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1.
Artículo en Inglés | MEDLINE | ID: mdl-33819337

RESUMEN

Keratinized mucosa (KM) is regarded as a key factor in peri-implant health. A lack of KM has been associated with discomfort, higher plaque accumulation, and mucosal inflammation. Persistent inflammation might lead to progressive peri-implant bone loss. Several approaches to manage peri-implantitis have been advocated. Despite the effectiveness shown by surgical therapeutic modalities, soft tissue conditioning seems pivotal for long-term peri-implant health and stability. Free epithelial grafts have been demonstrated to efficiently augment the band of KM. Nevertheless, morbidity, dynamic soft tissue changes, and longer healing periods are shortcomings to be considered. The purpose of this technical note is to provide an alternative therapeutic modality for the surgical management of peri-implantitis combined with simultaneous soft tissue conditioning by means of pedicle flaps. Three main clinical scenarios are provided to conceive pedicle epithelial or connective tissue flaps, combined or not with collagen matrices, as predictable approaches to augment KM in the surgical therapy of peri-implantitis.


Asunto(s)
Implantes Dentales , Placa Dental , Periimplantitis , Tejido Conectivo , Implantes Dentales/efectos adversos , Humanos , Periimplantitis/cirugía , Colgajos Quirúrgicos
2.
J Clin Periodontol ; 2021 Apr 04.
Artículo en Inglés | MEDLINE | ID: mdl-33817812

RESUMEN

AIM: To report the 36-month follow-up of a trial comparing the adjunct of a xenogenic collagen matrix (CMX) or connective tissue graft (CTG) to coronally advanced flaps (CAF) for coverage of multiple adjacent recessions. MATERIAL AND METHODS: 125 subjects (61 CMX) with 307 recessions in 8 centres from the parent trial were followed-up for 36-months. Primary outcome was change in position of the gingival margin. Multilevel analysis used centre, subject, and tooth as levels and baseline parameters as covariates. RESULTS: No differences were observed between the randomized and the follow-up population. Average baseline recession was 2.6 ± 1.0 mm. 3-year root coverage was 1.5 ± 1.5 mm for CMX and 2.0 ± 1.0 mm for CTG (difference of 0.32 mm, 95%CI from -0.02 to 0.65 mm). The upper limit of the confidence interval was over the non-inferiority margin of 0.25 mm. No treatment differences in position of the gingival margin were observed between 6- and 36-month follow-up (difference 0.06 mm, 95%CI -0.17 to 0.29 mm). CONCLUSION: CMX was not non-inferior with respect to CTG in multiple adjacent recessions. No differences in stability of root coverage were observed between groups and in changes from 6 to 36 months. Previously reported shorter time to recovery, lower morbidity and more natural appearance of tissue texture and contour observed for CMX in this trial are also relevant in clinical decision making.

3.
Clin Oral Investig ; 2021 Mar 16.
Artículo en Inglés | MEDLINE | ID: mdl-33725167

RESUMEN

OBJECTIVE: To compare gingival phenotype assessment methods based on soft tissue transparency on different backgrounds and assessor experience levels. METHODS: For this purpose, 24 gingival specimens were retrieved from pig jaws with tissue thicknesses from 0.2 to 1.25 mm. Three methods were assessed: periodontal probe PCP12 (thin/thick), double-ended periodontal probe DBS12 (thin/moderate/thick) and colour-based phenotype probe CBP (thin/moderate/thick/very thick). Each sample was photographed with each probe underneath and categorized whether the probe was visible or not using different coloured backgrounds. To measure experience level influence, dentists, dental undergraduate students and laypersons (n = 10/group) performed the evaluation. RESULTS: PCP12 probe showed a threshold between 0.4 and 0.5 mm. To distinct between thin and moderate thick gingiva, a comparable range for DBS12 was found while moderate thickness was between 0.5 and 0.8 mm and for thick above 0.8 mm. CBP also showed a comparable threshold of 0.5 mm for thin versus moderate as compared with the other methods; above 0.8 mm, predominantly a very thick tissue was measured. In general, the background colour had a minor impact on PCP12 and DBS12, and investigator experience showed no clear influence on GP assessment. CONCLUSION: Based on probe transparency and within the limitation of a preclinical study, we suggest GP differentiation into three entities: thin (< 0.5 mm; high risk), moderate (0.5-0.8 mm; medium risk) and thick (> 0.8 mm; low risk). CLINICAL RELEVANCE: All three GP assessment methods are easy to perform and seem to have a high predictive value with a three entities classification for DBS12 and CBP.

5.
Clin Oral Implants Res ; 32(3): 349-358, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33420729

RESUMEN

OBJECTIVES: To introduce an esthetic index for assessing the outcomes of peri-implant soft tissue dehiscence/deficiency (PSTD) coverage and test its within- and between-reviewer reliability. MATERIALS AND METHODS: Photographs of 51 single PSTDs at baseline and after treatment were provided to four periodontists from three centers. The examiners were asked to rate each case at two timepoints with the Implant soft tissue Dehiscence/deficiency coverage Esthetic Score (IDES) that involved the evaluation of the post-treatment level of the soft tissue margin, peri-implant papillae height, mucosa color, and mucosa appearance (summing up to a total score of 10). Variance components analysis was conducted using multilevel regression fit in a Bayesian framework for obtaining uncertainty intervals for fractional variance contributions and intraclass correlation values (ICC) of the IDES, and for each of its four clinical variables. RESULTS: Regression models showed reproducible esthetic evaluation among the examiners (inter-reliability) and negligible intra-reviewer variability (assessment of the same case at different timepoints). The ICC for the variability in the assessment of the overall IDES was 0.86, and for the individual components ranged from 0.78 to 0.87. Additionally, there was a strong similarity between the raters' IDES values, and their subjective esthetic response, by the same raters. CONCLUSION: The IDES showed persistent judgment among the 4 reviewers, and only a slight intra-reviewer variability across timepoints. Within its limitations, this study suggests that the proposed novel score can be a reliable tool for evaluating the esthetic outcomes of PSTD coverage, which can aid in standardization of esthetic assessments following the treatment of a PSTD.


Asunto(s)
Implantes Dentales de Diente Único , Implantes Dentales , Teorema de Bayes , Odontólogos , Estética Dental , Humanos , Reproducibilidad de los Resultados , Resultado del Tratamiento
6.
J Periodontol ; 2020 Nov 05.
Artículo en Inglés | MEDLINE | ID: mdl-33152103

RESUMEN

The new classification of periodontal diseases recognizes the key role of the interdental clinical attachment for defining the periodontal status and the extent of disease severity. Regenerating interdental clinical attachment not only improves the prognosis of the tooth, but it also lessens the severity of the disease condition. This manuscript provides a state-of-the-art review on surgical reconstructive approaches for treating papillary deficiency associated with soft and hard tissue interproximal defects. Combination therapy of papilla preservation, connective tissue grafting, and coronally advanced flaps may result in regeneration of the intrabony defect coupled with root coverage. Future research highlighted in this review may have the potential especially in combination approaches to repair challenging interproximal soft and hard tissue deficiencies.

7.
J Clin Periodontol ; 47(11): 1403-1415, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32654220

RESUMEN

BACKGROUND: Aim of this systematic review (SR) of randomized controlled trials (RCTs) was to evaluate effect of different flap designs and graft materials for root coverage, in terms of aesthetics, patient satisfaction and self-reported morbidity (post-operative pain/discomfort). MATERIAL AND METHODS: A comprehensive literature search was performed. A mixed-modelling approach to network meta-analysis was utilized to formulate direct and indirect comparisons among treatments for Root Coverage Esthetic Score (RES), with its individual components, and for subjective patient-reported satisfaction and post-operative pain/discomfort (visual analogue scale (VAS) of 100). RESULTS: Twenty-six RCTs with a total of 867 treated patients (1708 recessions) were included. Coronally Advanced Flap (CAF) + Connective Tissue Graft (CTG) (0.74 (95% CI [0.24, 1.26], p = .005)), Tunnel (TUN) + CTG (0.84 (95% CI [0.15, 1.53]), p = .01) and CAF + Graft substitutes (GS) (0.55 (95% CI [0.006, 1.094], p = .04)) were significantly associated with higher RES than CAF. No significant difference between CAF + CTG and TUN + CTG was detected (0.09 (95% CI [-0.54, 0.72], p = .77)). Addition of CTG resulted in less natural tissue texture (-0.21 (95% CI [-0.34, -0.08]), p = .003) and gingival colour (-0.06 (95% CI [-0.12, -0.03], p = .03)) than CAF. CTG techniques were associated with increased morbidity. CONCLUSIONS: Connective tissue graft procedures showed highest overall aesthetic performance for root coverage, although graft integration might impair soft tissue colour and appearance. Additionally, CTG-based techniques were also correlated with a greater patient satisfaction and morbidity.

8.
Int J Periodontics Restorative Dent ; 40(4): e137-e146, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32559031

RESUMEN

Furcation involvement (FI) is one of the most detrimental factors affecting tooth survival rate over time. Several authors have used the severity of FI for assessing the prognosis of the tooth and the complexity of periodontal disease. While many approaches have been shown to improve the prognosis of furcation-involved teeth, clinical guidelines recommending one treatment or another (based on the horizontal and vertical component of the furcation defects) have not yet been proposed. To this aim, the present article introduces recommendations for the treatment of molars with FI and discusses different treatment options with their potential regenerative approaches. Patient-related factors, together with hard and soft-tissue conditions that may affect the outcomes of periodontal regeneration, are discussed.


Asunto(s)
Defectos de Furcación/cirugía , Diente , Regeneración Tisular Guiada Periodontal , Humanos , Diente Molar/cirugía , Regeneración
9.
Artículo en Inglés | MEDLINE | ID: mdl-32231082

RESUMEN

Peri-implant soft tissues play a role of paramount importance, not only on the esthetic appearance, but also on the maintenance and long-term stability of implants. The present report presents the conclusions from the Consensus Conference of the South European North African Middle Eastern Implantology & Modern Dentistry Association (SENAME) (4-6 November 2016, Cairo, Egypt). The conference focused on the topic of the soft tissue around dental implants, and in particular, on the influence of implant configurations on the marginal soft tissues, soft tissue alterations after immediate, early or delayed implant placement and immediate loading, the long-term outcomes of soft tissue stability around dental implants, and soft tissue augmentation around dental implants. Thirty world experts in this field were invited to take part in this two-day event; however, only 29 experts were in the final consensus voting process.


Asunto(s)
Implantes Dentales , Mucosa Bucal , Consenso , Egipto , Humanos
10.
Artículo en Inglés | MEDLINE | ID: mdl-32032406

RESUMEN

Several approaches for horizontal ridge augmentation have been proposed, including guided bone regeneration (GBR), ridge split, and block grafts. Minimally invasive techniques for horizontal GBR have been introduced to reestablish an adequate bone volume, minimizing tissue trauma and patient morbidity. The present article describes a tunnel technique with a subperiosteal bag for horizontal GBR. A collagen membrane is partially perforated, folded, and sutured to form a bag that is filled with xenogeneic bone graft. The filled bag is inserted into a subperiosteal tunnel such that the perforated side faces the alveolar ridge and the nonperforated side faces the tunnel flap. The main advantage of this approach is the preservation of the periosteum and the enhanced blood supply to the flap, which may contribute to increased favorable wound healing and a reduced risk of flap dehiscence and membrane exposure. This novel tunnel approach for horizontal GBR using a customized bag made from a collagen membrane, specifically adapted and filled with deproteinized bovine bone, resulted in a significant ridge volume gain that allowed implant placement.


Asunto(s)
Aumento de la Cresta Alveolar , Proceso Alveolar , Animales , Regeneración Ósea , Trasplante Óseo , Bovinos , Implantación Dental Endoósea , Regeneración Tisular Guiada Periodontal , Humanos
11.
Artículo en Inglés | MEDLINE | ID: mdl-31815984

RESUMEN

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.


Asunto(s)
Tejido Conectivo , Recesión Gingival , Estudios de Seguimiento , Encía , Humanos , Fenotipo , Estudios Prospectivos , Raíz del Diente , Resultado del Tratamiento
12.
J Periodontol ; 91(1): 17-25, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31475361

RESUMEN

The present article focuses on the properties and indications of scaffold-based extracellular matrix (ECM) technologies as alternatives to autogenous soft tissue grafts for periodontal and peri-implant plastic surgical reconstruction. The different processing methods for the creation of cell-free constructs resulting in preservation of the extracellular matrices influence the characteristics and behavior of scaffolding biomaterials. The aim of this review is to discuss the properties, clinical application, and limitations of ECM-based scaffold technologies in periodontal and peri-implant soft tissue augmentation when used as alternatives to autogenous soft tissue grafts.


Asunto(s)
Encía , Procedimientos Quirúrgicos Reconstructivos , Materiales Biocompatibles , Matriz Extracelular , Cicatrización de Heridas
13.
J Periodontol ; 91(2): 147-154, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31479158

RESUMEN

This manuscript provides a state-of-the-art review on the efficacy of biologics in root coverage procedures, including enamel matrix derivative, platelet-derived growth factor, platelet concentrates, and fibroblast-growth factor-2. The mechanism of action and the rationale for using biologics in periodontal plastic surgery, as well as their anticipated benefits when compared with conventional approaches are discussed. Although the clinical significance is still under investigation, preclinical data and histologic evidence demonstrate that biologic-based techniques are able to promote periodontal regeneration coupled with the provision of tooth root coverage.


Asunto(s)
Productos Biológicos , Proteínas del Esmalte Dental , Recesión Gingival/cirugía , Regeneración Tisular Guiada Periodontal , Humanos , Periodoncio , Colgajos Quirúrgicos/cirugía , Ingeniería de Tejidos
14.
J Periodontol ; 91(1): 9-16, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31461778

RESUMEN

This state-of-the-art review presents the latest evidence and the current status of autogenous soft tissue grafting for soft tissue augmentation and recession coverage at teeth and dental implant sites. The indications and predictability of the free gingival graft and connective tissue graft (CTG) techniques are highlighted, together with their expected clinical and esthetic outcomes. CTGs can be harvested from the maxillary tuberosity or from palate with different approaches that can have an impact on graft quality and patient morbidity. The influence of CTGs on soft tissue thickness and keratinized tissue width are also discussed.


Asunto(s)
Implantes Dentales , Recesión Gingival/cirugía , Procedimientos Quirúrgicos Reconstructivos , Tejido Conectivo , Estética Dental , Encía/cirugía , Humanos , Plásticos
15.
J Periodontol ; 91(2): 155-164, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31465117

RESUMEN

The cultivation of human living cells into scaffolding matrices has progressively gained popularity in the field of periodontal wound healing and regeneration. Living cellular constructs based on fibroblasts, keratinocytes alone or in combination have been developed and used as alternatives to autogenous soft tissue grafts in keratinized tissue augmentation and in root coverage procedures. Their promising advantages include reduced patient morbidity, unlimited graft availability, and comparable esthetics. This manuscript reviews soft tissue augmentation and root coverage procedures using bioengineered living cellular therapy and highlights their expected clinical, esthetic, and patient-related outcomes.


Asunto(s)
Recesión Gingival/cirugía , Gingivoplastia , Tejido Conectivo , Estética Dental , Encía , Humanos , Periodoncio , Medicina Regenerativa
16.
Int J Periodontics Restorative Dent ; 39(6): e203-e210, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31613943

RESUMEN

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.


Asunto(s)
Recesión Gingival , Tejido Conectivo , Encía , Humanos , Estudios Prospectivos , Colgajos Quirúrgicos , Raíz del Diente , Resultado del Tratamiento
17.
Materials (Basel) ; 12(13)2019 Jul 08.
Artículo en Inglés | MEDLINE | ID: mdl-31288437

RESUMEN

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.

18.
J Periodontol ; 90(11): 1244-1251, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31177536

RESUMEN

BACKGROUND: Tooth location has been shown to play a significant role on root coverage outcomes. However, whether this has an impact on the outcomes of coronally advanced flap (CAF) for treating multiple adjacent gingival recessions (MAGRs) remains to be determined. The aim of this study was to investigate the impact of tooth location, flap design, and flap extension on the outcomes of MAGRs following CAF with or without a connective tissue graft (CTG). METHODS: A re-analysis of six previously published clinical trials evaluating the outcomes of CAF in the treatment of MAGRs was performed using mixed regression and logistics to assess the influence of potentially influential factors on the treatment outcomes. RESULTS: Six hundred and nine MAGRs in 166 patients were evaluated. The anterior maxilla (second sextant) was associated to the highest mean root coverage (mRC) and complete root coverage (CRC) outcome (P < 0.05). In addition, the maxillary teeth showed significantly greater mRC and CRC than teeth in the mandible (with the lower anterior [fifth sextant] showing the lowest outcomes) (P < 0.05). A higher mRC was observed for the anterior teeth compared with posterior dentition (P < 0.05). While CAF + CTG achieved better results than CAF alone, no differences were found when the flap was performed with or without vertical releasing incisions (P > 0.05). Lastly, teeth in the distal part of the flap showed lower mRC and CRC than teeth in the central or mesial position (P < 0.05). CONCLUSIONS: Tooth location was found to play a key role in determining the amount of root coverage achievable, with maxillary canines and incisors being associated with the highest outcomes compared with other sextants. Maxillary MAGRs showed greater mRC and CRC than mandibular MAGRs.


Asunto(s)
Recesión Gingival , Tejido Conectivo , Encía , Humanos , Colgajos Quirúrgicos , Raíz del Diente , Resultado del Tratamiento
19.
J Clin Periodontol ; 46(9): 937-948, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31242333

RESUMEN

AIM: To evaluate the long-term outcomes of Acellular Dermal Matrix (ADM) with Coronally Advanced Flap (CAF) or Tunnel technique (TUN) in the treatment of multiple adjacent gingival recessions (MAGRs). MATERIAL AND METHODS: Nineteen of the original 24 patients contributing to a total number of 33 sites for CAF and 34 for TUN were available for the 12 years follow-up examination. Recession depth, mean root coverage (mRC), keratinized tissue width (KTW), gingival thickness (GT) were evaluated and compared with baseline values and 6-months results. Regression analysis was performed to identify factors related to the stability of the gingival margin. RESULTS: A highly significant drop in mRC was observed for both groups from the 6 months timepoint to the 12 years recall (p < .001). While there were no statistically significant differences between the two groups in terms of Clinical Attachment Level (CAL), KTW, GT changes and Root Coverage Esthetic Score at each timepoint (p > .05). KTW ≥ 2 mm and GT ≥ 1.2 mm at 6-months were two predictors for stability of the gingival margin (p = .03 and p = .01, respectively). CONCLUSIONS: A significant relapse of the gingival margin of MAGRs treated with CAF or TUN + ADM was observed after 12 years.


Asunto(s)
Dermis Acelular , Recesión Gingival , Tejido Conectivo , Estética Dental , Estudios de Seguimiento , Encía , Humanos , Raíz del Diente , Resultado del Tratamiento
20.
J Oral Sci ; 61(2): 213-220, 2019 Jun 18.
Artículo en Inglés | MEDLINE | ID: mdl-30930356

RESUMEN

The present study aimed to assess the effects of a multimicronutrient food supplement on periodontal clinical parameters and systemic/local inflammatory markers. Thirty patients with severe chronic periodontitis who adhered to the Mediterranean diet (MD) underwent non-surgical therapy and daily took either the micronutrient complex (group-A) or olive oil (group-B) from baseline (T0) to 3 months (T2). Supragingival debridement was performed at T0. One month later (T1), one-stage-full-mouth disinfection was performed. Periodontal clinical parameters were monitored and correlated with serum C-reactive protein (CRP) and salivary matrix metalloproteinase-8/9 (MMPs-8/9) quantified at each time point. Longitudinal analysis revealed that in group-A, the MMP-8/-9 levels were decreased at T2 compared with at T0 (P = 0.013 and P = 0.004, respectively) and that the MMP-9 levels were decreased at T1 (P = 0.004). These reductions were not significant in group-B. The CRP levels in both groups did not change over time. No between-group differences were noted for any parameter. The correlation between the full-mouth bleeding score and the MMP-8 level in both groups was significant (P < 0.001). The investigated local and systemic inflammatory parameters were not affected by the tested multimicronutrient supplement in patients who adhered to MD. In conclusion, MMP-8 is useful for assessing the reduction in periodontal inflammation.


Asunto(s)
Periodontitis Crónica , Líquido del Surco Gingival , Raspado Dental , Suplementos Dietéticos , Humanos , Inflamación , Metaloproteinasa 8 de la Matriz , Pérdida de la Inserción Periodontal , Índice Periodontal
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