A double lateral pedicle graft technique for palatal recession coverage on dental implants.

Rough surfaces of dental implants, when exposed to the oral environment, are conducive to biofilm colonization and can predispose the affected implant to periimplantitis. Recession coverage using soft-tissue grafts is one of the treatment modalities used for the treatment of exposed implant threads. Recession coverage on the palatal aspect of maxillary implants is difficult due to the firm nature of the palatal mucosa and, consequently has not been widely documented in the literature. This case report documents a novel double-pedicle technique for palatal recession coverage on a dental implant. Two pedicle grafts were obtained from either side of the implant with the mucosal recession: a full-thickness lateral-pedicle graft from the distal aspect and a subepithelial connective tissue pedicle from the mesial aspect. The connective tissue pedicle was stabilized first on the area of mucosal recession and was then covered with the distal full-thickness lateral pedicle. Complete recession coverage was obtained, and the result was observed to be clinically stable after 18 months of follow-up. The technique demonstrated in this report can be a useful tool for the treatment of localized palatal recessions on dental implants.

Photobiomodulation of human gingival fibroblasts with diode laser - A systematic review.

Low-level laser therapy (LLLT) is being extensively studied in the field of periodontics as a noninvasive technique to achieve better results after nonsurgical and surgical therapy. However, there is a lack of definitive guidelines for the use of LLLT to promote gingival and periodontal wound healing. The primary objective of this systematic review was to critically analyze the studies evaluating the effect of low-level diode laser on human gingival fibroblasts in vitro and to develop wavelength-specific guidelines for photobiomodulation of human gingival fibroblasts. A thorough electronic and manual search was conducted for relevant articles published until December 2019. Nine studies were included in the review after the initial screening of 1334 articles. Our data analysis revealed that LLLT with diode laser stimulates human gingival fibroblasts as there was the increase in cell viability, proliferation, migration, and protein synthesis in irradiated cells. The diode lasers in the 600-700 nm spectrum were effective in the 10 mW to 30 mW power range. Lasers in the 700-800 nm range were effective in the 25-50 mW power range and diode lasers in the 800-900 nm range were effective at a power setting of 10 mW. It was possible to ascertain a suitable power setting for a particular wavelength spectrum, but no other parameters could be defined due to a lack of reporting of details. Hence, the authors have developed guidelines for comprehensive reporting of in-vitro studies to facilitate future research and overcome existing lacunae in knowledge.

Palatal pre-suturing for perioperative hemostasis at free gingival graft donor sites: A randomized, controlled clinical trial.

BACKGROUND: The palatal suture has been well known in literature as a method for palatal hemostasis but has not been validated for its efficacy. The aim of this parallel-arm randomized controlled clinical trial was to evaluate the efficacy of palatal pre-suturing using the greater palatine compression suture (GPCS) in reducing the perioperative hemorrhage associated with the palatal free gingival graft (FGG) procedure. METHODS: Twenty-four patients requiring the FGG procedure for recession coverage or augmentation of keratinized tissue were recruited in the study and randomized to the GPCS group and the control group. The GPCS was placed using a previously described protocol by a single operator in all the participants in the GPCS group. Perioperative blood loss was estimated by weighing the gauze used to mop the palatal hemorrhage, before and after the procedure. The time required for the surgery was also recorded by an independent observer. RESULTS: Significantly lesser blood loss was observed in the GPCS group (4.33 ± 0.89 g) as compared with the control group (8.91 ± 4.16 g). The difference in the time taken for the surgical procedure for the GPCS group (73.25 ± 22.35 minutes) was not significantly different from that required for the control group (76.08 ± 14.47 minutes). CONCLUSION: This study demonstrates that pre-suturing of the palate using the GPCS is an effective technique to reduce the perioperative blood loss associated with the palatal FGG procedure.

A novel clinical protocol for the greater palatine compression suture: A case report.

Bleeding from the palatal donor site is a worrisome complication of palatal soft tissue harvesting procedures and leads to considerable stress to both the patient and the surgeon. Several methods to control palatal hemorrhage have been suggested in literature, including a palatal suture, but a precise protocol has not been suggested. The present case report aims to suggest a protocol for the greater palatine compression suture (GPCS). Five patients who experienced profuse bleeding from the palatal free gingival graft donor site were treated with the GPCS. The palatal midline was used as a landmark and the location of the greater palatine foramen was estimated. The suture was placed anterior to the estimated location of the foramen and was passed deep into the palatal tissue with the aim of looping and compressing the vascular bundle. In all the patients, an immediate reduction and arrest of bleeding from the palatal wound was observed with blanching of the soft tissues around the suture. The proposed technique is a predictable method to control palatal hemorrhage and can be used if other less invasive techniques fail to stem the blood flow from an injured palatal vessel.

Identification of multiple strains of Porphyromonas gingivalis using heteroduplex polymerase chain reaction in varying severity of chronic periodontitis.

AIM: Research has demonstrated that there are multiple strains of Porphyromonas gingivalis with varying potency to cause periodontal disease. The current study aims at using heteroduplex polymerase chain reaction (PCR) to detect the strain diversity of P. gingivalis in periodontitis lesions of varying severity in a sample of the Indian population. MATERIALS AND METHODS: Subgingival plaque samples were collected from 60 individuals with varying severity of chronic periodontitis and 30 individuals with a clinically healthy periodontium. The samples were subjected to PCR analysis to identify P. gingivalis, followed by heteroduplex analysis to identify the strain diversity in a given sample. Bacterial culture was carried out as a comparative standard. RESULTS: Of the 56 samples that were positive for P. gingivalis by PCR, 54 samples yielded eight different heteroduplex patterns. Analysis of these patterns indicated that two strains of P. gingivalis were present in 41 individuals (45.6%) and three strains were present in 13 individuals (14.4%). Detection of P. gingivalis by PCR was significantly more in the periodontitis group as compared to the healthy group. CONCLUSIONS: Species-specific PCR and heteroduplex analysis provide a simple and accurate method to analyse the strain diversity of P. gingivalis. P. gingivalis was detected in both healthy periodontal sites as well as sites with periodontitis. The presence of two or three P. gingivalis strains was seen in 60% of the samples.

Applications of a modified palatal roll flap in peri-implant soft-tissue augmentation - A case series.

Abrams's palatal roll technique has been used extensively to augment peri-implant soft tissues in the maxillary esthetic zone and has seen numerous modifications. An adaptation of the palatal roll technique is described here and its simplicity of application in three different scenarios is demonstrated. At second-stage implant surgery, a partial thickness initial incision followed by a palatal subepithelial dissection at the site of implant was done and a connective tissue graft with a buccal pedicle was obtained. The graft was rolled under the buccal flap and allowed to heal with the support of a healing abutment. The graft healed uneventfully and provided excellent contours of tissues around the implant. The procedure demonstrated good results for augmentation of a buccal ridge deficiency, for covering exposed and unsightly implant fixtures and was also done with a papilla preservation incision. In addition, a second surgical site to obtain the connective tissue graft was avoided.

Post-operative morbidity following the use of the inverted periosteal graft: A case series.

Post-operative complications following flap surgeries or mucogingival procedures are important factors influencing patient's perception of periodontal procedures. Hence, it is important to foresee such complications and take adequate measures pre- and post-operatively. We treated five consecutive cases of gingival recession in the maxillary canine-premolar area using the inverted periosteal graft with a coronally positioned flap technique. Following each of these surgeries, the patients complained of post-operative swelling the next day involving the canine space or buccal space area. The swelling persisted for at least 5 days, however, it was painless. This paper highlights the post-operative complications associated with the said procedure and makes a case for detail enquiry in the form of controlled studies.

Platelet-rich fibrin as an adjunct to palatal wound healing after harvesting a free gingival graft: A case series.

BACKGROUND: Owing to its stimulatory effect on angiogenesis and epithelialization, platelet-rich fibrin (PRF) is an excellent material for enhancing wound healing. The use of PRF dressings may be a simple and effective method of reducing the morbidity associated with donor sites of autogenous free gingival grafts (FGGs). The purpose of this case series is to document the beneficial role of PRF in the healing of FGG donor sites. MATERIALS AND METHODS: A total of 18 patients treated with FGGs could be classified into two groups. PRF was prepared, compressed and used to dress the palatal wound followed by a periodontal pack in one group (10 patients) and only a periodontal pack was used in the other group (8 patients). Post-operative healing was assessed clinically at 7, 14 and 21 days and the morbidity was assessed qualitatively by an interview. RESULTS: Sites where PRF was used showed complete wound closure by 14 days and these patients reported lesser post-operative morbidity than patients in whom PRF was not used. CONCLUSIONS: PRF as a dressing is an effective method of enhancing the healing of the palatal donor site and consequently reducing the post-operative morbidity.