|
1
|
Alhumaidan AA, Alam BF, Alsuwaiyan A, Aljoghaiman EA, Helmi M, Ali S. Scientific Research Trend on Guided Tissue Regeneration: A Bibliometric Analysis. Eur J Dent 2025; 19:409-419. [PMID: 39572191 PMCID: PMC12020599 DOI: 10.1055/s-0044-1791529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2025] Open
Abstract
OBJECTIVES Guided tissue regeneration (GTR) is a widely used technique in contemporary dentistry which helps achieve regeneration of periodontal tissues. This study aims to identify leading countries, authors, institutes, journals, scientific publications, and mostly used keyword regarding role of GTR in treatment for periodontal disease using the Scopus database. MATERIALS AND METHODS A well-curated search through Scopus database for significant literature related to GTR published between 1987 and 2023 was performed. Bibliographical data which comprised of abstracts, title, keywords, references, citations, and other relevant information were composed. The data was analyzed using MS Excel and VOSviewer. RESULTS Scientific literature on GTR was manually scrutinized, and 308 paper were analyzed using the Scopus database. The first paper on GTR was published in 1987. Journal of Periodontology was identified as the leading journal, while the United States and Italy were the top contributing countries. University of Sienna was the most productive organization. Roberto Pontoriero was identified as the highly cited author. A highly cited scientific paper was published by Pintippa Bunyaratavej in 2001. CONCLUSION The present bibliometric study gives useful information related to the total number of scientific articles published from 1987 to 2023. A rising trend of scientific publication was identified which continued followed by a notable decline after 2004. The analysis also recognized the United States and University of Sienna, from Italy as most active country and organizations, while the Journal of Periodontology as the leading journal. CLINICAL RELEVANCE This study may assist in continuing education and evidence-based practice for clinicians and new researchers by providing knowledge and aiding literature searches in the domain of GTR used in treatment for periodontal conditions.
Collapse
Affiliation(s)
- Abdulkareem Abdullah Alhumaidan
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Beenish Fatima Alam
- Department of Oral Biology, Bahria University Dental College, Karachi, Pakistan
| | - Asim Alsuwaiyan
- Periodontics Unit, Dental Department, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - Eman Ahmed Aljoghaiman
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammad Helmi
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Saqib Ali
- Department of Biomedical Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| |
Collapse
|
|
2
|
Barootchi S, Tavelli L, Vinueza MEG, Sabri H, Andrade C, Pinto N, Sanz A, Wang H. Autologous platelet concentrates in root coverage procedures. Periodontol 2000 2025; 97:215-235. [PMID: 39403998 PMCID: PMC11808447 DOI: 10.1111/prd.12614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 08/07/2024] [Accepted: 08/29/2024] [Indexed: 02/11/2025]
Abstract
Gingival recessions are vastly prevalent among the general population. With regards to their treatment, recent advancements in periodontal and microsurgical procedures, focusing on minimal invasiveness and patient-centered therapies, have propelled a shift in their contemporary treatment, highlighting the field of biologics and bioactive mediators. Among different classes and types of biologics, autologous platelet concentrates (APCs), also referred to as autologous blood-derived products, are commonly used and preferred among many clinicians. These are essentially obtained via venipuncture (intravenous access) followed by centrifugation, for which numerous protocols and preparation methods have been used, leading to varieties of blood-derived products. In this review, via a systematic search, we explored the efficacy of the different utilized preparation methods and centrifugation protocols of APCs (e.g., platelet-rich plasma (PRP), platelet-rich fibrin (PRF), leucocyte-PRF, advanced-PRF, concentrated growth factor (CGF), etc.) for the treatment of type 1 gingival recessions (RT1, without interproximal attachment loss or noticeable tooth displacement), as well as their effectiveness relative to a common control (treatment with flap advancement alone without any additional material). Based on the available literature from randomized trials found in our systematic search, we observed that utilization of PRF can significantly enhance treatment outcomes when performing a coronally advanced flap, in terms of the amount of root coverage. The improvement in root coverage was further enhanced in the presence of baseline keratinized tissue width, and with an increasing relative magnitude (the more the baseline keratinized tissue width, the better the root coverage outcomes when using PRF). The efficacy of these products needs to be further explored with different graft substitutes and matrices, as well as relative to other commonly applied biologics, through well-conducted and adequately-powered randomized clinical trials.
Collapse
Affiliation(s)
- Shayan Barootchi
- Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA
- Center for Clinical Research and Evidence Synthesis in Oral Tissue Regeneration (CRITERION)BostonMassachusettsUSA
- Division of Periodontology, Department of Oral Medicine, Infection, and ImmunityHarvard School of Dental MedicineBostonMassachusettsUSA
| | - Lorenzo Tavelli
- Center for Clinical Research and Evidence Synthesis in Oral Tissue Regeneration (CRITERION)BostonMassachusettsUSA
- Division of Periodontology, Department of Oral Medicine, Infection, and ImmunityHarvard School of Dental MedicineBostonMassachusettsUSA
| | - Maria Elisa Galarraga Vinueza
- Tufts University School of Dental MedicineBostonMassachusettsUSA
- School of DentistryUniversidad de las Américas (UDLA)QuitoEcuador
| | - Hamoun Sabri
- Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA
- Center for Clinical Research and Evidence Synthesis in Oral Tissue Regeneration (CRITERION)BostonMassachusettsUSA
| | | | - Nelson Pinto
- Department of Periodontics and Implant Dentistry, Facultad de OdontologíaUniversidad de Los AndesSantiagoChile
- Research Center for Regenerative Medicine and Tissue EngineeringConcepcionChile
| | - Antonio Sanz
- Titular Periodoncia e Implantología Oral, Facultad de OdontologíaUniversidad de Los AndesSantiagoChile
- Director Programa Especialización en Implantología, U Andes Director Foundation for Bioesthetic Dentistry Latin American Division, Faculty MemberFoundation for Bioesthetic DentistryUnionMissouriUSA
| | - Hom‐Lay Wang
- Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA
| |
Collapse
|
|
3
|
Chambrone L, Coccaro M, Montaño AJ, Lafaurie GI. The influence of tobacco smoking on the outcomes achieved by root coverage procedures: An updated systematic review. J ESTHET RESTOR DENT 2025; 37:187-200. [PMID: 39138953 DOI: 10.1111/jerd.13296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Revised: 07/25/2024] [Accepted: 07/29/2024] [Indexed: 08/15/2024]
Abstract
OBJECTIVE This updated version of a systematic review (SR) originally published in 2009 evaluated the effect of smoking on the clinical outcomes achieved with root coverage (RC) procedures in the treatment of gingival recession (GR) defects. MATERIALS AND METHODS This SR includes randomized controlled trials, controlled clinical trials, and case series with a minimum follow-up of 6 months. Eligible studies involved GR defects without interproximal tissue loss submitted to RC procedures, as well as outcome measures from smokers (i.e., those smoking 10 or more cigarettes per day at baseline) and nonsmokers, recorded separately. Three electronic databases were searched up to March 31, 2024. Random effects meta-analyses were conducted thoroughly. RESULTS A total of 12 studies reporting on 181 smokers and 162 nonsmokers, submitted to different RC procedures, were included. Half of these trials were originally included in the 2009 SR, whereas the other half (six studies) were included in this update. Nonsmokers experienced greater reductions in GR and gains in clinical attachment level compared to smokers. Pooled estimates comparing smokers and nonsmokers who received coronally advanced flap (CAF) alone and subepithelial connective tissue graft (SCTG) + CAF showed that nonsmokers achieved greater mean root coverage (MRC) in both treatments. Significant differences in MRC of 10.85% (95% CI, 1.92 to 19.77) and 22.04 (95% CI, 14.25 to 29.83), favoring nonsmokers, were identified for CAF and SCTG + CAF, respectively. Similarly, nonsmokers treated with SCTG + CAF displayed superior number of sites exhibiting complete root coverage (CRF) when compared with smokers (risk ratio, 4.12; 95% CI, 1.73 to 9.80). CONCLUSIONS Smoking negatively impacts the outcomes of RC procedures, particularly those achieved by SCTG-based procedures. CLINICAL SIGNIFICANCE Smoking was linked to poorer RC outcomes. These outcomes highlight the critical need to integrate smoking cessation into periodontal treatment plans.
Collapse
Affiliation(s)
- Leandro Chambrone
- Unit of Basic Oral Investigation (UIBO), School of Dentistry, Universidad El Bosque, Bogota, Colombia
- Evidence-based hub, Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz, CRL, Monte de Caparica, Portugal
- Department of Periodontics, School of Dental Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Miguelángel Coccaro
- Unit of Basic Oral Investigation (UIBO), School of Dentistry, Universidad El Bosque, Bogota, Colombia
- Master of Science Dentistry Program, School of Dentistry, Universidad El Bosque, Bogota, Colombia
| | - Andrea Juliana Montaño
- Unit of Basic Oral Investigation (UIBO), School of Dentistry, Universidad El Bosque, Bogota, Colombia
| | - Gloria Inés Lafaurie
- Unit of Basic Oral Investigation (UIBO), School of Dentistry, Universidad El Bosque, Bogota, Colombia
| |
Collapse
|
|
4
|
La Terra SL, Travaglini D, Caccianiga G, Alzahrani F, Alabeedi FM. Outcomes of a Modified Envelope Flap Technique With Connective Tissue Graft and Enamel Matrix Derivative for Multiple Gingival Recessions: A Case Report. Cureus 2025; 17:e76990. [PMID: 39912044 PMCID: PMC11795332 DOI: 10.7759/cureus.76990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2025] [Indexed: 02/07/2025] Open
Abstract
Gingival recession is a prevalent condition with significant aesthetic and functional consequences. This case report is about a 36-year-old female who presented with multiple Miller's Class I gingival recession defects affecting teeth from 22 to 25. A modified envelope flap technique was utilized, incorporating connective tissue graft (CTG) harvested from the palate and supplemented with enamel matrix derivatives (EMD). The treatment resulted in significant root coverage in all treated sites. The patient reported high satisfaction with the aesthetic and functional improvements. This case report demonstrates the successful application of a combined approach utilizing a modified envelope flap, CTG, and EMD for the treatment of multiple gingival recessions. The findings suggest the potential of this technique for achieving predictable and favorable outcomes in similar cases.
Collapse
Affiliation(s)
- Salvatore L La Terra
- Faculty of Natural Health Science, Regenerative Cellular Therapy, Selinus University, London, GBR
- Periodontology, Oral Surgery, Private Dental Clinic, Rome, ITA
| | | | | | - Faisal Alzahrani
- Oral Surgery, Ulster University College of Medicine and Dentistry, Birmingham, GBR
- Oral Surgery, Ministry of Defense, Royal Armed Forces Medical Services, Riyadh, SAU
| | - Faris M Alabeedi
- Faculty of Dentistry, Maxillofacial Surgery and Diagnostic Science, Najran University, Najran, SAU
| |
Collapse
|
|
5
|
Yaghini J, Mogharehabed A, Feizi A, Yazdanfar F. Efficacy of autologous platelet concentrates for root coverage of Miller's Class I and II gingival recession defects: A systematic review and meta-analysis. Dent Res J (Isfahan) 2024; 21:63. [PMID: 39735223 PMCID: PMC11676317 DOI: 10.4103/drj.drj_437_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 04/05/2024] [Accepted: 08/22/2024] [Indexed: 12/31/2024] Open
Abstract
Background This systematic review and meta-analysis aimed to assess the efficacy of autologous platelet concentrate (APCs) in comparison with coronally-advanced flap alone or in combination with connective tissue graft or other biomaterials or bioactive agents for root coverage (RC) of Miller's Class I and II gingival recession defects by measuring the keratinized mucosa width (KMW). Materials and Methods This systematic review and meta-analysis was conducted in accordance with the preferred reporting items for systematic reviews and meta-analysis guidelines. An electronic search of the literature was conducted in PubMed, EMBASE, Scopus, Cochrane, Web of Science, Magiran, Scientific Information Database, and Irandoc for randomized clinical trials (RCTs) that used APCs for RC in their intervention group. Eligible articles were retrieved by assessment of titles and abstracts and then the full texts. The risk of bias was assessed by the Cochrane Library Risk of Bias Assessment Tool. Meta-analysis was carried out by RevMan 5.3 software. In the case of homogeneity, variables were reported as weighted mean difference (WMD) with 95% confidence interval (CI) for each group. Results The search yielded 689 articles; out of which, 32 were eligible for study inclusion. Meta-analysis did not show any additional effect for RC and KMW with APCs. Clinical parameters were as follows: RC: WMD = -1.57 mm (95% CI: -2.49, -0.659; P = 0.001) and KMW: -0.106 mm (95% CI: -0.3222, 0.110; P = 0.337). Conclusion The application of APCs for RC of Miller's Class I and II gingival recession defects does not seem to improve the clinical parameters.
Collapse
Affiliation(s)
- Jaber Yaghini
- Department of Periodontology, Dental Implant Research Center, Dental Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmad Mogharehabed
- Department of Periodontology, Dental Implant Research Center, Dental Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Yazdanfar
- Department of Periodontology, Dental Student’s Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
|
6
|
do Nascimento EB, Jurkevicz TS, Bonjardim LR, Sant' Ana ACP, Damante CA, Zangrando MSR. Qualitative somatosensory evaluation of recipient and donor sites of subepithelial connective tissue grafts: a preliminary study. Clin Oral Investig 2024; 28:555. [PMID: 39327312 DOI: 10.1007/s00784-024-05933-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 09/14/2024] [Indexed: 09/28/2024]
Abstract
OBJECTIVES The subepithelial connective tissue graft (SCTG) plus coronal advanced flap is commonly evaluated by clinical parameters, but potential sensory changes (patients' perception of painful or painless sensations) need to be further explored. This preliminary study aimed to qualitatively evaluate the somatosensory profile of recipient and palatal donor sites of SCTG. MATERIALS AND METHODS Sensory tests were applied at SCTG recipient and donor sites at baseline, after 3 and 6 months. A single calibrated examiner applied Douleur Neuropathique 4 questionnaire (DN4), qualitative sensory test (QualST), discriminating the areas as hypersensitive, hyposensitive or normosensitive, and two-point acuity test. Descriptive statistics, non-parametric Kruskal Wallis test for QualST evaluation and ANOVA for Two-point test (p < 0.05) were used. RESULTS QualST revealed that recipient areas presented no significant differences in tactile, pressure and thermal tests. Brush test revealed hyposensitivity after 3 months (p = 0.03). In donor areas, only thermal evaluation showed a significant difference (p = 0.01), being hypersensitive after 3 months and hyposensitive after 6 months. At baseline, all evaluations in recipient and donor areas were normosensitive. According to DN4, no patient reported pain in recipient and donor sites. Non-painful sensory perception was reported as numbness in recipient (3.14% of patients) and donor (18.4%) areas. No significant differences were found for two-point acuity test values. CONCLUSIONS Somatosensory variations were observed in donor and recipient areas using qualitative tests, with no detection of painful sensations, only non-painful sensations of numbness and electric shock. CLINICAL RELEVANCE This preliminary study demonstrated that alterations of hypo- and hypersensitivity may occur in donor and recipient areas of gingival grafts. However, when present, these alterations were non-painful and did not impact oral functions. CLINICAL REGISTRATION ReBEC #RBR-7zz3b6p.
Collapse
Affiliation(s)
| | | | - Leonardo Rigoldi Bonjardim
- Department of Biological Sciences- Bauru School of Dentistry, University of Sao Paulo, São Paulo, Brazil
| | - Adriana Campos Passanezi Sant' Ana
- Department of Periodontics- Bauru School of Dentistry, University of Sao Paulo, Dr. Octávio Pinheiro Brisolla 9-75, Vila Universitária, Bauru, SP, CEP: 17012-901, Brazil
| | - Carla Andreotti Damante
- Department of Periodontics- Bauru School of Dentistry, University of Sao Paulo, Dr. Octávio Pinheiro Brisolla 9-75, Vila Universitária, Bauru, SP, CEP: 17012-901, Brazil
| | - Mariana Schutzer Ragghianti Zangrando
- Department of Periodontics- Bauru School of Dentistry, University of Sao Paulo, Dr. Octávio Pinheiro Brisolla 9-75, Vila Universitária, Bauru, SP, CEP: 17012-901, Brazil.
| |
Collapse
|
|
7
|
Tuli P, Kolte AP, Kolte RA, Lathiya VN. Effectiveness of vestibular incision subperiosteal tunnel access technique in the treatment of multiple adjacent gingival recession defects: A systematic review. J Indian Soc Periodontol 2024; 28:407-416. [PMID: 40018714 PMCID: PMC11864343 DOI: 10.4103/jisp.jisp_66_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 11/21/2024] [Accepted: 12/20/2024] [Indexed: 03/01/2025] Open
Abstract
Objective To investigate the effectiveness of Vestibular Incision Subperiosteal Tunnel Access (VISTA) technique over other root coverage (RC) procedures for treating Millers Class I and II multiple adjacent gingival recession defects (MAGRD). Methods Patient, Intervention, Comparison, and Outcome question was established, and a literature review was carried out across PubMed, Cochrane Libraries, EMBASE, and hand-searched journals till April 2023 to identify the clinical research on the effectiveness of the VISTA Technique for RC procedures. Only randomized controlled trials (RCTs) with a minimum of 6 months' follow-up were considered. The outcomes assessed were complete RC (CRC), width of keratinized gingiva, and gingival thickness. Results A total of 30 articles were retrieved and ultimately 7 RCTs that met the inclusion criteria were incorporated into the systematic review. VISTA with biomaterials showed significant improvements in all the treatment outcomes over other RC procedures. Specifically, VISTA + subepithelial connective tissue graft (CTG)/CTG achieved an average CRC of 93.95%, along with significant increase in other parameters. In addition, biomaterials such as platelet concentrates, collagen membrane, Bioguide enhanced GEM21S, and Acellular dermal matrix proved viable alternatives producing similar outcomes. Conclusion VISTA technique is an effective procedure for treating MAGRD in terms of achieving CRC over other RC procedures. In addition, the use of biomaterials further enhances the treatment outcomes.
Collapse
Affiliation(s)
- Prabhnoor Tuli
- Department of Periodontics and Implant Dentistry, Ranjeet Deshmukh Dental College and Research Centre, Nagpur, Maharashtra, India
| | - Abhay Pandurang Kolte
- Department of Periodontics and Implant Dentistry, Ranjeet Deshmukh Dental College and Research Centre, Nagpur, Maharashtra, India
| | - Rajashri Abhay Kolte
- Department of Periodontics and Implant Dentistry, Ranjeet Deshmukh Dental College and Research Centre, Nagpur, Maharashtra, India
| | - Vrushali Nilesh Lathiya
- Department of Periodontics and Implant Dentistry, Ranjeet Deshmukh Dental College and Research Centre, Nagpur, Maharashtra, India
| |
Collapse
|
|
8
|
Katti N, Satpathy A, Mohanty D, Pape Reddy SS, Agrawal P, Pradhan SS. Gingival unit grafts for localized gingival recession: A split mouth randomized controlled trial. Med J Armed Forces India 2024; 80:466-474. [PMID: 39071762 PMCID: PMC11280126 DOI: 10.1016/j.mjafi.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/07/2024] [Indexed: 07/30/2024] Open
Abstract
Background The interaction between the recipient area and the graft is one of the key factors in the success of periodontal plastic surgery. This randomized controlled, split-mouth, double-blinded clinical trial aimed to compare the clinical and aesthetic outcomes of epithelialized palatal graft (EPG) and gingival unit graft (GUG) in achieving root coverage in localized (Recession Type 1) RT1 recession defects. Methods Twenty participants with forty bilateral recession defects randomly received EPG or GUG surgical treatment modalities for each of the recession defects. Clinical measurements recorded at baseline and after six months included recession depth (RD), recession width (RW), probing depth (PD), clinical attachment level (CAL), keratinized tissue width (KTW), and the average width of mesial and distal interdental papilla (aWIDP). Results There was a statistically significant greater mean root coverage (MRC) percentage at GUG sites (80.68 ± 16.12%) in comparison to EPG sites (71.05 ± 17.23%) (p = 0.01). The treatment satisfaction (p = 0.009) and aesthetic satisfaction (p < 0.001) experienced were significantly better for GUG as compared to EPG. The regression model (R 2 = 0.56) significantly predicted MRC percentage in GUG sites with baseline RD (β = -12.49; p = 0.02) and aWIDP (β = -9.31; p = 0.02). Conclusion GUG showed a better MRC, aesthetics and increased KTW. Root coverage procedures often need to suffice the dual objective of coverage and aesthetics at the same time. GUG is a simple modification of the conventional EPG that can provide better clinical and aesthetic outcomes.
Collapse
Affiliation(s)
- Neelima Katti
- Assistant Professor (Periodontics), SCB Dental College & Hospital, Cuttack, Odisha, India
| | - Anurag Satpathy
- Professor (Periodontics & Oral Implantology), Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar, Odisha, India
| | - Devapratim Mohanty
- Assistant Professor (Periodontics), SCB Dental College & Hospital, Cuttack, Odisha, India
| | | | - Poonam Agrawal
- Senior Resident (Periodontics), SCB Dental College & Hospital, Cuttack, Odisha, India
| | - Shib Shankar Pradhan
- Senior Resident (Periodontics), SCB Dental College & Hospital, Cuttack, Odisha, India
| |
Collapse
|
|
9
|
Katti N, Mohanty D, Srivani P, Siddiqui H, Raj SC, Baral D. A Single-Step Root Coverage Procedure Using Modified Bridge Flap Technique and De-epithelialized Gingival Unit Graft: A Prospective Clinical Study. Contemp Clin Dent 2024; 15:167-173. [PMID: 39512287 PMCID: PMC11540198 DOI: 10.4103/ccd.ccd_365_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 02/20/2024] [Accepted: 05/02/2024] [Indexed: 11/15/2024] Open
Abstract
Background The mucogingival conditions associated with the recession defects at the mandibular anterior region, not only make plaque control difficult to be performed by the patient but also pose a problem in passively advancing the tissues at the recipient site. This surgical technique is used to treat multiple recession defects in the mandibular anterior region. Materials and Methods Twenty-five sites in 17 subjects (11 women and 6 men) underwent modified bridge flap and de-epithelized gingival unit graft (d-GUG) as a single-step treatment modality to cover the denuded root surface, as well as increase the width of keratinized gingiva in recession type 1 gingival recession defects in the mandibular anterior region. Results Nearly 60% of sites in our study showed complete root coverage, with a mean root coverage percentage of 88.08%. Furthermore, keratinized tissue width, keratinized tissue thickness as well as vestibular depth showed statistically significant increases as compared to baseline levels. Conclusion Thus, the modified bridge flap technique using d-GUG within the limitations of our study design, showed promising results in terms of recession coverage as well as management of the difficult mucogingival conditions at the mandibular anterior region.
Collapse
Affiliation(s)
- Neelima Katti
- Department of Periodontology, SCB Dental College and Hospital, Cuttack, Odisha, India
| | - Devapratim Mohanty
- Department of Periodontology, SCB Dental College and Hospital, Cuttack, Odisha, India
| | - Peri Srivani
- Department of Periodontology, SCB Dental College and Hospital, Cuttack, Odisha, India
| | - Humaira Siddiqui
- Department of Periodontology, SCB Dental College and Hospital, Cuttack, Odisha, India
| | - Subash Chandra Raj
- Department of Periodontology, SCB Dental College and Hospital, Cuttack, Odisha, India
| | - Debajani Baral
- Department of Periodontology, SCB Dental College and Hospital, Cuttack, Odisha, India
| |
Collapse
|
|
10
|
Pilloni A, Dell'Olmo F. The mucosal released-coronally advanced flap: A novel surgical approach-A case report. Clin Adv Periodontics 2024. [PMID: 38853688 DOI: 10.1002/cap.10293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND The coronally advanced flap (CAF) can be a predictable surgical technique for the treatment of gingival recessions. However, the characteristics of the defect (e.g., limited amount of keratinized gingiva or flap tension, etc.) may limit the use of the CAF with a possible requirement of additional surgical interventions (i.e., the use of a tissue graft to be harvested from donor sites or connective tissue substitutes). METHODS A 28-year-old woman patient, with no history of periodontal disease, came for referral presenting receding gums as a chief complaint, poor esthetics, and dentinal hypersensitivity at the buccal surface of teeth 11, 12, and 13. Clinically, she presented a thick phenotype with gingival recession type, RT1, with detectable cemento-enamel junction (A‒) in the second quadrant. To reduce the need of harvesting soft tissue grafts, the amount of cutting of muscles and vessels from the inner portion of the flap and mitigate the postoperative discomfort associated with the CAF, a novel surgical approach is described here using an advanced flap that incorporates an external incision along the mucogingival junction. RESULTS The average root coverage achieved with the novel procedure presented in this case report was 95%, along with an increased amount of keratinized gingiva and minimal postoperative patient's discomfort. CONCLUSIONS The mucosal released CAF is a promising technique in which the CAF technique alone may not be an indication. KEY POINTS This technique has the following advantages: Reduce the need of harvesting soft tissue grafts. Reduce the amount of cutting of muscles and vessels from the inner portion of the flap. Minimal postoperative discomfort for the patient.
Collapse
Affiliation(s)
- Andrea Pilloni
- Department of Oral and Maxillofacial Sciences, Section of Periodontics, Sapienza University of Rome, Rome, Italy
| | - Fabiola Dell'Olmo
- Department of Oral and Maxillofacial Sciences, Section of Periodontics, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
|
11
|
Rodriguez AB, Chan HL, Velasquez D. Anatomy-driven complexity classification for soft-tissue tunneling procedures. Clin Adv Periodontics 2024; 14:113-120. [PMID: 37812141 DOI: 10.1002/cap.10267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 08/01/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND The tunnel technique (TUN) preserves the integrity of the papilla by creating envelope flaps that allow for the insertion of a connective tissue graft, and/or biomaterials. METHODS (1) A comprehensive overview of tunneling flap procedures in the treatment of gingival recessions (GRs) for soft tissue coverage is presented and (2) A classification system for soft and hard tissue anatomy of GR sites which may aid the clinician in determining the surgical complexity is being introduced. RESULTS A novel clinical classification system is proposed to illustrate complexity levels determined by soft and hard tissue anatomy of GR sites such as the mucogingival junction proximity to the gingival margin, bone morphotype, and mucosal margin thickness. CONCLUSIONS TUN is highly effective in treating single/multiple GRs. Its limitations are related to variability in surgical site anatomy and operator expertise. A classification system based on anatomical soft and hard tissue variations has been proposed to help identify complexity levels encountered during tunneling procedures. KEY POINTS Site-related factors directly impact the surgical variables related to tissue trauma, flap tension, soft tissue management, muscle pull, and wound stability during the healing of gingival recessions (GRs). The achievement of expedited and favorable wound healing is crucial to obtaining quantitative and qualitative success in the treatment of GR and the long-term stability of root coverage. A classification system based on anatomical soft and hard tissue variations has been proposed to facilitate tunneling procedures while respecting surgical principles.
Collapse
Affiliation(s)
- Amanda B Rodriguez
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Hsun-Liang Chan
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Diego Velasquez
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Seven Lakes Periodontics, Private Practice, Fenton, Michigan, USA
| |
Collapse
|
|
12
|
Kalimeri E, Roccuzzo A, Stähli A, Oikonomou I, Berchtold A, Sculean A, Kloukos D. Adjunctive use of hyaluronic acid in the treatment of gingival recessions: a systematic review and meta-analysis. Clin Oral Investig 2024; 28:329. [PMID: 38771388 PMCID: PMC11108902 DOI: 10.1007/s00784-024-05701-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 05/04/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVES To explore the efficacy of Hyaluronic acid as an adjunctive in treatment of gingival recessions (GR). MATERIALS AND METHODS A systematic literature search was performed in several electronic databases, including Medline/ PubMed, Embase, CENTRAL and LILACS. Recession improvement was evaluated through multiple outcome variables. The Cochrane Risk of Bias tool and the ROBINS-I tool were used to assess the quality of the included trials. Weighted Mean Differences (WMDs) and 95% confidence intervals (CIs) between test and control sites were estimated through meta-analysis using a random-effect model for the amount of Relative Root Coverage (RRC). RESULTS A total of 3 randomised studies were deemed as eligible for inclusion. Their data were also used for pooling the effect estimates. Overall analysis of RRC (3 studies) presented a WMD of 7.49% (p = 0.42; 95% CIs -10.88, 25.86) in favour of adjunctive use of hyaluronic acid during Coronally Advanced Flap (CAF) technique, although statistical significance was not reached. Statistical heterogeneity was found to be high (I2 = 80%). CONCLUSIONS Within their limitations, the present data indicate that the local application of Hyaluronic acid does not lead to additional clinical benefits when used as an adjunctive to the treatment of GR with CAF. However, due to the high heterogeneity among the studies, additional well-designed RCTs are needed to provide further evidence on this clinical indication for the use of Hyaluronic acid. CLINICAL RELEVANCE In the frame of the current review, the adjunctive use of Hyaluronic acid does not additionally improve the clinical outcomes obtained during treatment of GR with CAF.
Collapse
Affiliation(s)
- Eleni Kalimeri
- Department of Orthodontics and Dentofacial Orthopedics, 251 Hellenic Air Force & VA General Hospital, Athens, Greece
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Alexandra Stähli
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Ilias Oikonomou
- Department of Periodontology, 251 Hellenic Air Force & VA General Hospital, Athens, Greece
| | - Aaron Berchtold
- School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Dimitrios Kloukos
- Department of Orthodontics and Dentofacial Orthopedics, 251 Hellenic Air Force & VA General Hospital, Athens, Greece.
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, Freiburgstrasse 7, CH-3010, Bern, Switzerland.
| |
Collapse
|
|
13
|
Ravindran N, Sudhakar U, Mithradas N, Suresh S, Lakshmi KJ, Steffy J. Gingival tissue evaluation using soft tissue-cone-beam computed tomography and root coverage esthetic score in the treatment of isolated gingival recession: A clinical study. J Indian Soc Periodontol 2024; 28:312-318. [PMID: 39742054 PMCID: PMC11684574 DOI: 10.4103/jisp.jisp_491_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 09/18/2024] [Indexed: 01/03/2025] Open
Abstract
Objectives Comparative assessment of the effectiveness of coronally advanced flap (CAF) with subepithelial connective tissue graft (SCTG) and the envelope technique with SCTG in Miller's Class I recession utilizing soft tissue-cone-beam computed tomography (ST-CBCT) and root coverage esthetic score (RES). Materials and Methods Twenty patients were randomly assigned to Group I (CAF + SCTG) and Group II (envelope technique + SCTG) using the coin toss method, with 10 patients in each group. Recession height (RH) and width (RW), probing pocket depth (PD), clinical attachment level (CAL), and keratinized tissue height (HKT) were assessed at baseline and 6 months. The thickness of keratinized tissue (TKT) using transgingival probing (TGP) and ST-CBCT and the RES were recorded at the 6th month. Results On intragroup comparison, statistically significant difference was seen in the clinical parameters RH, RW, PD, CAL, and HKT, whereas on intergroup comparison, no significant difference was seen at baseline and 6 months. TKT was statistically significant at 6 months between the groups using TGP (P = 0.01) and ST-CBCT (P = 0.01). No statistical difference was seen between the methods in Group 1 (P = 0.61) and Group 2 (P = 0.62). No statistical significance was seen in the RES score (P = 0.10). Conclusion The study indicates the effectiveness of both the techniques, with the envelope technique demonstrating superior esthetics. Moreover, the research highlights the significance of ST-CBCT as an emerging alternative tool for assessing gingival dimensions.
Collapse
Affiliation(s)
- Navina Ravindran
- Department of Periodontics, Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Uma Sudhakar
- Department of Periodontics, Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Nimisha Mithradas
- Department of Periodontics, Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Snophia Suresh
- Department of Periodontics, Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Kotaru Jhansi Lakshmi
- Department of Periodontics, Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu, India
| | - J. Steffy
- Department of Periodontics, Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu, India
| |
Collapse
|
|
14
|
Enrile de Rojas FJ, Ventura de la Torre J, Romero Griñolo JM. Long-term outcome of implants exhibiting buccal soft tissue dehiscence in the esthetic zone. J ESTHET RESTOR DENT 2024; 36:539-547. [PMID: 37771295 DOI: 10.1111/jerd.13141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVE Increasing aesthetic demands require that the color and contour of the peri-implant soft tissues be in harmony with the neighboring teeth. Recession, migration toward the apical, is a frequent clinical finding. Its presence can lead to inflammation and increased marginal bone loss. These complications, in addition to affecting the aesthetic results of our treatment, are difficult to treat and can threaten the survival of the implant. There are fewer studies showing the outcome of treatment of soft-tissue defects around implants. The aim of this article is to describe the treatment of a soft-tissue defect around an implant-supported prosthesis treatment, performed on two neighboring implants, in the esthetic zone in a patient with a high smile and to evaluate both the coverage achieved and the patient's esthetic satisfaction. CLINICAL CONSIDERATIONS This study showed that a mucogingival approach, using a surgical technique designed for the treatment of alveolar ridge defects, together with tissue management with temporaries and a new restoration, achieved an optimal result. CONCLUSIONS The case has been closely followed up, for 10 years, and the authors have been able to confirm the long-term stability of the result. CLINICAL SIGNIFICANCE The following paper shows the result of an innovative approach. Connective tissue platform technique, usually performed for soft-tissue augmentation, was used for a defect in soft-tissue dehiscence. The authors followed the results for 10 years, and the results achieved were satisfactory in terms of esthetic.
Collapse
|
|
15
|
Pini Prato G, Di Gianfilippo R. Challenges and success in periodontal plastic surgery. J Clin Periodontol 2023; 50:1572-1581. [PMID: 37661329 DOI: 10.1111/jcpe.13869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 09/05/2023]
Abstract
To truly understand a field of study, one must delve into its past and examine the challenges and successes that have shaped its current practices. In the case of periodontal plastic surgery, recognizing how challenges induced changes over the last 70 years-from the 1950s to today-is essential to fully comprehend its evolution. This editorial provides a perspective on the field, highlighting the interrelationships between influential surgical techniques and advancements in research methodology. With each event building upon the last, the evolution of periodontal plastic surgery is a story of scientific progress and ongoing research, fostering a sense of community and shared knowledge.
Collapse
Affiliation(s)
| | - Riccardo Di Gianfilippo
- Department of Periodontics and Oral Medicine, The University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| |
Collapse
|
|
16
|
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] [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).
Collapse
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.
| |
Collapse
|
|
17
|
Qi B, Khazeinezhad R, Hariri A, Yim W, Jin Z, Sasi L, Chen C, Jokerst JV. Three-dimensional mapping of the greater palatine artery location and physiology. Dentomaxillofac Radiol 2023; 52:20230066. [PMID: 37641889 PMCID: PMC10968761 DOI: 10.1259/dmfr.20230066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE To develop a novel technique for localizing and reconstructing the greater palatine artery (GPA) using three-dimensional (3D) technology. METHODS A miniaturized intraoral ultrasound transducer was used to imaging landmarks including the GPA, gingival margin (GM), and palatal masticatory mucosa (PMM). A 5-mm-thick solid hydrogel couplant was integrated to replace traditional ultrasound gel and avoid bubbles when moving the transducer. RESULTS A panorama image provided the relative localization of landmarks including the GPA, PMM, and hard palate. Short- and long-axis imaging of GPA was performed in five subjects including 3D mapping of GPA branches and surrounding tissues in a volume of 10 mm × 8 mm × 10 mm. Full-mouth Doppler imaging was also demonstrated on both the dorsal and ventral tongue as well as buccal mucosa and sublingual region on two subjects. CONCLUSIONS This study can measure the vertical distance from the GM to the GPA and depth from PMM to GPA and visualize the GPA localization in a 3D manner, which is critical to evaluate the available volume of palatal donor tissues and avoid sectioning of GPA during surgical harvesting of the tissues. Finally, the transducer's small size facilitates full-mouth Doppler imaging with the potential to improve the assessment, diagnosis, and management of oral mucosa.
Collapse
Affiliation(s)
- Baiyan Qi
- Materials Science and Engineering Program, University of California San Diego, La Jolla, California, United States
| | | | - Ali Hariri
- StyloSonic LLC, Lake Forest, California, United States
| | - Wonjun Yim
- Materials Science and Engineering Program, University of California San Diego, La Jolla, California, United States
| | - Zhicheng Jin
- Department of Nanoengineering, University of California San Diego, La Jolla, California, United States
| | - Lekshmi Sasi
- Department of Nanoengineering, University of California San Diego, La Jolla, California, United States
| | - Casey Chen
- Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California, United States
| | | |
Collapse
|
|
18
|
Marques T, dos Santos NBM, Sousa M, Fernandes JCH, Fernandes GVO. Mixed-Thickness Tunnel Access (MiTT) through a Linear Vertical Mucosal Incision for a Minimally Invasive Approach for Root Coverage Procedures in Anterior and Posterior Sites: Technical Description and Case Series with 1-Year Follow-Up. Dent J (Basel) 2023; 11:235. [PMID: 37886920 PMCID: PMC10605838 DOI: 10.3390/dj11100235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/25/2023] [Accepted: 10/01/2023] [Indexed: 10/28/2023] Open
Abstract
PURPOSE The goal of this article was to introduce a new root coverage (RC) technique, the mixed-thickness tunnel access (MiTT) technique, which approaches a full-split design and intends to augment soft tissues coronal to the gingival margin. It was shown step-by-step, and the results were presented in a case series. METHODS Healthy individuals (non-diabetics) and non-smokers with gingival recession (GR) type 1 or 2 (RT1 or RT2) were included. After evaluation, prophylaxis was performed 14 days before the surgical procedure. During the surgical appointment, one or two vertical incision(s) on the mucosa (around 1-2 mm apical to the MGJ), lateral to the papilla base, was/were performed after anesthesia. Initially, there was a partial incision to detach the mucosa of the muscles (split design). It was permitted (but not mandatory) to perform intrasulcular incisions. Through the vertical incision, internally, subperiosteal access from the MGJ toward the gingival margin (coronally) was performed to create a full-thickness tunnel. Then, communication from the vertical incision with the gingival sulcus and the papilla base occurred, keeping the papilla tip intact. A connective tissue graft was harvested and inserted through the linear incision or intrasulcularly. There were interrupted sutures. An adjunctive material may be applied (e.g., Endogain). The root coverage was measured using a periodontal probe and considered fully covered when the gingival margin was 1 mm coronal to the cementum-enamel junction (CEJ). RESULTS Nine healthy individuals (seven females and two males) aged 19 and 43 were enrolled. They were treated following the MiTT steps. Four cases had a single GR; two patients had two teeth involved; and three others had three or four GR. There were seven cases of RT1 and two RT2. All RT1 cases achieved 100% RC, while the mean RC obtained for RT2 was around 80%. CONCLUSION The MiTT technique can be considered a more straightforward approach for minimally invasive surgical techniques, which is a feasible option to treat RC with a high success rate, predictability, and esthetic preservation. Therefore, there is a technical sensitivity to performing the full-split design procedure.
Collapse
Affiliation(s)
- Tiago Marques
- Faculty of Dental Medicine, Universidade Católica Portuguesa, 3504-505 Viseu, Portugal; (T.M.)
- Centre for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, 3504-505 Viseu, Portugal
| | | | - Manuel Sousa
- Faculty of Dental Medicine, Universidade Católica Portuguesa, 3504-505 Viseu, Portugal; (T.M.)
| | | | - Gustavo Vicentis Oliveira Fernandes
- Centre for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, 3504-505 Viseu, Portugal
- Periodontics and Oral Medicine Department, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA
| |
Collapse
|
|
19
|
Ren L, Jiang Z, Zhang H, Chen Y, Zhu D, He J, Chen Y, Wang Y, Yang G. Biomaterials derived from hard palate mucosa for tissue engineering and regenerative medicine. Mater Today Bio 2023; 22:100734. [PMID: 37636987 PMCID: PMC10458294 DOI: 10.1016/j.mtbio.2023.100734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/07/2023] [Accepted: 07/19/2023] [Indexed: 08/29/2023] Open
Abstract
Autologous materials have superior biosafety and are widely used in clinical practice. Due to its excellent trauma-healing ability, the hard palate mucosa (HPM) has become a hot spot for autologous donor area research. Multiple studies have conducted an in-depth analysis of the healing ability of the HPM at the cellular and molecular levels. In addition, the HPM has good maneuverability as a donor area for soft tissue grafts, and researchers have isolated various specific mesenchymal stem cells (MSCs) from HPM. Free soft tissue grafts obtained from the HPM have been widely used in the clinic and have played an essential role in dentistry, eyelid reconstruction, and the repair of other specific soft tissue defects. This article reviews the advantages of HPM as a donor area and its related mechanisms, classes of HPM-derived biomaterials, the current status of clinical applications, challenges, and future development directions.
Collapse
Affiliation(s)
- Lingfei Ren
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, 310000, China
| | - Zhiwei Jiang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, 310000, China
| | - Hui Zhang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, 310000, China
| | - Yani Chen
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, 310000, China
| | - Danji Zhu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, 310000, China
| | - Jin He
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, 310000, China
| | - Yunxuan Chen
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, 310000, China
| | - Ying Wang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, 310000, China
| | - Guoli Yang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, 310000, China
| |
Collapse
|
|
20
|
Chackartchi T, Bosshardt DD, Imber JC, Stähli A, Sacks H, Nagy K, Sculean A. Histological evaluation following treatment of recession-type defects with coronally advanced flap and a novel human recombinant amelogenin. Clin Oral Investig 2023; 27:5041-5048. [PMID: 37421492 PMCID: PMC10492744 DOI: 10.1007/s00784-023-05123-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 06/14/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVES To histologically evaluate the effects of a novel human recombinant amelogenin (rAmelX) on periodontal wound healing / regeneration in recession-type defects. MATERIALS AND METHODS A total of 17 gingival recession-type defects were surgically created in the maxilla of three minipigs. The defects were randomly treated with a coronally advanced flap (CAF) and either rAmelX (test), or a CAF and placebo (control). At three months following reconstructive surgery, the animals were euthanized, and the healing outcomes histologically evaluated. RESULTS The test group yielded statistically significantly (p = 0.047) greater formation of cementum with inserting collagen fibers compared with the control group (i.e., 4.38 mm ± 0.36 mm vs. 3.48 mm ± 1.13 mm). Bone formation measured 2.15 mm ± 0.8 mm in the test group and 2.24 mm ± 1.23 mm in the control group, respectively, without a statistically significant difference (p = 0.94). CONCLUSIONS The present data have provided for the first-time evidence for the potential of rAmelX to promote regeneration of periodontal ligament and root cementum in recession-type defects, thus warranting further preclinical and clinical testing. CLINICAL RELEVANCE The present results set the basis for the potential clinical application of rAmelX in reconstructive periodontal surgery.
Collapse
Affiliation(s)
- Tali Chackartchi
- Department of Periodontology, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dieter D Bosshardt
- Department of Periodontology, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Robert K. Schenk Laboratory of Oral Histology, Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Jean-Claude Imber
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - Alexandra Stähli
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | | | - Katalin Nagy
- Department of Oral Surgery, Faculty of Dentistry, University of Szeged, Szeged, Hungary
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland.
| |
Collapse
|
|
21
|
Kofina V, Wang YS, Fial A, Tatakis DN. Intra-marrow penetrations and root coverage outcomes: a systematic review. BMC Oral Health 2023; 23:256. [PMID: 37138270 PMCID: PMC10157995 DOI: 10.1186/s12903-023-02964-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/12/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Intra-marrow penetrations (IMPs) have been performed during guided tissue regeneration (GTR) procedures with reported clinical benefits. The aim of this systematic review was to investigate the use and effect of IMPs during root coverage procedures. METHOD A broad search for human and animal studies was performed on PubMed, Cochrane Database of Systematic Reviews and Cochrane Central Registry of Controlled Trials and Web of Science, following a registered review protocol (PROSPERO). All prospective study designs, case series and case reports on gingival recession treatment (follow-up ≥ 6 months) that employed IMPs were included. Root coverage, complete root coverage prevalence, and adverse effects were recorded, and risk of bias was assessed. RESULTS Of 16,181 screened titles, 5 articles (all of them human studies) met inclusion criteria. All studies (including two randomized clinical trials) treated Miller class I and II recession defects, using coronally advanced flap with IMPs alone or in conjunction with GTR protocols. Therefore, all treated defects received IMPs and no studies compared protocols with and without IMPs. Outcomes were indirectly compared with existing root coverage literature. Mean root coverage was 2.7 mm and 68.5% at 6.8 months (median: 6 months, range 6-15 months) for sites treated with IMPs. CONCLUSION IMPs are rarely used during root coverage procedures, have not been associated with intra-surgical or wound healing adverse effects and have not been investigated as independent factor. Future clinical studies are needed to directly compare treatment protocols with and without IMPs and investigate the potential benefits of IMPs for root coverage.
Collapse
Affiliation(s)
- Vrisiis Kofina
- Department of Surgical Sciences, School of Dentistry, Marquette University, P.O. Box 1881, Milwaukee, WI, 53201-1881, USA
| | - Ying S Wang
- Division of Periodontology, College of Dentistry, The Ohio State University, 4121 Postle Hall, 305 W. 12th Ave, Columbus, OH, 43210, USA
- Department of Periodontics, School of Dentistry, Texas A&M University, 3302 Gaston Avenue, Dallas, TX, 75246, USA
| | - Alissa Fial
- Raynor Memorial Libraries, Marquette University, P. O. Box 3141, Milwaukee, WI, 53201-3141, USA
| | - Dimitris N Tatakis
- Division of Periodontology, College of Dentistry, The Ohio State University, 4121 Postle Hall, 305 W. 12th Ave, Columbus, OH, 43210, USA.
| |
Collapse
|
|
22
|
García-Caballero L, Gándara M, Cepeda-Emiliani A, Gallego R, Gude F, Suárez-Quintanilla J, Ramos-Barbosa I, Blanco-Carrión J. Histological and histomorphometric study of human palatal mucosa: Implications for connective tissue graft harvesting. J Clin Periodontol 2023; 50:784-795. [PMID: 36872046 DOI: 10.1111/jcpe.13800] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/23/2023] [Indexed: 03/07/2023]
Abstract
AIMS To analyse the histological structure and histomorphometric characteristics of human hard palatal mucosa in order to determine the donor site of choice for connective tissue grafts from a histological point of view. MATERIALS AND METHODS Palatal mucosa samples from six cadaver heads were harvested at four sites: incisal, premolar, molar and tuberosity. Histological and immunohistochemical techniques were performed, as was histomorphometric analysis. RESULTS In the current study, we found that the density and size of cells were higher in the superficial papillary layer, whereas the thickness of the collagen bundles increased in the reticular layer. Excluding the epithelium, the mean percentage of lamina propria (LP) and submucosa (SM) was 37% and 63%, respectively (p < .001). LP thickness showed similar values in the incisal, premolar and molar regions, and a significantly greater thickness in tuberosity (p < .001). The thickness of SM increased from incisal to premolar and molar, disappearing in the tuberosity (p < .001). CONCLUSIONS As dense connective tissue of LP is the tissue of choice for connective tissue grafts, the best donor site from a histological point of view is tuberosity because it is composed only of a thick LP without the presence of a loose submucosal layer.
Collapse
Affiliation(s)
- Lucía García-Caballero
- Department of Morphological Sciences (Histology Area), School of Medicine and Dentistry, University of Santiago de Compostela and Health Research Institute of Santiago (IDIS), Santiago de Compostela, Spain
| | - Marina Gándara
- Department of Morphological Sciences (Histology Area), School of Medicine and Dentistry, University of Santiago de Compostela and Health Research Institute of Santiago (IDIS), Santiago de Compostela, Spain
| | - Alfonso Cepeda-Emiliani
- Department of Morphological Sciences (Histology Area), School of Medicine and Dentistry, University of Santiago de Compostela and Health Research Institute of Santiago (IDIS), Santiago de Compostela, Spain
| | - Rosalía Gallego
- Department of Morphological Sciences (Histology Area), School of Medicine and Dentistry, University of Santiago de Compostela and Health Research Institute of Santiago (IDIS), Santiago de Compostela, Spain
| | - Francisco Gude
- Epidemiology Unit, University Clinical Hospital and Health Research Institute of Santiago (IDIS), Santiago de Compostela, Spain
| | - Juan Suárez-Quintanilla
- Department of Morphological Sciences (Anatomy and Embryology Area), School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Isabel Ramos-Barbosa
- Orthodontic Unit, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Juan Blanco-Carrión
- Periodontology Unit, School of Medicine and Dentistry, University of Santiago de Compostela, and Health Research Institute of Santiago (IDIS), Santiago de Compostela, Spain
| |
Collapse
|
|
23
|
Abu-Ta'a M. Advanced Platelet-Rich Fibrin and Connective Tissue Graft for Treating Marginal Tissue Recessions: A Randomized, Controlled Split-Mouth Study. Cureus 2023; 15:e35761. [PMID: 36879584 PMCID: PMC9985511 DOI: 10.7759/cureus.35761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2023] [Indexed: 03/07/2023] Open
Abstract
OBJECTIVES This study aimed to evaluate and compare the clinical outcomes of advanced platelet-rich fibrin (A-PRF) and connective tissue graft (CTG) in treating marginal tissue recessions. MATERIALS & METHODS Fifteen patients with isolated bilateral maxillary gingival recessions were recruited for the study, with 30 defects. The defects were classified as Miller's class I/II gingival recession on the canine or premolar region. Patients were randomly divided into two groups, each receiving one of the two treatment techniques (A-PRF or CTG) on a different side of the maxilla in a split-mouth design. Clinical parameters such as recession height (RH), recession width (RW), probing pocket depth (PPD), clinical attachment level (CAL), a width of attached gingiva (WAG), and keratinized tissue height (KTH) were evaluated at baseline, 3, and 6 months. Changes in biotype, Recession Esthetic Score (RES), and Visual Analogue Score-Esthetics (VAS-E) were also evaluated at 6 months. TRIAL REGISTRATION Ethics approval number (Helsinki): PHRC/HC/877/21 and registered at the Clinical Trials Registry under the number NCT05267015 Results: At the end of 6 months, there was a statistically significant reduction in RH and RW in both groups, with the mean RC% of 69.2±22.91, and 88.66±33.18 in Groups I and II, respectively. Intergroup analysis showed statistically significant differences in recession parameters between groups at 3 and 6 months, with better outcomes for the CTG group. CONCLUSIONS This study demonstrates that A-PRF and CTG effectively manage gingival recession defects. However, CTG resulted in better clinical outcomes in terms of reduction in recession height and width.
Collapse
|
|
24
|
Jagtap A, Mangalekar SB, Kamble P. Clinical Evaluation of Coronally Advanced Flap With or Without Advance-Platelet Rich Fibrin Membrane in the Treatment of Miller's Class-II Localized Gingival Recession: A Clinical Study. Cureus 2023; 15:e34919. [PMID: 36938230 PMCID: PMC10015754 DOI: 10.7759/cureus.34919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/10/2023] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION Periodontal treatment focuses on maintaining a patient's natural teeth and gums. The gingival margin recedes to a point apical to the tooth in 20%-100% of people. Coronally advanced flap (CAF) is one of several effective treatments for this condition. This surgery covers the tooth root with gingiva. The predictability of this surgery depends on the blood supply, donor tissue, and surgical skills. Platelet concentrates, which include platelet-rich fibrin (PRF), majority of the time is used for various regenerative therapies. Since no bovine thrombin or anticoagulant is needed, its manufacturing is simpler, cheaper, and less biochemically modified than PRP. Platelet-rich fibrin (PRF) is a fibrin matrix that progressively releases platelet cells and cytokines. AIM The present study aimed to evaluate the efficacy of CAF with and without A-PRF in the treatment of Miller's class-II localized gingival recession. MATERIALS AND METHODS Twenty patients were chosen who had Miller's class-II localized gingival recession. A random number generator was used to place patients into either the "test" or "control" group. Treatment for both Groups A and B included a coronally advanced flap, but only Group A additionally got autologous platelet-rich fibrin (A-PRF). After receiving a detailed explanation of the treatment process, the patient signed an informed consent form. Complete medical and dental histories were taken to see whether there were any absolute or relative contraindications. RESULTS Following treatment with either method in the current study, gingival thickness improved considerably. The percentage of root coverage did not change considerably between the two groups. The clinical result might likely have been different if other factors, such as platelet concentration and PRF consistency, had been examined in the current investigation. Furthermore, there was no histological examination of the healing process. As a result, we are unsure of the extent to which PRF affects how effectively connective tissue attaches. CONCLUSION The additional use of A-PRF membrane did not provide additional benefits in terms of root coverage outcomes compared with CAF alone. The use of A-PRF membranes significantly reduced the recession depth.
Collapse
Affiliation(s)
- Anuja Jagtap
- Department of Periodontology, Bharati Vidyapeeth Dental College and Hospital, Sangli, IND
| | - Sachin B Mangalekar
- Department of Periodontology, Bharati Vidyapeeth Dental College and Hospital, Sangli, IND
| | - Pallavi Kamble
- Department of Periodontology, Bharati Vidyapeeth Dental College and Hospital, Sangli, IND
| |
Collapse
|
|
25
|
Kahn S, de Oliveira LZ, Dias AT, Fernandes GVDO. Clinical evaluation and biological understanding of the early step-by-step healing after periodontal microsurgery: A case report with PES analysis comparing initial and 31-day result. JOURNAL OF ADVANCED PERIODONTOLOGY & IMPLANT DENTISTRY 2022; 14:141-145. [PMID: 36714090 PMCID: PMC9871189 DOI: 10.34172/japid.2022.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/12/2022] [Indexed: 01/09/2023]
Abstract
Microsurgery has evolved, permitting faster vascularization and healing than macro-interventions, reducing tissue trauma and obtaining precise wound closure. Therefore, this study aimed to detail the initial healing steps after the periodontal microsurgical procedure. A -26 year-old female had a localized recession (anterior lower tooth, recession type1-), with the absence of local keratinized tissue width (KTW) and adjacent gingival thickness (GT)<1 mm. After oral prophylaxis and occlusal adjustments, the pink esthetic score was performed (5 points), followed by the microsurgery procedure. Prior to inserting the subepithelial connective tissue graft (SCTG), the epithelial layer was removed, and the root surface was biomodified. Two days postoperatively, it was possible to observe a white layer from the SCTG in the gingival margin, decreasing after 4 days. In 6 days, the sutures were removed; no graft and volume loss was observed. For 9 days, the volume was the maintenance. Nevertheless, there was a reduction in tissue volume in the facial zone. After 11 and 13 days, an improved healing process was found, whereas, after 16 days, it was possible to report stable tissues, which was confirmed after 31 days, with a significant GR reduction and an increase in KTW and GT. Moreover, the final pink esthetic score (PES) was 9. Microsurgery had a faster healing and predictable outcome, suggesting reduced trauma, which may allow a quicker suture removal without jeopardizing the outcomes.
Collapse
Affiliation(s)
- Sergio Kahn
- Veiga de Almeida University, Rio de Janeiro, Brazil
| | | | | | - Gustavo Vicentis de Oliveira Fernandes
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, USA,Corresponding author: Gustavo Vicentis de Oliveira Fernandes, E-mail:
| |
Collapse
|
|
26
|
Patra L, Raj SC, Katti N, Mohanty D, Pradhan SS, Tabassum S, Mishra AK, Patnaik K, Mahapatra A. Comparative evaluation of effect of injectable platelet-rich fibrin with collagen membrane compared with collagen membrane alone for gingival recession coverage. World J Exp Med 2022; 12:68-91. [PMID: 36157336 PMCID: PMC9350719 DOI: 10.5493/wjem.v12.i4.68] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 04/26/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Collagen membrane and platelet-rich fibrin (PRF) have emerged as vital biomaterials in the field of periodontal regeneration. Minimally invasive techniques are being preferred by most periodontists, as it is patient compliant with fewer post-surgical complications as compared to conventional surgical techniques. Thus, in this study we have evaluated the effect of injectable PRF (i-PRF) with collagen membrane compared with collagen membrane alone using vestibular incision subperiosteal tunnel access (VISTA) technique for gingival recession coverage.
AIM To compare the efficacy of VISTA using collagen membrane with collagen membrane soaked in injectable PRF for gingival recession coverage.
METHODS A split mouth randomized controlled clinical trial was designed;13 subjects having at least 2 teeth indicated for recession coverage were enrolled in this study. The sites were randomly assigned to control group (VISTA using collagen membrane alone) and the test group (VISTA using collagen membrane with i-PRF). The clinical parameters assessed were pocket depth, recession depth (RD), recession width (RW), relative attachment level, keratinised tissue width (KTW), keratinised tissue thickness (KTT), and percentage root coverage.
RESULTS RD showed a statistically significant difference between the test group at 3 mo (0.5 ± 0.513) and 6 mo (0.9 ± 0.641) and the control group at 3 mo (0.95 ± 0.51) and 6 mo (1.5 ± 0.571), with P values of 0.008 and 0.04, respectively. RW also showed a statistically significant difference between the test group at 3 mo (1 ± 1.026) and 6 mo (1.65 ± 1.04) and the control group at 3 mo (1.85 ± 0.875) and 6 mo (2.25 ± 0.759), with P values of 0.008 and 0.001, respectively. Results for KTW showed statistically significant results between the test group at 1 mo (2.85 ± 0.489), 3 mo (3.5 ± 0.513), and 6 mo (3.4 ± 0.598) and the control group at 1 mo (2.45 ± 0.605), 3 mo (2.9 ± 0.447), and 6 mo (2.75 ± 0.444), with P values of 0.04, 0.004, and 0.003, respectively. Results for KTT also showed statistically significant results between test group at 1 mo (2.69 ± 0.233), 3 mo (2.53 ± 0.212), and 6 mo (2.46 ± 0.252) and the control group at 1 mo (2.12 ± 0.193), 3 mo (2.02 ± 0.18), and 6 mo (1.91 ± 0.166), with P values of 0.001, 0.001, and 0.001, respectively. The test group showed 91.6%, 81.6%, and 67% root coverage at 1 mo, 3 mo, and 6 mo, while the control group showed 82.3%, 66.4%, and 53.95% of root coverage at 1 mo, 3 mo, and 6 mo, respectively.
CONCLUSION The use of minimally invasive VISTA technique along with collagen membrane and injectable form of platelet-rich fibrin can be successfully used as a treatment method for multiple or isolated gingival recessions of Miller’s class-I and class-II defects.
Collapse
Affiliation(s)
- Laxmikanta Patra
- Department of Periodontics, SCB Dental College and Hospital, Odisha 753007, India
| | - Subash Chandra Raj
- Department of Periodontics, SCB Dental College and Hospital, Odisha 753007, India
| | - Neelima Katti
- Department of Periodontics, SCB Dental College and Hospital, Odisha 753007, India
| | - Devapratim Mohanty
- Department of Periodontics, SCB Dental College and Hospital, Odisha 753007, India
| | - Shib Shankar Pradhan
- Department of Periodontics, SCB Dental College and Hospital, Odisha 753007, India
| | - Shaheda Tabassum
- Department of Periodontics, SCB Dental College and Hospital, Odisha 753007, India
| | - Asit Kumar Mishra
- Department of Periodontics, SCB Dental College and Hospital, Odisha 753007, India
| | - Kaushik Patnaik
- Department of Periodontics, SCB Dental College and Hospital, Odisha 753007, India
| | - Annuroopa Mahapatra
- Department of Periodontics, SCB Dental College and Hospital, Odisha 753007, India
| |
Collapse
|
|
27
|
Combined Surgical and Restorative Procedures to Treat Maxillary Canine with Gingival Recession and Cervical Wear. Case Rep Dent 2022; 2022:2670994. [PMID: 35719183 PMCID: PMC9200598 DOI: 10.1155/2022/2670994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/12/2022] [Accepted: 05/20/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction Gingival recession (GR) with cervical tooth wear is a major concern for patients on the prominent maxillary canines, from both esthetic and dentine hypersensitivity points of view. Hypersensitivity could be treated nonsurgically; however, esthetics remain the major patients' concern that mostly requires surgical intervention for covering the denuded root surface. Several surgical procedures are applied successfully for covering single and multiple gingival recession; however, these procedures are sensitive procedures and not always predictable. Semilunar coronally repositioned flap (SCRF) is a very simple procedure that found to be very predictable for covering a single recession in presence of sufficient keratinized gingiva apical to the recession. The procedure provides better clinical outcome by involving less adjacent papillary tissue that maintains greater blood supply and achieves maximum flap stability with mattress sutures with minimal postoperative complications. Therefore, this case report is aimed at explaining the simplicity of this surgical procedure in the presence of wide keratinized tissue around the recession and starting the restorative procedure after a sufficient soft tissue healing period. Case Presentation. 42-year-old systemically healthy female patient referred with a single wide gingival type 1 (RT1) and cervical wear around tooth #43. A semilunar coronally repositioned flap was released and advanced coronally to cover the denuded root totally; then, the flap stabilized by three mattress sutures, and complete root coverage was achieved. Six months later, the cervical lesion was restored with composite filling material. Sixteen-month and 32-month postoperative follow-up revealed full coverage of the denuded root surface with firm stable gingiva; later, the gingiva in the area looked stable and healthy. Conclusion Using SCRF in treating RT1 recession in the presence of wide keratinized gingiva is very promising surgical intervention for receded root coverage that requires less technical skill.
Collapse
|
|
28
|
Recession width evaluation after the use of Advanced PRF (A-PRF) verus subepithilial conncective tissue graft (SCTG) in combination with coronally advanced flap in treatment of gingival recession. Int J Health Sci (Qassim) 2022. [DOI: 10.53730/ijhs.v6ns4.6305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective: To evaluate the amount of recession width following the use CAF and advanced platelet rich fibrin (A-PRF) compared to CAF with SCTG in the treatment of single gingival recession. Materials and Methods: Twenty gingival recession defects were randomly assigned to receive either CAF+SCTG (n=10) or CAF+A-PRF (n=10). Recession width in mm was assessed at 3, 6 and 9 months post-operatively. Results: Patients in test group (CAF+A-PRF) reported 2.13 ± 0.35 recession width at 3 months, 2.00 ± 0 after 6 months. While, finally decreased to 1.25±1.04 after 9 months. In the control group (CAF+SCTG), the amount of recession width recorded 1.00 ± 1.07 at 3 months, while, after 6 and 9 months decreased to 0.5 ± 0.93. Conclusion and recommendation: There was no statistically significant difference between the two studied groups after 9 months. While, A significant difference reported at 3 and 6 months. Further studies with larger sample size and longer follow-up is needed.
Collapse
|
|
29
|
Altaleb AQM, Albader RA, Alfahad MA, AlGhizzi MGM, Aldhuwayhi S, Mustafa MZ, Thakare AA, Naqvi ZA. Knowledge, Awareness, and Practice of Gingival Veneer Prosthesis Among Dental Students, Interns, and Practitioners in the Riyadh Region: A Cross-Sectional Questionnaire-Based Survey. Open Dent J 2022. [DOI: 10.2174/18742106-v16-e2111172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
The treatment modality of using gingival veneer prosthesis for anterior gingival recession is not widely known even in the dental fraternity. This survey has been conducted considering its essential nature and absence of data on its awareness in the Riyadh region.
Aims:
The aim of the study was to assess the knowledge, awareness, and practice of gingival veneer prosthesis among dental students, interns, and practitioners in the Riyadh region.
Materials and Methods:
A descriptive cross-sectional electronic survey was conducted on dental students, interns, and practitioners of both genders in Saudi Arabia, using a convenient sampling method. The final questionnaire consisted of 12 questions. The percentage of various responses, with reference to the demographics, and statistical significance, were tested by independent sample t-test and p-value <0.05. The responses/data of 446 participants were tabulated and processed in SPSS (version 21.0).
Results:
The preferred treatment option for an anterior gingival recession proposed by prosthodontists was prosthetic correction (p<0.05), and for other groups, it was periodontal surgery (p<0.05). 66% of general practitioners’ group and 56% of dental students and interns’ group, respectively, were not sure about the ideal treatment option for Miller’s class III & IV gingival defects, while 70% of general practitioners’ group and 65% of the students and interns’ group, respectively, were not sure about the ideal treatment option for the management of gingival tissue loss between implants,.
Conclusion:
There is a significant lack of knowledge on using gingival veneer prosthesis as a treatment option for anterior gingival defects among general dental practitioners, interns, and dental students (p˂0.05).
Collapse
|
|
30
|
Sethiya K, Dhadse P, Bajaj P, Durge K, Subhadarsanee C, Hassan S. Platelet rich fibrin in combination with bioabsorbable guided tissue regeneration (GTR) membrane and GTR membrane alone using double lateral sliding bridge flap for treatment of multiple gingival recession defects in humans: A randomized controlled clinical trail. J Indian Soc Periodontol 2022; 26:245-253. [PMID: 35602531 PMCID: PMC9118950 DOI: 10.4103/jisp.jisp_322_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/22/2021] [Accepted: 12/12/2021] [Indexed: 11/04/2022] Open
|
|
31
|
Weinberg E, Kolerman R, Kats L, Cohen O, Masri D, Sebaoun A, Slutzkey G. Coronally Advanced Flap with Connective Tissue Graft for Treating Orthodontic-Associated Miller Class III Gingival Recession of the Lower Incisors: A One-Year Retrospective Study. J Clin Med 2022; 11:jcm11010235. [PMID: 35011976 PMCID: PMC8745991 DOI: 10.3390/jcm11010235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/27/2021] [Accepted: 12/31/2021] [Indexed: 12/04/2022] Open
Abstract
(1) Background: To assess the clinical outcome of coronally advanced flap combined with connective tissue graft for the treatment of orthodontic-associated Miller Class III gingival recession of the lower incisors. (2) Methods: This study included 15 patients who had undergone orthodontic treatment prior to development of recession. Measurements of recession depth, recession width, probing depth, and width of keratinized tissue were performed clinically immediately before surgery and after one year. In addition, digital measurements of recession depth, recession width, and root coverage esthetic score were performed on intraoral photographs. (3) Results: Significant reduction was observed for probing depth, recession depth, and recession width at one year, with significant increase in width of keratinized tissue. Mean root coverage was 83 ± 24% for recession depth, while complete root coverage was achieved in 10 out of 21 recessions (48%). The average root coverage esthetic score at 12 months was 7.1 ± 2.6. An interaction was found between initial recession depth and mean root coverage. (4) Conclusions: Within the limitations of this study, our results confirm that combination of coronally advanced flap and connective tissue graft is effective in reducing post-orthodontic Miller Class III recessions of the mandibular incisors, even when the correction of the tooth malposition, is unattainable.
Collapse
Affiliation(s)
- Evgeny Weinberg
- Departments of Periodontology and Oral Implantology, Departments of Oral Biology, Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence:
| | - Roni Kolerman
- Department of Periodontology and Oral Implantology, Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (R.K.); (O.C.); (A.S.); (G.S.)
| | - Lazar Kats
- Department of Oral Pathology, Oral Medicine and Maxillofacial Imaging, Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Omer Cohen
- Department of Periodontology and Oral Implantology, Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (R.K.); (O.C.); (A.S.); (G.S.)
| | - Daya Masri
- Rabin Medical Center, Department of Oral and Maxillofacial Surgery, Petach-Tikva 4941492, Israel;
| | - Alon Sebaoun
- Department of Periodontology and Oral Implantology, Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (R.K.); (O.C.); (A.S.); (G.S.)
| | - Gil Slutzkey
- Department of Periodontology and Oral Implantology, Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (R.K.); (O.C.); (A.S.); (G.S.)
| |
Collapse
|
|
32
|
Savithri N, Subramanian S, Prakash PG, Appukuttan D. Effect of microsurgical technique for root coverage using modified coronally advanced flap with connective tissue graft- Randomized controlled clinical trial. Dent Res J (Isfahan) 2022. [DOI: 10.4103/1735-3327.359324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
|
33
|
Gomaa M, El Guindy H, Shoukheba M, Metwalli A. Healing of experimental gingival recession defects treated with amnion allograft: histologic and histometric analysis in dogs. J Oral Biosci 2022; 64:93-99. [DOI: 10.1016/j.job.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/12/2022] [Accepted: 01/17/2022] [Indexed: 11/24/2022]
|
|
34
|
The comparison of the efficacy of gingival unit graft with connective tissue graft in recession defect coverage: a randomized split-mouth clinical trial. Clin Oral Investig 2021; 26:2761-2770. [PMID: 34787718 DOI: 10.1007/s00784-021-04252-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 10/23/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Gingival unit graft (GUG) is defined as the modified form of free gingival graft. The aim of this study is to compare the clinical efficacy of GUG with connective tissue graft (SCTG) with respect to clinical periodontal parameters and patient comfort scores in gingival recessions. MATERIALS AND METHODS Sixteen patients with bilateral recession type 1 (RT1) gingival recessions participated in this randomized and split-mouth study. Thirty-two defects received surgical treatment with SCTG or GUG. The recession defect coverage, periodontal measurements, and patient-reported outcomes (intra- and post-operative patient comfort, aesthetic satisfaction, and hypersensitivity) were evaluated at baseline and post-operative months 1, 3 and 6. RESULTS The favorable results were obtained in both study groups in gingival recession depth (RD), gingival recession width (RW), clinical attachment level (CAL), and keratinized tissue width (KTW). The average percentages of the recession defect coverage (RC) for GUG and SCTG group treatments after 6 months were 68.2 ± 33% and 76.4 ± 30.2%, respectively (p > 0.05). Although there was no significant difference between groups at post-operative 6 months (p > 0.05) in terms of RD, RW, CAL, RC, patient comfort, aesthetic satisfaction, and hypersensitivity parameters, the increase in KTW was significantly higher in GUG group (p < 0.05). CONCLUSIONS It was concluded that although both techniques were effective, GUG can be a convenient method for treatment of RT1 gingival recessions with inadequate KTW and (or) shallow vestibule depth. CLINICAL RELEVANCE According to the results of this study, GUG may be a preferred choice in localized gingival recessions with a lack of keratinized tissue. The trial registration number: NCT04637451.
Collapse
|
|
35
|
Gingival recession treatment with enamel matrix derivative associated with coronally advanced flap and subepithelial connective tissue graft: a split-mouth randomized controlled clinical trial with molecular evaluation. Clin Oral Investig 2021; 26:1453-1463. [PMID: 34536136 DOI: 10.1007/s00784-021-04119-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/01/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The goal of this study was to evaluate the impact of enamel matrix derivative (EMD) on periodontal healing after root coverage (RC) surgery, involving CAF in combination with SCTG, and to assess the molecular profile, verifying the inflammation level in early stage (1 and 2 weeks). MATERIALS AND METHODS Thirty-two recessions (RT1) were submitted to periodontal surgery with (test) or without (control) EMD. The clinical parameters analyzed on the day of surgery and 6 months after the surgical procedure were as follows: recession height and width, keratinized tissue height, percentual root coverage, and the gingival thickness of keratinized tissue. Moreover, the main inflammatory biomarkers and growth factors (IL-1β, IL-6, IL-8, FGF, MIP-1α and β, PDGF, TNF-α, and VEGF) were evaluated at baseline, 7, and 14 days after procedures. RESULTS The average root coverage was significantly higher in the test group as compared to the control group (86% vs. 66%, p = 0.008). The test side had significantly lesser final RH compared to the control side (p = 0.01). Also, there was a significant reduction of RW in both groups, with more significant results in the test group. KTH and GT were not significantly different at any time and group. After 14 days, the immunological analysis showed an increase of VEGF (p = 0.03) on the test group compared to the control side. CONCLUSION The use of EMD in RC surgeries resulted in a significantly higher RC, as well as a significant increase in VEGF expression, suggesting that EMD may contribute to the angiogenic and healing process. CLINICAL RELEVANCE EMD provided better results in root coverage treatment when associated with CAF and SCTG, beyond a greater releasing of angiogenic growth factor (VEGF), which enhanced the result.
Collapse
|
|
36
|
Assessment of Patients’ Satisfaction following Coverage of Gingival Recessions: Questionnaire-Based Case Series. BALKAN JOURNAL OF DENTAL MEDICINE 2021. [DOI: 10.2478/bjdm-2021-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Summary
Background/Aim: One of the most important goals of periodontal plastic surgery constitutes the predictable root coverage. Despite the thorough documentation that several surgical approaches can be implemented for the successful treatment of gingival recession (GR), only limited papers reported data on the evaluation according to patient’s opinion. Thus, the forthcoming study is aiming in the patient-based assessment of the outcome of root coverage procedures.
Material and Methods: Sixteen subjects (eight male, eight female; mean age 43.75 years, range: 23-73 years), with twenty one GRs, constituted the sample of this study and the root coverage procedures were executed in the period from 2011 to 2019. A patient-based questionnaire was used to assess the level of subjects’ concern on various aspects related to the GR, preand post-operatively. Patient’s overall post-operative satisfaction was evaluated with a VAS.
Results: After a period of at least 6 months of the surgical treatment, the majority of the subjects indicated that they were not concerned for all the examined criteria. The criteria with the highest improvement (reported as improvement by at least two levels of concern pre- and post-operatively) were the following: 1) fear to lose the involved teeth and 2) esthetics of the area of the recession defect. With regard to esthetics’ criteria, the majority of the patients indicated post-operatively the examined criteria as not important. The esthetics’ criteria yielding the highest improvement were: 1) position of the teeth and 2) the fact that the teeth showed longer. Mean patient’s overall post-operative satisfaction was 82,3 (range: 0-100).
Conclusions: The majority of the subjects were satisfied from the implemented root coverage procedures. Few studies on the international literature have evaluated patient satisfaction following therapy. Comprehensive, multi-center studies, comprised of a large sample and a using a standardized approach are needed in future research.
Collapse
|
|
37
|
KAYAR NA, AYTEKİN Z. IMPACT OF TOOTH LOCATION ON THE TREATMENT OF MULTIPLE GINGIVAL RECESSIONS WITH CONNECTIVE TISSUE GRAFT ASSOCIATED WITH A CORONALLY ADVANCED FLAP. CUMHURIYET DENTAL JOURNAL 2021. [DOI: 10.7126/cumudj.884369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
|
38
|
Maia VTG, Kahn S, de Souza AB, Fernandes GVDO. De-Epithelialized Connective Tissue Graft And The Reminiscent Epithelial Content After Harvested by the Harris' Technique: A Histological And Morphometrical Case Series. Clin Adv Periodontics 2021; 11:150-154. [PMID: 33527757 DOI: 10.1002/cap.10151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/27/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The remaining epithelial layer existent in connective tissue graft (CTG) harvested from the hard palate, which underwent de-epithelization outside the oral cavity, can be histologically detected unless it is completely removed. Its presence may cause adverse esthetics results, affecting thus the color and texture of the receptor site, and an increased risk of presence of scar tissues after surgical procedures. The proposal of this study was to evaluate the CTG (histological and morphometrically) collected from the hard palate using the Harris' technique, removing the epithelial layer outside the mouth, assessing the remaining presence of epithelial tissue. CASE SERIES Fourteen patients (14CTGs) were included in the present case series study, therefore there were two dropouts. A small part of the tip of the graft was harvested and fixed in formalin solution for histological processing, staining, and then to be morphometrically analyzed. The epithelial tissue and CTGs were assessed by three calibrated and double-blinded professionals. All information was compiled, and the statistical analysis was performed. CTGs obtained had a width average of 1224.26 μm. There was no presence of any residual of the epithelium in three samples, whereas only one had the epithelium tissue covering the entire connective layer. Furthermore, seven samples (approximately 50%) had the presence of epithelium. CONCLUSION Within the limitation of this study, there was incomplete removal of the epithelial layer after harvesting the CTG using the Harris' technique (44.32%), most likely due to its histological persistency, suggesting to be inaccurate the clinical removal.
Collapse
Affiliation(s)
| | | | - Alex Balduino de Souza
- Biology and Cellular Technology Laboratory (LaBioTeC), Veiga de Almeida University, Rio de Janeiro, Brazil
| | | |
Collapse
|
|
39
|
Beitlitum I, Barzilay V, Rayyan F, Sebaoun A, Sarig R. Post-Orthodontic Lower Incisors Recessions: Combined Periodontic and Orthodontic Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8060. [PMID: 33147692 PMCID: PMC7663667 DOI: 10.3390/ijerph17218060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/18/2020] [Accepted: 10/27/2020] [Indexed: 11/17/2022]
Abstract
The bonded lingual retainer (BLR) is considered a favorable choice for retaining lower incisors' alignment post-orthodontic treatment; however, it may cause some unwanted effects such as inadvertent tooth movement and torque changes. These often result in gingival recession (Miller class III-type) with exposure of the root surface, which compromises the esthetics and hinders the comfort of the patient. Fifteen post-orthodontic patients presenting Miller class III-type recessions with BLR were examined. Two protocols were used: the first included the removal of the BLR prior to surgery and the second included only a surgical approach. All patients underwent the same surgery of a modified tunnel double papilla procedure for root coverage. The gingival recession was measured using a dental probe before, and three to six months post-surgery. The average improvement in recession depth was significantly greater (p = 0.008) for the protocol that included removal of the BLR (4.0 ± 0.83 mm) with an improvement of 87.2% as compared to the second protocol that showed an improvement of 43.8% (1.88 ± 1.29 mm). Removing the BLR prior to surgery is beneficial for predictable root coverage in post-orthodontic Miller class III recessions.
Collapse
Affiliation(s)
- Ilan Beitlitum
- Department of Periodontology and Dental Implantology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (I.B.); (A.S.)
| | - Vered Barzilay
- Department of Orthodontics, The Maurice and Gabriela Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Fatma Rayyan
- Department of Oral Biology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Alon Sebaoun
- Department of Periodontology and Dental Implantology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (I.B.); (A.S.)
| | - Rachel Sarig
- Department of Orthodontics, The Maurice and Gabriela Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
- Department of Oral Biology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
- The Dan David Center for Human Evolution and Biohistory Research, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel
| |
Collapse
|
|
40
|
Barootchi S, Tavelli L, Zucchelli G, Giannobile WV, Wang HL. Gingival phenotype modification therapies on natural teeth: A network meta-analysis. J Periodontol 2020; 91:1386-1399. [PMID: 32392401 DOI: 10.1002/jper.19-0715] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/07/2020] [Accepted: 03/15/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The periodontal phenotype consists of the bone morphotype, the keratinized tissue (KT), and gingival thickness (GT). The latter two components, overlying the bone, constitute the gingival phenotype. Several techniques have been proposed for enhancing or augmenting KT or GT. However, how phenotype modification therapy (PMT) affects periodontal health and whether the obtained outcomes are maintained over time have not been elucidated. The aim of the present review was to summarize the available evidence in regard to the utilized approaches for gingival PMT and assess their comparative efficacy in augmenting KT, GT and in improving periodontal health using autogenous, allogenic, and xenogeneic grafting approaches. METHODS A detailed systematic search was performed to identify eligible randomized clinical trials (RCTs) reporting on the changes in GT and KT (primary outcomes). The selected articles were segregated into the type of approach based on having performed a root coverage, or non-root coverage procedure. A network meta-analysis (NMA) was conducted for each approach to assess and compare the outcomes among different treatment arms for the primary outcomes. RESULTS A total of 105 eligible RCTs were included. 95 pertaining to root coverage (3,539 treated gingival recessions [GRs]), and 10 for non-root coverage procedures (699 total treated sites). The analysis on root coverage procedures showed that all investigated techniques (the acellular dermal matrix [ADM], collagen matrix [CM], connective tissue graft [CTG]) are able to significantly increase the GT, compared with treatment with flap alone. However, KT was only significantly increased with the use of CTG or ADM. Early post-treatment GT was found to inversely predict future GR. For non-root coverage procedures, only the changes in KT could be analyzed; all investigated treatment groups (ADM, CM, free gingival graft [FGG], living cellular construct [LCC], in combination with an apically positioned flap [APF]), resulted in significantly more KT than treatment with APF alone. Additionally, the augmented GT was shown to be sustained, and KT displayed an incremental increase over time. CONCLUSIONS Within its limitations, it was observed that any graft material was able to significantly enhance GT, while KT in root coverage procedures was significantly enhanced with CTG and ADM, and in non-root coverage procedures, with ADM, CM, FGG, and LCC compared with APF alone. The autogenous soft tissue graft (CTG/FGG) proved to be superior in all comparisons for both outcomes of GT and KT.
Collapse
Affiliation(s)
- Shayan Barootchi
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Lorenzo Tavelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Giovanni Zucchelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - William V Giannobile
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
- Department of Biomedical Engineering & Biointerfaces Institute, College of Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Hom-Lay Wang
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| |
Collapse
|
|
41
|
Shenoy SB, Bhat V, Kottakkunnummal PB, Shahira, Hegde C, Thomas B. Interproximal Papilla Volumization Using Vestibular Incision Subperiosteal Tunneling Access Technique in Esthetic Rehabilitation. Contemp Clin Dent 2020; 11:76-78. [PMID: 33110313 PMCID: PMC7580747 DOI: 10.4103/ccd.ccd_33_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/10/2020] [Indexed: 11/12/2022] Open
Abstract
An accurate diagnostic and interdisciplinary approach is essential for obtaining suitable, conservative, and predictable results in areas with high esthetic demand. Patients reporting with an improper prosthesis that has a black triangle pose a challenge for soft-tissue esthetic rehabilitation. Re-restoration of such cases with conventional fixed prosthesis would be undesirable due to imbalance in pink and white esthetics. This case report describes an interdisciplinary approach to maintain the existing midline diastema and correction of black triangle in the interproximal area between abutment and pontic in the esthetic zone. Minimally invasive vestibular incision subperiosteal tunneling access technique with connective tissue graft was planned for reconstructing the interdental papilla, followed by prosthetic rehabilitation of edentulous site with fixed partial denture using loop connector design to maintain the midline diastema. Postoperative result showed a comprehensive, pink and white rehabilitation to meet the patient's esthetic demand.
Collapse
Affiliation(s)
- Santhosh B Shenoy
- Department of Periodontics, A B Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to be University), Mangalore, Karnataka, India
| | - Vinaya Bhat
- Department of Prosthodontics, A B Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to be University), Mangalore, Karnataka, India
| | - Parvathi B Kottakkunnummal
- Department of Prosthodontics, A B Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to be University), Mangalore, Karnataka, India
| | - Shahira
- Department of Periodontics, A B Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to be University), Mangalore, Karnataka, India
| | - Chethan Hegde
- Department of Prosthodontics, A B Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to be University), Mangalore, Karnataka, India
| | - Biju Thomas
- Department of Periodontics, A B Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to be University), Mangalore, Karnataka, India
| |
Collapse
|
|
42
|
A Modified Bilaminar Technique with the Use of a Fibrin-Fibronectin System for a Single Gingival Recession: A Case Report with a Follow-Up of 3 Years. Case Rep Dent 2020; 2020:3892753. [PMID: 33062343 PMCID: PMC7545419 DOI: 10.1155/2020/3892753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 12/01/2022] Open
Abstract
This case report described a modified bilaminar technique for treating a single gingival recession. Patient presented a gingival recession in a maxillary canine. Tooth was in a buccally prominent position and soft keratinized tissue apical to the recession was reduced but still present. A split-full-split thickness trapezoidal flap was designed. Root's surface was prepared with curettes. Epithelial-connective tissue graft was harvested from the palate with reduced dimension. After deepithelialization, the graft was placed with a fibrin-fibronectin system at the maximum root coverage level, and the flap coronally advanced and sutured. At 3-year follow-up control, the free gingival margin was still stable at the postsurgery position, with a thicker biotype corresponding to the grafted area, with no probing and a suitable aesthetic result.
Collapse
|
|
43
|
Toledo Stuani VD, do Prado Manfredi GG, Miyahara Kondo VA, Noritomi PY, Lisboa-Filho PN, Passanezi Sant’Ana AC. The use of additively manufactured scaffolds for treating gingival recession associated with interproximal defects. ACTA ACUST UNITED AC 2020. [DOI: 10.2217/3dp-2020-0008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Gingival recessions are a highly prevalent issue that is often associated with interproximal tissue deficiency. An intervention in these scenarios is of extreme importance since these defects can lead to aesthetic, phonetic and other dental problems. Unfortunately, the treatment of advanced gingival recessions is a major challenge in periodontics because of its unpredictability. In such cases, the use of injectable fillings, connective tissue grafts or bone grafts for vertical regeneration in interproximal area presents limited results. Considering that, this special report reviewed the possible use of additively manufactured scaffolds as a therapeutic option. A 3D-printed personalized therapy is expected to simplify the regeneration of interproximal area, enabling bone regeneration, new papilla formation and root coverage.
Collapse
Affiliation(s)
- Vitor de Toledo Stuani
- Discipline of Periodontology, Bauru School of Dentistry – University of Sao Paulo, Bauru, Brazil
| | | | | | - Pedro Yoshito Noritomi
- Nucleus of Three-Dimensional Technologies (NT3D), Center for Information Technology Renato Archer, Campinas, Brazil
| | | | | |
Collapse
|
|
44
|
Monika K, Sunkala L, Sandeep N, Keerthi K, Bharathi BV, Madhav GV. Evaluation of root coverage with pedicled buccal fat pad in class III and class IV gingival recession defects. J Family Med Prim Care 2020; 9:1656-1661. [PMID: 32509667 PMCID: PMC7266237 DOI: 10.4103/jfmpc.jfmpc_1104_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/05/2020] [Accepted: 02/20/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Gingival recession (GR) is a common clinical feature of periodontal disease and is an undesirable condition. More than 50% of the population has one or more sites with GR ≥ 1 mm. Material and Methods: In this study 15 subjects were subjected to initial periodontal therapy such as ultrasonic scaling and root planning with hand instruments and curettes. Patient is motivated for home care. The buccal fat pad is harvested and sutured in the gingival recession area and followed up for 6 months and root coverage was calculated. Results: At baseline mean recession of 5.60 ± 1.18 mm, probing depth of 0.73 ± 0.59 mm, clinical attachment loss of 6.40 ± 1.18 mm were recorded. At the end of 6 months, the mean recession was reduced from 5.60 ± 1.18 mm to 2.87 ± 0.74 mm, probing depth was increased from 0.73 ± 0.59 mm to 1.73 ± 0.70 mm and clinical attachment loss was decreased from 6.40 ± 1.18 mm to 4.53 ± 0.83 mm.The difference between baseline score and six months score for all three parameters are statistically significant. Conclusion: Buccal fat pad is a predictable procedure to cover Miller's class III and class IV gingival recession defects. There was a definitive improvement in clinical parameters (reduction in gingival recession, increased probing depth, gain in clinical attachment) after 6 months. There was 46.78% improvement in root coverage which was statistically significant.
Collapse
Affiliation(s)
- K Monika
- Private Practitioner, Department of Periodontics, Panineeniya Institute of Dental Sciences, Hyderabad, India
| | - Lokesh Sunkala
- Department of Prosthodontics Crown and Bridge, Army College of Dental Sciences, Secunderabad, Telangana, India
| | - N Sandeep
- Private Practitioner, Department of Periodontics, Panineeniya Institute of Dental Sciences, Hyderabad, India
| | - K Keerthi
- Private Practitioner, General Dentistry, Hyderabad, India
| | - B Vimal Bharathi
- Department of Prosthodontics Crown and Bridge, Panineeniya Institute of Dental Sciences, Hyderabad, India
| | - Gajula Venu Madhav
- Department of Prosthodontics Crown and Bridge, Army College of Dental Sciences, Secunderabad, Telangana, India
| |
Collapse
|
|
45
|
Palatal Wound Healing with Primary Intention in a Rat Model-Histology and Immunohistomorphometry. ACTA ACUST UNITED AC 2020; 56:medicina56040200. [PMID: 32344587 PMCID: PMC7230352 DOI: 10.3390/medicina56040200] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 01/07/2023]
Abstract
Background and objectives: Subepithelial connective tissue graft (SCTG) from the palate has been considered as the “gold standard” for the treatment of deep gingival recessions. A single-incision technique was reported to allow primary wound healing. A palatal single incision was performed in a rat model. The present study assessed the histology and histomorphometry of palatal wound healing following surgical closure with primary intention. Materials and Methods: Twenty-six 6-month-old male Wistar rats weighing 427–650 g. An incision was made on the maxillary palate. A full thickness flap was raised palatally, and then repositioned and sutured. Two experimental groups: S—Study group, I—Intact control group. Half of the animals were sacrificed 7 days and the remaining 14 days postoperatively. Outcome parameters included—epithelial gap; inflammatory infiltration; vascular fraction, expression of myofibroblasts and stem cell markers within the oral epithelium and stromal cells and physical properties of stromal collagen fibers. Investigations were performed at two time-points (7 and 14 days) during the wound healing process. Results: The epithelial gap closed completely after 14 days. The inflammatory reaction and vascular fraction were relatively low. Surgical trauma downregulated the expression of cytokeratin (CK) 14 and CK 15, which returned to normal after 14 days. Epithelial differentiation was mediated through upregulation of connective tissue sex- determining-region-Y-box2 (SOX2). Epithelial SOX2, CD34, alpha smooth muscle actin (αSMA) and physical properties of stromal collagen fibers were not influenced by the surgical trauma. Conclusions: Surgical trauma followed by palatal wound healing with primary intention in a rat model heals within 14 days. It induces minimal inflammatory infiltration and vascular proliferation. Epithelization is exerted through promotion of epithelial differentiation from stem cells by connective tissue SOX2.
Collapse
|
|
46
|
Moro MG, Souto MLS, Rovai ES, Cesar Neto JB, Holzhausen M, Pannuti CM. Effect of magnification on root coverage surgery. BRAZILIAN JOURNAL OF ORAL SCIENCES 2020. [DOI: 10.20396/bjos.v19i0.8658221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Root coverage surgery can be performed in patients with gingival recession to cover the exposed root aiming to control hypersensitivity and promotes better aesthetic. Optical magnification has been proposed as a refinement in this surgical technique to increase root coverage. This approach may lead to enhanced soft tissue stability, less post-operative discomfort, better predictability and esthetic appearance. Aim: This systematic review aimed to evaluate the effectiveness of magnification on root coverage surgery when compared to procedures performed without magnification. Methods: Randomized controlled trials with a follow-up of at least 6 months that compared surgeries for root coverage performed under optic magnification versus conventional (macro) root coverage surgery were screened. The primary outcome was mean root coverage (mm) (MRC) and secondary outcomes were percentage of root coverage (PRC) and complete root coverage (CRC). Results: Of 569 papers relevant to this review, seven were included. Meta-analysis showed that the use of magnification may favor greater PRC (7.38%, 95% CI 3.66-11.09). Conclusion: Magnification can increase PRC in root coverage surgeries. More randomized trials with the use of magnification may be necessary to verify if this benefit is clinically relevant, in order to justify the use of this device.
Collapse
|
|
47
|
Petsos H, Eickholz P, Raetzke P, Nickles K, Dannewitz B, Hansmeier U. Clinical and patient‐centred long‐term results of root coverage using the envelope technique in a private practice setting: 10‐year results—A case series. J Clin Periodontol 2020; 47:372-381. [DOI: 10.1111/jcpe.13242] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/10/2019] [Accepted: 12/16/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Hari Petsos
- Department of Periodontology Center for Dentistry and Oral Medicine (Carolinum) Johann Wolfgang Goethe‐University Frankfurt/Main Frankfurt/Main Germany
- Private Practice Soest Germany
| | - Peter Eickholz
- Department of Periodontology Center for Dentistry and Oral Medicine (Carolinum) Johann Wolfgang Goethe‐University Frankfurt/Main Frankfurt/Main Germany
| | - Peter Raetzke
- Department of Periodontology Center for Dentistry and Oral Medicine (Carolinum) Johann Wolfgang Goethe‐University Frankfurt/Main Frankfurt/Main Germany
| | - Katrin Nickles
- Department of Periodontology Center for Dentistry and Oral Medicine (Carolinum) Johann Wolfgang Goethe‐University Frankfurt/Main Frankfurt/Main Germany
- Private Practice Mannheim Germany
| | - Bettina Dannewitz
- Department of Periodontology Center for Dentistry and Oral Medicine (Carolinum) Johann Wolfgang Goethe‐University Frankfurt/Main Frankfurt/Main Germany
- Private Practice Weilburg Germany
| | | |
Collapse
|
|
48
|
Gursoy H, Yarimoglu E, Kuru B, Ozkan Karaca E, Ince Kuka G. Evaluation of the Effects of Er:YAG Laser for the De-Epithelialization of the Palatal Graft in the Treatment of Multiple Gingival Recessions: A Randomized Clinical Trial. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2019; 37:715-721. [DOI: 10.1089/photob.2019.4681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Hare Gursoy
- Department of Periodontology, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey
| | - Ece Yarimoglu
- Department of Periodontology, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey
| | - Bahar Kuru
- Department of Periodontology, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey
| | - Ebru Ozkan Karaca
- Department of Periodontology, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey
| | - Gizem Ince Kuka
- Department of Periodontology, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey
| |
Collapse
|
|
49
|
Kanmaz B, Kanmaz MG, Kaval B, Buduneli N. Root coverage with coronally advanced flap:6-year follow-up. Aust Dent J 2019; 64:346-352. [PMID: 31494957 DOI: 10.1111/adj.12718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2019] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to evaluate the long-term stability of root coverage without a regular control programme after coronally advanced flap (CAF) procedures in isolated gingival recessions. MATERIAL AND METHODS Recession defects were treated with CAF using microsurgery technique. Probing depth, clinical attachment level, keratinized gingival width, plaque index, papilla bleeding index, recession depth, recession width and root surface area was evaluated at baseline, and then postoperative 6-month and 6-year follow-up sessions. Percentages of root coverage and complete root coverage rates were also calculated. RESULTS In total, 12 defects in 12 patients of the 36 defects in 30 patients were available for analysis at the 6-year follow-up examination (66.7% of the initial sites could be reached). Percentage of mean root coverage was 95.06% at 6-month and 69.27% at 6-year and the difference was statistically significant (P < 0.05). Complete root coverage rate decreased from 75% (at 6-month) to 50% (at 6-year), but the difference was not statistically significant (P > 0.05). CONCLUSION Within the limits of this long-term follow-up study, there seems to be a rather high risk for relapse after root coverage with CAF possibly due to the lack of regular recalls and persistent traumatic tooth brushing habits.
Collapse
Affiliation(s)
- B Kanmaz
- Department of Periodontology, Faculty of Dentistry, İzmir Demokrasi University, Izmir, Turkey
| | - M G Kanmaz
- Private CTG Oral and Dental Health Center, İzmir, Turkey
| | - B Kaval
- Karşıyaka Oral and Dental Health Center, İzmir, Turkey
| | - N Buduneli
- Department of Periodontology, Faculty of Dentistry, Ege University, İzmir, Turkey
| |
Collapse
|
|
50
|
Nisha KJ, Choudhury SA, Guru S. Objective evaluation of healing and esthetic outcome of root coverage procedure using chorion membrane: a case series. Cell Tissue Bank 2019; 20:501-511. [PMID: 31446503 DOI: 10.1007/s10561-019-09783-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 08/19/2019] [Accepted: 08/21/2019] [Indexed: 11/25/2022]
Abstract
The ultimate goal of any periodontal plastic surgery aimed to treat gingival recession is predictable recession coverage and esthetic outcome. Due to the post-operative morbidity and discomfort related to subepithelial connective tissue graft, various other methods have been introduced including the use of fetal membranes. The fetal membranes have shown promising results in medicine and recently in the field of regenerative dentistry and could possibly become a viable alternative to autogenous grafts. This article reports a series of cases of Miller's class I gingival recession that were treated by chorion membrane combined with coronally advanced flap and evaluated using objective variables for post-operative healing and esthetics. Nine systemically healthy subjects with ten Miller's class I buccal gingival recession were included in the study. Clinical parameters were recorded at baseline, 3 months and 6 months post-surgery; wound healing index (WHI) was recorded one week post-surgery. At the end of 6 months, the percentage of root coverage and the root coverage esthetic score (RES) were calculated. The results showed statistically significant (p < 0.05) improvement in most of the parameters. The mean percentage of root coverage obtained was 62.20 ± 21.99% ranging from 33.3 to 100%. The WHI showed excellent healing score and RES assessed at the end of six months showed superior esthetic results. The chorion membrane along with coronally advanced flap is a predictable procedure for root coverage with better post surgical healing and superior esthetics.
Collapse
Affiliation(s)
- K J Nisha
- Department of Periodontics, Vydehi Institute of Dental Sciences and Research Centre, Whitefield, Bangalore, 560066, India.
| | - Suhail A Choudhury
- Department of Periodontics, Vydehi Institute of Dental Sciences and Research Centre, Whitefield, Bangalore, 560066, India
| | - Sanjeela Guru
- Department of Periodontics, Vydehi Institute of Dental Sciences and Research Centre, Whitefield, Bangalore, 560066, India
| |
Collapse
|