Identification of thin and thick gingival phenotypes by two transparency methods: A diagnostic accuracy study.

BACKGROUND: There is limited information on the diagnostic accuracy of the transparency method to diagnose gingival phenotypes taking into consideration not only the gingival thickness (GT) but also the keratinized tissue width (KTW). Thus, the aim of the present study was to compare the diagnostic accuracy of two transparency methods using a conventional steel probe (SP) and a plastic color-coded probe (CCP) to identify thin and thick gingival phenotypes. METHODS: Maxillary anterior teeth (n = 300) of 50 individuals were included in this study. The GT was measured via transgingival assessment at 2 mm apical to the gingival margin. Tooth sites were subdivided into thin or thick phenotypes according to the corresponding GT, respectively, ≤1 mm and >1 mm. SP and CCP were used to determine the gingival phenotype by the transparency method. The KTW was also evaluated. The diagnostic accuracy of the experimental periodontal probes to identify the thin and thick gingival phenotypes were compared. RESULTS: Of 300 gingival sites evaluated, 57% (n = 172) were identified as thin (GT: 0.82 ± 0.12 mm, KTW: 4 ± 1.2 mm) and 43% (n = 128) as thick phenotypes (GT: 1.16 ± 0.12 mm, KTW: 4.3 ± 1.3 mm) by the transgingival method. The SP and CCP were very sensitive (>0.94) to identify the thin phenotype, however, less specific (0.35-0.39) to diagnose thick phenotype. The diagnostic accuracy for the SP and CCP was similar, 0.69 and 0.70, respectively. CONCLUSION: The steel and color-coded plastic probe were equally effective in identifying thin gingival phenotype at maxillary anterior tooth sites.

The effect of brushing discomfort on peri-implant health in sites exhibiting inadequate keratinized mucosa width: A cross-sectional study.

OBJECTIVES: The aim of this cross-sectional study was to evaluate the effect of brushing discomfort (BD) on peri-implant health in sites exhibiting inadequate keratinized mucosa (KM) width. MATERIAL AND METHODS: Patients presenting with at least one implant exhibiting KM <2 mm and in function for ≥1 year were eligible for inclusion. BD was assessed with the visual analogue scale (VAS), and implants were classified into two groups: Absence (aBD; VAS = 0) or Presence (pBD; VAS > 0) of BD. Bleeding on probing (BoP), modified plaque index (mPI), probing depth (PD), clinical attachment level (CAL), suppuration (Sup), and marginal bone level (MBL) were recorded. Mann-Whitney, chi-square test, and a multilevel model were used for analysis. RESULTS: Fifty-nine patients with 155 dental implants were analyzed, of which 60 presented no BD, and 95 presented some level of BD. BoP, PD, CAL, and MBL were significantly higher in the pBD than in the aBD group (p < .05). The prevalence of peri-implant diseases at implant level was also higher in the pBD group than in the aBD group. However, after controlling for confounding factors, only mPI showed an effect on BoP. In addition, difficulty to perform oral hygiene was statistically higher in the pBD group. CONCLUSIONS: The findings of the present study suggest that although BD around implants exhibiting KM <2 mm did not influence tissue inflammation, it could represent a symptom of peri-implant diseases. Further clinical trials assessing the long-term effect of BD must be considered to better ascertain its effects on peri-implant health.

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.

Restorative Alveolar Interface Management Combined With Tunnel Technique and Connective Tissue Graft: A Conservative Approach for Root Fracture Treatment.

INTRODUCTION: The infringement of supracrestal tissue attachment by subgingival restorative margins, extensive caries, and root fractures, can compromise the periodontal health, resulting in inflammation and loss of periodontal supporting tissues. This report describes a case of a root fracture on the upper left central incisor that was successfully treated using a conservative approach, by applying the restorative alveolar interface (RAI) management combined with tunnel technique and a subepithelial connective tissue graft (SCTG). CASE PRESENTATION: A 24-year-old male patient presented with a provisional single-unit fixed prosthesis on his upper left central incisor, in function for 4 years, with the chief complaint of prosthesis discoloration. After clinical and radiographic examination, a diagnosis of root fracture was established. Following the removal of the provisional prosthesis, a full-thickness flap was elevated creating a tunnel. The elimination of the fracture line/angle, root recontouring, and planning was then performed with the aid of a conical long diamond bur and periodontal curets. Additionally, an SCTG was placed buccally into the tunnel. The final zirconia layered with E-max crown was placed 6 months after surgery. At 12- and 24-month follow-up, the periodontal tissues presented healthy aspect, no bleeding on probing, and a 4-mm probing depth. CONCLUSIONS: Surgical repositioning of the restorative margin can be an alternative and conservative treatment approach to compromised teeth with subgingival fracture line/angle. However, case selection should be carefully considered and restorability assessed as limitations might apply.

Influence of the keratinized mucosa on the stability of peri-implant tissues and brushing discomfort: A 4-year follow-up study.

OBJECTIVE: The purpose of the present prospective follow-up study was to evaluate the long-term influence of the peri-implant keratinized mucosa (KM) on marginal bone level (MBL), peri-implant tissues health, and brushing discomfort. MATERIAL AND METHODS: Eighty patients were initially recruited during their maintenance visit from January to October 2013 and allocated in two groups according to KM width around implants: Wide Group (KM ≥ 2 mm) and Narrow Group (KM < 2 mm). In the four-year follow-up examination (T4), marginal bone level (MBL), modified plaque index (mPI), probing depth (PD), clinical attachment level (CAL), bleeding on probing (BoP), and brushing discomfort (BD) were reassessed and compared to the initial assessments (T0). Mann-Whitney, Wilcoxon signed-rank test, and a multilevel model were used for the statistical analysis. RESULTS: Fifty-four patients with 202 implants returned at T4. Mean mPI (0.91 ± 0.60), BoP (0.67 ± 0.21), and BD (12.28 ± 17.59) were higher in the Narrow Group than in the Wide Group (0.54 ± 0.48, 0.56 ± 0.26, and 4.25 ± 8.39, respectively). Marginal bone loss was higher in the Narrow Group (0.26 ± 0.71) than in the Wide Group (0.06 ± 0.48). Multilevel analysis suggested that KM width and time in function had a statistically significant effect on MBL. CONCLUSIONS: The findings of the present study indicate that KM width had an effect on MBL, plaque accumulation, tissue inflammation, and brushing discomfort over the studied period. Thus, the presence of a KM ≥ 2 mm around implants appears to have a protective effect on peri-implant tissues.