Oral mesotherapy technique for the treatment of physiologic gingival melanin hyperpigmentation using locally injectable vitamin C: a clinical and histologic cases series.

OBJECTIVES: Vitamin C (ascorbic acid) is widely used in dermatology for skin depigmentation. However, there are very few clinical studies on the efficacy of vitamin C in gingival depigmentation. This preliminary case series aims to present the clinical effectiveness, histologic changes, and patient-reported outcomes of intra-epidermal vitamin C injections (oral mesotherapy) for managing patients with gingival melanin hyperpigmentation. METHOD AND MATERIALS: Five patients were administered locally injectable vitamin C (once per week for 4 to 5 visits) in maxillary or mandibular anterior pigmented gingiva. The depigmentation effect was evaluated using the Dummett Oral Pigmentation Index (DOPI) and Gingival Pigmentation Index (GPI). Digital photographs were used to assess gingival luminescence (L*) and pigmented surface area (PSA). Parameters were recorded at baseline and at 1 and 3 months. Melanocyte histopathologic count was determined at baseline and at 3 months. Pain, gingival color change, and patient satisfaction scores were also assessed. RESULTS: Median GPI, DOPI, and PSA were significantly reduced (P ≤ .05) from baseline to 1 month. There was no statistically significant change from 1 month to 3 months. L* value significantly increased from baseline to 3 months. A median pain score of 3 (scale of 0 to 10) was observed on the day of the procedure. A score of 3 (scale of 0 to 4) was reported for the gingival color and scores 3 and 4 (scale of 0 to 4) for the overall patient satisfaction. CONCLUSION: Oral mesotherapy using locally injectable vitamin C is a nonsurgical, minimally invasive, and efficient technique for gingival depigmentation. Indian patients were satisfied with the gingival color obtained and the overall treatment experience. CLINICAL IMPORTANCE: As all the branches of medicine, specifically dentistry, direct to minimally invasive approaches, mesotherapy shows great importance to reduce the surgical interventions, especially when esthetic outcomes are needed. Oral mesotherapy using locally injectable vitamin C can be a useful nonsurgical technique for achieving gingival depigmentation in the esthetic zone.

A Modified Suturing Protocol for Tripod Stabilization of Connective Tissue Graft and Coronal Advancement of Tunnel Flap for Treatment of Isolated Gingival Recession.

Preserving a sufficient blood supply and maintaining wound stability during the healing phase are the most crucial factors for success in root coverage procedures. Selecting the surgical technique and suturing protocol used to achieve these goals is therefore indispensable for predictable treatment outcomes. Tunneling flap procedures have evolved as a technical advancement in periodontal plastic surgery, particularly focusing on improving the vascular supply at the surgical site. Along with the development of newer flap designs for recession coverage, several suturing protocols for flap stability have been described. This paper illustrates the use of a modified suturing method for soft tissue graft stabilization in a coronally advanced tunnel flap procedure for the treatment of isolated gingival recession. It allows precise three-dimensional positioning and tripod stabilization of the graft in the tunnel as an independent step, differing from previously described techniques. A modified tissue-supported vertical mattress suture is then placed for coronal advancement and improved wound adaptation. The present authors have found that the proposed suturing protocol achieves successful integration of graft, maximum root coverage, excellent esthetic results, and limited postoperative morbidity. The suturing technique is described in detail with schematic illustrations and clinical cases, and its advantages and potential limitations are discussed.

A novel approach of combining the tunnel technique with a double papilla flap or a coronally positioned flap for the treatment of multiple adjacent gingival recessions: report of two cases.

The treatment of multiple gingival recessions (GRs) is often challenging for clinicians, mainly due to a larger avascular surface, limited blood supply, differences in recession depth, and residual keratinized tissue. Considering these factors, it may be prudent to take advantage of one surgical technique and overcome its limitations by combining it with another technique in certain clinical situations. The present clinical report describes the treatment of multiple GRs of different depths with a combination of the tunnel technique (TUN) and pedicle flap (PED) - double papilla flap (DPF) or coronally positioned flap (CPF) - in conjunction with deepithelialized connective tissue grafts in two patients. The TUN was considered as it allows faster wound healing and improved esthetics due to the avoidance of visible incisions on the surface. However, to achieve complete coverage of the exposed root surface in the deep recession of the terminal tooth, the DPF or CPF were performed. Healing was uneventful, and no postoperative complications were observed. Complete root coverage was achieved in the treated teeth of both patients at the 12-month follow-up. The combination techniques described in this article can be utilized when there is a deep recession on one of the terminal teeth and the remaining teeth exhibit shallow to moderate recession depths. Clinicians should consider the amalgamation of surgical techniques to achieve the goals of complete root coverage in order to meet patients' esthetic and functional demands while at the same time minimizing postsurgical morbidity.

Effect of antibiotic impregnation time on the release of gentamicin from cryopreserved allograft bone chips: an in vitro study.

Freezing is the most common method for storing bones until use in skeletal reconstruction. However, the effect of freezing at different temperatures on antibiotic delivery from antibiotic-coated bone chips has not been evaluated. In this study, we compared antibiotic delivery in vitro from gentamicin-coated human bone stored at different temperatures impregnated for different time periods. Bone chips obtained from human femur heads were chemically cleaned and mixed with gentamicin sulfate solution for 1 h and 10 h respectively. Samples of both groups were cryopreserved for 4 months at - 20 °C, 4 months at - 80 °C, or evaluated immediately without freezing. Antibiotic release from the bone chips was measured using Bacillus subtilis as an indicator strain. Zones of inhibition and rates of gentamicin were higher for the samples impregnated for 10 h as compared to 1 h. There was no significant difference between non-cryopreservation, cryopreservation at different temperatures of - 20 and - 80 °C on the release of gentamicin from bone chips even after storage for 4 months.