Collagen matrix biofunctionalized with injectable platelet-rich fibrin for the treatment of single gingival recession: A case report.

INTRODUCTION: Collagen matrices have been used as connective tissue graft (CTG) substitutes. However, they do not have the same efficacy compared to CTG. Adding biological agents may increase collagen matrices' efficacy. The present case reports the use of a biofunctionalized volume-stable collagen matrix (VCMX) with injectable platelet-rich fibrin (iPRF) associated with the coronally advanced flap (CAF) to treat single gingival recession (GR) defect. CASE PRESENTATION: A Recession Type 1 (RT1 A-) defect at maxillary left canine in a male patient was treated using a VCMX biofunctionalized with iPRF associated with CAF. No swelling or edema was observed during the first 14 days after surgery. Complete root coverage was observed (RecRed of 4.0 mm) after 6 months. Gingival thickness (GT) increased (1.0 mm) by the end of the follow-up. CONCLUSION: The present case report shows that CAF associated with VCMX+iPRF presents good clinical outcomes for single GR defect. KEY POINTS: Why is this case new information? This case is the first one to our knowledge to describe the biofunctionalization of VCMX with iPRF to treat single gingival recession. What are the keys to successful management of this case? Proper material handling. Proper iPRF protocol execution. What are the primary limitations to success in this case? Need of venipuncture. Correct preparation of VCMX+iPRF. Patient compliance.

Novo sistema de liberação de drogas ­ filme de fibroína de seda carregado ou não com insulina para reparo de feridas em mucosa palatina: estudo in vitro e clínico randomizado / A new drug delivery system ­ silk fibroin film loaded or not with insulin on palatal mucosa wound healing: in vitro study and a randomized clinical trial

Several types of periodontal and peri-implant soft tissue defects require surgical treatment to reestablish function and aesthetics. However, local, and systemic factors can jeopardize tissue repair leading to unexpected outcomes and postoperative discomfort. In order to overcome this problem, new devices have been developed to improve surgical procedures outcomes and patient experience. The aim of the present study was to develop a new silk fibroin (SF)/chitosan (CH) film loaded with insulin as a drug delivery system to improve palatal donor area healing after free gingival graft harvesting for ridge preservation. For this, biomaterial development, characterization and in vitro assessment were performed to evaluate the new delivery system. In addition, 3- months outcomes from palatal wound healing following the use of the proposed delivery system were assessed through clinical, patient centered parameters, immunological, microbiological, and histological evaluations. Sixty-nine patients with indication of tooth extraction were enrolled into 3 groups: Control Group (C) (n=23): open wound on palatal mucosa followed by spontaneous healing; SF/CH Film (F) (n=23): open wound on palatal mucosa and silk fibroin film as dressing; Insulin-loaded SF/CH film (IF) (n=23): open wound on palatal mucosa and an insulin- loaded silk fibroin film as a delivery system. : It was verified some characteristics that are favorable to the oral environment, such as mechanical properties, swelling and permeability to water vapor. The biomaterial presented a standard of a controlled release system through diffusion with delivery stability in human saliva, along with an excellent biocompatibility with the absence of cytotoxicity and genotoxicity increasing cell viability in lineage cells (HaCat). F and IF promoted accelerated palatal wound closure on day 7 and 14 after surgery, as well as an early epithelialization, compared to the C group. Both films were capable to reduce pro-inflammatory cytokines (IL-6, TNF-α, IL-1ß) and modulate biomarkers correlated to tissue degradation/remodeling. Spontaneous healing microbiome reported higher genus/species with pathogenic role in the oral mucosa with reduction in health species following this profile until de end of the follow-up. A tendency of eubiosis was observed in F and IF groups throughout healing process. It seems that this new device has a promising application in oral cavity and positively influence wound healing. (AU)

Diversos tipos de defeitos mucogengivais requerem abordagem cirúrgica para o reestabelecimento funcional e estético. Porém, alterações locais e sistêmicas podem prejudicar o processo de reparo gerando resultados inesperados e desconforto ao paciente. Biomateriais vem sendo desenvolvidos para melhorar os resultados dos procedimentos cirúrgicos e a experiência clínica do paciente. O objetivo do presente estudo foi desenvolver um filme de fibroína de seda (FS) e quitosana (QT) carregado com insulina (INS), atuando como um sistema de liberação, para acelerar a cicatrização de feridas na área doadora palatina após procedimento de preservação de rebordo com uso de enxerto gengival livre. Para isso, foi executado o desenvolvimento, caracterização e avaliação in vitro do biomaterial. Ademais, o resultado de 3 meses do reparo das feridas palatinas foi verificado por meio de avaliações clínicas, imunológica, microbiológica, histológica, bem como parâmetros centrados no paciente. Sessenta e nove pacientes foram alocados aleatoriamente nos grupos Controle (C) (n=23): ferida aberta em palato seguido de cicatrização espontânea; Filme de FS/QT (F) (n=23): ferida aberta em palato associada ao filme na área doadora; Filme de FS/QT carregado com INS (IF) (n=23): ferida aberta em palato associada ao filme carregado com INS na área doadora. Verificou-se propriedades mecânicas, bem como de entumecimento e permeabilidade ao vapor de água, favoráveis ao meio bucal sem nenhuma alteração com a inclusão da INS. O dispositivo apresentou liberação controlada por meio de difusão com estabilidade em saliva humana. Excelente biocompatibilidade com ausência de cito e genotoxicidade foi observada em diversos tipos celulares aumentando a viabilidade celular em células de linhagem (HaCat). F e IF favoreceram um fechamento acelerado da ferida palatina aos 7 e 14 dias pós-injuria, assim como uma epitelização precoce destes comparado ao grupo C. F e IF reduziram citocinas pró-inflamatórias (IL6, TNF-α, IL-1ß) além de apresentarem função modulatória na quantificação de biomarcadores relacionados a degradação tecidual. O Grupo C apresentou gênero/espécies com potencial patogênico e redução de microrganismos relacionados a saúde mantendo este perfil aos 14 e 30 dias. Enquanto isso, uma tendência a eubiose foi observado em F e IF ao longo do processo de cicatrização. Deste modo, verifica-se a aplicação promissora do novo dispositivo na cavidade oral bem como capacidade de influenciar positivamente o reparo da mucosa oral. (AU)

Comparison between connective tissue graft and xenogeneic acellular dermal matrix to treat single gingival recession: A data reanalysis of randomized clinical trials.

OBJECTIVES: There are few studies comparing xenogeneic acellular dermal matrixes (XDMs) with connective tissue graft (CTG) to treat single gingival recession (GR). The present study involved a reanalysis of previous studies and comparison of CTG or XDM to treat single RT1/GR. MATERIALS AND METHODS: Fifty patients from three previous randomized clinical trials treated either by CTG (n = 25) or XDM (n = 25) were evaluated after 6-month. Clinical, patient-centered, and esthetic parameters were assessed. Pearson's correlation and regression analyses were also performed. RESULTS: Greater recession reduction (RecRed), percentage of root coverage (%RC), and complete root coverage (CRC) were observed in the CTG group (p ≤ 0.02). Gingival thickness (GT) and keratinized tissue width (KTW) gains were higher in the CTG group. The CTG group showed better esthetic at 6-month. Logistic analyses reported that GT([OR] = 1.6473 ) and papilla height (PH) (OR = 8.20) are predictors of CRC. GT*XDM interaction was a negative predictor of CRC (OR = 7.105-5 ). GT at baseline acted as a predictor of RecRed in both groups (p = 0.03). The XDM graft impacted RecRed and %RC negatively. Baseline PH was a predictor of %RC for both grafts. CONCLUSION: CTG was superior for treating RT1/GR, providing better root coverage outcomes and tissue gains over time. GT, PH, and graft type were classified as predictors of CRC. CLINICAL SIGNIFICANCE: CTG presented better outcomes to treat single RT1 gingival recession when compared to the XDM.

Comparison of two types of xenogeneic matrices to treat single gingival recessions: A randomized clinical trial.

BACKGROUND: Xenogeneic matrices (XMs) have been increasingly used for root coverage procedures. This study compared the use of two types of XM (collagen matrix [CM] and xenogeneic acellular dermal matrix [XDM]) associated with the coronally advanced flap technique (CAF) to treat single gingival recessions. METHODS: Seventy-five patients presenting single RT1 gingival recession were treated by CAF (control group, n = 25), CAF+CM (test group 1, n = 25), or CAF+XDM (test group 2, n = 25) and completed 6-month follow-up. Clinical, patient-centered, and esthetic assessments were performed and intra- and intergroup differences were analyzed. RESULTS: At 6 months, the mean recession reduction for CAF, CAF+CM, and CAF+XDM was 2.4 ± 0.8 mm, 2.4 ± 0.9 mm and 2.1 ± 0.8 mm, respectively (P > 0.05). The corresponding mean percentage of root coverage was 78.9% ± 26.2% for CAF, 78.0% ± 28.5% for CAF+CM, and 65.6% ± 26.9% for CAF+XDM (P > 0.05). Dentin hypersensitivity and esthetic conditions showed significantly improvements in all groups. Test groups presented significant gains in gingival thickness (GT; CAF+CM: 0.4 ± 0.3 mm; CAF+XDM: 0.4 ± 0.2 mm) compared to the control group (CAF: 0.0 ± 0.1 mm; P < 0.05). CONCLUSION: The CAF, CAF+CM, and CAF+XDM treatments each provided similar results in the treatment of single gingival recessions. The addition of either CM or XDM to CAF increases the GT.

Enamel matrix derivative effects on palatal mucosa wound healing: Randomized clinical trial.

BACKGROUND: This study was conducted to evaluate the clinical, immunologic, and patient-centered outcomes of enamel matrix protein derivative (EMD) on excisional wounds in palatal mucosa. MATERIALS: Forty-four patients in need of ridge preservation were randomly allocated into two groups: control group (n = 22): open palatal wound after free gingival graft (FGG) harvest and EMD group (n = 22): open palatal wound after FGG harvest that received 0.3 ml of EMD. Clinical and patient-centered parameters were analyzed for 3 months post-treatment. Wound fluid levels of inflammatory markers were assessed 3 and 7 days postoperatively. RESULTS: No significant inter-group difference was observed in remaining wound area and re-epithelialization. EMD and control groups achieved wound closure and re-epithelialization 30 days postoperatively (p < .001), without inter-group differences. Similarly, number of analgesics and Oral Health Impact Profile scores did not present significant inter-group differences (p > .05). EMD appeared to selectively modulate wound fluid levels of monocyte chemoattractant protein-1, macrophage inflammatory protein-1α, matrix metallopeptidase 9, and tissue inhibitor of metalloproteinases-2. CONCLUSION: Within the limits of the present study, it can be concluded that EMD application to excisional palatal wounds using the investigated protocol does not provide clinical healing benefits, despite an apparent modulation of selected inflammatory markers.

Microcurrent electrotherapy improves palatal wound healing: Randomized clinical trial.

BACKGROUND: This study was conducted to assess the clinical, immunological, and patient-centered outcomes of microcurrent electrotherapy on palatal wound healing. METHODS: This was a parallel, double-masked randomized clinical trial, in which 53 patients with ridge preservation indications were selected and randomly assigned to one of two groups. In the control (sham) group (n = 27), palatal wounds, after free gingival grafts (FGG) harvest, received sham application of electrotherapy. In the test (electrotherapy treatment [EE]) group (n = 26), palatal wounds, after FGG harvest, received application of microcurrent electrotherapy protocol. Clinical parameters, patient-centered outcomes, and inflammatory markers were evaluated, up to 90 days postoperatively. RESULTS: The EE group achieved earlier wound closure (P <0.001) and epithelialization (P <0.05; P = 0.03) at 7 and 14 days after harvest when compared with the sham group. Painful symptomatology was reported less frequently in the EE group than in the sham group at 3-day follow-up (P = 0.008). Likewise, an improvement in Oral Health Impact Profile was reported 2 days after the procedure by the EE group (P = 0.04). In addition, favorable modulation of inflammatory wound healing markers occurred when electrotherapy was applied. CONCLUSION: Within the limits of the present study, it can be concluded that the use of a low-intensity electrotherapy protocol may accelerate palatal wound healing and decrease patient discomfort after FGG harvest.

Photobiomodulation for the treatment of periodontal pockets in patients with type 2 diabetes: 1-year results of a randomized clinical trial.

This study investigated the local effect of photobiomodulation (PBM) for the treatment of periodontal pockets in patients with periodontitis and type 2 diabetes. Thirty-eight periodontal pockets presenting probing depth (PD) and clinical attachment level (CAL) ≥ 5 mm were selected from 19 patients (two pockets/patient). The selected periodontal pockets were randomly assigned to receive mechanical debridement only (control group) or mechanical debridement with PBM (PBM group). Clinical measures, such as PD, CAL, bleeding on probing (BoP), and presence of supragingival biofilm (PI), were collected and compared at baseline, 3, 6, and 12 months. After 12 months, no statistically difference was observed for mean PD and mean CAL when control and PBM groups were compared. The frequency of pockets with PD 5-6 mm was significantly lower for the PBM group at 6 months when compared to the control group. Pockets with PD ≥ 7 mm changed significantly between baseline and 3, 6, and 12 months for the PBM group, while for the control group, statistical significance was only observed between baseline and 6 months. The PBM protocol used in this study did not provide significant changes for PD and CAL in periodontal pockets when compared to mechanical therapy only. However, PBM was more effective in reducing the percentage of moderate periodontal pockets at 6 months in patients with type 2 DM.