Diagnostic reproducibility of the 2018 Classification of Gingival Recession Defects and Gingival Phenotype: A multicenter inter- and intra-examiner agreement study.

BACKGROUND: The aim of this study was to investigate the inter- and intra-examiner agreement among international experts on the diagnosis of gingival recession defects using the 2018 Classification of Gingival Recession Defects and Gingival Phenotype as proposed in the 2017 World Workshop. METHODS: Standardized intraoral photographs from 28 gingival recession defects were evaluated twice by 16 expert periodontists. Recession type (RT), recession depth (RD), keratinized tissue width (KTW), gingival thickness (GT), detectability of the cemento-enamel junction (CEJ), and presence of root steps (RS) were recorded and used for the analysis. Intra- and inter-examiner agreements were calculated for individual variables and for the overall classification. Intraclass correlation coefficient with 95% CI was used for RD and KTW; Kappa with 95% CI was used for GT, CEJ, and RS; quadratic weighted Kappa with 95% CI was used for RT. RESULTS: Overall intra- and inter-examiner agreements were highest for KTW (0.95 and 0.90), lowest for GT (0.75 and 0.41), with the other variables in between (RD: 0.93 and 0.68, RS: 0.87 and 0.65, RT: 0.79 and 0.64, CEJ: 0.75 and 0.57). Overall intra- and inter-examiner agreements for the matrix were 62% and 28%, respectively. Significant effects existed between one variable's measurement and other variables' agreements. CONCLUSIONS: The 2018 Classification of Gingival Recession Defects and Gingival Phenotype is clinically reproducible within the examiners, and when the variables forming the matrix are analyzed individually. The between-examiner agreement for the complete matrix showed lower reproducibility. The agreement was highest for KTW and RD, and least for GT.

Short- and Long-Term Outcomes of Treatment of Multiple Lingual Recessions Using the Bilaminar Subperiosteal Tunnel Technique.

Treatment of gingival recession defects on the lingual surface of mandibular anterior teeth is a challenge for the periodontist because of the region's unique anatomical features. Although there are no esthetic issues, lingual recessions should be considered seriously, especially on mandibular incisors, because they are frequently associated with periodontitis and dental hypersensitivity. The treatments and the long-term outcomes (5 years) of three clinical cases of multiple lingual recessions are presented. The tunnel technique associated with subepithelial connective tissue graft was chosen. The postoperative period was almost uneventful in all treated cases, and the 1-year outcomes were successful. Great recession reduction, up to complete root coverage, was seen, as were significant increases of both the apicocoronal amount and thickness of keratinized tissue. At the 5-year follow-up, the tissues were stable; only a slight apical shift of the gingival margin was noted in one case. The modification of the periodontal phenotype following the tunnel technique with the subepithelial connective tissue graft allowed the patients to maintain good plaque control.

Periodontal Plastic Surgery for Reshaping the Mucogingival Junction Following Grafting Procedures: Case Reports.

The present clinical and histologic case reports describe the periodontal plastic approaches used for the correction of gingival deformities following free gingival grafting (FGG) procedures. Five patients with poor esthetic and functional outcomes following soft tissue grafting voluntarily requested corrective treatment due to differences in color, texture, thickness, and mucogingival junction (MGJ) alignment between grafted and adjacent tissue, or because of food retention apical to the grafted site. Plastic surgical approaches included eliminating the thick borders the graft, aligning the MGJ, and reducing the excessive apicocoronal dimension of the graft. Histologic images confirmed the morphologic differences between the graft and adjacent alveolar mucosa. After intervention, all treated sites achieved a satisfactory esthetic appearance and function, with a soft tissue anatomy indistinguishable from those of adjacent sites. All patients agreed that their goals for the treatment were completely fulfilled.

Coronally advanced flap achieved higher esthetic outcomes without a connective tissue graft for the treatment of single gingival recessions: a 4-year randomized clinical trial.

OBJECTIVES: Limited long-term data are available when comparing the esthetic outcomes of coronally advanced flap (CAF) with or without a connective tissue graft (CTG). The aim of this study was to compare the 4-year esthetic outcomes of CAF vs CAF + CTG for the treatment of isolated maxillary gingival recessions. MATERIAL AND METHODS: Forty-eight patients were randomly assigned for treatment either with CAF (control; N = 24) or to CAF + CTG (test group; N = 24). Patients were followed after the surgery until the final evaluation. A professional esthetic evaluation was performed using the Root coverage Esthetic Score (RES). Recession reduction, mean root coverage, and complete root coverage were also evaluated. RESULTS: Forty-two patients completed the study at the 4-year recall. A significant recession reduction was evident at 4 years, without significant intergroup differences. The CAF group showed a statistically significant higher final RES compared with the CAF + CTG group (9.14 ± 1.08 vs 7.25 ± 1.29, respectively, p < 0.001). Regarding the individual components of RES, gingival margin and marginal tissue contour were significantly higher in the CAF group compared with that in the CAF + CTG group. CONCLUSIONS: CAF presented with a significantly higher overall esthetic score than CAF + CTG, and in the individual RES components of marginal tissue contour and gingival margin after 4 years. CLINICAL RELEVANCE: CAF without the addition of CTG provided higher esthetic outcomes for the treatment of isolated gingival recessions.

Diseño de la sonrisa en PowerPoint / Smile design in PowerPoint

Digital Smile Design (DSD - Diseño Digital de la Sonrisa) es un software ideado por el Dr. Christian Coachman que permite diagnosticar, diseñar y comunicar al técnico dental y al paciente el resultado final pretendido mediante la rehabilitación oral. El objetivo de esta comunicación es divulgar cómo diseñar digitalmente la sonrisa utilizando PowerPoint, con los mismos fines y resultados del programa original. PowerPoint es un programa del paquete Office del sistema operativo Windows (Microsoft, Inc., Estados Unidos), por lo que esta herramienta permite acercar el diseño digital de la sonrisa a la gran mayoría de los odontólogos, quienes de esta manera pueden elaborar sus propios diseños de la sonrisa de sus pacientes de forma gratuita.

The Digital Smile Design is a software developed by Dr. Christian Coachman, which allows to diagnose, design and communicate to the dental technician and the patient the intended final result in oral rehabilitation. The objective of this technical note is to show how to digitally design the smileusing PowerPoint, with the same goals and results that theoriginal program executes. PowerPoint is a software that isin the operating system of Microsoft Windows. Therefore, the development that we have achieved in the use of this tool for digital smile design allows the vast majority of dentists toelaborate their own patients’ smile designs for free.

Procedimiento de descontaminación del biofilm para el tratamiento del absceso periodontal agudo y la periimplantitis / The biofilm decontamination approach for the treatment of periodontal abscess and peri-implantitis

Objetivo: mostrar el efecto de un nuevo procedimiento de descontaminación del biofilm sobre los abscesos periodontales agudos y la periimplantitis. Casos clínicos: un absceso periodontal agudo y una periimplantitis fueron tratados mediante un material de descontaminación de los tejidos bucales. Este consiste en un concentrado acuoso con una mezcla de ácidos hidroxibencensulfónicos e hidroxymetho-xybencénicos y ácido sulfúrico, que se coloca en las bolsas periodontales y alrededor de los implantes. En ninguno de los casos se utilizaron antibióticos locales ni sistémicos. Todos los casos tratados cicatrizaron rápidamente, sin complicaciones. Los pacientes sintieron una leve molestia durante la aplicación del material, que desapareció completamente en pocos segundos. Conclusión: el procedimiento de desecación del biofilm parecería ser una técnica promisoria para el tratamiento de los abscesos periodontales agudos ylas periimplantitis, con la ventaja adicional de que se evita el uso de antibióticos locales y sistémicos.

Two bilateral transposed and infraosseus impacted maxillary canines: a two-step combined periodontal and orthodontic approach.

An extremely rare case presenting two bilateral transposed and infraosseus impacted maxillary canines was treated with a combined two-step periodontal and orthodontic technique. The canines were transposed mesially and buccally to the lateral incisors, close to the midline and in a horizontal position. Direct orthodontically guided traction of the teeth toward the center of the alveolar ridge was not possible due to the roots of the lateral incisors. The procedure consisted of two distinct treatment phases for each side preceded by an initial orthodontic treatment to achieve the palatal inclination of the roots of the lateral incisors, creating a parallel buccal inclination of the crowns. This approach provided a submucosal buccal space into which the canines could be moved buccally and distally, avoiding any contact with the roots of the lateral incisors. In the first phase, the transposed canines were guided distally. When the canines, still in a submucosal position, were freed from those obstacles, the second phase was begun. The teeth were exposed, permitting the orthodontically guided traction toward the center of the ridge, simulating a proper physiologic eruption alignment pattern in the arch. The combined two-step periodontal and orthodontic approach used to treat two bilateral transposed and infraosseus impacted maxillary canines was extremely successful, resulting in adequate alignment in the arch associated with a physiologic sulcus depth, adequate keratinized tissue width, and absence of marginal recession at the end of the active treatment and 5 years postsurgery.

Tunnel technique for the treatment of impacted mandibular canines.

The tunnel technique is a combined therapeutic approach that includes both surgical exposure of the impacted canine and orthodontic traction of the tooth to the center of the alveolar ridge, followed by final orthodontic alignment. A healthy periodontium at the completion of therapy is the expected outcome. The tunnel technique has been shown to be effective in the treatment of impacted maxillary canines and can be suggested for the treatment of infraosseous impacted canines in the mandible when the corresponding primary canine is still present. Through the description of clinical cases, the management of the tunnel technique is reported.

Prevention of alveolar ridge deformities and reconstruction of lost anatomy: a review of surgical approaches.

Prevention and treatment of alveolar ridge deformities aim at preserving and/or reconstructing soft and hard tissues of the edentulous ridge. Different surgical techniques may be used to prevent ridge collapse before tooth extraction or to reconstruct lost ridge anatomy before tooth replacement. In cases of mild or moderate ridge defects, soft tissue augmentation is generally sufficient to repair the deformity. On the other hand, hard tissue augmentation should be selected primarily when implant therapy is scheduled. In cases of severe ridge defects, a staged or a combined approach may be appropriate. This article reviews the various approaches for the prevention and treatment of ridge deformities.