Short-term effect of regular vs mini curettes on periodontal tissue according to phenotype: a randomized control clinical trial.

AIM: The aim of this randomized control clinical trial was to compare the soft tissue response to mechanical root instrumentation procedures performed using periodontal curettes with different-sized working parts. MATERIALS AND METHODS: Twenty patients affected by Stage 3 Grade B periodontitis - a total of 109 teeth - were treated with either Mini-Five Gracey Curettes (MFC) or Conventional Gracey Curettes (CGC). Measurements were performed by a blinded examiner at baseline and at 6 weeks. Outcome measurements included pocket depth (PD), recession depth (RD), and difference in RD (∆RD). RESULTS: The use of MFC significantly reduced soft tissue shrinkage (1.5 ± 1 vs 2.4 ± 1.3; difference: -0.9 mm; P < 0.001). Patients in the MFC (test) group experienced lower gingival recession (GR), especially in both thin (2 ± 0.4 mm vs 3.1 ± 0.5 mm; difference: -1.1; P < 0.001) and medium (1.6 ± 0.5 mm vs 2.6 ± 0.6; difference: -1 mm; P = 0.010) periodontal phenotypes. Severe periodontal pockets (PD ≥ 7 mm) of patients in the MFC group experienced significantly lower soft tissue shrinkage than those in the CGC (control) group, regardless of periodontal phenotype. CONCLUSION: The use of MFC resulted in a greater PD reduction and lower rate of GR in the short term. Nonsurgical periodontal treatment performed with CGC led to more soft tissue shrinkage, particularly when performed in patients with a thin periodontal phenotype.

The Influence of Gingival Phenotype on the Outcomes of Coronally Advanced Flap: A Prospective Multicenter Study.

The goal of this study was to evaluate the influence of gingival phenotype (GPh) on the clinical outcomes of coronally advanced flap (CAF). In this prospective study, 24 gingival recessions (recession type RT1 class or Miller Classes I and II) in 21 patients were treated with CAF alone. Patients were classified as having thin, medium, thick, or very thick GPh using a color-coded probe. At 6 months, the lowest mean root coverage (mRC; 60.4% ± 28.8%) and complete root coverage (CRC; 25%) were found in patients with thin GPh compared to patients with medium (mRC: 86.4% ± 17.6%; CRC: 60%), thick (mRC: 93.3% ± 14.9%; CRC: 83.3%), and very thick (mRC: 86.7% ± 26.7%; CRC: 80%) GPh. Regression analysis showed a statistically significant difference (P < .05) between thin and thick/very thick GPh in the likelihood of achieving CRC. Higher RES values were observed in patients with thick and very thick GPh (8.2 ± 1.5 and 8.4 ± 1.4, respectively), while thin GPh was related to the lowest RES score (6.3 ± 2.2). CAF performed in patients with thick or very thick GPh resulted in superior clinical and esthetic outcomes than thin and medium GPh. In particular, thin GPh was associated with the lowest mRC, CRC, and root coverage esthetic scores.

Graftless Tunnel Technique for the Treatment of Multiple Gingival Recessions in Sites with Thick or Very Thick Biotype: A Prospective Case Series.

Tunnel (TUN) technique is normally performed in combination with soft tissue grafts, either autogenous connective tissue graft (CTG) or substitutes, regardless of a patient's biotype. The aim of this study was to investigate the efficacy of graftless TUN in the treatment of multiple gingival recessions (GRs) characterized by thick or very thick biotype. Twenty-seven GRs were treated in seven patients using graftless TUN. At 6-month postoperative evaluations, the mean root coverage (mRC) was 84.57% ± 31.1%, while complete root coverage (CRC) was achieved in 77.8% of treated GR sites and in six out of seven patients. On average, the esthetic evaluation performed using the root coverage esthetic score (RES) resulted in a final score of 9.1 ± 1.4. Sixteen sites achieved the maximum RES score, and in six patients, an RES ≥ 9 was observed in all sites. Graftless TUN showed predictable root coverage and improved esthetics in treating GRs in patients with a thick or very thick biotype. Nevertheless, further studies with a large number of subjects are needed to support these preliminary outcomes.

New Perspectives in the Use of Biomaterials for Periodontal Regeneration.

Periodontitis is a disease with a high prevalence among adults. If not treated, it can lead to loss of teeth. Periodontal therapy aims at maintaining patient's teeth through infection control and correction of non-maintainable anatomies including-when possible-regeneration of lost periodontal tissues. The biological regenerative potential of the periodontium is high, and several biomaterials can be utilized to improve the outcome of periodontal therapy. Use of different natural and synthetic materials in the periodontal field has been studied for many years. The main materials used today in periodontology analyzed in this review are: Resorbable and non-resorbable barrier membranes; autogenous, allogeneic, xenogeneic, and alloplastic bone substitutes; biological agents, such as amelogenins; platelet-derived growth factor; bone morphogenic proteins; rh fibroblast growth factor 2; teriparatide hormone; platelet concentrates; and 3D scaffolds. With the development of new surgical techniques some concepts on periodontal regeneration that were strictly applied in the past seem to be not so critical today. This can have an impact on the materials that are needed when attempting to regenerate lost periodontal structures. This review aims at presenting a rationale behind the use of biomaterials in modern periodontal regeneration.

Minimizing Patient Morbidity Following Palatal Gingival Harvesting: A Randomized Controlled Clinical Study.

This clinical study was conducted to evaluate the impact of different hemostatic treatments following palatal gingival harvesting on patient discomfort. Fifty patients who needed a mucogingival surgery requiring gingival graft harvesting were enrolled and randomly assigned to one of five groups: (1) a control group in which only sutures were applied; (2) a cyanoacrylate group; (3) a periodontal dressing material group; (4) a hemostatic gelatin sponge group; and (5) a group in which the gelatin sponge and cyanoacrylate were combined. In the 2 weeks following the procedures, perception of pain, healing, consumption of drugs, and willingness to repeat the procedure were recorded through visual analog scale (VAS) by patients. Over the 2 weeks, lower pain (VAS) was found in all test groups compared to the control group (P < .01, value for time-group interaction). Notably, the gelatin sponge combined with cyanoacrylate group had very low pain (VAS ≤ 0.5 points) throughout the 14 days. The lowest healing scores at day 10 were associated with the control group (6.8 VAS points) in contrast to the four test groups (8.2 to 9.0 VAS points, P = .0001). Pain was inversely correlated with age (P < .05). Pain also depended on the apicocoronal dimension of the graft: the higher the graft, the more pain was experienced by the participants (0.4 VAS points per 1 mm, P < .05). Within the limitations of this study, palatal coverage appears to result in better outcomes when compared to suture alone. In particular, a double-layered protection of the palatal wound with a gelatin sponge combined with cyanoacrylate appeared to be the best option in reducing pain and postoperative discomfort.

Predictor factors for long-term outcomes stability of coronally advanced flap with or without connective tissue graft in the treatment of single maxillary gingival recessions: 9 years results of a randomized controlled clinical trial.

AIM: To assess the clinical outcomes 9 years after the surgical treatment of single maxillary gingival recessions and identify predictors for long-term gingival margin stability. MATERIALS AND METHODS: Twenty-five gingival recessions (Miller Class I and II) were randomly treated with Coronally Advanced Flap (CAF) plus Connective Tissue Graft (CTG) or CAF alone. Outcomes included complete root coverage (CRC), recession reduction (REC), keratinized tissue (KT) gain and dentin hypersensitivity, and were evaluated at 6 months, 1 and 9 years. Multilevel analysis was performed to identify predictors for long-term gingival margin stability. RESULTS: Baseline gingival recession was 2.4 ± 0.8 mm and 2.4 ± 1.0 mm in the CAF + CTG and in the CAF-treated sites, respectively (p = 0.693). The chance to gain and preserve CRC over time is equal to 70% in the CAF + CTG group (Relative Risk [RR] = 1.70, 95% CI [0.84-3.45]; adjusted RR = 1.48, 95% CI [0.61-3.62]). Using the CTG, an increase in KT was recorded 9 years after the surgery (p = 0.019). An OR of 0.12 (p = 0.022) of not achieving CRC was observed in cases with non-carious cervical lesions (NCCL) compared to cases without NCCL. CONCLUSION: Both treatment modalities demonstrated stability over time. Additional use of CTG provided a greater increase in KT. The presence of NCCL negatively affected CRC and REC.

Gingival Margin Stability After Mucogingival Plastic Surgery. The Effect of Manual Versus Powered Toothbrushing: A Randomized Clinical Trial.

BACKGROUND: Oscillating-rotating power toothbrushes have been proven to be clinically efficacious. To the best of the authors' knowledge, a clinical evaluation of the safety of these toothbrushes after surgical root coverage procedures has not been published. The aim of this study is to evaluate the gingival margin (GM) stability with the use of an oscillating-rotating toothbrush compared with a manual toothbrush. METHODS: Sixty healthy individuals with at least one Miller Class I or II gingival recession underwent a surgical root coverage procedure. Soft-bristle manual and powered toothbrushes were given to participants randomly assigned to control and test groups, respectively. Full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), probing depth (PD), and recession depth (RD) were recorded at baseline and 1, 3, and 6 months after completion of the surgical procedure. Data analyses were performed using linear random-intercept models to take into account within-participant correlations over time. Temporal trend differences across treatments by including treatment-time interaction terms were then tested using a global Wald test. RESULTS: Use of a powered toothbrush resulted in a significantly greater reduction of recorded periodontal clinical indices compared with a manual device (FMPS, P = 0.05; FMBS, P = 0.005; RD, P = 0.004). No significant differences were noticed between the two experimental groups both for PD (P = 0.03) and clinical attachment level (P = 0.11). Complete root coverage was significantly higher in participants who used the powered toothbrush compared with the manual toothbrush at 6 months (control, 66.67%; test, 96.67%; P = 0.002). CONCLUSION: Use of an oscillating-rotating powered toothbrush with a soft-bristle head resulted in higher GM stability after root coverage procedures compared with the use of a manual soft-bristled toothbrush.

Influence of Periodontal Biotype on Root Surface Exposure During Orthodontic Treatment: A Preliminary Study.

The aim of this study was to investigate the role of periodontal biotype in the development of gingival recession in patients who have undergone orthodontic treatment. A total of 60 mandibular incisors were analyzed. The qualitative assessment of periodontal biotype was performed with the use of a new biotype probe. A strong correlation was found between thin biotype and proinclination in terms of recession depth and keratinized tissue width. Patients with thin periodontal biotype are more prone to gingival margin instability, irrespective of the type of orthodontic movements. Thin periodontal biotype and proinclination orthodontic movement were related to loss of keratinized tissue width.

Modified double papillae flap technique: a new surgical approach for the treatment of isolated gingival recession defects. A case series.

AIM: There have been no modifications made to the original double papillae flap surgical technique introduced by Cohen and Ross in 1968. The aim of the present case series is to evaluate the effectiveness of a modified surgical approach to the double papillae flap design in the treatment of isolated gingival recession. MATERIALS AND METHODS: A total of 12 healthy, young patients (age range 20 to 28 years) with isolated gingival recession were enrolled in this study. The gingival recession had the following characteristics: isolated defect, Miller Class I or II defect, visible cementoenamel junction (CEJ), and well represented interdental papillae. The following clinical measurements were taken before the surgery and at the 1-year follow-up examination: probing depth (PD) at the treated tooth, clinical attachment level (CAL), amount of keratinized tissue (KT) at the treated site, and recession depth (RD). All measurements were taken at baseline and after 12 months by means of a manual probe and were rounded up to the nearest millimeter. RESULTS: At the 1-year follow-up examination, the same clinical parameters taken at baseline were rerecorded. No statistical differences were noted for the PD (P=0.54). The mean increase for the CAL was statistically significant (P=0.04). Furthermore, the mean amount of KT increased by 2.5±0.4 mm (P<0.001). Finally, the mean RD decreased to 0.5±0.6 mm, corresponding to a root coverage of 3.8±0.8 mm (P<0.001). In terms of mean root coverage (MRC), 88.4% of exposed root surface was covered with soft tissue, and 9 of the 12 treated teeth (75%) showed complete coverage of the root surface. CONCLUSION: The results of the present case series show that the modified double papillae flap technique is effective in obtaining root coverage of isolated gingival recession defects. These rootcoverage outcomes were associated with clinically and statistically highly significant clinical attachment gain, with no noticeable change in either the PD values or the height of KT on the buccal aspect of the treated teeth.

Influence of enamel composite thickness on value, chroma and translucency of a high and a nonhigh refractive index resin composite.

OBJECTIVES: To evaluate the influence of thickness on the optical properties of two enamel shade composites, one with a high refractive index and one traditional. METHODS: A medium value enamel shade was selected from the resin composites Enamel Plus HRi (UE2) and Enamel Plus HFO (GE2). Enamel Plus HRi is a high refractive index composite. Samples were fabricated in five different thicknesses: 0.3, 0.5, 1, 1.5 and 2 mm. Three specimens per material and thickness were fabricated. Three measurements per sample, over white, black and dentin composite background were generated with a spectrophotometer (Spectroshade Micro, MHT). Value, chroma, translucency and color differences (ΔE) of the specimens were calculated. RESULTS were analyzed by the Pearson correlation test, ANOVA and a post-hoc Tukey test. RESULTS: Increasing the thickness of the enamel layers decreased the translucency and the chroma of the substrate for both materials tested. For HRi the increase of the thickness resulted in an increase of the value, whereas for HFO it resulted in a reduction of the value. The two composites showed a significant difference in value for each thickness, but not in translucency and chroma. Color difference between them was perceptible in layers equal or higher than 0.5 mm. CONCLUSIONS: The high refractive index enamel (HRi) composite exhibits different optical behavior compared to the traditional one (HFO). HRi enamel composite behaves more like natural enamel as by increasing the thickness of the enamel layer, the value also increases.

The soft tissue wall technique for the regenerative treatment of non-contained infrabony defects: a case series.

The ability to stabilize the blood clot is crucial in achieving predictable periodontal regeneration in infrabony defects. Unfortunately, micromovements may cause degradation of the clot-root interface and result in suboptimal wound healing. Current surgical and suturing techniques are aimed at reducing flap micromovement because flap management is one of the main factors influencing the stability of the clot. The aim of this paper is to describe the use of the soft tissue wall technique to enhance periodontal tissue regeneration outcomes of challenging non-contained infrabony defects. Nine one-wall infrabony defects were treated with a combination of a papilla preservation technique and a coronally advanced flap. Enamel matrix derivative was delivered to the defect, but no bone grafting materials or membranes were employed. Mean 1-year probing depth reduction was 6.3 ± 2.0 mm (P < .001) and mean clinical attachment gain was 7.1 ± 1.0 mm (P < .001). All treated sites showed a mean reduction of exposed root surface equal to 1.0 ± 0.4 mm (P = .05). The results suggest the possibility of improving the regenerative potential of a one-wall infrabony defect by the creation of a stable soft tissue wall while also enhancing the esthetic outcome of the surgical procedure. Further studies with a larger number of patients are needed to support these preliminary data.

Subepithelial connective tissue graft for treatment of gingival recessions with and without enamel matrix derivative: a multicenter, randomized controlled clinical trial.

The aim of this multicenter, randomized controlled trial was to compare the clinical outcomes of a connective tissue graft (CTG) alone or in combination with enamel matrix derivative (CTG + EMD) in the treatment of Miller Class I and II gingival recessions. The 56 selected defects were evaluated for probing depth, recession depth, keratinized tissue width, and probing attachment level, and were measured at baseline and 12 months after treatment. The mean recession reduction was 3.9 ± 0.8 mm for EMD-treated sites (test) and 3.6 ± 1.5 mm for the control group (P = .22), corresponding to a mean root coverage of 90% and 80% for test and control groups, respectively (P = .05). Complete root coverage was obtained in 62% of test sites compared to 47% in the control group (P = .27). Both procedures provided good soft tissue coverage. The better results of the test group did not achieve a statistically significant level.

Decision Making in Gingival Recession Treatment: Scientific Evidence and Clinical Experience.

Focused Clinical Question: What are the key considerations for selecting the best surgical approach in mucogingival plastic surgery? Summary: Treatment of gingival recession has become an important therapeutic issue due to the increasing number of cosmetic requests from patients. The dual goals of mucogingival treatment include complete root coverage, up to the cemento-enamel junction, and blending of tissue color between the treated area and non-treated adjacent tissues. Even though the connective tissue graft is commonly considered the "gold standard" for treatment of recession defects, it may not always be the best surgical option for every case. Conclusions: Under non-experimental conditions, all root coverage procedures may be effective in terms of complete root coverage and excellent esthetics. Careful analyses of patient- and defect-related factors, however, are key considerations prior to selecting an appropriate surgical technique.