Role of platelet-rich plasma in maxillofacial surgery

Platelet-rich plasma (PRP) has been reported as an efficacious modality that can enhance the process of wound healing and tissue regeneration and has been validated in different medical settings, including cardiovascular surgery, otolaryngology, head and neck surgery, and maxillofacial surgery. In dental and oral surgery settings, PRP has been reported as an efficacious approach with favorable outcomes in different settings. Some of these procedures include surgical repair of the alveolar cleft, mandibular reconstruction, ablative surgical procedures, placement of osseointegrated implants, periodontal plastic surgery, and management of infrabony periodontal defects. In the present study, we aim to discuss the role and mechanisms that PRP plays in the settings of maxillofacial surgery based on evidence from the relevant studies in the literature. Evidence indicates the wide acceptance of the modality, which has been proven to increase the rate of wound healing and reduce the frequency of pain and swelling. The administration of PRP has been reported to dispense with the need for invasive approaches that might be furtherly associated with complications and different morbidities. However, in most of the favorable events where the PRP administration of was associated with enhanced outcomes, the modality was used in combination with another therapeutic approach. Therefore, further research is needed to validate the efficacy of the modality in the different settings.

A new digital evaluation protocol applied in a retrospective analysis of periodontal plastic surgery of gingival recessions

This research aimed to develop a new digital evaluation protocol to objectively quantify the volumetric changes of root coverage periodontal plastic surgery when combined with connective tissue graft. Consecutive patients with Cairo recession type 1 (RT1) or Cairo recession type 2 (RT2) were treated. Accurate study models obtained at baseline and follow-ups were optically scanned. Healing dynamics were measured by calculating volume differences between time points. Nineteen patients were treated between December 2014 and January 2019. At 3-month follow-up, root coverage was 95.6% (± 14.5%) with tunnel and connective tissue graft (TUN + CTG) technique, and 88.9% (± 20.5%) with the vestibular incision subperiosteal tunnel access and connective tissue graft (VISTA + CTG) technique. Recession decreased 1.33 (± 0.86) mm and 1.42 (± 0.92) mm, respectively (p = 0.337). At 6-month follow-up, root coverage was 96.5% (± 10.4%) with the TUN + CTG and 93.9% (± 10.3%) with the VISTA + CTG. Recession decreased 1.35 (± 0.85) mm and 1.45 (± 0.82) mm, respectively (p = 0.455). Complete root coverage was achieved in 86.7% (± 0.4%) with TUN + CTG and 70.6% (± 0.5%) with VISTA + CTG. No statistically significant differences were found between techniques. The digital protocol presented proved to be a non-invasive technique for accurate measurements of clinical outcomes. Both techniques reduce gingival recessions, with no statistically significant differences.

“EVALUATION OF I-PRF INJECTION TECHNIQUE AS AN ALTERNATIVE FOR RECONSTRUCTION OF INTERDENTAL PAPILLAE - A PILOT STUDY

One of the most challenging and least predictable procedures in periodontal plastic surgery is the reconstruction of the lost interdental papilla. Preserving the integrity of the papillae is of utmost importance. Different variations of surgical procedures using connective tissue grafts have proved to be successful. Being less invasive in nature, non-surgical techniques such as hyaluronic acid injections have turned out to be a boon in this regard. Platelet concentrates like PRF & PRP have shown promising results when used in surgical reconstruction of the lost papilla. One of the recent advancements in PRF formulations is the injectable PRF which is a liquid concentrate encompassing higher leuckocyte numbers, which resulted in higher total growth factor release, requiring slower and shorter centrifugation speeds for preparation. i-PRF was shown to be a potent inducer of cell proliferation, migration and angiogenesis, inducer of higher broblast migration and expression of PDGF, TGF-β, and collagen,thereby playing a vital role in tissue regeneration. With the current understanding, this study was designed to investigate the efciency of iPRF in achieving interdental papillary enhancement. We have noted that mutilple doses of this autologous formulation prove to be a non-invasive alternative for the treatment of minimal interdental papilla loss; primarily Norland & Tarnow's Class I and to an extent Class II interdental papilla loss. Further validations of this technique are required

Assessment of Patients’ Satisfaction following Coverage of Gingival Recessions: Questionnaire-Based Case Series

Summary Background/Aim: One of the most important goals of periodontal plastic surgery constitutes the predictable root coverage. Despite the thorough documentation that several surgical approaches can be implemented for the successful treatment of gingival recession (GR), only limited papers reported data on the evaluation according to patient’s opinion. Thus, the forthcoming study is aiming in the patient-based assessment of the outcome of root coverage procedures. Material and Methods: Sixteen subjects (eight male, eight female; mean age 43.75 years, range: 23-73 years), with twenty one GRs, constituted the sample of this study and the root coverage procedures were executed in the period from 2011 to 2019. A patient-based questionnaire was used to assess the level of subjects’ concern on various aspects related to the GR, preand post-operatively. Patient’s overall post-operative satisfaction was evaluated with a VAS. Results: After a period of at least 6 months of the surgical treatment, the majority of the subjects indicated that they were not concerned for all the examined criteria. The criteria with the highest improvement (reported as improvement by at least two levels of concern pre- and post-operatively) were the following: 1) fear to lose the involved teeth and 2) esthetics of the area of the recession defect. With regard to esthetics’ criteria, the majority of the patients indicated post-operatively the examined criteria as not important. The esthetics’ criteria yielding the highest improvement were: 1) position of the teeth and 2) the fact that the teeth showed longer. Mean patient’s overall post-operative satisfaction was 82,3 (range: 0-100). Conclusions: The majority of the subjects were satisfied from the implemented root coverage procedures. Few studies on the international literature have evaluated patient satisfaction following therapy. Comprehensive, multi-center studies, comprised of a large sample and a using a standardized approach are needed in future research.

Cirurgia minimamente invasiva x cirurgia convencional na taxa de recobrimento radicular e previsibilidade estética: Uma revisão integrativa

A cirurgia minimamente invasiva (CMI), é um termo que descreve procedimentos cirúrgicos pouco invasivos com ou sem instrumentos de ampliação, porém ainda não existe evidência científica se existe maior previsibilidade estética e de taxa de recobrimento radicular nas CMI em relação a cirurgia para recobrimento radicular convencional. Desta forma, foi realizada uma revisão integrativa da literatura utilizando-se a seguinte estratégia de busca: (microsurgery OR surgical AND minimally invasive surgical OR surgery AND gingival recession AND periodontal plastic surgery OR surgical AND root coverage). nas bases de dados SciELO, PubMed, Scopus, Web of Science, Science Direct, BVS e Google Acadêmico utilizando-se de artigos publicados entre os períodos de 2011 à 2019. No total foram encontrados 546 artigos e após a seleção mediante os critérios de inclusão permaneceram 05 artigos para o estudo, todos ensaios clínicos randomizados. As informações avaliadas dos artigos foram seus objetivos, tamanho da amostra, técnicas cirúrgicas realizadas, o tempo de acompanhamento e os resultados e conclusão. Com base nas análises, pode-se concluir que a CMI não necessita do uso de instrumentos de magnificação. A tunelização realizada para recobrimento radicular proporciona melhores resultados como ganho tecidual e estético em relação ao Retalho tracionado coronalmente (RTC), principalmente para as classes I e II de Miller. O uso de enxerto conjuntivo associado a CMI aumentou a previsibilidade de resultados satisfatórios.

HISTOMORPHOMETRIC PARAMETERS IN SIMULATED GINGIVAL RECESSION

This study addresses the nature of morphological changes occurring in periodontal tissues through the development of gum recession in the experiment. Gingival recession was found to occur along with a decrease in epithelial thickness of the mucous membrane as well as a decreasing cross-sectional area of blood vessels, whereas the connective tissue featured fibrinoid swelling. Initial tissue ischemia in the affected area can have a negative effect on reparation. This should be borne in mind when planning a periodontal plastic surgery.

An Unusual Complication in Plastic Periodontal Surgery

Introduction. Oroantral communications may arise as a result of pathological processes or iatrogenic situations, particularly in oral surgery and implantology, but are uncommon in periodontal plastic surgery. Case Presentation. A healthy 37-year-old female patient with 5 mm Miller Class II recession on the maxillary left second molar was referred for a root coverage procedure. While preparing the recipient bed for the graft, an oroantral communication was created. Schneiderian membrane was sutured to reduce the dimension of the communication and covered with a connective tissue graft. Finally, the flap was laterally and coronally moved, and the patient instructed about postoperative precautions. This procedure allowed to achieve a complete closure of the oroantral communication and good root coverage after an 8-month follow-up. Conclusions. Different authors described different techniques that can be used to close oroantral communications. Nevertheless, in this clinical case, it was shown that the oroantral communication may be closed without having to postpone the periodontal plastic surgery.