Periodontal Procedures Research Articles

"Liver Clots" in Periodontology: A 10-Year Clinical Experience.

"Liver clots" are an uncommon complication following periodontal surgery, characterized by their distinctive gelatinous consistency and color resembling 'liver' tissue. Despite anecdotal reports, there is a lack of comprehensive evidence in the literature regarding its incidence, etiopathogenesis and optimal management strategies. This study aimed to address this knowledge gap by retrospectively analyzing cases to provide insights into this unusual post-operative complication. In this retrospective descriptive study, data spanning a decade (June 2013-June 2024) were collected from various dental centres. The data included patient demographics, medical history, surgical procedures performed, occurrence of "liver clot" formation, management measures and treatment outcomes. The 10-year retrospective data revealed a 2.03% incidence of "liver clots" among various periodontal procedures. The highest occurrence was observed following dental extractions, followed by periodontal surgical procedures. The observations also indicated a higher frequency in systemically healthy individuals. "Liver clot" formation is a rare, but specific complication after periodontal surgery. Minimally invasive management approaches are effective, highlighting the importance of vigilance and prompt intervention for optimal patient outcomes. Further research is warranted to elucidate the exact etiopathogenesis and to establish evidence-based management protocols for this unusual complication.

Multimorbidity Patterns and Periodontal Diseases in a French Hospital-Based Dental School: A Retrospective Cross-Sectional Study

Objectives: To assess the prevalence of systemic pathologies associated with periodontal diseases to determine multimorbidity patterns and risk factors for periodontal care. Methods: A single-center cross-sectional study analyzed patient records from 1 January 2019 to 31 December 2021 at the Department of Periodontology, part of the Dental Service of a hospital-based dental school in Lyon, France. The anonymized data included patient-reported medical history (questionnaire) and billing for periodontal procedures. Data were compared between patients in the Department of Periodontology and from Other Departments of the Dental Service. The association between clinically relevant pathologies, as defined as multimorbidity, and admission in the Department of Periodontology were assessed with logistic regression. Prevalences between the Department of Periodontology and the Other Departments of the Dental Service were compared with chi-squared tests. Relationship among pathologies was described through correlation analysis. Statistical analyses were conducted using R software with a significance level set at p < 0.05. Results: This study included records of 20,945 patients in the Dental Service with 1205 periodontal procedures performed in the Department of Periodontology. Patients admitted for periodontal care were older and mostly female (p-value < 0.001). The most frequent systemic pathologies were hypertension and diabetes in the Department of Periodontology. Hypertension associated with diabetes was the most frequent multimorbidity pattern, while the most frequent triad of multimorbidity was hypertension/diabetes/cardiac rhythm disorders. Patients with diabetes had a 1.49 times higher likelihood of admission to the Department of Periodontology (OR = 1.49 [1.20; 1.86]), with age also being a significant risk factor but with a smaller effect size (OR = 1.02 [1.01; 1.03]). Conclusions: Within the limitations of this study, hypertension, diabetes, cardiac rhythm disorders, and chronic renal insufficiency were identified as prevalent multimorbidity in the Department of Periodontology. Multimorbidity including diabetes seems to constitute a risk factor requiring periodontal care.

Autologous platelet concentrates in root coverage procedures.

Gingival recessions are vastly prevalent among the general population. With regards to their treatment, recent advancements in periodontal and microsurgical procedures, focusing on minimal invasiveness and patient-centered therapies, have propelled a shift in their contemporary treatment, highlighting the field of biologics and bioactive mediators. Among different classes and types of biologics, autologous platelet concentrates (APCs), also referred to as autologous blood-derived products, are commonly used and preferred among many clinicians. These are essentially obtained via venipuncture (intravenous access) followed by centrifugation, for which numerous protocols and preparation methods have been used, leading to varieties of blood-derived products. In this review, via a systematic search, we explored the efficacy of the different utilized preparation methods and centrifugation protocols of APCs (e.g., platelet-rich plasma (PRP), platelet-rich fibrin (PRF), leucocyte-PRF, advanced-PRF, concentrated growth factor (CGF), etc.) for the treatment of type 1 gingival recessions (RT1, without interproximal attachment loss or noticeable tooth displacement), as well as their effectiveness relative to a common control (treatment with flap advancement alone without any additional material). Based on the available literature from randomized trials found in our systematic search, we observed that utilization of PRF can significantly enhance treatment outcomes when performing a coronally advanced flap, in terms of the amount of root coverage. The improvement in root coverage was further enhanced in the presence of baseline keratinized tissue width, and with an increasing relative magnitude (the more the baseline keratinized tissue width, the better the root coverage outcomes when using PRF). The efficacy of these products needs to be further explored with different graft substitutes and matrices, as well as relative to other commonly applied biologics, through well-conducted and adequately-powered randomized clinical trials.

From Healing to Regeneration: A Comprehensive Review of the Efficacy of Platelet-Rich Fibrin in Periodontal Plastic Surgery Procedures.

This review examines platelet-rich fibrin (PRF) efficacy in periodontal plastic surgery, highlighting its crucial role in promoting periodontal regeneration and healing. Various forms of PRF are discussed, like leukocyte- and platelet-rich fibrin, advanced PRF, and injectable PRF, in addition to their application in different periodontal procedures such as root coverage and increasing the width of keratinized tissue surrounding the teeth. This review emphasizes the biological benefits of PRF, such as faster wound healing, reduced postsurgical pain, and better management of bleeding. The presence of growth factors, cytokines, and leukocytes in PRF significantly aids in promoting tissue regeneration, thereby improving the clinical outcomes of periodontal therapy. This review also provides recommendations for further research using standardized PRF protocols to optimize the benefits of PRF in clinical practice.

Periodontal Osseous Defects: A Treatment-Oriented Classification to Guide Regenerative Treatment Planning.

Periodontal bony defects are classified into 'supraosseous' ('suprabony') or 'infraosseous' ('infrabony') according to the location of the base of the defect compared to the coronal part of the residual alveolar crest. Infraosseous defects are generally considered more challenging to treat and are thought to be associated with a higher risk of periodontal progression. The emergence and advancement of periodontal regenerative procedures have improved the clinician's ability to manage infraosseous defects. However, limitations still exist. This paper reviews the definitions of periodontal osseous defects and provides a new classification framework for infraosseous defects, relating them to the chances of success of regenerative procedures and therefore to their treatment planning options. Infraosseous defects are hereby divided into intrabony and inter-root defects. Factors affecting treatment response, such as number of walls, depth and extension into buccal and lingual surfaces are added to the classification framework.

Preemptive oral analgesia with steroidal and nonsteroidal anti-inflammatory drugs in periodontal surgery: a systematic review.

Introduction: Periodontal procedures can promote prolonged intense pain, particularly in clinical situations requiring surgical procedures. In this context, preemptive analgesia has also been assessed for its utility in controlling post-operative pain and discomfort in patients undergoing periodontal invasive procedures. This study assessed the efficacy and safety of preemptive oral analgesia with steroidal and non-steroidal anti-inflammatory drugs in periodontal surgeries. Methods: This systematic review performed a search in the following electronic sources: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (via PubMed), EMBASE (via Ovid), Web of Science, Virtual Health Library and in clinical trials electronic databases for relevant randomized clinical trials (RCTs); published up to July 2023. Primary outcomes assessed were post-operative pain, edema and trismus. A narrative synthesis of the findings was carried out. Results: Six RCTs, involving a total of 250 participants, were included. The studies reviewed had a high risk of bias, particularly due to allocation concealment and blinding of participants and personnel. The RCTs reported only the outcome pain. The preemptive use of dexamethasone 8mg, etoricoxib 90mg or 120mg and ketorolac 20mg seems to be more effective for controlling post-operative pain than placebo. Discussion: The anti-inflammatory drugs evaluated proved to be effective for controlling post-operative pain. However, given the limitations regarding lack of studies, methodological biases, disparities in drugs and doses, report restricted the pain outcome; further RCTs confirming the effectiveness and safety of these drugs in periodontal surgical procedures are warranted.

Periodontal management during orthodontic-surgical treatment of maxillary impacted incisors: Acase report

The treatment of impacted teeth is a multidisciplinary process requiring close collaboration between periodontics and orthodontics. Impaction can have several causes, including physical obstructions in the eruption pathway, arch length discrepancies, or dental deformity. The management of these cases lies in the diagnosis established after an appropriate clinical and radiological examination. The age, position, etiology, and amount of space in the dental arch of an unerupted tooth determine how it should be treated. In several cases, orthodontic creating space, removing physical obstructions, and exposing the patient surgically with or without traction are general guidelines for treatment. In addition, ensuring adequate access to the tooth and the possibility of attaching an orthodontic anchor, the periodontal plastic surgery procedures associated with surgical clearance must preserve the integrity of the periodontium of the impacted tooth, as well as that of adjacent teeth, and above all promote the long-term maintenance of their periodontal health.

Patient-Reported Outcomes After Periodontal Surgical Procedures.

Background Patient satisfaction is the primary focus of the healthcare system. Patient-reported outcome measures (PROMs) are standardized and valid measures obtained directly from the patients and are used to assess and compare the efficacy of healthcare services. This can help improve the service provided by the healthcare system. Therefore, this study aimed to assess PROMs during the first week post-surgery across different periodontal surgical procedures and explore their correlation with surgical duration. Furthermore, the study sought to evaluate the occurrence of postoperative complications. Methodology A total of 30 healthy patients with no systemic history, requiring periodontal surgical procedures such as crown lengthening (CLP), open flap debridement (OFD), and soft tissue grafting (STG) were included in the study. The Visual Analog Scale (VAS) was utilized for gathering PROMs concerning bleeding, swelling, bruising, and pain at intervals of days zero, three, five, and seven after the surgical procedure. Results On the surgical day and over seven days, VAS scores were the lowest for CLP and highest for STG procedures. This result is in accordance with the duration required for surgery. VAS scores for OFD were intermediate. Prevalence of 20% soft tissue graft dehiscence and 40% tenderness on palpation was observed. Swelling and bleeding were noticed in 10% and 20% of OFD cases. Conclusions One week post-surgically, the mean VAS scores were minimum for CLP, whereas maximum for STG procedures. As CLP and OFD require less duration compared to STG, duration plays a significant role in post-surgical outcomes. Prevalence of the post-surgical complications is also related to the duration of the surgery.

Comparative Analysis of the Antibacterial Properties of Various Periodontal Bone Graft Materials In Vitro.

Periodontal bone grafting is a common procedure in dentistry to restore bone loss resulting from periodontal disease. Various graft materials are available, each with different antibacterial properties. Understanding these properties is crucial for successful grafting outcomes. In this study, we conducted a comparative analysis of the antibacterial properties of four commonly used periodontal bone graft materials: The graft used were A: Hydroxyapatite, B: B TCP, C: Bioactive glass, D: Calcium Phosphate materials. Each material was subjected to in vitro testing using a standardized bacterial culture assay. Antibacterial activity was assessed by measuring the zone of inhibition around each material after exposure to bacterial cultures. Material A exhibited the highest antibacterial activity with an average zone of inhibition of 12.3 mm, followed by Material C with 9.8 mm, Material D with 8.5 mm, and Material B with 6.2 mm. These arbitrary values reflect the relative efficacy of each material in inhibiting bacterial growth. Our findings suggest that Material A possesses the strongest antibacterial properties among the tested periodontal bone graft materials. This may contribute to improved clinical outcomes in periodontal bone grafting procedures by reducing the risk of postoperative infections. Further research is warranted to elucidate the mechanisms underlying the antibacterial effects of these materials and to validate our in vitro findings in clinical settings.

Palatal Graft Harvesting Site Healing and Pain Management: What Is the Best Choice? An Umbrella Review

The use of free gingival graft (FGG) and connective tissue graft (CTG) from the palate are among the most predictable periodontal and peri-implant plastic surgery procedures. However, palatal harvesting causes severe discomfort in the palatal area in patients undergoing harvesting. The aim of this umbrella review is to evaluate which products or techniques can result in fewer side effects and less morbidity in patients. Systematic reviews, with meta-analysis or not, about postoperative pain and wound healing in patients undergoing surgery to remove a free gingival graft or connective tissue graft from the palatal region, published only in the English language, were electronically searched for on BioMed Central, Scopus, MEDLINE/PubMed, the Cochrane library databases, and PROSPERO register. Of 1153 titles, only 7 articles were included in this review. The reviews included suggest that the more effective interventions for patient-reported outcomes, particularly for pain management, are cyanoacrylate adhesives, platelet-rich fibrin, hyaluronic acid, and the use of palatal stents. Low-level laser therapy also demonstrated good results in palatal wound healing speed after FGG procedures. Also, topical agents were also described. Future studies and more high-quality randomized clinical trials are needed to provide clear descriptions and standardized procedures of interventions to obtain clear results.

Chlorhexidine digluconate mouthwash alters the oral microbial composition and affects the prevalence of antimicrobial resistance genes.

Chlorhexidine (CHX) is a commonly used antiseptic in situations of limited oral hygiene ability such as after periodontal surgery. However, CHX is also considered as a possible factor in the emergence of cross-resistance to antibiotics. The aim of this study was to analyze the changes in the oral microbiota and the prevalence of antimicrobial resistance genes (ARGs) due to CHX treatment. We analyzed the oral metagenome of 20 patients who applied a 0.2% CHX mouthwash twice daily for 4 weeks following periodontal surgical procedures. Saliva and supragingival plaque samples were examined before, directly after 4 weeks, and another 4 weeks after discontinuing the CHX treatment. Alpha-diversity decreased significantly with CHX use. The Bray-Curtis dissimilarity increased in both sample sites and mainly streptococci showed a higher relative abundance after CHX treatment. Although no significant changes of ARGs could be detected, an increase in prevalence was found for genes that encode for tetracycline efflux pumps. CHX treatment appears to promote a caries-associated bacterial community and the emergence of tetracycline resistance genes. Future research should focus on CHX-related changes in the microbial community and whether the discovered tetracycline resistance genes promote resistance to CHX.

Patterns and factors associated with dental service utilization among insured people: a data mining approach

BackgroundInsurance databases contain valuable information related to the use of dental services. This data is instrumental in decision-making processes, enhancing risk assessment, and predicting outcomes. The objective of this study was to identify patterns and factors influencing the utilization of dental services among complementary insured individuals, employing a data mining methodology.MethodsA secondary data analysis was conducted using a dental insurance dataset from Iran in 2022. The Cross-Industry Standard Process for Data Mining (CRISP-DM) was employed as a data mining approach for knowledge extraction from the database. The utilization of dental services was the outcome of interest, and independent variables were chosen based on the available information in the insurance dataset. Dental services were categorized into nine groups: diagnostic, preventive, periodontal, restorative, endodontic, prosthetic, implant, extraction/surgical, and orthodontic procedures. The independent variables included age, gender, family size, insurance history, franchise, insurance limit, and policyholder. A multinomial logistic regression model was utilized to investigate the factors associated with dental care utilization. All analyses were conducted using RapidMiner Version 2020.ResultsThe analysis encompassed a total of 654,418 records, corresponding to 118,268 insured individuals. Predominantly, restorative treatments were the most utilized services, accounting for approximately 38% of all services, followed by diagnostic (18.35%) and endodontic (13.3%) care. Individuals aged between 36 and 60 years had the highest rate of utilization for any dental services. Additionally, families comprising three to four members, individuals with a one-year insurance history, people contracted with a 20% franchise, individuals with a high insurance limit, and insured individuals with a small policyholder, exhibited the highest rate of service usage compared to their counterparts. The regression model revealed that all independent variables were significantly associated with the use of dental services. However, the patterns of association varied among different service categories.ConclusionsRestorative treatments emerged as the most frequently used dental services among insured individuals, followed by diagnostic and endodontic procedures. The pattern of service utilization was influenced by the characteristics of the insured individuals and attributes related to their insurance.

Journey of Platelet concentrates in Periodontal Regeneration – A review

Platelet concentrates are the derivatives of blood which helps in haemostasis and wound healing after periodontal regenerative procedures and are enriched with growth factors are well-known to boost the healing process and have started to be in trend and utilized clinically in periodontal surgical procedures. These are prepared from the patient’s own blood throughout which the activated platelets become close and form a fibrin matrix scaffold that releases growth factors and cytokines which plays a key role in tissue regeneration; including cell proliferation and differentiation, extracellular matrix synthesis, chemotaxis and angiogenesis. Its autologous nature provides an advantage to the patients as it reduces treatment cost and minimizes the risk of cross-infection. Despite its exclusive application in promoting healing, there is data paucity on the role of platelet concentrates on bone regeneration. Therefore, this review aims to explore the potential bone regenerative effect of platelet concentrates that would be beneficial as one of the alternative options in periodontal regenerative procedures. Even though the application of platelet concentrates has shown promising outcomes, there is a need for further studies to discover the potential of platelet concentrates in bone regeneration. This review highlights various types of platelet concentrates, and their clinical applications within the treatment of periodontal diseases.

Revitalising Dentin Surfaces: Unlocking Periodontal Regeneration Potential through Cutting-edge Citric Acid Techniques

Introduction: Teeth affected by periodontitis exhibit an increased mineral content and endotoxins. They do not harmonise with the neighbouring periodontal cells, whose growth is essential for periodontal regeneration. This scanning electron microscope (SEM) study evaluated and compared the in vitro effects of different citric acid application techniques on naturally preserved dentin slabs. Materials and Methods: Thirty-two dentinal slabs were prepared for experimentation, with one group undergoing various treatments and a control group left untreated. The citric acid solution, with a pH of 1.0, was meticulously prepared and used in four different application methods on the experimental group. The dentin slabs were prepared for SEM evaluation, which assessed parameters such as exposed dentinal tubules, the surface area occupied by tubule orifices, the demineralised zone’s width and the exposed tubules’ morphological characteristics. Results: The data present the mean number of exposed dentinal tubules for different application techniques and the width of the demineralised zone. While the f-test did not show significant differences in the width of the demineralised zone, the number of exposed dentinal tubules varied significantly. Immersion treatment resulted in the highest number of open tubules, followed by cotton pellet placement and brushing. Conclusions: The study suggests that in periodontal regenerative procedures, passive citric acid application may be more effective than vigorous methods like burnishing for exposing inter-tubular fibrils and dentinal openings.

Clinical efficacy of titanium prepared platelet rich fibrin in periodontal regeneration: A systematic review and meta-analysis.

Periodontal regeneration therapies frequently involve autologous platelet concentrates (APCs). They can be used in sinus lift surgeries and socket preservation, among other clinical settings. Platelet rich fibrin (PRF) membrane has been used to treat gingival recession in individuals or groups of individuals using a coronally progressed or lateral pedicle flap. In the treatment of mixed periodontic endodontic lesion/furcation defect, PRF functions as a healing and interpositional biomaterial, filling a cystic cavity. PRF is known to help the bone regeneration process. In the last few years, efforts have been made to enhance the PRFs characteristics and quality. One of them is titanium platelet rich fibrin (T-PRF). Third-generation platelet concentrate no longer contains silica, and its preparation in glass vacuum containers, that no longer creates any known concerns. The effectiveness PRF's has been evaluated in connective tissue and bone repair. The aim of this study is to compare T-PRF to other platelet concentrates and different treatment modalities for periodontal regenerative procedures. A protocol of this systematic review have been registered in prospero (CRD42022293545). The online database searched were PUBMED, COCHRANE for published articles up to November 2022 without language restrictions. Studies in trial registers, handsearching, bibliographic references of relevant articles were also checked. Data collection and analysis was done by individual authors. Independent eligibility assessments were conducted by four review authors. Then, using the standard Cochrane methodology, four review authors extracted the data and evaluated the risk of bias for individual studies. We developed "Summary of findings" tables and used GRADE to evaluate the evidence. Three studies were included for meta-analysis. Results of meta-analysis supported that T-PRF is effective for correction of both hard and soft tissue defects. The overall qualitative and quantitative analysis suggest that T-PRF has superior structural properties and thicker fibrin network for ensuring predictable success periodontal regenerative procedures.

Management of Endo-Perio lesion in a Tooth with an Unfavorable Prognosis: a Clinical Case Report with an 18-Month Follow-Up

The aim of this case study is to report a successful clinical case of an endo-perio lesion in a tooth with an initially unfavorable prognosis, followed up for 18 months. A male patient, public servant, non-smoker, without a history of diabetes, and married sought dental treatment in 1995 due to periodontal problems. He was then 40 years old and diagnosed with moderate to advanced periodontal disease. The initial treatment consisted of supra and subgingival scaling, followed by the extraction of teeth indicated for removal. After discharge, the patient adhered to a preventive periodic maintenance (PPM) program to control periodontal disease recurrence. In 2021, tooth 43 showed an unfavorable endo-perio lesion during a routine check-up. Despite treatment options, the patient opted for conservative treatment with endodontic and periodontal procedures. Simultaneously, PPM sessions were performed. The patient was monitored every six months, showing regression of periodontal pockets and significant improvement after 18 months. This case highlights the importance of patient adherence to PPM, demonstrating that a conservative approach and proper maintenance can lead to positive clinical outcomes even in cases with an initially unfavorable prognosis.

Periodontal tissue regeneration: current therapeutic strategies and future directions in further research

Chronic and progressive destruction/damage of the periodontal tissues resulted from periodontitis is the leading cause of tooth loss in adults. Traditional periodontal therapies such as scaling and root planning or flap surgery have demonstrated effective in controlling local inflammation and in suppressing/arresting the disease progression of periodontitis. However, those infection control measures cannot help to regenerate lost periodontal tissues to a statistically or clinically significant degree. Although some successes regarding the reduction of the intrabony defect and maintenance of the periodontal homeostasis have been achieved in periodontal regenerative procedures, comprising but not limited to guided tissue regeneration (GTR) or bone grafting technique, the restorative effectiveness of the architecture and function of the lost or injured tissues is far from our clinical expectation. The use of the concept, technique, and method of tissue engineering for periodontal regeneration is a hotspot and animal studies have shown interesting outcomes in terms of functional regeneration of lost/damaged support tissues in the periodontium, including alveolar bone, periodontal ligament, and cementum. However, numerous issues need to be addressed before those regenerative approaches can be responsibly transformed to novel clinical therapies. Recently, paradigm that induces homing of host stem cells to site of the periodontium and encourage the body's innate capability to repair is a new research field termed endogenous regeneration. Given that endogenous regenerative technique avoids ex-vivo cell culture and transplantation, it should be relatively easier to be used in the treatment of clinical patients. Due to the limited oral microenvironment and harsh periodontal local condition for tissue regeneration, as well as poor understanding of periodontal regenerative biology, there is still a long way ahead to explore new effective, practical, and economical therapies to save and protect natural tooth and for combating highly prevalent periodontal disease.

Treatment for an Altered Passive Eruption (APE)

Altered Passive Eruption (APE) is a condition where the gingival margin is more incisal or occlusal than the cementoenamel junction. Apart from disrupting the aesthetics of a smile, this condition can also be a risk factor for periodontal disease. APE is characterized by a gummy smile and short-looking teeth. Periodontal crown lengthening surgery is a treatment option that can be given to treat this case. The choice of periodontal crown lengthening surgery procedure must be adjusted based on the APE classification of the patient's case. This case report aims to describe the management of APE type 1A with periodontal crown lengthening surgery through gingivectomy. A 25-year-old female patient came to RSGM UMY with complaint that the gums on the front teeth of the upper jaw seemed large. The patient's general health is good. The results of intraoral examination showed that there were an elevation of the gingiva towards the incisal direction, and the teeth appeared short on 12, 11, 21, and 22. The examination also showed the presence of cretinized gingival tissue that appeared larger vertically on 12, 11, 21, and 22. On radiographic examination, the distance between the cementoenamel junction and the crestal bone is greater than 1 mm. The patient's APE classification was type 1A, hence gingivectomy was performed in this case. In treating APE cases, determining the correct diagnosis and selecting appropriate therapeutic management must be considered according to the patient's case. All therapeutic decisions must be discussed with the patient in order to satisfy their desires

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

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

Factors associated with the performance and achieving goals of specialized periodontal procedures in Brazilian dental specialties centers

BackgroundThe Brazilian Dental Specialty Centers (CEO, in Portuguese) represent the strategy of the National Oral Health Policy to provide secondary-level dental care. They offer more complex procedures, such as the treatment of periodontitis. This study aims to investigate the factors associated with the performance and the achievement goals of specialized procedures and the achievement gols of periodontics in CEO.MethodologyAnalytical and cross-sectional study using secondary data. The database of the second cycle of the External Evaluation of the National Program for Improving Access and Quality in CEO (PMAQ-CEO, in Portuguese), was utilized, which assessed 1,042 CEO on-site in 2018. The data were analyzed using multiple Poisson regression, estimating the prevalence ratio (PR) (p < 0.05).ResultsA third of the CEO (n = 305) performed all specialized procedures, with a higher prevalence observed in those with more than one bicarbonate jet prophylaxis unit (RP = 2.12; 95% CI: 1.160–3.881; p = 0.015) and when they had a higher percentage of specialist professionals (RP = 1.004; 95% CI: 1.002–1.006; p < 0.001). The periodontics goal was achieved by 617 (59.2%) CEO, with a higher prevalence among those who had a manager with supplementary training (PR = 1.21; 95% CI: 1.100-1.335; p < 0.001) and with a higher workload for the periodontist dentist (PR = 1.15; 95% CI: 1.103–1.201; p < 0,001).ConclusionAlthough most CEOs do not perform allspecialized periodontics procedures, more than half achieved the established goals. The provision of specialized periodontics services in CEO and the achievement of goals are influenced by the quantity and professional qualifications, as well as the availability of equipment.