Histological evaluation following treatment of recession-type defects with coronally advanced flap and a novel human recombinant amelogenin.

OBJECTIVES: To histologically evaluate the effects of a novel human recombinant amelogenin (rAmelX) on periodontal wound healing / regeneration in recession-type defects. MATERIALS AND METHODS: A total of 17 gingival recession-type defects were surgically created in the maxilla of three minipigs. The defects were randomly treated with a coronally advanced flap (CAF) and either rAmelX (test), or a CAF and placebo (control). At three months following reconstructive surgery, the animals were euthanized, and the healing outcomes histologically evaluated. RESULTS: The test group yielded statistically significantly (p = 0.047) greater formation of cementum with inserting collagen fibers compared with the control group (i.e., 4.38 mm ± 0.36 mm vs. 3.48 mm ± 1.13 mm). Bone formation measured 2.15 mm ± 0.8 mm in the test group and 2.24 mm ± 1.23 mm in the control group, respectively, without a statistically significant difference (p = 0.94). CONCLUSIONS: The present data have provided for the first-time evidence for the potential of rAmelX to promote regeneration of periodontal ligament and root cementum in recession-type defects, thus warranting further preclinical and clinical testing. CLINICAL RELEVANCE: The present results set the basis for the potential clinical application of rAmelX in reconstructive periodontal surgery.

Hyaluronic Acid: A New Approach for the Treatment of Gingival Recession-A Systematic Review.

This systematic review aimed to investigate the effectiveness of hyaluronic acid (HA) on the clinical treatment outcomes of patients with gingival recession. A systematic search was performed in PubMed, Cochrane Central Register of Controlled Trials, Embase, Scopus, and Google Scholar for studies up to 15 August 2022. Two reviewers separately selected the papers for eligibility after conducting a thorough search. The study includes randomized controlled clinical trials in which participants were given HA in addition to periodontal treatment surgical procedures. The changes following the treatment protocol were evaluated for complete and mean root coverage as a primary outcome and gingival recession gain as the secondary outcome. Three articles met the eligibility criteria out of 557 titles. In periodontal surgery, HA exhibited better results in complete root coverage and mean root coverage when compared to the control group. Gingival recession reduction, clinical attachment level, and keratinized tissue gain were significantly increased compared to the control groups. However, the comparison presented in the following study might show heterogeneity among the studies and risk of bias in general. Given the scope of this analysis, results suggest that adjunctive treatment with HA gel for root coverage could be clinically beneficial.

Efficacy of biologics in root coverage and gingival augmentation therapy: An American Academy of Periodontology best evidence systematic review and network meta-analysis.

BACKGROUND: The aim of this systematic review was to assess the efficacy of three biologics, namely autologous blood-derived products (ABPs), enamel matrix derivatives (EMD) and recombinant human platelet-derived growth factor BB (rhPDGF-BB), in root coverage and gingival augmentation therapy. METHODS: The protocol of this PRISMA 2020-compliant systematic review was registered in PROSPERO (CRD42021285917). After study selection, data of interest were extracted. A network meta-analysis (NMA) was conducted to assess the effect of different surgical interventions on the main clinical outcomes of interest (i.e., mean root coverage [MRC%], complete root coverage [CRC%], keratinized tissue width [KTW], gingival thickness [GT] change, and recession depth [RD] reduction). RESULTS: A total of 48 trials reported in 55 articles were selected. All studies reported on the treatment of gingival recession defects for root coverage purposes. Forty-six treatment arms from 24 trials were included in the NMA. These arms consisted of treatment with coronally advanced flap (CAF) alone, EMD + CAF, platelet-rich fibrin (PRF) + CAF, and subepithelial connective tissue graft (SCTG) + CAF. Regarding MRC%, SCTG+CAF was associated with a significant higher estimate (13.41%, 95% CI [8.06-18.75], P <  0.01), while EMD+CAF (6.68%, 95% CI [-0.03 to 13.4], P = 0.061) and PRF+CAF (1.03%, 95% CI [-5.65 to 7.72], P = 0.71) failed to show statistically significant differences compared with CAF alone (control group) or with each other. Similarly, only SCTG+CAF led to a significantly higher CRC% (14.41%, 95% CI [4.21 to 24.61], P < 0.01), while treatment arms EMD + CAF (13.48%, 95% CI [-3.34 to 30.32], P = 0.11) and PRF+CAF (-0.91%, 95% CI [-15.38, 13.57], p = 0.81) did not show significant differences compared with CAF alone or with each other. Differences in the CI of PRF+CAF (symmetrical around a zero adjunctive effect) and EMD+CAF (non-symmetrical) suggest that EMD could have some additional value compared with PRF. Treatment with SCTG+CAF led to a statistically significant higher RD reduction (-0.39 mm, 95% CI [-0.55 to 0.22], P < 0.01), however EMD+CAF (-0.13 mm, 95% CI [-0.29 to 0.01], P = 0.08) and PRF+CAF (-0.06 mm, 95% CI [-0.23 to 0.09], P = 0.39) failed to show significant differences compared with CAF or with each other. While SCTG+CAF was associated with a statistically significant higher gain of KTW (0.71 mm, 95% CI [0.48 to 0.93], P < 0.01), EMD+CAF (0.24 mm, 95% CI [-0.02 to 0.51], P = 0.08) and PRF+CAF (0.08 mm, 95% CI [-0.23 to 0.41], P = 0.58) did not result into significant changes compared with CAF alone or with each other. Regarding the use of rhPDGF-BB+CAF, although available studies have reported equivalent results compared with SCTG+CAF, evidence is very limited. CONCLUSIONS: The use of ABPs, EMD, or rhPDGF-BB in conjunction with a CAF for root coverage purposes is safe and generally promotes significant improvements respective to baseline clinical parameters. However, the adjunctive use of ABPs and EMD does not provide substantial additional improvements in terms of clinical outcomes and patient-reported outcome measures to those achieved using CAF alone, when baseline KTW is >2 mm. Both PRF+CAF and EMD+CAF rendered inferior MRC%, CRC%, RD reduction, and KTW gain compared with SCTG+CAF, which should still be considered the gold-standard in root coverage therapy. Although some studies have reported equivalent results for rhPDGF-BB+CAF compared with the gold-standard intervention, limited evidence precludes formal comparisons with CAF or SCTG+CAF that could be extrapolated to guide clinical practice.

Cell Therapy Based on Gingiva-Derived Mesenchymal Stem Cells Seeded in a Xenogeneic Collagen Matrix for Root Coverage of RT1 Gingival Lesions: An In Vivo Experimental Study.

(1) Background: To investigate the effect of a xenogeneic collagen matrix (CMX) seeded with autologous gingiva-derived mesenchymal cells (GMSCs) when combined with a coronally advanced flap (CAF) in the treatment of localized gingival recession type 1 (RT1). (2) Methods: Dehiscence-type defects were created in seven dogs. GMSCs were isolated, transfected with a vector carrying green fluorescent protein (GFP) and expanded. Once chronified, the defects were randomly treated with (1) CAF plus the combination of CMX and GFP+ GMSCs, (2) CAF plus CMX with autologous fibroblasts, (3) CAF plus CMX and (4) CAF alone. Histological and clinical outcomes at 2- and 6-week healing periods were analyzed and compared among groups. (3) Results: Histologically, the addition of autologous cells to the CMX resulted in reduced inflammation and a variable degree of new cementum/bone formation. CMX plus GMSCs resulted in greater mean recession reduction (1.42; SD = 1.88 mm) and percentage of teeth with recession reduction of ≥2 mm (57%) when compared to the other groups, although these differences were not statistically significant. (4) Conclusions: The histometric and clinical results indicated a positive trend favouring the combination of CMX and GMSCs with the CAF when compared to the groups without cells, although these differences were not statistically significant.

Long-term clinical outcomes of periodontal regeneration with enamel matrix derivative: A retrospective cohort study with a mean follow-up of 10 years.

BACKGROUND: Despite the large body of evidence on the efficacy of enamel matrix derivative (EMD) in the treatment of periodontal intrabony defects, few studies reported long-term data (≥10-year). METHODS: Periodontal patients treated with regenerative surgery with EMD between 1999 and 2012 were invited to participate in a clinical examination. The following clinical parameters were recorded and compared at baseline (T0), 6 months after surgery (T1) and after at least 8 years of follow-up (T2): probing depth (PD), gingival recession (GR), clinical attachment level (CAL), plaque and bleeding scores. The primary outcome variable was CAL change. RESULTS: Forty-one patients with 75 treated teeth were available for analysis. Out of these, 68 (tooth survival rate: 90.7%) reached the latest follow-up with a mean observation period of 10.3 years (range: 8.0 to 21.3). The most frequent reason for tooth loss was recurrence of periodontal disease. Tooth survival curves showed a statistically significant difference between smokers and non-smokers (P = 0.028). Mean CAL changed from 8.43 ± 1.86 (T0) to 6.47 ± 1.70 (T1) (P < 0.001) and to 5.91 ± 1.83 (T2) (P < 0.001). At T1, a CAL gain of ≥3 mm was measured in 35% of the defects whereas at T2 it was detected in 51% of cases. CONCLUSIONS: Within their limitations, the present results have shown that in intrabony defects, the clinical improvements obtained following regenerative surgery with EMD can be maintained on a mean period of 10 years. Smoking status and maxillary molars were correlated with an increased risk for tooth and CAL loss, respectively.

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.

Apical approach in periodontal reconstructive surgery with enamel matrix derivate and enamel matrix derivate plus bone substitutes: a randomized, controlled clinical trial.

OBJECTIVES: This parallel, randomized controlled clinical trial evaluated the influence of bone substitutes (BS) on the efficacy of the non-incised papillae surgical approach (NIPSA) with enamel matrix derivate (EMD) in resolving deep, isolated, combined non-contained intrabony and supra-alveolar periodontal defects, preserving the soft tissue. MATERIAL AND METHODS: Twenty-four patients were randomized to treatment with NIPSA and EMD or NIPSA plus EMD and BS. Bleeding on probing (BoP), interproximal clinical attachment level (CAL), interproximal probing depth (PD), recession (REC), location of the tip of the papilla (TP), and width of the keratinized tissue (KT) were evaluated before surgery and at 1 year post-surgery (primary outcomes). Wound closure was assessed at 1 week post-surgery, and supra-alveolar attachment gain (SUPRA-AG) was recorded at 1 year post-surgery. RESULTS: At 1 week, 87.5% of cases registered complete wound closure and there were no cases of necrosis, without differences between groups (p > .05). At 1 year, all cases showed negative BoP. A significant PD reduction (NIPSA + EMD 8.25 ± 2.70 mm vs. NIPSA + EMD + BS 6.83 ± 0.81 mm) and CAL gain (NIPSA + EMD 8.33 ± 2.74 mm vs. NIPSA + EMD + BS 7.08 ± 2.68 mm) were observed (p < .001) in both groups, without significant between-group differences (p > .05). The residual PD was < 5 mm in all defects (NIPSA + EMD 2.50 ± 0.67 mm vs. NIPSA + EMD + BS 2.67 ± 0.78 mm). Soft tissues were preserved without significant between-group differences (REC: NIPSA + EMD 0.25 ± 0.45 mm vs. NIPSA + EMD + BS 0.17 ± 0.58 mm, p > .05; KT: 0.00 ± 0.43 mm vs. 0.08 ± 0.67 mm, p > .05). There were improvements in the papilla in both groups (TP: NIPSA + EMD 0.33 ± 0.49 mm vs. NIPSA + EMD + BS 0.45 ± 0.52 mm, p > .05), which was only significant in the NIPSA EMD + BS group (0.45 ± 0.52 mm; p < .05). In both groups, CAL gain was recorded in the supra-alveolar component, showing full resolution of the intrabony component of the defect in all cases (SUPRA-AG: NIPSA + EMD 1.83 ± 1.11 mm vs. NIPSA + EMD + BS 2.00 ± 1.76 mm, p > .05). CONCLUSIONS: NIPSA and EMD with or without BS seem to be a valid surgical approach in the treatment of isolated, deep non-contained periodontal defects. In our study, both treatments resulted in significant PD reduction and CAL gain, that extended in the supra-alveolar component, without differences with the use of BS. Both treatments resulted in soft tissue preservation. However, the addition of BS may improve interdental papillary tissue. CLINICAL RELEVANCE: NIPSA, with or without bone substitutes, resulted in significant periodontal improvement, with soft tissue preservation in isolated, deep non-contained periodontal defects. The application of bone substitutes may provide interproximal soft tissue gain. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov: NCT04712630.

Treatment of intrabony periodontal defects in controlled diabetic patients with an enamel matrix derivative: a split-mouth randomized clinical trial.

OBJECTIVE: This split-mouth randomized controlled trial aimed to evaluate the effect of enamel matrix derivative (EMD) associated with a simplified papilla preservation flap (SPPF) compared to SPPF alone in the surgical treatment of intrabony defects (ID) in type 2 diabetic mellitus (T2DM) patients. MATERIAL AND METHODS: Thirteen patients with controlled T2DM presenting with ID in at least two quadrants were included. In each patient, the test site (TS) was treated with SPPF plus EMD, whereas the control site (CS) was treated only with SPPF. Prior to surgery and at 6 months after intervention, the following parameters were evaluated: clinical attachment level (CAL), probing pocket depth (PPD), and gingival recession (GR). RESULTS: The TS and CS demonstrated a mean CAL gain of 3.31 ± 0.96 mm and 1.61 ± 1.12 mm, and a PPD reduction from 8.15 ± 0.98 to 3.00 ± 0.57 mm and 7.53 ± 0.96 to 4.69 ± 0.63 mm after 6 months, respectively. In both sites, the mean CAL gain and PPD reduction improved significantly after 6 months compared to baseline; however, the improvement was higher in the TS (p < 0.001). CONCLUSIONS: Both surgical procedures presented with clinical improvements in controlled T2DM patients. However, the additional use of EMD showed enhanced clinical results after 6 months with regard to CAL gain and PPD reduction. CLINICAL RELEVANCE: This study showed a better PPD reduction and CAL gain when an EMD was applied in addition to SPPF. Therefore, EMD may be used to enhance clinical outcomes in periodontal ID of controlled T2DM patients.

Single flap approach with or without enamel matrix derivative in the treatment of severe supraosseous defects: a retrospective study.

AIM: To comparatively evaluate the clinical effectiveness of the single flap approach (SFA) with and without enamel matrix derivative (EMD) in the treatment of supraosseous defects (SDs) associated with deep pockets. MATERIALS AND METHODS: Twenty patients, each contributing one SD associated with a deep (≥ 6 mm) pocket and treated with buccal SFA either alone (SFA group; n = 10) or in combination with EMD (SFA+EMD group; n =10), were retrospectively selected. Clinical parameters (probing depth, PD; clinical attachment level, CAL; gingival recession, REC) had been assessed at pre-surgery and 12 months post-surgery. RESULTS: Complete wound closure was observed in 70% and 80% of defects treated with SFA and SFA+EMD, respectively. Treatments resulted in a significant PD reduction of 3.1±1.0 mm (p=0.005). In SFA+EMD group, 100% of closed pockets was obtained, while 90% of closed pockets was observed in SFA group. Both treatments resulted in a significant CAL gain of 2.1±0.9 mm and 1.9±1.7 mm in SFA and SFA+EMD group, respectively (p= 0.465). In both groups, REC significantly increased 1.0±1.1 mm in SFA group and 1.1±1.1 mm in SFA+EMD group (p= 0.722). CONCLUSIONS: Within their limits, the findings of present study suggest that SFA may represent a valuable option for the surgical treatment of SDs associated with deep pockets. EMD did not result in a significant clinical benefit to the procedure. CLINICAL RELEVANCE: SFA may represent a valuable option in obtaining pocket closure when treating SDs associated with deep residual pockets.

A New Approach for Root Surface Biomodification Using Injectable Platelet-Rich Fibrin (I-PRF).

BACKGROUND This study investigated the potential effects of Injectable Platelet-Rich Fibrin (I-PRF) on root coverage of free gingival graft surgery. MATERIAL AND METHODS A total of 40 patients with Miller class I or II gingival recession were included. The patients who participated in this study were randomly divided into 2 groups, including the control and experiment groups. The patients in the control group were treated only with free gingival graft (FGG). The patients in the experiment group were treated with free gingival graft and injected with I-PRF as a root surface biomodification agent (FGG+I-PRF). The patients were called back after 3 months, and the amount of exposed root surface was determined and compared to the preoperative findings. RESULTS The mean initial exposed root surface was 4.7±1.49 mm for the FGG+I-PRF group, 4.1±1.07 mm for the FGG group, and 4.4±1.31 mm for all subjects. Three months after the operation, the mean root surface coverage values of the 2 groups were 3.5±1.05 and 3.9±0.78 mm in the control and experiment groups, respectively. CONCLUSIONS The findings showed that the injection of Injectable Platelet-Rich Fibrin (I-PRF) had a positive effect on root coverage in free gingival graft surgery.

Evaluation of the effect of dose-dependent platelet-rich fibrin membrane on treatment of gingival recession: a randomized, controlled clinical trial.

Miller's class I gingival recessions (GR) have been treated using coronally advanced flap (CAF) with platelet-rich fibrin membrane (PRF membrane) or connective tissue graft (CTG). The aim of this study was to evaluate the effect of different multiple layers of PRF membranes for the treatment of GR compared with the CTG procedure. Sixty-three Miller class I GR were treated in this study. Twenty-one GR selected randomly were treated with two layers of PRF membranes+CAF in 2PRF+CAF (test group-1), four layers of PRF membranes+CAF in 4PRF+CAF (test group-2), and CTG+CAF in the control group. The plaque index (PI), gingival index (GI), probing depth (PD), keratinized tissue thickness (KTT), clinical attachment level (CAL), recession depth (RD), recession width (RW), and keratinized tissue height (KTH) measurements were performed at baseline and 1, 3, and 6 months after surgery. The post-operative discomfort of patients, assessed with the visual analog scale (VAS) and healing index (HI), was recorded after surgery. PI, GI, and PD scores were similar for all patients at all times. RD and RW scores were similar for each patient at 1 month, but these values were significantly increased in the subsequent periods in test group-1. The increase in KTT was significantly higher in the control group compared with the test groups. Similar root coverage scores were obtained in the test group-2 and control groups, and these scores were significantly higher compared with test group-1. The PRF membrane+CAF technique may be an alternative to the CTG+CAF technique for postoperative patient comfort. However, PRF membranes should use as many layers as possible.

Evaluation of the effect of dose-dependent platelet-rich fibrin membrane on treatment of gingival recession: a randomized, controlled clinical trial

Abstract Miller's class I gingival recessions (GR) have been treated using coronally advanced flap (CAF) with platelet-rich fibrin membrane (PRF membrane) or connective tissue graft (CTG). Objective: The aim of this study was to evaluate the effect of different multiple layers of PRF membranes for the treatment of GR compared with the CTG procedure. Material and Methods: Sixty-three Miller class I GR were treated in this study. Twenty-one GR selected randomly were treated with two layers of PRF membranes+CAF in 2PRF+CAF (test group-1), four layers of PRF membranes+CAF in 4PRF+CAF (test group-2), and CTG+CAF in the control group. The plaque index (PI), gingival index (GI), probing depth (PD), keratinized tissue thickness (KTT), clinical attachment level (CAL), recession depth (RD), recession width (RW), and keratinized tissue height (KTH) measurements were performed at baseline and 1, 3, and 6 months after surgery. The post-operative discomfort of patients, assessed with the visual analog scale (VAS) and healing index (HI), was recorded after surgery. Results: PI, GI, and PD scores were similar for all patients at all times. RD and RW scores were similar for each patient at 1 month, but these values were significantly increased in the subsequent periods in test group-1. The increase in KTT was significantly higher in the control group compared with the test groups. Similar root coverage scores were obtained in the test group-2 and control groups, and these scores were significantly higher compared with test group-1. Conclusions: The PRF membrane+CAF technique may be an alternative to the CTG+CAF technique for postoperative patient comfort. However, PRF membranes should use as many layers as possible.

Xenogenous Collagen Matrix and/or Enamel Matrix Derivative for Treatment of Localized Gingival Recessions: A Randomized Clinical Trial. Part II: Patient-Reported Outcomes.

BACKGROUND: Gingival recession (GR) might be associated with patient discomfort due to cervical dentin hypersensitivity (CDH) and esthetic dissatisfaction. The aim is to evaluate the effect of root coverage procedure with a xenogenous collagen matrix (CM) and/or enamel matrix derivative (EMD) in combination with a coronally advanced flap (CAF) on CDH, esthetics, and oral health-related quality of life (OHRQoL) of patients with GR. METHODS: Sixty-eight participants with single Miller Class I/II GRs were treated with CAF (n = 17), CAF + CM (n = 17), CAF + EMD (n = 17), and CAF + CM + EMD (n = 17). CDH was assessed by evaporative stimuli using a visual analog scale (VAS) and a Schiff scale. Esthetics outcome was assessed with VAS and the Questionnaire of Oral Esthetic Satisfaction. Oral Health Impact Profile-14 (OHIP-14) questionnaire was used to assess OHRQoL. All parameters were evaluated at baseline and after 6 months. RESULTS: Intragroup analysis showed statistically significant reduction in CDH and esthetic dissatisfaction with no intergroup significant differences (P >0.05). The impact of oral health on QoL after 6 months was significant for CAF + CM, CAF + EMD, and CAF + CM + EMD (P <0.05). Total OHIP-14 score and psychologic discomfort, psychologic disability, social disability, and handicap dimensions showed negative correlation with esthetics. OHIP-14 physical pain dimension had positive correlation with CDH (P <0.05). OHIP-14 showed no correlation with percentage of root coverage, keratinized tissue width, or keratinized tissue thickness (P >0.05). CONCLUSION: Root coverage procedures improve patient OHRQoL by impacting on a wide range of dimensions, perceived after reduction of CDH and esthetic dissatisfaction of patients with GRs treated with CAF + CM, CAF + EMD, and CAF + CM + EMD.

Xenogenous Collagen Matrix and/or Enamel Matrix Derivative for Treatment of Localized Gingival Recessions: A Randomized Clinical Trial. Part I: Clinical Outcomes.

BACKGROUND: Considering xenogeneic collagen matrix (CM) and enamel matrix derivative (EMD) characteristics, it is suggested that their combination could promote superior clinical outcomes in root coverage procedures. Thus, the aim of this parallel, double-masked, dual-center, randomized clinical trial is to evaluate clinical outcomes after treatment of localized gingival recession (GR) by a coronally advanced flap (CAF) combined with CM and/or EMD. METHODS: Sixty-eight patients presenting one Miller Class I or II GRs were randomly assigned to receive either CAF (n = 17); CAF + CM (n = 17); CAF + EMD (n = 17), or CAF + CM + EMD (n = 17). Recession height, probing depth, clinical attachment level, and keratinized tissue width and thickness were measured at baseline and 90 days and 6 months after surgery. RESULTS: The obtained root coverage was 68.04% ± 24.11% for CAF; 87.20% ± 15.01% for CAF + CM; 88.77% ± 20.66% for CAF + EMD; and 91.59% ± 11.08% for CAF + CM + EMD after 6 months. Groups that received biomaterials showed greater values (P <0.05). Complete root coverage (CRC) for CAF + EMD was 70.59%, significantly superior to CAF alone (23.53%); CAF + CM (52.94%), and CAF + CM + EMD (51.47%) (P <0.05). Keratinized tissue thickness gain was significant only in CM-treated groups (P <0.05). CONCLUSIONS: The three approaches are superior to CAF alone for root coverage. EMD provides highest levels of CRC; however, the addition of CM increases gingival thickness. The combination approach does not seem justified.

Use of Platelet-Rich Fibrin Membrane in the Treatment of Gingival Recession: A Systematic Review and Meta-Analysis.

BACKGROUND: The aim of this systematic review is to evaluate the effects of platelet-rich fibrin (PRF) membranes on the outcomes of clinical treatments in patients with gingival recession. METHODS: Articles that were published before June 2015 were searched electronically in four databases without any date or language restrictions and searched manually in regular journals and unpublished studies. The eligibility criteria comprised randomized controlled trials (RCTs) and prospective controlled trials with follow-up periods of ≥ 6 months that compared the performance of PRF to other biomaterials in the treatment of Miller Class I or II gingival recessions. For the meta-analysis, the inverse variance method was used in fixed- or random-effect models, which were chosen according to heterogeneity. The estimates of the intervention effects were expressed as the mean differences in percentages or millimeters. RESULTS: Six RCTs and one prospective clinical trial are included in this review. Root coverage (RC) and clinical attachment level (CAL) did not differ significantly between the analyzed subgroups (P = 0.57 and P = 0.50, respectively). The keratinized mucosa width (KMW) gain was significantly greater (P = 0.04) in the subgroup that was treated with connective tissue grafts. CONCLUSION: The results of the meta-analysis suggest that the use of PRF membranes did not improve the RC, KMW, or CAL of Miller Class I and II gingival recessions compared with the other treatment modalities.

Healing of localized gingival recessions treated with a coronally advanced flap alone or combined with an enamel matrix derivative and a porcine acellular dermal matrix: a preclinical study.

OBJECTIVE: This study aimed to evaluate the effects of a porcine acellular dermal matrix (PADM) with or without an enamel matrix derivative (EMD) on gingival recession defects treated with a coronally advanced flap (CAF) in dogs. MATERIALS AND METHODS: Miller class II gingival recession defects (5 mm wide and 7 mm deep) were surgically created on the labial side of bilateral maxillary canines in 12 dogs. After 8 weeks of plaque accumulation, the 24 chronic defects were randomly assigned to one of the following 4 treatments: CAF, CAF with PADM (CAF/PADM), CAF with EMD (CAF/EMD), and CAF with EMD and PADM (CAF/EMD/PADM). The animals were sacrificed 10 weeks after surgery for histologic evaluation. RESULTS: In all groups, root coverage was obtained to a varying degree. PADM was well incorporated in gingival connective tissue in the CAF/PADM and in the CAF/EMD/PADM groups. The height of newly formed bone was significantly greater in the CAF/EMD/PADM group than in the CAF and CAF/PADM groups. New cementum with periodontal ligament-like tissue was predominantly found in the CAF/EMD and CAF/EMD/PADM groups. The CAF/EMD/PADM group showed the greatest amount of new cementum among the groups examined, although the difference was not statistically significant. CONCLUSION: Within the limitations of the present study, it can be concluded that CAF/EMD/PADM treatment may promote periodontal regeneration in gingival recession defects. CLINICAL RELEVANCE: The present results suggest that the combination of EMD and PADM in conjunction with CAF may represent a promising approach for treating single Miller class II gingival recessions.

Clinical Comparison of Platelet-Rich Fibrin and a Gelatin Sponge in the Management of Palatal Wounds After Epithelialized Free Gingival Graft Harvest: A Randomized Clinical Trial.

BACKGROUND: Platelet-rich fibrin (PRF) promotes tissue regeneration by releasing various growth factors. The palatal donor site of the epithelialized connective tissue (CT) graft significantly influences the patient's morbidity. The aim of this study is to compare the effects of PRF and gelatin sponge on the healing of palatal donor sites and the patient's morbidity. METHODS: Forty patients with at least one site of Miller Class I or II gingival recession were treated by a coronally advanced flap with CT graft resulting from the de-epithelialization of a free gingival graft. In the test group (20 patients), a PRF membrane was placed over the palatal wounds; conversely, the 20 control group patients were treated with an absorbable gelatin sponge. Patients were monitored at 1, 2, 3, and 4 weeks after surgery for the complete re-epithelialization of the palatal wound (CWE), the alteration of sensitivity around the wound area, postoperative discomfort, and changes in feeding habits (CFH). Furthermore, the consumption of analgesics during the postoperative week 1 was assessed. RESULTS: The test group showed a significantly faster CWE (P <0.001); 35% of the test patients showed CWE at the end of week 2 (controls, 10%), whereas at the end of week 3, all palatal wounds in the test patients epithelialized completely (controls, 25%). Similarly, test patients reported significantly less discomfort and CFH (P ≤ 0.02) and took a significantly lower dose of analgesics (P = 0.02). CONCLUSION: The PRF-enriched palatal bandage significantly accelerates palatal wound healing and reduces the patient's morbidity.

A rare cause of gingival recession: morphea with intra-oral involvement.

Morphea is an inflammatory disorder of the skin and underlying tissues characterized by an overabundance of collagen leading to fibrosis. The prevalence of this disease is estimated at around 0.4-2.7/100,000 people. When the process occurs in the gingival tissues, it induces traction, which can cause gingival recession. A 19-year-old woman was referred to the clinic for a progressive recession on teeth 11 and 12. A pale, atrophic, linear region extending from her nose to her upper lip on the right-hand side of her face was diagnosed as morphea en coup de sabre. Cone beam computed tomography, quantitative polymerase chain reaction and histologic evaluation were used to assess the pathology. Treatment with methotrexate was conducted. After 12 months, no progression of the recession could be observed.

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.

Effects of photodynamic therapy on clinical and gingival crevicular fluid inflammatory biomarkers in chronic periodontitis: a split-mouth randomized clinical trial.

BACKGROUND: There are limited clinical experiments addressing the effects of photodynamic therapy (PDT) as an adjunct to conventional scaling and root planing (SRP) on clinical and biologic features of periodontitis. This trial compares the clinical parameters and cytokine profiles in gingival crevicular fluid of patients with moderate-to-severe chronic periodontitis (CP) who have been treated using SRP alone or SRP + PDT. METHODS: Twenty-two patients with two contralateral teeth affected with moderate-to-severe CP were selected. After SRP, the participants' teeth were randomized to receive either no further treatment or a single application of PDT using a 638-nm laser and toluidine blue. Although the change in probing depth was the primary outcome, bleeding on probing, clinical attachment level, gingival recession, interleukin-1ß, tumor necrosis factor (TNF)-α, and matrix metalloproteinase 8 and 9 were also evaluated at baseline and 3 months postintervention. An oral rinse assay was also performed to determine the total levels of oral polymorphonuclear cells (PMNs) before and 3 months after the treatments. RESULTS: Within each group, significant improvements (P <0.001) were found for all variables in 3-month follow-up compared with baseline. Only TNF-α was significantly improved in the PDT + SRP versus SRP group. Total levels of PMNs were reduced for all patients compared with baseline levels (P <0.001). CONCLUSION: In patients with CP, a single application of PDT (using a 638-nm laser and toluidine blue) did not provide any additional benefit to SRP in terms of clinical parameters or inflammatory markers 3 months following the intervention.