Gingival Phenotype Research Articles

Gingival Phenotype and its Role in Dentistry

Diş eti taşıdığı kendine has özellikleri ile oral yapının önemli temel yapı taşlarından birini oluşturmaktadır. Literatür incelendiğinde diş eti fenotipinin farklı şekillerde tanımlandığı görülmektedir. Her tanımlamanın kendine has özellikleri ve kendine has avantaj ve dezavantajları vardır. Bu tanımlama girişimsel ve girişimsel olmayan yöntemler ile yapılmaktadır. Klinikte izlenen diş eti yapısının beraberinde getirdiği olumlu-olumsuz yönleri bulunmaktadır. Diş eti yapısı; yaş, cinsiyet, alveoler kemik yapısı, diş yapısı, yüz yapısı, ortodontik durumlar gibi durumlarda değişiklik göstermektedir. Ama halen birçok konuda ve terminolojide bir görüş birliği sağlanamamıştır. Periodontal, restoratif, protetik ve implant uygulamalarında diş eti yapısı önem kazanmaktadır. Bu derlemede diş eti fenotipi tartışılacak olup, fenotipin klinik uygulamalarda oynadığı rol üzerinde durulacaktır.

Gingival Phenotype Changes and the Prevalence of Mucogingival Deformities during the Early Transitional Dentition Phase-A Two-Year Longitudinal Study.

Thin gingival phenotype (GPh) may contribute to periodontal tissue breakdown and recession development. Thus, the early identification of thin GPh in children can allow proper preventive care and the identification of children at risk during orthodontic treatment. The present long-term study aimed to monitor GPh changes, i.e., thickness (GT) and width of attached gingiva (AGW) during the early transitional dentition phase, as well as its potential associations with the mucogingival deformities. Materials and Methods: 83 systematically healthy children were examined twice with an interval of 2 years. Probing depth, GT and AGW at mandibular incisors, vestibular depth, type of lower lip frenum attachment and mucogingival defects were recorded. Results: 95.2% of participants at baseline and 93.9% at 2-year examination expressed thin GPh. During the transition from the deciduous to permanent dentition, GT and AGW declined, but the GT of permanent incisors already erupted at the baseline examination increased in the observation period. Conclusions: Gingival phenotype undergoes changes in the early transitional dentition phase. In spite of the thin gingival phenotype, only single pseudo-recessions and primary shallow vestibule were noticed.

Perceptions of NZ orthodontists and periodontists on the management of gingival recession in orthodontic patients.

This study aimed to investigate the perceptions and opinions of orthodontists and periodontists on the management of gingival recession in orthodontic patients. An online survey was sent to 29 periodontists and 80 orthodontists registered and currently practising in New Zealand. All participants answered questions about the timing and clinical indications of mucogingival surgeries in orthodontic patients diagnosed with mucogingival deformities. Most periodontists and orthodontists believed that gingival grafts should ideally be performed after orthodontic treatment. In clinical practice, 40% of periodontists indicated that they would receive referrals after completion of orthodontic treatment. However, 29.6% of orthodontists indicated that they would refer to a periodontist before orthodontic treatment in clinical practice. The most crucial factor that affected periodontists' decision-making was 'evidence-based guidelines' (35.0%), followed by 'clinical experience' (30.0%) and 'patient concerns' (15.0%). All four factors of 'gingival phenotype', 'presence of gingival recession', 'amount of keratinised tissue' and 'planning specific tooth movements' were equally considered by orthodontists regarding their decision-making. The majority of the surveyed New Zealand periodontists and orthodontists expressed a belief that the ideal timing for the management of gingival recessions would be after the completion of orthodontic treatment.

Gingival Recessions and Periodontal Status after Minimum 2-Year-Retention Post-Non-Extraction Orthodontic Treatment

The objectives of this study were to assess gingival recessions (GR) and periodontal status in patients previously treated with non-extraction orthodontic treatment and retention at a follow-up of a minimum of two years after the end of treatment. Data from patients aged between 16 and 35 years with a previous non-extraction orthodontic treatment and at least 2 years of retention and full records before and after treatment were collected. The casts were digitalized using the 3Shape TRIOS® intraoral scanner and the Viewbox4 software was used for the measurements. The following parameters were scored: inclination of the lower and upper incisors (IMPA and I^SN) and anterior crowding (Little index). The included patients were recalled for a clinical periodontal follow-up examination and the following parameters were evaluated: buccal and lingual GR (mm) of incisors and canines, bleeding of probing score, plaque score, and gingival phenotype. The digital cast analysis showed a mean Little index of 7.78 (SD 5.83) and 1.39 (SD 0.79), respectively, before and after treatment. The initial and final cephalometric analyses showed an I^SN of 103.53° and 105.78° (SD 7.21) and IMPA of 91.3°and 95.1°, respectively. At the follow-up periodontal visits, the patients showed an overall low oral hygiene with bleeding at probing in 66.6% and plaque in the anterior area in 76.2% of patients. From the total examined 240 teeth of the frontal sextants, three patients had GR (from 1 to 6.5 mm): in the upper arch two at canines and one at central incisor, whereas in the lower arch two at central and one at lateral incisors. The gingival phenotype was thick in 55% of cases. The lingual-to-lingual retainers at follow-up were present in 61.9% of patients. A slight increased risk for buccal GR development was found only in correlation with the presence of fixed retainer and thin gingival phenotype mainly in patients with gingivitis. Thus, non-extraction orthodontic treatment performed with controlled forces and biomechanics seems to not affect the development of GR or the periodontal health after retention.

Assessment of the effect of orthodontic treatment on the stability of pre-orthodontic recession coverage by connective tissue graft: a randomized controlled clinical trial.

To compare the changes in periodontal parameters after orthodontic treatment in patients having isolated gingival recession treated with and without pre-orthodontic gingival recession coverage. Thirty-six patients requiring orthodontic treatment with a facially positioned mandibular anterior tooth with labial recession were randomly allocated to either test group: root coverage by subepithelial connective tissue graft (SCTG) followed by orthodontic treatment, or control group (orthodontic treatment only). Primary clinical parameters included recession depth, keratinized tissue width, root coverage, root esthetic score, and gingival phenotype. The patients were followed up for at least 1 year. Level of gingival margin attained in test group teeth after SCTG were maintained at end of orthodontic treatment (P = .727). Root coverage achieved was 69.33 ± 30.74% versus 22.36 ± 27.70% in test and control group, respectively (P = .000), and gain in keratinized tissue width was 1.59 ± 0.73 mm in test versus 0.41 ± 0.49 mm in control group (P = .000). The number of teeth with improved gingival phenotype and decreased hypersensitivity was also observed to be statistically significant in the test group (P = .049, P = .002). Root coverage procedure may be performed before the planned orthodontic treatment as graft stability is preserved throughout the course of orthodontic treatment.

English

The success of dental implant depends on its integration with the surrounding tissue and this is influenced by various factors, like implant material, amount of bone and its quality and the implant loading condition. The peri-implant tissue is comprised of the soft (mucosa) and hard (bone) tissues. Absolute contact between the peri-implant bone and the implant surface is another factor essential for the success of any implant system. The direct structural and functional connection between ordered living bone and the surface of a load-carrying implant is defined as ''Osseointegration''. The bone undergoes remodelling so as to maintain bone strength and mineral homeostasis. The preservation of biological seal, the anatomy and quality of bone where implant needs to be positioned, implant macrostructure are some of the factors that dictate the integration of the implant to the hard tissue. In addition, the gingival morphology also plays an important role in determining the final aesthetic outcome. Gingival morphology is described in terms of gingival phenotype or gingival biotype. ‘‘Gingival phenotype’’ is a term that addresses to the variations in the thickness and width of the keratinized tissuewhereas ''Gingival biotype'' depicts the thickness of the gingiva in the facio-palatal / faciolingual dimension.Inadequate gingival thickness is a major reason for periodontal attachment loss and marginal tissue recession in a patient, directly contributing to the periodontal disease progression. The peri-implant soft tissue consists of a junctional epithelium (JE) and the connective tissue but owing to the biologic differences between the peri-implant and periodontal tissues, the periimplant tissues are more vulnerable to mucosal inflammation and bone loss. The health of the peri–implant tissues play an important role in the long-term outcome of dental implants. The preservation and reconstruction of soft tissue around dental implants is an important aspect of dental implantology. Restoring the function, aesthetics and harmony of dentition is the primary intention of implantology. This is achieved with a sound crestal bone stability and healthy peri-implant soft tissue. Other factors like abutment material and its connection to the implant, the neck design also affects the peri-implant soft tissue integrity. This review discusses the various factors that directly and indirectly influence the aesthetic outcomes following a dental implant placement. KEY WORDS Aesthetics, Peri-Implant Tissue, Osseointegration, Platform Switching

Effectiveness of acellular dermal matrix graft with a coronally advanced flap for the treatment of Miller Class I/II single gingival recession with thin gingival phenotype: study protocol for a split-mouth randomised controlled trial

IntroductionGingival recession is one of the most common mucogingival deformities requiring surgical correction. The American Academy of Periodontology Regeneration Workshop recommended connective tissue graft (CTG) combined with coronally advanced flap...

'Combined endo-perio lesions' - what is the best treatment?

Aims To assess the radiographic and periodontal healing of combined endo-perio lesions in anterior teeth treated with orthograde root canal treatment (RCT), with and without guided tissue regeneration (GTR) and bone grafting.Sample selection A total of 120 individuals attending the Dental University Hospital in Riyadh, Saudi Arabia, diagnosed with true combined endo-perio lesions were selected. Inclusion criteria included being between 25 and 55 years old and having a single-rooted non-vital maxillary anterior tooth with a true combined endo-perio lesion, assessed using a cone beam computed tomography (CBCT) scan. Exclusion criteria included uncontrolled systemic disease, a history of oral cancer or sepsis, recent use of antibiotics, the use of bone metabolism modifying drugs and the presence of fractures, resorption or associated pathological cysts. Power calculations were used to set a minimum sample size of 120 teeth.Design A randomised controlled trial involving four treatment arms: root canal treatment (RCT) with gutta percha (GP) obturation; RCT with mineral trioxide aggregate (MTA) obturation; RCT with GP obturation and guided tissue regeneration (GTR); and RCT with MTA obturation and GTR. Participants were randomly assigned using computer software to each treatment arm via block randomisation.Baseline periodontal measurements (gingival phenotype, keratinised tissue width, pocket depth and clinical attachment level) and a CBCT scan to obtain a CBCT periapical index (CBCTPAI) score were taken at visit one. Visit two involved scaling, root planing and a RCT performed using hand files and a thermoplastic obturation technique for the GP obturation arm (Obtura II, Obtura Spartan, USA) and vertical compaction for the MTA obturation arm (ProRoot White, Dentsply, USA). Visit three (for the GTR and bone-grafting arms), one week later, included regenerative periodontal surgery - raising a three-sided buccal flap, removal of granulation tissue, filling the defect with demineralised, freeze-dried bone allograft, coverage with a resorbable collagen membrane and closure with resorbable sutures. Visit two was performed by a single endodontist and visit three, for the GTR and bone grafting arms, was performed by a single periodontist. Previous or future planned treatment was concealed to operators and they were only informed of the treatment to be performed on the day. All teeth received definitive restorations.The follow-up schedule was one, three, six and twelve months post-treatment. CBCT scans were repeated at six and twelve months; clinical periodontal measurements were repeated at three, six and twelve months.Data analysis Descriptive analysis was performed and results were presented as cross-tabulations and a bar chart. Inferential statistics were used; one-way analysis of variance with Tukey's multiple comparison test to compare the mean value of measurements between treatment arms at follow-up visits and Kruskal-Wallis test to compare mean CBCTPAI scores between arms at follow-up visits. The p-value was set at ≤0.05.Results Baseline comparison showed no statistically significant differences between treatment arms. No participants were lost to follow up. At 12 months, GTR showed improved healing, with 98% of cases showing CBCTPAI scores better than 1, compared to 100% cases scoring 1 + D or worse without GTR. Statistically significant differences were found between treatment arms with respect to CBCTPAI score and pocket depth at 12 months.Conclusions GTR may improve radiographically-assessed healing of combined endo-perio lesions. MTA obturation may play a role in the management of combined endo-perio lesions. Study limitations do not allow for more definitive conclusions.

Incidence of Malocclusion among Young Patients with Gingival Recessions-A Cross-Sectional Observational Pilot Study.

Background and Objectives: Dental occlusion and gingival recession have been studied over the past years especially because of the increasing incidence of occlusal interferences in young patients. The purpose of this pilot study is to investigate any association between occlusal dysfunctions and gingival recessions. Data on gingival phenotype and previous orthodontic treatment were also collected to assess any correlation with the presence of gingival recession. Materials and Methods: Forty systemically healthy subjects, without signs of periodontitis and with gingival recessions, were included in the study. The following parameters were determined: location and extent of the gingival recession, gingival phenotype and functional occlusion by means of observing and registering the occlusal contacts in maximum intercuspation position, protrusive and lateral guidance. Results: Premolars were mostly affected in cases of working-side interferences during lateral guidance (71.19% of the affected teeth during left and 75% during right mandibular movements). The chi-squared exact test applied for the analysis of contingency tables revealed statistically significant associations between excursive interferences during lateral guidance and anterior guidance and the presence of gingival recession on the involved group of teeth. Conclusions: The results suggest that most gingival recessions might be associated with working-side interferences, the highest number of gingival recessions being associated with active interferences during lateral guidance.

Effects of autologous concentrated growth factor on gingival thickness in periodontal accelerated osteogenic orthodontics: a 6-month randomized controlled trial

BackgroundEarlier studies have not given clear results of concentrated growth factor (CGF) on gingival thickness (GT) in periodontal accelerated osteogenic orthodontics (PAOO). This randomized controlled trial aimed to evaluate the effects of CGF on GT in patients with thin gingival phenotype undergoing PAOO.MethodsForty four patients presenting 264 anterior mandibular teeth were recruited and randomly allocated to one of the groups: test—positioning of autologous CGF after PAOO or control—positioning of a collagen membrane after PAOO. GT, gingival height (GH), buccal alveolar bone thickness (BT), and buccal alveolar bone height (BH) were evaluated depending on cross-sectional CBCT images at t0 (before surgery) and t1(6 months after surgery).ResultsGT were increased in both groups at t1 compared to t0. Yet, higher values were observed in the test group (from 0.94 ± 0.23 to 1.31 ± 0.33 mm) compared to the control group (from 0.94 ± 0.19 to 1.02 ± 0.16 mm) (p < 0.05). Moreover, in the intergroup comparison, GT at t1 in the test group was significantly higher compared to the control group (p < 0.01). Furthermore, the GT of central incisors, lateral incisors and canine teeth all showed significantly changes compared with baseline and the test group showed higher increase (p < 0.01). No statistically significant difference were found in GH, BT, BH and all clinical parameters between two groups at t1 (p > 0.05).ConclusionsWithin the limitation of this study, gingival thickness could be increased by using CGF in PAOO for the patients with thin gingival phenotype.Trial registration The study was registered in Chinese Clinical Trial Registry (http://www.chictr.org.cn/index.aspx) under the number ChiCTRINR17013346, Registered 11 November 2017.

Gingival phenotype distribution in young Caucasian women and men - An investigative study.

ObjectivesTo evaluate the relationship between gingival phenotype and tooth location based on selected index teeth (“Ramfjord”) and assess possible differences between women and men.Material and MethodsThirty‐six women and 20 men voluntarily participated in this investigation with an average age of 23 years (min: 19; max: 37). Gingival phenotypes (GP) were assessed by transparency of a periodontal probe through the buccal gingival margin.ResultsA comparable and similar GP on all index teeth was only found in seven out of the 56 subjects, that is, thin or thick only: Five participants (three male/two female) showed a uniform and constantly thick and two females a constantly thin GP. While the majority of molars (94.6%; p = 0.006) showed a thick GP, premolars (61.6%; p = 0.09) as well as incisors (70.5%; p = 0.046) were predominantly categorized as thin. In addition, significantly thicker GP was in general observed for maxillary teeth (p = 0.001) but without differences between genders (p = 0.722).ConclusionNo constant GP can be expected within one dentition. The use of the “Ramfjord teeth” may serve as a quick overview and reliable method to screen GP distribution.

Relationship between anterior maxillary tooth sagittal root position and periodontal phenotype: a clinical and tomographic study.

To evaluate the relationship between the tomographic sagittal root position (SRP) of maxillary anterior teeth and periodontal phenotype (PP). Seventy volunteers (420 teeth) were evaluated. Clinical and photographic exams included the evaluation of gingival phenotype (GP) by transparency of the periodontal probe, keratinized tissue width (KTW), gingival architecture, tooth shape, and papilla height (PH). Soft tissue tomographic scan (ST-CBCT) measurements included the SRP classification, GP, gingival thickness in the tissue zone (GT-TZ) and in the bone zone (GT-BZ), buccal bone thickness (BBT), and the distances from the gingival margin and from cementoenamel junction to the buccal bone crest (GM-BBC and CEJ-BBC). Kruskal-Wallis test and a linear regression analysis model were used. The frequency of SRP over the 420 teeth was 65.2% (class I), 9.3% (class II), 0.7% (class III), and 24.8% (class IV). Linear regression analysis showed that SRP is related to PP (p < 0.05). Significantly different measurements of PP parameters were found in SRP classes. The higher and lower GT and BBT were found in classes II and I, respectively. Class IV presented the highest KTW, PH, CEJ-BBC, and GM-BBC. Central incisors (CI) classes I and II were most frequently square-shaped, while 89% of CI Class IV were triangular-shaped. The SRP of maxillary anterior teeth is related to periodontal phenotype. Clinical and ST-CBCT individual analysis of PP and SRP may be helpful for an esthetic and functional treatment plan based on soft and hard tissue thickness and tooth positioning.

Are colored periodontal probes reliable to classify the gingival phenotype in terms of gingival thickness?

This cross-sectional study assessed the potential of colored periodontal probes (CPP) to classify gingival phenotype in terms of gingival thickness (GT). Buccal GT in three anterior teeth in each of 50 patients was measured by transgingival sounding and classified by three different methods by eight examiners. Specifically, the diagnostic potential of visual judgment and transparency of a standard periodontal probe (SPP) to discriminate thin and thick gingiva, and of CPP to discriminate thin, medium, thick, or very thick gingiva was assessed. GT ranged from 0.57 to 2.37mm. Using CPP resulted in a medium judgment in 87% of the cases, on average, and only between 1-10 cases/examiner were judged as thick or very thick. Considering 1mm GT as relevant cut-off value, all methods showed a high positive predictive value (≥ 0.82) to identify thick cases, but also a high false omission rate (≥ 0.73) indicating that many cases classified as thin were actually thick. Further, 88% of the cases being ≤ 1mm, were not classified as thin with CPP; this was inferior to SPP, for which, however, still 64% of the cases being ≤ 1mm thick were wrongly classified. The highest, yet moderate agreement among examiners was achieved by SPP (κ =0.427), whereas visual judgment and CPP showed only fair (κ =0.211) and slight agreement (κ =0.112), respectively. Using CPP resulted in most of the cases in a medium judgment. It seems that CPP cannot distinctly discriminate between "thick" and "very thick" cases and fails to capture the thin high-risk cases.

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

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

Does the pre-operative buccal soft tissue level at teeth or gingival phenotype dictate the aesthetic outcome after flapless immediate implant placement and provisionalization? Analysis of a prospective clinical case series

BackgroundImmediate implant placement (IIP) often is related to mid-buccal recession in literature. To draw conclusions about the behavior of the soft tissues following IIP, pre-operative aesthetic measurements have to be taken into account. The aim of analysis of these prospective clinical case series data was to elucidate whether the pre-operative buccal soft tissue level (STL) or gingival phenotype influence the 1-year pink aesthetic outcome after performing flapless immediate implant placement and provisionalization (FIIPP) maxillary incisor cases.Materials and methodsIn 97 patients, a maxillary incisor was replaced performing FIIPP. STL and phenotype were analyzed on light-photographs made pre-operatively (T0), direct post-operatively (T1), after placement of the permanent crown (T2), and 1 year post-operatively (T3). To investigate if a pre-operative buccal soft tissue deficiency or excess influenced the total pink esthetic score (total-PES) per patient at T3, PES-3 was modified by adding a minus (“−”) or plus (“+”) in case of a STL-deficiency or excess, respectively.ResultsPre-operatively, 40% of the cases showed a mid-buccal recession (STL-deficiency), 19% STL-excess, while in 41% an equal level in comparison with the contra-lateral tooth was observed (STL-neutral). One year post-operatively, 79% (31/39) of the recession cases showed soft tissue gain, while STL-excess cases showed the highest rate of soft tissue reduction (94%; 17/18). This resulted in a decrease of soft tissue recessions and excesses (to 26% and 4%, respectively), and an increase of ideal STL (PES-3-score 2) to 70%. The 1-year aesthetic outcome was not statistically different (p = 0.577) between patients with a pre-operative soft tissue recession (mean T3 total-PES = 12.18) or STL excess (mean T3 total-PES = 11.94). Of the total population, 71 patients with a thin, and 26 with a thick phenotype were evaluated. No statistical difference (p = 0.08) was present in aesthetic outcome between the two phenotypes (thin mean T3 total-PES = 12.30, thick mean T3 total-PES = 11.65).ConclusionRegardless of phenotype, preoperative soft tissue recession, or excess, comparable high aesthetic outcomes were achieved 1 year post-operatively.Trial registrationEthical approval was obtained and registered on 20 October 2015 (NTR5583/NL4170).

Effect of periodontal-orthodontic treatment of teeth with pathological tooth flaring, drifting, and elongation in patients with severe periodontitis: A systematic review with meta-analysis.

AimTo assess the beneficial and adverse effects on the dental and periodontal issues of periodontal–orthodontic treatment of teeth with pathological tooth flaring, drifting, and elongation in patients with severe periodontitis.Materials and methodsNine databases were searched in April 2020 for randomized/non‐randomized clinical studies. After duplicate study selection, data extraction, and risk‐of‐bias assessment, random‐effect meta‐analyses of mean differences (MDs) and their 95% confidence intervals (CIs) were performed, followed by subgroup/meta‐regression analyses.ResultsA total of 30 randomized and non‐randomized clinical studies including 914 patients (29.7% male; mean age 43.4 years) were identified. Orthodontic treatment of pathologically migrated teeth was associated with clinical attachment gain (−0.24 mm; seven studies), pocket probing depth reduction (−0.23 mm; seven studies), marginal bone gain (−0.36 mm; seven studies), and papilla height gain (−1.42 mm; two studies) without considerable adverse effects, while patient sex, gingival phenotype, baseline disease severity, interval between periodontal and orthodontic treatment, and orthodontic treatment duration affected the results. Greater marginal bone level gains were seen by additional circumferential fiberotomy (two studies; MD = –0.98 mm; 95% CI = –1.87 to −0.10 mm; p = .03), but the quality of evidence was low.ConclusionsLimited evidence of poor quality indicates that orthodontic treatment might be associated with small improvements of periodontal parameters, which do not seem to affect prognosis, but more research is needed.

Evaluation of the peri-implant tissues in the esthetic zone with prefabricated titanium or zirconia abutments: A randomized controlled clinical trial with a minimum follow-up of 7 years

Statement of problemLong-term clinical studies are lacking on the influence of the type of abutment, titanium or zirconia, on peri-implant tissues. PurposeThe purpose of this randomized clinical trial was to evaluate peri-implant tissues with titanium or zirconia abutments. Material and methodsA total of 26 single-tooth implant-supported prostheses in 14 participants were analyzed. They received either a titanium abutment with a metal-ceramic crown (TAG) or a zirconia abutment with a ceramic crown (ZAG). Data were collected immediately, at 5 months, and at a minimum of 7 years after crown delivery. The success rate, plaque and bleeding indexes, bleeding on probing, white and pink esthetic scores, and the relationships of the gingival phenotype with the pink esthetic score were analyzed. Statistical analyses were conducted with the t test for paired and independent data (α=.05). ResultsThe mean follow-up time was 95.2 ±2.6 months, showing an implant success rate of 96.7%. No statistically significant differences were found between TAG and ZAG among the time intervals evaluated for plaque or bleeding indexes (P>.05). A statistically significant difference was found for peri-implant probing depths in the mid-buccal sites between the groups at all the time intervals evaluated (TAG, P=.008; ZAG, P=.021): TAG showed an increase between 5 months (3.65 ±0.93 mm) and over 7 years (4.47 ±1.32 mm); and ZAG showed a reduction (5 months=5.22 ±1.71 mm; over 7 years=4.25 ±1.28 mm) in values. For the pink (PES) and white esthetic score (WES), ZAG (PES: immediately=6.33 ±1.41; 5 months=7.44 ±1.81; over 7 years=8.25 ±1.03; WES: immediately=7.67 ±1.50; over 7 years=8.38 ±0.74) showed higher mean values than TAG (PES: immediately=5.94 ±2.35; 5 months=6.53 ±2.15; over 7 years=7.44 ±1.81; WES: immediately=7.00 ±1.17; over 7 years=8.35 ±1.27) (P<.05). Statistically significant differences were found for gingival phenotype and for PES in TAG (P=.031), and the participants with thick phenotype showed higher PES in the 3 time intervals studied. ConclusionsZirconia abutments exhibited better results than titanium abutments in terms of the peri-implant tissues. Moreover, in those with a thin phenotype, zirconia provided improved gingival esthetics.

Regenerative Therapy Modality for Treatment of True Combined Endodontic-Periodontal Lesions: A Randomized Controlled Clinical Trial.

The aim of this in-vivo study was to evaluate/compare the clinical periodontal parameters in patients with true combined endo-perio lesions (EPL), treated with gutta-percha (GP) and mineral trioxide (MTA) as an obturation material alone and with addition of bone grafting in such lesions. 120 Saudi patients (mean age = 41yrs) diagnosed with true combined EPL participated in this study. Group I (control group, n = 30) was treated with conventional endodontic treatment using GP for obturation. Group II (n = 30) was treated with conventional endodontic treatment using MTA for obturation. Group III (n = 30) was treated with conventional endodontic treatment using GP for obturation + grafting procedure to fill the bony defect. Group IV (n = 30) was treated with conventional endodontic treatment using MTA for obturation + grafting procedure to fill the bony defect. Clinical parameters (Pocket depth (PD); Clinical attachment loss (CAL); keratinized tissue width (KTW); gingival phenotype (G.Ph.) and Cone Beam Computed Tomography Periapical Index (CBCTPAI)) were recorded and compared at baseline, 3, 6, 12 months’ interval. For the groups III and IV, CBCTPAI showed significant difference (p < 0.0001) with the other groups at 6 months and 1-year interval. The group with MTA + bone graft showed 76% and 90% patients with 0 score at 6 months and 1-year follow-up, respectively. Comparison of mean values of PD among study groups at 3 months, 6 months and 1 year showed significant difference at 3 months, whereas the mean PD values of subjects in GP + bone graft showed significantly higher PD values than other 3 groups (p = 0.025). Use of GP and MTA for root canal obturation along with periodontal therapy and bone augmentation helps in resolving complex endo-perio lesions. Bone grafting in addition to obturation with MTA was found to be the best treatment strategy in management of EPL cases and is recommended for clinicians who are treating EPL patients.

Flapless Immediate Implant Placement and Provisionalization (FIIPP) in the Aesthetic Region: Surgical Protocol of a Prospective Clinical Cohort Study on 100 Patients – Two Case Reports: Intact Socket, and Defect Socket with a Thin Gingival Phenotype

Background: Immediate implant placement and provisionalization (IIPP) is considered as a high-risk treatment for aesthetic failure and generally only recommended in case of post-extraction intact sockets and a thick phenotype gingiva. During a prospective clinical cohort study on one-hundred consecutive patients, using this strict flapless immediate implant placement and provisionalization (FIIPP) protocol, we found high and stable aesthetic outcomes (WES/PES = 8.2/12.1) in both intact – and defect sockets, and both thin- as thick gingival phenotype. By means of one case report (Case 1), the total FIIPP treatment is illustrated. Results of two other cases, show that comparable high aesthetic outcomes can be reached in cases with a thin phenotype gingiva or buccal bone defect using the same protocol. Case Presentation: In a 24-year-old male with good general and oral health, root fracture of tooth 21 was diagnosed and FIIPP was indicated. Direct post-extraction, an implant was placed in a palatal position of an intact socket by a flapless approach. A minimum space of 2 mm in front of the implant was created and filled with a bone-substitute prior to implant placement. Subsequently, the implant was restored by use of a titanium abutment and a composite temporary crown. Three months later, the temporary crown was replaced by a customized zirconium abutment and ceramic crown resulting in a high aesthetic outcome. A comparable aesthetic outcome using this protocol can be reached in cases with a thin phenotype gingiva and/or a buccal bone defect (Case 2). Conclusion: Using described surgical FIIPP protocol, high aesthetic outcomes are reached in only 4 visits and within a treatment period of 4 months. A thin phenotype gingiva, or a pre-operative buccal bone defect, does not seem to affect the aesthetic outcome using this treatment method.

Minimally invasive free gingival graft technique prior-to orthodontic therapy: case report

Introduction: A gingival recession (GR) is an affection in which the gingiva displaces apical to the cement-enamel junction causing exposure of the root surface. A thin gingival phenotype can be associated to GR, especially when exposed to orthodontic movements. To solve this condition, several mucogingival techniques have been proposed. Free gingival grafts taken from the palate are the gold standard; however, they are related to poor esthetical results and postoperative complications. In order to reduce those disadvantages, a «Minimally Invasive Esthetic Free Gingival Graft» (MIEFGG) technique is proposed, which involves a donor site placed on the buccal aspect of upper molars to modify the phenotype or regain attachment in the recipient site. Aim: To describe a new graft technique, used in mucogingival surgery, which is both esthetic and minimally invasive. Material and methods: A 24-year-old female patient who requested a periodontal evaluation before orthodontic treatment. Diagnosis: Cairo’s RT3 along with thin phenotype, type II mobility, and extrusion associated to teeth 4.1 and 4.2. Treatment plan: thicken the gingival phenotype surrounding teeth 4.1 and 4.2 before orthodontic therapy. Since the patient expressed esthetical concerns, the MIEFGG technique was selected. Results: Postsurgical follow-ups were performed 7, 14, 30, and 150 days. Both the width and the height of the keratinized gingiva around teeth 4.1 and 4.2 increased by 1 mm. The esthetic outcome was satisfactory, according to the patient. No complications or postoperative pain was reported. Conclusion: MIEFGG is a technique that presents good results in terms of gingival augmentation, little discomfort to the patient, and esthetic results. Concerning the clinical case presented here, those advantages were achieved. However, more research is needed in order to prove its effectiveness