Assessment of the relationship between labial gingival thickness and the underlying bone thickness in maxillary anterior teeth by two digital techniques

This study aimed to noninvasively assess the relationship between the labial gingival thickness (GT) and the underlying bone thickness (BT) of maxillary anterior teeth by two digital techniques. A total of 30 periodontally healthy participants with 172 maxillary anterior teeth were enrolled. GT and BT were measured at 2, 4 and 6 mm apical to the cemento-enamel junction (CEJ) by two digital techniques: M1—cone-beam computed tomography (CBCT) and M2—digital intraoral scanning (DIS) combined with CBCT. The Pearson's correlation coefficient was calculated to determine the correlation between GT and BT. A significant negative correlation was identified between GT and BT at 2 mm apical to the CEJ for central incisors (CI), lateral incisors (LI), and canines (CA) both by M1 and M2, while a weak negative correlation at 4 mm apical to the CEJ was observed by M1 for CA. No significant correlation was found at other sites by both M1 and M2. The labial BT was < 1 mm in most cases (85% of CI; 97% of LI; and 90% of CA). Within the limitation of this study, it was concluded that GT and BT seemed to be negatively correlated at 2 mm apical to the CEJ. Therefore, caution is warranted when implant restoration at the esthetic area of the anterior teeth.

Effect of Root Surface Biomodification on Multiple Recession Coverage with Modified Coronally Advanced Tunnel Technique and Subepithelial Connective Tissue Graft: A Retrospective Analysis

To improve treatment efficacy of gingival recessions (GR), chemical preparation of the exposed root surface was advocated. The aim of this study was to compare the additional influence of root biomodifications with 24% ethylenediaminetetraacetic acid (EDTA) alone or with enamel matrix derivative (EMD) on the 12 month outcomes of modified coronally advanced tunnel (MCAT) with subepithelial connective tissue graft in the treatment of multiple GR. Average root coverage (ARC), complete root coverage (CRC), reduction in GR, reduction in recession width (RW), gain in clinical attachment level (CAL), increase in gingival thickness (GT), increase in keratinized tissue width (KTW) and changes in root coverage esthetic score (RES) were evaluated. A total of 60 patients with 215 GR were enrolled. In 70, GR root surfaces were treated with EDTA + EMD, in other 72, with EDTA, while in the remaining 73 saline solution was applied. ARC was 94%, 89%, and 91% in the EDTA + EMD, the EDTA and the saline groups, respectively (p = 0.8871). Gains in clinical attachment level (CAL; 2.1 ± 1.1 mm) and RES values (9.6 ± 0.9) were significantly higher in the EDTA + EMD group, when compared with two other groups. The differences between other preoperative and postoperative parameters showed statistical significance only within but not between groups. MCAT outcomes may benefit from adjunctive use of EDTA + EMD regarding 12 month CAL gain and professionally assessed esthetics using RES following treatment of GR.

Effects of autologous concentrated growth factor on gingival thickness in periodontal accelerated osteogenic orthodontics: a 6-month randomized controlled trial

Background Earlier studies have not given clear results of concentrated growth factor (CGF) on gingival thickness (GT) in periodontal accelerated osteogenic orthodontics (PAOO). This randomized controlled trial aimed to evaluate the effects of CGF on GT in patients with thin gingival phenotype undergoing PAOO. Methods Forty four patients presenting 264 anterior mandibular teeth were recruited and randomly allocated to one of the groups: test—positioning of autologous CGF after PAOO or control—positioning of a collagen membrane after PAOO. GT, gingival height (GH), buccal alveolar bone thickness (BT), and buccal alveolar bone height (BH) were evaluated depending on cross-sectional CBCT images at t0 (before surgery) and t1(6 months after surgery). Results GT were increased in both groups at t1 compared to t0. Yet, higher values were observed in the test group (from 0.94 ± 0.23 to 1.31 ± 0.33 mm) compared to the control group (from 0.94 ± 0.19 to 1.02 ± 0.16 mm) (p < 0.05). Moreover, in the intergroup comparison, GT at t1 in the test group was significantly higher compared to the control group (p < 0.01). Furthermore, the GT of central incisors, lateral incisors and canine teeth all showed significantly changes compared with baseline and the test group showed higher increase (p < 0.01). No statistically significant difference were found in GH, BT, BH and all clinical parameters between two groups at t1 (p > 0.05). Conclusions Within the limitation of this study, gingival thickness could be increased by using CGF in PAOO for the patients with thin gingival phenotype. Trial registration The study was registered in Chinese Clinical Trial Registry (http://www.chictr.org.cn/index.aspx) under the number ChiCTRINR17013346, Registered 11 November 2017.

The effect of different soft-tissue management techniques for alveolar ridge preservation: a randomized controlled clinical trial

Purpose For alveolar ridge preservation, various treatment protocols have been described. While most studies focus on the effect of the bone graft material, the aim of this study was to analyze the influence of different soft-tissue management techniques on the soft and hard tissue. Methods A total of 20 maxillary extraction sockets were grafted with an anorganic xenogenic bone graft and then randomly treated with either a combined epithelialized-subepithelial connective tissue graft (CECG) or a porcine collagen matrix (CM) placed in labial and palatal tunnels. Measurements of soft-tissue thickness were performed at tooth extraction (T0), implant insertion (T1) and second stage surgery (T2). Results In the CECG group, gingival thickness was 1.18 ± 0.56 mm (T0), 1.29 ± 0.26 mm (T1) and 1.2 ± 0.32 mm (T3). In the CM group, the measurements were 1.24 ± 0.50 mm (T0), 1.6 ± 0.6 mm (T1) and 1.7 ± 1.06 mm. Thus, there was an overall increase in gingival thickness from T0 to T2 of 0.02 ± 0.66 mm (CECG) compared to 0.46 ± 0.89 mm (CM). The thickness of keratinized soft-tissue was 3.91 ± 1.11 mm (CECG) and 4.76 ± 1.48 mm (CM) before extraction and 3.93 ± 1.17 mm (CECG) and 4.22 mm ± 1.26 mm (CM) at implant follow-up. Mean peri-implant probing depths were 3.15 ± 1.39 mm (CECG) and 3.41 ± 0.99 mm (CM). Conclusions After ridge preservation, comparable soft-tissue parameters were observed in both groups, whether treated with a collagen matrix or a combined autologous connective tissue graft.

Co-Relation of Gingival Biotype (Periodontal Phenotype) with Width of Keratinized Gingiva in Maxillary Anterior Teeth in Patients Reporting to a Local Tertiary Care Dental Hospital

Objective: To find out the correlation of gingival biotype with width of keratinized gingiva in maxillary anterior teeth in patients at tertiary care dental hospital presenting for routine periodontal care. Materials And Methods: In this crossectional study, a total of 87 patients were observed in department of Periodontology, Fatima Memorial Hospital College of Medicine and Dentistry Lahore. The gingival biotype (gingival thickness) were determined by using the transparency of the periodontal probe through gingival sulcus. The width of the keratinized gingiva was measured by measuring the distance between the most coronal point of the gingival margin and the mucogingival junction measured at the midpoint of the vestibular face of the teeth using a Michigan O periodontal probe with William’s markings. Results: In this study mean age was 38 years with SD ± 10.88. Forty six percent patients were male and 54% patients were female. Mean width of keratinized gingiva was 4.22mm ± 1.10 while mean gingival biotype was 1.5 mm ± 0.65. The correlation coefficient r=0.277 shows a positive correlation of width of keratinized gingiva with gingival biotype Conclusion: The study concluded that there is a positive correlation of gingival biotype with width of keratinized gingiva in maxillary anterior teeth. Keywords: gingival biotype, width of keratinized gingival, maxillary anterior teeth

Effect of 24% EDTA root conditioning on the outcome of modified coronally advanced tunnel technique with subepithelial connective tissue graft for the treatment of multiple gingival recessions: a randomized clinical trial

Objectives To investigate effects of root conditioning with 24% ethylenediaminetetraacetic acid (EDTA) on the 12-month outcomes after treatment of multiple gingival recessions (GR) with modified coronally advanced tunnel (MCAT) and subepithelial connective tissue graft (SCTG). Materials and methods Twenty patients with 142 GR were treated (72 test sites: SCTG + EDTA and 70 control sites: SCTG). Average and complete root coverage (ARC, CRC), gain in keratinized tissue width (KTW), gain in gingival thickness (GT), root esthetic coverage score (RES), and patient-reported outcome measures (PROMs) were evaluated at 12 months post-operatively. Results Differences between pre- and post-operative values were statistically significant only within but not between treatment modalities. At 12 months, ARC was 86.0% for SCTG + EDTA-treated and 84.6 for SCTG-treated defects (p = 0.6636). CRC was observed in 90.2% (tests) and 91.4% (controls) of all cases (p = 0.9903). Professional assessment of esthetic outcomes using RES showed highly positive results reaching the value of 8.9 in case of test sites and 8.7 for control sites (p = 0.3358). Severity of pain and swelling did not differ between sites, regardless of whether EDTA was used. Conclusions Test and control sites presented similarly positive outcomes related to root coverage, periodontal and esthetic parameters, and patient satisfaction and self-reported morbidity with no statistical differences between them 12 months after surgery. No significant differences in evaluated variables were observed between sites treated with and without 24% EDTA. Clinical relevance Considering the limitations of the present study, the use of 24% EDTA for root conditioning did not improve 12-month outcomes after treatment of multiple RT1 and RT2 gingival recessions with MCAT and SCTG. Trial registration ClinicalTrials.gov identifier: NCT03354104

Xenogeneic collagen matrix for the treatment of multiple gingival recessions in esthetics areas: a case series with 24-month follow-up

Introduction: Multiple gingival recessions (GR) are often associated with high hypersensitivity and esthetics concerns due to exposed roots. The collagen matrix (CM) associated with coronally advanced flap (CAF) may be a suitable treatment for multiple GR in esthetic areas. However, there is a lack of long term follow up investigations. Objective: To evaluate a 24-month follow-up of the CM + CAF treatment for multiple RT1 GRs in esthetics areas. Materials and Methods: Six patients presenting 6 adjacent Cairo’s gingival recessions type 1 (RT1) in the anterior maxilla were treated with CM + CAF, and based on these patients a brief statistical analysis was conduct. The evaluated parameters included gingival recession depth (GRD), gingival recession width (GRW), probing depth (PD), clinical attachment level (CAL), keratinized tissue width (KTW), gingival thickness (GT), and mean root coverage (MRC). Patient-related outcomes measurements (PROMs) were assessed using an oral health impact profile (OHIP-14) questionnaire and visual analogue scale (VAS). Results: There was significant improvement in GRD, GRW, and CAL measurements at 3 months postoperatively (p<0.05). Besides, CAL also increased from 12 months to 24 months’ follow-up (p=0.0023). The MRC percentage was 82%. PD, GT, and KTW presented no statistical difference. PROMs revealed a high score for esthetics (82.2%) and a significant reduction in hypersensitivity and surgical pain/discomfort. Conclusions: Considering the limitations of a case series, the use of CM + CAF on RT1 multiple gingival recessions in esthetic areas demonstrated positive outcomes after 24 months.

Periodontal Behavior and Patient Satisfaction of Anterior Teeth Restored with Single Zirconia Crowns Using a Biologically Oriented Preparation Technique: A 6-Year Prospective Clinical Study

Objectives. The aim of this study was to analyze the behavior of the periodontal tissues around teeth in the anterior region when restored with zirconia single crowns, using a biologically oriented preparation technique (BOPT), over a 6-year follow-up. Methods. The study investigated tooth-supported single crowns in the anterior region that were fabricated with a zirconia core and feldspathic ceramic covering, in 34 patients. Follow-up analysis took place annually for 6 years, assessing periodontal responses by evaluating the following variables: plaque index (PI); probing depth (PD); gingival index (GI); gingival thickness adjacent to the restoration; and stability of the gingival margin (MS). Any (biological and mechanical) complications were also recorded, as well as the patients’ satisfaction with the treatment. Results. After 6 years’ follow-up, a low mean plaque index was obtained, probing depth was stable, and gingival thickness and margin stability had increased. Complications (biological and mechanical) did not present a statistically significant incidence and a crown survival rate of 97.2% was achieved. Patients’ satisfaction obtained a mean VAS score of 9.04 under 10. Conclusion. Teeth that are prepared with BOPT in the anterior region present good periodontal behavior around the restored teeth, particularly in terms of the stability of the gingival margin and increased gingival thickness. Single crowns prepared with BOPT obtain an excellent clinical survival rate, as well as a high score in patients’ satisfaction after 6 years.

Assessment of the Relationship Between Labial Gingival Thickness and Underlying Bone Thickness in Maxillary Anterior Teeth by Two Digital Techniques

The aim of this study is to noninvasively assess the relationship between the labial gingival thickness (GT) and the underlying bone thickness (BT) of the maxillary anterior teeth by two digital techniques. GT and BT were measured at 2、4 and 6 mm apical to the cemento-enamel junction (CEJ) by two digital techniques: M1- cone-beam computed tomography (CBCT) and M2- digital intraoral scanning (DIS) combined with CBCT (30 healthy participants, 172 maxillary anterior teeth). Pearson's correlation coefficient was calculated to assess the correlation between GT and BT. A significant negative correlation was identified between GT and BT at 2、4 mm apical to the CEJ for central incisors (CI), lateral incisors (LI), and canines (CA) both by M1 and M2, but not at 4 mm apical to the CEJ for CA (M2) or at 6 mm apical to the CEJ for all (M1, M2). The labial BT was demonstrated < 1 mm in most cases (85% of the CI; 97% of the LI; and 90% of the CA). Within the limitation of this study, it is concluded that the GT and BT seems to be negatively correlated in most cases, which should be cautious clinically.