Gingival Biotype Research Articles

Assessment of Gingival Biotype in the Esthetic Zone among Dental Students at University of Tripoli

The form and structure of the soft tissue and maxillary anterior teeth at the esthetic zone play an important role in determining the outcome. The gingival biotype is important because of the structural characteristics of the periodontics. This study targeted to determine gingival biotype prevalence and characteristics in the esthetic zone among Libyan dental students. A cross-sectional study was done for 220 students aged between 20 and 30 years. In the periodontal department, healthy periodontal tissues with no loss of attachment and the presence of all upper anterior teeth were selected. Clinically, gingival biotype was examined and recorded according to the transparency of the periodontal probe and visual inspection. The present study evaluated the frequency of gingival biotype and its association with gender and crown shape. All measurements were made for a total of students according to gingival transparency and were statistically evaluated. This study has shown that gingival biotype varies among different genders, ages, and tooth forms in our population. Understanding tissue biotypes can help dentists choose the correct dental treatment for better results.

The Efficacy of Leukocyte-Platelet-Rich Fibrin in Combination with Sub-Epithelial Connective Tissue Graft in Peri-Implant Soft Tissue Augmentation: A Randomized Controlled Clinical Trial

Aims and Background The aim of the current study is to assess and compare the efficacy of the leukocyte-platelet-rich fibrin [L-PRF] in combination with sub-epithelial connective tissue graft [SCTG] and SCTG only in promoting aesthetic results and strengthening the state of the soft tissue surrounding implants. Materials and Methods A parallel-arm randomized controlled clinical trial was used for this investigation. A total of 120 patients who had missing teeth with a thin gingival biotype [less than 1.5 mm] were included in this study. The patients of Group I were treated with PRF and SCTG during second-stage implant surgery, while the patients of Group II were treated with SCTG only. Treatment outcomes included the assessment of the width and thickness of the keratinized tissue at the baseline, 3 and 6 months postoperatively; pro- and anti-inflammatory cytokines [IL-1β, TNF-α, and IL-4] in the peri-implant crevicular fluid on the 1st, 7th and 30th days after surgical procedure; swabs from the surface of postoperative wounds of the mucous membrane on days 3, 5, 7, and 10; Pink aesthetic score [PES] 6 months after prosthesis placement; and laser Doppler flowmetry on days 1, 7, and 14 after augmentation. Results and Discussion Patients who received L-PRF+SCTG had a significant increase in keratinized tissue thickness [KTT] [p = 0.08] than those who received SCTG only [KTT 1.86 ± 0.17 Vs 1.48 ± 0.15] 6 months after surgery. The mean [±SD] of PES was found to be 13.1 [±0.02] for Group I and 11.3 [±0.08] for Group II. The cytology, LDF, and local immunoassay analysis demonstrated faster epithelialization and better revascularization in Group I. Conclusion The use of L-PRF and SCTG is an effective method in augmenting peri-implant soft tissue and improving gingival biotype and aesthetic outcomes, which would help overcome complications and increase patients’ satisfaction.

The Difference in the Morphometric Assessment of Gingival Biotype by Using Periodontal Probe Transparency Method and Photogrammetry

Objective: To evaluate the photogrammetric assessment of gingival biotype against the clinical gold standard method of probe transparency in terms of their consistency in assessment Study Design and Setting: Cross-sectional comparative; Periodontology Department, Institute of Dentistry, CMH Medical and Dental College, Lahore Methodology: The study targeted 149 adult subjects aged 18-30 years reporting to dental out patient department for routine dental treatment. A periodontal probe was inserted into the marginal gingiva of maxillary right central incisor and probe visibility through the gingival soft-tissues was judged. A probe visible through the tissues yielded thin gingiva and vice versa. For morphometric analysis, standardized clinical photographs were captured using digital DSLR camera. A photoshop software was used to measure crown width, crown height and papillary height for maxillary central incisor on all photographs. A crown width-to-height ratio >0.75 and a papillary height <4.5 mm indicated thick gingiva and vice versa. Data was analyzed via Statistical Package for Social Sciences version 24. Descriptive statistics were calculated. An inter-method reliability analysis using Cohen’s Kappa was performed to determine the consistency among the two methods in diagnosing gingival biotype. p=0.05 was taken as significant. Results: About 54.4% subjects were identified having a thin gingival biotype. A significant difference was observed between males and females as well as between age groups for gingival biotypes (p<0.001). Using Cohen’s Kappa, a “perfect agreement” between probe transparency and photogrammetric methods was observed (ê = 1, p<0.001) Conclusion: Photogrammetry offers a reliable and noninvasive method for evaluation of gingival thickness

Effect of zirconia personalized gingival penetration on peri-implant soft and hard tissue of thin gingival biotypes in the anterior region: a retrospective study

Objective: To investigate the effect of zirconia personalized gingival structure on peri-implant soft and hard tissue stability after single-tooth implant restorations in patients with thin gingival biotypes in the anterior region, with a view to provide a clinical guideline. Methods: This retrospective study included 20 patients with thin gingival biotype and implant restorations in the anterior region. These patients included 9 males and 11 females, and the age was (35.2± 10.3) years. The patients were from the Department of Periodontal Implantology, Stomatology Hospital, Southern Medical University from January 2018 to December 2022. Computer-aided design/computer-aided manufacturing (CAD/CAM) techniques were used to fabricate a titanium base zirconia personalized gingival structure to maintain the soft-tissue perforated gingival contour of the anterior esthetic zone. This structure consists of two modalities: titanium base + zirconia outer crown or titanium base personalized zirconia abutment + zirconia outer crown. Clinical outcomes were recorded immediately and after delivery of the final restorations. Implant retention was recorded, esthetic scoring was performed using the pink esthetic index, the amount of bone resorption at the implant margins was measured based on digitized apical radiographs, and periodontal health was evaluated using the modified plaque index and the modified bleeding index. Results: The survival rate of the 20 implants was 100% after 3 years of wearing the final restorations, with a pink aesthetic score of 9.3±0.9. Bone resorption at the proximal and distal mesial margins of the implants was 0.09 (-0.21, 0.20) mm, 0.17 (-0.12, 0.27) mm after 3 years, respectively, and the difference was not statistically significant when compared to bone resorption immediately after placement of the final restoration [0(0, 0) mm] (Z=-1.03, P=0.394; Z=-2.05, P=0.065). Conclusions: Zirconia personalized gingival structure maintains the stability of peri-implant hard and soft tissues of thin gingival biotypes in the anterior region.

Correlations of gingival biotype with clinical crown and periodontal parameters in maxillary and mandibular jaws.

The gingival biotype (GB) influences treatment planning and clinical outcomes in several dental specialties. This study aimed to investigate the associations between the GB and various clinical crown and periodontal parameters, such as probing depth (PD), papillary height (PH), keratinized tissue width (KTW), crown width/crown length ratio (CW/CL), and gingival thickness (GT). The secondary objective was to evaluate the optimal cutoff values for all parameters to determine the GB in both the maxillary and mandibular anterior teeth. This cross-sectional study included 50 healthy individuals (26 men and 24 women) aged between 20 and 35 years. The GB was determined as a binary variable based on the transparency of a periodontal probe through the buccal gingival margin (TRAN). The clinical crown and periodontal parameters, such as PH, PD, KTW, GT (free gingival thickness [FGT] and attached gingival thickness [AGT]), and the CW/CL ratio were measured. The associations between different variables were evaluated by the chi-square test. Correlations between various clinical parameters and GB were assessed using point-biserial correlation analyses. Receiver operating characteristic (ROC) analysis and the Youden index were used to calculate the optimal cutoff values for the PH, PD, KTW, FGT, AGT, and CW/CL ratio to discriminate GB. The statistical significance level was set at p <0.05. The mean age of the males was 28.23±2.81 years, while that of the females was 27.08 ±2.85 years. Thick GB was present in 56% of individuals, and thin GB was present in 44% of individuals. Compared with females, males had a predilection for thick GB compared with females. According to the ROC analysis, the cutoff values to discriminate GB for mandibular anterior teeth were 3.4mm for PH, 1.96mm for PD, 4.21mm for KTW, 0.98mm for FGT, 0.43mm for AGT, and 0.91 for the CW/CL ratio. Similarly, the cutoff values for discriminating the GB for maxillary anterior teeth were 4.02mm for PH, 1.92mm for PD, 3.89mm for KTW, 1.02mm for FGT, 0.42mm for AGT, and 0.83 for the CW/CL ratio. PH, PD, and FGT showed strong positive correlations with GB, whereas KTW, AGT, and the CW/CL ratio showed weak positive correlation with GB. Within the limitations of the present study, a significant association between all clinical crown and periodontal parameters with the GB has been confirmed. FGT for mandibular anterior teeth and PH for the mandibular anterior teeth have emerged as the most reliable measurements to differentiate between thick and thin GB based on ROC analysis. All the clinical parameters such as papillary height, probing depth, width of keratinized gingiva, gingival thickness, and crown width/height ratio were significantly associated with gingival biotype. Free gingival thickness for mandibular anterior teeth and papillary height for the maxillary anterior teeth have emerged as the most reliable measurement to differentiate between thick and thin gingival biotypes.

Altered Passive Eruption among Patients Visiting Dental Outpatient Department in a Tertiary Care Center: A Descriptive Cross-sectional Study.

The eruption of teeth is considered to be a continuous phenomenon. Two types of eruption are possible namely, active and passive eruption. Failure in passive eruption (by the apical movement of gingiva from the enamel surface) generally results in a clinical condition known as altered passive eruption. It can result in the shortened crown height of a tooth and an esthetically unpleasant situation i.e., excessive gingival display or gummy smile. The main motto of this study was to find out the prevalence of altered passive eruption and associated gingival biotypes in adult patients visiting for dental treatment in tertiary centers along with strategically placed outreach centers. A descriptive cross-sectional study was done in the Department of Dentistry, Dhulikhel Hospital, and four outreach centers of the same hospital. The study was conducted from October 2022 to April 2023 after obtaining the ethical approval. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Among 165 patients, the prevalence of altered passive eruption was 21 (12.72%) (7.62-17.78 at 95% Confidence Interval). Furthermore, among 21 patients, the altered passive eruption was seen in the thick biotype patients in 16 (76.19%) and thin biotype patients in 5 (23.81%). The prevalence of altered passive eruption appeared to be equivalent when compared with the previous studies.

ВЛИЯНИЕ РЕВМАТОИДНОГО АРТРИТА НА ТЕЧЕНИЕ ЗАБОЛЕВАНИЙ ПАРОДОНТА

The most common chronic systemic autoimmune disease of connective tissue is rheumatoid arthritis, the incidence of which is up to 50% (in Russia). The etiology of rheumatoid arthritis is still not known for certain. Scientists pay special attention to searching and studying the factors influencing the occurrence of this disease. Researchers are interested in periodontitis as a likely factor in the development of rheumatoid arthritis. The literature presents limited data on the study of the characteristics of the course of dental diseases in patients with rheumatoid arthritis, which indicates the need for further study of this issue and clarification of the relationships between the intensity of caries, the condition of periodontal tissues and the temporomandibular joint in this category of patients. The study of these issues is of scientific and practical interest, as it allows us to improve the methods of diagnosis and monitoring of patients with rheumatoid arthritis by a dentist. The purpose of this study is to determine the effect of rheumatoid arthritis on the course of periodontal diseases. Materials and methods. The methodology of the scientific research is based on the analysis of domestic and foreign literature in the eLIBRARY databases; basic and additional methods of examining the patient were carried out. During the clinical examination, we assessed the general condition of the patient with rheumatoid arthritis, his dental and periodontal status. Results and discussion. A clinical examination of a patient with somatic pathology was carried out. Microorganisms of periodontal pockets were determined, the data obtained were compared with a patient who does not have a systemic disease. Conclusions. Patients with rheumatoid arthritis generally have a thin gingival biotype. Immunological parameters of oral fluid (IgA) in rheumatoid arthritis decrease, which indicates a lack of local and general immunity and leads to damage to periodontal tissue. In the future, this scientific research will help us develop optimal methods for diagnosing and treating patients with autoimmune disease.

Gingival Biotype: A Key to Successful Aesthetics–Its Role and Functions–Observation-Based Research

To achieve primary implant stability and enhance bone-to-implant contact, implant dentistry has seen significant advancements. The emphasis is now on developing an aesthetic restoration that blends in with natural teeth and is long-lasting. Patients now have higher expectations for improved aesthetics due to dental treatment advancements in implant and perioplastic surgery. Planning the best course of action for periodontal and implant therapy involves considering how predictable post-operative outcomes will be. Therefore, a thorough comprehension and examination of the surrounding tissues is required. The long-term success of aesthetic restorations is influenced by a number of variables, including gingival phenotype, gingival tissue architecture, and anterior tooth shape. Therefore, determining the gingival tissue biotype accurately is crucial to developing a suitable treatment strategy and obtaining a predictable aesthetic result. As a result, this study demonstrates how important gingival biotype is to the success of implants.

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

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

Association between Gingival Phenotype and Periodontal Disease Severity-A Comparative Longitudinal Study among Patients Undergoing Fixed Orthodontic Therapy and Invisalign Treatment.

This longitudinal study aimed to compare the association between gingival phenotype (thin vs. thick) and periodontal disease severity in patients undergoing fixed orthodontic therapy (FOT) and Invisalign treatment over a six-month follow-up period. Clinical periodontal parameters, including full mouth plaque score (FMPS), full mouth bleeding score (FMBS), gingival index (GI), probing pocket depth (PPD), clinical attachment loss (CAL), gingival recession (GR), keratinized tissue width (KTW), transgingival probing, and gingival biotype assessment, were recorded at baseline and 6 months into treatment for both orthodontic groups and a control group. Statistical analysis evaluated differences in parameters between groups and across time points. In the thick phenotype, both Invisalign and FOT groups showed a significant mean reduction in FMPS (baseline to 6 months) by -24.8707 and -12.3489, respectively (p < 0.05). The gingival index decreased significantly for both groups, with Invisalign and FOT showing reductions of -0.83355 and -1.10409, respectively (p < 0.05). FMBS (baseline to 6 months) decreased significantly for Invisalign and FOT, with mean differences of -9.10298 and -12.6579 (p < 0.05). Probing pocket depth (baseline to 6 months) was also significantly reduced for both Invisalign and FOT groups while CAL showed non-significant differences in both groups (p > 0.05). Similar changes were seen in the thin phenotype too. This study highlights the positive influence of both Invisalign and fixed orthodontic therapy on periodontal health, particularly in patients with thin and thick gingival biotypes. These findings, with significant reductions in key periodontal parameters, offer valuable insights to guide orthodontic treatment decisions and enhance patient outcomes.

The Use of Injectable Platelet-Rich Fibrin As an Alternative Treatment for Interdental Papilla Reconstruction in Black Triangle Case

Introduction: Interdental papilla is triangular soft tissues that fill the gaps between teeth andfunction as protective periodontal tissues and are important in terms of aesthetics, ifinadequate, they will form black triangles, which are blackish areas between teeth. Non-surgical treatment of black triangle is preferred by patients as it is painless. Injectable Platelet-Rich Fibrin (i-PRF) is a platelet concentrate derived from the patient&amp;#39;s blood that does notcause immunological reactions and contains growth factors for remodeling the interdentalpapilla. Case Report: A 20-year-old female patient, systemically healthy, came to Prof.Soedomo UGM Dental Hospital with complaints that the gums of the middle part of her upperteeth had a blackish area and disturbed her confidence. An objective examination was carriedout including, gingival biotype, black triangle area, and radiographs, so it was concluded thatthe black triangle was classified as class I Nordland and Tarnow and interdental papillareconstruction to correct the black triangle could be planned. The patient refused surgery so i-PRF can be used as an alternative non-surgical treatment. The black triangle closed completelyafter the i-PRF injection was given. Discussion: I-PRF has the ability to accelerate cellproliferation and migration as well as angiogenesis so that it can modulate fibroblastregeneration in the interdental papilla area. Conclusion: The use of i-PRF can be an alternativenon-surgical option for the treatment of interdental papilla reconstruction.

Comparison of crestal bone loss and papilla fill after conventional and immediate implant placement: A 12 month clinical and radiographic prospective study

Background The problem of missing teeth persists in all age groups. The main objective of implants in dentistry is to provide a restoration that reconstructs the shape and restores esthetics and functions of edentulous areas. The objectives of this study are to compare the crestal bone level changes and papillary fill after placement of implants in fresh extraction socket, i.e. immediate implant placement, and healed extraction socket, i.e. delayed or conventional implant placement, and to assess other clinical parameters such as modified plaque index (mPI), modified gingival index (mGI) and gingival biotype in between the groups and within the groups. Methods 18 patients were recruited in the study out of which 9 patients received implants as per immediate implant placement protocol (group 1) and 9 patients received implants as per conventional implant placement protocol (group 2). All patients were evaluated for gingival biotype, mPI and mGI and papillary fill was assessed as per Jemt’s papilla score as clinical parameters. Implant site was assessed for radiographic bone loss using Image J software. Statistical analysis was performed using independent t test, paired t test and chi square test. Results At the end of 1 year, results showed that crestal bone loss was seen more in the immediate group than the conventional group. Conventional implants showed better papillary fill than implants placed in fresh extraction sockets. Plaque scores were assessed as per modified plaque index, which showed better results in the conventional group. Modified gingival index was used to assess gingival status which showed better results in the immediate group one year later. Conclusions Findings from the study suggest that crestal bone loss was found to be increased in the immediate group than the conventional group and papillary fill was better in the conventional group than the immediate group. Registration: CTRI (CTRI/2019/09/021340).

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.

Influence of connective tissue grafts on implants in the aesthetic area: A systematic review. Are connective grafts essential?

Achieving adequate aesthetics with implants in the anterior sector continues to be a challenge. One of the most studied and currently used techniques is the use of autologous connective tissue grafts to improve the peri-implant soft tissues in this area. Our objective is to analyze whether these techniques have a predictable impact on the tissues and aesthetics; and if it is worth performing them. A bibliographic search was carried out, including different digital portals. A total of 8 articles were analyzed. This procedure did not have an impact on the hard tissue but did have an impact on gingival recessions and soft tissue thickness. Regarding aesthetics, the results are controversial. It seems that they can slightly improve the PES (Pink Esthetic Score or Pink Index). Also, a negative impact on the texture of the soft tissue has been found. It is necessary to individualize each case (especially depending on the gingival biotype) since taking a connective tissue graft from the palate entails discomfort for the patient, and this technique is not free of complications. Key words:Dental implants, aesthetics, connective graft.

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.

The Effectiveness of Autogenous Dentin Graft as a Biomaterial in Optimizing the Esthetic Outcomes of Immediate Dental Implants: A Prospective Clinical Study

Background: Immediate implant placement in the maxillary anterior region was challenging, especially with the jumping gap and limited primary implant stability. Objective: To assess the autogenous dentin graft biomaterial's ability to improve the esthetic outcomes of an immediately inserted implant. Methods: Twenty patients with non-restorable retained roots in the maxillary non-molar region surrounded by natural sound teeth were included in this study after a complete clinical and radiological examination, including patient health and clinical fitness for the immediate dental implant procedure. A single dental implant was inserted for each patient, and the resulting jump distance was filled with the mineralized dentin graft and covered by gel foam with the figure of eight suturing. The Pink Esthetic Score index of the implant-supported prostheses was evaluated six months after the initial surgery. Results: Twenty eligible patients were included in this study. The assessment of the clinical measurements of the alveolar ridge width and gingival biotype before surgical intervention and after 6 months showed no significant differences between them. The mean Pink Esthetic Score (PES) was 7.75. Only two patients achieved a total esthetic score of 10; another three patients had a score of 8, four with a score of 7, and the rest with a score of 6. Conclusion: An autogenous dentine graft effectively achieves acceptable esthetic results with an isolated immediate dental implant inserted in the anterior maxillary area.

Comparison of Clinical Efficacy of Bio-Resorbable Xenogeneic Peritoneal Membrane with Connective Tissue Graft in the Management of Gingival Recession Defects: A Randomized Controlled Clinical Trial.

This randomized controlled trial was aimed to determine the clinical efficacy of xenogeneic collagen membrane derived from porcine peritoneum (XCM) in combination with a coronally advanced flap (CAF) in the management of gingival recession defects and to compare the outcomes to those of connective tissue graft (CTG). 12 systemically healthy individuals presenting with 30 isolated/multiple Cairo's RT 1/2 gingival recession defects in maxillary canines and premolars, were randomly treated either with CAF+XCM or CAF+CTG. Recession height (RH), gingival biotype (GB), gingival thickness (GT), width of keratinized gingiva (WKG) and attached gingiva (WAG) were recorded at baseline, 3, 6 and 12 months. Patient perception for pain, esthetics and modification of root coverage esthetic score (MRES) were also documented. From baseline to 12 months, both groups showed a significant reduction in mean RH (CAF+CTG: 2.73±0.79mm to 0.33±0.61mm and CAF+XCM: 2.73±0.88mm to 1.20±0.77mm). At 12 months, CAF+CTG sites had a MRC of 85.60±28.74%, whereas CAF+XCM sites had a MRC of 55.13±31.22%. CAF+CTG treated sites had significantly better outcomes, with greater number of sites achieving complete root coverage (n=11) and higher MRES scores than porcine peritoneal membrane group (P<0.05). Int J Periodontics Restorative Dent. doi: 10.11607/prd.6232.

Oral health, periodontal phenotype in patients with different mineral density (morphotypes) of bone tissue

Background. Studying the systemic influence of bone mineral density (BMD) and bone turnover on oral health and periodontal phenotype is relevant for predicting the course of periodontitis and making clinical decisions to achieve good treatment results. The purpose of the research is to study the oral health, periodontal phenotype, and bone metabolism depending on the BMD of the skeleton. Material and methods. One hundred and thirty-eight patients were examined and divided into three study groups depending on the BMD (Z-score): group І — increased BMD ­(Z-score &gt; +1 SD), group ІІ (Z-score from +1 to –1 SD), group ІІІ (Z-score &lt; –1 SD). The state of oral health, the severity and course of periodontal diseases, the peculiarities of bone metabolism according to biochemical markers of bone remodeling, and the BMD according to the results of dual-photon densitometry were determined. Results. Reduced bone turnover, resulting in decreased serum osteocalcin (18.96 ± 1.87 ng/ml in men and 19.11 ± 1.54 ng/ml in women), high level of parathyroid hormone was registered in patients with high BMD (group I). The oral health characteristics were identified, namely, the pathological tooth wear — abfraction (84.21 %) and attrition (76.31 %), the periodontal phenotype was characterized by a thick gingival biotype, mandibular exostoses, periodontitis and periodontitis were diagnosed. Increased bone turnover, active course of generalized periodontitis, thin gingival biotype, cervical caries and hyperesthesia of the dental hard tissues were registered in patients with low BMD (group III). Conclusion. The state of oral health, namely, the dental hard tissues, the periodontal phenotype has its own characteristics and are related to the morphotype of bone tissue — its BMD and bone metabolism. Such features must be taken into account when planning treatment measures for dental patients.

Occlusal Contact Changes With Traumatic Occlusion After Orthodontic Treatment: A Prospective Study

Aim: The aim of this study was to evaluate trauma from occlusion in patients undergoing orthodontic treatment through assessment of fremitus, pocket depth, gingival biotype, and occlusal contacts pre-orthodontic treatment (T0) and post-orthodontic treatment (T1). Materials and Methods: This prospective randomized trial included 40 participants selected based on a simple random sampling method, of which 27 were women and 13 were men with ages ranging from 25 to 40 years. All the participants were clinically checked for gingival recession, fremitus, pocket depth, gingival biotype, and occlusal contacts obtained via digital intraoral scans and fed to 3Shape software to perform the occlusal mapping analysis for pre-orthodontic treatment (T0) and post-orthodontic treatment (T1). T-Scan occlusal analysis was performed to check the force levels pertaining to each tooth. A paired t-test was done to find out the changes in fremitus, pocket depth, gingival biotype, and number of occlusal contacts between T0 and T1. Results: Results of paired t-tests showed a statistically significant difference for fremitus between T0 and T1 ( p &lt; .05). Gingival biotype and pocket depth did not show any improvement post-orthodontic treatment (T1) ( p &gt; .05). Number of traumatic occlusal contacts reduced at T1 for incisors and canines showing a statistically significant difference between T0 and T1 ( p &lt; .05). Conclusion: Orthodontic treatment helps in relieving the traumatic occlusal contacts, especially in the incisors and canine regions. As the teeth are relieved from traumatic occlusal contacts, fremitus also has shown to have drastically improved at the end of orthodontic treatment. Gingival biotype and pocket depth might take a longer time to regenerate and improve, which requires long-term observation.

Influence of ternion of soft tissue attributes on gingival recession and root coverage outcome – A retrospective analysis

The independent influence of Keratinized Tissue Width (KTW) and Gingival Biotype (GB) on root coverage outcomes have been reported over the years. These parameters along with Recession Depth (RD) might act as a triad and assessing this ternion would be beneficial in determining prognosis and devising treatment plan for gingival recession. The aim of this retrospective analysis is to evaluate a possible association between KTW, GB and RD and their influence on Gingival Recession and root coverage outcome.45 isolated gingival recession defects were assessed for KTW (&amp;#60;2mm, &amp;#62;2mm), GB (thin vs thick) and RD (1-4mm). Primary outcome was to establish an association between the above-mentioned parameters. Secondary outcome was to find the percentage Root Coverage (%RC) obtained after coronally advanced flap procedure. To evaluate the relationship of KTW vs GB, GB vs RD and KTW vs RD, chi-square test was used. To analyse the intra-parametric correlation and the association between all three parameters, Pearson correlation test and ANOVA were carried out respectively.The Chi-square test results revealed a statistically significant association of p&amp;#60;0.03 for the relationship of KTW vs GB and GB vs RD and p&amp;#60;0.001 for KTW vs RD. Pearson correlation test showed a positive correlation between KTW and GB (.320), negative correlation between GB and RD (-.046), and KTW and RD (-.136). ANOVA showed a p-value of 0.041 inferring that any change in KTW and GB significantly influenced RD. Sites with &amp;#60;2mm KTW, thin GB and deeper RD, which can be referred to as negative ternion, exhibited 43.8% mean RC while sites with &amp;#62;2mm KTW, thick GB and shallow RD, which can be referred to as positive ternion had 94.7% mean RC. There is a definitive association between Keratinized Tissue Width, Gingival Biotype and Recession Depth. A ternion of these parameters greatly influences the outcome of root coverage procedures.