Interdental Papilla Research Articles

SURGICAL MANIPULATION OF SOFT AND BONE TISSUE IN CONTEMPORARY DENTAL IMPLANTOLOGY

Adequate and correct manipulation of soft and bone tissues during implant therapy is extremelyimportant. Knowledge of the biological, histological and of course the surgical characteristics of the tissues canlargely be a predictor of the correct implant prosthetic rehabilitation. The main aim of this research was to describeall aspects of surgical manipulation of the soft and bone tissues during the dental implantology procedures. We havemade adequate literature research for articles relevant to our topic-surgical manipulation of the soft and hard tissuesduring the dental implantology procedures published in the last two decades (2001-2021). Kew words used for theresearch were: “surgical manipulation”, “dental implantology”, “soft tissues”, “bone tissues” and their combination.Each implantologist should take into account the biological limitations of each patient, as well as the technicallimitations that may occur during the treatment. Oral soft tissues can be affected during the various stages of theimplant treatment. During the planning of a surgical intervention such as the placement of an implant, regardless ofwhether it is an immediate or a delayed loading implant, it is necessary to have an adequate manipulation of thesurrounding soft tissue and bone structures. When designing the flap should be taken into account the degree ofaccessibility required to access the bone, as well as the final position of the flap. It is also of great importance to takeinto account the preservation of good blood supply to the flap. Based on the exposure of bone after elevation, flapscan be classified as either full-thickness or mucoperiosteal flaps and partial-thickness or mucosal flaps. Dependingon how the interdental papilla will be treated, the incisions can either divide the papilla (conventional incision) orpreserve it (papilla-preserving incision). Based on the placement of flaps after surgery, they can be classified as: 1)nondisplaced flaps, where the flap is returned and sutured to its original position, or 2) displaced flaps, which areplaced apically, coronally, or laterally from their original position. The work in bone is quite complex and requiresknowledge of its morphological and histological characteristics. When working on bone, and especially whenplacing dental implants, it is necessary to note that it is necessary to enable constant cooling. The improvement ofold techniques and the development of new technologies have created a revolution in oral implantology, and now atherapist has numerous therapeutic options that can be incorporated into daily practice to facilitate the surgicalapproach itself. Hard-tissue and soft-tissue dental lasers, which are constantly improving and have a wide range ofindications, are becoming a part of everyday dental practice and also show significant advantages compared toconventional instruments and techniques when placing dental implants. Therefore, over time they will become aninvaluable and irreplaceable tool in modern dental implantology. After the performed extensive and deductiveliterature review, it can be concluded that from particular importance is the correct manipulation of soft and bonetissues during dental implantation. After tooth extraction, the placement of dental implants is largely determined bythe integrity of existing hard and soft tissues, such as the aesthetic outcome from the prosthodontic suprastructureover dental implants. Careful assessment of soft and bone tissue loss during implantation is paramount to the successof aesthetic implant procedures

Necrotizing periodontal disease in a nutritionally deficient patient: A case report

Necrotizing periodontal disease (NPD) is a microbial infectious inflammatory disease of the gingiva and/or periodontium that is characterized by a rapid onset of inflammation, pain, and “punched out” cratered interdental papillae. Although NPD is not very common, diagnosis is mostly based on its unique clinical presentation. Some predisposing factors for developing NPD include poor oral hygiene, smoking, malnutrition, immunosuppression (such as in HIV infection, uncontrolled diabetes, and cancer), and stress. This case report presented a 22-year-old Caucasian female, heavy smoker but otherwise no systemic disease, who suffered from severe inflammation of the gingiva, ulceration, and necrosis of the interdental papillae, and pseudomembrane formation. The patient had been hospitalized for a seizure episode and was diagnosed with malnutrition-induced seizure. NPD was diagnosed and the patient was treated successfully with nonsurgical scaling and root planing and behavioral modifications including smoking cessation and balanced nutrition intake. Disease remission was achieved after treatment. In addition, the present case report reviewed the effect of nutrients on the health of the periodontium.

Case Report: Interstitial-intralesional laser therapy and laser-assisted new attachment procedure for the treatment of alveolar bone loss provoked by an aggressive pyogenic granuloma

A pyogenic granuloma (PG) is a common benign vascular lesion found in the oral cavity. The gold standard treatment of this lesion, comprising surgical excision and the elimination of etiological factors, cannot avoid tooth loss in the case of an aggressive pyogenic granuloma. Because of the prominent properties of 980 nm and 635 nm diode lasers in photocoagulation and photobiomodulation, we applied these wavelengths in the treatment of a large pyogenic granuloma with alveolar bone loss. Our objective was to use a combination of interstitial-intralesional laser therapy, photocoagulation and laser-assisted new attachment procedure (LANAP) to preserve the teeth and periodontal tissue in a case of an aggressive pyogenic granuloma. The patient was a 13-year-old Thai male with a pyogenic granuloma involving the interdental papilla and lingual gingiva of the lower left first and second molars. The teeth were also displaced by the lesion. After treatment with three sessions of photocoagulation, three sessions of interstitial-intralesional laser therapy and two sessions of LANAP, the lesion was completely resolved. The periodontal status of the teeth was improved at the six-month follow-up. The combination of interstitial-intralesional laser therapy, photocoagulation and LANAP was able to treat an aggressive pyogenic granuloma with tooth preservation.

The Esthetic Outcome of Interproximal Papilla Between Implant-Restored Unilateral and Bilateral Maxillary Central Incisors: A Cross-Sectional Comparative Study.

Restoring the esthetics of anterior teeth with implants is challenging. This study aimed to evaluate the esthetic outcome of interproximal papilla between implant-restored unilateral and bilateral maxillary central incisors. A total of 56 adults with implant restorations in the maxillary central incisors were enrolled, including 40 cases of unilateral incisors and 16 cases of bilateral incisors. Photographic and radiographic assessments were performed, and patient-reported esthetic satisfaction was collected. The papilla index (PI) in the unilateral group was superior to that in the bilateral group (P = .002). Patients in the two groups reported equal satisfaction regarding the final esthetic outcome (P = .470). Statistically significant differences were noted between the two groups in papilla height (P = .000), implant-implant or implant-tooth distance (P = .002), and vertical distance from the implant platform to the bone crest (P = .000). In the bilateral group, tested variables were not correlated with PI by nonparametric Spearman correlation. In the unilateral group, the multivariate binary logistic regression model showed that incomplete papilla fill was associated with abutment type (OR = 0.019), implant-tooth distance (range, 2.1 to 6.2 mm; OR = 6.435), and distance from the bone crest to the contact point (range: 3.5 to 6.9 mm; OR = 4.589). In implant-restored maxillary central incisors, PI in the unilateral group was superior to that in the bilateral group. In the bilateral group, no clinical variable was correlated with PI. In the unilateral group, the risk of incomplete papilla fill was reduced by the customized zirconia abutment and was increased by the larger implant-tooth distance and higher distance from the bone crest to the contact point.

Evaluation of Regenerative Potential of Locally Delivered Vitamin C along with Microneedling in the Treatment of Deficient Interdental Papilla: A Clinical Study

To evaluate the efficacy of intrapapillary injections of vitamin C along with microneedling (MN) in enhancing deficient interdental papilla (IDP) in esthetic zones clinically. Fifteen patients diagnosed with black triangles according to Norland classification system for loss of papillary height were selected. After oral prophylaxis and baseline measurements of insufficient interdental papilla, the vitamin C injection was loaded in disposable syringe 30G × 1/2" needle. The needle was inserted at 45° angle, 2-3-mm apical to the involved papilla and all surrounding areas. Each involved papilla was injected with an amount till blanching was visible. After that, MN was done in the required area. This method was repeated for 5 times at 7 days intervals consecutively. The final clinical photographs and measurements were recorded after 7 days of last dose administered. There was a statistically significant difference in the mean IDP height observed over the time period (p = 0.002). An overall healthy appearance of gingiva with a remarkable increase in papilla growth was observed. Vitamin C injection along with MN can be considered as an alternative to invasive surgical procedures in reconstruction or regeneration of the missing IDP.

Frenectomy with laterally displaced flap: An aesthetic approach

Frenum is a mucous membrane fold that attaches the lip and the cheek to the alveolar mucosa, gingiva, and the underlying periosteum. The frena may endanger the gingival health when they are attached closely to the gingival margin. An aberrant frenum is presupposed to create functional and aesthetic problems. Archer’s ‘classical frenectomy’ is an extensive procedure including the excision of fibers, interdental papilla, and exposure of the alveolar bone up to the palatine papilla. The aftermath delayed healing, loss of interdental papilla, and unusual scar led toward the traditional approaches such as Edward’s frenectomy, frenum relocation by Z-plasty, and free gingival graft, with their practical and esthetic restriction. A superior approach to make a primary closure in midline and to bypass anaesthetic scar by creating a zone of attached gingiva, frenectomy is associated with lateral pedicle graft. Miller, in his study on 27 subjects, proposed that newly created zone of attached gingiva may have bracing effect inhibiting reopening of diastema. A case report of this approach with its well defined benefits is presented.

Clinical and radiographic evaluation of non-incised papilla surgical approach (NIPSA) versus modified minimally invasive surgical technique (M-MIST) in treatment of intraosseous defects in patients with stage III periodontitis

Background: Minimally invasive surgical (MIS) procedure" in multiple and isolated intra-osseous defects maintained the entire interdental papilla with significant improvement in clinical and radiographic outcomes compared to traditional periodontal surgeries. Methods: Thirty-two intra-osseous defects in 15 patients were enrolled for this study and were randomly allocated to both groups i.e. (16 defects) per group. Patients in group I (test group) went for Non-Incised Papilla Surgical Approach (NIPSA), while, in group II (control group), patients received Modified Minimally Invasive Surgical Technique (M-MIST). All clinical and radiographic periodontal parameters were measured at baseline, six months and twelve months. Results: Patients in both groups showed significant improvements in clinical and radiographic outcomes after twelve months of follow-up including reductions in CAL, potential effect in post-surgical patients’ satisfaction and intra-osseous defect fill. Absence of significant difference regarding intergroup comparisons. The minimal surgical flap design plays a very important role in the success of the therapy, creating and maintaining a stable space for the clot. Conclusions: NIPSA is viewed as a promising minimally invasive technique even in hopeless teeth with severe periodontal bone loss, clinical attachment loss to the apex and minimal keratinized tissue.

Volumetric Soft Tissue Changes After Using Injectable Platelet-Rich Fibrin (I-PRF) Versus Subepithelial Connective Tissue Graft in Interdental Papillae Defects: A Randomized Controlled Clinical Study

Background: Lost interdental papillae in the esthetic region are of great concern from the esthetic and functional point of view. We elicit a clinical study of papillary reconstruction in this article using injectable platelet-rich fibrin (I-PRF) as a nonsurgical procedure and compare its results to those of the subepithelial connective tissue graft (SECTG), being considered the gold standard method used to reconstruct interdental papillae. Methods: Twenty-four patients seeking treatment for black triangles were randomized into two groups: group A patients were treated with the SECTG technique, and group B patients were treated with I-PRF. Four injections were given at each papilla site at baseline, two-, four-, and six-week intervals to ensure optimal esthetics. Pain, clinical, and volumetric assessments were done. Volumetric assessment was completed through intraoral scanning of the papilla site at baseline and after six months, after which the results were obtained by superimposition of both scans. Results: Group A (5.08 ±2.15) had a significantly higher mean pain score value than group B (1.17 ±0.94) (p < 0.001). Group B (0.31 ±0.21) had a higher mean value of volumetric changes at the interdental papillae than group A (0.25 ±0.17), yet the difference was not significant (p = 0.517). Conclusion: Injectable platelet-rich fibrin gave comparable results to SECTG in Nordland Class I defects only, provided that the injection protocol was once every 15 days for a two-month period. Patients treated with I-PRF were more satisfied with the procedure and the results than patients who were treated with SECTG.

Formation of the interdental papilla by surgical method

BACKGROUND: The loss of interdental gingival papillae or the presence of black triangles between the teeth is one of the important problems in aesthetic dentistry, along with the loss of teeth and violation of the integrity of the hard tissues of the tooth. These patients have aesthetic, phonetic disorders, and it is also possible that food gets stuck between the teeth, which causes discomfort in the oral cavity and leads to periodontal diseases. Currently, an increasing percentage of people with orthopedic structures have a recession of the interdental gum. To improve the predicted result, it is necessary to approach this problem in an interdisciplinary way.
 MATERIAL AND METHODS: The search for publications was conducted in four electronic databases: Pubmed, Google search, eLibrary and dissercat from 2006 to 2021. 157 full-text publications were analyzed, of which 40 publications were included in the systematic review.
 RESULTS: According to various studies, the restoration of the lost interdental papilla varies from 1.68 to 5 mm. Complete restoration of the interdental papilla occurs when using microsurgical methods of restoration of the interdental gum. The least injury to soft tissues leads to the best results and reduces the risk of complications.
 CONCLUSION: Restoration of the interdental papilla is a complex surgical manipulation where microsurgical instruments must be used. Any rupture or excessive injury of the isthmus of the interdental papilla leads to a violation of blood supply, which leads to necrosis of the graft and aesthetic dissatisfaction.

Comparative Evaluation of Platelet-Rich Fibrin versus Connective Tissue Grafting in Treatment of Gingival Recession Using Pouch and Tunnel Technique: A Randomized Clinical Study.

Aims:The aim of the study was to compare the clinical efficacy of platelet-rich fibrin (PRF) and connective tissue grafting in the treatment of gingival recession (GR) using pouch and tunnel (P and T) technique.Materials and Methods:A total of 40 Class I or Class II GR defects in 17 patients were randomized treated with P and T with PRF (Group I, n = 20) and P and T with CTG (Group II, n = 20). The parameters measured were plaque index (PI), gingival index (GI), probing pocket depth (PPD), clinical attachment level (CAL), horizontal gingival recession (HGR), vertical gingival recession (VGR), width of attached gingiva (WAG), width of keratinised gingiva (WKG), gingival thickness-mid buccal (GTMB), and gingival thickness interdental papilla (GTIP). Postsurgical discomfort level (PSDL), hypersensitivity score (HS), and patient esthetic score (PES) were recorded using visual analog scale (VAS). The PI, GI, PPD, CAL, HGR, VGR, WAG, WKG, GTMB, and GTIP were assessed at pretreatment (baseline) and 1-, 3-, and 6-month posttreatment. The PSDL, HS, and PES were assessed at baseline, day 10, 1, 3, and 6-month posttreatment.Results:P and T with PRF and CTG resulted in root coverage of 73.75% ± 7.80% and 70.83% ±8.26%, respectively. Patient response and acceptance for the surgical treatment modality showed less discomfort and better esthetics in Group I as compared to Group II.Conclusions:PRF treated sites were comparable to the gold standard CTG with better patient acceptance and a lesser invasive approach in terms of graft procurement.

Maxillary labial frenulum attachment among patients visiting a tertiary level hospital of Nepal

Background: The maxillary labial frenum is frequently inserted in the mucogingival junction. However, it may show variation in attachment. Despite the fact that an aberrant labial frenum has been associated to a range of syndromic and non-syndromic disorders, it is frequently overlooked during routine intraoral examinations. Objectives: To find the prevalence of types of maxillary labial frenum attachment in patients visiting tertiary hospital in Nepal. Methods: This analytical cross-sectional study comprised of 140 patients visiting the dental outpatient department of Tribhuvan University Teaching Hospital from December 23, 2021 to March 13, 2022. Investigators assessed the patient’s frenum insertion in the dental chair with the lip softly pulled away from the alveolar process in a nearly horizontal direction under good lighting. Data were entered and analysed statistically using SPSS.v21 where mean, standard deviation, frequency, and percentage were calculated depending upon the nature of data. Fisher’s exact test was done to determine the association of age category and sex with the types of frenulum attachment. Results: Most of the individuals (83, 59.3%) had the mucosal type of frenum followed by gingival (46, 32.9%), papillary (9, 6.4%), and least with papillary penetrating (2, 1.4%). Age and sex did not show any association with types of frenulum attachment. Conclusion: The insertion level of the labial frenum may vary, implying the significance of careful assessment during an intraoral examination. It also suggests that in presence of the abnormal attachment, an effective treatment approach planned timely could prevent gingival and interdental papilla pathological alterations.

Fibrous epulis - case report

<p><strong><span id="page359R_mcid63" class="markedContent"><span dir="ltr" style="left: 377.953px; top: 418.511px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(1.05778);" role="presentation">Introduction</span></span></strong><span id="page359R_mcid64" class="markedContent"><span dir="ltr" style="left: 469.901px; top: 418.511px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.890469);" role="presentation"><strong>.</strong> Epulis is a change in gingival tissue that occurs under the </span></span><span id="page359R_mcid65" class="markedContent"><span dir="ltr" style="left: 377.953px; top: 438.511px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.932733);" role="presentation">influence of chronic irritation. Histologically, there are several different </span></span><span id="page359R_mcid66" class="markedContent"><span dir="ltr" style="left: 377.953px; top: 458.511px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.933634);" role="presentation">types of epulis. Fibrous epulis is benign tumor of gingiva that most of</span></span><span id="page359R_mcid68" class="markedContent"><span dir="ltr" style="left: 377.953px; top: 478.511px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.956314);" role="presentation">ten occurs in interdental papilla area as a result of local irritation (in</span></span><span id="page359R_mcid70" class="markedContent"><span dir="ltr" style="left: 377.953px; top: 498.511px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.92806);" role="presentation">adequate restorative fillings, carious teeth, subgingival deposits or the </span></span><span id="page359R_mcid71" class="markedContent"><span dir="ltr" style="left: 377.953px; top: 518.511px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.908543);" role="presentation">combination of them). The aim of this paper is to present a clinical case </span></span><span id="page359R_mcid72" class="markedContent"><span dir="ltr" style="left: 377.953px; top: 538.511px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.919242);" role="presentation">of fibrous epulis.</span></span></p> <p><span id="page359R_mcid73" class="markedContent"><strong><span dir="ltr" style="left: 377.953px; top: 567.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.983097);" role="presentation">Case report.</span></strong></span><span id="page359R_mcid74" class="markedContent"><span dir="ltr" style="left: 468.103px; top: 567.96px; font-size: 16.6667px; font-family: sans-serif;" role="presentation"> </span><span dir="ltr" style="left: 473.815px; top: 567.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.966329);" role="presentation">A 25-year-old girl reported to the Specialist Center for </span></span><span id="page359R_mcid75" class="markedContent"><span dir="ltr" style="left: 377.953px; top: 587.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.949471);" role="presentation">Dentistry in Foca. Clinical examination revealed a gingival tissue en</span></span><span id="page359R_mcid77" class="markedContent"><span dir="ltr" style="left: 377.953px; top: 607.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.978601);" role="presentation">largement in the area of</span><span dir="ltr" style="left: 550.203px; top: 607.96px; font-size: 16.6667px; font-family: sans-serif;" role="presentation"> </span><span dir="ltr" style="left: 555.903px; top: 607.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.970168);" role="presentation">the upper jaw central incisors with speech </span></span><span id="page359R_mcid78" class="markedContent"><span dir="ltr" style="left: 377.953px; top: 627.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.948603);" role="presentation">and chewing function disturbances. Intraoral examination revealed a </span></span><span id="page359R_mcid79" class="markedContent"><span dir="ltr" style="left: 377.953px; top: 647.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.955671);" role="presentation">change above the level of gingiva, reddish-pink in color with smooth </span></span><span id="page359R_mcid80" class="markedContent"><span dir="ltr" style="left: 377.953px; top: 667.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.897711);" role="presentation">surface texture and soft consistency. The size of the change was 1 x 1.5 </span></span><span id="page359R_mcid81" class="markedContent"><span dir="ltr" style="left: 377.953px; top: 687.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.939751);" role="presentation">cm. It was connected to the interdental gingiva between teeth 12 and </span></span><span id="page359R_mcid82" class="markedContent"><span dir="ltr" style="left: 377.953px; top: 707.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.922157);" role="presentation">21 by a narrower base. Clinically, a significant amount of soft and hard </span></span><span id="page359R_mcid83" class="markedContent"><span dir="ltr" style="left: 377.953px; top: 727.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.964691);" role="presentation">dental deposits surrounded the remaining teeth. Remaining gingiva </span></span><span id="page359R_mcid84" class="markedContent"><span dir="ltr" style="left: 377.953px; top: 747.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.910207);" role="presentation">was swollen, red, bleeding on provocation. The anamnesis did not con</span></span><span id="page359R_mcid86" class="markedContent"><span dir="ltr" style="left: 377.953px; top: 767.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.911782);" role="presentation">firm the presence of other acute and chronic diseases. The patient was </span></span><span id="page359R_mcid87" class="markedContent"><span dir="ltr" style="left: 377.953px; top: 787.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.902162);" role="presentation">not pregnant. She was informed about clinical condition assessment, as </span></span><span id="page359R_mcid88" class="markedContent"><span dir="ltr" style="left: 377.953px; top: 807.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.938384);" role="presentation">well as possible therapeutic procedures. Our patient was treated with </span></span><span id="page359R_mcid89" class="markedContent"><span dir="ltr" style="left: 377.953px; top: 827.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.936212);" role="presentation">non-surgical periodontal therapy and surgical excision of the enlarge</span></span><span id="page359R_mcid91" class="markedContent"><span dir="ltr" style="left: 377.953px; top: 847.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.952075);" role="presentation">ment. After histopathological examination of the removed tissue, the </span></span><span id="page359R_mcid92" class="markedContent"><span dir="ltr" style="left: 377.953px; top: 867.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.900182);" role="presentation">diagnosis was made:</span></span><span id="page359R_mcid93" class="markedContent"><span dir="ltr" style="left: 518.036px; top: 867.96px; font-size: 16.6667px; font-family: sans-serif;" role="presentation"> </span><span dir="ltr" style="left: 521.234px; top: 867.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.861328);" role="presentation">“Fibrous epulis cum ulceration”.</span></span></p> <p><span id="page359R_mcid94" class="markedContent"><strong><span dir="ltr" style="left: 377.953px; top: 897.409px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.972244);" role="presentation">Conclusion.</span></strong></span><span id="page359R_mcid95" class="markedContent"><span dir="ltr" style="left: 462.603px; top: 897.409px; font-size: 16.6667px; font-family: sans-serif;" role="presentation"> </span><span dir="ltr" style="left: 467.385px; top: 897.409px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.945574);" role="presentation">Clinical examination is insufficient for definite diagnosis. </span></span><span id="page359R_mcid96" class="markedContent"><span dir="ltr" style="left: 377.953px; top: 917.409px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.938323);" role="presentation">Therefore, a histopathological examination of the tissue is mandatory </span></span><span id="page359R_mcid97" class="markedContent"><span dir="ltr" style="left: 377.953px; top: 937.409px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.921552);" role="presentation">for fibrous epulis definite diagnosis. Treatment of choice is surgical ex</span></span><span id="page359R_mcid99" class="markedContent"><span dir="ltr" style="left: 377.953px; top: 957.409px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.921339);" role="presentation">cision of the enlargement and removal of predisposing factors to avoid </span></span><span id="page359R_mcid100" class="markedContent"><span dir="ltr" style="left: 377.953px; top: 977.409px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.901523);" role="presentation">recurrence.</span></span></p>

Influence of marginal incision and Le Fort I osteotomy on periodontal tissues: a prospective longitudinal study

The purpose of this prospective study was to evaluate whether the surgical protocol involving marginal incision and Le Fort I osteotomy affects the periodontal outcome. Twenty-nine patients requiring surgical correction of maxillary dysgnathia were selected for this study. Periodontal conditions of maxillary anterior teeth were assessed prior to the surgery (T0), one month (T1), and 6 months (T2) after the surgical procedure. Interdental papillae loss, periodontal parameters and aesthetic outcomes in the anterior zone were assessed. Statistical analysis was performed with Friedman´s test and within ANOVA (p ≤ 0.05) followed by post-hoc tests. Papilla height decreased from T0 to T1 (p = 0.003), followed by an increase from T1 to T2 (p = 0.040). PPD (T0 = 1.72 ± 0.46; T2 = 2.13 ± 0.43) and CAL (T0 = 1.24 ± 0.55; T2 = 1.99 ± 0.70) increased after 6 months. There were statistically significant differences in aesthetic score among T0, T1 and T2. Periodontal changes after orthognathic surgery were within acceptable biological levels. Although a change in papillae height was reported after the surgery, initial values were recovered after 6 months. Surgical incision design might improve the outcome of Le-Fort I osteotomy. Anterior aesthetic zone may benefit from a marginal incision design, as it respects vascularization principle and may ensure a wound healing without complications.

Preservation of Peri-Implant Papilla: A Narrative Review

AbstractBeside osseointegration and restoration of function, the patient's subjective satisfaction with the esthetic result is a touchstone of the success of implant therapy. The long-term maintenance and reconstruction of papilla-like soft tissue between two adjacent implants in the esthetic zone which is esthetically satisfactory is generally regarded as a challenge. The road to success is much more complicated with implants, because of biologic and anatomical limitations of peri-implant tissues. Numerous techniques have been proposed to manage the hard and soft tissues in an attempt to achieve ideal esthetic results which includes surgical and nonsurgical techniques. The goal of reconstructive procedures is to provide peri-implant bone that supports and maintains gingival contours. An interdisciplinary approach has an obvious advantage of long-term preservation of a healthy peri-implant tissue which is of key importance in ensuring acceptable function and subjective satisfaction of esthetics of dental implants. A detailed literature search was performed in English language from 1986 to 2012, which included review articles, original research, as well as case reports. The search was performed in National Library of Medicine's PubMed database, Google Search, and Science Direct. A manual search of hard copies of available journal was also performed using interdental papilla, peri-implant papilla, esthetics, and dental implant as key words, in an attempt to gain insight into the limitations of papilla preservation, the factors which may potentially affect the maintenance and reconstruction of inter-implant papilla, and the contemporary methods to augment it.

Influence of interproximal peri-implant tissue and prosthesis contours on food impaction, tissue health and patients' quality of life.

To investigate tissue features and interproximal contour of posterior implant-supported single crowns (ISSC), which correlate with food impaction. 2) To evaluate the influence of food impaction on the health of the adjacent peri-implant tissue and patients' oral health-related quality of life (OHRQoL). Patients with posterior ISSC under maintenance between July 2019 and July 2020 were recruited. OHRQoL of patients who self-reported food impaction between ISSC and teeth was evaluated by Oral Impacts on Daily Performance questionnaire and reported at patient level. Interproximal prosthesis contours and periodontal/peri-implant tissue conditions were assessed by clinical and radiographic examination. Differences between food impaction (FI) and non-food impaction (NFI) sites were analysed. Totally, 178 patients (286 ISSC and 410 interproximal spaces) were included. Among 119 patients who self-reported food impaction, 84 (70.6%) reported their OHRQoL to be affected with minor-to-severe intensity. The most commonly affected daily performance was the ability to clean the teeth. Plaque accumulation at ISSC, deeper probing depth, complete interdental papilla fill, loose contact, longer contact length, lower contact point level, closer distance between ISSC and tooth, lesser embrasure surface area, tissue-level implant and cement-retained restoration were found significantly more in the FI group than the NFI group (p < .05). Interproximal features of the implant prosthesis were associated with food impaction between the ISSC and the adjacent tooth, which might affect periodontal and/or peri-implant tissue health conditions. Patients' OHRQoL was commonly affected by food impaction, but the intensity was low.

Role of implant loading time in the prevention of marginal bone loss after implant-supported restorations: A targeted review.

The implant-supported restoration of missing teeth is a recognized method of treatment that ensures a functional, esthetic and durable effect, along with patient satisfaction. However, the preferable time of dental implant loading is under debate. Currently, 3 protocols are used: immediate loading; early loading; and conventional (late) loading. Immediate loading provides benefits such as short treatment time, the elimination of the second surgery required for later loading protocols, the protection of the gingival papilla, an immediate esthetic effect, and high patient satisfaction. This review aimed to summarize the evidence on the impact of loading time on marginal bone loss (MBL) around dental implants, which is considered a useful measure of implantological treatment effects. A literature search was conducted based on the PubMed/MEDLINE database. The search focused on studies providing the MBL values by protocol. Out of the 1,366 hits received in the initial search, 10 studies were included in the qualitative analysis. At 12 months, the MBL range was 0.17-1.86 mm in patients undergoing the immediate protocol, 0.14-1.22 mm in patients undergoing the early protocol, and 0.44-0.91 mm in patients undergoing the late protocol. The studies were heterogeneous, but no significant differences in the occurrence of MBL were reported between the immediately and early loaded implants as compared with the conventionally loaded ones. Further studies are needed to determine other factors that might be related to the type of protocol, important for optimal patient treatment.

Digital assessment of gingival thickness changes after initial periodontal treatment: comparison of central and interdental areas in the anterior maxillary region

To develop digital parameters for direct evaluation of gingival thickness changes (GTC) and to test their correlations with standard periodontal parameters. Ten Stage III/IV periodontitis patients were treated with conventional debridement protocol using ultrasonic scaler (PiezoLED, KaVo) and Gracey curettes (Hu-Friedy). Before recording baseline and 3-months re-evaluation probing pocket depth (PPD) and gingival recession (REC) with Williams probe (POW6, Hu-Friedy), patients underwent intraoral scanning (CEREC Omnicam AC, Dentsply Sirona). Digital assessment (GOM Inspect 2017) was made on superimposed digital models of 3-mm wide gingival margin region of maxillary incisors and canine for evaluation of GTC. The GTC was evaluated in the central region (C) and interdental buccal region (INT). For different differences in REC (diffREC) points, GTC distribution was plotted on a Box diagram. Correlations were calculated between diffPPD, diffREC and GTC for C and INT regions. The median GTC in C and INT regions was -0.24 mm (range: -0.18 mm to -0.38 mm) and -0.50 mm (range: -0.30 mm to -0.72 mm), respectively (Mann-Whitney, p < 0.001). Wider variability of GTC distribution at neutral diffREC value in INT than in C region was also apparent on color–coded superimposed models. GTC in INT region correlated with diffPPD (Spearman rho = 0.57, p < 0.0001). The proposed digital parameters revealed dimensional changes after initial periodontal treatment undetected by standard periodontal parameters. As clinically significant changes were detected in aesthetically important regions of interdental papillae, new parameters can be recommended for the evaluation of different periodontal treatment modalities.

Smile Aesthetic Evaluation on Videographs: An Intra-Rater and Inter-Rater Agreement Study.

The aim of this study was to assess on videographs the intra- and inter-rater reproducibility of the Smile Esthetic Index (SEI) that has been previously validated on photographs. Smile videographs were obtained using a smartphone associated with the Smile Lite MDP mounted on a tripod. They were then randomized and evaluated twice consecutively at a 1-week interval by three periodontists according to the SEI based on 10 variables. Cohen’s Kappa and Fleiss’ Kappa tests were performed to measure intra- and inter-rater agreement. Sixty-five smile videographs of 24 men and 41 women (mean age 33 ± 11.3 years) were scored. A mean intra-rater agreement of 0.68 (0.64–0.73) was obtained, representing substantial agreement. The inter-rater agreement calculated for each variable ranged from 0.31 for the variable “absence of visible excessive gingiva” to 0.90 for the variable “absence of diastema and/or missing inter-dental papilla.” Within the limits of this study, we have demonstrated that it was possible to use videographs to reproducibly evaluate an aesthetic score (SEI) previously validated on photographs.

Combination Therapy with Connective Tissue Graft, Amelogenins, and Bone Substitutes for Treatment of Deep Intrabony Defects Associated with Gingival Recession: 1-Year Follow-up of 12 Cases.

Combined surgical procedures have been introduced that combine periodontal regenerative/reconstructive procedures in intrabony defects with a connective tissue graft to compensate for a deficient bone wall and limit soft tissue shrinkage, but little is known about the reproducibility of these advanced surgical techniques. This 12-case series applies a combined surgical procedure, combining amelogenins, bone substitutes, and connective tissue graft to treat deep intrabony defects associated with gingival recession. Twelve deep intrabony defects with a mean clinical attachment loss of 9.9 ± 2.1 mm, mean probing depth (PPD) of 7.8 ± 1.5 mm, mean recession of the tip of the interdental papilla (TP) of 2.1 ± 1.5 mm, and mean buccal recession (REC) of 2.3 ± 1.8 mm were treated. At 1 year, the average attachment gain was 5.1 ± 1.8 mm (P < .001), the residual PPD was 2.9 ± 0.7 mm (P < .001), no change was observed in the TP (-0.4 ± 0.8 mm, P = .078), and the REC slightly decreased to 1.7 ± 1.5 mm (P = .047). These results suggest that the proposed technique led to predictable clinical outcomes that support regeneration while maintaining or improving the position of the soft tissue margin for the interdental and buccal aspects in deep intrabony defects associated with gingival recession.

Comparison between orthodontist, general dentist, and layperson in the perception of pink esthetics on smile: A cross-sectional study

Objectives: Smile designing has become an essential part of dental training and a beautiful smile not only adds to the esthetics of the face but also conveys emotions and augments the self-esteem of an individual. A beautiful smile is achieved by well-balanced pink and white esthetics. This study was designed to evaluate the difference in perceptions of orthodontists, general dentists, and laypersons to alterations in gingival characteristics on smile. Material and Methods: Smile images were modified intentionally to obtain the desired variations in gingival features such as color and contour of free gingival margins, inflammation, pigmentation, gingival margins with or without recession, zenith, and interdental papilla. A total of 51 images were rated by orthodontists, general dentists, and laypersons using Q sort methodology. Results: Variations in the position of free gingival margin with recession was most negatively ranked gingival factor by orthodontists, general dentists, and laypersons followed by variations in the position of interdental papilla. Position of free gingival margin without a recession, color changes due to pigmentation, and inflammation were moderately ranked. Control images and altered gingival zenith images were most positively ranked. Bilateral changes were perceived more readily compared to unilateral in factors such as a black triangle, zenith position, pigmentation, inflammation, and recession. Conclusion: Orthodontists seem to be less tolerant in their evaluations in comparison to general dentists and laypersons. The findings of this study point toward a crucial fact that smile designing should focus on parameters that are perceived readily by the public in general.