Keratinized Tissue Width Research Articles

Treatment of Multiple Recessions Associated with Noncarious Cervical Lesions: A Case Series.

Gingival recessions with noncarious cervical lesions (NCCLs), also called combined defects, are common problems, and patients often seek treatment due to esthetic concerns or dentin hypersensitivity. This case series evaluates the effectiveness of the non-coronally advanced flap (CAF) technique combined with restorative treatment for Miller Class III gingival recessions with NCCLs. A total of 16 combined defects were included. The combined defect height (CDH), recession depth (RD), pocket depth (PD), keratinized tissue width (KTW), and presence of dentin hypersensitivity were recorded at baseline and 6 months postsurgery. The mean root coverage (mRC) was 83%, and 50% of defects presented complete root coverage (CRC). In the group with an initial KTW ≥ 2 mm, mRC and CRC were significantly higher. Further randomized controlled studies with larger sample sizes are needed to verify the prognostic factor of combined non-CAF techniques and restorative treatment for gingival recessions with NCCLs.

Comparative Evaluation of Recession Coverage Obtained Using the Pinhole Surgical Technique With and Without Platelet-Rich Fibrin: A Randomized Clinical Trial.

This randomized controlled clinical trial evaluated the pinhole surgical technique (PST) combined with platelet-rich fibrin (PRF) for the management of multiple recession defects compared to PST alone. Ten patients with 51 Miller Class I/ II or III gingival recessions were selected. Control sites were treated with PST alone, whereas test sites were treated with PST with PRF. Gingival recession depth (GRD), gingival recession width (GRW), probing depth (PD), clinical attachment level (CAL), keratinized tissue width (KTW), total soft tissue gain (TSTG), Plaque Index (PI), Gingival Index (GI), and gingival bleeding index (GBI) were measured at baseline and at 1, 3, and 6 months posttreatment. Both groups showed statistically significant root coverage. The mean recession coverage was 60.25% in the test group and 49.6% in the control group. The recession reduction from baseline was 2.50 mm for the test group and 1.88 mm for the control group. At the end of 6 months, all sites achieved adequate root coverage. PRF is a feasible alternative to connective tissue grafts as an adjunct to PST for the treatment of multiple recession defects.

Role of Keratinized Tissue on the Management of Peri-implantitis: A Case Report.

Peri-implantitis is an inflammatory condition that involves the loss of attachment and support around dental implants. In this case report, a middle-aged woman presented with two implants in the mandibular right quadrant that were diagnosed with peri-implantitis. The patient also had tenderness around the implants and reported sensitivity when performing oral hygiene procedures. Surgical treatment comprised a free gingival graft to augment the keratinized tissue width around the implants, followed by a second procedure of implantoplasty and surface decontamination. The outcome showed radiographic resolution of the peri-implant defect around the premolar implant with a marked increase of keratinized tissue (> 4 mm) around both implants after 1 year of follow up. On a patient level, significantly reduced sensitivity around the implants and better home care were reported. This case report showed that the increase of keratinized tissue may benefit the clinical and patient outcomes of peri-implantitis treatment in terms of decreased probing depths, absence of inflammation, and improved radiographic crestal stability. The combined correction of both hard and soft tissue defects around peri-implantitis lesions may facilitate treatment success and help maintain peri-implant stability.

Two-stage method of free gingival graft prior to periodontal regenerative surgery for the treatment of intrabony defects with insufficient keratinised tissue width: a study protocol for an open-label randomised controlled trial

IntroductionGuided tissue regeneration (GTR) combined with bone grafting for periodontal regenerative surgery has ideal clinical results for intrabony defect. However, some sites of intrabony defects often suffer from insufficient keratinised...

Impact of gingival phenotype on the periodontal disease.

The aims of the present study were to explore the relations between the gingival phenotype (GP) and the periodontal health status and find the prevalence of a specific gingival phenotype in a small Bulgarian population.

Three-dimensional changes of a porcine collagen matrix and free gingival grafts for soft tissue augmentation to increase the width of keratinized tissue around dental implants: a randomized controlled clinical study

BackgroundEmerging clinical data points to the relevance of the presence of keratinized tissue (KT). Although apically positioned flap/vestibuloplasty along with free gingival graft (FGG) is considered as a standard intervention for augmenting KT, substitute materials appear to be a viable treatment alternative. So far, there is a lack of data investigating the dimensional changes at implant sites treated with soft-tissue substitutes or FGG.AimThe present study aimed at comparing three-dimensional changes of a porcine derived collagen matrix (CM) and FGG for increasing KT at dental implants over a 6-month follow-up period.Materials and MethodsThe study enrolled 32 patients exhibiting deficient KT width (i.e., < 2 mm) at the vestibular aspect who underwent soft tissue augmentation using either CM (15 patients/23 implants) or FGG (17 patients/31 implants). The primary outcome was defined as tissue thickness change (mm) at treated implant sites between 1- (S0), 3- (S1), and 6-months (S2). Secondary outcomes considered changes of KT width over a 6-month follow-up period, surgical treatment time, and patient-reported outcomes.ResultsDimensional analyses from S0 to S1 and from S0 to S2 revealed a mean decrease in tissue thickness of − 0.14 ± 0.27 mm and − 0.04 ± 0.40 mm in the CM group, and − 0.08 ± 0.29 mm and − 0.13 ± 0.23 mm in the FGG group, with no significant differences noted between the groups (3 months: p = 0.542, 6 months: p = 0.659). Likewise, a comparable tissue thickness decrease was observed from S1 to S2 in both groups (CM: − 0.03 ± 0.22 mm, FGG: − 0.06 ± 0.14 mm; p = 0.467). The FGG group exhibited a significantly greater KT gain after 1, 3 and 6 months compared to the CM group (1 month: CM: 3.66 ± 1.67 mm, FGG: 5.90 ± 1.58 mm; p = 0.002; 3 months: CM: 2.22 ± 1.44; FGG: 4.91 ± 1.55; p = 0.0457; 6 months: CM: 1.45 ± 1.13 mm, FGG: 4.52 ± 1.40 mm; p < 0.1). Surgery time (CM: 23.33 ± 7.04 min.; FGG: 39.25 ± 10.64 min.; p = 0.001) and postoperative intake of analgesics were significantly lower in the CM group (CM: 1.2 ± 1.08 tablets; FGG: 5.64 ± 6.39 tablets; p = 0.001).ConclusionsCM and FGG were associated with comparable three-dimensional thickness changes between 1 and 6 months. While a wider KT band could be established with FGG, the use of CM significantly reduced surgical time and patients´ intake of analgesics.Graphical abstract

Adult periodontal comparison after treatment of palatally impacted canines aligned by conventional or accelerated minimally-invasive corticotomy-assisted orthodontic traction: A randomized controlled trial

To compare the post-treatment periodontal status of the palatally impacted canines and their adjacent teeth treated by an accelerated minimally-invasive corticotomy-assisted method versus the conventional traction method. A parallel-group two-arm randomized controlled trial was conducted on patients with palatally or mid-alveolar unilateral impacted canines. Participants were randomly selected and allocated to receive the conventional treatment (CT) with a closed surgical approach, or accelerated treatment (CAT). The evaluated periodontal variables were periodontal pocket depth (PPD), keratinized tissue width (KTW), gingival recession level (GRL), papillary bleeding index (PBI) and Gingival Index (GI). All post-treatment periodontal measurements were performed two weeks after removing the fixed orthodontic appliance. In total, 46 patients were included (CT group: n=23; mean age: 20.26±2.17 years), or accelerated treatment (CAT group: n=23; mean age: 20.39±2.27 years). The differences between the two study groups were non-significant for all periodontal outcomes at all measurement points (P>.05). The mean total values of PPD around the aligned canine did not exceed 2mm (XPPD=1.99±0.25mm; 1.91±0.26mm, in the CT and CAT group, respectively, P=0.677). The results of total values of PPD on the adjacent teeth were nearly similar in the two study groups (mean difference: 0.12mm; 0.02mm, for the lateral incisor and the first premolar, respectively). Very low GRL values were detected in the two study groups. The use of corticotomy-assisted method did not impair the periodontal health in the short follow-up term. Both treatment modalities are considered acceptable in terms of post-treatment periodontal outcomes, as the gingival indices levels were at low values.

Gingival Augmentation in the Thin Phenotype Using Injectable Platelet-Rich Fibrin and Microneedling.

Objective This study set out to examine the results of microneedling (MN) with and without injectable platelet-rich fibrin (i-PRF) in treating individuals with thin periodontal phenotypes, specifically focusing on the effects on gingival thickness (GT) and keratinized tissue width (KTW). Materials and methods Thiswas a split-mouth study involving 32 healthy patients with 64 sites having thin phenotypes classified into two groups. On the one side, i-PRF was injected (Group A), while on the other side (Group B), MN along with i-PRF was used at intervals of 10 days for a month. GT and KTW were measured at baseline, three months, and six months. The parameters were compared intra and intergroup-wise at baseline, three months, and six monthsusing the IBM SPSS Statistics software version 24(IBM Corp., Armonk, NY)and thechi-square test. Results The findings revealed that when comparing Group A, which received just i-PRF, to Group B, which had i-PRF in conjunction with MN, there was a statistically significant increase in GT in Group B. Conclusions This is a novel method in that it does not need surgical innervations to expand the gingiva in breadth or thickness. Although MN's neoangiogenesis impact contributed to thicker gingiva, i-PRF showed a greater capacity for the release of several growth factors.

Clinical outcomes of diode laser as an adjunct to nonsurgical periodontal therapy for residual periodontal pockets in mandibular second molars-a randomized controlled clinical trial.

The aim of this study was to evaluate the clinical outcomes of diode laser as an adjunct to nonsurgical periodontal therapy (NSPT) for residual periodontal pockets in mandibular second molars. Sixty-seven mandibular second molars (154 residual periodontal pockets) were recruited into the study and randomly assigned to the Laser + NSPT group and the NSPT group. The Laser + NSPT group underwent NSPT adjunct with diode laser radiation (wavelength: 810nm, power: 1.5 W, 40s maximum), while the NSPT group underwent nonsurgical periodontal therapy alone. Clinical parameters were measured at baseline (T0) and 4(T1), 12(T2), and 24(T3), weeks after treatment. Periodontal pocket depth (PPD), clinical attachment loss (CAL), and bleeding on probing (BOP) in both groups showed significant improvements at the end of study compared to baseline. The reductions of PPD, CAL, and BOP in the Laser + NSPT group were significantly greater than NSPT group. At T3, the Laser + NSPT group had a mean PPD of 3.06 ± 0.86mm, CAL of 2.58 ± 0.94mm and BOP of 15.49%, while the NSPT group had a mean PPD of 4.46 ± 1.57mm, CAL of 3.03 ± 1.25mm and BOP of 64.29%. The diode laser as an adjunct to nonsurgical periodontal therapy may contribute to clinical outcomes for residual periodontal pockets. However, the approach may cause reductionof keratinized tissue width. This study was registered in the Chinese Clinical Trial Registry ChiCTR2200061194. Diode laser as an adjunct to nonsurgical periodontal therapy may contribute to the clinical outcomes for residual periodontal pockets in mandibular second molars.

Multiple coronally advanced flap with a selective use of connective tissue graft: A 3-year prospective clinical and histological study.

The purpose of the present study was to prospectively evaluate the 3-year changes in the gingival dimensions following multiple coronally advanced flap (MCAF) with selective use of connective tissue graft (CTG). In addition, the secondary aim was to histologically identify the factors related to phenotype changes. Twenty patients treated with MCAF and site-specific application of a CTG were available for the 3-year follow-up. Outcome measures included complete root coverage (CRC), recession reduction, keratinized tissue width (KTW), marginal tissue thickness changes, and primary flap position. Biopsies were harvested at one of the sites treated with the adjunct of CTG. All sections were stained with hematoxylin and eosin, Masson trichrome, Verhoeff-van Gieson, tenascin, and alcian blue stain for semiquantitative evaluation. At 3 years, CRC was detected in 86% of sites treated with MCAF alone and 81% of sites treated with MCAF+CTG. The 47% of sites treated with MCAF+CTG presented an apical shift of primary flap from its original position. Linear regression showed a significant association between KTW change and the initial KTW in MCAF-treated sites, while both initial KTW and position of primary flap were statistically significantly associated factors with KTW changes in the MCAF+CTG group. In all the biopsies examined, there is always a marked and clear separation between the connective tissue of the gingival flap and the palatal connective tissue of the graft. The selective use of CTG is an effective treatment for multiple gingival recessions. Only a limited increase in KTW can be expected in a bilaminar technique if, during the healing phases, the connective tissue is maintained completely covered.

Influence of immediate postoperative gingival thickness and gingival margin position on the outcomes of root coverage therapy: A 6 months prospective case series study using 3D digital measuring methods.

To assess linear and volumetric changes following the treatment of gingival recessions (GRs) by means of a modified coronally advanced tunnel technique combined with acellular dermal matrix (MTUN + ADM). Patients presenting GR type 1 (RT1) GRs underwent root coverage surgery consisting of MTUN + ADM. Clinical measurements were made, and intraoral scans were obtained at baseline, postoperatively, and 6 weeks, 3 and 6 months after surgery, to evaluate changes in probing depth (PD), keratinized tissue width (KTW), recession depth (RD), recession area (RA), marginal gingival thickness (MGT), and mucosal volume (MV). The impact of patient-level and surgical-site variables upon percentage root coverage (% RC) and the likelihood of achieving complete root coverage (CRC) were explored. A total of 20 patients (n = 47 teeth) were treated. After 6 months, RD and RA decreased, while KTW, MGT, and MV increased. The mean % RC was 93% at 6 months and CRC was found on 72.3% of the sites at 6 months. The postoperative MGT changes at 1.5 and 3 mm were significantly correlated to % RC and CRC at 6 months. Each additional mm of postoperative gain of gingival thickness resulted in a 4-fold increase in the probability of achieving CRC. Additionally, gingival margin positioned ≥0.5 mm coronal to the cementoenamel junction immediately after surgery was a strong predictor of CRC. The MGT gain at 1.5 and 3 mm achieved in the immediate postoperative period is a significant predictor of CRC at 6 months when treating multiple GRs via MTUN + ADM. The Scientific rationale for the study relies on the lack of 3D digital measuring tools in the assessment of soft tissue healing dynamics after root coverage therapy. The principal findings of this study can be summarized as follows: tooth type, tooth position, and post-operative gingival margin position and gingival thickness and volume changes are predictors of CRC. Therefore, the practical implications are that the more thickness and more coronal advancement achieved immediately after root coverage surgery, the higher chance of achieving CRC.

Efficacy of Tunnel Technique (TUN) versus Coronally Advanced Flap (CAF) in the Management of Multiple Gingival Recession Defects: A Meta-Analysis.

We systematically assessed the efficacy of tunnel technique (TUN) vs. coronally advanced flap (CAF) in the management of multiple gingival recession defects in adults. Five databases were searched until September 2021 for randomized controlled trials (RCTs) assessing TUN vs. CAF; grafts of interest were acellular dermal matrix (ADM) and connective tissue graft (CTG). Primary outcomes were root coverage (RC) and complete root coverage (CRC). Secondary outcomes were clinical attachment level (CAL), keratinized tissue width (KTW), probing depth (PD), and recession coverage (REC). Effect measures were risk ratio (RR) or mean difference (MD) with their confidence intervals (95% CI). Inverse variance methods and random-effects model meta-analyses were used. Subgroup analyses by the type of graft were performed. Quality of evidence was assessed using GRADE methodology. Five RCTs (n = 173) were included, with a follow-up of 6 months for all outcomes. In comparison to CAF, TUN did not significantly reduce CRC (RR 0.65; 95% CI 0.002-176.7; p = 0.51) and did not increase RC (MD 0.99%; 95% CI -6.7 to 8.6; p = 0.80). In comparison to CAF, TUN showed no significant reduction of secondary outcomes. Subgroup analyses by type of graft showed no differences in comparison to primary analyses for primary and secondary outcomes. Three RCTs had a high risk of bias, and five RCTs had very low quality of evidence for all outcomes. In adults with gingival recessions, TUN had similar primary and secondary outcomes in comparison with CAF. Subgroup analyses by the type of graft did not affect main conclusions. More RCTs with better design are needed to further characterize the effects of TUN vs. CAF in the treatment of multiple gingival recession defects.

Relationship between supracrestal soft tissue dimensions and other periodontal phenotypic features: A cross-sectional study.

The purpose of this study was to determine the association between periodontal supracrestal soft tissue dimensions (PSSTDs) and other phenotypic features in non-molar maxillary teeth. Adult subjects in need of comprehensive dental treatment were recruited. Periodontal phenotypic variables (i.e., facial and palatal gingival thickness [GT], alveolar bone thickness [BT], and PSSTDs, namely distance from the gingival margin to the bone crest defined as periodontal supracrestal tissue height [PSTH] and distance from the cementoenamel junction to the bone crest [CEJ-BC]) were recorded using cone-beam computed tomography scans. Standardized intraoral photographs were obtained to assess facial keratinized tissue width (KTW) and other anatomical parameters (i.e., tooth type, gingival architecture, and interproximal papilla height). The study sample was constituted of 87 participants that contributed with a total of 522 maxillary anterior teeth. Differences in mean values of PSSTDs, KTW, GT, and BT were observed between tooth types and gender. Males exhibited a thicker GT and BT, and taller PSTH and KTW compared to females. Shorter CEJ-BC was associated with shorter PSTH, wider KTW, and thicker GT and BT. Shorter PSTH was associated with thicker facial BT. Notably, BT and GT were positively correlated at both facial and palatal sites, meaning that the thicker the gingival phenotype, the thicker the bone morphotype. Facial BT and facial GT were positively correlated with KTW. A flat gingival architecture was associated with the thick periodontal phenotype. Square teeth had shorter CEJ-BC, wider KTW, and thicker GT. Periodontal phenotypic features vary across and within subjects, between facial and palatal sites at different apico-coronal levels, and as a function of gender and tooth type. The shorter the PSSTDs, the wider the KTW and the thicker the GT and BT. PSSTDs, particularly PSTH, should be considered an integral component of the periodontal phenotype.

Gingival phenotype changes after different periodontal plastic surgical techniques: a single-masked randomized controlled clinical trial.

Sixty patients with RT1 single maxillary gingival recession were treated with CAF + L-PRF (20 patients), CAF + SCTG (20 patients) or CAF alone (20 patients). At baseline and 6-month after treatment, gingival thickness (GT), keratinized tissue width (KT), gingival recession (GR), clinical attachment level (CAL), probing depth (PD), PROMs, and the aesthetic outcome were recorded. CAF + SCTG and CAF + L-PRF groups showed a significantly greater mean GT increase than CAF alone (0.31 ± 0.10mm) with no significant differences between CAF + SCTG (0.99 ± 0.02mm) and CAF + L-PRF (0.92 ± 0.52mm) groups (p = 0.55). CAF + SCTG was associated with a significantly greater KT gain (3.85 ± 1.04mm), while in CAF + L-PRF (2.03 ± 0.53mm) and CAF (1.50 ± 0.69mm) groups, KT was not significantly increased. Both GR and CAL showed a significant within groups' improvement, without among-groups differences. No significant among-groups difference for the aesthetic outcome but greater discomfort and pain-killer consumption in CAF + SCTG group was detected. All investigated surgical techniques produced significant GR reduction and CAL gain. GT was similarly augmented by CAF + L-PRF and CAF + SCTG techniques; however, the CAF + SCTG technique produced a more predictable KT and GT increase. The results of our study suggest that the CAF + SCTG technique represents the most predictable method for the clinician to improve the gingival phenotype, an important factor for long term gingival margin stability.

Esthetics and bone changes of immediate implants with or without vascularized interpositional periosteal connective tissue grafting: A 2-year randomized controlled trial.

To compare esthetics at single immediately placed implants with and without soft tissue augmentation. Patients with non-restorable maxillary teeth in the esthetic zone were assigned into 2 groups: immediately placed implants with simultaneous vascularized interpositional periosteal connective tissue grafting (VIP-CTG) or non-grafted immediately placed implants (NG). The outcomes included: pink esthetic score (PES), gingival thickness, keratinized tissue width, buccal bone changes, marginal bone loss, pain, and satisfaction. Eighteen implants were included. At 2 years the mean value for PES was 12 ± 3.2 for the VIP-CTG and 12.9 ± 1.3 for the NG (p=.855). Mucosal thickness and keratinized tissue width showed no statistically significant difference between the two groups (p=.253) and (p=.931) respectively. Clinically buccal bone showed mean bone loss of 2.03 ± 1.57 mm for VIP-CTG and 1.09 ± 1.3 mm for NG (p=.247) and radiographically showed 1.67 ± 0.84 mm at the VIP-CTG and 1.16 ± 0.47 mm at the NG (p=.118). No statistically significant difference between both groups was demonstrated regarding marginal bone level changes (p=.142), pain (p=.622), or satisfaction (p=.562) at any time point. Simultaneous soft tissue grafting with immediate implant placement did not provide a more favorable outcome regarding esthetics or alveolar bone preservation effect. Undisturbed healing with the least surgical intervention seems to provide more favorable outcomes.

Comparison of the effectiveness of Gingival unit transfer and free Gingival graft in the management of localized Gingival recession - A systematic review.

Gingival Recession (GR) is defined as the displacement of the soft tissue margin apical to the cementoenamel junction which can lead to root exposure and hypersensitivity. Treatment of GR has become an important therapeutic issue due to the increasing number of cosmetic requests from patients. Several techniques exist for the management of GR that include Sub-Epithelial Connective Tissue Graft (SECTG), Pedicle Graft (lateral and coronal), and Free Gingival Graft (FGG) and more. FGG is a non-submerged grafting procedure carried out for the management of recession defects. However, FGG has limitations like aesthetic mismatch and bulky appearance. A relatively newer modification of FGG was introduced by Allen in 2004 wherein a palatal graft including the marginal gingiva and interdental tissue was used as donor tissue for recession coverage. This review aims to study and compare the use of Gingival Unit Graft/Transfer (GUG/GUT) (palatal graft including the marginal gingiva and papillae) and FGG in the management of GR. Randomized Clinical Trials, Non-Randomized Controlled Clinical Trials for the treatment of Miller Class I,II, and III of GRs by GUG with FGG were identified. Data sources included electronic databases and hand-searched journals. The primary outcome variables were complete root coverage, mean root coverage, vertical recession depth. The secondary outcome variables were keratinized tissue width gain, clinical attachment level and probing depth. Three Randomized Control Trials (RCTs) met the inclusion criteria and were evaluated in this systematic review. Both techniques showed significant improvement in clinical parameters. GUG procedure resulted in a greater percentage of sites achieving complete root coverage and vertical recession depth reduction when compared to FGG group in all the studies. Two studies reported significantly greater mean root coverage in GUG group compared to FGG group. GUG procedure revealed statistically significant greater gain in keratinized tissue width when compared to FGG group in all the studies. Because of the limited number of selected studies, no conclusive statement could be made regarding the advantage of the GUG technique over FGG. However, the percentage of sites with complete root coverage obtained in the GUG technique is higher than FGG. More RCTs with aesthetic and patient satisfaction-related parameters are needed to provide definite evidence.

Evaluation of esthetic outcome of delayed implants with de-epithelialized free gingival graft in thin gingival phenotype with or without immediate temporization: a randomized clinical trial

AimThe current study investigates the effect of immediate temporization on the pink esthetics of delayed implants in patients with thin gingival phenotype in combination with a De-epithelialized Free Gingival Graft in the maxillary premolar area.MethodologyThe study population was randomly assigned into two groups. The two groups were treated with delayed implants with simultaneous placement of a de-epithelialized free gingiva graft. The test group was immediately temporized while the control group had no temporization. The pink esthetic score was assessed as the primary outcome. Additional secondary outcomes were assessed such as the keratinized tissue width and the soft tissue thickness.ResultsTwenty implants were placed in the current study, split into 10 implants per group. The results showed that the Pink Esthetic Score of the IT group was 11.88 ± (1.13) and 11.33 ± (1.25) for the CTG group, which showed no statistical difference between the groups after 1 year of follow-up. There was also no significant difference between the two groups at 12 months regarding the keratinized tissue width and the soft tissue thickness.ConclusionsImmediate and delayed temporizations have no effect on the Pink Esthetics of the delayed implants; however, immediate temporization allowed earlier provisional crown delivery. Soft tissue augmentation of the thin gingival phenotype improved esthetics for both groups.Trial registration Name of the registry: clinicaltrials.gov; trial registration number: NCT03792425. Date of registration: January 3, 2019. URL of trial registry record: https://clinicaltrials.gov/ct2/show/NCT03792425?term=NCT03792425&draw=2&rank=1Graphical

Vertical soft tissue augmentation to treat implant esthetic complications: A prospective clinical and volumetric case series.

Challenging implant esthetic complications are often characterized by implant malpositioning and interproximal attachment loss of the adjacent teeth. However, limited evidence is available on the treatment of these conditions. The aim of this study was to evaluate the clinical, volumetric, and patient-reported outcome following treatment of peri-implant soft tissue dehiscences (PSTDs) exhibiting interproximal attachment loss on adjacent teeth, performed through vertical soft tissue augmentation with implant submersion. Ten subjects with isolated PSTD in the anterior maxilla characterized by adjacent dentition exhibiting interproximal attachment loss were consecutively enrolled and treated with horizontal and vertical soft tissue augmentation, involving crown and abutment removal, two connective tissue grafts, and submerge healing. Clinical outcomes of interest included mean PSTD coverage, mean PSTD reduction, clinical attachment level (CAL) gain at the implant and adjacent sites and soft tissue phenotype modifications at 1 year. Optical scanning was used for assessing volumetric changes. Professional assessment of esthetic outcomes was performed using the Implant Dehiscence coverage Esthetic Score (IDES), while patient-reported esthetic assessment involved a 0-10 visual analogue scale. The mean PSTD depth reduction and mean PSTD coverage at 1 year were 2.25 mm, and 85.14%, respectively. A mean keratinized tissue width (KTW) gain of 1.15 mm was observed, while the mean gain in mucosal thickness (MT) was 1.58 mm. A mean CAL gain of 1.45 mm was obtained at the interproximal aspect of the adjacent dentition at 1 year. Greater linear dimensional (LD) changes were observed at the midfacial aspect of the implant compared to the interproximal sites. The mean final IDES was 6.90 points, while patient-reported esthetic evaluation was 8.83 points. The present study demonstrated that vertical soft tissue augmentation with a submerged healing is an effective treatment approach for the treatment of challenging PSTDs with adjacent dentition exhibiting interproximal attachment loss. This technique can be effective in resolution of esthetic complications in most cases, providing a substantial gain in interproximal attachment levels at the adjacent dentition.

Multiple gingival recessions associated with non-carious cervical lesions treated by partial restoration and modified coronally advanced flap with either connective tissue graft or xenogeneic acellular dermal matrix: A randomized clinical trial.

This study aimed to compare a connective tissue graft (CTG) to a (porcine) xenogeneic acellular dermal matrix (XDM), both associated with modified coronally advanced flap (MCAF) and partial resin composite restoration to treat multiple combined defects (CDs). Seventy-eight defects in 38 patients presenting multiple combined defects, that is, gingival recession associated with non-carious cervical lesions, were treated by partial resin composite restoration (apical margin up to 1mm of the estimated cement-enamel junction) and MCAF along with CTG or XDM. After 6 months, the groups were compared with regard to clinical, patient-centered, and esthetic outcomes. CD coverage was 72.9% for CTG versus 50.7% for XDM (P<0.001). Recession reduction was 2.3mm for CTG versus 1.5mm for XDM (P<0.001). CTG resulted in a greater increase in keratinized tissue width (CTG: 0.96mm vs. XDM: 0.3mm,P=0.04) and gingival thickness (CTG: 0.9mm vs. XDM: 0.3mm,P<0.001). Both treatments successfully reduced dentin hypersensitivity and increased esthetics satisfaction, with no statistically significant intergroup differences. Moreover, XDM patients experienced a shorter surgery duration (CTG: 57.2 min vs. XDM: 37.4 min,P<0.001) and less time to no pain (visual analog scale = 0; CTG: 6.5 days vs. XDM: 3.5 days,P=0.04). CTG resulted in significantly greater root coverage and increased keratinized tissue width compared to XDM for treating multiple partially restored CDs. However, increased root coverage at the CTG sites was accounted for by increased probing depth compared to the XDM sites.

Analysis of clinical parameter and tumor necrosis factor-alpha levels on keratinized tissue around implant and tooth.

Studies have shown the importance of keratinized tissue around implants to prevent peri-implant diseases. This study aims to analyze the correlation of keratinized tissue around implants and teeth with clinical parameter scores and tumor necrosis factor-alpha (TNF-α) levels. A cross-sectional study of 20 adults with 20 dental implants and 20 contralateral teeth that have functioned suprastructurally for more than 3 months without any systemic diseases. Keratinized tissue around implant and tooth was measured. The clinical examinations included the plaque index (PI), papilla bleeding index (PBI), and pocket depth (PD). Peri-implant sulcus fluid (PISF) and gingival crevicular fluid were collected to measure TNF-α levels. Spearman's test was used to analyze the correlation. Significant differences were found between keratinized tissue around the implant in PI, PBI, and PD (P < 0.05). Differences were found between wide and narrow keratinized tissue around contralateral teeth in PI and PBI (P < 0.05) but not in PD. TNF-α levels were not correlate to keratinized tissue width around implant and contralateral tooth (P > 0.05). Strong correlations were found between each clinical parameter score and the keratinized tissue width of peri-implant tissue in PI, PBI, and PD. The clinical parameter score between wide and narrow keratinized tissue around implant showed strong correlation, particularly in PBI. This shows the importance of adequate keratinized tissue around implant to maintain implant stability.