Factors associated with gingival recession prevalence in undergraduate students of the Faculty of Dentistry of the Universidad de los Andes in the year 2022. / Factores asociados a prevalencia de recesiones gingivales en alumnos de pregrado de la Facultad de Odontología de la Universidad de Los Andes en 2022.

Objective: To determine the prevalence of gingival recessions in students of the faculty of odontology at Universidad de Los Andes and the factor associated with its presence. Methods: In this cross-sectional study, a randomized stratified sampling was used to select the students. The sample included 311 undergraduate students evaluated between March and December 2022. The year spectrum was from 17 to 29 years old. Two calibrated examiners intra e interoperator completed a clinical evaluation with a periodontal probe, where the purpose was to diagnose gingival recessions and identify if there were any related factors such as smoking, braces, bruxism, marginal insertion frenulum, fine phenotype, and malposition. The total prevalence was described with each trust interval of 95%. The association between categorical variables was analyzed with the chi-square test, and the t-student test of the Mann-Whitney test analyzed the difference between continuous variables and recession prevalence. Results: 93,56% of the students presented at least one gingival recession. The highest prevalence related to teeth occurred in pieces 1.6, 3.4, 2.6, and 4.1, and the most severe were 3.3, 4.3, and 1.3. The most associated factor related to recessions was orthodontics, with a prevalence of 75,2%. Bruxism showed a positive association with the number of recessions, with a prevalence of 60,7%. Conclusions: Buccal gingival recessions were very prevalent in undergraduate students at the dental school of Universidad de los Andes during 2022, and they were strongly associated with the history of orthodontics.

Objetivo: Determinar la prevalencia de recesiones gingivales en alumnos de pregrado de la Facultad de Odontología de la Universidad de Los Andes, y los factores asociados a su presencia. Métodos: En este estudio transversal para la selección de los participantes, se utilizó el muestreo aleatorio estratificado. La muestra incluyó a 311 alumnos de pregrado evaluados entre marzo y diciembre del año 2022. Las edades fluctuaron entre los 17 y los 29 años. Dos examinadores calibrados intra e interoperador, realizaron una evaluación clínica con una sonda periodontal, para diagnosticar recesiones gingivales, También se buscó determinar si existían factores asociados a estas, como tabaquismo, ortodoncia, bruxismo, frenillos marginales, fenotipo fino, malposiciones. La prevalencia total fue descrita con sus respectivos intervalos de confianza al 95%. La asociación entre variables categóricas fue analizada con la prueba Chi-cuadrado y la diferencia de medias entre variables continuas y prevalencias de recesiones, fueron analizadas a través de la prueba t Student o prueba de Mann-Whitney. Resultados: Un 93,56% de los alumnos presentó al menos una recesión gingival. Los dientes con mayor prevalencia de recesiones gingivales fueron 1,6; 3,4; 2,6 y 4,1; los con mayor severidad fueron el 3,3, 4,3 y 1,3. El factor con mayor asociación a la ocurrencia de recesiones fue el historial de tratamiento ortodóncico con una prevalencia del 75,2%. El bruxismo presentó asociación positiva con respecto al número de recesiones gingivales con una prevalencia de 60,7%. Conclusiones: Las recesiones gingivales vestibulares son una condición muy prevalente en estudiantes de odontología de la Universidad de Los Andes durante el año 2022, con una fuerte asociación a la historia de tratamiento ortodóncico.

Effect of suturing in root coverage via coronally advanced flaps: A systematic review.

BACKGROUND: To analyze the evidence about the influence of the suturing technique and material in terms of the percentage of mean root coverage (%MRC) following root coverage therapy in teeth diagnosed with single/localized gingival recession defects (GRD) via a monolaminar coronally advanced flap. METHODS: The protocol of this systematic review was registered in PROSPERO (CRD42024514043). A literature search was conducted to identify investigations that fulfilled the eligibility criteria. Variables of interest were extracted, subsequently categorized, and qualitatively analyzed. RESULTS: A total of 15 randomized clinical trials, including 301 localized GRD in non-molar sites classified as Miller class I-II/RT1, in 253 patients were included. The studies reporting the combination of sling and single interrupted sutures, or interrupted sutures alone showed an MRC of 70.2%±16.6%, and 74.1%±0.75%, respectively. The highest MRC was observed in the studies using polyglactin 910 with a pooled value of 76.6% ± 15.3%, and monofilament materials, with a pooled MRC of 74.8%±7.1%. When the suturing diameter was evaluated, the highest pooled MRC with values of 79.1%±9.8% was observed with the use of 5-0. CONCLUSIONS: For the treatment of single/localized GRD in non-molar sites via a monolaminar coronally advanced flap, the use of a combination of sling and single interrupted sutures, or single interrupted sutures, polyglactin 910 or monofilament materials, and material diameter of 5-0 showed a higher MRC as compared to the use of expanded polytetrafluoroethylene, and silk with/without dressing, and other suture diameters. KEY POINTS: There were no differences in the percentage of root coverage achieved between the use of sling and single interrupted, versus single interrupted sutures alone on the treatment of single/localized GRD in non-molar sites. Polyglactin 910 and monofilament sutures resulted in a higher percentage of root coverage achieved as compared to expanded polytetrafluoroethylene, and silk with/without dressing. The use of 5-0 material diameter showed the highest percentage of root coverage achieved. PLAIN LANGUAGE SUMMARY: This study was primarily aimed at evaluating how different suturing techniques and materials could affect the percentage of root coverage in single/localized recession defects, without the use of soft tissue substitutes or autogenous soft tissue grafts. After the pooled analyses of 15 randomized clinical trials that fulfilled the inclusion criteria, we observed that the adequate selection of suturing techniques, materials, and size could lead to a higher percentage of root coverage. Specifically, the use of single interrupted with or without sling sutures at the most coronal portion, Polyglactin 910 or monofilament materials, and size of 5-0 showed a higher percentage of root coverage as compared to the use of expanded polytetrafluoroethylene, and silk with/without dressing, and other suture diameters.

Digital and analog techniques for cemento-enamel junction reconstruction: A case study.

BACKGROUND: Non-carious cervical lesions (NCCLs) refer to the loss of dental hard tissue in the cervical region due to physical and/or chemical factors, often associated with the disappearance of the cemento-enamel junction (CEJ), posing challenges in both diagnosis and treatment of gingival recessions (GR). This case study introduces two protocols for multidisciplinary CEJ reconstruction prior to the root coverage therapy (RCT). METHODS: Two patients with GR and NCCLs were treated using two CEJ reconstruction techniques: both, analogically and digitally guided. For each case, the position of the therapeutic CEJ was predetermined using a combination of the methods described by Zucchelli and Cairo. Then, an analog or digital diagnostic wax-up was performed accordingly. In the analogically guided technique, a transparent silicone guide matrix was used to transfer information from the dental wax-up. In contrast, the digitally guided technique employed a rigid, translucent resin prosthetic guide matrix that was designed and printed. Restorations were fabricated using direct composite resin and RCT was performed 1 week later in both techniques. RESULTS: At 6 months, both cases demonstrated complete root coverage and effective healing of the soft tissues surrounding the restorations. CONCLUSIONS: Dimensional changes in materials and precise guide adjustment in the analog technique are operator-dependent and can affect the outcomes. Digital procedures, though effective, are costly and may limit their use. The usage of these two CEJ reconstruction techniques enhances communication within the multidisciplinary team and ensures optimal aesthetic outcomes and precise placement of the gingival margin. KEY POINTS: There are no established clinical protocols described in the literature for reconstructing the cemento-enamel junction (CEJ) once the position of a therapeutic CEJ has been predetermined and prior root coverage therapy (RCT). Performing a diagnostic wax-up (analogically or digitally) to reconstruct the therapeutic CEJ is crucial and facilitates the creation of a prosthetic guide that accurately reproduces the defined CEJ position. The reconstruction of the CEJ may improve the prognosis of RCT. PLAIN LANGUAGE SUMMARY: This study looked at a dental issue called non-carious cervical lesions, which happens when the hard tissue near the gum line of a tooth wears away, making it harder to treat gum recession. Two different approaches were tested to rebuild the lost tissue in the gum area before performing a procedure to cover the exposed roots. One approach used traditional methods with physical guides to help place the new tissue, while the other used advanced digital techniques to create a precise guide using 3D printing. After 6 months, both methods successfully covered the exposed roots and helped the gums heal properly. However, the traditional method's results can vary depending on the dentist's skill, while the digital method, although more accurate, can be expensive. Using these methods can improve teamwork among dental specialists and lead to better-looking results by ensuring the gum line is placed exactly where it should be.

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.

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.

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.

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.

Efficacy of acellular xenogeneic dermal matrix graft in the treatment of multiple gingival recessions: systematic review and meta-analysis.

OBJECTIVE: This study aimed to compare the efficacy of acellular xenogeneic dermal matrix graft (AXDM) compared to connective tissue graft (CTG) in treating multiple gingival recessions. MATERIALS AND METHODS: A systematic search of electronic databases was conducted to identify randomized clinical trials (RCTs) that compared AXDM and CTG. The selected studies were subjected to bias risk assessment, data extraction, and meta-analyses. Parameters such as gingival recession height, width, mean percentage of root coverage, and complete root coverage were analyzed. RESULTS: Seven RCTs involving 146 patients were included. The meta-analyses indicated that CTG was statistically superior to AXDM in reducing gingival recession height at the final follow-up (mean difference: -0.104 mm, 95% confidence interval [CI]: -0.180-0.028, p = 0.008) and width at the final follow-up (mean difference: -0.285 mm, 95% CI: -0.541-0.030, p = 0.029). CTG also demonstrated a significantly higher mean percentage of root coverage at the 6-month follow-up (difference in means: -2.761 mm, 95% CI: -4.932-0.590, p = 0.013) and a higher percentage of complete root coverage at the 6-month follow-up (odds Ratio [OR]: 0.598, 95% CI: 0.4-0.892, p = 0.012) compared to AXDM. However, there was no significant difference in the number of teeth with complete root coverage between CTG and AXDM (OR: 1.610, 95% CI: 0.983-2.636, p = 0.058) and aesthetic outcomes (mean difference: 0.148, 95% CI: -0.277-0.573, p = 0.494). CONCLUSIONS: CTG is more effective than AXDM in treating multiple gingival recessions. This is evidenced by significant reductions in gingival recession height and width, a higher mean percentage of root coverage, and a greater percentage of complete root coverage at the 6-month follow-up. CLINICAL RELEVANCE: In some clinical situations an alternative to CTG is required for the treatment of multiple gingival recessions. AXDM, despite presenting clinical outcomes that are not as satisfactory as CTG, can be used for this purpose.

Long-term stability of gingival margin and periodontal soft-tissue phenotype achieved after mucogingival therapy: A systematic review.

BACKGROUND: The aim of this systematic review was two-fold: (i) to evaluate the long-term (≥5 years) stability of the gingival margin position, keratinized tissue width (KTW) and gingival thickness (GT) in sites that underwent root coverage (RC) or gingival augmentation (GA); and (ii) to assess the influence of different local variables on the long-term stability of dental and gingival tissues. MATERIALS AND METHODS: Randomized controlled trials (RCTs) and non-RCTs reporting short-term (i.e., 6-12 months after baseline surgical intervention) and long-term (≥5 years) follow-up data after surgical treatment of adult patients presenting single or multiple mucogingival deformities, defined as sites presenting gingival recession defects (GRDs) and/or (KTW) deficiency (i.e., <2 mm), were considered eligible for inclusion. MEDLINE-PubMed, EMBASE and Cochrane Central Register of Controlled Trials databases were searched for articles published up to 15 May 2023. Mixed-effects multiple linear regression was used to assess the association between KTW, type of surgical procedure and time (i.e., independent variables) on the stability of the gingival margin in sites that received RC or GA therapy. RESULTS: Of the 2569 potentially eligible records, 41 (reporting 40 studies) met the eligibility criteria. Graphical estimates including data from all RC procedures found an upward trend in recession depth (RD) increase over time. Conversely, it was observed that in 63.63% of RC studies and in 59.32% of RC treatment arms KTW increased over time, particularly in sites treated with subepithelial connective tissue grafts (SCTGs). Conversely, sites that underwent GA procedures generally exhibited an overall reduction of KTW over time. However, sites treated with free gingival grafts (FGGs) showed a decrease in RD after 10 years of follow-up. Three main findings derived from the pooled estimates were identified: (i) Gingival margin stability was associated with the amount of KTW present during short-term assessment (i.e. the greater the KTW at 6-12 months after treatment, the more stable the gingival margin). (ii) The use of autogenous soft-tissue grafts was associated with lower RD increase over time. (iii) Treatment approaches that contribute to the three-dimensional enhancement of the gingival phenotype, as clearly demonstrated by FGG, were associated with gingival margin stability. CONCLUSIONS: The extent of apical migration of the gingival margin appears to be directly related to the amount of KTW and GT upon tissue maturation. Interventions involving the use of autogenous grafts, either SCTG or FGG, are associated with greater short-term KTW gain and lower RD increase over time.

Co-occurrence of periodontal lesions and dental wear in incisor and masticatory teeth in two sheep flocks in Brazil.

BACKGROUND: Periodontitis and tooth wear are multifactorial diseases with distinct etiopathogenesis that affect the health, feed efficiency and welfare of sheep. METHODS: This study evaluated the co-occurrence of tooth wear and periodontal lesions in 129 ewes from two Brazilian flocks, clinically classified the lesions and presence of dental calculus, and identified potential pathogens in the dental biofilm of 63 ewes by polymerase chain reaction. RESULTS: Of the 129 ewes included in the study, 75 presented periodontal lesions, while all animals presented tooth wear and dental calculus. Of the animals with periodontal lesions, 16.2% had lesions in incisor teeth and 52.7% in masticatory teeth. Regarding excessive tooth wear, 38.6% had severe wear on the incisor teeth and 89.1% on the masticatory teeth. Ewes older than 36 months had a higher frequency of periodontal lesions in incisor teeth (p < 0.001) and a greater amount of dental calculus (p < 0.001), but there was no association between tooth wear and animal age. Fusobacterium nucleatum, Tannerella forsythia and Fusobacterium necrophorum predominated in periodontal lesions. LIMITATION: This study is limited by the small sample size and lack of diagnostic imaging to assess periodontal disease. CONCLUSION: The co-occurrence of periodontal lesions and excessive dental wear involving both the incisor and masticatory teeth suggests that although the two diseases have different aetiologies, they likely have common risk factors.

Protocolo para el tratamiento de la recesión gingival con membrana de fibrina rica en plaquetas / Protocol for the Treatment of Gingival Recession with Platelet-rich Fibrin Membrane

Introducción: Es necesario la aplicación de protocolos de actuación como herramientas que permiten homogeneizar los procedimientos plásticos periodontales regenerativos y establecer las pautas de actuación del Periodontólogo para el abordaje de las recesiones gingivales con esta modalidad terapéutica de avanzada. Objetivo: Diseñar un protocolo para el tratamiento de la recesión gingival mediante la utilización de la membrana de fibrina rica en plaquetas, asociada al colgajo de avance coronal. Métodos: Se realizó una investigación con enfoque cualitativo en la Facultad de Estomatología de Villa Clara, de julio de 2020 a diciembre de 2021. Para el diseño del protocolo se empleó una fase de preparación y una de elaboración; dentro de esta última se estructuraron tres momentos: revisión sistemática de la literatura, aplicación de técnicas grupales (grupo focal y nominal) y conclusión del documento. Se realizó una valoración por criterios de especialistas externos antes de concluir la estructura definitiva del protocolo. Resultados: Se consultaron cinco guías para la confección de protocolos, cinco protocolos de atención médica y enfermería y 10 estomatológicos. La estructura del documento quedó conformada por: portada, introducción, objetivos, profesionales a quienes va dirigido, población diana, proceso de elaboración, procedimiento, algoritmo, fecha de implementación y revisión, proceso de implantación, indicadores de evaluación, glosario y referencias bibliográficas. Conclusiones: Se diseñó un protocolo de actuación que establece las pautas para la realización del proceder terapéutico regenerativo, desde la selección de los pacientes hasta la evolución de la terapéutica. El documento se valoró por especialistas externos como positivo(AU)

Introduction: It is necessary to apply action protocols as tools to homogenize regenerative periodontal plastic procedures and to establish the guidelines for the periodontist to approach gingival recession with this advanced therapeutic modality. Objective: To design a protocol for the treatment of gingival recession using platelet-rich fibrin membrane associated with coronal advancement flap. Methods: A research with a qualitative approach was carried out in the School of Stomatology of Villa Clara, from July 2020 to December 2021. For the design of the protocol, a preparation phase and an elaboration phase were used; within the latter, three moments were structured: systematic review of the literature, application of group techniques (focal and nominal group) and conclusion of the document. An evaluation by external specialists was carried out before finalizing the definitive structure of the protocol. Results: Five guides for the preparation of protocols, five medical and nursing care protocols and 10 stomatological protocols were consulted. The structure of the document consisted of: cover page, introduction, objectives, target professionals, target population, elaboration process, procedure, algorithm, implementation and revision date, implementation process, evaluation indicators, glossary and bibliographic references. Conclusions: An action protocol was designed that establishes the guidelines for carrying out the regenerative therapeutic procedure, from the selection of patients to the evolution of the therapy. The document was positively evaluated by external specialists(AU)

Treatment of single gingival recessions using biofunctionalized collagen matrix: A case series.

BACKGROUND: Connective tissue graft substitutes have been used widely to overcome autogenous graft limitations. Nevertheless, they do not provide comparable results in the treatment of periodontal and peri-implant soft tissue defects. Based on the principles of tissue-engineered materials, injectable platelet-rich fibrin (i-PRF) has been combined with collagen matrices (CMs) to enhance their clinical efficacy. To the best of our knowledge, this is the first case series demonstrating the use of i-PRF for the biofunctionalization of a volume-stable collagen matrix (VCMX) as an adjunct to coronally advanced flap (CAF) to treat single gingival recession (GR) defects. METHODS & RESULTS: The study included 10 patients. Bleeding on probing, probing depth, GR height, clinical attachment level, esthetics, and dentin hypersensitivity were evaluated. After 6 months, a significant GR reduction (RecRed: 2.15 ± 0.7 mm; p = 0.005) and percentage of root coverage (% RC) of 81.13% were observed. Additionally, 40% of the sites showed complete root coverage. Gingival thickness increased 0.64 mm. Patient-centered evaluations demonstrated dentin hypersensitivity and esthetics improvements by the end of follow-up. CONCLUSION: VCMX biofunctionalized with i-PRF associated with CAF technique showed promising clinical outcomes in the treatment of single RT1 GR defects.

Treatment of Multiple Gingival Recessions in Maxilla and Mandible: a Case Report / Tratamento de Recessões Gengivais Múltiplas em Maxila e Mandíbula: um Relato de Caso

This study aimed to report a treatment of multiple gingival recession in a 43-year-old female patient. After clinical and tomographic evaluation, Miller's class I and II (or Cairo RT1) gingival recessions were observed in several teeth of maxilla and mandible. Non-carious cervical lesions, poorly adapted crowns and unbalanced occlusion were also diagnosed, with the absence of canine guides. A thin gingival phenotype was also found. Orthodontic treatment was not performed, as a thin vestibular bone wall in the mandible was detected. Therefore, correction of the occlusion was performed by means of selective wear on cusps of the posterior teeth to relieve premature contacts. For root coverage, tunneling technique was used in the first, second and fourth sextants. In the fifth sextant, full covering occurred only after a second surgery. A third surgery was performed in the fourth quadrant, and the modified Bruno technique was chosen. The donor region was the palate in all the procedures. The two techniques employed reached up to 100% root coverage in all areas that received the surgery. The patient was satisfied with the final result. It was concluded that complete root coverage is possible when using tunneling technique in patients without interproximal bone loss. (AU)

Esse estudo objetivou reportar um tratamento de recessões gengivais múltiplas em uma paciente do sexo feminino de 43 anos. Após avaliação clínica e tomográfica, recessões gengivais classe I e II de Miller (ou RT1 de Cairo) foram observadas em diversos dentes da maxila e mandíbula. Lesões cervicais não cariosas, coroas mal adaptadas e oclusão desbalanceada também foram diagnosticadas, com ausência de guias caninas. Um fenótipo gengival fino foi observado. Tratamento ortodôntico não foi realizado, pois uma parede óssea vestibular fina na mandíbula foi detectada. Portanto, correção da oclusão foi realizada com desgastes seletivos de cúspides dos dentes posteriores para avaliar os contatos prematuros. Para o recobrimento radicular, técnica de tunelização foi utilizada no primeiro, secundo e quarto sextantes. No sexto sextante, recobrimento completo foi conseguido apenas após a segunda cirurgia. Uma terceira cirurgia foi realizada no quarto quadrante, e a técnica modificada de Bruno foi escolhida. O palato foi a região doara em todos os procedimentos. As duas técnicas cirúrgicas empregadas chegaram até a 100% de recobrimento radicular em todas as áreas que receberam a cirurgia. A paciente ficou satisfeita com o resultado final. Foi concluído que o recobrimento radicular complete é possível quando se utiliza a técnica da tunelização em pacientes sem perda óssea interproximal. (AU)

Lower incisor inclination and thickness of the alveolar process and mandibular symphysis in the development of gingival recession: A retrospective cohort study.

Introduction: Retrospective studies have found conflicting results regarding the relationship between lower incisor inclination and the development of gingival recession (GR) after orthodontic treatment. Objective: This study aimed to investigate the relationship between lower incisor inclination and alveolar process (AP) and mandibular symphysis (MS) thickness in the development of GR. Materials and Methods: Frontal intraoral photography and cephalometric radiography were conducted before (T0) and after (T1) orthodontic treatment of 62 subjects. The presence of GR was considered when the cementoenamel junction was visible in the lower incisor on the frontal intraoral photograph. The circumstances for improvement, stability, and worsening of the gingival situation were based on the reduction, maintenance, and increase in the number of lower incisors with GR before and after treatment. To measure the incisor-mandibular plane angle (IMPA) and the thickness of the AP and the MS were used the cephalometric radiographs. Results: Men had a significantly thicker MS than women at T0 and T1 (p < 0.0004). There was a significant reduction of approximately 10% in AP between T0 and T1 (p < 0.0001). Among subjects without GR at T0, 70.4% presented a stable gingival situation at T1. For subjects with 1 lower incisor with GR at T0, 50% showed improvement in the gingival situation at T1, 21.4% remained stable, and 28.6% experienced worsening. Sixteen lateral incisors presented a worsening gingival situation, representing an increase of 129% compared to the central incisors. Conclusion: No relationship was found between lower incisor inclination and the thickness of the AP and MS in the development of GR.

Recubrimiento radicular de recesiones gingivales con matriz dérmica acelular / Root coverage of gingival recession with acellular dermal matrix

La recesión gingival es considerada como una deformidad o condición mucogingival, la Academia Americana de Periodontología, define a la recesión gingival como el desplazamiento del margen del tejido blando apical a la unión cemento-esmalte con la exposición de la superficie radicular. El tratamiento de las recesiones gingivales es un motivo de consulta común debido a razones estéticas, hipersensibilidad dentinaria, molestias durante el cepillado e incluso temor a la pérdida dentaria. Es una situación clínica común, 60% de la población humana tiene algún tipo de recesión gingival. Al realizar el examen clínico a paciente masculino de 55 años, se observó una recesión gingival tipo 1 (RT1) sin pérdida de inserción interproximal de la clasificación de Cairo. Se realizó el colgajo posicionado coronalmente (CPC) utilizando una matriz dérmica acelular (MDA) de origen humano OrACELL®. Se obtuvo resultado favorable en el recubrimiento de recesiones gingivales múltiples; considerándolos como una buena alternativa frente a los injertos gingivales autógenos. Concluyendo que, el uso de la matriz dérmica acelular para el tratamiento de la recesión gingival tipo 1 es una adecuada opción para el recubrimiento radicular. Se recomiendan más estudios a largo plazo para ver la estabilidad de los resultados obtenidos con la MDA (AU)

Gingival recession, considered a deformity or mucogingival condition, the American Academy of Periodontology, defines gingival recession as the exposure of the root surface resulting from migration of the gingival margin apical to the cementoenamel junction (CEJ). The treatment of gingival recessions is a common reason for consultation due to aesthetic reasons, dentin hypersensitivity, discomfort during brushing and even fear of tooth loss. It is a common clinical situation, 60% of the human population has some kind of gingival recession. Clinical examination of a 55-year-old male patient showed a type 1 gingival recession (RT1) without loss of interproximal insertion of the Cairo classification. Coronally advanced flap (CAF) was performed using an acellular dermal matrix (ADM) of human origin OrACELL®. Favorable results were obtained in the coating of multiple gingival recessions; considering them as a good alternative to autogenous gingival grafts. Concluding that, the use of the acellular dermal matrix for the treatment of gingival recession type 1, is a suitable option for root lining. Further long-term studies are recommended to see the elasticity of MDA outcomes (AU)

Gingival recession in canines orthodontically aligned: a narrative review / Recessão gengival em caninos ortodonticamente alinhados: uma revisão narrativa

Background: The orthodontic traction of impacted canines represents a great challenge for Orthodontics. Surgical exposure of the impacted canine and the complex orthodontic mechanics applied to align the tooth back to the arch can lead to complications involving supporting tissues inducing gingival recession when the teeth are moved out of the alveolar bone. Aim: The aim of this study is to present an updated bibliographic review of the main periodontal results found in the literature after the clinical management of impacted canines and the prevalence of gingival recession. Materials and methods: Research in electronic databases PubMed, PMC, and MedLine until June 2020 and reference lists of relevant publications were used to identify studies that assessed the periodontal status of impacted and orthodontically tractioned canines. Controlled and randomized clinical trials, literature reviews, systematic reviews, studies in humans, meta- analyzes and text that had at least one occurrence relating to gingival recession, periodontal outcomes and impacted canines tractioned orthodontically, whether by buccal or palatal, superior and / or lower as the eligibility criteria. Results: 691 articles were found in a free search. After applying the eligibility criteria, 7 relevant articles were subtracted, and these results were more frequent for upper canines. Conclusion: Currently, there is no clear evidence to determine which surgical technique procedure is better to discover canines in terms of periodontal outcomes. The results found stated that clinically the evidence were insignificant when compared to teeth normally erupted.

Introdução: O tracionamento ortodôntico de caninos inclusos representa um grande desafio para a Ortodontia. A exposição cirúrgica do canino impactado e a complexa mecânica ortodôntica aplicada para alinhar o dente de volta ao arco podem levar a complicações envolvendo os tecidos de suporte, induzindo recessão gengival quando os dentes são movimentados para fora do osso alveolar. Objetivo: O objetivo deste estudo foi apresentar uma revisão bibliográfica atualizada dos principais resultados periodontais encontrados na literatura após o manejo clínico de caninos impactados e a prevalência de recessão gengival. Materiais e métodos: Foram feitas pesquisas eletrônicas no PubMed, PMC e MedLine até junho de 2020 e uma listas de referência de publicações relevantes foram usadas para identificar estudos que avaliaram o estado periodontal de caninos impactados e tracionados ortodonticamente. Ensaios clínicos controlados e randomizados, revisões de literatura, revisões sistemáticas, estudos em humanos, metanálises e textos que tiveram pelo menos uma ocorrência relacionada a recessão gengival, desfechos periodontais e caninos impactados tracionados ortodonticamente, seja por vestibular ou palatino, foram os critérios de elegibilidade. Resultados: Foram encontrados 691 artigos em busca livre. Após a aplicação dos critérios de elegibilidade, 7 artigos relevantes foram subtraídos, sendo esses resultados mais frequentes para caninos superiores. Conclusão: Atualmente, não há evidências claras para determinar qual técnica cirúrgica é melhor para descobrir caninos em termos de resultados periodontais. Os resultados encontrados afirmaram que clinicamente as evidências foram insignificantes quando comparadas a dentes normalmente

Current state about root coverage using soft-tissue substitutes in the presence of noncarious cervical lesions: A literature review.

About half of the cases of gingival recession are associated with the noncarious cervical lesion (NCCL), resulting in combined defects (CDs). NCCL negatively affects the root coverage outcomes. In addition, considering the morbidity associated with graft harvesting, soft-tissue substitutes (STSs) appeared as a suitable option for connective tissue grafts for surgical root coverage. Currently, the literature addressing the therapy of CDs employing STSs is scarce. Thus, the present review aimed to update the literature and outline the future perspectives about root coverage of CDs using STSs. A detailed literature search was conducted on MEDLINE, Web of Science, EMBASE, LILACS, Scopus, and Google Scholar databases using keywords and Boolean operators. Randomized clinical trials (2) and case reports (6) were included. None of the selected studies reported any adverse effect using STSs. Based on the limited evidence available, we cannot state that STSs may benefit the periodontal clinical and patient-centered outcomes. Randomized controlled trials are needed to assess the long-term outcomes, surgical approaches, and restorative protocols.

Recesión mandibular única tratada con colgajo desplazado lateral: Reporte de un caso / Single mandibular recession treated with a laterally advanced flap: a case report

Introducción: Hoy en día, uno de los motivos de consulta de los pacientes es la inconformidad con su apariencia estética debido a la presencia de recesiones gingivales. Dentro de las diversas técnicas para tratar este tipo de defectos se encuentra el colgajo posicionado lateral, el cual, se utiliza para la cobertura radicular de recesiones gingivales únicas en dientes mandibulares y cuyos resultados han demostrado ganancia en altura de tejido queratinizado, ganancia en inserción clínica y una cobertura radicular completa. Reporte de Caso: Paciente femenino de 32 años, diagnosticado con defecto mucogingival único en torno a pieza dental 3.1 y que fue tratado con un colgajo posicionado lateral en combinación con proteínas derivadas de la matriz del esmalte, con el objetivo de cubrir la recesión gingival. Conclusión: La técnica de colgajo posicionado lateral es un tratamiento viable y eficaz para la cobertura radicular completa de defectos mucogingivales únicos en torno a diente, donde además se obtiene ganancia en altura de encía queratinizada, así como de nivel de inserción clínica.

Introduction: Nowadays, one of the reasons for consultation of patients is the dissatisfaction with their aesthetic appearance due to the presence of gingival recessions. Among the various techniques to treat this type of defects is the laterally positioned flap, which is used for root coverage of single gingival recessions in mandibular teeth and whose results have shown gain in height of keratinized tissue, clinical attachment gain and complete root coverage. Case Report: 32-year-old female patient, diagnosed with a single mucogingival defect around tooth 3.1 and treated with a laterally positioned flap in combination with enamel matrix derivatives, in order to cover the gingival recession. Conclusion: The laterally positioned flap technique is a viable and effective treatment for complete root coverage of single mucogingival defects around the tooth. In addition, there is a gain in keratinized gingiva and in clinical attachment.