The biologically oriented preparation technique (BOPT) approach for preventing gingival recessions in fixed prosthodontics. A 5- to 13-year follow-up retrospective study.

AIM: The present study was a retrospective medium- to long-term follow-up assessment of the clinical outcomes of patients rehabilitated with fixed prostheses according to the biologically oriented preparation technique (BOPT) principles. MATERIALS AND METHODS: Clinical records of patients rehabilitated between January 2007 and December 2014 were retrospectively assessed. Patients whose records met the inclusion criteria were also recalled for a hygiene visit. Data analyzed included the patients' periodontal condition, the presence of gingival recessions as well as any technical or biologic prosthetic complication. RESULTS: Fifty-eight patients were recalled; of these, 52 patients who had received 220 crowns were available for the evaluation (the dropout being 13.8%). The average follow-up was 9.3 years (range 5 to 13 years): 14 patients (114 prosthetic crowns) had a follow-up between 5 and 8 years, and 36 patients (106 prosthetic crowns) between 9 and 13 years. The prosthetic survival rate was 99.6%. One radicular fracture (0.4%) and four chippings of the veneering porcelain (1.8%) were recorded. Six teeth (2.7% of the examined prosthetic crowns) presented gingival recession of < 1 mm, and 13 teeth (24 sites) had a pocket probing depth of 4 mm (5.9% of the prosthetic crowns/1.8% of the sites). Finally, 20 sites (1.5%) in seven teeth (3.2%) showed bleeding on probing. CONCLUSIONS: Tooth preparation according to the BOPT principles (ie, with a vertical finishing line) resulted in medium- to long-term periodontal health and stability of the gingival tissue, and prosthetic success was maintained.

Treatment of multiple adjacent gingival recessions using leucocyte- and platelet-rich fibrin with coronally advanced flap: a 12-month split-mouth controlled randomized clinical trial.

OBJECTIVE: This split-mouth randomized study aimed to assess efficacy of leucocyte-platelet-rich fibrin (L-PRF) versus connective tissue graft (CTG) in achieving root coverage (RC) for multiple adjacent gingival recessions (MAGRs) throughout 12-month period. MATERIALS AND METHODS: The study enrolled 59 teeth from 12 patients with Miller Class I MAGRs ≥ 2 mm on bilateral or contralateral sides. Patients were randomly assigned to receive coronally advanced flap (CAF) with either CTG (control) or L-PRF (test) treatment. Various parameters, including plaque and gingival index, clinical attachment level, recession depth, probing depth, recession width (RW), papilla width (PW), keratinized tissue width (KTW), gingival thickness (GT), percentage of RC, complete root coverage (CRC), and location of the relative gingival margin concerning the cemento-enamel junctions (GMCEJ) after CAF, were recorded at baseline, 3-, 6-, and 12-months post-surgery. On June 29, 2021 the study was registred to ClinicalTrials.gov (NCT04942821). RESULTS: Except KTW and GT gain, all clinical parameters, RC, and CRC were similar between the groups at all follow-up periods (p > 0.05). The higher GT and KTW gains were detected in the control group compared to test group at 12 months (p < 0.05). Both RC and CRC were positively associated with initial PW and GMCEJ, but negatively with initial RW (p < 0.05). CONCLUSIONS: The current study concludes that L-PRF were equally effective as CTG in treating MAGRs in terms of RC and CRC. Additionally, RC and CRC outcomes appeared to be influenced by GMCEJ, PW, and RW. CLINICAL RELEVANCE: L-PRF could represent a feasible substitute for CTG in treating MAGRs.

Adjunctive use of hyaluronic acid in the treatment of gingival recessions: a systematic review and meta-analysis.

OBJECTIVES: To explore the efficacy of Hyaluronic acid as an adjunctive in treatment of gingival recessions (GR). MATERIALS AND METHODS: A systematic literature search was performed in several electronic databases, including Medline/ PubMed, Embase, CENTRAL and LILACS. Recession improvement was evaluated through multiple outcome variables. The Cochrane Risk of Bias tool and the ROBINS-I tool were used to assess the quality of the included trials. Weighted Mean Differences (WMDs) and 95% confidence intervals (CIs) between test and control sites were estimated through meta-analysis using a random-effect model for the amount of Relative Root Coverage (RRC). RESULTS: A total of 3 randomised studies were deemed as eligible for inclusion. Their data were also used for pooling the effect estimates. Overall analysis of RRC (3 studies) presented a WMD of 7.49% (p = 0.42; 95% CIs -10.88, 25.86) in favour of adjunctive use of hyaluronic acid during Coronally Advanced Flap (CAF) technique, although statistical significance was not reached. Statistical heterogeneity was found to be high (I2 = 80%). CONCLUSIONS: Within their limitations, the present data indicate that the local application of Hyaluronic acid does not lead to additional clinical benefits when used as an adjunctive to the treatment of GR with CAF. However, due to the high heterogeneity among the studies, additional well-designed RCTs are needed to provide further evidence on this clinical indication for the use of Hyaluronic acid. CLINICAL RELEVANCE: In the frame of the current review, the adjunctive use of Hyaluronic acid does not additionally improve the clinical outcomes obtained during treatment of GR with CAF.

[A novel periodontal endoscopy-aided non-incisional periodontal regeneration technique：a case series study].

PURPOSE: To investigate the effect of endoscopy-aided non-incisional periodontal regeneration technique (NIT) in the treatment of alveolar bone angular resorption. METHODS: Thirteen patients with severe periodontitis(13 diseased teeth) were selected. All patients had alveolar bone angular resorption on adjacent surface. The patients received NIT treatment 6 weeks after periodontal primary therapy. The visualization of subgingival environment was acquired by the periodontal endoscopy. Following the removal of the subgingival plaque, calculus and intra-bony granulation tissue, bone grafting materials were placed into the intra-bony defects with the assistance of a delicate gingival protector. No flap was elevated and no sutures were applied. Probing depth (PD), gingival recession (GR), clinical attachment level (CAL), as well as radiographic parameters were evaluated at baseline and 2 years after treatment. SPSS 22.0 software package was used for data analysis. RESULTS: At 2-years follow-up, an average CAL gain of (3.65±2.10) mm (P＜0.001), PD reduction of (4.42±1.66) mm (P＜0.001), and minimal increase in GR of (0.38±0.87) mm (P=0.25) were observed. Alveolar bone was significantly improved at 2-years follow-up on radiographs (P＜0.001). CONCLUSIONS: For angular resorption site of alveolar bone, NIT treatment can obtain good periodontal regeneration results without flap inversion.

Successful Regenerative Therapy of Periodontal Defects Associated With Tongue Piercing: A Clinical Report.

Oral piercing habits are associated with various degrees of complications. Tongue piercing increases the risk of gingival recession and infrabony defects, subsequently leading to localized periodontitis. In the case presented, the patient had persistent swelling and suppuration around her mandibular anterior teeth attributed to tongue piercing jewelry that was placed approximately 12 years prior. Intraoral examinations revealed a localized deep pocket, purulent discharge, swelling, plaque accumulation, bleeding on probing, gingival recession, and teeth mobility. The patient was diagnosed with localized stage III, grade C periodontitis. Following full-mouth debridement and the placement of an extracoronal lingual splint, minimally invasive, papillae-sparing incisions were made, and regenerative therapy with bone allograft and collagen membrane was used to manage the infrabony defects. During the 18-month postoperative follow-up, complete soft-tissue healing was observed along with a significant reduction in pocket depth and the absence of bleeding on probing or suppuration. Radiographic evaluation showed evidence of bone fill. The reported case demonstrates how careful diagnosis and treatment planning are crucial for managing different periodontal defects and emphasizes the importance of proficient periodontal management, which can save teeth that would otherwise be extracted and replaced with implant therapy or fixed bridgework.

Evaluation of Postoperative Complications Following Modified Coronally Advanced Flap as Root Coverage Procedure - A Prospective Clinical Study.

BACKGROUND: Root coverage procedures are very technique sensitive and require patients' compliance for successful treatment outcomes. Post operative complications can influence patients' acceptance of treatment and compromise further periodontal maintenance. AIM: The aim of this study was to evaluate the frequency and severity of complications after a modified coronally advanced flap procedure. METHODS AND MATERIALS: A total of 78 modified coronally advanced flap procedures were performed in 42 patients for root coverage. Duration of surgical procedure, history of smoking, gender, and age were recorded for each patient. A questionnaire was given to every patient to fill in at first post operative week regarding their experience of postoperative pain, swelling, and bleeding. RESULTS: Pain and duration of surgery had a correlation (OR: 1.05, P < 0.05). Post operative bleeding was significantly correlated with duration of surgery (OR: 1.03, P < 0.05). Current smokers experienced post operative swelling (P < 0.05). However, post operative pain in current smokers was not significantly different (P > 0.05) as compared to nonsmokers. Descriptive statistics were expressed as mean and standard deviations. Odd's ratio was obtained to evaluate risk indicators for moderate to severe types of complications. P < 0.05 was considered as significant. CONCLUSIONS: The duration of the surgery, long duration, and the presence of smoking can increase the frequency and severity of post operative complications.

[Effects and techniques of soft tissue augmentation in immediate implant treatment].

Immediate implant placement can reduce the number of treatments and the time without teeth, but it carries a higher aesthetic risk. Soft tissue augmentation can reduce the risk of gingival recession to a certain extent, improve the predictability and long-term stability of immediate implant aesthetics, and is currently a hot research topic. A comprehensive understanding of the evidence-based medicine and surgical techniques using soft tissue augmentation in immediate implant surgery can assist in clinical diagnosis, treatment decisions and improve treatment outcomes. This article elucidates the changes in soft and hard tissues after immediate implant placement, aesthetic risks, and risk factors. It also discusses the advantages, timing, material selection, and commonly used clinical techniques of soft tissue transplantation in immediate implantation, aiming to provide reference for clinical doctors to improve the effectiveness of immediate implantation.

Comparative evaluation of the effect of impregnated retraction cord versus laser on gingival attachment level and pain perception following retraction for subgingival margins - A prospective, split-mouth, controlled, clinical study.

AIM: To evaluate and compare the effect of impregnated retraction cord vs Laser on gingival attachment level and pain perception following retraction for subgingival margins. SETTINGS AND DESIGN: Many methods for achieving and measuring the amount of gingival retraction in fixed prosthodontic work have been advocated. Though the gingival attachment level is crucial in Periodontology, the literature available regarding the effect of these retraction methods on the same is scarce. Hence, this clinical study was designed to compare the pain perception and amount of gingival recession when impregnated cord and laser were used for retraction. MATERIALS AND METHODS: In 40 subjects (age range of 20 to 40 years) with single missing maxillary incisor, the abutments were prepared with subgingival margins, to receive a full coverage metal-ceramic fixed dental prosthesis. The gingiva was retracted on one of the abutments with impregnated retraction cord and on the other with diode laser. Gingival attachment levels were compared at six sites per abutment using superimposition of digital scans, preoperative and four weeks after cementation of final prosthesis. STATISTICAL ANALYSIS USED: Statistical analysis of the data for gingival recession was done using t-test. Pain perception was analysed with Chi-square test. Pain perception by patients following retraction was compared with VAS scale. RESULTS: The average values of gingival recession on buccal side were 0.61 mm and 0.38 mm and on the palatal side were 0.58 mm and 0.35 mm for impregnated retraction cord and laser respectively. The P values of <0.01 indicated a highly significant difference between the two groups. Intragroup comparison did not show significant differences between various sites. Pain and discomfort produced by cord method was moderate in comparison with mild/no pain with diode laser and the difference was highly significant.Conclusion: Retraction cord produced more gingival recession than the diode laser, which was statistically highly significant on both buccal and palatal aspects of the teeth. Patients experience with diode laser technique was less painful in comparison with retraction cord method.

Analysis of the treatment of RT2 recessions with a xenogeneic collagen matrix vs. connective tissue graft combined with a coronally advanced flap. A double-blinded randomized clinical trial.

OBJECTIVES: To compare the clinical efficacy in terms of mean root coverage in RT2 recession treated with a coronally advanced flap combined with a xenogeneic collagen matrix versus a connective tissue graft. MATERIALS AND METHODS: A total of 20 patients were randomized to receive one of two treatments: coronally advanced flap + xenogeneic collagen matrix (test group) and coronally advanced flap + connective tissue graft (control group). Patient-related outcomes measures and professional aesthetic assessment by root esthetic score were performed. A descriptive and analytical statistical analysis of the variables was performed. RESULTS: At 12 months, the mean root coverage was 56.48% in the test group and 69.72% in the control group (p = 0.048), with a 35% and 40% complete root coverage in the xenogeneic collagen matrix and connective tissue graft, respectively. Test group presented less pain (3.65 vs. 5.2 VAS units) (p = 0.015) and less surgical time (45 vs. 49.15 min) (p = 0.004) than control group. CONCLUSION: The use of xenogeneic collagen matrix in RT2 recessions was effective for recession reduction to those obtained using autologous grafts; with the advantage that the duration of surgery and patient morbidity decreased. Therefore, xenogeneic collagen matrix in RT2 recessions could be an alternative to autologous grafts. CLINICAL RELEVANCE: The use of xenogeneic collagen matrix decreases the surgery time and patient morbidity but connective tissue graft results in significantly better mean root coverage and complete root coverage. Xenogeneic collagen matrix can be used in the treatment of RT2 gingival recessions. STUDY REGISTRATION: NCT03344315.

Assessing the Reliability of Miller's Classification and Cairo's Classification in Classifying Gingival Recession Defects: A Comparison Study.

Background and Objectives: Gingival recession results in adverse aesthetics and root sensitivity, and there is a need to treat and prevent its further progression. To overcome these problems, various advances have been made by clinicians in treating gingival recession based on the type of gingival recession. Miller's classification has been used for a long time to classify the type of recession. However, certain limitations have been found with use of Miller's classification such as a lack of clarity in the method for measuring soft and hard tissue loss in the interproximal area. Cairo classification was proposed to overcome limitations of Miller's classification to classify gingival recession. Cairo's classification is a treatment-oriented classification based on buccal and interproximal attachment loss. Therefore, the study was conducted to assess and compare the reliability of Miller's and Cairo's classifications in determining gingival recession. Material and methods: A total of 220 buccal gingival recession defects were included in the study based on the inclusion and exclusion criteria. Four examiners were included in the study. Two examiners classified the recession defects according to Miller's classification and the other two examiners classified recession defects according to Cairo's classification at baseline and at a 1-week interval. Statistical analysis was conducted using SPSS software version 25.0 using Cohen's kappa correlation coefficient and Chi-square test statistics to determine the intra- and inter-rater agreement among the examiners for the two gingival recession classification systems. A p value of <0.05 was considered statistically significant. Results: The intra-rater agreement for Cairo's classification was 0.86 and 0.82, whereas for Miller's classification, it was found to be 0.68. The inter-rater reliability agreement for Cairo's classification was 0.82 and 0.8, whereas for the Miller's classification, it was 0.56 and 0.67. Conclusions: Within the limitations of the study, it was found that Cairo's classification is clearer and more reliable than Miller's classification in the assessment of gingival recession.

Clinical evaluation of Artificial Intelligence Driven Remote Monitoring technology for assessment of patient oral hygiene during orthodontic treatment.

INTRODUCTION: This study aimed to clinically evaluate the accuracy of Dental Monitoring's (DM) artificial intelligence (AI) image analysis and oral hygiene notification algorithm in identifying oral hygiene and mucogingival conditions. METHODS: Twenty-four patients seeking orthodontic therapy were monitored by DM oral hygiene protocol during their orthodontic treatment. During the bonding appointment and at each of 10 subsequent adjustment visits, a total of 232 clinical oral examinations were performed to assess the presence of the 3 oral hygiene parameters that DM monitors. In each clinical timepoint, the subjects took an oral DM scan and received a notification regarding their current oral status at that moment in time. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated to evaluate AI and clinical assessment of plaque, gingivitis, and recession. RESULTS: A total of 232 clinical time points have been evaluated clinically and by the DM AI algorithm. For DM's AI detection of plaque and calculus, gingivitis, and recession, the sensitivity was 0.53, 0.35, and 0.22; the specificity was 0.94, 0.96, and 0.99; and the accuracy was 0.60, 0.49, and 0.72, respectively. CONCLUSIONS: DM's oral hygiene notification algorithm has low sensitivity, high specificity, and moderate accuracy. This indicates a tendency of DM to underreport the presence of plaque, gingivitis, and recession.

Efficacy of acellular xenogeneic dermal matrix graft in the treatment of multiple gingival recessions: systematic review and meta-analysis.

OBJECTIVE: This study aimed to compare the efficacy of acellular xenogeneic dermal matrix graft (AXDM) compared to connective tissue graft (CTG) in treating multiple gingival recessions. MATERIALS AND METHODS: A systematic search of electronic databases was conducted to identify randomized clinical trials (RCTs) that compared AXDM and CTG. The selected studies were subjected to bias risk assessment, data extraction, and meta-analyses. Parameters such as gingival recession height, width, mean percentage of root coverage, and complete root coverage were analyzed. RESULTS: Seven RCTs involving 146 patients were included. The meta-analyses indicated that CTG was statistically superior to AXDM in reducing gingival recession height at the final follow-up (mean difference: -0.104 mm, 95% confidence interval [CI]: -0.180-0.028, p = 0.008) and width at the final follow-up (mean difference: -0.285 mm, 95% CI: -0.541-0.030, p = 0.029). CTG also demonstrated a significantly higher mean percentage of root coverage at the 6-month follow-up (difference in means: -2.761 mm, 95% CI: -4.932-0.590, p = 0.013) and a higher percentage of complete root coverage at the 6-month follow-up (odds Ratio [OR]: 0.598, 95% CI: 0.4-0.892, p = 0.012) compared to AXDM. However, there was no significant difference in the number of teeth with complete root coverage between CTG and AXDM (OR: 1.610, 95% CI: 0.983-2.636, p = 0.058) and aesthetic outcomes (mean difference: 0.148, 95% CI: -0.277-0.573, p = 0.494). CONCLUSIONS: CTG is more effective than AXDM in treating multiple gingival recessions. This is evidenced by significant reductions in gingival recession height and width, a higher mean percentage of root coverage, and a greater percentage of complete root coverage at the 6-month follow-up. CLINICAL RELEVANCE: In some clinical situations an alternative to CTG is required for the treatment of multiple gingival recessions. AXDM, despite presenting clinical outcomes that are not as satisfactory as CTG, can be used for this purpose.

Influence of fixed orthodontic steel retainers on gingival health and recessions of mandibular anterior teeth in an intact periodontium - a randomized, clinical controlled trial.

OBJECTIVE: Aim of this randomized clinical controlled trial was to evaluate the influence of fixed orthodontic steel retainers on gingival health and recessions of mandibular anterior teeth. MATERIALS AND METHODS: After end of the orthodontic treatment, patients were randomly assigned into the test (fixed steel retainer) or control group (modified removable vacuum-formed retainer). Periodontal parameters (periodontal probing depth: PPD; recession: REC; bleeding on probing: BOP) as well as plaque and gingival index were assessed on mandibular anterior teeth directly before attaching/handing over the retainer (baseline: BL), 6 and 12 months after orthodontic treatment. RESULTS: 37 patients (test: n = 15, mean age: 16.1±4.2 years; control: n = 17, mean age: 17.1±5.4 years) completed the study. REC and PPD failed to show significant pairwise differences. The number of patients showing gingival health in the area of the mandibular anterior teeth (test: BL n = 10, 6 months n = 9, 12 months n = 11; control: BL n = 10, 6 months n = 16, 12 months n = 15) revealed a significant difference for the intra-group comparison between BL and 6 months in the control group (p = 0.043). The inter-group comparisons failed to show significant differences. CONCLUSION: Young orthodontically treated patients with fixed steel retainers show in 73.3% healthy gingival conditions after one year which are comparable to the control group (88.2%). Gingival recessions were in a clinically non-relevant range at any time of the examination. CLINICAL TRIAL NUMBER: DRKS00016710.

Clinical and radiographic evaluation of Bio-Oss granules and Bio-Oss Collagen in the treatment of periodontal intrabony defects: a retrospective cohort study.

OBJECTIVE: This retrospective study aimed to analyze the clinical efficacy of two regenerative surgical methods - Bio-Oss granules combined with barrier membranes and Bio-Oss Collagen alone - and to help clinicians achieve better periodontal regeneration outcomes in the specific periodontal condition. METHODOLOGY: Patients who underwent periodontal regeneration surgery from January 2018 to April 2022 were retrospectively screened, and their clinical and radiographic outcomes at 6 months postoperatively were analyzed. The probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), gingival recession (GR), distance from the cemento-enamel junction to the bottom of the bone defect (CEJ-BD), and depth of intrabony defects (INFRA) were recorded before the operation (T0) and 6 months after it (T1), and subsequently compared. RESULTS: In total, 143 patients were included - 77 were placed in the Bio-Oss group and 66 were placed in the Bio-Oss Collagen group. All indicators, including PD and CAL at T1, showed significant differences compared to baseline, for both groups (P<0.001). PD reduction was greater in the group receiving the Bio-Oss Collagen treatment (P=0.042). Furthermore, in cases when the baseline PD range was 7-11 mm and the age range was 35-50 years, PD reduction was more significant for patients receiving the Bio-Oss Collagen treatment (P=0.031, 0.023). A linear regression analysis indicated that postoperative PD and CAL were positively correlated with baseline values, and that the efficacy tended to decrease with increasing age. CONCLUSION: Both the use of Bio-Oss Collagen alone and the use of Bio-Oss granules combined with barrier membranes resulted in significant effects in the treatment of periodontal intrabony defects. The Bio-Oss Collagen treatment generated more improvements in PD than the Bio-Oss granules combined with barrier membranes, particularly within the baseline PD range of 7-11 mm and the 35-50 years age group. Additionally, age was the main factor influencing the effectiveness of regenerative surgery for intrabony defects: older individuals exhibited fewer improvements.

Palatal shield technique: a novel approach for improved donor site healing in mucogingival procedures - report of two cases.

OBJECTIVE: Mucogingival surgery involving tissue grafts is commonly employed for cosmetic procedures like root coverage, and is increasingly applied in implant therapy to modulate peri-implant soft tissues and enhance implant survival. These procedures involve harvesting autologous connective or epithelial connective tissue, often from the palate or tuber maxillae. However, this can cause patient morbidity due to postoperative pain. Substitute materials, including animal-derived and xenografts, have been developed but lack qualities of autologous grafts. METHOD AND MATERIALS: To address postoperative discomfort, a novel technique, named "palatal shield," using composite resin stabilized on adjacent teeth's palatal surface is proposed as an aid to donor site healing after mucogingival procedures. Two cases are reported where this technique was successfully applied. The first case involves a 53-year-old woman undergoing free gingival graft surgery for peri-implant treatment. The second case features a 58-year-old man receiving subepithelial connective tissue graft surgery for root sensitivity. RESULTS: Ten days post surgery, both patients reported excellent postoperative comfort. The technique's effectiveness is highlighted in these cases, demonstrating its applicability in various surgical cases involving free gingival graft or connective tissue graft harvesting. CONCLUSION: The proposed "palatal shield" technique offers several advantages, including enhanced patient comfort, ease of application, and cost-effectiveness, making it a promising addition to mucogingival surgical procedures.

To intrude or not to intrude? A systematic review of the controversy surrounding orthodontic intrusion on reduced periodontium.

OBJECTIVE: The main objective of this review was to evaluate the effects of orthodontic intrusion on patients with reduced periodontium. Additionally, this review aims to explore the potential for attachment gain and tissue regeneration in these patients and identify optimal therapeutic conditions to mitigate any negative effects of intrusion. METHODS: A systematic review was conducted according to the PRISMA 2020 statement. Duplicate electronic searches of the PubMed, Cochrane, EMC Premium, and Science Direct databases were performed by two independent reviewers. Data extraction and quality assessments, including risk of bias evaluation using the Cochrane and ROBINS-I tools were conducted. RESULTS: From an initial pool of 418 articles, 29 were selected after title and abstract screening for full-text review. Following thorough full-text reading, 15 studies were ultimately included in the analysis. The total number of patients included in the studies is 528, who underwent orthodontic intrusion on reduced periodontium. Studies indicated a decrease in periodontal pocket depth and an increase in clinical attachment with ortho-periodontal treatment. Alveolar bone level outcomes varied, showing both increases and losses. Authors generally observed improved papillary regeneration and reduced gingival recessions. CONCLUSION: Clinical studies involving combined ortho-periodontal treatment showed that orthodontic intrusion on a reduced but healthy periodontium can be considered a beneficial treatment for the periodontium, provided that potential adverse effects are carefully monitored.

Minimally invasive periodontal regeneration with the buccal approach: a systematic review and meta-analysis of clinical studies.

OBJECTIVE: The aim of this study was to investigate clinical periodontal parameters after treatment using the Minimally Invasive Surgical Technique (MIST), Modified Minimally Invasive Surgical Technique (M-MIST), and/or any technique for papilla preservation, such as Entire Papilla Preservation (EPP), modified-papilla preservation technique (M-PPT), or simplified-papilla preservation technique (SPPT). METHODS: The focus question was "For patients with periodontal intrabony defects (P), what is the best minimally invasive regenerative approach (I), comparing MIST, M-MIST, and papilla preservation techniques' outcomes (C) to improve PD, CAL, GR, and periodontal stability (O)?" An online search was conducted on PubMed, Cochrane Library, and Embase. Only randomized clinical trials and case series with a minimum of 10 enrolled patients were included. The risk of bias was evaluated using the Critical Appraisal tools in JBI Systematic Reviews. The meta-analysis compared the data obtained for the periodontal parameters analyzed, and the heterogeneity was verified. RESULTS: After the screening, nine articles were included. Seven studies applied MIST and its modifications; two used M-PPT, one SPPT, and one approached EPP. A general statistically significant PD reduction and CAL gain were noted between the groups, comparing baseline and follow-up for all articles, independently of the technique or materials used. Also, all studies showed a non-significant increase in the gingival recession. Four studies had a low risk of bias, four had a moderate risk, and only 1 had a high risk. Moderate heterogeneity was found in one analysis for CAL (65.73%); moderate and substantial heterogeneity was found in the PD results (71.91% and 89.19%); and no heterogeneity was found within all analyses for gingival recession (0%). CONCLUSION: MIST, M-MIST, and papilla preservation techniques demonstrated their potential and efficacy to improve periodontal conditions of sites with intrabony defects with minimal morbidity.

Appraising and comparing the role of autogenous periosteal graft as a barrier membrane in the treatment of intrabony defects in chronic periodontitis cases: A systematic review and meta-analysis.

Periodontal regeneration refers to procedures aimed at restitution of lost supporting tissue around the periodontally compromised tooth. Regenerative procedures very often include the use of barrier materials to encourage the growth of key surrounding tissues. The current study aimed to evaluate the effectiveness of autogenous periosteal graft as a barrier membrane for the treatment of intrabony defects in chronic periodontitis patients. A total of four data bases MEDLINE (by PubMed), Cochrane database, EBSCO, and Google Scholar were explored to identify the studies in English up to December 2022. An additional hand search of relevant journals was also done. A team of three independent reviewers screened the retrieved articles using the inclusion criteria. Randomized control trials (RCTs) evaluating the effectiveness of autogenous periosteal grafts in the treatment of intrabony defects in chronic periodontitis cases were included in the study. A total of six relevant articles were recognized for data procurement. A total of 117 patients with 68 sites with an age range between 18 years and 55 years were selected. Outcome variables examined were pocket depth (PD), clinical attachment level (CAL), radiographic bone defect fill (BDF), gingival recession (GR), plaque index (PI), gingival index (GI) and bleeding on probing (BOP). Data were analyzed using Revman 5.3 software. The mean differences and 95% confidence interval were used to illustrate the estimate of effect size. There is an equal effect in both groups for the PI, GI, and BOP reduction. For PD reduction, the result was in the favor of periosteal graft with open flap debridement (OFD) group. For CAL gain, radiographic BDF and GR, results also favored the periosteal graft, but no statistically significant difference was found amongst the groups. Within the limitation of the study, it seems that the autogenous periosteal graft can be used successfully along with OFD to treat intrabony defects in chronic periodontitis patients.

Risk indicators for gingival recession in the esthetic zone: A cross-sectional clinical, tomographic, and ultrasonographic study.

BACKGROUND: To evaluate the risk indicators associated with midfacial gingival recessions (GR) in the natural dentition esthetic regions. METHODS: Cone-beam computed tomography (CBCT) results of thirty-seven subjects presenting with 268 eligible teeth were included in the cross-sectional study. Clinical measurements included presence/absence of midfacial GR; the depth of the midfacial, mesial, and distal gingival recession; the recession type (RT); keratinized tissue width (KT); and attached gingiva width (AG). Questionnaires were utilized to capture patient-reported esthetics and dental hypersensitivity for each study tooth. Buccal bone dehiscence (cBBD) and buccal bone thickness (cBBT) were measured on the CBCT scans. High-frequency ultrasonography was performed to assess gingival thickness (GT) and buccal bone dehiscence (uBBD). Intraoral optical scanning was obtained to quantify the buccolingual position of each study site (3D profile analysis). Multilevel logistic regression analyses with generalized estimation equations were performed to assess the factors associated with the conditions of interest. RESULTS: The presence of midfacial GR was significantly associated with the history of periodontal treatment for pocket reduction (OR 7.99, p = 0.006), KT (OR 0.62, p < 0.001), cBBD (OR 2.30, p = 0.015), GT 1.5 mm from the gingival margin (OR 0.18, p = 0.04) and 3D profile 1 mm from the gingival margin (OR 1.04, p = 0.001). The depth of midfacial GR was significantly correlated to previous history of periodontal treatment (OR 0.96, p = 0.001), KT (OR -0.18, p < 0.001), presence of bone fenestration (OR 0.24, p = 0.044), and cBBD (OR 0.43, p < 0.001). The depth of midfacial GR was also the only factor associated with patient-reported esthetics (OR -3.38, p = 0.022), while KT (OR 0.77, p = 0.018) and AG (OR 0.82, p = 0.047) were significantly correlated with patient-reported dental hypersensitivity. CONCLUSIONS: Several risk indicators of midfacial and interproximal GR in the esthetic region were identified. The use of imaging technologies allowed for detection of parameters associated with the conditions of interest, and, therefore, their incorporation in future clinical studies is advocated. Ultrasonography could be preferred over CBCT for a noninvasive assessment of periodontal phenotype.

Efficacy of amniotic membrane with coronally advanced flap in the treatment of gingival recession: an updated systematic review and meta-analysis.

OBJECTIVES: This systematic review aims to evaluate the efficacy of combining the amniotic membrane (AM) with the coronally advanced flap (CAF) in the treatment of Miller class I and II gingival recession (GR). METHODS: The protocol of this updated PRISMA-compliant systematic review was registered in PROSPERO (CRD42023431501). The following treatment outcomes were recorded; recession depth (RD), recession width (RW), width of keratinized gingiva (WKG), and clinical attachment level (CAL). We searched the following databases: MEDLINE, Cochrane Library, Google Scholar, EMBASE, Web of Science, and Science Direct. RESULTS: Two independent reviewers screened the selected articles. Twenty-two eligible articles were extracted, with 689 sites of GR in 481 patients. No statistically significant difference was found in RD, RW, WKG, and CAL between (AM&CAF) in comparison to control groups. However, the subgroup analysis showed statistically significant differences in RD between the (AM & CAF) group v/s (CAF) alone (P = 0.004). Moreover, the subgroup analysis of the WKG showed statistically significant differences between (AM & CAF) v/s (CAF&CM) (p = 0.04). Additionally, a statistically significant difference was found in the subgroup analysis of CAL between both (AM & CAF) group v/s (CAF) alone (p = 0.0009). CONCLUSION: With the limitations of this meta-analysis due to short follow-up periods (6 months), the AM can be considered a viable treatment option for GR defects with satisfactory treatment outcomes comparable to other previously investigated treatment modalities. CLINICAL SIGNIFICANCE: While AM showed various beneficial properties as an ideal membrane for the coverage of GR, future studies are required to completely understand the potential application of AM in the treatment of GR.