Gingival Graft Research Articles

Free Gingival and Connective Tissue Graft: Split Mouth Case of Root Coverage

Free Gingival and Connective Tissue Graft: Split Mouth Case of Root Coverage

Cover Image

The cover image is based on the Editorial Challenges and Success in Periodontal Plastic Surgery by GiovanPaolo Pini Prato et al., https://doi.org/10.1111/jcpe.13869.image

Injectable platelet rich fibrin versus hyaluronic acid with bovine derived xenograft for alveolar ridge preservation. A randomized controlled clinical trial with histomorphometric analysis.

Alveolar ridge preservation (ARP) is a technique that aims to maintain bone volume and minimize resorption after tooth extraction. This study aimed to compare the effectiveness of injectable platelet-rich fibrin (I-PRF) versus hyaluronic acid (HA) in combination with xenografts for ARP. This randomized controlled trial included 36 patients (20 females and 16 males) who required implant placement in the upper arch. The patients were randomly allocated to one of three groups (n = 12 each): I-PRF with xenografts, HA with xenografts, or xenografts alone. All patients underwent ARP, and the extraction sockets were sealed with a free gingival graft harvested from the palate, a total of 36 implants were inserted. Cone-beam CT scans were performed before and 4 months postoperatively to measure radiographic bone gain as the primary outcome. Clinical parameters, including soft tissue thickness and clinical bone width, were evaluated preoperatively, and at 4 months and 1 year postoperatively. Additionally, histological assessment of core bone biopsies was performed 4 months postoperatively using histomorphometric analysis to determine the percentages of newly formed bone, mature bone, and residual grafts. Regarding the radiographic bone gain 4 months postoperative the HA group exhibited the highest value (9.78 ± 0.87), which was significantly greater than the values observed in the I-PRF and control groups (8.60 ± 1.27 and 7.99 ± 0.89, respectively) (one-way ANOVA, p = 0.007). Crestal bone loss was significantly higher in the control group (-0.98 ± 0.18) than in the I-PRF group (-0.53 ± 0.11) and HA group (-0.33 ± 0.15) groups (one-way ANOVA, p < 0.001). In the histomorphometric analysis, the mean area fraction of newly formed bone trabeculae was significantly higher in the HA group (56.66 ± 7.35) than in the I-PRF group (28.74 ± 5.15) and the control group (24.05 ± 3.64) (repeated measures ANOVA, p < 0.001). Additionally, the mean area fraction of residual graft material was higher in the I-PRF group (6.76 ± 2.59), followed by the control group (2.71 ± 1.24), while the HA group had the lowest value (2.63 ± 1.27) (Repeated measures ANOVA, p < 0.001). The combination of HA with xenografts yielded better radiographic and histological outcomes in terms of new bone formation and degree of bone maturation than the I-PRF and control groups. Furthermore, I-PRF improved soft tissue thickness. Please note that clinical trial registration was not completed prior to participant recruitment and randomization. The registration link for this trial is https://clinicaltrials.gov/ct2/show/NCT05781529.

Root coverage using modified tunneling technique with acellular dermal matrix for treatment of gingival recession associated with orthodontic treatment: A case report

Background: Gingival recession has a number of causes, including orthodontic therapy. The degree and extent of gingival recession and orthodontic therapy are strongly correlated. Care must be taken in choosing the best soft tissue grafting technique. Development of a number of new and improved surgical techniques, including the modified tunneling technique. Case Management: A-24-year-old female patient came to Periodontic Clinic Dental Hospital of Airlangga University with a chief complain of gingival recession in mandibular central incisors since 6 months ago. The patient complained about dental sensitivity. The dental history revealed that she had undergone fixed orthodontic therapy for 7 years. She revealed the fixed orthodontic appliance was put off since 8 months ago. The patient concern about her appearance and aesthetic problem. Gingival recession on buccal surface tooth 31 and 41 extending 1,5-2 mm apical of the incisors was found in clinical assessment. This case classified as Miller class III. The doctor planned root coverage procedure using modified tunnel technique. Acellular dermal matrix (Surederm®) was chosen as a gingival graft. Discussion: Creating a "tunnel" through the buccal mucosa to treat gingival recession enables coronal repositioning of the soft tissue with predictable root coverage and a pleasing appearance. Tissue graft implantation is made possible by a horizontal incision. Conclusion: In brief, root coverage using modified tunnel technique is effective and predictable treatment modality. Comparing with other root coverage method it give quite satisfying result. The use of Acellular Dermal Matrix (ADM) considered as an alternative to Connective Tissue Graft (CTG).

Update on suspensory suture techniques in reconstructive periodontal surgeries.

Reconstructive periodontal surgery, which has received more and more interest in modern periodontology, can help save severely compromised teeth and solve aesthetic problems caused by the destruction of periodontal tissues in periodontal diseases. Unfortunately, there is fewliteratures reviewing the use of suspensory suture techniques in reconstructive periodontal surgeries. Anelectronic search of the PubMed andWeb of Science was performed. Full-text articles were obtained from the records after screening in the title and abstracts. Effective suture is of central importance to a successful treatment outcome of periodontal surgeries, especially incremental soft or hard tissue surgeries. Limitations in suture techniques may negatively affect the intimate contact of the affected tissues, wound closure and stabilization, and successful wound healing. Suitable anchors can be selected to help achieve this objective. Suspensory sutures may be more precise suture techniques, due to the use of relatively immobile anchors. This review aims to provide key points of successful wound healing and summarize the current state of the suspensory suture techniques for reconstructive periodontal surgeries in daily practice, including their treatment application, detailed steps, advantages, and disadvantages.

Considerations for Selecting Root Coverage Techniques in the Anterior Mandible.

The anterior mandible is the most challenging anatomical site for performing periodontal plastic surgeries. Increased demands for optimal root coverage and esthetic outcomes contribute to the development of pedicle flap-based surgical solutions, in contrast to the predominantly used free gingival graft. The aims of this study were to (1) summarize the current literature to identify the mostused techniques, indications, and their efficacy, and (2) provide a decision table for surgeons to navigate through the selection of appropriate techniques. Four main approaches were identified: free gingival graft, lateral sliding, tunneling, and coronally advanced flap. The flap approaches are mostly combined with a connective tissue graft. The decision table considers the patient's chief complaint, local anatomical factors, and technique sensitivity. The table provides a framework for supporting an evidence-based selection of surgical techniques and for studying novel methods to achieve predictable root coverage in the anterior mandible.

Healing outcomes of open versus closed flap procedures for collagen membrane coverage following immediate dental implant placements with simultaneous guided tissue regeneration

ObjectiveTo compare the outcomes of open healing to complete closure for collagen membrane coverage for immediate implant placements with simultaneous guided bone regeneration (GBR) in two retrospective cohorts. MethodsThe subjects included 118 patients who received Bio-Gide® collagen membrane coverage for immediate implant placements and GBR in 20 anterior and 98 posterior teeth. For 58 patients, gingival flaps were released to achieve full coverage of collagen membrane (CC group). For 60 patients, no efforts were made to release the gingival flaps and collagen membrane was left exposed for open healing (OH group). Antibiotics and analgesics were prescribed for 7 days after surgery. The width of crestal open wounds were measured after surgery (W0), and at 1, 2 and 16 weeks (W16). Changes in bone mass were assessed by cone-beam computed tomography after implant placement and again at W16. Gingival and bone tissues over the implant cover screws were harvested and assessed for 16 patients in the OH group at W16. ResultsNo wound dehiscence occurred in the CC group from W0 to W16. Both the vertical and horizontal bone dimension changes were not significantly different between the OH and CC group. For the OH group, soft tissue was completely healed at W16 when the initial wound widths were ≤6 mm. For those with initial wound widths ≥ 7 mm, the cover screws were exposed in 5/16 patients at W16 but did not affect the final restorations. Tissue staining showed keratinized mucosa and new bone formation above the dental implant in the OH group. ConclusionOpen healing achieved healing outcomes similar to those of complete closure for collagen membrane coverage following immediate implant placements. Clinical significanceFor immediate implant placement requiring bone grafting and collagen membrane coverage, it is unnecessary to release the gingival flaps or use tissue grafts to achieve full coverage of the crestal wounds. Open healing with exposed membrane could achieve similar outcomes with less pain and swelling.

Modified Coronally Advanced Tunnel (MCAT) Technique with or without Vestibular Incision for the Treatment of Multiple Gingival Recessions: A Case Series and Literature Review

&lt;p&gt;Treatment of multiple gingival recessions with periodontal plastic surgery is challenging due to several factors that needed to be considered in one surgical session. The success and stability of root-coverage outcomes depend on gingival thickness (GT), defect characteristics and anatomical limitations addressing hard and soft tissue relationships and periodontal structures. Root coverage is less predictable in the presence of interproximal attachment loss. Evidence on the treatment of multiple recession-type defects, particularly Miller Classes III and IV, is scarce. The modified coronally advanced tunnel technique (MCAT) has been report-ed to exert root-coverage effects in Miller Class III cases via partial papilla elevation. To gain surgical access in challenging anatomies, the use of additional vestibular incisions (vestibular incision subperiosteal tunnel access, [VISTA]) has been proposed. In this case report, two patients who underwent surgeries for Miller Class II-III recessions with thin phenotypes are described. After non-surgical periodontal treatment, creeping attachment of 0.5-1 mm was observed in some teeth in case 1. Both patients underwent the treatment of MCAT technique combined with connective tissue grafting, whereas only the patient in case 2 underwent VIS-TA. Complete root coverage, increased GT and aesthetic outcomes with a follow-up period of at least 5 months were achieved in multiple teeth in both cases. The report and the literature review suggested that MCAT w/wo VISTA can predict root coverage and modify phenotypes for the treatment of multiple recessions.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Evaluation of platelet derived growth factor-BB levels in injectable platelet rich fibrin coated graft using gingival pedicle split thickness tunnel technique for isolated gingival recession: A randomized controlled trial

BackgroundUse of injectable-platelet rich fibrin (i-PRF) in the field of periodontal regeneration is quite well known due to its efficacy. The study was aimed to evaluate the platelet derived growth factor-BB (PDGF-BB) levels in cases of isolated gingival recession using gingival pedicle split thickness tunnel technique (GPST) and de-epithelialized gingival graft (DGG) with or without coating it with i-PRF. Methodology20 patients exhibiting Miller’s class I/II isolated gingival recession were selected for this parallel arm randomized controlled trial. Recipient site was prepared using GPST technique, free gingival graft was harvested and de-epithelialized, further graft was coated with i-PRF and wound fluid samples from surgical site were collected at baseline, 3rd day and 7th day for group A. The same procedure without coating the graft in i-PRF was carried out for group B. Clinical parameters like probing depth, recession depth, recession width, width of keratinized gingiva, wound healing index (WHI), complete root coverage was recorded at baseline and after 4 months. ResultsSignificant intergroup difference was seen in WHI and the levels of PDGF-BB from baseline to the last estimated time point (p < 0.05). ConclusionThe study emphasizes on the use of novel GPST technique in conjunction with DGG coated with liquid PRF, which has shown sustained release of PDGF-BB resulting in better wound healing.

Insertion of orthodontic temporary anchorage devices with free gingival grafting for phenotype modification of the peri-implant mucosa

BackgroundMini Implants are widely used in contemporary orthodontics, they provide skeletal anchorage even in non-compliant patients, facilitate orthodontic tooth movement, are easy to place and are relatively inexpensive. Their failure is multifactorial, and the quality of the soft tissue can present a risk limitation for the insertion of TADS. Orthodontic Mini Implants inserted in keratinized gingiva present fewer tissue-related complications and higher survival rate, than those inserted in non-keratinized mucosa. The purpose of this report is to present and describe this novel technique to modify and enhance the peri-implant mucosa of Orthodontic Mini Implants inserted in nonkeratinized gingiva. MethodsA free gingival graft was harvested from the palate in combination with a buccal recipient site preparation in the alveolar mucosa and a TAD insertion procedure. ResultsAfter twenty-one days of healing, graft integration was observed. One hundred and eighty days after insertion and twelve weeks of loading, none to mild signs of clinical inflammation were documented, and the patient reported no pain or discomfort. ConclusionWithin the limitations of this report, free gingival grafting for phenotype modification of the peri-implant mucosa, can benefit patients who need insertion of orthodontic mini-implants in non-keratinized mucosa for orthodontic tooth movement.

Highly Ozonated Sunflower Oil Dose May Cause Oxidative Stress and Impact the Quality of Life After Palatal Graft Removal: Secondary Endpoints of a Randomized Controlled Clinical Trial

ABSTRACT The aim of this study was to evaluate the effect of highly ozonated sunflower oil on postoperative pain and quality of life in patients undergoing removal of a free gingival graft (FGG) in the donor area of the palate. After graft removal, the palatal wound was treated with highly ozonated sunflower oil with a peroxide index between 510 and 625 meq/kg in the test group (n = 14) and with non-ozonated sunflower oil in the control group (n = 14). These are the secondary endpoints of a randomized clinical trial. Questionnaires assessing oral health impact on quality of life (OHIP-14) and postoperative pain (VAS scale) were applied to all participants at day 7. The results did not reveal a statistically significant difference in the postoperative pain between groups in all periods (P>0.05). There was a significant positive correlation in both groups for pain and amount of analgesic consumption (P<0.0001). It was found that participants in the test group showed a higher overallscore for OHIP-14 than the control group (P < 0.05), with impact on unsatisfactory diet, meal interruptions and irritability (P < 0.05). MDA levels measured 7 days post-treatment were higher in the test group compared to those of the control group (P < 0.05). It can be concluded that high dose and overapplication of the ozonated sunflower oil had a negative impact on the quality of life of individuals after palatal graft removal, which might have been aggravated by oxidative stress. Trial Registration number NCT05620550/Date of registration: November 16, 2022

Comparison of morbidity at the donor site and clinical efficacy at the recipient site between two different connective tissue graft harvesting techniques from the palate: A randomized clinical trial.

This study was conducted to compare the pain levels in patients and the clinical efficacy of grafts obtained using two techniques, namely de-epithelialized gingival graft (DGG) and subepithelial connective tissue graft (SCTG), in combination with coronally advanced flap (CAF) for the treatment of multiple adjacent gingival recessions. Twelve patients were treated using DGG+CAF on one side and SCTG+CAF on the other. The patients' pain levels at the surgical site, the number of analgesics taken on days 3 and 7, the mean root coverage (MRC), the percentage of complete root coverage (CRC), color match, and gingival thickness (GT) at the graft recipient site were evaluated 6 months after surgery. The total number of analgesics taken during the 7-day period after surgery and pain levels at the surgical site from day 3 to day 7 were significantly higher in the DGG+CAF group compared to the SCTG+CAF group (P=0.001). In the 6-month follow-up, color match and CRC were significantly higher in the SCTG+CAF group, while GT was significantly higher in the DGG+CAF group. There was no significant difference in MRC between the two groups. The pain and analgesic consumption levels were higher in the DGG+CAF group compared to the SCTG+CAF group, and the recipient site had a weaker color match. However, this technique can lead to a greater increase in the thickness of the grafted area.

Awareness and Knowledge of Periodontal Plastic and Aesthetic Surgery amongst House Surgeons – An Online Survey

Abstract Aim: The survey aims to assess the degree of awareness and knowledge of periodontal plastic and aesthetic surgery amongst house surgeons. Materials and Methods: A questionnaire-based study was conducted to assess the degree of awareness and knowledge of periodontal plastic and aesthetic surgical procedures amongst 80 house surgeons in KMCT Dental College, Manassery, Kerala. A questionnaire containing 10 questions in English was prepared for data collection and distributed to 80 interns through Google form. Questions were formulated based on basic knowledge about mucogingival problems and their treatment modalities, understanding of various terminologies, indications for mucogingival procedures and awareness about prognosis and treatment outcome after mucogingival procedure. The possible options chosen by the participants were tabulated and the percentile for each question was represented using pie charts. Results: Amongst the 80 participants, around 80% of participants were having basic knowledge about mucogingival problems and their treatment modalities. About 48% of participants were aware of the indications of periodontal plastic and aesthetic surgical procedures and 85% of the participants knew about the prognosis and treatment outcome of these surgical procedures. Conclusion: Mucogingival procedures or periodontal plastic surgery involves the correction of soft-tissue defects involving the periodontium and frenum. The present study was able to assess the degree of knowledge of periodontal plastic surgical procedure amongst house surgeons. The awareness and knowledge of periodontal plastic and aesthetic surgery amongst house surgeons were good however it could be improved.

Minimally Invasive Gingival Recession Treatment by Using Vista Combined With PRF and Collagen Membrane: A Case Report

Abstract Root exposure generates major concerns regarding aesthetics and other problems like hypersensitivity and root caries. Gingival recession has traditionally been treated by periodontal plastic surgery, often using soft tissue grafts to fill the defect with excellent clinical results. Advancements in root coverage procedures in the aesthetic zone have led to increasing the ability of clinicians to harness a treatment modality that delivers better outcomes with less surgical morbidity. Collagen membrane is most commonly used for guided tissue regeneration (GTR). On the other hand, platelet-rich fibrin (PRF) has gained popularity due to its simple method of acquisition, low cost and the presence of growth factors. Therefore, this case report describes the treatment of a 38-year-old patient with bilateral multiple Miller’s class I recession defects extending from central incisors to canines by using the vestibular incision subperiosteal tunnel access (VISTA) with PRF and collagen membrane. Clinical parameters such as recession height (RH) and width of keratinised gingiva (WKG) were measured at 6-month and 1-year follow up intervals. The 6-month follow-up revealed optimum root coverage with excellent outcomes for both sites, with an increase in the width of keratinised gingiva and a decrease in the recession height, and less discomfort in the site treated with a PRF membrane. These clinical parameters were maintained at the 1-year follow up. The increase in the width of keratinised gingiva and the decrease in the recession height in both groups and the patient compliance due to this minimally invasive procedure suggests its potential use when aesthetics and patient comfort are of paramount concern.

Comparative evaluation of the effectiveness of bioresorbable collagen membrane in combination with deproteinized bovine bone matrix xenograft (DBBM), and advanced platelet rich fibrin membrane in combination with deproteinized bovine bone matrix xenograft for periodontal regeneration

Introduction: Periodontitis is a chronic, multifactorial, inflammatory disease that leads to gradual loss of bone and periodontal attachment. Thus, periodontal surgery is required according to severity of diseases. The goal of periodontal reconstructive surgery is to regenerate soft and hard tissues destroyed during periodontal disease. Aim: To compare the effectiveness of bioresorbable collagen membrane in combination with Deproteinized Bovine Bone Matrix xenograft (group A); and Advanced Plasma rich fibrin(A-PRF) membrane in combination with Deproteinized Bovine Bone Matrix xenograft (group B) in the treatment of human infrabony defects. Methods: This randomised controlled trial will be carried out at the periodontics outpatient department. We will choose 24 patients with moderate to advanced chronic periodontitis who are otherwise systemically healthy. Infrabony defects will be treated by open flap debridement using bovine-derived xenograft and bioresorbable collagen membrane (group A) and open flap debridement using bovine-derived xenograft and A-PRF after the completion of first therapy (group B). At baseline and six months after undergoing periodontal surgery, probing pocket depth, clinical attachment level, radiographic bone fill, gingival recession, oral hygiene status, and gingival health will be measured. Expected results: It is suggested that Bioresorbable Collagen Membrane in combination with Deproteinized Bovine Bone Matrix xenograft will show better results as compared to Advanced Platelet Rich Fibrin Membrane with Deproteinized Bovine Bone Matrix Xenograft. Clinical trial registry of India (CTRI): REF/2023/05/066732. Protocol version: v1 (12/05/23)

Root coverage surgeries using modified tunneling technique of xenogenic collagen matrix versus autologous connective tissue graft as a treatment of Miller class II gingival recession (RCT study)

BackgroundRecently, there is increased demand for periodontal plastic surgery and development of new surgical approaches for aesthetic purposes. Gingival recession (GR) is the exposure of the root surfaces leading to esthetic problems, hypersensitivity, caries of the roots and teeth loss. Coronally advanced flap is considered a predictable treatment of GR but it needs a filler like subperiosteal connective tissue graft (CTG) which is considered as the gold standard treatment approach. The aim of the present study is to compare the clinical benefits and effectiveness of a xenogenic collagen matrix (mucoderm, botiss, dental, Berlin, Germany) to CTG for treatment of GR.ResultsRegarding clinical parameters, mean preoperative values for attached gingiva, probing depth, clinical attachment loss and gingival recession for group I were (1.8 ± 0.7 mm, 1.2 ± 0.3 mm, 6.6 ± 0.4 mm and 5.4 ± 0.2 mm) respectively. While mean postoperative values were (2.3 ± 0.9 mm, 1.1 ± 0.4 mm, 3.4 ± 0.5 mm and 2.7 ± 0.7 mm For group two preoperative mean values were (1.9 ± 0.3 mm, 1.1 ± 0.5 mm, 6.8 ± 0.5 mm and 5.4 ± 0.2 mm) respectively. While mean for postoperative values of attached gingiva, probing depth, clinical attachment loss and gingival recession for group tow were (2.5 ± 0.6 mm, 0.8 ± 0.3 mm, 3.7 ± 0.2 mm and 3.1 ± 0.3 mm) respectively All of the clinical parameters measured showed a significant difference between pre ad postoperative measurements while there was no significant differences between the two groups (test and control group). Regarding the patients satisfaction the percentage was greater in test group but the difference was not statistically significant.ConclusionsIn general, all of the parameters measured showed a significant difference between pre and postoperative measurements for each group but there is no significant difference between the two groups using (two treatment approaches. Both treatment procedures are considered efficient in increasing zone of attached gingiva and decreasing its clinical attachment loss. Mucoderm is considered as an efficient alternative to CTG for treatment of gingival recession.

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.

Effect of an Oral Ointment Containing Propolis on Palatal Donor Site Pain and Wound Healing After Harvesting a Free Gingival Graft: a Split-Mouth, Double-Blind Clinical Trial

Effect of an Oral Ointment Containing Propolis on Palatal Donor Site Pain and Wound Healing After Harvesting a Free Gingival Graft: a Split-Mouth, Double-Blind Clinical Trial

Self-Curing Glass Ionomer Cement Covered by Photopolymerizable Adhesive for Protection of Mucoperiosteal or Gingival Flap Sutures in Canine Oral Surgery.

Periodontal disease is one of the main affections of the oral cavity of dogs. Its main complication is the formation of periapical abscess, which, when affecting the maxillary canine teeth, can lead to the formation of oronasal fistulae. The objective of this study was to evaluate the efficiency of self-curing glass ionomer cement, covered by photopolymerizable adhesive, as a protective element for mucoperiosteal or gingival flap sutures in oral surgery of dogs. We studied 15 dogs from the clinical routine of the dental service of a teaching veterinary hospital, which needed oral surgeries to correct oronasal fistulae, defects or oral cavity communications, regardless of the causal agent. Group one (G1) was composed of seven animals that presented oronasal fistulae after the extraction of maxillary canine teeth compromised by severe periodontal disease. These fistulae were reduced by the double-mucoperiosteal-flap technique, 15 days after the dental extraction. Group two (G2) was composed of five other dogs that presented oronasal fistulae after the extraction of maxillary canine teeth compromised by severe periodontal disease. In this group, the fistulae were reduced by the single-flap technique, immediately after the dental extraction. Group three (G3) was composed of three animals, two of which presented oronasal fistulae due to maxillary fracture and the third one after excision of oral neoplasia. In all groups, simple interrupted sutures were used with 3.0 nylon, and a thin layer of self-curing glass ionomer cement was applied immediately over the operated area. After cement's settling time, a thin layer of photopolymerizable adhesive was applied to the already polymerized cement. In G1, the protective cement was removed on average at 15 (±2) postoperative days, in G2 at 6 (±1) days and in G3 at 11 (±9) days. In the postoperative period, the animals received antibiotics and anti-inflammatory drugs, and they received their usual dry dog food diet. No Elizabethan collar or any other protective measure was used for suturing or the surgical wound. The result was healing of 100% of the oronasal fistulae, without suture dehiscence or the need for new surgical interventions. Thus, it was concluded that the use of self-curing glass ionomer cement covered by photopolymerizable adhesive was fully satisfactory, providing protection of sutures and surgical wounds and showing the potential for routine use in oral surgery in dogs.

Levels of smoking and outcome measures of root coverage procedures: a systematic review and meta-analysis.

This systematic review and meta-analysis was performed to investigate if there was a significant association between the number of cigarettes smoked per day and the results of root coverage procedures. Electronic search was performed through PubMed, Web of Science, Embase, and Scopus until January 2023. Studies were included if evaluated the outcomes of periodontal plastic surgery procedures for the treatment of gingival recession in smokers. Statistical evaluation was conducted using random-effects method to analyze the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CI). From a total of 4494 references, 15 studies were considered relevant to be included in this study. The results showed that 44.39% sites had complete root coverage (CRC) at 6months (non-smokers: 54.06%, < 10 cigarettes/day: 48%, 10-20 cigarettes/day: 19.56%, ≥ 20 cigarettes/day: 50%). Mean root coverage at 6months were as follows: non-smokers: 74.94% ± 16.71%, < 10 cigarettes/day: 84.20% ± 2.24%, 10-20 cigarettes/day: 75.30% ± 14.69%, ≥ 20 cigarettes/day: 68.75% ± 26.51%. A significant difference was revealed between non-smokers and individuals who smoked 10-20 cigarettes/day in terms of CRC at 6months: OR = 0.15 (95% CI = 0.03 to 0.71; P = .017). However, no significant difference was detected comparing 10-20 and ≥ 20 cigarettes/day. As there was not enough data available, any definitive conclusions about the connection between an increase in the amount of cigarettes consumed per day and the results of root coverage procedures could not be reached. Further research is required with comparative studies involving individuals who smoke varying numbers of cigarettes.