Keratinized Tissue Thickness Research Articles

The Efficacy of Leukocyte-Platelet-Rich Fibrin in Combination with Sub-Epithelial Connective Tissue Graft in Peri-Implant Soft Tissue Augmentation: A Randomized Controlled Clinical Trial

Aims and Background The aim of the current study is to assess and compare the efficacy of the leukocyte-platelet-rich fibrin [L-PRF] in combination with sub-epithelial connective tissue graft [SCTG] and SCTG only in promoting aesthetic results and strengthening the state of the soft tissue surrounding implants. Materials and Methods A parallel-arm randomized controlled clinical trial was used for this investigation. A total of 120 patients who had missing teeth with a thin gingival biotype [less than 1.5 mm] were included in this study. The patients of Group I were treated with PRF and SCTG during second-stage implant surgery, while the patients of Group II were treated with SCTG only. Treatment outcomes included the assessment of the width and thickness of the keratinized tissue at the baseline, 3 and 6 months postoperatively; pro- and anti-inflammatory cytokines [IL-1β, TNF-α, and IL-4] in the peri-implant crevicular fluid on the 1st, 7th and 30th days after surgical procedure; swabs from the surface of postoperative wounds of the mucous membrane on days 3, 5, 7, and 10; Pink aesthetic score [PES] 6 months after prosthesis placement; and laser Doppler flowmetry on days 1, 7, and 14 after augmentation. Results and Discussion Patients who received L-PRF+SCTG had a significant increase in keratinized tissue thickness [KTT] [p = 0.08] than those who received SCTG only [KTT 1.86 ± 0.17 Vs 1.48 ± 0.15] 6 months after surgery. The mean [±SD] of PES was found to be 13.1 [±0.02] for Group I and 11.3 [±0.08] for Group II. The cytology, LDF, and local immunoassay analysis demonstrated faster epithelialization and better revascularization in Group I. Conclusion The use of L-PRF and SCTG is an effective method in augmenting peri-implant soft tissue and improving gingival biotype and aesthetic outcomes, which would help overcome complications and increase patients’ satisfaction.

A Single-Step Root Coverage Procedure Using Modified Bridge Flap Technique and De-epithelialized Gingival Unit Graft: A Prospective Clinical Study.

The mucogingival conditions associated with the recession defects at the mandibular anterior region, not only make plaque control difficult to be performed by the patient but also pose a problem in passively advancing the tissues at the recipient site. This surgical technique is used to treat multiple recession defects in the mandibular anterior region. Twenty-five sites in 17 subjects (11 women and 6 men) underwent modified bridge flap and de-epithelized gingival unit graft (d-GUG) as a single-step treatment modality to cover the denuded root surface, as well as increase the width of keratinized gingiva in recession type 1 gingival recession defects in the mandibular anterior region. Nearly 60% of sites in our study showed complete root coverage, with a mean root coverage percentage of 88.08%. Furthermore, keratinized tissue width, keratinized tissue thickness as well as vestibular depth showed statistically significant increases as compared to baseline levels. Thus, the modified bridge flap technique using d-GUG within the limitations of our study design, showed promising results in terms of recession coverage as well as management of the difficult mucogingival conditions at the mandibular anterior region.

Coronally advanced flap with and without connective tissue graft in root coverage procedure: A Case Series

Objective: This paper aims to report the outcome of the coronally advanced flap with and without connective tissue graft in the root coverage procedure. We intend to explain the importance of connective tissue graft in coronally advanced flap surgery. Methods: Two patients with gingival recession required surgical intervention to get root coverage and improve aesthetics. Both patients were treated with a coronally advanced flap. We combined the coronally advanced flap with a connective tissue graft for the first patient's maxillary left second incisor and canine; meanwhile, we only did the coronally advanced flap for the second patient's maxillary right canine and first premolar. Results: Surgical intervention was done for both patients with good results. For the first patient with a connective tissue graft, we noticed increased thickness on the keratinized gingiva and gained 1 mm of root coverage. Meanwhile, we got full root coverage for the second patient. In this article, a patient with a connective tissue graft was observed for six months, and a patient without a connective tissue graft was observed for two years. In both cases, we noticed stable and good results. Conclusions: Coronally advanced flap procedure can be a reliable treatent for root coverage in the tooth with gingival recession. An additional connective tissue graft combined with a coronally advanced flap can increase keratinized tissue thickness.

Evaluation of Soft Tissue Changes Following Platelet-rich Fibrin in Immediate Implantation of Posterior Teeth: A Randomized Clinical Trial

Background: Currently, immediate implant placement is favored due to its reduced number of surgical appointments and shorter overall treatment duration. However, a notable disadvantage of this protocol is the inadequate dimension of soft tissue surrounding the implant, which presents a challenge for immediate implantation in posterior teeth. As a result, patients frequently necessitate soft tissue augmentation to alleviate potential complications. In this randomized clinical trial study, a minimally invasive technique utilizing platelet-rich fibrin (PRF) was employed to enhance soft tissue thickness and keratinized tissue width during immediate implantation in the posterior region of the jaw. Methods and Materials: A total of 20 bone-level implants were utilized in 20 patients through the immediate implantation protocol. In order to augment soft tissue, 10 patients were subjected to treatment with platelet-rich fibrin (PRF) on immediate implants in the test group, while 10 patients received connective tissue graft (CTG) on immediate implants in the control group. After a period of 3 months, all implants were uncovered through surgery, and healing abutments were placed on fixtures. Keratinized tissue width was measured using a periodontal probe at baseline, 1 month, and 3 months after implant placement, while soft tissue thickness was measured at baseline and 3 months after implant placement. Results: Treatment was successful for all the patients. The average keratinized tissue width in the test and control group was 3.45 and 2.65 at baseline, 4.00 and 3.40 one month after surgery, and 4.20 and 3.85 three months after implant placement, respectively. Average keratinized tissue thickness in the test and control group was 2.45 and 2.05 at baseline and 3.20 and 3.25 at reentry (three months after implant placement), respectively. The average increase in keratinized tissue thickness from baseline to 3rd month was 0.75 in the test and 1.20 in the control group. The average increase in keratinized tissue width from baseline to 1st month was 0.55 in the test and 0.75 in the control group, and from baseline to 3rd month, it was 0.75 in the test and 1.20 in the control group, respectively. Data for both parameters in each group from baseline to 3rd month were statistically significant. Data for keratinized tissue thickness (p=0.077) and keratinized tissue width (p=0.089) between both the groups were not statistically significant. Conclusion: Platelet-rich fibrin (PRF) has the potential to serve as a minimally invasive approach for augmenting soft tissue in the posterior region of the jaw during immediate implant placement. Clinical Trial Registration Number: The clinical trial registration number for this study is IRCT20190723044313N1.

Anti-Apoptotic and Pro-Apoptotic Bcl-2 Family Proteins in Peri-Implant Diseases.

Intrinsic apoptosis, which is regulated by Bcl-2 family proteins, has an important role in chronic inflammatory diseases. The aim of the study was to identify the tissue levels and ratios of anti- and pro-apoptotic Bcl-2 family proteins in peri-implant diseases. Twenty-three individuals with peri-implant mucositis, 25 individuals with peri-implantitis, and 24 controls were included. The following clinical parameters were recorded: keratinized mucosa width, modified bleeding index, probing depth, modified plaque index, modified gingival index, and keratinized tissue thickness. Marginal alveolar bone assessments were performed by a software program. Granulation tissues were collected during treatments of peri-implant diseases. The control tissue samples were collected during the second stage of implant surgery. The tissue levels of Bcl-2 family pro-apoptotic (Bak, Bax, active caspase-3) and anti-apoptotic (Bcl-2, Bcl-xL, Mcl-1) proteins were determined by multiplex immunoassay method. The pro-apoptotic proteins; Bak, Bax and anti-apoptotic proteins Bcl-2, Bcl-xL, Mcl-1 were detected significantly higher in controls compared with patients with peri-implant mucositis and peri-implantitis (p < .001), respectively. The higher active caspase-3 levels were also detected in controls in comparison with peri-implant mucositis (p = .018) and peri-implantitis (p = .005). Anti-apoptotic: pro-apoptotic protein ratios (Bcl-2:Bax, p < .001; Bcl-2:Bak, p = .01; Bcl-xL: Bax, p = .006, Bcl-xL:Bak, p = .011; Mcl-1:Bak, p < .001) were significantly increased in diseased groups. A positive correlation was demonstrated between clinical variables and anti-apoptotic: pro-apoptotic ratios. Our findings indicate dysregulation of the Bcl-2 family proteins in peri-implant diseases. This unregulated response may disturb the homeostasis of peri-implant tissue.

Xenogeneic Acellular Dermal Matrix for the Treatment of Multiple Gingival Recessions Associated with Partially Restored Noncarious Cervical Lesions.

This study evaluated the use of a xenogeneic acellular dermal matrix (XADM) combined with a modified coronally advanced flap (MCAF) and partial resin composite filling (anatomic crown plus 1 mm of the root surface) to treat multiple Type 1 gingival recessions associated with B+ noncarious cervical lesions (NCCLs). The study included 24 recessions in 10 patients. Bleeding on probing, probing depth, combined defect height, relative gingival recession, clinical attachment level, esthetics, and dentin hypersensitivity were recorded. After 6 months, the treatment provided statistically significant outcomes: It reduced the combined defect height by 2.02 ± 0.65 mm, increased clinical attachment level by 1.96 ± 0.83 mm, and increased keratinized tissue thickness by 0.46 ± 0.47 mm, and shallow probing depths were seen. Significant dentin hypersensitivity reduction and esthetic improvements were observed. Therefore, XADM associated with MCAF and partial restoration might be a promising alternative to autogenous grafts used to treat multiple gingival recessions associated with B+ NCCLs.

Clinical Comparison of the Volumetric Changes in Single Pontic Site Development through Connective Tissue Grafting Using Modified Pouch Technique versus Pouch Technique in the Maxillary Esthetic Zone: A Randomized Controlled Clinical Trial.

The aim is to compare the volumetric changes between pouch technique versus the modified pouch technique in pontic site development using connective tissue graft in patients that have Seibert class I ridge defects in the maxillary esthetic zone. Methodology. This randomized, controlled, double-blinded, parallel-grouped clinical trial included sixteen patients with a single pontic site in the maxillary esthetic area presenting Seibert Class I ridge defects. Patients were randomly assigned into two equal groups: test group (n: 8) received soft tissue augmentation with connective tissue graft using the modified pouch technique and control group (n: 8) received soft tissue augmentation with connective tissue graft using pouch technique. The volumetric evaluation was carried out by taking impressions at baseline, 3 and 6 months after the surgery. Keratinized tissue thickness was also measured at baseline, 3 and 6 months after the surgery. Visual analogue scale (VAS) was recorded by the patients at day 3, day 7, and day 14 after the surgery. The test group had more increase in soft tissue volume than the control group at baseline, 3 months, and 6 months. The keratinized tissue width at baseline in the test group had a higher value than that of the control group. At 3 months, both groups had the same mean value, while at 6 months, the test group had a higher value than the control group. Regarding postoperative pain, the visual analogue scale shown at day 3 in the test group had a higher value than that of the control group, while at day 7, the control group had a higher value than the test group. At day 14, both groups had the same mean value. Soft tissue augmentation using both the traditional pouch technique and the modified pouch technique led to successful soft tissue volume augmentation in pontic site development in Seibert Class I ridge defects with no statistically significant difference between the two techniques.

Concentrated growth factors in the treatment of adjacent multiple gingival recessions: A split-mouth randomized control trial

: The aim of this study was to determine the clinical effect of Concentrated Growth Factor (CGF) in combination with Coronally Advanced Flap (CAF) compared to CAF alone in the treatment of adjacent multiple Miller’s Class I GRs. A total of 10 patients with Class I Miller’s recession were randomly assigned by a coin toss method as Group I which received Coronally Advanced Flap alone (CAF) and Group II which received Coronally Advanced Flap (CAF) with Concentrated Growth Factor (CGF). The clinical parameters such as, Recession Height (RH), Recession Width (RW), Probing Pocket Depth (PPD), Clinical Attachment Level (CAL), Keratinized Tissue Width (KTW) and Thickness of Keratinized Tissue (TKT) were measured at baseline and 3 months postoperatively. The Mean Root Coverage (MRC), Complete Root Coverage (CRC) and Root coverage Esthetic Score (RES) were measured after 3 months postoperatively. Statistically significant difference in RH, RW, CAL, KTW, TKT, MRC and RES were observed on comparison of Group I and Group II at 3 months. On comparison, of Group I and Group II, no statistically significant difference was seen in PPD and CRC between the groups at 3 months.The present study indicates that CAF with a CGF proved to be superior. The KTW and TKT augmentation might improve the long-term predictability of the root coverage procedures, hence the use of CGF combined with CAF, diminishes post-surgical relapse and thus providing long-term stability.

Comparative evaluation of the efficacy of xenogeneic collagen matrix and platelet-rich fibrin in the treatment of gingival recession.

The main focus of the study is to determine the difference between the efficacy of xenogeneic collagen matrix (XCM) versus platelet-rich fibrin (PRF) adjunct to coronally advanced flap to treat the gingival recession. Because of esthetic concerns or root hypersensitivity, typical necessity dictates for buccal gingival recession treatment. This study was planned to evaluate and compare the efficacy of XCM with PRF in the treatment of the recessed gingiva. Thirty-four sites with Cairo's RT1 and RT2 gingival recessions were taken, out of which 17 sites received XCM (test) and 17 sites received PRF (control). A periodontal treatment was performed first, followed by a re-evaluation. All clinical measurements, including recession height (RH), recession width (RW), clinical attachment level (CAL), keratinized tissue width, and keratinized tissue thickness, were taken before surgery (baseline) and at a 6-month interval following periodontal surgery. Landry's healing index was also measured at the 1st and 2nd weeks after surgery. None of the acquired data implies a significant difference statistically for CAL, RW, RH, thickness, and width of keratinized tissue (WKT) at 6-month interval between both the groups. Comparison of healing at the 1st and 2nd week intervals among both the groups showed no statistical significance. No significant difference among both Groups A and B was seen according to the intergroup analysis in terms of periodontal parameters such as CAL (P = 0.374), RW (P = 0.542), RH (P = 0.890), WKT (P = 0.877) and thickness of keratinized tissue (P = 0.547), and Landry's healing index (P = 0.429). In consideration of the patient's comfort and the method's simplicity, it can be concluded that PRF or XCM can be employed as an alternative.

A novel cone-beam CT scanning technique for measuring periodontal soft tissues in the esthetic area.

This study investigated and tested a novel cone-beam computed tomography (CBCT) scanning technique capable of obtaining clear contours of soft tissues in the esthetic area. Twenty-three periodontally healthy participants underwent this novel CBCT scanning technique. Soft tissue morphological parameters were measured on the CBCT images obtained. Intraoral clinical data were also collected at the same locations, and the accuracy of the CBCT method was tested. The median (interquartile range [IQR]) of the supracrestal gingival tissue thickness as 0.91 (0.73-1.13) mm, and the thickness of the central incisors was significantly greater than that of the canines (P < 0.05). The median (IQR) of keratinized tissue thickness was 0.73 (0.55-0.91) mm, which also showed a significantly greater thickness in the central incisors than in the canines (P < 0.05). Bland-Altman analysis suggested that CBCT could be accurate for measuring soft tissues in the esthetic area. The novel CBCT technique described yields clear contours of soft tissues in the esthetic area without the need for auxiliary tools. Moreover, measurements of soft tissue morphological parameters on CBCT appear to be accurate.

Thickness of keratinized tissue as an indicator of success in connective tissue operations

To investigate how keratinized tissue thickness have an impact on clinical outcome of the subepithelial connective tissue graft with coronally advanced flap procedure in Miller Class I defects which previously grouped as having either “thick” or “thin” phenotypes. Recession defects were treated with the same surgical approach in both “thick” (n=18), “thin” (n=19) groups. Plaque index (PI), gingival index (GI), recession depth (RD), recession width (RW) and width of keratinized tissue (WKT) were recorded on baseline, 6. week, 3., 6., 9., and 12. months respectively. Probing depth (PD), clinical attachment level (CAL), thickness of keratinized tissue (TKT) of defects were recorded on baseline, 3., 6., 9. and 12. months. The percentage of root coverage was measured on 3., 6. and 12. months. Palatal mucosa thickness measurements were repeated on 6. and 12. months. Compared to baseline, there was statistically significant decrease in CAL, RD and RW; and a significant increase in PD, WKT and TKT in both groups (p<0,05). TKT was the highest on 3. month, decreased till 9. month and became stable then. According to phenotypes, only defects of thin group's baseline TKT was positively correlated with the amount of thin group's root coverage. Within the results of this study success of root coverage in connective tissue operations is influenced by a threshold thickness of flap in the operation area only in thin phenotype group.

Single gingival recession associated with non-carious cervical lesion treated by partial restoration and coronally advanced flap with or without xenogenous collagen matrix: A randomized clinical trial evaluating the coverage procedures and restorative protocol.

Evaluate the use of collagen matrix (CM) as adjunctive to coronally advanced flap (CAF versus CAF + CM) to treat gingival recession (GR) associated with non-carious cervical lesion-combined defects (CDs). Sixty-two patients presenting 62 CDs (RT1 GR and non-carious cervical lesion (NCCLs) were randomly allocated to either CAF group (n=31): partial restoration of the NCCL and CAF; or to CAF + CM group (n=31): partial restoration of the NCCL and CAF associated with CM. Clinical, esthetic, patient-centered outcomes, and restorative parameters were assessed. After 12 months, CD coverage were 55.2% for CAF and 54.4% for CAF + CM (P=0.8). Recession reduction were 1.9 ± 0.8mm for CAF and 2.0 ± 0.7mm for CAF + CM (P=0.6). CAF+CM resulted in higher increase in keratinized tissue (KT) width (CAF: 0.3 ± 0.7mm; CAF + CM: 0.9 ± 0.8mm; P=0.004) and KT thickness gain (CAF: 0.1 ± 0.3mm; CAF + CM: 0.7 ± 0.2mm; P=0.001). Both treatments presented low postoperative pain and resulted in esthetics improvements. In addition, no restoration was lost, 27.4% showed a reduction of the superficial polishing, and 8% showed marginal staining, but still clinically acceptable. Partial resin composite restoration (with the apical limit up to 1mm of the estimated CEJ) and CAF alone or combined with CM are suitable for treating CDs. The use of CM provided additional benefits in terms of KT width and thickness gain. (NCT03341598).

Root coverage with tunneling technique or modified advanced flap associated with acellular dermal matrix: results from 6 months randomized clinical trial.

This study compared two surgical techniques using acellular dermal matrix (ADM) for the treatment of multiple gingival recessions. Twenty patients, with bilateral RT1 gingival recessions, were selected. One side received a modified extended coronally advanced flap (MECAF), and the contralateral side a supra-periosteal flap (TUN). The evaluated parameters were probing depth (PD), relative clinical attachment level, gingival index, gingival recession height (GR), width of keratinized tissue, keratinized tissue thickness, and gingival recession area at baseline and 6 months postoperative. Pain was evaluated weekly, using a visual analog scale (VAS) during first month postoperative. Both groups were effective in reducing GR (ΔGR: MECAF 2.28 mm; TUN 1.93 mm), without significant differences. The % of root coverage was numerically superior favoring MECAF (MECAF 61.24%; TUN 56.07%), without significant differences between groups. VAS scale failed to provide differences between groups. Both treatment were effective in root coverage and might be valuable for the treatment of multiple gingival recessions. The use of vertical releasing incisions and a flap design including the papillae did not hamper root coverage. This study compared two techniques for use of ADM in large multiple gingival recessions. Within its limitations, both treatments successfully achieved root coverage and were able to reduce gingival recession. It is expected a partial root coverage when using these techniques in large gingival recessions. The study failed to provide significant differences between groups. The use of modified extended coronally advanced flap may be advisable for the treatment of multiple gingival recessions, specially involving large defects when using ADM, to avoid early matrix exposure.

Clinical and patient-centered outcomes using two types of subepithelial connective tissue grafts: A split-mouth randomized clinical trial.

This split-mouth randomized clinical trial compared two different types of subepithelial connective tissue grafts (SCTG) considering clinical parameters and patient-centered outcomes in patients with bilateral recession type 1 multiple gingival recessions after 6 months postoperatively. A total of 21 patients were surgically treated with coronally advanced flap (CAF) associated with SCTG harvested by: double blade scalpel (DBS) and de-epithelialized (DE) SCTG. Periodontal clinical parameters and esthetics were evaluated by a calibrated periodontist at baseline and after 6 months. Patient-centered outcomes related to pain/discomfort and esthetics were assessed with visual analogue scale after 7 days and 6 months, respectively. All clinical parameters, with the exception of probing depth, demonstrated differences in intragroup evaluation, comparing baseline to 6-month evaluation (P<0.05). Both groups presented reduction of recession depth and recession width and gain of keratinized tissue thickness, keratinized tissue width, and clinical attachment level (P<0.05). Intergroup comparison (DBS × DE) demonstrated no significant differences considering clinical parameters and periods. Both techniques improved esthetics evaluated by patients, without a difference between groups in patients and professional analysis. However, DBS group presented inferior pain/discomfort compared with DE (P<0.05). DBS and DE associated with CAF presented satisfactory clinical outcomes. However, DBS presented inferior morbidity, an important fact for decision-making process.

Comparative Evaluation of Root Coverage Between Smokers and Non-Smokers After Surgical Therapy-A Review and Meta-Analysis

Background: Several studies have demonstrated that nicotine induces a pro-inflammatory effect due to the upregulation of receptors of the advanced glycation end product as well as the fibroblastic cell migration in the gingiva is reduced in smokers. Thus, this meta-analysis aims to evaluate and compare the effectiveness of root coverage after surgical therapy in smoker and non-smoker individuals. Methods: A total of 15 articles were included in this study in which the different types of periodontal surgical procedures for root coverage of gingival recession were evaluated in both smokers and non-smokers. The databases are searched from 1997 to 2018. The inclusion criteria included the available evidence and the articles published only in the English language. Result: In this meta-analysis, comparing smokers and non-smokers treated with different types of periodontal surgery, the result showed a statistically significant reduction in probing pocket depth (PPD), whereas, Gingival recession height (GRH), Gingival recession width (GRW) reduction and gain in clinical attachment level (CAL) and Keratinized tissue thickness (KTT) between smokers and non-smokers were not statistically significant. The percentage of complete and mean root coverage showed statistically significant variations when compared with smokers. Conclusion: Periodontal surgical interventions exhibited less favorable healing outcomes and there were significant variations observed in the percentage of mean and complete root coverage in smokers than compared with non-smoker.

A novel soft tissue cone-beam computed tomography study in the evaluation of gingival thickness associated with subepithelial connective tissue graft versus acellular dermal matrix in the management of gingival recession: A clinical study.

Background:Dental esthetic awareness among patients led the clinicians to introduce newer materials and predictable techniques that satisfy the patients' esthetic demands.Aim:To evaluate and compare the efficacy of subepithelial connective tissue graft (SECTG) and acellular dermal matrix (ACDM) allograft in the treatment of Millers Class I or Class II recession with the determination of gingival thickness using an impertinent method, soft tissue cone-beam computed tomography (ST-CBCT).Materials and Methods:A split-mouth study with a total of ten patients with bilateral Millers class I or class II recession is randomly assigned by a coin toss method as Group I (SECTG) and Group II (ACDM) along with coronally advanced flap. Clinical parameters including recession height (RH), recession width (RW), probing depth, clinical attachment level (CAL), and height of keratinized tissue (HKT) were evaluated at baseline, 90th day, and 180th day for both groups. The thickness of keratinized tissue (TKT) was determined by most reliable, predictable and noninvasive method called ST-CBCT.Results:Statistically significant reduction in RH and RW, gain in CAL, and increase in HKT and TKT in both Group I and Group II were seen in 90th day and 180th day. However, when both Group I and Group II were compared between 0 and 180th day, the change in RH and RW, gain in CAL, and increase in HKT and TKT did not show any statistically significant change.Conclusion:The present study suggested that root coverage with both SECTG and ACDM is very predictable procedure and it is stable for 6 months. ST-CBCT is a newer dimension in periodontal imaging and will certainly aid clinicians in the execution of various treatment modalities with increased predictability.

Gingival recession treatment with concentrated growth factor membrane: a comparative clinical trial.

Objective This clinical trial sought to evaluate the clinical effectiveness of concentrated growth factor (CGF) and compare it with connective tissue graft (CTG) with coronally advanced flap (CAF) in the treatment of Miller Class I gingival recessions (GR).Methodology This split-mouth study included 74 Miller Class I isolated (24 teeth) or multiple (50 teeth) GRs in 23 jaws of 19 patients. GRs were randomly treated using CGF (test group: 37 teeth; 12 teeth in isolated GRs, 25 teeth in multiple GRs) or CTG with CAF (control group: 37 teeth;12 teeth isolated GRs, 25 teeth in multiple GRs). Clinical variables, plaque index (PI), gingival index (GI), probing depth (PD), recession depth (RD), recession width (RW), clinical attachment level (CAL), keratinized tissue thickness (KTT), keratinized tissue width (KTW), and root coverage (RC) were assessed at the baseline as well as at three and six months post-surgery. Healing index (HI) were obtained in the second and third weeks post-surgery. Postoperative pain was assessed for the first seven days using a horizontal visual analog scale (VAS).Results No significant change was observed in PI, GI, or PD values in either the intergroup or the intragroup comparisons. A statistically significant decrease was observed in CAL, RD, and RW, and KTT increased in all groups at three and six months compared with the baseline. The control group had greater increases in KTW, KTT, and RC at three and six months. No significant difference was found in CAL or RD at the third and sixth months between the two groups. Healing was found to be similar for both groups in the second and third weeks post-surgery. The VAS values in the control group were higher than in the test group, especially at the second, fourth, fifth, and seventh days postoperatively.Conclusions CTG is superior to CGF with CAF for increasing KTT, KTW, and RC. CGF may be preferable due to decreased postoperative pain.

Treatment of multiple adjacent Miller Class I and II gingival recessions with collagen matrix and the modified coronally advanced tunnel technique

To clinically evaluate the treatment of Miller Class I and II multiple adjacent gingival recessions using the modified coronally advanced tunnel technique combined with a newly developed bioresorbable collagen matrix of porcine origin. Eight healthy patients exhibiting at least three multiple Miller Class I and II multiple adjacent gingival recessions (a total of 42 recessions) were consecutively treated by means of the modified coronally advanced tunnel technique and collagen matrix. The following clinical parameters were assessed at baseline and 12 months postoperatively: full mouth plaque score (FMPS), full mouth bleeding score (FMBS), probing depth (PD), recession depth (RD), recession width (RW), keratinized tissue thickness (KTT), and keratinized tissue width (KTW). The primary outcome variable was complete root coverage. Neither allergic reactions nor soft tissue irritations or matrix exfoliations occurred. Postoperative pain and discomfort were reported to be low, and patient acceptance was generally high. At 12 months, complete root coverage was obtained in 2 out of the 8 patients and 30 of the 42 recessions (71%). Within their limits, the present results indicate that treatment of Miller Class I and II multiple adjacent gingival recessions by means of the modified coronally advanced tunnel technique and collagen matrix may result in statistically and clinically significant complete root coverage. Further studies are warranted to evaluate the performance of collagen matrix compared with connective tissue grafts and other soft tissue grafts.

Clinical and radiographics results at 3 years of RCT with split-mouth design of submerged vs. nonsubmerged single laser-microgrooved implants in posterior areas

AimTo evaluate and compare radiographic crestal bone loss (CBL) and soft tissue parameters around submerged/two-stage and nonsubmerged/one-stage single implants with the same endosseous portion (body design and surface, thread design and distance) and identical intramucosal laser-microgrooved surface, after 3 years of loading.Materials and methodsTwenty submerged/two-stage implants and 20 nonsubmerged/one-stage implants were placed randomly with a split-mouth design in the posterior areas of 20 partially edentulous patients.Radiographic and clinical examinations were carried out at the implant placement, at the delivery of prosthetic restorations, and at each year of the follow-up period. Plaque index (PI), probing depth (PD), bleeding on probing (BOP), and gingival recession (REC) were recorded. Radiographic crestal bone levels were assessed at the mesial and distal aspect of the implant sites. In addition, the influence of the vertical keratinized tissue thickness (KTT) on CBL was investigated.ResultsAt the delivery of prosthetic restorations, a statistically significant difference (P = 0.013) was found in radiographic mean CBL between submerged and nonsubmerged implants (0.15 ± 0.05 mm vs. 0.11 ± 0.04 mm). At the end of the follow-up period, no statistical difference (P = 0.741) was found in the mean CBL between submerged and nonsubmerged implants (0.27 ± 04 mm vs. 0.26 ± 0.5 mm). The changes in the soft tissues including PI, PD, BOP, and REC had no significant differences in either group. Moreover, KTT did not show a statistical correlation with CBL.ConclusionsAfter 3 years of loading, no statistical difference was noted in CBL and soft tissue conditions between single submerged two-stage and nonsubmerged one-stage laser-microgrooved implants.Trial registrationhttp://clinicaltrials.gov/ct2/show/NCT03674762

Surgical procedures for soft tissue augmentation at implant sites. A systematic review and meta-analysis of randomized controlled trials.

Different procedures were proposed to augment soft tissue around dental implants. Aims of this Systematic Review (SR) were to evaluate (a) clinical benefit of soft tissue augmentation at implant sites (b) which is the best surgical procedure to augment soft tissue. Manual/electronic searches were performed to identify randomized controlled trials (RCTs). Change in keratinized tissue thickness (STT) and height (KT) were primary outcomes. Random effects meta-analyses were performed where suitable and expressed as weighted mean differences (MD) with their associated 95% confidence intervals (CI). Fourteen RCTs accounting for 475 patients and 538 implants were included. Only five studies were judged at low risk of bias. In the single studies, soft augmentation lead to higher STT and KT compared to no augmentation. Considering primary outcomes, connective tissue graft (CTG) was more effective than xenogeneic collagen matrix (XCM) to improve STT (MD: -0.30 mm; 95% CI -0.43; -0.17; P < .00001) in the meta-analysis for different techniques for augmentation. Even if further studies at low risk of bias are needed, soft tissue augmentation techniques improved quantity and quality of peri-implant soft tissue. Among the augmentation procedures, CTG was associated to higher STT change compared to XCM.