Width Of Attached Gingiva Research Articles

Treatment of gingival recession with vestibular incision subperiosteal tunnel access and advanced platelet-rich fibrin

ObjectivesThe current literature about the effect of advanced platelet rich fibrin(A-PRF) with vestibular incision subperiosteal tunnel access (VISTA) technique in treating gingival recession is scarce. Therefore, the aim of the current randomized clinical trial is to evaluate the effect of A-PRF with VISTA technique in the treatment of Cairo class 1 gingival recession (RT1).MethodsTwenty-four patients who met the eligibility criteria were randomly allocated into two groups. VISTA + A-PRF was the treatment of the study group, while VISTA + collagen matrix was performed for the control group. The clinical outcomes were assessed by a single-blind assessor at baseline, three months, and six months. They were divided into primary and secondary outcomes. The primary outcomes included recession depth (RD), recession width (RW), gingival thickness (GT), mean of root coverage % (MRC%), and width of attached gingiva (WAG) while the secondary outcome included clinical attachment level (CAL).ResultsThe primary outcomes analysis demonstrated statistically significant improvements in RD, RW, MRC%, GT, and WAG after 3 and 6 months in both groups (p < 0.001). However, the study group demonstrated a significantly greater improvement than the control group in RD, RW, and MRC%. No significant differences were observed between the two groups regarding GT and WAG.ConclusionsBoth treatment approaches were effective in the treating of RT1 adjacent gingival recessions. A-PRF showed promising results compared to collagen matrix.Trial registrationThe current randomized clinical trial was registered at ClinicalTrials.gov (Registration number: NCT06357351) and it was released on 10/04/2024.

The Impact of Orthodontic Extrusion on Keratinized Gingiva.

Background and Objectives: The key factor that enables osteoblastic activity and the formation of new bone, as well as gingiva, during orthodontic tooth extrusion (OE) is the periodontal ligament. The reaction of periodontal tissues associated with changes in the gingiva is a part of orthodontic tooth displacement. The aim of this study was to examine the effect of OE on the width of the zone of the keratinized and attached gingiva, the position of the mucogingival junction, and the height of the interdental papillae in the region where the OE was performed as well as in the adjacent region. Materials and Methods: This research included 28 adult patients (both orthodontically treated and untreated). The treated group included 15 patients, in whom orthodontic extrusion of the upper or lower frontal teeth was indicated and performed. The untreated group included 13 patients, with no previous or undergoing orthodontic treatment. Patients with periodontal disease and periodontal pockets in the frontal region and patients allergic to iodine were excluded from the study. Gingivomorphometric measurements were performed on two occasions in three groups of teeth (24 extruded and 30 agonist teeth in the treated patients; 66 teeth in the untreated patients). Statistical analysis of the obtained data was performed using the software package SPSS version 26.0. Results: Orthodontic extrusion induced changes in the position of the mucogingival line and an increase in the width of the keratinized gingiva. There were no statistically significant effects on the depth of the gingival sulcus, the attached gingiva width, or the height of the interdental papillae. Conclusions: Orthodontic tooth extrusion has an effect on the periodontium in the observed region. Vertical orthodontic force, directed towards the coronal plane, affects the surrounding soft oral tissues.

Associations between maxillary labial frenum Morphology, Attachment, and Patient-Related clinical factors in Saudi Arabian Adults: Cross-sectional study

ObjectiveThis study investigated the prevalence of maxillary labial frenum morphologies and attachment types and their associations with various patient-related clinical variables in a population of Saudi Arabian adults. MethodsThis study comprehensively examined 100 participants of both genders to categorize frenum types and attachment sites. The following clinical variables were recorded: probing depth, clinical attachment loss, attached gingiva width, overjet, overbite, diastema width, central incisor condition, occlusion, previous orthodontic treatment, and the incidence of gummy smile. ResultsThe mean age was 32.6 years, and the average diastema width was 0.23 mm. The study found that the simple frenum type was the most common morphology (57 %), and gingival attachment was the most frequent attachment type (54 %). Simple frenum was significantly associated with class I occlusion (p = 0.018), and frenum with nichum was significantly associated with class II occlusion (p = 0.019). Females were more likely to exhibit simple frenum with nodule frenum than males (p = 0.042). Mucosal frenum attachment was significantly correlated with the absence of previous orthodontic treatment (p = 0.042). ConclusionThe study identified a relationship between the features of the maxillary labial frenum and occlusion as well as previous orthodontic treatment. Our findings suggest that understanding each patient’s unique frenum features can lead to more effective and personalized dental care, thus improving patient satisfaction.

Free gingival grafting technique for gingival recession coverage: A 6-month follow-up interventional study

Background: Both the practitioner and the patient frequently deal with gingival recession. In Miller’s Classes I and II mandibular gingival recession, the goal of this study was to evaluate the predictability of the free gingival graft (FGG), as a single-step operation in terms of root coverage and esthetics. Materials and Methods: 10 patients between the ages of 25 and 50 who were sent to the Department of Periodontics (3 men and 7 women) made up the study group. There were a total of 14 mandibular recession sites that were chosen. Recession depth (RD), recession width, probing depth (PD), clinical attachment level (CAL), width of attached gingiva (WAG), and visual analog scale (VAS) were assessed at baseline, 3 months, and 6 months post-operatively. Results: The mean RD was 3.13±2.0 mm at the baseline and decreased to 0.80±0.78 mm after 6 months. At baseline, the VAS was 3.52±0.81, and at 6 months after surgery, it had improved to a mean of 6±2.14. From a baseline WAG of 0.35±0.38 to 2.83±0.68 mm, there wasa significant increase with p&lt;0.0001. Six months after surgery, there was an increase in CAL, from 5.63±1.12 to 1.28±0.76 mm. In addition, PD improved from 1.98±0.54 to 0.97±0.36 mm. Conclusion: FGG showed statistically significant gain in recession coverage and had good esthetic score. The technique produced a reliable single-step gain in WAG as well as root coverage in cases of Miller’s Classes I and II gingival recession.

Evaluating the efficacy of laterally positioned flap in the management of Miller's Class I and II gingival recession: A 6 months follow-up study

Background: The goal of the study is to evaluate the clinical effectiveness of a laterally positioned flap (LPF) six months after it was used to correct Miller's Class I and II gingival recession abnormalities. Materials and methods: The LPF approach was used to treat 10 Miller's Class I or II gingival recession defects of height ≥3 mm (n = 10) on the labial surface of anterior teeth. At baseline, 3 months, and 6 months after surgery, clinical measures including probing pocket depth (PPD), clinical attachment level (CAL), width of attached gingiva (WAG), and height of gingival recession (HGR) were measured, and percentage of root coverage was calculated. Data were gathered, and repeated-measures ANOVA with the post hoc Bonferroni test was used for statistical analysis. Results: All clinical parameters such as PPD, CAL, WAG, and HGR showed improvement. All of the evaluated clinical measures showed statistically significant changes at post-operative 3 and 6 months compared to baseline values. With a p-value of &lt;0.001, the HGR decreased from 3.21 ± 0.52 mm to 0.23 ± 0.65 mm at three months and to 0.36 ± 0.78 mm at six months. At six months, the average level of recession coverage was 97.93%. Conclusion: Employing the LPF technique led to substantially improved gingival recession coverage, which effectively covered isolated deep narrow defects.

Effects of topically administered 0.6% hyaluronic acid on the healing of labial frenectomy in conventional and 940-nm indium gallium arsenide phosphide (InGaAsP) diode laser techniques in pediatric patients: a randomized, placebo-controlled clinical study

This study aimed to investigate the effects of 0.6% hyaluronic acid (HA) gel on the healing process and postoperative pain levels after diode laser-assisted labial frenectomy in pediatric patients. Ninety-six pediatric patients (females, 50 and males, 46) aged 8–14 years were randomly divided into four groups as follows: (1) conventional frenectomy with 0.6% topically administered HA (CFH, n = 24); (2) conventional frenectomy with placebo gel (CFP, n = 24); (3) frenectomy performed by diode laser with 0.6% topically administered HA (DLH, n = 24); and (4) frenectomy performed by diode laser with placebo gel (DLP, n = 24). HA application was continued for 1 week thrice daily after the frenectomy. Visual analog scale forms were collected from patients 1 week after the operation. In addition, the plaque index, gingival index, periodontal probing depth, and keratinized tissue width and thickness were recorded. This process was repeated 1 and 3 months after the first visit. The DLH group revealed significant differences in the probing depth, bleeding on probing, keratinized gingiva width, and attached gingiva width according to dual comparisons of the initial, first, and third-month values (p = 0.010, p = 0.007, p<0.001, and p = 0.001, respectively). Significant differences were observed between the CFP and CFH groups according to the initial and initial third-month values with regard to the bleeding on probing (p=0.019 and p = 0.019, respectively). The attached gingival thickness revealed significant differences between the CFP and CFH groups for the initial and initial-third-month comparisons (p = 0.005 and p = 0.007, respectively). The mean values of the initial and initial-third-month differences were significantly higher in the CFH group than those in the CFP group. HA- and laser-assisted labial frenectomies revealed better outcomes in terms of the probing depth, attached gingiva width, keratinized gingiva width, healing process, and postoperative comfort.

Risk indicators for gingival recession in the esthetic zone: A cross-sectional clinical, tomographic, and ultrasonographic study.

To evaluate the risk indicators associated with midfacial gingival recessions (GR) in the natural dentition esthetic regions. Cone-beam computed tomography (CBCT) results of thirty-seven subjects presenting with 268 eligible teeth were included in the cross-sectional study. Clinical measurements included presence/absence of midfacial GR; the depth of the midfacial, mesial, and distal gingival recession; the recession type (RT); keratinized tissue width (KT); and attached gingiva width (AG). Questionnaires were utilized to capture patient-reported esthetics and dental hypersensitivity for each study tooth. Buccal bone dehiscence (cBBD) and buccal bone thickness (cBBT) were measured on the CBCT scans. High-frequency ultrasonography was performed to assess gingival thickness (GT) and buccal bone dehiscence (uBBD). Intraoral optical scanning was obtained to quantify the buccolingual position of each study site (3D profile analysis). Multilevel logistic regression analyses with generalized estimation equations were performed to assess the factors associated with the conditions of interest. The presence of midfacial GR was significantly associated with the history of periodontal treatment for pocket reduction (OR 7.99, p=0.006), KT (OR 0.62, p<0.001), cBBD (OR 2.30, p=0.015), GT 1.5mm from the gingival margin (OR 0.18, p=0.04) and 3D profile 1mm from the gingival margin (OR 1.04, p=0.001). The depth of midfacial GR was significantly correlated to previous history of periodontal treatment (OR 0.96, p=0.001), KT (OR -0.18, p<0.001), presence of bone fenestration (OR 0.24, p=0.044), and cBBD (OR 0.43, p<0.001). The depth of midfacial GR was also the only factor associated with patient-reported esthetics (OR -3.38, p=0.022), while KT (OR 0.77, p=0.018) and AG (OR 0.82, p=0.047) were significantly correlated with patient-reported dental hypersensitivity. Several risk indicators of midfacial and interproximal GR in the esthetic region were identified. The use of imaging technologies allowed for detection of parameters associated with the conditions of interest, and, therefore, their incorporation in future clinical studies is advocated. Ultrasonography could be preferred over CBCT for a noninvasive assessment of periodontal phenotype.

Comparative Evaluation of Coronally Advanced Flap with and without Amniotic Membrane in the treatment of Localised Miller’s Class I and Class II Gingival Recession Defects: A Randomised Controlled Trial

Introduction: Gingival recession is the exposure of the root surface of the tooth, characterised by the displacement of the gingival margin apically from the Cementoenamel Junction (CEJ). Various techniques have been suggested for treating recession, such as Free Gingival Graft (FGG), Connective tissue grafts, laterally or Coronally Advanced Flaps (CAF), and Guided Tissue Regeneration (GTR)-based procedures. Different membranes have been used for GTR, one of which is the amnion membrane. Aim: To evaluate root coverage using Coronally Advanced Flap (CAF) with and without amniotic membrane in the treatment of localised gingival recession. Materials and Methods: A randomised controlled trial was conducted at Pandit Deendayal Upadhyay Dental College and Hospital, Solapur, Maharashtra, India from March 2017 to February 2018. In this study, 30 teeth were treated, with 15 teeth undergoing CAF with amniotic membrane (Group IITest Group) and 15 teeth treated with CAF without amniotic membrane (Group I-Control Group). Probing Depth (PD), Clinical Attachment Level (CAL), Relative Attachment Level (RAL), Recession Width (RW), Recession Depth (RD), Width of Keratinised Gingiva (WKG), Width of Attached Gingiva (WAG), and gingival biotype were assessed between baseline and after three months. Statistical analysis was performed using paired t-test, independent t-test, and Mann-Whitney U-Test. Statistical Package for Social Sciences (SPSS) software version 20.0 was used for analysis. The α error of 5% (p-value=0.05) and β error of 20% were taken into consideration. Results: The mean age of the study population was 30.36±4.55 years, with 18 males and 12 females. There was a decrease in RD, RW, PD, and a gain in CAL and RAL in both groups after three months compared to the baseline values. Additionally, there was an increase in WKG, WAG, and a significant change in the thickness of the gingival biotype from thin to thick in both groups at the end of three months. On inter group comparison, the changes in PD (p-value=1.00), RD (p-value=1.00), RW (0.176), CAL (0.664), RAL (1.00), WKG (p-value=0.313) were not statistically significant at the end of three months. WAG was higher in Group II compared to Group I (p-value=0.014*), and the mean root coverage was greater in Group II (15.62%) than in the control group (11.642%) (p-value=0.005) at the end of three months. There was a statistically significant difference (p-value=0.005*) in Group II (15.62%) compared to the control group (11.642%). Conclusion: Amniotic membrane in combination with CAF proves to be a successful option for root coverage in localised recession defects. However, histological evidence and a greater number of future longitudinal studies are necessary to study the efficacy of this approach.

Evaluation of Width and Thickness of the Attached Gingiva and Its Association with Age, Gender, and Arch Location in the Nepalese Population

Purpose. The width and thickness of the attached gingiva are important clinical parameters. Considerable variations exist in the same as well as in different individuals. This study aimed to assess the width and thickness of the attached gingiva and its relationship with age, gender, and arch location in the Nepalese population. Methods. An observational cross-sectional study was conducted among 120 individuals visiting the periodontics department, who were categorized into three age groups with an equal distribution of gender in each group. The width of attached gingiva (WAG) was determined using the University of North Carolina-15 probe after locating the mucogingival junction. Data were gathered and entered in Excel sheet version 19, and SPSS version 20 was used for further analysis. The mean and standard deviations were calculated. The independent t-test and one-way ANOVA were used to find out the significant difference between variables. The correlation between dependent and independent variables was discovered with the help of the Pearson correlation test. The significance level was set at 5% with a 95% confidence level. Results. 120 individuals with 1440 teeth were examined to measure the WAG with an equal distribution of gender. The maximum WAG was found on the maxillary right lateral incisor and minimum width on the mandibular left first premolar. The average WAG was greater in the upper arch (3.19 mm) than in the lower arch (2.71 mm). The maximum thickness (1.728 mm) of the attached gingiva was found on the mandibular left first molars and minimum width (0.667 mm) on the mandibular left first premolars. Conclusions. As individuals age, there is a reduction in gingival thickness, accompanied by an increase in the WAG across both dental arches. In terms of gender differences, females exhibit a higher thickness of attached gingiva (TAH) than their male counterparts.

Marine Collagen Matrix Carrier with Injectable Platelet-Rich Fibrin in Management of Gingival Recession Defects

Background. The gold standard in the management of gingival recession (GR) defects has been connective tissue graft (CTG) with coronally advanced flap (CAF). But patient morbidity associated with graft harvesting is a major drawback and has led to the development of various substitute biomaterials which have been tried and tested. Aim. Our study is aimed at checking the efficacy of marine collagen matrix (MCM) impregnated with injectable platelet-rich fibrin (I-PRF) with modified CAF in the treatment of Miller’s class I and II recession defects. Case Description. Six patients with ten GR defects in maxilla were treated with CAF + MCM + I-PRF. Clinical parameters like recession height (RH), recession width (RW), root coverage (RC%), width of attached gingiva (WAG), keratinized tissue height (KTH), probing pocket depth (PPD), clinical attachment level (CAL), gingival biotype (GB), plaque index (PI), and visual analogue score (VAS-E) esthetic scores were evaluated up to six months. There was significant root coverage observed at three- and six-month follow-ups. Conclusion. The proposed treatment was effective in the management of GR defects and improvement in soft tissue biotype without the morbidity associated with soft tissue harvest.

Liquid platelet-rich fibrin in root surface biomodification during gingival recession treatment: Randomized, controlled, split-mouth, clinical trial.

Free gingival graft (FGG) has been successfully used in the treatment of gingival recessions, as it is the most predictable technique for increasing the attached gingiva. This study aimed to evaluate the effect of liquid platelet-rich fibrin (PRF) with FGG on root surface coverage as root surface biomodification. The research sample consisted of 32 surgical sites in 16 patients, they had 2 bilateral recessions in the incisor area of the same dental arch, the sample was divided into 2 groups randomly, and liquid PRF was applied in the first group with the FGG (experimental group), and in the second group the FGG was applied alone (control group). Gingival recession depth (RD) and width of attached gingiva (WAG) were measured before starting, after 1, 3, and 6 months. The percentage of root coverage (RC) was calculated after 6 months. Healing Index (HI) was recorded after 1 week, 2 weeks, and 1 month. Both groups showed a reduction in gingival RD during all follow-up periods but the difference between both groups was not statistically significant (p > 0.05) at 1 and 3 months, whereas there were significant differences at 6 months (p = 0.001). RC was better in the liquid PRF group than in the control group, but this difference was not statistically significant (p > 0.05). The postoperative 7th and 14th days HI scores of the liquid PRF group were significantly better than the control group (p = 0.000 and p = 0.004, respectively), whereas there were no significant differences in HI scores between both groups at first month (p > 0.05). According to the results, the addition of liquid PRF to the root surface with FGG showed further development in terms of decreasing RD, increasing WAG, and accelerated wound-healing.

Advanced Platelet-Rich Fibrin and Connective Tissue Graft for Treating Marginal Tissue Recessions: A Randomized, Controlled Split-Mouth Study.

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. 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. 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. 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.

Semilunar vestibular incision technique for treatment of multiple gingival recession in maxillary teeth - An evaluative study.

Recession is a mucogingival condition affecting teeth causing hypersensitivity. Although many techniques are there for recession coverage, semilunar vestibular incision technique (SVIT) is a novel procedure for management of multiple gingival recession in maxillary teeth. To evaluate the efficacy of root coverage in maxillary teeth with multiple gingival recession using SVIT. Twenty systemically healthy patients were recruited with Miller's class I and II gingival recessions in maxillary teeth. Parameters such as recession height (RH), recession weight (RW), avascular surface area (ASA), width of keratinized gingiva (WKG), width of attached gingiva (WAG), and clinical attachment level (CAL) were measured at baseline three and six months post-surgery. The outcome measures were statistically significant at baseline, three and six months. A reduction of 86% was achieved in terms of RH and RW. Gain in WKG and WAG as achieved at six-month follow-up was 31.5% and 55%, respectively. An 87% decrease in ASA was obtained and reduction in CAL was 82.4%. Between three and six months there was a significant increase in WAG. SVIT results in improved measures of attached gingiva on six-month follow-up.

Comparative Evaluation of Platelet-Rich Fibrin versus Connective Tissue Grafting in Treatment of Gingival Recession Using Pouch and Tunnel Technique: A Randomized Clinical Study.

Aims:The aim of the study was to compare the clinical efficacy of platelet-rich fibrin (PRF) and connective tissue grafting in the treatment of gingival recession (GR) using pouch and tunnel (P and T) technique.Materials and Methods:A total of 40 Class I or Class II GR defects in 17 patients were randomized treated with P and T with PRF (Group I, n = 20) and P and T with CTG (Group II, n = 20). The parameters measured were plaque index (PI), gingival index (GI), probing pocket depth (PPD), clinical attachment level (CAL), horizontal gingival recession (HGR), vertical gingival recession (VGR), width of attached gingiva (WAG), width of keratinised gingiva (WKG), gingival thickness-mid buccal (GTMB), and gingival thickness interdental papilla (GTIP). Postsurgical discomfort level (PSDL), hypersensitivity score (HS), and patient esthetic score (PES) were recorded using visual analog scale (VAS). The PI, GI, PPD, CAL, HGR, VGR, WAG, WKG, GTMB, and GTIP were assessed at pretreatment (baseline) and 1-, 3-, and 6-month posttreatment. The PSDL, HS, and PES were assessed at baseline, day 10, 1, 3, and 6-month posttreatment.Results:P and T with PRF and CTG resulted in root coverage of 73.75% ± 7.80% and 70.83% ±8.26%, respectively. Patient response and acceptance for the surgical treatment modality showed less discomfort and better esthetics in Group I as compared to Group II.Conclusions:PRF treated sites were comparable to the gold standard CTG with better patient acceptance and a lesser invasive approach in terms of graft procurement.

Comparative evaluation of coronally advanced flap with and without Biomesh® membrane for the treatment of localized gingival recession defects - a clinical study.

Numerous surgical procedures are used to correct gingival recession, like free gingival graft, pedicle graft, and connective tissue graft. Our study aimed to compare and clinically evaluate root coverage using a coronally advanced flap (CAF) with and without Biomesh® membrane to treat recession type 1 (RT1) and type 2 (RT2) defects. A total of 20 systemically stable patients, both males and females between the ages of 20 and 40, with bilateral recession defects in maxillary canines and premolars, were included in the study. Patients were divided into two groups: the control group: coronally advanced flap only and the test group: coronally advanced flap with Biomesh® membrane. All clinical parameters showed significant reductions from baseline, 1 month, 3 months, and 6 months post-surgery. Gingival recession significantly reduced both in test and control groups with no intergroup difference. The exposed root was covered by 70% in the test group and 78% in the control group. Clinical attachment level, the width of keratinized tissue, recession height, and recession width was significantly increased in the case of coronally advanced flap alone with significant intragroup comparison. The results for both treatment techniques for recession coverage were compared. CAF displayed superior results than CAF along with Biomesh® membrane in terms of clinical attachment level, root coverage percentage, and attached gingiva width.

Comparative Evaluation of Clinical Efficacy of Leukocyte-Rich Platelet-Rich Fibrin with Advanced Platelet-Rich Fibrin in Management of Gingival Recession Defects: A Randomized Controlled Trial

Background: The aim of this research was to determine and compare the clinical efficacy of leukocyte platelet-rich fibrin (L-PRF) and advanced platelet-rich fibrin (A-PRF) in combination with coronally advanced flap (CAF) in the treatment of gingival recession defects. Methods: Systemically healthy subjects presenting with 30 Miller’s class I or II gingival recession defects in maxillary anteriors and premolars, were treated with either CAF + L-PRF or CAF + A-PRF. Clinical parameters such as recession height (RH), width, probing pocket depth, clinical attachment level (CAL), keratinized tissue height (KTH), and width of attached gingiva (WAG) were measured at baseline, 3, and 6 months. Gingival biotype was evaluated at baseline and 6 months post-surgery. Mean root coverage percentage (MRC%) was evaluated at 3 and 6 months. Results: Statistically significant reduction in mean RH was observed from baseline (2.53 ± 0.74 mm, 2.63 ± 0.82 mm) to 6 months (0.87 ± 0.83 mm, 0.53 ± 0.91 mm) in CAF + L-PRF and CAF + A-PRF groups, respectively. The MRC% achieved at 6 months was 67.20 ± 32.81 in the CAF + L-PRF group and 81.66 ± 28.21 in the CAF + A-PRF group. Statistically significant gain in CAL, WAG, and KTH was observed in both therapeutic groups (p < 0.05). Intergroup analysis revealed no statistically significant differences among study parameters between groups at any time point (p > 0.05). Conclusion: Based on the findings of this study, both L-PRF and A-PRF may be suggested as viable treatment options for the management of gingival recession in maxilla.

Gender- and age-related differences in the width of attached gingiva and clinical crown length in anterior teeth

BackgroundThe anatomical features of the gingiva and the clinical crowns and their interrelation, especially in aesthetically and functionally demanding areas, are important in complex dental or implant-retained prosthetic rehabilitations. This observational cross-sectional study was designed to evaluate gender- and age-related differences in the width of attached gingiva (WAG), the clinical crown length (CCL), and their interrelation in the anterior teeth to determine the relationship between the pink and white aesthetics.MethodsEighty (54 females, 26 males) fully dentate Caucasian participants between the ages of 20 and 25 years and 36 probands (23 females, 13 males) between the ages of 45 and 55 years were included in the present study. The CCL of the maxillary and mandibular canines, as well as the central incisors of the maxilla and mandible, were determined with a dental sliding caliper measuring from the middle margin of the gingiva at its deepest point to the incisal edge. The clinical investigation of the WAG was performed by inserting a periodontal probe into the gingival sulcus in the middle of the buccal surface to firstly measure the probing pocket depth. The distance between the gingival margin and mucogingival junction (MGJ) was then measured with a Beerendonk sliding caliper in the middle of the labial curvature, and the clinical WAG was determined by subtraction of the measured probing depth. For the statistical analysis, the Mann–Whitney U test, the Wilcoxon-Test, the Spearman’s rank correlation, and a two-factorial non-parametric analysis were used.ResultsThere was no correlation between the CCL and the WAG in a healthy periodontium. Gender influenced the CCL, with men having significantly longer teeth than women in both maxilla (P ≤ 0.01) and mandible (P ≤ 0.05). Age did not influence the CCL significantly neither in the upper (P = 0.06) nor in the lower jaw (P = 0.33). Gender did not show to have a significant influence on the WAG of maxilla (P = 0.69) and mandible (P = 0.26). But differences in the WAG between young and old participants were observed in both upper (P ≤ 0.01) and lower jaw (P ≤ 0.05).ConclusionThe present observational study demonstrated that the mean values of cohorts with mixed age groups and genders should not be considered when attempting to determine the ideal relationships between the pink and white aesthetics since the statistical analyses showed significant differences between different age groups and genders.

AESTHETIC AMELIORATION OF GINGIVAL RECESSION BY MODIFIED CORONALLY ADVANCED FLAP PROCEDURE: A 6 MONTHS FOLLOW-UP INTERVENTIONAL STUDY

Background:In recent times, aesthetics has become a major reason for the patients to seek the dentist. Gingival recession of the anterior teeth leads to long tooth appearance thereby hampering the aesthetics. The aim of the present study is to assess the efciency of modied coronally advanced ap (MCAF) technique in combination with platelet-rich brin (PRF) for recession coverage of Miller's class I and II cases. Materials and method: 10 patients with Miller's class I or class II gingiva were treated by modied coronally advanced ap (MCAF) technique in combination with platelet-rich brin (PRF). The clinical parameters such as gingival index (GI), bleeding on probing (BOP), probing pocket depth (PPD), clinical attachment level (CAL), width of attached gingiva (WAG), thickness of attached gingiva (TAG) and the height of gingival recession (HGR) were recorded at baseline, 3 months and 6 months follow-up visits. Results: All the clinical parameters showed signicant improvement at 3 months and 6 months post-operatively when compared with the baseline values. The results obtained during the initial follow-up visit remained stable over a period of 6 months. Conclusion: MCAF is a foreseeable technique to achieve gingival recession coverage. Additionally, the use of PRF enables in improved WAG and TAG due to the release of growth factors.

Gingival phenotype and its relationship with different clinical parameters: a study in a Dominican adult sample

The purpose of this study was to estimate the prevalence of thin and thick gingival phenotype (GPh) in a sample of Dominican subjects and correlate it with clinical parameters. One-hundred seven periodontal healthy volunteers in the range of 18-73 years were enrolled in the study. GPh was defined by the transparency of a periodontal probe through the buccal gingival margin on the upper right or left central incisor. Clinical periodontal parameters such as keratinized gingiva width (WKG), attached gingiva width (WAG), probing depth (PD), plaque index (PI), and gingival index (GI) were recorded by a calibrated examiner. Frequency distribution of qualitative variables was calculated. For quantitative variables, Mann-Whitney and Kruskal-Wallis tests were used for comparison of groups. There was no association between GPh and sex. There were no significant differences between thin and thick GPh regarding age, PD, GI, and interproximal index. The association between tooth morphology and GPh was significant (p = 0.018). Median amount of keratinized gingiva was significantly larger (p = 0.01) in subjects with thin gingival phenotype (median = 6.00 mm) when compared with subjects with thick gingival phenotype (median = 5 mm). Subjects with thin GPh presented larger WKG. Furthermore, there was an association between tooth morphology and GPh. This is the first study to report the distribution of gingival phenotype and its relationship with different periodontal parameters of a Caribbean population. Our findings can contribute to the clinicians when planning or performing dental procedures.

Innovative use of increasing the width of attached gingiva using chorion membrane along with platelet rich fibrin membrane.

Width of attached gingiva plays an important role in maintaining periodontal health, provides stabilization of the gingival margin against frictional forces and aids in dissipating physiological forces exerted by the muscular fibers of the alveolar mucosa on the gingival tissues. Inadequate width of attached gingiva leads to attachment loss, soft tissue recession, and impedes oral hygiene measures. Hence, procedures using autografts and allografts have been proposed to augment the attached gingiva. Allografts like chorionic membrane (CM) are known to enhance release of growth factors, promote neovascularization, healing and enhance biotype. To assess the efficacy of CM in increasing the width of attached gingiva, vestibular depth and gingival thickness. Fifteen patients with inadequate attached gingival width were included in the study. Patients were randomly allocated to each group: Control group, CM group and CM + platelet rich fibrin (PRF) group. Attached gingiva width, vestibular depth, and gingival thickness were measured at baseline and 4weeks post procedure. The control, CM and CM + PRF groups showed an increase in all parameters from baseline to 4weeks. The increase in the attached gingiva (p = 0.042) width, vestibular depth (p = 0.043) and gingival thickness (p = 0.034) were statistically significant at 4weeks for CM group and CM + PRF grouprespectively. The CM + PRF group showed better results compared to other groups. CM and PRF can be effectively incorporated to increase the width of attached gingiva and depth of vestibule.