Coronally advanced flap and envelope type of flap plus acellular dermal matrix graft for the treatment of thin phenotype multiple recession defects. A randomized clinical trial.

INTRODUCTION: The aim of this randomized clinical trial was to assess the aesthetical and clinical outcomes of acellular dermal matrix graft (ADMG) plus coronally advanced flap (CAF) with vertical incisions or the envelope flap in the treatment of thin phenotype, multiple-recession defects. MATERIAL AND METHODS: Twenty-two participants with 55 class recession type 1 (RT1) with a depth of ≥3 mm were investigated. Control group was treated with ADMG plus conventional CAF with vertical releasing incisions, whereas test group received the envelope flap with ADMG. Primary outcome variables were complete root coverage (CRC), root coverage aesthetic score and patient satisfaction. RESULTS: Tooth-based CRC was observed in 23 of the 28 recession defects in mCAF + ADMG group (82.1%), whereas in 19 of the 27 recession defects in CAF + ADMG group (70.37%), with no inter-group difference (p > .05). CRC was observed in 9 of the 11 patients in mCAF + ADMG group (81.8%). On the other hand, in CAF + ADMG group, CRC was achieved in 8 of the 11 patients (72.7%). Results were similar between the groups (p > .05). CONCLUSIONS: Both techniques were successful in the management of multiple recessions; however, superior results regarding patient's satisfaction were achieved with mCAF + ADMG.

Laterally positioned flap along with acellular dermal matrix graft in the management of maxillary localized recessions.

OBJECTIVES: The aim of this study was to evaluate acellular dermal matrix graft (ADM) combination with laterally positioned flap (LPF) and to compare the results with LPF alone in terms of root coverage, esthetics, and patient perspectives in gingival recessions. MATERIALS AND METHODS: Twenty-two patients with localized Miller Class I/II recessions ≥ 3 mm with gingival thickness (GT) < 0.8 mm were included. Outcome parameters such as recession height and width, keratinized tissue (KT) height, GT, mean and complete defect coverage, patient satisfaction, and root coverage esthetic score (RES) were re-evaluated at 12 months postoperatively. RESULTS: Mean and complete defect coverage were 94.80 and 72.73% in LPF+ADM group and 77.25 and 45.45% in LPF group, respectively. Significant differences were observed for KT and GT gain, patient satisfaction, and RES in favor of LPF group (p < 0.05). A significant positive correlation was established between GT and mean defect coverage (r = 0.448; p < 0.05). CONCLUSION: LPF is a successful approach in the treatment of localized Miller I/II gingival recessions. On the other hand, when thin donor tissue was thickened with an allogenic graft, more successful results regarding complete defect coverage, patient satisfaction, and RES were obtained. CLINICAL RELEVANCE: Increase in gingival thickness and keratinized tissue height represents critical improvements in the prognosis of the advanced localized recessions and will be beneficial for patient's periodontal health and esthetics. Both approaches can be used successfully as an alternative for soft tissue root coverage in specific localized cases with a limited amount of keratinized tissue apical to the defect.

Clinical evaluation of coronally advanced flap with or without platelet-rich fibrin for the treatment of multiple gingival recessions.

OBJECTIVES: The aim of this randomized, controlled study was to assess the clinical effect of platelet-rich fibrin (PRF) in combination with coronally advanced flap (CAF) on root coverage, esthetics, and patient satisfaction when compared to CAF alone for the treatment of multiple Miller class I recessions. MATERIALS AND METHODS: A total of 24 patients with 52 Miller class I multiple recessions ≥ 3 mm were included and divided into CAF + PRF and CAF groups. At baseline and 12 months after surgery, recession height (RH), keratinized tissue height, gingival thickness (GT), and mean and complete defect coverage were evaluated. Patient satisfaction and root coverage esthetic scores were also assessed. RESULTS: Baseline RH in CAF + PRF and CAF groups was 3.15 ± 0.24 and 3.36 ± 0.34 mm, respectively. Intragroup comparisons revealed significant differences at 12 months for all parameters (p < 0.05). RH reduction was 2.75 ± 0.33 and 2.51 ± 0.33 mm (mean root coverage of 88.36 and 74.63%) in the CAF + PRF and CAF groups, respectively. Intergroup differences were found to be significant for GT gain (p < 0.05). CONCLUSIONS: The additional use of PRF membrane did not provide additional benefits in terms of root coverage outcomes compared with CAF alone. The use of PRF membranes increased tissue thickness significantly.

Tunnel technique versus coronally advanced flap with acellular dermal matrix graft in the treatment of multiple gingival recessions.

AIM: The aim of this randomized controlled clinical study was to evaluate the outcomes of acellular dermal matrix (ADM) graft in combination with tunnel technique (TUN) on root coverage, aesthetics, and patient satisfaction and to compare with coronally advanced flap (CAF)+ADM in the treatment of multiple gingival recessions. MATERIAL AND METHODS: A total of 20 patients with 58 Miller Class I multiple recessions ≥3 mm were included and divided into TUN+ADM and CAF+ADM groups. At baseline and 12 months, probing depth (PD), clinical attachment level (CAL), recession height (RH) and width (RW), keratinized tissue height (KT), gingival thickness, and complete and mean root coverage (CRC, MRC) were evaluated. Patient satisfaction and root coverage aesthetic scores (RES) were also assessed. RESULTS: Mean root coverage was 75.72% in TUN+ADM and 93.81% in CAF+ADM. Intragroup comparisons revealed significant differences at 12 months for all parameters in both groups (p < 0.05). Intergroup differences were found to be statistically significant for RH and RW reduction, KT increase, CAL gain, MRC, CRC, and RES in favour of CAF+ADM group (p < 0.05). CONCLUSION: Both techniques were effective in root coverage of multiple recessions; however, better clinical results were achieved with CAF and ADM combination.

Clinical and Biochemical Evaluation of Lozenges Containing Lactobacillus reuteri as an Adjunct to Non-Surgical Periodontal Therapy in Chronic Periodontitis.

BACKGROUND: This study evaluates the effects on clinical and biochemical parameters of Lactobacillus reuteri-containing probiotic supplementation adjunctive to initial periodontal therapy in patients with chronic periodontitis (CP). METHODS: Thirty patients with CP were included and divided into two groups. Every patient had, in each quadrant, ≥2 teeth each with approximal sites with a probing depth (PD) of 5 to 7 mm and gingival index (GI) of ≥2. The test group received scaling and root planing (SRP) and probiotic-containing lozenges. The control group received SRP and placebo lozenges. Plaque index (PI), GI, bleeding on probing (BOP), PD, and attachment gain were measured. Gingival crevicular fluid (GCF) was sampled for the analysis of matrix metalloproteinase (MMP)-8 and tissue inhibitor of metalloproteinase (TIMP)-1 by enzyme-linked immunosorbent assay. All evaluations were performed at baseline and on days 21, 90, 180, and 360. RESULTS: Differences in intergroup comparisons of PI, GI, BOP, and PD were found to be significant (P <0.05) in favor of the test group at all time points. Decreased GCF MMP-8 levels and increased TIMP-1 levels were found to be significant up to day 180 (P <0.05). Mean values of attachment gain were significantly higher in the test group compared with the control group on days 90, 180, and 360. CONCLUSIONS: Lozenges containing L. reuteri may be a useful supplement in moderately deep pockets of patients with CP. Low MMP-8 and high TIMP-1 levels may indicate the role of the lozenges in reduction of inflammation-associated markers up to day 180.

Clinical and microbiological effects of probiotic lozenges in the treatment of chronic periodontitis: a 1-year follow-up study.

AIM: The objective of this study was to evaluate the effects of lozenges containing L. reuteri as an adjuvant treatment to initial periodontal therapy for chronic periodontitis patients and to detect the level of L. reuteri colonization in the periodontal pockets of treated patients. MATERIAL AND METHODS: A total of 40 patients were selected and randomly divided into two groups. Each patient had at least two teeth with one approximal site each with a probing depth (PD) of 5-7 mm and gingival index (GI) of ≥2 in each quadrant. Group I received scaling and root planing (SRP) plus L. reuteri-containing lozenges, and Group II received SRP plus placebo. The plaque index (PI), GI, bleeding on probing (BoP), PD and relative attachment level were measured. Microbiological sampling was performed at baseline and on days 21, 90, 180 and 360 and were analysed by culturing. The Bonferroni-corrected paired sample t-test, Bonferroni-corrected Wilcoxon signed rank test and paired sample t-test were used to evaluate intra-group differences. The Bonferroni-corrected Student's t-test and the Mann-Whitney U-tests were used to evaluate inter-group differences. RESULTS: After treatment, the measured PI, GI, BoP and PD were significantly (p < 0.05) lower in Group I compared with Group II at all time points. Similar observations were made for the total viable cell counts and the proportions of obligate anaerobes with the exception of day 360. In Group I, significantly fewer patients required surgery on ≥3 sites. CONCLUSION: L. reuteri-containing lozenges may be a useful adjuvant agent to slow re-colonization and improve clinical outcomes of chronic periodontitis. Further studies are required to clarify the optimal dose of the lozenges.

Comparison of two different xenografts in bilateral sinus augmentation: radiographic and histologic findings.

OBJECTIVE: The aim of this study was to evaluate the radiographic and histomorphometric results of two different xenografts in bilateral sinus augmentation in patients with posterior maxillary atrophy. METHOD AND MATERIALS: Eight patients with less than 5 mm residual alveolar bone height were included in this study. One side was augmented with bovine bone graft-1 and the other side with bovine bone graft-2. Radiographic analyses were performed before and after augmentation, and before the implant placement. After 8 months of healing period, bone biopsies were obtained during implant placement. RESULTS: No statistically significant difference was found between the groups, based on post-augmentation and pre-implantation graft heights (P > .05). Histomorphometric evaluation demonstrated 24.63% and 29.13% newly formed bone in the graft-1 and graft-2 groups, respectively. Intergroup differences were not significant for the mean percentage of new bone formation (P > .05). CONCLUSION: Within the limitations of this study, it can be concluded that xenograft materials resulted in satisfactory bone height and trabecular new bone formation, and they could be used for the rehabilitation of atrophic maxillae.

Evaluation of the effects of Er:YAG laser and desensitizing paste containing 8% arginine and calcium carbonate, and their combinations on human dentine tubules: a scanning electron microscopic analysis.

OBJECTIVE: The aim of this study was to evaluate the in vitro effects of Er:YAG laser and an in-office desensitizing paste alone or in combination by using scanning electron microscopic (SEM) analysis. BACKGROUND DATA: Various treatment modalities have been proposed for dentin hypersensitivity, but to date, no single agent or form of treatment has been found effective. MATERIAL AND METHODS: Forty dentine specimens obtained from freshly extracted impacted third molars were included and divided into four groups. Group I served as the control, whereas Group II, Group III, and Group IV recieved Er:YAG laser (30 Hz, 60 mJ/pulse, 10 sec), a desensitizing paste (DP) containing 8% arginine and calcium carbonate, and DP+Er:YAG laser in combination, respectively, evaluated under SEM. RESULTS: SEM analysis presented occlusion and narrowing of dentinal tubules in all treatment groups, but more prominent occlusion was observed in the combined treatment group. Intergroup comparisons regarding the tubule diameters and the number of the open dentinal tubules per 100 µm2 revealed statistically significant difference in favor of combined group (p<0.05). The difference between single effects of Er:YAG and DP in all parameters were found statistically nonsignificant. CONCLUSIONS: The present study has shown that all treatment procedures are effective in dentinal tubule occlusion. However, more prominent occlusion is observed in the combined treatment group.

Clinical evaluation of coronally advanced flap with or without acellular dermal matrix graft on complete defect coverage for the treatment of multiple gingival recessions with thin tissue biotype.

AIM: The objective of this study was to compare acellular dermal matrix graft (ADM) combination with coronally advanced flap (CAF) on complete defect coverage, aesthetics and patient satisfaction with CAF alone for multiple recessions with gingival thickness (GT) <0.8 mm. MATERIALS AND METHODS: Forty-eight Miller Class I multiple recessions ≥3 mm were divided into test (CAF + ADM) and control (CAF) groups. At baseline and 12 months, recession height (RH), keratinized tissue height (KT), GT, mean and complete defect coverage were evaluated. Patient satisfaction, root coverage aesthetic score (RES) and the correlation between GT and defect coverage were also assessed. RESULTS: Baseline RH in CAF + ADM and CAF groups was 3.25 ± 0.34 mm and 3.21 ± 0.26 mm, respectively. Mean and complete defect coverage were 94.84% and 83.33% in test group, 74.99% and 50.00% in control group, respectively. Inter-group differences were found to be statistically significant for RH reduction, attachment gain, KT and GT increase, mean defect coverage and RES in favour of test group (p < 0.05). There was a significant positive correlation between GT and mean defect coverage (p < 0.05). CONCLUSION: Coronally advanced flap in association with ADM can be proposed as a valid approach for the treatment of multiple recessions with thin tissue biotype.

In vitro evaluation of the effects of different treatment procedures on dentine tubules.

OBJECTIVE: The objective of this preliminary study was to evaluate the occluding effect of topical gaseous ozone application and Er:YAG laser on human dentine tubules by scanning electron microscopic (SEM) analysis. METHODS: Twenty-four dentine specimens were divided into three groups. Group I, including specimens treated only with citric acid, served as the control. Group II was treated with Er:YAG (30 Hz 60 mJ, 10 sec), and Group III received only topical gaseous ozone application (10 sec at level 2). Diameters and the number of open dentinal tubules per 100 µm(2) were counted from SEM photomigrophraphs at ×2000 magnification. RESULTS: In terms of diameters and numbers of open dentinal tubules per 100 µm(2), both treatment modalities presented significant occlusion. The mean values of the diameters and the number of open dentinal tubules per 100 µm(2) were observed in Group I, Group II, and Group III, in decreasing order. Significant differences were found among the groups in favor of the topical gaseous ozone applied group. CONCLUSIONS: The dentine tubules in both treatment groups were occluded, however more marked occlusion were seen in ozone treated group.

Treatment of intrabony periodontal defects with platelet-rich plasma versus platelet-poor plasma combined with a bovine-derived xenograft: a controlled clinical trial.

BACKGROUND: The purpose of this study is to assess the healing outcomes of intrabony defects after treatment with platelet-rich plasma (PRP) versus platelet-poor plasma (PPP) combined with bovine-derived xenograft (BDX). METHODS: Using a split-mouth design, a total of 79 intrabony defects with an intrabony component of ≥3 mm in 20 patients were treated either with PRP/BDX (group 1) or PPP/BDX (group 2). At baseline and 12 months after surgery, plaque and sulcus bleeding indices, probing depth (PD), relative attachment level, recession, and probing and radiographic bone levels were recorded. RESULTS: After 12 months, groups 1 and 2 presented a mean PD reduction of 3.87 ± 0.86 and 3.76 ± 0.80 mm, recession of 1.35 ± 0.68 and 1.58 ± 0.54 mm, attachment gain of 2.51 ± 0.97 and 2.18 ± 0.87 mm, clinical bone gain of 2.18 ± 0.86 and 2.09 ± 0.89 mm, and radiographic bone gain of 2.11 ± 0.87 and 2.19 ± 0.96 mm, respectively. Intergroup differences were found to be insignificant. CONCLUSIONS: Within its limits, these results suggest that the outcomes of the treatment after PRP/BDX and PPP/BDX applications in intrabony defects are similar. When the platelet counts are taken into consideration, PPP seems to demonstrate similar clinical efficacy as the PRP.

Healing of two and three wall intrabony periodontal defects following treatment with an enamel matrix derivative combined with autogenous bone.

BACKGROUND: There are still limited data on the outcomes of regenerative periodontal surgery using a combination of an enamel matrix protein derivative (EMD) and autogenous bone (AB). AIM: To evaluate the healing of deep intrabony defects treated with either a combination EMD+AB or EMD alone. MATERIALS AND METHODS: Forty patients with advanced chronic periodontitis, with one deep intrabony defect, were randomly treated with either EMD+AB (test) or EMD (control). Clinical assessments were performed at baseline and at 1 year after treatment. The primary outcome variable was relative attachment level (RAL). RESULTS: Healing was uneventful in all patients. The test sites showed a reduction in the mean probing pocket depth (PPD) of 5.6 +/- 0.9 mm (p<0.001), a gain in the mean RAL of 4.2 +/- 1.1 mm (p<0.001) and a gain in the mean probing bone level (PBL) of 3.9 +/- 1.0 mm (p<0.001). The control group displayed a mean PPD reduction of 4.6 +/- 0.4 mm (p<0.001), a mean RAL gain of 3.4 +/- 0.8 mm (p<0.001) and a mean PBL gain of 2.8 +/- 0.8 mm (p<0.001). RAL gains of > or =4 mm were measured in 90% of the test defects and in 55% of the controls. PBL gains of > or =4 mm were obtained in 85% of the test defects and in 25% of the control ones. The test treatment resulted in statistically higher PPD reductions, RAL gains and PBL gains compared with the control (p<0.01). CONCLUSIONS: Within their limits, the present results indicate that: (i) at 1 year after surgery, both therapies resulted in statistically significant clinical improvements compared with baseline and (ii) although the combination of EMD+AB resulted in statistically significant higher soft and hard tissue improvements compared with treatment with EMD, the clinical relevance of this finding is unclear.

Regenerative treatment with platelet-rich plasma combined with a bovine-derived xenograft in smokers and non-smokers: 12-month clinical and radiographic results.

AIM: The purpose of this study was to assess the healing response of intrabony defects following regenerative treatment with platelet-rich plasma (PRP) combined with a bovine-derived xenograft (BDX) in smokers and non-smokers. MATERIALS AND METHODS: A total of 24 advanced chronic periodontitis patients, 12 smokers and 12 non-smokers, with 113 intrabony defects with an intrabony component of or /=3 mm were included in this study. Defects were surgically treated with PRP/BDX. At baseline and 12 months after surgery, the following parameters were recorded: plaque and sulcus bleeding indices, probing depth (PD), relative attachment level, marginal recession, probing and radiographic bone levels. RESULTS: Considering the soft tissue measurements, smokers and non-smokers presented a mean PD reduction of 3.97 +/- 0.76 and 4.63 +/- 0.52 mm, recession of 0.76 +/- 0.44 and 0.50 +/- 0.12 mm and attachment gain of 3.26 +/- 0.42 and 4.06 +/- 0.40 mm, respectively. Evaluation of the hard tissue findings revealed that the mean clinical and radiographic bone gains in smokers and non-smokers were 2.83 +/- 0.47 and 3.63 +/- 0.38 mm, 2.98 +/- 0.38 and 3.67 +/- 0.48 mm, respectively. Inter-group differences for PD reduction (p<0.05), attachment (p<0.001), clinical (p<0.001) and radiographic bone gains (p<0.001) were found to be significant between smokers and non-smokers. CONCLUSIONS: Within the limits of this study, the results indicate that treatment outcome following PRP/BDX application in intrabony defects is impaired with smoking.

Platelet-rich plasma in combination with bovine derived xenograft in the treatment of deep intrabony periodontal defects: a report of 20 consecutively treated patients.

There is currently great interest concerning the use of platelet-rich plasma (PRP) in combination with bone grafts for predictably obtaining periodontal regeneration. The aim of the present study was to investigate the effectiveness of PRP and bovine derived xenograft (BDX) combination in the treatment of deep intrabony defects with an emphasis on the evaluation of early wound healing. A total of 85 intrabony defects with an intrabony component of > or =3 mm were selected in 20 advanced chronic periodontitis patients. Defects were surgically treated with PRP/BDX. At baseline and 12 months after surgery, the following parameters were recorded: plaque and sulcus bleeding indices, probing depth (PD), relative attachment level, marginal recession (REC), probing bone and radiographic bone levels. Postoperative healing was evaluated by an early healing index at 1 and 2 weeks after surgery. At 12 months, all clinical and radiographic parameters were improved (p < 0.0001). The mean changes at 12 months were: PD reduction of 4.78 +/- 1.20 mm, attachment gain of 4.24 +/- 1.03 mm, REC of 0.54 +/- 0.34 mm, clinical bone gain of 3.75 +/- 0.97 mm, and radiographic bone gain of 3.79 +/- 1.02 mm, respectively. Two weeks after surgery, primary closure was maintained in 95% of the defect sites. Treatment with a combination of PRP and BDX leads to a significantly favorable clinical and radiographic improvement in deep intrabony periodontal defects.

Clinical evaluation of lasers and sodium fluoride gel in the treatment of dentine hypersensitivity.

OBJECTIVE: The aim of the present study was to evaluate and compare the efficacy of CO(2) and Er:YAG lasers alone and in combination with topical sodium fluoride (NaF) in the management of dentine hypersensitivity. MATERIALS AND METHODS: A group of 50 patients presenting with a total of 420 hypersensitive teeth were randomly allocated into five groups. Group 1 was treated with 2% NaF, groups 2 and 3 were lased by a CO(2) (1 W, continuous wave mode, for 10 sec) or Er:YAG (30 Hz, 60 mJ for 10 sec, without water/air spray) laser, and groups 4 and 5 received NaF plus the CO(2) and the Er:YAG laser, respectively. The scanning speed of the laser was 0.8 mm/sec. The degree of thermal sensitivity was determined with an evaporative stimulus consisting of a 1-sec air blast at a distance of 2 mm from each site tested. Quantification of the degree of discomfort was determined according to a four-point pain scale before treatment and 1 wk, 1 mo, and 6 mo after treatment. RESULTS: All treatment forms resulted in significant improvement of discomfort. At 1 wk, 1 mo, and 6 mo, cold air blast scores were significantly reduced compared to baseline scores, except for the NaF group. In the NaF group, there was a statistically significant increase in mean degree of discomfort at 6 mo compared with 1 wk (p +/- 0.01) and 1 mo (p +/- 0.001). Comparison of the other treatment regimens revealed that cold air blast scores were significantly lower for the other four treatments than for NaF gel alone (p +/- 0.001). No superiority was found for desensitization among the CO(2), Er:YAG, CO(2) + NaF, and Er:YAG + NaF groups. CONCLUSIONS: We concluded that both the CO(2) and Er:YAG lasers have promising potential for the treatment of dentine hypersensitivity. Lasers in combination with NaF gel appear to show better efficacy compared to either treatment modality alone.

Effect of Er:YAG and CO2 lasers with and without sodium fluoride gel on dentinal tubules: a scanning electron microscope examination.

OBJECTIVE: The aim of this pilot study was to evaluate the occluding effect of erbium:yttrium-aluminum-garnet (Er:YAG) and carbon dioxide (CO2) lasers as monotherapy and in combination with topical fluoride gel on human dentinal tubules by scanning electron microscopic (SEM) examination. MATERIALS AND METHODS: Thirty-six dentine specimens with exposed dentinal tubule orifices were included in this study. The samples were divided into six groups. Group A served as controls, group B was treated with 2% sodium fluoride (NaF) gel alone, groups C and D were irradiated with Er:YAG (30 Hz, 60 mJ, for 10 sec) and CO2 (1 W, continuous-wave mode, for 10 sec) lasers, respectively, and groups E and F received NaF gel plus Er:YAG and CO2 laser irradiation, respectively. RESULTS: Under SEM analysis, numerous exposed, normally-structured dentinal tubule orifices were seen in the control group. Some narrowing of the exposed tubule orifices was seen in group B. A melted, irregular surface structure with small peaks was observed in group C. The surface of group D also had a melted appearance, but a fibrillar deformation of the surface structure was seen on the specimens. However, the surface morphologies seen were remarkably different in groups E and F. While the tubule orifices were obviously occluded but depressed into craters in group E, the surface structure of group F primarily showed a smooth appearance. In terms of numbers and diameters of open dentinal tubules, there was no significant difference between the laser-alone and combination groups, whereas the difference was found to be significant when the control and NaF groups were compared with each other and the remaining laser-alone or combination groups. CONCLUSION: The dentinal tubules in all laser groups were occluded after laser irradiation, but more marked occlusions were observed when laser and NaF gel were combined.