Effect of 24% EDTA root conditioning on the outcome of modified coronally advanced tunnel technique with subepithelial connective tissue graft for the treatment of multiple gingival recessions: a randomized clinical trial.

OBJECTIVES: To investigate effects of root conditioning with 24% ethylenediaminetetraacetic acid (EDTA) on the 12-month outcomes after treatment of multiple gingival recessions (GR) with modified coronally advanced tunnel (MCAT) and subepithelial connective tissue graft (SCTG). MATERIALS AND METHODS: Twenty patients with 142 GR were treated (72 test sites: SCTG + EDTA and 70 control sites: SCTG). Average and complete root coverage (ARC, CRC), gain in keratinized tissue width (KTW), gain in gingival thickness (GT), root esthetic coverage score (RES), and patient-reported outcome measures (PROMs) were evaluated at 12 months post-operatively. RESULTS: Differences between pre- and post-operative values were statistically significant only within but not between treatment modalities. At 12 months, ARC was 86.0% for SCTG + EDTA-treated and 84.6 for SCTG-treated defects (p = 0.6636). CRC was observed in 90.2% (tests) and 91.4% (controls) of all cases (p = 0.9903). Professional assessment of esthetic outcomes using RES showed highly positive results reaching the value of 8.9 in case of test sites and 8.7 for control sites (p = 0.3358). Severity of pain and swelling did not differ between sites, regardless of whether EDTA was used. CONCLUSIONS: Test and control sites presented similarly positive outcomes related to root coverage, periodontal and esthetic parameters, and patient satisfaction and self-reported morbidity with no statistical differences between them 12 months after surgery. No significant differences in evaluated variables were observed between sites treated with and without 24% EDTA. Clinical relevance Considering the limitations of the present study, the use of 24% EDTA for root conditioning did not improve 12-month outcomes after treatment of multiple RT1 and RT2 gingival recessions with MCAT and SCTG. Trial registration ClinicalTrials.gov identifier: NCT03354104.

Laterally closed tunnel technique with and without adjunctive photobiomodulation therapy for the management of isolated gingival recession-a randomized controlled assessor-blinded clinical trial.

The objective of this prospective randomized controlled single-center clinical trial was to prove the efficacy of adjunctive photobiomodulation in improving selected outcomes following the use of laterally closed tunnel technique for the management of isolated gingival recession. Nineteen participants (with isolated gingival recession) each treated by laterally closed tunnel technique were randomized to either add on treatment with control (sham laser application) or test group (photobiomodulation with 660 nm diode, 3.5 J/cm2 per point of application). The primary outcome variable was change in recession depth and secondary variables included recession width, width of keratinized gingiva, periodontal biotype, and VAS score for pain assessment and EHS index for early wound healing assessment. Analysis was performed using a linear mixed effects model. There were no significant differences in the gingival recession depth (p = 0.8324) and recession width (p-0.969) at 3-month follow-up. The VAS scores were significantly lower for the test (laterally closed tunnel technique + photobiomodulation) group as compared to control (laterally closed tunnel technique + sham laser) over time (p = < 0.0001) as well as per site (p = 0.0006) The Early Wound Healing Index scores were significantly higher in the test (laterally closed tunnel technique + photobiomodulation) group as compared to control (laterally closed tunnel technique + sham laser) group (p < 0.0001). The adjunctive use of photobiomodulation did not show a better outcome concerning recession depth but appears to provide faster healing of the surgical wounds and better patient comfort. The result needs further evaluation in particular with respect to long-term effect and due to limitation in sample size. Clinical Trial Registry of India: CTRI/2019/11/022012.

Endodontic and Periodontal Treatment of Complete Buccal Root and Apex Exposition: A Challenging Case Report With 17 Months Follow-Up.

INTRODUCTION: This case report demonstrated a challenging clinical case addressed within a multidisciplinary approach to achieve its maintenance, even though had a poor prognosis. It was associated with the endodontic treatment with mucogingival techniques, including periodontal microsurgery and connective tissue graft. CASE PRESENTATION: A patient presented a deep gingival recession with the apex-exposed non-vital tooth with interproximal bone loss (RT2) and without mobility. The treatment involved an initial endodontic approach and periodontal therapy (scaling and root planing), microsurgical techniques with coronally advanced flap, root preparation with PrefGel (24% EDTA), enamel matrix derivatives (Emdogain), and connective tissue graft. As a clinical result, it was verified an increase of keratinized tissue width and gingival thickness, and root coverage (RC), reaching good esthetics and a stable result after 17 months. CONCLUSION: The correct diagnosis and technique selection may affect directly the outcome, especially in challenging cases. Even though there was a poor prognosis, an adequate treatment plan, patient cooperation, and technique mastery help to achieve a high level of RC, esthetic recovering, and successful outcome.

Gingival Recession Treatment with the Use of Xenogeneic Matrix: Optimization of Patient-Centered Outcomes by the Digital Soft Tissue Design

Abstract Objective: To evaluate the impact of the originally-developed approach aimed at pre-treatment graphical modelling of soft-tissue changes (digital soft tissue design) for the optimization of patient-centered outcomes after Class I and Class II single gingival recessions treatment with the use of a xenogeneic dermal matrix. Material and Methods: Patients enrolled in the study group received single gingival recession treatment via CAF+XDM method supported by pre-treatment graphical modelling of potential soft-tissue changes (digital soft tissue design), while patients enrolled in the control group received single gingival recession treatment via CAF+CTG method with no pre-treatment graphical modeling of gingival level changes. Patient-centered outcomes were measured by visual analogue scale, OHIP-14, and Mahajan's scales. Results: Realization of pre-treatment graphical modelling of soft-tissue changes supported the achievement of better patient-centered outcomes, such as root coverage (p<0.05), surgical phase (p<0.05), post-surgical phase (p<0.05), cost-effectiveness (p<0.05) and diagnostics and patient-orientation (p<0.05) based on patient's personal perception grades. Conclusion: Patient-centered results were found to be more successful within the group using the xenogeneic type of graft accompanied with the implementation of pre-treatment graphical modeling of soft tissue changes, which helped to balance patients' pre-operative expectations and post-operative satisfaction with the received results, reduce post-operative morbidity and improve oral health-related quality of life (AU).

[Home treatment of dental hyperesthesia symptoms]. / Simptomaticheskoe lechenie giperestezii zubov v domashnikh usloviyakh.

THE AIM OF THE STUDY: Was to assess the efficacy of Sensodyne toothpast for the improvement of dental hypersensitivity of various origin and the duration of the achieved effect. MATERIALS AND METHODS: We examined 142 patients of which 95 people had tooth sensitivity. Of these, 4 groups were formed homogeneous by age and sex. Group 1 comprised 27 people (average age 34±3 years) with I grade dental abrasion. Group 2 comprised 23 people (average age 33±5 years) with II grade dental abrasion. Group 3 consisted of 23 people (average age 37±4 years) with grade 3 abrasion with gingival recession of varying severity. Group 4 (comparison) comprised 22 people (mean age 36±4 years) with tooth hypersensitivity who were offered a different toothpaste. The severity of hyperesthesia was assessed using the Schiff method. RESULTS: The study revealed statistically significant decrease in dental sensitivity in all studied groups. The first positive results were noted by day 3. The maximum effect was achieved by day 30 regardless of the etiology of the primary pathology. The hypersensitivity decreased in group 1 from 1.69±0.59 to 0.48±0.20 (by 71.5%), in group 2 from 1.78±0.88 to 0.3±0.22 (by 83.1%), in group 3 from 1.94±0.6 to 0.35±0.17 (by 82%). The duration of the effect obtained was 60 days. In the comparison group, the symptom of hyperesthesia decreased by 51% after 30 days with gingival recession and increased abrasion of hard tissues when using another toothpaste. The achieved effect of reducing hyperesthesia was less stable. At day 60 it decreased by 30% from the maximum value. CONCLUSION: The study proved the high efficiency of the Sensodyne toothpaste as a home remedy for symptomatic treatment of hyperesthesia.

Rhodoptilometrin, a Crinoid-Derived Anthraquinone, Induces Cell Regeneration by Promoting Wound Healing and Oxidative Phosphorylation in Human Gingival Fibroblast Cells.

Gingival recession (GR) potentially leads to the exposure of tooth root to the oral cavity microenvironment and increases susceptibility to dental caries, dentin hypersensitivity, and other dental diseases. Even though many etiological factors were reported, the specific mechanism of GR is yet to be elucidated. Given the species richness concerning marine biodiversity, it could be a treasure trove for drug discovery. In this study, we demonstrate the effects of a marine compound, (+)-rhodoptilometrin from crinoid, on gingival cell migration, wound healing, and oxidative phosphorylation (OXPHOS). Experimental results showed that (+)-rhodoptilometrin can significantly increase wound healing, migration, and proliferation of human gingival fibroblast cells, and it does not have effects on oral mucosa fibroblast cells. In addition, (+)-rhodoptilometrin increases the gene and protein expression levels of focal adhesion kinase (FAK), fibronectin, and type I collagen, changes the intracellular distribution of FAK and F-actin, and increases OXPHOS and the expression levels of complexes I~V in the mitochondria. Based on our results, we believe that (+)-rhodoptilometrin might increase FAK expression and promote mitochondrial function to affect cell migration and promote gingival regeneration. Therefore, (+)-rhodoptilometrin may be a promising therapeutic agent for GR.

Low-intensity laser for harvesting palatal graft for the treatment of gingival recession: A systematic review.

The aim of the present study was to assess the efficacy of low-intensity laser therapy (LILT) for harvesting palatal connective tissue graft (PCTG) in the treatment of gingival recession. Databases were searched up to May 2018. The addressed focused question was: Is adjunctive LILT effective in the healing of donor palatine area after harvesting PCTG? Screening of the initially identified studies resulted in four clinical studies. All studies showed that LILT was effective in improving clinical outcomes, such as tissue thickness, postoperative discomfort, remaining wound area, and visual analog score at follow up. Upon comparison with the control group, two studies showed significantly greater improvements in the clinical parameters and patient-centered outcomes for LILT than control groups at follow up. Due to the low number of included clinical studies, it remains debatable whether LILT improves clinical and patient-centered outcomes of PCTG procedures. Further randomized controlled trials are needed to evaluate the outcomes of LILT on the healing of donor palatine area after harvesting PCTG.

Efeito de estimulação elétrica no retalho posicionado coronariamente para tratamento de recessões gengivais: estudo clínico controlado randomizado / Electrical stimulation effect on coronally advanced flap for the treatment of gingival recession: randomized controlled clinical trial

A recessão gengival é um problema muito comum na clínica odontológica, podendo afetar até 100% da população. Mesmo as melhores técnicas cirúrgicas para recobrimento radicular apresentam certa variação em seus resultados, e muitas estratégias são usadas para acelerar o processo de cicatrização. Uma delas é a aplicação de uma estimulação elétrica local para ativar o reparo tecidual. O objetivo deste estudo foi avaliar clinicamente e através da quantificação de diversos biomarcadores, os resultados de 6 meses do retalho posicionado coronalmente (CAF), associado ou não à um protocolo de eletroestimulação (E) para o tratamento de recessões gengivais. Para isso, 60 pacientes portadores de recessões gengivais unitárias Classe I e II de Miller, foram divididos em 2 grupos: CAF+E (n=30): retalho avançado coronalmente seguido de estimulação elétrica e grupo CAF (n=30): retalho avançado coronalmente e estimulação SHAM. Os resultados clínicos e centrados no paciente foram avaliados no baseline e 6 meses após os procedimentos. O fluido crevicular dos sítios tratados foi analisado para citocinas, colagenases e seus inibidores. Aos seis meses, ambos os grupos obtiveram porcentagem significativa de recobrimento e redução da recessão, sendo de 79,4 ±27,2% para o CAF e 85,9±17,4% para o CAF+E (p=0,6). O recobrimento radicular completo foi obtido em 53% e 56% dos defeitos tratados com CAF e CAF+E, respectivamente (p=0,9). Aos 7 dias, pacientes do grupo CAF+E relataram menor desconforto pós-operatório (p=0,04). A expressão de IL1ß, IL-6, TNF-α e VEGF foi reduzida significantemente no grupo CAF+E aos 7 e 14 dias (p˂0,05), já a concentração das MMPs e TIMPs não mostrou diferença entre os grupos em nenhum dos períodos avaliados. A estimulação elétrica não apresentou benefícios adicionais quando associada ao CAF em termos de recobrimento radicular para o tratamento de recessões gengivais. Entretanto, o protocolo de eletroterapia utilizado promoveu menor desconforto pós-operatório e modulação favorável dos marcadores inflamatórios durante a primeira semana de reparo(AU)

Gingival recession is a very common problem in dentistry and can affect up to 100% of the population. Even the best surgical techniques for root coverage have some variation in their results, and many strategies are used to accelerate the healing process. The objective of this study was to evaluate clinically and through the quantification of several biomarkers, the 6-month results of the coronally advanced flap (CAF), associated or not to an electrostimulation protocol (E) for the treatment of gingival recessions. For this, 40 patients with Miller Class I and II gingival recessions were divided into 2 groups: CAF+E (n=20): advanced flap coronally followed by electrical stimulation and CAF group (n=20): advanced flap coronally and SHAM stimulation. Clinical and patient-centered outcomes were assessed at baseline and 6 months post- procedure. The crevicular fluid of the treated sites was analyzed for cytokines, collagenases and their inhibitors. At six months, both groups had a significant percentage of root coverage and recession reduction, being 79.4±27.2% for CAF and 85.9 ± 17.4% for CAF+E (p=0.6). Complete root coverage was obtained in 53% and 56% of the defects treated with CAF and CAF+E, respectively (p=0.9). At 7 days, patients in the CAF+E group reported less postoperative discomfort (p=0.04). The expression of IL-1ß, IL-6, TNF-α and VEGF was significantly reduced in the CAF+E group at 7 and 14 days (p˂0.05), whereas the concentration of MMPs and TIMPs showed no difference between groups in any of the evaluated periods. Electrical stimulation did not present additional benefits when associated with CAF in terms of root coverage for the treatment of gingival recessions. However, the electrotherapy protocol used promoted less postoperative discomfort and favorable modulation of inflammatory markers during the first week of healing(AU)

Effect of EDTA root conditioning on the outcome of coronally advanced flap with connective tissue graft: a systematic review and meta-analysis.

OBJECTIVES: CAF in combination with a connective tissue graft (CTG) is considered the technique of choice for treating gingival recessions (GRs). Among the many recognized factors that can affect the outcomes, the use of chemical agents has been proposed. The effect of EDTA, as a commonly used agent, remains controversial. Therefore, the aim of this review was to assess the efficacy of EDTA root conditioning when combined to CAF + CTG. MATERIAL AND METHODS: A literature search was conducted to identify randomized clinical trials (RCTs) that performed CAF + CTG with and without EDTA for root coverage procedures. The following outcomes were assessed: recession reduction (Rec Red), complete root coverage (CRC), keratinized tissue gain (KT gain), clinical attachment level changes (CAL gain), and changes in pocket depth (PD changes). RESULTS: Fourteen RCTs (575 GRs) were included and analyzed. Six articles were included in the EDTA group, with 8 in the non-EDTA group. Meta-analyses revealed statistically significant differences for the outcomes of Rec Red (3.68 mm versus 3.07 mm), CAL gain (4.15 mm versus 3.07 mm), and PD changes (- 0.44 mm versus 0.27 mm) in favor of the EDTA group, while outcomes of CRC (odds ratio of 1.15) and KT gain (1.98 mm versus 1.62 mm) were not significantly different. CONCLUSIONS: Limited evidence is available when evaluating the effectiveness of EDTA root conditioning with CAF + CTG. However, the adjunct application of EDTA with CAF + CTG appears to be beneficial. CLINICAL RELEVANCE: The adjunct application of EDTA may provide benefits when performing root coverage procedure via CAF + CTG.

Effects of Laser Photobiomodulation and Ozone Therapy on Palatal Epithelial Wound Healing and Patient Morbidity.

OBJECTIVE: The aim of this study was to compare the effects of laser photobiomodulation (PBM) and topical ozone therapy on the reepithelialization of palatal donor site wounds through clinical assessment and computer-aided image analysis and to assess the patient morbidity following free gingival graft (FGG) surgeries. MATERIAL AND METHODS: Thirty-six patients requiring FGG were randomly allocated into three groups: laser group (n = 12), ozone group (n = 12), and control group (n = 12). Epithelialization was evaluated by applying 3% hydrogen peroxide (H2O2) to the wound area and also measured by using digital image analysis (ImageJ). Bland-Altman plots were used for assessing agreement between H2O2 and ImageJ measurements. Parameters in relation to patient morbidity were assessed by using visual analog scale (VAS) on the first 3, 7, 14, and 30 days postoperatively. RESULTS: At day 14, statistically significant smaller wounds were observed with digital image analysis in the ozone group as compared with the control group (p = 0.034). However, intergroup comparison of the remaining wound area evaluated by the clinician using the H2O2 method did not reveal any significant differences (p > 0.05). Nonetheless, according to Bland-Altman analysis, the lower and upper limits showed a moderate agreement between the two measurement methods. The mean VAS sores exhibiting postoperative discomfort was observed to be significantly higher in the control group compared with the laser group (p = 0.002) and ozone group (p < 0.001) at day 7. CONCLUSIONS: Adjunctive ozone therapy could have a significantly beneficial effect on the acceleration of palatal wound healing following FGG procedures. Both PBM and ozone treatment modalities reduced postoperative discomfort as compared with spontaneous healing.

Association between traditional oral hygiene methods with tooth wear, gingival bleeding, and recession: A descriptive cross-sectional study.

BACKGROUND: Oral hygiene maintenance is crucial for prevention of various oral diseases. Oral hygiene practices across the country vary largely and people in peri-urban and rural areas use traditional methods of oral hygiene like powders, bark, oil and salt etc. Their effect on oral soft and hard tissues need to be studied to understand their beneficial and/ or harmful effects on maintenance of oral hygiene and prevention or causation of oral diseases. OBJECTIVES: This study aimed to assess the plaque-cleaning efficacy, gingival bleeding, recession and tooth wear with different traditional oral hygiene methods as compared to use of toothpaste-toothbrush, the most accepted method of oral hygiene practice. STUDY DESIGN: Hospital based cross sectional analytical study. Results: Total 1062 traditional oral hygiene method users were compared with same number of toothpaste-brush users. The maximum number in the former group used tooth powder (76%) as compared to other indigenous methods, such as use of bark of trees etc and out of tooth powder users; almost 75% reported using red toothpowder. The plaque scores and gingival bleeding & recession were found to be more in traditional oral hygiene method users. The toothwear was also more severe among the toothpowder users. CONCLUSIONS: Traditional methods were found to be inferior in plaque control as was documented by increased bleeding and gingival recession. Its effect on hard tissues of teeth was very damaging with higher tooth wear scores on all surfaces.

Low-level laser therapy as an adjunct to connective tissue graft procedure in the treatment of gingival recession defects: A systematic review and meta-analysis.

OBJECTIVE: The aim of this study was to systematically evaluate the effectiveness of low level laser therapy (LLLT) as an adjunct to connective tissue graft (CTG) procedure for the treatment of gingival recession (GR). MATERIALS AND METHODS: The addressed PICO question was; "In patients with Miller Class I or II recession defects (Population), what is the effect of LLLT as adjunct to CTG (Intervention) in comparison to CTG alone (Comparison) on gingival recession depth (Outcome)" Electronic databases were searched up to December 2017. Primary outcomes included gingival recession depth (GRD), whereas secondary outcomes were width of keratinized tissue (WKT) and relative clinical attachment level gain (RCAL). The weighted mean differences (WMD) of outcomes and 95% confidence intervals (CI) for each variable were calculated using random effect model. RESULTS: Four randomized clinical studies were included. Two studies showed significantly greater improvements with LLLT whereas, 2 studies showed comparable outcomes between LLLT and CTG group. Considering the effects of adjunctive LLLT as compared to CTG, a high degree of heterogeneity for GRD (Q value = 9.40, P = .02, I2 =68.11%) and WKT ((Q value = 16.04, P = .001, I2 =81.31%) was noticed among both the groups. Meta-analysis showed a statistically significant GRD (WMD= -0.61, 95% CI= -1.23 to 0.004, P = .05) for LLLT + CTG treatment versus CTG alone only. CONCLUSIONS: LLLT improves clinical and patient-centered outcomes of CTG procedures for the treatment of GR remains debatable. However, due to the small number of included studies and high heterogeneity in the laser parameters, precautions must be exercised when interpreting the results of the present systematic review. CLINICAL SIGNIFICANCE: Gingival recessions in dentistry are of major esthetic concern. Minimal gingival recessions can be treated by flap operations, but the predictability and stability of the outcomes is debatable. In the present review, low level laser therapy (LLLT) adjunct to connective tissue graft (CTG) depicted a significant improvement in the predictability and stability of root coverage outcomes compared with CTG alone.

Effectiveness of laser adjunctive therapy for surgical treatment of gingival recession with flap graft techniques: a systematic review and meta-analysis.

Various flap graft techniques in the treatment of gingival recession have already been reported in the literatures for root coverage. Laser therapy has effects of ablative, hemostatic, and decontamination. Therefore, we performed a meta-analysis of randomized controlled trials (RCTs) to compare the efficacy of flap surgery combined with laser with surgery alone for treating gingival recession. The studies were searched from PubMed, Embase, Web of science, and the Cochrane Central Register of Controlled Trials by two reviewers up to August 2017. The quality of RCTs was assessed by Cochrane Handbook. Data were extracted from studies and analyzed by Review Manager 5.3. 95% confidence interval (CI) and risk ratio (RR) were calculated for dichotomous data. Seven RCTs with 173 patients and 296 teeth were included in the meta-analysis. We found no statistically significant differences between two groups in GRD (gingival recession depth) (P = 0.21), GRW (gingival recession width) (P = 0.92), RES (root esthetic score) (P = 0.21), and CRC (complete root coverage) (P = 0.09). Statistically significant differences were found between two groups in the WKT (width of keratinized tissue) (P < 0.0001) and 1-year follow-up of PD (probing depth) (P = 0.03) and CAL (clinical attachment level) (P < 0.00001). The meta-analysis found that surgery with laser therapy provided clinical advantages in terms of WKT and 1-year follow-up of PD and CAL. However, flap graft associated with laser did not offer additional benefit to root coverage and esthetics in treating gingival recession. More long-term studies are required to assess these parameters.

Ultrasound assessment of soft tissue augmentation around implants in the aesthetic zone using a connective tissue graft and xenogeneic collagen matrix - 1-year randomised follow-up.

PURPOSE: A comparative, ultrasound evaluation of the thickness of keratinized mucosa (TKT) around implants one year after gingival augmentation (GA) by means of a connective tissue graft (CTG) and the xenogeneic collagen matrix (CMX). MATERIALS AND METHODS: A total of 75 bone level tapered implants (Conelog® Camlog) were inserted in 57 patients in the aesthetic area of both jaws. The patients were divided into 3 groups: control group I- without GA; group II- GA 3 months before implantation, and group III- GA 3 months after implantation. Groups II and III were divided into two subgroups depends on type of material used for GA: (a) CMX (Mucograft®, Geistlich Pharma AG) and (b) CTG. The patients underwent a clinical and ultrasound examination before, then after 3 and 12 months following GA respectively to evaluate TKT at two points using ultrasound equipment (Pirop®, Echoson). Point 1 was considered to be in the middle of the line connecting the cemento-enamel junction (CEJ) to the adjacent teeth, and point 2 on the mucogingival junction (MGJ). RESULTS: Three months after GA, the highest increase in gingival thickness was noted in group IIIb (point 1 - 0.95mm, 2 - 1.01mm). However, 12 months after GA the highest gingival thickness was observed in group IIb (point 1 - 1.76mm, 2 - 1.36m) and next IIIb (point 1 - 1.52mm, 2 - 1.15mm). CONCLUSIONS: Both CTG and Geistlich Mucograft® increased TKT, but higher values were noted using CTG augmentation before implantation. An ultrasonic device can be used as a non-invasive, reliable, and reproducible method for evaluating TKT.

2-Year Assessment of Tissue Biostimulation With Low-Level Laser on the Outcomes of Connective Tissue Graft in the Treatment of Single Gingival Recession: A Randomized Clinical Trial.

BACKGROUND: Periodontal wound healing has been accelerated by different low-level laser therapy (LLLT) protocols. However, just a few studies have evaluated use of this therapy adjunctive to periodontal plastic surgery procedures. The present study shows 2-year results of a connective tissue graft (CTG) associated with LLLT in the treatment of gingival recession (GR) defects. METHODS: Forty patients presenting Miller Class I and II GRs were previously treated by CTG (control group; n = 20) or CTG + LLLT (test group; n = 20). A diode laser (aluminum-gallium-arsenide, 660 nm) was applied to test sites immediately after surgery and every other day for 14 days (total of eight applications). After a follow-up of 2 years, clinical and esthetic evaluations were performed in 36 patients. RESULTS: Mean percentage of root coverage was 93.43% for the test group and 92.32% for the control group (P = 0.55). Complete root coverage was 79% (n = 15) for the test group and 76% (n = 13) for the control group (n = 13) (P = 0.80). Both groups showed esthetics maintenance after 2 years. CONCLUSION: Within the limitations of this study, results indicate that LLLT showed no additional benefit in the long term when associated with a CTG in the treatment of Miller Class I and II GRs.

Dispositivo acrílico simples para medir as alterações nos tecidos moles da maxila após procedimentos implantares ou restauradores protético-periodontais / A simple acrylic device to measure maxillary soft tissue alterations after implant and/or restorative periodontal and prosthetic procedures

Alterações nos tecidos moles, na zona estética, podem ocorrer por procedimentos restauradores associados ou não à Implantodontia. Os autores propuseram um dispositivo acrílico simples associado a uma sonda periodontal, para verificação destes níveis em todos os momentos do tratamento reabilitador. O dispositivo em questão também pode ser desenhado e confeccionado em qualquer sistema CAD/CAM.

Soft tissue changes in the esthetic zone can occur after restorative procedures associated or not to implant dentistry. The authors describe a simple acrylic device associated to a periodontal probe to verify those levels during all treatment procedure steps. Also, this device can be design and milled at any CAD/CAM system.

Adjunct Antimicrobial Therapy and Periodontal Surgery to Treat Generalized Aggressive Periodontitis: A Case Report.

Here we report a case of generalized aggressive periodontitis treated with periodontal therapy including adjunct antimicrobial therapy and periodontal surgery. The patient was a 22-year-old woman who presented with the chief complaint of gingival recession. Baseline examination revealed generalized plaque deposition and gingival inflammation. Thirty-nine percent of the sites had a probing depth (PD) of 4-6 mm and 2% a PD of ≥7 mm; 63% exhibited bleeding on probing (BOP). Radiographic examination revealed vertical bone loss in the molars and horizontal bone loss in other teeth. Microbiological examination of subgingival plaque revealed the presence of Aggregatibacter actinomycetemcomitans and Tannerella forsythia. Oral health-related quality of life was assessed as a measure of patient-reported outcome. Based on a clinical diagnosis of generalized aggressive periodontitis, initial periodontal therapy and adjunct antimicrobial therapy were implemented. After reducing inflammation and subgingival bacteria, open flap debridement was performed for teeth with a PD of ≥4 mm. Reevaluation showed no sites with a PD of ≥5 mm, a minimal level of BOP, and a marked reduction in the level of the targeted periodontal pathogens. The patient's oral health-related quality of life was slightly worsened during supportive periodontal therapy (SPT). Implementation of adjunct antimicrobial therapy targeting periodontal pathogens and subsequent periodontal surgery resulted in improvement in periodontal and microbiological parameters. This improvement has been adequately maintained over a 2-year period. However, additional care is necessary to further improve the patient's oral health-related quality of life during SPT.

Tratamiento de recesión única de clase III con injerto libre subepitelial mediante técnica de colgajo de doble papila reposicionado: informe de un caso clínico / Treatment of a single Class III recession combining free subepithelial connective tissue graft and a double papilla repositioned flap: report of a clinical case

Objetivo: mostrar y evaluar los resultados clínicos de un procedimiento de cirugía plástica periodontal, efectuada para cubrir una recesión radicular de clase III de Miller, con una técnica bilaminar. Además, analizar el aumento de la banda de encía y el cambio de biotipo gingival de la pieza dentaria. Caso clínico: paciente femenino de 30 años de edad, con una recesión gingival de Clase III de Miller por vestibular de la pieza 43 que no sobrepasa la línea mucogingival, con pérdida interproximal de tejidos duros y blandos. El tratamiento consiste en un colgajo de doble papila a espesor parcial, con injerto libre subepitelial tomado del paladar, con seguimiento a 1 año. Conclusiones: la técnica bilaminar es una solución viable en casos de recubrimiento radicular poco predecibles, como la recesión de clase III de Miller. El biotipo gingival se vio engrosado y la encía queratinizada no sufrió variaciones.