Improvement of Periodontal Parameters with the Sole Use of Free Gingival Grafts in Orthodontic Patients: Correlation with Periodontal Indices. A 15-Month Clinical Study.

The aim of this study was to evaluate the changes in periodontal parameters solely using free gingival grafts during orthodontic treatment without any oral hygiene re-enforcement. METHODS: A total of 19 patients underwent periodontal examination before orthodontic treatment. Patients received oral hygiene instruction and professional hygiene therapy. Where needed; full periodontal treatment was completed. Only periodontally stable patients were included in the study. Periodontal indices and keratinized tissue were recorded at time 0 (T0) (delivery of orthodontic appliances), and at three months (T1) during orthodontic therapy; when surgery was performed. At T1; orthodontically treated sites with minimum keratinized tissue (≤1 mm) received a free gingival graft to enhance the band of keratinized tissue. At three months after surgery (T2), new measurements were recorded. The orthodontics-treated sites after three months (T1) were used as control. The same sites were used as a test three months after mucogingival correction (T2). Between T1 and T2; orthodontics was suspended; no professional oral hygiene was performed; and no additional oral hygiene instructions were given to the patient. No oral hygiene procedures were administered for 15 months (T3), when the final recordings were taken. RESULTS: The results showed that there was a worsening of gingival index (GI) and plaque index (PI) of the treated sites between T0 and T1 during initial orthodontics treatment; whereas there was an improvement of the gingival inflammation at T2 when compared with T1. At T2; there was also a statistically significant improvement in GI and PI compared with T0. A T3 improvement in periodontal parameters was sustained. A non-parametric test (Wilcoxon signed-rank test) was used for statistical analysis. CONCLUSIONS: Augmentation of the width of keratinized gingiva; as the sole treatment; favors the improvement of GI and PI during orthodontic therapy.

Long-term clinical results on the use of bone-replacement grafts in the treatment of intrabony periodontal defects. Comparison of the use of autogenous bone graft plus calcium sulfate to autogenous bone graft covered with a bioabsorbable membrane.

BACKGROUND: Many clinical investigations have demonstrated the benefits of different regenerative approaches in the treatment of infrabony defects. The aim of this investigation was to evaluate the results obtained with the combination of autogenous bone grafting plus calcium sulfate and to compare this outcome with the results obtained using autogenous bone grafting with a bioabsorbable membrane. METHODS: Twelve subjects participated in this split-mouth trial. Twelve 2- or 3-wall periodontal defects were treated with a combination of autogenous bone grafting plus calcium sulfate (test) and were compared to 12 defects treated with autogenous bone grafting with a bioabsorbable membrane (control). Before surgery, subjects were instructed in oral hygiene techniques, and scaling and root planing were completed. Surgery was identical for both groups except for the regenerative material. After healing, subjects followed a periodontal maintenance program. Probing depth (PD), clinical attachment level, and bleeding on probing were recorded at baseline, 6 months, and 6 years. RESULTS: There were no statistical differences between test and control defects at baseline. At 6 months, there was a PD reduction of 4.3 +/- 1.0 mm in the control group and 4.4 +/- 1.1 mm in the test group. There was a clinical attachment gain of 3.5 +/- 1.1 mm in the control group and 3.6 +/- 1.0 mm in the test group. At 6 years, there was a PD reduction of 3.3 +/- 1.0 mm in the control group and 4.2 +/- 1.2 mm in the test group. There was a clinical attachment gain of 2.6 +/- 1.2 mm in the control group and 2.4 +/- 1.1 mm in the test group. Differences between treatment groups were not statistically significant at 6 months or 6 years. CONCLUSION: Both therapies led to significant short- and long-term improvements in the outcome variables assessed.

Esthetic and dimensional evaluation of free connective tissue grafts in prosthetically treated patients: a 1-year clinical study.

BACKGROUND: The aim of this study was to evaluate the predictability of the free connective tissue graft in prosthetically treated patients needing gingival augmentation. The following outcome variables were studied 1) dimensional changes of free connective gingival grafts; 2) color blending with adjacent tissues; and 3) periodontal and marginal health status, when compared to a non-surgical control group. METHODS: Two groups of patients without periodontitis were investigated. The test group (group A) consisted of 16 patients. The inclusion criteria for surgical correction were: 1) at least 1 site lacking (<1 mm) keratinized tissue and/or lacking vestibular depth; 2) insufficient plaque control; and 3) the selected site was scheduled to undergo or had already received a fixed prosthetic restoration. The control group (group B) included 14 patients with the same inclusion criteria, but declining to undergo surgery. Group A patients were treated with a free connective tissue graft to augment the keratinized tissue at the selected sites. The size of the graft was recorded at baseline (surgical intervention) and the width of keratinized tissue was measured at 1, 4, 26, and 52 weeks. Gingival inflammation and plaque accumulation were assessed at baseline and 52 weeks in both groups. Probing depth and clinical attachment levels were recorded at baseline and 26 and 52 weeks in both groups. Evaluation of the esthetic results was carried out at the end of the study. All patients in both groups received oral hygiene instructions and supragingival plaque and calculus removal before and at the end of the investigation. RESULTS: In group A, the results showed a mean amount of keratinized tissue of 5.81 +/- 1.42 mm at 26 weeks and 5.25 +/- 1.34 mm at 52 weeks. Mean shrinkage of the graft was 10.2% (P = 0.001) at 1 week, 28.4% (P = 0.0004) at 4 weeks, 37.2% (P = 0.0004) at 26 weeks, and 43.25% (P = 0.0004) at 52 weeks. All the dimensional changes were statistically significant, when compared to baseline. Evaluation of color blending with the surrounding gingiva demonstrated an "excellent result" at 52 weeks with an 87.5% agreement among the three masked examiners. In the test group, the periodontal indices improved or remained stable; in the control group, there was a minor improvement of the indices, with three patients showing a worse gingival inflammation score and two a worse plaque score. CONCLUSION: Although these results are not conclusive, mostly due to a lack of a large enough sample population, the statistically significant results shown in this investigation tend to support the use of gingival augmentation procedures in prosthetic patients with insufficient keratinized gingiva and/or shallow or absent vestibules, when they cannot demonstrate adequate plaque control.