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1.
Int. j. odontostomatol. (Print) ; 14(4): 602-609, dic. 2020. tab, graf
Artículo en Español | LILACS | ID: biblio-1134546

RESUMEN

RESUMEN: Comparar mediante una revisión sistemática los resultados clínicos de los procedimientos de cirugía plástica periodontal/periimplantar (CP) con injerto de tejido blando autógeno (ITB) obtenido del área lateral del paladar (ALP) versus del área de la tuberosidad (AT). Se realizó una búsqueda electrónica de ensayos clínicos en la base de datos Medline/Pubmed, Cochrane y las revistas de Periodoncia e Implantes de mayor impacto según la Web of Science, para hallar artículos publicados hasta abril del 2020. Se valoró el riesgo de sesgo de los artículos añadidos según el manual Cochrane Versión 5.1.0 para ensayos clínicos aleatorizados y la escala Newcastle-Ottawa para ensayos clínicos controlados. De una muestra inicial de 930 artículos, cuatro ensayos clínicos (tres aleatorizados) fueron incluidos en el presente estudio, donde se realizaron un total de 87 CP alrededor de piezas e implantes dentales, de las cuales 42 cirugías fueron realizadas con ITB del ALP y 45 cirugías con ITB del AT, se evaluó los resultados desde las 8 semanas hasta los 12 meses. No se hallaron diferencias estadísticamente significativas en los resultados clínicos entre ambos grupos, se mejoró el fenotipo gingival en la zona receptora para el grupo que obtuvo el ITB del AT y el nivel del dolor del sitio donador del AT fue menor en las dos primeras semanas que el sitio donante del ALP. Los estudios incluidos manifestaron un bajo riesgo de sesgo en promedio. Ambas áreas donantes de injerto de tejido blando proporcionan resultados clínicos similares, el injerto del área de la tuberosidad mejora el fenotipo gingival de la zona receptora y reduce el dolor post operatorio en las primeras semanas del sitio donador.


ABSTRACT: The objective of the study was to compare, through a systematic review, the clinical results of periodontal / peri-implant plastic surgery (CP) procedures with autogenous soft tissue graft (ITB) obtained from the lateral palate area (ALP) versus the tuberosity area (AT). We conducted an electronic search of clinical trials in the Medline/Pubmed, Cochrane database and the journals of Periodontics and Implants with the greatest impact according to the Web of Science, to find articles published until April 2020. The risk of bias of the articles added was assessed according to the Cochrane Manual Version 5.1.0 for randomized clinical trials and the Newcastle-Ottawa scale for controlled clinical trials. From the initial sample of 930 articles, four clinical trials were included (three randomized) in the present study, where a total of 87 PC were performed around dental pieces and implants, of which 42 surgeries were performed with ITB of the ALP and 45 surgeries with ITB of the AT, the results were evaluated from the 8 weeks to 12 months. No statistically significant differences were found in the clinical results between the two groups, the gingival phenotype in the receiving area was improved for the group that obtained the ITB of the AT and the level of pain at the donor site was lower in the first two weeks than the ALP donor site. The studies showed a lowrisk of bias on average. Both soft tissue graft donor areas provide similar clinical results, grafting the tuberosity area improves the gingival phenotype of the recipient area and reduces post-operative pain of the donor site in the first few weeks.


Asunto(s)
Humanos , Implantes Dentales/estadística & datos numéricos , Procedimientos Quirúrgicos Orales , Implantación Dental Endoósea , Paladar (Hueso) , Trasplante Autólogo , Sesgo de Selección , Trasplante de Tejidos , Tejido Conectivo/trasplante , Recesión Gingival
2.
BMJ Case Rep ; 13(12)2020 Dec 21.
Artículo en Inglés | MEDLINE | ID: mdl-33370955

RESUMEN

The application of free connective tissue graft (CTG) is the gold standard in the treatment of gingival recession in the area of teeth and implants. The aim of this case report is to demonstrate a possible mucosal overgrowth complication in the soft tissue grafting area. A 24-year-old patient underwent the treatment of gingival recession in the tooth 2.3 region by an envelope technique using a free CTG from the hard palate region. Seven years after the surgery, a mucosal overgrowth was observed, which developed asymptomatically and did not cause any problems to the patient.


Asunto(s)
Tejido Conectivo/trasplante , Encía/cirugía , Sobrecrecimiento Gingival/etiología , Recesión Gingival/cirugía , Complicaciones Posoperatorias/etiología , Adulto , Enfermedades Asintomáticas , Femenino , Humanos , Estudios Longitudinales , Paladar Duro/trasplante , Trasplante Autólogo/efectos adversos , Resultado del Tratamiento , Adulto Joven
3.
Int J Esthet Dent ; 15(4): 440-453, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33089259

RESUMEN

Soft tissue augmentation techniques have become crucial to improve tissue volume and quality in periodontal and peri-implant dental surgery. A clinician's knowledge of the principle of flap design and management is a key aspect for treatment success, particularly in the esthetic area. Implant failures in the esthetic area are one of the most challenging situations in modern dentistry, and often cases have to be resolved through multidisciplinary treatments in which soft tissue management and patient selection are substantial aspects. Ridge defects are commonly treated with bone regeneration-like techniques in order to place implants. However, in young patients, where implant treatment should be carefully selected, fixed prosthetic restorations in combination with mucogingival surgery could be a successful option to enhance esthetics. The present case report describes a treatment approach for implant failure in the esthetic area in young patients, consisting of a combination of connective tissue platform technique, resective surgery, and a Maryland bridge restoration.


Asunto(s)
Aumento de la Cresta Alveolar , Estética Dental , Tejido Conectivo/trasplante , Implantación Dental Endoósea , Humanos , Colgajos Quirúrgicos/cirugía
4.
Int J Periodontics Restorative Dent ; 40(5): 749-756R, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32926005

RESUMEN

This investigation was designed to evaluate the long-term effectiveness of human placental allograft in root coverage procedures in terms of clinical and esthetic outcomes. Thirteen patients with 28 maxillary or mandibular recession defects > 4 mm deep were reexamined at 6 months and 5 years postoperatively. Overall, mean percentage of root coverage decreased from 65.58% ± 16.45% to 49.75% ± 19.40% with a greater stability of the gingival margin in the mandible. At 5 years, 18 sites maintained at least 2 mm of keratinized tissue. Gingival color and texture blended well with adjacent soft tissue area in 78.6% of treated sites.


Asunto(s)
Recesión Gingival , Aloinjertos , Tejido Conectivo/trasplante , Estética , Femenino , Encía , Humanos , Embarazo , Colgajos Quirúrgicos , Raíz del Diente , Resultado del Tratamiento
5.
Rev. ADM ; 77(3): 168-171, mayo-jun. 2020. ilus
Artículo en Español | LILACS | ID: biblio-1128903

RESUMEN

El póntico E es una alternativa de tratamiento para la pérdida prematura dental, este tipo de póntico fue publicado por primera vez en 2014 por Robert P. Korman. El diseño del póntico permite ofrecer predictibilidad en cuanto a soporte y mantenimiento de la arquitectura gingival, también promueve que el tejido vestibular migre coronalmente sobre el póntico, creando un surco gingival. Se recibió a una paciente que presentaba fragmento radicular del diente 21 y ausencia del diente 12, reborde residual atrófico (clase I según Seibert). Como plan de tratamiento, se realizó la extracción atraumática del fragmento radicular del diente 21 para retardar el colapso del reborde alveolar y se colocó injerto de tejido conectivo en la zona del diente 12 para corregir el defecto clase I de Seibert, se realizó la conformación de los nichos gingivales con electrobisturí en conjunto con la prótesis provisional y la preparación de los dientes pilares para la recepción y rehabilitación con pónticos E. Se colocó una prótesis fija de cinco unidades (dientes 13 al 23) en material núcleo de Zr y estratificada con cerámica (AU)


Pontic E is an alternative treatment for premature dental loss, this type of pontic was published for the first time in 2014 by Robert P. Korman. The design of the pontic allows to offer predictability in terms of support and maintenance of the gingival architecture, it also promotes that the vestibular tissue migrates coronally over the pontic, creating a gingival groove. A patient was received who presented a radicular fragment of tooth 21 and absence of tooth 12, atrophic residual ridge (class I according to Seibert). As a treatment plan, atraumatic extraction of the root fragment of tooth 21 was performed to delay the collapse of the alveolar ridge and connective tissue graft was placed in the area of tooth 12 to correct Seibert's class I defect, conformation was performed of the gingival niches with electrocautery in conjunction with the provisional prosthesis and the preparation of the abutment teeth for the reception and rehabilitation with pontics E. A fixed prosthesis of five units was placed (teeth from 13 to 23) of Zr core material and stratified with ceramic (AU)


Asunto(s)
Humanos , Femenino , Adulto , Dentadura Parcial Fija , Estética Dental , Aumento de la Cresta Alveolar , Planificación de Atención al Paciente , Extracción Dental , Cerámica , Tejido Conectivo/trasplante , Electrocirugia , México
6.
J Appl Oral Sci ; 28: e20190236, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32236353

RESUMEN

OBJECTIVE: This clinical trial sought to evaluate the clinical effectiveness of concentrated growth factor (CGF) and compare it with connective tissue graft (CTG) with coronally advanced flap (CAF) in the treatment of Miller Class I gingival recessions (GR). METHODOLOGY: This split-mouth study included 74 Miller Class I isolated (24 teeth) or multiple (50 teeth) GRs in 23 jaws of 19 patients. GRs were randomly treated using CGF (test group: 37 teeth; 12 teeth in isolated GRs, 25 teeth in multiple GRs) or CTG with CAF (control group: 37 teeth;12 teeth isolated GRs, 25 teeth in multiple GRs). Clinical variables, plaque index (PI), gingival index (GI), probing depth (PD), recession depth (RD), recession width (RW), clinical attachment level (CAL), keratinized tissue thickness (KTT), keratinized tissue width (KTW), and root coverage (RC) were assessed at the baseline as well as at three and six months post-surgery. Healing index (HI) were obtained in the second and third weeks post-surgery. Postoperative pain was assessed for the first seven days using a horizontal visual analog scale (VAS). RESULTS: No significant change was observed in PI, GI, or PD values in either the intergroup or the intragroup comparisons. A statistically significant decrease was observed in CAL, RD, and RW, and KTT increased in all groups at three and six months compared with the baseline. The control group had greater increases in KTW, KTT, and RC at three and six months. No significant difference was found in CAL or RD at the third and sixth months between the two groups. Healing was found to be similar for both groups in the second and third weeks post-surgery. The VAS values in the control group were higher than in the test group, especially at the second, fourth, fifth, and seventh days postoperatively. CONCLUSIONS: CTG is superior to CGF with CAF for increasing KTT, KTW, and RC. CGF may be preferable due to decreased postoperative pain.


Asunto(s)
Tejido Conectivo/trasplante , Recesión Gingival/cirugía , Péptidos y Proteínas de Señalización Intercelular/uso terapéutico , Colgajos Quirúrgicos/trasplante , Adulto , Plaquetas , Índice de Placa Dental , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor Postoperatorio , Índice Periodontal , Valores de Referencia , Reproducibilidad de los Resultados , Estadísticas no Paramétricas , Factores de Tiempo , Resultado del Tratamiento , Cicatrización de Heridas , Adulto Joven
7.
Clin Implant Dent Relat Res ; 22(3): 311-318, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32212303

RESUMEN

BACKGROUND: In the treatment of anterior implants, few studies have quantitatively evaluated the effects of connective tissue grafts on labial bone resorption and soft tissue recession. PURPOSE: To evaluate the influence of connective tissue grafting (CTG) on the peri-implant tissue morphology by quantitatively measuring change over time the tissue surrounding the implant in the anterior esthetic zone. MATERIAL AND METHODS: Twenty-six patients who received implants with platform shifting in the anterior esthetic region were included in this follow-up study. Patients were classified as those who received CTG [CTG (+) group] and those who did not [CTG (-) group]. The vertical and horizontal dimensions of the buccal alveolar bone of the implant and its surrounding soft tissues were evaluated using cone-beam computed tomography. RESULTS: At 1 year after connection of the superstructure, labial soft tissue recession was on average 0.64 mm in the CTG (-) group and 0.09 mm in the CTG (+) group, and this difference was significant (P < .001). Furthermore, mean labial bone resorption was 0.65 mm in the CTG (-) group and 0.13 mm in the CTG (+) group, and also this difference was significant (P = .003). CONCLUSIONS: Within the limitations of this study, these findings suggest that CTG may be effective in both reducing labial bone resorption around the implant and reducing the recession of the soft tissue.


Asunto(s)
Implantes Dentales de Diente Único , Implantes Dentales , Tejido Conectivo/trasplante , Estética , Estudios de Seguimiento , Humanos , Estudios Prospectivos , Resultado del Tratamiento
8.
Braz Oral Res ; 33: e123, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31994596

RESUMEN

The objective of this study was to determine whether collagen matrix (CM) is an alternative to connective tissue graft technique (CTG) in the treatment of multiple gingival recessions (GR). The indication of CM for the treatment of multiple GR is not yet clear. More studies are needed to better understand this treatment modality, as an alternative to CTG. In this single-blind, split-mouth randomized clinical trial, fifteen patients with multiple Miller class I upper GR were selected and randomly assigned to control group (CTG) or test group (CM). Root coverage (RC) and patient-centered outcomes were evaluated at baseline and after 3, 6, and 12 months. A total of 82 GRs were treated. There was no significant difference regarding GR depth (GRD, primary outcome) between CTG (0.5 ± 0.9 mm) and CM groups (0.6 ± 1.0 mm) (p = 0.225). Percentage of RC was 82.14% in CTG and 77.7% in CM. Both groups demonstrated a gain in keratinized tissue width at 12 months (p < 0.05). Dentine hypersensitivity was effectively reduced in both groups. Postoperative pain was significantly higher in the CTG (p = 0.001). Esthetic satisfaction was high for both groups, with no significant difference (p > 0.05) between groups. After 12 months, both surgical treatments were able to promote RC, and GRD was similar in both CTG and CM groups.


Asunto(s)
Colágeno/uso terapéutico , Tejido Conectivo/trasplante , Recesión Gingival/cirugía , Adolescente , Adulto , Sensibilidad de la Dentina/prevención & control , Femenino , Estudios de Seguimiento , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Tempo Operativo , Reproducibilidad de los Resultados , Método Simple Ciego , Estadísticas no Paramétricas , Colgajos Quirúrgicos , Factores de Tiempo , Resultado del Tratamiento , Escala Visual Analógica , Adulto Joven
9.
J Periodontal Res ; 55(2): 296-306, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31808142

RESUMEN

BACKGROUND AND OBJECTIVE: The study compared clinical and patient-centered outcomes of subepithelial connective tissue graft (CTG) with and without enamel matrix derivative (EMD) in the treatment of Class I-II Miller periodontal recession defects. MATERIAL AND METHODS: This prospective clinical study evaluated 80 patients over a 3 years follow-up in a private periodontal practice. A total of 144 maxillary and mandibular anterior teeth were divided into two groups: group 1 (CTG with EMD-80 teeth) and group 2 (CTG only-64 teeth). Recession (REC), keratinized tissue (KT) width, % root overage, patient-centered outcomes, and pain visual analog scale (P-VAS) were compared between the two groups. RESULTS: At 3 years follow-up at a patient level, statistically significant changes in REC were achieved in both group 1 (4.65 ± 1.84 to 0.39 ± 0.19 mm) and group 2 (4.43 ± 1.11 to 0.92 ± 0.43 mm). Complete root coverage (CRC) was achieved in 66.4% of group 1 and 50.1% of group 2. At both patient and tooth level, the 3-year outcomes were superior for group 1 compared with group 2 in terms of % root coverage, REC, and KT width. Clinical attachment loss (CAL) was reduced in group 1 compared with group 2 at the tooth level analysis only (<.01). Significantly less pain was reported using the pain visual analog Scale (P < .001) at the two weeks follow-up post-surgery in group 1. CONCLUSIONS: Addition of EMD results in improved root coverage outcomes and higher amounts of keratinized tissue width 36 months after treatment of multiple adjacent recessions on maxillary and mandibular anterior teeth. The adjunctive use of EMD also resulted in significantly reduced pain 14 days after the surgery.


Asunto(s)
Tejido Conectivo/trasplante , Proteínas del Esmalte Dental/uso terapéutico , Recesión Gingival/cirugía , Adulto , Femenino , Encía , Humanos , Masculino , Atención Dirigida al Paciente , Estudios Prospectivos , Raíz del Diente , Resultado del Tratamiento
10.
Clin Oral Investig ; 24(1): 425-436, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31104113

RESUMEN

OBJECTIVES: The aim of this study is to determine the use of platelet-rich fibrin (PRF) in the management of soft tissue donor site healing after harvesting connective tissue graft (CTG) from the palate and evaluate the postoperative discomfort (pain, bleeding, analgesic consumption, tissue color match) of patients. MATERIALS AND METHODS: Forty patients were randomly assigned to PRF or control group. In the PRF group, PRF membrane was placed into CTG donor site. After surgery, delayed bleeding, early healing index (EHI), tissue color match, and analgesic consumption were recorded. The visual analog scale (VAS) was used to observe the postoperative pain and tissue color match. Data were analyzed using the independent sample t test and the repeated measure ANOVA test. RESULTS: The patients in the PRF group reported significantly lower pain scores at all-time points. Postoperative 3rd and 7th day, EHI scores were lower in the favor of the PRF group. VAS score values of tissue color match were lower in the control group at 7th and 14th day, compared with the PRF group. Analgesic intake was significantly lower in the PRF group postoperatively at 1st and 3rd day that of control group. CONCLUSION: PRF application at the palatal donor site demonstrates promising results in terms of better wound healing and reduced postoperative discomfort in the patients after harvesting CTG. CLINICAL RELEVANCE: Patients may avoid surgical operations because of the discomfort or pain feeling. Reducing postoperative pain and discomfort and accelerating recovery meet the wishes of every patient and physician. PRF can provide these requirements as an easy method to obtain and implement.


Asunto(s)
Tejido Conectivo , Dolor Postoperatorio , Fibrina Rica en Plaquetas , Cicatrización de Heridas , Adulto , Tejido Conectivo/trasplante , Femenino , Humanos , Masculino , Dolor Postoperatorio/prevención & control , Paladar (Hueso) , Recolección de Tejidos y Órganos , Sitio Donante de Trasplante
11.
Shanghai Kou Qiang Yi Xue ; 29(6): 617-622, 2020 Dec.
Artículo en Chino | MEDLINE | ID: mdl-33778829

RESUMEN

PURPOSE: To evaluate the clinical aesthetic effect of buccal alveolar ridge preservation (ARP) and connective tissue transplantation (CTG) in patients who received a single implant. METHODS: Forty-three patients with tooth loss admitted to the Department of Stomatology of Shunde Hospital of Southern Medical University from May 2014 to May 2016 were included in the study. Tooth extraction, ARP, implant implantation, CTG and permanent repair were performed respectively. The incidence of bleeding, depth of probing, marginal bone resorption, and red-white aesthetic effect of implants were evaluated 1 year and 3 years after surgery. The buccal mucosa thickness of implants before, immediately after CTG, 1 year and 3 years after surgery were measured. The patient satisfaction was evaluated by visual analogue scale (VAS) from masticatory function, overall aesthetics, attachment height, and color, respectively. The implant conditions at the third year after surgery were observed, and complications during follow-up were recorded. SPSS 20.0 software package was used for statistical analysis of the data. RESULTS: The follow-up rate in the first year after surgery was 100%, and that in the third year after surgery was 90.70%. One year and 3 years after operation, the aesthetic effect of the implant was satisfactory. At the 3rd year after operation, the scores of the near middle gingival papillary were significantly higher than that at the 1st year after operation (P<0.05). The buccal mucosal thickness of the implant immediately after CTG and 1 year and 3 years after surgery increased significantly compared with that before CTG (P<0.05). The buccal mucosal thickness of the implant increased 1.02 mm (relative stability: 90.12%) 1 year after operation and 1.01 mm (relative stability: 84.31%) 3 years after operation, respectively. The satisfaction scores of the patients on chewing function, overall aesthetics, attachment height and color of the implant immediately after CTG, one year after surgery and 3 years after surgery were all > 8. The 3-year survival rate of the implants was 100%, and the 3-year success rate of the implants was 97.44%. During the follow-up, two patients developed peri-implant mucositis, which was relieved after tooth cleaning, but no complications such as tissue flap necrosis, limited opening and tongue movement disorder occurred. CONCLUSIONS: ARP and CTG have good clinical and aesthetic effects on patients with tooth loss. In three years, the buccal mucosal thickness of the implant can be increased and relatively stable, which is worthy of clinical promotion and application.


Asunto(s)
Implantes Dentales de Diente Único , Implantes Dentales , Proceso Alveolar , Tejido Conectivo/trasplante , Implantación Dental Endoósea , Estética Dental , Humanos , Resultado del Tratamiento
12.
J. appl. oral sci ; 28: e20190236, 2020. tab, graf
Artículo en Inglés | LILACS, BBO - Odontología | ID: biblio-1090786

RESUMEN

Abstract Objective This clinical trial sought to evaluate the clinical effectiveness of concentrated growth factor (CGF) and compare it with connective tissue graft (CTG) with coronally advanced flap (CAF) in the treatment of Miller Class I gingival recessions (GR). Methodology This split-mouth study included 74 Miller Class I isolated (24 teeth) or multiple (50 teeth) GRs in 23 jaws of 19 patients. GRs were randomly treated using CGF (test group: 37 teeth; 12 teeth in isolated GRs, 25 teeth in multiple GRs) or CTG with CAF (control group: 37 teeth;12 teeth isolated GRs, 25 teeth in multiple GRs). Clinical variables, plaque index (PI), gingival index (GI), probing depth (PD), recession depth (RD), recession width (RW), clinical attachment level (CAL), keratinized tissue thickness (KTT), keratinized tissue width (KTW), and root coverage (RC) were assessed at the baseline as well as at three and six months post-surgery. Healing index (HI) were obtained in the second and third weeks post-surgery. Postoperative pain was assessed for the first seven days using a horizontal visual analog scale (VAS). Results No significant change was observed in PI, GI, or PD values in either the intergroup or the intragroup comparisons. A statistically significant decrease was observed in CAL, RD, and RW, and KTT increased in all groups at three and six months compared with the baseline. The control group had greater increases in KTW, KTT, and RC at three and six months. No significant difference was found in CAL or RD at the third and sixth months between the two groups. Healing was found to be similar for both groups in the second and third weeks post-surgery. The VAS values in the control group were higher than in the test group, especially at the second, fourth, fifth, and seventh days postoperatively. Conclusions CTG is superior to CGF with CAF for increasing KTT, KTW, and RC. CGF may be preferable due to decreased postoperative pain.


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Colgajos Quirúrgicos/trasplante , Tejido Conectivo/trasplante , Péptidos y Proteínas de Señalización Intercelular/uso terapéutico , Recesión Gingival/cirugía , Dolor Postoperatorio , Valores de Referencia , Factores de Tiempo , Cicatrización de Heridas , Plaquetas , Índice Periodontal , Índice de Placa Dental , Reproducibilidad de los Resultados , Resultado del Tratamiento , Estadísticas no Paramétricas
13.
Int. j. odontostomatol. (Print) ; 14(3): 457-463, 2020. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1114921

RESUMEN

To evaluate clinically the results of two surgical techniques used for root coverage, the coronally advanced flap in '' L '' isolated (CAF) or associated with subepithelial connective tissue graft (SCTG). The surgical procedures were performed in seventeen individuals, ten individuals in the control group (coronally advanced flap in "L") and seven individuals in the test group (coronally advanced flap in "L" associated with SCTG), who presented Miller class I and II gingival recession. The depth gingival recession (GR) index was evaluated in the following periods: immediate preoperative and 180 postoperative days. The control group had a success rate of 85 +/- 18 % and the test group had a success rate of 95 +/- 4 %. The variable success rates (p=0.36) did not present a statistically significant difference. The isolated CAF or its association with SCTG showed favorable outcomes in the treatments of Miller's class I and II gingival recessions.


El objetivo fue evaluar clínicamente los resultados de dos técnicas quirúrgicas utilizadas para la cobertura radicular, el colgajo coronalmente avanzado en "L" aislado (CAF) o asociado con injerto de tejido conectivo subepitelial (SCTG). Los procedimientos quirúrgicos se realizaron en diecisiete individuos, diez individuos en el grupo de control (colgajo coronario avanzado en "L") y siete individuos en el grupo de prueba (colgajo coronalmente avanzado en "L" asociado con SCTG), que presentaron la clase I de Miller y II recesión gingival. El índice de recesión gingival profunda (RG) se evaluó en los siguientes períodos: preoperatorio inmediato y 180 días postoperatorios. El grupo de control tuvo una tasa de éxito de 85 +/- 18 % y el grupo de prueba tuvo una tasa de éxito de 95 +/- 4 %. Las tasas de éxito variables (p = 0,36) no presentaron una diferencia estadísticamente significativa. La CAF aislada o su asociación con SCTG mostraron resultados favorables en los tratamientos de las recesiones gingivales de clase I y II de Miller.


Asunto(s)
Humanos , Colgajos Quirúrgicos , Tejido Conectivo/trasplante , Recesión Gingival/cirugía , Raíz del Diente , Estudios de Casos y Controles , Resultado del Tratamiento
14.
Clin Exp Dent Res ; 5(5): 566-579, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31687192

RESUMEN

A systematic review and meta-analysis was performed to understand the efficacy of xenogeneic collagen matrix (CMX) compared with connective tissue graft (CTG) for the treatment of multiple adjacent gingival recessions (MAGRs). A literature search was performed for published randomized controlled trials in adult patients (≥18 years old) with Multiple Adjacent Miller class I and II gingival recessions (MAGRs). The assessments included recession depth, Recession width, complete root coverage, mean root coverage, probing depth, clinical attachment level, and keratinized tissue width. Pooled data were analyzed using fixed- and random-effects models, and Forest plots were constructed. Heterogeneity within studies was calculated to assess publication bias. Four randomized controlled trials were included based on the eligibility criteria. Although the recession depth, complete root coverage, and mean root coverage were significantly lower with CMX (p = .017 and p = .001, p = .001, respectively), there was no statistically significant difference in the Recession width between CMX and CTG (p = .203). CMX showed significantly lower Probing Depth than CTG (p = .023); however, no significant difference in clinical attachment level (p = .060) and keratinized tissue width (p = .052) was observed between the groups. Owing to the heterogeneity in the included studies, firm conclusions cannot be drawn regarding the noninferiority of CMX compared with CTG. Long-term studies are therefore needed to conclusively establish the relative efficacy of CMX in MAGR.


Asunto(s)
Colágeno/uso terapéutico , Tejido Conectivo/trasplante , Recesión Gingival/terapia , Xenoinjertos , Humanos , Colgajos Quirúrgicos
15.
Clin Adv Periodontics ; 9(1): 29-33, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-31490038

RESUMEN

INTRODUCTION: Gingival recession (GR) is one of the most common esthetic concerns for patients, and several surgical procedures have been developed for its treatment. It has been widely demonstrated that root coverage of shallow Miller class I and II areas of gingival recession is generally predictable, but the treatment of deep recessions associated with lack of attached keratinized tissue remains a challenge even for skilled surgeons. Although this type of recessions can be treated with tunneling procedures, because of their size, covering the connective tissue grafts (CTGs) with displaced flaps provide better graft nutrition and improve the outcome. The purpose of this case series is to present an alternative treatment to the traditional laterally displaced flap and tunneling techniques used for deep narrow recessions: The "laterally stretched flap" (LSF) with CTG. CASE PRESENTATION: Five healthy patients with isolated Miller Class II narrow deep gingival recessions were included in the case series. All the defects were treated with LSF and CTG. Complete root coverage (CRC) was achieved in 80% of the cases (4/5). Keratinized tissue increase was obtained in all the cases. The follow-up was between one and three years. CONCLUSIONS: Within the limitations of this case series, LSF + CTG demonstrated to be a promising technique for the treatment of narrow deep recessions. The lack of vertical incisions and an envelope approach renders a more stable wound with minimal scar formation and patient discomfort.


Asunto(s)
Tejido Conectivo , Recesión Gingival , Incisivo , Tejido Conectivo/trasplante , Estética Dental , Recesión Gingival/cirugía , Humanos , Resultado del Tratamiento
16.
Clin Adv Periodontics ; 9(2): 70-76, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31498574

RESUMEN

INTRODUCTION: This case report presents the successful multidisciplinary treatment of a maxillary lateral incisor with a deep and narrow recession involving the root apex associated with pulpal necrosis. The tooth initially considered with a hopeless prognosis, was treated with a combined periodontal plastic, regenerative, and endodontic surgical procedure. CASE PRESENTATION: A recently reported technique, the laterally stretched (LAST) flap with a connective tissue graft (CTG) technique for root coverage, was combined with enamel matrix derivative (EMD) for periodontal regeneration of the periapical lesion, that complemented an apicoectomy with retrograde sealing. The 6-year follow-up evidenced root coverage (RC) of 91.6% and increased keratinized tissue. Clinical and radiographic evaluation showed resolution of the periapical process. CONCLUSIONS: A severe gingival recession with endodontic involvement can be repaired if adequate control of the endodontic infection is obtained. The LAST flap, originally described for lower anterior teeth, was used successfully in a maxillary tooth, under extreme circumstances.


Asunto(s)
Tejido Conectivo , Proteínas del Esmalte Dental , Recesión Gingival , Gingivoplastia , Tejido Conectivo/trasplante , Recesión Gingival/cirugía , Humanos , Plásticos
17.
Clin Adv Periodontics ; 9(2): 50-54, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31498575

RESUMEN

INTRODUCTION: The indications for augmentation of gingival tissue by connective tissue graft (CTG) are numerous. The techniques are widely adopted with extensive literature reporting high success. Harvest techniques include the mid to anterior palate, versus the posterior palate and tuberosity. The latter comprises denser collagen, identified as a more suitable graft. Alas, rarely have hyperplastic responses been reported. CASE PRESENTATION: Two adult, Caucasian patients presented with clinical need for soft tissue augmentation. Autogenous tissue was opted for, harvesting from the tuberosity gingiva. De-epithelialized outside the mouth and inserted into envelope flaps, late healing resulted in hyperplastic gingival lesions. Neither lesion could be successfully removed, and biopsy for histopathological investigation was carried out. CONCLUSION: Hyperplastic response resulting from soft tissue augmentation with tuberosity CTG is rare but may occur. Laser or scalpel might not ensure complete removal. Informing the patient of this rare adverse effect may be important.


Asunto(s)
Tejido Conectivo , Encía , Recesión Gingival , Adulto , Colágeno , Tejido Conectivo/trasplante , Estética , Encía/trasplante , Recesión Gingival/cirugía , Humanos , Paladar (Hueso)
18.
J Dent Res ; 98(11): 1195-1203, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31381868

RESUMEN

The stability of root coverage outcomes has gained a great deal of interest. However, insufficient evidence is available, mainly due to limited direct comparisons among different techniques and the small sample size among clinical trials. Therefore, the aim of this study was to propose a mixed-models network meta-analysis (NMA) that includes the novelty of assessing time on root coverage outcomes while simultaneously comparing different surgical approaches. A literature search was performed by 2 individual reviewers to identify randomized clinical trials (RCTs) reporting the outcomes of root coverage procedures of at least 2 time points to estimate the slopes of different treatment approaches. The primary outcomes were the changes in slopes for recession depth (REC), keratinized tissue width (KTW), and clinical attachment level. Sixty RCTs with a total of 2,554 gingival recessions (1,864 patients) were included in the NMA. Connective tissue graft (CTG) and enamel matrix derivative (EMD) approaches provided superior initial REC reduction compared to flap advancement alone. However, only CTG-based procedures were effective in maintaining the stability of the gingival margin over time, while EMD, acellular dermal matrix, collagen matrix, and flap alone showed a similar tendency for gingival recession recurrence. Baseline REC and KTW at the earliest postoperative recall were predictors for the stability of the gingival margin. In addition, a geographic center effect on the treatment slopes was observed for REC and KTW. While limitations of the present linear mixed-modeling approach should be considered as it refers to estimation and comparison of time slopes based on an examined while linear framework, the designed NMA showed to be an effective tool for the simultaneous comparison of multiple treatment approaches while taking into account the critical element of time.


Asunto(s)
Tejido Conectivo/trasplante , Recesión Gingival/terapia , Raíz del Diente , Dermis Acelular , Colágeno , Proteínas del Esmalte Dental/uso terapéutico , Encía , Humanos , Metaanálisis en Red , Resultado del Tratamiento
19.
Acta Odontol Latinoam ; 32(1): 10-16, 2019 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-31206569

RESUMEN

Subepithelial connective tissue graft (SCTG) is an essential therapeutic tool in periodontal plastic surgery and implantology. The aim of this preliminary study was to observe and make a histological and histomorphometric comparison of the composition of subepithelial connective tissue grafts (SCTGs) harvested from the palatal mucosa by two different harvesting techniques: mucoperiosteal (lamina propria and complete submucosa including periosteum) and mucosal (lamina propria and a portion of the submucosa). The main hypothesis proposes that SCTG harvested with the mucosal technique contains a greater proportion of connective tissue proper (CTP) and a lower proportion of adipose tissue (AT) than the mucoperiosteal technique. Twenty healthy patients who required SCTG for different purposes were selected and assigned to one of the two following groups: group A (n=10; mucoperiosteal harvesting technique) and group B (n=10, mucosal harvesting technique). The histological sample was obtained by removing a 2 mm thick slice from the most distal portion of the graft. The proportions of adipose tissue (AT), connective tissue proper (CTP) and vascular tissue (VT) were evaluated. In group A, histomorphometric analysis showed that CTP accounted for 58.2% of the graft while AT accounted for 32.64%. In group B, the proportions of CTP and AT were 79.86% and 11.93%, respectively. The differences between groups were statistically significant for both tissues (p< .05). In contrast, no statistically significant difference was observed in the proportion of VT. Within the limitations of this study, the results show that the SCTGs harvested by the mucosal technique contain a greater proportion of CTP and a lower proportion of AT than those obtained by the mucoperiosteal technique, whereas the proportion of VT does not differ. Further long-term clinical and histological studies with more samples are needed to evaluate the clinical implications of SCTG composition.


Asunto(s)
Tejido Conectivo/anatomía & histología , Tejido Conectivo/trasplante , Encía/anatomía & histología , Encía/trasplante , Recesión Gingival/cirugía , Paladar (Hueso)/anatomía & histología , Trasplante de Tejidos , Trasplantes , Autoinjertos , Tejido Conectivo/cirugía , Encía/cirugía , Humanos , Paladar (Hueso)/cirugía , Periodoncia , Trasplante de Tejidos/métodos , Trasplantes/cirugía , Trasplantes/trasplante
20.
Biomed Res Int ; 2019: 9346567, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31073531

RESUMEN

Background: Repairs of large to massive rotator cuff tears have a high failure rate. We investigated the efficacy of a novel, reinforced, low immunogenic, porcine small intestine submucosa (SIS) patch to repair a supraspinatus tendon defect in a rabbit model. We hypothesized that the histological and biomechanical results of SIS patch repair would be comparable with those of autologous fascia lata (FL) repair. Methods: The study mainly comprised two parts. First, the characteristics of the SIS patch were evaluated, including its micromorphology, mechanical properties, and immunogenic properties. Second, a supraspinatus tendon defect model was created in 36 rabbits (72 shoulders). The bilateral shoulders were randomly chosen to undergo repair using either a SIS patch (SIS group) or autologous FL (FL group). At 4, 8, and 12 weeks, histological analysis was performed using four shoulders from each group, and biomechanical tests were performed using eight shoulders from each group. Results: The SIS patch was a three-dimensional construct mainly composed of collagen fibers. The mean single and double suture retention loads of the SIS patch were 48.6 ± 5.8 N and 117.9 ± 2.7 N, respectively. The DNA content in the SIS patch was 53.9 ± 10.9 ng/mg dry weight. Both the histological score and ultimate load to failure increased in a time-dependent manner in both groups, with no significant differences between the SIS and FL groups at 12 weeks. Conclusion: Repair of a large supraspinatus tendon defect using a reinforced, low immunogenic, SIS patch achieves similar effects as autologous FL in a rabbit model. This novel patch might be useful to be employed as a structural tissue replacement in medical activities.


Asunto(s)
Mucosa Intestinal/ultraestructura , Intestino Delgado/ultraestructura , Lesiones del Manguito de los Rotadores/terapia , Traumatismos de los Tendones/terapia , Animales , Tejido Conectivo/trasplante , Modelos Animales de Enfermedad , Humanos , Mucosa Intestinal/química , Intestino Delgado/química , Conejos , Manguito de los Rotadores/fisiopatología , Lesiones del Manguito de los Rotadores/fisiopatología , Articulación del Hombro/crecimiento & desarrollo , Articulación del Hombro/lesiones , Porcinos , Traumatismos de los Tendones/fisiopatología , Parche Transdérmico , Cicatrización de Heridas
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