The association between periodontal disease severity and metabolic syndrome in Vietnamese patients.

OBJECTIVE: To investigate the association between periodontal disease severity and metabolic syndrome (MetS) in a group of Vietnamese patients. METHODS: A total of 412 participants (114 males, 298 females, average age 57.8 ± 5.7 years) including 206 patients with MetS and 206 participants without MetS were selected for this study. Information on sociodemographic characteristics, dental behaviours and smoking status was collected from a self-administrated questionnaire. Periodontal status including plaque index (PI), gingival index (GI) pocket depth (PD) and clinical attachment level (CAL) was recorded. Logistic regression analyses were used to evaluate the association between severity of periodontal disease and MetS with adjustments for related confounders. RESULTS: The prevalence of moderate and severe periodontitis assessed by GI, PD and CAL was all significantly higher in the MetS group than in the control group and was significantly increased by a number of MetS components. Logistic regression, adjusted for confounders, showed that people with mean PI ≥2.51 or GI ≥1.01 or number of teeth with bleeding on probing of ≥20 teeth or PD ≥3.66 or CAL ≥3.66 showed a significant association with greater OR for MetS compared to counterparts (P < .05). The OR for MetS was 4.06 (95% CI 2.11-7.84) in severe periodontitis patients compared to non-periodontitis participants (P < .001). CONCLUSION: Much severe and extensive periodontal disease was found in MetS participants and increased with number of MetS components. Participants with higher periodontal parameters had a higher risk of MetS.

A comparative study of encode protocol versus conventional protocol for restoring single implants: One-year prospective randomized controlled clinical trial.

BACKGROUND: The Encode protocol (Biomet 3i, Palm Beach Gardens, Fla) has been proposed as a simplified implant restoration protocol. PURPOSE: To compare the 1-year clinical outcome of the Encode and conventional protocols for restoring single implants. MATERIALS AND METHODS: Forty-seven implants were inserted in 44 patients. After randomizing the implants, 24 implants were allocated to the Encode protocol and 23 implants were allocated to the conventional protocol. After 1 year, changes in esthetics, patient satisfaction, proximal contacts quality, occlusal contacts quality, marginal bone level (MBL), and probing pocket depth (PPD) were evaluated. Further, the prosthesis cleansability, mucosal health, bleeding on probing (BoP), metallic discoloration, and all forms complications were recorded. RESULTS: Forty patients with 41 implants (22 Encode and 19 conventional) were recalled. One conventional crown failed due to excessive looseness. Esthetics, patient satisfaction, and prosthesis cleansability were favorable for the two protocols. One Encode crown (4.5%) and six conventional crowns (33.3%) had slight mucosal redness. BoP was present around 8 Encode crowns (36.4%) and eight conventional crowns (45.4%). Only two conventional crowns showed metallic discoloration of the mucosa. The two protocols had similar PPD alteration (Encode = 0.04 mm, conventional = 0.13 mm), and MBL loss (Encode = 0.71 mm, conventional = 0.78 mm). Similar proximal contacts and occlusal contacts were observed for the two protocols. CONCLUSIONS: After 1 year, the Encode protocol for restoring single implants appears to be comparable to the conventional protocol from the biological, prosthetic, and esthetic perspectives.

The association between dental health and nutritional status in chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) and periodontitis are chronic inflammatory systemic diseases with common risk factors (smoking and aging). In COPD, poor periodontal health could result in inadequate nutrition, potentially causing loss of muscle volume. The purpose of this case-control study was to examine our hypothesis that COPD patients have poorer periodontal health and poorer nutritional status than non-COPD patients. Periodontal status was assessed using bleeding on probing (BOP), pocket depth (PD), and plaque-control ratio (PCR). Nutritional status was assessed using body mass index, lean body mass, and serum albumin levels. The COPD group ( n = 60) had fewer remaining teeth, greater BOP, greater PD, and lower serum albumin levels compared with smokers without COPD ( n = 41) and nonsmokers ( n = 35; p < 0.001). COPD was an independent risk factor for poor periodontal health, demonstrated by fewer remaining teeth (relative risk (RR), 5.48; p = 0.0024), BOP (RR, 12.8; p = 0.0009), and having >30% of remaining teeth with a PD ≥ 4 mm (RR, 4.82; p = 0.011). A significant negative correlation existed between the number of teeth with a PD ≥ 4 mm and serum albumin level ( r2 = 0.127; p = 0.013). We demonstrated that poor periodontal health was associated with hypoalbuminemia, suggesting poor nutritional status and inflammation in COPD.

Locally Delivered 0.5% Azithromycin as an Adjunct to Non-Surgical Treatment in Patients With Chronic Periodontitis With Type 2 Diabetes: A Randomized Controlled Clinical Trial.

BACKGROUND: Several epidemiologic studies have identified a greater incidence of periodontitis in patients with type 2 diabetes. Recent developments suggest that local delivery of antimicrobials into periodontal pockets improve periodontal health. The present study is designed to investigate the adjunctive effects of subgingivally delivered azithromycin (AZM; 0.5% concentration) as an adjunct to scaling and root planing (SRP) for treating chronic periodontitis in patients with type 2 diabetes. METHODS: A total of 63 patients were categorized into two treatment groups: 1) group 1: SRP + placebo gel and 2) group 2: SRP + 0.5% AZM. Clinical parameters were recorded at baseline and 3, 6, and 9 months; they included modified sulcus bleeding index (mSBI), plaque index (PI), probing depth (PD), and clinical attachment level (CAL). RESULTS: Both therapies resulted in significant improvements. Using a patient-based analysis, patients in group 2 treated with SRP + 0.5% AZM showed enhanced reductions in PI, GI, mSBI, and PD and gains in CAL (P <0.05) over 9 months compared with group 1. CONCLUSION: Although both treatment strategies seem to benefit the patients, the adjunctive use of 0.5% AZM as a controlled drug delivery system enhances the clinical outcome.

Effect of antihypertensive therapy with angiotensin-converting enzyme inhibitors on chronic periodontitis: a case-control study.

BACKGROUND: Angiotensin-converting enzyme (ACE) downregulates the activity of bradykinin, a potent proinflammatory and immunostimulatory peptide liberated from an internal portion of kininogens. Here, we asked whether periodontitis is worsened in patients under antihypertensive treatment with ACE inhibitors. METHODS: Periodontal parameters were recorded from 30 individuals taking ACE inhibitors (case) and 35 taking a non-ACE inhibitor medication (control). Data were analyzed by nonparametric and parametric statistical tests. RESULTS: Most sociodemographic figures were similar in both groups. However, family income was statistically higher in the control group, and the percentage of sites with visible plaque (PL) was statistically higher in the case group (P = 0.043 and P = 0.005, respectively). The prevalence of individuals with chronic periodontitis varied from 31.5% in the control group to 63.4% in the case group (P = 0.001). Patients in the case group presented a 3.2-fold higher risk of having sites with pocket depth ≥5 mm and a 2.9-fold higher risk of having sites with clinical attachment loss ≥5 mm in comparison with those in the control group (P = 0.009 and P = 0.001, respectively; adjusted for family income and visible PL). CONCLUSION: Angiotensin-converting enzyme inhibitors may increase the prevalence and extent of chronic periodontitis in Brazilian patients.

Clinical parameters and aMMP-8-concentrations in gingival crevicular fluid in pregnancy gingivitis.

BACKGROUND: During pregnancy hormonal changes may increase the risk for developing gingivitis. The aim of this study was to evaluate the signs of gingival inflammation and the enzyme activity of matrix metalloproteinase-8 (aMMP-8) in the gingival crevicular fluid of pregnant women. METHODS: After approval by the ethics commission, a total of 40 volunteers participated in the study; group 1 (n = 20, age: 32 +/- 4 years) with pregnant women, and group 2 (n = 20, age: 30 +/- 10 years) with age-matched non-pregnant women as controls. After obtaining anamnestic data, the dental examination included assessment of oral hygiene, gingival inflammation, probing pocket depth, and recession. Gingival crevicular fluid was collected from both groups. A quantitative determination of aMMP-8 concentrations in the gingival crevicular fluid samples was performed. RESULTS: The aMMP-8 values of group 1 were higher (median 6.25 ng/mL aMMP-8 eluate) compared with group 2 (median 3.88 ng/mL aMMP-8 eluate), but the difference was not statistically significant (p = 0.265). Group 1 showed significantly increased probing pocket depths (p = 0.001). Gingival inflammation was present in 80% of the pregnant women, but only in 40% of the control subjects. CONCLUSIONS: It was shown that during pregnancy changes related to periodontal health could be observed. Higher aMMP-8 values, elevated probing pocket depths, and an increase of gingival inflammation could be detected in comparison with non-pregnant women.

Comparative evaluation of short- and long-term treatment of periodontitis with alpha-lipoic acid.

The ultimate goal of research was to make a comparative evaluation of efficiency of periodontitis treatment with alpha-lipoic acid in the short-term and long-term period in people which are under the influence of heavy metal salts of low intensity. 50 patients residing on the territory under the influence of heavy metal salts of low intensity, were under observation and they were given medical treatment to evaluate the efficiency of periodontitis treatment with the help of alpha-lipoic acid in short-term and long-term period. The patients were undergone clinical evaluation of periodontal status according to general indexes and data of laboratory examinations prior to treatment, in 14 days and in 12 months. After intaking of 600 mg of alpha-lipoic acid per day during 14 days the condition of periodontitis tissues in the reference group and in the basic group has no statistically significant differences. The basic group took alpha-lipoic acid during 2 months, that favored improving of clinical and laboratory indexes. In comparison with the reference group in the basic group PMA index decreased in 2.3 times, IIS in 1.4 times, BPI in 1.8 times, complex parodontal index improved in 1.3 times, leucocytes emigration decreased in 1.2 times and microbial contamination of epithelium in 1.22 times. Efficiency of anti-inflammatory therapy was 1.4 times higher. Depth of gingival pockets and level of oral hygiene had no statistical significant differences.

BRAF gene polymorphism (rs10487888) assessment in chronic periodontitis and peri-implantitis in an Iranian population.

BACKGROUND: Peri-implantitis (PI) and chronic periodontitis (CP) are multifactorial diseases of implant/tooth supporting tissue that are caused by bacterial infection and increased host immune response. T-cell proliferation plays a pivotal role in the orchestration of host response to bacterial infection. BRAF is a positive regulator of T-cell proliferation. The aim of this study was to evaluate for the first time the role of a functional single nucleotide polymorphism (SNP) of the BRAF gene in association to PI and CP. METHODS: A total of 194 individuals referred to the Periodontology Department of Shahid Beheshti Dental School, Tehran, Iran, were divided into three groups: 74 patients in the CP group (39 men and 35 women, with mean age of 48.3 years), 38 patients in the PI group (20 men and 18 women, with mean age of 50.2 years), and 82 patients in the healthy periodontium group (39 men and 43 women, with mean age of 45.4 years). DNA was extracted from fresh blood samples collected from the arm vein of participants and was transferred to KBiosience institute (United Kingdom) for genotyping. χ2 and Kruskal-Wallis tests were conducted using SPSS software v. 19 for statistical analysis (p<0.05). RESULTS: The allele (C/T) and genotype (CC, CT, TT) frequencies had insignificant differences among the three groups; however, the CC genotype was more prevalent in the healthy condition than in the disease conditions. CONCLUSIONS: The BRAF gene polymorphism (rs10487888) may not be a genetic determinant for increasing the risk of CP and PI among the Iranian population. More studies with more sample size in different populations are necessary for determining the effect of this SNP.

Treatment of localized gingival recessions using gingival unit grafts: a randomized controlled clinical trial.

BACKGROUND: One of the success factors in periodontal plastic surgery is the synergistic relationship between involved tissues and vascular supply. Gingiva as a functional unit is unique with a specific vascular configuration and contains the supracrestal portion naturally created to survive over avascular root surfaces. The aim of this randomized controlled trial is to clinically evaluate the treatment of localized gingival recessions by using gingival unit grafts (palatal tissue involving marginal gingiva and papillae) compared with conventional palatal grafts. METHODS: Seventeen patients with Class I to II recession defects on mandibular anterior teeth were included and randomly divided into two groups. Recessions were treated with gingival unit grafts in group 1 (n = 8) and with palatal grafts in group 2 (n = 9). Clinical parameters including vertical recession (VR), probing depth, keratinized tissue (KT), and attachment level were recorded at baseline and 8 months after surgery. RESULTS: Both treatments produced significant clinical improvements within the groups. Intergroup comparison revealed significantly higher VR reduction, attachment, and KT gain in group 1 than in group 2; mean percentages of the defect coverage were 91.62% ± 9.74% and 68.97% ± 13.67%, respectively (P <0.05). Healing of the gingival unit donor site was uneventful. CONCLUSION: Within its limits, this study demonstrates the possibility of treating buccal recessions with gingival unit grafts as an alternative technique using gingival donor graft of site-specific vascular configuration, with better defect coverage, clinical, and esthetic improvements compared with palatal grafts.

Human neutrophil defensins and their effect on epithelial cells.

BACKGROUND: The aims of the present study include: 1) to localize human neutrophil defensin-1 (HNP-1) through HNP-3 in gingiva and in neutrophil extract-treated epithelial cell monolayers; 2) to determine the effects of HNP-1 on the epithelial cell viability, attachment, and spreading; and 3) to analyze the effect of HNP-1 on the bacterial adherence to epithelial cells. METHODS: For localization of HNP-1 through HNP-3 in gingival tissue and in preincubated cell monolayers, immunohistochemical and immunocytochemical methods were used. Viability and proliferation of epithelial cells were determined with commercial kits after incubating the keratinocytes with different HNP-1 concentrations (low, 1 to 5 µg/mL; moderate, 10 µg/mL; high, 20 to 50 µg/mL). Attachment and spreading of keratinocytes on fibronectin-coated surfaces in the presence of HNP-1 were evaluated under microscope. Attachment of Fusobacterium nucleatum ATCC25586 and Prevotella intermedia ATCC25611 on keratinocytes preincubated with HNP-1 were determined with a standard antibiotic test. RESULTS: HNP-1 through HNP-3 localized in the junctional epithelium of clinically healthy gingiva and in the pocket epithelium of gingiva with periodontitis. When keratinocyte monolayers were incubated with neutrophil extracts, HNP-1 through HNP-3 were bound to the periphery of the growing cell colonies. In low HNP-1 concentrations, the keratinocyte proliferation enhanced. Moderate and high concentrations of HNP-1 increased the cellular death significantly. HNP-1 increased the attachment and spreading of keratinocytes on fibronectin-coated surfaces and bacterial attachment to keratinocytes in a concentration-dependent manner. CONCLUSION: HNP-1 plays a role in the integrity of keratinocytes by stimulating their proliferation, attachment, and spreading, whereas higher doses increase the bacterial attachment and keratinocyte death.

Relationship between the width of the zone of keratinized tissue and thickness of gingival tissue in the anterior maxilla.

The aim of this study was to evaluate whether there is a positive correlation between the width of the zone of gingival keratinized tissue and its thickness. Maxillary right canines, lateral incisors, and central incisors of 60 patients (30 men, 30 women) between the ages of 20 and 35 years were examined. Using an endodontic spacer with a rubber cursor and a digital caliper of 0.01-mm resolution, the values of the width of the zone of gingival keratinized tissue and gingival thickness were obtained. It was observed that the lateral incisor has the largest mean zone of gingival keratinized tissue (5.54 ± 1.09 mm), followed by the central incisor (4.62 ± 1.02 mm) and canine (4.32 ± 1.33 mm). The mean gingival thickness was greater in the central incisor (1.17 ± 0.20 mm), followed by the lateral incisor (1.04 ± 0.24 mm) and canine (0.87 ± 0.27 mm). No statistically significant difference was verified for the mean width of the zone of gingival keratinized tissue and gingival thickness between men and women. A positive correlation between gingival thickness and width of the zone of gingival keratinized tissue was observed in the maxillary canine (Pearson r = 0.398, P < .05), lateral incisor (Pearson r = 0.369, P < .05), and central incisor (Pearson r = 0.492, P < .05). In patients 20 to 35 years of age, there was a positive correlation between gingival thickness and width of the zone of gingival keratinized tissue for the maxillary right canine, lateral incisor, and central incisor.

Colocalization of Porphyromonas gingivalis with CD4+ T cells in periodontal disease.

Porphyromonas gingivalis, an anaerobic, asaccharolytic gram-negative bacterium, is a causative agent in chronic periodontitis. It has many virulence factors that facilitate infection of the gingiva, but little is known about the local immune cells that respond to this bacterium. The aims of this study were to quantify P. gingivalis in gingival biopsies from patients with periodontitis using laser capture microdissection (LCM) plus qRT-PCR and to determine the phenotype of immune cells associated with the bacteria using immunofluorescence. The presence of P. gingivalis was confirmed in periodontitis gingival tissue from 10 patients, and differences in bacterial distribution in the epithelium and connective tissue with or without inflammatory infiltrates were observed. Immune cells found in the biopsy tissues, including CD20+ mature B cells and CD138+ plasma cells, were associated with the Th2-type immune response. Most P. gingivalis was in direct contact with CD4+ T cells. This study revealed for the first time the colocalization of P. gingivalis with immune cells. Use of LCM combined with qRT-PCR enabled quantitative analysis of bacteria in a selected area of a biopsy sample without any tissue degradation. Observation of the immune cells associated with these bacteria was also performed by immunofluorescence.

The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: an explorative and reliability study.

BACKGROUND: The aims of this study were (i) to test the reliability of a new classification system of gingival recessions using the level of interproximal clinical attachment as an identification criterion and (ii) to explore the predictive value of the resulting classification system on the final root coverage outcomes. MATERIAL AND METHODS: Patients showing at least one buccal gingival recession were recruited by one operator. Three recession types (RT) were identified. While class RT1 included gingival recession with no loss of interproximal attachment, class RT2 recession was associated with interproximal attachment loss less than or equal to the buccal site and class RT3 showed higher interproximal attachment loss than the buccal site. The classification was tested by two examiners blinded to the data collected by the other examiner. Intra-rater and inter-rater agreement was assessed. Furthermore, the 6-month root coverage outcomes of consecutively treated gingival recessions were retrospectively evaluated in order to explore the predictive value of the proposed classification on the final recession reduction (Rec Red). RESULTS: The new classification system of gingival recessions was tested in a total of 116 gingival recessions (mean 3.2±1.2 mm) in 25 patients. The intra-class correlation coefficient (ICC) for inter-rater agreement was 0.86, showing an almost perfect agreement between the examiners. The RT classification was predictive of the final Rec Red (p<0.0001) at the 6-month follow-up in 109 treated gingival recessions. CONCLUSIONS: The evaluation of interproximal clinical attachment level may be used to classify gingival recession defects and to predict the final root coverage outcomes.

A clinical and histologic evaluation of gingival fibroblasts seeding on a chitosan-based scaffold and its effect on the width of keratinized gingiva in dogs.

BACKGROUND: Finding biocompatible matrix materials capable of enhancing the procedures of gingival augmentation is a major concern in periodontal research. This has prompted the investigation of a safe grafting technique by means of synthetic or natural polymers. The objective of this study is to examine the effect of a gingival fibroblast cultured on a naturally derived (i.e., chitosan-based) scaffold on the width of keratinized gingiva in dogs. METHODS: Gingival fibroblasts were cultured from a small portion of hard palates of five dogs. A bilayered chitosan scaffold was seeded with the gingival fibroblasts and transferred to dogs. Surgery was performed bilaterally, and the regions were randomly divided into two groups: chitosan only (control site) and chitosan + fibroblast (test site). Periodontal parameters, including probing depth and width of keratinized and attached gingiva, were measured at baseline and 3 months after surgery. A histologic evaluation was also performed on the healed grafted sites. RESULTS: Comparison of width of keratinized and attached gingiva in control and test sites showed that the mean width of keratinized and attached gingiva increased in each group after surgery. However, the difference between control and test groups was not statistically significant. Concerning the existence of the keratinized epithelium, exocytosis, and epithelium thickness, no significant difference was observed in test and control sites. The difference was significant in relation to rete ridge formation. CONCLUSION: The tissue-engineered graft consisting of chitosan + fibroblast was applied to gingival augmentation procedures and generated keratinized tissue without any complications usually associated with donor-site surgery.

Evaluation of hyaluronan gel (Gengigel(®) ) as a topical applicant in the treatment of gingivitis.

AIM: To clinically and histopathologically evaluate the anti-inflammatory effect of 0.2% hyaluronan gel alone and with mechanical therapy on gingivitis. The argyrophilic nucleolar organizer region staining technique was attempted to routinely determine its diagnostic and prognostic dependability for periodontal lesions. METHODS: In each of the 28 gingivitis patients, the four quadrants were subjected to different treatments: scaling, scaling + topical hyaluronan gel, only topical hyaluronan gel, and topical + intrasulcular hyaluronan gel. Clinical parameters were recorded at baseline, and on days 7, 14, and 21. Biopsies were taken from each quadrant, inflammatory infiltrates were graded, and the argyrophilic nucleolar organizer region count was measured before and after treatment. RESULTS: A significant reduction was seen in clinical parameters, inflammatory infiltrates, and the argyrophilic nucleolar organizer region count within the groups. The effect of topical + intrasulcular gel was equivalent to scaling (P > 0.05). Topical + intrasulcular hyaluronan gel application demonstrated a better reduction than topical hyaluronan gel alone. CONCLUSIONS: Hyaluronan gel is an effective topical agent for treating gingivitis, along with scaling and intrasulcular application. The argyrophilic nucleolar organizer region count can be used as a histopathological indicator in cases of non-responsive gingivitis to assess the severity of gingival inflammation.

The coronally advanced flap in combination with platelet-rich fibrin (PRF) and enamel matrix derivative in the treatment of gingival recession: a comparative study.

OBJECTIVE: The main objective of this study was to evaluate the clinical effectiveness of platelet-rich fibrin membrane used in combination with a coronally advanced flap (CAF) and to compare it with the use of an enamel matrix derivative (EMD) in combination with a coronally advanced flap in gingival recession treatment. MATERIAL AND METHODS: 20 split-mouth cases of maxillary anterior teeth or bicuspids presenting with Miller Class I or II gingival recession were treated with a CAF combined with a platelet-rich fibrin membrane (PRF group) or with EMD (EMD group) placed under a CAF. The following parameters were measured at baseline and at 12 months post treatment: gingival recession (GR), apicocoronal width of the keratinized tissue (WKT), and probing depth (PD). RESULTS: Complete rot coverage in the PRF group was 65% (13 out of 20 recessions) and 60% in the EMD group (12 out of 20 recessions). GR was 4.10 ± 1.05 mm in the PRF group and 3.90 ± 1.00 mm in the EMD group at baseline, and 1.05 ± 0.45 mm in the PRF group and 1.15 ± 0.65 mm in the EMD group at 12 months. The difference observed between the tow groups at 12 months was statistically significant. Average root coverage was 70.5% in the EMD group and 72.1% in the PRF group. WKT was 1.30 ± 0.56 mm in the EMD group and 1.45 ± 0.86 mm in the PRF group at baseline, and 1.90 ± 0.81 mm in the EMD group and 1.62 ± 0.28 mm in the PRF group at 12 months. The difference observed between the two groups at 12 months was not statistically significant. Twelve-month changes in PD were not significantly different between the two groups. The pain intensity was statistically different between the two groups. The pain intensity was statistically different between groups for the first 5 days, favoring the PRF group. CONCLUSIONS: The present study did not succeed in demonstrating any clinical advantage of the use of PRF compared to EMD in the coverage of gingival recession with the CAF procedure. The EMD group showed a higher success rate in increasing WKT than did the PRF group.

Periodontal conditions of sites treated with gingival-augmentation surgery compared to untreated contralateral homologous sites: a 10- to 27-year long-term study.

BACKGROUND: The aim of this retrospective long-term split-mouth study was to compare the periodontal conditions of sites treated with gingival-augmentation procedures to untreated homologous contralateral sites over a long period of time (10 to 27 years). METHODS: Fifty-five subjects with 73 sites (test group) lacking attached gingiva associated with recessions were treated by means of submarginal free gingival grafts (SMFGGs) and marginal free gingival grafts (MFGGs). The 73 contralateral homologous sites (control group), with or without recession and with or without attached gingiva, were not treated. Patients were recalled every 4 months during the follow-up period (10 to 27 years). Clinical variables, including recession depth, amount of keratinized tissue (KT), and probing depth (PD), were measured in treated and untreated sites at baseline, at 1 year, and at the end of the follow-up period. RESULTS: At the end of the follow-up period, recession was reduced in all treated sites (1.5 +/- 1.0 mm for SMFGG and 1.3 +/- 0.9 mm for MFGG), whereas it was increased in the untreated sites (-0.7 +/- 0.7 mm for SMFGG and -1.0 +/- 0.5 mm for MFGG). In the treated sites, the increased KT remained quite stable during the follow-up period. PD remained stable (1 mm) in the treated and untreated sites. CONCLUSIONS: The sites treated with gingival-augmentation surgery showed a tendency for coronal displacement of the gingival margin with a reduction in recession. The contralateral untreated sites showed a tendency for apical displacement of the gingival margin with an increase in the existing recessions.

A quantitative evaluation of the spatial displacement of the gingival zenith in the maxillary anterior dentition.

BACKGROUND: The appearance of gingival tissues plays an important role in the esthetics of the anterior maxillary region of the mouth. The gingival zenith (GZ) is defined as the most apical point of the marginal gingival scallop; however, its quantitative orientation in the apico-coronal (AC) and mesio-distal (MD) directions has not been reported. Thus, this study aimed to quantify the specific spatial displacement of the GZ in the maxillary anterior dentition. METHODS: Bilateral measurements, taken with a digital caliper in maxillary stone casts from periodontally healthy volunteers, were recorded to the nearest 1/100th millimeter in the canine (C), lateral incisor (LI), and central incisor (CI) teeth to evaluate the MD displacement of the GZ in relation to the long axis of the crowns and the AC displacement of the GZ of LI teeth in relation to CI and C teeth. Intermeasurement differences were analyzed with the chi(2) or paired t test, with significance set at alpha <0.05. RESULTS: The GZ was distally displaced between 0.06 and 0.96 mm in 12%, 70%, and 96% of the C, LI, and CI teeth, respectively. The majority of the population (70%) presented with the GZ of LI teeth positioned 0.75 +/- 0.60 mm coronally to the GZ of the ipsilateral C and CI. CONCLUSIONS: The GZ is not universally displaced toward the distal aspect. The frequency and magnitude of distal displacement is tooth-dependent and larger in CI than in LI, which, in turn, is larger than in C. Consideration of these findings may improve clinical management of the dentogingival complex and enhance periodontal and restorative procedures in the anterior maxillary dentition.

Free gingival grafts to increase keratinized tissue: a retrospective long-term evaluation (10 to 25 years) of outcomes.

BACKGROUND: Gingival augmentation procedures are indicated primarily to increase an insufficient amount of gingiva and sometimes to halt the progression of gingival recession. The aim of this retrospective long-term study was to evaluate changes in the amount of keratinized tissue (KT) and in the position of the gingival margin after free gingival graft procedures over a period of 10 to 25 years. METHODS: One hundred three subjects presenting with 224 sites completely lacking attached gingiva associated with gingival recessions were treated in a private practice. The experimental sites were treated with gingival augmentation procedures (free gingival grafts). The grafts were positioned at the presurgical level of the gingival margin or in a submarginal position. Clinical variables, including recession depth, amount of KT, and probing depth (PD), were measured at baseline (T(0)), 1 year after surgery (T(1)), and at the end of the follow-up period (10 to 25 years) (T(2)) and analyzed using descriptive statistics and multilevel models. RESULTS: From T(0) to T(1), the gingival margin shifted coronally 0.8 mm, and KT increased 4.2 mm. From T(1) to T(2), the gingival margin shifted coronally 0.6 mm, and the overall KT decreased 0.7 mm. PD remained stable. CONCLUSION: Gingival augmentation procedures performed in sites with an absence of attached gingiva associated with recessions provide an increased amount of KT associated with recession reduction over a long period of time.

Effect of connective tissue graft orientation on the root coverage outcomes of coronally advanced flap.

The aim of the present study was the evaluation of the effect of connective tissue graft orientation on clinical outcome of root coverage procedure when applied in conjunction with coronally advanced flap. Sixteen similar bilateral recession defects--Miller's class I and II--in eight patients were treated using coronally advanced flap and connective tissue graft harvested from the palate. The defects in each patient were randomly allocated to P-teeth or P-flap groups with the periosteum contacting the tooth surface or the flap, respectively. After initial scaling and root planing, acrylic templates of the treatment sites were generated. Recession depth (RD), recession width (RW), gingival sulcular depth, clinical attachment level, length of keratinized tissue, papilla width, and percentage of root coverage were measured at baseline, 1 and 3 months postoperatively. Wilcoxon and Mann-Whitney U tests were used for analyzing the data. The reduction in RD averaged 3.68 mm in P-teeth and 3.25 mm in P-flap. RW decreased 2.68 and 2.6 mm in P-teeth and P-flap, respectively. Keratinized tissue increased an average of 1.25 mm in P-teeth and 1.31 mm in P-flap. Clinical attachment gain equaled 3.87 mm for P-teeth and 3.32 mm for P-flap. All variables exhibited significant improvement compared to baseline (P < 0.0001), but between-group differences were negligible (P > 0.05). It could be concluded that while the application of connective tissue graft with coronally advanced flap is efficient for coverage of Miller's class I and II gingival recession defects, the short-term clinical outcome of this surgical method is not affected by orientation of connective tissue graft.