Modified interproximal tunneling technique with customized sub-epithelial connective tissue graft for gingival papilla reconstruction: report of three cases with a cutback incision on the palatal side.

BACKGROUND: Gingival papilla defects, which cause an unpleasant appearance and involve the upper anterior teeth, may be triggered by several factors. Several noninvasive and invasive techniques have been proposed for gingival papilla reconstruction. The combination of interproximal tunneling and customized connective tissue grafts (CTGs) has shown promise in papilla augmentation. However, due to the narrowness and limited blood supply of the gingival papilla, the long-term outcomes of these techniques remain unpredictable. Therefore, achieving tension-free coronal advancement of the interdental papilla and proper placement of the CTG is crucial for successful long-term outcomes and could provide widely applicable methods for papilla augmentation. CASE REPORT: In this study, we enrolled three patients with gingival papilla defects in the maxillary anterior teeth. For reconstruction, we proposed a modified interproximal tunneling (MIPT) technique combined with a CTG. A crucial modification based on previous studies involved adding a cutback incision to the base of the palatal vertical incision, resulting in tension-free healing. Additionally, the CTG was sutured upright to further enhance the height of the gingiva papilla. To evaluate the efficacy of the MIPT technique, the clinical parameters-including the Jemt papilla index and the distance from the tip of the papilla to the interproximal contact point-were examined using a periodontal probe (UNC15, Hu-friedy) at baseline and 12 months after surgery. All three patients achieved satisfactory papilla reconstruction 12 months after the surgery. These three cases were used to evaluate the efficacy of the MIPT technique combined with the customized CTG. An average increase in the Jemt papilla score from 1.6 to 2.8 and a reduction in the distance from the papilla tip to the contact point of adjacent teeth from 2 mm to 0.08 mm were observed 12 months after surgery. CONCLUSION: The preliminary results confirmed that this technique holds promise for gingival papilla augmentation between tooth/tooth or tooth/implant.

[The effect of inflammation on proliferation and osteogenic differentiation of periodontal ligament cells].

PURPOSE: To investigate the effects of inflammatory microenvironment on proliferation and osteogenic differentiation of periodontal ligament cells(PDLCs) in vitro. METHODS: Human PDLCs were isolated and characterized. MTT was used to investigate the proliferation rate of PDLCs under different concentration of lipopolysaccharide（LPS）. The PDLCs' osteogenic differentiation was investigated using real-time PCR and Western blot. The date were statistically analyzed with SPSS 13.0 software package. RESULTS: Treatment with 0.1 µg/mL LPS increased proliferation of PDLCs and enhanced the expression of osteogenic gene and protein. The proliferation of PDLCs and expression of alkaline phosphatase(ALP), RUNX2, Collagen-I, BMP2 were significantly decreased by 10 µg/mL LPS. CONCLUSIONS: The inflammatory microenvironment (10 µg/mL LPS) inhibits the proliferation and osteogenic differentiation of human PDLCs.

[The effect of rhAm and EMPs on promoting differentiation of hBMSCs into osteoblasts].

PURPOSE: To compare the effect of recombinant full-length human amelogenin (rhAm) and enamel matrix proteins (EMPs) on differentiation of human bone marrow stromal cells (hBMSCs) into osteoblasts. Meanwhile, to investigate the possible mechanism of rhAm promoting osteogenic differentiation of hBMSCs. METHODS: The hBMSCs were cultured in vitro. The cells were treated with 10 µg/mL rhAm and 200 µg/mL EMPs. The gene and protein expression of Runx2, ALP, Col-I were observed by using RT-PCR and Western blot at different time points. The influence of rhAm and EMPs on mineralization and osteogenesis of hBMSCs were observed by using alkaline phosphatase and alizarin red staining methods. The data was analyzed with SPSS 13.0 software package. RESULTS: Both rhAm and EMPs significantly promoted gene and protein expression of Runx2, ALP and Col-I in hBMSCs. Meanwhile, rhAm and EMPs also facilitated osteogenesis and mineralization of hBMSCs. The effects of two proteins on hBMSCs had no significant difference. CONCLUSIONS: Both 10 µg/mL rhAm and 200 µg/mL EMPs can significantly promote differentiation of hBMSCs into osteoblasts. The rhAm may be used in inducing periodontal tissue regeneration in the future.