Coronally Advanced Flap with Connective Tissue Graft for Treating Orthodontic-Associated Miller Class III Gingival Recession of the Lower Incisors: A One-Year Retrospective Study

(1) Background: To assess the clinical outcome of coronally advanced flap combined with connective tissue graft for the treatment of orthodontic-associated Miller Class III gingival recession of the lower incisors. (2) Methods: This study included 15 patients who had undergone orthodontic treatment prior to development of recession. Measurements of recession depth, recession width, probing depth, and width of keratinized tissue were performed clinically immediately before surgery and after one year. In addition, digital measurements of recession depth, recession width, and root coverage esthetic score were performed on intraoral photographs. (3) Results: Significant reduction was observed for probing depth, recession depth, and recession width at one year, with significant increase in width of keratinized tissue. Mean root coverage was 83 ± 24% for recession depth, while complete root coverage was achieved in 10 out of 21 recessions (48%). The average root coverage esthetic score at 12 months was 7.1 ± 2.6. An interaction was found between initial recession depth and mean root coverage. (4) Conclusions: Within the limitations of this study, our results confirm that combination of coronally advanced flap and connective tissue graft is effective in reducing post-orthodontic Miller Class III recessions of the mandibular incisors, even when the correction of the tooth malposition, is unattainable.

Modified Coronally Positioned Flap for Isolated Gingival Recession, Evaluated with Root Coverage Esthetic Score System

Background: Various modifications of the coronally displaced flap have been proposed in the literature with the attempt of treating gingival recession. This study is undertaken to evaluate the predictability of the modified coronally positioned flap in isolated gingival recession not only in terms of root coverage but also with the esthetic outcome. Materials and Methods: Fifteen isolated gingival recessions with at least 1mm of keratinized tissue apical to the defect were treated with a modified coronally advanced flap. All recessions fall into Miller class I. The clinical re-evaluation was performed 3 months and 1year after the surgery. Statistical analysis was performed using statistical application software (SPSS16.0). Multivariate ANOVA was used for analysis. Results: At the 1-year examination, the average root coverage was 94.6% of the pre-operative recession depth. There was a mean clinical attachment gain of 3.3±0.1 mm at 1 year follow-up.The average increase of keratinized tissue between the baseline and the 1-year follow-up amounted to 1.53±0.13 mm. Root coverage esthetic score (RES) was recorded at the end of follow-up period. 13/15 cases showed RES score of 9 and 2/15 cases showed RES score of 6. Conclusion: The modified coronally advanced surgical technique is effective in the treatment of isolated gingival recession in the upper jaw.

Spectrum of dermatophytes in a tertiary care centre in Northern India

Dermatophytes is major public health challenge in many parts of the world, mainly in developing countries due to poor housing facilities, high population per capita, and poor sanitary conditions. Early diagnosis and identification is must for preventing and early treatment of dermatophytosis. Also, some studies suggest that in prepubescent children there is an inadequate amount of fungi inhibiting fatty acids synthesized predisposing them to dermatophytic infections. Reduction in the synthesis of these fungistatic triglycerides in sebum premenopausal women is also seen predisposing them to infection by dermatophytes. However, low socioeconomic status along with illiteracy and overpopulation has been a main predisposing factor to dermatophytic infections in developing parts of the world. The incidence also been increased due to the rise in the number of immunocompromised patients and considerable use of broad-spectrum antibioticsEarly finding of infection is must for prevention and early management of dermatophytosis. Dermatophytes enter keratinized tissue via keratinases, which produce a dermal inflammatory response causing burning, itching and rednessTo determine prevalence of species of dermatophytes. This Study was conducted on 334 samples i.e. skin scrapings, nail clippings, and hair for fungal culture in the Mycology laboratory over a period of one year extending from December 2019 to December 2020. Specimens were cultured on modified Sabouraud's dextrose agar media containing antibiotics and incubated at 25°C and 37°C for a period of 4 weeks. Isolation and identification of various species of dermatophytes were done. A cross-sectional study was conducted on patients who came to our hospital in the department of dermatology or were referred to the department of microbiology over a period of one year extending from November 2019 to November 2020. Microbiological tests of suspected patients included potassium hydroxide (KOH) mount and fungal culture examination. Cases with culture-positive results were correlated with clinical diagnosis. In the study total of 334 samples (skin scrapings, nail clippings, and hair) were received for fungal culture in the microbiology laboratory during the study period. Samples obtained were cultured on modified Sabouraud's dextrose agar (SDA) media containing antibiotics and incubated at 25°C and 37°C for a period of 4 weeks. Species identification was performed based on colony's morphology, finding of the teased mount by using lactophenol cotton blue stain (LCB) and slide culture, and also with urea hydrolysis test as seen.The Study was performed on 334 samples received from the department of dermatology for fungal culture. Fungal elements were seen in 31% of cases and were isolated in 30% of cases. In these culture-positive cases, dermatophytes were reported in 90% cases, Candida species in 4%, and another fungus was reported in 6% cases. Trichophyton species is most commonly isolated (27.6%). Microsporum and Epidermophyton species were isolated in 5.1% cases. T. mentagrophytes was the most common fungal isolate among all the culture-positive cases.

The clinical type and etiological agents of superficial dermatophytosis: A cross sectional study

Dermatophytosis are fungal infections caused by three genera of fungi that have the unique ability to invade and multiply within keratinized tissue (hair, skin, and nails). Although dermatomycoses are globally distributed, the endemic and most prevalent species of dermatophytosis differ strikingly from one geographic locality to another. Changing trend has been noticed in last few years with dermatophytic infections presenting as chronic, treatment unresponsive and recurrent. Also various microscopic and fungal culture studies have shown shift in identification of causative fungal species in recent years. Numerous studies have been done on the occurrence of dermatophytes in various parts of our country illustrating the range and changing pattern of fungal infection as well as causative fungal species. Total number of 150 patients attending outpatient department of our hospital who were clinically diagnosed as having superficial dermatophytosis were enrolled into the study. Patients were carefully screened as per inclusion and exclusion criteria and then enrolled in the study. Samples were taken from all the patients and examined for KOH direct microscopy and sent for fungal culture on Sabouraud’s Dextrose Agar as well as on Dermtophyte Test Medium. Results were then analyzed using standard statistical methods. Out of total 150 patients, 101 were males and 49 were females. Most common age group was 21-30 years (37.3%). 58 patients (38.7%) showed positivity to KOH microscopy as well as fungal culture. Additionally 25 more samples demonstrated positivity to KOH microscopy (total 83 patients) but negativity to culture, while 9 patient samples were positive to culture but negative to direct microscopy. Predominant fungal species isolated on culture was Trichophyton mentagrophytes (50.7%) while next common species isolated was T. tonsurans (29.9%). No significant association was found between dermatophyte isolate on culture and clinical type. Trichophyton mentagrophytes and Trichophyton tonsurans were the most common species isolated among subjects with Tinea faciei, Tinea cruris and Tinea corporis. The study showed a male preponderance and T. corporis was the commonest clinical type found. Majority of patients were in the 3rd decade and came within a duration of 1 month to 6 months of getting an infection. In patients diagnosed with tinea corporis, tinea cruris, tinea pedis and tinea manuum, T. mentagrophytes was the most predominant species isolated.

One-Time Cortical Lamina: A New Technique for Horizontal Ridge Augmentation. A Case Series

The aim of this case series is to introduce the One-Time Cortical Lamina Technique, a simplification of the F.I.R.S.T. (Fibrinogen-Induced Regeneration Sealing Technique) in cases where only horizontal augmentation is needed. The indications for this technique are ASA2 and ASA1 anxious patients. Pre-requisites for this surgical technique are: a good amount of keratinized tissue, sufficient alveolar ridge width for placement of implants, thickness of vestibular bone at CBCT planning less than 1 mm with risk of threads exposure. Five patients with horizontal deficiencies were selected to test the efficacy of this approach. The defects were augmented using a porcine cortical bone lamina in combination with collagenated porcine bone mixed with fibrin sealant. The cortical lamina was placed only buccal to the implants and stabilized with fibrin sealant, without pins or screws. Upon completion of the implant surgery, healing abutments were connected to the implants and the soft tissue sutured around them. The healing was uneventful in all cases. Six months after surgery impressions for final restorations were taken and screwed crowns delivered. The new volume had hard consistency and the follow-up CBCT measured an average of 4.17 mm of horizontal bone augmentation. One to three years of follow up demonstrated the maintenance of vestibular volume, hard consistency and clinical stability. Intraoral X-rays showed no marginal bone loss. An advantage of this technique could be the one stage surgery that creates a stable environment for regeneration from day one.

Marginal Bone Loss around Implants with Internal Hexagonal and Internal Conical Connections: A 12-Month Randomized Pilot Study

The aim of this study was to analyze the differences in terms of the marginal bone level (MBL) around implants with either an internal conical or an internal hexagonal implant–prosthesis connection. A randomized clinical trial included patients in need of a single implant-supported restoration. The implant–prosthesis connection was either internal conical or internal hexagonal while maintaining the same type of implant macro- and microarchitecture. Clinical and radiographical variables were registered up to 12 months of follow-up, including MBL. A total of 30 patients were included in the study. The main outcome variable, MBL 12 months after prosthesis delivery, was statistically different in both groups: −0.25 (0.12) vs. −0.70 (0.43) (conical vs. hexagonal; p = 0.033). Differences were also observed at the 3- and 6-month follow-up visits as well as for the MBL change from prosthesis delivery to the 12-month follow-up (−0.15 (0.13) vs. −0.56 (0.44); conical vs. hexagonal; p = 0.023). Correlations between MBL around the implants and radiographic measurements on the adjacent teeth, buccal bone to implant, tissue thickness or keratinized tissue were not significant neither globally nor when analyzed independently by group. In view of such results, it can be concluded that single-unit restorations with internal hexagonal-connection implants induce higher marginal bone loss after 12 months of follow-up from prosthesis delivery than internal conical-connection implants.

Aesthetic Outcomes of Early Occlusal Loaded SLA Dental Implants with Hydroxyl Ion Modified Surface—A 12 Months Prospective Study

Background: Many efforts have been made recently to arrange a newer, more hydrophilic and more osteoconductive implant surface. One of the possible options in this matter is modification with hydroxyl ion. Materials and Methods: Forty implants with the diameters 3.5 and 4.0 mm were inserted as a single missing tooth restoration protocol in the frontal aspect of the maxilla. All implants were loaded early in a 4 week period. Prior to and during the surgery, the following indices were considered: height of keratinized tissue, the thickness of soft tissue, and the initial level of bone tissue. After 12 months, the implant and the tissues in its direct vicinity were evaluated once more with the following indices: marginal bone loss (MBL), height of keratinized tissue (HKT), probing pocket depth (PPD), pink and white aesthetics scores (PES, WES), as well as pain sensations combined with the procedure (VAS). All results were related to the diameter of the implant and thickness of periodontal biotype. Results: High aesthetic outcomes were reported regardless of soft tissue thickness and implant diameter. The VAS score was higher for the 4.0 implant group, and the thickness of soft tissue had no influence on VAS. In case of implantation in thin or soft tissue, higher MBL levels were reported (0.26 mm), while in case of a thick phenotype, MBL was 0.06 mm. Conclusions: Hydrophilic surface implants can be used for a protocol of early functional occlusal loading. The initial thickness of soft tissue does not influence aesthetic outcomes and does not raise pain perception, although it may elevate crestal bone resorption.

Comparison of Polymeric Cyanoacrylate Adhesives with Suturing in Free Gingival Graft Stability: A Split Mouth Trial

The aim is to compare the use of Cyanoacrylate adhesives (CAA) to the conventional suturing technique in terms of free gingival grafts (FGG) stability and healing in lower anterior and premolar regions. A split mouth design was initiated on 22 participants. Each side (from 2nd premolar to central incisor) was randomized to either the control or test groups. In the control group, sutures were used to stabilize the FGG, while, in the test group, the FGG was stabilized with butyl-cyanoacrylate. Full-periodontal clinical parameters were employed to assess the periodontal health. FGG-related parameters assessed included the keratinized tissue width (KTW), gingival tissue thickness (GTT), FGG shrinkage% and pain using the VAS score. No significant differences in the mean values of the KTW nor FGG shrinkage% across six time points (p < 0.05) were observed, whereas highly significant differences in the mean values of GTT across six time points (F = 3.32; p = 0.008) were observed. The use of CAA in FGG stability and healing is comparable to conventional suturing for soft tissue grafts in terms of success outcomes. With its cost effectiveness, lesser time consumption, post-operative pain and comparable graft stability and dimensions, the use of CAA may be a promising alternative for conventional and microsurgical techniques for the stabilization of FGG in the oral cavity.

Peri-implant soft tissue au gmentation with connective tissue graft using „Two stage“ technique

Soft tissue augmentation using autogenous gingival grafts is a procedure often used in implantology and periodontal surgery. The technique of connective tissue grafting refers to the placement of connective tissue under a flap of partial thickness, which aims to induce the formation of keratinized tissue. It is indicated for partially or totally edentulous patients to increase the areas with the absence or reduction of the height of the keratinized tissue, as well as to increase the volume of soft tissue. The structural differences between the implant / bone tissue interface and the natural tooth / bone tissue make dental implants more susceptible to the development of inflammatory processes and bone loss. For these reasons, the intangibility of the seal around the implants is one of the primary objectives in its success over a long period of time. The function of the peri–implant seal is to “maintain internal homeostasis in response to external environmental challenges.”