Treatment of Multiple Recessions Associated with Noncarious Cervical Lesions: A Case Series.

Gingival recessions with noncarious cervical lesions (NCCLs), also called combined defects, are common problems, and patients often seek treatment due to esthetic concerns or dentin hypersensitivity. This case series evaluates the effectiveness of the non-coronally advanced flap (CAF) technique combined with restorative treatment for Miller Class III gingival recessions with NCCLs. A total of 16 combined defects were included. The combined defect height (CDH), recession depth (RD), pocket depth (PD), keratinized tissue width (KTW), and presence of dentin hypersensitivity were recorded at baseline and 6 months postsurgery. The mean root coverage (mRC) was 83%, and 50% of defects presented complete root coverage (CRC). In the group with an initial KTW ≥ 2 mm, mRC and CRC were significantly higher. Further randomized controlled studies with larger sample sizes are needed to verify the prognostic factor of combined non-CAF techniques and restorative treatment for gingival recessions with NCCLs.

Evaluation of mid-buccal gingival recessions and occlusal interferences.

BACKGROUND: Dental malocclusions may cause disruption in occlusal harmony, and destructive interferences during mandibular functional movements can be seen. Ideal occlusal contacts during dynamic mandibular movements may be crucial for preventing the occurrence of mid-buccal gingival recession (mbGR). While determining mbGR risk factors in young adults, the effect of occlusal interferences on mbGR has not yet been focused on. Based on this gap, this field needs to be clarified with new studies. OBJECTIVE: The aim of this case-control study was to evaluate the relationships between the presence, extent and severity of mbGRs to dental malocclusions, occlusal interferences in anterior (AG) and lateral guidance (LG) and to determine the potential risk indicators in a young population. METHODS: A total of 149 dental students were comprised and 70 of them presented mbGR(s) and 79 did not (18-25 years, 4553 teeth). Periodontal status was assessed with full mouth bleeding (FMBS) and plaque score (FMPS), probing depth, clinical attachment level, recession depth and keratinised tissue width (KTW) by a periodontist. Malocclusions and occlusal interferences were evaluated by an orthodontist. Logistic regression analyses provided data on the effect of occlusal interferences and the other indicators towards mbGR. RESULTS: The mean of the number of teeth with mbGR(s) per subject was 4.3. The mean of the overall extent of teeth with mbGR(s) was 14.2%. FMBS, decreased KTW, self-reported bruxism, group function occlusion, increased contact number of all teeth and only premolars/molars in AG or LG and Class III malocclusions were significantly associated with the presence of mbGR. Decreased KTW presenting mbGR in the mandible and non-carious cervical lesion adjunct to mbGR significantly increased the odds of the severity of mbGR. Group function occlusion revealed higher mbGRs in premolar/molars than canine guided occlusion. CONCLUSION: Increase in the occlusal interferences in premolars/molars during lateral and anterior guidance may have an effect on the presence and severity of mbGR. Further studies should be designed to confirm these findings.

Periodontal phenotype modification of complexes periodontal-orthodontic case scenarios: A clinical review on the applications of allogenous dermal matrix as an alternative to subepithelial connective tissue graft.

OBJECTIVES: The aim of this review is to address the potential applications of allogenous dermal matrix (ADM), as an alternative to subepithelial connective tissue graft (SCTG), in promoting periodontal phenotype modification (PPM) of challenging periodontal-orthodontic clinical scenarios. OVERVIEW: The rationale behind the need of changing thin to thick gingival tissues is associated to the superior and more stable treatment outcomes promoted by PPM therapy. PPM, via soft tissue grafting, leads to clinical and histological changes of the pre-established original genetic conditions of the gingiva. Although SCTG-based procedures are recognized as the "gold standard" for the treatment of sites requiring root coverage and gingival augmentation, ADM has been recognized as the most suitable alternative to SCTG, particularly in clinical scenarios where the use of autogenous grafts is not possible. Thus, ADM is considered an optimal option for the treatment of patients with a history (or in need) of orthodontic tooth movement, due its two-fold potential indication: (1) the promotion of periodontal soft tissue phenotype modification; and (2) its use, as a barrier membrane, in hard tissues augmentation procedures. CONCLUSIONS: ADM is a viable option for soft tissue augmentation, as well as for treatment approaches involving buccal bone gain. CLINICAL SIGNIFICANCE: Periodontal phenotype modification therapy, when applied in challenging periodontal-orthodontic clinical scenarios, promotes root coverage and prevents the onset and development clinical attachment loss.

Xenogeneic Acellular Dermal Matrix for the Treatment of Multiple Gingival Recessions Associated with Partially Restored Noncarious Cervical Lesions.

This study evaluated the use of a xenogeneic acellular dermal matrix (XADM) combined with a modified coronally advanced flap (MCAF) and partial resin composite filling (anatomic crown plus 1 mm of the root surface) to treat multiple Type 1 gingival recessions associated with B+ noncarious cervical lesions (NCCLs). The study included 24 recessions in 10 patients. Bleeding on probing, probing depth, combined defect height, relative gingival recession, clinical attachment level, esthetics, and dentin hypersensitivity were recorded. After 6 months, the treatment provided statistically significant outcomes: It reduced the combined defect height by 2.02 ± 0.65 mm, increased clinical attachment level by 1.96 ± 0.83 mm, and increased keratinized tissue thickness by 0.46 ± 0.47 mm, and shallow probing depths were seen. Significant dentin hypersensitivity reduction and esthetic improvements were observed. Therefore, XADM associated with MCAF and partial restoration might be a promising alternative to autogenous grafts used to treat multiple gingival recessions associated with B+ NCCLs.

Evaluation of Omega-3 piscine acellular dermal matrix membrane as a soft tissue alternative for the treatment of mucogingival defects.

BACKGROUND: The natural Omega-3 lipids in the OADM serve to reduce inflammation. Preliminary results in a human model reported no adverse events and favorable healing and esthetic outcomes. OBJECTIVE: The primary objective of this animal model study was to histologically evaluate the use of Omega-3 piscine acellular dermal matrix (OADM) as a soft tissue alternative in surgically created mucogingival defects. METHODS: Bilateral maxillary canines in 6 adult beagle dogs were randomly assigned to the test (OADM) and control sub-epithelial connective tissue graft (SCTG) groups. Dehiscence defects 4 × 6 mm were created surgically on the buccal surfaces. The OADM/SCTG were placed to completely cover the root surface to the level of the cemento-enamel junction and sutured with resorbable sling sutures. The gingival flap was repositioned to cover the grafts. At two months follow-up, the dogs were sacrificed, and block samples were retrieved, including the whole canine and periodontium. The histological outcomes were evaluated using qualitative analysis. RESULTS: The qualitative histological analysis revealed the oral, sulcular and junctional epithelium had healed with normal appearance on both test and control sites. None of the test (OADM) samples presented with any foreign body reaction. CONCLUSION: The use of this new piscine xenograft resulted in minimal complications and the attachment apparatus healed normally.

Age-at-death estimation in adults using three forensic methodologies: A Lamendin's technique approach for Latin American context and the extension of a forensic international dental database.

In forensic science, the information that teeth provide to the age estimation process is very important. In adults, one of the most widely used indicators of skeletal age is the Root Dentin Translucency (RDT), mainly through the Lamendin technique, which is used in various Latin American contexts. Recently, Parra et al. (2020) have developed a Bayesian regression model using the Lamendin technique to establish standardized criteria for estimating age-at-death in adults in various forensic contexts. In this study, we evaluate the applicability of this proposal together with the proposal by Lamendin et al. (1992) and Prince and Ubelaker (2002) in Latin American contexts. A sample of single-rooted teeth belonging to 805 individuals from six Latin American countries was used. The results of the three proposals considered were analyzed taking into account factors such as age, sex, origin, and the tooth surface on which the variables were surveyed. Of the factors that would affect the estimates, it was found that the age of the individuals had the greatest influence. However, it was confirmed that the sex and surface of the teeth on which the measurements were taken did not influence the final result. On the other hand, as we expected, the application of the analyzed proposals would also be possible in other forensic contexts, as shown by the results obtained according to the origin. This research expands the FIDB with more information on Latino contexts.

The effect of non-surgical and surgical mechanical root debridement on infrabony defects: a retrospective study.

The aim of this retrospective study was to assess the outcomes of non-surgical and surgical mechanical root debridement for the treatment of infrabony defects and explore potential prognostic factors. Treated infrabony defects followed for at least 1 year were selected. All data pertaining to the clinical outcomes were recorded. Multi-level regression analysis and Cox Proportional-Hazards Models were used to assess the immediate (3-6 months) clinical outcomes, survival of the treated teeth, and factors influencing these results. 132 patients were included in the analysis. The analysis showed 1.42 ± 1.71 and 2.23 ± 1.64 mm in pocket depth (PD) reduction, 0.13 ± 1.83 and 0.08 ± 1.76 mm in clinical attachment level (CAL) gain, and 1.29 ± 1.56 and 2.15 ± 1.33 mm increase in gingival recession (REC) for the non-surgical and surgical groups, respectively. The 5-year survival rates were 93% for the non-surgically and 90% for the surgically treated teeth. Several factors affected clinical outcomes and tooth survival. Within its limitations, the treatment of infrabony defects with non-surgical and surgical mechanical root debridement was found to result in moderate but significant PD reduction, nevertheless, this may also be attributable to the resultant REC.

Dynamics of Matrix Metalloproteinase-1 and -8 Secretion in Gingival Crevicular Fluid after Gingival Recession Therapy via MCAT with Either Subepithelial Connective Tissue Graft or Collagen Matrix.

OBJECTIVES: The objective of this study was to determine and estimate the changing levels of matrix metalloproteinases 1 and 8 (MMP-1 and MMP-8) in GCF at consecutive stages of healing after root coverage procedure via modified coronally advanced tunnel (MCAT) combined with either sub-epithelial connective tissue graft (SCTG) or collagen matrix (CM) and also to relate those changes to clinical outcomes of both therapeutic approaches. MATERIALS AND METHODS: The study involved 20 patients with a total of 91 recessions. Those on one side of the mandible received MCAT plus CM while the contralateral ones MCAT plus SCTG. The evaluation of MMP-1 and MMP-8 concentrations in Gingival Crevicular Fluid (GCF) took place at baseline, then at 1, 2, and 4 weeks, and finally at 3 months after surgery. Elisa protocol was applied to determine the levels of MMP-1 and MMP-8 in GCF. RESULTS: Three-month observation revealed statistically significant changes in MMP-1, MMP-8 and Sulcus Fluid Flow Rate (SFFR) values after implementation of both techniques. A correlation was found between a difference in MMP-1 concentrations and gain in Keratinized Tissue (KT) after SCTG and CM. MMP-8 levels and a Gingival Thickness (GT) gain observed after CM was also correlated. CONCLUSIONS: A type of augmentative material does appear to determine the dynamics of MMP-1 secretion.

Correlation of periodontal parameters to various types of smokeless tobacco in tobacco pouch keratosis patients: A cross-sectional study.

BACKGROUND: Tobacco practice in relation with oral diseases is a foremost cause for the global oral disease burden and is accountable for up to 50% of all periodontitis cases among adults. The present cross-sectional study was undertaken to evaluate the local effects of various types of smokeless tobacco on periodontal health in tobacco pouch keratosis (TPK) patients in Mangalore city in the state of Karnataka. MATERIALS AND METHODS: A total of 345 TPK patients were evaluated of which all were smokeless tobacco users. All the patients were clinically examined for different clinical periodontal parameters such as stains, gingival recession (GR), periodontal pocket, furcation involvement, and mobility and local effects of various types of smokeless tobacco on periodontal health in TPK sites were recorded. RESULTS: The prevalence of GR was of 87.5%. Haathichaap was the most common smokeless tobacco used (35.9%) closely followed by nonpackaged type (loose tobacco) (19.4%). This was followed by Madhu (14.2%). Likewise, periodontal parameters were observed more in these patients in decreasing order. CONCLUSION: The results of the present study agree strongly with other smokeless tobacco user studies in terms of the strong association between GR and smokeless tobacco placement. The present cross-sectional study indicates that TPK lesions are positively associated with periodontal diseases. It is important to raise awareness of both oral cancer and periodontal risks and inform about its possible health consequences thereby working towards an improvement of oral and general health and related quality of life in these patients.

A Review of the Role of Probiotic Supplementation in Dental Caries.

Dental diseases are among the common health issues experienced around the world. Dental caries is one of the most predominant oral diseases worldwide. Major factors associated with caries development include poor oral hygiene, the content of specific carbohydrates in the diet, dental biofilm formation, the cariogenic microbial load, reduction in salivary flow, insufficient fluoride exposure, gingival recession, genetic factors, and lack of personal attention to one's dental health. Several preventive measures have been implemented to reduce the risk of the development of caries. Probiotics are live microbes that when administered in suitable amounts confer health benefits on the host; they are recognized as potential adjunct therapeutic agents for several diseases. The present manuscript summarizes recent findings on the role of probiotics in dental caries prevention and the possible mechanisms of probiotic effects. Review of the literature indicates the regular consumption of probiotic products significantly reduced the risk of caries by inhibiting cariogenic bacteria and enriching commensal microbes in the oral cavity. Buffering the salivary pH, production of bacteriocin and enzymes (dextranase, mutanase, and urease), the capacity of competing for the adhesion and colonization on tooth surfaces are the possible mechanisms behind the beneficial effect of probiotics. Further studies are necessary to address the efficacy of long-term probiotic supplementation on the control of dental diseases and the influence of childhood probiotic supplementation on the risk of caries development.

Clinical and radiographic evaluation of the Periodontium with biologic width invasion.

BACKGROUND: The biologic width is defined as the coronal dimension to the alveolar bone that is occupied by healthy gingival tissue. The objective of the present study was to correlate radiographic findings of biologic width invasion with the periodontium status. METHODS: It were included 14 patients with restored teeth with biological width invasion, on the proximal sites, observed clinically and radiographically. 122 proximal sites were evaluated, 61 in the test group (biological width invasion) and 61 in the control group (adequate biological width). Smokers and patients presenting periodontal disease or restorations with contact in eccentric movements, horizontal over-contour or secondary caries were excluded from the sample. The invasion of the biologic width was diagnosed when the distance from the gingival margin of restoration to the bony crest was less than 3 mm. Intrabony defect and bone crest level, as well as, their vertical and horizontal components were radiographically evaluated when present. Plaque index, bleeding on probing, probing depth, gingival recession height, keratinized gingival height and thickness, and clinical attachment level were clinically evaluated. Data were subjected to Spearman's Correlation and Wilcoxon's test. RESULT: The most prevalent tooth with biological width invasion was the first molar. There was a statistically significant correlation between the bone crest (p < 0.001), vertical (p < 0.001) and horizontal (p = 0.001) components. In the test group, there was a statistically significant correlation between bleeding on probing (p < 0.001; r = 0.618) and width of gingival recession (p = 0.030; r = - 0.602) with the intraosseous component; and between keratinized gingival height and bone level (p = 0.037; r = - 0.267). In the control group, there was a correlation between plaque index (p = 0.027; r = - 0.283) with bone level and correlation between keratinized gingival thickness and bone level (p = 0.034; r = - 0.273) and intrabony component (p = 0.042; r = 0.226). CONCLUSION: A statistically significant relationship was found between bleeding on probing and gingival recession in patients who presented intrabony defects due to the invasion of biological width, which may be also related to the thickness of the keratinized gingiva.

CO2 Laser De-epithelization Technique for Subepithelial Connective Tissue Graft: A Study of 21 Recessions.

BACKGROUND/AIM: To report cases in which we achieved sufficient width of the keratinized gingiva using a coronally advanced flap in combination with a subepithelial connective tissue graft (SCTG) obtained by the 'CO2 laser de-epithelization technique' (CODE). PATIENTS AND METHODS: Eleven patients with 21 Miller Class I, II, and III gingival recessions had surgery. To prepare SCTG, free gingival grafts were harvested and de-epithelialized extra-orally. De-epithelialization was conducted by irradiation of CO2 laser. Postoperative examinations were performed at 12 months. RESULTS: At 12 months, statistically highly significant root coverage was achieved in all recessions. Complete root coverage was obtained in 7 of the 21 recessions. The treatment yielded mean root coverage of 41.0%, and was associated with a mean gain of keratinized gingiva of 2.9±0.3 mm. CONCLUSION: The use of CODE allows harvesting grafts of excellent quality and quantity and increases the keratinization of the overlying mucosal epithelium.

A Multidisciplinary Approach of an Endo-Perio Lesion in a Severely Compromised Tooth: An 18-Year Follow-up Case Report.

This case report describes the diagnosis, multidisciplinary treatment, and long-term follow-up of a severely compromised tooth in a patient who was referred for assessing a gingival recession. Clinical evaluation of the left maxillary canine showed 12 mm of mid-buccal gingival recession, probing depth of 14 mm on the mesial-buccal aspect, and grade III mobility. A periapical radiograph revealed extensive periapical and lateral radiolucency. The first step of the treatment was to carry out oral hygiene instructions and full-mouth debridement. After that, endodontic treatment was performed immediately. Periodontal reevaluation four months after endodontic therapy revealed that probing depths of all sites were within 3 mm and periapical radiograph showed a slight decrease in periapical and lateral radiolucency. It was subsequently decided to perform root coverage with a laterally positioned flap and subepithelial connective tissue graft. Six months after surgery, the root surface showed 1 mm recession, representing root coverage of 91.7% and a gain of attachment of 13 mm. The patient was enrolled in a 6-month supportive periodontal therapy. Treatment outcomes were evaluated over 18 years, with successful radiographic and clinical results throughout the follow-up period. The successful management of endo-periodontal lesions requires an accurate diagnosis, which is imperative to provide proper therapy in the correct treatment sequence.

Treatment of peri-implant soft tissue defects: a narrative review.

Soft tissue defects around dental implants, such as papilla or volume loss, peri-implant recession and alterations of the ridge color and/or texture, lead to esthetic and functional complaints. Treatments of these defects in implants are more demanding than in teeth because peri-implant tissue exhibits different anatomical and histological characteristics. This narrative review discusses the proposed treatments for soft tissue defects around implants in the current literature. Several clinical and pre-clinical studies addressed methods to augment the quantity of the peri-implant keratinized mucosa. Autogenous grafts performed better than soft tissue substitutes in the treatment of soft tissue defects, but there is no clinical consensus on the more appropriate donor area for connective tissue grafts. Treatment for facial volume loss, alterations on the mucosa color or texture and shallow peri-implant recessions are more predictable than deep recessions and sites that present loss of papilla. Correction of peri-implant soft tissue defects may be challenging, especially in areas that exhibit larger defects and interproximal loss. Therefore, the regeneration of soft and hard tissues during implant treatment is important to prevent the occurrence of these alterations.

Comparison of two soft tissue substitutes for the treatment of gingival recession defects: an animal histological study.

OBJECTIVES: This study aimed to compare two different soft tissue replacement grafts in their ability to treat gingival recession defects and successfully integrate with the surrounding tissues. METHODOLOGY: Nine beagle dogs were included and followed up to 10 weeks. Sites for intervention were allocated to one of the grafting materials investigated. Treatment consisted of coronally advanced flap combined with one of the two soft tissue substitutes on a previous surgically created defect. Materials employed were porcine-derived acellular dermal matrix (ADM) [Novomatrix™ (Test)] and collagen-based matrix (CBM) [Mucograft® (Control)]. Animals were sacrificed at 2, 6, and 10 weeks postoperatively and compared using descriptive histology and histomorphometric outcomes. RESULTS: Macroscopic findings were similar between test and control groups at all intervals. After 10 weeks, both groups demonstrated successful incorporation of the grafting materials without signs of rejection and with comparable tissue integration. The histomorphometric data were similar between groups at 2 weeks; however, the test group provided greater root coverage and increase in tissue thickness than the control at 6- and 10-weeks post surgically. CONCLUSIONS: Both porcine-derived ADM and CBM revealed similar histological outcomes with successful integration and absence of adverse events. Test group provided superior outcomes regarding root coverage and increase in tissue thickness.

Objective evaluation of healing and esthetic outcome of root coverage procedure using chorion membrane: a case series.

The ultimate goal of any periodontal plastic surgery aimed to treat gingival recession is predictable recession coverage and esthetic outcome. Due to the post-operative morbidity and discomfort related to subepithelial connective tissue graft, various other methods have been introduced including the use of fetal membranes. The fetal membranes have shown promising results in medicine and recently in the field of regenerative dentistry and could possibly become a viable alternative to autogenous grafts. This article reports a series of cases of Miller's class I gingival recession that were treated by chorion membrane combined with coronally advanced flap and evaluated using objective variables for post-operative healing and esthetics. Nine systemically healthy subjects with ten Miller's class I buccal gingival recession were included in the study. Clinical parameters were recorded at baseline, 3 months and 6 months post-surgery; wound healing index (WHI) was recorded one week post-surgery. At the end of 6 months, the percentage of root coverage and the root coverage esthetic score (RES) were calculated. The results showed statistically significant (p < 0.05) improvement in most of the parameters. The mean percentage of root coverage obtained was 62.20 ± 21.99% ranging from 33.3 to 100%. The WHI showed excellent healing score and RES assessed at the end of six months showed superior esthetic results. The chorion membrane along with coronally advanced flap is a predictable procedure for root coverage with better post surgical healing and superior esthetics.

Root surface demineralization by citric acid/tetracycline gel and aPDT associated to subepithelial connective tissue graft improves root coverage outcomes. A 12-month preliminary randomized clinical trial.

Root conditioners are used to promote root surface biomodification to increase the success rate of root coverage. Citric acid and tetracycline are commonly used. There is recent indication for using antimicrobial photodynamic therapy (aPDT) with this purpose. The aim of this study is to evaluate the effects of citric acid/tetracycline gel and aPDT in root coverage of gingival recessions using subepithelial connective tissue graft. This parallel, double-blinded clinical trial enrolled 17 patients (60 recession defects; 20/group). Experimental groups were: Control group (SRP) - scaling and root planing only; Citric acid/tetracycline gel (CAT) group - SRP plus citric acid/tetracycline gel; aPDT - SRP, toluidine blue O (100 µl/ml) and red laser. At baseline and after 3, 6 and 12 months, the clinical parameters were evaluated: recession depth (RD), percentage of root coverage (%RC), keratinized tissue width (KTW), soft tissue thickness (STT), probing depth (PD), clinical attachment level (CAL), dentin hypersensitivity (HYPER) and esthetic perception by patient (EST). CAT group presented reduction in PD, CAL, RD, increase in KTW and STT, higher %RC (81.6%) and better esthetic in relation to SRP group (p < .05). aPDT treatment promoted CAL reduction, gain of KTW and STT and higher %RC (82.1%) in relation to SRP (57.7%) (p < .05). There was a reduction in dentin sensitivity in all groups. Complete root coverage was higher for CAT group (65%) and aPDT group (70%) in relation to SRP (30%) (p < .05). Root conditioning, with citric acid/tetracycline gel and aPDT, promotes better long-term clinical outcomes and root coverage after SCTG procedures.

Efficacy of xenogeneic collagen matrix in the treatment of gingival recessions: A systematic review and meta-analysis.

OBJECTIVES: This review aims to evaluate the efficacy of xenogeneic collagen matrix (XCM) for the treatment of single or multiple gingival recessions in terms of clinical parameters and patient-related outcomes. MATERIALS AND METHODS: Various electronic databases (The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, etc.) from 1966 to April 2018 and hand literatures were searched. Quality of the included studies was assessed through the Cochrane Collaboration's Risk of Bias tool. A meta-analysis was performed to calculate risk ratios and mean differences. RESULTS: Nine randomized controlled trials were included. The results revealed a higher percentage of mean root coverage (MRC) and a greater recession reduction (RecRed) for single recessions for the combination of coronally advanced flap (CAF) with XCM compared to CAF alone (n = 3; MD = 10.00%; 95%CI [3.56%; 16.43%]; p = 0.002) (n = 3; MD = 0.35 mm; 95%CI [0.10 mm; 0.60 mm]; p = 0.005). Comparing XCM with connective tissue graft (CTG), no significant differences were detected in MRC or RecRed for single and multiple recessions. CONCLUSIONS: The addition of XCM under CAF could improve MRC and RecRed at single tooth recessions. Initial data suggest that XCM shows promising results to improve the clinical efficacy of CAF for multiple recessions. In addition, XCM could be a valid alternative to CTG in terms of MRC and RecRed at both single and multiple recessions. Based on limited evidence, XCM may decrease postoperative morbidity and operation time compared to CTG.

Association of initial mucogingival status with clinical outcome of non-surgical periodontal therapy: A retrospective analysis of 204 patients.

BACKGROUND/PURPOSE: This study was conducted to evaluate the influence of mucogingival parameters, including keratinized mucosa (KM) and attached gingiva (AG), on the outcome of non-surgical periodontal therapy (NSPT). METHODS: A total of 204 non-smoking patients with generalized chronic periodontitis who received NSPT between 2012 and 2014 were included. The Mantel-Haenszel chi-square test was used to assess the associations between initial mucogingival parameters and initial clinical parameters on the buccal aspect, and the associations between initial mucogingival parameters and outcome clinical parameters on the buccal aspect of the sites with severe periodontal destruction. The generalized liner model was used to evaluate the contribution of initial clinical parameters to the outcome of NSPT. RESULTS: KM ≥ 3 mm was associated with greater probing pocket depth (PD), less gingival recession (REC), and less clinical attachment level (CAL), and AG < 1 mm was associated with greater PD, REC, and CAL before NSPT. At the sites with severe periodontal destruction, KM ≥ 3 mm was associated with greater PD reduction (0.25 ± 0.08 mm) and CAL gain (0.25 ± 0.09 mm), and AG < 1 mm was associated with greater CAL gain (0.15 ± 0.08 mm) after NSPT. Initial PD ≥ 7 mm and non-molar teeth showed greater contribution to the outcome of NSPT. CONCLUSION: Less AG (<1 mm) was associated with greater periodontal destruction at baseline. At the sites with severe periodontal destruction, greater KM (≥3 mm) and less AG (<1 mm) resulted in better outcomes of NSPT.