The influence of tobacco smoking on the outcomes achieved by root coverage procedures: An updated systematic review.

OBJECTIVE: This updated version of a systematic review (SR) originally published in 2009 evaluated the effect of smoking on the clinical outcomes achieved with root coverage (RC) procedures in the treatment of gingival recession (GR) defects. MATERIALS AND METHODS: This SR includes randomized controlled trials, controlled clinical trials, and case series with a minimum follow-up of 6 months. Eligible studies involved GR defects without interproximal tissue loss submitted to RC procedures, as well as outcome measures from smokers (i.e., those smoking 10 or more cigarettes per day at baseline) and nonsmokers, recorded separately. Three electronic databases were searched up to March 31, 2024. Random effects meta-analyses were conducted thoroughly. RESULTS: A total of 12 studies reporting on 181 smokers and 162 nonsmokers, submitted to different RC procedures, were included. Half of these trials were originally included in the 2009 SR, whereas the other half (six studies) were included in this update. Nonsmokers experienced greater reductions in GR and gains in clinical attachment level compared to smokers. Pooled estimates comparing smokers and nonsmokers who received coronally advanced flap (CAF) alone and subepithelial connective tissue graft (SCTG) + CAF showed that nonsmokers achieved greater mean root coverage (MRC) in both treatments. Significant differences in MRC of 10.85% (95% CI, 1.92 to 19.77) and 22.04 (95% CI, 14.25 to 29.83), favoring nonsmokers, were identified for CAF and SCTG + CAF, respectively. Similarly, nonsmokers treated with SCTG + CAF displayed superior number of sites exhibiting complete root coverage (CRF) when compared with smokers (risk ratio, 4.12; 95% CI, 1.73 to 9.80). CONCLUSIONS: Smoking negatively impacts the outcomes of RC procedures, particularly those achieved by SCTG-based procedures. CLINICAL SIGNIFICANCE: Smoking was linked to poorer RC outcomes. These outcomes highlight the critical need to integrate smoking cessation into periodontal treatment plans.

Efecto de dos pastas dentales en pacientes diagnosticados con Gingivitis / Effect of Two Toothpastes on Patients Diagnosed with Gingivitis / Efeito de duas pastas dentais em pacientes diagnosticados com Gengivite

La gingivitis se ha definido como una inflamación de la encía caracterizada por edema, eritema, cambio de la morfología normal, exudado acuoso y hemorragia de interés mundial. El objetivo fue evaluar el efecto dos pastas dentales en pacientes jóvenes diagnosticados con gingivitis en la ciudad de CuscoPerú en el año 2022. La investigación se realizó en alumnos de la Facultad de Economía de la Universidad Nacional San Antonio Abad del Cusco todos ellos diagnosticados con gingivitis en el mismo año. El estudio se desarrolló bajo un diseño experimental pre-test post-test con dos grupos experimentales cada uno con n=15. Evaluados con el índice de placa de Löe & Silness y el índice gingival de Löe & Silness (IG). Los participantes fueron orientados a cepillar los dientes con el dentífrico tres veces al día, por un periodo de 2 semanas. Se utilizó como instrumento de recolección de datos una matriz de registro para la medición antes y después de aplicado el tratamiento en la cual se plasmaron los índices de placa e índice gingival de Löe & Silness. Resultó que los sujetos del estudio en su gran mayoría presentaron gingivitis moderada y un estado de higiene oral regular. Con lo cual concluimos que la pasta dental aplicada en el Grupo I resultó más efectiva en la recuperación de pacientes con gingivitis. El dentífrico con contenido de Ratania fue bien tolerado por los participantes, no existiendo ningún tipo de alteración de tipo alérgica en los tejidos bucales, por lo tanto, no interrumpió el tratamiento.

Gingivitis has been defined as an inflammation of the gum characterized by edema, erythema, change in normal morphology, watery exudate, and bleeding of global interest. The aim was to evaluate the effect of two toothpastes on young patients diagnosed with gingivitis in the city of Cusco, Peru in 2022. The research was conducted on students from the Faculty of Economics at the National University of San Antonio Abad in Cusco, all diagnosed with gingivitis in the same year. The study was carried out under a pre-test post-test experimental design with two experimental groups, each with n=15. Evaluated using the Löe & Silness plaque index and the Löe & Silness gingival index (GI). Participants were instructed to brush their teeth with the toothpaste three times a day for a period of 2 weeks. A data collection instrument was used, a record matrix for measurement before and after treatment application, where the Löe & Silness plaque and gingival indices were recorded. The study subjects mostly presented moderate gingivitis and a regular oral hygiene status. Therefore, we conclude that the toothpaste applied in Group I was more effective in the recovery of patients with gingivitis. The toothpaste containing Ratania was well tolerated by the participants, with no allergic tissue alterations in the oral tissues, thus not interrupting the treatment.

A gengivite foi definida como uma inflamação da gengiva caracterizada por edema, eritema, alteração na morfologia normal, exsudato aquoso e sangramento de interesse mundial. O objetivo foi avaliar o efeito de duas pastas de dentes em pacientes jovens diagnosticados com gengivite na cidade de Cusco, Peru, em 2022. A pesquisa foi realizada em alunos da Faculdade de Economia da Universidade Nacional de San Antonio Abad em Cusco, todos diagnosticados com gengivite no mesmo ano. O estudo foi realizado sob um desenho experimental pré-teste pós-teste com dois grupos experimentais, cada um com n=15. Avaliados com o índice de placa de Löe & Silness e o índice gengival de Löe & Silness (IG). Os participantes foram orientados a escovar os dentes com a pasta de dentes três vezes ao dia, por um período de 2 semanas. Foi utilizado como instrumento de coleta de dados uma matriz de registro para medição antes e depois da aplicação do tratamento, na qual foram registrados os índices de placa e índice gengival de Löe & Silness. A maioria dos sujeitos do estudo apresentou gengivite moderada e um estado de higiene oral regular. Portanto, concluímos que a pasta de dentes aplicada no Grupo I foi mais eficaz na recuperação de pacientes com gengivite. A pasta de dentes com conteúdo de Ratania foi bem tolerada pelos participantes, não havendo nenhuma alteração alérgica nos tecidos bucais, portanto, não interrompendo o tratamento.

Efecto de dos pastas dentales en pacientes diagnosticados con Gingivitis

La gingivitis se ha definido como una inflamación de la encía caracterizada por edema, eritema, cambio de la morfología normal, exudado acuoso y hemorragia de interés mundial. El objetivo fue evaluar el efecto dos pastas dentales en pacientes jóvenes diagnosticados con gingivitis en la ciudad de Cusco-Perú en el año 2022. La investigación se realizó en alumnos de la Facultad de Economía de la Universidad Nacional San Antonio Abad del Cusco todos ellos diagnosticados con gingivitis en el mismo año. El estudio se desarrolló bajo un diseño experimental pre-test post-test con dos grupos experimentales cada uno con n=15. Evaluados con el índice de placa de Löe & Silness y el índice gingival de Löe & Silness (IG). Los participantes fueron orientados a cepillar los dientes con el dentífrico tres veces al día, por un periodo de 2 semanas. Se utilizó como instrumento de recolección de datos una matriz de registro para la medición antes y después de aplicado el tratamiento en la cual se plasmaron los índices de placa e índice gingival de Löe & Silness. Resultó que los sujetos del estudio en su gran mayoría presentaron gingivitis moderada y un estado de higiene oral regular. Con lo cual concluimos que la pasta dental aplicada en el Grupo I resultó más efectiva en la recuperación de pacientes con gingivitis. El dentífrico con contenido de Ratania fue bien tolerado por los participantes, no existiendo ningún tipo de alteración de tipo alérgica en los tejidos bucales, por lo tanto, no interrumpió el tratamiento.

Gingivitis has been defined as an inflammation of the gum characterized by edema, erythema, change in normal morphology, watery exudate, and bleeding of global interest. The aim was to evaluate the effect of two toothpastes on young patients diagnosed with gingivitis in the city of Cusco, Peru in 2022. The research was conducted on students from the Faculty of Economics at the National University of San Antonio Abad in Cusco, all diagnosed with gingivitis in the same year. The study was carried out under a pre-test post-test experimental design with two experimental groups, each with n=15. Evaluated using the Löe & Silness plaque index and the Löe & Silness gingival index (GI). Participants were instructed to brush their teeth with the toothpaste three times a day for a period of 2 weeks. A data collection instrument was used, a record matrix for measurement before and after treatment application, where the Löe & Silness plaque and gingival indices were recorded. The study subjects mostly presented moderate gingivitis and a regular oral hygiene status. Therefore, we conclude that the toothpaste applied in Group I was more effective in the recovery of patients with gingivitis. The toothpaste containing Ratania was well tolerated by the participants, with no allergic tissue alterations in the oral tissues, thus not interrupting the treatment.

A gengivite foi definida como uma inflamação da gengiva caracterizada por edema, eritema, alteração na morfologia normal, exsudato aquoso e sangramento de interesse mundial. O objetivo foi avaliar o efeito de duas pastas de dentes em pacientes jovens diagnosticados com gengivite na cidade de Cusco, Peru, em 2022. A pesquisa foi realizada em alunos da Faculdade de Economia da Universidade Nacional de San Antonio Abad em Cusco, todos diagnosticados com gengivite no mesmo ano. O estudo foi realizado sob um desenho experimental pré-teste pós-teste com dois grupos experimentais, cada um com n=15. Avaliados com o índice de placa de Löe & Silness e o índice gengival de Löe & Silness (IG). Os participantes foram orientados a escovar os dentes com a pasta de dentes três vezes ao dia, por um período de 2 semanas. Foi utilizado como instrumento de coleta de dados uma matriz de registro para medição antes e depois da aplicação do tratamento, na qual foram registrados os índices de placa e índice gengival de Löe & Silness. A maioria dos sujeitos do estudo apresentou gengivite moderada e um estado de higiene oral regular. Portanto, concluímos que a pasta de dentes aplicada no Grupo I foi mais eficaz na recuperação de pacientes com gengivite. A pasta de dentes com conteúdo de Ratania foi bem tolerada pelos participantes, não havendo nenhuma alteração alérgica nos tecidos bucais, portanto, não interrompendo o tratamento.

Gingivitis espongiótica. Manejo clínico no quirúrgico. Reporte de un caso / Spongiotic gingivitis. Non-surgical clinical management. Report of a case

Objetivo: La gingivitis espongiótica es una patología benigna poco común y una entidad clínica patológica poco frecuente que los odontólogos pueden observar durante la atención odontológica. Es importante conocer la misma para poder diagnosticarla adecuadamente, describir sus características clínicas y elaborar un plan para su tratamiento. El objetivo de este artículo es presentar un caso clínico de esta patología poco conocida, describir sus características y su manejo clínico. Caso clínico: Un niño de 7 años que ingresó derivado por su odontólogo a la cátedra de Estomatología de la Facultad de Odontología de la Universidad Nacional de Córdoba, Argentina, presentaba en la encía libre e insertada del maxilar superior una lesión con ausencia de sintomatología y evolución crónica, benigna y con cambios estéticos notorios. Se deriva a la cátedra de Periodoncia para realizar un tratamiento interdisciplinario. Tuvo una respuesta favorable al tratamiento de la lesión, y se realizó un seguimiento periódico de la misma evitando la técnica quirúrgica convencional para su tratamiento.(AU)

Aim: Spongiotic gingivitis is a rare benign pathology and a rare clinical pathological entity that dentists can observe during dental care. It is important to know it to be able to properly diagnose it, describe its clinical characteristics and develop a plan for its treatment. The aim of this article is to present a clinical case of this little-known pathology and describe its characteristics as well as its clinical management. Clinical case: A 7-yeard-old child who was referred by his dentist to the Department of Stomatology of the Faculty of Dentistry of the National University of Córdoba, Argentina, presented a lesion in the free and inserted gingiva of the upper jaw, with absence of symptoms and chronic, benign evolution with notable aesthetic changes. He is referred to the Periodontics department to perform interdisciplinary treatment. He had a favorable response to the treatment of the lesion, and a periodic follow-up was carried out, avoiding the conventional surgical technique for its treatment.(AU)

Interaction of periodontal clinical indicators in metabolic syndrome and nonalcoholic fatty liver disease: Implications for preventive interventions.

Introduction: The behavior of periodontal clinical indicators in metabolic syndrome (MetS) and fatty liver disease (NAFLD) are not clearly defined. It's even considered that high-risk cases for NAFLD are currently underreported or not identified in a timely manner. The aim of the study is to elucidate the interaction of periodontal clinical indicators in MetS and NAFLD. Materials and methods: 336 patients were eligible because they met the diagnostic criteria for metabolic syn-drome and nonalcoholic fatty liver disease. Those selected were randomly selected for a cross-sectional study. Metabolic status and non-alcoholic fatty liver disease were measured using the MetS Metabolic Syndrome Diagnostic Criteria (NCEP/ATP-III) and laboratory tests, respectively. In addition, periodontal clinical indicators were evaluated: probing depth, clinical attachment, plaque index and gingival bleeding. Results: The association for NAFLD and probing depth was p = 0.736. The association for MetS and probing depth was p = 0.598. For NAFLD and clinical attachment loss, the association was p = 0.751. For MetS and clinical attachment loss, the association was p = 0.435. The plaque index for MetS was p = 0.238. The plaque index for NAFLD was p = 0.269. The gingival bleeding association for NAFLD was p = 0.673 and for MetS was p = 0.522. Conclusions: Periodontal clinical indicators of metabolic syndrome were as-sociated with elevated serum levels of low-density lipoproteins (LDL), HDL-cholesterol, and triglycerides. However, when comparing the values in NAFLD and MetS, a greater significance is evident in the first study group.

Gingivectomy-Gingivoplasty for Oral Physiological Melanosis Depigmentation: A Case Report Involving Human Papillomavirus.

Gingiva hyperpigmentation resulting from physiological melanosis causes aesthetic discomfort and is usually perceived as a disease by patients because healthy attached gingiva is typically characterized by coral pink coloring with stippling and scalloped contours. When physiological melanosis compromises the aesthetics of smiling, it may induce insecurity in patients, who usually seek out alternatives for reducing or eliminating hyperpigmentation. We present a case report of a surgical procedure combining gingivectomy with gingivoplasty for the management of physiological melanosis. The surgical procedure was performed on a 40-year-old female patient with bilateral pigmentation in both arches. The results of the histological analysis confirm the diagnoses of melanotic macula, with papillary hyperplasia and cytopathic changes being suggestive of HPV infection, which was verified using an immunohistochemistry analysis based on the detection of a major capsid protein of HPV. Acceptable functional and aesthetic results were obtained for the patient without major discomfort during the postoperative period. In cases when HPV infection is present, long-term follow-up becomes necessary.

Gingival Enlargement Associated with Orthodontics Appliance Increases Protein Carbonylation and Alters Phosphorylation of Salivary Proteome.

Gingival enlargement is a common clinical sign in the gingival diseases associated with orthodontic treatment. Its biological mechanisms are not completely understood; nevertheless, the biochemical changes associated with these inflammatory and overgrowth processes could alter the post-translational protein modifications occurring in various locations within the mouth. Here, changes in the profiles of the carbonylated and phosphorylated proteins in saliva were examined in donors with gingival enlargement (seven men and seven women) and healthy donors (six men and eight women). The sociodemographic characteristics of both groups did not present significant differences. Carbonylation was measured by a quantitative immunoassay (Dot Blot), whereas the profiles of the phosphorylated proteins were visualized by SDS-PAGE with quercetin staining. Some phosphopeptides were also identified using a typical LC-MS-MS approach. Our results showed that gingival enlargement induced a significant increase in oxidative damage in salivary proteins. While a significant reduction in phosphorylation was observed at the stain level in SDS-PAGE, there was a slight increase in the number of phosphorylated proteins identified by MS in samples with gingival enlargement.

Cytokine levels in the gingival crevicular fluid and their association with periodontal status of down syndrome patients: a cross-sectional study.

OBJECTIVE: To evaluate cytokine levels of interleukin (IL)-1ß, IL-4, IL-6, IL-17a, tumor necrosis factor (TNF)-α, and interferon (IFN)-γ in the gingival crevicular fluid (GCF) of periodontal sites in individuals with Down syndrome (DS) and analyze their relationship with clinical periodontal parameters. MATERIALS AND METHODS: A cross-sectional study was conducted with 49 DS patients and 32 individuals without DS (non-DS group). Periodontal probing depth (PPD), clinical attachment level (CAL), bleeding on probing (BoP), and visible plaque index (VPI) were evaluated. The periodontal sites were classified as shallow, moderate, and deep. GCF was collected in all shallow sites and, when present, in moderate and deep sites for the analysis of cytokine levels. The cytokines, IL-1ß, IL-4, IL-6, IL-17a, TNF-α, and IFN-γ, were quantified using the Luminex® automatic analyzer system. RESULTS: The DS group presented greater severity of periodontitis compared to the non-DS group (P = 0.005). The DS group showed a significant direct correlation of IL-1ß and an inverse correlation of IFN-γ and IL-14 with all periodontal variables. In the analysis stratified by periodontal pocket depth, we observed a higher level of IFN-γ, IL-17a, IL-1ß, and IL-6 in the shallow sites, and IL-17a, IL-1ß, and IL-6 in deep pockets of DS group individuals. Multivariate models showed that higher levels of IL-1ß, IL-4, IL-6, and IL-17a were associated with Down syndrome even after adjusting for periodontal status, sex, and age. CONCLUSION: The findings suggest that people with DS have greater periodontal impairment and higher levels of cytokines in GCF, even in sites having clinical periodontal parameters similar to those of individuals without DS. These data reiterate the concept of an altered and less effective immune response in the population with DS in the face of a periodontal microbial challenge. CLINICAL RELEVANCE: Elevated periodontal inflammation burden can be observed with higher cytokine levels in the gingival crevicular fluid of people with Down syndrome, especially IL-1, IL-4, IL-6, and IL-17, regardless of the stage of periodontitis.

IFN-γ-Preconditioned Human Gingival-Derived Mesenchymal Stromal Cells Inhibit Plasmacytoid Dendritic Cells via Adenosine.

Plasmacytoid dendritic cells (pDCs) are vital players in antiviral immune responses because of their high levels of IFN-α secretion. However, this attribute has also implicated them as critical factors behind the immunopathogenesis of inflammatory diseases, and no currently available therapy can efficiently inhibit pDCs' aberrant activation. Mesenchymal stromal cells (MSCs) possess stromal immunomodulatory functionality, regulating immune cell activation through several mechanisms, including the adenosinergic (CD39/CD73/adenosine) pathway. The IFN-γ preconditioning of bone marrow MSCs improves their inhibitory properties for therapy applications; however, isolating human gingival tissue-derived MSCs (hGMSCs) is more accessible. These cells have shown better immunomodulatory effects, yet the outcome of IFN-γ preconditioning and its impact on the adenosinergic pathway has not been evaluated. This study first validated the immunoregulatory properties of primary-cultured hGMSCs, and the results showed that IFN-γ preconditioning strengthens CD39/CD73 coexpression, adenosine production, and the regulatory properties of hGMSC, which were confirmed by describing for the first time their ability to reduce pDC activation and their IFN-α secretion and to increase the frequency of CD73+ pDC. In addition, when CD73's enzymatic activity was neutralized in hGMSCs, adenosine production and the IFN-γ preconditioning effect were restrained. This evidence might be applied to design hGMSCs- and adenosine-based immunotherapeutic strategies for treating inflammatory disorders that are associated with pDC overactivation.

Digital resources for surgical and restorative treatment of excessive gingival display in one session.

OBJECTIVE: This article aims to showcase the implementation of a digital workflow in addressing a case of multifactorial excessive gingival display in a patient with high esthetic demands, incorporating both surgical and restorative interventions in a single session. CLINICAL CONSIDERATIONS: A 28-year-old female patient presented with excessive gingival display, attributed to a combination of short teeth due to altered passive eruption, lip hyperactivity, and a sub-nasal depression that lodged the upper lip during spontaneous smiling. The multidisciplinary treatment strategy encompassed surgical crown lengthening, the placement of a biovolume in the maxillary concavity, and the rehabilitation of the six anterior teeth with direct composite resin, all done in a single session. Smilecloud Biometrics was used to digitally plan the smile, and the final wax-up/mock-up was approved by the patient prior to any irreversible procedure. A digital planning center (GuiderLab) enabled the materialization of the virtual planning and the printing of the periodontal surgical guide, the biovolume, and the resin layering guides for the restorative technique. CONCLUSIONS: Adopting a digital workflow in multidisciplinary cases with excessive gingival display leads to predictable and more expedited outcomes, ensuring a favorable result between soft and hard tissues. CLINICAL SIGNIFICANCE: Excessive gingival display is a condition with multifactorial etiologies, including dentoalveolar, periodontal, skeletal, or muscular origins, or a combination of these factors. The diagnoses of altered passive eruption and a hypermobile upper lip are common in daily clinical practice and can be successfully managed through surgical crown lengthening and filling of the maxillary concavity, respectively. To achieve the desired outcome, restorative procedures often complement these surgical interventions.

Actualización de las técnicas para el tratamiento de las recesiones periodontales / actualization

Introducción: A lo largo de los años se ha propuesto una notable variedad de protocolos quirúrgicos periodontales, cuyo enfoque pasó de la simple resolución de defectos de tejidos blandos a la realización de procedimientos predecibles y mínimamente invasivos. Inicialmente se usaba el injerto gingival libre. Posteriormente se han probado diversas técnicas, incluidas aquellas con sustitutos de tejidos blandos, como membranas tipo Alloderm. Hoy en día se considera el gold standard el injerto de tejido conectivo subepitelial asociado al colgajo de avance coronal. Por último, se ha examinado la técnica Pinhole, con mayor preservación de tejido y resultado más estético. Objetivos: El objetivo de esta revisión fue la comparación de técnicas actualizadas para el tratamiento de recesiones múltiples en maxilar superior e inferior. El resultado del procedimiento se evaluó en términos de cobertura radicular completa, reducción de la recesión, ganancia en altura y volumen, resultado estético, dolor postoperatorio y morbilidad del lecho donante y receptor del paciente. Material y métodos: Se realizaron búsquedas electrónicas y manuales para recopilar estudios de boca dividida, ensayos clínicos controlados aleatorios, series de casos, estudios piloto, libros de periodoncia, estudios de casos, revisiones sistemáticas y metanálisis, incluyendo los defectos de recesiónes gingivales múltiples, en maxilar y mandibular, de las cuatro clases de Miller, debido a su extensa evidencia. Resultados: Se incluyeron treinta y cuatro publicaciones y se extrajeron datos sobre el resultado de las técnicas quirúrgicas de dieciocho artículos. La evaluación clínica analizó la cantidad de cobertura radicular completa, la reducción de la recesión y la ganancia de altura y volumen, mientras que la perspectiva del paciente se expresó en términos de satisfacción estética y posibles complicaciones postoperatorias. Los procedimientos de los últimos diez años mostraron mejores resultados en todos los factores mencionados anteriormente. Conclusión: La predictibilidad y la estabilidad del tratamiento a largo plazo representan los factores que guían el proceso de elección de la técnica y que añaden valor a los procedimientos más actualizados. Se observaron progresos tanto a nivel estético, al reducir las discrepancias entre el área intervenida y el tejido circundante, como a nivel postoperatorio, al aminorar las molestias del paciente. Los desafíos propios de esta rama pronto podrían encontrar respuesta gracias a su rápida evolución, la cual permite concebir más avances.

Background: Along the years, a remarkable variety of periodontal surgical protocols has been proposed, the focus of which has shifted from the mere resolution of a soft tissue defect to the performance of predictable and minimally invasive procedures. Initially, the free gingival graft was used. Subsequently, many different techniques were experimented, including those using soft tissue substitutes, such as the Alloderm membrane. Nowadays, the association of the connective tissue graft with the coronally advanced flap is considered the gold standard. Finally, the Pinhole technique, being a more conservative method in terms of tissue preservation and aesthetic outcome, was proposed. Objectives: The aim of this review was the comparison of the updated techniques for the treatment of multiple periodontal recessions, affecting both maxilla and mandible. The procedure outcome was assessed in terms of complete root coverage, recession reduction, gain in height and volume, aesthetic outcome, patient's post-operative pain and morbidity of donor and recipient sites. Material and methods: Electronic and hand searches were performed to collect split- mouth studies, randomized controlled clinical trials, case series, pilot studies, periodontal books, case studies, systematic reviews and meta-analysis, including maxillary and mandibular multiple gingival recession defects of all four Miller's classes, for its extensive evidence. Results: Thirty-four publications were included and data regarding the surgical techniques outcome were extracted from eighteen articles. The clinical evaluation analyzed the amount of complete root coverage, recession reduction and gain in height and volume, while the patient's perspective was expressed in terms of aesthetic satisfaction and possible postoperative complications. Procedures in the last ten years showed better results in all the above-mentioned factors. Conclusion: Procedural predictability and long-lasting treatment stability embody the factors driving the technique election process and adding value to more updated procedures. Progress was observed both at an aesthetic level, by reducing the discrepancias between the surgical region and the surrounding tissue, and at a postoperative level, by reducing patient discomfort. The challenges inherent to this branch could soon find answers thanks to its prompt evolution, which allows for further advances to be conceived.

Tratamiento de Sonrisa Gingival. Informe de Caso

El recontorneo estético es una cirugía plástica periodontal que tiene como objetivo restablecer una sonrisa más armoniosa de acuerdo al aspecto facial del paciente, el principal motivo para realizar este procedimiento es cuando existe un diagnóstico de una erupción pasiva alterada o sonrisa gingival. La sonrisa gingival es una de las principales preocupaciones de acuerdo a la estética cuando existe una exposición gingival de más de 3 mm en lo cual es justificable realizar el recontorneo estético. Paciente femenino de 28 años de edad, con diagnóstico de erupción pasiva alterada 1B con un seguimiento de 4 meses. El tratamiento consistió en realizar el recontorneo estético para corregir la sonrisa gingival. El recontorneo estético es un procedimiento quirúrgico que se realiza con el objetivo de mejorar la estética del paciente cuando existe una exposición gingival excesiva y para facilitar la armonía de acuerdo a su aspecto facial.

Esthetic recontouring is a periodontal plastic surgery that aims to restore a more harmonious smile according to the patient's facial appearance, since the main reason to perform this procedure is when there is a diagnosis of an altered passive eruption or gingival smile. The gingival smile is one of the main concerns according to aesthetics when there is a gingival exposure of more than 3 mm in which it is justifiable to perform the aesthetic recontouring. 28-year-old female patient with a diagnosis of altered passive eruption 1B with a 4-month follow-up. Treatment consisted of esthetic recontouring to correct the gingival smile. Esthetic recontouring is a surgical procedure performed with the aim of improving the patient's esthetics when there is excessive gingival exposure and to facilitate harmony according to facial appearance.

Actualización de las técnicas para el tratamiento de las recesiones periodontales / Update of techniques for the treatment of periodontal recessions

RESUMEN Introducción: A lo largo de los años se ha propuesto una notable variedad de protocolos quirúrgicos periodontales, cuyo enfoque pasó de la simple resolución de defectos de tejidos blandos a la realización de procedimientos predecibles y mínimamente invasivos. Inicialmente se usaba el injerto gingival libre. Posteriormente se han probado diversas técnicas, incluidas aquellas con sustitutos de tejidos blandos, como membranas tipo Alloderm. Hoy en día se considera el gold standard el injerto de tejido conectivo subepitelial asociado al colgajo de avance coronal. Por último, se ha examinado la técnica Pinhole, con mayor preservación de tejido y resultado más estético. Objetivos: El objetivo de esta revisión fue la comparación de técnicas actualizadas para el tratamiento de recesiones múltiples en maxilar superior e inferior. El resultado del procedimiento se evaluó en términos de cobertura radicular completa, reducción de la recesión, ganancia en altura y volumen, resultado estético, dolor postoperatorio y morbilidad del lecho donante y receptor del paciente. Material y métodos: Se realizaron búsquedas electrónicas y manuales para recopilar estudios de boca dividida, ensayos clínicos controlados aleatorios, series de casos, estudios piloto, libros de periodoncia, estudios de casos, revisiones sistemáticas y metanálisis, incluyendo los defectos de recesiónes gingivales múltiples, en maxilar y mandibular, de las cuatro clases de Miller, debido a su extensa evidencia. Resultados: Se incluyeron treinta y cuatro publicaciones y se extrajeron datos sobre el resultado de las técnicas quirúrgicas de dieciocho artículos. La evaluación clínica analizó la cantidad de cobertura radicular completa, la reducción de la recesión y la ganancia de altura y volumen, mientras que la perspectiva del paciente se expresó en términos de satisfacción estética y posibles complicaciones postoperatorias. Los procedimientos de los últimos diez años mostraron mejores resultados en todos los factores mencionados anteriormente. Conclusión: La predictibilidad y la estabilidad del tratamiento a largo plazo representan los factores que guían el proceso de elección de la técnica y que añaden valor a los procedimientos más actualizados. Se observaron progresos tanto a nivel estético, al reducir las discrepancias entre el área intervenida y el tejido circundante, como a nivel postoperatorio, al aminorar las molestias del paciente. Los desafíos propios de esta rama pronto podrían encontrar respuesta gracias a su rápida evolución, la cual permite concebir más avances.

ABSTRACT Background: Along the years, a remarkable variety of periodontal surgical protocols has been proposed, the focus of which has shifted from the mere resolution of a soft tissue defect to the performance of predictable and minimally invasive procedures. Initially, the free gingival graft was used. Subsequently, many different techniques were experimented, including those using soft tissue substitutes, such as the Alloderm membrane. Nowadays, the association of the connective tissue graft with the coronally advanced flap is considered the gold standard. Finally, the Pinhole technique, being a more conservative method in terms of tissue preservation and aesthetic outcome, was proposed. Objectives: The aim of this review was the comparison of the updated techniques for the treatment of multiple periodontal recessions, affecting both maxilla and mandible. The procedure outcome was assessed in terms of complete root coverage, recession reduction, gain in height and volume, aesthetic outcome, patient's post-operative pain and morbidity of donor and recipient sites. Material and methods: Electronic and hand searches were performed to collect split- mouth studies, randomized controlled clinical trials, case series, pilot studies, periodontal books, case studies, systematic reviews and meta-analysis, including maxillary and mandibular multiple gingival recession defects of all four Miller's classes, for its extensive evidence. Results: Thirty-four publications were included and data regarding the surgical techniques outcome were extracted from eighteen articles. The clinical evaluation analyzed the amount of complete root coverage, recession reduction and gain in height and volume, while the patient's perspective was expressed in terms of aesthetic satisfaction and possible postoperative complications. Procedures in the last ten years showed better results in all the above-mentioned factors. Conclusion: Procedural predictability and long-lasting treatment stability embody the factors driving the technique election process and adding value to more updated procedures. Progress was observed both at an aesthetic level, by reducing the discrepancias between the surgical region and the surrounding tissue, and at a postoperative level, by reducing patient discomfort. The challenges inherent to this branch could soon find answers thanks to its prompt evolution, which allows for further advances to be conceived.

Er:YAG Laser and Hemolasertherapy: Bone and Gingiva Gain-Case Report.

Background: Modern dentistry has increasingly valued conservative and biologically less invasive clinical practices, seeking to preserve the patients' tissues and natural dental elements. Most extractions in the dental clinic are preceded by periodontal disease that presents bone and gingival tissue loss, compromising the aesthetics as well as the support of dental elements. Objectives: The clinical approach in these cases often involves bone exertion followed by the successful installation of osseointegrated implants. Material and Methods: In this study, a case of extensive periodontal involvement and mobility of dental elements was carried out in a minimally invasive way, using the Er:YAG laser for periodontal decontamination and the hemolasertherapy technique to regenerate adjacent tissues, totaling nine weeks of treatment. Results: Clinical and radiographical improvement of tissue health and complete preservation of dental elements were observed. Conclusion: The patient underwent a follow-up appointment 2 years after the start of treatment when it was still possible to verify the stability of the clinical condition and the tissue gains obtained.

Effectiveness of dental floss in the management of gingival health: A 6-month follow-up of a randomized controlled clinical trial.

OBJECTIVES: To evaluate, (i) if subjects submitted to a structured oral hygiene training program (OHt) maintain adopted habits over 180 days without professional guidance; and (ii) in perspective whether flossing provides additional benefits to toothbrushing on gingival health. MATERIALS AND METHODS: Seventy-five adult subjects showing approximately 40% proximal gingival bleeding were randomized to receive OHt (1 session weekly over 8 weeks) using toothbrush and dental floss or toothbrush alone. The subjects were then followed over 180 days without professional guidance. Primary outcomes were mean interproximal Gingival Index (GI) and GI = 2 (gingival bleeding). Mixed linear models were used for the comparison between groups (p < 0.05). RESULTS: 68 subjects received OHt, 48 subjects completed the 180-day follow-up. Subjects maintained adequate oral hygiene routines. Besides a reduction in gingival inflammation, no alterations in gingival status were observed among groups, subjects additionally instructed to use dental floss showing a mean interproximal GI = 2 of 12.8 ± 2.5 compared with 19.8 ± 2.2 for subjects limited to tooth brushing alone. CONCLUSIONS: OHt intensive training promotes gingival health and maintenance lasting at least 6 months without professional supervision reinforcing important principles: (i) dental health professionals should dedicate time training and motivating their patients to reach adequate self-performed plaque control; and (ii) the adjunctive use of dental floss appears essential to reduce interproximal gingival inflammation in subjects with intact interdental papillae. CLINICAL RELEVANCE: Dentists need to invest time in training/motivating/engage their patients to achieve adequate OH; adjunct flossing in subjects with papilla filling the interdental space appears essential to reach and maintain gingival health. CLINICALTRIALS: GOV : (53831716.5.0000.5346). TRIAL REGISTRATION: The protocol registration was filed May 9, 2018 (# 538,311,716.5.0000.5346) on ClinicalTrials.gov. An NCT number (NCT04909840) was generated upon completed registration.

Coronally advanced flap with connective tissue graft for the treatment of multiple recession defects: Case Report

Mucogingival deformities are a group of conditions that affect many patients, having an impact on function and esthetics; they can be congenital, developmental, or acquired. Gingival recession is defined by the American Academy of Periodontology as the location of the gingival margin apical to the amelocemental junction. They can be localized or generalized and include one or more sides of the tooth. Among the treatments, subepithelial connective tissue grafting and acellular dermal matrix can be considered, whose objectives are root coverage and keratinized tissue width. Case report: A 54-year-old female patient diagnosed with mucogingival deformities around the tooth, was treated with subepithelial connective tissue graft to obtain root coverage in recessions RT2 and RT3. Conclusion: The purpose of using a bilaminar technique where a flap is made, and a connective tissue graft is placed to cover gingival recessions is to obtain better esthetic results.

Guided coronally advanced flap to treat gingival recession: Digital workflow and case report.

BACKGROUND: The inherently technique-sensitive nature of periodontal plastic procedures demands a significant level of skill and expertise. The incorporation of three-dimensional (3D) printing technologies emerges as a potential strategy to optimize and simplify surgical procedures. This case report describes the digital workflow and presents the clinical outcomes achieved using a guided coronally advanced flap for the treatment of a single gingival recession (GR). METHODS AND RESULTS: A female patient with a gingival recession type 1 (RT1 B-) defect on the mandibular second left premolar underwent successful treatment using a guided coronally advanced flap (g-CAF) and de-epithelized connective tissue graft (CTG). The digital planning included intraoral scanning of the mandible and hard palate using an intraoral scanner, with resulting polygon format (PLY) files exported for virtual model creation. The CAF guide was meticulously designed to orient horizontal and vertical incisions at the papillae base adjacent to the GR defect. For the donor site, a guide was specifically created, positioning the graft area 2 mm apically to the premolars' gingival margins. The delineation of this area involved two horizontal and vertical incisions, meticulously based on the dimensions of the GR. The digitally designed guides were then 3D-printed using a surgical guide-specific resin, contributing to the precise execution of the innovative surgical approach. Complete root coverage was achieved. CONCLUSION: This case report demonstrates that g-CAF can be a promising approach for the treatment of single GR. HIGHLIGHTS: Why is this case new information? To the best of the authors' knowledge, this is the first manuscript to report a guided procedure for the treatment of gingival recession. This report provides the digital workflow for the fabrication of a guide to perform the coronally advanced flap for single recession defects. What are the keys to successfully manage this case? It is necessary to adequately scan the recession defect area and palate. Properly not only design the guide using specific software but also print it. The guide has to be stable when in position for the surgical procedure. What are the primary limitations of this technique? This guide was designed to help surgeons during the incisions. However, it does not provide aid to split and release the flap and suture.

Epithelial cyst following subepithelial connective tissue graft: A case report.

BACKGROUND: Various surgical approaches have been employed to manage gingival recession, including subepithelial connective tissue grafting, which has yielded favorable outcomes. METHODS AND RESULTS: We present the case of a 17-year-old patient who developed gingival recession on tooth #6 following an esthetic crown lengthening procedure. The recession was treated with a subepithelial connective tissue graft; however, this case details the occurrence of two epithelial cysts adjacent to the region subjected to the surgical procedure, 6 months after surgery. The treatment involved periodontal surgical intervention, during which the lesions were completely excised and the associated osseous defect was filled using an inorganic bovine bone matrix along with a collagen membrane. The healing progressed without any complications. Histopathological analysis revealed the presence of cystic lesions, which were characterized by a cystic cavity lined with stratified orthokeratinized epithelium with cuboidal cells in some areas surrounded by fibrous connective tissue. The patient's progress was monitored through tomography performed 6 months, 1 year, and 5 years post-procedure, all of which demonstrated the absence of any signs of lesion recurrence. CONCLUSION: This case study emphasizes the effectiveness and predictability of subepithelial connective tissue grafting in the treatment of gingival recession. However, dental professionals should be cautious about the potential risk of gingival recession following esthetic crown lengthening procedures and recognize the potential complications associated with subepithelial connective tissue grafting, such as the observed development of epithelial cysts in this specific case. KEY POINTS: Why is this case new information? We present a case of an epithelial cyst following a subepithelial connective tissue graft, which resulted in buccal cortical bone resorption. The treatment involved excisional biopsy and the use of an inorganic bovine bone matrix with a collagen membrane. What are the keys to the successful management of this case? Successful treatment included periodontal surgery, bone defect filling using an inorganic bovine bone matrix and a collagen membrane, and regular monitoring with CT scans at 6 months, 1 year, and 5 years post-surgery; all showed no recurrence. Success factors included careful surgery, appropriate biomaterial usage, and ongoing follow-up. What are the primary limitations to success in this case? The limitations involve potential complications from subepithelial connective tissue grafting such as cyst development. This report stresses the importance of meticulous patient selection and periodontal phenotype evaluation to minimize risks. Continuous follow-up is critical to detect recurrence and other issues.

ELMO2 biallelic pathogenic variants in a patient with gingival hypertrophy and cherubism phenotype: Case report and molecular review.

Ramon syndrome (OMIM #266270) was first described in a patient with cherubism, gingival fibromatosis, epilepsy, intellectual disability, hypertrichosis, and stunted growth. In 2018, Mehawej et al. described a patient with Ramon syndrome in whom a homozygous variant in ELMO2 was identified, suggesting that this gene may be the causative for this syndrome. ELMO2 biallelic pathogenic variants were also described in patients with a primary intraosseous vascular malformation (PIVM; OMIM #606893). These patients presented gingival bleeding and cherubism phenotype. Herein, a patient with gingival hypertrophy, neurodevelopmental delay, and cherubism phenotype with a novel homozygous predicted loss-of-function (LOF) variant in the ELMO2 gene and family recurrence was reported. A surgical approach to treat gingival bleeding and mandible vascular malformation was also described. Furthermore, this study includes a comprehensive literature review of molecular data regarding the ELMO2 gene. All the variants, except one described in the ELMO2, were predicted as LOF, including our patient's variant. There is an overlapping between PIVM, also caused by LOF biallelic variants in the ELMO2 gene, and Ramon syndrome, which can suggest that they are not different entities. However, due to a limited number of cases described with molecular evaluation, it is hard to establish a genotype-phenotype correlation. Our study supports that LOF pathogenic biallelic variants in the ELMO2 gene cause a phenotype that has cherubism and gingival hypertrophy as main characteristics.

IL-23/IL-17 axis levels in gingival crevicular fluid of subjects with periodontal disease: a systematic review.

BACKGROUND: The IL-23/IL-17 axis plays an important role in the immunopathogenesis of periodontal disease. A systematic review was conducted to synthesize all research reporting on the levels of the IL-23/IL-17 axis in gingival crevicular fluid (GCF) from subjects with gingivits, and periodontitis, compared to healthy controls. METHODS: The protocol followed the PRISMA, and Cochrane guidelines, and was registered with the Open Science Framework (OSF): https://doi.org/10.17605/OSF.IO/7495V . A search was conducted in the electronic databases PubMed/MEDLINE, Scopus, Google Schoolar, and Cochrane from November 15th, 2005, to May 10th, 2023. The quality of the studies was assessed using the JBI tool for cross-sectional studies. RESULTS: The search strategy provided a total of 2,098 articles, of which 12 investigations met the inclusion criteria. The total number of patients studied was 537, of which 337 represented the case group (subjects with gingivitis, and chronic periodontitis), and 200 represented the control group (periodontally healthy subjects). The ages of the patients ranged from 20 to 50 years, with a mean (SD) of 36,6 ± 4,2, of which 47% were men, and 53% were women. 75% of the investigations collected GCF samples with absorbent paper strips, and analyzed cytokine IL-17 levels individually. In addition, qualitative analysis revealed that there are differences between IL-23/IL-17 axis levels in subjects with chronic periodontitis, gingivitis and healthy controls. CONCLUSIONS: Thus, IL-23/IL-17 axis levels could be used in the future as a diagnostic tool to distinguish between periodontal diseases.