Miller Class Research Articles

Root Coverage in Miller's Class 3 Gingival Recession using a Laterally Positioned Flap with Advanced PRF: A Two-year Follow-up Case Report

Introduction: Gingival recession, marked by the apical migration of gingival tissue, presents aesthetic and functional challenges. The laterally positioned flap (LPF) technique, often used for localized root coverage, remains effective, particularly when combined with advanced platelet-rich fibrin (A-PRF). Case Report: A 23-year-old male presented with Miller Class III gingival recession on tooth 41, with clinical attachment loss of 4.5 mm and high frenum attachment. A treatment plan involved the revised LPF technique, A-PRF membrane application, and frenectomy. Surgical Procedure: Following patient consent and scaling, a sulcular incision was made, and flaps were elevated. A-PRF was prepared and placed over the exposed root, with the flap secured by sutures. Post-operative Care: The patient received antibiotics and analgesics, with follow-up at 2 years showing a 4 mm gain in clinical attachment level and complete root coverage. Results: The combination of the LPF technique and A-PRF effectively managed Miller Class III gingival recession, restoring both function and aesthetics. Conclusion: This case underscores the efficacy of using A-PRF with the LPF technique for treating gingival recession, offering a reliable approach for restoring the keratinized gingival zone.

Effect of suturing in root coverage via coronally advanced flaps: A systematic review.

To analyze the evidence about the influence of the suturing technique and material in terms of the percentage of mean root coverage (%MRC) following root coverage therapy in teeth diagnosed with single/localized gingival recession defects (GRD) via a monolaminar coronally advanced flap. The protocol of this systematic review was registered in PROSPERO (CRD42024514043). A literature search was conducted to identify investigations that fulfilled the eligibility criteria. Variables of interest were extracted, subsequently categorized, and qualitatively analyzed. A total of 15 randomized clinical trials, including 301 localized GRD in non-molar sites classified as Miller class I-II/RT1, in 253 patients were included. The studies reporting the combination of sling and single interrupted sutures, or interrupted sutures alone showed an MRC of 70.2%±16.6%, and 74.1%±0.75%, respectively. The highest MRC was observed in the studies using polyglactin 910 with a pooled value of 76.6% ± 15.3%, and monofilament materials, with a pooled MRC of 74.8%±7.1%. When the suturing diameter was evaluated, the highest pooled MRC with values of 79.1%±9.8% was observed with the use of 5-0. For the treatment of single/localized GRD in non-molar sites via a monolaminar coronally advanced flap, the use of a combination of sling and single interrupted sutures, or single interrupted sutures, polyglactin 910 or monofilament materials, and material diameter of 5-0 showed a higher MRC as compared to the use of expanded polytetrafluoroethylene, and silk with/without dressing, and other suture diameters. There were no differences in the percentage of root coverage achieved between the use of sling and single interrupted, versus single interrupted sutures alone on the treatment of single/localized GRD in non-molar sites. Polyglactin 910 and monofilament sutures resulted in a higher percentage of root coverage achieved as compared to expanded polytetrafluoroethylene, and silk with/without dressing. The use of 5-0 material diameter showed the highest percentage of root coverage achieved. This study was primarily aimed at evaluating how different suturing techniques and materials could affect the percentage of root coverage in single/localized recession defects, without the use of soft tissue substitutes or autogenous soft tissue grafts. After the pooled analyses of 15 randomized clinical trials that fulfilled the inclusion criteria, we observed that the adequate selection of suturing techniques, materials, and size could lead to a higher percentage of root coverage. Specifically, the use of single interrupted with or without sling sutures at the most coronal portion, Polyglactin 910 or monofilament materials, and size of 5-0 showed a higher percentage of root coverage as compared to the use of expanded polytetrafluoroethylene, and silk with/without dressing, and other suture diameters.

Exploring the correlation between periodontal disease and serum biomarkers in haemodialysis patients

BackgroundPatients undergoing haemodialysis are more susceptible to infectious diseases, including periodontitis. This study aimed to investigate the Correlation between periodontal disease and serum markers in Yemeni haemodialysis patients.MethodsA cross-sectional study was conducted on a sample of 70 haemodialysis patients. Patient interviews, clinical examinations, and laboratory tests were performed to collect data. Serum levels of albumin, calcium, phosphorus, haemoglobin, ferritin, and creatinine were measured, with separate measurements for cystatin C The association between categorical variables was assessed using the chi-square test and Pearson’s correlation coefficient, considering a significance level of p < 0.05.ResultsSignificant correlations were found between serum biomarkers and periodontal clinical parameters. Phosphorus, creatinine, albumin, ferritin, and creatinine levels correlated significantly with the Plaque Index (p < 0.001, p < 0.001, p = 0.015, p = 0.018, and p = 0.03). While the Ferritin level showed significant correlations with both the Plaque Index and Miller Classes (r = 0.281, p = 0.018 and r = 0.258, p = 0.031), respectively. The Calcium level showed a significant correlation with the Gingival Index (r = 0.266, p = 0.027). Cystatin C level was statistically correlated with mobility (r = 0.258, p = 0.031). Also, the result showed a significant correlation between Creatinine levels and Periodontitis (r = 0.26, p = 0.03).ConclusionThis study provides evidence of a strong association between periodontal disease and chronic kidney disease in Yemeni haemodialysis patients. The findings emphasize the significance of maintaining good oral health in the care of haemodialysis patients.

A comparative study of the effects of advanced platelet-rich fibrin and resorbable collagen membrane in the treatment of gingival recession: a split-mouth, randomized clinical trial

AimThis study aimed to assess the effectiveness of advanced platelet-rich fibrin (A-PRF) combined with the pinhole surgical technique (PST) for enhancing root coverage (RC) in individuals with Miller class I or II gingival recessions (GR). Additionally, it compared the clinical effect of A-PRF and resorbable collagen membrane (RCM).Materials and methodsA total of 18 patients, encompassing 36 treatment sides of 18 Miller class I or II, were randomly assigned to the PST + A-PRF side (18 sides) and the PST + RCM side (18 sides). Clinical assessments of various parameters, including plaque index (PI), clinical attachment level (CAL), keratinized tissue width (KTW), recession depth (RD), recession width (RW), and gingival thickness (GT) were conducted at baseline and three months after the surgical procedure. A numeric rating scale (NRS) was also evaluated during the 1st, 2nd, 3rd and 4th days. This study was formally recorded under the TCTR identification number TCTR20230613005 in the Thai Clinical Trials Register-Medical Research Foundation of Thailand (MRF) on 13/06/2023. Furthermore, it was ethically approved by Sana’a University’s Ethical Committee for Medical Research.ResultsWhen comparing the values of 3 months follow-up with the baseline values, intra-side comparison of the PST + A-PRF group showed significant improvements in PI (P = 0.02), CAL (P = 0.01), and RD (P = 0.04), and GT values (P < 0.01). The improvements in the PST + A-PRF group were through the reduction of baseline values of PI, CAL, and RD; the mean reductions in PI, CAL, and RD were 0.44 ± 0.71, 0.33 ± 0.45, and 0.22 ± 0.43 respectively, and a significant increase in GT value (0.44 ± 0.24). While there was an insignificant increase in KTW value with no change in RW values (4.50 ± 0.71, P = 1). In contrast, intra- side comparison of PST + RCM side showed only a significant reduction in PI value (0.44 ± 0.71, P = 0.02) and a significant increase in GT value (0.42 ± 0.26, P = < 0.01). Meanwhile, there were insignificant improvements in CAL (2.89 ± 0.95), KTW (3.97 ± 0.74), and RD (1.94 ± 0.87) values. Regarding inter-side comparison, there were no statistically significant among all variables (p > 0.05). The pain scores of the numeric rating scale were significantly lower on the PST + A-PRF sides compared with the PST + RCM sides, especially on the 1st, 2nd, and 3rd days (P < 0.001).ConclusionBoth A-PRF and RCM showed not wholly satisfactory outcomes in gingival recession treatment. Interestingly, the combination of PST with A-PRF has proven more effective than combining PST with RCM. Additionally, the localized application of A-PRF has been shown to reduce post-operative pain following the pinhole surgical technique.

Effectiveness of Tunnelling Modification Technique Using Platelet-rich Fibrin and Connective Tissue Graft in Gingival Recession: A Systematic Review

Background Gingival recession is a concern in aesthetic and functional perspective. The tunneling technique (TT) is one of the effective root coverage treatments in some gingival recession defects and is associated with favorable outcomes. This paper aims to evaluate the effectiveness of platelet-rich fibrin (PRF) and connective tissue graft (CTG) in gingival recession treatment with TT. Methods This systematic review used the PRISMA method and electronic bibliographic searches were conducted on seven databases (Google Scholar, Wiley, Pubmed, Sage, Ovid Technologies, Quintessence Publishing, Springer) from December 2018 to January 2023. The search focused on randomized clinical trials (RCTs) that reported TT outcomes in the treatment of Miller class I and II recession with a minimum of six months follow-up. Results Three out of 399 studies met the inclusion criteria. The three selected studies presented PRF and CTG use in multiple gingival recessions to evaluate tissue condition and clinical parameters before and after the surgical procedure. The clinical parameters evaluated were probing pocket depth (PPD), recession width (RW), width of keratinized gingiva (WKG), and vertical depth of recession (VDR). TT with PRF and TT with CTG is effective in treating gingival recession. PRF is well accepted by patients with a less invasive procedure compared to the CTG procedure. However, TT with CTG showed better results in all parameters at follow-up. Conclusions TT with PRF can be used as an alternative to treat some gingival recession defects. However, TT with CTG produced better clinical results in recession closure.

Growth factor-enhanced matrix combined either with free connective tissue graft or with collagen membrane in the treatment of Miller class II gingival recession

Abstract Purpose The goal of the study was to examine the efficacy of collagen membrane or free connective tissue graft in conjunction with growth factor-enhanced matrix (GEM) for treating Miller class two gingival recession. Patients and methods Twenty sites in 10 patients, with class II Miller gingival recession were allocated randomly to be treated by (GEM21s) with free connective tissue graft (group I) or GEM21s with collagen membrane (group II). Recession width, recession depth, height of keratinized tissue and digital measurements were recorded at baseline, 1, 3, and 6 months. Probing pocket depth, clinical attachment level, gingival thickness, and radiographic parameters were recorded at baseline and 6 months. Root coverage percentage were recorded 6 months postoperative and wound healing index were recorded at 1, 3, and 6 months postoperative. Results Both groups showed significant improvement in all clinical parameters and increase in bone level was observed after 6 months compared to baseline measures. There was no statistically significant difference between both groups except for recession depth at 1 and 3 months after surgery and height of keratinized tissue at 1, 3, and 6 months in favor of group I. Radiographically there was a statistically significant difference (P ≤ 0.05) in amount of labial bone gain and bone density in favor of group I compared to group II. Conclusion GEM21s combined either with free connective tissue graft or collagen membrane led to favorable gingival coverage and radiographical results with better results for free connective tissue graft with GEM21s.

Treatment of gum recession by the method of a coronally displaced flap and application of phytoextract

BACKGROUND: Owing to the widespread prevalence of gum recession in the morbidity structure of the population, the search for optimal treatment tactics for patients with this pathology is crucial in dentistry. AIM: To evaluate the effectiveness of treatment of patients with gum recession using the coronally displaced flap method and application of a phytoextract. MATERIALS AND METHODS: Overall, 123 patients diagnosed with gum recession were clinically examined. During examination, all patients revealed a defect such as exposed roots in the area of the frontal group of teeth. Moreover, the size of the defect was measured, and the Miller class was determined. Then, complex treatment was performed, including conservative treatment and, if required, surgical intervention, as well as orthopedic treatment. RESULTS: In the surgical treatment of gum recession, flap operations were performed. On postoperative day 2, to achieve the best healing and regeneration of the gums, a phytoextract was applied. Over a 3-year period after treatment of patients with gum recession, the effectiveness of treatment was monitored, and relapses of the disease were detected. The following complications were identified after treatment of patients diagnosed with gum recession: transition from class I to II to Miller, 15% of cases; class II to III according to Miller, 19.5%; temporomandibular joint diseases during recession, 16.5%; and occlusal deformation during recession, 19.8%. Stabilization in class I recession occurred in 45.0% of patients, class II in 33.4%, and class III in 8.5%. CONCLUSION: The etiology and pathogenesis of gum recession requires long term treatment and observation and early diagnosis and an integrated approach. Therefore, new treatment methods that will be most effective and can be used in all age groups are required. One of these methods is the method developed by the authors for the treatment of gum recession using a coronally displaced flap and the application of a phytoextract, which has shown high effectiveness in the long term.

Cirurgia de Recobrimento Radicular com Enxerto Conjuntivo Subepitelial no Tratamento de Recessão Gengival: Relato de Caso Clínico

Gingival recession, a common periodontal condition, occurs when the gingival margin migrates apically to the cementoenamel junction (CEJ), exposing the root and potentially causing dental hypersensitivity, caries, and aesthetic dissatisfaction. Causes include bacterial biofilm, frenulum and frenum insertions, band of keratinized gingiva, gingival phenotype, alveolar morphology, tooth positioning, and mechanical trauma. It is classified into three types: RT1 (no CEJ exposure), RT2 (interproximal loss equal to or less than buccal loss), and RT3 (interproximal loss greater than buccal loss). Among root coverage techniques, the subepithelial connective tissue graft (SCTG) is highlighted for its predictability, color compatibility with adjacent gingival tissue, and good blood supply, reducing the likelihood of necrosis. This qualitative and descriptive study reported a clinical case of root coverage surgery with SCTG in a 60-year-old female patient with Miller class III and Cairo RT2 recessions on teeth 31 and 41. The palate was chosen as the donor site for the graft due to its adequate thickness. The SCTG technique combined with a laterally positioned flap and double papilla was used. The procedure resulted in reduced dentinal hypersensitivity and patient satisfaction with aesthetics, along with an increase in keratinized tissue, despite not achieving total root coverage. The success of the treatment was attributed to the precise indication of the case and professional skill.

Treatment of multiple adjacent gingival recessions using leucocyte- and platelet-rich fibrin with coronally advanced flap: a 12-month split-mouth controlled randomized clinical trial.

This split-mouth randomized study aimed to assess efficacy of leucocyte-platelet-rich fibrin (L-PRF) versus connective tissue graft (CTG) in achieving root coverage (RC) for multiple adjacent gingival recessions (MAGRs) throughout 12-month period. The study enrolled 59 teeth from 12 patients with Miller Class I MAGRs ≥ 2mm on bilateral or contralateral sides. Patients were randomly assigned to receive coronally advanced flap (CAF) with either CTG (control) or L-PRF (test) treatment. Various parameters, including plaque and gingival index, clinical attachment level, recession depth, probing depth, recession width (RW), papilla width (PW), keratinized tissue width (KTW), gingival thickness (GT), percentage of RC, complete root coverage (CRC), and location of the relative gingival margin concerning the cemento-enamel junctions (GMCEJ) after CAF, were recorded at baseline, 3-, 6-, and 12-months post-surgery. On June 29, 2021 the study was registred to ClinicalTrials.gov (NCT04942821). Except KTW and GT gain, all clinical parameters, RC, and CRC were similar between the groups at all follow-up periods (p > 0.05). The higher GT and KTW gains were detected in the control group compared to test group at 12 months (p < 0.05). Both RC and CRC were positively associated with initial PW and GMCEJ, but negatively with initial RW (p < 0.05). The current study concludes that L-PRF were equally effective as CTG in treating MAGRs in terms of RC and CRC. Additionally, RC and CRC outcomes appeared to be influenced by GMCEJ, PW, and RW. L-PRF could represent a feasible substitute for CTG in treating MAGRs.

Passive Root Coverage Through Creeping Attachment of the Gingiva Before and After Scaling and Root Planning Therapy in the Mandibular Anterior Teeth: A Clinical Study.

Introduction Root coverage is one of the most imperative procedures in periodontal therapy. The demands from patients for aesthetics and sensitivity are some of the complaints in root exposure cases. Creeping attachment is a passive apical migration of the marginal gingiva and can be proposed as a noteworthy root coverage technique. The purpose of this study was to evaluate the position of the marginal gingiva and quantify the creeping attachment before and after the scaling and root planning (SRP) procedure. Materials and methods The present study was based on a single-centreclinical trial in which 30 sites from 10 patients were selected. Patients with Miller's class I gingival recession were selected. The plaque index, gingival biotype, and gingival margin position were measured at baseline and then at 10 and 21 days after SRP. The gingival biotype was measured with an endodontic file with a stopper and a digital vernier calliper. The gingival margin position was measured from the incisal surface of the tooth to the marginal gingiva with the help of a University of North Carolina (UNC) 15 periodontal probe. After recording the clinical parameters, a thorough SRP was performed using an ultrasonic scaler and manual instruments. Results The results were compared clinically at baseline and after 10 days and 21 days postoperatively. Statistical analysis was conducted for pre-SRP and post-SRP findings using the IBM SPSS Statistics for Windows, Version 19 (Released 2010; IBM Corp., Armonk, New York) software. A statistically significant improvement was seen in all the clinical parameters at baseline, at 10 days, andat 21 days postoperatively after the procedure (P < 0.01). Conclusion The position of the gingival margin was shifted towards the crown, and the creeping attachment was significantly observed from baseline to 10 and 21 days. Clinical significance Creeping attachment after the SRP procedure can be considered a significant root coverage technique. The genetic memory of the gingiva may playan important role in achieving root coverage. Once local irritants are removed, the gingiva attempts to regain its original position. In addition, the gingival phenotype plays an important role in gingival marginal positioning after basic therapy and root coverage procedures.

Comparative Evaluation of Autologous Fibrin Glue and Conventional Sutures in the Treatment of Gingival Recession Using Connective Tissue Graft - A Randomised Controlled Clinical Trial.

The combination of the coronally positioned flap with connective tissue grafting in treating gingival recession defects has been shown to demonstrate the highest success rate. The aim of the present study was to compare and evaluate the efficiency between autologous fibrin glue (AFG) and conventional absorbable sutures in the treatment of marginal tissue recessions using connective tissue grafts (CTGs) and the coronally advanced flap (CAF) technique. Twenty Miller's class I and II recession sites in maxillary or mandibular areas in chronic periodontitis patients were treated as group I (test): CTG + CAF + AFG; and group II (control): CTG + CAF with conventional absorbable sutures. Clinical parameters in both groups were recorded at baseline (t0) and six months (t1) postoperatively in terms of gingival recession height (RH), root coverage esthetic score (RCES), visual analogue scale (VAS), and healing index (HI). The RH, RCES, VAS, and HI were significantly reduced at the end of six months compared to baseline ( P < 0.005) in both groups; however, there was no statistical difference between the groups, indicating the equivalent efficacy of AFG and conventional sutures in healing. All the treated sites were found to have appreciable root coverage with satisfactory post-operative healing. Hence, it may be suggested that both AFG and absorbable sutures are equally efficient in post-surgical soft tissue healing.

THE USE OF A MODIFIED DEEPITHELIALISED FREE GINGIVAL GRAFT IN THE TREATMENT OF GINGIVAL RECESSIONS ASSOCIATED WITH INTERPROXIMAL BONE LOSS. CASE REPORT

The prevalence of gingival recessions is very high, and it increases with age. The gingival recessions occur frequently in populations both with high and low standards of dental care. Gingival recessions are surgically treated to improve aesthetics, reduce root hypersensitivity. Recently, the coronally advanced flap is more frequently used, displacing the free gingival graft and the laterally positioned flap. Connective tissue graft or a deepithelialised free gingival graft is often used in combination with coronally advanced flap. It has been stated, that periodontal plastic procedures may predictably determine complete root coverage in multiple Miller class I and II recessions. According to the treatment of multiple Miller class III recessions, there is lack of evidence by clinical trials in the literature. It should be considered, that dealing with multiple recessions can be associated with different limitations in the same surgical area, such as interproximal bone loss, larger avascular surface, position of the teeth, high muscle and frenulum attachments, etc. There is a quite big difference in the literature according to the data of complete root coverage percentage. Another problem is dealing with black triangles because of interproximal bone loss. Of course, patients expect not only recession closure, but also papillary reconstruction. But it is very hard to predict a complete root coverage at Miller class III recession and papillary reconstruction at the same time. The purpose of this clinical report is to evaluate the effectiveness of the coronally advanced flap in combination with modified deepithelialised free gingival graft (MDFGG). The scalloped form of the deepithelialised free gingival graft in combination with the coronally advanced flap helped to solve two problems simultaneously: recession closure and papillary reconstruction. The results lead to further researches for the treatment of Miller class III and IV recessions, and also papillary reconstruction techniques.

Evaluating the efficacy of laterally positioned flap in the management of Miller's Class I and II gingival recession: A 6 months follow-up study

Background: The goal of the study is to evaluate the clinical effectiveness of a laterally positioned flap (LPF) six months after it was used to correct Miller's Class I and II gingival recession abnormalities. Materials and methods: The LPF approach was used to treat 10 Miller's Class I or II gingival recession defects of height ≥3 mm (n = 10) on the labial surface of anterior teeth. At baseline, 3 months, and 6 months after surgery, clinical measures including probing pocket depth (PPD), clinical attachment level (CAL), width of attached gingiva (WAG), and height of gingival recession (HGR) were measured, and percentage of root coverage was calculated. Data were gathered, and repeated-measures ANOVA with the post hoc Bonferroni test was used for statistical analysis. Results: All clinical parameters such as PPD, CAL, WAG, and HGR showed improvement. All of the evaluated clinical measures showed statistically significant changes at post-operative 3 and 6 months compared to baseline values. With a p-value of &lt;0.001, the HGR decreased from 3.21 ± 0.52 mm to 0.23 ± 0.65 mm at three months and to 0.36 ± 0.78 mm at six months. At six months, the average level of recession coverage was 97.93%. Conclusion: Employing the LPF technique led to substantially improved gingival recession coverage, which effectively covered isolated deep narrow defects.

Efficacy of amniotic membrane with coronally advanced flap in the treatment of gingival recession: an updated systematic review and meta-analysis

ObjectivesThis systematic review aims to evaluate the efficacy of combining the amniotic membrane (AM) with the coronally advanced flap (CAF) in the treatment of Miller class I and II gingival recession (GR).MethodsThe protocol of this updated PRISMA-compliant systematic review was registered in PROSPERO (CRD42023431501). The following treatment outcomes were recorded; recession depth (RD), recession width (RW), width of keratinized gingiva (WKG), and clinical attachment level (CAL). We searched the following databases: MEDLINE, Cochrane Library, Google Scholar, EMBASE, Web of Science, and Science Direct.ResultsTwo independent reviewers screened the selected articles. Twenty-two eligible articles were extracted, with 689 sites of GR in 481 patients. No statistically significant difference was found in RD, RW, WKG, and CAL between (AM&CAF) in comparison to control groups. However, the subgroup analysis showed statistically significant differences in RD between the (AM & CAF) group v/s (CAF) alone (P = 0.004). Moreover, the subgroup analysis of the WKG showed statistically significant differences between (AM & CAF) v/s (CAF&CM) (p = 0.04). Additionally, a statistically significant difference was found in the subgroup analysis of CAL between both (AM & CAF) group v/s (CAF) alone (p = 0.0009).ConclusionWith the limitations of this meta-analysis due to short follow-up periods (6 months), the AM can be considered a viable treatment option for GR defects with satisfactory treatment outcomes comparable to other previously investigated treatment modalities.Clinical significanceWhile AM showed various beneficial properties as an ideal membrane for the coverage of GR, future studies are required to completely understand the potential application of AM in the treatment of GR.

Novel Membrane for the Treatment of Multiple Gingival Recession Defects-RCT

Objective Evaluation and comparison of Collagen Matrix Ossixreg Volumax and Subepithelial connective tissue graft SCTG in combination with modified coronally advanced flap MCAF in the treatment of Miller Class I and II multiple gingival recession defects MARDs.Methods Twelve patients presenting adjacent Miller Class I and II maxillary and mandibular gingival recession defects participated in this randomized controlled study. A total of sixty defects were received n 30 either Ossix Volumax collagen matrix VCMX and MCAF test group or MCAF and Subepithelial connective tissue graft control group n 30. Parameters like gingival recession depth gingival recession width probing depth clinical attachment level and keratinized tissue width were checked at baseline 6 weeks 3 months and at 6 months after treatment. P value lt0.05 was considered statistically significant.Results The percentage of complete root coverage was 80 for the test group and 60 for the control group. The percentage of mean recession coverage for the test group was 60 and the control group was 85. Adjacent gingival recession was successfully treated with MCAF and Ossixreg Volumax or with MCAF and SCTG. The use Ossixreg Volumax was more comfortable during the postoperative period.Conclusion We suggest the use of Ossixreg Volumax as a promising collage matrix for the treatment of MARDs.

Effectiveness of the periodontal dressing upon periodontal parameters during treatment of gingival recession by free gingival graft

Background:Various grafting procedures have been used to convert a thin periodontal phenotype to a thick phenotype, including free gingival graft.Objective:To evaluate the effectiveness of the periodontal dressing upon periodontal parameters such as Pocket depth, width of keratinized gingiva and recession depth during treatment of the Miller class I, II or III gingival recession of the lower anterior teeth. Materials andMethods:34 lower anterior teeth with Miller class I, II or III gingival recession were selected and randomly grouped into two groups. The first group included 19 teeth and was treated with a single-step free gingival graft procedure with the application of the periodontal dressing. The second group had 15 teeth and was treated with a single-step free gingival graft (FGG) procedure without applying the periodontal dressing. Clinical parameters such as probing depth, the width of keratinized gingiva and recession depth were recorded before surgery (B0), two weeks (B1) and three months (B2) after surgery. Results:No significant differences (P&gt;0.05) in PD were observed in both groups at different time intervals and between both groups at two weeks and three months after surgery. However, a significant reduction (P&lt;0.05) in RD in both groups at two weeks and three months after the surgery was seen. Also, both groups saw a significant decrease (P&lt;0.05) at two weeks and three months after surgery. WKG was significantly (P&lt;0.05) increased at two weeks and three months after the surgery in both groups. The difference in the increase was highly significant (P&lt;0.001) between both groups at 2-weeks and 3-months after the surgery.Conclusions:The group that used periodontal dressing at 2-weeks and 3-months after surgery reported greater improvements in root coverage and increased width of keratinized gingiva compared to those who did not use periodontal dressing.

Clinical analysis of the results of recessions elimination using tunnel technology

In modern plastic surgery of soft tissues of the oral cavity, there is a wide variety of ways to close recessions of the gingival margin and increase the keratinized gum zone, but only a few of them give a well-predicted and effective result. So, one of the most popular techniques is the tunneling technique using a de-epithelized free gingival graft. The prevalence of this method is primarily due to its minimally invasive nature, which allows for accelerated regeneration of the gingival margin and reduces the likelihood of postoperative complications. The analysis of 20 clinical cases of closure of recessions of the gingival margin of the teeth on the upper and lower jaws according to the Miller classification of class I and II, subclasses A and B and the Francesco Cairo classification type 1 and type 2 with the use of tunnel technology according to Zuhr. The high efficiency of this method of closing recessions has been revealed, including in terms of achieving an optimal long-term forecast and aesthetic result.

Comparative Evaluation of Vestibular Incision Subperiosteal Tunnel Access (VISTA) Technique With and Without Advanced Platelet Rich Fibrin for Treatment of Maxillary Anterior Gingival Recessions.

Gingival recession is an apical shift of the gingival margin with exposure of the root surface to the oral cavity which creates an aesthetic problem. The present study was attempted to compare Vestibular incision subperiosteal tunnel access (VISTA) with and without Advanced platelet rich fibrin(A-PRF) in the treatment of Miller's class I gingival recessions. 24 patients were assigned randomly either to test (VISTA with A-PRF) or control (VISTA alone) group. Clinical parameters like recession depth (RD), recession width (RW), clinical attachment loss (CAL), width of keratinized gingiva (WKG), gingival thickness (GT) and probing depth (PD) were recorded at baseline,3 and 6 months post operatively. Inter group comparison of mean RC in mm, %RC, ΔWKG and CAG revealed no statistically significant difference (p>0.05). Change in GT showed statistically significant improvement in test group. Within the limitations of this study, both treatment options (VISTA with A-PRF and VISTA alone) have resulted in predictable and comparable root coverage with increased gingival thickness in the test group.

Xenogeneic collagen matrix vs. connective tissue graft for the treatment of multiple gingival recession: a systematic review and meta-analysis.

The aim of this systematic review (SR) compared the effect of xenogeneic collagen matrix (XCM) vs. connective tissue graft (CTG) for the treatment of multiple gingival recession (MGR) Miller Class I and II or Cairo type I. Five databases were searched up to August 2022 for randomized clinical trials (RCTs) comparing the clinical effects of XCM vs. CTG in the treatment of MGR. The random effects model of mean differences was used to determine reduction of gingival recession (GR), gain in keratinized tissue width (KTW), gain in gingival thickness (GT) and gain in clinical attachment level (CAL). The risk ratio was used to complete root coverage (CRC) at 6 and 12months. 10 RCTs, representing 1095 and 649 GR at 6 and 12months, respectively, were included in this SR. The meta-analysis showed no statistically significant difference in GR reduction, KTW gain GT gain or CAL gain between groups at 6months. However, at 12months of follow-up, differences favoring the control group were observed (p < 0.05). CRC was significantly higher in the CTG group at 6 and 12months. Regarding dentine hypersensitivity (DH), no statistically significant differences were found between groups at 6 and 12months of follow-up (p < 0.05). At 12months, CTG showed significantly superior clinical results in the treatment of MGR: however, this difference was not observed in the decrease of DH.

Evaluation of the Effect of Surgical Experience Level on the Success of the Coronally Advanced Flap (CAF) Technique.

To investigate the effects of experience level on the clinical and esthetic results of coronally advanced flap (CAF) surgery. A postgraduate student's first 40 CAF operations in the periodontology residency program were followed. The Miller Class I gingival recessions were divided into four chronologic groups (n: 10 in each). Clinical and esthetic evaluations were performed at baseline and after 6 months. The results of chronologic intervals were statistically compared. While the overall mean root coverage (RC) percentage was 73.6% and the complete RC was 60%, the mean RC percentages of the groups, respectively, were 45%, 55%, 86%, and 95%, showing that the mean and complete RC percentage increased as the experience level increased (P < .05). Similarly, as the experience level increased, closure of the gingival recession depth and width and esthetic scores increased, while the surgical time decreased significantly (P < .05). Complications were observed in three patients during the first interval and in two patients during the second interval, while no complications were observed in the other groups. This study showed that experience level can significantly affect the clinical and esthetic outcomes, operative time, and complication rates of CAF surgery. All education programs should determine how many of each surgical procedure residents must perform before they are considered experienced or expert surgeons who can work independently and predictably achieve safe, acceptable outcomes.