Evaluation of microneedling with and without injectable-platelet rich fibrin for gingival augmentation in thin gingival phenotype-A randomized clinical trial.

Objective: The purpose of the current study was to investigate the effect of micro needling (MN) on gingival thickness (GT) and keratinized tissue width (KTW) in individuals with thin gingival phenotypes, either with or without injectable platelet-rich fibrin (i-PRF). Materials and methods: In this randomized, split-mouth clinical trial, 15 systemically healthy patients, with thin gingival phenotype (<1.5 mm) were randomly treated with MN + i-PRF and MN. MN was performed on one side, and MN + i-PRF on the contralateral side of the same arch at 4 sessions with 10-day intervals. GT; KTW the primary outcome and Plaque index; gingival index Secondary outcome were assessed at baseline and at 1st, 3rd, and 6th months post-treatment. Results: The results of the present study showed that both techniques demonstrated a statistically significant increase in GT. GT showed a statistically significant increase from baseline (0.453 ± 0.069 mm in MN, 0.451 ± 0.069 mm in MN + i-PRF) (p = 0.81) to 1 month (0.567 ± 0.075 mm in MN, 0.649 ± 0.075 mm in MN + i-PRF) (p < 0.001*). A follow-up at 3rd month (0.566 ± 0.076 mm in MN, 0.647 ± 0.091 mm in MN + i-PRF) (p < 0.001*) and 6th month (0.564 ± 0.076 mm in MN, 0.644 ± 0.089 mm in MN + i-PRF) (p < 0.001*) showed a statistically significant increase. Intergroup comparison showed a statistically significant GT increase in MN + i-PRF sites at all the time intervals. No, statistically significant difference in KTW was observed in both groups from baseline to 6 months. Conclusions: The utilization of MN + i-PRF stands as a minimally invasive, non-surgical method to improve GT. Interestingly, using i-PRF as an additional component demonstrated more favorable outcomes compared to using MN alone in enhancing tissue thickness.

Comparison of the effectiveness of Gingival unit transfer and free Gingival graft in the management of localized Gingival recession - A systematic review.

Background: Gingival Recession (GR) is defined as the displacement of the soft tissue margin apical to the cementoenamel junction which can lead to root exposure and hypersensitivity. Treatment of GR has become an important therapeutic issue due to the increasing number of cosmetic requests from patients. Several techniques exist for the management of GR that include Sub-Epithelial Connective Tissue Graft (SECTG), Pedicle Graft (lateral and coronal), and Free Gingival Graft (FGG) and more. FGG is a non-submerged grafting procedure carried out for the management of recession defects. However, FGG has limitations like aesthetic mismatch and bulky appearance. A relatively newer modification of FGG was introduced by Allen in 2004 wherein a palatal graft including the marginal gingiva and interdental tissue was used as donor tissue for recession coverage. This review aims to study and compare the use of Gingival Unit Graft/Transfer (GUG/GUT) (palatal graft including the marginal gingiva and papillae) and FGG in the management of GR. Materials and Methods: Randomized Clinical Trials, Non-Randomized Controlled Clinical Trials for the treatment of Miller Class I,II, and III of GRs by GUG with FGG were identified. Data sources included electronic databases and hand-searched journals. The primary outcome variables were complete root coverage, mean root coverage, vertical recession depth. The secondary outcome variables were keratinized tissue width gain, clinical attachment level and probing depth. Results: Three Randomized Control Trials (RCTs) met the inclusion criteria and were evaluated in this systematic review. Both techniques showed significant improvement in clinical parameters. GUG procedure resulted in a greater percentage of sites achieving complete root coverage and vertical recession depth reduction when compared to FGG group in all the studies. Two studies reported significantly greater mean root coverage in GUG group compared to FGG group. GUG procedure revealed statistically significant greater gain in keratinized tissue width when compared to FGG group in all the studies. Conclusion: Because of the limited number of selected studies, no conclusive statement could be made regarding the advantage of the GUG technique over FGG. However, the percentage of sites with complete root coverage obtained in the GUG technique is higher than FGG. More RCTs with aesthetic and patient satisfaction-related parameters are needed to provide definite evidence.

A 5-year Prospective validation of the Miller-McEntire Periodontal Prognostic Index.

Background: This 5-year prospective survival analysis study aimed to examine the prognostic validity of a periodontal prognostic score specific for diseased molars: Miller-McEntire Periodontal Prognostic Index (MMPPI). Materials and Methods: One thousand and twenty-three molars were evaluated from 129 patients. The MMPPI scoring factors included age, smoking, diabetes, probing depth, mobility, molar type, and furcation involvement. MMPPI was computed as the sum of scores for all seven prognostic factors. Appropriate periodontal treatment and supportive periodontal therapy were provided. All patients were evaluated at baseline and annually posttreatment up to 5 years. Hazard risk ratios (HR) were computed for each prognostic factor, MMPPI scores assigned. The MMPPI score were then analyzed using Kaplan-Meier survival analyses. Results: A total of 31/1023 (0.3%) molars were extracted over the 5-year follow-up duration. Significant and positive hazard risk ratio (HR = 1.9) was noted for the total MMPPI score, validating its prognostic value for molar survival at 5 years prospectively. Kaplan-Meier survival analysis showed a significantly lower probability of molar survival with increasing MMPPI scores, where total score >8 showed worse survival probability over time. The hazard risk ratio was significant for individual prognostic factors: mobility (HR = 1.63), smoking (HR = 1.61), diabetes mellitus (DM) (HR = 1.4), molar type (1.97), and furcation involvement (2.22). Conclusions: The findings of the current study demonstrate significant prognostic validity of MMPPI scores for molar loss for 5 years, and a score >8 showed markedly worse molar survival probability in a well-maintained, university-based, prospective cohort. Mobility, smoking, DM, molar type, and furcation were component factors that were significant individual predictors.

Gingival crevicular fluid levels of Interleukin-22 (IL-22) and human ß Defensin-2 (hBD-2) in periodontal health and disease : A correlative study.

BACKGROUND: Interleukin 22(IL-22), a recently identified, Th-22 associated cytokine has a key role in the production of human ß defensin-2(hBD-2) and hence an indirect role in innate, nonspecific immunity. Hence this study was conducted as preliminary research to quantify and correlate the levels of IL-22 and hBD-2 in periodontal disease. MATERIALS AND METHODS: Gingival crevicular fluid from subjects with chronic periodontitis (n = 27), gingivitis (n = 25) and healthy controls (n = 27) were obtained for the study. The periodontal status of each subject was assessed by criteria based on plaque index, gingival index, bleeding on probing, probing depth and clinical attachment loss. The levels of IL-22 and hBD-2 were measured in GCF samples with an enzyme-linked immunosorbent assay. RESULT: Periodontal parameters were described and reported as mean values. The distribution and comparison of clinical parameters and gingival crevicular fluid IL-22, hBD-2 levels in healthy controls, gingivitis and chronic periodontitis groups were assessed using one way ANOVA test. Post Hoc Bonferroni test was used for intergroup comparisons. Association among the IL-22 , hBD-2 and clinical parameters in all three groups were examined using Pearson's correlation test.The IL-22 level was significantly greater in chronic periodontitis group than healthy controls (P < 0.001) and gingivitis group (P < 0.001). The hBD-2 level was significantly higher in the chronic periodontitis group compared to gingivitis (P = 0.003) and healthy controls (P < 0.001). The results also showed a statistically significant correlation (P = 0.002) between IL-22 and hBD-2 concentration in chronic periodontitis group. CONCLUSION: These results indicate the role of IL- 22 and hBD-2 in the innate immune response during periodontitis.

Efficacy of free gingival graft in the treatment of Miller Class I and Class II localized gingival recessions: A systematic review.

BACKGROUND: Currently, the leading theme in mucogingival surgery is the correction of gingival recession defects. Free gingival graft (FGG) has been successfully in use in this category of reconstructive therapeutic modality. OBJECTIVES: The aim of this systematic review was to evaluate the literature with respect to efficacy of FGG in the management of Miller Class I and II localized gingival recessions. DATA SOURCES: Search strategies were performed via electronic database which included Pubmed-Medline, Google scholar and manual search using University library resources. Two reviewers assessed the eligibility of the studies. STUDY ELIGIBILITY CRITERIA: Controlled clinical trials, randomized clinical trials and longitudinal studies evaluating recession areas treated by FGG with minimum of 6 months follow up were included. In-vitro and animal studies, studies mainly done on Miller Class III and IV gingival recession defect, studies on multiple gingival recessions and case series and case reports were excluded from the search. RESULTS: The electronic and manual search identified a total of 557 articles. A final screen consisted of 39 articles out of which 17 articles were selected for full-text assessment. Finally, 7 articles were selected for detailed evaluation for this systematic review. FGG has shown significant results in all the studies except for one study. CONCLUSION: FGG produces substantial results, however, highly depends on the case selection and operator's skill and experience. FGG gives an impression of being the best alternative option in zones where gingival recession presents with inadequate width of attached gingiva and depth of vestibular fornix.