Invasive dental treatment and acute vascular events: A systematic review and meta-analysis.

BACKGROUND: Acute infection/inflammation increases the risk of acute vascular events (AVEs). Invasive dental treatments (IDTs) trigger short-term acute inflammation. PURPOSE: The aim of this work is to critically appraise the evidence linking IDTs and AVEs. DATA SOURCES: Six bibliographical databases were searched up to 31 August 2021. A systematic review following PRISMA guidelines was performed. STUDY SELECTION: Intervention and observational studies reporting any AVEs following IDT were included. DATA EXTRACTION: Two reviewers independently extracted data and rated the quality of studies. Data were pooled using fixed-effect, inverse variance weights analysis. RISK OF BIAS: Risk of bias was assessed by the Newcastle-Ottawa Quality Assessment Scale for observational studies and the Cochrane Handbook-Rob 2.0 for randomized controlled trials. DATA SYNTHESIS: In 3 out of 16 clinical studies, a total of 533,175 participants, 124,344 myocardial infarctions, and 327,804 ischaemic strokes were reported. Meta-analysis confirmed that IDT did not increase incidence ratios (IR) for combined vascular events either at 1-4 weeks (IR of 1.02, 95% CIs: 0.92 to 1.13) and at 5-8 weeks (IR of 1.04, 95% CIs: 0.97 to1.10) after treatment. LIMITATIONS: A high level of heterogeneity (study designs and time point assessments) was found. CONCLUSION: Patients who received IDT exhibited no substantial increase in vascular risk over 8 weeks post treatment.

Factors influencing the aesthetics of smile: An observational study on clinical assessment and patient's perception.

AIM: To clinically assess the aesthetics of smile and the possible influencing factors. MATERIALS AND METHODS: In this explorative study, an initial questionnaire on demographic variables and perception of own quality of smile (Visual Analogue Scale) was administered by a first examiner. A second blinded assessor examined all patients and recorded clinical data. In addition, for each patient, the Smile Aesthetic Index (SEI) was calculated. Descriptive statistics and multilevel logistic models were performed. RESULTS: One hundred consecutive subjects were enrolled. The mean SEI was 8.4 ± 1.2, while the mean patient's perception of smile was 7.1 ± 2.0. However, they did not correlate (r = 0.16 from -0.04 to 0.34; p = .12). Gingival recessions were perceived by 21.9% of subjects, tooth alignment by 38.6%, tooth dyschromia by 34.3%, and missing papilla/diastema by 26.7%. In particular, gingival recessions were perceived when they were deeper (p = .0342), located in the upper jaw (p = .0223), and corresponding to incisors (p < .0001) and canines (p = .0159) with respect to molars. CONCLUSIONS: Clinical assessment and patient perception represent two important diagnostic phases. However, there is no correlation between them. Attention should be given to specific variables to provide the most comprehensive aesthetic analysis of smile.

Smile esthetic evaluation of mucogingival reconstructive surgery.

To assess the difference in smile esthetic impact of Coronally Advanced Flap (CAF) with or without the adjunct of a collagen matrix (CMX) used as root coverage procedures. Subjects with esthetic demands showing multiple upper gingival recessions of at least 2 mm, without interproximal attachment loss and cervical abrasion no more than 1 mm were recruited and randomized to CAF plus CMX or CAF alone. The Smile Esthetic Index (SEI) was adopted to quantify the quality of the smile recorded at baseline and 12 months after treatment for each treatment group. In addition, between group difference in the SEI was calculated. 24 Patients were treated and analysed. At baseline, mean gingival recession depths were 2.3 ± 0.7 mm for Test group and 2.6 ± 1.0 mm for Control group. After 1 year, the residual recession depth was 0.3 ± 0.4 mm in the CAF + CMX group and 0.6 ± 0.3 mm in the control group. The SEI at baseline was 8.1 ± 1.0 and 7.9 ± 0.7 for Test and Control group, respectively. The between groups difference at 12 months in SEI was 0.4 (95% C.I. - 0.0 to 0.8, P = 0.0697). Twelve months after treatment, CAF + CMX provided a similar SEI compared to CAF alone and the adjunct of a collagen matrix did not show a different impact on the smile esthetic appearance.

Adjunctive benefit of a xenogenic collagen matrix associated with coronally advanced flap for the treatment of multiple gingival recessions: A superiority, assessor-blind, randomized clinical trial.

AIM: To evaluate the superiority of coronally advanced flaps (CAFs) when used in combination with a xenogeneic collagen matrix (CMX) for root coverage of multiple adjacent gingival recessions. MATERIALS AND METHODS: Participants with at least 2 upper adjacent teeth exhibiting gingival recession depth ≥2 mm were recruited and randomized to CAF with (test) or without (control) CMX, respectively. Mean and complete root coverage, amount of keratinized tissue (KTw), gingival thickness (GThick) and patient-reported outcomes (PROMs) were recorded at baseline, 3, 6 and 12 months. RESULTS: Twenty-four patients providing 61 gingival recessions were analysed. After 1 year, gingival recession depth decreased from 2.3 ± 0.7 to 0.3 ± 0.4 mm in the CAF + CMX group (2.0 ± 0.8 mm meanRC) and from 2.6 ± 1.0 to 0.6 ± 0.3 mm in the control group (2.0 ± 1.1 mm meanRC). No difference was observed between the two groups (p = 0.2023). Nineteen (63%) of the test and 16 (52%) of control defects showed complete root coverage (p = 0.4919). GThick greatly increased in the test group (0.5 mm; 0.2-0.8 mm, 95% CI; p = 0.0057). No difference between the two groups was observed for KTw (p = 0.5668) and PROMs. CONCLUSION: At 1 year, CAF + CMX provided similar root coverage to CAF alone, but a significant increase in gingival thickness.

Root coverage procedures for treating localised and multiple recession-type defects.

BACKGROUND: Gingival recession is defined as the oral exposure of the root surface due to a displacement of the gingival margin apical to the cemento-enamel junction and it is regularly linked to the deterioration of dental aesthetics. Successful treatment of recession-type defects is based on the use of predictable root coverage periodontal plastic surgery (RCPPS) procedures. This review is an update of the original version that was published in 2009. OBJECTIVES: To evaluate the efficacy of different root coverage procedures in the treatment of single and multiple recession-type defects. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 15 January 2018), the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 12) in the Cochrane Library (searched 15 January 2018), MEDLINE Ovid (1946 to 15 January 2018), and Embase Ovid (1980 to 15 January 2018). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials (15 January 2018). No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: We included randomised controlled trials (RCTs) only of at least 6 months' duration evaluating recession areas (Miller's Class I or II ≥ 3 mm) and treated by means of RCPPS procedures. DATA COLLECTION AND ANALYSIS: Screening of eligible studies, data extraction and risk of bias assessment were conducted independently and in duplicate. Authors were contacted for any missing information. We expressed results as random-effects models using mean differences (MD) for continuous outcomes and odds ratios (OR) for dichotomous outcomes with 95% confidence intervals (CI). We used GRADE methods to assess the quality of the body of evidence of our main comparisons. MAIN RESULTS: We included 48 RCTs in the review. Of these, we assessed one as at low risk of bias, 12 as at high risk of bias and 35 as at unclear risk of bias. The results indicated a greater reduction in gingival recession for subepithelial connective tissue grafts (SCTG) + coronally advanced flap (CAF) compared to guided tissue regeneration with resorbable membranes (GTR rm) + CAF (MD -0.37 mm; 95% CI -0.60 to -0.13, P = 0.002; 3 studies; 98 participants; low-quality evidence). There was insufficient evidence of a difference in gingival recession reduction between acellular dermal matrix grafts (ADMG) + CAF and SCTG + CAF or between enamel matrix protein (EMP) + CAF and SCTG + CAF. Regarding clinical attachment level changes, GTR rm + CAF promoted additional gains compared to SCTG + CAF (MD 0.35; 95% CI 0.06 to 0.63, P = 0.02; 3 studies; 98 participants; low-quality evidence) but there was insufficient evidence of a difference between ADMG + CAF and SCTG + CAF or between EMP + CAF and SCTG + CAF. Greater gains in the keratinized tissue were found for SCTG + CAF when compared to EMP + CAF (MD -1.06 mm; 95% CI -1.36 to -0.76, P < 0.00001; 2 studies; 62 participants; low-quality evidence), and SCTG + CAF when compared to GTR rm + CAF (MD -1.77 mm; 95% CI -2.66 to -0.89, P < 0.0001; 3 studies; 98 participants; very low-quality evidence). There was insufficient evidence of a difference in keratinized tissue gain between ADMG + CAF and SCTG + CAF. Few data exist on aesthetic condition change related to patients' opinion and patients' preference for a specific procedure. AUTHORS' CONCLUSIONS: Subepithelial connective tissue grafts, coronally advanced flap alone or associated with other biomaterial and guided tissue regeneration may be used as root coverage procedures for treating localised or multiple recession-type defects. The available evidence base indicates that in cases where both root coverage and gain in the width of keratinized tissue are expected, the use of subepithelial connective tissue grafts shows a slight improvement in outcome. There is also some weak evidence suggesting that acellular dermal matrix grafts appear as the soft tissue substitute that may provide the most similar outcomes to those achieved by subepithelial connective tissue grafts. RCTs are necessary to identify possible factors associated with the prognosis of each RCPPS procedure. The potential impact of bias on these outcomes is unclear.

Scanning Electron Microscopy Evaluation of Root Surfaces After Instrumentation With Two Piezoelectric Devices.

Scanning electron microscopy evaluation of root surfaces after ultrasonic instrumentation was performed with 2 different metallic tips on piezoelectric devices. Fresh extracted teeth were collected for experimental observation and randomly divided into 2 groups: Test Group, where the root surfaces were treated using an iron, rough, double nano-structural coated (T-Black), corindone-treated tip, and Control Group where the root surfaces were treated with a conventional iron smooth tip. A scanning electronic microscope analysis was performed and the surface roughness and the amount of residual debris were evaluated. Descriptive and inferential statistics were performed. Twenty specimens were analyzed, 10 per group and a total of 21.4 × 10 µm has been observed. On treated area percentage of debris after ultrasonic scaling in Test Group was 1.9 ±â€Š1.8%, while in Control Group it was 5.7 ±â€Š4.3%. Within the limits of the study, it seems that the efficacy of the novel iron, rough, double nano-structural coated (T-Black), corindone-treated structure tip showed greater performance in terms of root surface debridement than the conventional iron smooth tip. The possibility to use a single tool (ultrasonic device with a specific tip) for the root planing procedure within the nonsurgical mechanical therapy may represent a significant advantage for the clinicians. The tested novel tip seems to be able to show the requested ideal characteristics. However, further clinical studies are needed to demonstrate the in vitro results.

Influence of inter-dental tissues and root surface condition on complete root coverage following treatment of gingival recessions: a 1-year retrospective study.

AIM: To explore the influence of inter-dental tissues and root surface condition on complete root coverage following surgical treatment of gingival recessions. METHODS: Three hundred and eighty-six single recessions treated over 28 years were assessed. Patient-level and periodontal variables, presence/loss of inter-dental tissues, and presence/absence of non-carious cervical lesions (NCCLs) were recorded. Root coverage was assessed 1-year post-surgery. Multilevel analysis was performed to identify predictors of CRC. RESULTS: Based on type of root coverage procedure four patient groups were created: free gingival graft (FGG) (n = 116), coronally advanced flap (CAF) (n = 107), CAF+connective tissue graft (CTG) (n = 131), and guided tissue regeneration (GTR) (n = 32). Percentages of complete root coverage (CRC) were 18.1% for FGG, 35.5% for CAF, 35.1% for CAF+CTG, and 18.8% for GTR. There was an OR = 0.26 (p < 0.0001) of achieving CRC in cases with loss of inter-dental tissue compared with cases with no inter-dental tissue loss. Similarly, cases with presence of NCCL showed an OR = 0.28 (p < 0.0001) of achieving CRC compared with cases without a NCCL. FGG achieved less CRC then CAF+CTG (p = 0.0012; OR = 0.32). CONCLUSIONS: NCCLs, just like inter-dental tissue loss, are significant negative prognostic factors in achieving CRC following root coverage procedures.

Long-term outcomes of soft tissue augmentation around dental implants on soft and hard tissue stability: a systematic review.

AIM: To investigate whether the height and volume of the soft tissues and peri-implant bone levels around dental implants are stable, when soft tissue augmentation has been performed. MATERIALS AND METHODS: Three operators conducted a search on electronic databases (MEDLINE, COCHRANE, EMBASE) and a hand searching on the main journals dealing with periodontology and implantology until 30 October 2014. Only articles that considered peri-implant soft tissue augmentation performed in a group of at least 10 patients and with a follow-up of at least 1 year were selected. The outcome variables were peri-implant attached/keratinized tissue width (KTW) changes, peri-implant marginal soft tissue level (PSL) changes, and peri-implant marginal bone level (PBL) changes. The review was performed according to the PRISMA statements. RESULTS: Ten articles were selected for the qualitative synthesis, but only one meta-analysis was accomplished, indicating that 1 year after implant recession coverage procedures, a mean gain of 1.65 ± 0.01 mm (90% CrI [1.44; 1.85]) was observed. CONCLUSIONS: There is no long-term evidence whether augmented soft tissues can be maintained over time and able to influence the peri-implant bone levels.

Long-term stability of peri-implant tissues after bone or soft tissue augmentation. Effect of zirconia or titanium abutments on peri-implant soft tissues. Summary and consensus statements. The 4th EAO Consensus Conference 2015.

INTRODUCTION: Several surgical techniques and prosthetic devices have been developed in the last decades, aiming to improve aesthetic, hygienic and functional outcomes that may affect the peri-implant tissues, such as procedures of bone and soft tissue augmentation and the use of custom-made abutments of titanium and zirconium. MATERIALS AND METHODS: Three systematic reviews, based on randomized clinical trials and prospective studies covering the above reported topics were analysed, and the detected evidence was exposed to interactive experts' discussion during the group's and general assembly's meetings of the 4th EAO Consensus Conference. The results are reported using the following abbreviations: S-T: short-term evidence, M-T: medium-term evidence; L-T: long-term evidence; LE: limited evidence. RESULTS: Soft tissue augmentation procedures may be indicated for the increase of soft tissue thickness and keratinized tissue, the reduction of interproximal peri-implant bone loss, and the coverage of shallow peri-implant soft tissue recessions (S-T, LE), L-T is lacking. Guided bone regeneration approaches (GBR) showed efficacy when used for ridge reconstruction after the complete healing of the soft tissues (S-T & L-T), and the stability of the augmented bone may play a role in the maintenance of the soft tissue position and dimensions (LE). No significant differences were observed between titanium and zirconia abutments when evaluating probing pocket depth, bleeding on probing, marginal bone levels and mucosal recessions. Zirconia abutments were associated with more biological complications but demonstrated superiority in terms of achieving natural soft tissue colour (S-T).

Soft Tissue Substitutes in Periodontal and Peri-Implant Soft Tissue Augmentation: A Systematic Review.

BACKGROUND: Different extracellular matrix (ECM)-based technologies in periodontal and peri-implant soft tissue augmentation have been proposed in the market. The present review compared the efficacy of soft tissue substitutes (STSs) and autogenous free gingival grafts (FGGs) or connective tissue grafts (CTGs) in mucogingival procedures to increase keratinized tissue (KT) width around teeth and implants. METHODS: Two independent examiners performed an electronic search on MEDLINE and the Cochrane Library based on the following PICOS format: (P) adult patients; (I) soft tissue substitutes and FGGs/CTGs; (C) STSs vs. CTGs; STSs vs. FGGs; STSs vs control; (O) KT width gain; (S) systematic reviews, randomized controlled trials. Studies published before November 2023 were included. RESULTS: Around teeth, all biomaterials showed superior performance compared to a coronally advanced flap (CAF) alone for treating gingival recessions. However, when compared to CTGs, acellular dermal matrices (ADMs) yield the most similar outcomes to the gold standard (CTGs), even though in multiple recessions, CTGs continue to be considered the most favorable approach. The use of STSs (acellular matrix or tissue-engineered) in combination with apically positioned flaps (APF) resulted in significantly less gain in KT width compared to that achieved with FGGs and APFs. Around dental implants, free gingival grafts were deemed more effective than soft tissue substitutes in enhancing keratinized mucosa width. CONCLUSIONS: Based on the available evidence, questions remain about the alternative use of soft tissue substitutes for conventional grafting procedures using free gingival grafts or connective tissue grafts around teeth and implants.

Patient perceptions of buccal gingival recessions and requests for treatment.

AIMS: The aims of this study were to verify patients' perception of buccal recessions and their requests for treatment. METHODS: The patients filled out a questionnaire dealing with demographic variables and perception of buccal gingival recessions. A calibrated examiner checked for recessions and recorded the clinical variables. Then, the patients were asked to explain what they believed to be the causes of the recessions and whether they were interested in obtaining treatment of their lesions. Descriptive statistics and multilevel logistic models were used. RESULTS: Of 120 enrolled patients, 96 presented 783 gingival recessions, of which 565 were unperceived. Of 218 perceived recessions, 160 were asymptomatic, 36 showed dental hypersensitivity, 13 aesthetics, 9 aesthetic + hypersensitivity issues. Only 11 patients requested treatment for their 57 recessions. Younger individuals (p = 0.0077), deeper recessions (p < 0.0001), incisors and canines (p < 0.0001) and non-carious cervical lesions (p = 0.0441) were significantly associated with patient perception of own recessions. Younger subjects (p = 0.0118), deeper recessions (p = 0.0387) and incisors (p = 0.0232) were significantly associated with patient request of treatment. Four hundred and sixty-eight recessions (60%) were not ascribed to exact causes by the patients. CONCLUSION: This study shows that perception of gingival recessions and the patients' requests for treatment should be evaluated carefully before proceeding with decision making.

A Novel Piezoelectric-Assisted Non-Surgical Periodontal Treatment: A Prospective Case Series.

The purpose of this study was to evaluate the clinical efficacy of a non-surgical periodontal treatment using a piezoelectric power-driven device with a novel insert. Plaque index (PlI), bleeding on probing (BoP), probing depth (PD), recession depth (Rec) and clinical attachment level (CAL) were assessed at 6 weeks, 3 months and 6 months. Furthermore, tooth mobility and furcation involvement were recorded and chewing discomfort and dental hypersensitivity were evaluated. Eighteen stage I to IV periodontitis patients providing 437 teeth and 2622 sites in total were analyzed. At six weeks, CAL gain (0.4; p < 0.0001), PD reduction (0.4; p < 0.0001) and Rec increase (0.1; p = 0.0029) were statistically significant. Similarly, the mean number of sites with PD > 4 mm and absence of BoP significantly decreased between baseline and 6 weeks (-12.7; p < 0.0001). At this time point, the patient's chewing discomfort was also significantly diminished (1.4; p = 0.0172). Conversely, no statistically significant changes were observed between 6 weeks and 3 months and between 3 months and 6 months for any of the clinical variables evaluated. In conclusion, within the limitation of this study, mechanical piezo-assisted non-surgical periodontal treatment in conjunction with an innovative tip resulted significantly efficacious to reduce pathological periodontal pockets, to gain clinical attachment and to reduce gingival inflammation.

Fourteen-year outcomes of coronally advanced flap for root coverage: follow-up from a randomized trial.

TRIAL DESIGN: This long-term 14-year-randomized split-mouth study aimed at evaluating (1) the outcomes of two different methods of root surface modifications (root surface polishing versus root planing) used in combination with a coronally advanced flap (CAF) and (2) the long-term results of CAF performed for the treatment of single gingival recessions. METHODS: Ten patients with similar bilateral recessions ≥2 mm were selected for a split-mouth randomized design study. Exposed root surfaces were assigned to receive polishing (test sites) or root planing (control sites). A multilevel model was used to analyse data at 3 months, 1, 5 and 14 years. RESULTS: One patient dropped out after 1 year. At 14 years, recession depth (Rec) was 0.9 (1.2) mm for the test sites and 0.9 (0.9) mm for the control sites. The interaction between treatment and keratinized tissue was significant (p=0.0035). Rec increased slightly over time (p=0.0006) in both the groups. CONCLUSIONS: This study shows that during a long-term follow-up, gingival recession recurred in 39% of the treated sites following the CAF procedure.

Coronally advanced flap versus connective tissue graft in the treatment of multiple gingival recessions: a split-mouth study with a 5-year follow-up.

AIM: The aim of this long-term study was to compare the clinical outcomes of coronally advanced flap (CAF) alone versus coronally advanced flap plus connective tissue graft (CAF+CTG) in the treatment of multiple gingival recessions using a split-mouth design over 5 years of follow-up. MATERIALS AND METHODS: A total of 13 patients (mean age 31.4 years) showing multiple bilateral gingival recessions were treated. On one side, CAF+CTG was used, while in the contra-lateral side, a CAF alone was applied. Clinical outcomes were evaluated at the 6-month, 1-year and 5-year follow-ups. RESULTS: A total of 93 Miller class I, II and III gingival recessions were treated. In the CAF+CTG-treated sites, the baseline gingival recession was 3.6 +/- 1.3 mm, while in the CAF-treated sites, it was 2.9 +/- 1.3 mm (p=0.0034). No difference in terms of the number of sites with complete root coverage (CRC) was reported (OR=0.49, p=0.1772) at the 6-month follow-up. At the 5-year follow-up, CAF+CTG-treated sites showed a higher percentage of sites with CRC (52%) than CAF-treated sites (35%) (OR=3.94; p=0.0239). An apical relapse of the gingival margin in CAF-treated sites was observed while a coronal improvement of the margin was noted in CAF+CTG-treated sites between the 6-month and the 5-year follow-ups. CONCLUSIONS: CAF+CTG provided better CRC than CAF alone in the treatment of multiple gingival recessions at the 5-year follow-up.

Lack of adjunctive benefit of Er:YAG laser in non-surgical periodontal treatment: a randomized split-mouth clinical trial.

AIM: This split-mouth, randomized, clinical trial aimed to evaluate the efficacy of erbium-doped:yttrium-aluminium-garnet (Er:YAG) laser application in non-surgical periodontal treatment. MATERIALS AND METHODS: A total of 27 patients underwent four modalities of non-surgical therapy: supragingival debridement; scaling and root planing (SRP)+Er:YAG laser; Er:YAG laser; and SRP. Each strategy was randomly assigned and performed in one of the four quadrants. Clinical outcomes were evaluated at 3 and 6 months. Subjective benefits of patients have been evaluated by means of questionnaires. RESULTS: Six months after therapy, Er:YAG laser showed no statistical difference in clinical attachment gain with respect to supragingival scaling [0.15 mm (95% CI -0.16; 0.46)], while SRP showed a greater attachment gain than the supragingival scaling [0.37 mm (95% CI 0.05; 0.68)]. No difference resulted between Er:YAG laser+SRP and SRP alone [0.05 mm (95% CI -0.25; 0.36)]. CONCLUSIONS: The adjunctive use of Er:YAG laser to conventional SRP did not reveal a more effective result than SRP alone. Furthermore, the sites treated with Er:YAG laser showed similar results of the sites treated with supragingival scaling.

Crown-root reattachment of a severe subgingival tooth fracture: a 15-month periodontal evaluation.

Traumatic tooth fractures represent an intriguing challenge for clinicians, particularly when they involve the anterior region of the maxilla. In such situations, esthetic, psychosocial, functional, and therapeutic problems may have a negative effect on the patient's quality of life. In addition, fractures that involve the biologic width of the periodontium are even more difficult to treat. An interdisciplinary approach based on crown lengthening with or without orthodontic extrusion and the definitive prosthetic rehabilitation represent the standard modality of treatment for these conditions to restore the appropriate biologic dimension and to reduce the damage esthetically. However, if the margins of the fragment and the tooth show perfect juxtaposition with no interfragmentary space, an adhesive technique may be indicated. The aim of this case report is to describe the treatment of a severe subgingival tooth fracture by means of adhesive reattachment of the fragment followed by a periodontal evaluation over a 15-month period.

Factors affecting the clinical approach to impacted maxillary canines: A Bayesian network analysis.

INTRODUCTION: The aim of this study was to apply Bayesian networks to evaluate the relative role and possible causal relationships among various factors affecting the diagnosis and final treatment outcome of impacted maxillary canines. METHODS: A total of 168 patients with infraosseous impacted maxillary canines had a combined surgical-orthodontic approach aimed to guide the impacted tooth to the center of the alveolar ridge. Demographic, orthodontic, and periodontal variables were recorded and analyzed by means of Bayesian network analysis. RESULTS: All 168 impacted canines were successfully moved and aligned in the dental arches with healthy periodontiums. According to the Bayesian network analysis, bilateral impaction was associated with palatal impaction and longer treatment; the pretreatment alpha-angle was a determinant for the duration of orthodontic traction, also because of the associations between greater angulation of impacted canines with more severe tooth displacement and with greater distance of the impacted canine from the occlusal plane; the posttreatment periodontal outcome was not related to the pretreatment radiographic variables. CONCLUSIONS: Bayesian network analysis was useful to identify possible relationships among the variables considered for diagnosis and treatment of impacted canines.

From initial case report to randomized clinical trial through 20 years of research in periodontal therapy.

AIM: Case reports (CRs) are often the first publication of a new treatment, but randomized clinical trials (RCTs) are needed to confirm the data. The aim of this study was to evaluate how many therapies published as CRs were followed by RCTs of these therapies over a 20-year period. MATERIAL AND METHODS: Two researchers conducted a search through international periodontal journals and found the CRs on periodontal treatments published from 1984 to 1986. Subsequent electronic searches made it possible to verify how many of the treatments published as CRs were also investigated through RCTs over the following 20 years. RESULTS: Thirty-one different therapies were selected out of the 33 published CRs; 15 (48%) of these 31 treatments were investigated by RCTs over the next 20 years. CONCLUSIONS: As 52% of the CRs were not validated by RCTs, practitioners should view their results with caution.

Does placement of a connective tissue graft improve the outcomes of coronally advanced flap for coverage of single gingival recessions in upper anterior teeth? A multi-centre, randomized, double-blind, clinical trial.

AIMS: This parallel-group, multi-centre, double-blind, randomized-controlled clinical trial was undertaken to compare the clinical outcomes and patient morbidity of coronally advanced flap (CAF) alone or in combination with a connective tissue graft (CAF+CTG) in single Miller Class I and II gingival recessions. MATERIAL AND METHODS: Three centres enrolled 85 patients with one recession each. Surgery was performed elevating a pedicle flap; 42 sites randomly received a graft under the flap. Measurements were taken by blind and calibrated examiners. Outcome measures included recession reduction, complete root coverage (CRC), intra-operative and post-operative morbidity, dentine sensitivity, and side effects. RESULTS: No differences were noted in the intra-operative and post-operative patient-related variables between the two groups. Surgical time was significantly shorter in the CAF group. Recession reduction was not statistically different between the two groups, even though a model showed a tendency towards improved outcomes in sites treated with CAF+CTG (adjusted difference 0.33 mm, 95% CI=-0.06 to 0.72, p=0.1002). Significantly greater probability of CRC was observed after CAF+CTG (adjusted OR=5.09, 95% CI=1.69-17.57, p=0.0033). Dentine hypersensitivity improved in both the groups. CONCLUSIONS: Both treatments were effective in providing a significant reduction of the baseline recession and dentine hypersensitivity, with only limited intra-operative and post-operative morbidity and side effects. Adjunctive application of a CTG under a CAF increased the probability of achieving CRC in maxillary Miller Class I and II defects.

Root coverage esthetic score: a system to evaluate the esthetic outcome of the treatment of gingival recession through evaluation of clinical cases.

BACKGROUND: Generally, esthetic outcomes following root-coverage procedures are not assessed. This article proposes a score for evaluating the esthetic outcome following root-coverage surgery. METHODS: Thirty-one patients with Miller Class I and II recession defects treated with root-coverage procedures were evaluated. Esthetic outcomes were assessed using the root coverage esthetic score (RES) 6 months after surgery. This score evaluates five variables: level of the gingival margin, marginal tissue contour, soft tissue texture, mucogingival junction alignment, and gingival color. Because complete root coverage was the primary treatment goal, and the other variables were considered secondary, the value assigned for root coverage was 60% of the total score, whereas 40% was assigned to the other four variables. With regard to assessment of the final position of the gingival margin, 3 points were given for partial root coverage, and 6 points were given for complete root coverage; 0 points were assigned when the final position of the gingival margin was equal or apical to the previous recession. One point was assigned for each of the other four variables. Thus, 10 points was a perfect score. RESULTS: Of the 31 treated recession defects, 24 (77%) exhibited complete root coverage at 6 months. The mean amount of root coverage was 89.4% (range, 0% to 100%). The mean RES was 7.8. Five of 24 cases of complete root coverage achieved a perfect score (RES = 10). In one case, RES = 0. CONCLUSION: The RES system may be a useful tool to assess the esthetic outcome following root-coverage procedures.