Keratinized Tissue Width Research Articles

Prevalence of peri-implant disease and risk indicators in a Japanese population with at least 3years in function-A multicentre retrospective study.

The aim of this study was to evaluate the prevalence of peri-implant disease and analyze risk indicators in Japanese subjects with ≥3years of implant function. Five hundred and forty-three subjects treated with 1,613 implants were evaluated. Information was collected about the patients' physical and dental history, as well as implant details. Peri-implant evaluation included probing depth, bleeding on probing (BoP), suppuration (Sup), and keratinized tissue width. Bone loss was calculated from intra-oral radiographs taken after 1year and more than 3years of function. Implants were classified into three groups: healthy, peri-implant mucositis (BoP without bone loss), and peri-implantitis (BoP and/or Sup with bone loss >1mm). These data were analyzed by multivariable multinomial logistic regression. The prevalence of peri-implant mucositis and peri-implantitis at the subject level was 23.9% and 15.8%, respectively. An association was found between peri-implant mucositis and plaque control record (PCR) >20% and keratinized tissue width <2mm. Peri-implantitis was associated with PCR >20%, smoking, insertion in the maxilla, and keratinized tissue width <2mm. Within the limitations of this study, the prevalence of peri-implant diseases was elucidated in a Japanese population. Peri-implant mucositis was associated with poor oral hygiene and less keratinized tissue. Poor oral hygiene, smoking, insertion in the maxilla, and less keratinized tissue were risk indicators for peri-implantitis.

Coronally advanced flap with and without platelet-rich fibrin in the treatment of multiple adjacent recession defects: A randomized controlled split-mouth trial.

Background:The objective of our study was to evaluate and compare the effectiveness of coronally advanced flap (CAF) with or without the use of platelet-rich fibrin (PRF) membrane in the treatment of multiple adjacent recession defects (MARD) clinically and by cone-beam computed tomography (CBCT).Materials and Methods:Twenty healthy patients having 75 MARD were allocated randomly to CAF with orthodontic button group (CAFB) or CAFB + PRF membrane group (CAFB + PRF). Clinical parameters such as gingival recession depth (GRD), probing depth (PD), and keratinized tissue width (KTW) were calculated at baseline, 3 months, and 6 months. The distance from the facial alveolar crest of bone to gingival margin bone and gingival thickness (GT) at three different points were assessed by CBCT at baseline and 6-month postsurgery. Esthetic outcome and postoperative discomfort were evaluated using root coverage esthetic score and visual analog scale, respectively.Results:Percent root coverage achieved in CAFB category was 93.17% ± 13.23% and that in CAFB + PRF group was 95.68% ± 10.13% at 6 months, with no notable difference. Similarly, no difference was found in either group in GRD reduction, PD, and CAL postoperatively. Use of PRF resulted in statistically highly significant (P < 0.001) increased GT at 6 months’ time point as compared to participants treated with CAF without PRF, which indicates clinical and esthetic benefits achieved through the procedure.Conclusions:CAFB can be used successfully to treat MARD with predictable outcome. Additional benefit in terms of gain in KTW and GT can be achieved when PRF membrane is used as an adjunct.

Treatment of multiple recessions with collagen matrix versus connective tissue: a randomized clinical trial

The objective of this study was to determine whether collagen matrix (CM) is an alternative to connective tissue graft technique (CTG) in the treatment of multiple gingival recessions (GR). The indication of CM for the treatment of multiple GR is not yet clear. More studies are needed to better understand this treatment modality, as an alternative to CTG. In this single-blind, split-mouth randomized clinical trial, fifteen patients with multiple Miller class I upper GR were selected and randomly assigned to control group (CTG) or test group (CM). Root coverage (RC) and patient-centered outcomes were evaluated at baseline and after 3, 6, and 12 months. A total of 82 GRs were treated. There was no significant difference regarding GR depth (GRD, primary outcome) between CTG (0.5 ± 0.9 mm) and CM groups (0.6 ± 1.0 mm) (p = 0.225). Percentage of RC was 82.14% in CTG and 77.7% in CM. Both groups demonstrated a gain in keratinized tissue width at 12 months (p < 0.05). Dentine hypersensitivity was effectively reduced in both groups. Postoperative pain was significantly higher in the CTG (p = 0.001). Esthetic satisfaction was high for both groups, with no significant difference (p > 0.05) between groups. After 12 months, both surgical treatments were able to promote RC, and GRD was similar in both CTG and CM groups.

Longitudinal study on risk indicators for peri-implantitis using survival-time analysis

PurposeThe purpose of this study was to evaluate the incidence of peri-implantitis and to identify potential associated risk indicators. MethodsThis longitudinal study included 477 patients treated with 1420 implants. Medical and dental histories were evaluated in all patients. The location, size, connection type, surgical protocol, use of prosthesis splinting and fixation type were evaluated for each implant. In peri-implant evaluation, minimum keratinized tissue width around implants, peri-implant probing depths, peri-implant bleeding and peri-implant suppuration were assessed. Bone resorption around implants was evaluated with intraoral radiographs at baseline and at follow-up examinations. The study endpoint was peri-implantitis, which was defined as the presence of bleeding on probing and/or suppuration with bone resorption >1mm, in accordance with previous studies. Data were analyzed with mixed-effects Cox models. ResultsPeri-implantitis occurred in 15.3% of patients and 9.2% of implants. The overall 5- and 10-year cumulative implant survival rates were 0.95 (95% confidence interval [CI]: 0.93–0.96) and 0.83 (95% CI: 0.8–0.87), respectively. Age (hazard ratio [HR]=0.94, 95% CI: 0.90–0.98, p<0.01), plaque control record >20% (HR=2.61, 95% CI: 1.02–6.67, p=0.04), maxillary placement (HR=1.90, 95% CI: 1.11–3.23, p=0.02) and number of occlusal supports (HR=0.87, 95% CI: 0.77–0.99, p=0.03) were significantly correlated with peri-implantitis development. ConclusionsWithin the limitations of this longitudinal study on risk indicators for peri-implantitis, age, inadequate plaque control, insertion in the maxilla and less occlusal support of natural teeth correlated with peri-implantitis development.

Modified tunnel technique for management of gingival recession in esthetic zone using acellular dermal matrix versus connective tissue graft

Gingival recession often results in major aesthetic problems. Further complains of increased root surface sensitivity and root caries could also be encountered. Numerous techniques have been described for the management of recession. The development of the tunnel technique represents an important esthetic advancement in managing recession defects. This study was performed to compare between the use of Acellular Dermal Matrix (ADM) and connective tissue graft (CTG) under a modified tunnel technique for management of gingival recession in the esthetic zone. Sixteen Miller class I and II recession defects were equally divided for treatment with the two donor materials. Plaque index (PI), gingival index (GI), gingival recession depth (GR), clinical attachment level (CAL) and keratinized tissue width (KTW) were assessed at base line and six months postoperatively. Both groups showed significant decrease in GR and gain in CAL slightly in favor to the ADM group. However no significant difference was recorded between the two groups in any of the studied parameters. Hence, ADM can be used as an alternative to CTG having the advantage of the absence of a secondary surgical site.

Correlation between keratinized tissue width and periodontal indices around implant-supported fixed partial dentures.

Background The effect of keratinized tissue width on the peri-implant health has not been well elucidated. The results of previous studies on this topic are controversial and the role of keratinized tissue width in the long-term success of dental implants has not been confirmed. This cross-sectional study aimed to assess the correlation of keratinized tissue width with periodontal indices around implant-supported fixed partial dentures (FPDs). Methods This cross-sectional study evaluated 73 implants. Patients underwent periodontal examinations, including measurement of plaque index (PI), gingival index (GI), clinical probing depth (PD), bleeding on probing (BOP), marginal gingival recession, keratinized mucosa width and radiographic marginal bone level. Data were analyzed using SPSS. Results The mean GI, PI and marginal gingival recession around implants with <2 mm width of keratinized gingiva were greater than the corresponding values around implants with keratinized tissue width of ≥2 mm. However, this difference was not statistically significant (P>0.05). No significant differences were noted in PD and radiographic marginal bone level between the two implant groups with keratinized tissue width <2 mm and ≥2 mm. Thus, no correlation was found between the keratinized tissue width and the measured indices. Conclusion Although this study did not show a significant correlation between the keratinized tissue width and peri-implant tissue health and consequently the implant success rate, long-term interventional studies are required to make a final judgment in this respect.

Periodontally Accelerated Osteogenic Orthodontics (PAOO) Using Platelet‐Rich Fibrin Alone: A Modified Approach With a 3‐Year Follow‐Up

IntroductionOrthodontists are reportedly seeing more adult patients in their practices. Hence, it becomes increasingly important to evaluate the periodontium for any existing problems or potential issues that could be caused by orthodontic treatment. Periodontally accelerated osteogenic orthodontics (PAOO) is a method of surgically assisted tooth movement achieved through a combination of corticotomy and bone grafting allowing rapid tooth movement and decreased treatment time. Platelet‐rich fibrin (PRF) is shown to have osteoinductive effects along with enhanced soft and hard tissue healing outcomes. The aim of this case report is to describe a variation of the PAOO technique using PRF membranes alone and provide a proof of concept for the effect of PRF on soft and hard tissue healing outcomes when used with PAOO.Case PresentationA 43‐year‐old female expressed displeasure over her malaligned lower anterior teeth and difficulty performing oral hygiene in that area. Clinical examination showed inadequate keratinized tissue, and cone‐beam computed tomography (CBCT) images revealed extensive loss of buccal bone. Ultrasonic buccal corticotomies were made using a piezoelectric device from the alveolar crest extending past the tooth apices in the lower anterior region. Five PRF membranes were placed over the teeth and secured with sutures.ConclusionsThree‐year follow‐up showed exceptional improvement in soft tissue appearance and keratinized tissue width. CBCT images revealed no further loss of buccal bone. This is the first case to demonstrate that PAOO using PRF can be a viable option for orthodontic movement of periodontally compromised teeth.

Do Implant Surgical Guides Allow an Adequate Zone of Keratinized Tissue for Flapless Surgery?

A major advantage of guided implant surgery using 3-dimensionally printed guides is the ability to perform accurate flapless surgery.A drawback of a flapless technique is the inability to manipulate soft tissue to ensure sufficient gingiva around the implant. The purpose of this study was to determine how often flapless surgery using surgical guides results in less than 2mm of keratinized tissue surrounding the implant. This retrospective analysis included 27 maxillary and 27 mandibular implant sites that underwent treatment planning for implant-guided surgery using 3Shape Implant Studio (3Shape, Copenhagen, Denmark).Intraoral scan images were used to measure the width of the keratinized tissue on the buccal aspect of each implant site in both arches and the lingual aspect in the mandibular arch. Three examiners measured the amount of buccal and lingual keratinized tissue in millimeters at each implant site. Analysis of variance (P<.05) and correlation coefficients were used to determine statistically significant differences in keratinized tissue among sites. No statistically significant difference was found either between the widths of buccal keratinized tissue in the maxillary anterior (4.06±1.42mm) and posterior (4.93±2.54mm) areas (P=.293) or between the amounts of buccal and lingual keratinized tissue in the mandible (P=.995). The keratinized tissue width in the maxillary buccal area was significantly different (4.48±2.04mm) from that in the mandibular posterior buccal (1.98±1.41mm) and lingual (1.98±1.23mm) areas (P<.001). Over 77% of maxillary implant sites had greater than 3mm of gingiva, and just over 20% had sufficient gingiva in the mandible. Adequate keratinized tissue was found in most of the planned maxillary implant sites, whereas most of the mandibular posterior implant sites had inadequate keratinized tissue. Therefore, elevation of a flap to preserve and reposition existing keratinized tissue around implants should be considered when planning to use tooth-borne surgical guides in the posterior mandible.

The Use of a Novel Porcine Derived Acellular Dermal Matrix (Mucoderm) in Peri-Implant Soft Tissue Augmentation: Preliminary Results of a Prospective Pilot Cohort Study.

Objective Over the years, several techniques have been proposed for soft tissue augmentation around dental implants in order to improve keratinized mucosa width (KMW). Recently, a porcine derived acellular dermal matrix (Mucoderm®) has been proposed as autogenous graft substitute in order to avoid palatal harvesting and obtain comparable results to connective tissue grafts, in terms of aesthetics and function. The aim of this study is to present the one-year follow-up results of this matrix in peri-implant soft tissue augmentation procedures. Material and Methods Twelve patients were enrolled in this pilot prospective study: a dental implant was placed in the upper premolar area and, at implant uncovering after eight weeks, the matrix was inserted. KMW gain was considered as primary outcome variable. Results After one month from matrix insertion, mean KMW was 7.86±3.22 mm (100%), with no statistically significant intragroup variations (p>0.05). No membrane exposures or wound healing complications occurred during postoperative phase and, after one year, mean KMW was 5.67±2.12 mm (72.13%). Conclusions The results of the present pilot study indicate that by placing a Mucoderm membrane during implant surgery the keratinized tissue width can be augmented, and the width remains stable for the assessment period of 12 months. Further studies with greater power and longer investigation period are needed to confirm the suggestion for clinical use. Clinical trial registration number is EudraCT number 2018-000147-16.

The Laterally Closed Tunnel for the Treatment of Deep Isolated Mandibular Recessions: Surgical Technique and a Report of 24 Cases

Predictable coverage of deep isolated mandibular gingival recessions is one of the most challenging endeavors in plastic-esthetic periodontal surgery, and limited data is available in the literature. The aim of this paper is to present the rationale, the step-by-step procedure, and the results obtained in a series of 24 patients treated by means of a novel surgical technique (the laterally closed tunnel [LCT]) specifically designed for deep isolated mandibular recessions. A total of 24 healthy patients (21 women and 3 men, mean age 25.75 ± 7.12 years) exhibiting one single deep mandibular Miller Class I (n = 4), II (n = 10), or III (n = 10) gingival recession ≥ 4 mm were consecutively treated with LCT in conjunction with an enamel matrix derivative (EMD) and palatal subepithelial connective tissue graft (SCTG). The following clinical parameters were assessed at baseline and 12 months postoperatively: probing depth (PD), clinical attachment level (CAL), complete root coverage (CRC), mean root coverage (MRC), recession depth (RD), and keratinized tissue width (KTW). The primary outcome variable was CRC. The postoperative morbidity was low, and no complications, such as bleeding, infections/abscesses, or loss of SCTG, occurred. At 12 months, CRC was obtained in 17 of the 24 defects (70.83%), while in the remaining 7 defects RC amounted to 80% to 90% (in 6 cases) and 79% (in 1 case). Of the 17 defects exhibiting CRC, 12 were central incisors and 5 were canines. With respect to defect type, CRC was found in 3 of the 4 Miller Class I, 8 of the 10 Class II, and in 6 of the 10 Class III defects. Mean RD changed from 5.14 ± 1.26 mm at baseline to 0.2 ± 0.37 mm at 12 months, while MRC amounted to 4.94 ± 1.19 mm, representing 96.11% (P < .0001). Mean KTW increased from 1.41 ± 1.00 mm at baseline to 4.14 ± 1.67 mm (P < .0001) at 12 months, yielding a KTW gain of 2.75 ± 1.52 (P < .0001). No statistically significant changes in mean PD occurred following root coverage surgery (1.8 ± 0.2 mm at baseline and 2.1 ± 0.3 mm at 12 months). The present results suggest that the LCT is a valuable approach for the treatment of deep isolated mandibular Miller Class I, II, and III gingival recessions.

Does enamel matrix derivative application improve clinical outcomes after semilunar flap surgery? A randomized clinical trial.

To evaluate the treatment of gingival recessions by semilunar coronally positioned flap plus enamel matrix derivative (SCPF + EMD). Thirty patients with class I localized gingival recession were included. They were randomly allocated in two groups: SCPF + EMD and SCPF. Recession height (RH), recession width (RW), width of keratinized tissue (WKT), thickness of keratinized tissue (TKT), probing depth (PD), and clinical attachment level (CAL) were measured at baseline, 6 and 12months post-surgery. Patient/professional evaluation of esthetics and root sensitivity was performed. After 12months, mean root coverage was 1.98 ± 0.33mm for SCPF + EMD (90.86 ± 14.69%) and 1.85 ± 0.41mm (79.76 ± 17.44%) for SCPF (p > 0.05). The esthetic evaluation by the patient showed preference for SCPF + EMD. According to the professional evaluation (QCE), the use of EMD decreases the appearance of postoperative scar tissue line. There was a significant reduction in root hypersensitivity with no further complaints by the patients. The addition of EMD provides significantly better esthetics to SCPF, according to patient and professional assessments. SCPF + EMD is effective but not superior to SCPF for root coverage, after 12months. Previous clinical trials showed that the combination of EMD with coronally advanced flaps may enhance the outcome of root coverage. There is a lack of studies testing the combination of EMD with SCPF. The combination SCPF + EMD provides better esthetics when compared to the SCPF and is effective, but not superior, to SCPF for root coverage, after 12months. NCT02459704.

PR541: Three‐dimensional analysis of soft tissue on digital data using Trios intraoral scanner and Geomagic software: measurement of keratinized tissue width in clinical trial

PR541: Three‐dimensional analysis of soft tissue on digital data using Trios intraoral scanner and Geomagic software: measurement of keratinized tissue width in clinical trial

Acellular dermal matrix allograft versus free gingival graft: a histological evaluation and split-mouth randomized clinical trial.

This split-mouth controlled randomized clinical trial evaluated clinical and histological results of acellular dermal matrix allograft (ADM) compared to autogenous free gingival graft (FGG) for keratinized tissue augmentation. Twenty-five patients with the absence or deficiency of keratinized tissue (50 sites) were treated with FGG (control group) and ADM (test group). Clinical parameters included keratinized tissue width (KTW) (primary outcome), soft tissue thickness (TT), recession depth (RD), probing depth (PD), and clinical attachment level (CAL). Esthetic perception was evaluated by patients and by a calibrated periodontist using visual analog scale (VAS). Histological analysis included biopsies of five different patients from both test and control sites for each evaluation period (n = 25). The analysis included percentage of connective tissue components, epithelial luminal to basal surface ratio, tissue maturation, and presence of elastic fibers. Data were evaluated by ANOVA complemented by Tukey's tests (p < 0.05). After 6months, PD and CAL demonstrated no differences between groups. ADM presented higher RD compared to FGG in all periods. Mean tissue shrinkage for control and test groups was 12.41 versus 55.7%. TT was inferior for ADM group compared to FGG. Esthetics perception by professional evaluation showed superior results for ADM. Histomorphometric analysis demonstrated higher percentage of cellularity, blood vessels, and epithelial luminal to basal surface ratio for FGG group. ADM group presented higher percentage of collagen fibers and inflammatory infiltrate. Both treatments resulted in improvement of clinical parameters, except for RD. ADM group presented more tissue shrinkage and delayed healing, confirmed histologically, but superior professional esthetic perception. This study added important clinical and histological data to contribute in the decision-making process between indication of FGG or ADM.

Impact of timing on soft tissue augmentation during implant treatment: A systematic review and meta-analysis.

To achieve a predictable esthetic and functional outcome, soft tissue augmentation has become popular in implant treatment. The aim of this systematic review and meta-analysis was to assess the influence of different timing for soft tissue augmentation during implant treatment on soft tissue conditions and its stability. Electronic and manual searches for articles written in English up to September 2017 were performed by two independent reviewers. Human clinical studies with the purpose of evaluating outcomes (at least 3-month follow-up) of autogenous soft tissue graft for augmentation during implant treatment, either simultaneous or after implant placement (staged), were included. Cumulative changes of keratinized tissue width (KTW), soft tissue thickness (STT), and mid-buccal mucosal recession (MR) data were analyzed with a random-effects model to compare the postoperative outcomes. Twenty-nine human studies (eight randomized clinical trials, six cohort studies, and 15 case series) that met the inclusion criteria were included. For the overall data, the weighted mean STT gain (1year after surgery) was 1.03mm (95% CI: 0.78-1.29mm), among which the simultaneous group was 1.12mm (95% CI: 0.75-1.49mm) and staged group (3-6months after implant placement) was 0.95mm (95% CI: 0.58-1.31mm). There was no statistically significant difference in KTW and MR between 3months and more than 3months after surgery. This review revealed that the stability of soft tissue, in terms of KTW and mid-buccal MR, can be obtained 3months after surgery. There is no difference between simultaneous and staged soft tissue augmentation during implant treatment, and both procedures significantly enhance KTW and STT.

Incidence of Peri-implant Diseases on Implants With and Without Laser-Microgrooved Collar: A 5-Year Retrospective Study Carried Out in Private Practice Patients.

To retrospectively evaluate the incidence of peri-implant mucositis and peri-implantitis around dental implants with the same body design and surface but different collar surface (laser-microgrooved vs not laser-microgrooved) after 5 years of loading in private practice patients. The study was carried out on patients at a private dental clinic enrolled in a periodontal maintenance program, who received at least one implant with a laser-microgrooved collar surface and one implant without a laser-microgrooved collar surface. Clinical variables such as plaque, pocket depth, bleeding on probing, suppuration, and radiographic marginal bone loss at > 5 years around implants were investigated. The correlation between the prevalence of peri-implant mucositis/peri-implantitis and biotype, keratinized tissue width, prosthetic connection type, and prosthetic design type was also analyzed. A total of 166 implants in 74 patients were investigated. At the end of the 5-year follow-up period, 38 implants presented peri-implant mucositis, accounting for 22.8% of the total, affecting a total of 24 patients (32.4%), while 13 implants (7.8%) in 10 patients (13.5%) were diagnosed with peri-implantitis. Sixteen of 82 laser-microgrooved implants (19.5%) and 24 of 84 implants (28.5%) without a laser-microgrooved collar presented peri-implant mucositis, while 3 of 82 (3.6%) of laser-microgrooved implants and 10 of 84 (11.9%) implants without a laser-microgrooved collar demonstrated peri-implantitis. Differences in implant-based incidence of peri-implant diseases between implants with and without a laser-microgrooved collar were statistically significant (P < .05). In private practice patients enrolled in a professional, controlled oral hygiene regimen, implants with a laser-microgrooved collar, compared with implants without a laser-microgrooved collar, presented a statistically significantly lower incidence of peri-implant diseases.

Efficiency of platelet-rich plasma on acellular dermal matrix application with coronally advanced flap in the treatment of multiple adjacent gingival recessions: A randomized controlled clinical trial

Background/PurposeThe aim of this study was to evaluate the effectiveness of platelet rich plasma (PRP) combined with coronally advanced flap plus acellular dermal matrix application (CAF + ADM) in the treatment of multiple adjacent gingival recessions (MAGRs). Materials and methods12 patients with 84 Miller Class I or II recession defects were participated. Sites were randomly assigned into CAF + ADM + PRP or CAF + ADM groups. Gingival recession depth (GRD), recession width (GRW), width of keratinized tissue (WKT), creeping attachment (CRA), root coverage (RC) as well as plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment level (CAL) were recorded at baseline and 3rd,6th and 12th months postoperatively. The data were analyzed statistically. ResultsGRD and GRW values were statistically higher in group CAF + ADM compared to the CAF + ADM + PRP group at 6th and 12th month (P < 0.05). CRA showed statistically significant increases in 3rd, 6th and 12th months with regard to the baseline in CAF + ADM + PRP group (P < 0.05), however CRA remained stable in CAF + ADM group at 6th and 12th month. The mean RC% was 77.9% and 69.4% for the CAF + ADM + PRP and CAF + ADM groups, respectively, at 12th month (P < 0.05). GRD reduction was statistically greater in the maxillary teeth treated with CAF + ADM + PRP compared to mandibular teeth treated with CAF + ADM at 12 months. ConclusionOur data suggested that addition of PRP to CAF + ADM in the treatment of MAGRs significantly improved the clinical outcomes, according to 1-year follow-up results.(Clinicaltrials.gov identification NCT03043638).

Effectiveness of laser adjunctive therapy for surgical treatment of gingival recession with flap graft techniques: a systematic review and meta-analysis.

Various flap graft techniques in the treatment of gingival recession have already been reported in the literatures for root coverage. Laser therapy has effects of ablative, hemostatic, and decontamination. Therefore, we performed a meta-analysis of randomized controlled trials (RCTs) to compare the efficacy of flap surgery combined with laser with surgery alone for treating gingival recession. The studies were searched from PubMed, Embase, Web of science, and the Cochrane Central Register of Controlled Trials by two reviewers up to August 2017. The quality of RCTs was assessed by Cochrane Handbook. Data were extracted from studies and analyzed by Review Manager 5.3. 95% confidence interval (CI) and risk ratio (RR) were calculated for dichotomous data. Seven RCTs with 173 patients and 296 teeth were included in the meta-analysis. We found no statistically significant differences between two groups in GRD (gingival recession depth) (P = 0.21), GRW (gingival recession width) (P = 0.92), RES (root esthetic score) (P = 0.21), and CRC (complete root coverage) (P = 0.09). Statistically significant differences were found between two groups in the WKT (width of keratinized tissue) (P < 0.0001) and 1-year follow-up of PD (probing depth) (P = 0.03) and CAL (clinical attachment level) (P < 0.00001). The meta-analysis found that surgery with laser therapy provided clinical advantages in terms of WKT and 1-year follow-up of PD and CAL. However, flap graft associated with laser did not offer additional benefit to root coverage and esthetics in treating gingival recession. More long-term studies are required to assess these parameters.

The efficacy of a porcine collagen matrix in keratinized tissue augmentation: a 5-year follow-up study

BackgroundWhen keratinized tissue width around dental implants is poorly represented, the clinician could resort to autogenous soft tissue grafting. Autogenous soft tissue grafting procedures are usually associated with a certain degree of morbidity. Collagen matrices could be used as an alternative to reduce morbidity and intra-operatory times. The aim of this study was to assess the efficacy of a xenogeneic collagen matrix as a substitute for soft tissue grafting around dental implants.MethodsFifteen consecutive patients underwent a vestibuloplasty and keratinized tissue reconstruction around dental implants, both in the mandible and the maxilla, with a porcine collagen matrix. The so obtained keratinized tissues were measured and evaluated after 6 months and 1, 4, and 5 years.ResultsThe average gain of keratinized tissue was 5.7 mm. After 6 months, it was observed a resorption of 37%, after 1 year 48%, and after 5 years 59%. The mean gain of keratinized tissue after 5 years was 2.4 mm. Hemostatic effect and post-operative pain were evaluated too. All subjects referred minimal pain with no bleeding. No adverse reaction nor infection was noted.ConclusionsThe present study showed the efficacy of a porcine collagen matrix in keratinized tissue augmentation. The possibility to use a soft tissue substitute is a great achievement as morbidity decreases and bigger areas can be treated in a single surgery.

Coronally advanced flap and connective tissue graft with or without plasma rich in growth factors (PRGF) in treatment of gingival recession.

BackgroundSeveral researchers have tried to improve the results of gingival recession treatment techniques. One of the methods is to use growth factors The present study was undertaken to evaluate the effect of CAF (coronally advanced flap) + CTG (connective tissue graft) + PRGF (plasma rich in growth factors) in the treatment of Miller Class I buccal gingival recession.Material and MethodsTwenty-two teeth with Miller Class I gingival recession in 6 patients 26 ‒ 47 years of age were included in a split-mouth designed randomized controlled trial (RCT). In each patient, one side was treated with CAF + CTG + PRGF (test) and the other side was treated with CAF + CTG (control). The following parameters were measured before surgery and up to 6 months after surgery on the mid-buccal surface of the tooth: keratinized tissue width (KTW), clinical attachment level (CAL), probing depth (PD), vertical recession depth (VRD), recession depth (RD), gingival thickness (GT), root coverage in percentage (RC%) and the distance between the CEJ and mucogingival junction (MGJL). Data were analyzed with paired t-test and repeated measures ANOVA.ResultsAfter 6 months noticeable improvements were observed in both groups in all the variables measured except for PD; however, the differences between the two groups were not significant. RC% was 80 ± 25% and 67 ± 28% in the test and control groups, respectively, after 6 months.ConclusionsBoth CAF + CTG + PRGF and CAF + CTG treatment modalities resulted in favorable root coverage; however, the addition of PRGF added no measurable significant effect. Key words:Connective tissue graft, dental root coverage, gingival recession, growth factors, mucogingival surgery, periodontal plastic surgery.

Nonincised Papillae Surgical Approach (NIPSA) in Periodontal Regeneration: Preliminary Results of a Case Series.

A new surgical approach has been developed to optimize the preservation of the gingival margin and papillae when treating periodontal defects. The flap is raised by one mucosal incision far away from the marginal tissues. This case series reports on the effectiveness of a nonincised surgical approach (NIPSA) in conjunction with a hydroxyapatite-based graft biomaterial and enamel matrix derivative in treating intrabony defects. Ten defects in 10 patients were treated. The follow-up period ranged from 6 to 18 months (mean: 10.8 ± 4.7 months). Probing pocket depth was 9.6 ± 2.3 mm before surgery and 2.3 ± 0.5 mm postsurgery. Clinical attachment level (CAL) decreased from 10.4 ± 2.7 mm to 3.1 ± 0.87 mm postsurgery. The gingival papilla height, keratinized tissue width, and buccal gingival margin remained stable over time. No wound dehiscence was recorded. Mean Early Healing Index was 1.5 ± 0.7. Results show a substantial CAL gain, limited postsurgical shrinkage, minimal morbidity, and early healing.