MODIFIED CORONALLY ADVANCED FLAP APPROACH WITH ISTHMUS DEEPITHELIALIZATION FOR THE TREATMENT OF MULTIPLE RECESSION DEFECTS IN CASES WITH INTERDENTAL TISSUE LOSS

PURPOSE: This presentation demonstrates a modified surgical approach for multiple gingival recessions in sites with interdental papillae loss and a newly developed method for prediction of the possible root coverage MATERIAL/METHODS: A 41 years old patient with a diagnosis of Periodontitis II Stage, Grade A. The main complaint was the hypersensitivity, which has even increased after the initial periodontal therapy and his chief request was to cover the exposed root surfaces. In order to achieve a harmonic gingival display and good esthetics, root coverage on all teeth from 13 to 25 was required. The surgical planning revealed a decreased height of interdental papillae. The analysis of the maximum achievable root coverage demonstrated that the intended line of coverage could not be reached with the available root coverage procedures. A new surgical technique, together with a new measuring protocol for accurate prediction of the achievable level of root coverage were developed. RESULT: One year after treatment, a consistent root coverage was observed with an established proper gingival profile The achieved line of the gingival margin completely coincided with the presurgical planning. The patient was fully satisfied with the esthetic result and the reduction of the hypersensitivity. CONCLUSION: In the limitation of the presented case, the developed new method for prediction of the root coverage and modified surgical approach for cases with interdental papillae loss and preserved isthmus provided a predictable increase of the achievable root coverage. Further research is required to study the efficiency of this newly developed surgical approach.

Association between root/coronal caries and individual factors in institutionalised elderly using ICDAS severity and activity

Background Caries in the elderly has been associated with dependence, oral-health status and -care practices. This cross-sectional study aimed to investigate the association between root/coronal caries and individual factors among institutionalised elderly people in Bogotá, Colombia, using the International Caries Detection and Assessment System severity and activity criteria (ICDAS). Methods A total of 226 institutionalised elderly were clinically examined for root and coronal caries in 40 institutions. Caries risk was assessed with Cariogram, and demographics, oral health knowledge and practices, oral health-related quality of life and denture-use habits using a questionnaire. Results Participants (mean age: 80.1 ± 9.3 years; 63.7% female) presented a mean number of 10.8 ± 7.3 teeth and 19.4 ± 18.8 exposed root surfaces. Prevalence of Coronal-ICDAS caries experience (C-ICDAS DF) was of 100% and of 54.4% for C-ICDAS D; mean number of C-ICDAS DFS was 16.76 ± 27.36, with 50.9% of subjects having ≥ one active C-ICDAS DS. Prevalence of Root Caries Index was of 49.1% and of R-ICDAS DF of 46%; mean number of R-ICDAS DFS was 2.03 ± 2.78, with 40.3% of subjects having ≥ one active R-ICDAS DS. Most individuals had a systemic condition (94.2%) and required oral-hygiene assistance (58%). Logistic regression analyses showed significant associations (p < 0.05): for coronal active caries when having over six teeth (OR: 2.7), and for root caries, when having coronal caries (OR: 2.41), being a man (OR: 1.95), and having over 14 teeth (OR: 0.30). Those presenting with > eight exposed root surfaces were 4.04 more likely to have root caries and 2.4 times more likely to have active root caries. Conclusion In the institutionalised elderly population in Bogotá significant associations were found, both for the presence as for the activity status of root and coronal caries, with individual clinical factors including coronal caries, exposed root surfaces and number of teeth.

AN UNUSUAL CASE OF EXTRAGINGIVAL PYOGENIC GRANULOMA ASSOCIATED WITH A FENESTRATION DEFECT

Pyogenic granulomas are relatively common benign mucocutaneous lesions found in the oral cavity or extra orally; The first case was reported in 1844 by Hullihen and the term “pyogenic granuloma” or “granuloma pyogenicum” was coined only in 1904 by Hartzell. It is a reactive tumor like lesion which arises in response to various stimuli such as chronic low grade irritation[1], trauma and hormonal imbalance[2]. It's an inflammatory hyperplasia commonly seen in the oral cavity caused due to chronic irritation and trauma. In this case report we present a case of pyogenic granuloma associated with gingival/bony fenestration caused due to chronic irritation by exposed root tip.

Effect of magnification on root coverage surgery

Root coverage surgery can be performed in patients with gingival recession to cover the exposed root aiming to control hypersensitivity and promotes better aesthetic. Optical magnification has been proposed as a refinement in this surgical technique to increase root coverage. This approach may lead to enhanced soft tissue stability, less post-operative discomfort, better predictability and esthetic appearance. Aim: This systematic review aimed to evaluate the effectiveness of magnification on root coverage surgery when compared to procedures performed without magnification. Methods: Randomized controlled trials with a follow-up of at least 6 months that compared surgeries for root coverage performed under optic magnification versus conventional (macro) root coverage surgery were screened. The primary outcome was mean root coverage (mm) (MRC) and secondary outcomes were percentage of root coverage (PRC) and complete root coverage (CRC). Results: Of 569 papers relevant to this review, seven were included. Meta-analysis showed that the use of magnification may favor greater PRC (7.38%, 95% CI 3.66-11.09). Conclusion: Magnification can increase PRC in root coverage surgeries. More randomized trials with the use of magnification may be necessary to verify if this benefit is clinically relevant, in order to justify the use of this device.