Apical Shift Research Articles

Comparative Evaluation of Vestibular Incision Subperiosteal Tunnel Access (VISTA) Technique With and Without Advanced Platelet Rich Fibrin for Treatment of Maxillary Anterior Gingival Recessions.

Gingival recession is an apical shift of the gingival margin with exposure of the root surface to the oral cavity which creates an aesthetic problem. The present study was attempted to compare Vestibular incision subperiosteal tunnel access (VISTA) with and without Advanced platelet rich fibrin(A-PRF) in the treatment of Miller's class I gingival recessions. 24 patients were assigned randomly either to test (VISTA with A-PRF) or control (VISTA alone) group. Clinical parameters like recession depth (RD), recession width (RW), clinical attachment loss (CAL), width of keratinized gingiva (WKG), gingival thickness (GT) and probing depth (PD) were recorded at baseline,3 and 6 months post operatively. Inter group comparison of mean RC in mm, %RC, ΔWKG and CAG revealed no statistically significant difference (p>0.05). Change in GT showed statistically significant improvement in test group. Within the limitations of this study, both treatment options (VISTA with A-PRF and VISTA alone) have resulted in predictable and comparable root coverage with increased gingival thickness in the test group.

Multiple coronally advanced flap with a selective use of connective tissue graft: A 3-year prospective clinical and histological study.

The purpose of the present study was to prospectively evaluate the 3-year changes in the gingival dimensions following multiple coronally advanced flap (MCAF) with selective use of connective tissue graft (CTG). In addition, the secondary aim was to histologically identify the factors related to phenotype changes. Twenty patients treated with MCAF and site-specific application of a CTG were available for the 3-year follow-up. Outcome measures included complete root coverage (CRC), recession reduction, keratinized tissue width (KTW), marginal tissue thickness changes, and primary flap position. Biopsies were harvested at one of the sites treated with the adjunct of CTG. All sections were stained with hematoxylin and eosin, Masson trichrome, Verhoeff-van Gieson, tenascin, and alcian blue stain for semiquantitative evaluation. At 3 years, CRC was detected in 86% of sites treated with MCAF alone and 81% of sites treated with MCAF+CTG. The 47% of sites treated with MCAF+CTG presented an apical shift of primary flap from its original position. Linear regression showed a significant association between KTW change and the initial KTW in MCAF-treated sites, while both initial KTW and position of primary flap were statistically significantly associated factors with KTW changes in the MCAF+CTG group. In all the biopsies examined, there is always a marked and clear separation between the connective tissue of the gingival flap and the palatal connective tissue of the graft. The selective use of CTG is an effective treatment for multiple gingival recessions. Only a limited increase in KTW can be expected in a bilaminar technique if, during the healing phases, the connective tissue is maintained completely covered.

Formation and stability of mucogingival junction on teeth without clinically detectable mucogingival junction secondary to vestibular extension procedure done for multiple adjacent teeth: A clinical study.

There are very limited data on the postsurgical formation of a mucogingival junction (MGJ) on teeth without its clinical detectability. The purpose of this study was to assess the formation and stability of MGJ on teeth without clinically detectable MGJ secondary to vestibular extension procedures for multiple adjacent teeth evaluated 6 months postoperatively. This prospective interventional single-arm clinical study was conducted in the department of Periodontology, which was approved by the institutional ethical committee, MUHS, Nashik, and registered with the Clinical Trial Registry of India. This trial included 22 participants aged between 18 and 50 years of either gender, including teeth without clinically detectable MGJ along with adjacent teeth having detectable MGJs. The following clinical parameters were taken at baseline, presurgical, immediate postsurgical, 1-month and 6-month follow-ups: plaque index, gingival index, and position of MGJ. gingival margin level, probing depth, width of keratinized gingiva, width of attached gingiva, clinical attachment level, and vestibular depth. Descriptive statistics included mean, median, mode, etc., and the inferential statistics done were analysis of variance along with post hoc Tukey and independent sample tests. Apical shift of MGJ was observed from baseline to 6 months secondary to split-full-split repositioning MGJ with vestibular extension procedure, which was statistically significant (P < 0.05). The formation of MGJ was delineated by clinical and biochemical methods at sites with nondetectable MGJ. The coronal migration of MGJ at 6 months as compared to 1 month was not statistically significant (P > 0.05). The MGJ remained stable at 6 months postoperatively at detectable and nondetectable sites. Within the limitations of this study, we can conclude that there is a definite formation of MGJ in participants without clinically detectable MGJ treated with "split-full-split MGJ-repositioning vestibular extension procedure." The MGJ, which formed apically at a 1-month postsurgical visit compared to the presurgical position, remained stable for 6 months to 1-year follow-up period at both detectable and nondetectable sites.

Surgical Approach for Facial Peri-implant Soft Tissue Deficiency in the Esthetic Area

Peri-implant soft tissue dehiscence/deficiency (PSTD) is an apical shift in the peri-implant facial soft tissue margin, including mid-facial recession, mucosal recession or dehiscence, soft-tissue dehiscence/deficiency, or a soft-tissue defect. PSTD of maxillary anterior implants can be resolved with soft tissue grafting to improve esthetics of the implant-supported crown and health of peri-implant tissue. Here, we report two cases of efficiently managed PSTD using different surgical procedures in the esthetic area. The soft tissue augmentation technique, including subepithelial connective tissue grafting with a coronally advanced flap and free gingival graft, could achieve healthy peri-implant tissue and esthetics of the implant-supported crown through coverage of PSTD. Clinicians should prevent PSTD by fully considering the factors that increase the risk of PSTD before implant placement.

Effects of fixed retainers on gingival recession – a 10-year retrospective study

Objective The aetiology of gingival recessions is not fully understood, and no evidence has yet emerged of a single predisposing factor that instigates this apical shift of the gingival margin. Nonetheless, both fixed retainers and orthodontic treatment have been cited as potential risk factors. The aim of this study was to assess the effects of orthodontic treatment and orthodontic fixed retainers on gingival recessions. Subjects and methods In total, 105 patients at the Department of Orthodontics at the University of Gothenburg who had undergone orthodontic treatment between 1995 − 2003 were included in this study. Intraoral photographs of the anterior segment and study casts acquired at baseline (pre-treatment), post-treatment and at the 10-year follow-up were used as recorded measurements of gingival recession and orthodontic treatment. At the 10-year follow-up, the patients were divided into two groups based on: long-term (10 years) presence of a fixed retainer [orthodontic treatment and retainer (OR) group; N = 76]; and short-term (<5 years) presence of a fixed retainer [orthodontic treatment (O) group; N = 57]. These groups were compared to a control group (C) of untreated subjects (N = 29). Results In the anterior segment, gingival recessions were not present at baseline and post-treatment between the two orthodontically treated groups. At the 10-year follow-up, there was no statistically significant difference between the two orthodontically treated groups and the controls. Conclusions Orthodontic treatment per se does not increase the risk for gingival recessions, nor does the use of fixed retainers following orthodontic treatment.

An expansion to the Nägerl’s theory of proportionality in reduced alveolar bone height models: a 3D finite element analysis

IntroductionOrthodontic tooth movement is a basic theme in an orthodontic treatment. According to Nägerl, A nearer force application to the center of resistance will bring a farther center of rotation to the center of resistance. The main goal of this study was to evaluate this theory of proportionality by Finite element method (FEM) and find out its applicability in a bone loss situation.Materials and methodsThree 3D FEM of an upper central incisor were designed in Solidworks 2016, the first one with a healthy bone height (model 1), with 3 mm of bone loss (model 2) and with 4.5 mm of bone loss (model 3). An 0.5 N force was applied in different predefined locations on the labial surface of the crown in model 2. This was 0.2 N for the model 3. The exact location of the center of resistance (Cres), center of rotation (Crot) for each force application point was calculated using a C++ code specially design for this study in all models.ResultsAn apical shift of the Cres positions were shown in gradual steps of bone loss from 7.9708 mm incisal from the apex to 6.6292 mm in model 2 and 5.6105 mm in model 3. Modification of the location of the Crot in different force magnitudes and points of force applications were shown whit a constant a*b.ConclusionIn healthy teeth and teeth with alveolar bone loss, Cres located in the apical third of the root. The product of the distance between the point of force application and Cres (“a”) and the Cres and Crot (“b”) is constant, thus; Nägerl theory is applicable in both healthy and reduced bone height. In this way, applying a single force nearer to the cervical point will result in a more apical location of the Crot, reducing the angle change in the long axis of the tooth.

Combined Effect of Platelet-Rich Fibrin Matrix (PRFM) and Demineralized Freeze-Dried Bone Allograft (DFDBA) in Immediate Implant Placement: A Single-Arm Clinical Trial

Introduction Placement of immediate implants in contrast to delayed implant placement may be favorable. The factors contributing to this are shortened overall treatment time, aid in ideal orientation andfixture placement, bone preservation following extraction, and achieving optimal aesthetics involving soft tissue. However,the gap distance between the surface of the implant and the buccal bony wall during implant placement is critical for subsequent bone healing in a fresh extraction socket. Considering that as the gap broadens, the amount of bone-to-implant contact (BIC) decreases, causing an apical shift of the highest bone-implant contact. Incorporating a bone substitute material (BSM) within the fixture-socket gap preserves alveolar ridge volume by minimizing socket remodeling and encouraging de-novo bone formation. Aim and objectives To evaluate the efficacy of platelet-rich fibrin matrix (PRFM) and demineralized freeze-dried bone allograft (DFDBA) in fresh extraction socket with simultaneous implant placement. Methods Implants were immediately placed in 12 patients following a two-stage submerged protocol. The combination of PRFM and DFDBA was used to fill the gap between the implant body and the surrounding socket wall. The final restoration was placed after 3 months following implant placement. The full mouth plaque, gingival bleeding index, and gingival esthetics scores were assessed at baseline, 3, and 6 months. The crestal changes were evaluated using intraoral periapical radiographs (IOPA) at baseline, 3, and 6 months. Cone beam computed tomography (CBCT) images were obtained at baseline and 6 months after implant loading to analyze the buccolingual changes. Results At 6 months follow-up, the coronal bone remodeling detected on CBCT revealed a minimal (0.1 mm) narrowing of the alveolar ridge in a buccolingual direction, with a mean bone loss of 0.10+0.09, which was statistically non-significant (p > 0.05). Implant success was 100% at 6 months after loading as determined by Akbrektsson's criteria for implant success. Conclusions The adjunctive use of PRFM with DFDBA following immediate implant placement yielded a significant reduction in bone resorption and maintenance of buccolingual dimensions.

Clinical implications of a diagnosis of taurodontism: A literature review.

Taurodontism is a morphological anomaly involving multirooted teeth that is characterized by a vertical shift of the pulp chamber and shortening of the roots. The literature was analyzed to determine the impact of a diagnosis of taurodontism on dental treatment. A total of 85 full-text publications from the years 2005-2021 were analyzed and 20 publications were included in this research. The endodontic treatment of a taurodont tooth is challenging due to the apical displacement of the pulpal chamber floor and the incorrect configuration of the root canal system, or the presence of additional canals. In terms of prosthetics, the use of taurodont teeth as abutments is not recommended as they lack stability due to shorter roots. The extraction of taurodont teeth can be complicated due to an apical shift of the root furcation. In periodontology, taurodont teeth can have a better prognosis as there is less chance of furcation involvement. From an orthodontic point of view, it is important to note that taurodont teeth are not sufficiently embedded in the alveolus and have a greater tendency for root resorption. With regard to genetic diseases, it has been reported that this anomaly can exist as an isolated feature. However, the majority of authors agree that taurodontism is associated with conditions such as Down syndrome, Klinefelter syndrome, cleft lip and palate, hypodontia, amelogenesis imperfecta, and others. From a clinical standpoint, it is very important to diagnose taurodontism before treatment. A diagnosis of taurodontism can be important in the early diagnosis of malformations that commonly occur with this condition.

Periodontal Therapy With Intracoronal Fiber Splint in Case of Tooth Mobility With Crowded Anterior in Adolescents: A Case Report

Background: Plaque is a significant factor that leads to periodontal disease. One of the most common areas for plaque accumulation is the lower anterior region. Crowding acts as a predisposing factor for plaque accumulation and if not treated eventually leads to periodontal disease. Periodontal disease progression may lead to pathological tooth mobility which can result from acute periodontal inflammation, traumatic occlusion and an apical shift of the rotational center of the tooth as it occurs in advanced alveolar bone loss, and the increased mobility can cause inconveniences for the patient. The new classification of periodontal disease states that teeth with progressive mobility may require splinting therapy to improve patient comfort and additional improvement for the Oral Health-related Quality of Life.&#x0D; Objective: To describe the correction of tooth mobility with intracoronal fiber splint to improve function and comfort.&#x0D; Case Report: A 26-year-old male patient with crowded anterior presented to the Periodontics Department of the Dental and Oral Hospital of Gadjah Mada University (RSGM UGM) with the main complaints of lower front teeth mobility and frequently bleeding of gums, especially when brushing the teeth. The treatment plans of periodontal therapy begins with the initial phase, followed by the correction and the maintenance phases. In the initial phase, DHE, SRP, desensitization, occlusion adjustment and intracoronal fiber splint were carried out to eliminate inflammation and stabilize the mobility of the teeth.&#x0D; Conclusion: The splint is a periodontal therapy done through the redistribution of forces on the affected teeth, the splint minimizes the impact of the loss of support. The loss of support structures of the teeth leads to the mobility of the teeth. Increased mobility of the teeth affects the function, aesthetics and comfort of the patient. Splints are used to overcome all these&#x0D; Keywords: periodontal therapy, intracoronal fiber splint, mobility

Prestin derived OHC surface area reduction underlies age‐related rescaling of frequency place coding

Outer hair cells (OHC) are key to the mammalian cochlear amplifier, powered by the lateral membrane protein Prestin. In this study, we explored age-related OHC changes and how the changes affected hearing in mouse. OHC nonlinear membrane capacitance measurements revealed that, starting upon completion of postnatal auditory development, a continuous reduction of total Prestin in OHCs accompanied by a significant reduction in their cell surface area. Prestin's density is unaffected by Prestin level drop over the whole age range tested, suggesting that the OHC size reduction is Prestin-dependent. Stereocilia length in aged OHCs remained unchanged but the first row stereocilia on the aged inner hair cells (IHCs) were elongated. Distortion product otoacoustic emission (DPOAE) group delays became longer with aging, suggesting an apical shift in vibration on basilar membrane. Acoustic lesion experiments revealed an apical shift in damage place in old cochleae accompanied by a shallower progression in synaptic damage over a wider frequency range that was indicative of a broader frequency filter. Overall, these findings suggest that in aging cochlea, a shift in frequency place coding could occur due to the changes in cochlear active and passive mechanics.This article is part of the Special Issue Outer hair cell Edited by Joseph Santos-Sacchi and Kumar Navaratnam.

Survival rates of ultra-short (

BackgroundShort and ultra‐short implants represent a predictable treatment, in terms of implant survival, with patients presenting insufficient available bone volumes. Moreover, single crown restorations represent a gold standard in terms of oral hygiene.PurposeThe aim of this retrospective study was to evaluate implant survival, marginal bone loss, and peri‐implant complications in 333 locking‐taper short and ultra‐short implants.Materials and MethodsImplants were placed in the maxillary and mandibular posterior regions of 142 patients. Clinical and radiographic examinations were performed at 5‐year recall appointments.ResultsAll implants placed consisted of 8.0‐, 6.0‐, and 5.0‐mm length, 38.14%, 34.53%, and 27.33%, respectively. Three hundred thirty‐two implants (one early failure) were rehabilitated with single crowns in 141 patients. In 45.48% of the implants the crown‐to‐implant ratio was ≥2, with a mean value of 1.94. Overall implant‐based survival after 5 years of follow‐up was 96.10%: 96.85%, 95.65%, and 95.60% for 8.0‐, 6.0‐, and 5.0‐mm length implants, respectively (p = 0.82). Overall patient‐based survival was 91.55%. Regarding crestal bone level variations, average crestal bone loss and apical shift of the “first bone‐to‐implant contact point” position were 0.69 and 0.01 mm, respectively. Setting the threshold for excessive bone loss at 1 mm, during the time interval from loading to follow‐up, 28 implants experienced loss of supporting bone greater than 1 mm: 19 of them (67.85%) were surgically treated with a codified surgical regenerative protocol. After 60 months, a peri‐implantitis prevalence of 5.94% was reported, with an overall implant success of 94.06%: 95.93%, 92.73%, and 93.10% for 8.0‐, 6.0‐, and 5.0‐mm length implants, respectively (p = 0.55).ConclusionLong‐term outcomes suggest that short and ultra‐short locking‐taper implants can be successfully restored with single crowns in the posterior area of the maxilla and mandible.

Short- and Long-Term Outcomes of Treatment of Multiple Lingual Recessions Using the Bilaminar Subperiosteal Tunnel Technique.

Treatment of gingival recession defects on the lingual surface of mandibular anterior teeth is a challenge for the periodontist because of the region's unique anatomical features. Although there are no esthetic issues, lingual recessions should be considered seriously, especially on mandibular incisors, because they are frequently associated with periodontitis and dental hypersensitivity. The treatments and the long-term outcomes (5 years) of three clinical cases of multiple lingual recessions are presented. The tunnel technique associated with subepithelial connective tissue graft was chosen. The postoperative period was almost uneventful in all treated cases, and the 1-year outcomes were successful. Great recession reduction, up to complete root coverage, was seen, as were significant increases of both the apicocoronal amount and thickness of keratinized tissue. At the 5-year follow-up, the tissues were stable; only a slight apical shift of the gingival margin was noted in one case. The modification of the periodontal phenotype following the tunnel technique with the subepithelial connective tissue graft allowed the patients to maintain good plaque control.

Indication and Timing of Mucogingival Soft Tissue Augmentation Associated with Orthodontic Treatment

Gingiva recession is defined as an apical shift of the gingival margin caused by different conditions/pathologies. It is associated with clinical attachment loss. Several studies showed prevalence of gingiva recession in orthodontic patients. Some predisposing factors should be taken carefully considering the effect of the treatment modality. No consensus agreement was identified about the timing of the soft tissue augmentation intervention for orthodontic patients with the risk of gingival recession. However, several critical factors can guide the decision making to obtain the most preferred treatment option.

Gingival Phenotype Modification as a Result of Root Coverage Procedure with Two Human Dermal Matrices: Long-Term Assessment of a Randomized Clinical Trial.

The gingival thickness (GT) and keratinized tissue width (KTW) constitute the gingival phenotype, a concept that has received a great deal of appreciation in recent years. Gingival phenotype modification has been achieved via different surgical techniques and grafting materials. Despite the superiority of autogenous grafts, their increased patient morbidity and limited recourse has led to the development of graft substitutes. The human dermal matrix is a notable example that, depending on its processing method, can become freeze-dried or solvent-dehydrated acellular dermal matrix (FDADM and SDADM, respectively). This article reports the 9-year outcomes of a randomized clinical trial regarding gingival phenotype modification following root coverage with FDADM and SDADM. Twelve of the original 20 patients were available at the 9-year follow-up. Overall, the outcomes of gingival phenotype modification were maintained in both groups and at all sites after 9 years. For KTW, an incremental increase was observed over time in both groups, and minimal or no changes were noted in GT from the 1-year recall to the 9-year recall. However, the gingival margin level showed an apical shift for both groups.

Bracing for infantile scoliosis: no sedation needed.

Mehta casting technique applied under anesthesia is standard treatment for infantile scoliosis (IIS). However, concern has been raised about frequent anesthesia in children less than three years. The development of a customized thoracolumbar sacral orthosis (TLSO) could avoid the risks of Mehta casting. To develop a bracing technique for IIS that achieves patient compliance and scoliosis correction. Nine patients with ISS were offered a custom TLSO as an alternative to Mehta casting. One patient declined due to an insurance issue. No anesthesia was required for measurement or fitting of the TLSO. A temperature sensitive monitor recorded wear time. Brace success was determined by radiographic correction and adherence to prescription of greater than 18 hours per day. Eight patients had brace treatment with mean(range): age 19(12-44) months, curve magnitude 34°(22-44°), rib vertebral angle of greater than 20°with follow-up 17(3-28) months. In brace correction was less than 15 degrees in 6 of 8 patients. Compliance monitor recorded wear: 4 patients ≥ 18 hours, 2 patients 16-18 hours, 1 had 14 hours, and 1 monitor malfunctioned and could not be read. Brace design evolved to maximize ipsilateral abdominal relief away from the lateral apical shift of the design. Foam lining was added to prevent skin irritation through the relief opening. Average number of braces per year =2.2. A customized TLSO can achieve in brace correction comparable to Mehta casting with acceptable compliance and without the need for general anesthesia, while allowing bathing and skin care.

Lateral pedicle graft: A treatment modality for root coverage of localized gingival recession: A case report

Gingival recession has been defined as the apical shift of gingival margin from its physiologic level (1 to 2 mm coronal to cementoenamel junction) causing pathologic exposure of root surfaces. Mucogingival esthetic surgery is all about treatment of mucogingival esthetic alterations. Mucogingival problems may be caused by gingival recession often in association with non-carious cervical lesion or by root caries or by altered passive eruption. Patient with gingival recession frequently report to dental clinics which could lead to pain or hypersensitivity, esthetic problem, retention of plaque hence inflamed gingiva, root caries, abrasion and fear of tooth loss. Gingival recession can be treated by surgical or non-surgical means. Nonsurgical means include - restorations, crowns, veneers and gingival masks whereas surgical approaches includes various methods of increasing the width of keratinized tissue such as frenectomy in case of high frenal attachment & root coverage procedures. The lateral displaced pedicle flap was first described by Grupe and Warren in 1956. It was used to cover the isolated, denuded root surfaces that have adequate amount of donor tissue adjacent to the recipient site. The vestibular depth must be adequate to laterally slide the pedicle. A case of gingival recession is presented that was managed using LPG technique. This technique was selected because of certain advantages – single surgical area, preservation of blood supply of flap, the postoperative color being in harmony with surrounding tissue. Keywords: Lateral pedicle, Graft, Gingival recession.

Lateral Pedicle Graft for management of isolated gingival recession - A case report

Gingival recession is the apical shift of the marginal gingiva from its normal position on the crown of the tooth to levels on the root surface beyond the cemento-enamel junction.It is a widespread clinical finding in adults with more than 50% of the population having one or additional sites with gingival recession of 1mm or more and its severity increases with age. Root surfaces exposure in oral environment can cause root hypersensitivity, root caries and create esthetic problems. The pedicle graft is simple and less time-consuming surgical procedure with excellent results, without involving second surgical site for donor harvesting. In this case report the Miller’s Class-II isolated gingival recession defect was treated with lateral pedicle graft and postoperative clinical outcome showed stable & significant root coverage. Keywords: Gingival recession, Lateral pedical graft, laterally positioned flap, Root coverage, Mucogingival surgery

The Relationships Between Tooth-Supported Fixed Dental Prostheses and Restorations and the Periodontium.

To search the literature and to critically evaluate the findings on the periodontal outcomes of restorations and tooth-supported fixed prostheses. PubMed was searched according to a systematic methodology, previously reported, but updated to include a larger database. Filters applied were: Case reports, clinical trial, review, guideline, randomized controlled trial, meta-analysis, systematic reviews, and English. A narrative review was then synthesized to discuss periodontal outcomes related to restorations and tooth-supported fixed prostheses. Relevant data was organized into four sections: Direct restorations, indirect restorations, biologic width or supracrestal tissue attachment and tooth preparation/finish line design. While increased gingival index, bleeding on probing, probing depth and clinical attachment loss have been associated with subgingival restorations, intracrevicular margins do not cause periodontal diseases. Inflammation and bone loss occur, for both direct and indirect restorations, only with large overhangs. Different restorative materials are associated with different clinical responses when placed in the gingival sulcus or within the epithelial and connective tissue attachments. When the connective tissue attachment is removed, histological changes occur causing its apical shift and subsequent re-establishment. Gingival displacement during impression procedures can cause gingival recession. Emergence profile can have a range of values, not associated with periodontal diseases. Periodontal response appears to be clinically not different when compared among different finish line designs. Contemporary procedures and materials used for the placement and fabrication of tooth-supported restorations and fixed prostheses are compatible with periodontal health when adequate patient education and motivation in self-performed oral hygiene are present. Periodontal diagnostic criteria should be thoroughly reviewed before fixed restorative treatments are planned and executed.

Treatment of Gingival Recession by Lateral Positioned Pedicle Graft: A Case Report

Gingival recession (GR) is a condition in which there is an apical shift of gingival margin leading to exposureof root surface. On exposure of root surface, there will be root sensitivity, pain, root caries, poor aesthetic,and ultimately tooth loss. There are various techniques used to treat gingival recession. In this case report,a laterally positioned pedicle graft technique was used to treat gingival recession. A 37-year-old male cameto the Department of Periodontics, with a chief complaint of sensitivity in lower left front teeth regions.On clinical examination, there was Miller Class III in 33 with the presence of generalized mild plaque andcalculus. It was planned for phase I therapy followed by phase II therapy. So scaling and root planing wasperformed to reduce inflammation and after 4 weeks, lateral positioned pedicle graft technique was doneunder infiltration local anesthesia. The subject was instructed to maintain oral hygiene. After 2 months, itwas found significant coverage of root with keratinized gingiva. He was very satisfied with the result.

Acellular dermal matrix for root coverage procedures: 9-year assessment of treated isolated gingival recessions and their adjacent untreated sites.

The long-term outcomes of acellular dermal matrix (ADM) for the treatment of isolated gingival recessions has not yet been evaluated. Thus, the aim of this study was to observe the root coverage outcomes of coronally advanced flap with ADM over time, and compare them with their adjacent untreated sites. Twelve patients (from 20) were available at the 9-year recall. Clinical parameters (recession depth, mean root coverage [mRC], keratinized tissue width [KTW], and gingival thickness) were evaluated and compared with the 1-year results, and the ADM-adjacent untreated sites (on mesial and distal) via mixed-modeling regression analyses. From 1 to 9 years, the ADM-treated isolated recessions showed a relapse from 77% to 62% mRC (P<0.05). A similar pattern toward apical shift of the gingival margin was noticed for the ADM-adjacent untreated sites without baseline recession. However, ADM-adjacent untreated sites which had presented with recession at baseline but were not treated showed a significantly more apical shift of the gingival margin (almost two-fold). A significant increase in KTW was noted for all sites. Baseline KTW ≥2mm was a significant predictor for the stability of the gingival margin at the ADM-treated, and the ADM-adjacent sites with baseline recession. ADM-treated sites displayed recession relapse from 1 to 9 years. The untreated adjacent sites with a recession at baseline, showed a higher apical displacement of the gingival margin compared with the ADM-treated sites, and ADM-adjacent sites without a recession at baseline.