Mucogingival Junction Research Articles

Alveolar Ridge Regeneration With Open Versus Closed Healing in Damaged Extraction Sockets: A Preclinical InVivo Study.

The objective of this study was to compare open versus closed healing of soft and hard tissue following alveolar ridge preservation (ARP) procedures in damaged extraction sockets. ARP was performed in five mongrel dogs using collagenated deproteinized bovine bone mineral (cDBBM) and a resorbable non-cross-linked collagen membrane (NCCM) in damaged extraction sockets, with each socket entrance left either open (open group) or closed (closed group). Clinical wound epithelization at the socket entrance and the dimensions of keratinized tissue were evaluated over time. Additionally, the augmented ridge dimensions and new bone formation were assessed radiographically and histologically at 8 weeks after surgery. The dimensions of the socket entrance gradually decreased in the open group, and wound epithelization was almost complete within 4 weeks. The mucogingival junction was maintained more apically in the open group than in the closed group (0.14 ± 0.40 mm vs. -0.86 ± 0.71 mm [mean ± SD], p < 0.05). The augmented ridge dimensions did not differ significantly between the open and closed groups (93.1% ± 5.4% vs. 88.3% ± 11.2%, p > 0.05). Histological analyses revealed no significant differences in the amount of newly formed bone. However, membrane resorption in the crestal region was more pronounced in the open group. Open and closed healing approaches for ARP in extraction sockets with damaged buccal wall resulted in similar ridge dimensions and new bone formation. However, there was less reduction of the buccal bone crest and wider keratinized tissue width after open healing.

A Modification of Fenestration Technique (MOFT) to Increase Vestibular Depth: A Case Series.

The most prevalent mucogingival issues include insufficient gingival width, decreased vestibular depth, abnormal frenal attachment, gingival recession, pockets that reach the mucogingival junction, excess gingival, inconsistent gingival margin, excessive gingival display and abnormal gingival colour. Numerous periodontal plastic operations have been used to treat these issues. However, each approach has its own drawbacks and is technique-dependent. Adequate depth of vestibule is necessary to maintain good oral health as shallow vestibule leads to accumulation of food and thus impedes oral hygiene maintenance. This case series describes a vestibular deepening procedure performed using modification of periosteal fenestration technique. This technique includes a series of eight cases of shallow vestibule where vestibular deepening was conducted by giving a full-thickness incision to expose the periosteum and create a window of fenestration followed by suturing the labial mucosa to the periosteum at the apical level. The results reported an excellent post-operative outcome showing increased depth of the vestibule.

The Associations of Adherent Gingival Thickness in the Buccal and Palatal Regions of the Maxilla and Mandibula with Age and Gender

Purpose: This study aimed to investigate gingival thickness variations regarding age, gender, and sites where mini-screws are frequently applied and to guide mini-screw size selection. Materials and Methods: In our study, gingival thickness measurements were performed by a transgingival probing method in 224 patients who presented for examination to the Department of Orthodontics, Faculty of Dentistry, XXXX University. Fifty-six females and 56 males aged 14-20 and 21-27 years were enrolled in the study. In each individual, measurements were made from the mucogingival junction at the interdental area in the buccal mandibular and buccal maxillary regions, whereas at the interdental area within 4 mm and 8 mm distance from the gingival crest in the palatinal maxilla. Results: Comparisons between genders indicated that gingival thickness in the buccal region of the maxilla was statistically significantly greater in males than in females (p

A case report on the management of mandibular midline diastema by using laser as a treatment modality

A frenum is a fold of mucous membrane that connects the labial mucosa (lips) to the gingiva or that connects the tongue to the floor of the mouth and hence providing support to the lips and the tongue. The normal frenal attachment is at the level of mucogingival junction (mucosal) and hence maintaining a balance between the interproximal contacts of the anterior teeth of either maxilla or mandible. But if this frenal attachment is high or in other words if there is a an aberrant frenum, then this type of frenal attachment either results in spacing between the anterior teeth or in some cases can lead to the loss of gingival embrasure resulting in the creation of black triangle between the anterior teeth. Present case report is on a 38 years old female whose chief complaint was spacing between the mandibular central incisors and upon intraoral examination, it was noted that there was an aberrant frenum which has also resulted in loss of gingival embrasure between the mandibular anterior teeth and hence this aberrant frenum was treated by a process called frenectomy by using a thermal treatment modality called as Laser. Upon follow up after 1 week, there was a reduction in spacing between mandibular central incisors.

The Impact of Orthodontic Extrusion on Keratinized Gingiva.

Background and Objectives: The key factor that enables osteoblastic activity and the formation of new bone, as well as gingiva, during orthodontic tooth extrusion (OE) is the periodontal ligament. The reaction of periodontal tissues associated with changes in the gingiva is a part of orthodontic tooth displacement. The aim of this study was to examine the effect of OE on the width of the zone of the keratinized and attached gingiva, the position of the mucogingival junction, and the height of the interdental papillae in the region where the OE was performed as well as in the adjacent region. Materials and Methods: This research included 28 adult patients (both orthodontically treated and untreated). The treated group included 15 patients, in whom orthodontic extrusion of the upper or lower frontal teeth was indicated and performed. The untreated group included 13 patients, with no previous or undergoing orthodontic treatment. Patients with periodontal disease and periodontal pockets in the frontal region and patients allergic to iodine were excluded from the study. Gingivomorphometric measurements were performed on two occasions in three groups of teeth (24 extruded and 30 agonist teeth in the treated patients; 66 teeth in the untreated patients). Statistical analysis of the obtained data was performed using the software package SPSS version 26.0. Results: Orthodontic extrusion induced changes in the position of the mucogingival line and an increase in the width of the keratinized gingiva. There were no statistically significant effects on the depth of the gingival sulcus, the attached gingiva width, or the height of the interdental papillae. Conclusions: Orthodontic tooth extrusion has an effect on the periodontium in the observed region. Vertical orthodontic force, directed towards the coronal plane, affects the surrounding soft oral tissues.

Challenges and solutions in plasma cell gingivitis: A clinical case analysis

Plasma cell gingivitis (PCG) is an uncommon benign gingival condition characterized by sharply defined erythematous and oedematous gingival lesions, often extending to the mucogingival junction. This hypersensitivity reaction presents as diffuse, papillary gingival inflammation, prone to bleeding upon minimal trauma. Histologically, PCG manifests as a dense infiltration of normal plasma cells within collagenous stroma, typically localized to the free and attached gingiva. The primary management approach involves identification and avoidance of the allergen source, alongside nonsurgical periodontal therapy. We report a 26-years-old female patient diagnosed clinically as plasma cell gingivitis and confirmed histologically. Surgical treatment along with pharmacological interventions resulted in complete resolution of symptoms. This case underscores the importance of comprehensive evaluation and tailored treatment approaches in managing plasma cell gingivitis.

Modified Roll Envelope Technique Combined With Apically Repositioned Flap (MRARF) for Peri-Implant Soft Tissue Augmentation-A Case Series.

In the present case series, we performed implant surgery using a modified roll envelope technique and an apically repositioned flap (MRARF). To improve patients' peri-implant soft tissue phenotypes, they underwent dental implantation following the buccal contour concavities, inadequate keratinized tissue width, and soft tissue thickness simultaneously. This case series includes 4 patients treated between July 2021 and February 2022 who received dental implants and guided bone regeneration treatment 6 months earlier and were to be taken up for second-stage surgery. They were eligible for the MRARF technique if each implant site showed a labial and buccal deficiency and a reduced keratinized mucosa width than the adjacent teeth. Sutures were removed 2 weeks after surgery, and a provisional restoration was delivered. A final impression was taken at 6 weeks to produce the definitive implant-supported restoration. All surgery sites healed uneventfully, and no postoperative pain or excessive swelling was reported. The modified flap design allowed for increasing the width and thickness of keratinized mucosa with a minimally invasive technique. A harmonious color, texture, and mucogingival junction position that matched the surrounding tissue and adjacent teeth was achieved, and all patients were satisfied with the final results. MRARF at second-stage implant surgery could obtain satisfactory results regarding vertical and horizontal aesthetic gingival contours and an adequate width and thickness of keratinized mucosa around the implants.

Preventive Effect of Ultraviolet Photofunctionalization on Peri-implant Biofilm Formation: An In vivo Randomized Study.

Peri-implant biofilm formation due to local bacterial colonization is one of the important factors for the instability of temporary anchorage devices (TADs). The aim of this study was to quantify and compare the colonization of Streptococcus sanguinis on ultraviolet (UV) treated and untreated titanium TADs. This prospective, in vivo study included 20 subjects requiring orthodontic treatment with first premolar extraction, followed by retraction of the anterior teeth with absolute anchorage using TADs. TADs were placed interdentally, in the keratinized tissue between the upper second premolar and the first molar on the buccal side, at the mucogingival junction. It was a split-mouth study where one side of TAD was UV-treated for 15 min, and the other side was kept untreated as a control. TADs were removed after 6 months for S. sanguinis quantification on both sides and were compared for biofilm reduction. Statistical software was used to perform unpaired t-tests for the individual samples as well as for comparing total UV-treated and untreated samples. P <0.05 was considered significant. The mean bacterial count (per ml) was found to be 2.2 × 106 copy numbers and 8.9 × 106 copy numbers in the UV group and untreated group, respectively. The total count of bacteria was found to be less in the UV-treated group compared to the untreated group. The study concludes that UV photofunctionalization results in a significant reduction of S. sanguinis colony on TADs with reduced chances of failure due to inflammation.

Efficacy of bone ring grafts for the reconstruction of alveolar ridge deficiencies: a systematic review. Part II: animal trials.

Bone ring (BR) grafts have been introduced to reconstruct alveolar ridge defects with simultaneous implant placement, but their clinical effectiveness remains undetermined. The aim of the current systematic review was to critically appraise evidence from animal studies regarding the effectiveness of BR grafts in alveolar ridge reconstruction and their variations under different surgical protocols. Electronic retrieval of six databases (MEDLINE, Embase, Cochrane Library, ScienceDirect, Web of Science, and Scopus) and citation search until 11 October 2023, for animal studies on bone augmentation employing BR grafts. The outcome variables were total bone area (BA), bone volume (BV), bone-implant contact (BIC), and histology. The protocol was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and prospectively registered with PROSPERO (CRD42023453949). Ten studies were included in the qualitative analysis according to the screening criteria. Two studies demonstrated favorable bone remodeling and osseointegration of the BR with both the implant and pristine bone. A comparative study between autogenous BRs and allogenic BRs reported a higher percentage of BA and BIC at 4 months of healing, but conflicting data were observed at 8 months. Another study indicated a significant advantage of autogenous BRs over bovine and biphasic ceramic BRs in terms of BA and BIC after 5 weeks. Three studies found that using collagen membranes did not significantly affect BA, BV, or BIC when used simultaneously with autogenous BRs during implant placement. Two studies evaluated one-stage and two-stage implant placement in conjunction with BR grafts, revealing similar levels of BA, BV, and BIC except for differences in total treatment time. Furthermore, one study found that the use of mucogingival junction incision and split-thickness flap significantly reduced the incidence of wound dehiscence compared with conventional incision and flap. Vertical bone augmentation surgery utilizing BR grafts with one-stage implant placement yielded histological and histomorphometric outcomes comparable to those achieved with two-stage implant placement or the additional application of collagen membrane.

The Treatment Of Miller’s Class I Gingival Recession Implementing The Modified Coronally Advanced Tunnel Technique (MCAT) And Acellular Dermal Matrix (ADM)

Background: Gingival recession can lead to root hypersensitivity, root caries, and impaired aesthetic concerns. Modified coronally advanced tunnel (MCAT) technique, which possesses various benefits that can be used to support the success in the treatment of gingival recession. Acellular dermal matrix (ADM) is used in the procedure, frequently documented indicating encouraging results in the treatment of gingival recession. The following case report is to indicate an evaluation on the treatment utilizing MCAT with ADM. Case presentation: A male of 27 year-old arrived with main complaints of aesthetic concerns and dental hypersensitivity on the upper right teeth posterior caused by Miller’s class I gingival recession. The aforementioned technique is chosen in treatment considering the rate of success to treat the defects as the impact of gingival recession. Case management: The MCAT with ADM commenced with the fabrication of composite stops at the contact points. Later local anaesthesia (lidocaine HCl 2% with epinephrine 1:100,000) was given. Intrasulcular incision was then made and the mucoperiosteal flap was raised with tunneling knives. The tunnel was then extended over the mucogingival junction. ADM was pulled into the tunnel by means of mattress sutures. Finally the tunnel was positioned coronally to the CEJ by means of suspended sutures placed around the contact points. Conclusion: The use of MCAT technique with ADM (Mucoderm) is able to show satisfying outcome with the improvement of root coverage in the case of Miller’s class I gingival recession.

Displacement and stress distribution pattern during complete mandibular arch distalization using buccal shelf bone screws - A three-dimensional finite element study.

To evaluate and compare the distribution of stress and displacement of teeth during mandibular arch distalization using buccal shelf screws. Three three-dimensional finite element models of mandibular arch were constructed with third molars extracted. Models 1, 2, and 3 were constructed on the basis of the lever arm heights of 0 mm, 3 mm, and 6 mm, respectively, between the lateral incisor and canine. A buccal shelf screw was placed at the area in the second molar region with the initial point of insertion being inter-dental between the first and second molars and 2 mm below the mucogingival junction. MBT pre-adjusted brackets (slot size 0.022 × 0.028") were placed over the clinical crown's center with a 0.019 × 0.025" stainless-steel archwire on three models. A retraction force of 300 g was applied with buccal shelf screws and a lever arm bilaterally using nickel-titanium closed coil springs. The displacement of each tooth was calculated on X, Y, and Z axes, and the von Mises stress distribution was visualized using color-coded scales using ANSYS 12.1 software. The maximum von Mises stress in the cortical and cancellous bones was observed in model 1. The maximum von Mises stress in the buccal shelf screw and the cortical bone decreased as the height of the lever arm increased. Applying orthodontic forces at the level of 6 mm lever arm height resulted in greater biomechanical bodily movement in distalization of the mandibular molars compared to when the orthodontic forces were applied at the level of 0 mm lever arm height. Displacement of the entire arch may be dictated by a direct relationship between the center of resistance of the whole arch and the line of action generated between the buccal shelf screw and force application points at the archwire, which makes the total arch movement highly predictable.

Prehydrated collagenated cortico-cancellous heterologous bone gel and papillae tunneling for isolated intrabony defects: 12-month noninferiority trial.

This study assessed the effectiveness of prehydrated collagenated xenogenic bone gel and a collagenated cortico-cancellous heterologous bone mixture in conjunction with papillae tunneling techniques (PTT) for treating isolated periodontal intraosseous defects. Twenty patients with periodontitis stage III/IV and at least one deep isolated interdental 2/3-wall intraosseous defect were included in the study. Surgical incisions were made vertically at the adjacent tooth or horizontally at the mucogingival junction. A full-thickness flap was then carefully lifted under the papillae using special tunneling instruments. The root surfaces were completely cleaned, and the defects were randomly filled with either prehydrated collagenated bone gel (test group; n = 10) or collagenated cortico-cancellous heterologous bone mixture (control group; n = 10). Wounds were closed with microsurgical sutures. We predicted that the lower 95% confidence interval for the difference between the two procedures would exceed a prespecified noninferiority threshold. All wounds closed sufficiently to prevent biomaterial exposure. The test and control groups showed similar mean pocket depth reduction (3.5 ± 1.0vs. 3.9 ± 1.7 mm; p = 0.52), similar gingival recession (-0.10 ± 0.99vs. 0.2 ± 0.8 mm; p = 0.46), and similar clinical attachment gain (3.6 ± 1.51vs. 3.7 ± 1.8 mm; p = 0.89) at the 12-month follow-up. All results were below the noninferiority margin of the sample. At 12 months, prehydrated collagenous bone gel performed similarly to collagenous heterologous bone granules in the treatment of intraosseous lesions with PTT. In addition, both biomaterials preserved soft tissue with minimal further recession at 1 year. When combined with PTT, collagenous xenogeneic bone granules and prehydrated collagenous bone gel achieve comparable clinical outcomes in intrabony defects.The study was registered under the NCT04782921 on ClinicalTrails.

Accuracy and reliability of mandibular digital model superimposition based on the morphological characteristics of vessels in extraction adult patients

BackgroundThis study aimed to validate the availability of superimposing full-color mandibular digital models (DMs) by the morphological characteristics of vessels in extraction adult patients.MethodsTwenty-eight adult patients were included, and their DMs were superimposed with pre- and posttreatment cone beam computed tomography (CBCT) and the morphological characteristics of lingual vessels. The measurements of each tooth were compared under the same coordinate system.ResultsThe ICC results displayed exceptional agreement in intra- and interrater assessments, with scores exceeding 0.891 in the crown for intrarater agreement and scores surpassing 0.888 in the crown for interrater agreement. Furthermore, no statistically significant differences were found in the 2 superimposition methods (P > 0.05).ConclusionThe morphological characteristics of vessels under the mucogingival junction in the lingual side of mandible of are stable enough for the superimposition of mandibular DMs in the adult patients undergo orthodontic treatment with premolars extraction.

Evaluation of student readiness for clinical dental education at the end of preclinical education.

This study examined results of a summative objective structured clinical examination (OSCE) at the end of preclinical periodontal education to identify deficient areas for dental students in patient care and to explore factors affecting the probability of passing the OSCE. The summative OSCE was administered to two consecutive cohorts, Classes A (class of 2024; n1=134) and B (class of 2025; n2=129). The questions for each station in the OSCEs were available to both classes 1 week before the OSCEs. Descriptive statistics were used to identify deficient areas. The multiple logistic regression model was built to predict the probability of passing the OSCE based on the cohort, gender, and the practical and written examination scores. Fifty-one (38%) students in Class A and 66 (51%) students in Class B completed the OSCE by passing all stations. Students undergoing remediation showed deficiencies in demonstrating how to detect tooth mobility, performing periodontal probing, drawing the healthy positive bony architecture and the mucogingival junction, and using a universal and a Gracey 13/14 curette. The probability of passing the OSCE was significantly correlated with Class B (p=0.035) and the practical examination score (p=0.03) while not associated with gender (p=0.53) and the written examination score (p=0.11). Students showed deficiencies in assessment skills at the end of preclinical education. The study findings suggest that the implementation of the OSCE at the conclusion of preclinical education would be beneficial since the written examination score might not accurately reflect student readiness for clinical patient care.

Determining the Checkpoint of Transition from Thin to Thick Periodontal Phenotypes in the Maxillary and Mandibular Anterior Regions of South Indian Population

Abstract Aim: The aim of this study was to compare and investigate the tissue thickness at the maxillary and mandibular central incisors utilizing the probe visibility method and traditional way of measuring gingival thickness (GT) by endodontic files. Methodology: In 200 selected patients, the GT was measured at both the maxillary and mandibular anterior using an endodontic file after local infiltration at the mid-distance from the gingival margin to the mucogingival junction. The checkpoint of transition from thin to thick periodontal phenotype was determined by probe visibility method in the following age groups: Group A: 21–30 years; Group B: 31–40 years; Group C: 41–50 years; and Group D: 51–60 years. Results: GT varied from 0.3 to 1.9 mm. Gingival translucency was observed up to the thickness of 0.7 mm. At 0.8 mm of GT, there was no probe visibility. Conclusion: According to the present research, the gingiva appears transparent up to a thickness of around 0.7 mm. The checkpoint of transition between thin and thick periodontal phenotypes at both the maxillary and mandibular anterior was associated with a GT of 0.8 mm.

Evaluation of Width and Thickness of the Attached Gingiva and Its Association with Age, Gender, and Arch Location in the Nepalese Population

Purpose. The width and thickness of the attached gingiva are important clinical parameters. Considerable variations exist in the same as well as in different individuals. This study aimed to assess the width and thickness of the attached gingiva and its relationship with age, gender, and arch location in the Nepalese population. Methods. An observational cross-sectional study was conducted among 120 individuals visiting the periodontics department, who were categorized into three age groups with an equal distribution of gender in each group. The width of attached gingiva (WAG) was determined using the University of North Carolina-15 probe after locating the mucogingival junction. Data were gathered and entered in Excel sheet version 19, and SPSS version 20 was used for further analysis. The mean and standard deviations were calculated. The independent t-test and one-way ANOVA were used to find out the significant difference between variables. The correlation between dependent and independent variables was discovered with the help of the Pearson correlation test. The significance level was set at 5% with a 95% confidence level. Results. 120 individuals with 1440 teeth were examined to measure the WAG with an equal distribution of gender. The maximum WAG was found on the maxillary right lateral incisor and minimum width on the mandibular left first premolar. The average WAG was greater in the upper arch (3.19 mm) than in the lower arch (2.71 mm). The maximum thickness (1.728 mm) of the attached gingiva was found on the mandibular left first molars and minimum width (0.667 mm) on the mandibular left first premolars. Conclusions. As individuals age, there is a reduction in gingival thickness, accompanied by an increase in the WAG across both dental arches. In terms of gender differences, females exhibit a higher thickness of attached gingiva (TAH) than their male counterparts.

Orthodontic tooth extrusion to regenerate missing papilla adjacent to maxillary anterior single implants: A 2- to 7-year retrospective study.

Regeneration of the missing papilla adjacent to single implants in the esthetic zone has always been challenging, despite advances in vertical hard and soft tissue regeneration. Orthodontic tooth extrusion has been shown to effectively gain alveolar bone and gingival tissue. This retrospective study evaluated the effectiveness of orthodontic tooth extrusion on regenerating missing papilla between existing maxillary anterior single implant and its adjacent tooth. Patients who underwent orthodontic tooth extrusion to regenerate missing papilla adjacent to a single implant in the esthetic zone were included in this study. The gingival phenotype, orthodontic extrusion movement, proximal bone level, dento-implant papilla level, facial gingival level, mucogingival junction level, and keratinized tissue width, of the extruded tooth were recorded at pre-orthodontic extrusion (T0 ), post-orthodontic extrusion and retention (T1 ), and latest follow-up (T2 ). A total of 17 maxillary single tooth had orthodontic tooth extrusion to regenerate missing papilla adjacent to 14 maxillary anterior single implants in 14 patients. After a mean follow-up time of 48.4 months, implant success rate was 100% (14/14), with none of the orthodontically extruded teeth being extracted. After a mean extrusion and retention period of 14.3 months, a mean orthodontic extrusion movement of 4.62 ± 0.78 mm was noted with a mean proximal bone level gain of 3.54 ± 0.61 mm (77.0% efficacy), dento-implant papilla level gain of 3.98 ± 0.81 mm (86.8% efficacy), and facial gingival tissue gain of 4.27 mm ± 0.55 mm (93.4% efficacy). A mean keratinized tissue width gain of 4.17 ± 0.49 mm with minimal mean mucogingival junction level change of 0.10 ± 0.30 mm were observed. The efficacy of orthodontic eruption movement on dento-implant papilla gain was less in the thin (80.5%) phenotype group when compared with that in the thick (91.5%) phenotype group. Within the confines of this study, orthodontic extrusion is an effective, noninvasive method in regenerating mid-term stable proximal bone and papilla adjacent to maxillary anterior single implants. This retrospective study presents a mid-term result on orthodontic extrusion as a mean to regenerate dento-implant papilla defect. The extended retention period following orthodontic extrusion showed stable and efficacious proximal bone and papilla gain.

Anatomy-driven complexity classification for soft-tissue tunneling procedures.

The tunnel technique (TUN) preserves the integrity of the papilla by creating envelope flaps that allow for the insertion of a connective tissue graft, and/or biomaterials. (1) A comprehensive overview of tunneling flap procedures in the treatment of gingival recessions (GRs) for soft tissue coverage is presented and (2) A classification system for soft and hard tissue anatomy of GR sites which may aid the clinician in determining the surgical complexity is being introduced. A novel clinical classification system is proposed to illustrate complexity levels determined by soft and hard tissue anatomy of GR sites such as the mucogingival junction proximity to the gingival margin, bone morphotype, and mucosal margin thickness. TUN is highly effective in treating single/multiple GRs. Its limitations are related to variability in surgical site anatomy and operator expertise. A classification system based on anatomical soft and hard tissue variations has been proposed to help identify complexity levels encountered during tunneling procedures. Site-related factors directly impact the surgical variables related to tissue trauma, flap tension, soft tissue management, muscle pull, and wound stability during the healing of gingival recessions (GRs). The achievement of expedited and favorable wound healing is crucial to obtaining quantitative and qualitative success in the treatment of GR and the long-term stability of root coverage. A classification system based on anatomical soft and hard tissue variations has been proposed to facilitate tunneling procedures while respecting surgical principles.

The perspectives of a novel operative procedure for free gingival graft

Graft shrinkage, epithelial disintegration, and even necrosis are the well-known clinical complications during initial healing stage of free gingival graft (FGG) procedure. This article presented a novel operative prodecure for FGG in a dental implant with insufficient keratinized tissue over a 3-year follow-up period. Briefly, donor site for FGG harvested from maxillary tuberosity would minimize the volume of graft shrinkage. The new periosteum suture technique could secure FGG firmly adapted on the recipient site. With 1 mm gap between FGG and muco-gingival junction may improve plasmatic circulation and revascularization. The clinical findings of case report demonstrated that this novel operative procedure may provide a viable therapeutic alternative for FGG.

Effect of Low level laser on miniscrew displacement during canine retraction: A randomized controlled clinical trial

Background: Anchorage is an important consideration for successful orthodontic treatment. Skeletal anchorage by miniscrews provided better anchorage control then the ordinary extra-oral and intra-oral appliances. However, the stability of the miniscrews is still questionable since they might move under orthodontic loading. Objectives: The aim of this study was to evaluate the effect of Low Level Laser on the miniscrew displacement when subjected to orthodontic force during canine retraction using CBCT. Methods: Twelve patients who required bilateral extraction of upper first premolar and absolute anchorage were recruited from the outpatient clinics of the Department of Orthodontics, Faculty of Dentistry, Beirut Arab University of age ranging 14-28 years. Twenty-four miniscrews were assessed; two miniscrews were inserted into the buccal alveolar bone between the second premolar and first molar on the right and left side for each patient in a 60o oblique direction at the mucogingival junction to avoid root injury. They were divided into 2 sides; test side and a control side, the test side received 4 application of low-level laser therapy during the first twelve days of insertion with a 60 seconds for each application. While the control side did not receive any laser application. After waiting a period of twelve days from miniscrew insertion to allow for soft tissue healing, the upper right and left canines were retracted by 150g of nickel-titanium (NiTi) closed coil springs. A cone-beam computed tomography was taken to evaluate the miniscrew position before application of the force at baseline (T0) and after canine retraction at 6 months (T1). Results: There was no statistically significant difference of miniscrew head and tail displacements of the test side and a sta- tistically significant difference of the heads for the control sides when compared to baseline. Conclusions: Miniscrews used in the current study with the suggested protocol underwent non-significant displacement when using low level laser. The miniscrews remained stable throughout the follow-up period (6 month) without any significant displacement on the test side.