Quintessence International, 7/2021
DOI: 10.3290/j.qi.b1098307, PubMed ID (PMID): 33749221Pages 576-582, Language: English
Objectives: To describe the step-by-step procedure of a novel surgical technique consisting of a combination of the laterally closed tunnel (LCT) and the modified coronally advanced tunnel (MCAT) (ie, LCT/MCAT), designed to treat multiple mandibular adjacent gingival recessions (MAGR) and to present the clinical outcomes obtained in 11 consecutively treated patients.
Method and materials: Eleven systemically and periodontally healthy patients (7 females, mean ± SD 33.62 ± 14.6 years, min. 19 years max. 67 years) with a total of 40 adjacent mandibular RT1 (ie, Miller Class 1 and 2) gingival recessions with a minimum depth ≥ 3 mm, were consecutively treated with LCT/MCAT, in conjunction with an enamel matrix derivative (EMD) and subepithelial palatal connective tissue graft (SCTG). Treatment outcomes were assessed at baseline and at 12 months postoperatively. Prior to surgery and at 12 months postoperatively, recession depth (RD) and recession width (RW) were evaluated. The primary outcome variable was complete root coverage (CRC, ie 100% root coverage), the secondary outcome was mean root coverage (MRC).
Results: Postoperative pain and discomfort were low and the healing was uneventful in all cases without any complications. At 12 months, statistically significant (P < .05) root coverage (RC) was obtained in all patients. CRC was obtained in five patients with a total of 21 recessions, while MRC measured 92.9% (ie, 3.75 mm). In seven patients (ie, 63.6%), RC amounted to > 93% while the minimum RC per patient measured 83.76%.
Conclusion: The results of the present case series suggest that the LCT/MCAT is a valuable technique for the treatment of mandibular RT1 MAGR.
Keywords: laterally closed tunnel, modified coronally advanced tunnel, multiple adjacent mandibular gingival recessions, recession coverage, subepithelial palatal connective tissue graft, surgical technique
Quintessence International, 5/2021
DOI: 10.3290/j.qi.b937015, PubMed ID (PMID): 33533238Pages 394-401, Language: English
Objective: Transgingival probing is often used in the clinic to assess gingival thickness. However, what is not completely known is how well this method represents the true value of soft tissue thickness. The aim of this study was to assess differences and variation in gingival thickness when measured with transgingival probing or scanned with an intraoral device. Method and materials: This ex vivo study evaluated gingival thickness on 20 porcine cadavers. Gingival thickness was assessed at both central and lateral mandibular incisors through transgingival probing with a standard metal periodontal probe and also using intraoral scanning, which was considered as the method providing the ‘true value’ of soft tissue thickness. Intra-examiner repeatability and method error were evaluated.
Results: No evidence of systematic difference for any of the mandibular central or lateral incisors (mandibular right incisors: mean difference −0.17 to −0.01 mm, and mandibular left incisors: mean difference −0.11 to 0.04 mm) was observed between the periodontal probe and intraoral scanning methods. The absolute differences between the repeated measurements with intraoral scanning for each tooth type (n = 30) were calculated: the overall median was 0.089 mm and the interquartile range was 0.080 mm.
Conclusions: Transgingival probing with a standard metal periodontal probe for assessing gingival thickness is a reliable method, with values very close to the true gingival thickness, and it can thus be considered as the clinical gold standard.
Keywords: periodontal, scan, tooth anatomy
Quintessence International, 4/2021
DOI: 10.3290/j.qi.b937003, PubMed ID (PMID): 33533237Pages 308-316, Language: English
Objectives: In-vitro data have shown that cross-linked hyaluronic acid (HA) enhances the proliferative and migratory properties of cells involved in periodontal wound healing/regeneration, stabilizes the blood clot, reduces the inflammatory response, and facilitates angiogenesis. The aim of this study was to histologically evaluate the effects of cross-linked HA alone or combined with a collagen matrix (CM) on the periodontal wound healing/regeneration in intrabony defects. Method and materials: Two-wall intrabony defects (5 mm wide, 5 mm deep) were surgically created at the distal and mesial aspects of mandibular premolars in six beagle dogs. The 24 defects were randomly treated as follows: open flap debridement (OFD) + HA, OFD + CM, OFD + HA + CM (HA/CM), and OFD alone (control). At 2 months, the animals were euthanized for histologic evaluation.
Results: The HA (2.43 ± 1.25 mm) and HA/CM (2.60 ± 0.99 mm) groups yielded statistically significantly (P < .05) greater formation of new attachment (ie, linear length of new cementum adjacent to newly formed bone, with inserting collagen fibers) compared with the OFD (0.55 ± 0.99 mm) group. Among the four treatment groups, the HA/CM group demonstrated the highest amount of regenerated tissues, although no statistically significant differences in any of the histometric parameters were observed between the HA and HA/CM groups.
Conclusion: Within their limits, it can be concluded that cross-linked HA alone or combined with CM promotes periodontal wound healing/regeneration in two-wall intrabony defects in dogs.
Keywords: animal study, biomaterials, hyaluronic acid, intrabony defect, periodontal wound healing/regeneration
International Journal of Periodontics & Restorative Dentistry, 4/2021
Pages 539-545, Language: English
Bone exostosis is defined as a benign overgrowth of bone tissue of unclear origin. Rarely, bone exostosis might develop following soft tissue graft procedures like mucogingival surgical interventions (eg, FGG or subepithelial CTG). This aberration has been mainly associated with surgical trauma or fenestration of the periosteum but is still a matter of debate. The present paper (1) presents a clinical case with clinical, radiographic, and histologic findings at 30 years following application of an FGG to increase the gingival width and (2) provides a short literature review on this particular clinical condition. At the clinical examination, the FGG was firm to palpation, and the 3D images showed an area of increased radiopacity. Histologic analysis revealed localized thickening of the bone with an overlaying connective tissue covered by keratinized epithelium. The bony tissue was vital, had a convex shape, and contained many osteocytes and resting lines, demonstrating some moderate signs of bone remodeling. The connective tissue and keratinized epithelium displayed a regular thickness without any signs of inflammation. Taken together, the histologic findings failed to reveal any pathologic signs except for the presence of vital bone formed outside the bony envelope. It can be concluded that: (1) the development of a bone exostosis following a mucogingival procedure is a rare clinical sequela of uncertain etiology, and (2) surgical removal of the exostosis may be indicated accordingly with patient symptoms.
Pages 161-169, Language: German
Seit ihrer Entwicklung und Einführung vor ca. 25 Jahren haben sich die Schmelz-Matrix-Proteine (SMP) als ein Standardmaterial in der regenerativen Parondontaltherapie etabliert. Ergebnisse aus In-vitro-Experimenten, Tierstudien und randomisierten klinischen Studien haben die Evidenz geliefert, dass die Anwendung der SMPs im Rahmen der chirurgischen Therapie die parodontale Wundheilung und Regeneration in intraossären Defekten, Grad-II-Furkationsbefall, aber auch in Rezessionsdefekten fördert und dabei die klinischen Ergebnisse signifikant verbessert. Neueste Daten konnten sogar den Hinweis liefern, dass die SMPs die Ergebnisse der chirurgischen Therapie in supraalveolären Defekten und der nichtchirurgischen Therapie verbessern können und somit eine Erweiterung der klinischen Anwendungen ermöglichen. Ziel der vorliegenden Arbeit ist es, basierend auf der vorhandenen Evidenz die klinischen Indikationen für die Anwendung der Schmelz-Matrix-Proteine darzustellen. Trotz aller positiven Eigenschaften müssen SMPs dennoch streng indikationsbezogen und vor allem bei der Therapie von vertikalen Defekten, Grad-II-Furkationsbefall und Rezessionen im Rahmen eines Gesamtkonzepts gesehen werden. Die Anwendungen im Rahmen der chirurgischen Therapie von supraaveolären Defekten, der nichtchirurgischen Therapie oder in Kombinationen mit Bindegewebetransplantaten für die Rezessionsdeckung sollten kritisch und fallbezogen erwogen werden.
Manuskripteingang: 23.12.2020, Annahme: 25.04.2021
Keywords: Schmelz-Matrix-Proteine, parodontale Regeneration, chirurgische Parodontaltherapie, nichtchirurgische Parodontaltherapie, intraossäre Defekte, Furkationsdefekte, Rezessionsdeckung
Quintessence International, 10/2021
DOI: 10.3290/j.qi.b1702285, PubMed ID (PMID): 34235909Pages 848-861, Language: English
Objective: To evaluate the clinical outcomes 2 years after the adjunctive use of an InGaAsP diode and Er,Cr:YSGG laser for nonsurgical treatment of severe periodontitis.
Method and materials: Forty-two patients (45.31 ± 9.78 years old, n = 22 females, n = 23 smokers) with stage III or IV grade B periodontitis were randomly treated either with laser (InGaAsP + Er,Cr:YSGG) adjunctive to subgingival debridement (test group, n = 21) or with subgingival debridement alone (control group, n = 21). Subjects in the test group received a second laser treatment in residual sites 2 months after the initial laser therapy. At baseline, and at 12 and 24 months after therapy, periodontal clinical parameters were evaluated. The primary outcome variable was the number of residual deep sites at 12 months (probing depth [PD] ≥ 6 mm).
Results: One and two years after nonsurgical periodontal treatment, both groups yielded statistically significant clinical improvements. The adjunctive use of InGaAsP and Er,Cr:YSGG laser to mechanical debridement resulted in statistically significantly higher clinical (PD, clinical attachment level, bleeding on probing, number of sites with PD ≥ 5 mm, PD ≥ 6 mm, PD ≥ 7 mm) improvements (P < .05) compared to subgingival debridement alone both at 12 and 24 months after therapy.
Conclusion: In patients with stage III or IV grade B periodontitis, InGaAsP and Er,Cr:YSGG used adjunctively to subgingival debridement may additionally improve the clinical outcomes compared to mechanical debridement alone over a period of 24 months.
Keywords: YSGG, InGaAsP, periodontal laser therapy, periodontal treatment, periodontitis
Quintessence International, 1/2021
DOI: 10.3290/j.qi.a45171, PubMed ID (PMID): 32901241Pages 32-44, Language: English
Objective: To evaluate the long-term clinical results after treatment of multiple adjacent recession type (RT) I and II gingival recessions treated with the modified coronally advanced tunnel (MCAT) in conjunction with a porcine acellular dermal matrix (PADM).
Method and materials: Nine periodontally healthy nonsmoking patients (seven women, 37.5 ± 7.36 years old) with a total of 41 adjacent RT I (n = 23) and RT II (n = 18) gingival recessions exhibiting a minimum depth of 2 mm were treated by means of MCAT+PADM. Recession depth and width, width of attached and keratinized tissue, probing depths, and clinical attachment level were measured at baseline and at 1 and 4 years postsurgically. The primary outcome variable was complete root coverage (ie 100% root coverage), while secondary outcomes were mean root coverage and increase in keratinized tissue and attached gingiva widths.
Results: At 1 and 4 years, statistically highly significant (P < .001) root coverage was obtained in all nine patients compared to baseline. Mean root coverage decreased in these nine patients from 72.05 ± 30.18% at 1 year to 56.79 ± 27.53% at 4 years. Complete root coverage was obtained in 18 gingival recessions at 1 year (baseline RT: 12 RT I, 6 RT II) and in seven gingival recessions (5 RT I, 2 RT II) at 4 years. Most root coverage occurred in the first year postsurgically, showing a statistically significant decrease between the first and fourth year (P = .003). Mean width of attached gingiva increased statistically significantly (P < .05) from 2.85 ± 1.08 mm to 3.14 ± 1.08 mm at 1 year with a statistically significant decrease at 4 years. At 1 year, 78.05% of gingival recessions showed a root coverage > 50%, and 68.29% still exhibited a root coverage > 50% at 4 years.
Conclusion: The use of MCAT+PADM represents a valuable treatment option for multiple adjacent maxillary and mandibular RT I and II gingival recessions on a long-term basis.
Keywords: clinical study, coronally advanced tunnel, gingival recession, porcine acellular dermal matrix, root coverage
Oral Health and Preventive Dentistry, 1/2021
Open Access Online OnlyPeriodontologyDOI: 10.3290/j.ohpd.b1248937, PubMed ID (PMID): 33881288Pages 255-261, Language: English
Purpose: Systemic inflammation is characteristic for the pathogenesis of Alzheimer’s disease (AD) and is responsible for the accumulation of its disease-specific Tau-protein and β-amyloid plaques. Studies focusing on an association with periodontitis showed worse periodontal conditions in patients with dementia, but until now, no study has investigated the differences between AD and other forms of dementia (noAD/DEM). Expecting severe periodontal disease in AD, the aim of this pilot-study was to compare the periodontal and dental status in patients with either AD or noAD/DEM.
Materials and Methods: Twenty patients recently diagnosed with AD and 20 with noAD/DEM between the ages of 50 and 70 years were recruited at the Department of Neurology, University Hospital, Münster, Germany and clinically examined at the Department of Periodontology, School of Dental Medicine, Münster, Germany. Neuropsychological testing, levels of Tau-protein and β-amyloid in serum and liquor were used to distinguish between both groups. Dental and periodontal parameters such as clinical attachment loss (CAL), probing pocket depth (PPD), bleeding-on-probing (BOP), radiographic bone loss, full-mouth plaque score (FMPS), and missing and restored teeth were recorded.
Results: Periodontitis was diagnosed in all patients. Patients with AD presented mean BOP of 54.7 ± 31.1% and radiographic bone loss of 42.5 ± 25.3%; the mean BOP of those with noAD/DEM was 52.0 ± 23.7% and radiographic bone loss was 40.9 ± 32.3%. There was also no statistically significant difference regarding other periodontal and dental parameters.
Conclusions: Both patients with AD and noAD/DEM had periodontal disease. Consequently, patients with all forms of dementia (AD/other) need special dental care to improve periodontal and oral health.
Keywords: Alzheimer’s disease, dementia, dental care, oral health, periodontal disease
Oral Health and Preventive Dentistry, 1/2021
Open Access Online OnlyPeriodontologyDOI: 10.3290/j.ohpd.b1248965, PubMed ID (PMID): 33881289Pages 263-270, Language: English
Purpose: To use and evaluate two methods for measuring gingival thickness (GT) at mandibular incisors of orthodontic patients and compare their performance in assessing periodontal anatomy through soft tissue thickness.
Materials and Methods: The sample consisted of 40 consecutive adult orthodontic patients. GT was measured just before bracket placement at both central mandibular incisors, mid-facially on the buccal aspect, 2 mm apically to the free gingival margin with two methods: clinically with an ultrasound device (USD) and radiographically with cone-beam computed tomography (CBCT).
Results: CBCT measurements were consistently higher than USD measurements, with the difference ranging from 0.13 mm to 0.21 mm. No statistically significant difference was noted between the repeated CBCT measurements at the right central incisor (bias = 0.05 mm; 95% CI = -0.01, 0.11; p = 0.104). Although the respective results for the left incisor statistically indicated that the measurements were not exactly replicated, the magnitude of the point estimate was small and not clinically significant (bias = 0.06 mm; 95% CI = 0.01, 0.11; p = 0.014). Small differences between CBCT measurements made by the 2 examiners at the left central incisor (bias = 0.06 mm; 95% CI = 0.01, 0.11; p = 0.014) were detected. However, this difference was minor and also not clinically significant. The respective analysis on the right incisor showed no statistically significant difference (bias = 0.05 mm; 95% CI = -0.01, 0.11; p = 0.246).
Conclusions: Based on reproducibility, CBCT imaging for gingival thickness assessment proved to be as reliable as ultrasound determination. However, CBCT consistently yielded higher values, albeit at a marginal level, than did the ultrasound device.
Keywords: cone-beam CT, gingival phenotype, periodontal tissue, ultrasound
Quintessence International, 9/2020
DOI: 10.3290/j.qi.a44808, PubMed ID (PMID): 32577705Pages 710-719, Language: English
Objectives: To evaluate the healing of multiple adjacent type 1 and 2 gingival recessions (RT1 and RT2) treated with the modified coronally advanced tunnel (MCAT) or the laterally closed tunnel (LCT) in conjunction with a cross-linked hyaluronic acid and subepithelial palatal connective tissue grafts.
Method and materials: Fifteen healthy patients exhibiting multiple adjacent mandibular or maxillary RT1 and RT2 of a depth of ≥ 2 mm, were treated with the MCAT or LCT in conjunction with cross-linked hyaluronic acid and subepithelial palatal connective tissue grafts. Results were assessed at baseline and after a minimum of 6 months. The primary outcome variable was root coverage. Esthetic outcomes were evaluated on photographs using the root coverage esthetic score.
Results: Postoperative pain and discomfort were low and no complications occurred. Data analyses were performed at patient level. After a mean follow-up of 17 ± 5.4 months, statistically significant root coverage was obtained in all 15 cases (P < .0001). Complete root coverage was obtained in 3 out of 15 cases (20%). Root coverage amounted to > 95% in three patients, was between 90% and 95% in four patients, and reached 87.5% in another patient. In three further patients root coverage measured 75%, 77%, and 64.6%, respectively. Mean root coverage measured 85.1 ± 23.2%. Mean keratinized tissue width increased from 2.5 ± 1.0 mm to 3.7 ± 0.7 mm (P < .0001) from baseline to follow-up, while mean probing depth showed no statistically significant changes (1.3 ± 0.5 mm vs 1.5 ± 0.5 mm). The mean root coverage esthetic score was 7.9 ± 1.9, while in the three cases exhibiting complete root coverage, a maximum root coverage esthetic score (10) was given for all treated teeth.
Conclusion: Within their limits, the present results indicate that the described treatment approach may lead to predictable root coverage of multiple mandibular and maxillary RT1 and RT2.
Keywords: connective tissue graft, hyaluronic acid, laterally closed tunnel, modified coronally advanced tunnel, multiple gingival recession