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.

Impact of dietary inflammatory index on gingival health.

BACKGROUND: Periodontal disease is a biofilm-dependent chronic inflammatory condition triggered by a host response. Several factors impact systemic inflammation and could lead to changes in disease pathogenesis. Recently, studies have assessed the influence of nutritional patterns on the development of periodontitis. In the present cross-sectional study, we evaluated the dietary inflammatory profile on periodontal conditions, focusing on clinical, subgingival microbial, and cytokine assessment of individuals with periodontal health or gingivitis. METHODS: One hundred patients with periodontal health or gingivitis were included. Plaque index (PI), Bleeding on probing (BoP), the probing depth (PD), and the clinical attachment level (CAL) for each patient were assessed. Nutritional data and the Dietary Inflammatory Index (DII) were recorded by two 24-h food recalls on non-consecutive days. Biofilm and gingival crevicular fluid (GCF) to assess the microbiome profile and inflammatory biomarkers were collected. Multiple regressions focused on the DII, age, and sex as predictors of periodontal conditions were done. RESULTS: Age and moderate DII scores increased the risk of gingivitis by 1.64 and 3.94 times, respectively. Males with an elevated DII score had 27.15 times higher odds of being diagnosed with gingivitis and BoP (ß = 6.54; p = 0.03). Elderly patients with a moderate or high DII score were less prone to gingivitis and increased BoP (p < 0.04) compared with younger subjects. Considering the DII, there were no differences in microbial alpha and beta diversity; however, distinct species abundance and a higher concentration of monocyte-chemoattractant protein-1 and interleukin 33 were seen in patients with a higher DII. CONCLUSION: A pro-inflammatory diet significantly contributes to periodontal inflammation, modulating inflammatory biomarkers and affecting the subgingival microbial community in healthy individuals.

Barbell Technique for Three-Dimensional Bone Augmentation.

Introduction: Appositional bone augmentation is considered a challenging surgical problem to correct for the deficient alveolar ridge. To overcome this challenge, a novel concept was recently published called "Barbell Technique." This technique has been used more commonly for horizontal bone augmentation. To our knowledge, this is the first report on using the Barbell Technique for vertical bone augmentation. Case Report. This report describes and demonstrates the clinical feasibility of the use of this concept in the reconstruction of a tridimensional alveolar ridge defect in the anterior maxilla. Due to the severity of the defect, both hard and soft tissue deficiencies required augmentation. The first surgery involved a soft tissue grafting procedure while in the second surgical procedure, hard tissue augment was performed using the Barbell device to provide both vertical and horizontal support for the hard tissue graft. The donor material consisted of equal volume of xenograft and autogenous bone used to fill the defect and covered with a collagen barrier membrane. After a healing period of 9 months, the site was reopened. Bone formation clinically verified the correction of alveolar bone contour and volume permitted placement of two titanium implants after the removal of Barbell device. Conclusion: This case report demonstrates successful vertical and horizontal bone augmentation of a critical size defect in the anterior maxilla, correcting both hard and soft tissue contours, and providing the tissues needed to support dental implants in the anterior maxilla.

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+).

Effect of collagen sponge and flowable resin composite on pain management after free gingival graft harvesting: A randomized controlled clinical trial.

The aim of this study was to compare the effect of the application of a flowable resin composite coating, over a collagen sponge stabilized with suture, on postoperative pain after free gingival graft harvesting. Thirty-two free gingival grafts were harvested from the palate in 32 patients, who were subsequently randomized to have only a collagen sponge stabilized with sutures applied to the palatal wound (control), or to have the collagen sponge coated with a flowable resin composite (test). Patients were observed for 14 days, and the pain level was evaluated by using a numerical rating scale. The consumption of analgesics during the postoperative period and the characteristic of the graft were also analyzed. The patients in the test group reported having experienced significantly less pain statistically than the patients in the control group throughout the study. The consumption of analgesics was lower in the test group. The dimensions of harvested grafts in the control and test groups showed no significant differences in height, width, and thickness. In conclusion, the addition of flowable resin composite coating to the hemostatic collagen sponge on the palatal wound following free gingival graft harvesting helped to minimize postoperative pain.

Porphyrin-associated fluorescence spectroscopy (Photogen®) for the optical diagnosis of dental biofilm in orthodontic treatment: An observational clinical trial.

OBJECTIVE: This study assessed the presence of dental biofilm with fluorescence spectroscopy associated with porphyrin (Photogen®) in users of orthodontic appliances. METHODS: This cross-sectional observational clinical trial included 21 patients with metallic orthodontic fixed appliances. The presence of biofilm was evaluated by fluorescence spectroscopy (Evince-MMÓptics. São Carlos-SP, Brazil) with a porphyrin photo-evidence device (Photogen®). Digital images of the buccal surface of the upper anterior teeth (central and lateral incisors and canines) without and with porphyrin were analyzed using the histogram R (red) function in ImageJ software. The results were analyzed using the maximum and mode values of the red pixels from the histograms. The statistical analysis considered the significance level of 5%. RESULTS: The maximum values and modes of the red pixels were significantly higher in biofilms analyzed by porphyrin-associated optical spectroscopy compared to optical spectroscopy alone. CONCLUSIONS: Porphyrin-associated fluorescence spectroscopy was able to detect dental biofilm in the oral environment of patients with orthodontic treatment. This method better evidenced the presence of biofilm on the buccal surfaces of the upper teeth compared to that observed with fluorescence spectroscopy without porphyrin.

Parents with periodontitis drive the early acquisition of dysbiotic microbiomes in their offspring.

AIM: To evaluate the microbial colonization in different dentition phases on individuals from 0 to 18 years of age belonging to families with a history of periodontitis compared to descendants of periodontally healthy parents. MATERIALS AND METHODS: The offspring of subjects with periodontitis ('Perio' group) and the offspring of periodontally healthy subjects ('Healthy' group), matched for gender and age, were included in this cross-sectional study and divided according to the dentition phase: pre-dentate, primary, mixed and permanent. The patients were clinically assessed, and their saliva was collected. DNA was extracted, and V1-V3 and V4-V5 regions of the 16S rRNA gene were sequenced. RESULTS: Fifty children of parents with periodontitis and 50 from healthy parents were included in the study and divided according to the dentition phase: pre-dentate (n = 5/group), primary dentition (n = 15/group), mixed dentition (n = 15/group) and permanent dentition (n = 15/group) in each group. The microbiome composition was different between dentitions for both groups. Children of the Perio group presented a microbial diversity different from that of the Healthy group in mixed and permanent dentitions. The more intense shift in the community occurred between primary and mixed dentition in the Perio group, while the transition between mixed and permanent dentition was the period with greater changes in the microbiome for the Healthy group. Furthermore, a pathogen-rich environment-higher prevalence and abundance of periodontitis-associated species such as Prevotella spp., Selenomonas spp., Leptotrichia spp., Filifactor alocis, Prevotella intermedia, Treponema denticola and Tannerella forsythia- was observed in the Perio group. CONCLUSIONS: The parents' periodontal status significantly affects the microbiome composition of their offspring from an early age. The mixed dentition was the phase associated with establishing a dysbiotic and pathogen-rich microbiome in descendants of parents with periodontitis.

Multiple gingival recessions associated with non-carious cervical lesions treated by partial restoration and modified coronally advanced flap with either connective tissue graft or xenogeneic acellular dermal matrix: A randomized clinical trial.

BACKGROUND: This study aimed to compare a connective tissue graft (CTG) to a (porcine) xenogeneic acellular dermal matrix (XDM), both associated with modified coronally advanced flap (MCAF) and partial resin composite restoration to treat multiple combined defects (CDs). METHODS: Seventy-eight defects in 38 patients presenting multiple combined defects, that is, gingival recession associated with non-carious cervical lesions, were treated by partial resin composite restoration (apical margin up to 1 mm of the estimated cement-enamel junction) and MCAF along with CTG or XDM. After 6 months, the groups were compared with regard to clinical, patient-centered, and esthetic outcomes. RESULTS: CD coverage was 72.9% for CTG versus 50.7% for XDM (P < 0.001). Recession reduction was 2.3 mm for CTG versus 1.5 mm for XDM (P < 0.001). CTG resulted in a greater increase in keratinized tissue width (CTG: 0.96 mm vs. XDM: 0.3 mm, P = 0.04) and gingival thickness (CTG: 0.9 mm vs. XDM: 0.3 mm, P < 0.001). Both treatments successfully reduced dentin hypersensitivity and increased esthetics satisfaction, with no statistically significant intergroup differences. Moreover, XDM patients experienced a shorter surgery duration (CTG: 57.2 min vs. XDM: 37.4 min, P < 0.001) and less time to no pain (visual analog scale  =  0; CTG: 6.5 days vs. XDM: 3.5 days, P = 0.04). CONCLUSION: CTG resulted in significantly greater root coverage and increased keratinized tissue width compared to XDM for treating multiple partially restored CDs. However, increased root coverage at the CTG sites was accounted for by increased probing depth compared to the XDM sites.

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.

Evaluation of a novel restorative protocol to treat non-carious cervical lesion associated with gingival recession: a 2-year follow-up randomized clinical trial.

OBJECTIVE: To compare 2 different resin composites and 2 adhesive systems used in a new restorative protocol (partial restoration) to treat non-carious cervical lesions associated with gingival recession type 1 (RT1). MATERIAL AND METHODS: Eighty combined defects (CDs) were treated with a partial restoration and periodontal plastic surgery for root coverage. The CDs were randomly assigned to one of the following groups: NP + TE (n = 20), nanofilled composite and 2-step total-etch adhesive system; NP + UA (n = 20), nanofilled composite and universal adhesive system; MH + TE (n = 20), microhybrid composite and 2-step total-etch adhesive; MH + UA (n = 20), microhybrid composite and universal adhesive. Restorations were assessed using the United States Public Health Service (USPHS) criteria at 1 week (baseline) and 6, 12, and 24 months. Survival rate, periodontal parameters, dentin hypersensitivity (DH), and aesthetics were also evaluated. RESULTS: After 24 months, only the MH + TE group did not lose any restoration, with no significant differences between groups. For surface roughness parameter, MH presented 83.3% of the restorations scoring Bravo, whereas NP presented 48.5% of the restorations scoring Bravo. All groups presented restorations with marginal discoloration. All periodontal parameters behaved similarly, regardless of the restorative material. All groups presented significant reductions of dentin hypersensitivity and improved aesthetic perceptions (p < 0.05). CONCLUSION: Both resin composites and adhesives tested can be combined for partial restorations to treat CDs. CLINICAL RELEVANCE: This new restorative-surgical protocol to treat CDs presents satisfactory outcomes. The partial restorations can be successfully executed with both combinations of adhesives and resin composites evaluated in this investigation. TRN : ClinicalTrial.gov: NCT03215615; registration date July 12, 2017.

Xenogeneic Acellular Dermal Matrix for the Treatment of Multiple Gingival Recessions Associated with Partially Restored Noncarious Cervical Lesions.

This study evaluated the use of a xenogeneic acellular dermal matrix (XADM) combined with a modified coronally advanced flap (MCAF) and partial resin composite filling (anatomic crown plus 1 mm of the root surface) to treat multiple Type 1 gingival recessions associated with B+ noncarious cervical lesions (NCCLs). The study included 24 recessions in 10 patients. Bleeding on probing, probing depth, combined defect height, relative gingival recession, clinical attachment level, esthetics, and dentin hypersensitivity were recorded. After 6 months, the treatment provided statistically significant outcomes: It reduced the combined defect height by 2.02 ± 0.65 mm, increased clinical attachment level by 1.96 ± 0.83 mm, and increased keratinized tissue thickness by 0.46 ± 0.47 mm, and shallow probing depths were seen. Significant dentin hypersensitivity reduction and esthetic improvements were observed. Therefore, XADM associated with MCAF and partial restoration might be a promising alternative to autogenous grafts used to treat multiple gingival recessions associated with B+ NCCLs.

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.

Single implant placement in the maxillary aesthetic area with or without connective tissue grafting: A 1-year follow-up randomised clinical trial.

PURPOSE: To evaluate the influence of connective tissue graft on the soft tissue thickness and aesthetics around single implants placed in the aesthetic zone of the maxilla. MATERIALS AND METHODS: Forty-two patients with indications for single implant placement in the aesthetic zone were randomly allocated into two groups: the implant group (implant insertion) and the implant + connective tissue graft group (implant insertion and placement of a 1.50-mm-thick connective tissue graft). Clinical evaluations were performed at baseline, 4 months after surgery (prior to prosthetic reconstruction) and 1 year after crown placement to assess tissue thickness at the crestal aspect and the buccal aspect, buccal defects, keratinised tissue width and proximal bone resorption. Aesthetics were assessed using the pink aesthetic score index, and postoperative discomfort and pain tests were also performed. RESULTS: Only the implant + connective tissue graft group presented a significant increase in tissue thickness at the buccal aspect, with 2.36 ± 0.94 mm at baseline, 3.35 ± 1.00 mm after 4 months and 3.23 ± 0.77 mm after 1 year (P < 0.05), whereas no change was observed in the implant group. The difference between the two groups was significant after 4 months and 1 year (P < 0.05). The implant + connective tissue graft group also showed a greater reduction in buccal defects after 1 year compared to the implant group (∆ -0.50 ± 0.70 mm and ∆ -1.80 ± 1.30 mm, respectively; P < 0.05). After 1 year, a significant intergroup difference in proximal bone resorption was observed, with the implant + connective tissue graft group showing less bone resorption compared to the implant group (0.75 ± 0.20 mm and 0.92 ± 0.30 mm, respectively; P < 0.05). CONCLUSIONS: Placement of a connective tissue graft simultaneous to single implant insertion in the anterior maxillary region can increase the thickness of the peri-implant mucosa and reduce proximal bone resorption.

Effect of systemic antibiotic and probiotic therapies as adjuvant treatments of subgingival instrumentation for periodontitis: a randomized controlled clinical study.

OBJECTIVE: This study assessed the efficacy of two adjunct therapies (antibiotic and probiotic) for periodontal treatment based on clinical and immunological parameters in patients with Stage II and III Grade B periodontitis. METHODOLOGY: 45 patients were randomly allocated into three groups: control group (CG); antibiotic group (GAtb), in which 500 mg amoxicillin + 400 mg metronidazole were used; and probiotic group (GProb), for which Lactobacillus reuteri was used. Patients received medications after undergoing periodontal debridement. Clinical and immunological parameters were assessed at baseline, 30 days, and 90 days. RESULTS: All therapies reduced bleeding on probing (BoP) in the evaluated periods, and the GAtb had a greater reduction at 90 days (p=0.03). The GProb group showed better results for plaque index (PI) and gingival recession (GR) compared to the GAtb at 90 days (p=0.0014; p=0.006). The area of inflammation (PISA Index) significantly decreased in all therapies in the evaluated periods. Therapies had no significant differences regarding moderate pockets. The GAtb had a greater reduction in probing depth (PD) for deep pockets (p=0.03) at 90 days and in the number of deep pocket sites at 30 days (p=0.04). The occurrence of adverse effects was commonly reported in the GAtb as a percentage per patient. The GAtb had a significant reduction in the concentration of interleukins IL-1ß and IL-8 and an increase in IL-10 and TNF-α. The CG had a reduction in IL-6 and IL-1 ß, whereas in the GProb there was no difference. CONCLUSION: After three months, none of the adjuvant therapies provided any additional benefit for subgingival instrumentation.

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.

Single gingival recession associated with non-carious cervical lesion treated by partial restoration and coronally advanced flap with or without xenogenous collagen matrix: A randomized clinical trial evaluating the coverage procedures and restorative protocol.

BACKGROUND: Evaluate the use of collagen matrix (CM) as adjunctive to coronally advanced flap (CAF versus CAF + CM) to treat gingival recession (GR) associated with non-carious cervical lesion-combined defects (CDs). METHODS: Sixty-two patients presenting 62 CDs (RT1 GR and non-carious cervical lesion (NCCLs) were randomly allocated to either CAF group (n = 31): partial restoration of the NCCL and CAF; or to CAF + CM group (n = 31): partial restoration of the NCCL and CAF associated with CM. Clinical, esthetic, patient-centered outcomes, and restorative parameters were assessed. RESULTS: After 12 months, CD coverage were 55.2% for CAF and 54.4% for CAF + CM (P = 0.8). Recession reduction were 1.9 ± 0.8 mm for CAF and 2.0 ± 0.7 mm for CAF + CM (P = 0.6). CAF+CM resulted in higher increase in keratinized tissue (KT) width (CAF: 0.3 ± 0.7 mm; CAF + CM: 0.9 ± 0.8 mm; P = 0.004) and KT thickness gain (CAF: 0.1 ± 0.3 mm; CAF + CM: 0.7 ± 0.2 mm; P = 0.001). Both treatments presented low postoperative pain and resulted in esthetics improvements. In addition, no restoration was lost, 27.4% showed a reduction of the superficial polishing, and 8% showed marginal staining, but still clinically acceptable. CONCLUSION: Partial resin composite restoration (with the apical limit up to 1 mm of the estimated CEJ) and CAF alone or combined with CM are suitable for treating CDs. The use of CM provided additional benefits in terms of KT width and thickness gain. (NCT03341598).

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.