Subepithelial Connective Tissue Research Articles

Association of subepithelial connective tissue graft and plasma rich-fibrin for treatment of gingival recession – clinical case report with 12 months post-surgical follow-up

Gum is a portion of periodontal tissue that plays an important role in protecting the surface of the teeth. Its migration beyond the boundaries of the cementum enamel junction, exposing the root of the tooth, is called Gingival Recession (GR) which increases susceptibility to root caries, dentin sensitivity, and aesthetic discomfort. Objective: The main goal of this case report is to describe a surgical procedure that combined the technique of subepithelial connective tissue graft and Plasma-rich fibrin for treatment of gingival recession. Case report: A man, 45 years old, leucoderma, attended the Positive University dental clinic complaining that ‘his gum was rising, and his teeth were sensitive’. Clinical buccal examination was performed according to international guidelines for periodontal data collection and was the man was diagnosed with GR in the region comprising the buccal faces of the first right upper molar to the first right premolar. Before surgical procedure, 60 ml of blood Gum is a portion of periodontal tissue that plays an important role in protecting the surface of the teeth. Its migration beyond the boundaries of the cementum enamel junction, exposing the root of the tooth, is called Gingival Recession (GR) which increases susceptibility to root caries, dentin sensitivity, and aesthetic discomfort. Objective: The main goal of this case report is to describe a surgical procedure that combined the technique of subepithelial connective tissue graft and Plasma-rich fibrin for treatment of gingival recession. Case report: A man, 45 years old, leucoderma, attended the Positive University dental clinic complaining that ‘his gum was rising, and his teeth were sensitive’. Clinical buccal examination was performed according to international guidelines for periodontal data collection and was the man was diagnosed with GR in the region comprising the buccal faces of the first right upper molar to the first right premolar. Before surgical procedure, 60 ml of blood

Plasma Cell Gingivitis Mimicking Granulomatous Disease: A Diagnostic Dilemma

Plasma cell gingivitis is an uncommon benign inflammatory condition of the gingiva which is considered to arise as a hypersensitivity reaction to certain allergens. The distinguishing feature of this condition is massive infiltration of plasma cells into the subepithelial connective tissue. This case report discusses a case of plasma cell gingivitis which produced a diagnostic dilemma due to its unusual histopathologic appearance. A 13-year-old female patient presented with diffuse gingival enlargement in relationship to upper anterior teeth. The case was managed successfully by gingivectomy following phase I therapy. Histopathological examination showed presence of epithelioid granulomas and foreign body giant cells along with plasma cells which is an uncommon finding in plasma cell gingivitis. Further tests conducted excluded granulomatous disease and the diagnosis was confirmed as plasma cell gingivitis. Plasma cell gingivitis can present a diagnostic dilemma and should be included in the differential diagnosis of patients presenting with non-specific gingival enlargements.

A Surgical Procedure for Free Subepithelial Connective Tissue Graft to Treat a Soft Tissue Dehiscence in a Single-Tooth Implant-Supported Restoration : A Case Report

A Surgical Procedure for Free Subepithelial Connective Tissue Graft to Treat a Soft Tissue Dehiscence in a Single-Tooth Implant-Supported Restoration : A Case Report

A 3-Year Prospective Study on a Porcine-Derived Acellular Collagen Matrix to Re-Establish Convexity at the Buccal Aspect of Single Implants in the Molar Area: A Volumetric Analysis.

Background: Xenogeneic soft tissue substitutes are currently being investigated as an alternative to subepithelial connective tissue grafts (CTG) with the intention to avoid postoperative morbidity associated with autologous grafting. The aim of the present study was to volumetrically evaluate the effectiveness and mid-long-term stability of a porcine-derived collagen matrix (PDCM) (Mucoderm®, Botiss gmbh, Berlin, Germany) in increasing soft tissue volume at the buccal aspect of molar implant sites. Methods: Periodontally healthy non-smoking patients with a single tooth gap in the molar area were selected for a prospective case series. All sites had a bucco-oral bone dimension of at least 8 mm and demonstrated a horizontal alveolar defect. A wide diameter implant was placed under the elevated buccal flap and a PDCM was applied. The primary outcome was the linear increase in buccal soft tissue profile (BSP) within a well-defined area of interest. This was performed with designated software (SMOP; Swissmeda AG, Zurich, Switzerland) on the basis of superimposed digitalized study casts taken before surgery (T0), immediately after surgery (T1), at three months (T2), one year (T3) and three years (T4). Secondary outcomes were alveolar process deficiency and clinical parameters. Results: Fourteen out of 15 treated patients attended the three-year re-assessment (four females; mean age 51.4 years). Mean linear increase in BSP at T1 was 1.53 mm (p = 0.001). The PDCM showed substantial resorption at T2 (1.02 mm or 66.7%) (p = 0.001). Thereafter, a 0.66 mm volume gain was observed (p = 0.030), possibly due to the installation of a permanent crown displacing the soft tissues to the buccal aspect. This resulted in a linear increase in BSP of 1.17 mm (76.5%) at T4. Alveolar process deficiency significantly reduced over time (p = 0.004). However, 50% of patients still demonstrated a slight (6/14) or obvious (1/14) alveolar process deficiency at study termination. Implants demonstrated healthy clinical conditions. Conclusions: The PDCM demonstrated marked resorption during the early stages of healing. Due to the matrix thickening the tissues, and the permanent crown displacing the tissues, 76.5% of the initial increase in BSP could be maintained over a three-year period. Half of the patients failed to show perfect soft tissue convexity at the buccal aspect.

Tunnel technique with enamel matrix derivative in addition to subepithelial connective tissue graft compared with connective tissue graft alone for the treatment of multiple gingival recessions: a randomized clinical trial

ObjectivesThe aim of this study was to compare outcomes of the modified coronally advanced tunnel technique (MCAT) combined with subepithelial connective tissue graft (SCTG) with or without enamel matrix derivative (EMD), in the treatment of gingival recession types 1 and 2.Materials and methodsA total of 20 patients with 150 multiple gingival recessions (GR) were included in the study. On one side, MCAT was combined with SCTG and EMD (tests), whereas MCAT with SCTG was applied on the contralateral side (controls). Clinical parameters were measured at baseline and 6 months after surgery. Visual analog scales (VAS) and questionnaires were used to assess patient-reported outcomes and the root coverage esthetic score (RES) for professional esthetic evaluation.ResultsMCAT+SCTG+EMD was not superior with regard to root coverage. At 6 months, average root coverage (ARC) was 87.4% for SCTG+EMD-treated and 90.9% for SCTG-treated defects (p = 0.4170). Complete root coverage (CRC) was observed in 86.7% (tests) and 85.3% (controls) of the cases (p = 0.9872). Significantly less pain was reported using VAS (p = 0.0342) post-operatively in the SCTG+EMD group. Professional assessment of esthetic outcomes using RES showed a significant difference (9.25 versus 8.71, p = 0.0103) in favor of the test group.ConclusionsBoth treatment modalities were equally effective in treatment of multiple GR and led to similar improvements in clinical parameters. However, the application of EMD as an adjunct resulted in less post-operative pain and better professionally assessed esthetic outcomes.Clinical relevancePatients’ early morbidity and 6-month esthetic outcomes following GR coverage with MCAT might be influenced by means of EMD utilization.

Root coverage using coronally advanced flap with porcine-derived acellular dermal matrix or subepithelial connective tissue graft: a randomized controlled clinical trial.

The aim of this study is to investigate the use of a porcine-derived acellular dermal matrix (MD) in root coverage procedures combined with extended coronally positioned flap (eCAF), in comparison to the subepithelial connective tissue graft (SCTG) associated with the eCAF. Eighteen adult patients presenting bilateral type 1 gingival recession were randomly assigned to SCTG or MD groups. Clinical and patient-based outcomes were recorded at 3 and 6months after the surgical procedure. Both groups showed a significant reduction in the mean recession height of 3.33 ± 0.89mm to 1.24 ± 1.10mm (MD) and 3.21 ± 0.8mm to 0.83 ± 0.86mm (SCTG) without difference between groups. Six patients in the test group and eight in the control group obtained complete root coverage. The keratinized tissue height and thickness (KTT) showed a significant increase after 3 and 6months in both groups. The average KTT gains were 0.39 ± 0.4mm (MD) and 0.51 ± 0.5mm (SCTG) (p < 0.05). Performing multivariate analysis suggests that MD addition to coronally advanced flaps may be similar to SCTG. The MD had similar results in comparison to SCTG and in the context of reducing patient morbidity it can be used as an alternative for the treatment of gingival recessions. The SCTG is the gold standard therapy for root coverage. The MD has been widely used in mucogingival surgery as a substitute for SCTG and proposed similar results. A substitute is very important for clinicians and patients. It will give a better postoperative and possibilities to treat multiples recession. (Clinicaltrials.gov Identifier: NCT03675334).

Comparative Histopathologic Analysis of Granulomatous Tissue of Endodontic and Periodontal Origin.

The aim of this study was to compare the percentage of tissue types and assess the presence/absence of odontoblasts or preodontoblasts in granulation tissue harvested from lesions associated with teeth extracted due to endodontic and periodontal reasons. Histologic reports of cases with a confirmed diagnosis (ie, endodontic or periodontal diseases) were included. These should include a semiquantitative analysis of the percentage of tissue types per sample (ie, epithelium, subepithelial connective tissue, bone or chronic inflammation/deep connective tissue). The overall percentage of tissue type per diagnosis was calculated. Quantitative variables were summarized with means and standard deviations. Normal distribution was tested by the D'Agostino-Pearson omnibus normality test. The level of P < .05 was adopted for statistical significance. Finally, an analysis of the salient findings was summarized. The reports from 19 patients were included, 9 of endodontic and 10 of periodontal origins. The granulomatous tissue of endodontic and periodontal disease origin was similar, and consisted mainly of chronic inflammation (endodontic 40%, periodontal 41.7%), followed by epithelium (endodontic 25.7%, periodontal 29.2%), subepithelial connective tissue (endodontic 18.6%, periodontal 20.8%), and bone (endodontic 15.7%, periodontal 8.3%). No significant differences were found when comparing the groups regarding the percentage of tissue types (P ≥ .05). No osteoblasts or preosteoblasts were reported. Within the limitations of the study, the granulomatous tissues associated with chronic infection of endodontic or periodontal origin are comparable and consist primarily of chronic inflammatory cells.

An Unusual Granular Ulcer Secondary Oral Tuberculosis of Vestibule Mandibular Mucosa.

Tuberculosis (TB) is a chronic infectious disease caused by Mycobacterium tuberculosis . In the oral cavity, clinical manifestations are considered atypical lesions. The aim of this study was to report an unusual granular ulcer secondary oral TB that does not heal, chronic, had irregular appearance with deep depression of 2 cm in diameter, and was located in buccal mucosa of the premolar area–the left mandibular arch, of a 42-year-old woman. The patient was subjected to surgical excision of ulcer in its entirety and accordingly a periodontal plastic surgery in the area of the lesion was performed positioning an autograft subepithelial connective tissue. We obtained optimal results in improving oral health, function, and patient’s comfort, in postoperative controls at 15, 30, and 60 days, respectively.

Randomized controlled clinical trial comparing implant sites augmented with a volume‐stable collagen matrix or an autogenous connective tissue graft: 3‐year data after insertion of reconstructions

To assess mid-term clinical, radiographic and profilometric outcomes at implant sites, previously grafted with a volume-stable collagen matrix (VCMX) or an autogenous subepithelial connective tissue graft (SCTG). VCMX or SCTG were randomly applied to single implant sites in 20 patients. Following abutment connection and insertion of final reconstructions (baseline), patients were re-examined at 6months (6M), at 1year (FU-1) and at 3years (FU-3). Measurements included the following: clinical data, radiographic measurement of first bone to implant contact (fBIC), soft tissue thickness and volumetric outcomes. Non-parametric tests and estimates were applied for the statistical analysis. The median buccal mucosal thickness increased by 0.5 mm (Q1: -0.5; Q3: 1.25) (VCMX) (p=.281) and by 0.8 mm (Q1: 0.0; Q3: 2.5) (SCTG) (p=.047) between BL and FU-3 (intergroup p=.303). The profilometric changes of the buccal soft tissues demonstrated a median decrease between BL and FU-3 of -0.2mm (Q1: -0.5; Q3: -0.1) (p=.039) for VCMX and a decrease of -0.1mm (Q1: -0.8; Q3: 0.1) (p=.020) for SCTG, respectively (intergroup p=.596). Peri-implant soft tissues and bone levels remained healthy throughout the entire study period. PROMs did not show any significant differences between the groups nor significant changes over time. Minimal changes of the peri-implant tissue contour as well as of the soft tissue thickness were observed at implant sites previously grafted with VCMX or SCTG.

Soft tissue stability around dental implants after soft tissue grafting from the lateral palate or the tuberosity area – A randomized controlled clinical study

To compare the soft tissue stability (STA) around single implants previously augmented with either subepithelial connective tissue graft (SCTG) from the lateral palate (LP) or from the tuberosity area (TA). Twenty-nine patients showing 33 implants with buccal volume deficiency randomly received SCTG from LP (control group/CG) or TA (test group/TG). At 4months (FU-4) the definitive crown was installed and an intra-oral scan performed. At 12months (FU-12), a new scan was registered. Between FU-4 and FU-12 STA was evaluated by STL image superimposition. Clinical parameters and the modified pink aesthetic score (PES) (Fürhauser et al. 2005) were recorded. After FU-4 both tissues demonstrated a similar STA without statistically significant differences (SSD). The mean soft tissue changes were 0.03±0.22mm for CG and 0.04±0.23mm for TG (p=.870). SSD were observed for changes in keratinized tissue (KT) with greater stability for TG (0±0.32mm) compared with CG (-0.3±0.33mm) (p=.002). PES resulted in mean values of 8.37±2.46 for CG and 8.54±2.43 for TG (p=.59). Both groups demonstrated similar STA between the definitive crown placement and 12months, while greater stability of the KT gained was observed in TG.

Palatal Wound Healing with Primary Intention in a Rat Model-Histology and Immunohistomorphometry.

Background and objectives: Subepithelial connective tissue graft (SCTG) from the palate has been considered as the “gold standard” for the treatment of deep gingival recessions. A single-incision technique was reported to allow primary wound healing. A palatal single incision was performed in a rat model. The present study assessed the histology and histomorphometry of palatal wound healing following surgical closure with primary intention. Materials and Methods: Twenty-six 6-month-old male Wistar rats weighing 427–650 g. An incision was made on the maxillary palate. A full thickness flap was raised palatally, and then repositioned and sutured. Two experimental groups: S—Study group, I—Intact control group. Half of the animals were sacrificed 7 days and the remaining 14 days postoperatively. Outcome parameters included—epithelial gap; inflammatory infiltration; vascular fraction, expression of myofibroblasts and stem cell markers within the oral epithelium and stromal cells and physical properties of stromal collagen fibers. Investigations were performed at two time-points (7 and 14 days) during the wound healing process. Results: The epithelial gap closed completely after 14 days. The inflammatory reaction and vascular fraction were relatively low. Surgical trauma downregulated the expression of cytokeratin (CK) 14 and CK 15, which returned to normal after 14 days. Epithelial differentiation was mediated through upregulation of connective tissue sex- determining-region-Y-box2 (SOX2). Epithelial SOX2, CD34, alpha smooth muscle actin (αSMA) and physical properties of stromal collagen fibers were not influenced by the surgical trauma. Conclusions: Surgical trauma followed by palatal wound healing with primary intention in a rat model heals within 14 days. It induces minimal inflammatory infiltration and vascular proliferation. Epithelization is exerted through promotion of epithelial differentiation from stem cells by connective tissue SOX2.

Comparison of acellular dermal matrix allograft (ADMA) and a subepithelial connective tissue graft (SCTG) for the treatment of gingival recession.

Background This study aimed to evaluate the effect of acellular dermal matrix allograft (ADMA) for the treatment of gingival recession as a substitute for subepithelial connective tissue graft (SCTG).Methods In this controlled clinical trial, 18 teeth were selected in nine subjects with bilateral gingival recession. One side was treated with SCTG and a coronally displaced flap as the control group, and the other side was treated with ADMA and a coronally displaced flap as the test group. Probing pocket depth (PPD), clinical attachment level, vertical recession depth, recession width, gingival thickness, keratinized tissue width, and the root coverage percentage were measured before the surgery and at 1-, 3-, and 6-month postoperative intervals. The healing index, pain index, and patient satisfaction were also investigated. The data were analyzed with a general linear model (GLM) repeated measures and paired t-test.Results All the parameters improved except for PPD; however, a comparison between the groups did not reveal statistically significant differences. Only root coverage percentage and pain index were significantly lower in the test group. The average percentage of root coverage in the control and test groups were 82.01±16.62% and 64.44±9.4%, respectively. Conclusion Both methods resulted in improvements in the clinical results. However, the use of the ADMA led to less pain and root coverage in comparison with the SCTG method.

Platelet-Rich Fibrin in Coverage of Gingival Recession: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis sought to evaluate the efficacy of platelet-rich fibrin (PRF) membranes versus subepithelial connective tissue grafts (SCTGs) in the coverage of Miller class I and II gingival recessions. After the inclusion and exclusion criteria were applied, the quality of seven articles (Cohen’s Kappa = 0.9) was evaluated using the Jadad scale. The MEDLINE/PubMed, Cochrane, and Web of Science databases were consulted, and manual searches were performed in the most popular periodontics journals. The studies included considered a total of 122 patients, 203 surgical fields on which SCTGs were used, and 205 surgical fields on which PRF was used. The parameters analyzed were probing depth, clinical attachment level, gingival recession, and keratinized mucosa. The minimum follow-up period accepted was 6 months. A statistically significant difference between the SCTG and PRF groups was found only in the case of keratinized mucosa. However, gingival recession, clinical attachment level, and probing depth parameters in the PRF group were found to be statistically equal to those of the SCTG group (the gold standard) ( p ≥0.05). PRF membranes were determined to be a promising alternative to autogenous gingival grafts in the treatment of Miller class I and II gingival recessions.

Treatment of Multiple Mandibular Gingival Recession Defects Using MCAT Technique and SCTG With and Without rhPDGF-BB: A Randomized Controlled Clinical Trial.

The aim of this randomized controlled trial was to compare the clinical outcomes of modified coronally advanced tunnel technique (MCAT) with subepithelial connective tissue graft (SCTG) with and without recombinant human platelet-derived growth factor-BB (rhPDGF-BB) for mandibular multiple recessions. Twenty-four Miller Class I and III recessions were randomly assigned to a group: test (MCAT+SCTG+rhPDGF-BB) or control (MCAT+SCTG). After 6 months, mean recession-depth reduction was higher in the test group (2.08 ± 0.90 mm) than the control (1.83 ± 0.93 mm). Mean root coverage was achieved, favoring the test group (82.6% ± 23.69%) instead of the control (56.2% ± 28.55%). Complete root coverage for the test group was 58.3%, which was significantly superior to control (16.7%). The use of rhPDGF-BB+SCTG using MCAT offered an advantage of a minimally invasive, predictable method for achieving optimal outcomes.

Adhesion and optics: The challenges of esthetic oral rehabilitation on varied substrates—Reflections based on a clinical report

Patients with challenging prosthodontic conditions require rehabilitation with a biological, functional, and esthetic approach. When one or more teeth are badly discolored, their restoration is problematic because poor appearance affects not only the crown but also the periodontal tissues. This clinical report describes a complex esthetic rehabilitation with conservative tissue management and ceramic restorations. Subepithelial connective tissue graft surgery and the replacement of a cast metal post with a glass fiber post addressed the problem of a discolored maxillary central incisor. The discolored right maxillary incisor was restored with a combination of a medium-opaque, lithium-disilicate ceramic coping to mask the dark root and to approximate the color of the other incisors. Subsequently, 6 ceramic veneers were placed. A knowledge of the materials’ optical properties and adhesion possibilities helped solve this complex problem.

Comparative Randomized Clinical Study of Acellular Dermal Matrix Allograft and Subepithelial Connective Tissue Graft Around Immediate Dental Implants: 12-Months Clinical and Esthetic Outcomes

Objectives: The aim of the present study was to compare the clinical outcomes of immediate implant placement in the anterior maxilla with subepithelial connective tissue graft (SCGT) and acellular dermal matrix allograft (ADMA), during a 12-month postsurgical evaluation. The primary outcome of the study was to assess keratinized mucosa (KM) width changes following the two different clinical protocols. Secondary outcomes were to assess enhancement of the soft tissue using pink esthetic score (PES), changes in bleeding index score and probing depth.Material and methods: Adult patients were eligible for the study if they needed one immediate implant placement (IIP) replacing a tooth to be extracted with thin gingival biotype within the maxillary anterior region. The patients included in the study were divided into two groups; the first group received IIP simultaneously with subepithelial connective tissue graft while patients in the second group received IIP simultaneously with acellular dermal matrix allograft. Clinical assessments including width of keratinized mucosa (KM), pink esthetic score (PES) bleeding Index (BI) and probing depth (PD) were performed before IIP (baseline) and scheduled 4, 8 and 12 months after implant placement. Results: The means of BI and PD values at the 12 months follow up indicated healthy peri-implant soft tissues for both groups. There was no statistically significant difference in KM and PES between both groups through 12 months follow up period.Conclusions: Using acellular dermal matrix allograft can predictably maintain keratinized mucosa and esthetic outcomes as those achieved using subepithelial connective tissue when performed with immediate dental implants. Acellular dermal matrix allograft can be an alternative to subepithelial connective tissue to maintain soft tissue contour around immediate implant placement in esthetic zone with inherited thin soft tissue biotype.

A Case of Fibrolipoma of the Hard Palate

An extremely rare case of fibrolipoma in the hard palate is presented and discussed with reference to the literature. An 85-year-old woman visited the Tokyo Dental College Chiba hospital in September 2016 with the chief complaint of a mass in the hard palate. The patient had first become aware of this mass several years earlier. An examination at another hospital in June 2009 resulted in a clinical diagnosis of lipoma. Regular examinations followed every 6 months until September 2014, at which time she stopped attending these appointments because there was no change. In August 2016, however, the patient realized that the tumor was increasing in size. Although there was no pain, awareness of a foreign body in the oral cavity when eating or talking was increasing, so she decided to visit our clinic for detailed examination and treatment. At this point, the mass extended from the center to the left side of the hard palate. It measured 15 mm along the major axis, and had a clear border; nearly spherical, its surface was smooth and glossy, and was of a slightly yellowish color. The mass was painless, elastic, and soft. Computed tomography and magnetic resonance imaging revealed a tumorous lesion. Based on a clinical diagnosis of lipoma, it was subsequently excised under general anesthesia in January 2017. The tumor lay under the palatal mucosa, extending from the center to the left side of the hard palate. It was surrounded by a single-layered membranous structure, and had not adhered to the surrounding tissues. Healthy palatal mucosa and periosteum were also removed en bloc with the tumor within a safety margin of approximately 5 mm. No pressure absorption of palatine bone was seen. Histopathologically, proliferation of mature adipose tissue was observed. This was surrounded by a thin, single-layer membrane within the subepithelial connective tissue, which was covered by stratified squamous epithelium. Proliferation of fibrotic connective tissue was seen between the adipocytes. The final diagnosis was fibrolipoma. To date, at 18 months postoperatively, no recurrence has been observed and progress has been satisfactory.

Evaluation of 2 techniques of epithelial removal in subepithelial connective tissue graft surgery: a comparative histological study.

PurposeSubepithelial connective tissue grafts (SCTGs) are commonly performed for the treatment of gingival recession due to their high predictability. This study evaluated and histologically compared connective tissue grafts in terms of the presence of epithelial remnants and composition of the tissue types that were present (epithelium, lamina propria, and submucosa).MethodsTen patients underwent epithelium removal using 2 different techniques: the use of a blade (group B) and through abrasion (group A). Twenty samples were collected and each tissue type was analyzed histologically in terms of its area, thickness, and proportion of the total area of the graft.ResultsIn 4 samples (40%) from group B (n=10) and 2 samples (20%) from group A (n=10), the presence of an epithelial remnant was observed, but the difference between the groups was not statistically significant (P>0.05). Likewise, no statistically significant differences were observed between the groups regarding the area, mean thickness, or proportion of the total area for any of the tissue types (P>0.05).ConclusionsHistologically, SCTGs did not show statistically significant differences in terms of their tissue composition depending on whether they were separated from the epithelial tissue by abrasion or by using a blade.

A novel soft tissue cone-beam computed tomography study in the evaluation of gingival thickness associated with subepithelial connective tissue graft versus acellular dermal matrix in the management of gingival recession: A clinical study.

Background:Dental esthetic awareness among patients led the clinicians to introduce newer materials and predictable techniques that satisfy the patients' esthetic demands.Aim:To evaluate and compare the efficacy of subepithelial connective tissue graft (SECTG) and acellular dermal matrix (ACDM) allograft in the treatment of Millers Class I or Class II recession with the determination of gingival thickness using an impertinent method, soft tissue cone-beam computed tomography (ST-CBCT).Materials and Methods:A split-mouth study with a total of ten patients with bilateral Millers class I or class II recession is randomly assigned by a coin toss method as Group I (SECTG) and Group II (ACDM) along with coronally advanced flap. Clinical parameters including recession height (RH), recession width (RW), probing depth, clinical attachment level (CAL), and height of keratinized tissue (HKT) were evaluated at baseline, 90th day, and 180th day for both groups. The thickness of keratinized tissue (TKT) was determined by most reliable, predictable and noninvasive method called ST-CBCT.Results:Statistically significant reduction in RH and RW, gain in CAL, and increase in HKT and TKT in both Group I and Group II were seen in 90th day and 180th day. However, when both Group I and Group II were compared between 0 and 180th day, the change in RH and RW, gain in CAL, and increase in HKT and TKT did not show any statistically significant change.Conclusion:The present study suggested that root coverage with both SECTG and ACDM is very predictable procedure and it is stable for 6 months. ST-CBCT is a newer dimension in periodontal imaging and will certainly aid clinicians in the execution of various treatment modalities with increased predictability.

Porphyromonas gingivalis W83 traffics via ICAM1 in microvascular endothelial cells and alters capillary organization in vivo

ABSTRACT Objective: Microvascular dysfunction is a feature of periodontal disease. P. gingivalis, one of the most common oral bacteria present in gingival tissue biofilms, has also been identified in the gingival capillaries of patients with chronic periodontitis. We sought to determine the effect of P. gingivalis W83 infection on microvascular endothelium in vivo and in vitro. Methods and Results: Interdental papillae of rats with P. gingivalis-induced alveolar bone loss had a more dilated and denser subepithelial capillary network than uninfected controls. P. gingivalis W83 was detected in the epithelial layers, the subepithelial connective tissue matrix, and subgingival capillaries. P. gingivalis invaded human dermal microvascular endothelial cells (HD-MVECS) and persisted up termination (24 h). Colocalization analysis at 2.5, 6, and 24 h post-inoculation showed that 79–88% of internalized bacteria were in ICAM-1 positive endosomes, and 10–39% were in Rab5, Rab7, or LAMP1 positive compartments, but never in autophagosomes. Antibody-based blockade of ICAM-1 significantly reduced W83 invasion in HD-MVECS. P. gingivalis infected HD-MVECS were unable to form vascular networks in Matrigel. Conclusions: P. gingivalis perturbs microvascular endothelial function and invasion of these cells via ICAM-1 may be important for microbial persistence within tissues.