Autologous connective tissue graft or xenogenic collagen matrix with coronally advanced flaps for coverage of multiple adjacent gingival recession. 36-month follow-up of a randomized multicentre trial.

AIM: To report the 36-month follow-up of a trial comparing the adjunct of a xenogenic collagen matrix (CMX) or connective tissue graft (CTG) to coronally advanced flaps (CAF) for coverage of multiple adjacent recessions. MATERIAL AND METHODS: 125 subjects (61 CMX) with 307 recessions in 8 centres from the parent trial were followed-up for 36 months. Primary outcome was change in position of the gingival margin. Multilevel analysis used centre, subject and tooth as levels and baseline parameters as covariates. RESULTS: No differences were observed between the randomized and the follow-up population. Average baseline recession was 2.6 ± 1.0 mm. 3-year root coverage was 1.5 ± 1.5 mm for CMX and 2.0 ± 1.0 mm for CTG (difference of 0.32 mm, 95% CI from -0.02 to 0.65 mm). The upper limit of the confidence interval was over the non-inferiority margin of 0.25 mm. No treatment differences in position of the gingival margin were observed between 6- and 36-month follow-up (difference 0.06 mm, 95% CI -0.17 to 0.29 mm). CONCLUSION: CMX was not non-inferior with respect to CTG in multiple adjacent recessions. No differences in stability of root coverage were observed between groups and in changes from 6 to 36 months. Previously reported shorter time to recovery, lower morbidity and more natural appearance of tissue texture and contour observed for CMX in this trial are also relevant in clinical decision-making.

The relationship between dental implant papilla and dental implant mucosa around single-tooth implant in the esthetic area: A retrospective study.

OBJECTIVE: The aim of the present study was (a) to evaluate the relationship between dental implant mucosa and dental implant papilla levels; and (b) to identify the clinical parameters associated with peri-implant soft tissue stability over time. MATERIALS AND METHODS: This is a retrospective study on a cohort of patients seeking a single-tooth implant therapy in a private practice in the Paris area. Two independent examiners analyzed photographs and radiographs taken the day of definitive crown load (baseline) and the last follow-up visit (at least 12 months later) in order to measure four peri-implant soft and hard tissue parameters. RESULTS: Seventy-four patients corresponding to 90 implants were analyzed. During a mean follow-up of 53.88 months, five implants (5.6%) presented with an apical displacement of the mid-facial marginal mucosal level of at least 1 mm. Changes in the mid-facial mucosa level were explained by changes in (a) the keratinized tissue height over time (p < .0001); (b) changes in the papilla height (p < .0001); and (c) by the periodontal phenotype (p = .007). A significant difference between papillae that gain in height (n = 85) and papilla that lost height (n = 78) was observed concerning (a) the timing of the implant placement (p = .019); and (b) the presence of an incomplete papilla fill (distance from the top of the papilla to the contact point) at baseline (p = .004). CONCLUSIONS: The present findings indicate a dependent association between dental implant mucosa and dental implant papilla levels. Stability of peri-implant soft tissues depends on periodontal phenotype, keratinized tissue height and papilla height.

Xenogenic collagen matrix or autologous connective tissue graft as adjunct to coronally advanced flaps for coverage of multiple adjacent gingival recession: Randomized trial assessing non-inferiority in root coverage and superiority in oral health-related quality of life.

AIM: To evaluate the non-inferiority of the adjunct of a xenogeneic collagen matrix (CMX) or connective tissue graft (CTG) to coronally advanced flaps (CAF) for coverage of multiple adjacent recessions and compare superiority in patient-reported outcomes (PROM). MATERIAL AND METHODS: One hundred and eighty-seven subjects (92 CMX) with 485 recessions in 14 centres were randomized and followed up for 6 months. Patients filled daily diaries for 15 days to monitor patient-reported experience. The primary outcome was changed in position of the gingival margin. Multilevel analysis used centre, subject and tooth as levels and baseline parameters as covariates. RESULTS: Average baseline recession was 2.5 ± 1.0 mm. The surgery was 15.7 min shorter (95%CI from 11.9 to 19.6, p < .0001) and perceived lighter (11.9 VAS units, 95%CI from 4.6 to 19.1, p = .0014) in CMX subjects. Time to recovery was 1.8 days shorter in CMX. Six-month root coverage was 1.7 ± 1.1 mm for CMX and 2.1 ± 1.0 mm for CTG (difference of 0.44 mm, 95%CI from 0.25 to 0.63 mm). The upper limit of the confidence interval was over the non-inferiority margin of 0.25 mm. Odds of complete root coverage were significantly higher for CTG (OR = 4.0, 95% CI 1.8-8.8). CONCLUSION: Replacing CTG with CMX shortens time to recovery and decreases morbidity, but the tested generation of devices is probably inferior to autologous CTG in terms of root coverage. Significant variability in PROMs was observed among centres.

Clinical evaluation of two dental implant macrostructures on peri-implant bone loss: a comparative, retrospective study.

OBJECTIVES: To compare the effect of two implant macrostructures on peri-implant bone level. MATERIAL AND METHODS: This retrospective cohort study was conducted in a private practice. Patients received test (Nobel Speedy Groovy implants) or control implants (Mk III implants) or both. Baseline and corresponding follow-up radiographs, taken with a long-cone technique, were analyzed to evaluate mean bone level changes around implants during a mean follow-up of 69 ± 19 months. A chi-squared test was performed to compare the bone level changes between the two types of implants. A multivariate analysis was used to explain the difference between the two groups. RESULTS: After controlling for inclusion and exclusion criteria, 144 dental implants corresponding to 68 implants in the test group and 76 implants in the control group were placed in 59 patients. Nine dental implants (6.25%) were lost during the observation period: five implants in the test group and four implants in the control group. Consequently, a total of 135 implants placed in 58 patients were available for analysis. Our study shows a significant difference of peri-implant bone level overtime between the test and control groups (P < 0.01). At the end of the observation period, a bone growth was observed in the control group (0.02 ± 0.80 mm), whereas a bone loss was found in the test group (-0.43 ± 1.11 mm). The mean bone level at baseline and the type of periodontal therapy and the maintenance care program were involved in this difference (P < 0.001, P = 0.035, P < 0.001, respectively). CONCLUSION: Our study demonstrates a significant difference in peri-implant bone level between test and control groups. The mean bone level at baseline, the type of periodontal therapy, and the maintenance program may explain peri-implant bone level changes overtime.

A retrospective study of root coverage procedures using an image analysis system.

AIM: To investigate the efficacy of root coverage procedures and factors that may affect the clinical outcomes in non-experimental patients. MATERIAL AND METHODS: Two hundred and eighty-seven root coverage surgical procedures in 215 adult patients were evaluated retrospectively. Descriptive statistics were used to determine the patient profile. Comparisons between surgeries were assessed, and the impact of different parameters on the probability of mean/complete root coverage and gingival augmentation was explored. RESULTS: The mean percentage of root coverage was 72.29 (+/- 28)%. Complete root coverage was observed in 35.56% of the defects. The difference between the surgical procedures was not significant. The mean percentage of gingival augmentation was 106.18 (+/- 260)%. The difference between non-submerged grafts and the other techniques was significant (p<10(-3)). A significant negative impact of smoking, and maxillary teeth for both mean and complete root coverage were found. A significant positive impact of the tuberosity donor site was found for complete root coverage. Maxillary teeth and Miller's Class II and III were positive predictive factors for gingival augmentation. CONCLUSIONS: Under non-experimental conditions, root coverage procedures are effective. Smoking, maxillary teeth, donor site, and Miller's Classes are prognostic factors that may affect the results.

Root coverage assessment: validity and reproducibility of an image analysis system.

AIM: The aim of this methodological study was to validate a new method for root coverage evaluation following periodontal plastic surgery. MATERIAL AND METHODS: Thirty recessions were treated in 21 consecutive patients, using a subepithelial connective tissue graft technique. Clinical measurements and photographs were taken at baseline and 12+/-6 months after treatment. The mean percentage of root coverage for linear and surface area measurements was calculated using conventional clinical evaluation, and compared with ImageJ, a public domain Java image processing program. Bland-Altman plots were used for assessing repeatability and agreement between clinical and ImageJ measurements. The strength of the relationship was calculated using the Pearson product moment correlation coefficient. RESULTS: The repeatability of ImageJ was excellent for both linear and surface area measurements. The agreement between clinical and ImageJ measurements was good for the linear evaluation, showing lower and upper limits of -13.14% and 17.42%, respectively. Significant correlations (p<0.001) were found between clinical and ImageJ measurements, ranging from 0.93 to 0.94 for linear evaluation, and from 0.89 to 0.90 for surface evaluation. CONCLUSIONS: The outcomes of this study show that the ImageJ analysis is a reliable, reproducible method to evaluate the percentage of root coverage after periodontal plastic surgery, when a midfacial linear measurement is used.