A study to evaluate the prevalence of teeth without clinically detectable mucogingival junction.

Context: The mucogingival junction (MGJ) is one of the important anatomical entities which mark the apical termination of attached gingiva, except that at palatal side. Its position is genetically determined like other organs and tissues in our body. There are certain anatomic aberrations such as abnormal teeth eruption or high frenal attachments and pathologies, such as periodontitis, leading to its absence. There are no studies on the prevalence of teeth having no clinically detectable MGJ. There is a resurgence of importance of attached gingiva, reflected by the definite presence of MGJ, through the field of dental implantology. Aims: We aim to evaluate the prevalence of teeth without clinically detectable MGJ on the buccal aspect of dentate alveolar processes. Settings and Design: This cross-sectional observational clinical study was conducted in the department of periodontology which was approved by the institutional ethical committee. Materials and Methods: Periodontally healthy as well as diseased patients of age 18-50 years were included in the study. The detection of MGJ was carried out by visual method, tension test, rolling probe method, and Lugol's iodine solution, and confirmation from any two methods was considered for the absence of MGJ. The etiology of MGJ absence (gingival recession, pocket till MGJ, trauma, abnormal frenal attachment, malposition of tooth, abnormal habits, severe abrasion, etc.,) was also evaluated. Statistical Analysis Used: Simple statistics in the form of averages and percentages were used for calculations. Results: A total of 130 subjects (3637 teeth) were examined out of which 32 (24.6%) subjects showed no clinically detectable MGJ. In all subjects, on an average, every subject has 28 teeth and out of the total 3637 teeth analyzed, only 91 (2.5%) teeth were without detectable MGJ. Conclusion: Almost 25% of the population may show a tooth or few teeth without a clinically detectable MGJ. The prevalence of teeth without clinically detectable MGJ per mouth is very low at 0.7 (approximately 1 tooth/subject).

Changes in mucogingival junction after an apically positioned flap with collagen matrix at sites with or without previous guided bone regeneration: A prospective comparative cohort study.

AIM: To assess changes in the position of the mucogingival junction (MGJ) after an apically positioned flap (APF) with collagen matrix performed at sites with or without previous guided bone regeneration (GBR). MATERIALS AND METHODS: Dental implants were placed with or without GBR (group GBR or non-GBR) depending on the available ridge width in 30 patients with a limited width of keratinized mucosa (MGJ placed more coronally than the expected prosthetic margin). An apically positioned flap with collagen matrix was performed in both groups. Changes in the position of the MGJ from the day of an apically positioned flap up to 1, 3, and 12 months thereafter were assessed on digital scans (primary endpoint). Secondary endpoints were the width and thickness of the keratinized mucosa, and the position of the mucosal margin. RESULTS: The position of the MGJ changed significantly from baseline to the first month, by 5.25 ± 2.10 and 4.40 ± 1.41 mm in groups GBR and non-GBR, respectively. Thereafter, the position remained stable in both groups up to 1 year (changes from baseline of 5.46 ± 2.28 and 4.58 ± 1.92 mm, respectively; p = .34). The position of the mucosal margin did not differ between groups GBR and non-GBR (-1.57 ± 2.04 and -1.75 ± 2.08 mm, respectively; p = .84), nor did the width of the keratinized mucosa (1.20 ± 1.03 and 0.99 ± 0.66 mm, p = .91) or its thickness (1.28 ± 0.44 and 1.40 ± 0.78 mm, p = .87). CONCLUSION: Apically positioned flap combined with a collagen matrix results in a more apical position of the MGJ at sites with or without GBR. Following a coronal shift during the first month after the apical positioning of the flap, the level of the MGJ remained stable.

Lip repositioning: An alternative to invasive surgery a 4 year follow up case report.

Excessive Gingival Display (EGD) is a multifactorial condition that needs to be managed in a sequential manner in order to reach the proper treatment technique that targets and resolves the underlying etiologies. An innovative procedure called lip repositioning has been introduced and used recently either alone or in combination with other techniques. It can be used in certain cases as an easier, less complicated alternative to major surgical methods providing a pleasant satisfactory camouflage effect with lower morbidity. A case report is presented to show the preparatory and surgical steps used to treat a 25-year-old patient with EGD using lip repositioning technique as an alternative to invasive surgery with satisfactory results that has been stable for 4 years.

Treatment of gingival recession using a coronally-advanced flap procedure with or without placental membrane.

AIM: The aim of the present study was to compare the treatment of gingival recession defects using a coronally-advanced flap procedure with or without placental membrane. METHODS: Sixty teeth in 15 patients with single and multiple Miller's class I and II gingival recession defects bilaterally in the anterior and premolar region of the maxilla and mandible were divided into two groups. In group I (control), 30 recession defects were treated with coronally-advanced flap alone using Zucchelli's technique. In group II (test), 30 recession defects were treated with coronally-advanced flap along with placental membrane. Probing depth, height of the gingival recession (HGR), clinical attachment level (CAL), width of the gingival recession, and width of the keratinized tissue (WKT) were recorded at baseline and 3 and 6 months after the surgical procedures. RESULTS: There was a statistically-significant reduction in the HGR, gain in the CAL, and WKT in group II compared to group I. CONCLUSION: Coronally-advanced flap with placental allograft provides a reliable technique for root coverage when compared to coronally-advanced flap alone.

Sub-epithelial connective tissue graft for the management of Miller's class I and class II isolated gingival recession defect: A systematic review of the factors influencing the outcome.

The aim of the present systematic review was to analyze the factors that affect the outcome of subepithelial connective tissue graft (SCTG) for managing Miller's class I and class II isolated gingival recession defect. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for systematic reviews were used. Quality assessments of selected articles were performed. Data on root surface condition, recession type defect, flap thickness, different flap designs, different harvesting techniques, presence/absence of the epithelial collar, graft thickness, flap tension, suturing techniques, and smoking-related outcomes on root coverage were assessed. The SCTG procedure provides the best root coverage outcomes for Miller's class I and class II recession. The critical threshold of flap thickness was found to be 1 mm. Maximum root coverage was achieved by envelope and modified tunnel technique. SCTG with the epithelial collar does not provide additional gains than SCTG without the epithelial collar. The thickness of SCTG for root coverage was found to be 1.5-2 mm. Greater flap tension and smoking adversely affect root coverage outcomes. Analysis of the factors discussed would be of key importance for technique selection, and a combined approach involving factors favoring outcomes of SCTG could be of clinical relevance in recession coverage.

Lip Repositioning: A Boon in Smile Enhancement.

This clinical report describes the successful use of lip repositioning technique for the reduction of excessive gingival display. The lip repositioning technique was performed with the main objective of reducing gummy smile by limiting the retraction of elevator muscles (e.g., zygomaticus minor, levator anguli, orbicularis oris, and levator labii superioris). This technique includes removing a strip of mucosa from the maxillary buccal vestibule, creating a partial-thickness flap between mucogingival junction and upper lip musculature, and suturing the lip mucosa with mucogingival junction, resulting in a narrow vestibule and restricted muscle pull, thereby reducing gingival display.

A rare presentation of lipoma on mandibular mucogingival junction.

Lipoma is the most common tumor of mesenchymal tissues of body, but its occurrence in oral cavity is infrequent. Buccal mucosa is the most common intraoral site of lipoma followed by tongue, floor of the mouth, and buccal vestibule. The involvement of mucogingival junction is rare. We present a unique case report of oral lipoma occurring on mandibular mucogingival junction with review of literature which has emphasis on differential diagnosis.

Comparison of the clinical applicability of Miller's classification system to Kumar and Masamatti's classification system of gingival recession.

BACKGROUND: The aims of the present study were to (i) Find the percentage of recession cases that could be classified by application of Miller's and/or Kumar and Masamatti's classification of gingival recession, and (ii) compare the percentage of clinical applicability of Miller's criteria and Kumar and Masamatti's criteria to the total recessions present. MATERIALS AND METHODS: A total of 104 patients (1089 recession cases) were included in the study wherein they were classified using both Miller's and Kumar and Masamatti's classification systems of gingival recession. Percentage comparison of the application of both classification systems was done. RESULTS: Data analysis showed that though all the cases of the recession were classified by Kumar and Masamatti's classification, only 34.61% cases were classified by Miller's classification. 19.10% cases were completely (having only labial/buccal recession) classified. In 15.51% (out of 34.61%) cases, only buccal recession was classified according to Miller's criteria and included in this category, although these cases had both buccal and lingual/palatal recessions. Furthermore, 29.75% cases of recession with interdental loss and marginal tissue loss coronal to mucogingival junction (MGJ) remained uncategorized by Miller's classification; categorization of palatal/lingual recession was possible with Kumar and Masamatti's classification. CONCLUSION: The elaborative evaluation of both buccal and palatal/lingual recession by the Kumar and Masamatti's classification system can be used to overcome the limitations of Miller's classification system, especially the cases with interdental loss and having marginal tissue loss coronal to MGJ.

Assessment of the width of attached gingiva using different methods in various age groups: A clinical study.

BACKGROUND: The width of attached gingiva varies from tooth to tooth and also among individuals with mixed opinions regarding an "adequate" or "sufficient" dimension of the gingiva. Although the need for a so-called adequate amount of keratinized tissue for maintenance of periodontal health is questionable, the mucogingival junction serves as an important clinical landmark in periodontal evaluation. There are various methods of locating the mucogingival junction namely the functional method and the visual method with and without histochemical staining, which aid in the measurement of the width of attached gingiva. MATERIALS AND METHODS: This study was carried out to assess the full mouth mid-buccal width of attached gingiva in individuals of four different age groups. This study also evaluated the difference in visual and histochemical methods in identification of the mucogingival junction to calculate the width of attached gingiva. RESULTS: It was seen that the width of attached gingiva increases with age, and there was no significant difference in the width of attached gingiva by both the methods. CONCLUSION: Width of attached gingival varies in different areas of the mouth and also increases with age with no significant difference in the method of its assessment.

A new classification system for gingival and palatal recession.

Various classifications have been proposed to classify gingival recession. Miller's classification of gingival recession is most widely followed. With a wide array of cases in daily clinical practice, it is often difficult to classify numerous gingival recession cases according to defined criteria of the present classification systems. To propose a new classification system that gives a comprehensive depiction of recession defect that can be used to include cases that cannot be classified according to present classifications. A separate classification system for palatal recessions (PR) is also proposed. This article outlines the limitations of present classification systems and also the inability to classify PR. A new comprehensive classification system is proposed to classify recession on the basis of the position of interdental papilla and buccal/lingual/palatal recessions.