Recession Depth Research Articles

Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivate for root coverage: 5-year results of an RCT using 3D digital measurement technology for volumetric comparison of soft tissue changes.

Comparison of the clinical efficacy (digitally volumetric, aesthetic, patient-centred outcomes) of tunnel technique (TUN) with subepithelial connective tissue graft (CTG) versus coronally advanced flap (CAF) with enamel matrix derivate (EMD) 5years after gingival recession therapy. In 18 patients contributing 36 RT1 recessions, study models were collected at baseline and follow-ups. Optical scans assessed recessions computer-assisted [recession depth, recession reduction (RECred), complete root coverage (CRC), percentage of root coverage (RC), pointwise (pTHK) and mean areal (aTHK) marginal soft tissue thickness]. Root coverage aesthetic Score (RES) was used for aesthetic evaluation and visual analogue scales for patient-centred data collection applied. Sixty months after surgery, 50.0% (TUN+CTG) and 0.0% (CAF+EMD) of sites showed CRC (p=0.0118), 82.2% (TUN+CTG) and 32.0% (CAF+EMD) achieved RC, respectively (p=0.0023). CTG achieved significantly better RECred (TUN+CTG: 1.75±0.74mm; CAF+EMD: 0.50±0.39mm; p=0.0009) and aTHK (TUN+CTG: 0.95±0.41mm; CAF+EMD: 0.26±0.28mm; p=0.0013). RES showed superior outcomes (p=0.0533) for TUN+CTG (6.86±2.31) compared to CAF+EMD (4.63±1.99). The study failed to find significant differences related to patient-centred outcomes (TUN+CTG: 8.30±2.21; CAF+EMD: 7.50±1.51; p=0.1136). Five years after treatment, CTG resulted in better clinical and aesthetic outcomes than CAF+EMD. Increased THK was associated with improved outcomes for RECred and RC.

Vertically Coronally Advanced Flap (V-CAF) to Increase Vestibule Depth in Mandibular Incisors.

Treatment of gingival recessions affecting mandibular incisors is scarcely documented. Despite a shallow vestibule depth being considered a poor anatomical condition, it has never been measured nor deemed a clinical parameter affecting the outcome of root coverage procedures. This study describes a vertically and coronally advanced flap (V-CAF) + connective tissue graft (CTG) technique to obtain root coverage and increased vestibule depth in the treatment of gingival recessions affecting mandibular incisors. Twenty patients with single gingival recessions were treated. The results showed that V-CAF+CTG is effective in increasing residual vestibule depth and in reducing recession depth. Immediately after surgery, a vestibule-depth increase of 5.9 ± 1.2 mm was reported, which was statistically significant compared to baseline, and it remained stable after 12 months (4.8 ± 1.1 mm). The mean percentage of root coverage was 98.3% ± 5.2% for all treated recessions, and complete root coverage (CRC) was achieved in 90% of cases (18 of 20). V-CAF+CTG could be considered a successful technique in terms of vestibule depth increase and CRC for the treatment of single gingival recessions in the mandibular incisors.

Treatment of Gingival Recession with Microinvasive Surgical Technology

Objective. The purpose of this clinical research was to evaluate the result of microinvasive surgical technology: vestibular incision subperiosteal tunnel access (VISTA) and subepithelial connective tissue graft (SCTG) in multiple gingival recession. Methods. A total of 20 patients with 25 Miller I and 30 Miller III gingival recession teeth were treated with VISTA+SCTG. The data at baseline and 12 months were assessed: probing depth (PD), clinical attachment loss (CAL), gingival recession depth (RD), gingival recession width (RW), width of keratinized tissue (WKT), and gingival biotype (GB), and percentage of root coverage (RC) and complete root coverage (CRC) were calculated. Results. The average root coverage was 1.52 ± 0.70 mm in Miller I and 0.82 ± 0.79 mm in Miller III. The mean root coverage rate was 99.00 % ± 5.00 % in Miller I and 60.73 ± 37.90 % in Miller III. The width of clinical attachment loss of keratinized tissue was significantly improved. Conclusions. VISTA and SCTG are effective in the treatment of both Miller class I and III multiple gingival recessions. Gingival increment in Miller class I is better than that in III. It is the same for maxillary and mandibular teeth.

A comparative assessment of root coverage of gingival recession using modified coronally advanced flap using microsurgical and macro surgical techniques

Gingival anatomic factors, chronic trauma, periodontitis, and tooth alignment are the main conditions leading to gingival recession. The present study was conducted to compare the root coverage of localized GR using modified coronally advanced flap (CAF) and root conditioning with 24% EDTA when performed under magnification and without magnification. This study was conducted on 30 patients with Miller’s Class I and II GR. Patients were divided into 2 groups i.e 15 in each group. Group I (Coronally advanced flap with microsurgery ) was test group and group II (Coronally advanced flap with macrosurgical approach) was control. Plaque index (PI), gingival index (GI), pocket probing depth (PD), and clinical attachment level (CAL) width of keratinized gingival, recession width and recession depth was recorded in both groups at baseline 1and 3 months for the test and control group. Visual analog scale (VAS) was used to record pain postoperatively on 3rd and 7th day of the surgery. CAF and root conditioning were done with 24% EDTA. Surgical procedure at test site was carried under magnification 3.5 and at control site was done without magnification.The mean gingival index at baseline in group I was 0.45 and in group II was 0.66, PI was 0.86 in group I and 0.86 in group II, clinical attachment level was 3.02 in group I and 3.34 in group II, PD was 0.76 in group I and 0.74 in group II, width of keratinized tissue 4.20 in group I and 3.26 in group II, recession depth was 2.54 in group I and 2.68 in group II and recession width was 3.60 in group I and 3.68 in group II. There was alteration in mean GI, PI, CAL, PD, width of keratinized tissue, recession depth and recession width between both groups recorded at 1 month. Significant reduction was found in GI, CAL, width of keratinized tissue, recession depth and recession width in both groups (P< 0.05). We found that mean VAS at 3 day in group I was 4.12 and in group II was 1.84 and at 7 day 0.68 in group I and 0.34 in group II.Authors found that microsurgery had less postoperative pain and discomfort when compared to macrosurgical approach. The use of the microscope augments the results, but obtaining an expertise in using needs a lot of practice.

Behaviour of reinforced concrete beams having recesses in tension and compression sides

A reinforced concrete beam with a recess is an example of a non-prismatic beam, which develops stress concentrations at the corner of the recess owing to the abrupt change in its depth. This entails appropriate detailing of internal reinforcement in order to avoid premature failure. This study presents the load transfer mechanism employing the strut-and-tie model (STM) for four non-prismatic beams with recesses in the shear span zone at both compression and tension sides, tested under a four-point loading scheme. The proposed STMs for the tested beams were developed based on both the cracking patterns near failure of experimentally tested beams and the developed stress contours based on linear static analysis. In addition, a simplified method is proposed to estimate the maximum mid-span deflection of simply supported beams with recesses. The results obtained reveal that the STM gave good predictions, with an average of about 86% of the ultimate experimental loads. Based on the results of the parametric study conducted, it was found that the most significant parameter was the recess depth from the viewpoint of stress concentration factor, cracking load and maximum crack width. Finally, recommendations and guidelines for the design of reinforced concrete beams with recesses are presented.

Clinical and radiographic effects of ascorbic acid-augmented platelet-rich fibrin versus platelet-rich fibrin alone in intra-osseous defects of stage-III periodontitis patients: a randomized controlled clinical trial

AimTo assess platelet-rich fibrin (PRF) with ascorbic acid (AA) versus PRF in intra-osseous defects of stage-III periodontitis patients.MethodologyTwenty stage-III/grade C periodontitis patients, with ≥ 3 mm intra-osseous defects, were randomized into test (open flap debridement (OFD)+AA/PRF; n = 10) and control (OFD+PRF; n = 10). Clinical attachment level (CAL; primary outcome), probing pocket depth (PPD), gingival recession depth (RD), full-mouth bleeding scores (FMBS), full-mouth plaque scores (FMPS), radiographic linear defect depth (RLDD) and radiographic defect bone density (RDBD) (secondary-outcomes) were examined at baseline, 3 and 6 months post-surgically.ResultsOFD+AA/PRF and OFD+PRF demonstrated significant intragroup CAL gain and PPD reduction at 3 and 6 months (p < 0.001). OFD+AA/PRF and OFD+PRF showed no differences regarding FMBS or FMPS (p > 0.05). OFD+AA/PRF demonstrated significant RD reduction of 0.90 ± 0.50 mm and 0.80 ± 0.71 mm at 3 and 6 months, while OFD+PRF showed RD reduction of 0.10 ± 0.77 mm at 3 months, with an RD-increase of 0.20 ± 0.82 mm at 6 months (p < 0.05). OFD+AA/PRF and OFD+PRF demonstrated significant RLDD reduction (2.29 ± 0.61 mm and 1.63 ± 0.46 mm; p < 0.05) and RDBD-increase (14.61 ± 5.39% and 12.58 ± 5.03%; p > 0.05). Stepwise linear regression analysis showed that baseline RLDD and FMBS at 6 months were significant predictors of CAL reduction (p < 0.001).ConclusionsOFD+PRF with/without AA significantly improved periodontal parameters 6 months post-surgically. Augmenting PRF with AA additionally enhanced gingival tissue gain and radiographic defect fill.Clinical relevancePRF, with or without AA, could significantly improve periodontal parameters. Supplementing PRF with AA could additionally augment radiographic linear defect fill and reduce gingival recession depth.

Clinical evaluation of the treatment of multiple gingival recessions with connective tissue graft or concentrated growth factor using tunnel technique: a randomized controlled clinical trial.

To assess the effectiveness of the combination of tunnel technique (TT) and concentrated growth factor (CGF) for root coverage in treating multiple gingival recessions (GR) and compare with the connective tissue graft (CTG). Forty patients with Miller Class I and II maxillary or mandibular GR were randomly divided into two groups as follows: TT + CTG and TT + CGF. The results at baseline and 6 months were evaluated for the following clinical parameters: complete root coverage (CRC), mean root coverage (MRC), gingival thickness (GT), gingival recession width (RW), gingival recession depth (RD), and keratinized tissue width (KTW). At 6 months, a statistically significant difference was found in RD, RW, MRC, CRC, KTW, and GT compared with the baseline (p < 0.05). MRC was determined 89.52±16.36% in the TT + CTG and 76.60±24.10% in the TT + CGF (p < 0.05). CRC was achieved in 66.7% of the TT + CTG and 47.4% of the TT + CGF (p < 0.05). The increase in KTW and GT was significantly better in the TT + CTG group compared to the TT + CGF (p < 0.05). The study showed that TT + CGF did not improve the results as much as TT + CTG in the treatment of Miller Class I and II GR. However, this finding is not sufficient to advocate the true clinical effects of CGF on GR treatment with TT. CGF could not serve as a direct alternative biomaterial to the gold standard CTG. ClinicalTrials.gov Identification Number: NCT04561947.

De-epithelialized gingival graft versus subepithelial connective tissue graft in the treatment of multiple adjacent gingival recessions using the tunnel technique: 1-year results of a randomized clinical trial.

To compare the clinical efficacy and postoperative morbidity of de-epithelialized gingival graft (DGG) with subepithelial connective tissue graft (SCTG) on treatment of multiple adjacent gingival recessions (MAGRs) with tunnel technique (TUN) and to evaluate histological characteristics of the palatal grafts. Twenty-seven patients with MAGRs affecting at least 2 adjacent teeth were treated with either DGG+TUN or SCTG+TUN. Recession depth(RD) and width(RW), probing depth(PD), clinical attachment level(CAL), keratinized tissue height(KTH), gingival thickness(GT), and complete and mean root coverage(CRC, MRC) were evaluated at 6 and 12months postoperatively. Multilevel analysis was performed to identify patient- and tooth/site-related predictors for the 12-month MRC outcomes. Postoperative patient morbidity and histological characteristics of palatal graft samples obtained during harvesting were investigated. At the 12-month follow-up, MRC was 91.72%±16.59% and 84.72%±19.72% in DGG+TUN and SCTG+TUN groups (p=.001). Multilevel regression analysis identified RD, KTH and GT as variables associated with MRC. No significant difference between the groups was observed regarding postoperative patient morbidity parameters. Cellularity was found significantly higher in the SCTG samples compared to the DGG samples (p<.05). Although DGG+TUN presented higher MRC and CRC compared to SCTG+TUN in the treatment of MAGRs, treatment method was not a significant predictive factor for the amount of MRC outcomes while RD, KTH and GT were significant predictive factors.

Comparative assessment between bio-adhesive material and silk suture in regard to healing, clinical attachment level and width of keratinized gingiva in gingival recession defects cases.

The objective of this study was to compare the silk suture with a cyanoacrylate adhesive to stabilize the free gingival graft in conjunction with Er: YAG laser-assisted recipient site preparation to augment the keratinized tissue in gingival recession cases. This randomized trial comprised of 300 recession defects patients. All the included patients were diagnosed using Miller class I and II gingival recession defects classification. Group I sites were treated with a free gingival graft (FGG) harvested using an Er: YAG laser and further sutured with silk. Group II sites were stabilized with isoamyl 2 cyanoacrylate bio-adhesive material. Clinical parameters, such as gingival recession depth, clinical attachment level, gain in gingival tissue thickness, and width of keratinized gingiva were recorded at baseline, and at third month, sixth month, and 12th month postoperatively. The mean changes in gingival recession from months 3 to 6 and months and 6 to 12 were significant (p < 0.05) in both groups. However, the improvement in recession depth was better in group II than in group I. The mean change in clinical attachment level did not differ significantly between the groups at the different time intervals. However, values tended to be higher in group II than in group I. The width of the keratinized gingiva tended to be higher from baseline to 3 months, baseline to 6 months, baseline to 12 months, 3 to 6 months, and from 6 to 12 months in group II as compared with group I (p > 0.05). Cyanoacrylate could be used as a substitute to silk sutures to stabilize FGGs. Cyanoacrylate was easy to apply, consumed less operating time, and was considered equally efficacious for stabilizing FGGs.

Root coverage stability: A systematic overview of controlled clinical trials with at least 5 years of follow-up.

ObjectivesTo systematically assess the long‐term outcome (≥5 years) of root coverage procedures reported in controlled clinical trials.Material and MethodsLiterature search was performed according to the PRISMA guidelines with the following eligibility criteria: (a) English or German language; (b) controlled (CT) or randomised controlled clinical trials (RCT); (c) root coverage procedure with ≥5 years follow‐up; and (d) clinical treatment effect size and/or patient‐related outcome measures (PROMs) reported.ResultsFour CT and 14 RCT with a follow‐up of 5–20 years fulfilled the eligibility criteria; sample size per study ranged from 8 to 70 patients contributing with 18–149 sites. Coronally advanced flap (CAF) and CAF + connective tissue graft (CTG) were the prevalent treatments (i.e., in 24 and 38% of the groups, respectively), while other flap designs and adjuncts (i.e., enamel matrix derivative, bone graft, collagen membrane) were represented only once. For single Miller class I/II gingival recessions (GR), CAF + CTG appeared advantageous compared to other techniques, and provided low residual recession depths (i.e., ≤0.5 mm), and complete root coverage in ≥2/3 of the patients; similar tendency was observed for multiple GR. No data on Miller class III/IV GR is available. No meta‐analysis was feasible due to lack of similarity in the clinical and methodological characteristics across the trials and observed comparisons of interventions.ConclusionsCAF + CTG appears to be the ‘gold standard’ technique for the treatment of single and multiple Miller class I/II GR also in regard to long‐term (i.e., ≥5 years of follow‐up) treatment outcomes. There is little information regarding the performance, on the long‐term, of other techniques and adjuncts.

Periosteal pedicle graft with coronally advanced flap and its comparison with modified coronally advanced flap in the treatment of multiple adjacent gingival recessions-a randomized clinical trial

The present study aimed at evaluating clinical utility of periosteal pedicle graft with coronally advanced flap (PPG ​+ ​CAF) vs modified coronally advanced flap (M-CAF) in cases of multiple adjacent gingival recessions involving maxillary and mandibular anteriors labially. Random allocation of 40 patients with 269 gingival recessions was done into two groups. In Test group (20 patients) periosteal pedicle graft followed by coronally advanced flap (PPG ​+ ​CAF) technique was performed and in control group (20 patients) modified coronally advanced flap (M-CAF) was attempted. Primary outcome measures included percentage root coverage (PRC), gingival thickness (GT), probing depth (PD), clinical attachment level (CAL), recession depth (RD) and width of keratinized gingiva (WKG). Secondary outcomes measures were patient centred outcomes, plaque index (PI) and gingival index (GI). Patients were recalled at baseline, 3,6 and 18 months postoperatively. ResultsThere was a significant decrease in the mean recession depth from 3.58 ​± ​0.53 ​mm (baseline) to 0.22 ​± ​0.01 ​mm (18 months) in PPG ​+ ​CAF test group and 3.7 ​± ​0.56 ​mm (baseline) to 0.21 ​± ​0.01 mm (18 months) in M-CAF control group. With 85% root coverage in test group and 78% root coverage in control group, the difference was statistically significant at 18 months. The test group showed significant higher clinical attachment level gain and increase in width of keratinized gingiva as compared to control group. ConclusionIn both the study groups PPG ​+ ​CAF and M-CAF, significant root coverage was achieved. However, in terms of increase in width of keratinized gingiva, gingival thickness and percentage root coverage, PPG ​+ ​CAF group presented significantly better results than M-CAF group at 18 months follow up. Thus, periosteum can be used as a pedicle graft along with coronally advanced flap as an alternative method in achieving better results with minimal cost.

Comparative evaluation of vestibular incision subperiosteal tunnel access with platelet-rich fibrin and connective tissue graft in the management of multiple gingival recession defects: A randomized clinical study.

Background:The etiology of gingival recession is often multifactorial. Wide array of surgical techniques are available to manage gingival recession. The aim of the present study was to compare, minimally invasive approach (vestibular incision subperiosteal tunnel access [VISTA]), in combination with platelet-rich fibrin (PRF) and connective tissue graft (CTG) in the management of multiple recession defects in maxillary anterior region.Materials and Methods:A total of 32 sites from 10 systemically healthy controls were allocated randomly to VISTA with PRF (VISTA + PRF) and VISTA with CTG (VISTA + CTG). Plaque index, gingival index, Probing probing pocket depth (PPD), relative attachment level (RAL), recession depth (RD), recession width (RW), width of keratinized gingiva (WKG), and percentage of root coverage (%RC) were calculated at 6 months postoperatively.Results:Results showed significant improvement in mean PPD, RAL, RD, RW, and KTW. %RC in VISTA + PRF and VISTA + CTG was 83.25% ± 25.02% and 86.43% ± 22.79%, respectively, at 6 months. There were no significant differences in the parameters between the VISTA + PRF and VISTA + CTG groups.Conclusion:VISTA is a minimally invasive surgical approach, which can be combined with CTG or PRF in the management of Miller's Class I and Class II recession defects, with predictable outcomes. There were significant improvements in the clinical parameters from baseline to 6 months in both the groups. To match with the CTG, which is the gold standard procedure, PRF can be used as an alternative for treating multiple recession defects.

Autologous Platelet Concentrate of 2nd and 3rd generations efficacy in the surgical treatment of gingival recession: an overview of systematic reviews.

Background:Autologous platelet concentrate (APC)/platelet-rich fibrin (PRF) of second and third generations has increased use in periodontics to optimize wound healing. Few systematic reviews (SRs) have reported improved clinical outcomes, while other studies reported significantly better results for the connective tissue graft (CTG). There is still unclear clinical evidence about APC/PRF use to treat gingival recession (GR) defects. Then, the purpose of this SR was to evaluate the use of APC/PRF membranes (2nd and 3rd generations) in root coverage (RC) procedures and assess its efficacy as a substitute biomaterial.Materials and Methods:An electronic search was conducted in PubMed, Cochrane Central, Web of Science, Google Scholar, BookSC databases, and gray literature. The search strategy, without date restriction up to April 2020, included keywords as “platelet-rich fibrin,” “autologous platelet concentrates,” “blood,” “systematic review,” “periodontics,” “surgery,” “tissue,” “gingiva,” “gingival recession,” “connective tissue,” “graft,” and “root coverage.” The methodological quality was evaluated through the AMSTAR2, and a population, index test, comparator, outcome strategy was used to assess specific clinical parameters such as recession depth, clinical attachment levels, and RC outcomes.Results:Nine SRs were included. Only three articles described the technique of APC/PRF production. Three studies reported unfavorable outcomes using APC, while six reported favorable results and postoperative discomfort reduction. Articles included in this SRs that provided information about APC/PRF membranes (n = 13) showed no significant difference between APC/PRF and the control group for the parameters analyzed.Conclusions:This implies that APC/PRF may be considered a feasible substitute biomaterial for treating GR defects, although the CTG still provides superior outcomes. Further long-term and controlled studies are needed to verify this finding.

Comparative Evaluation of Connective Tissue Graft and Platelet Rich Fibrin for The Management of Gingival Recession: A Split Mouth Study in 40 Cases with Long Follow Up of 3 Years

Introduction: Periodontal problems have taken top priority for treatment in patients suffering from periodontal diseases including gingival recession. This study aimed to compare Connective Tissue Graft (CTG) along with Coronally Advanced Flap (CAF) versus Platelet Rich Fibrin (PRF) along with Coronally Advanced Flap (CAF) in 40 sites of miller’s class I and II recession sites over a period of 3 years. Materials and methods: 40 bilateral Miller's class I and class II gingival recession cases were selected for the study and divided into two groups. Group A was treated with PRF and CAF whereas Group B was treated with CTG and CAF. Following clinical parameters i.e., change in recession depth, change in probing depth, change in clinical attachment level, change in width of keratinized gingiva were assessed at baseline 3, 6 and 36-months post-surgery. Results: 1. Group A showed root coverage of 71.00% whereas in Group B it was 83.33%. Group B subjects showed clinically higher and statistically significant amount of root coverage as compared to Group A. 2. Group B was associated with better clinical outcomes in terms of keratinized tissue gain. Conclusion: Current study concludes that CTG along with CAF is a better option for root coverage procedure as compared to PRF along with CAF.

Clusters and the Great Recession

The depth of the Great Recession and the current COVID-19 crisis have increased the interest in the economic resilience of regions. This paper evaluates the role of clusters in the resilience of regional industry employment to economic downturns. Regions specialized in particular clusters (groups of closely related industries operating within a region) enjoy agglomeration economies that could mitigate the effects of recessions and the resulting increase in uncertainty. However, cluster specialization could also propagate negative shocks among related industries, increasing the impact of recessions. This paper explores these issues over the period of the Great Recession. Using a recently available set of cluster definitions (Delgado, Porter, and Stern, 2016), we examine annual employment growth in region-industries (6-digit NAICS) in the United States from 2003 through 2011. Overall, we find that larger regional industries experienced lower employment growth over the full business cycle, and this convergence effect was greater during the financial crisis. However, those industries located within a stronger cluster (in terms of employment, number of businesses, the presence of buyers and suppliers, and shared labor occupations) or a broader cluster (in terms of the number of specialized industries) experienced relatively higher annual growth from 2003 to 2011, and especially during the crisis. The benefits of location in a strong cluster were greater for supply chain industries (i.e., those that sell primarily to other businesses) than for business-to-consumer industries across the whole business cycle. These findings suggest that the strength and breadth of regional clusters improve the employment resilience of the constituent industries, with inter-firm, inter-industry linkages as a relevant source of resilience in the face of uncertainty. In contrast, large regional industries located in weak clusters were highly vulnerable to the Great Recession.

Periodontium and restoration

Background: Restorations have been known to have a detrimental effect on the periodontium with certain teeth or groups of teeth prone to develop more severe periodontal destruction. This study compared the periodontal health of restored molars with that of unrestored molars and determined the correlation between the type, age, and status of the restorations on the molars and the health of the associated periodontium. Materials and Methods: Patients with at least one restored molar and its contralateral counterpart of one unrestored molar were recruited for the study. The type of restoration and material, age of restoration, and type of defects on the restoration were noted in the restored group, while the degree of tooth mobility, furcation involvement, gingival recession, gingival status, and periodontal pockets depth were measured in all teeth studied. Data were analyzed using IBM SPSS version 21.0. Results: A total of 160 molars (80 restored and 80 unrestored molars) were studied. There were more restored mandibular molars (53.7%) than restored maxillary molars (46.3%). More first molars (43) compared to second molars (37) were restored. The most prevalent type of restoration was amalgam restoration (67.5%), followed by glass ionomer cement restoration (10%). There was no statistically significant association between the type of restoration and the periodontal clinical parameters assessed (P &gt; 0.05). Similarly, there was no statistically significant association between the class of the restoration whether Class I or II and the periodontal clinical parameters assessed. The restored molars had 3.2 (95% confidence interval [CI] 0.5–32.8) times the odds of bleeding on probing, 1.5 (95% CI 0.2–8.9) times the odds of having Grade 1 mobility, 2.1 (95% CI 0.5–10.0) times the odds of having Grade 1 gingival recession, and 1.5 (95% CI 0.3–9.2) times the odds of having Grade 1 furcation involvement than the unrestored. Conclusion: It can be concluded that there is no statistically significant difference in the health of the periodontium of restored and unrestored molars or correlation between the type, age, and status of the restorations on the molars and their periodontal health. The odds of having bleeding on probing, tooth mobility, gingival recession, and furcation involvement tends to be higher with the restoration of the molars.

Two-year follow-up of platelet-rich fibrin-reinforced and modified coronally advanced flap: Pinnacle of the regeneration milieu: Case series

Root coverage (RC) is a sine qua non for the restoration of periodontal vigor altered by the gingival recession (GR). The objective of this study was to clinically evaluate platelet-rich fibrin + coronally advanced flap (P-CAF) and novel platelet-rich fibrin + laterally slided coronally advanced flap (PLSCAF) procedures. RC is done using an assortment of biomaterials, even though they are overpriced and technique sensitive. The success of any autograft depends upon the survival of the same, which is determined by conducive healing. PRF has an edge for being autogenous, angiogenic, immunogenic, inexpensive, easily available, and lacks donor-site morbidity. This study was conducted on three middle-aged systemically healthy patients, one female and two males who had sufficient width, length, and thickness of keratinized tissue adjacent to isolated Miller's I or II GR. A significant improvement in recession width, depth, and gingival thickness was clearly delineated at the second year follow-up. We evinced expected positive outcome on all patients, besides a 100% RC with PLSCAF prowess. Within the limitation of this case series, P-CAF and PLSCAF demonstrated to be promising techniques when treating Miller's I or II GR. Nonetheless, embracing a four-pronged strategy for rapid healing is veritably demonstrated here.

T-gate ALGaN/GaN HEMT with effective recess engineering for enhancement mode operation

This paper reports, AlGaN/GaN HEMT device with Enhancement mode (Positive threshold voltage) operation achieved by Piezo neutralization layer (PNT) and T-Gate structure, along with gate recess engineering technique. The Proposed T-Gate structure HEMT device is analyzed with two different gate recess depths. Better results is obtained with 0.015 µm gate recess, showing double the time transconductance gm of 370 mS/mm compared with conventional AlGaN/GaN HEMT, Moreover positive Threshold Voltage +0.3 V is achieved without compromising ON-resistance RON = 0.00269 Ω. The TCAD simulation results evidence that proposed HEMT structure efficient in terms enhancement mode operation and device parameters than conventional HEMT.

A Comparative Evaluation of Silk Suture and Cyanoacrylate Adhesive in the Stabilization of Free Gingival Graft Harvested with Erbium: Yttrium-Aluminum-Garnet Laser: A Clinical Study.

Background:The most common technique for gingival augmentation is free gingival graft (FGG). The aim of this study is to clinically compare the efficacy of FGG harvested with erbium: yttrium-aluminum-garnet (Er: YAG) laser stabilized with 5-0 silk suture in comparison to N-butyl-2-cyanoacrylate tissue adhesive in increasing the width of keratinized gingiva (WK) for the management of Miller's Class I and II gingival recession.Methodology:Forty-eight gingival recession defects were divided into two Groups I and II. Group I sites were treated with FGG harvested using Er: YAG laser stabilized with 5-0 silk suture and Group II sites were treated with FGG harvested using Er: YAG laser stabilized with N-butyl-2-cyanoacrylate tissue adhesive. Clinical parameters such as gingival recession depth, clinical attachment level (CAL), gain in gingival tissue thickness, and WK were recorded at baseline and 3 and 6 months postoperatively.Results:A significant reduction in gingival recession defects, gain in CAL, increase in WK, and gain in gingival tissue thickness were observed in both the groups. Intergroup comparison of gingival recession defects, CAL, WK, and gingival tissue thickness yielded nonsignificant differences.Conclusion:Within the limits of this study, it can be concluded that both 5-0 silk suture and n-butyl-2-cyanoacrylate were equally efficacious in the stabilization of FGG. N-butyl-2-cyanoacrylate was easy to apply, consumed less operating time, and had no adverse effect. Hence, cyanoacrylate can be used as an alternative to suture in stabilization of FGG.

Creeping attachment after gingival augmentation using a free gingival graft. A case report

Introduction: Gingival recession presents an apical proliferation of the gingival margin to the cemento-enamel junction of the tooth and can be accompanied by aesthetics dissatisfaction and be associated with insufficient width of keratinized gingiva. Some surgical interventions are proposed for augmentation of gingival tissues when there is an insufficient width of keratinized gingival tissues. Such surgical approach is the use of a free gingival graft. This technique shows good results in gingival augmentation and treatment of shallow recessions with depth less than 3 mm. Aim: The aim of this case report is to demonstrate the creeping attachment of the gingival margin after use of a free gingival graft for augmentation of the width of keratinized gingival tissues on the vestibular side of the mandibular anterior area. Case Presentation: Lack of keratinized attached gingival tissues apically to the mandibular central incisors is established. A free gingival graft is used for augmentation of the width of the insufficient keratinized gingiva. Results : Three months after gingival augmentation with a free gingival graft, the reduction of the depth of gingival recessions was not significant. Compared to baseline, a significant increase in the width of keratinized attached gingiva was reported 6 months later. The depth of gingival recessions was reduced and gain of clinical attachment level was achieved on the vestibular side in both lower central incisors. Conclusion: The presented case report confirmed that, due to creeping attachment, a reduction of depth of gingival recessions and vestibular clinical attachment level gain were recorded after gingival augmentation with a free gingival graft.