The effects of vertically coronally advanced flap and free gingival graft techniques on shallow vestibule: a randomized comparative prospective trial.

OBJECTIVES: The present study aimed to compare the influence of vertically coronally advanced flap (V-CAF) and free gingival graft (FGG) techniques on shallow vestibule depth (VD). MATERIALS AND METHODS: Parallel-arm randomized clinical trial was conducted on 38 sites treated with either FGG or V-CAF. Periodontal variables (VD, recession depth and width, probing depth, clinical attachment level, keratinized tissue height (KTH), and tissue thickness (TT)), clinician- and patient-based subjective variables were assessed. RESULTS: All periodontal variables showed significant improvements in both groups at all follow-up intervals compared to baseline (p < 0.05). Both groups increased VD compared to baseline. RC and CRC were similar after treatment for both techniques. FGG provided a greater increase in KTH (p < 0.001) and VD (VD1, p = 0.02 and VD2, p < 0.001) while V-CAF exhibited more TT gain (p = 0.002). Except overall tissue appearance that was better in V-CAF (p < 0.001), no inter-group significant difference existed in patient-based variables. CONCLUSIONS: Both techniques were significantly effective in VD increasing. While both techniques were equally successful in RC, V-CAF provided higher TT gain and better tissue appearance. V-CAF can be chosen instead of FGG in the treatment of recessions with shallow VD. CLINICAL RELEVANCE: It can be recommended to prefer V-CAF instead of FGG in the treatment of shallow vestibule. TRIAL REGISTRATION NUMBER: NCT05777811 (clinicaltrials.gov).

An Unusual Case of Early Dental Implant Failure in an Otherwise-Healthy Patient due to Actinomycosis.

Actinomyces species are members of normal oral flora that may give rise to a rare disease-oral actinomycosis. Presented herein is a case of early implant failure associated with actinomycosis in an otherwise healthy 43-year-old female and the treatment adopted after explantation. Clinically, 1 month after the implant placement, the peri-implant soft tissues were hyperplastic and associated with an excessive tissue reaction, bleeding, suppuration, deep probing depth, and implant mobility of #19 and #20 implants. Both implants were removed and all granulomatous tissues were thoroughly debrided. Histopathological examination revealed signs of acute ulcerative inflammatory reaction and Actinomyces colonies. The patient was prescribed short-term oral penicillins. Six months after explantation, the deficient bone was augmented using a combination of absorbable collagen membrane, autogenous block bone, and xenograft. The patient was followed for 1 year; and subsequently, 2 implants were re-inserted at the same positions. The patient was followed and no recurrences were observed. Implant failure due to actinomycosis is an extremely rare condition, and a definitive diagnosis is therefore essential for successful treatment.

Cyanoacrylate and hyaluronic acid combination on palatal donor site management after de-epithelialized graft harvesting.

BACKGROUND: Although soft tissue substitutes showed promising improvement in the past decade, epithelialized gingival graft (EGG) is still widely used in periodontal plastic surgery applications. Donor site management after EGG harvesting has been challenging for clinicians. This study aimed to compare the effectiveness of cyanoacrylate, hyaluronic acid, and their combination in palatal donor site management after EGG harvesting. METHODS: Data from 89 patients were included and categorized as gelatin sponge (GS), gelatin sponge with either cyanoacrylate (GS + CY), hyaluronic acid (GS + HA), or both (GS + CY + HA). The data of pain perception (PP), quantity of analgesics (QA), secondary bleeding (SB), epithelization level (EL), and color match (CM) were assessed retrospectively. RESULTS: The GS + CY and GS + HA + CY groups showed lower PP scores compared to the GS and GS + HA groups (p < 0.05). The QA was higher in the GS group compared to the GS + CY and GS + HA + CY groups (p < 0.001). All study groups showed greater EL than GS group on day 7 (p < 0.001). On day 14, full EL was present in 81% of the patients in the GS + HA + CY group, which was higher than the other groups (p < 0.001). All study groups reported lower SB in the first 3 days, which was lower compared to the GS group (p < 0.001) and showed higher CM scores than the GS group on days 7 and 14 (p < 0.001). CONCLUSIONS: CY application reduces pain and analgesic intake and HA may support the wound healing with increased EL. Using the CY-HA combination provides additional benefits for donor site management.

Statherin and alpha-amylase levels in saliva from patients with gingivitis and periodontitis.

OBJECTIVES: Salivary statherin and alpha-amylase play significant roles in biofilm formation and pathogenic bacteria adhesion. Examination of these proteins may provide information on their roles in periodontal diseases. The present study was based on the hypothesis that; the salivary proteins -statherin and alpha-amylase- effective on biofilm formation, may play important roles in the etiology of periodontal disease. Therefore, we aimed to analyze the differences in periodontal diseases compared to periodontal health in order to search their roles in periodontal disease. METHODS: Patients with gingivitis (n = 26) and periodontitis (n = 20), and periodontally healthy individuals (n = 21) were included in this study. Unstimulated whole saliva samples were obtained from a total of 67 individuals. Salivary statherin level and alpha-amylase activity were determined using ELISA and enzymatic methods, respectively. RESULTS: Statherin levels in saliva were significantly higher in the periodontitis group compared to the gingivitis group (p = 0.014), while alpha-amylase activities and total protein levels were slightly higher in the periodontitis and gingivitis groups compared to controls, without significant differences among the groups (p = 0.295 and p = 0.019, respectively). Statherin levels showed positive correlations with gingival and plaque indices in the disease groups. CONCLUSIONS: The results suggest that statherin level in saliva increase to provide a protective effect against periodontitis, and higher salivary statherin level is related to the degree of gingival inflammation and plaque accumulation.

Comparison of two techniques in gingival recession treatment: A randomized one-year clinical follow-up study.

BACKGROUND: Gingival recession (GR) is highly prevalent in the general population and represents a significant concern for patients and clinicians. Various surgical techniques have been proposed to treat gingival recession. Well-designed trials with clinicianand patient-based parameters, evaluating the envelope connective tissue graft (E-CTG) and semilunar coronally advanced flap (SCAF) techniques are still needed. OBJECTIVES: The aim of this trial was to compare the effectiveness of E-CTG and SCAF in the treatment of GR during a 1-year follow-up. MATERIAL AND METHODS: A total of 42 patients with GR were treated with E-CTG (n = 20) or SCAF (n = 22). Clinician-based recordings of recession depth (RD), recession width (RW), probing depth (PD), clinical attachment level (CAL), keratinized tissue width (KTW), tissue thickness (TT), clinical attachment gain (CAG), root coverage (RC), keratinized tissue change (KTC), and wound healing index (WHI), as well as patient-based parameters of dentine hypersensitivity (DH), tissue appearance, patient expectations, and esthetics were collected at baseline (BL), 6 weeks (T 1 ), 6 months (T 2 ), and 1 year (T 3 ). RESULTS: After the treatment, E-CTG demonstrated better outcomes than SCAF in terms of CAG (50.70% vs. 33.33%), RC (85.60% vs. 35.60%) and KTC (1.70 ±1.49 mm vs. 0.36 ±0.96 mm) at T 3 . Similar findings were detected in terms of WHI, tissue appearance, patient expectations, and esthetics. Although inconvenient surgical experience was recorded, better results were obtained after E-CTG in terms of DH and meeting the RC expectations. CONCLUSIONS: Despite it being more difficult surgical experience and the risk of keloid formation, E-CTG was superior to SCAF in terms of RC percentage, reducing DH and obtaining satisfactory RC. However, it is still necessary to improve patient comfort in the case of E-CTG.

Analysis of the nano and microstructures of the cervical cementum and saliva in periodontitis: A pilot study.

OBJECTIVES: During the progression of periodontitis, the structures of the cementum and saliva are altered due to pathological changes in the environment. This study aimed to analyze the nanostructures of the cervical cementum and saliva in patients with periodontitis. METHODS: Patients with periodontitis (n = 10) and periodontally healthy controls (n = 8) were included. Single-rooted teeth with indications for extraction were obtained from individuals. The cervical-thirds of the roots were sectioned transversely to obtain 1 mm thick sections. Unstimulated whole saliva samples were collected from each individual. The nanostructures of the cementum and saliva were analyzed using small and wide-angle X-ray scattering methods. RESULTS: The mean radius and distance values of the cementum nanoparticles in the periodontitis and control groups were 368 Å and 1152 Å, and 377 Å and 1186 Å, respectively. The mean radius and distance values of the saliva nanoparticles in the periodontitis and control groups were 425 Å and 1359 Å, and 468 Å and 1452 Å, respectively. More wide-angle X-ray scattering profile peaks were observed in the cementum of the controls. Similarities were observed between the 3D profiles of the cementum and the saliva nanoparticles. CONCLUSIONS: According to the results of the present study, (i) the cementum and saliva nanoparticles were of similar size in periodontitis and healthy controls, (ii) the cementum was more crystalline according to the (002) crystallographic plane in controls, and (iii) the similarities in the 3D-profile of the cementum and saliva nanoparticles suggest some interactions between them in the sulcus/periodontal pocket at the nanolevel.