Long-term comparison of root coverage procedures at single RT2 maxillary gingival recessions: Ten-year extension results from a randomized, controlled clinical trial.

AIM: The purpose of the present study was to assess root coverage outcomes 10 years after connective tissue graft plus coronally advanced flap (CTG + CAF) or CAF alone, at single RT2 maxillary gingival recession. MATERIALS AND METHODS: Twenty-one of the original 29 patients (11 treated with CAF + CTG and 10 with CAF alone) were available for the 10-year follow-up. A blinded and calibrated examiner performed all the measurements. Outcome measures included complete root coverage (CRC), recession reduction (RecRed), root coverage aesthetic score (RES), and keratinized tissue (KT) gain. A visual analogue scale was used to evaluate patient satisfaction. RESULTS: CRC was maintained in 63% of the test group and 20% of the control group after 10 years, with a significant difference favouring CAF + CTG (p = .030). Furthermore, the addition of CTG was associated with greater KT gain (p = .0002) and greater papilla tip recession (p = .023) than with CAF at the last follow-up. No difference was detected regarding RecRed, RES, and patient satisfaction. CONCLUSIONS: Adding CTG under CAF improved the probability of maintaining complete root coverage 10 years after single maxillary RT2 recession treatment.

Gingival recessions caused by Herpes Simplex Virus in a patient with COVID-19 infection.

Herpes Simplex Virus type 1 (HSV-1) is a very common infection often localized in the mucocutaneous junction of the lip. Rarely, it could be detected also in periodontal tissues, associated with an elevated risk of periodontal disease progression and gingival recessions. Recently, HSV-1 and numerous co-infections have been reported in literature associated with the Coronavirus and subsequent COVID-19 disease. This report illustrates a case of HSV-1 in a patient with Covid-19 infection, showing the presence of ulcers and vesicles on the gingival margin of maxillary teeth associated with soreness and pain. The histology highlighted the presence of intraepithelial cell ballooning, confirming the diagnosis of HSV-1 infection.

Rethinking the decision-making process to treat gingival recession associated with non-carious cervical lesions.

The presence of a tooth-surface defect, such as a non-carious cervical lesion (NCCL), associated with sites of gingival recession (GR) defects creates a combined soft tissue/tooth defect (CD) that requires a different treatment plan. This study aimed to critically review the literature regarding the available treatment protocols for CDs and suggest a new decision-making process. NCCLs were classified as Class A-: the cementoenamel junction (CEJ) was visible and the root surface discrepancy was < 0.5 mm (no step); Class A+: CEJ was visible and the root surface discrepancy was > 0.5 mm (with a step); Class B-: unidentifiable CEJ without a step; Class B+: unidentifiable CEJ with a step. NCCLs affecting both root and crown surfaces (Class B) lead to CEJ destruction and consequently eliminate an important landmark used before and after root coverage procedures. The depth of the root surface discrepancy is vital owing to its possible impact on soft tissue adaptation after healing, which, in turn, may influence the treatment options, namely the use of graft and/or composites to compensate for the discrepancy. Clinically, a step with horizontal depth greater than 0.5 mm should be recognized as the minimum threshold value to define this condition. Extremely deep defects tend to assume a V-shaped topography. Therefore, extremely deep V-shaped defects were classified into subclasses A+V, a V-shaped defect, and B+V, a V-shaped defect with loss of CEJ, for management considerations. The treatment options, supported by the literature, and a decision-making process to deal with each condition are presented.

Interdisciplinary orthodontic-periodontal treatment of unerupted permanent maxillary incisors following traumatic injury to deciduous teeth. Case report with long-term follow-up (11 years).

Orthodontic and periodontal treatment of the permanent maxillary teeth, which were retained due to trauma on the deciduous dentition, showed a perfect alignment of the teeth associated with healthy and stable periodontal tissues during an 11-year follow-up.

Retrograde Peri-implantitis: Report of a Case Successfully Treated by Resection of the Implant Apex.

Retrograde peri-implantitis (RPI) is a periapical lesion that develops after implant insertion in which the coronal portion of the implant achieves a normal bone-to-implant interface. The most common etiology of RPI is the presence of an adjacent endodontic lesion. In most of the case reports available in the literature, the diagnosis of RPI occurred between 1 week and 4 years after implant placement. This case report illustrates the treatment of RPI that occurred more than 15 years after implant loading, caused by endodontic infection of the adjacent tooth.

Rethinking the decision-making process to treat gingival recession associated with non-carious cervical lesions

Abstract The presence of a tooth-surface defect, such as a non-carious cervical lesion (NCCL), associated with sites of gingival recession (GR) defects creates a combined soft tissue/tooth defect (CD) that requires a different treatment plan. This study aimed to critically review the literature regarding the available treatment protocols for CDs and suggest a new decision-making process. NCCLs were classified as Class A-: the cementoenamel junction (CEJ) was visible and the root surface discrepancy was < 0.5 mm (no step); Class A+: CEJ was visible and the root surface discrepancy was > 0.5 mm (with a step); Class B-: unidentifiable CEJ without a step; Class B+: unidentifiable CEJ with a step. NCCLs affecting both root and crown surfaces (Class B) lead to CEJ destruction and consequently eliminate an important landmark used before and after root coverage procedures. The depth of the root surface discrepancy is vital owing to its possible impact on soft tissue adaptation after healing, which, in turn, may influence the treatment options, namely the use of graft and/or composites to compensate for the discrepancy. Clinically, a step with horizontal depth greater than 0.5 mm should be recognized as the minimum threshold value to define this condition. Extremely deep defects tend to assume a V-shaped topography. Therefore, extremely deep V-shaped defects were classified into subclasses A+V, a V-shaped defect, and B+V, a V-shaped defect with loss of CEJ, for management considerations. The treatment options, supported by the literature, and a decision-making process to deal with each condition are presented.

Long-Term Results (24 Years) of the Treatment of Amalgam Tattoo in the Anterior Maxillary Region: A Histologic and Clinical Case Report.

Amalgam tattoos are a serious cosmetic problem for patients. A 35-year-old woman came to a private periodontal practice complaining of black pigmentation (amalgam tattoo) above temporary crowns on the lateral and central maxillary incisors and asked that the cosmetic problem be solved before the new permanent crowns were cemented into place. A full-thickness coronoapical incision was made to raise a thick flap; another incision parallel to the surface of the alveolar mucosa made it possible to remove the pigmented connective tissue, which was sent for histologic examination. Due to the fact that the pigmentation extended into the gingival epithelium, the gingiva of the lateral and central incisors was completely removed, with a horizontal incision in the alveolar mucosa from the ends of the distal releasing incisions. Therefore, partially denuded alveolar bone was used as the recipient site for a free gingival graft (FGG). The histologic analysis revealed the presence of amalgam fragments of different sizes in both connective tissue and epithelium. At 6 months, 3 years, and 24 years postoperatively, the periodontal tissues appeared healthy, and the treated area was pink, without pigmentation or scarring, and was perfectly integrated with the adjacent tissues. The patient was very pleased with her appearance. A one-stage procedure, namely an FGG, should be considered an effective treatment of amalgam tattoo providing positive morphologic and cosmetic outcomes over a 24-year follow-up period.

Effect of gingival augmentation procedure (free gingival graft) on reducing the risk of non-carious cervical lesions: A 25- to 30-year follow-up study.

BACKGROUND: The aim of this long-term case series was to assess the development/prevalence of non-carious cervical lesions (NCCLs) at sites that have and have not been treated with gingival augmentation following free gingival graft (FGG). METHODS: Fifty-two patients had at least one test and one control site: 1) test site showing absence of attached gingiva (AG) associated with gingival recession (GR) treated with FGG; and 2) contralateral site with or without AG. Patient/tooth/site-associated variables were recorded for each tooth/site at baseline (T0), 12 months after surgery (T1), during the follow-up period (T2) (15 to 20 years), and at the end of the follow-up period (T3) over 25 to 30 years. Mixed-effects logistic regression was used throughout the study. RESULTS: Forty-nine patients/130 sites were available for analysis at T2 whereas 44 patients/120 sites at T3. Twenty-two NCCLs >0.5 mm were restored in the test sites and in 35 in the untreated sites. The development of NCCL over time appeared associated with sites with attached KT <2 mm (i.e., odds ratio [OR]: 3.80 [P = 0.045] and 3.47 [P = 0.046], 15- to 20- and 20- to 30-year follow-ups, respectively), as well as to teeth presenting a thin/non-modified periodontal phenotype (i.e., OR: 3.53 [P = 0.037] and 5.51 [P = 0.008], 15- to 20- and 20- to 30-year follow-ups, respectively). CONCLUSIONS: Periodontal phenotype modification achieved by FGG may prevent the development/progression of NCCL. Evidence suggests that the thickness and width of the AG had a direct influence on the need of restoring these lesions during the 25- to 30-year observation period.

Success in periodontology: An evolutive concept.

AIM: The purpose of this editorial was to discuss a definition of success after periodontal therapy based on the retention of natural dentition. MATERIALS AND METHODS: Based on topic and relevance, references were collected and then divided into four categories: (a) the influence of available therapeutic techniques on the definition of hopeless teeth, (b) the long-term rate of tooth loss during supportive periodontal therapy, (c) the duration of time that the treatment outcomes may be considered stable and (d) patients' perception and satisfaction of periodontal therapy. RESULTS: Periodontal therapy can change the prognosis of hopeless teeth, making them maintainable in the long term. The rate of tooth loss can be minimized in a way that a period of 10 years or more is needed to evaluate further periodontal breakdown. In addition, patients' perception and satisfaction of the treatment should be considered as the main therapeutic endpoints of the provided periodontal therapy. CONCLUSIONS: Definition of success is linked to the available therapeutic tools. Due to the recent advancement of treatment modalities, periodontally hopeless teeth can now be treated and maintained for a long period of time with health, function and patient satisfaction.

Root coverage procedures for treating localised and multiple recession-type defects.

BACKGROUND: Gingival recession is defined as the oral exposure of the root surface due to a displacement of the gingival margin apical to the cemento-enamel junction and it is regularly linked to the deterioration of dental aesthetics. Successful treatment of recession-type defects is based on the use of predictable root coverage periodontal plastic surgery (RCPPS) procedures. This review is an update of the original version that was published in 2009. OBJECTIVES: To evaluate the efficacy of different root coverage procedures in the treatment of single and multiple recession-type defects. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 15 January 2018), the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 12) in the Cochrane Library (searched 15 January 2018), MEDLINE Ovid (1946 to 15 January 2018), and Embase Ovid (1980 to 15 January 2018). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials (15 January 2018). No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: We included randomised controlled trials (RCTs) only of at least 6 months' duration evaluating recession areas (Miller's Class I or II ≥ 3 mm) and treated by means of RCPPS procedures. DATA COLLECTION AND ANALYSIS: Screening of eligible studies, data extraction and risk of bias assessment were conducted independently and in duplicate. Authors were contacted for any missing information. We expressed results as random-effects models using mean differences (MD) for continuous outcomes and odds ratios (OR) for dichotomous outcomes with 95% confidence intervals (CI). We used GRADE methods to assess the quality of the body of evidence of our main comparisons. MAIN RESULTS: We included 48 RCTs in the review. Of these, we assessed one as at low risk of bias, 12 as at high risk of bias and 35 as at unclear risk of bias. The results indicated a greater reduction in gingival recession for subepithelial connective tissue grafts (SCTG) + coronally advanced flap (CAF) compared to guided tissue regeneration with resorbable membranes (GTR rm) + CAF (MD -0.37 mm; 95% CI -0.60 to -0.13, P = 0.002; 3 studies; 98 participants; low-quality evidence). There was insufficient evidence of a difference in gingival recession reduction between acellular dermal matrix grafts (ADMG) + CAF and SCTG + CAF or between enamel matrix protein (EMP) + CAF and SCTG + CAF. Regarding clinical attachment level changes, GTR rm + CAF promoted additional gains compared to SCTG + CAF (MD 0.35; 95% CI 0.06 to 0.63, P = 0.02; 3 studies; 98 participants; low-quality evidence) but there was insufficient evidence of a difference between ADMG + CAF and SCTG + CAF or between EMP + CAF and SCTG + CAF. Greater gains in the keratinized tissue were found for SCTG + CAF when compared to EMP + CAF (MD -1.06 mm; 95% CI -1.36 to -0.76, P < 0.00001; 2 studies; 62 participants; low-quality evidence), and SCTG + CAF when compared to GTR rm + CAF (MD -1.77 mm; 95% CI -2.66 to -0.89, P < 0.0001; 3 studies; 98 participants; very low-quality evidence). There was insufficient evidence of a difference in keratinized tissue gain between ADMG + CAF and SCTG + CAF. Few data exist on aesthetic condition change related to patients' opinion and patients' preference for a specific procedure. AUTHORS' CONCLUSIONS: Subepithelial connective tissue grafts, coronally advanced flap alone or associated with other biomaterial and guided tissue regeneration may be used as root coverage procedures for treating localised or multiple recession-type defects. The available evidence base indicates that in cases where both root coverage and gain in the width of keratinized tissue are expected, the use of subepithelial connective tissue grafts shows a slight improvement in outcome. There is also some weak evidence suggesting that acellular dermal matrix grafts appear as the soft tissue substitute that may provide the most similar outcomes to those achieved by subepithelial connective tissue grafts. RCTs are necessary to identify possible factors associated with the prognosis of each RCPPS procedure. The potential impact of bias on these outcomes is unclear.

Long-term evaluation (20 years) of the outcomes of subepithelial connective tissue graft plus coronally advanced flap in the treatment of maxillary single recession-type defects.

BACKGROUND: Subepithelial connective tissue graft with coronally advanced flap (SCTG + CAF) has been considered the best and most predictable root coverage procedure. Thus, the aims of this study are two-fold: 1) to evaluate the long-term outcomes following SCTG + CAF in the treatment of gingival recessions (GR) and 2) to explore the influence of several tooth/patient-related factors on the stability of gingival margin at 1 year and at 5,10, 15, and 20 years after surgery. METHODS: Forty-five patients with 45 maxillary GR (Miller's Class I or III) were treated with SCTG + CAF in a private practice between 1990 and 1997. Recession depth (RD), probing depth (PD), keratinized tissue (KT) width and patient/tooth-associated variables were recorded for each GR at baseline, 1, 5, 10, 15, and 20 years after surgery. Parametric, non-parametric, and logistic regression statistics were used throughout the study. RESULTS: A total of 21 Class I (44.67%) and 24 Class III (53.33%) GR were treated. Considering all the 45 GR, statistically significant improvements were found for RD in all evaluations (P < 0.05) compared with baseline data. Over the course of the study, mean root coverage (MRC) decreased from 74.23% (1 year) to 67.69% (20 years). Within maxillary Class I defects, complete root coverage (CRC) at 1-year follow-up was 57.14% (n = 12) and 47.62% (n = 10) at the end of study period, whereas MRC decreased from 82.37% to 77.62%, respectively. Within maxillary Class III recessions, CRC of 20.83% (n = 5) was found at both the 1-year and the 20-year follow-ups. On the other hand, MRC decreased from 66.55% to 58.18%, respectively. The results of logistic regression analysis showed that the achievement of CRC was associated with sites not presenting interdental tissue loss (i.e., Class I, odds ratio: 5.031, P = 0.024), whereas GR recurrence appeared associated with sites with attached KT < 2 mm (i.e., 5-, 10-, 15- and 20-year follow-ups), to teeth presenting root steps (i.e., 10- and 20-year follow-ups), and smoking (i.e., 15-year follow-up). CONCLUSIONS: Positive RD reduction and KT improvements achieved by SCTG + CAF at short-term may be preserved long-term with the majority of the treated sites not displaying relapse of the gingival margin. Teeth lacking a minimal 2-mm width of attached KT and presenting non-carious cervical lesions were more prone to develop an apical shift of the gingival margin during a 20-year follow-up period.

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.

Long-term evaluation (20 years) of the outcomes of coronally advanced flap in the treatment of single recession-type defects.

BACKGROUND: Coronally advanced flap (CAF) has been considered as one of the most predictable and versatile root coverage procedures. Thus, the aims of this study are two-fold: 1) to evaluate the long-term outcomes following CAF in the treatment of gingival recession (GR); and 2) to explore the influence of several tooth/patient-related factors on the stability of gingival margin at 5, 10, and 20 years after surgery. METHODS: Ninety-four patients with 97 GR (73 Miller`s Class I and 24 Miller's Class III) were treated with CAF in a private practice between 1984 and 1996. Recession depth (RD), probing depth (PD), keratinized tissue (KT) width and patient/tooth-associated variables were recorded for each GR at baseline, 1 year, 5 years, 10 years, 15 years and 20 years after surgery. Parametric, non-parametric, and logistic regression statistics were used throughout the study RESULTS: A total of 72 patients with 72 GR were available for analysis at the 20-year follow-up examination (final patients' dropout rate = 23.4%). Statistically significant improvements were found for RD in all evaluations (P < 0.05). Little more than a half (56%) of the sites treated with CAF did not display RD changes between the short-term (i.e., 1 year) and long-term (i.e., 20 years) examinations. Overall, mean root coverage (MRC) decreased from 68.59% to 56.11%. The achievement of complete root coverage (CRC) 1 year after treatment was associated to GR not presenting interdental tissue loss (P = 0.001), the root condition (i.e., lack of non-carious cervical lesion [step] - P < 0.001), an attached KT band ≥ 2 mm (P = 0.019), and baseline RD (P = 0.020). GR recurrence seemed to be influenced by age, RD at 1-year follow-up, sites displaying an attached KT < 2 mm and interdental tissue loss. CONCLUSIONS: The aging process, the condition of the interdental periodontal tissue, and the presence of an attached KT band < 2 mm seem to be negative factors influencing the stability of the gingival margin during the 20-year observation period.

Procedimiento de descontaminación del biofilm para el tratamiento del absceso periodontal agudo y la periimplantitis / The biofilm decontamination approach for the treatment of periodontal abscess and peri-implantitis

Objetivo: mostrar el efecto de un nuevo procedimiento de descontaminación del biofilm sobre los abscesos periodontales agudos y la periimplantitis. Casos clínicos: un absceso periodontal agudo y una periimplantitis fueron tratados mediante un material de descontaminación de los tejidos bucales. Este consiste en un concentrado acuoso con una mezcla de ácidos hidroxibencensulfónicos e hidroxymetho-xybencénicos y ácido sulfúrico, que se coloca en las bolsas periodontales y alrededor de los implantes. En ninguno de los casos se utilizaron antibióticos locales ni sistémicos. Todos los casos tratados cicatrizaron rápidamente, sin complicaciones. Los pacientes sintieron una leve molestia durante la aplicación del material, que desapareció completamente en pocos segundos. Conclusión: el procedimiento de desecación del biofilm parecería ser una técnica promisoria para el tratamiento de los abscesos periodontales agudos ylas periimplantitis, con la ventaja adicional de que se evita el uso de antibióticos locales y sistémicos.

Stability of root coverage outcomes at single maxillary gingival recession with loss of interdental attachment: 3-year extension results from a randomized, controlled, clinical trial.

BACKGROUND: The aim of this study was to assess the stability of root coverage outcomes 3 years after Connective Tissue Graft (CTG) plus Coronally Advanced Flap (CAF) or CAF alone at single maxillary gingival recession with minimal inter-dental clinical attachment loss. MATERIAL AND METHODS: Twenty-four of the original 29 patients, 13 treated with CAF + CTG and 11 with CAF, were available for the 3-year follow-up. Measurements were performed by a blind and calibrated examiner. Outcome measures included complete root coverage (CRC), recession reduction (RecRed), Root coverage Esthetic Score (RES) and Keratinized Tissue (KT) Gain. Visual Analogue Scale (VAS) was used to evaluate patient satisfaction. RESULTS: After 3 years, CAF + CTG resulted in better outcomes in terms of CRC (p = 0.0054) than CAF alone. No difference was detected in terms of RecRed, RES score and VAS values. Furthermore, CAF + CTG was associated with higher KT gain than CAF at the last follow-up (p < 0.0001). CONCLUSION: Root coverage outcomes in single gingival recession with inter-dental CAL loss are stable after 3 years. The application of CTG under CAF was associated with increased probability to obtain CRC than CAF alone at the final follow-up.

Two bilateral transposed and infraosseus impacted maxillary canines: a two-step combined periodontal and orthodontic approach.

An extremely rare case presenting two bilateral transposed and infraosseus impacted maxillary canines was treated with a combined two-step periodontal and orthodontic technique. The canines were transposed mesially and buccally to the lateral incisors, close to the midline and in a horizontal position. Direct orthodontically guided traction of the teeth toward the center of the alveolar ridge was not possible due to the roots of the lateral incisors. The procedure consisted of two distinct treatment phases for each side preceded by an initial orthodontic treatment to achieve the palatal inclination of the roots of the lateral incisors, creating a parallel buccal inclination of the crowns. This approach provided a submucosal buccal space into which the canines could be moved buccally and distally, avoiding any contact with the roots of the lateral incisors. In the first phase, the transposed canines were guided distally. When the canines, still in a submucosal position, were freed from those obstacles, the second phase was begun. The teeth were exposed, permitting the orthodontically guided traction toward the center of the ridge, simulating a proper physiologic eruption alignment pattern in the arch. The combined two-step periodontal and orthodontic approach used to treat two bilateral transposed and infraosseus impacted maxillary canines was extremely successful, resulting in adequate alignment in the arch associated with a physiologic sulcus depth, adequate keratinized tissue width, and absence of marginal recession at the end of the active treatment and 5 years postsurgery.

Patient perceptions of buccal gingival recessions and requests for treatment.

AIMS: The aims of this study were to verify patients' perception of buccal recessions and their requests for treatment. METHODS: The patients filled out a questionnaire dealing with demographic variables and perception of buccal gingival recessions. A calibrated examiner checked for recessions and recorded the clinical variables. Then, the patients were asked to explain what they believed to be the causes of the recessions and whether they were interested in obtaining treatment of their lesions. Descriptive statistics and multilevel logistic models were used. RESULTS: Of 120 enrolled patients, 96 presented 783 gingival recessions, of which 565 were unperceived. Of 218 perceived recessions, 160 were asymptomatic, 36 showed dental hypersensitivity, 13 aesthetics, 9 aesthetic + hypersensitivity issues. Only 11 patients requested treatment for their 57 recessions. Younger individuals (p = 0.0077), deeper recessions (p < 0.0001), incisors and canines (p < 0.0001) and non-carious cervical lesions (p = 0.0441) were significantly associated with patient perception of own recessions. Younger subjects (p = 0.0118), deeper recessions (p = 0.0387) and incisors (p = 0.0232) were significantly associated with patient request of treatment. Four hundred and sixty-eight recessions (60%) were not ascribed to exact causes by the patients. CONCLUSION: This study shows that perception of gingival recessions and the patients' requests for treatment should be evaluated carefully before proceeding with decision making.

Benefits of fibre retention osseous resective surgery in the treatment of shallow infrabony defects: a double-blind, randomized, clinical trial describing clinical, radiographic and patient-reported outcomes.

BACKGROUND: The aim of this randomized clinical trial was to evaluate the efficacy of Apically Positioned Flap with Fibre Retention Osseous Resective Surgery (FibReORS) or Osseous Resective Surgery (ORS) to treat periodontal pockets associated with infrabony defect ≤3 mm at posterior natural teeth. MATERIAL AND METHODS: Thirty patients with chronic periodontitis showing persistent periodontal pockets after cause-related therapy were enrolled; 15 patients were randomly assigned to FibReORS (test group) and 15 to ORS (control group). Measurements were performed by a blind and calibrated examiner. Outcome measures included intra-operative and post-operative morbidity and root sensitivity, 1-year probing depth (PD), gingival recession (Rec) and radiographic bone changes. RESULTS: No differences in clinical and bone defect parameters were observed at baseline. Marginal bone resection was reduced by 0.9-1.6 mm in the FibReORS group. ORS was associated with patient perception of greater surgical hardship (p = 0.0264), higher 1-week pain experience (p = 0.0001) and greater dental hypersensitivity (p = 0.0002). After 1 year, shallow, maintainable PD with no difference between the two procedures (p = 0.3707) was obtained. FibReORS was associated with less final Rec (p < 0.0001) and less radiographic bone loss (p < 0.0001) than ORS. Dental hypersensitivity remained significantly higher in the ORS group (p = 0.0024). CONCLUSION: FibReORS was similarly effective as ORS for PD reduction with less final Rec and patient morbidity.