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.

Microbiological evaluation in invisible aligner chemical cleaning methods against Candida albicans and Streptococcus mutans.

INTRODUCTION: This study aimed to assess the efficacy of chemical agents in removing Candida albicans and Streptococcus mutans biofilm from invisible aligners. METHODS: The samples were made of EX30 Invisalign trays, biofilm was cultured by standardized suspensions of C. albicans ATCC strain and S. mutans clinical strain on the sample. The treatments used were 0.5% sodium hypochlorite (NaClO) (20 minutes), 1% NaClO (10 minutes), chlorhexidine (5 minutes), peroxide (15 minutes), and orthophosphoric acid (15 seconds). The control group received phosphate-buffered saline for 10 minutes. The colony-forming units per milliliter of each microorganism were determined by serial dilutions seeded in plates with selective culture mediums for each one. Data were analyzed by the Kruskal-Wallis and Conover-Iman tests at an α of 0.05. RESULTS: For the C. albicans biofilm group, the control group had 9.7 Log10 of microorganism growth, and all treatment groups had statistically significant biofilm reduction, in which chlorhexidine presented the highest inhibition of 3 Log10, followed by alkaline peroxide and orthophosphoric acid both with 2.6 Log10, 1% NaClO (2.5 Log10), and 0.5% NaClO (2 Log10). As for S. mutans, the control group had 8.9 Log10 of growth, and a total microorganism inhibition was reached by chlorhexidine, 1% NaClO, and orthophosphoric acid, whereas alkaline peroxide inhibited growth to 7.9 Log10 and 0.5% NaClO 5.1 Log10. CONCLUSIONS: Within the limitations, chlorhexidine and orthophosphoric acid had greater efficacy in both biofilms. In addition, 1% NaClO and alkaline peroxide also had significant effects; therefore, their incorporation aligners disinfection protocols are valid.

Collagen matrix biofunctionalized with injectable platelet-rich fibrin for the treatment of single gingival recession: A case report.

INTRODUCTION: Collagen matrices have been used as connective tissue graft (CTG) substitutes. However, they do not have the same efficacy compared to CTG. Adding biological agents may increase collagen matrices' efficacy. The present case reports the use of a biofunctionalized volume-stable collagen matrix (VCMX) with injectable platelet-rich fibrin (iPRF) associated with the coronally advanced flap (CAF) to treat single gingival recession (GR) defect. CASE PRESENTATION: A Recession Type 1 (RT1 A-) defect at maxillary left canine in a male patient was treated using a VCMX biofunctionalized with iPRF associated with CAF. No swelling or edema was observed during the first 14 days after surgery. Complete root coverage was observed (RecRed of 4.0 mm) after 6 months. Gingival thickness (GT) increased (1.0 mm) by the end of the follow-up. CONCLUSION: The present case report shows that CAF associated with VCMX+iPRF presents good clinical outcomes for single GR defect. KEY POINTS: Why is this case new information? This case is the first one to our knowledge to describe the biofunctionalization of VCMX with iPRF to treat single gingival recession. What are the keys to successful management of this case? Proper material handling. Proper iPRF protocol execution. What are the primary limitations to success in this case? Need of venipuncture. Correct preparation of VCMX+iPRF. Patient compliance.

New Volume-Stable Collagen Matrix and Modified Coronally Advanced Flap to Treat Multiple Gingival Recessions Associated With Partially Restored Non-Carious Cervical Lesions: A Case Report.

INTRODUCTION: Gingival recession (GR) is a prevalent problem that is related to esthetic demands and dentin hypersensitivity. Frequently, GR is associated with non-carious cervical lesion (NCCLs) forming a combined defect (CD), which requires restorative and surgical treatment. Connective tissue graft procedures allow predictable root coverage but can result in patient discomfort. CASE PRESENTATION: This first case report describes multiple GRs associated with B+ NCCL at teeth #4 and #6 of a 27-year-old patient with a thin periodontal phenotype. The aim of this report was to evaluate the 6-month outcome of a new volume-stable collagen matrix (VCMX) combined with modified coronally advanced flap (MCAF) and partial restoration to treat CDs. After 6 months, significant improvement was observed regarding CD coverage (69.05%), recession reduction (2.25 mm), gingival thickness gain (0.74 mm), and keratinized tissue width gain (0.75 mm). In addition, excellent esthetic evaluation and patient comfort were achieved by using the biomaterial. CONCLUSION: VCMX associated with MCAF and partial restoration may be an option to treat multiple recession defects plus B+ NCCLs.

Confecção, caracterização e avaliação do efeito de membranas à base de fibroína carregadas ou não com neurotensina em feridas abertas em palato: estudo clínico randomizado / Manufacturing, characterization, and evaluation of silk fibroin-based membranes with or without neurotensin on palatal wound healing: in vitro and randomized clinical trial

A utilização de enxertos autógenos provenientes do palato para reconstrução de tecidos gengivais, apesar de serem considerados o padrão-ouro, causam grande morbidade e dor pós-operatória. Assim, com o intuito de reduzir essas complicações, alguns biomateriais podem ser explorados, acelerando a cicatrização e trazendo maior conforto ao paciente. Dessa forma, os objetivos do presente estudo foram: confeccionar e caracterizar membranas à base de fibroína de seda sem carregamento (F) ou carregadas com neurotensina (FN) e avaliar clinicamente seus efeitos no reparo de feridas abertas no palato. Para a primeira parte, as membranas foram confeccionadas e caracterizadas quanto à espessura, propriedades mecânicas, textura superficial, permeabilidade ao vapor de água, degradação enzimática, citotoxicidade, genotoxicidade e intumescimento. Para a segunda parte, sessenta e um pacientes com necessidade de exodontia e preservação alveolar foram randomizados em três grupos: Controle: exodontia e selamento do alvéolo com EGL removido do palato; Grupo F: exodontia com EGL e inserção da membrana F na ferida palatina; Grupo FN: exodontia com EGL e membrana FN na ferida palatina. A reparação da área doadora palatina foi avaliada por parâmetros clínicos centrados nos pacientes. A partir dos resultados de caracterização, pode-se constatar a homogeneidade das membranas, alta resistência mecânica e maior intumecimento, permeabilidade e rugosidade superficial, características favoráveis para feridas intraorais. Em adição, não apresentaram citotoxicidade (HFF-1, HaCaT e fibroblastos gengivais humanos) e genotoxicidade (HaCaT) in vitro. Em relação aos resultados clínicos, em 14 dias FN mostrou maior diminuição de ARF (p<0,001) e melhor ET (p = 0,022) do que F e GC; ao analisar-se o ICPF, ambos os biomateriais F e FN apresentaram melhores resultados em 14 dias comparados ao GC (p= 0,009 e p = 0,001 respectivamente); não houve diferença entre os grupos em relação ao ED (p= 0,312) e ET (p = 0,120). OHIP em F e FN se mostrou superior a GC a partir do 5º dia, NA e DPO mantiveram-se mais baixas em F e FN. Conclui-se que o uso de membranas à base de fibroína de seda carregadas ou não com NT apresenta benefícios clínicos no reparo de feridas e na qualidade de vida dos pacientes (AU)

The use of autogenous grafts from the palate for gingival tissue reconstruction, despite being considered the gold standard, causes great morbidity and postoperative pain. Thus, in order to reduce these complications, biomaterials can be explored, accelerating healing and bringing greater comfort to the patient. The objectives of the present study were: to manufacture and characterize unloaded (F) or neurotensinloaded (FN) silk fibroin-based membranes and to clinically evaluate their effects on the repair of palatal open wounds. For the first part, the membranes were made and characterized in terms of thickness, mechanical properties, surface texture, water vapor permeability, enzymatic degradation, cytotoxicity, genotoxicity and swelling. For the second part, sixty-one patients in need of extraction and alveolar preservation were randomized into three groups: Control: extraction and alveolar socket sealing with FGG removed from the palate; Group F: extraction with FGG and F membrane incorporation in the palatal wound; Group FN: extraction with EGL and FN membrane in the palatal wound. Palatal donor site repair was assessed by patient-centered and clinical parameters. From the characterization results, membranes' high homogeneity, mechanical resistance, swelling, permeability and surface roughness, can be verified, being favorable characteristics for intraoral wounds. In addition, they showed no cytotoxicity (HFF-1, HaCaT and human gingival fibroblasts) and genotoxicity (HaCaT) in vitro. Regarding the clinical results, at 14 days FN showed a greater decrease in ARF (p<0.001) and better ET (p = 0.022) than F and GC; when analyzing the ICPF, both biomaterials F and FN showed better results at 14 days compared to GC (p=0.009 and p=0.001 respectively); there was no difference between the groups regarding ED (p=0.312) and ET (p=0.120). OHIP in F and FN was superior to GC from the 5th day, NA and DPO remained lower in F and FN. It is concluded that the use of silk fibroinbased membranes loaded or not with NT has clinical benefits in wound repair and in the quality of life of patients (AU)