Mucogingival Defects Research Articles

The effect of Ozone therapy on pain perception after free gingival graft surgery in patients with mucogingival defects. A Randomized Controlled Clinical Trial.

The effect of Ozone therapy on pain perception after free gingival graft surgery in patients with mucogingival defects. A Randomized Controlled Clinical Trial.

Preclinical evaluation of mucogingival defect treatment using piscine membranes: An in vivo assessment of wound healing.

Periodontitis is a bacteria-induced chronic inflammatory disease characterized by degradation of the supporting tissue and bone in the oral cavity. Treatment modalities seek to facilitate periodontal rehabilitation while simultaneously preventing further gingival tissue recession and potentially bone atrophy. The aim of this study was to compare two differently sourced membranes, a resorbable piscine collagen membrane and a porcine-derived collagen membrane, in the repair of soft tissue defects utilizing a preclinical canine model. This in vivo component consisted of 10 beagles which were subjected to bilateral maxillary canine mucogingival flap defects, as well as bilateral soft tissue defects (or pouches) with no periodontal ligament damage in the mandibular canines. Defects received either a piscine-derived dermal membrane, (Kerecis® Oral, Ísafjörður, Iceland) or porcine-derived dermal membrane (Geistlich Mucograft®, Wolhusen, Switzerland) in a randomized fashion (to avoid site bias) and were allowed to heal for 30, 60, or 90 days. Statistical evaluation of tissue thickness was performed using general linear mixed model analysis of variance and least significant difference (LSD) post hoc analyses with fixed factors of time and membrane. Semi-quantitative analysis employed for inflammation assessment was evaluated using a chi-squared test along with a heteroscedastic t-test and values were reported as mean and corresponding 95% confidence intervals. In both the mucogingival flap defects and soft tissue gingival pouches, no appreciable qualitative differences were observed in tissue healing between the membranes. Furthermore, no statistical differences were observed in the thickness measurements between piscine- and porcine-derived membranes in the mucogingival flap defects (1.05 mm [±0.17] and 1.29 mm [±0.17], respectively [p = .06]) or soft tissue pouches (1.36 mm [±0.14] and 1.47 mm [±0.14], respectively [p = .27]), collapsed over time. Independent of membrane source (i.e., piscine or porcine), similar inflammatory responses were observed in both the maxilla and mandible at the three time points (p = .88 and p = .79, respectively). Histologic and histomorphometric evaluation results indicated that both membranes yielded equivalent tissue responses, remodeling dynamics and healing patterns for the mucogingival flap as well as the soft tissue gingival pouch defect models.

Recombinant human platelet-derived growth factor-BB-soaked gelatin sponge reduces patient pain in palatal graft donor sites

The free gingival graft (FGG) remains a gold standard for treating mucogingival defects and increasing the width of keratinized tissue. However, patients receiving FGG surgery report substantial post-operative discomfort, bleeding, and swelling, more so than those receiving connective tissue grafts, for example, and some of these post-operative sequelae can be difficult to manage. Various techniques are utilized in achieving hemostasis, but no current techniques effectively reduce the pain and discomfort to the patient. Ten FGGs were harvested from the palates of 10 patients to treat mucogingival deficiencies elsewhere in each patient. Immediately (<1 min) after harvesting the FGG, a gelatin sponge soaked in recombinant human platelet-derived growth factor-BB (rhPDGF-BB) was placed into the wound site and sutured in place with absorbable sutures. Patients were followed up on days 3, 7, and 14 for assessing pain levels utilizing patient-reported outcome measures (PROMs), which incorporate the visual analog scale and the quantification of analgesics consumed. Clinically, the rhPDGF-BB/gelatin sponge-treated FGG palatal donor sites began to heal by day 3 of follow-up, and the healing was completed during the visit on day 14. No adverse effects, including swelling or bleeding, were observed at any of the post-surgical time points. According to the visual pain score, patients experienced minor discomfort, but no dissatisfaction was reported. Patients whose palatal FGG donor site was treated with a gelatin sponge soaked in rhPDGF-BB reported little or no post-surgery discomfort and low morbidity at the donor site within 2 weeks. These findings are in sharp contrast to the well-known substantial discomfort most patients experience following the harvesting of a palatal FGG. The data suggest that treating FGG palatal donor sites with rhPDGF-BB-soaked gelatin sponge can improve patient experience.

Navigating the landscape of periodontal and peri-implant microsurgery: A contemporary review

Periodontal and per-implant microsurgery have revolutionized the field of dental surgery, enabling precise and minimally invasive procedures with improved outcomes. The advent of microsurgical instruments, enhanced magnification systems, and specialized suturing techniques has allowed clinicians to achieve superior aesthetic and functional results while minimizing patient discomfort and morbidity. Furthermore, emerging technologies such as digital planning and guided surgery have complemented microsurgical techniques, enabling more predictable outcomes and patient-centered treatment approaches. The review aims to discuss the principles of microsurgery, including flap design, tissue handling, and suture placement, and explores their applications in the management of mucogingival defects and periimplantitis. Continued research and clinical advancements in this field are essential to further enhance treatment outcomes and refine surgical protocols for the benefit of patients and practitioners.

Bacterial cellulose matrix and acellular dermal matrix seeded with fibroblasts grown in platelet-rich plasma supplemented medium, compared to free gingival grafts: a randomized animal study.

Mucogingival defects (MGDs), such as dental root recessions, decreased vestibular depth, and absence of keratinized tissues, are commonly seen in dental clinics. MGDs may result in functional, aesthetic, and hygienic concerns. In these situations, autogenous soft tissue grafts are considered the gold-standard treatment. This study compares the healing process of free gingival grafts (FGGs) to bacterial cellulose matrix (BCM) and human acellular dermal matrix (ADM) seeded with fibroblasts from culture supplemented with platelet-rich plasma in a rat model. Surgical defects were made in rats, which received the following treatments in a randomized manner: group I, negative control (defect creation only); group II, positive control (FGG); group III, BCM; group IV, BCM + fibroblasts; group V, ADM; and group VI, ADM + fibroblasts. Clinical, histological, and immunological analyses were performed 15 days after grafting. Clinical examinations recorded epithelium regularity and the presence of ulcers, erythema, and/or edema. The histological analysis revealed the degree of reepithelization, width, regularity, and presence of keratin. The Fisher exact statistical test was applied to the results (P<0.05). No groups showed ulcers except for group I. All groups had regular epithelium without erythema and without edema. Histologically, all groups exhibited regular epithelium with keratinization, and myofibroblasts were present in the connective tissue. The groups that received engineered grafts showed similar clinical and histological results to the FGG group. Within the limitations of this study, it was concluded that BCM and ADM can be used as cell scaffolds, with ADM yielding the best results. This study supports the use of this technical protocol in humans.

Establishing the Essential Zone: Free Gingival Graft for Gingival Augmentation and Root Coverage

Gingival recession is a frequently encountered clinical finding which causes compromised aesthetics and dentinal hypersensitivity leading to an inadequate zone of keratinized gingiva and might facilitate subgingival plaque formation resulting in further attachment loss. Epithelized soft tissue graft harvested from the hard palate, commonly known as free gingival graft is simple and highly predictable when used to increase the amount of keratinized tissue. This case report highlights the use of free gingival graft as a gingival augmentation and root coverage procedure for 26-year-old patients with Cairo RT2 mucogingival defects with optimum aesthetic outcome. ­­

The Effectiveness of the Influence of the Second Generation Platelet-rich Fibrin in the Treatment of Localized Individual Miller I and II Gingival Recessions (Case Report)

BACKGROUND: The mucogingival surgical modality subepithelial connective tissue graft (SCTG) and the coronally positioned flap (CAF) in the treatment of Miller I and II gingival recessions are considered “gold standard,” that is, a technique for predictable and complete gingival root coverage defects, with long-term clinical stability of the obtained results. The counterpart of this type of technique is the relatively young platelet-rich fibrin (PRF) +CAF operational mode, due to the biological characteristics of this autologous platelet concentrate-PRF (angiogenesis, mitogenesis, osteopromotion, immunomodulation, and the capture of stem cells). The aim of this paper is to evaluate the clinical efficacy of the CAF+PRF combined technique, in the treatment of localized individual gingival recessions Miller I and II, through the comparison of the values of periodontal clinical parameters, measured preoperatively and 1 month postoperatively, as well as through the obtained immunohistochemical and histomorphometric analyzes of the taken biopsy material from the recipient site (the area of the grafted gingival defect), 1 month postoperatively. CASE REPORT: A 37-year-old man was admitted to the Clinic for Oral Surgery at JZU USKC “St. Panteleimon”- Skopje for surgical treatment of localized maxillary gingival recession Miller II at tooth 31. Periodontal clinical parameters were measured preoperatively: Vertical dimension of gingival recession (RD/VGR), periodontal pocket depth (PPD/PD), level of keratinized/attached gingiva (CAL), width of keratinized gingiva (KTW/KMW) and thickness of gingiva (GT), all measured in mm, as well as gingival biotype. A CAF+PRF therapy modality was used for the treatment of the gingival defect. One month postoperatively, repeated measurements of the values of the clinical periodontal indices were performed and they were compared with the measurements obtained preoperatively. CONCLUSION: A significant decrease in the values of RD, PPD, and CAL was determined at the 1-month measurements postoperatively. A non-significant gain in KTW and GT values was noted 1 month post-operative. There were no changes in the gingival biotype before and after surgery. PRF as second-generation autologous concentrates is not only an adjuvant and/or replacement of SCTG – the “gold standard” in the treatment of Miller I and II recessions but it is also a superior alternative in the surgical treatment of this type of shallow mucogingival defects.

Recurrent peripheral odontogenic keratocyst: Review of the literature and presentation of a novel case initially masquerading as an atypical infected lateral periodontal cyst

AimTo review published cases and case series of the peripheral odontogenic keratocyst (POKC) of the gingiva, report an unusual presentation, and discuss lesional recurrence. Materials and methodsA search of the English language literature for gingival OKCs was conducted. The inclusion of new case yielded a database containing 29 affected patients. Clinical, surgical, radiographic, and histopathologic findings have been summarized. ResultsWith available patient demographics, 62.5% were female and 37.5% were male, with an overall mean age at diagnosis of 53.8 years. There was near-equal lesional affinity for the jaws, of which 44.0% occurred in the posterior region, 32.0% anteriorly, and 24.0% overlapped these areas. Twenty-five percent of lesions had a normal color, 30.0% appeared yellow, 20.0% were white, and 10.0% were blue. The majority of lesions were < 1 cm and nearly 42% manifested exudation or fluctuance. Lesional pain was infrequent. Pressure resorption was recorded in 45.8% of cases. Most lesions were managed with conservative surgical modalities. Follow-up information was available in 16 primary cases, of which 5 recurred, signifying a 31.3% recurrence rate, including the featured case, which recurred twice. ConclusionTo reduce recurrence of a gingival OKC, supraperiosteal dissection is advocated. Further, it is advised to follow POKCs for 5–7 years postoperatively, remaining vigilant for subtle clinical manifestations of recurrence. Timely discovery and excision of a POKC of the gingiva may decrease the incidence of a mucogingival defect.

Comparative evaluation between collagen membrane (PerioCol®) and periosteum membrane in the treatment of gingival recession defects of maxillary anterior teeth: a clinical study

Abstract Background: The most common mucogingival defect is gingival recession (GR), which is characterized by apical displacement of the gingival margin from the cementoenamel junction and root exposure. Several techniques are available for treating GR and are collectively termed root coverage (RC) procedures. This study presents 3 months’ results of a randomized clinical trial comparing RC in areas of isolated GR by coronally advanced flap (CAF) with periosteum membrane and PerioCol® membrane. Materials and Methods: Twenty recession sites were selected for the study and further divided into two groups (Test group 1 [C AF + Periosteum membrane] and Test group 2 [CAF + Guided tissue regeneration membrane]) and completed the 3-month follow-up. Result: Satisfactory result obtained after three months in both the cases but CAF+Periosteum showed better and fast healing. Conclusion: Both treatment modalities showed a significant improvement in clinical parameters at 3 months postoperatively.

Https://scholarhub.ui.ac.id/jdi/vol30/iss1/1/

Fenestration term is derived from the Latin word ‘fenestra’ means ‘window’. Gingival fenestration is not found in routine while its actual occurrence is assumed to be higher. Additionally, if these mucogingival defects persist for a longer duration it may lead to adverse outcomes like compromised esthetics, hypersensitivity, plaque and calculus deposition, and susceptibility to dental caries. Present cases of gingival fenestration were successfully treated by using full-thickness flap elevation with connective tissue graft placement. Two cases were presented with the accumulation of plaque and calculus and having gingival fenestration to the respective sites. After phase 1 therapy, full thickness flap was raised and a connective tissue graft was placed beneath the fenestrated area. The successful results were obtained in both cases in terms of complete closure of gingival fenestration defects and well-adapted margins with adjacent tissues at one year of follow-up. Full thickness flap with connective tissue graft procedure resulted in complete closure of gingival fenestration in both cases with no recurrence at one-year follow-up and can be used as a successful and predictable treatment modality for the management of such cases.

Evaluation of Omega-3 piscine acellular dermal matrix membrane as a soft tissue alternative for the treatment of mucogingival defects.

The natural Omega-3 lipids in the OADM serve to reduce inflammation. Preliminary results in a human model reported no adverse events and favorable healing and esthetic outcomes. The primary objective of this animal model study was to histologically evaluate the use of Omega-3 piscine acellular dermal matrix (OADM) as a soft tissue alternative in surgically created mucogingival defects. Bilateral maxillary canines in 6 adult beagle dogs were randomly assigned to the test (OADM) and control sub-epithelial connective tissue graft (SCTG) groups. Dehiscence defects 4 × 6 mm were created surgically on the buccal surfaces. The OADM/SCTG were placed to completely cover the root surface to the level of the cemento-enamel junction and sutured with resorbable sling sutures. The gingival flap was repositioned to cover the grafts. At two months follow-up, the dogs were sacrificed, and block samples were retrieved, including the whole canine and periodontium. The histological outcomes were evaluated using qualitative analysis. The qualitative histological analysis revealed the oral, sulcular and junctional epithelium had healed with normal appearance on both test and control sites. None of the test (OADM) samples presented with any foreign body reaction. The use of this new piscine xenograft resulted in minimal complications and the attachment apparatus healed normally.

A New Matrix for Soft Tissue Management.

Gingival recession is a mucogingival defect defined as the apical shifting of the gingival margin in relation to the CEJ. The use of connective tissue autografts allows for the obtention of very satisfactory results but is associated with undoubted disadvantages. The aim of the present work is to carry out a systematic review of the literature using a meta-analysis to investigate the clinical efficacy of xenogeneic collagen matrix (XCM) in the treatment of gingival recessions. This revision was carried out strictly following the guidelines published in the Cochrane Handbook. Thus, a meta-analysis was performed to calculate relative risks and standardized mean differences for each of the variables considered. The results of the meta-analysis show that CAF + CTG was statistically better than CAF + XCM in almost all the variables analyzed: complete root coverage (RR 0.46), mean root coverage (SMD −0.89), recession reduction (SMD −0.98), clinical attachment level (SMD −0.63) and gingival thickness (SMD −1.68). Meanwhile, CAF + XCM was slightly better than CAF alone in regard to: mean root coverage (SMD 0.51), recession reduction (SMD 0.47) and gingival thickness (SMD 0.56). It is possible to conclude that CAF + CTG still remains the gold standard in radicular coverage.

Gingival Phenotype Changes and the Prevalence of Mucogingival Deformities during the Early Transitional Dentition Phase-A Two-Year Longitudinal Study.

Thin gingival phenotype (GPh) may contribute to periodontal tissue breakdown and recession development. Thus, the early identification of thin GPh in children can allow proper preventive care and the identification of children at risk during orthodontic treatment. The present long-term study aimed to monitor GPh changes, i.e., thickness (GT) and width of attached gingiva (AGW) during the early transitional dentition phase, as well as its potential associations with the mucogingival deformities. Materials and Methods: 83 systematically healthy children were examined twice with an interval of 2 years. Probing depth, GT and AGW at mandibular incisors, vestibular depth, type of lower lip frenum attachment and mucogingival defects were recorded. Results: 95.2% of participants at baseline and 93.9% at 2-year examination expressed thin GPh. During the transition from the deciduous to permanent dentition, GT and AGW declined, but the GT of permanent incisors already erupted at the baseline examination increased in the observation period. Conclusions: Gingival phenotype undergoes changes in the early transitional dentition phase. In spite of the thin gingival phenotype, only single pseudo-recessions and primary shallow vestibule were noticed.

Evaluating the efficacy of a minimally invasive root coverage procedure with platelet rich fibrin using the gum drop technique

Gingival recession is manifested as an apical displacement of the gingival tissues, leading to root surface exposure. They may cause root hypersensitivity, root caries, and pose esthetic concerns to patients when left untreated. Various surgical treatment modalities are being practised to treat these mucogingival defects. The innovations and the advances in the surgical techniques has led to the development of surgeries that could be done with minimal tissue manipulation and trauma improving the healing and overall clinical parameters. In the current study a novel, minimally invasive surgical approach called the Gum Drop Technique, which utilises both A-PRF membrane and i-PRF as the regenerative biomaterials for recession defects in the maxillary anterior region has been described.

Clinical Evaluation of Lateral Pedicle Flap Stabilized with Cyanoacrylate Tissue Adhesive: A Randomized Controlled Clinical Trial.

Context:Gingival recession is the most common mucogingival defect and is susceptible to tooth hypersensitivity, root caries, and esthetic problems if left untreated. A lateral pedicle flap is used to cover denuded roots that have adequate donor tissue laterally and adequate vestibular depth. A carefully planned surgery needs proper immobilization of the flap at the recipient site and this can be achieved by proper wound closure technique with appropriate material such as sutures or tissue adhesives.Aim:The aim of the present study is to evaluate the clinical outcomes of lateral pedicle flap stabilized with cyanoacrylate tissue adhesive and resorbable sutures.Materials and Methods:Twenty-two patients with Miller's class I and class II gingival recession were randomly divided into two groups: lateral pedicle flap stabilized with cyanoacrylate tissue adhesive (test) and lateral pedicle flap stabilized with resorbable sutures (control). Plaque index, gingival index, probing pocket depth, clinical attachment level, recession depth and width, height and thickness of keratinized gingiva were evaluated at baseline and 1st and 3rd month postoperatively. The percentage of root coverage was evaluated at the end of 3rd month postoperatively.Statistical Analysis Used:Intergroup comparisons for the clinical attachment level, recession depth, recession width, thickness of keratinized gingiva, and height of keratinized gingiva were made by Mann–Whitney test by analyzing the difference of two time periods. Intragroup comparisons were made by the Kruskal–Wallis test. Mann–Whitney test was used to compare the difference between various time periods within the group for all the selected variables.Results:The mean plaque index and gingival index at the 1st and 3rd month were found to be statistically significant and did not present any significant influence over other clinical parameters evaluated. A partial root coverage was observed in both the groups (71.97% for the test group and 61.36% for the control group).Conclusions:Cyanoacrylate tissue adhesive is clinically effective in the stabilization of the lateral pedicle flap and can be used as an alternative to resorbable sutures.

Clinical Comparison of MEBO and Hyaluronic Acid Gel in the Management of Pain after Free Gingival Graft Harvesting: A Randomized Clinical Trial.

Aim This study aimed to compare the effect of MEBO versus 0.2% hyaluronic acid gel (Gengigel®) applied to the palatal donor site on postoperative pain reduction and wound healing after free gingival graft harvesting. Methodology. Thirty-nine patients with different mucogingival defects were included in this study for harvesting a free gingival graft (FGG) for soft tissue augmentation. Patients were randomly assigned into three equal groups: group I (MEBO), group II (0.2% HA Gengigel®), and group III (control). Postoperative pain was recorded by using the Visual Analogue Scale (VAS). Analgesic consumption was recorded for 7 days postoperatively. Wound size was measured at baseline and on days 3, 7, 14, and 21. Postoperative healing of the palatal wound was assessed by the VAS score for color match on days 3, 7, 14, 21, and 42. Results Results of this study showed significant postoperative pain reduction for the three groups; MEBO showed statistically significant less VAS score compared to the other two groups, while HA showed statistically significant less VAS score compared to the control group. Both MEBO and HA showed statistically significant less total analgesic consumption. No statistically significant difference was observed between groups for wound size. MEBO showed statistically significant higher VAS for color match. Conclusions Both treatment modalities could reduce postoperative pain following harvesting of FGG and improve the palatal wound healing. However, MEBO showed better outcomes in terms of postoperative pain and color match.

Classification of Mucogingival Defects in Implantology and Proposed Corrective Approaches.

The aim of this classification is to diagnose and grade four different types of soft tissue deficiency around loaded, osseointegrated implants according to increasing severity. The suggested soft tissue augmentation to increase the width of the peri-implant keratinized mucosa will improve the long-term stability of peri-implant tissues.

Periodontal phenotype modification therapy in a patient undergoing orthodontic treatment: a case report

Introduction: Gingival recessions are mucogingival defects of multifactorial etiology that interfere with aesthetics and function; in many cases these defects require multidisciplinary treatment. Objective: To report a clinical case of gingival recession treatment using a periodontal and orthodontic approach. Case report: Patient a 20-year-old woman, sought the Extension Project of Clinical and Surgical Periodontics (PROEPECC/UFCG) complaining of developing gingival recession in tooth 31, which was poorly positioned in the arch after orthodontic movement. Periodontal examination revealed type 1 gingival recession associated with a prominent labial frenulum, with a gingival height of 3 mm, width of 2 mm, probing depth of 1 mm, and absence of attached gingiva. The root was covered using a subepithelial connective tissue graft removed from the palatal mucosa and coronally positioned flap; in addition, inferior labial frenectomy was performed. After 1 year and 6 months, tooth 31 was again moved to reposition it in the arch. One year and 10 months post-surgery, new periodontal examination was performed to evaluate the mucogingival characteristics of the treated area. The recession was completely covered and there was a 4-mm increase in the attached gingiva. Conclusion: Orthodontics may positively or negatively influence periodontal structures and periodontics may favor the prognosis of tooth movement in a risk area by modifying the periodontal phenotype, increasing its resistance to gingival recession.

Dental Pathology of the Domestic Pig (Sus Scrofa Domesticus).

Antemortem domestic pig (Sus scrofa domesticus) dental pathology literature is sparse. This observational descriptive study evaluated 23 client-owned pigs that while sedated/anesthetized for routine annual care had intraoral dental radiographs and an oral examination performed. Age, gender, weight, and breed for each pig were recorded. Oral examination and radiographic findings were reviewed to create a comprehensive list of dental abnormalities identified. Descriptive statistics were performed to summarize the data. The study population included 14 castrated males and 20 Vietnamese pot-bellied mini-pigs. The median age was 3 years (range 2-12 years), and the median weight was 39 kg (range 11-140 kg). The most common finding was missing teeth (21/23 pigs); the first premolar tooth was the most likely to be absent (64/106 missing teeth). Periodontal disease was common (20/23 pigs). Advanced stages primarily affected the first molar teeth frequently in the form of a mucogingival defect. Supernumerary roots were discovered on the maxillary canine teeth in female pigs only (10/25 teeth with supernumerary roots). The most common persistent deciduous tooth was the maxillary second incisor (15/19 persistent deciduous teeth). Non-age or gender related open apices were most likely associated with mandibular first and second incisor teeth (26/96 teeth with open apices). Tooth resorption was also identified (7/23 pigs). The study findings prove that pet pigs commonly have dental pathology; therefore, thorough oral examinations with intraoral radiographs should be included in porcine routine health care regimens.

Keratinized tissue gain after free gingival graft augmentation procedures around teeth and dental implants: A prospective observational study.

The primary goal was to compare the amount of keratinized tissue width (KTW) gain after free gingival graft (FGG) procedures around implants and teeth after 6 and 12months of healing. Patients with mucogingival defects (<2mm of KT) around teeth and implants underwent a gingival augmentation procedure by means of a FGG. Clinical measurements were performed with an individual stent to determine keratinized tissue width (KTW), length (KTL), graft shrinkage (GS) and gingival margin position (GMP) at 2weeks, 6weeks, 3months, 6months and 12months after surgery. Twenty-nine patients (35 sites) participated in this prospective study. After surgery, KTW decreased and GS increased significantly in both treatment groups during the whole follow-up period, but the biggest changes were observed at 6weeks. When comparing both treatment groups, implant sites showed significantly more reduction in KTW and more GS. Thus, at 12months, KTW and GS reduced 2.03±2.1mm and 36.74±38.2% in the teeth group and 2.91±12.03mm and 61.8±36.25% around implants, respectively. A significantly greater reduction in KTW and more GS might be expected at implant sites.