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1.
Int J Legal Med ; 133(3): 921-930, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30790037

RESUMO

Regressive dental changes appear to be suitable for age assessment in living adults. In 2012, Olze et al. showed that several criteria presented by Gustafson for extracted teeth can also be applied to orthopantomograms. The objective of this study was to test the applicability and reliability of this method in a Chinese population. For this purpose, 1300 orthopantomograms of 650 female and 650 male Chinese aged between 15 and 40 years were evaluated. The characteristics of secondary dentin formation, periodontal recession, attrition, and cementum apposition were reviewed in all the mandibular premolars. The sample was split into a training and test dataset. Based on the training set, the correlation of the individual characteristics with chronological age was studied with a stepwise multiple regression analysis, in which individual characteristics formed the independent variable. According to the results, the R values amounted to 0.80 to 0.83; the standard error of estimate was 4.29 to 4.75 years. By analyzing the test dataset, the accuracy of the present study, Olze's and Timme's formulas were determined by the difference between the estimated dental age (DA) and chronological age (CA). Taking both mean differences and mean absolute differences into account, the Chinese age estimation formula did not always perform better compared with Olze's and Timme's formulas for both males and females. It was concluded that this method can be used in Chinese individuals for age assessment. However, the applicability of the method is limited by the quality of the X-ray images, and the method should only be applied by experienced forensic odontologists.


Assuntos
Determinação da Idade pelos Dentes/métodos , Adolescente , Adulto , Grupo com Ancestrais do Continente Asiático , Dente Pré-Molar/diagnóstico por imagem , China , Cemento Dentário/diagnóstico por imagem , Dentina Secundária/diagnóstico por imagem , Feminino , Retração Gengival/classificação , Retração Gengival/diagnóstico por imagem , Humanos , Masculino , Radiografia Panorâmica , Análise de Regressão , Atrito Dentário/classificação , Atrito Dentário/diagnóstico por imagem , Adulto Jovem
2.
Clin Oral Investig ; 23(2): 595-601, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29725851

RESUMO

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


Assuntos
Derme Acelular , Retração Gengival/cirurgia , Maxila/cirurgia , Retalhos Cirúrgicos , Adulto , Estética Dentária , Feminino , Retração Gengival/classificação , Humanos , Masculino , Satisfação do Paciente , Resultado do Tratamento
4.
Rev. ADM ; 75(6): 326-333, nov.-dic. 2018. tab
Artigo em Espanhol | LILACS | ID: biblio-986294

RESUMO

La exposición de dentina radicular asociada a una recesión gingival puede producir dolor ante distintos estímulos, situación que puede difi cultar la vida cotidiana de los pacientes que lo padecen, además de presentar complicaciones estéticas que pueden afectar la autoestima. La hipersensibilidad dentinaria tiene una etiología asociada a múltiples factores, siendo el principal factor de riesgo la recesión gingival, situación clínica común que se observa en gran parte de la población. El propósito de esta revisión es reunir distintos conceptos que expliquen la asociación que mantienen estas dos patologías, sus etiologías, el cuadro clínico que presenta la hipersensibilidad dentinaria para poder realizar un diagnóstico diferencial y las distintas opciones de tratamiento para realizar un adecuado manejo de esta condición que incluyen desde recursos terapéuticos que buscan resolver la sintomatología hasta procedimientos quirúrgicos que resultan más invasivos y que se enfocan en tratar el factor predisponente como es la recesión gingival misma (AU)


Dentin exposure level periodontal tissues can cause pain to diff erent stimuli, a situation which can hinder the daily lives of patients who suff er, in addition to having aesthetic complications that can damage self-esteem. Dental hypersensitivity has a multifactorial etiology associated being the main risk factor gingival recession, the common clinical situation observed in much of the population. The purpose of this review is to bring together various concepts that explain the association that maintain these two pathologies, their etiologies, clinical picture presented dentine hypersensitivity to perform a diff erential diagnosis and treatment options for proper management of this condition ranging from therapeutic procedure seeking to resolve the symptoms to surgical procedures that are more invasive and that focus on treating the predisposing factor such as the gingival recession itself (AU)


Assuntos
Humanos , Sensibilidade da Dentina/diagnóstico , Sensibilidade da Dentina/etiologia , Sensibilidade da Dentina/terapia , Retração Gengival/complicações , Compostos de Potássio , Diagnóstico Diferencial , Terapia a Laser , Retração Gengival/classificação
5.
Indian J Dent Res ; 29(5): 600-604, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30409939

RESUMO

Background: Marginal gingival recession can cause major functional and esthetic problems. Advanced flaps are the simplest, yet unpredictable procedures for managing these conditions. The predictability of root coverage can be increased by combining coronally advanced flap (CAF) or its modified approach with other regenerative techniques. Objective: To ascertain the potential benefits of platelet-rich fibrin (PRF) on modified CAF for the treatment of gingival recession. Materials and Methods: Study comprised of 12 patients with Millers' class I and class II gingival recession in two non-adjacent anterior teeth having a minimum 3 mm width of attached gingiva. Following split-mouth design, one tooth with gingival recession was subjected to modified CAF, while another was treated by CAF with PRF. The clinical parameters, i.e., plaque index, modified sulcular bleeding index, vertical gingival recession depth (VGRD), gingival recession width (GRW), clinical attachment level (CAL), and gingival thickness (GT) were recorded at baseline, 1 month, 3 months, and 6 months. Results: VGRD, GRW, CAL, and GT improved significantly from baseline to 1 month in both test and control groups. However, change in these parameters from 1 month to 3 months and 3 months to 6 months were statistically nonsignificant in both groups. On intergroup comparison, only the change in GT was found to be statistically significant (P < 0.05) at all three post-treatment visits. Conclusion: Benefits of the combined technique in terms of increased GT appear to justify the use of PRF along with modified CAF for the treatment of mild to moderate gingival recessions.


Assuntos
Retração Gengival/cirurgia , Fibrina Rica em Plaquetas , Retalhos Cirúrgicos , Raiz Dentária/cirurgia , Adolescente , Adulto , Estética Dentária , Feminino , Retração Gengival/classificação , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
6.
Compend Contin Educ Dent ; 39(8): 514-520, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30188152

RESUMO

Published more than three decades ago, the original classification of marginal tissue recession described four classes of recession. For example, in Miller Class III recession, there were different scenarios in which complete root coverage could not be achieved. Today, however, newer surgical techniques have made it possible for clinicians to potentially achieve complete root coverage when interdental bone loss exists. Currently, dentistry has a better understanding of the role of interdental papilla. Therefore, this article presents a new classification of papilla form that emphasizes the significance of the width and height of the papilla. Additionally, an updated classification of periodontal terminology will be presented.


Assuntos
Retração Gengival/classificação , Gengiva/patologia , Retração Gengival/patologia , Humanos , Terminologia como Assunto
7.
Artigo em Inglês | MEDLINE | ID: mdl-29889911

RESUMO

Predictable coverage of deep isolated mandibular gingival recessions is one of the most challenging endeavors in plastic-esthetic periodontal surgery, and limited data is available in the literature. The aim of this paper is to present the rationale, the step-by-step procedure, and the results obtained in a series of 24 patients treated by means of a novel surgical technique (the laterally closed tunnel [LCT]) specifically designed for deep isolated mandibular recessions. A total of 24 healthy patients (21 women and 3 men, mean age 25.75 ± 7.12 years) exhibiting one single deep mandibular Miller Class I (n = 4), II (n = 10), or III (n = 10) gingival recession ≥ 4 mm were consecutively treated with LCT in conjunction with an enamel matrix derivative (EMD) and palatal subepithelial connective tissue graft (SCTG). The following clinical parameters were assessed at baseline and 12 months postoperatively: probing depth (PD), clinical attachment level (CAL), complete root coverage (CRC), mean root coverage (MRC), recession depth (RD), and keratinized tissue width (KTW). The primary outcome variable was CRC. The postoperative morbidity was low, and no complications, such as bleeding, infections/abscesses, or loss of SCTG, occurred. At 12 months, CRC was obtained in 17 of the 24 defects (70.83%), while in the remaining 7 defects RC amounted to 80% to 90% (in 6 cases) and 79% (in 1 case). Of the 17 defects exhibiting CRC, 12 were central incisors and 5 were canines. With respect to defect type, CRC was found in 3 of the 4 Miller Class I, 8 of the 10 Class II, and in 6 of the 10 Class III defects. Mean RD changed from 5.14 ± 1.26 mm at baseline to 0.2 ± 0.37 mm at 12 months, while MRC amounted to 4.94 ± 1.19 mm, representing 96.11% (P < .0001). Mean KTW increased from 1.41 ± 1.00 mm at baseline to 4.14 ± 1.67 mm (P < .0001) at 12 months, yielding a KTW gain of 2.75 ± 1.52 (P < .0001). No statistically significant changes in mean PD occurred following root coverage surgery (1.8 ± 0.2 mm at baseline and 2.1 ± 0.3 mm at 12 months). The present results suggest that the LCT is a valuable approach for the treatment of deep isolated mandibular Miller Class I, II, and III gingival recessions.


Assuntos
Retração Gengival/cirurgia , Retração Gengival/terapia , Gengivoplastia/métodos , Mandíbula/cirurgia , Cirurgia Bucal/métodos , Adulto , Tecido Conjuntivo/transplante , Feminino , Gengiva/diagnóstico por imagem , Gengiva/cirurgia , Gengiva/transplante , Retração Gengival/classificação , Retração Gengival/diagnóstico por imagem , Humanos , Masculino , Bolsa Periodontal/cirurgia , Retalhos Cirúrgicos , Resultado do Tratamento , Adulto Jovem
8.
Indian J Dent Res ; 29(2): 233-237, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29652020

RESUMO

Background: Gingival recession is one of the most usual esthetic concerns associated with the periodontal tissues. Classification of such condition is important to diagnose, determine the prognosis, and frame the treatment plan. Various classifications have been put forward since decades to classify gingival recession. Miller's classification is the widely used classification among all classifications, but certain drawbacks have been noted in this classification. Therefore, an effort is made to review most commonly used classification systems for gingival recession, and their drawbacks further come up with a proposal of new classification system for gingival recession.


Assuntos
Retração Gengival/classificação , Humanos
9.
Clin Implant Dent Relat Res ; 20(3): 285-293, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29575589

RESUMO

BACKGROUND: Recessions following immediate implant insertion are frequently reported in the literature. Data regarding implant installation in presence of mucogingival recessions are rare. PURPOSE: This study observes soft tissue level changes following immediate implant insertion and provisionalization of implants with or without connective tissue grafts in the anterior maxilla in patients with initial mucogingival recession within a follow-up period between one and eight years. MATERIALS AND METHODS: Twenty-six patients with marginal gingival recessions, which were designated for extraction and immediate implant insertion in the anterior zone of the maxilla (13-23), were included. Out of a larger group of immediate implants only single tooth replacements with 1 to 3 mm recession and a pre- and post-op CB-CT were selected. Facial bone deficiencies were grafted flaplessly with autologous bone in all sites. In a group of 13 patients the recessions (mean 2.3 ± 0.7 mm, range 1.0-3.0 mm) were grafted additionally by connective tissue (ABG + CTG), in the remaining 13 patients no soft tissue grafting (mean recession 1.8 ± 0.6 mm, range 1.0-3.0 mm) was performed (ABG). The marginal hard and soft tissue level, the width of the keratinized mucosa, the PES, and implant success were evaluated. RESULTS: After a mean follow-up period of 45 months the recessions were significantly reduced in the ABG group from 1.8 to 0.9 mm. The improvement was even more pronounced in the ABG + CTG group (from 2.3 to 0.5 mm). The PES improved significantly in both groups. At final examination all implants were still in function. Within the observational period, in 5 of 13 implants a marginal bone loss of more than 1 mm was noticed in the ABG, but in none of the ABG + CTG group. CONCLUSIONS: These clinical results provide evidence that immediate implant placement might improve the facial soft tissue level. This was more evident in cases with a greater recession and an additional treatment with connective tissue grafts.


Assuntos
Tecido Conjuntivo/transplante , Implantes Dentários para Um Único Dente , Estética Dentária , Retração Gengival/terapia , Carga Imediata em Implante Dentário/métodos , Adulto , Idoso , Transplante Ósseo , Tomografia Computadorizada de Feixe Cônico , Implantes Dentários , Planejamento de Prótese Dentária , Prótese Dentária Fixada por Implante , Feminino , Seguimentos , Alemanha , Gengiva/patologia , Retração Gengival/classificação , Retração Gengival/diagnóstico por imagem , Retração Gengival/patologia , Humanos , Incisivo/diagnóstico por imagem , Incisivo/patologia , Incisivo/cirurgia , Masculino , Maxila/diagnóstico por imagem , Maxila/patologia , Maxila/cirurgia , Pessoa de Meia-Idade , Bolsa Periodontal/classificação , Estudos Retrospectivos , Extração Dentária , Transplante Autólogo , Resultado do Tratamento , Adulto Jovem
10.
J Investig Clin Dent ; 9(3): e12325, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29424485

RESUMO

The aim of the present systematic review was to analyze the factors that affect the outcome of subepithelial connective tissue graft (SCTG) for managing Miller's class I and class II isolated gingival recession defect. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for systematic reviews were used. Quality assessments of selected articles were performed. Data on root surface condition, recession type defect, flap thickness, different flap designs, different harvesting techniques, presence/absence of the epithelial collar, graft thickness, flap tension, suturing techniques, and smoking-related outcomes on root coverage were assessed. The SCTG procedure provides the best root coverage outcomes for Miller's class I and class II recession. The critical threshold of flap thickness was found to be 1 mm. Maximum root coverage was achieved by envelope and modified tunnel technique. SCTG with the epithelial collar does not provide additional gains than SCTG without the epithelial collar. The thickness of SCTG for root coverage was found to be 1.5-2 mm. Greater flap tension and smoking adversely affect root coverage outcomes. Analysis of the factors discussed would be of key importance for technique selection, and a combined approach involving factors favoring outcomes of SCTG could be of clinical relevance in recession coverage.


Assuntos
Tecido Conjuntivo/transplante , Epitélio/transplante , Retração Gengival/cirurgia , Retalhos Cirúrgicos , Retração Gengival/classificação , Humanos
11.
Quintessence Int ; 48(10): 777-782, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28944378

RESUMO

OBJECTIVE: To clinically evaluate the outcomes following surgical coverage of single and multiple Miller Class I and III gingival recessions at crown-restored teeth in the esthetic area by means of the modified coronally advanced tunnel (MCAT). METHOD AND MATERIALS: Eight systemically healthy patients (5 females) with a total of 23 single or multiple maxillary Miller Class I or III gingival recessions were consecutively treated with MCAT in conjunction with a subepithelial connective tissue graft (SCTG). Out of the 23 recessions, 16 were classified as Miller Class I and seven as Miller Class III. All patients presented at least one facial gingival recession at a crown-restored tooth, located in the maxillary anterior area. In all cases, the facial recession was associated with an impaired esthetic appearance. Clinical measurements were made at baseline (immediately before reconstructive surgery) and at 12 months postoperatively. The primary outcome variable was complete root coverage (CRC) (ie, 100% root coverage). RESULTS: Healing was uneventful in all cases. At 12 months, statistically highly significant (P < .0001) root coverage was obtained in all patients and defects. CRC was obtained in 22 out of the 23 recessions (in 16 Miller Class I and in six out of the seven Miller Class III recessions). In one Miller Class III recession, root coverage measured 89.10%. The treatment yielded a mean root coverage of 92.62% and 3.75 mm, respectively, and was associated with a mean gain of keratinized tissue width of 0.62 ± 1.15 mm (P < .05). CONCLUSION: Within their limits, the present findings indicate that MCAT in conjunction with SCTG represents a valuable option for treating single and multiple gingival recessions at crown-restored teeth in the maxillary esthetic area thus avoiding the replacement of the prosthetic restorations.


Assuntos
Coroas , Estética Dentária , Retração Gengival/cirurgia , Gengivoplastia/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Retração Gengival/classificação , Humanos , Masculino , Maxila , Pessoa de Meia-Idade , Resultado do Tratamento
12.
Implant Dent ; 26(6): 848-852, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28753196

RESUMO

PURPOSE: The etiology and progression of periimplant mucogingival defects are multifactorial. As such, the aim of this study was to discern and discuss the key long-term prognostic factors that change the balance of homeostasis/regeneration in periimplant mucogingival and recession defects. MATERIALS AND METHODS: This report provides cases and a discussion of anatomical factors that affect the long-term maintenance of periimplant soft tissue. RESULTS: The factors guiding long-term maintenance of the periimplant soft tissue apparatus are increasingly complex due to the additive combination of patient-related factors, anatomical variations, and unique material-host interactions. CONCLUSIONS: Severity and number of these contributing factors should be considered before implant placement and/or in the treatment of periimplant defects to achieve the best esthetic and functional outcome. In addition, assessment of prognostic factors should be used to provide the patient a realistic, long-term assessment of the esthetic and functional stability of both implant and the surrounding periimplant tissues.


Assuntos
Implantação Dentária Endo-Óssea/efeitos adversos , Implantes Dentários/efeitos adversos , Retração Gengival/classificação , Retração Gengival/etiologia , Progressão da Doença , Estética Dentária , Humanos , Prognóstico
13.
Artigo em Inglês | MEDLINE | ID: mdl-28196164

RESUMO

This article aims to describe a modification of the semilunar coronally advanced flap. A total of 12 systemically and periodontally healthy patients presenting Miller Class I gingival recession were treated with the modified semilunar coronally advanced flap technique described in this article. After 1 year of follow-up, the mean root coverage was 85.4% ± 24.7%. Significant gingival recession reduction, clinical attachment gain, and reduction in dentin sensitivity was observed 1 year after surgery. This novel semilunar coronally advanced flap technique was demonstrated to be effective for root coverage in Miller Class I gingival recessions.


Assuntos
Retração Gengival/cirurgia , Retração Gengival/terapia , Gengivoplastia/métodos , Retalhos Cirúrgicos/cirurgia , Adulto , Brasil , Sensibilidade da Dentina/cirurgia , Sensibilidade da Dentina/terapia , Estética Dentária , Feminino , Gengiva , Retração Gengival/classificação , Retração Gengival/diagnóstico por imagem , Humanos , Masculino , Maxila/diagnóstico por imagem , Maxila/cirurgia , Pessoa de Meia-Idade , Raiz Dentária/cirurgia , Resultado do Tratamento
14.
Artigo em Inglês | MEDLINE | ID: mdl-27977825

RESUMO

The aim of this study was to evaluate the laterally moved coronally advanced flap (LMCAF) technique in which magnified vision was used in conjunction with microsurgical instruments (LMCAF-M), and to compare the results with conventional LMCAF technique (LMCAF-C) in Miller Class III isolated recession-type defects. A total of 50 patients with recessions located at incisors and canines were treated with LMCAF-M or LMCAF-C. Outcome parameters (complete root coverage [CRC] and mean root coverage [MRC]) were assessed 6 months postoperatively. Of the 25 defects in each group, 13 in the LMCAF-M (92.0%) and 17 in the LMCAF-C group (68.0%) exhibited CRC (P < .007). MRC scores were 90.48% for the LMCAF-C group and 97.64% for the LMCAF-M group (P < .04). Patient satisfaction with esthetics and postoperative morbidity were better in the LMCAF-M group (P < .032). This study indicates that performing LMCAF with microsurgical instruments offers definite advantages in terms of CRC and MRC, decreased postoperative morbidity, and increased acceptance by patients.


Assuntos
Retração Gengival/cirurgia , Gengivoplastia/instrumentação , Microcirurgia/instrumentação , Retalhos Cirúrgicos , Adulto , Dente Canino , Estética Dentária , Feminino , Retração Gengival/classificação , Humanos , Incisivo , Masculino , Satisfação do Paciente , Resultado do Tratamento
15.
Artigo em Inglês | MEDLINE | ID: mdl-27977826

RESUMO

A xenogeneic collagen matrix recently has been suggested as an alternative to connective tissue graft for the treatment of gingival recession. The matrix avoids the second surgical site, and as a consequence could decrease surgical morbidity. This new matrix was used in various clinical situations and compared to connective tissue graft (CTG) in a split-mouth design case series. A total of 17 recessions were treated with a coronally advanced flap, 9 with CTG, and 8 with the matrix. Mean recession reduction was 2.00 mm with the CTG and 2.00 mm with the matrix. No significant statistical differences between the techniques were observed in this case report.


Assuntos
Colágeno/uso terapêutico , Tecido Conjuntivo/transplante , Retração Gengival/cirurgia , Gengivoplastia/métodos , Retalhos Cirúrgicos , Adulto , Feminino , Retração Gengival/classificação , Xenoenxertos , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
16.
Compend Contin Educ Dent ; 37(7): 468-80, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27548399

RESUMO

This article introduces a novel protocol for the predictable treatment of Class II division 2 implantrelated gingival recession and presents an innovative acrylic template for scoring the peri-implant soft-tissue gain, used before and after treatment. Ten patients with Class II division 2 single-implant-related gingival recession received combined double-papillary flap approximation and rotated subepithelial connective tissue grafting from the palate, along with any preferred optimal grafting technique that suits the type of preexisting defect. Clinical gingival recession was recorded using a scoring template at 4, 6, and 9 months postoperatively. At the end of the 9-month follow-up period, 80% of the cases showed improved soft-tissue coverage; two patients showed significant wound complications that were related to poor home-care measures. The scoring method used can be considered a diagnostic and prognostic tool for better understanding of implant-related gingival recession.


Assuntos
Implantes Dentários/efeitos adversos , Retração Gengival/cirurgia , Prostodontia/métodos , Adulto , Feminino , Retração Gengival/classificação , Retração Gengival/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Palato Mole/transplante , Projetos Piloto , Complicações Pós-Operatórias , Retalhos Cirúrgicos
17.
Rev Stomatol Chir Maxillofac Chir Orale ; 117(6): 403-410, 2016 Dec.
Artigo em Francês | MEDLINE | ID: mdl-27522241

RESUMO

Gingival recession is an oral exposure of the root surface due to an apical displacement of the gingival margin below the cemento-enamel junction. The root coverage is indicated for esthetic reasons, to reduce root hypersensitivity and to create or to augment keratinized tissue. Several surgical techniques have been described, the decision depending on anatomical and technical parameters. The main therapeutic goal is to achieve complete root coverage (CRC) and a satisfactory esthetic result. The purpose of this work was to make an update on the different factors that determine the success of root coverage and to evaluate the efficacy of different surgical techniques reported in literature.


Assuntos
Retração Gengival/diagnóstico , Retração Gengival/cirurgia , Procedimentos Cirúrgicos Bucais/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos , Raiz Dentária/cirurgia , Retração Gengival/classificação , Retração Gengival/patologia , Humanos , Prognóstico , Raiz Dentária/patologia
18.
Quintessence Int ; 47(8): 653-9, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27446995

RESUMO

OBJECTIVE: To clinically evaluate the healing of multiple adjacent maxillary Miller Class I, II, and III gingival recessions (MAGR) treated with the modified coronally advanced tunnel (MCAT) in conjunction with an enamel matrix derivative (EMD) and subepithelial connective tissue graft (SCTG). METHOD AND MATERIALS: Twelve systemically healthy patients (6 females) with a total of 54 adjacent maxillary Miller Class I, II, or III MAGR were consecutively treated with MCAT in conjunction with EMD and SCTG. Out of the 54 recessions, 44 were classified as Miller Class I, five as Miller Class II, and five as Miller Class III. Patients were included in the study if they presented at least two adjacent recessions with a depth of ≥ 3 mm. Measurements were made at baseline (immediately before reconstructive surgery) and at 12 months postoperatively. The primary outcome variable was complete root coverage (CRC) (ie, 100% root coverage). RESULTS: Healing was uneventful in all cases without any complications such as postoperative bleeding, allergic reactions, abscesses, or loss of SCTG. At 12 months, statistically highly significant (P < .0001) root coverage was obtained in all patients and recessions. CRC was obtained in 37 Miller Class I, three Miller Class II, and one Miller Class III recessions, respectively. Mean root coverage was 96%. Mean keratinized tissue width increased statistically highly significantly (P < .004) from 2.04 ± 0.95 mm at baseline to 2.37 ± 0.89 mm at 12 months. CONCLUSION: The present findings indicate that the proposed treatment concept results in predictable coverage of multiple adjacent maxillary Miller Class I, II, and III MAGR.


Assuntos
Tecido Conjuntivo/transplante , Proteínas do Esmalte Dentário/uso terapêutico , Retração Gengival/cirurgia , Gengivoplastia/métodos , Adulto , Feminino , Retração Gengival/classificação , Humanos , Masculino , Maxila , Pessoa de Meia-Idade , Retalhos Cirúrgicos , Resultado do Tratamento , Cicatrização
19.
Dental Press J Orthod ; 21(3): 18-29, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27409650

RESUMO

Gingival recession has direct causes and predisposing factors. Orthodontic treatment is able to prevent recession and even contribute to its treatment, with or without periodontal approach, depending on the type and severity of gingival tissue damage. There is no evidence on the fact that orthodontic treatment alone might induce gingival recession, although it might lead the affected teeth (usually mandibular incisors or maxillary canines) to be involved in situations that act as predisposing factors, allowing direct causes to act and, therefore, trigger recession, especially when the buccal bone plate is very thin or presents with dehiscence. Several aspects regarding the relationship between orthodontic treatment and gingival recession have been addressed, and so has the importance of the periosteum to the mechanism of gingival recession formation. Clinical as well as experimental trials on the subject would help to clarify this matter, of which understanding is not very deep in the related literature.


Assuntos
Retração Gengival/etiologia , Retração Gengival/terapia , Terminologia como Assunto , Técnicas de Movimentação Dentária , Retração Gengival/classificação , Retração Gengival/diagnóstico , Humanos , Técnicas de Movimentação Dentária/efeitos adversos
20.
Artigo em Inglês | MEDLINE | ID: mdl-27333010

RESUMO

This study investigated whether enamel matrix derivative (EMD) contributes to root coverage of gingival recessions performed with acellular dermal matrix graft (ADMG) in smokers during a 12-month follow-up. A sample of 19 smokers presenting bilateral Miller Class I or II gingival recessions were included. Selected sites randomly received both ADMG and EMD (test) or ADMG alone (control). Probing depth, clinical attachment level, gingival recession height, keratinized tissue, and root coverage were evaluated. Mean gain in recession height (P < .05), sites with complete root coverage (P < .05), and percentage of root coverage (59.7% and 52.8%, respectively) favored the test group compared with the control group.


Assuntos
Derme Acelular , Proteínas do Esmalte Dentário/uso terapêutico , Retração Gengival/cirurgia , Fumar/efeitos adversos , Raiz Dentária/cirurgia , Adulto , Feminino , Retração Gengival/classificação , Humanos , Masculino , Maxila/cirurgia , Pessoa de Meia-Idade , Índice Periodontal , Retalhos Cirúrgicos , Resultado do Tratamento
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