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1.
J Clin Periodontol ; 2020 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-32654220

RESUMO

BACKGROUND: Aim of this systematic review (SR) of randomized controlled trials (RCTs) was to evaluate effect of different flap designs and graft materials for root coverage, in term of esthetics, patient satisfaction and self-reported morbidity (post-operative pain/discomfort). MATERIAL AND METHODS: A comprehensive literature search was performed. A mixed-modeling approach to Network Meta-Analysis was utilized to formulate direct and indirect comparisons among treatments for Root Coverage Esthetic Score (RES), with its individual components, and for subjective patient-reported satisfaction and post-operative pain/discomfort (visual analogue scale (VAS) of 100). RESULTS: Twenty-six RCTs with a total of 867 treated patients (1708 recessions) were included. Coronally Advanced Flap (CAF) + Connective Tissue Graft (CTG) (0.74 (95% CI[0.24, 1.26], p=0.005)), Tunnel (TUN) + CTG (0.84 (95% CI[0.15, 1.53]), p=0.01) and CAF + Graft substitutes (GS) (0.55 (95% CI[0.006, 1.094], p=0.04)) were significantly associated with higher RES than CAF. No significant difference between CAF+CTG and TUN+CTG was detected (0.09 (95% CI [-0.54, 0.72], p=0.77)). Addition of CTG resulted in less natural tissue texture (-0.21 (95% CI [-0.34, -0.08]), p=0.003) and gingival color (-0.06 (95% CI [-0.12, -0.03], p=0.03)) than CAF. CTG techniques were associated with increased morbidity. CONCLUSIONS: CTG procedures showed highest overall aesthetic performance for root coverage, although graft integration might impair soft tissue color and appearance. Additionally, CTG-based techniques were also correlated with a greater patient satisfaction and morbidity.

2.
Acta Diabetol ; 2020 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-32318875

RESUMO

AIMS: Data about the association between periodontal disease or periodontitis (PD), diabetes and hyperglycemia have been reported mostly in patients with type 2 diabetes. Conversely, information about PD in type 1 diabetes (T1DM) is relatively scarce. The aim of this meta-analysis is therefore: (1) to assess the prevalence and severity of PD in patients affected by T1DM in comparison with the general population and (2) to verify the association between severity of PD and glycemic control in type 1 diabetics. METHODS: An electronic search was performed on MEDLINE, Cochrane Central Register of Trials and EMBASE, up to October 31, 2019. Estimates of prevalence of PD in T1DM were calculated together with Mantel-Haenszel odds ratios (MH-OR) of the risk of PD associated with T1DM; weighed mean difference in CAL between T1DM and control and weighed mean difference in CAL in patients with T1DM and unsatisfactory glycemic control as compared with those in good glycemic control were also evaluated.. RESULTS: The prevalence of PD in type 1 diabetes was 18.5 [8.0; 37.1] %; the MH-OR for PD is 2.51 (1.32;4.76) in T1DM patients versus general population (p = 0.005). The weighed mean difference in CAL depth between T1DM patients and controls is 0.506 [0.181; 0.832] mm (p < 0.005), and in T1DM patients with good glycemic control CAL depth is - 0.71 [- 1.00; - 0.42] mm less deep than in subjects with HbA1c > 7%. CONCLUSIONS: The present data confirm that T1DM is a relevant risk factor for the development of PD. The proportion of patients affected by PD is more than doubled in subjects with T1DM in comparison with non-diabetic individual, and among patients with T1DM, PD seems to be more severe and the differences appear very wide between subjects in optimal and suboptimal glycemic control.

3.
Minerva Stomatol ; 69(1): 27-36, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32181606

RESUMO

BACKGROUND: Root trunk length (RTL) plays an important role in the diagnosis, prognosis and treatment of periodontitis. The aim of this retrospective pilot study was to evaluate the RTL of first maxillary premolar and to study the correlation with age and sex in this value. METHODS: The sample included 110 cone beam computed tomography (CBCT) images comprising 220 maxillaries first premolars from systemically healthy patients aged between 18 and 70 years. The tooth length (TL), root length (RL) and RTL were measured (dependent variables). Age and sex were considered as independent variables. RESULTS: No statistically significant correlation was found between the RTL and the TL. Longer RL and longer RTL were observed in younger patients than older subjects only in the left maxillary premolars. On the other hand, the sex of the patients had no effect on either of the dependent variables. The single rooted maxillary premolars were more frequent (relative to those with two roots) in woman and in elderly patients. CONCLUSIONS: A correlation between the age and the RTL and RL has been found but only in left premolars. Sex seemed to have only a slight correlation on the frequency of single-rooted teeth of the right side of the mouth. Further studies should be addressed to clarify the significance of the asymmetries observed in the present study between the two sides of the mouth with the aim of deepening the knowledge and understanding of the different variables that could be correlated with the RTL.


Assuntos
Cavidade Pulpar , Maxila , Adolescente , Adulto , Idoso , Dente Pré-Molar , Tomografia Computadorizada de Feixe Cônico , Feminino , Humanos , Pessoa de Meia-Idade , Projetos Piloto , Estudos Retrospectivos , Raiz Dentária , Adulto Jovem
4.
Clin Oral Investig ; 24(3): 1125-1135, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32052179

RESUMO

OBJECTIVE: The aim of this systematic review was to explore the efficacy of different minimal invasive surgical (MIS) and non-surgical (MINST) approaches for the treatment of intra-bony defect in terms of clinical attachment level (CAL) gain and periodontal pocket depth (PPD) reduction. METHODS: A detailed review protocol was designed according to PRISMA guideline. Online search was conducted on PubMed, Cochrane library and Embase. Only randomized clinical trials (RCTs) testing MIS or MINST procedure, with or without the application of a regenerative tool for the treatment of intra-bony defect, were included. Cochrane checklist for risk of bias assessment was used. Network meta-Analysis (NMAs) was used to rank the treatment efficacy. RESULTS: Nine RCTs accounting for 244 patients and a total of 244 defects were included. Only two studies were at low risk of bias. CAL gain for included treatment ranged from 2.58 ± 1.13 mm to 4.7 ± 2.5 mm while PPD reduction ranged from 3.19 ± 0.71 mm to 5.3 ± 1.5 mm. On the basis of the ranking curve, MINST showed the lowest probability to be the best treatment option for CAL gain. Pairwise comparisons and treatment rankings suggest superiority for regenerative approaches (CAL difference 0.78 mm, (0.14-1.41); P < 0.05) and surgical treatment elevating only the buccal or palatal flap (CAL difference: 0.95 mm, (0.33-1.57); P < 0.05). CONCLUSIONS: Minimally invasive surgical (MIS) and non-surgical (MINST) periodontal therapy show promising results in the treatment of residual pocket with intra-bony defect. CLINICAL RELEVANCE: MIS procedures represent a reliable treatment for isolated intra-bony defect.


Assuntos
Perda do Osso Alveolar/cirurgia , Perda do Osso Alveolar/terapia , Procedimentos Cirúrgicos Minimamente Invasivos , Procedimentos Cirúrgicos Bucais , Humanos , Metanálise em Rede , Bolsa Periodontal , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
5.
J Clin Periodontol ; 47(3): 362-371, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31811742

RESUMO

BACKGROUND: Aim of this study was to compare coronally advanced flap (CAF) and composite restoration of the cement-enamel junction (CEJ) with or without connective tissue graft (CTG) for treatment of single maxillary gingival recession with non-carious cervical lesion (NCCL). MATERIAL AND METHODS: Thirty patients with single gingival recessions and previously restored NCCL were randomly allocated to the two groups. A masked examiner evaluated recession reduction (RecRed), complete root coverage (CRC), keratinized tissue (KT) gain, increase in gingival thickness (GT), patient satisfaction and Root coverage Esthetic Score (RES). RESULTS: No significant difference for RecRed and CRC was detected at 12 months. CAF + CTG resulted in greater increase of KT width and thickness (p < .001). An interaction between baseline GT and type of treatment was reported, suggesting that when baseline GT was ≤0.84 mm adding CTG led to higher RecRed, while for values >0.84 mm the use of CAF was associated with better outcomes. Similarly, CAF alone provided better final RES score for baseline GT > 0.82 mm. CONCLUSION: Both procedures were effective for root coverage at single RT1 recession with previously restored CEJ. Adding a CTG under CAF should be considered for Rec with thin gingival phenotype.

6.
J Clin Periodontol ; 47 Suppl 22: 320-351, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31860134

RESUMO

BACKGROUND: The aim of this systematic review was to compare clinical, radiographic and patient-reported outcomes (PROMs) in intra-bony defects treated with regenerative surgery or access flap. MATERIALS AND METHODS: A systematic review protocol was written following the PRISMA checklist. Electronic and hand searches were performed to identify randomized clinical trials (RCTs) on regenerative treatment of deep intra-bony defects (≥3 mm) with a follow-up of at least 12 months. Primary outcome variables were probing pocket depth (PPD) reduction, clinical attachment level (CAL) gain and tooth loss. Secondary outcome variables were Rec, radiographic bone gain, pocket "closure," PROMs and adverse events. Meta-analysis was carried out when possible. To evaluate treatment effect, odds ratios were combined for dichotomous data and mean differences for continuous data using a random-effect model. RESULTS: A total of 79 RCTs (88 articles) published from 1990 to 2019 and accounting for 3,042 patients and 3,612 intra-bony defects were included in this systematic review. Only 10 of included studies were rated at low risk of bias. A total of 13 meta-analyses were performed. All regenerative procedures provided adjunctive benefit in terms of CAL gain (1.34 mm; 0.95-1.73) compared with open flap debridement alone. Both enamel matrix derivative (EMD) and guided tissue regeneration (GTR) were superior to OFD alone in improving CAL (1.27 mm; 0.79-1.74 mm and 1.43 mm; 0.76-2.22, respectively), although with moderate-high heterogeneity. Among biomaterials, the addition of deproteinized bovine bone mineral (DBBM) improved the clinical outcomes of both GTR with resorbable barriers and EMD. Papillary preservation flaps enhanced the clinical outcomes. The strength of evidence was low to moderate. CONCLUSION: EMD or GTR in combination with papillary preservation flaps should be considered the treatment of choice for residual pockets with deep (≥3 mm) intra-bony defects.

7.
Clin Implant Dent Relat Res ; 21(6): 1262-1270, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31729830

RESUMO

BACKGROUND: Different procedures were proposed to augment soft tissue around dental implants. OBJECTIVE: Aims of this Systematic Review (SR) were to evaluate (a) clinical benefit of soft tissue augmentation at implant sites (b) which is the best surgical procedure to augment soft tissue. MATERIALS AND METHODS: Manual/electronic searches were performed to identify randomized controlled trials (RCTs). Change in keratinized tissue thickness (STT) and height (KT) were primary outcomes. Random effects meta-analyses were performed where suitable and expressed as weighted mean differences (MD) with their associated 95% confidence intervals (CI). RESULTS: Fourteen RCTs accounting for 475 patients and 538 implants were included. Only five studies were judged at low risk of bias. In the single studies, soft augmentation lead to higher STT and KT compared to no augmentation. Considering primary outcomes, connective tissue graft (CTG) was more effective than xenogeneic collagen matrix (XCM) to improve STT (MD: -0.30 mm; 95% CI -0.43; -0.17; P < .00001) in the meta-analysis for different techniques for augmentation. CONCLUSIONS: Even if further studies at low risk of bias are needed, soft tissue augmentation techniques improved quantity and quality of peri-implant soft tissue. Among the augmentation procedures, CTG was associated to higher STT change compared to XCM.


Assuntos
Implantes Dentários , Mucosa Bucal , Peri-Implantite , Colágeno , Tecido Conjuntivo , Humanos , Peri-Implantite/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto
8.
J Clin Periodontol ; 46(11): 1124-1133, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31446625

RESUMO

AIM: To evaluate the long term root coverage outcomes of coronally advanced flap plus a connective tissue graft with (CAF + CTG) or without an epithelial collar (CAF + ECTG), and evaluate the adjacent treated sites included in the flap. METHODS: Seventeen of the original 20 subjects included in the randomized clinical trial were available at 12 years (43 sites). Mean root coverage (mRC), keratinized tissue width (KTW), gingival thickness (GT) on the grafted and adjacent sites were evaluated and compared with baseline and 6 months. RESULT: There was a reduction in the mRC at all sites: 16.52% in the CAF + CTG (p > .05), 19.42% in the CAF + ECTG (p < .05) and 34.12% in the CAF-alone (adjacent treated sites) group (p < .05). No significant differences were observed within the groups for changes in KTW, GT and clinical attachment level (CAL) (p > .05). Keratinized tissue width at baseline and at 6 months was found to be predictors for the stability of the gingival margin in the long term. CONCLUSIONS: CAF + CTG and CAF + ECTG were found equally efficacious in maintaining the levels of the gingival margin with a small amount of relapse over the period of 12 years while CAF-alone sites showed a greater gingival recession (GR) reoccurrence.


Assuntos
Retração Gengival , Tecido Conjuntivo , Seguimentos , Gengiva , Humanos , Raiz Dentária , Resultado do Tratamento
9.
J Clin Periodontol ; 46(9): 937-948, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31242333

RESUMO

AIM: To evaluate the long-term outcomes of Acellular Dermal Matrix (ADM) with Coronally Advanced Flap (CAF) or Tunnel technique (TUN) in the treatment of multiple adjacent gingival recessions (MAGRs). MATERIAL AND METHODS: Nineteen of the original 24 patients contributing to a total number of 33 sites for CAF and 34 for TUN were available for the 12 years follow-up examination. Recession depth, mean root coverage (mRC), keratinized tissue width (KTW), gingival thickness (GT) were evaluated and compared with baseline values and 6-months results. Regression analysis was performed to identify factors related to the stability of the gingival margin. RESULTS: A highly significant drop in mRC was observed for both groups from the 6 months timepoint to the 12 years recall (p < .001). While there were no statistically significant differences between the two groups in terms of Clinical Attachment Level (CAL), KTW, GT changes and Root Coverage Esthetic Score at each timepoint (p > .05). KTW ≥ 2 mm and GT ≥ 1.2 mm at 6-months were two predictors for stability of the gingival margin (p = .03 and p = .01, respectively). CONCLUSIONS: A significant relapse of the gingival margin of MAGRs treated with CAF or TUN + ADM was observed after 12 years.


Assuntos
Derme Acelular , Retração Gengival , Tecido Conjuntivo , Estética Dentária , Seguimentos , Gengiva , Humanos , Raiz Dentária , Resultado do Tratamento
10.
J Clin Periodontol ; 46(5): 564-571, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30868622

RESUMO

BACKGROUND: Few studies have looked at professional assessment or patient perception of aesthetics after root coverage procedures. The addition of connective tissue grafts (CTG) seems to improve aesthetic outcomes. The objective of this a priori analysis was to compare aesthetics after addition of CTG or a collagen matrix (CMX) to coronally advanced flap (CAF). METHODS: Two independent, trained and calibrated assessors analysed baseline and 6-month post-operative Images from 183 subjects with 475 recessions from a previously reported multicentre multinational randomized clinical trial. The root coverage aesthetic score (RES) was assessed in its five constituent components after assessing the suitability of images blindly with regard to treatment assignment and centre. Data were analysed at the tooth and subject level. RESULTS: One hundred and fifty-five subjects (81 CTG) and 393 teeth (207 CTG) were included in the analysis. CTG control subjects had higher total RES scores (mean adjusted difference of 1.3 ± 0.8 RES units, p = 0.002). Analyses of RES subcomponents showed that the CTG group had higher scores in terms of gingival margin position but that better marginal tissue contour (OR 3.0, 95% CI 1.2-7.7) and soft tissue texture (OR 3.3, 95% CI 1.9-5.8) was observed for the CMX group. No significant differences were observed for mucogingival alignment and gingival colour. CONCLUSION: Better overall RES scores were observed for the CTG group. Better marginal tissue texture and marginal contour were observed in the CMX group. More research and development is needed to optimize materials to be used in conjunction with CAF to improve root coverage without negatively affecting tissue texture and marginal contour.


Assuntos
Retração Gengival , Colágeno , Tecido Conjuntivo , Estética , Seguimentos , Gengiva , Humanos , Perda da Inserção Periodontal , Raiz Dentária , Resultado do Tratamento
12.
J Clin Periodontol ; 45(1): 78-88, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29087001

RESUMO

AIM: To evaluate the non-inferiority of the adjunct of a xenogeneic collagen matrix (CMX) or connective tissue graft (CTG) to coronally advanced flaps (CAF) for coverage of multiple adjacent recessions and compare superiority in patient-reported outcomes (PROM). MATERIAL AND METHODS: One hundred and eighty-seven subjects (92 CMX) with 485 recessions in 14 centres were randomized and followed up for 6 months. Patients filled daily diaries for 15 days to monitor patient-reported experience. The primary outcome was changed in position of the gingival margin. Multilevel analysis used centre, subject and tooth as levels and baseline parameters as covariates. RESULTS: Average baseline recession was 2.5 ± 1.0 mm. The surgery was 15.7 min shorter (95%CI from 11.9 to 19.6, p < .0001) and perceived lighter (11.9 VAS units, 95%CI from 4.6 to 19.1, p = .0014) in CMX subjects. Time to recovery was 1.8 days shorter in CMX. Six-month root coverage was 1.7 ± 1.1 mm for CMX and 2.1 ± 1.0 mm for CTG (difference of 0.44 mm, 95%CI from 0.25 to 0.63 mm). The upper limit of the confidence interval was over the non-inferiority margin of 0.25 mm. Odds of complete root coverage were significantly higher for CTG (OR = 4.0, 95% CI 1.8-8.8). CONCLUSION: Replacing CTG with CMX shortens time to recovery and decreases morbidity, but the tested generation of devices is probably inferior to autologous CTG in terms of root coverage. Significant variability in PROMs was observed among centres.


Assuntos
Colágeno , Tecido Conjuntivo/transplante , Retração Gengival/cirurgia , Saúde Bucal , Qualidade de Vida , Retalhos Cirúrgicos , Raiz Dentária , Adulto , Autoenxertos , Feminino , Retração Gengival/patologia , Humanos , Masculino , Procedimentos Cirúrgicos Bucais/métodos , Método Simples-Cego
13.
Periodontol 2000 ; 75(1): 296-316, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28758301

RESUMO

This manuscript aims to review periodontal plastic surgery for root coverage at single and multiple gingival recessions. Techniques are assessed based on biological principles, surgical procedures, prognosticative factors and expected clinical and esthetic outcomes. The use of coronally advanced flap, laterally sliding flap, free gingival graft, the tunnel grafting technique, barrier membranes, enamel matrix derivative, collagen matrix and acellular dermal matrix are evaluated. The clinical scenario and practical implications are analyzed according to a modern evidence-based approach.


Assuntos
Retração Gengival/cirurgia , Procedimentos Cirúrgicos Bucais/métodos , Periodontia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Derme Acelular , Colágeno/uso terapêutico , Proteínas do Esmalte Dentário/uso terapêutico , Gengiva/transplante , Humanos , Membranas Artificiais , Retalhos Cirúrgicos
14.
J Clin Periodontol ; 44(7): 769-776, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28548210

RESUMO

BACKGROUND: Peri-implant soft tissue may be critical to prevent inflammation and promote gingival margin stability. The purpose of this randomized clinical trial (RCT) is to compare xenogeneic collagen matrix (XCM) versus connective tissue graft (CTG) to increase buccal soft tissue thickness at implant site. MATERIALS AND METHODS: Soft tissue augmentation with XCM (test) or CTG (control) was performed at 60 implants in 60 patients at the time of implant uncovering. Measurements were performed by a blinded examiner at baseline, 3 and 6 months. Outcome measures included buccal soft tissue thickness (GT), apico-coronal keratinized tissue (KT), chair time and post-operative discomfort. Visual Analogue Scale (VAS) was used to evaluate patient satisfaction. RESULTS: After 6 months, the final GT increase was 0.9 ± 0.2 in the XCM group and 1.2 ± 0.3 mm in the CTG group, with a significant difference favouring the control group (0.3 mm; p = .0001). Both procedures resulted in similar final KT amount with no significant difference between treatments. XCM was associated with significant less chair-time (p < .0001), less post-operative pain (p < .0001), painkillers intake (p < .0001) and higher final satisfaction than CTG (p = .0195). CONCLUSION: CTG was more effective than XCM to increase buccal peri-implant soft tissue thickness.


Assuntos
Tecido Conjuntivo/transplante , Implantes Dentários , Gengivoplastia/métodos , Colágeno , Feminino , Xenoenxertos , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Resultado do Tratamento
15.
J Clin Periodontol ; 44(2): 215-224, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27978602

RESUMO

AIM: To compare need for bone augmentation, surgical complications, periodontal, radiographic, aesthetic and patient reported outcomes in subjects receiving implant placement at the time of extraction (Immediate Implant) or 12 weeks thereafter. METHODS: Subjects requiring single tooth extraction in the anterior and premolar areas were recruited in seven private practices. Implant position and choice of platform were restoratively driven. Measurements were performed by calibrated and masked examiners. RESULTS: IMI was unfeasible in 7.5% of cases. One hundred and 24 subjects were randomized. One implant was lost in the IMI group. IMI required bone augmentation in 72% of cases compared with 43.9% for delayed (p = 0.01), while wound failure occurred in 26.1% and 5.3% of cases, respectively (p = 0.02). At 1 year, IMI had deeper probing depths (4.1 ± 1.2 mm versus 3.3 ± 1.1 mm, p < 0.01). A trend for greater radiographic bone loss was observed at IMI over the initial 3-year period (p-trend < 0.01). Inadequate pink aesthetic scores were obtained in 19% of delayed and in 42% of IMI implant cases (p = 0.03). No differences in patient reported outcomes were observed. CONCLUSIONS: Immediate implant placement should not be recommended when aesthetics are important, IMI should be limited to selected cases. Longer follow-up is needed to assess differences in complication rates.


Assuntos
Implantação Dentária Endo-Óssea/métodos , Extração Dentária , Feminino , Humanos , Carga Imediata em Implante Dentário , Masculino , Pessoa de Meia-Idade , Método Simples-Cego , Fatores de Tempo
16.
J Clin Periodontol ; 43(11): 965-975, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27454460

RESUMO

BACKGROUND: The aim of this study was to perform a systematic review (SR) of randomized controlled trials (RCTs) to explore if periodontal plastic surgery procedures for the treatment of single and multiple gingival recessions (Rec) may improve aesthetics at patient and professional levels. MATERIAL AND METHODS: In order to combine evidence from direct and indirect comparisons by different trials a Bayesian network meta-analysis (BNM) was planned. A literature search on PubMed, Cochrane libraries, EMBASE, and hand-searched journals until January 2016 was conducted to identify RCTs presenting aesthetic outcomes after root coverage using standardized evaluations at patient and professional level. RESULTS: A total of 16 RCTs were selected in the SR; three RTCs presenting professional aesthetic evaluation with Root coverage Aesthetic Score (RES) and three showing final self-perception using the Visual Analogue Scale (VAS Est) could be included in a BNM model. Coronally Advanced Flap plus Connective Tissue Graft (CAF + CTG) and CAF + Acellular Dermal Matrix (ADM) and Autologous Fibroblasts (AF) were associated with the best RES outcomes (best probability = 24% and 64%, respectively), while CAF + CTG and CAF + CTG + Enamel matrix Derivatives (EMD) obtained highest values of VAS Est score (best probability = 44% and 26%, respectively). CONCLUSIONS: Periodontal Plastic Surgery (PPS) techniques applying grafts underneath CAF with or without the adding of EMD are associated with improved aesthetics assessed by final patient perception and RES as professional evaluation system.


Assuntos
Estética Dentária , Teorema de Bayes , Tecido Conjuntivo , Proteínas do Esmalte Dentário , Estética , Gengiva , Retração Gengival , Humanos , Metanálise em Rede , Resultado do Tratamento
17.
J Clin Periodontol ; 43(10): 849-56, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27329829

RESUMO

BACKGROUND: The aim of this study was to assess the clinical efficacy of coronally advanced flap (CAF) with or without connective tissue graft (CTG) for the treatment of multiple adjacent gingival recessions in the upper arch. MATERIAL AND METHODS: Thirty-two patients with a total of 74 gingival recessions were randomly allocated to the two groups. Outcome measures, collected by a blind examiner, included complete root coverage (CRC), recession reduction (RecRed), keratinized tissue (KT) gain, increase in gingival thickness (GT), patient satisfaction and root coverage esthetic score (RES). RESULTS: An interaction between treatment and baseline GT was detected. At 1 year, CAF + CTG resulted in better outcomes in terms of CRC (p = 0.0016) and RecRed (p < 0.0001) than CAF alone at sites with thin gingiva (thickness ≤ 0.8 mm). No difference was found between CAF alone and CAF + CTG at sites with thick gingiva (>0.8 mm). CAF resulted in higher aesthetic scores (RES) than CAF + CTG at sites with thick gingiva. CAF + CTG was associated with greater KT gain (p < 0.0001) and greater post-operative morbidity (p < 0.0001). CONCLUSION: Connective tissue graft under CAF results in increased probability of CRC only at sites with thin baseline gingiva. CAF alone is associated with similar clinical outcomes and better aesthetics at sites with thick baseline gingiva.


Assuntos
Tecido Conjuntivo , Retração Gengival , Estética Dentária , Seguimentos , Gengiva , Humanos , Perda da Inserção Periodontal , Raiz Dentária , Resultado do Tratamento
18.
Int J Esthet Dent ; 11(2): 220-32, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27092348

RESUMO

The aim of this article is to present a clinical case of a 54-year-old patient where the cementoenamel junction (CEJ) level was restored and a root coverage procedure carried out after gingival augmentation on the mandibular teeth. A very thin buccal keratinized tissue (KT) was detected apical to the recessions. The restorative approach consisted of identifying the lost CEJ, thus differentiating the area of restoration from the area of root coverage of the abraded teeth. Subsequently, a free gingival graft (FGG) was applied. A coronally advanced flap procedure was performed 3 months later. The clinical outcomes obtained through combined restorative/ periodontal treatment were maintained at the 4-year follow-up.


Assuntos
Gengivoplastia/métodos , Mandíbula/cirurgia , Raiz Dentária/cirurgia , Estética Dentária , Retração Gengival/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Suturas
20.
Curr Vasc Pharmacol ; 13(6): 749-58, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26282351

RESUMO

Endothelial dysfunction (ED) is the initial step in the development of atherosclerosis, leading to cardiovascular disease (CVD). It has been suggested that periodontal disease (PD) could be associated to pathogenesis of atherosclerosis, since it is able to trigger a host response with systemic inflammation. Although a number of epidemiological studies have shown that periodontitis could be associated with ED, it is still unclear whether periodontal treatment could improve ED and therefore cardiovascular outcomes. In this narrative review we analysed the literature in the databases of Medline under ''endothelial function OR dysfunction OR vasodilatation'', AND ''periodontal disease" OR periodontal treatment" AND "cardiovascular disease" OR atherosclerosis AND "endothelial biomarker". Research articles, systematic reviews and clinical trials were screened. ED could be related to periodontitis as well as to CVD. Periodontal treatment reduces the risk of teeth loss and may improve ED and the risk of CVD. Since controversial results exist, there is an urgent need for well-designed clinical trials to find and validate novel biomarkers of endothelial function, such as circulating endothelial progenitors, which may be crucial for further investigation of the association of PD with endothelial function and CVD.


Assuntos
Aterosclerose/prevenção & controle , Endotélio Vascular/patologia , Periodontite/terapia , Aterosclerose/etiologia , Biomarcadores/metabolismo , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Humanos , Inflamação/etiologia , Inflamação/prevenção & controle , Periodontite/complicações , Perda de Dente/prevenção & controle , Vasodilatação/fisiologia
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