Entire Papilla Preservation Technique with Enamel Matrix Proteins and Allogenic Bone Substitute for the Treatment of Isolated Intrabony Defects: A Prospective Case Series.

The aim of this study was to evaluate the outcomes of a modified entire papilla preservation technique (EPPT) in the treatment of isolated intrabony defects in patients diagnosed with stage III periodontitis. A total of 18 intrabony defects were treated: 4 one-wall, 7 two-wall, and 7 three-wall. Mean probing pocket depth reductions of 4.33 mm (P < .0001), clinical attachment level gains of 4.87 mm (P < .0001), and radiographic defect depth reductions of 4.27 mm (P < .0001) were observed at 6 months. Changes in gingival recession and keratinized tissue were not statistically significant. It can be concluded that the proposed modification of the EPPT is useful in the treatment of isolated intrabony defects.

Clinical and Aesthetic Outcomes of Multiple Gingival Recessions Coverage with Modified Coronally Advanced Tunnel and Subepithelial Connective Tissue Graft in Maxilla and Mandible: A 2-Year Retrospective Study.

Limited long-term data are available when analyzing gingival recession coverage between the maxillary and mandibular sites. Therefore, the aim of this study was to evaluate the influence of location (maxilla versus mandible) of multiple gingival recessions on 24 months clinical and aesthetic outcomes of modified coronally advanced tunnel with subepithelial connective tissue graft. Forty patients with multiple gingival recessions (GR) located at maxillary or mandibular teeth were treated between January 2018 and December 2019. Reduction in GR, average root coverage (ARC), complete root coverage (CRC), increase in keratinized tissue width (KTW), increase in gingival thickness (GT), and aesthetic evaluation with the root coverage esthetic score (RES) were evaluated after 24 months. Thirty patients with 270 recessions in the upper teeth and ten patients with 90 recessions in the lower teeth completed the 2-year recall. The differences between preoperative and postoperative clinical parameters showed statistical significance only within but not between groups. ARC at 2 years was 93.31% for maxillary teeth and 93.06% for mandibular teeth (p = 0.7906). Mean RES values were comparable for upper and lower teeth (9.25 versus 8.92, respectively, p = 0.6733). However, upper teeth achieved significantly higher scores for marginal tissue contour (MTC), muco-gingival junction alignment (MGJ), and gingival color (GC). Lower teeth had decreased chances of receiving better RES (OR = 0.49, CI 0.24-0.99, p = 0.0457) in regression analysis, when compared with upper teeth. MCAT + SCTG achieved comparably favorable 2-year outcomes for the treatment of multiple GR in upper and in lower teeth. However, the individual RES components were higher in maxillary teeth, and upper teeth had higher odds of receiving better RES.

Periodontal condition of mandibular incisors treated with modified Kazanjian vestibuloplasty compared to untreated sites: A prospective study.

BACKGROUND: A shallow vestibule, insufficient keratinized tissue width and pulling of marginal gingiva may be associated with gingival recession, plaque accumulation and gingivitis. Conventional techniques for treatment of gingival recession use autogenous or allogenic grafts. However, these methods result in soreness at the donor site and pose an economic burden, which may cause patients to withdraw from treatment. Alternative therapy is currently not available to treat such patients. OBJECTIVES: The aim of this study was to evaluate changes in periodontal tissue at the mandibular incisors after vestibuloplasty, focusing on functional improvement of the existing soft tissue with no grafting. MATERIAL AND METHODS: Thirty patients with a shallow vestibule, minimal keratinized tissue width (KTW; ≤1 mm), gingival recession (REC) and pulling of gingiva underwent modified Kazanjian vestibuloplasty were included into the test group, whereas 27 patients did not undergo any surgery (control group). The probing pocket depth (PPD), clinical attachment level (CAL), gingival recession depth (GRD), and KTW were assessed at baseline and 12 months post-surgery. RESULTS: The mean KTW, GRD and CAL values improved in the test group. A significant increase in mean KTW value (1.17 ±1.22 mm, p = 0.0406) was detected in the test group, while the control group showed a further reduction in mean KTW value (0.13 ±0.45 mm). The mean GRD value decreased from 2.09 ±1.78 mm to 1.22 ±1.46 mm (p = 0.0087) in the test group, whereas in controls the mean GRD value increased from 1.95 ±1.29 mm to 2.34 ±1.44 mm (p = 0.0164). The mean KTW value at 3, 6 and 12 months compared to baseline showed an increase in the test group, and the mean GRD and CAL values exhibited the potential to improve. CONCLUSIONS: Sites treated with vestibuloplasty showed increased KTW, improvement in the gingival margin and CAL gain, whereas untreated sites showed continuous deterioration of the evaluated parameters. Vestibuloplasty may be recommended for patients avoiding major surgery for which functional improvement in tissue alone would provide a sufficient therapeutic outcome.

Patient morbidity at the palatal donor site depending on gingival graft dimension.

BACKGROUND: Autogenous gingival grafts are considered the gold standard procedure with proven clinical success when it comes to gingival augmentation. Different graft harvesting procedures have been described in the literature. Understanding which factors might affect the level of discomfort (morbidity) that patients are likely to experience and oral health-related quality of life outcomes in general seems to be crucial. OBJECTIVES: An evaluation of patients' morbidity depending on the free gingival graft (FGG) dimension. MATERIAL AND METHODS: Sixty patients were divided into 3 groups depending on the length of their graft (group L1: ≤10 mm, group L2: 10-20 mm, group L3: ≥20 mm) and into 2 groups depending on the thickness of the graft (group T1: ≤2 mm, group T2: >2 mm). Discomfort at the donor site was evaluated 1 week postoperatively, using a visual analog scale (VAS). RESULTS: With the length of the FGG, the mean VAS scores for pain, bleeding, eating and speaking disorders, stress and interference with social life increased. Analgesic consumption increased with the length of the graft. The thicker the grafts, the less discomfort and pain, and more problems with speaking, stress, daily and work routines occurred; however, without statistical significance. CONCLUSIONS: No differences were demonstrated in the post-operative patients' morbidity between the examined groups; however, pain gradually increased with the FGG length and width.

Periodontal Indices and Status in 34 Growing Patients with Unilateral Cleft Lip and Palate: A Split-Mouth Study.

Periodontal examination in growing patients with unilateral cleft lip and palate was performed in a split-mouth study design. Higher plaque acumulation and bleeding indices were recorded for teeth on the cleft side. Pocket probing depth (PPD) and clinical attachment level (CAL) values were higher at lateral incisors and canines adjacent to the cleft. Keratinized gingiva and depth of the vestibule were lower adjacent to the cleft. This study shows that growing patients with clefts present differences regarding periodontal parameters between the cleft and the control side. These alterations affected patients' ability to maintain proper oral hygiene and resulted in differences in PPD and CAL.

Evaluation of periodontal tissues in growing patients with bilateral cleft lip and palate. A pilot study.

AIM: To evaluate the periodontal status, mucogingival parameters and oral hygiene in growing patients with bilateral cleft lip and palate. MATERIAL AND METHODS: Assessment was performed in 15 patients aged 6 to 18 years with a bilateral cleft. Records included probing pocket depth, clinical attachment level, keratinized gingiva, recession, vestibule depth, biotype, type of fraena, dental plaque and bleeding. RESULTS: The mean scores of pocket depth were: 1.9 mm for central incisors, 1.6 mm for lateral incisors, 1.7 mm for canines, 2.0 mm for first premolars. There were only a few teeth with minimal attachment loss (1 mm). Gingival recessions were not recorded. High scores were recorded for the hygiene indicator, especially on the buccal, mesial and distal surfaces. Due to soft and hard tissue malformations, it was difficult to precisely assess the biotype and keratinized gingiva. However, keratinized gingiva was narrower near the teeth adjacent to the cleft. Similarly, the vestibule was shallower in this area. In 12 out of 15 children it was impossible to define the type of labial fraenum. CONCLUSIONS: Evaluation of the periodontal status is important for successful comprehensive rehabilitation in cleft patients. Specific features of hard (alveolar process) and soft tissue (scars, unusual fraena) malformations caused by the cleft and previous surgical procedures have functional and morphological implications. Narrower gingiva and a shallower vestibule in the presence of dental plaque and bleeding are unfavourable conditions to maintain a healthy periodontium. It is essential to include periodontal assessment and preventive treatment to a comprehensive approach as early as possible.

Evaluation of changes in the width of gingiva in children and youth. Review of literature.

Comprehensive health care in children and youth includes periodic oral examinations. The mucogingival complex undergoes significant changes during development. The factors that impact the width of attached and keratinized gingiva during this period of life are: tooth eruption phase, the position in the arch, the type of frena attachment and oral hygiene. Along with the child's development the width of attached and keratinized gingiva increases, except for the period of tooth replacement, when a temporary narrowing of attached gingiva of erupting permanent teeth is observed. The understanding of physiological processes of the mucogingival complex is prerequisite for diagnostics and treatment of gingival abnormalities in children and youth. Therefore close cooperation between paediatrician and dental specialists: paedodontist, orthodontist and periodontologist is essential.