Diagnostic accuracy of artificial intelligence versus manual detection in marginal bone loss around fixed semicolon. a systematic review.

Objectives: The aim of the review is to evaluate the existing precision of artificial intelligence (AI) in detecting Marginal Bone Loss (MBL) around prosthetic crowns using 2-Dimentional radiographs. It also summarises the recent advances and future challenges associated to their clinical application. Methodology: A literature survey of electronic databases was conducted in November 2023 to recognize the relevant articles. MeSH terms/keywords were used to search ("panoramic" OR "pantomogram" OR "orthopantomogram" OR "opg" OR "periapical") AND ("artificial intelligence" OR "deep" OR "machine" OR "automated" OR "learning") AND ("periodontal bone loss") AND ("prosthetic crown") in PubMed database, SCOPUS, COCHRANE library, EMBASE, CINAHL and Science Direct. RESULTS: The searches identified 49 relevant articles, of them 5 articles met the inclusion criteria were included. The outcomes measured were sensitivity, specificity and accuracy of AI models versus manual detection in panoramic and intraoral radiographs. Few studies reported no significant difference between AI and manual detection, whereas majority demonstrated the superior ability of AI in detecting MBL. CONCLUSIONS: AI models show promising accuracy in analysing complex datasets and generate accurate predictions in the MBL around fixed prosthesis. However, these models are still in the developmental phase. Therefore, it is crucial to assess the effectiveness and reliability of these models before recommending their use in clinical practice.

Tele-dentistry in COVID-19 era: A conduit for dental care in uncertain times.

Tele-dentistry encompasses all sorts of digital technologies that involve the exchange of patient's clinical data from a distant site for the provision of dental health care. Tele-dentistry has emerged from the concept of telemedicine, which has been in practice since the 19th century. In recent times, an upsurge in the digital technologies was noted, which has made the possibility of remote access to dental care. The outbreak of COVID- 19 pandemic has restricted the normal routine ways of clinical practice. In these challenging times, tele-dentistry serves as effective platform for providing dental health care. Tele-dentistry has vast applications across various disciplines of dentistry, including preventive dentistry, paediatric dentistry, oral medicine, and oral pathology etc. In these pandemic times, tele-dentistry can be efficiently used for identification of dental emergencies, allowing effective triage and subsequent management. There are different communication platforms available for tele-dentistry. The most common technologies used are web-based video conferencing and smart phone-based applications. As the clinicians are not aware of these digital technologies utilised in tele-dentistry, there are certain challenges associated with its use. In conclusion, tele-dentistry serves as an effective tool in providing health care in challenging times, but it has been underutilised by the dental fraternity. The legislative authorities should establish proper standard protocols to ensure the safety and confidentiality of patient information while using these digital platforms.

Comparison of the positional accuracy of robotic guided dental implant placement with static guided and dynamic navigation systems: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: The development of robotic computer assisted implant surgery (r-CAIS) offers advantages, but how the positional accuracy of r-CAIS compares with other forms of guided implant surgery remains unclear. PURPOSE: The purpose of this systematic review and meta-analysis was to evaluate the positional accuracy of r-CAIS and to compare the positional accuracy of r-CAIS with s-CAIS and d-CAIS. MATERIAL AND METHODS: Five databases were systematically searched by 2 independent reviewers for articles published before May 2023. A manual search was also performed. Articles evaluating the positional accuracy of r-CAIS were included. The Cochrane risk of bias tool was used for the clinical studies, whereas the QUIN tool was used for the in vitro studies. A meta-analysis was performed to compare the positional accuracy of r-CAIS with d-CAIS. RESULTS: Thirteen studies were included, with 9 in vitro studies, 4 clinical studies, and a total of 920 dental implants. A high risk of bias was noted in 6 studies and low to moderate in 7 studies. R-CAIS showed greater accuracy for the coronal, apical, and angular deviations compared with d-CAIS. (-0.17 [-0.24, 0.09], (P<.001); -0.21 [-0.36, -0.06] (P=.006), and -1.41 [-1.56, -1.26] (P<.001)) CONCLUSIONS: R-CAIS can provide improved positional accuracy compared with d-CAIS when considering coronal, apical, and angular deviations. However, evidence to compare the positional accuracy of r-CAIS with s-CAIS was insufficient. These results should be interpreted with caution because of the limited data and the bias noted in several studies.

Frequency of Contamination on Used Healing Abutments after Sterilization: An In Vitro Study.

PURPOSE: To determine and compare the frequency of contamination on different sites of healing abutments (HAs) after sterilization with Phloxine B dye on unused and used HAs after sterilization. MATERIALS AND METHODS: A total of 60 HAs were divided into two test groups: (1) used and sterilized and (2) a control group (unused). The test group was evaluated for contamination after sterilization; the control group did not undergo any procedure. Data were analyzed using SPSS version 22 (IBM). Descriptive statistics were used to determine the frequency of contamination in the different groups and at the different HA sites. Chi-square test was used to evaluate the association of frequency of contamination with the HA site and design. The level of significance was kept at P ≤ .01. RESULTS: The test group showed more contamination compared to the control group. The most contaminated sites were the screw thread and the screwdriver engagement location. CONCLUSIONS: HA reuse is cost-effective, but cleaning and sterilization was not effective for these components; thus, HAs need to be reused with caution because they were heavily contaminated when compared to new HAs. Among the different sites, the screw thread and screwdriver engagement sites were more prone to contamination. HA type did not influence the frequency of contamination.

Writing Letters to the Editors as a Method to Teach and Support Learning.

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Clinical applications and novel approaches in stem cell: an insight to dental pulp regeneration.

Objectives: The aim of the review is to present the currently applied tissue regeneration through stem cells technology in regenerative endodontics. This review also summarises the various preclinical models used for the evaluation of stem cell-based therapies, their limitations, recent advances and challenges related to clinical applications of human stem cells. Methodology: A literature survey from 2010 to August 2022 was carried out in various electronic databases to identify the articles required for review on Pulp Regeneration through Stem Cells Technology. MeSH terms/keywords such as "Pulp regeneration," "Pulp Revascularization," "Pulp revitalization," "Regenerative Endodontics" were used to search in the electronic databases comprised of PubMed database, SCOPUS, COCHRANRE library, EMBASE, CINAHL, ICTRP, Science Direct and a manual search was also done using the cross references and textbooks. RESULTS: The searches revealed 299 articles. After reading the full text articles and applying the inclusion and exclusion criteria 15 articles were selected for the review fulfilling the criteria of the study. CONCLUSIONS: Currently in regenerative endodontics, there is a broad consent that the final tissue acquired is more likely to bone-like tissue mixed with connective tissue rather than the pulp-dentin complex. Moreover, re-innervation from sensory axons in regenerated tissue, is still to date, difficult to achieve.

The Implication of Stem Cells in Direct Pulp Capping: Where Do We Stand?

Direct pulp capping has been established as a more conservative alternative to root canal therapy, especially in case of an iatrogenic or traumatic exposure of the dental pulp. However, recent literature focuses on regeneration therapies to develop a physiological dentin barrier. The process of tissue regeneration through stem cell therapy involves a complex interaction between stem cells, growth factors and scaffolds known as the 'tissue engineering triad'. Recent advancements in stem cell therapy focus on the re programming of stem cells, development of scaffolds and enhancement of the regenerative potential of these stem cells, using appropriate growth factors and transfer media. This article provides a summary of the current evidence regarding the use of stem cell therapy in direct pulp capping. The sources of stem cells, types of scaffolds and growth factors have been described in detail along with the limitations and future prospects.

Evaluation of the Nasopalatine Canal (NPC) in a subset of Pakistani population, using Cone Beam Computed Tomography (CBCT).

OBJECTIVE: To evaluate variations in the shape, diameter, length and width of the nasopalatine canal along with the width of the buccal cortical bone anterior to it, using cone beam computed tomography imaging. METHODS: The retrospective, cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, from September to October 2020, and comprised pre-existing cone beam computed tomography scans taken between 2015 and 2020 of patients of either gender aged 18-60 years who had maxillary central incisors present. The shapes and dimensions of the nasopalatine canal were observed along with the buccal bone anterior to the nasopalatine canal. Data was compared with respect to age and gender. Data was analysed using SPSS 23. RESULTS: Of the 90 scans evaluated, 46(51.1%) belonged to females with a mean age of 37.85±18.19 years, and 44(48.9%) belonged to males with a mean age of 38.07±13.58 years. The mean length and width of the nasopalatine canal was 11.28±1.90mm and 2.62±0.91mm, respectively. The nasopalatine canal was significantly longer (p<0.01) and wider (p=0.02) in males than females. The mean diameter of foramen of Stenson was 2.99±1.17mm and incisive foramen was 6.09±1.80mm. The mean width of the buccal cortical bone at the most coronal, middle and most incisal levels was 7.20±1.70mm, 6.12±1.31mm and 6.12±1.31mm, respectively. Buccal bone width was wider in males than females, but the difference was significant only at the midpoint (p<0.05). CONCLUSIONS: There was a significant difference in the dimensions of the width and length of the NPC with respect to gender. No significant differences were observed with respect to age.

Effect of different access cavity designs on fracture toughness of endodontically treated teeth: a systematic review and network meta-analysis.

Objective To compare the effect of different endodontic access cavities on fracture toughness of extracted endodontically treated human teeth.Data/sources An electronic literature search was performed in seven databases as well as hand search until September 2020. Risk-of-bias tool was used to evaluate the quality of included studies. Random effects frequentist network meta-analysis was performed, with mean difference (MD) and 95% confidence interval (CI) as the effect measure. Confidence in the documented evidence was assessed through the newly fuelled Confidence in Network Meta-analysis (CINeMA) framework based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.Study selection A total of 844 articles were obtained in the electronic and hand search. After the application of the eligibility criteria and duplicate removal, 14 studies were included in this systematic review. All included studies were in vitro that evaluated the influence of conservative endodontic cavities (CECs) on fracture toughness in extracted endodontically treated human teeth and compared to traditional endodontic cavities (TECs). In total, ten studies (n = 456) were included in the network meta-analysis for molars. The overall risk of bias was moderate.Results The results showed that when compared to intact teeth, the greatest reduction in fracture resistance was reported for TEC (MD: -927.52; 95% CI [-1304.80; -550.24]) and CEC showed least reduction in fracture resistance (MD: -365.59; 95% CI [-759.02; 27.83]). The surface under the cumulative ranking curve (SUCRA) value for intact teeth was highest (85.4% probability of being ranked as first), followed by CEC (51.4% probability of being ranked as second), with CEC presenting the highest probabilities to be the most effective access cavity design, according to the RANK (receptor activator of NF-kappaB) table. Level of confidence varied from low to moderate across all formulated comparisons.Conclusion Overall, based on the included in vitro studies in this systematic review, CEC was the most favourable access cavity design when compared to other (truss access cavities, TEC and ninja cavities) and TEC was the least favourable for fracture resistance; however, the level of evidence was moderate.

Frequency of Contamination on Used Healing Abutments after Sterilization. An In Vitro Study.

PURPOSE: To determine and compare the frequency of contamination on different sites of healing abutments after sterilization with Phloxine B dye on unused and used healing abutments after sterilization. MATERIALS & METHODS: A total of 60 healing abutments were divided into two test groups: (1) used and sterilized and (2) a control group (unused). The test group was evaluated for contamination after sterilization; the control group did not undergo any procedure. Data were analyzed using SPSS version 22. Descriptive statistics were used to determine the frequency of contamination in the different groups and at the different healing abutment sites. Chi-square test was used to evaluate the association of frequency of contamination with the site and design of the healing abutment. The level of significance was kept at P ≤ .01. RESULTS: The test group showed more contamination compared to the control. The most contaminated sites were the screw thread and the screwdriver engagement location. CONCLUSION: Reuse of healing abutments is cost-effective, but cleaning and sterilization was not effective for these components; thus, healing abutments need to be reused with caution as they were heavily contaminated when compared to new healing abutments. Among the different sites, the screw thread and screwdriver engagement sites were more prone to contamination. Healing abutment type did not influence the frequency of contamination.

Effect of Light Emitting Diode (LED) Curing Modes on Depth of Cure (DoC) in BulkFill Composite Resin: An invitro study.

Objectives: To evaluate the depth of cure in smart dentin replacement bulkfill composite resins polymerized by constant, pulse and ramped light-emitting diode curing modes. METHODS: The in vitro experimental study was conducted in November and December 2019 at the dental clinics of Aga Khan University Hospital, Karachi, and comprised of cylindrical composite specimens 8x4mm in size which were polymerised in Teflon moulds using light-emitting diode under constant mode in Group 1, pulse mode in Group 2 and ramped mode in Group 3. Once polymerised, each specimen was extruded from the mould and, using the International Organisation for Standardisation-4049 scrapping method, uncured resin was removed. Specimen lengths were measured with a Vernier calliper. Each specimen was measured thrice and the mean was taken as the depth of cure. Data was analysed using SPSS 24. RESULTS: Of the 33 specimens, there were 11(33.3%) in each of the 3 groups. Mean depth of cure in Group 1 was 2.92±0.29mm, in Group 2 it was 2.88±0.27mm, and it was 3.18±0.26mm in Group 3. The difference between Group 2 and Group 3 was statistically significant (p<0.05). Conclusion: Maximum depth of cure of smart dentin replacement bulkfill composite was achieved by ramped cure mode of light-emitting diode unit, followed by constant and pulse modes.

Knowledge and awareness regarding uses of extracted natural tooth in clinical practice.

Restoration of aesthetics is one the major patients' concern in dentistry which may be disrupted due to tooth-loss secondary to trauma, or as part of orthodontic treatment or periodontal problem. A number of treatment options are available for the replacement of teeth, but they may be expensive, and time-consuming, involving artificial teeth. For immediate tooth replacement, patient's own intentionally extracted or unintentionally avulsed tooth maybe used. The current narrative review was planned to discuss various techniques for the use of natural tooth pontic, which preserves the original contours, size and colour of the replaced tooth. Before using these teeth in a prosthesis, they need to be thoroughly disinfected and stored in appropriate medium according to the global guidelines. This reversible option would boost patient's confidence, preserve natural tooth anatomy and improve patient's acceptance.

Radiographic evaluation of the margins of clinically acceptable metal-ceramic crowns.

OBJECTIVE: To radiographically evaluate the proximal marginal fit of the clinically acceptable metal-ceramic crowns. METHODS: The prospective study was conducted at the dental clinics of Aga Khan University, Karachi, from July to December 2018, and comprised metal-ceramic crowns that were evaluated prior to the cementation. Clinical examinations were conducted by seating the crown on the tooth preparation and visual assessment was done using sharp explorer along the margins. Clinically acceptable crowns were then evaluated on the bite-wing radiograph. Any horizontal or vertical inaccuracy of >0.5mm at the proximal margins was recorded as 'discrepancy'. Data was analysed using SPSS 22. RESULTS: Of the 230 interproximal margins of 115 crowns evaluated, 113(49.1%) sites had marginal discrepancies; 44(19.1%) horizontal discrepancies, 58(25.2%) vertical discrepancies, and 11(4.8%) having both horizontal and vertical discrepancies. Horizontal crown margin discrepancies were most associated with the mesial site of the maxillary crowns, while vertical discrepancies were commonly associated with the distal aspect of all crowns (p<0.050). CONCLUSIONS: Almost half of the crowns that were considered clinically acceptable had some vertical or horizontal marginal discrepancy on radiographic evaluation.

Comparison of surface defects in Protaper Next and Hyflex EDM files after single clinical use: A stereoscopic evaluation.

OBJECTIVE: To compare the surface defects created on the ProTaper Next files versus HyFlex Electrical Discharge Machining files after single clinical use in molars. METHODS: The cross-sectional study was conducted in the dental department of the Aga Khan University Hospital, Karachi, from December 2018 to June 2019, and comprised Nickel-Titanium files belonging to HyFlex Electrical Discharge Machining and ProTaper Next to perform complete root canal treatment of molar teeth. The files were first visually examined and then analysed under 25.6x magnification using a stereomicroscope for the evaluation of surface defects. A photographic record was maintained and studied. Data was analysed using SPSS 23.0. RESULTS: Of the 114 files, 38(33.3%) each were ProTaper Next X1, ProTaper Next X2 and HyFlex Electrical Discharge Machining. The number of files showing defects under microscopic evaluation were 17(14.9%). Deformation of the cutting edge was the most frequently seen defect type, found in 9(7.9%) files. The frequency of fractured files was 4(3.5%). The odds of microscopic defects in HyFlex Electrical Discharge Machining files was 2.64 times that of ProTaper Next files. CONCLUSIONS: Even after single clinical use, HyFlex Electrical Discharge Machining files were more likely to get microscopic defects on their surface compared to ProTaper files.

Oral manifestations of Covid-19-A literature review.

Initially, it was reported that coronavirus 2019 disease (Covid-19) affects respiratory, gastrointestinal and neurological systems, but the oral, olfactory and integumentary systems are also involved. This review discusses various oral manifestations of Covid-19 reported in the literature along with possible underlying mechanisms. The reported manifestations include taste impairment, oral mucosal changes (petechiae, ulcers, plaque-like lesions, reactivation of herpes simplex virus 1(HSV1), geographical tongue and desquamative gingivitis) and dry mouth. The prominent location for mucosal lesions are tongue, palate and labial mucosa. The exact pathogenesis of these oral symptoms is not known. Angiotensin-converting enzyme 2 (ACE2) cell receptors are expressed in abundance on oral mucosa allowing severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) to infect them. Gustatory impairment along with olfactory changes is now listed as a symptom of Covid-19 by the World Health Organization, but further research is needed to confirm a link between reported additional oral symptoms and Covid-19. Dental professionals may encounter individuals with Covid-19 and be called upon to identify various oral manifestations of this disease.

Cone Beam Computed Tomography based evaluation of position of mental foramen and its relation to apices of mandibular posterior teeth in a sample of Pakistani population.

OBJECTIVE: To radiographically determine the mental foramen position, its distance to the nearest apex and the prevalence of anterior loop of mandibular nerve using cone-beam computed tomography scans. METHODS: The cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, from January to June 2020, and comprised cone-beam computed tomography scans of males or females of Pakistani origin aged 15-65 years with intact mandibular dentition and fully formed roots with matured apex. The scans were analysed to determine the horizontal position of mental foramen and to classify it according to the Tebo and Telford classification. The vertical distance from mental foramen to the nearest tooth apex was measured and the mandibular nerve configuration was determined. Data was analysed using SPSS 23. RESULTS: Among the 96 scans, the most frequent location of mental foramen MF was along the long axis of 2nd premolars for both right 50(52.1%) and left 49(51%) sides, followed by between 1st and 2nd premolars for both right 28(29.2%) and left 38(39.6%) sides. The mean minimum distance from mental foramen to the nearest root apex was 3.75±2.59mm and 3.99±2.26mm on right and left sides, respectively. There was bilateral symmetry on both sides. The most frequent mandibular nerve configuration on the right 69(72.6%) and left 75(78.1%) sides, with anterior loop being the least common; right side 3(3.2%) and 5(5.2%) left side. Conclusion: The most common position of mental foramen was along the long axis of 2nd premolars while the anterior loop was the least common.

A CBCT based evaluation of root proximity of maxillary posterior teeth to sinus floor in a subset of Pakistani population.

OBJECTIVE: To evaluate the vertical relationship of the roots of maxillary posterior teeth with maxillary sinus floor, and its association with age, gender and bilateral jaw symmetry. METHODS: The cross-sectional study was conducted at a tertiary care hospital in Karachi from June to December 2018, and comprised patients who visited the dental clinics and underwent cone-beam computed tomography scans. The scans were evaluated in the axial, coronal and sagittal planes and roots were classified using Jungs classification for proximity to maxillary sinus floor. The distance between the sinus floor and the apices of maxillary posterior teeth was measured. Data was analysed using SPSS 23. RESULTS: There were 60 scans with 1066 roots. The most common maxillary tooth root in Type III group of Jung classification was the mesio-buccal root of the 2nd molar with the shortest mean distance of 0.44±3.05mm, followed by palatal roots of the 1st molar with the shortest mean distance of 1.58±4.01mm. The maxillary tooth root most frequent in Type I group was buccal root of 1st premolar with a mean distance of 8.15±6.65mm, and the 2nd premolar with a mean distance of 7.38±6.60mm. No significant difference was found in terms of gender and sides (p ≥0.05). CONCLUSIONS: The most common tooth root protruding in the sinus was found to be the mesio-buccal root of the 2nd molar, followed by palatal roots of the 1st molar. The most distant maxillary tooth root from the sinus was the buccal root of 1st and 2nd premolars.

Comparison of antimicrobial efficacy of Calcipex and Metapex in endodontic treatment of chronic apical periodontitis: a randomised controlled trial study protocol.

INTRODUCTION: Various intracanal medicaments have been used in cases of chronic apical periodontitis for appropriate disinfection of the root canal system to eliminate microbes especially from the inaccessible areas. Calcium hydroxide is the most common intracanal medicament available in various forms, but its effectiveness with or without iodoform using microbial culture is unknown. Therefore, our aim is to compare the antimicrobial efficacy of Calcipex and Metapex in endodontic treatment of teeth presenting with chronic apical periodontitis by assessing the bacterial load reduction. METHOD AND ANALYSIS: 60 single rooted teeth of patients with diagnosis of chronic apical periodontitis will be selected and the canals debrided chemomechanically. The patients will be randomised into two groups: Calcipex and Metapex. The first sample (S1) for bacterial culture will be taken before placement of intracanal medicament and the second sample (S2) will be taken after 7 days, before final obturation from the canal and sent to lab for culture. Colony-forming unit will be evaluated. Paired t-test will be used to assess difference between antimicrobial efficacies within the group of medicaments. Independent sample t-test will be used to assess antimicrobial efficacies between groups. Level of significance will be kept at 0.05. ETHICS AND DISSEMINATION: Approval from Aga Khan University Hospital Ethical review committee is taken. Findings will be reported according to the Standard Protocol Items for Randomised Trials guidelines. Research findings will be disseminated through annual reports, peer-reviewed journals and conferences. TRIAL REGISTRATION NUMBER: NCT04336709.

Comparison Of Centering Ability And Transportation Of The Protaper Next And Oneshape File Rotary Systems For Preparing Simulated Curved Canal.

BACKGROUND: To compare the effect of ProTaper Next and One Shape rotary files on canal transportation and centering abilities in resin block with simulated curved canal. METHODS: An in-vitro experimental study was carried out in Dental clinics. Sixty resin blocks (30 per group) having simulated curved canals prepared with ProTaper Next and One Shape and then filled with red and blue Indian ink, respectively. Photographs of resin blocks obtained using standardized manner were then transferred to the Adobe Photoshop 7.0. Centering abilities and amount of transportation were then calculated at coronal, middle and apical portion of canal for both the groups. Independent sample t-test was used to compare the transportation and centering ability of both file systems. Level of significance was kept at p-value ≤0.01. RESULTS: One Shape file resulted in more canal transportation at all the levels (apical, middle and coronal part) as compared to ProTaper Next file, however, difference was not statistically significant (p-value >0.01). Statistically significant difference was noted at the apical third between these two rotary files with One Shape file showing more centered preparation as opposed to ProTaper Next file (p-value <0.01). CONCLUSIONS: One Shape file system had more centered canal preparations specifically at the apical region as compared to ProTaper Next. One Shape also lead to more canal transportation in comparison to ProTaper Next, however the difference was not statistically significant.

Effect of full sulcular versus papilla-sparing flap on periodontal parameters in periradicular surgeries: A systematic review and meta-analysis.

BACKGROUND: Access to apical root canal system is gained after flap elevation using various incision techniques. Soft-tissue healing after periradicular surgery may include gingival recession, papilla recession, changes in probing depth, and clinical attachment loss. OBJECTIVE: The objective of this study was to compare the effect of full sulcular flap design versus papilla-sparing flap design on the periodontal parameters in periradicular surgeries. MATERIALS AND METHODS: It was a systematic review and meta-analysis. Electronic and manual searches were conducted in multiple databases including PubMed, Dental and Oral Sciences, Cochrane, and CINAHL Plus until May 2019. Initial search yielded 2575 studies with 5 articles meeting the inclusion criteria. The primary outcomes assessed were gingival recession and change in the papilla height. The secondary outcomes evaluated were probing depth, clinical attachment loss, postoperative pain, bleeding, and discomfort. Random-effects model was employed for computation of effect size, and forest plots were made. RESULTS: Out of the five articles that satisfied the inclusion criteria, three were randomized control trials and two were nonrandom trials. No significant differences were found in the gingival recession (P = 0.79), papilla height (P = 0.55), gingival bleeding, and plaque indices. Statistically significant differences in probing depth (P = 0.006) and clinical attachment loss (P = 0.0004) were observed for the two flap designs in probing depth (P = 0.006) and clinical attachment loss (P = 0.0004). CONCLUSIONS: The present systematic review and meta-analysis showed that probing depth and attachment loss are affected by the choice of flap design. On the other hand, gingival recession and papilla height are not influenced by the type of incision. However, finding of the present review may change if more studies on this topic will be included in the future. Therefore, more clinical trials with long-term follow-ups are needed.