Enhancing root coverage and esthetic outcomes in isolated gingival recession using orthodontic intervention and lateral closed tunnel technique: An interdisciplinary prospective case series.

BACKGROUND: Gingival recession (GR) in malposed tooth in association with bone dehiscence and/or fenestration poses a challenge for successful root coverage treatment. Lateral closed tunnel (LCT) technique is particularly useful in isolated GR in mandibular anterior region, where the shallow vestibular depth prevents tension-free coronal mobilization of tissues. METHODS: Twenty patients with GR associated with tooth malposition were treated using a combined orthodontic-periodontic approach with a torquing auxiliary spring followed by LCT technique. RESULTS: The two techniques resulted in a combined recession depth reduction from 3.75 ± 1.14 mm to 0.40 ± 0.50 mm at the end of 6-month study period. The orthodontic intervention led to an increase in labial marginal bone levels, as assessed through cone beam computed tomography (CBCT), while the LCT achieved closure of residual recession defect. Also, an increase of keratinized tissue width from 0.81 ± 0.88 mm at baseline to 3.30 ± 0.67 mm at 6 months was achieved. Mean root coverage percentage (MRC%) of 91.40% + 10.25% was seen, with 11 out of 20 sites (55%) showing complete root coverage (CRC). CONCLUSIONS: Single tooth orthodontic repositioning followed by LCT technique proved effective in successfully managing isolated recession defects in the mandibular anterior gingival region, which often presents challenging mucogingival conditions. The precise single tooth repositioning resulted in labial marginal bone augmentation, while the LCT surgical approach allowed residual defect closure. KEY FINDINGS: Why are these cases new information? Correction of single tooth malposition is achieved before recession coverage treatment to achieve a favorable environment for graft uptake. The reduction in denuded root surface along with the bone remodeling results in increasing the ratio of vascular to avascular region, thus improving the overall prognosis of the treatment. What are the keys to successful management of these cases? The lateral closed tunnel technique involves creating a mucoperiosteal tunnel to close the recession site. Precision is crucial to avoid damage to surrounding tissues. The recipient site should be wider than the width of recession to improve graft vascularity. What are the primary limitations to success in these cases? Limitations may arise when dealing with complex cases, such as multiple teeth involvement or teeth with significant vertical or horizontal bone loss.

Comparative evaluation of the clinical and radiographic efficacy of 0.05% zoledronate gel as local drug delivery system in treating intrabony defects in stage III grade B periodontitis patients with and without type-2 diabetes mellitus-A randomized split-mouth clinical trial.

BACKGROUND: This 6-month randomized split-mouth and placebo-controlled clinical trial aimed to evaluate the clinical and radiographic efficacy of adjunctive use of 0.05% zoledronate (ZLN) gel as local drug delivery to scaling and root planing (SRP) in stage III, grade B periodontitis patients with and without controlled type-2 diabetes mellitus (DM). METHODS: A total of 120 infrabony sites were divided into two groups: Group-1 (non-diabetic periodontitis) and Group-2 (periodontitis + DM). A total of 60 sites in each group were randomized to receive treatment with SRP + placebo gel (control) or SRP + 0.05% ZLN gel (test). Plaque index (PI), modified sulcus bleeding index (mSBI), pocket probing depth (PPD), and relative attachment levels (RAL) were assessed at baseline, 3 and 6 months, and digital intraoral periapical and cone-beam computed tomography imaging were used to measure the linear and percentage reduction of intrabony defect depth (DD, DDR%) after 6 months. RESULTS: Group-1 showed significant reduction in PI (0.56 ± 0.15 and 0.52 ± 0.19 from 0.67 ± 0.17), mSBI (0.7 ± 0.60 and 0.47 ± 0.57 from 0.9 ± 0.48), PPD (4.6 ± 0.85 and 3.43 ± 0.63 from 6.5 ± 1.04) and gain in RAL (7.03 ± 0.85 and 5.93 ± 0.69 from 8.9 ± 1.09) in the ZLN-treated sites than the placebo sites and also from Group-2 sites after 3 and 6 months, respectively. A significant reduction in DD of 28.79% in Group-1 and 22.20% in Group-2 at ZLN sites was seen compared to placebo sites of both groups. CONCLUSION: ZLN gel applied subgingivally in infrabony pockets resulted in significant clinical improvements evident by probing depth reduction and gain in attachment levels along with radiographic evidence of more bone fill seen in non-diabetic patients compared to diabetic periodontitis patients.

Comparative evaluation of effect of injectable platelet-rich fibrin with collagen membrane compared with collagen membrane alone for gingival recession coverage.

BACKGROUND: Collagen membrane and platelet-rich fibrin (PRF) have emerged as vital biomaterials in the field of periodontal regeneration. Minimally invasive techniques are being preferred by most periodontists, as it is patient compliant with fewer post-surgical complications as compared to conventional surgical techniques. Thus, in this study we have evaluated the effect of injectable PRF (i-PRF) with collagen membrane compared with collagen membrane alone using vestibular incision subperiosteal tunnel access (VISTA) technique for gingival recession coverage. AIM: To compare the efficacy of VISTA using collagen membrane with collagen membrane soaked in injectable PRF for gingival recession coverage. METHODS: A split mouth randomized controlled clinical trial was designed;13 subjects having at least 2 teeth indicated for recession coverage were enrolled in this study. The sites were randomly assigned to control group (VISTA using collagen membrane alone) and the test group (VISTA using collagen membrane with i-PRF). The clinical parameters assessed were pocket depth, recession depth (RD), recession width (RW), relative attachment level, keratinised tissue width (KTW), keratinised tissue thickness (KTT), and percentage root coverage. RESULTS: RD showed a statistically significant difference between the test group at 3 mo (0.5 ± 0.513) and 6 mo (0.9 ± 0.641) and the control group at 3 mo (0.95 ± 0.51) and 6 mo (1.5 ± 0.571), with P values of 0.008 and 0.04, respectively. RW also showed a statistically significant difference between the test group at 3 mo (1 ± 1.026) and 6 mo (1.65 ± 1.04) and the control group at 3 mo (1.85 ± 0.875) and 6 mo (2.25 ± 0.759), with P values of 0.008 and 0.001, respectively. Results for KTW showed statistically significant results between the test group at 1 mo (2.85 ± 0.489), 3 mo (3.5 ± 0.513), and 6 mo (3.4 ± 0.598) and the control group at 1 mo (2.45 ± 0.605), 3 mo (2.9 ± 0.447), and 6 mo (2.75 ± 0.444), with P values of 0.04, 0.004, and 0.003, respectively. Results for KTT also showed statistically significant results between test group at 1 mo (2.69 ± 0.233), 3 mo (2.53 ± 0.212), and 6 mo (2.46 ± 0.252) and the control group at 1 mo (2.12 ± 0.193), 3 mo (2.02 ± 0.18), and 6 mo (1.91 ± 0.166), with P values of 0.001, 0.001, and 0.001, respectively. The test group showed 91.6%, 81.6%, and 67% root coverage at 1 mo, 3 mo, and 6 mo, while the control group showed 82.3%, 66.4%, and 53.95% of root coverage at 1 mo, 3 mo, and 6 mo, respectively. CONCLUSION: The use of minimally invasive VISTA technique along with collagen membrane and injectable form of platelet-rich fibrin can be successfully used as a treatment method for multiple or isolated gingival recessions of Miller's class-I and class-II defects.

Successful management of gingival recession with interdental attachment loss using gingival unit grafts.

Background: Gingival recession leads to root surface exposure devoid of periodontal attachment. Recession defects with interdental attachment loss (RT2, RT3), further increase the avascular area which is critical for survival of soft-tissue grafts. Nonsubmerged grafts such as free gingival grafts and gingival unit grafts (GUGs) rely primarily on plasmatic circulation from the recipient area during the initial stages of healing for its survival. Methods: Nineteen isolated RT2 recession defects, in the mandibular anterior region, were treated using GUG. The clinical parameters of recession depth (RD), recession width (RW), interdental clinical attachment levels (iCAL) were measured at baseline. Percentage of mean root coverage (MRC) was calculated at 3 months and 6 months. Results: The percentage of mean root coverage (MRC) achieved at the end of 6 months was 81.79% ± 6.16%. Further, Simple linear regression analysis to predict MRC at 6 months using baseline RW revealed, for every 1 mm decrease in RW, the percentage of root coverage significantly increased by 5.25% (P = 0.04). Conclusion: GUG can be used as an alternative treatment modality to achieve successful root coverage in RT2 recession defects. Baseline RW can be used to predict the outcome of root coverage at the end of 6 months.

Treatment of Localized Gingival Recession Using Gingival Unit Grafts: An 18-month Follow-up Study.

AIM: The study aimed to longitudinally evaluate the efficacy of gingival unit grafts (GUGs), a modification of free gingival grafts, in the management of Miller's class I and class II recession defects in mandibular anterior region, over a period of 18 months. MATERIALS AND METHODS: 17 subjects with 21 recession defects in mandibular anterior region were treated using GUG. Clinical parameters of recession depth (RD), clinical attachment levels (CALs), and keratinized tissue width (KTW) were recorded at baseline, 1, 6, and 18 months. Patient-centered outcomes were measured using a visual analog scale (VAS) for pain and discomfort on 14th postoperative day and for treatment satisfaction at the end of 18 months. RESULTS: There was a statistically significant improvement in RD, CAL, and KTW at 18 months when compared to baseline levels. A mean root coverage (MRC) percentage of 84.76 ± 11.79% was achieved at the end of 18 months. Patient-related outcomes for VAS for pain and discomfort as well as treatment satisfaction showed favorable results. CONCLUSION: GUG can be used as a predictable treatment modality for Miller's class I and class II recession defects in mandibular anterior region. The results obtained can be well maintained over 18-month period with optimal maintenance care. CLINICAL SIGNIFICANCE: The advantage of involving marginal gingiva in GUG results in a well-contoured graft, which increases the ease of adaptation and suturing. The biological characteristic of intact marginal vasculature results in early integration of graft into the recipient area and greater success in graft survival over denuded root surface, causing better long-term RC outcomes.

Histomorphometric Analysis of Residual Alveolar Ridge Preserved using Collagen Cell Occlusive Membrane Alone and Along with Demineralized Bone Matrix Following Tooth Extraction: A Randomized Control Trial.

Context: The changes in the volume and dimensions of the alveolar bone after tooth extraction often lead to challenges in prosthetic rehabilitation of the same necessitating ridge preservation procedures (RPP). Aim: The aim of this randomized clinical trial was to evaluate and compare the dimensional and histomorphometric changes of the sites preserved using the collagen membrane with and without demineralized bone matrix (DMBM). Settings and Design: Interventional, parallel-design, double blinded, randomized controlled trail. Materials and Methods: A randomized controlled trial was designed with 45 participants having at least 2 teeth indicated for were enrolled in this study. The sites were randomly assigned to the control group (RPP using collagen membrane) and the test group (RPP using collagen membrane with DMBM). The clinical parameters assessed were alveolar bone width and alveolar bone height. Histomorphometric analysis was carried out on tissue trephined from the preserved sites to evaluate the percentage of bone and connective tissue (CT %) formed 8 months postRPP. Statistical Analysis Used: Shapiro - Wilk test and paired and unpaired t-test. Results: Horizontal resorption was significantly less in the test group (7.375 ± 1.64). Histomorphometry of these sites revealed a complete absence of residual graft particles, presence of trabecular bone, and a more mineralized matrix (63.256%) as compared to the control sites (46.833%). Conclusions: The use of DMBM along with the collagen membrane for RPP yielded better results both clinically and histomorphometically.

Retraction With and Without Piezocision-Facilitated Orthodontics: A Randomized Controlled Trial.

The aim of the present study was to compare the effect of traditional orthodontics and Piezocision-assisted orthodontics on the periodontal status and rate of canine retraction. In a split-mouth study, 20 subjects undergoing orthodontic treatment were selected. Conventional orthodontics was performed on 20 canine sites (control side), and contralateral canines were subjected to Piezocision-assisted orthodontics (experimental side). The experimental side showed statistically significant increase in rate of canine retraction as well as an increase in alveolar bone level in mesial and buccal aspects.

Association of Human Interleukin-35 Level in Gingival Crevicular Fluid and Serum in Periodontal Health, Disease, and after Nonsurgical Therapy: A Comparative Study.

BACKGROUND: Innovating newer methods to diagnose a multifactorial disease such as periodontitis is always challenging for a clinician. Gingival crevicular fluid (GCF) which is closely associated with the periodontal tissue environment has been used a viable alternative to saliva for the diagnosis of periodontitis. AIM: The aim of the present study was to estimate and compare the interleukin-35 (IL-35) levels in GCF and serum among healthy, gingivitis, and chronic periodontitis (CP) individuals as well as to evaluate the effect of nonsurgical periodontal treatment (NSPT) on IL-35 level among patients with CP. SETTINGS AND DESIGN: The study was conducted at the Department of Periodontics, Srirama Chandra Bhanja Dental College and Hospital, Cuttack, Odisha, India. It is a comparative study. MATERIALS AND METHODS: A total of 60 participants were divided into healthy (Group I; n = 20), gingivitis (Group II; n = 20), and CP (Group IIIA; n = 20). GCF samples collected from each individual at baseline and 6 weeks after NSPT for Group III individuals (Group IIIB; n = 20) were quantified for IL-35 levels using enzyme-linked immunosorbent assay. STATISTICAL ANALYSIS: All analyses were performed using Shapiro-Wilk test, analysis of variance, Tukey's honestly significant difference post hoc test, and multiple regression analysis. RESULTS: The mean IL-35 concentration in GCF was significantly high (P < 0.05) for Group IIIA (70.26 ± 4.0 pg/ml), as compared to Group I (54.81 ± 22.3 pg/ml) and Group IIIB (55.72 ± 10.2 pg/ml). CONCLUSION: In the present study, GCF and serum IL-35 concentration among CP individuals was highest among all the groups. Individuals receiving NSPT showed a significant reduction in IL-35 levels as compared to CP individuals.