Subepithelial Connective Tissue Graft Group Research Articles

Post-extraction volumetric analysis of alveolar ridge contour using subepithelial connective tissue graft in esthetic zone: a randomized controlled clinical trial

ObjectivesThe aim of this randomized clinical trial was to assess the alveolar ridge contour after soft tissue augmentation using subepithelial connective tissue graft (SCTG) buccal to fresh extraction sockets in patients with thin buccal bone, versus minimally-traumatic extraction followed by spontaneous healing solely.Materials and methodsForty non-restorable maxillary teeth in the esthetic zone were randomly assigned into two groups: minimally-traumatic extraction with SCTG (test) and minimally-traumatic extraction followed by spontaneous healing (control). The outcomes assessed included linear volumetric change of buccal soft tissue contour, vertical tissue loss, gingival thickness (GT), and interdental papilla (IDP) height after 6 months.ResultsThe SCTG group showed a significant improvement (P < 0.001) in all outcomes after 6 months. The SCTG group showed a statistically significant (P < 0.001) gain in the buccal soft tissue volumetric change compared to the control group. The SCTG group showed a statistically significant increase in GT (P < 0.001) and IDP height (P < 0.05) after 6 months compared to the control group.ConclusionsThe use of SCTG buccal to extraction sockets in the anterior maxilla might be considered as a predictable approach for preserving the alveolar ridge contour.Clinical relevanceSCTG buccal to extraction sockets might counteract post-extraction hard and soft tissue alterations in the esthetic zone.

Gingival biotype modification with collagen matrix or autogenous subepithelial connective tissue graft: Histologic and volumetric analyses in a beagle model

ObjectivesTo evaluate the volumetric effect and biocompatibility of porcine tendon-derived type I collagen matrix graft (CG) in gingival biotype modification (GBM) compared with subepithelial connective tissue graft (SCTG) in a beagle model. MethodsSurface analysis using scanning electron microscopy and a collagen degradation assay of CG was performed in vitro. Six adult dogs were used in in vivo experiment, and each received autologous SCTG or CG at the anterior side. Histometric and three-dimensional digital volume analyses were conducted to compare quantitative changes in CG and SCTG in GBM. Immunohistochemical analysis was performed for the qualitative evaluation of CG compared to SCTG. ResultsCG had a double-layered structure, and its degradation was slower than that of other well-reported materials. No critical problems were associated with the healing procedure. Changes in gingival thickness and volume in the CG and SCTG groups were equivalent, with no significant differences between the groups. Type I collagen and vascular endothelial growth factor expression levels were similar in both groups. SignificanceCG and SCTG had equivalent potential for GBM in terms of quantity and quality. Additionally, CG could be used as a reasonable substitute for SCTG, making surgery convenient and predicting successful clinical outcomes.

Xenogeneic collagen matrix versus connective tissue graft for soft tissue augmentation at immediately placed implants: a prospective clinical trial

The advantages of immediate implant placement for patients include a reduced number of surgical procedures and a shorter overall treatment time. Disadvantages include a higher risk of aesthetic complications. The aim of this study was to compare xenogeneic collagen matrix (XCM) versus a subepithelial connective tissue graft (SCTG) used for soft tissue augmentation in combination with immediate implant placement without provisionalization. Forty-eight patients requiring a single implant-supported rehabilitation were selected and assigned to one of two surgical procedures: immediate implant with SCTG (SCTG group) or immediate implant with XCM (XCM group). Marginal changes in the peri-implant soft tissue and the facial soft tissue thickness (FSTT) were assessed after 12 months. Secondary outcomes included peri-implant health status, aesthetics, patient satisfaction, and perceived pain. All of the implants placed were successfully osseointegrated, resulting in 1-year survival and success rates of 100%. The patients in the SCTG group had a significantly lower mid-buccal marginal level (MBML) recession (P = 0.021) and a greater increase in FSTT (P < 0.001) than the patients in the XCM group. Using xenogeneic collagen matrix during immediate implant placement significantly increased FSTT from the baseline, leading to good aesthetic and patient satisfaction results. However, the connective tissue graft yielded better MBML and FSTT results.

Tunnel technique with cross-linked hyaluronic acid in addition to subepithelial connective tissue graft, compared with connective tissue graft alone, for the treatment of multiple gingival recessions: 6-month outcomes of a randomized clinical trial.

The aim of this study was to investigate differences in clinical and esthetic outcomes in the treatment of multiple gingival recession types 1 and 2, using the modified coronally advanced tunnel technique (MCAT) combined with subepithelial connective tissue graft (SCTG), with or without cross-linked hyaluronic acid (HA). A total of 24 patients with 266 multiple gingival recessions (GR) were enrolled in the study (133 recessions per group). MCAT was combined with SCTG and HA on the test side, while MCAT with SCTG was used on the control side. Clinical parameters were measured at baseline and 6months post-operatively. Visual analogue scales (VAS) and questionnaires were used to assess patient-rated outcomes, and the root coverage esthetic score (RES) was used for professional esthetic evaluation. No significant improvement in root coverage was observed as a result of adding HA. After 6months, mean root coverage (MRC) was 85% for SCTG + HA group and 83% for SCTG group (p = 0.9819). Complete root coverage (CRC) was observed in 91% (test) and 93% (control) of the cases (p = 0.9001). Professional assessment of soft tissue texture (STT) using RES showed a significant difference (0.94 versus 0.69, p = 0.0219) in favor of the experimental group. Both treatments were similarly effective in treating multiple GRs and led to comparable improvements in clinical parameters. However, application of HA improved the appearance of soft tissue texture. Adjunctive application of HA in the MCAT + SCTG procedure may improve STT results.

Clinical evaluation of periosteal pedicle flap in the treatment of gingival recessions for esthetic root coverage: A randomized controlled clinical trial.

Root coverage using subepithelial connective tissue graft (SCTG) is gold standard with few drawbacks such as requirement of second surgical site, reduced donor tissue availability, and increased surgical complications and pain. Periosteal pedicle graft (PPG) due to its rich source of pluripotent stem cells and nonrequirement of second surgical site could be a successful alternative for invasive SCTG. Therefore, current research aims to compare the amount of root coverage obtained with PPG to SCTG. Fifty-two single gingival recessions were included in the sample, with 26 patients allocated to the SCTG (control) and PPG (test) groups at random. At baseline, 3, and 6 months after surgery, clinical measurements of probing depth, clinical attachment level (CAL), recession depth (RD), recession width (RW), and width of keratinized tissue were taken. Both procedures, i.e., SCTG and PPG, resulted in root coverage to a variable extent and a significant decrease in RD (1.69, 1.38 mm in SCTG and PPG groups, respectively) and RW, CAL gain is found in both the groups without any intergroup statistical variance. Complete root coverage (CRC) was obtained in 14 out of 26, i.e., 53.8% defects in both SCTG and PPG groups. A better comfort level is found in the group treated with PPG. Gingival recessions can be successfully treated with PPG, which has predictability comparable to SCTG and does not require a second surgical site.

In vitro and in vivo evaluation of a modified porcine acellular dermal matrix for soft tissue augmentation.

To evaluate the effects of a modified porcine acellular dermal matrix (P-ADM), subepithelial connective tissue graft (SCTG) and other commercial bovine acellular dermal matrix membrane materials (B-ADM) on gingival soft tissue augmentation in the oral esthetic zone. The characteristics of P-ADM were observed by scanning electron microscope (SEM), Hematoxylin and eosin (H&E) and Masson's trichrome staining (Masson staining). The biocompatibility of P-ADM was verified by CCK8, phalloidin and living/dead cell staining. Beagle dog models were constructed and the thickness of gingiva was analyzed by the intraoral scanner. The morphology was observed by H&E and Masson staining. Scanning electron microscopy, H&E and Masson staining showed that the P-ADM was mainly composed of collagen fibers, with no component of nuclear. The results of CCK8, phalloidin and living/dead cell staining indicated that the P-ADM had good cytocompatibility and no cytotoxicity. Human gingival fibroblasts were able to adhere and stretch on the surface of the material with pseudopodia. The SCTG group outperformed the B-ADM and P-ADM groups in terms of effectiveness, according to the analysis of digital oral scanning data at various time points following incremental soft tissue surgery. Compared with the B-ADM group, the effect of soft tissue increment was better in the P-ADM group. P-ADM, as a biocompatible biomaterial, can be used as an alternative biomaterial for oral soft tissue thickening. However, the results of this study need to be verified by more clinical trials.

Splith mouth randomized control trial comparison of T-PRF and subepithelial connective tissue graft in the treatment of maxillar multiple gingival recessions.

The aim of this study is to compare the treatment efficacy of the bilateral multiple gingival recession areas with a titanium-platelet-rich-fibrin (T-PRF) and subepithelial connective tissue graft (SCTG) combined with a modified coronal advanced flap (MCAF) and the clinical results. In the study, 118 maxillary bilateral multiple Miller I recessions were treated. Gingival index, plaque index, probing pocket depth, gingival thickness, recession height, recession width, keratinized gingival width and open root surface area were measured at baseline and at 6months. Postoperative pain levels Visual Analog Scale, healing status, wound healing index evaluated with. The results of both groups pre and postoperative were compared. The initial recession height was 2.15 ± 1.0 mm in the T-PRF group; 2.04 ± 0.80 mm in the SCTG group. After 6months, the mean root closure rate was 61.77%, 75.31% in T-PRF and SCTG group, respectively. Clinical attachment gain was achieved in both groups compared to baseline. When the results were compared, the gains achieved in the SCTG group were statistically significantly higher. İt was determined that patient satisfaction was higher in T-PRF group and wound healing was faster. Considering the advantages of T-PRF such as providing effective results in the treatment of defects, patient satisfaction and rapid recovery; It can be applied as an alternative to SCTG. T-PRF can be an alternative to SCTG in the treatment of gingival recessions.

A Comparison between Mucoderm® and Connective Tissue Graft for Root Coverage.

Subepithelial connective tissue graft (SCTG) is the gold stand-ard treatment for root coverage procedure; however, this technique has limitations such as the need for a donor site and the difficulty of the harvesting procedure. The potential bene-fits of Mucoderm®, a collagen matrix derived from porcine dermis, as an alternative treat-ment for root coverage can be investigated. This study aimed to evaluate the efficacy of Mucoderm® for root coverage and compare its results with SCTG. This double-blind split-mouth randomized clinical trial was con-ducted on seven patients with 12 bilateral gingival recessions (24 recession sites). Coronally advanced flap + Mucoderm® was applied on one side and coronally advanced flap + con-nective tissue graft (CTG) was applied on the contralateral side. We measured the periodon-tal pocket depth (PPD), clinical attachment level (CAL), recession depth (RD), keratinized tissue width (KTW) and gingival thickness (GT) with a surgical stent at baseline (preopera-tively) and at 1, 3 and 6 months postoperatively. The Wilcoxon and Friedman tests were used to analyse the data. The mean percentage of root coverage was 26% in the Mucoderm® group and 60% in the SCTG group at 6 months, compared with baseline. The mean percentage of root coverage was significantly different between the two groups (p Value< 0.05). The results indicated that Mucoderm® did not increase the KTW, while CTG significantly increased the KTW (p Value< 0.05 at 1, 3 and 6 months). The results of this study showed that Mucoderm® might not be an appropriate alternative for the CTG in root coverage procedures.

Pontic site development for fixed dental prostheses with and without soft tissue grafting: 1-year results of a cohort study

AimTo describe and compare the pontic site development for fixed-dental prostheses (FDPs) with and without soft tissue grafting up to one-year post insertion of FDPs.Materials and methodsA convenience sample of 24 patients participating in an ongoing RCT was provided with three-unit tooth-borne FDPs. Six patients received a subepithelial connective tissue graft (SCTG) at the pontic site, whereas 18 patients were treated without any soft tissue graft (CONTROL). Digital impressions were taken prior to tooth preparation, after tooth preparation, after insertion of the final FDP, and at the 1 year of follow-up. The obtained stereolithography files (STL) were superimposed and profilometric as well as linear changes of the soft tissue profile were assessed at the pontic regions. Profilometric outcomes included changes of the ridge contour, the alveolar ridge width, and the crown height of the pontic. Further outcomes assessed included: the papilla index, the pink esthetic score (PES), probing depth (PD), bleeding on probing (BOP), and plaque control record (PCR). Descriptive and nonparametric statistics were applied for all outcome measures.ResultsThe median profilometric contour between tooth preparation and 1 year after the insertion of the final FDP decreased by − 0.25 mm [Q1, Q3: − 0.36, 0.14] in the CONTROL group and increased by 0.61 mm [Q1, Q3: − 0.18, 1.06] in the SCTG group (intergroup p = 0.038). The alveolar ridge width between prior to tooth preparation and the one-year follow-up amounted to − 0.12 mm [Q1, Q3: − 0.74, 0.70] (= loss) in the CONTROL group and to 2.23 mm [Q1, Q3: 0.62, 3.86] (= gain) in the SCTG group (intergroup p = 0.032). At one year, the median crown height of the pontic tended to decrease by − 1.24 mm [Q1, Q3: − 2.05, − 1.05] in the SCTG group (intragroup p = 0.094) and by − 0.22 mm [Q1, Q3: − 0.58, 0.66] in the CONTROL group (intragroup p = 0.831), with significant differences between the groups (intergroup p = 0.022). The papilla index between prior to tooth preparation and one year of follow-up improved significantly in both groups (p < 0.05). Between FDP delivery and one year of follow-up, the PES values decreased significantly in the CONTROL group (intragroup p = 0.007), while in the SCTG group the change was not significant (intragroup p = 0.875). Clinical parameters (PD, BOP, and PCR) remained stable over time and did not differ between the groups at any time point (intergroup p > 0.05).ConclusionWithin the limitations of the present study, soft tissue grafting tends to limit contour changes at pontic sites, thus maintaining the esthetic outcomes over time. The lack of soft tissue grafting results in stable clinical outcomes; however, it may lead to a decrease in aesthetic outcomes over time.Clinical relevanceAutogenous soft tissue grafting seems to be a valid therapeutic option for the development of the pontic site to restore ridge defects prior to the delivery of fixed dental prostheses and to limit dimensional changes over time.

Double Lateral Sliding Bridge Flap versus Laterally Closed Tunnel for the Treatment of Single Recessions in the Mandibular Anterior Teeth: A Pseudorandomized Clinical Trial.

(1) Background: This study compared the clinical and esthetic results of the double lateral sliding bridge flap (DLSBF) and the laterally closed tunnel (LCT) techniques, with a subepithelial connective tissue graft (SCTG), for the treatment of single Miller class II-III recessions in the mandibular anterior teeth. (2) Methods: This pseudorandomized clinical trial evaluated 14 patients, 7 of whom were part of the DLSBF + SCTG group, with an average follow-up of 58.7 ± 24.0 months, and 7 of whom were in the LCT + SCTG group, with an average follow-up of 16.7 ± 3.3 months. Clinical and esthetic evaluations of the following parameters were performed and the results for the two groups were compared: gingival recession depth, probing depth, keratinized tissue width, gingival thickness, percentage of root coverage and root coverage esthetic score. (3) Results: After the follow-up period, each technique provided evidence of a reduction in recession depth and clinical attachment level, as well as increased keratinized tissue width and gingival thickness, with statistically significant differences (p < 0.05). The analysis showed that gingival recession depth decreased less in the DLSBF group (4.3 ± 1.2 mm to 0.6 ± 1.1 mm) than it did in the LCT group (4.9 ± 1.1 mm to 0.1 ± 0.4 mm), but no significant difference was found between the two groups. Similarly, a greater reduction in the clinical attachment level parameter was observed in the LCT group, while a greater increase in gingival thickness was observed in the DLSBF group. The presence of scars was the only parameter for which statistically significant differences (p < 0.05) between the two study groups were found. (4) Conclusions: Within the limitations of the study, it indicates that the LCT + SCTG technique may be considered an optimal technique in terms of reducing gingival recession depth, complete root coverage and esthetic results for the treatment of single gingival recessions in the mandibular anterior teeth.

Influence of Immediate Implant Placement and Provisionalization with or without Soft Tissue Augmentation on Hard and Soft Tissues in the Esthetic Zone: A One-Year Retrospective Study.

The purpose of this clinical research was to evaluate peri-implant marginal changes around immediate implants placed either with the application of SCTG or XCM or without soft tissue grafting. A total of 48 patients requiring a single implant-supported restoration in the anterior jaw were selected for inclusion. Three surgical procedures were performed, as follows: type 1 implant with subepithelial connective tissue graft (SCTG), type 1 implant with xenogenic collagen matrix (XCM), and type 1 implant without soft tissue augmentation (NG) (control group). The marginal change of peri-implant soft tissue, facial soft tissue thickness (FSTT), peri-implant health status, esthetics, and patient satisfaction were assessed at one year after surgery. All of the placed implants showed a survival rate of 100%. No significant differences in FSTT were recorded between the SCTG group and the XCM group after treatment (P > 0.05), while the NG group presented a significant difference (P < 0.05). Patients in the NG group lost significantly more in the buccal marginal level than did patients in the SCTG group and those in the XCM group (P < 0.05). The favourable success rate recorded in all groups confirmed immediate tooth replacement as a choice of treatment for a missing anterior single tooth. The NG group presented significant changes of FSTT and buccal marginal level, while XCM constituted a viable alternative to SCTG.

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).

A randomized split mouth clinical study to compare the clinical outcomes of subepithelial connective graft and acellular dermal matrix in Miller's Class I recession coverage therapy.

Background:According to the American Association of Periodontology, subepithelial connective tissue graft (SCTG) is one the most reliable surgical technique available for the treatment of gingival recession (GR) with Miller's Class I defect. However, due to its various disadvantages, alternate grafts such as acellular dermal matrix (ADM) grafts have been introduced for recession coverage. The present study compares the clinical outcome of these two grafts in treating Miller's Class I GR.Materials and Methods:All the 15 patients participated in the study who had totally 30 bilateral Miller's Class I GR were divided randomly into SCTG group and ADM group each containing 15 defects. In the SCTG group, coronally advanced flap (CAF) with SCTG was performed, and in ADM group, CAF with ADM was done. Clinical parameters were measured on the day of surgery (baseline) and after 6 months. Data collected were statistically analyzed using paired and unpaired t-tests.Results:The analysis of the data collected at the baseline and 6 months later showed that there were no statistically significant differences in the recorded clinical parameters such as probing pocket depth, clinical attachment loss, and GR depth. ADM group showed a better color match than the SCTG group, while SCTG group achieved more keratinized tissue width than ADM group.Conclusion:From the outcome of the current study, we can conclude that ADM is an efficient substitute for SCTG for treating Miller's Class I GR. However, additional studies with greater number of samples and lengthier follow-up periods are necessary to validate the present inference.

Is platelet rich fibrin a viable alternative to subepithelial connective tissue graft for gingival root coverage?

One of the most common aesthetic concerns associated with the periodontal tissue is gingival recession. Covering the root surface exposed during the disease process with soft and hard tissue surgeries may decrease these problems. The aim of the study was to compare the clinical outcome of coronally advanced flap (CAF) procedure in root coverage with platelet-rich fibrin (PRF) or subepithelial connective tissue graft (SCTG) for the treatment of Miller's Class-I gingival recession. The split mouth design consisted of 15 patients with a total of 30 sites with bilateral Miller's Class-I recession on anterior teeth. They were randomly assigned into PRF group (test) or SCTG group (control). The values obtained were tabulated and analyzed using Mann--Whitney U-test and repeated measure ANOVA test. All the statistical tests were carried out using SPSS software. It was observed that both the autogenous grafts healed without any complications and at the end of 6 months the grafts were stable and recession coverage between 88-100% was achieved. CAF procedure with either PRF or SCTG were both effective in the treatment of Miller's Class-I gingival recessions. CAF with SCTG showed better root coverage than CAF with PRF. Use of PRF offered additional benefit of avoiding second surgical site. Therefore, PRF can be considered as a viable alternative to SCTG in certain cases.

Periimplant soft tissue volume changes after connective tissue grafting. The autologous connective tissue graft vs. the porcine collagen matrix. A clinical follow‐up case series

Background The thickness of peri-implant soft tissue is very important in the high risk esthetic area. Especially in advanced cases, i.e. high lip line, thin gingival biotype, loss of soft or hard tissues or bony atrophy, soft tissue grafting can be indicated in order to avoid gingival recession and periimplantitis. Gold standard is the autologous subepithelial connective tissue graft (SCTG) of the palate. To avoid tissue removal, porcine collagen matrices have been introduced as possible alternatives. Aim/Hypothesis This clinical study evaluates a porcine collagen matrix (CM) in comparison to the subepithelial connective tissue graft (SCTG) from the palate for soft tissue thickening around implants with a 3D follow- up. Material and Methods Patients (n = 12) were included after implant placement in the esthetic area with buccal tissue deficit. At the time point of implant exposure, buccal soft tissue were either thickened with the CM (n = 6) or the SCTG (n = 6). Impressions with a scan optimized vinylsiloxanether (Identium® Scan, Kettenbach GmbH, Eschenburg, Germany) were taken before augmentation (i), after surgery (ii), after 10 (iii), 30 (iv), 90 (v) and 180 days (vi). The impressions were optically scanned with a high precision scanner (Atos II Triple Scan, GOM GmbH, Braunschweig, Germany). The acquired data was visualized and superimposed with the ATOS Professional software (GOM GmbH, Braunschweig, Germany). The region of interest (ROI) was defined at the buccal area from the margin of the suprastructure to the mucogingival junction at the implant site and to the 2 adjacent teeth (primary outcome variable- volume increase in mm3+ secondary outcome variables- volume increase in%, mean and maximum thickness increases in mm. Results The evaluation of the region of interest at the different time points showed that there was a volume increase in both groups after surgery. After ten days, volume further increased in the SCTG group (183.88 mm3 = 139.03%) compared to the CM group (80.74 mm3 = 71.03%). This was a thickness increase (mm) of 2.31 mm in the SCT group and 1.12 mm in the CM group. Volume and thickness decreased in both groups over time (6 months- SCTG- 61.75 mm3 = 43.61%+ CM- 19.56 mm3 = 18.24%). This resulted in a thickness increase of 0.3 mm in the CM and 0.8 mm in the SCTG group with statistically significant difference after 6 months. Conclusions and Clinical Implications After 6 months, soft tissues thickness gain with the use of the porcine collagen matrix was significantly lower than with the use of the autologous subepithelial connective tissue graft. The SCTG still remains the gold standard for such procedures.

Comparison of effectiveness of hyaluronic acid in combination with polylactic acid/polyglycolic acid membrane and subepithelial connective tissue graft for the treatment of multiple gingival recession defects in human: A clinical study

Background: The patients today are increasingly conscious of personal appearance, and much attention has been focused on denuded roots that are exposed during smiling which look unesthetic. These concerns have given rise to numerous approaches for covering denuded root surfaces; however, difference of opinions is prevailing among the clinicians. Objectives: Therefore, the present study was undertaken to compare the effectiveness between hyaluronic acid (HA) in combination with polylactic acid/polyglycolic acid (PLA/PGA) membrane with that of subepithelial connective tissue graft (SCTG) for the treatment of multiple gingival recession defects. Material and Methods: Twenty-four systemically healthy patients were randomly assigned to the test guided tissue regeneration (GTR-HA) and control SCTG groups. Clinical measurements, including probing pocket depth, relative attachment level, and relative gingival margin level, were measured at baseline and at the 6-month follow-up. Result and Conclusions: After 6 months, the mean reduction in gingival recession in the test group was 2.55 ± 0.45 mm whereas in the control group, it was 2.11 ± 0.58 mm. The test group showed mean root coverage of 92.93%, and the control group showed 84% at 6 months postsurgery. When HA in combination with bioresorbable PLA/PGA membrane was compared with SCTG group; there was signifi cantly greater root coverage, clinical attachment level gain, and increased width of keratinized gingiva in the test group.

A novel volumetric analysis using cad/cam scanners in gingival recession treatment

Objective: In this study, randomized clinical trial (RCT), the aim was to compare clinical periodontal data of subepithelial connective tissue graft (SCTG) group and SCGT+enamel matrix derivatives (EMD) group in terms of gained gingiva volume (GGV) and gained gingiva surface area (GGSA) by scanners of computer-aided design/computer-aided manufacturing (CAD/CAM) devices. Material and Methods: In this study, a total of 35 Miller class I-II gingival recession defects were involved (n=17 in SCTG group, n=18 in SCTG+EMD group). In addition to, periodontal clinical parameters, and three dimensional (3D) images were recorded by using CAD/CAM system before the treatment, at the 1st month and the 6th months after the treatment. The images were superimposed by using softwares and GGV, and GGSA were calculated. Results: There was no significant difference in terms of GGV and GGSA values at the 1st month and 6thmonths between SCTG+EMD and SCTG groups. Similarly, there was no significant difference in periodontal clinical parameters between groups. Conclusion: Images obtained from CAD/CAM system can be easily used in calculating GGV and GGSA data after the gingival recession treatment and in determining of the success of administered treatment. It is expected that the evaluation of the success of many therapeutic approaches for periodontal treatment will be carried out by using CAD/CAM system in the future.

Soft tissue volume alterations after connective tissue grafting at teeth: the subepithelial autologous connective tissue graft versus a porcine collagen matrix - a pre-clinical volumetric analysis.

This study evaluates a porcine collagen matrix (CM) for soft tissue thickening in comparison to the subepithelial connective tissue graft (SCTG). In eight beagle dogs, soft tissue thickening was performed at the buccal aspects of the upper canines (SCTG and CM). Impressions were taken before augmentation (i1), after surgery (i2), after one (i3), three (i4) and ten month (i5). Casts were optically scanned with a 3D scanner and each augmented region (unit of analysis) evaluated (primary outcome variable: volume increase in mm(3) ; secondary outcome variables: volume increase in percent, mean and maximum thickness increases in mm). 3D tissue measurements after surgery revealed a significant higher volume increase in the CM (86.37mm(3) ±35.16mm(3) ) than in the SCTG group (47.65mm(3) ±17.90mm(3) ). After 10months, volume increase was non-significant between groups (SCTG:11.36mm(3) ±9.26mm(3) ; CM: 8.67mm(3) ±13.67mm(3) ). Maximum soft tissue thickness increase (i1-i5) was 0.66mm±0.29mm (SCTG) and 0.79mm±0.37mm (CM) with no significant difference. Ten months after soft tissue thickening, the CM is statistically non-inferior to the SCTG in terms of soft tissue volume and thickness increase. Further 3D studies are needed to confirm the data.

Vascularization after treatment of gingival recession defects with platelet-rich fibrin or connective tissue graft.

The aim of this study was to evaluate histologically the following treatment of bilateral localized gingival recessions with coronally advanced flap (CAF) combined with platelet-rich fibrin (PRF) or subepithelial connective tissue graft (SCTG). Tissue samples were harvested from 14 subjects either 1 or 6months after the surgeries. The 2-mm punch biopsies were obtained from the mid-portion of the grafted sites. Neutral buffered formalin fixed, paraffin-embedded 5-μm thick tissue sections were stained with hematoxylin eosin and Masson's trichrome in order to analyze the collagen framework, epithelium thickness and rete-peg length. Multiple sequential sections were cut from paraffin-embedded blocks of tissue and immunohistochemically prepared for detection of vascular endothelial growth factor, CD31 and CD34, for the assessment of vascularization. Rete peg formation was significantly increased in the sites treated with PRF compared to the SCTG group after 6months (p < 0.05). On the contrary, the number of vessels was increased in the SCTG group compared to the PRF group after 6months (p < 0.05). No statistically significant differences were observed in the collagen density. Staining intensity of CD31 increased in submucosal area of PRF group than SCTG group after 1month. Higher staining intensity of CD34 was observed in the submucosal area of PRF group compared with SCTG group after 6months. The results of the present study suggest that in histological evaluation because of its biological compounds, PRF results earlier vessel formation and tissue maturation compared to connective tissue graft. PRF regulated the vascular response associated with an earlier wound healing.

Non-Pedicled Buccal Fat Pad Grafts to Treatment for Class I and II Gingival Recessions: A Clinical Trial.

The aim of this study was to analyze the transplant efficiency of non-pedicled buccal fat pad graft (BFPG) for the treatment of Miller Class I or II gingival recessions (GRs) and to compare these results with those of subepithelial connective tissue graft (SCTG), which is considered the gold standard. Twelve patients with Miller Class I or II (≥2 mm) bilateral recessions in maxillary premolars or canines were selected. Recessions were randomly assigned to receive SCTG or BFPG. The clinical parameters evaluated at baseline and at 1, 3, and 6 months postoperatively included gingival index, plaque index, probing depth, GR, clinical attachment level, width of keratinized tissue, thickness of keratinized tissue and gingival margin to the acrylic guide. None of the evaluated clinical parameters differed significantly between the groups. At all evaluated postoperative time-points, both groups exhibited statistically significant differences in GR and gingival margin to the acrylic guide compared to baseline. Six months after surgery, the mean percentages of root coverage were 67.5% and 87.5% in the BFPG and SCTG groups respectively. In both groups, complete root coverage was observed in 50% of cases 6 months after surgery. The results presented herein indicate that the use of BFPG transplant has clinical similarities with SCTG and both may be considered as clinically successful methods for treating Miller Class I and II GRs.