Entire Papilla Preservation Technique with Recombinant Human Fibroblast Growth Factor-2 and Autogenous Bone Grafting in the Treatment of Isolated Non-Contained Intrabony Defect: Case Report of a 5-Year Follow-Up.

Regenerative periodontal surgery is an effective procedure for the treatment of intrabony defects. Various flap designs preserving the defect-associated interdental papilla have been proposed to improve early wound stability. This case report describes the long-term results of a regenerative treatment in severely compromised mandibular canine using entire papilla preservation technique. Surgical access was provided by a single buccal vertical incision without any papilla incision. Combination of autogenous bone harvested from the same surgical site and recombinant human fibroblast growth factor-2 was applied to non-contained intrabony defect following the granulation tissue removal. Surgical site was closed with single interrupted sutures. The clinical outcomes and 5-year stability of pocket closure with no increase in gingival recession show the potential of entire papilla preservation technique with the use of combined biomaterials.

Coronally Advanced Entire Papilla Preservation (CA-EPP) Flap in the Treatment of an Isolated Intrabony Defect to Promote Buccal and Interproximal Soft Tissue Stability: Case Reports.

Surgical treatment of infrabony defects may result in gingival recession of the neighboring teeth. The aim of this clinical report is to describe a surgical technique to promote gingival margin stability in the treatment of infrabony defects at sites with a thin or medium gingival phenotype. A coronally advanced entire papilla preservation (CA-EPP) flap with a connective tissue graft (CTG) was executed in two different clinical cases. This technique substantially improved interproximal clinical attachment level and pocket closure, with no gingival recession. A CA-EPP flap using a CTG may promote gingival margin stability and can be recommended in regenerative periodontal procedures.

Assessment of gingival thickness in the maxillary anterior region using different techniques.

OBJECTIVES: Gingival phenotype is closely related to treatment success and aesthetic results in the maxillary anterior region. Several methods were proposed to measure the dimensions of the gingival tissue. This study aimed to evaluate the gingival thickness using clinical and radiographic techniques and to explore the association between gingival thickness and gingival phenotypes classified by color-coded phenotype probes. MATERIALS AND METHODS: The gingival thickness of 86 periodontally healthy maxillary anterior teeth was assessed using transgingival probing (TGP) and cone-beam computed tomography (CBCT). The gingival phenotype was classified as thin, medium, thick, or very thick by transparency of the color-coded probes through the gingival sulcus. The labial alveolar bone thickness was measured on CBCT images. The keratinized tissue width (KTW) was recorded. RESULTS: Good to excellent agreement was found between TGP and CBCT regarding the thickness of the gingiva (p<0.001). There was a very high correlation between the phenotypes determined by color-coded probes and the gingival thickness measured by TGP (r=0.953, p<0.001). KTW was significantly higher in thick and very thick phenotype groups compared with thin phenotype group. CONCLUSION: Cone-beam computed tomography images and the probe transparency method with color-coded probes are reliable for identifying the gingival phenotype in the maxillary anterior region, based on comparisons to direct transgingival probing. CLINICAL RELEVANCE: The assessment of the gingival phenotype is essential, especially in the aesthetic zone, to obtain predictable and favorable clinical outcomes in various dental procedures. The newly introduced color-coded probes comprise a non-invasive and reliable method for this.

Introduction of a Novel Anatomic Recession Ratio in the Treatment of Gingival Recession: A Proof-of-Principle Study.

The present study introduces a novel "anatomic recession ratio" (ARR) and evaluates the clinical outcomes of using a tunnel technique (TUN) with a connective tissue graft (CTG) for root coverage (RC). Sixteen systemically healthy patients contributing a total of 33 recession types 1 and 2 were treated with TUN + CTG. The predictive value of a panel of baseline clinical parameters (ARR) on RC was evaluated 12 months postoperatively. At 12 months, mean recession depth decreased from 2.74 ± 0.22 mm to 0.46 ± 0.13 mm (P < .0001); 19 sites (58%) showed complete RC, and the mean RC rate was 88.85% ± 2.73%. The mean ARR value was 0.74 ± 0.3, revealing a positive correlation with RC (r2: 0.73, P < .0001). The 12-month esthetic evaluation resulted in a score of 8.52 ± 1.75 using the root coverage esthetic score. TUN + CTG is effective in reducing recession depth and obtaining good esthetic outcomes. Within the limits of the present study, it may be suggested that ARR has potential as an analytical baseline parameter for RC outcomes with TUN + CTG.

Thin lens narcissus model in infrared lens design with cooled detectors.

A mathematical model of the narcissus effect in infrared lenses with cooled detectors is discussed. The proposed model enables optical designers to take the narcissus performance of infrared lenses into consideration in the thin lens predesign stage. Third order thin lens aberration theory is the basis for the newly proposed narcissus analysis. Two narcissus metrics are defined in terms of structural parameters of the infrared lens to be designed. The metrics provide an indirect way of controlling narcissus performance in thin lens predesign. A long wave infrared lens is discussed from a narcissus perspective within the proposed model as an example. It is shown that the proposed narcissus model is a very effective way of controlling narcissus performance, starting from the early stages of lens design.

A Novel Technique for the Estimation of Gingival Thickness: A Preliminary Study.

This study aimed to evaluate the correlation between soft tissue thickness measured by CBCT and phenotype probing estimation and to assess the thickness cutoffs for each phenotype probing outcome. CBCT was performed with a lip retractor in order to isolate periodontal soft tissues in 10 consecutive patients. Using colored probes, the phenotype was evaluated for all present teeth and recorded as thin, medium, thick, or very thick. The overall correlation between tissue thickness and the phenotype probe score was r = 0.86 (CI: 0.80, 0.90). The correlation was r = 0.90 (CI: 0.81, 0.94) when only maxillary anterior teeth were considered. The obtained cutoffs were 0.83 mm between thin and medium phenotypes, 1.07 mm between medium and thick phenotypes, and 1.24 mm between thick and very thick phenotypes. Thus, a high correlation between tissue thickness and the phenotype probe score was found. Preliminary data on the use of phenotype probes as an evaluation method for gingival thickness were promising.

Reconstructive surgical treatment of isolated deep intrabony defects with guided tissue regeneration using entire papilla preservation technique: A prospective case series.

BACKGROUND: The aim of this prospective study is to evaluate the clinical applicability of the entire papilla preservation (EPP) technique in the regenerative treatment of isolated deep intrabony defects using native collagen membrane and bone grafting materials. METHODS: Fifteen healthy and non-smoker patients (nine males and six females; mean age: 47.73 ± 12.18; range 21 to 63 years) with one isolated deep intrabony defect each (baseline probing depth (PD): 9.03 ± 1.62 mm; clinical attachment level (CAL): 11.16 ± 1.81 mm) were treated with guided tissue regeneration. Surgical access to the defect was provided by a single buccal vertical incision with an interdental tunneling flap. Following the granulation tissue removal, intrabony defect was filled with bone substitutes. A collagen barrier was trimmed and placed under the intact defect-associated papilla with palatal positioning suture. Microsurgical sutures were used for primary closure. RESULTS: At 1 week, healing of the 15 sites was uneventful. During the study, all sites showed 100% primary closure rate. At 1-year follow-up, an average CAL gain of 5.86 ± 1.28 mm (P < 0.0001), PD reduction of 6.1 ± 1.47 mm (P < 0.0001), and minimal increase in gingival recession of 0.23 ± 0.62 mm (P = 0.168) were observed. CONCLUSION: This novel surgical technique, that keeps the interdental papilla intact, seems promising to provide optimal biomaterial protection and healing conditions, even when a collagen barrier and bone substitutes are applied.

Clinical outcomes of the entire papilla preservation technique with and without biomaterials in the treatment of isolated intrabony defects: A randomized controlled clinical trial.

AIM: This study compared the clinical efficacy of the entire papilla preservation technique (EPP) alone and in combination with enamel matrix proteins plus bovine-derived bone substitutes (EPP EMD + BS) in the treatment of isolated inter-dental intrabony defects. MATERIAL AND METHODS: Thirty patients, each with one isolated intrabony defect, were randomly assigned to EPP EMD + BS or EPP alone. Clinical outcomes were assessed 1-year post-surgery. RESULTS: Early healing phase was uneventful in all cases, and 100% primary wound closure was maintained throughout the study period. Intragroup differences between baseline and 1-year were statistically significant in both groups in terms of clinical attachment level (CAL) gain and probing depth (PD) reduction (p ≤ .001). No statistically significant differences were detected in gingival recession (REC) (p > .05). No statistically significant differences were detected in terms of CAL gain (6.3 ± 2.5 mm vs. 5.83 ± 1.12 mm), PD reduction (6.5 ± 2.65 mm vs. 6.2 ± 1.33 mm) or increase in gingival recession (0.2 ± 0.25 mm vs. 0.36 ± 0.54 mm) between the groups treated with EPP EMD + BS or EPP alone. CONCLUSIONS: Application of EPP with and without regenerative biomaterials resulted in significant amounts of CAL gain and PD reduction, with negligible increase in gingival recession. Within the limits of the present study, it can be concluded that the addition of regenerative biomaterials does not improve the clinical outcomes of EPP alone. NCT03923465.

The Influence of Gingival Phenotype on the Outcomes of Coronally Advanced Flap: A Prospective Multicenter Study.

The goal of this study was to evaluate the influence of gingival phenotype (GPh) on the clinical outcomes of coronally advanced flap (CAF). In this prospective study, 24 gingival recessions (recession type RT1 class or Miller Classes I and II) in 21 patients were treated with CAF alone. Patients were classified as having thin, medium, thick, or very thick GPh using a color-coded probe. At 6 months, the lowest mean root coverage (mRC; 60.4% ± 28.8%) and complete root coverage (CRC; 25%) were found in patients with thin GPh compared to patients with medium (mRC: 86.4% ± 17.6%; CRC: 60%), thick (mRC: 93.3% ± 14.9%; CRC: 83.3%), and very thick (mRC: 86.7% ± 26.7%; CRC: 80%) GPh. Regression analysis showed a statistically significant difference (P < .05) between thin and thick/very thick GPh in the likelihood of achieving CRC. Higher RES values were observed in patients with thick and very thick GPh (8.2 ± 1.5 and 8.4 ± 1.4, respectively), while thin GPh was related to the lowest RES score (6.3 ± 2.2). CAF performed in patients with thick or very thick GPh resulted in superior clinical and esthetic outcomes than thin and medium GPh. In particular, thin GPh was associated with the lowest mRC, CRC, and root coverage esthetic scores.

Computer-aided planning of soft tissue augmentation with prosthetic guidance for the establishment of a natural mucosal contour in late implant placement.

OBJECTIVE: Late implant placement in volume deficient sites has been considered a challenging situation for the establishment of a natural mucosal topography. Dimensional relations of hard and soft tissues together with the prosthetic components have not been clarified in the literature. The aim of this proof-of-concept case report was to establish the tooth-like appearance with virtual planning prior to surgical intervention and to calculate the ideal amount of desired soft tissue. CLINICAL CONSIDERATIONS: Minimum amount of tissue reconstruction was calculated with computer-aided soft tissue augmentation and a temporary restoration mimicking the emergence profile of a molar was fabricated for guiding the peri-implant mucosa in the early wound healing phase. After 4 months of healing, the final restoration was completed with a screw-retained crown-abutment. The 2-year follow-up period demonstrated a stability of the mucosal margin and peri-implant health. CONCLUSIONS: A natural mucosal contour could be established with the help of virtual planning. The calculation of required tissue quantity may help clinicians for the creation of a natural appearance in late implant placement. CLINICAL SIGNIFICANCE: Virtual soft tissue augmentation may determine the required tissue quantity and therefore, could play an important role in the establishment of natural mucosal contour for late implant placement.

Improved volume and contour stability with thin socket-shield preparation in immediate implant placement and provisionalization in the esthetic zone.

Tooth replacement with a dental implant in the esthetic zone is a challenging treatment modality for the clinician. Each step of the treatment from tooth extraction to the definitive restoration should be performed meticulously to achieve a good esthetic outcome. Negative effects of the extraction can be minimized by various treatment protocols. Recent developments involving partial root retention (socket-shield technique) offer enhanced buccal tissue contour in these cases. This clinical report presents a slight modification to the socket-shield technique by preparing a thin shield and performing immediate implant placement. The gap between the shield and the implant was filled with a bone graft, and a screw-retained provisional restoration supported the natural emergence profile. Through the 6-month healing period, and after 1 year of function, the natural appearance of the buccal contour was maintained. Cone beam computed tomography (CBCT) and volumetric analysis confirmed the presence of the buccal bone plate and volume stability. This case report demonstrates that improved buccal contour stability and a high esthetic outcome can be achieved with thin socket-shield preparation.

Entire papilla preservation technique in the regenerative treatment of deep intrabony defects: 1-Year results.

AIM: This study evaluates the clinical outcomes of a novel tunnel-like surgical technique in the treatment of isolated deep intrabony defects. MATERIAL AND METHODS: Twelve patients presenting with at least one isolated deep intrabony defect received regenerative periodontal treatment with "entire papilla preservation (EPP)" technique. Access to the intrabony defect for debridement was provided by a bevelled vertical releasing incision positioned in the buccal gingiva of the neighbouring inter-dental space. Following the elevation of a buccal flap, an inter-dental tunnel was prepared undermining the defect-associated papilla. Granulation tissue was removed, root surfaces were carefully debrided and bone substitutes and enamel matrix derivative were applied. Microsurgical suturing technique was used for optimal wound closure. RESULTS: Early healing was uneventful in all cases, and 100% wound closure was maintained during the entire healing period. At 1-year, there was significant attachment gain of 6.83±2.51 mm (p<0.001). The 7±2.8 mm reduction in probing depth was also significant (p<0.001), which was associated with minimal increase in gingival recession (0.16±0.38 mm, p=0.166). CONCLUSIONS: Tunnel-like "EPP" technique may limit the risk of wound failure particularly in the early healing phase, thereby preventing exposure of regenerative biomaterials, possibly enhancing stabilization of blood clot in deep intrabony defects and leading to optimal clinical outcomes.

Entire Papilla Preservation Technique: A Novel Surgical Approach for Regenerative Treatment of Deep and Wide Intrabony Defects.

Primary wound closure and uneventful early wound stability over the biomaterials are the most critical elements of successful periodontal regeneration. Yet the surgical elevation of the interdental papilla to access deep and wide intrabony defects entails an impairment of the papillary blood supply that can result in difficult healing due to a lack of primary closure in the early healing period. This negative event might complicate the healing process, favoring bacterial contamination. A novel modified tunnel surgical technique designed to maintain the integrity of the interdental papilla is presented in this article, with the aim of providing an optimal environment for wound healing in regenerative procedures. Entire papilla preservation is described and applied in three different cases, in association with the use of a combination of bone substitutes and enamel matrix derivative for periodontal regeneration. The entire papilla preservation technique was successfully applied to the three selected cases, resulting in an uneventful postsurgical period and a substantial defect fill over the 8-month follow-up. This tunnel-like technique can be recommended for further research to support the success identified in this case series.