Tissue Graft Research Articles

Evaluation of the comparative efficacy and safety of surgical strategies for long bone defects: a network meta-analysis.

To evaluate the safety and efficacy of various surgical treatments for long bone defects. Despite numerous observational studies, randomized controlled trials (RCTs), and meta-analyses, the optimal surgical treatment for long bone defects remains undetermined. A network meta-analysis (NMA) was conducted. PubMed, Embase, and the Cochrane Library were searched for articles published between 1 January 2000, and 12 January 2023, on surgical treatments for long bone defects. RCTs and observational studies comparing five surgical treatments were selected: the Masquelet technique (MT), bone transport (BT), vascularized bone graft (VBG), non-VBG (NVBG), and bone tissue engineering (BTE). Data were extracted by two independent reviewers. The NMA aggregated direct and indirect evidence. Treatments were ranked using the surface under the cumulative ranking curve (SUCRA) scores. Data are presented as mean differences and 95% confidence intervals. The primary outcomes were the postoperative healing rate, with subgroup analysis based on defect size (4-8cm and >8cm). The secondary outcomes included postoperative complications. This NMA included 23 studies (3 RCTs and 20 observational studies) with 930 participants (median age, 35years). There were no significant differences in clinical outcomes among the treatments. VBG (SUCRA, 75.1%) was rated as optimal for healing, and BTE (SUCRA, 28.5%) was the least effective. BTE had the highest complication rate (SUCRA, 90.9%), whereas NVBG had the lowest complication rate (SUCRA, 27.6%). Subgroup analysis showed reduced heterogeneity: for 4-8cm defects, VBG (SUCRA, 80.4%) was optimal, and for >8cm defects, BT (SUCRA, 76.2%) was optimal. VBG and BT may offer superior clinical outcomes for long bone defects compared to MT, NVBG, and BTE. However, BTE is associated with a high risk of complications. Further high-quality, large-sample RCTs are required to confirm these findings.

Analysis of influencing factors on the height of gingival papilla around implants

The anatomical structure of the gingival papilla around the implant is special, and it is difficult to recover after injury. The reduction of its height will have a negative impact on function and esthetics, and it is one of the many problems in implant treatment at present. This paper analyzes the influencing factors of implant gingival papilla height from three aspects: anatomical factors, implant surgical design and implant restorative design, including the classical influencing factors such as the shape of natural teeth, interproximal distance between the implant and the adjacent tooth, soft tissue grafting, and contour of implant restorations, as well as the hot and controversial influencing factors in recent years such as the thickness of soft tissues around the implant, the implant surgical timing, the flap design, and the surgical incision, in order to provide reference for clinicians in the process of implant treatment for gingival papilla preservation and reconstruction.

Cartilage graft and temporal muscle fascia graft in revision myringoplasty: a comparison of anatomical and functional results with an innovative surgical technique

BackgroundThe temporal muscle fascia is the most widely used type of tissue graft in revision myringoplasty procedures. The aim of this study was to verify if the use of a cartilage graft may be a valid alternative to temporalis fascia. Tympanic reperforations are frequent after myringoplasty, especially in complicated, large, or anterior perforations, so we decided to compare the neodrum stability of two different surgical techniques.Materials and methodsThe study was conducted on 42 patients who underwent revision myringoplasty, carried out with the overlay technique, between 2004 and 2020. In all patients, the retroauricular approach was used. The subjects included in the study were divided into 2 groups: the former was treated with a cartilage graft, while in the latter a temporalis fascia graft was used. In the comparison of the two groups, the following outcomes were taken into consideration: engraftment rate, incidence of complications, pre- and postoperative air conduction pure tone average and air-bone gap.ResultsThe success rate was 100% for the first group and 83.3% for the second, with a statistically not significant difference. Among the subjects treated with cartilage graft, complications were observed in 8.3% of the cases, while in patients treated with fascia graft the observed complication rate was 43.3% (p = 0.03), maybe due to the shorter follow-up period of the first group. The improvement of the air conduction pure tone average was greater with cartilage graft (p = 0.02), whereas the difference between air-bone gap closures in the two groups was not statistically significant.ConclusionThe cartilage graft can represent a valid alternative to temporal muscle fascia, guaranteeing excellent engraftment, fewer complication rate and satisfactory hearing outcomes.

Challenges and solutions in soft tissue grafting for receding gums

Soft tissue grafting plays a critical role in addressing periodontal challenges, particularly in managing receding gums. It serves both functional and aesthetic purposes, offering solutions for root exposure, sensitivity, and compromised oral health. Advances in surgical techniques and material science have propelled the field forward, providing clinicians with diverse options to achieve optimal outcomes. Autologous grafts remain a standard for many cases, valued for their biocompatibility and success rates, though they present limitations such as donor site morbidity and limited availability. Innovative materials like nanofibrous scaffolds and hydrogels have revolutionized tissue engineering. These materials mimic the extracellular matrix (ECM), promoting cell attachment and tissue integration while enabling the controlled delivery of bioactive agents. The emergence of 3D bioprinting has further enhanced precision, allowing for patient-specific graft designs that integrate vascular structures for improved survival. Decellularized matrices offer a biologically compatible alternative, preserving natural tissue architecture while reducing immune response risks. Patient-specific factors, including systemic health, genetic predispositions, and site-specific anatomy, significantly influence graft success. Advanced computational tools and predictive models now allow for personalized treatment strategies, addressing these variables effectively. Technologies such as bioreactors and imaging systems provide real-time insights into graft performance, bridging the gap between research and clinical application. Future directions focus on integrating cutting-edge biomaterials with regenerative medicine and computational modelling to develop smarter, more adaptive grafting solutions. As the field continues to evolve, the emphasis lies on achieving outcomes that balance functionality, aesthetics, and patient satisfaction while minimizing risks and complications. These advancements promise to reshape the landscape of periodontal therapy, offering innovative solutions for complex clinical challenges.

Haploid like spermatid generation by transplantation of neonatal mouse testicular tissue into the epididymal fat of castrated adult mouse.

Many cancer survivors may experience irreversible infertility due to chemotherapy treatment for childhood cancer. In this study, spermatogenesis development was evaluated following the grafting of fresh and frozen-thawed testicular tissue from neonatal mice to the epididymal fat of adult mice. After bilateral castration of recipient mice, fresh or frozen-thawed neonatal testis tissues were grafted into the epididymal fat of the mice. Grafted testicular tissue was evaluated eight weeks after implantation using H&E staining, real-time PCR, immunofluorescence staining, and TUNEL assay. Blood was drawn from recipient mice to determine testosterone, FSH, and LH levels. A gradient of different types of germ cells, from spermatogonia to elongated spermatids was observed. The upregulation of meiotic and post-meiotic genes and proteins in fresh and frozen grafted groups confirmed the progression of meiosis and post-meiosis in grafted tissues. There were no significant differences in the expression of apoptosis and necrosis genes between the grafted and non-grafted control groups. Additionally, no significant differences were observed between the control and experimental groups in hormonal assessments. The optimal hormonal and temperature conditions of the epididymal fat could support spermatogenesis in grafted immature testicular tissue. This grafting technique could pave the way for fertility preservation.

MGST1 overexpression ameliorates mitochondrial dysfunction and ferroptosis during myocardial ischemia/reperfusion injury after heart transplantation.

Mitochondrial dysfunction and ferroptosis play crucial roles in myocardial ischemia/reperfusion (I/R) following heart transplantation. Microsomal glutathione s transferase 1 (MGST1) is widely distributed in mitochondria and has a protective effect against ferroptosis, and its involvement in myocardial I/R injury has not yet been elucidated. In this study, donor hearts from C57BL/6 male mice were subjected to 12h of ex-vivo cold ischemia treatment and transplanted into the abdomen of recipient mice for 24h of reperfusion. The results showed that MGST1 was significantly down-regulated in the model heart graft tissues, and overexpressing MGST1 effectively alleviated myocardial infarction, inflammation and histological damage of myocardial tissues in the model group. Subsequently, mouse cardiomyocytes HL-1 cells were subjected to oxygen-glucose deprivation/re‑oxygenation (OGD/R) condition, and MGST1 overexpression reduced cell apoptosis and inflammation in OGD/R-induced HL-1 cells. Of note, MGST1 overexpression attenuated I/R-induced mitochondrial damage and inhibited ferroptosis in vitro and in vivo. Moreover, MGST1 was found to be negatively regulated by DNA methyltransferase 1 (DNMT1)-mediated promoter methylation, and DNMT1 silence suppressed OGD/R-induced damage in HL-1 cells through restoring MGST1 expression. Altogether, targeting MGST1 hyper-methylation ameliorates mitochondrial damage and ferroptosis of cardiomyocytes, and prevents myocardial I/R injury following heart transplantation.

∆9-Tetrahydrocannabinol Increases Growth Factor Release by Cultured Adipose Stem Cells and Adipose Tissue in vivo.

Because of its biocompatibility and its soft and dynamic nature, the grafting of adipose tissue is regarded an ideal technique for soft-tissue repair. The adipose stem cells (ASCs) contribute significantly to the regenerative potential of adipose tissue, because they can differentiate into adipocytes and release growth factors for tissue repair and neovascularization to facilitate tissue survival. The present study tested the effect of administering a chronic low dose of ∆9-tetrahydrocannabinol (THC) on these regenerative properties, in vitro and in vivo. Human ASCs were exposed to increasing concentrations of THC. Resazurin conversion was applied to investigate the effect on metabolic activity, cell number was assessed by crystal violet staining, tri-linear differentiation was evaluated by specific colorimetric approaches, and the release of growth factors was analyzed by ELISA. Two groups of mice were treated daily either with a low dose of THC (3mg/kg) or a vehicle solution. After 3weeks, adipose tissue was obtained from excised fat deposits, homogenized and tested for growth factor contents. THC decreased ASC proliferation but increased metabolic activity as well as adipogenic and chondrogenic differentiation. A low concentration of THC (1µM) enhanced the growth factor release by ASCs. The concentration of these cytokines was also increased in adipose tissue of mice treated with THC. Our results indicate that chronic activation of the endocannabinoid system promoted differentiation and growth factor release of ASCs, which could be of specific value for enhancing the regenerative potential of adipose tissue.

Novel Approach to Vascular Thymic Tissue Transplantation in Humans: A Case Report.

Vascular thymus transplantation has been explored in animal models but remains untested in humans. Current approaches to congenital athymia involve avascular transplantation of allogeneic thymic tissue, which may delay immune recovery. Building on animal studies, we propose revascularization of thymic tissue in a human model. This case report details about the revascularization of neonatal thymic tissue in an elderly woman with terminal cancer, evaluating revascularization efficacy, rejection risks, and procedural safety over a 3-week period. A thymic tissue graft obtained from a neonate during corrective heart surgery was implanted into the left radial forearm of an 85-year-old woman. The graft was evaluated for 3 weeks, with one thymic vein anastomosed to the cephalic vein and one thymic artery to the radial artery. No immunosuppression or HLA matching was employed. Weekly Doppler ultrasound and postexplantation histopathology monitored blood flow and graft status. Hematologic, biochemical, radiological evaluations, and daily clinical follow-up were conducted. This preliminary research demonstrates the feasibility of revascularizing a neonatal thymus in an adult using microsurgical techniques.

Corneal donation and its relationship with public awareness

Only one donor tissue is available for seventy patients awaiting a corneal graft, indicating a global scarcity of corneal graft tissue. The lack of awareness and information among potential donors and their families is directly linked to this deficiency in eye donation practices. There is a much greater need for corneal tissue than there are eye donations. Prompt corneal procurement demonstrates its maximum utility. A maximum of six hours from the time of death is the optimal window for corneal procurement.

Acellular Adipose Matrices Seem to Be an Effective and Safe Strategy for Soft Tissue Regeneration and Volume Restoration: A Systematic Review of Clinically Relevant Literature.

Significance: Autologous adipose tissue grafting (AAG) can provide soft tissue reconstruction in congenital defects, traumatic injuries, cancer care, or cosmetic procedures; over 94,000 AAG procedures are performed in the United States every year. Despite its effectiveness, the efficiency of AAG is limited by unpredictable adipocyte survival, impacting graft volume retention (26-83%). Recent Advances: Acellular adipose matrices (AAMs) have emerged as a potential alternative to AAG. AAMs include adipose tissue-derived extracellular matrix (ECM) and growth factors (GFs), but not cells. When grafted, AAMs serve as scaffolds with biochemical and biophysical cues for local cell (especially adipocytes) proliferation, regenerating soft tissue, and restoring volume. Being acellular, the AAM is not limited by adipocyte necrosis/apoptosis. Critical Issues: Research on AAM has mostly been conducted on small animal models and with small grafts. Clinically relevant AAM research (large animal models and/or clinical trials) is sparse and limited. To address this gap, we conducted a systematic review of clinically relevant AAM literature to assess AAM's clinical efficacy and safety. Across 11 human and 1 porcine study involving reconstructive or cosmetic procedures, we found that AAMs resulted in significant volume retention, adipogenesis, and angiogenesis, without notable adverse effects. Future Directions: Available quantitative and qualitative data suggest that AAM is an effective and safe alternative to AAG. Yet, the current literature is still limited; more robustly designed studies with standardized methods to assess outcomes will help validate these positive preliminary findings, and possibly pave the way for a broader clinical adoption of AAM.

Optimizing axial inclination with clear aligner orthodontic treatment to address recession defects: a case series.

Proper alignment of the teeth not only aids in functional occlusion but also promotes harmonious gingival contours, potentially reducing the risk of inflammation and gingival recession. This case series aimed to evaluate the effectiveness of optimizing axial inclination through clear aligner orthodontic treatment in addressing gingival recession defects. This case series included nine patients, aged 20-36 years, who presented with varying degrees of gingival recession on 12 mandibular incisors. All patients had undergone orthodontic treatment during childhood and were maintained with a fixed stainless-steel canine-to-canine retainer. The exhibited gingival recessions were potentially caused by inadvertent torque discrepancies in the teeth induced by the retention wire. Prior to treatment, a comprehensive radiographic and periodontal evaluation was performed, and clear aligner orthodontic treatment was used to correct the axial inclination of the affected teeth. Following the completion of the orthodontic treatment, patients were re-evaluated to assess changes in recession depth and width; those with remaining recession were considered for soft tissue grafting. The average treatment duration was 21.6 ± 3.7 months, ranging from 18 to 29 months. Root torque adjustments averaged 12 ± 9 degrees, ranging from a correction of 14 degrees lingually to 33 degrees labially, while bucco-lingual crown movement averaged 1.7 ± 1.2 mm, with a range from 3.4 mm lingually to 0.6 mm labially. All cases showed improvement in gingival recession, with complete recovery in one tooth and an average of 58 ± 21% reduction in recession depth and width for the remaining 11 teeth. Surgical intervention, consisting of soft tissue grafting, was required in four cases, while the remaining 8 teeth showed sufficient improvement and were monitored with follow-up care. Correcting axial inclination with clear aligner orthodontic treatment positively impacts both tooth alignment and gingival recession. These findings propose a new approach: initiating orthodontic treatment before periodontal surgery to streamline treatment and reduce the need for invasive procedures. Orthodontists, general dentists, and patients should be aware of the potential complications of fixed retainers and their possible orthodontic adjustments correction.

Evaluation of the Palatal Features in Relation to Graft Harvesting in the Saudi Population.

Background and Objectives: The palate's morphological characteristics are of great importance, especially in periodontology, where the palatine tissue represents a source of tissue graft for multiple mucogingival surgeries. This study aimed to estimate the amount of donor tissue available through the average palatal height and average location of the greater palatine artery in the Saudi population according to age and gender. Materials and Methods: Digital casts for adult Saudi patients at the age of 18-60 years old with a mean age of 37.76 ± 12.68 years were collected and analyzed using EXOCAD software. The digital casts were evaluated, and measurements of arch width at molars and canines, palatal vault height (PVH), palatal height index (PHI), and extension of the palatal rugae were registered. Finally, the amount available for soft tissue graft harvesting was calculated. Results: Overall, 109 maxillary casts for Saudi patients, 52 (47.7%) males and 57 (52.3%) females, were analyzed. The maxillary inter-molar arch width, inter-canine width, and palatal vault height significantly differed between males and females (p < 0.05). The mean PHI was 45.51% ± 8.12%, and 27.5% were classified as orthostaphyline, while 72.5% were categorized as hypsistaphyline, with no significant difference between the genders. The mean maximum graft width was 11.45 mm, and the graft width was significantly different between males and females (p < 0.005), while the mean maximum graft length was 17.78 mm, and the graft length showed no significant difference. Conclusions: The results of this study provide specific clinical guidelines for periodontal procedures by emphasizing the importance of gender-specific anatomical considerations. Data on graft dimensions and palatal measurements will enable the exact planning of soft tissue harvesting to minimize surgical risks and optimize mucogingival surgery outcomes in the Saudi population.

Lower ACLR Failure Rates in Bone–Soft Tissue Versus Soft Tissue–Only Allografts in Adults: A Systematic Review and Meta-analysis

Background: While allografts are commonly used for anterior cruciate ligament reconstruction (ACLR), evidence to guide specific allograft selection is lacking. Purpose: To compare clinical and graft failure rates after ACLR using soft tissue–only allografts and bone–soft tissue allografts in adults. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: English-language studies with clinical outcome data on primary and revision ACLR in adults with nonirradiated soft tissue–only and bone–soft tissue grafts were identified in the search. Data extracted included allograft type, patient characteristics, follow-up time, and failure rates. The cumulative failure rate was defined as International Knee Documentation Committee grade C/D, graft retear, grade ≥2+ Lachman, grade ≥2+ pivot shift, and/or side-to-side KT-1000 laxity of &gt;5 mm. The graft rupture rate was defined solely by the proportion of patients who had a graft rupture. Meta-analyses using the inverse variance method were used to estimate the pooled rates with 95% CIs. Subgroup analysis was conducted to compare allograft types and determine whether age, sex, and follow-up time influenced the estimates. Results: A total of 14 studies met the inclusion criteria: 7 investigated bone–soft tissue allografts, 6 investigated soft tissue–only allografts, and 1 investigated both. The comparative study showed a difference in the cumulative failure rate between bone–patellar tendon–bone and soft tissue–only allografts. The pooled cumulative failure rates for bone–soft tissue and soft tissue–only allografts were 11% (95% CI, 7-17) and 20% (95% CI, 14-29), respectively ( P = .05). The pooled graft rupture rates for bone–soft tissue and soft tissue–only allografts were 6% (95% CI, 4-9) and 13% (95% CI, 7-23), respectively ( P = .07). Conclusion: The meta-analysis results showed that bone–soft tissue allografts have lower cumulative failure rates than soft tissue–only allografts. Bone–soft tissue allografts may be the preferred allograft choices for ACLR.

The "HAT-TRICK" technique: A modification of soft tissue grafting using volume stable collagen matrix and cross-linked hyaluronic acid. Part B: Clinical applications in the esthetic zone.

Soft tissue deficiency around dental implants can negatively impact outcomes in terms of esthetics and long-term stability. While autogenous connective tissue grafting is still considered the gold standard treatment, alternative approaches are being proposed primarily to enhance patient comfort and avoid invasive procedures such as two-sites surgeries using xenogeneic collagen matrices. Despite the advantages, the quality of the regenerated tissues remains unpredictable and, in many cases, questionable, highlighting the need for alternative and innovative approaches. After introducing in a previous technical note, the "HAT-TRICK" technique, to address these challenges in pontic sites, the present study highlights the "HAT-TRICK" technique for thickening the keratinized gingiva in both immediate and delayed implant placement sites within the esthetic zone. The "HAT-TRICK" technique is demonstrated through two clinical cases, accompanied by a digital comparison conducted at baseline and after one year of follow-up in order to assess and quantify the augmented areas.

Collagen as a bio-ink for 3D printing: a critical review.

The significance of three-dimensional (3D) bioprinting in the domain of regenerative medicine and tissue engineering is readily apparent. To create a multi-functional bioinspired structure, 3D bioprinting requires high-performance bioinks. Bio-inks refer to substances that encapsulate viable cells and are employed in the printing procedure to construct 3D objects progressive through successive layers. For a bio-ink to be considered high-performance, it must meet several critical criteria: printability, gelation kinetics, structural integrity, elasticity and strength, cell adhesion and differentiation, mimicking the native ECM, cell viability and proliferation. As an exemplar application, tissue grafting is used to repair and replace severely injured tissues. The primary considerations in this case include compatibility, availability, advanced surgical techniques, and potential complications after the operation. 3D printing has emerged as an advancement in 3D culture for its use as a regenerative medicine approach. Thus, additive technologies such as 3D bioprinting may offer safe, compatible, and fast-healing tissue engineering options. Multiple methods have been developed for hard and soft tissue engineering during the past few decades, however there are many limitations. Despite significant advances in 3D cell culture, 3D printing, and material creation, a gold standard strategy for designing and rebuilding bone, cartilage, skin, and other tissues has not yet been achieved. Owing to its abundance in the human body and its critical role in protecting and supporting human tissues, soft and hard collagen-based bioinks is an attractive proposition for 3D bioprinting. Collagen, offers a good combination of biocompatibility, controllability, and cell loading. Collagen made of triple helical collagen subunit is a protein-based organic polymer present in almost every extracellular matrix of tissues. Collagen-based bioinks, which create bioinspired scaffolds with multiple functionalities and uses them in various applications, is a represent a breakthrough in the regenerative medicine and biomedical engineering fields. This protein can be blended with a variety of polymers and inorganic fillers to improve the physical and biological performance of the scaffolds. To date, there has not been a comprehensive review appraising the existing literature surround the use of collagen-based bioink applications in 'soft' or 'hard' tissue applications. The uses of the target region in soft tissues include the skin, nerve, and cartilage, whereas in the hard tissues, it specifically refers to bone. For soft tissue healing, collagen-based bioinks must meet greater functional criteria, whereas hard tissue restoration requires superior mechanical qualities. Herein, we summarise collagen-based bioink's features and highlight the most essential ones for diverse healing situations. We conclude with the primary challenges and difficulties of using collagen-based bioinks and suggest future research objectives.

Simultaneously Modified Onlay Soft Tissue Graft and Apically Positioned Flap for Implant Phenotype Modification: A Case Series.

Bone augmentation procedures often leads to coronal displacement of the mucogingival junction, a deficiency of keratinized mucosa, and a reduction in soft tissue height. These challenges complicate the achievement of an ideal peri-implant phenotype. It is known that addressing both the quantity and quality of soft tissue is crucial for the long-term success and aesthetics of implants. This paper introduces a novel technique for peri-implant phenotype modification following bone augmentation, which combines a modified onlay graft (MOG) with an apically positioned flap (APF) performed simultaneously with implant placement. Two clinical cases are presented to demonstrate this approach, highlighting the restoration of the soft tissue environment through a single surgical intervention. The technique resulted in successful outcomes, including increased vestibular depth, keratinized tissue width, and vertical soft tissue volume. The modified onlay graft technique effectively manages soft tissue in post-bone augmentation scenarios, providing an ideal peri-implant phenotype and leading to stable, aesthetic, and functional implant restorations. This method requires fewer surgical interventions than traditional alternatives, minimizing patient discomfort and enhancing overall treatment outcomes.

Engineering considerations in the design of tissue specific bioink for 3D bioprinting applications.

Over eight million surgical procedures are conducted annually in the United Stats to address organ failure or tissue losses. In response to this pressing need, recent medical advancements have significantly improved patient outcomes, primarily through innovative reconstructive surgeries utilizing tissue grafting techniques. Despite tremendous efforts, repairing damaged tissues remains a major clinical challenge for bioengineers and clinicians. 3D bioprinting is an additive manufacturing technique that holds significant promise for creating intricately detailed constructs of tissues, thereby bridging the gap between engineered and actual tissue constructs. In contrast to non-biological printing, 3D bioprinting introduces added intricacies, including considerations for material selection, cell types, growth, and differentiation factors. However, technical challenges arise, particularly concerning the delicate nature of living cells in bioink for tissue construction and limited knowledge about the cell fate processes in such a complex biomechanical environment. A bioink must have appropriate viscoelastic and rheological properties to mimic the native tissue microenvironment and attain desired biomechanical properties. Hence, the properties of bioink play a vital role in the success of 3D bioprinted substitutes. This review comprehensively delves into the scientific aspects of tissue-centric or tissue-specific bioinks and sheds light on the current challenges of the translation of bioinks and bioprinting.

The Use of Connective Tissue Graft Wall as an Adjunct to Regenerative Treatment for Deep Intrabony Defects Associated with Gingival Recession: A Retrospective Case Series with 5-Year Follow-up.

The adjunctive use of connective tissue grafts (CTGs) in the periodontal regeneration of intrabony defects has been proposed to prevent or limit postoperative gingival recession. However, there is limited evidence regarding the long-term clinical performance of this approach. This article presents the five-year follow-up outcomes of a combination therapy using CTG, bone substitutes, and biologics for the treatment of deep intrabony defects associated with gingival recession. Twelve healthy, non-smoking patients with 12 deep intrabony defects participated in the study. These patients had a mean clinical attachment loss (CAL) of 9.9 ± 2.1 mm, a mean probing depth (PPD) of 7.8 ± 1.5 mm, and a mean buccal recession (REC) of 2.3 ± 1.8 mm at baseline, before= undergoing the described treatment regimen. After five years, the mean clinical attachment level (CAL) gain was 5.7 ± 3.2 mm (p < 0.001), the mean reduction in probing pocket depth (PPD) was 5.1 ± 1.6 mm (p < 0.001), and the mean reduction in recession (REC) was 1.2 ± 2.1 mm (p = 0.07) Ninety-one percent of sites achieved CAL gain of ≥3 mm and PPD ≤ 4 mm. Compared to baseline, 7 out of 12 sites showed a REC reduction of ≥1 mm, while three sites remained stable, and two sites experienced an increase in gingival recession depth of 1 and 2 mm respectively. Within the limitations of this case series, periodontal regenerative therapy incorporating the adjunctive use of CTG showed to be effective for treating deep non-contained periodontal intrabony defects and respectively stabilize or slightly improve the gingival margin over five years.

Tunneled Coronally Advanced Flap and Connective Tissue Graft Wall for the Treatment of Isolated Infrabony Defect Associated with Gingival Recession: Technical Report with Cases.

The integrity and phenotype of periodontal soft tissues significantly influence the outcome of surgical periodontal regenerative therapy. In cases with thin gingival phenotype, treating infrabony defects surgically can worsen gingival recession and loss of papillae. This report outlines a surgical approach for addressing infrabony defects at sites with gingival recession and thin phenotype. The treatment involves using a tunneled coronally advanced flap (TCAF) to obtain access for defect debridement, root instrumentation, graft placement, and tissue advancement for root coverage. A connective tissue graft (CTG) is secured to the two teeth flanking the infrabony defect with two subperiosteal sling (SPS) sutures to create a buccal soft tissue wall and to tent up the papilla overlying the defect to provide and maintain the necessary space for biomaterials and clot stability. The treatment significantly improved interproximal clinical attachment levels, tissue phenotype, and root coverage one-year post surgery. Treatment outcomes suggest that this approach may be used to effectively treat isolated infrabony defects associated with gingival recession.

Importance of pain perception after mucogingival surgery in multiple Miller class III/RT2 gingival recessions: A randomized clinical trial.

Background: Although postoperative pain after mucogingival surgery can modify the patient's daily life, few studies have compared daily postoperative pain in mucogingival surgery considering patient characteristics. The aim of this study was to evaluate postoperative pain in 24 patients with Miller class III/RT2 multiple recessions treated with the modified VISTA (m-VISTA) versus the coronally advanced flap (CAF) with a connective tissue graft (CTG). Material and Methods: Data related to pain intensity (PI), pain duration (PD), analgesic drug intake (AI), and time of analgesic need (TAN) were collected in the “UPV/EHU pain diary”. Other data were also evaluated such as the patient’s central sensitization level, pre-surgical pain, dimensions of CTG, and postoperative incidences were included. A descriptive and analytical statistical analysis was performed. Results: PI (m-VISTA = 11.19 vs. CAF = 8.10) and PD (m-VISTA = 25.27 min. vs. CAF = 10.34 min.) were higher in the test group, being statistically significant at 2 and 8 hours. TAN (m-VISTA = 63.58 min. vs. CAF = 53.25 min.) was higher in the test group, while AI was two times higher in the control group (m-VISTA = 15 vs. CAF = 38). An association was observed between PI and both the length of the SCTG and drugs/alcohol consumption. Conclusions: Postoperative pain was greater in the group of patients treated with m-VISTA. However, these patients showed a higher number of risk factors which might have increased or modified their pain symptoms.