Apical Migration Research Articles

Root Coverage in Miller's Class 3 Gingival Recession using a Laterally Positioned Flap with Advanced PRF: A Two-year Follow-up Case Report

Introduction: Gingival recession, marked by the apical migration of gingival tissue, presents aesthetic and functional challenges. The laterally positioned flap (LPF) technique, often used for localized root coverage, remains effective, particularly when combined with advanced platelet-rich fibrin (A-PRF). Case Report: A 23-year-old male presented with Miller Class III gingival recession on tooth 41, with clinical attachment loss of 4.5 mm and high frenum attachment. A treatment plan involved the revised LPF technique, A-PRF membrane application, and frenectomy. Surgical Procedure: Following patient consent and scaling, a sulcular incision was made, and flaps were elevated. A-PRF was prepared and placed over the exposed root, with the flap secured by sutures. Post-operative Care: The patient received antibiotics and analgesics, with follow-up at 2 years showing a 4 mm gain in clinical attachment level and complete root coverage. Results: The combination of the LPF technique and A-PRF effectively managed Miller Class III gingival recession, restoring both function and aesthetics. Conclusion: This case underscores the efficacy of using A-PRF with the LPF technique for treating gingival recession, offering a reliable approach for restoring the keratinized gingival zone.

Nuclear deformability facilitates apical nuclear migration in the developing zebrafish retina.

Nuclear positioning is a crucial aspect of cell and developmental biology. One example is the apical movement of nuclei in neuroepithelia before mitosis, which is essential for proper tissue formation. While the cytoskeletal mechanisms that drive nuclei to the apical side have been explored, the influence of nuclear properties on apical nuclear migration is less understood. Nuclear properties, such as deformability, can be linked to lamin A/C expression levels, as shown in various invitro studies. Interestingly, many nuclei in early development, including neuroepithelial nuclei, express only low levels of lamin A/C. Therefore, we investigated whether increased lamin A expression in the densely packed zebrafish retinal neuroepithelium affects nuclear deformability and, consequently, migration phenomena. We found that overexpressing lamin A in retinal nuclei increases nuclear stiffness, which in turn indeed impairs apical nuclear migration. Interestingly, nuclei that do not overexpress lamin A but are embedded in a stiffer lamin A-overexpressing environment also exhibit impaired apical nuclear migration, indicating that these effects can be cell non-autonomous. Additionally, in the less crowded hindbrain neuroepithelium, only minor effects on apical nuclear migration are observed. Together, this suggests that the material properties of the nucleus influence nuclear movements in a tissue-dependent manner.

The Role of Nde1 phosphorylation in interkinetic nuclear migration and neural migration during cortical development.

Nde1 is a cytoplasmic dynein regulatory protein with important roles in vertebrate brain development. One noteworthy function is in the nuclear oscillatory behavior in neural progenitor cells, the control and mechanism of which remain poorly understood. Nde1 contains multiple phosphorylation sites for the cell cycle-dependent protein kinase CDK1, though the function of these sites is not well understood. To test their role in brain development, we expressed phosphorylation-state mutant forms of Nde1 in embryonic rat brains using in utero electroporation. We find that Nde1 T215 and T243 phosphomutants block apical interkinetic nuclear migration (INM) and, consequently, mitosis in radial glial progenitor cells. Another Nde1 phosphomutant at T246 also interfered with mitotic entry without affecting INM, suggesting a more direct role for Nde1 T246 in mitotic regulation. We also found that the Nde1 S214F mutation, which is associated with schizophrenia, inhibits Cdk5 phosphorylation at an adjacent residue which causes alterations in neuronal lamination. These results together identify important new roles for Nde1 phosphorylation in neocortical development and disease, and represent the first evidence for Nde1 phosphorylation roles in INM and neuronal lamination.

Lateral pedicle graft for the treatment of isolated tooth recession

ABSTRACT Gingival recession is defined as the apical migration of the gingival margin from its normal position leading to exposure of the root surface. It not only poses problems in maintaining good oral hygiene but also simultaneously hampers the esthetics. In the present case, the patient came up with a complaint of a denuded root surface due to apical migration of the gingival margin and also a complaint of sensitivity in the same. The case was diagnosed as chronic generalized gingivitis with localized periodontitis in relation to 31. Based on the clinical outcomes, the lateral pedicle graft (LPG) technique was performed. A complete coverage of the exposed root surface was achieved. This case report shows that a simple technique of root coverage like LPG can result in the successful coverage of the denuded root surface.

Experimental Model of Ligature-Induced Peri-Implantitis in Mice.

Dental implants have a high success and survival rate. However, complications such as peri-implantitis (PI) are highly challenging to treat. PI is characterized by inflammation in the tissues around dental implants with progressive loss of supporting bone. To optimize dental implants' longevity in terms of health and functionality, it is crucial to understand the peri-implantitis pathophysiology. In this regard, using mouse models in research has proven clear benefits in recreating clinical circumstances. This study aimed to describe an experimental model of ligature-induced peri-implantitis in mice and determine whether there is effectiveness in inducing this disease, given the observed bone and tissue changes. The experimental peri-implantitis induction comprehends the following steps: teeth extraction, implant placement, and ligature-inducted PI. A sample of eighteen 3-week-old C57BL/6J male mice was divided into two groups, ligature (N=9) and control non-ligature (N=9). The evaluation of clinical, radiographical, and histological factors was performed. The ligature group showed significantly higher bone loss, increased soft tissue edema, and apical epithelial migration than the non-ligature group. It was concluded that this pre-clinical model can successfully induce peri-implantitis in mice.

Passive Root Coverage Through Creeping Attachment of the Gingiva Before and After Scaling and Root Planning Therapy in the Mandibular Anterior Teeth: A Clinical Study.

Introduction Root coverage is one of the most imperative procedures in periodontal therapy. The demands from patients for aesthetics and sensitivity are some of the complaints in root exposure cases. Creeping attachment is a passive apical migration of the marginal gingiva and can be proposed as a noteworthy root coverage technique. The purpose of this study was to evaluate the position of the marginal gingiva and quantify the creeping attachment before and after the scaling and root planning (SRP) procedure. Materials and methods The present study was based on a single-centreclinical trial in which 30 sites from 10 patients were selected. Patients with Miller's class I gingival recession were selected. The plaque index, gingival biotype, and gingival margin position were measured at baseline and then at 10 and 21 days after SRP. The gingival biotype was measured with an endodontic file with a stopper and a digital vernier calliper. The gingival margin position was measured from the incisal surface of the tooth to the marginal gingiva with the help of a University of North Carolina (UNC) 15 periodontal probe. After recording the clinical parameters, a thorough SRP was performed using an ultrasonic scaler and manual instruments. Results The results were compared clinically at baseline and after 10 days and 21 days postoperatively. Statistical analysis was conducted for pre-SRP and post-SRP findings using the IBM SPSS Statistics for Windows, Version 19 (Released 2010; IBM Corp., Armonk, New York) software. A statistically significant improvement was seen in all the clinical parameters at baseline, at 10 days, andat 21 days postoperatively after the procedure (P < 0.01). Conclusion The position of the gingival margin was shifted towards the crown, and the creeping attachment was significantly observed from baseline to 10 and 21 days. Clinical significance Creeping attachment after the SRP procedure can be considered a significant root coverage technique. The genetic memory of the gingiva may playan important role in achieving root coverage. Once local irritants are removed, the gingiva attempts to regain its original position. In addition, the gingival phenotype plays an important role in gingival marginal positioning after basic therapy and root coverage procedures.

One-time definitive attachment connection versus healing abutment placement for an implant-retained mandibular overdenture: Peri-implant metabolic activity

Statement of problemUnscrewing the healing abutment can affect the soft tissue integration and apical migration of the biological width, which may compromise the integrity of peri-implant soft tissue. PurposeThe purpose of this clinical study was to determine the level of glycosaminoglycan (GAG) detected in the peri-implant crevicular fluid (PICF) between the test group (1-time abutment) and control group (healing abutment) for implant-retained mandibular overdentures. Material and methodsTwo dental implants were installed in the canine regions of the mandibular ridge of 18 healthy completely edentulous participants using 2-stage surgery and a delayed loading protocol. At the second stage surgery, the implant on the right side was exposed, and a healing abutment was screwed onto the implant (control group), while on the left side the definitive ball abutment was screwed onto the implant (test group). After 10 days, the healing abutment in the control group was unscrewed and replaced with the definitive ball abutment. For both groups, the ball attachment was directly picked up to incorporate the attachment house to the mandibular denture. PICF samples were collected from the participants at 7 days, 3 months, and 6 months after overdenture use. Statistical analysis was done with an independent samples t test (α=.05). ResultsA significant difference was found in the volume of PICF and the level of GAG between the test and control groups at the 7-day evaluation period (P=.008, P=.002, respectively), while the volumes of PICF and the levels of GAG were not significantly different (P>.05) at the other evaluation periods. ConclusionsThe 1-time abutment protocol offers biochemical and economic advantages compared with the conventional method of using the healing abutment before placement of the definitive attachment for an implant-retained overdenture with single attachments.

Stage III Grade A Mandibular Anterior Tooth Periodontitis Treatment

Chronic periodontitis is inflammation caused by periodontopathogenic microorganisms characterized by alveolar bone resorption, loss of attachment and apical migration of junctional epithelium. Non-surgical and surgical periodontitis treatments including curettage are performed to reduce inflammation and form new attachments before flap surgery. The purpose of this writing is to treat periodontitis before flap surgical treatment is carried out. Case report: Female, 39 years old, came to RSGM UMY with complaints of loose lower front teeth and gums that bleed easily when brushing her teeth. The patient had no history of systemic disease. Intra-oral examination at the first visit revealed that the gingiva of the mandibular anterior teeth was reddish, unstippling and loose texture grade 2, OHI 7.3 (poor), PD 8 mm, PI score 30%, CAL 8 mm, and 3 tooth loss due to periodontitis. X-ray results showed resorption of the alveolar bone horizontally in the apical 1/3. DHE treatment plan, scaling and root planning, occlusal adjustment, splinting, curettage, flap surgery. Results: Control 2 weeks after curettage, gingiva was coral pink and PD was reduced. Conclusion: Curettage treatment in periodontitis cases reduces the depth of periodontal pockets and there are changes in clinical attachment levels (CAL) in mandibular anterior teeth. Surgical flap treatment is required in this case after curettage

Gingival Recession Treatment With Utilization Of Free Gingival Autograft Technique: A Case Study

Background: Gingival recession is apical migration of marginal gingiva, causing exposure of the root surface of the tooth.To treat this condition, free gingival autograft is used to increase the keratinized gingiva in the deformed area. The aim of the case is to prove the efficacy of Free Gingival Autograft technique in increasing amount of keratinized gingiva in area affected by gingival recession. Case presentation: In this clinical case presentation, a systemically healthy 61‑years‑old female come to the Periodontics Department of Airlangga Dental and Mouth Hospital seeking treatment for her mandibular front teeth which appeared to be elongated clinically and aesthetically unpleasing. Case management: The patient was treated by free gingival autograft. Graft is harvested from the palatal, placed, and sutured on the recipient site. 1 month post treatment follow up showed good result, evident with increased amount of keratinized mucosa in the previously deformed area. Conclusion: Gingival recession is a complex condition which can be treated with free gingival autograft. This technique showed satisfactory result, evident with increase of keratinized gingiva at 1 month follow-up.

MODERN VIEW ON ISSUES OF DIAGNOSING GINGIVAL RECESSION

Background. Given that the exposure of the tooth root is not only an aesthetic concern but also leads to dental hypersensitivity, cervical caries, non-carious lesions, and even tooth loss, understanding the causes and characteristics of gum recession, along with its timely detection, is crucial and relevant. The aim of this study is to analyze and consolidate scientific research dedicated to the investigation of factors influencing the development of gum recession, its diagnosis, and the clinical features. This understanding is essential for addressing the challenge dealing with the treatment of this condition. A comprehensive review of scientific publications addressing the specified topics was conducted using library sources and search systems, including PubMed, Web of Science, OUCI (Open Ukrainian Citation Index), and Index Copernicus. The prevalence of gingival recession varies from 9.7% in adolescents to nearly 100% in adults. Most investigators identified a higher number of recession areas on both the upper and lower jaws around the central and lateral incisors, as well as the right first molar. However, conflicting findings exist, with some researchers suggesting that gum recession occurs most frequently in the premolars and canines area. Nevertheless, there is a unanimous agreement among researchers that this disease is polyetiological. Authors assess the significance of different factors provoking recession in varying ways. Moreover, under specific conditions, several factors may combine, with one of them dominating. Despite numerous classification attempts by specialists, efforts to propose a classification that accurately reflects the characteristic features of this pathology, the severity of manifestations, and the prognosis of its treatment are still remaining pressing issues. Thus, among the factors that provoke the development of apical migration of the gingival margin, the leading role is played by the thin biotype of the gums and the peculiarities of the anatomical and morphological structure of the periodontal tissues, inflammatory diseases in the oral cavity, incorrect implementation of hygienic and preventive measures, orthopedic and orthodontic devices that lead to mechanical injury. Despite the large number of existing classifications of gum recession, none of them can fully satisfy dentists, as they are not able to objectively determine all the clinical manifestations of the disease, establish a connection with its etiology, and predict the course.

CHANGES IN THE WIDTH OF THE PERIODONTAL GAP OF RATS WITH SUPRAOCCLUSAL RELATIONSHIPS OF INDIVIDUAL TEETH IN THE AGE ASPECT

Introduction. The dentoalveolar apparatus is a complex of complicated interaction of the jaws, masticatory muscles, teeth, and temporomandibular joints. This connection is carried out by the trigeminal nerve system with sensory and motor nuclei closely connected to the cortical and subcortical centers of the brain. Occlusal trauma is a lesion that develops in the periodontium as a result of forces that exceed the periodontal potential for functional adaptation. Occlusal trauma can be classified as primary or secondary. The first one occurs in the pulp and periodontal ligament when the force of the action on the dental structures is greater than usual, under optimal periodontal support conditions. It includes orthodontic movements, "high" restorations, and parafunctional habits such as bruxism. Secondary occlusal trauma occurs when the teeth with previous supporting tissue changes are subjected to the action of normal and excessive forces with supporting tissue changes caused by periodontal disease or previous trauma. The available evidence has demonstrated that bacterial plaque bioactive substances lead to local inflammatory responses in periodontal tissues which contribute to bone tissue resorption through osteoclasts in periodontitis. Excessive functional stress can initiate inflammatory changes in the periodontium and thus, increase destructive bacterial processes. Traumatic occlusion can expand the space of the periodontal ligament and in this way stimulate apical bacterial migration and proliferation. However, few attempts have been made to investigate the molecular mechanisms that trigger bone tissue resorption in traumatic occlusion. The analysis of publications on the studies of morphological changes in periodontal tissues in individual teeth supraocclusion in the age aspect shows the contradictory data. The aim: to determine the morphometric changes of the periodontal gap as a component of the periodontal complex in rats of different age groups in the supraocclusal relationship of individual teeth in the age aspect. Materials and methods of the study. The scientific experiment was conducted on 60 white laboratory rats aged 4 to 22 months and weighing 90 to 330 g. The rats were divided into control (30 animals) and experimental (30 animals) groups. Each group was divided into 3 subgroups (10 animals each) depending on the age of the rats: young, mature and senile. Young animals included rats aged 3–4 months with a weight of 90–100 g; mature animals - aged 6–8 months with a weight of 150–170 g; senile rats – 20–22 months and weighing 200–220 g. The method of modelling the state of supraocclusal relations of individual teeth is described in the previous publication. For histological examination of dental blocks, the following was performed. Fixation in a 10% solution of neutral formalin for two days, dehydration in alcohols of increasing concentration and embedding in paraffin. After preparation, sections were made on a Shandon Finesse 325 rotary microtome with a section thickness of 4-6 µm. The histological sections were fixed on pre-degreased slides and dried. Van Gieson staining was performed. The width of the periodontal gap was determined using the ZEISS ZEN 3.7 program by Carl Zeiss Microscopy. For statistical data processing, the AtteStat v.12.5 software was used to determine the mean value and its standard error (M±m). The probability of a statistically significant difference between the data obtained was assessed using the Student's parametric test (at a significance level of p ≤ 0.05). All samples were tested for normality using the Gupta test. Results of the study. Statistical differences were observed in rats of all groups, as well as between the indicators of all rats of the control and experimental groups (≤0.05). The width of the periodontal gap increased by 34.1% in young rats, by 25.5% in mature rats, and by 21.1% in senile rats. Conclusions The presence of supraocclusal relationships of individual teeth causes an increase in the periodontal gap in rats of all age groups. The greatest expansion of the periodontal gap has occurred in young rats. The width of the periodontal gap in rats decreases with age.

Etiology of gingival recession - a literature review.

Gum recession is a common problem that in most cases does not cause any bothersome symptoms to the patient. They can affect people of any age and are most often diagnosed on the vestibular surfaces of the teeth. They are manifested by the exposure of part of the root through the apical migration of the gingival margin. Its etiology is not fully understood, but it is known that it consists of many factors. The authors discussed such factors as inflammation, gum biotype, patient's age, mechanical and chemical damage, smoking, presence of tartar, cervical defects and their reconstruction, orthodontic treatment, occlusal overload and iatrogenic factors. Additionally, important risk factors also include genetic predispositions and abnormalities in the immune system. In addition, certain hygiene habits, such as improper brushing techniques or lack of regular check-ups at the dentist, may also contribute to the development of gum recession. Understanding the comprehensive nature of these factors is crucial to the effective treatment and prevention of this common condition. It is also worth taking into account the importance of educating patients on proper oral hygiene and regular dental check-ups to prevent gum recession.

Clinical substantiation of the platelet-rich plasma effectiveness in complex surgical treatment of gingival recession

Gingival recession is a non-inflammatory pathological process characterized by apical migration of the marginal gingiva below the CEJ. The use of platelet-rich plasma is one of the current technologies in the complex treatment of gingival recession. The aim of the study was to increase the effectiveness of surgical treatment of gingival recession using platelet plasma. As a result of the treatment of gingival recession I, II and III Millers classes, the coverage area of the recipient surface was 84%, 77% and 60%, accordingly; the thickness of the keratinized gingiva increased by an average of 2 times. The use of platelet plasma in the complex treatment of gingival recession optimizes the healing period in the regeneration phase, improves the microcirculation of periodontal tissues and reduces the duration of treatment by an average of three days; shows more efficiency due to less physiological shrinkage of the graft over time.

ENHANCEMENT OF SOFT TISSUE SURROUNDING DENTAL IMPLANTS – AN OVERVIEW OF LITERATURE

Dental implants have traditionally been focused on bone quality and quantity to house the dental implant for successful restoration of the edentulous ridge. Rough surface implants provide predictable osseointegration but results in the development of peri-implantitis when exposed to the oral environment. The peri-implant mucosa provides protection to the underlying bone via its immune response and protection from apical biofilm migration. An adequate band of keratinized mucosa also improves comfort with performing oral hygiene, limit early marginal bone loss and improved aesthetic outcomes around implant prostheses. The purpose of this article is to provide a literature review on the importance of attached keratinized mucosa around dental implants. It also shares simple strategies to improve the peri-implant mucosa before, during and after implant placement

Evaluation of the biological effects of amelogenin on human oral keratinocytes.

Amelogenins are clinically used in periodontal regeneration as main components of root surface modifying agents, even without specifically preventing the premature colonization of the healing tissue defect by means of a physical barrier membrane. The objective of this study was to investigate the effects of human amelogenin on the proliferation, migration, and morphology of Immortalized Human Oral Keratinocytes (iHOKs). Immortalized Human Oral Keratinocytes were expanded in Keratinocyte Growth Medium-2 (KGM-2). Full-length recombinant amelogenin protein was diluted in KGM-2 in five concentrations (10ng/ml, 100ng/ml, 1.000ng/ml, 5.000ng/ml and 10.000ng/ml). iHOKs were cultured in medium supplemented with the amelogenin dilutions. Samples without amelogenin served as control. Cell metabolism and cell proliferation together with cell migration were evaluated at day 7, 14, 21. At day 7, iHOKs treated with 10,000ng/ml showed a significant decrease in keratinocytes´ proliferation. The metabolic activity at this timepoint was significantly lower for concentrations ≥1000ng/ml. At days 14 and 21, both the addition of 5000ng/ml and even more 10,000ng/ml amelogenin reduced significantly the proliferation of keratinocytes. The effects on the metabolic activity for these timepoints were visible already with 100ng/ml. Treatment of iHOKs with amelogenin of ≥1000ng/ml led to inhibitory effects on cell migration already after 24h. The full-length recombinant amelogenin has a significant biological impact on iHOKs. The increasing dose dependent inhibitory effects of amelogenin shown on iHOKs might explain the disruption of the apical migration of the junctional epithelium during regenerative healing. Amelogenin, presents time- and dose-dependent inhibitory effects on the growth of keratinocytes, which might explain the biological rationale behind its application in periodontal regeneration.

Influences of standardized clinical probing on peri-implant soft tissue seal in a situation of peri-implant mucositis: A histomorphometric study in dogs.

Clinical probing is commonly recommended to evaluate peri-implant conditions. In a situation of peri-implant mucositis or peri-implantitis, the peri-implant seal healing from the disruption of soft tissue caused by probing has not yet been studied. This study aimed to investigate soft tissue healing after standardized clinical probing around osseointegrated implants with peri-implant mucositis in a dog model. Three transmucosal implants in each hemi-mandible of six dogs randomly assigned to the peri-implant healthy group or peri-implant mucositis group were probed randomly in the mesial or distal site as probing groups (PH or PM), the cross-sectional opposite sites as unprobed control groups. Histomorphometric measurements of implant shoulder (IS)-most coronal level of alveolar bone contact to the implant surface (BCI), apical termination of the junctional epithelium (aJE)-BCI, mucosal margin (MM)-BCI, and MM-aJE were performed at 1day, 1week, and 2weeks after probing. Apoptosis, proliferation, proinflammatory cytokines, and matrix metalloproteinases (MMPs) of peri-implant soft tissue were estimated by immunofluorescent analysis. In the PM group, apical migration of junctional epithelium was revealed by significantly decreased aJE-BCI from 1day to 2weeks in comparison to unprobed sites (p<0.05), while no significant differences were found in the PH group. Immunofluorescent analysis showed higher levels of interleukin-1β (IL-1β), IL-6, tumor necrosis factor-α (TNF-α), MMP-1, and MMP-8, together with exaggerated apoptosis and proliferation of peri-implant soft tissue in the PM group. Within the limitations, standardized clinical probing might lead to apical migration of the junctional epithelium in a situation of peri-implant mucositis.

Group 1 ITI Consensus Report: The role of bone dimensions and soft tissue augmentation procedures on the stability of clinical, radiographic, and patient-reported outcomes of implant treatment.

The aims of Working Group 1 were to address the role (i) of the buccolingual bone dimensions after implant placement in healed alveolar ridge sites on the occurrence of biologic and aesthetic complications, and (ii) of soft tissue augmentation (STA) on the stability of clinical, radiographic, and patient-related outcomes of implant treatments. Two systematic reviews were prepared in advance of the Consensus Conference and were discussed among the participants of Group 1. Consensus statements, clinical recommendations, recommendations for future research, and reflections on patient perspectives were based on structured group discussions until consensus was reached among the entire group of experts. The statements were then presented and accepted following further discussion and modifications as required by the plenary. Dimensional changes of the alveolar ridge occurred after implant placement in healed sites, and a reduction in buccal bone wall thickness (BBW) of 0.3 to 1.8 mm was observed. In healed sites with a BBW of <1.5 mm after implant placement, increased vertical bone loss, and less favorable clinical and radiographic outcomes were demonstrated. Implants with buccal dehiscence defects undergoing simultaneous guided bone regeneration, showed less vertical bone loss, and more favorable clinical and radiographic outcomes, compared to non-augmented dehiscence defects during initial healing. At healthy single implant sites, probing depths, bleeding and plaque scores, and interproximal bone levels evaluated at 1 year, remained stable for up to 5 years, with or without STA. When single implant sites were augmented with connective tissue grafts, either for soft tissue phenotype modification or buccal soft tissue dehiscence, stable levels of the soft tissue margin, and stable or even increased soft tissue thickness and/or width of keratinized mucosa could be observed from 1 to 5 years. In contrast, non-augmented sites were more prone to show apical migration of the soft tissue margin in the long-term. Favorable aesthetic and patient-reported outcomes after STA were documented to be stable from 1 to 5 years. It is concluded that dimensional changes of the alveolar ridge occur after implant placement in healed sites and that sites with a thin BBW after implant placement are prone to exhibit less favorable clinical and radiographic outcomes. In addition, it is concluded that STA can provide stable clinical, radiographic, aesthetic, and patient-reported outcomes in the medium and long-term.

Evaluation of Root Coverage Procedures Using Root Coverage Esthetic Score System – A Case Series

ABSTRACT Background: Gingival recession, characterized by root surface exposure due to apical gingival margin migration, is a prevalent condition in the general populace, frequently prompting patient intervention. Mucogingival therapy may be indicated for recession control, plaque management, and dentin hypersensitivity; nevertheless, the consideration of esthetics correction as a therapeutic rationale is increasingly significant in contemporary clinical practice. Objective: The goal of this case series was to evaluate the most esthetic root coverage procedure of the three procedures performed. Methods: Patients with localized recession were treated with three different root coverage procedures, namely the free gingival graft (FGG), connective tissue graft + coronally repositioned flap (CTG + CAF), and platelet-rich fibrin (PRF) + coronally positioned flap. The root coverage procedures were assessed for the root coverage esthetic score (RES) system after 6 months. The RES scores of these procedures were compared to determine if one procedure offered a greater esthetic result over the other. Results: All three procedures were effective in obtaining root coverage and improved clinical parameters. However, CTG with CAF, along with complete root coverage (CRC), produced a better esthetic outcome than other root coverage procedures compared in this case series. The success of root coverage procedures is based on the overall esthetic outcome along with CRC. Thus through the incorporation of the RES into everyday clinical practice, clinicians can enhance the accuracy and consistency of their evaluations, leading to improved patient care and optimizing treatment planning.

Comparison of Amnion Membrane and Hyaluronic Acid in Gingival Recession Coverage and Gain in Clinical Attachment Level following Coronally Advanced Flap Procedure-A Clinical Study.

Gingival recession is defined as the apical migration of gingival margin to the cementoenamel junction. Recently, amnion membrane, the third-generation membrane which is a placental-derived tissue, has been introduced. Study included 45 subjects with age group of 20-60 years of both genders. Patients with Miller's Class I and Class II gingival recession were selected for the study. The progress was assessed at baseline one, three, and six months observation interval through clinical parameters RD, RW, PD, and CAL at the end of six months. Recession depths in the first, third, and sixth month were 1.82 ± 0.442, 1.31 ± 0.47 mm, and 0.91 ± 0.29, respectively, which showed a significant reduction from the baseline. Recession widths in the first, second, and third weeks were 3.04 ± 0.442 mm, 1.31 ± 0.47 mm, and 1.49 ± 0.59 mm, respectively. There was a statistically significant reduction (P > 0.005) when compared to the baseline. Pocket depths in the first, third, and sixth month were 0.93 ± 0.447, 0.42 ± 0.50, and 0.24 ± 0.43 (P > 0.005) which is significant when compared to baseline. Clinical attachment levels in the first, third, and sixth month were 2.73 ± 0.751, 1.78 ± 0.70, and 1.18 ± 0.53 (P > 0.005) which is significant compared to six months. Within the limitations of the present study, the data obtained by periodic assessment of the clinical parameters indicate the use of amnion membrane and hyaluronic acid, and proper technique may thus be the panacea for root coverage procedure.

Improving dental epithelial junction on dental implants with bioengineered peptides.

Introduction: The functionalization of titanium (Ti) and titanium alloys (Ti6Al4V) implant surfaces via material-specific peptides influence host/biomaterial interaction. The impact of using peptides as molecular linkers between cells and implant material to improve keratinocyte adhesion is reported. Results: The metal binding peptides (MBP-1, MBP-2) SVSVGMKPSPRP and WDPPTLKRPVSP were selected via phage display and combined with laminin-5 or E-cadherin epithelial cell specific peptides (CSP-1, CSP-2) to engineer four metal-cell specific peptides (MCSPs). Single-cell force spectroscopy and cell adhesion experiments were performed to select the most promising candidate. In vivo tests using the dental implant for rats showed that the selected bi functional peptide not only enabled stable cell adhesion on the trans-gingival part of the dental implant but also arrested the unwanted apical migration of epithelial cells. Conclusion: The results demonstrated the outstanding performance of the bioengineered peptide in improving epithelial adhesion to Ti based implants and pointed towards promising new opportunities for applications in clinical practice.