Gingival Thickness Research Articles

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 biotype as an indicator for the buccal bone thickness - a systematic review of the literature.

Introduction A relationship between thin gingiva and thin buccal bone has been proposed but concrete evidence for this is lacking. This study was undertaken to assess the reliability of measuring gingival thickness in estimating the buccal bone thickness.Objectives To answer the following PICO question: do periodontally healthy individuals exhibit any correlation between gingival biotype and buccal/labial/facial bone thickness?Data sources and selection An electronic search was performed in PubMed and Embase databases. English language articles that have met the inclusion and exclusion criteria were selected. Only observational studies were considered. Since the studies have demonstrated heterogeneity, conducting a meta-analysis was not possible, so the results were synthesised using a vote counting method and narrative synthesis.Data synthesis After screening the titles and abstracts, 13 studies which met the study criteria were included in the systematic review. Out of these 13 studies, nine studies assessed only the maxillary anterior/premolars; one study assessed the mandibular anterior, and three studies assessed both maxillary and mandibular anterior/premolars.Conclusions The findings of this systematic review indicated that the gingival biotype may be a reliable indicator for estimating the thickness of buccal bone in maxillary anterior. However, its relation to the buccal bone thickness in mandible is unclear.

Efficacy of tunnel technique for treatment of gingival recession of upper adjacent teeth with noncarious cervical defect

To evaluate the efficacy of tunnel technique (TUN) in treatment of teeth with adjacent gingival regression (GR) combined with noncarious cervical lesions (NCCL). We collected data from 21 patients (79 teeth) undergoing TUN surgery for GR combined with NCCL. According to GR depth (GRD) and lesion depth (LD) of NCCL, the teeth were divided into group 1 with GRD≤3 mm and LD≤1 mm; group 2 with GRD≤3 mm and LD>1mm; group 3 with GRD>3 mm and LD≤1 mm; and group 4 with GRD>3 mm and LD>1 mm. The mean root coverage (MRC) rate, complete root coverage (CRC) rate, keratinized gingival width, and keratinized gingival thickness were compared among the 4 groups after TUN surgery. The keratinized gingival width and thickness were significantly improved after the surgery in the 4 groups. When the GRD was below 3 mm, the MRC was not significantly different between group 1 and group 2 (8.55% vs 95.45%, P>0.05); When the GRD was beyond 3 mm, the MRC and CRC rates were both decreased in group 3 and group 4, especially in group 4, where the CRC rate (25%) was significantly lower than those in the other 3 groups (P < 0.01). In patients with GR combined with NCCL, TUN surgery can obviously improve keratinized gingival width and thickness. GRD has a greater effect on the outcome of root coverage than LD, suggesting that NCCL restoration before TUN surgery may not be necessary. Both GRD and LD should be considered in the evaluation of the clinical efficacy of TUN surgery.

The effect of different soft-tissue management techniques for alveolar ridge preservation: a randomized controlled clinical trial

PurposeFor alveolar ridge preservation, various treatment protocols have been described. While most studies focus on the effect of the bone graft material, the aim of this study was to analyze the influence of different soft-tissue management techniques on the soft and hard tissue.MethodsA total of 20 maxillary extraction sockets were grafted with an anorganic xenogenic bone graft and then randomly treated with either a combined epithelialized-subepithelial connective tissue graft (CECG) or a porcine collagen matrix (CM) placed in labial and palatal tunnels. Measurements of soft-tissue thickness were performed at tooth extraction (T0), implant insertion (T1) and second stage surgery (T2).ResultsIn the CECG group, gingival thickness was 1.18 ± 0.56 mm (T0), 1.29 ± 0.26 mm (T1) and 1.2 ± 0.32 mm (T3). In the CM group, the measurements were 1.24 ± 0.50 mm (T0), 1.6 ± 0.6 mm (T1) and 1.7 ± 1.06 mm. Thus, there was an overall increase in gingival thickness from T0 to T2 of 0.02 ± 0.66 mm (CECG) compared to 0.46 ± 0.89 mm (CM). The thickness of keratinized soft-tissue was 3.91 ± 1.11 mm (CECG) and 4.76 ± 1.48 mm (CM) before extraction and 3.93 ± 1.17 mm (CECG) and 4.22 mm ± 1.26 mm (CM) at implant follow-up. Mean peri-implant probing depths were 3.15 ± 1.39 mm (CECG) and 3.41 ± 0.99 mm (CM).ConclusionsAfter ridge preservation, comparable soft-tissue parameters were observed in both groups, whether treated with a collagen matrix or a combined autologous connective tissue graft.

Width and thickness of the gingiva in periodontally healthy individuals in a central Indian population: a cross-sectional study.

The present study was performed to determine the gingival dimensions (width and thickness) among young individuals in a central Indian population. Periodontal probing depth, width of the keratinized and attached gingiva, and gingival thickness were recorded on maxillary and mandibular teeth from central incisor to first molar unilaterally in 75 systemically healthy individuals (32 males and 43 females; 19-30years of age). Comparisons were made gender-wise, arch-wise, tooth-wise, and site-wise using either the Student's t test or the ANOVA. Keratinized and attached gingiva were wider in the maxilla than in the mandible both at proximal and at mid-buccal aspects (p < 0.001). At the tooth level also, gingiva was wider at the maxillary teeth than the corresponding mandibular teeth and at proximal aspects than at the mid-buccal aspect (p < 0.001). Regarding the thickness, gingiva was thicker among males, in the mandible, and at inter-proximal sites (p < 0.001). In either arch, maximum thickness was observed at the incisor region and least at the canine region. Dimensions of the gingival tissues vary between different populations and between different areas of the dentition within the same subject. These variations need to be better understood because these aspects may have an important bearing on periodontal treatment planning as width and thickness of gingiva are important in terms of maintenance of periodontal health. The dimensions of the clinically healthy gingiva are important in clinical practice as they can influence the progression of periodontal disease as well as impact the outcome of periodontal and restorative and orthodontic therapy.

Comparison of two types of xenogeneic matrices to treat single gingival recessions: A randomized clinical trial.

Xenogeneic matrices (XMs) have been increasingly used for root coverage procedures. This study compared the use of two types of XM (collagen matrix [CM] and xenogeneic acellular dermal matrix [XDM]) associated with the coronally advanced flap technique (CAF) to treat single gingival recessions. Seventy-five patients presenting single RT1 gingival recession were treated by CAF (control group, n=25), CAF+CM (test group 1, n=25), or CAF+XDM (test group 2, n=25) and completed 6-month follow-up. Clinical, patient-centered, and esthetic assessments were performed and intra- and intergroup differences were analyzed. At 6 months, the mean recession reduction for CAF, CAF+CM, and CAF+XDM was 2.4 ± 0.8mm, 2.4 ± 0.9mm and 2.1 ± 0.8mm, respectively (P>0.05). The corresponding mean percentage of root coverage was 78.9% ± 26.2% for CAF, 78.0% ± 28.5% for CAF+CM, and 65.6% ± 26.9% for CAF+XDM (P>0.05). Dentin hypersensitivity and esthetic conditions showed significantly improvements in all groups. Test groups presented significant gains in gingival thickness (GT; CAF+CM: 0.4 ± 0.3mm; CAF+XDM: 0.4 ± 0.2mm) compared to the control group (CAF: 0.0 ± 0.1mm; P<0.05). The CAF, CAF+CM, and CAF+XDM treatments each provided similar results in the treatment of single gingival recessions. The addition of either CM or XDM to CAF increases the GT.

Leukocyte- and Platelet-Rich Fibrin Versus Connective Tissue Graft for a Coronally Advanced Flap in the Treatment of Miller Class I and II Localized Gingival Recessions: A Randomized Controlled Clinical Trial.

The aim of the present study was to compare leukocyte- and platelet-rich fibrin (L-PRF) membranes with a connective tissue graft (CTG) in combination with a coronally advanced flap (CAF) in the treatment of Miller Class I or II localized gingival recessions. A randomized controlled clinical trial with 17 recessions in each group was initiated; the control group received treatment with CAF+CTG, and the test group received CAF+L-PRF. The following variables were measured before treatment and after 1, 3, and 6 months: gingival recession depth (RD), gingival recession width (RW), gingival thickness (GT), probing depth (PD), clinical attachment level (CAL), and keratinized tissue height (KTH). Also, the root coverage percentage (RC), the pain score, postoperative complications, and the root coverage esthetic score (RES) were recorded after surgery. Both treatments presented significant improvements in the RD, RW, and CAL at 1, 3, and 6 months. CTG achieved a significantly higher RC at 1, 3, and 6 months and a significantly higher RES score at 6 months. L-PRF presented a significantly lower pain score and less postoperative complications. Both strategies were effective for the treatment of localized gingival recessions. The CTG obtained higher RC and esthetic results, and L-PRF had less pain and postsurgical complications.

Co-Relation of Gingival Biotype (Periodontal Phenotype) with Width of Keratinized Gingiva in Maxillary Anterior Teeth in Patients Reporting to a Local Tertiary Care Dental Hospital

Objective: To find out the correlation of gingival biotype with width of keratinized gingiva in maxillary anterior teeth in patients at tertiary care dental hospital presenting for routine periodontal care. Materials And Methods: In this crossectional study, a total of 87 patients were observed in department of Periodontology, Fatima Memorial Hospital College of Medicine and Dentistry Lahore. The gingival biotype (gingival thickness) were determined by using the transparency of the periodontal probe through gingival sulcus. The width of the keratinized gingiva was measured by measuring the distance between the most coronal point of the gingival margin and the mucogingival junction measured at the midpoint of the vestibular face of the teeth using a Michigan O periodontal probe with William’s markings. Results: In this study mean age was 38 years with SD ± 10.88. Forty six percent patients were male and 54% patients were female. Mean width of keratinized gingiva was 4.22mm ± 1.10 while mean gingival biotype was 1.5 mm ± 0.65. The correlation coefficient r=0.277 shows a positive correlation of width of keratinized gingiva with gingival biotype Conclusion: The study concluded that there is a positive correlation of gingival biotype with width of keratinized gingiva in maxillary anterior teeth. Keywords: gingival biotype, width of keratinized gingival, maxillary anterior teeth

Periodontal outcomes of anterior fixed partial dentures on teeth treated with the biologically oriented preparation technique: A 6-year prospective clinical trial

Statement of problemOne of the most frequent complications in participants with fixed partial dentures (FPDs) is the apical migration of the gingival margin, which may be associated with factors such as fit, gingival margin location, or tooth preparation type. The prevalence of the complication in participants restored with FPDs prepared by using the biologically oriented preparation technique (BOPT) is unclear. PurposeThe purpose of this prospective clinical trial was to evaluate the clinical and biologic outcomes of FPDs on teeth prepared by using the BOPT, over a 6-year follow-up period. Material and methodsTooth-supported zirconia FPDs in the anterior region prepared by using the BOPT were evaluated. Each participant was monitored annually for 6 years by evaluating plaque index, probing depth, vestibular gingival thickness, and gingival margin stability. Biologic and/or mechanical complications were also recorded. Patient satisfaction was measured by using a visual analog scale (VAS). ResultsA total of 25 FPDs supported by 70 teeth in 24 participants were analyzed. Low plaque index values and stable probing depths were observed, whereas the gingival index was 0 for most of the teeth. Teeth treated by using the BOPT presented significant increase in gingival thickness, and the gingival margin was found to be stable in 100% of the treatments. FPD survival was 100%. ConclusionTooth supporting FPDs prepared by using the BOPT presented good periodontal health and gingival margin stability, without recession and with a 100% survival rate during a 6-year follow-up.

Gingival recession treatment with enamel matrix derivative associated with coronally advanced flap and subepithelial connective tissue graft: a split-mouth randomized controlled clinical trial with molecular evaluation.

The goal of this study was to evaluate the impact of enamel matrix derivative (EMD) on periodontal healing after root coverage (RC) surgery, involving CAF in combination with SCTG, and to assess the molecular profile, verifying the inflammation level in early stage (1 and 2weeks). Thirty-two recessions (RT1) were submitted to periodontal surgery with (test) or without (control) EMD. The clinical parameters analyzed on the day of surgery and 6months after the surgical procedure were as follows: recession height and width, keratinized tissue height, percentual root coverage, and the gingival thickness of keratinized tissue. Moreover, the main inflammatory biomarkers and growth factors (IL-1β, IL-6, IL-8, FGF, MIP-1α and β, PDGF, TNF-α, and VEGF) were evaluated at baseline, 7, and 14days after procedures. The average root coverage was significantly higher in the test group as compared to the control group (86% vs. 66%, p = 0.008). The test side had significantly lesser final RH compared to the control side (p = 0.01). Also, there was a significant reduction of RW in both groups, with more significant results in the test group. KTH and GT were not significantly different at any time and group. After 14days, the immunological analysis showed an increase of VEGF (p = 0.03) on the test group compared to the control side. The use of EMD in RC surgeries resulted in a significantly higher RC, as well as a significant increase in VEGF expression, suggesting that EMD may contribute to the angiogenic and healing process. EMD provided better results in root coverage treatment when associated with CAF and SCTG, beyond a greater releasing of angiogenic growth factor (VEGF), which enhanced the result.

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.

Gingivitis resolution followed by optical coherence tomography and fluorescence imaging: A case study.

Gingivitis is highly prevalent in adults, and if left untreated, can progress to periodontitis. In this article, we present an interesting case study where the resolution of gingivitis was followed over a period of 10 days using optical coherence tomography (OCT) and light-induced autofluorescence (LIAF). We demonstrate that OCT and its functional angiography can distinctively capture the changes during the resolution of gingivitis; while LIAF can detect red-fluorescent signals associated with mature plaque present at the inflamed site. The acute inflammatory region showed evidence of angiogenesis based on the quantification of vessel density and number; while no angiogenesis was detected within the less inflamed region. Gingival thickness showed a reduction of 140 ± 26 μm on average, measured between the peak gingivitis event and the period wherein the inflammation was resolved. Vessels in the angiogenesis site was found to reduce exponentially. The mildly inflamed site showed a decreasing trend in the vessel size, which however was within the error of the measurement.

Comparative Evaluation of Connective Tissue Graft with Pouch/Tunnel Technique versus Connective Tissue Graft with Coronally Advanced Tunnel Flap for the Treatment of Maxillary Recession Cases in Severe Periodontitis.

The long-term stability for both the patient and periodontist remains an important priority after connective tissue graft to manage the gingival recession cases. The goal of this analysis was to assess and compare the connective tissue graft with Pouch/Tunnel technique versus connective tissue graft with coronally advanced tunnel flap for the treatment of maxillary recession cases in severe periodontitis. The total sample size was comprised of 200 subjects. The control group, coronally advanced flap along with connective tissue graft (CTG) was comprised of 100 samples and test group, pouch/tunnel technique with connective tissue graft (POT + CTG) was also comprised of 100 samples. The clinical findings included medium root coverage (MRC) and absolute root (CRC) coverage, gingival (GT) distribution and keratinized tissue (KT) gain. Esthetic findings were also evaluated. All findings analyzed initially after 6th months and have been expanded to 4years. There were no major variations between the MRC and CRC patient classes with non significant values. In the POT + CTG category, GT and KT improvements were slightly greater at 4years, with a substantial improvement in texture in control group. Pouch/Tunnel technique along with connective tissue graft allows for the clinical coverage of gingival recessions that is equivalent to Coronally advanced flap with CTG, however this may improves the gingival thickness, KT and esthetic performance.

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.

Effect of 24% EDTA root conditioning on the outcome of modified coronally advanced tunnel technique with subepithelial connective tissue graft for the treatment of multiple gingival recessions: a randomized clinical trial

ObjectivesTo investigate effects of root conditioning with 24% ethylenediaminetetraacetic acid (EDTA) on the 12-month outcomes after treatment of multiple gingival recessions (GR) with modified coronally advanced tunnel (MCAT) and subepithelial connective tissue graft (SCTG).Materials and methodsTwenty patients with 142 GR were treated (72 test sites: SCTG + EDTA and 70 control sites: SCTG). Average and complete root coverage (ARC, CRC), gain in keratinized tissue width (KTW), gain in gingival thickness (GT), root esthetic coverage score (RES), and patient-reported outcome measures (PROMs) were evaluated at 12 months post-operatively.ResultsDifferences between pre- and post-operative values were statistically significant only within but not between treatment modalities. At 12 months, ARC was 86.0% for SCTG + EDTA-treated and 84.6 for SCTG-treated defects (p = 0.6636). CRC was observed in 90.2% (tests) and 91.4% (controls) of all cases (p = 0.9903). Professional assessment of esthetic outcomes using RES showed highly positive results reaching the value of 8.9 in case of test sites and 8.7 for control sites (p = 0.3358). Severity of pain and swelling did not differ between sites, regardless of whether EDTA was used.ConclusionsTest and control sites presented similarly positive outcomes related to root coverage, periodontal and esthetic parameters, and patient satisfaction and self-reported morbidity with no statistical differences between them 12 months after surgery. No significant differences in evaluated variables were observed between sites treated with and without 24% EDTA.Clinical relevanceConsidering the limitations of the present study, the use of 24% EDTA for root conditioning did not improve 12-month outcomes after treatment of multiple RT1 and RT2 gingival recessions with MCAT and SCTG.Trial registrationClinicalTrials.gov identifier: NCT03354104

Xenogeneic collagen matrix for the treatment of multiple gingival recessions in esthetics areas: a case series with 24-month follow-up

Introduction: Multiple gingival recessions (GR) are often associated with high hypersensitivity and esthetics concerns due to exposed roots. The collagen matrix (CM) associated with coronally advanced flap (CAF) may be a suitable treatment for multiple GR in esthetic areas. However, there is a lack of long term follow up investigations. Objective: To evaluate a 24-month follow-up of the CM + CAF treatment for multiple RT1 GRs in esthetics areas. Materials and Methods: Six patients presenting 6 adjacent Cairo’s gingival recessions type 1 (RT1) in the anterior maxilla were treated with CM + CAF, and based on these patients a brief statistical analysis was conduct. The evaluated parameters included gingival recession depth (GRD), gingival recession width (GRW), probing depth (PD), clinical attachment level (CAL), keratinized tissue width (KTW), gingival thickness (GT), and mean root coverage (MRC). Patient-related outcomes measurements (PROMs) were assessed using an oral health impact profile (OHIP-14) questionnaire and visual analogue scale (VAS). Results: There was significant improvement in GRD, GRW, and CAL measurements at 3 months postoperatively (p&lt;0.05). Besides, CAL also increased from 12 months to 24 months’ follow-up (p=0.0023). The MRC percentage was 82%. PD, GT, and KTW presented no statistical difference. PROMs revealed a high score for esthetics (82.2%) and a significant reduction in hypersensitivity and surgical pain/discomfort. Conclusions: Considering the limitations of a case series, the use of CM + CAF on RT1 multiple gingival recessions in esthetic areas demonstrated positive outcomes after 24 months.

Periodontal Behavior and Patient Satisfaction of Anterior Teeth Restored with Single Zirconia Crowns Using a Biologically Oriented Preparation Technique: A 6-Year Prospective Clinical Study.

Objectives. The aim of this study was to analyze the behavior of the periodontal tissues around teeth in the anterior region when restored with zirconia single crowns, using a biologically oriented preparation technique (BOPT), over a 6-year follow-up. Methods. The study investigated tooth-supported single crowns in the anterior region that were fabricated with a zirconia core and feldspathic ceramic covering, in 34 patients. Follow-up analysis took place annually for 6 years, assessing periodontal responses by evaluating the following variables: plaque index (PI); probing depth (PD); gingival index (GI); gingival thickness adjacent to the restoration; and stability of the gingival margin (MS). Any (biological and mechanical) complications were also recorded, as well as the patients’ satisfaction with the treatment. Results. After 6 years’ follow-up, a low mean plaque index was obtained, probing depth was stable, and gingival thickness and margin stability had increased. Complications (biological and mechanical) did not present a statistically significant incidence and a crown survival rate of 97.2% was achieved. Patients’ satisfaction obtained a mean VAS score of 9.04 under 10. Conclusion. Teeth that are prepared with BOPT in the anterior region present good periodontal behavior around the restored teeth, particularly in terms of the stability of the gingival margin and increased gingival thickness. Single crowns prepared with BOPT obtain an excellent clinical survival rate, as well as a high score in patients’ satisfaction after 6 years.

The influence of gingival biotypes on periodontal health: A cross-sectional study in a tertiary care center

Dimensional characteristic of gingiva is a predisposing factor for initiation and course of periodontal diseases and conditions. Knowledge about variations of gingival biotype among subjects is a prognostic determinant in Periodontics.The purpose of the study was to determine the prevalence of gingival biotypes and to evaluate its influence on various periodontal health parameters.Among the patients who reported to the out-patient section, a cross-sectional study was done on those who satisfied the inclusion criteria.Gingival thickness was measured on six anterior teeth of maxillary and mandibular arch using no.15 endodontic spreader and digital caliper by a single examiner on 112 subjects. Another examiner recorded the clinical parameters pertaining to periodontal health. Subjects with gingival thickness 1.5mm were categorized to thin and those with 2mm into thick gingival biotype.Difference in mean values of quantitative variables was tested by Mann Whitney U test. Bivariate correlation was assessed by Pearson correlation. Multiple linear regression models were developed for modified gingival index and interproximal attachment loss.Prevalence of thin and thick gingival biotype was 48.21% and 39.28% respectively. Mean gingival thickness observed was 1.49±0.59mm. Mean score of all clinical parameters were significantly higher in thin gingival biotype. Gingival biotype had a negative correlation with modified gingival index and interproximal attachment scores.Thicker gingival biotype can be considered to have a protective effect against the development of periodontal pathology.

Modified coronally advanced tunnel technique with enamel matrix derivative in addition to subepithelial connective tissue graft compared with connective tissue graft alone for the treatment of multiple gingival recessions: prognostic parameters for clinical treatment outcomes

ObjectivesTo investigate factors that influence 12-month outcomes after treatment of multiple gingival recessions (GR) with modified coronally advanced tunnel (MCAT) and subepithelial connective tissue graft (SCTG) with enamel matrix derivative (EMD) (tests) or without (controls).Materials and methodsTwenty patients with 150 GR were treated. Logistic regression models were used to identify baseline parameters that could predict 12-month average root coverage (ARC), complete root coverage (CRC), root esthetic coverage score (RES), gain in keratinized tissue width (KTW), and gain in gingival thickness (GT).ResultsThe likelihood of ARC > 85% increased sevenfold (odds ratio [OR] = 7.33; 95% confidence interval [CI] = 2.43–12.12), of achieving CRC: 21-fold (OR = 21.23; 95% CI = 10.21–45.32), and of gaining RES = 10: tenfold (OR = 10.23; 95% CI = 5.78–32.23) in favor of EMD-treated sites. With each 1-mm2 increase in baseline avascular exposed root surface area (AERSA), the odds of failure (ARC ≤ 85%, not achieving CRC and postoperative GT ≤ 2 mm) increased almost fourfold (OR = 3.56; 95% CI = 1.98–10.19), fourfold (OR = 4.23; 95% CI = 1.11–9.02), and nearly sixfold (OR = 5.76; 95% CI = 2.43–12.87), respectively. The greater the baseline GT, the more likely the chance of achieving CRC (OR = 10.23; 95% CI = 8.37–16.23) and RES = 10 (OR = 5.50; 95% CI = 3.34–16.43). All models exhibited fair to excellent discrimination and satisfactory calibration.ConclusionsBased on logistic regression, EMD application improved postoperative ARC, CRC and RES; baseline AERSA predicted 12-month ARC, CRC, and GT gain, whereas baseline GT was a predictor of achieving CRC and perfect RES.Clinical relevanceAdditional use of EMD, lower baseline AERSA, and greater baseline GT significantly increase the odds of obtaining better outcomes 12 months after MCAT + SCTG technique.