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.

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.

A new volume-stable collagen matrix (VCMX) to treat single gingival recession associated with partially restored non-carious cervical lesions: a case series.

Collagen matrixes have been developed as possible connective tissue graft substitutes to overcome patient discomfort, undesired palatal healing, and the limited amount of donor tissue. The aim of this case series is to assess a coronally advanced flap (CAF) with a new volume-stable collagen matrix (VCMX) to treat single gingival recession (GR) associated with partially restored non-carious cervical lesions (NCCL). Twelve patients diagnosed with single GR RT1 + NCCL (B+) were included in this study and received a restorative - partial resin composite with apical margin 1 mm beyond the estimated cementoenamel junction (CEJ) - and a surgical approach - CAF+VCMX. Clinical and patient-centered assessments were recorded at baseline and 6 months postoperatively from ten patients. Significant recession reduction (RecRed:2.1mm), clinical attachment level gain (CAL:1.34mm), and combined defect coverage (CDC) of 51.67% were observed at 6 months. The estimate root coverage (RC) was 69.48%, obtained using the estimated CEJ. No difference in keratinized-tissue width (KTW) was observed over time. A gain in gingival thickness (GT) of 0.42 mm was observed after 6 months (p=.002) and an improvement in patient satisfaction due to better esthetics (p<.001). Within the present study's limits, CAF plus VCMX provided significant improvement in treating single GR combined with partially restored NCCL (B+).

Long-term evaluation (up to 7 years) of the use of a collagen matrix to treat gingival recession associated with noncarious cervical lesion: Report of two cases.

INTRODUCTION: Gingival recession (GR) is a relevant clinical condition due to its high prevalence worldwide, which leads to aesthetic demands and dentin hypersensitivity. Collagen matrices have been associated with different designs of coronally advanced flaps (CAFs) to treat GR defects. However, the literature lacks long-term follow-up of this treatment option. The aim of this study is to present the long-term follow-up (up to 7 years) of two GR defects (associated or not with noncarious cervical lesion) treated with a CAF and a collagen matrix (CM). CASE PRESENTATION: Case 1 underwent a CAF associated with a CM to treat a single GR defect. After 7 years, Case 1 presented with 3 mm of recession reduction, which corresponds with the 85.7% of root coverage. Case 2 presented two GR defects associated with noncarious cervical lesions (NCCLs). The NCCLs were partially restored with resin composite and then underwent a modified CAF for multiple defects and a CM. After 5 years of follow-up, Case 2 presented with 1.5 and 2.5 mm of recession reduction, which corresponds with the average 83.3% defect coverage. CONCLUSION: These two cases may show that CMs can provide long-term stable outcomes in the treatment of GR defects. Why is this case new information? One of the cases is the first one to describe a 7 years of follow-up after CAF+CM to treat gingival recession defects. What are the keys to successful management of this case? Correct material handling. Adequate restorative protocol and surgical technique. What are the primary limitations to success in this case? Diagnose Patient compliance.

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.

Novo sistema de liberação de drogas ­ filme de fibroína de seda carregado ou não com insulina para reparo de feridas em mucosa palatina: estudo in vitro e clínico randomizado / A new drug delivery system ­ silk fibroin film loaded or not with insulin on palatal mucosa wound healing: in vitro study and a randomized clinical trial

Several types of periodontal and peri-implant soft tissue defects require surgical treatment to reestablish function and aesthetics. However, local, and systemic factors can jeopardize tissue repair leading to unexpected outcomes and postoperative discomfort. In order to overcome this problem, new devices have been developed to improve surgical procedures outcomes and patient experience. The aim of the present study was to develop a new silk fibroin (SF)/chitosan (CH) film loaded with insulin as a drug delivery system to improve palatal donor area healing after free gingival graft harvesting for ridge preservation. For this, biomaterial development, characterization and in vitro assessment were performed to evaluate the new delivery system. In addition, 3- months outcomes from palatal wound healing following the use of the proposed delivery system were assessed through clinical, patient centered parameters, immunological, microbiological, and histological evaluations. Sixty-nine patients with indication of tooth extraction were enrolled into 3 groups: Control Group (C) (n=23): open wound on palatal mucosa followed by spontaneous healing; SF/CH Film (F) (n=23): open wound on palatal mucosa and silk fibroin film as dressing; Insulin-loaded SF/CH film (IF) (n=23): open wound on palatal mucosa and an insulin- loaded silk fibroin film as a delivery system. : It was verified some characteristics that are favorable to the oral environment, such as mechanical properties, swelling and permeability to water vapor. The biomaterial presented a standard of a controlled release system through diffusion with delivery stability in human saliva, along with an excellent biocompatibility with the absence of cytotoxicity and genotoxicity increasing cell viability in lineage cells (HaCat). F and IF promoted accelerated palatal wound closure on day 7 and 14 after surgery, as well as an early epithelialization, compared to the C group. Both films were capable to reduce pro-inflammatory cytokines (IL-6, TNF-α, IL-1ß) and modulate biomarkers correlated to tissue degradation/remodeling. Spontaneous healing microbiome reported higher genus/species with pathogenic role in the oral mucosa with reduction in health species following this profile until de end of the follow-up. A tendency of eubiosis was observed in F and IF groups throughout healing process. It seems that this new device has a promising application in oral cavity and positively influence wound healing. (AU)

Diversos tipos de defeitos mucogengivais requerem abordagem cirúrgica para o reestabelecimento funcional e estético. Porém, alterações locais e sistêmicas podem prejudicar o processo de reparo gerando resultados inesperados e desconforto ao paciente. Biomateriais vem sendo desenvolvidos para melhorar os resultados dos procedimentos cirúrgicos e a experiência clínica do paciente. O objetivo do presente estudo foi desenvolver um filme de fibroína de seda (FS) e quitosana (QT) carregado com insulina (INS), atuando como um sistema de liberação, para acelerar a cicatrização de feridas na área doadora palatina após procedimento de preservação de rebordo com uso de enxerto gengival livre. Para isso, foi executado o desenvolvimento, caracterização e avaliação in vitro do biomaterial. Ademais, o resultado de 3 meses do reparo das feridas palatinas foi verificado por meio de avaliações clínicas, imunológica, microbiológica, histológica, bem como parâmetros centrados no paciente. Sessenta e nove pacientes foram alocados aleatoriamente nos grupos Controle (C) (n=23): ferida aberta em palato seguido de cicatrização espontânea; Filme de FS/QT (F) (n=23): ferida aberta em palato associada ao filme na área doadora; Filme de FS/QT carregado com INS (IF) (n=23): ferida aberta em palato associada ao filme carregado com INS na área doadora. Verificou-se propriedades mecânicas, bem como de entumecimento e permeabilidade ao vapor de água, favoráveis ao meio bucal sem nenhuma alteração com a inclusão da INS. O dispositivo apresentou liberação controlada por meio de difusão com estabilidade em saliva humana. Excelente biocompatibilidade com ausência de cito e genotoxicidade foi observada em diversos tipos celulares aumentando a viabilidade celular em células de linhagem (HaCat). F e IF favoreceram um fechamento acelerado da ferida palatina aos 7 e 14 dias pós-injuria, assim como uma epitelização precoce destes comparado ao grupo C. F e IF reduziram citocinas pró-inflamatórias (IL6, TNF-α, IL-1ß) além de apresentarem função modulatória na quantificação de biomarcadores relacionados a degradação tecidual. O Grupo C apresentou gênero/espécies com potencial patogênico e redução de microrganismos relacionados a saúde mantendo este perfil aos 14 e 30 dias. Enquanto isso, uma tendência a eubiose foi observado em F e IF ao longo do processo de cicatrização. Deste modo, verifica-se a aplicação promissora do novo dispositivo na cavidade oral bem como capacidade de influenciar positivamente o reparo da mucosa oral. (AU)

Comparison between connective tissue graft and xenogeneic acellular dermal matrix to treat single gingival recession: A data reanalysis of randomized clinical trials.

OBJECTIVES: There are few studies comparing xenogeneic acellular dermal matrixes (XDMs) with connective tissue graft (CTG) to treat single gingival recession (GR). The present study involved a reanalysis of previous studies and comparison of CTG or XDM to treat single RT1/GR. MATERIALS AND METHODS: Fifty patients from three previous randomized clinical trials treated either by CTG (n = 25) or XDM (n = 25) were evaluated after 6-month. Clinical, patient-centered, and esthetic parameters were assessed. Pearson's correlation and regression analyses were also performed. RESULTS: Greater recession reduction (RecRed), percentage of root coverage (%RC), and complete root coverage (CRC) were observed in the CTG group (p ≤ 0.02). Gingival thickness (GT) and keratinized tissue width (KTW) gains were higher in the CTG group. The CTG group showed better esthetic at 6-month. Logistic analyses reported that GT([OR] = 1.6473 ) and papilla height (PH) (OR = 8.20) are predictors of CRC. GT*XDM interaction was a negative predictor of CRC (OR = 7.105-5 ). GT at baseline acted as a predictor of RecRed in both groups (p = 0.03). The XDM graft impacted RecRed and %RC negatively. Baseline PH was a predictor of %RC for both grafts. CONCLUSION: CTG was superior for treating RT1/GR, providing better root coverage outcomes and tissue gains over time. GT, PH, and graft type were classified as predictors of CRC. CLINICAL SIGNIFICANCE: CTG presented better outcomes to treat single RT1 gingival recession when compared to the XDM.

Use of Platelet-Rich Fibrin Membranes With Single Implant Placement for Peri-Implant Mucosal Thickness Augmentation: A Case Series Study.

INTRODUCTION: The use of platelet-rich fibrin (PRF) membranes has been evaluated for different purposes. However, few studies aimed to assess the effect of PRF membranes on peri-implant mucosal thickness augmentation. Thus, the aim was to evaluate whether the use of PRF membranes placed using the same surgical procedure of single implant installation in the anterior area of the maxilla can result in peri-implant mucosal thickness increase. CASE SERIES: Eight patients received single maxillary implants (anterior area), covered by three PRF membranes (2,500 rpm/12 minutes, RCFmax = 719.71 g). Clinical parameters (baseline and 3 months postoperative) and patient-centered parameters were evaluated. The buccal peri-implant mucosal thickness (BMT) and ridge defect (RD) parameters showed a statistically significant difference, with a gain of 0.7 ± 0.3 mm in BMT and reduction of 0.8 ± 0.3 mm in RD. Supracrestal tissue height (STH) was >3 mm after 3 months. Postoperative pain and number of analgesics showed low values (0.95 ± 1.06 and 1.92 ± 2.75), respectively, using a visual analog scale (VAS). CONCLUSION: The use of three PRF membranes along with single implant placement in the anterior maxilla led to an increase in the BMT.

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.

Comparison of two types of xenogeneic matrices to treat single gingival recessions: A randomized clinical trial.

BACKGROUND: Xenogeneic matrices (XMs) have been increasingly used for root coverage procedures. This study compared the use of two types of XM (collagen matrix [CM] and xenogeneic acellular dermal matrix [XDM]) associated with the coronally advanced flap technique (CAF) to treat single gingival recessions. METHODS: Seventy-five patients presenting single RT1 gingival recession were treated by CAF (control group, n = 25), CAF+CM (test group 1, n = 25), or CAF+XDM (test group 2, n = 25) and completed 6-month follow-up. Clinical, patient-centered, and esthetic assessments were performed and intra- and intergroup differences were analyzed. RESULTS: At 6 months, the mean recession reduction for CAF, CAF+CM, and CAF+XDM was 2.4 ± 0.8 mm, 2.4 ± 0.9 mm and 2.1 ± 0.8 mm, respectively (P > 0.05). The corresponding mean percentage of root coverage was 78.9% ± 26.2% for CAF, 78.0% ± 28.5% for CAF+CM, and 65.6% ± 26.9% for CAF+XDM (P > 0.05). Dentin hypersensitivity and esthetic conditions showed significantly improvements in all groups. Test groups presented significant gains in gingival thickness (GT; CAF+CM: 0.4 ± 0.3 mm; CAF+XDM: 0.4 ± 0.2 mm) compared to the control group (CAF: 0.0 ± 0.1 mm; P < 0.05). CONCLUSION: The CAF, CAF+CM, and CAF+XDM treatments each provided similar results in the treatment of single gingival recessions. The addition of either CM or XDM to CAF increases the GT.

Enamel matrix derivative effects on palatal mucosa wound healing: Randomized clinical trial.

BACKGROUND: This study was conducted to evaluate the clinical, immunologic, and patient-centered outcomes of enamel matrix protein derivative (EMD) on excisional wounds in palatal mucosa. MATERIALS: Forty-four patients in need of ridge preservation were randomly allocated into two groups: control group (n = 22): open palatal wound after free gingival graft (FGG) harvest and EMD group (n = 22): open palatal wound after FGG harvest that received 0.3 ml of EMD. Clinical and patient-centered parameters were analyzed for 3 months post-treatment. Wound fluid levels of inflammatory markers were assessed 3 and 7 days postoperatively. RESULTS: No significant inter-group difference was observed in remaining wound area and re-epithelialization. EMD and control groups achieved wound closure and re-epithelialization 30 days postoperatively (p < .001), without inter-group differences. Similarly, number of analgesics and Oral Health Impact Profile scores did not present significant inter-group differences (p > .05). EMD appeared to selectively modulate wound fluid levels of monocyte chemoattractant protein-1, macrophage inflammatory protein-1α, matrix metallopeptidase 9, and tissue inhibitor of metalloproteinases-2. CONCLUSION: Within the limits of the present study, it can be concluded that EMD application to excisional palatal wounds using the investigated protocol does not provide clinical healing benefits, despite an apparent modulation of selected inflammatory markers.

Microcurrent electrotherapy improves palatal wound healing: Randomized clinical trial.

BACKGROUND: This study was conducted to assess the clinical, immunological, and patient-centered outcomes of microcurrent electrotherapy on palatal wound healing. METHODS: This was a parallel, double-masked randomized clinical trial, in which 53 patients with ridge preservation indications were selected and randomly assigned to one of two groups. In the control (sham) group (n = 27), palatal wounds, after free gingival grafts (FGG) harvest, received sham application of electrotherapy. In the test (electrotherapy treatment [EE]) group (n = 26), palatal wounds, after FGG harvest, received application of microcurrent electrotherapy protocol. Clinical parameters, patient-centered outcomes, and inflammatory markers were evaluated, up to 90 days postoperatively. RESULTS: The EE group achieved earlier wound closure (P <0.001) and epithelialization (P <0.05; P = 0.03) at 7 and 14 days after harvest when compared with the sham group. Painful symptomatology was reported less frequently in the EE group than in the sham group at 3-day follow-up (P = 0.008). Likewise, an improvement in Oral Health Impact Profile was reported 2 days after the procedure by the EE group (P = 0.04). In addition, favorable modulation of inflammatory wound healing markers occurred when electrotherapy was applied. CONCLUSION: Within the limits of the present study, it can be concluded that the use of a low-intensity electrotherapy protocol may accelerate palatal wound healing and decrease patient discomfort after FGG harvest.

Omega-3 Fatty Acids and Low-Dose Aspirin in the Treatment of Periodontitis and Metabolic Syndrome: Case Report.

AIMS: To investigate the use of ω-3 fatty acids and low-dose aspirin as adjuncts to periodontal debridement in a patient with periodontitis and metabolic syndrome. METHODS: Periodontal and systemic parameters were assessed at baseline and 6 months. Gingival crevicular fluid was analyzed for interleukin (IL)-1ß, IL-6 and interferon (IFN)-γ levels by multiplex ELISA at baseline, 3 and 6 months. RESULTS: The treatment was effective in reducing probing depth, clinical attachment level, bleeding on probing and plaque index, and glycated hemoglobin, triglycerides IL-1ß, IL-6 and IFN-γ levels over time. CONCLUSIONS: The adjunctive use of ω-3 and low-dose aspirin to periodontal debridement might have potential benefits in the treatment of periodontitis in a patient with metabolic syndrome.

Randomized clinical trial evaluating single maxillary gingival recession treatment with connective tissue graft and tunnel or trapezoidal flap: 2-year follow-up.

BACKGROUND: The literature lacks long-term evidence regarding outcomes of the coronally advanced tunnel flap (TUN) combined with connective tissue graft (CTG) when compared to the trapezoidal coronally advanced flap (CAF) and CTG combination. This study presents 2-year results of a randomized clinical trial comparing CTG combined with either CAF or TUN in the treatment of single maxillary gingival recession (GR) defects. METHODS: Thirty-nine patients, each contributing a single Miller Class I or II GR defect, were treated by CAF+CTG (control; n = 19) or TUN+CTG (test; n = 20) and completed the 2-year follow up. Clinical, patient centered, and esthetic evaluations were performed and differences among groups were analyzed. RESULTS: At 2 years, mean root coverage for control and test group was 89.5% ± 14.6% and 87.7% ± 18.4%, respectively (P = 0.5). The corresponding complete root coverage prevalence was 68.4% and 50% (P = 0.4). Dentin hypersensitivity significantly decreased for both groups. The two groups showed improvement in esthetics, as assessed by both professionals and patients, without significant intergroup differences (P > 0.5). TUN+CTG sites were much more likely to present improvement in root coverage between 6 months and 2 years, exhibiting creeping attachment of 0.7 ± 0.6 mm. CONCLUSIONS: At 2 years of follow up, both CAF+CTG and TUN+CTG resulted in significant clinical and esthetic improvements and provided similar results in the treatment of single maxillary GRs.

Photobiomodulation for the treatment of periodontal pockets in patients with type 2 diabetes: 1-year results of a randomized clinical trial.

This study investigated the local effect of photobiomodulation (PBM) for the treatment of periodontal pockets in patients with periodontitis and type 2 diabetes. Thirty-eight periodontal pockets presenting probing depth (PD) and clinical attachment level (CAL) ≥ 5 mm were selected from 19 patients (two pockets/patient). The selected periodontal pockets were randomly assigned to receive mechanical debridement only (control group) or mechanical debridement with PBM (PBM group). Clinical measures, such as PD, CAL, bleeding on probing (BoP), and presence of supragingival biofilm (PI), were collected and compared at baseline, 3, 6, and 12 months. After 12 months, no statistically difference was observed for mean PD and mean CAL when control and PBM groups were compared. The frequency of pockets with PD 5-6 mm was significantly lower for the PBM group at 6 months when compared to the control group. Pockets with PD ≥ 7 mm changed significantly between baseline and 3, 6, and 12 months for the PBM group, while for the control group, statistical significance was only observed between baseline and 6 months. The PBM protocol used in this study did not provide significant changes for PD and CAL in periodontal pockets when compared to mechanical therapy only. However, PBM was more effective in reducing the percentage of moderate periodontal pockets at 6 months in patients with type 2 DM.

Influência da aplicação de estimulação elétrica e de proteínas derivadas da matriz do esmalte no reparo de feridas em palato: dois estudos clínicos randomizados / Influence of electric stimulation and enamel matrix protein derivative application on palatal wound healing: two randomized clinical trials

Procedimentos periodontais cirúrgicos podem levar a execução de feridas na região do palato como por exemplo na remoção de enxertos autógenos. Contudo, tais abordagens podem causar ao paciente certo grau de morbidade e desconforto na área operada. Procura-se, portanto, terapias para a área palatina auxiliando a cicatrização de feridas no local doador, que eventualmente também poderiam ser utilizadas para outras finalidades. Assim, o objetivo dos presentes estudos clínicos foi avaliar clínica e imunologicamente os resultados de três meses de duas abordagens, estímulo elétrico (EE) e matriz derivada do esmalte (EMD), no reparo de feridas palatinas advindas da remoção de enxerto gengival livre para preservação de alvéolo. Dois ensaios clínicos randomizados foram realizados seguindo o CONSORT-STATEMENT 2010. (1) Selecionou-se 53 pacientes apresentando necessidade de preservação de rebordo, divididos nos grupos: Sham (n=27) - simulação de EE na ferida aberta no palato, EE (n=26) - estímulo elétrico na ferida aberta no palato. As avaliações clínicas revelaram fechamento precoce da ferida palatina, bem como epitelização desta, aos 7 e 14 dias no grupo EE quando comparado ao grupo Sham (p<0,05 e p=0,03, respectivamente). Sintomatologia dolorosa revelou-se reduzida no grupo EE em relação ao grupo Sham aos 3 dias pós-operatórios (p=0,008). Bem como, uma melhoria na qualidade de vida do paciente foi reportada após 2 dias do procedimento cirúrgico (p<0,04). A modulação de certos biomarcadores de modo favorável à reparação tecidual se fez presente com o uso da eletroterapia. Deste modo, conclui-se que o uso da eletroterapia apresenta benefícios clínicos e imunológicos no reparo de feridas. (2) Selecionou-se 44 pacientes com necessidade de preservação de rebordo, divididos nos grupos: Controle (n=22) - ferida aberta no palato sem terapia e EMD (n=22) - aplicação de Emdogain® na ferida palatina. Nenhum benefício clínico, como fechamento da ferida e epitelização, foi visto com a aplicação de EMD. Contudo, verificou-se uma modulação favorável em biomarcadores inflamatórios importantes ao reparo bem como menor sintomatologia dolorosa. Por conseguinte, o uso do EMD revelou uma modulação positiva do processo inflamatório local à resolução da ferida(AU)

Surgical periodontal procedures may favor the formation of wounds in the palatal region as for example to obtain autogenous graft. Discomfort and a certain degree of morbidity may be present in patients undergoing this procedure. Thus, treatments for the palatine donor area has been sought to aid wounds healing and eventually be useful for other functions. Therefore, the aim of the investigations was to evaluate the 3-month clinical and immunological outcomes of two approaches, electric stimulus (EE) and enamel matrix derivative (EMD), on palatal open wound healing due to harvesting a graft for socket preservation. For this, two clinical trials were carried out following the CONSORT STATEMENT 2010. (1) Fifty-three patients presenting need of ridge preservation were divided into 2 groups: Sham (n=27) - sham electrical stimulation on the open palatal wound; EE (n=26) - electrical stimulation on open palatal wound. Clinical perceptions shown early wound closure, as well as, better epithelization in 7 and 14 days after surgery in EE group when related to Sham group (p<0,05 e p=0,03, respectively). Painful symptomatology was less reported in EE group in comparison to Sham group at 3 days after surgical approach (p=0,008). Likewise, an improvement in Oral Health Impact Profile was reported after 2 days of the procedure when combinate with electrotherapy protocol (p<0,04). Biomarkers modulation occurred in a favor manner when electric stimulus was applied at the wound. Therefore, the use of electrotherapy presented benefits for clinical wound healing and influenced the expression of favorable biomarkers during injury resolution. (2) Forty-four patients presenting need of ridge preservation were allocated into 2 groups: Control (n=22) - open palatal wound without treatment and EMD (n=22) ­ Emdogain® applied on the open palatal wound. None clinical benefits, as wound closure and epithelization was seen when EMD was used. However, important biomarkers modulation for repair occurred, as well as, less painful symptomatology. In conclusion, EMD application shown a positive influence in local inflammation during wound repair(AU)