Root coverage with tunneling technique or modified advanced flap associated with acellular dermal matrix: results from 6 months randomized clinical trial.

OBJECTIVES: This study compared two surgical techniques using acellular dermal matrix (ADM) for the treatment of multiple gingival recessions. MATERIAL AND METHODS: Twenty patients, with bilateral RT1 gingival recessions, were selected. One side received a modified extended coronally advanced flap (MECAF), and the contralateral side a supra-periosteal flap (TUN). The evaluated parameters were probing depth (PD), relative clinical attachment level, gingival index, gingival recession height (GR), width of keratinized tissue, keratinized tissue thickness, and gingival recession area at baseline and 6 months postoperative. Pain was evaluated weekly, using a visual analog scale (VAS) during first month postoperative. RESULTS: Both groups were effective in reducing GR (ΔGR: MECAF 2.28 mm; TUN 1.93 mm), without significant differences. The % of root coverage was numerically superior favoring MECAF (MECAF 61.24%; TUN 56.07%), without significant differences between groups. VAS scale failed to provide differences between groups. CONCLUSIONS: Both treatment were effective in root coverage and might be valuable for the treatment of multiple gingival recessions. The use of vertical releasing incisions and a flap design including the papillae did not hamper root coverage. CLINICAL RELEVANCE: This study compared two techniques for use of ADM in large multiple gingival recessions. Within its limitations, both treatments successfully achieved root coverage and were able to reduce gingival recession. It is expected a partial root coverage when using these techniques in large gingival recessions. The study failed to provide significant differences between groups. The use of modified extended coronally advanced flap may be advisable for the treatment of multiple gingival recessions, specially involving large defects when using ADM, to avoid early matrix exposure.

Root coverage using coronally advanced flap with porcine-derived acellular dermal matrix or subepithelial connective tissue graft: a randomized controlled clinical trial.

OBJECTIVE: The aim of this study is to investigate the use of a porcine-derived acellular dermal matrix (MD) in root coverage procedures combined with extended coronally positioned flap (eCAF), in comparison to the subepithelial connective tissue graft (SCTG) associated with the eCAF. MATERIAL AND METHODS: Eighteen adult patients presenting bilateral type 1 gingival recession were randomly assigned to SCTG or MD groups. Clinical and patient-based outcomes were recorded at 3 and 6 months after the surgical procedure. RESULTS: Both groups showed a significant reduction in the mean recession height of 3.33 ± 0.89 mm to 1.24 ± 1.10 mm (MD) and 3.21 ± 0.8 mm to 0.83 ± 0.86 mm (SCTG) without difference between groups. Six patients in the test group and eight in the control group obtained complete root coverage. The keratinized tissue height and thickness (KTT) showed a significant increase after 3 and 6 months in both groups. The average KTT gains were 0.39 ± 0.4 mm (MD) and 0.51 ± 0.5 mm (SCTG) (p < 0.05). Performing multivariate analysis suggests that MD addition to coronally advanced flaps may be similar to SCTG. CONCLUSION: The MD had similar results in comparison to SCTG and in the context of reducing patient morbidity it can be used as an alternative for the treatment of gingival recessions. CLINICAL RELEVANCE: The SCTG is the gold standard therapy for root coverage. The MD has been widely used in mucogingival surgery as a substitute for SCTG and proposed similar results. A substitute is very important for clinicians and patients. It will give a better postoperative and possibilities to treat multiples recession. (Clinicaltrials.gov Identifier: NCT03675334).

Root coverage of gingival recessions with non-carious cervical lesions: a controlled clinical trial.

OBJECTIVE: The non-carious cervical lesion (NCCL) is commonly produced by improper toothbrushing techniques, occlusion trauma, anatomic mal-positioned teeth, and acid erosion, thus sharing the same etiology of gingival recession (GR). The association of a graft to the coronally advanced flap had demonstrated the best long-term outcome for root coverage (RC). However, substitutes for the autogenous graft must be studied. This split-mouth clinical trial investigates the RC and the increase in keratinized tissue (KT) when comparing RC of NCCLs associated with GR with intact roots using an extended coronally advanced flap (ECAF) associated with the acellular dermal matrix graft (ADMG), a connective tissue replacement graft. MATERIAL AND METHODS: Seventeen individuals with bilateral GR were included in the study. One side had a NCCL (TG) and the opposite root was intact (CG). All patients were treated with the ECDF associated with ADMG. All clinical parameters were assessed at baseline and 6 months postoperative. RESULTS: Root coverage means (CG, 69.5 ± 19 and TG. 72.2 ± 16.5; p value = 0.849570) were not significantly different between control and test groups. In addition, the KT had an increase in the follow-up period for both groups. CONCLUSION: GR associated with NCCLs can be successfully treated with the ECDF and ADMG. CLINICAL RELEVANCE: Patients frequently search for GR treatment due to cervical wear, root sensitivity, and compromising aesthetics. The NCCL participates with the same issues. The present study contributes to the literature that GR associated with NCCLs can be successfully treated with the ECAF and the ADMG.

Experimental and clinical studies on plastic periodontal procedures.

We have compiled, in this Periodontology 2000 review, all Latin American literature on experimental and clinical studies of periodontal plastic procedures. The body of literature on this subject has led to a discussion of the features and treatment outcomes of root-coverage procedures. Over time, knowledge on periodontal plastic procedures has become less empirical and more supportive of the clinical management of recession-type defects. Gingival recession etiology, animal studies, free gingival grafts, pedicle flaps (semilunar, laterally positioned, and coronally positioned), and subepithelial connective tissue grafts are extensively reviewed. The use of allografts as an alternative to subepithelial connective tissue grafts, the treatment of multiple gingival recessions, and the rationale for use of guided tissue regeneration and enamel matrix derivative in plastic periodontal procedure is discussed. We also assess how smoking can affect the treatment outcomes in plastic surgery procedures. Minimally invasive procedures are of great value in improving the features of the final tissues. The following aspects identified in this compilation were of great interest: (a) some factors, anatomical in nature, favor the formation of root recessions, but it is the inflammatory process (caused by the presence of biofilm and/or by traumatic toothbrushing) that is responsible for the development of root recessions; and (b) pedicle flap procedures (especially the coronally positioned flap) are extremely versatile and have the most predictable outcome of all root-coverage procedures, especially when combined with subepithelial connective tissue grafting and/or allogeneic grafts. In summary: subepithelial connective tissue grafting is considered as the first option to augment gingival width and thickness, and it may provide better long-term results; the same principles of root-coverage procedures in individual sites appear be used in clinical practice also for multiple-recession type defects; an allograft is an efficient alternative to a subepithelial connective tissue graft and, when it is the treatment option of choice, the use of wide, extended flaps should be considered; because of the superiority of plastic periodontal procedures over guided tissue regeneration and the technical difficulty of the latter, guided tissue regeneration has become obsolete for root-coverage procedures; there is rather a large body of evidence attesting that smoking negatively influences root-coverage procedures, especially subepithelial connective tissue grafts; and minimally invasive techniques may be of great value for improving the results obtained with plastic periodontal procedures, but these techniques need to be better addressed in clinical trials, both in terms of the quality and quantity of the new tissue generated.

Antimicrobial photodynamic therapy as adjunct to non-surgical periodontal treatment in smokers: a randomized clinical trial.

OBJECTIVES: This study aims to investigate the additional influence of multiple applications of antimicrobial photodynamic therapy (aPDT) in smokers with chronic periodontitis. MATERIALS AND METHODS: Twenty smokers with chronic periodontitis were treated in a split-mouth design study with aPDT adjunct to Scaling and Root Planing (SRP) or SRP. aPDT was performed by using a laser light source with 660 nm wavelength associated with a photosensitizer. The applications were performed in four episodes (at days 0, 2, 7, and 14). All patients were monitored for 90 days. Plaque index, probing depth, clinical attachment level, and bleeding on probing were performed at baseline, 30, and 90 days after the SRP. Gingival crevicular fluid and subgingival plaque samples were collected for immunological and microbiological analysis, respectively. Data obtained were statistically analyzed. RESULTS: aPDT as an adjunct to SRP did not demonstrate statistically significant advantages on clinical parameters when compared with SRP alone. No statistic significant differences between groups were observed (p < 0.05). Levels of anti-inflammatory cytokines and bacterial species were comparable in both groups at day 90 after treatment. CONCLUSION: Periodontal treatment with SRP + aPDT in multiples episodes was not able to promote additional clinical, immunological, and microbiological benefits in smokers when compared SRP alone in patients with chronic periodontitis. CLINICAL RELEVANCE: Multiple episodes of aPDT adjunctive to non-surgical treatment did not improve significantly the clinical, immunological, and microbiological parameters when compared with SRP alone. More randomized clinical trials are needed to evaluate adjuvant therapies for scaling and root planning in smokers with chronic periodontitis. ClinicalTrials.gov Identifier: NCT03039244.

Effects of Bifidobacterium probiotic on the treatment of chronic periodontitis: A randomized clinical trial.

AIM: This randomized placebo-controlled clinical trial evaluated the effect of Bifidobacterium animalis subsp. lactis (B. lactis) HN019-containing probiotic lozenges as adjuvant to scaling and root planing (SRP) in patients with generalized chronic periodontitis. MATERIALS AND METHODS: Forty-one chronic periodontitis patients were recruited and monitored clinically, immunologically, and microbiologically at baseline (before SRP) and 30 and 90 days after SRP. All patients were randomly assigned to a Test (SRP + Probiotic, n = 20) or Control (SRP + Placebo, n = 21) group. The probiotic lozenges were used twice a day for 30 days. The data were statistically analysed. RESULTS: The Test group presented a decrease in probing pocket depth and a clinical attachment gain significantly higher than those of the Control group at 90 days. The Test group also demonstrated significantly fewer periodontal pathogens of red and orange complexes, as well as lower proinflammatory cytokine levels when compared to the Control group. Only the Test group showed an increase in the number of B. lactis HN019 DNA copies on subgingival biofilm at 30 and 90 days. CONCLUSION: The use of B. lactis HN019 as an adjunct to SRP promotes additional clinical, microbiological, and immunological benefits in the treatment of chronic periodontitis (NCT03408548).

Evaluation of a bone substitute covered with a collagen membrane for ridge preservation after tooth extraction. Clinical and tomographic randomized controlled study in humans.

OBJECTIVE: To evaluate the use of a synthetic bone substitute covered with a collagen membrane for ridge preservation after tooth extraction, by clinical and tomographic analysis. MATERIAL AND METHODS: Fifteen patients, presenting at least two maxillary anterior teeth indicated for extraction, were selected: in the test group (TG), post-extraction sockets were filled by a synthetic bone substitute; in the control group (CG), by blood clot. In both groups, the sockets were covered by a collagen membrane. Cone-beam computerized tomography (CBCT) scans were acquired immediately after and 6 months post-surgically, and horizontal and vertical dimensional bone changes were quantified. RESULTS: Transurgical clinical analysis presented no statistically significant differences between TG and CG (p > .05). CBCT intragroup evaluation presented statistically significant reduction for the buccal alveolar measurement (TG = 1.58 mm or 21.82%, and CG = 1.66 mm or 24.08%) and horizontal cervical measurement (TG = 0.55 mm or 8.30% and CG = 1.30 mm or 17.68%), and not significant for palatal alveolar measurement (TG = 0.44 mm or 3.42% and CG = 0.26 mm or 3.89%). For alveolar height and horizontal apical measurements, this decrease was significant only for the CG, with reductions of 1.03 mm and 0.50 mm, respectively, compared to a decrease of 0.57 mm and 0.19 mm for the TG. The intergroup analysis showed significant difference for cervical horizontal measurement after 6 months (p < .05). CONCLUSION: The results showed that the use of the bone substitute covered with a collagen membrane resulted in less changes in vertical and horizontal alveolar ridge dimensions than the collagen membrane alone.

Effect of surgical periodontal treatment associated to antimicrobial photodynamic therapy on chronic periodontitis: A randomized controlled clinical trial.

AIM: This randomized controlled clinical trial evaluated the effects of an adjunctive single application of antimicrobial photodynamic therapy (aPDT) in Surgical Periodontal Treatment (ST) in patients with severe chronic periodontitis (SCP). MATERIAL AND METHODS: In a split-mouth design, 20 patients with SCP were treated with aPDT+ST (Test Group, TG) or ST only (Control Group, CG). aPDT was applied in a single episode, using a diode laser and a phenothiazine photosensitizer. All patients were monitored until 90 days after surgical therapy. Levels of 40 subgingival species were measured by checkerboard DNA-DNA hybridization at baseline, 60 and 150 days. Clinical and microbiological parameters were evaluated. RESULTS: In deep periodontal pockets depth (PPD ≥5 mm), Test Group presented a significantly higher decrease in PPD than Control Group at 90 days after surgical therapy (p < .05). Test Group also demonstrated significantly less periodontal pathogens of red complex (Treponema denticola) (p < .05). CONCLUSION: A single episode of aPDT used in adjunct to open flap debridement of the root surface in the surgical treatment of SCP: i) significantly improved clinical periodontal parameters; ii) eliminates periodontal pathogens of the red complex more effectively (NCT02734784).

The effect of a flapless alveolar ridge preservation procedure with or without a xenograft on buccal bone crest remodeling compared by histomorphometric and microcomputed tomographic analysis.

OBJECTIVES: This study evaluated buccal bone crest remodeling, socket composition after healing, and dimensional ridge preservation after flapless tooth extraction procedures with or without a xenograft comparing histomorphometric and microcomputed tomographic (micro-CT) data. MATERIAL AND METHODS: The mandibular premolars of eight dogs were extracted without flaps. One socket on each side received a grafting material (test group), and the other remained only with a blood clot (control group). Twelve weeks after treatment, buccal bone crest, alveolar ridge dimensions, and composition were analyzed by histomorphometry and micro-CT. RESULTS: Two- and three-dimensional evaluations showed better results for the grafted group when compared to the non-grafted group. CONCLUSION: The flapless alveolar ridge preservation procedure with deproteinized bovine bone material enhanced buccal bone crest, alveolar ridge dimensions and bone formation when compared to sockets with the blood clot only, as observed by histomorphometric and micro-CT analysis.

Comparison between two antimicrobial protocols with or without guided bone regeneration in the treatment of peri-implantitis. A histomorphometric study in dogs.

OBJECTIVES: This study used a dog model to evaluate two antimicrobial protocols with or without guided bone regeneration (GBR) in the surgical reconstruction of peri-implantitis defects. MATERIAL AND METHODS: Eight beagle dogs subject to ligature-induced peri-implantitis were used. The animals either received antimicrobial photodynamic therapy or topical tetracycline hydrochloride combined with GBR or as stand-alone surgical interventions. Block biopsies of the defect sites for histological analysis were obtained at euthanasia, 12 weeks postsurgery. The primary outcome of the study was re-osseointegration; secondary outcomes included alveolar bone gain and remaining defect characteristics. The effects of the implant site, early exposure, and type of antimicrobial protocol on bone regeneration were also evaluated. RESULTS: No significant differences were observed between the two antimicrobial protocols, and the adjunctive use of GBR failed to significantly improve re-osseointegration or bone gain using either protocol. Buccal sites and implant early exposure negatively affected bone regeneration. CONCLUSION: Both antimicrobial therapies stand-alone or combined with GBR allowed similar and limited bone gain.

Antimicrobial photodynamic therapy as an alternative to systemic antibiotics: results from a double-blind, randomized, placebo-controlled, clinical study on type 2 diabetics.

AIM: This double-blind, placebo-controlled clinical study compared multiple applications of the antimicrobial photodynamic therapy (aPDT) treatment protocol, to systemic doxycycline as adjuvant to scaling and root planing (SRP) on type 2 diabetic patients on clinical, systemic and immune-inflammatory outcomes. MATERIALS AND METHODS: Thirty patients with Hba1c >7% were allocated in two groups, SRP + Doxy (n = 15) using systemic doxycycline 100 mg/day (14 days) and SRP + aPDT (n = 15) with multiple applications (0, 3, 7 and 14 days). Primary outcome was glycated haemoglobin levels (HbA1c). Clinical parameters: plaque score (PS), bleeding on probe, probing depth, suppuration, gingival recession, and clinical attachment level, percentage of pockets with desired clinical endpoint were measured at baseline and 3 months after therapy. Cytokine profile was assessed at 0, 1 and 3 month to measure IL1-ß, TNF-α and TGF-ß on gingival crevicular fluid. RESULTS: No significant difference was detected on HbA1c, between treatments. The SRP + aPDT group showed advantage on reducing moderate pockets in single-rooted teeth at 3 months. SRP + aPDT presented better results at 3 months on IL1-ß levels. There were no significant differences between TNF-α and TGF-ß. CONCLUSIONS: Both treatments improved clinical and systemic outcomes (Hba1c). SRP + aPDT performed better in moderate probing pocket depth on single-rooted teeth, reduced favourably inflammation in short term, and may be an alternative to systemic antibiotics. (Clinicaltrials.org ID NCT01595594).

Comparison between one-session root canal treatment with aPDT and two-session treatment with calcium hydroxide-based antibacterial dressing, in dog's teeth with apical periodontitis.

To evaluate one-session endodontic treatment with aPDT and two-session treatment with calcium hydroxide (CH)-based dressing in dog's teeth with apical periodontitis. After experimental induction of apical periodontitis, 48 teeth were randomly assigned to the following groups: groups OS/aPDT120d and OS/aPDT180d (one-session treatment with aPDT) and groups TS/CH120d and TS/CH180d (two-session treatment with CH-based dressing-control groups). The animals were euthanized after 120 and 180 days. After histotechnical processing, microscopic and radiographic analyses were performed. Data were analyzed by Kruskal-Wallis and Fisher's exact tests (α = 0.05). Groups TS/CHs presented repaired resorbed cemental areas, with collagen bundles and few inflammatory cells. In groups OS/aPDTs, the areas of cemental resorption were not repaired with reduced presence of cells and fibers. In the analysis of the apical closure, fluorescence microscopy and percentage of radiographic reduction of lesions, there was significant difference between groups TS/CH120d and OS/aPDT120d and between TS/CH180d and OS/aPDT180d (p < 0.05). Groups TS/CHs had weak RANKL expression and positive immunostaining for RANK and OPG. In OS/aPDT120d, there was positive immunostaining for RANKL. In OS/aPDT180d, the three osteoclastogenesis markers were expressed. The results using aPDT were worse than those obtained with two-session endodontic treatment using a CH-based dressing in teeth with apical periodontitis.

Adjunctive effect of antimicrobial photodynamic therapy in induced periodontal disease. Animal study with histomorphometrical, immunohistochemical, and cytokine evaluation.

Scaling and root planing (SRP) may not always be effective in preventing periodontal disease (PD) progression. The aim of this study was to evaluate the adjunctive effect of antimicrobial photodynamic therapy (aPDT) to SRP on induced PD in rats, analyzing histomorphometrical, immunohistochemical, and immunoenzymatic parameters. Ligatures were placed around the first mandibular molars and second maxillary molars of 60 rats to induce PD. After 14 days, they were removed and the animals were divided into six groups, with nine animals each: G1 = no treatment, G2 = SRP, G3 = light-emitting diode (LED), G4 = SRP + aPDT, G5 = aPDT, and G6 = erythrosine. The animals were euthanized after 3, 7, and 15 days. There were also two control groups (n = 3): without PD (WPD) induction and with maximum PD (PD+). In the histomorphometrical analysis of linear bone loss, G4 showed a statistically significant difference from the other experimental groups after 3 and 15 days. The tartrate-resistant acid phosphatase (TRAP)-positive cell counting was significantly lower in G4 when compared to G2 and PD+ after 3 days. Immunoenzymatic assay shows the values of the ratio (RANKL/OPG × 100). The lowest value is from the WPD group, and the group that received the SRP + aPDT treatment tended to approach this value over time. After 3 days, statistically significant differences were observed between G4 and all other experimental groups, as well as versus PD+ (one-way ANOVA + Tukey's post hoc test were performed, p < 0.05). It was concluded that the adjunctive use of aPDT in combination with SRP showed the best therapeutic results in the treatment of periodontal disease in rats.

Influence of periodontal tissue thickness on buccal plate remodelling on immediate implants with xenograft.

AIM: To evaluate the influence of gingival thickness and bone grafting on buccal bone plate remodelling after immediate implant placement in sockets with thin buccal bone, using a flapless approach. MATERIALS AND METHODS: The gingiva of eight dogs was thinned at one side of the mandible, mandibular premolars were extracted without flaps, and four implants were installed on each side at 1.5 mm from the buccal bone. The sites were randomly assigned into: TG (test group) = thin gingiva; TG + GM (TG with grafting material); CG (control group) = normal gingiva; and CG + GM (CG with grafting material). After 12 weeks the dogs were sacrificed and the samples were processed for histological analysis. RESULTS: All animals exhibited a thin buccal bone initially. In all the experimental groups the buccal gap was filled with newly formed bone and the buccal bone level was slightly apical to the implant shoulder. There were no statistically significant differences among the groups for the histomorphometric parameters. CONCLUSIONS: The thickness of the buccal bone was a fundamental factor in buccal bone plate resorption, even with flapless implantation. The gingival thickness or the addition of a biomaterial in the gap did not influence the results.

The influence of the periodontal biotype on peri-implant tissues around immediate implants with and without xenografts. Clinical and micro-computerized tomographic study in small Beagle dogs.

OBJECTIVE: Soft tissues and buccal bone plate remodeling after immediate implantation in sockets with thin buccal bone, using the flapless approach with or without bone graft into the buccal gap, was compared between sites with thin and normal gingiva. MATERIAL AND METHODS: Eight dogs had the gingiva of one side of the mandible thinned, the mandibular premolars were extracted without flaps, and 4 implants were installed in each side, positioned 1.5 mm from the buccal bone. The sites were randomly assigned into: TG (test group) = thin gingiva; TG + GM (TG with grafting material); CG (control group) = normal gingiva; and CG + GM (CG with grafting material). Buccal bone thickness (BBT), thickness of keratinized tissue (TKT), alveolar thickness (AT), gingival recession (GR), and probing depth (PD) were clinically evaluated. Within 12 weeks the dogs were sacrificed and the samples were analyzed by micro-computerized tomography. RESULTS: A thin BBT was observed in all the dogs. The presurgical procedures reduced TKT in the test group, with minimal changes of the AT. There were no statistically significant differences among the groups for the clinical parameters and the tomographic analysis showed similar linear and tri-dimensional bone reduction in all the groups. CONCLUSION: The thickness of the buccal bone was a fundamental factor in buccal bone plate resorption, even with flapless implantation. The decrease in gingival thickness or the addition of a biomaterial in the gap did not influence the results.

Adjunctive effect of antimicrobial photodynamic therapy to nonsurgical periodontal treatment in smokers: a randomized clinical trial.

The aim of this study was to investigate the adjunctive effect of antimicrobial photodynamic therapy (aPDT) to scaling and root planing (SRP) in smokers with chronic periodontitis. Twenty subjects had two contralateral teeth randomly assigned to receive SRP (SRP group) or SRP + a single episode of aPDT (SRP + aPDT group), with a diode laser and a phenothiazine photosensitizer. Plaque index, bleeding on probing, probing depth (PD), clinical attachment level (CAL), and gingival recession were recorded, and gingival crevicular fluid was collected for assay of IL-1ß and matrix metalloproteinase (MMP)-8 levels. There was a significant PD reduction (SRP 1.81 ± 0.52 mm/SRP + aPDT 1.58 ± 1.28 mm; p < 0.001) and a significant CAL gain (SRP 1.60 ± 0.92 mm/SRP + aPDT 1.41 ± 1.58 mm; p < 0.001) for both groups. Significant differences were not observed in between-group comparisons. IL-1ß level in gingival crevicular fluid was higher in SRP group after 1 week (SRP 24.65 ± 18.85 pg/µL/SRP + aPDT 34.07 ± 24.81 pg/µL; p = 0.048), and MMP-8 level was higher in SRP group after 12 weeks (SRP 303.31 ± 331.62 pg/µL/SRP + aPDT 534.23 ± 647.37 pg/µL; p = 0.024). There were no statistically significant differences in intragroup comparisons. The adjunctive effect of aPDT did not warrant improvements on clinical parameters in smokers. However, it resulted in a suppression of IL-1ß and MMP-8 when compared with SRP alone.

A modified surgical flap for root coverage in association with grafting materials.

PURPOSE: To clinically evaluate in humans the effectiveness of a modified flap for root coverage associated with connective tissue graft or acellular dermal matrix graft after a postoperative period of 12 months. MATERIALS AND METHODS: Thirty bilateral gingival recessions were selected and randomly assigned into experimental groups. All of them were treated with a modified surgical flap, with the releasing incisions placed on the mesial and distal line angles of the adjacent teeth, distant from the main defect, providing a broader flap. One site was treated with the autograft and the contralateral site, with the allograft. Probing depth, clinical attachment level, gingival recession, and keratinized tissue width were measured at baseline and after 12 months. RESULTS: Both procedures significantly improved the clinical parameters evaluated, without statistically significant differences between them. While the autograft group had a mean gingival recession reduction from 3.15 to 0.67 mm, in the allograft group, it was from 3.47 to 0.93 mm. CONCLUSION: The extended flap technique can improve the root coverage results using the subepithelial connective tissue graft or the acellular dermal matrix. CLINICAL SIGNIFICANCE: Graft survival plays a decisive role in mucogingival therapy results and the selection of the appropriate surgical technique is important to achieve it. This 12-month randomized study showed that an extended flap is able to improve the results of root coverage of localized gingival recessions not only when using the acellular dermal matrix as shown in a previous study, but also when using the subepithelial connective tissue. On this basis, this surgical technique can be suggested as the procedure of choice for treating this type of defect.

Buccal bone plate remodeling after immediate implants with or without synthetic bone grafting and flapless surgery: a histomorphometric and fluorescence study in dogs.

OBJECTIVE: The aim of this study was to evaluate the buccal bone plate remodeling after immediate implantation using the flapless approach with or without bone graft into the gap between the implant and the buccal bone. MATERIAL AND METHODS: Eight dogs had the mandibular bicuspids extracted without flaps, and four implants were installed on each side, totaling eight implants per animal. Randomly, in one side, the implants were positioned at the bone crest level (equicrestal), and on the opposite side, the implants were positioned 2 mm subcrestal. All the implants were positioned 2.0 mm from the buccal bone plate (gap) and associated or not with grafting material. Therefore, the following treatments were performed: implants subcrestal test (SCTG) with bone graft and control (SCCG) without bone graft, and equicrestal test (ECTG) with bone graft and control (ECCG) without bone graft. One week following the surgeries, metallic prostheses were installed. Bone markers were administered 1, 2, 4, and 12 weeks after implant placement for fluorescence analysis. Ground sections were prepared from 12-week healing biopsies, and histomorphometry was performed. RESULTS: The histomorphometric evaluation presents significant better results for the ECTG in the vertical crestal bone resorption, but the other parameters showed better results for the SCCG. The fluorescence evaluation in adjacent areas showed numerically different results between groups with a small decrease at 12 weeks, except for the SCCG, which was higher at this time. The distant area showed a continuous increase in the marked bone. CONCLUSION: The equicrestally placed implants presented little or no loss of the buccal bone wall. The subcrestally positioned implants presented loss of buccal bone, regardless of the use of bone graft. However, the buccal bone was always coronal to the implant shoulder. Both the equicrestal and subcrestal groups were benefited in the early stages of bone healing as evidenced by the fluorescence analysis.

Additional effects of aPDT on nonsurgical periodontal treatment with doxycycline in type II diabetes: a randomized, controlled clinical trial.

The association of doxycycline and periodontal treatment in non-controlled diabetes mellitus (DM) has shown positive results on clinical and metabolic parameters. Antimicrobial photodynamic therapy (aPDT) is a local and painless antimicrobial treatment that can be applied in periodontal treatment without systemic risks. The aim of this study was to evaluate the potential improvement of aPDT on clinical and metabolic effects in patients with type 2 diabetes mellitus in conjunction with nonsurgical periodontal treatment plus doxycycline. Thirty patients with type 2 diabetes and diagnosis of chronic periodontitis were treated with scaling and root planning (SRP; N = 15) or SRP plus phenothiazine chloride photosensitizer-induced aPDT (SRP + aPDT, N = 15). Patients of both groups took doxycycline (100 mg/day) for 2 weeks and plaque index, bleeding on probe (BOP), probing pocket depth (PPD), suppuration, clinical attachment level (CAL), and glycated hemoglobin levels (HbA1c) were measured at baseline and 3 months after therapy. An improvement in clinical parameters such as PPD, CAL, S, and BOP between groups was observed but without statistical significance (p > 0.05). Intragroup analysis showed a significant reduction of HbA1c (8.5 ± 0.9 to 7.5 ± 0.1, p < 0.01) in the SRP + aPDT group. The differences of HbA1c between baseline and 3 months were greater for the SRP + aPDT (11.4 %) than SRP (10 %) (0.87 ± 0.9 and 0.4 ± 0.84 respectively; p < 0.05). A single application of the aPDT as an adjunct to periodontal treatment did not show additional benefits in the clinical parameters but resulted in a slight greater decrease in HbA1c.

Buccal bone remodeling after tooth extraction using the flapless approach with and without synthetic bone grafting. A histomorphometric study in dogs.

OBJECTIVE: The aim of this study was to evaluate buccal bone remodeling of fresh sockets following tooth extraction using the flapless approach, with or without synthetic graft materials. MATERIAL AND METHODS: Eight dogs had the mandibular bicuspids extracted without flaps, and two alveoli on each side (total of 4) were selected. The following groups were devised: one socket on each side received a grafting material (test group), and the other remained only with a blood clot (control group). Ground sections were prepared from 12-week healing biopsies, and histomorphometry was performed. RESULTS: The buccal crest level (BCL) relative to the new bone (i), in the test group, showed numerically better data when compared with the control group, but without statistical relevance. The BCL relative to the old bone (ii) was very similar for the groups without statistical relevance. The alveolar ridge width (ARW) showed similar results without statistically significant difference between the groups. The total bone area (TBA) showed statistically significant differences between the test (38.60%) and control (47.18%) groups. The new bone area (NBA) presents a numerical difference between the test (15.62%) and control (22.24%), but without statistically significant differences. The old bone and the bone marrow were similar for both groups. CONCLUSION: It was observed that there was no loss of the buccal bone crest in relation to the lingual bone crest, especially in the test group.