department of Periodontics and Dental Hygiene, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Seiko Min
- Department of Periodontics and Dental Hygiene, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 S. Robertson St. Suite 1300, New Orleans, LA`, 70112, USA
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
- Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA
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Ehab K, Abouldahab O, Hassan A, Fawzy El-Sayed KM. Alvogyl and absorbable gelatin sponge as palatal wound dressings following epithelialized free gingival graft harvest: a randomized clinical trial. Clin Oral Investig 2020; 24:1517-1525. [PMID: 32144515 DOI: 10.1007/s00784-020-03254-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 12/05/2019] [Accepted: 02/26/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES This randomized controlled trial compares for the first time effects of Alvogyl versus absorbable gelatin sponge as palatal wound dressings on postoperative pain, amount of analgesic consumption, post-surgical bleeding, and wound re-epithelization. MATERIALS AND METHODS Following sample size calculation, 36 systemically healthy patients requiring palatal mucosal graft harvesting were randomized to receive Alvogyl (intervention group, 18 patients) or absorbable gelatin sponge (control group, 18 patients) palatal dressings. Patient-reported VAS pain scores over 2 weeks were defined as primary outcome. Post-surgical bleeding, number of analgesics consumed, and complete re-epithelialization of the palatal wound for up to 5 weeks were defined as secondary outcomes. RESULTS Although significantly higher VAS pain scores were reported in the control as compared with the intervention group up to 12 days post-surgically (from (median [range]) 8.5 [2-10] to 1 [0-2] and from 6 [0-10] to 0 [0-2] respectively), with higher analgesics consumption (from 2 [1-3] to 1 [0-3] and from 1 [0-3] to 0 [0-2] tablets respectively), a multivariate regression analysis considering age, gender, graft width/length, tissue thickness, analgesics intake, and dressing type demonstrated no statistically significant effect of any factor, including dressing type on VAS pain scores. At 4 weeks, 22.2% of patients in the intervention group versus 11.1% in the control group demonstrated complete re-epithelization of their palatal engraftment site, before complete re-epithelization in both groups at 5 weeks. No post-surgical bleeding was reported with both dressings. CONCLUSIONS Within the study's limitations, results suggest Alvogyl as a practical palatal surgical dressing, comparable with absorbable gelatin sponge in cost, pain reduction, hemostasis, and re-epithelization properties. TRIAL REGISTRATION www.ClinicalTrials.gov Identifier: NCT03402321 CLINICAL RELEVANCE: Alvogyl could present a novel palatal wound dressing material, comparable with gelatin sponge.
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Affiliation(s)
| | - Omneya Abouldahab
- Oral Medicine and Periodontology Department, Faculty of Oral and Dental Medicine, Cairo University, Giza, Egypt
| | - Abdallah Hassan
- Periodontology Department, School of Dentistry, New Giza University, Giza, Egypt
| | - Karim M Fawzy El-Sayed
- Oral Medicine and Periodontology Department, Faculty of Oral and Dental Medicine, Cairo University, Giza, Egypt.
- Oral Medicine and Periodontology Faculty of Dentistry, Cairo University, Al Saraya Str. 11, Manial, Cairo, Egypt.
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50
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Di Girolamo M, Barlattani A, Grazzini F, Palattella A, Pirelli P, Pantaleone V, Baggi L. Healing of the post extractive socket: technique for conservation of alveolar crest by a coronal seal. J BIOL REG HOMEOS AG 2019; 33:125-135. DENTAL SUPPLEMENT. [PMID: 31916428] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The first aim of the following experimental study was to assess bone changes in the horizontal and vertical dimension when using different socket preservation procedures. The second objective of our work was also to compare two clinical methods of coronal seal's management: an experimental group was treated using the natural extracted tooth; another experimental group saw the use of a provisional resin preformed as a seal technique. In twelve patients a premolar tooth was extracted without elevation of a mucoperiosteal flap and the patients were randomly distributed into four groups. The first and second group was considered as a control groups: in the first, the extraction socket was left with its blood clot and interrupted sutures were applied; In the second, the extraction socket was filled with BioOss Collagen (Geistlich Biomaterials, Wolhusen, Switzerland) and a free gingival graft was sutured to cover the socket. The third and fourth groups was considered as a test group. In the third group, after tooth extraction, for aesthetic reasons, the root of the natural dental element is cut to allow immediate temporary prosthesis. In the fourth group, as in group 3, the patient is discharged through a temporary restoration performed or by the dental technician or directly to the chair. Standardized photographs were taken eight months after tooth extraction. Five competent observers analyzed the esthetic outcome according to the PES. To assess the level of bone healing at the extraction site, the following parameters were evaluated: 1) changes in soft tissue and 2) changes in bone level. As for soft tissues, they were assessed using the PES score by two assessments, four weeks apart. The overall scores of the four treatment groups revealed PES values of 8.47 (SD 2.08, group 3), 6.62 (SD 3.24, group 4). The differences between groups 1 and 2 and were statistically significant (P=0.015 and P=0.047). The single parameter analysis displayed a certain range of fluctuation and heterogeneity. As regards hard tissue, during the 6-month period, bone remodeling occurred in all four experimental groups with different percentages. The mean vertical loss of the buccal bone plate for the Tx 1 group was -2 ± 0.2 mm. The Tx 2 group showed vertical loss of - 0.34 ± 0.2 mm. The Tx 3 group demonstrated - 0.3 mm of mean vertical loss and the 4 groups demonstrated -0.46 of mean vertical loss. The horizontal dimension of the alveolar process was 13.5 ± 0.1 mm, 7.6 ± 0.1 mm e 6.7 ± 0.1 mm at the three different levels for the Tx 1 group. The Tx 2 group depicted bone dimensions of 14.4 ± 0.2 mm, 13.7 ± 0.3 mm e 13.4 ± 0.1 mm. The horizontal dimension of the Tx 3 - Tx 4 group was 13.7 ± 0.3 mm, 13.1 ± 0.1 mm e 13 ± 0.1 mm and 13.5 ± 0.1 mm, 13.2 ± 0.1 mm e 12.9 ± 0.1 mm. The findings from the present study disclose that incorporation of coronal seals define a particular respect to the buccal bone plate.
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Affiliation(s)
- M Di Girolamo
- Department of Clinical Sciences and Translational Medicine, University Tor Vergata, Rome, Italy
| | - A Barlattani
- Department of Clinical Sciences and Translational Medicine, University Tor Vergata, Rome, Italy
| | - F Grazzini
- Department of Clinical Sciences and Translational Medicine, University Tor Vergata, Rome, Italy
| | - A Palattella
- Department of Clinical Sciences and Translational Medicine, University Tor Vergata, Rome, Italy
| | - P Pirelli
- Department of Clinical Sciences and Translational Medicine, University Tor Vergata, Rome, Italy
| | - V Pantaleone
- Graduated in Dentistry, University of Tor Vergata, Rome, Italy
| | - L Baggi
- Department of Clinical Sciences and Translational Medicine, University Tor Vergata, Rome, Italy
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