Gingival Recession Treatment with the Use of Xenogeneic Matrix: Optimization of Patient-Centered Outcomes by the Digital Soft Tissue Design

Abstract Objective: To evaluate the impact of the originally-developed approach aimed at pre-treatment graphical modelling of soft-tissue changes (digital soft tissue design) for the optimization of patient-centered outcomes after Class I and Class II single gingival recessions treatment with the use of a xenogeneic dermal matrix. Material and Methods: Patients enrolled in the study group received single gingival recession treatment via CAF+XDM method supported by pre-treatment graphical modelling of potential soft-tissue changes (digital soft tissue design), while patients enrolled in the control group received single gingival recession treatment via CAF+CTG method with no pre-treatment graphical modeling of gingival level changes. Patient-centered outcomes were measured by visual analogue scale, OHIP-14, and Mahajan's scales. Results: Realization of pre-treatment graphical modelling of soft-tissue changes supported the achievement of better patient-centered outcomes, such as root coverage (p<0.05), surgical phase (p<0.05), post-surgical phase (p<0.05), cost-effectiveness (p<0.05) and diagnostics and patient-orientation (p<0.05) based on patient's personal perception grades. Conclusion: Patient-centered results were found to be more successful within the group using the xenogeneic type of graft accompanied with the implementation of pre-treatment graphical modeling of soft tissue changes, which helped to balance patients' pre-operative expectations and post-operative satisfaction with the received results, reduce post-operative morbidity and improve oral health-related quality of life (AU).

Manejo de defectos tipo recesiones múltiples luego de la terapia de ortodoncia: un caso reportado basado en la evidencia científica / The management of multiple recession like defects after orthodontic therapy: report of a case based on scientific evidence

Por qué en este caso hay nueva in- formación? - Este caso demostró métodos basado en la evidencia para el manejo de severas recesiones gingivales luego de la terapia or- todóntica. - La modificación del grosor gin- gival lleva a resultados estables a largo plazo estéticos y funcio- nales. - Este caso demostró beneficios clínicos usando injertos tomados desde el mismo sitio donador en diferentes momentos de tiempo. Cuales son las claves de éxito para manejar este caso? - Sólidos conocimientos de la anatomía periodontal - Identificación de las caracterís- ticas de RC relacionadas con las causas de la terapia ortodóntica. - ITCSE su toma del paladar. - Uso de colgajos sin tensión. - Incremento del grosor gingival para promover resultados a largo plazo. Cuales son las limitaciones prima- rias del éxito en este caso? - Necesidad de tomas de paladar en ambos lados - Anatomía de las RG y la fina en- cía que puede limitar la extensión del colgajo - Experiencia clínica (AU)

Técnica de injerto supraperióstico tunelizado de Allen en recesiones periodontales múltiples / Supraperiosteal tissue grafting employing the Allen tunnel technique in multiple periodontal recessions

RESUMEN La técnica de tunelización modificada con injerto de tejido conjuntivo subepitelial es un procedimiento de cirugía plástica periodontal que permite el logro de la cobertura radicular de recesiones múltiples en dientes correctamente alineados. Se presenta el caso de una paciente de 22 años de edad, modelo de profesión, la cual acudió a la consulta de Periodoncia y refirió preocupación por presentar la encía separada de los dientes. Al realizar el examen clínico, se pudo apreciar alteración en la posición normal de la encía en los incisivos centrales y lateral derecho mandibulares 31,41 y 42. Una vez concluida la fase higiénica, se procedió a realizar un injerto de tejido conectivo mediante la técnica del túnel con el cual se obtuvo una cobertura efectiva de las superficies radiculares expuestas.

ABSTRACT The modified tunneling technique with subepithelial connective tissue grafting is a periodontal plastic surgery procedure that allows root coverage of multiple recessions in correctly aligned teeth. We present a 22-year-old female patient, modelling profession, who came to the Periodontal consultation and reported a concern about her gums separating from her teeth. Alterations in the normal position of the gingiva in 31, 41 and 42 central and mandibular right lateral incisors were observed on clinical examination. Once the hygienic phase had been completed, a connective tissue graft was performed using the tunnel technique, which effectively covered the exposed root surfaces.

Evaluation of coronally advanced flap in ''l'' associated with subepithelial connective tissue graft in the treatments of Miller's class i and ii gingival recessions / Evaluación de colgajo coronalmente avanzado en ''l'' asociado con injerto subepitelial de tejido conectivo en el tratamiento de recesiones gingivales de clases I y II de Miller

To evaluate clinically the results of two surgical techniques used for root coverage, the coronally advanced flap in '' L '' isolated (CAF) or associated with subepithelial connective tissue graft (SCTG). The surgical procedures were performed in seventeen individuals, ten individuals in the control group (coronally advanced flap in "L") and seven individuals in the test group (coronally advanced flap in "L" associated with SCTG), who presented Miller class I and II gingival recession. The depth gingival recession (GR) index was evaluated in the following periods: immediate preoperative and 180 postoperative days. The control group had a success rate of 85 +/- 18 % and the test group had a success rate of 95 +/- 4 %. The variable success rates (p=0.36) did not present a statistically significant difference. The isolated CAF or its association with SCTG showed favorable outcomes in the treatments of Miller's class I and II gingival recessions.

El objetivo fue evaluar clínicamente los resultados de dos técnicas quirúrgicas utilizadas para la cobertura radicular, el colgajo coronalmente avanzado en "L" aislado (CAF) o asociado con injerto de tejido conectivo subepitelial (SCTG). Los procedimientos quirúrgicos se realizaron en diecisiete individuos, diez individuos en el grupo de control (colgajo coronario avanzado en "L") y siete individuos en el grupo de prueba (colgajo coronalmente avanzado en "L" asociado con SCTG), que presentaron la clase I de Miller y II recesión gingival. El índice de recesión gingival profunda (RG) se evaluó en los siguientes períodos: preoperatorio inmediato y 180 días postoperatorios. El grupo de control tuvo una tasa de éxito de 85 +/- 18 % y el grupo de prueba tuvo una tasa de éxito de 95 +/- 4 %. Las tasas de éxito variables (p = 0,36) no presentaron una diferencia estadísticamente significativa. La CAF aislada o su asociación con SCTG mostraron resultados favorables en los tratamientos de las recesiones gingivales de clase I y II de Miller.

Gingival recession treatment with concentrated growth factor membrane: a comparative clinical trial

Abstract Objective This clinical trial sought to evaluate the clinical effectiveness of concentrated growth factor (CGF) and compare it with connective tissue graft (CTG) with coronally advanced flap (CAF) in the treatment of Miller Class I gingival recessions (GR). Methodology This split-mouth study included 74 Miller Class I isolated (24 teeth) or multiple (50 teeth) GRs in 23 jaws of 19 patients. GRs were randomly treated using CGF (test group: 37 teeth; 12 teeth in isolated GRs, 25 teeth in multiple GRs) or CTG with CAF (control group: 37 teeth;12 teeth isolated GRs, 25 teeth in multiple GRs). Clinical variables, plaque index (PI), gingival index (GI), probing depth (PD), recession depth (RD), recession width (RW), clinical attachment level (CAL), keratinized tissue thickness (KTT), keratinized tissue width (KTW), and root coverage (RC) were assessed at the baseline as well as at three and six months post-surgery. Healing index (HI) were obtained in the second and third weeks post-surgery. Postoperative pain was assessed for the first seven days using a horizontal visual analog scale (VAS). Results No significant change was observed in PI, GI, or PD values in either the intergroup or the intragroup comparisons. A statistically significant decrease was observed in CAL, RD, and RW, and KTT increased in all groups at three and six months compared with the baseline. The control group had greater increases in KTW, KTT, and RC at three and six months. No significant difference was found in CAL or RD at the third and sixth months between the two groups. Healing was found to be similar for both groups in the second and third weeks post-surgery. The VAS values in the control group were higher than in the test group, especially at the second, fourth, fifth, and seventh days postoperatively. Conclusions CTG is superior to CGF with CAF for increasing KTT, KTW, and RC. CGF may be preferable due to decreased postoperative pain.

Uso de plasma rico en fibrina comparado con colágeno en el tratamiento de recesión gingival utilizando la técnica estenopéica. Ensayo clínico aleatorizado / Use of fibrin-rich plasma compared to collagen in the treatment of gingival recession using the stenopic technique. Randomized clinical trial

La recesión gingival (RG) es un problema de salud bucodental frecuente que aumenta con la edad, predispone a hipersensibilidad dentaria, caries radicular, inflamación gingival y efectos antiestéticos. El objetivo de este ensayo clínico aleatorizado fue evaluar comparativamente el efecto clínico del recubrimiento radicular utilizando la técnica estenopéica Pinhole con colágeno y la técnica estenopéica Pinhole modificada al incorporarle plasma rico en fibrina (PRF). Veintiséis participantes sistémicamente sanos, con diagnóstico de RG grado I de Miller, fueron reclutados y seguidos por 6 meses después de la cirugía. Los parámetros clínicos registrados fueron nivel de inserción clínica (NIC), RG y banda de encía queratinizada. Los participantes fueron asignados aleatoriamente a un grupo en quienes se utilizó PRF con 14 participantes, tratando 36 piezas dentales, y otro grupo en quienes se utilizó membrana de colágeno con 12 participantes, tratando 35 piezas dentales. Los resultados muestran un logro de ganancia en el NIC en ambos grupos, (M = 45.24 %, DE = 17.37 %) en el grupo PRF y (M = 47.37 %, DE = 15.67 %) en el grupo colágeno, diferencia que no fue significativa (p = .59). En ambos grupos existió un aumento significativo en la banda de encía queratinizada (p < .01). El uso de PRF como material de relleno al realizar la técnica estenopéica genera resultados similares al ser comparado con la técnica convencional que utiliza colágeno. Al presentar un menor costo el PRF aumenta las posibilidades que más personas tengan acceso al tratamiento.

Gingival recession (GR) is a frequent oral health disease that increases with age and may increase risk of dental hypersensitivity, root decay, gingival inflammation and aesthetic problems. The aim of this randomized clinical trial was to compare clinical parameters of dental root coverage using Pinhole technique with collagen and modi¬fied Pinhole technique using platelet-rich fibrin (PRF). Twenty-six participants, systemically healthy, with Miller class I GR diagnosis, were recruited and measured at baseline and after 6 months follow-up. Clinical parameters measured included clinical attachment level (ICL), GR and keratinized gingival width (KGW). All participants were randomly assigned to a group using PRF, with 14 participants and 36 teeth treated, and other group using collagen, with 12 participants and 35 teeth treated. Both PRF group and collagen group gained ICL, (M = 45.24 %, SD = 17.37 %) in PRF group and (M = 47.37 %, SD = 15.67 %) in collagen group, with no statistically significant difference (p = .59). Both groups gained KGW (p < .01). Use of PRF as filled material by using Pinhole technique resulted in similar clinical improvements compare to collagen as filled material. Considering that PRF is cheaper than collagen, it increases chances that people can have access to treatment.

Efectividad Analgésica de Paracetamol Post-Cirugía Mucogingival: Ensayo Clínico Aleatorizado Paralelo / Analgesic Effectiveness of Paracetamol Post-Mucogingival Surgery: Parallel Randomized Clinical Trial

RESUMEN: El objetivo de este trabajo fue determinar la efectividad analgésica de paracetamol post-cirugía mucogingival. El estudio, prospectivo, longitudinal, comparativo y experimental, se desarrolló en la Clínica Odontológica de la Universidad Privada Antenor Orrego (Trujillo, Perú) con los pacientes de la asignatura Periodoncia II. Se incluyeron 39 pacientes, quienes fueron distribuidos de manera aleatoria en 2 grupos de 19 y 20 cada uno, según los criterios establecidos. La medicación se inició 20 minutos después de concluida la cirugía, y se mantuvo por 24 horas. Para determinar la efectividad analgésica se usó la escala visual analógica (0-100 mm) y se recogió la información que fue procesada, utilizando la prueba de U Mann-Whitney con un nivel de significancia del 5 %. No existe diferencia en cuanto a la efectividad analgésica post-cirugías mucogingivales entre paracetamol y el control a las 2 horas (p=0.415), 8 horas (p=0.279) y 24 horas (p=0.736). Paracetamol es efectivo como analgésico post-cirugía mucogingival.

ABSTRACT: The objective of this study was to determine the analgesic effectiveness of paracetamol after mucogingival surgery. This prospective, longitudinal, comparative and experimental study was developed in the Stomatology Clinic of the Universidad Privada Antenor Orrego (Trujillo, Perú) with the patients of the Periodontics II subject. We included 39 patients, who were randomly distributed into 2 groups of 19 and 20 each, according to the established criteria. The medication was started 20 minutes after the surgery was completed, and was maintained for 24 hours. To determine the analgesic effectiveness, the analogue visual scale (0-100 mm) was used and the information that was processed was collected, using the U Mann-Whitney test with a level of significance of 5 %. There is no difference in terms of analgesic effectiveness post-mucogingival surgery between paracetamol and control at 2 hours (p = 0.415), 8 hours (p = 0.279) and 24 hours (p = 0.736). Paracetamol is effective as a mucogingival post-surgery analgesic.

Leucocyte Platelet Rich Fibrin with Autologous Gingival Fibroblasts in the Treatment of Adjacent Recession Defects / Fibrina Rica en Plaquetas Leucocitarias con Fibroblastos Gingivales Autólogos en el Tratamiento de Defectos de Recesión Adyacentes

ABSTRACT: Periodontium can submit changes that lead to loss of integrity, such as periodontal disease, immune disorders or traumatic brushing. One of the most common consequences resulting from these events is the apical migration of gingival marginal tissue. Among biomaterials used for periodontal tissue regeneration, fibrin matrices have received significant attention to correct gingival recessions. Five oral mucosa biopsies were extracted, fibroblasts were in vitro cultured and frozen in liquid nitrogen. Three 10 mL glass sterile tubes were filled with patient blood and centrifuged immediately; clots were extracted and compressed to obtain L-PRF membranes. Autologous oral mucosa fibroblasts were added to the membranes and surgical procedures were performed in five patients. L-PRF fibrin network pore size was too small to allow human fibroblasts penetration but they were firmly attached to membrane surface. Gingival fibroblasts from fresh cell culture and recently thawed were used to attach on the L-PRF membranes. It was possible to establish a protocol for blood collection, centrifugation, fibrin clot compression, fibroblast adhesion to the membrane surface and patient application in a relatively short time (1 hour-1 hour and 30 minutes). Two patients expressed pain symptoms and the other ones presented light swelling without pain. In the first week, adjacent tissue showed few inflammation signs. Research efforts are being conducted to develop more conservative surgical techniques and new biomaterials that can promote cellular proliferation. Because of its properties, L-PRF membranes represent a tempting alternative. A combined technique to treat adjacent recession defects with L-PRF membranes and autologous oral mucosa fibroblasts in a coronal displaced flap did not show initial advantage compared with a gold standard surgery that includes an autologous soft tissue graft. Nevertheless, it could be an alternative for clinical application as a new functional cell biomaterial. More clinical evidence is needed.

RESUMEN: El periodonto puede presentar cambios que conducen a la pérdida de integridad, como la enfermedad periodontal, los trastornos inmunes o el cepillado traumático. Una de las consecuencias más comunes que resultan de estos eventos es la migración apical del tejido marginal gingival. Entre los biomateriales utilizados para la regeneración del tejido periodontal, las matrices de fibrina han recibido una atención significativa para corregir las recesiones gingivales. Se extrajeron cinco biopsias de mucosa oral, los fibroblastos se cultivaron in vitro y se congelaron en nitrógeno líquido. Tres tubos de vidrio estériles de 10 ml se llenaron con sangre del paciente y se centrifugaron inmediatamente. Los coágulos fueron extraídos y comprimidos para obtener membranas de L-PRF. Se agregaron fibroblastos autólogos de mucosa oral a las membranas y se realizaron procedimientos quirúrgicos en cinco pacientes. El tamaño de poro de la red de fibrina L-PRF era demasiado pequeño para permitir la penetración de los fibroblastos humanos, pero estaban firmemente unidos a la superficie de la membrana. Se usaron fibroblastos gingivales de cultivos de células frescas y recientemente descongelados para unirlos a las membranas L-PRF. Fue posible establecer un protocolo para la extracción de sangre, centrifugación, compresión de coágulos de fibrina, adhesión de fibroblastos a la superficie de la membrana y aplicación al paciente en un tiempo relativamente corto (1 hora, 1 hora y 30 minutos). Dos pacientes expresaron síntomas de dolor y los otros presentaron hinchazón leve sin dolor. En la primera semana, el tejido adyacente mostró pocos signos de inflamación. Se están realizando esfuerzos de investigación para desarrollar técnicas quirúrgicas más conservadoras y nuevos biomateriales que puedan promover la proliferación celular. Debido a sus propiedades, las membranas L-PRF representan una alternativa tentadora. Una técnica combinada para tratar los defectos de recesión adyacentes con membranas de L-PRF y fibroblastos de mucosa oral autóloga en un colgajo coronal desplazado no mostró una ventaja inicial en comparación con una cirugía estándar que incluye un injerto de tejido blando autólogo. Sin embargo, podría ser una alternativa para la aplicación clínica como un nuevo biomaterial de células funcionales. Se necesita más evidencia clínica.

Abordagem interdisciplinar no tratamento das recessões gengivais: relato de caso / Interdisciplinary approach in the treatment of gingival recessions: case report

Objetivo: o artigo faz uma revisão literária com abordagem interdisciplinar acerca do tratamento das recessões gengivais, por meio de relato de caso, exemplificando características clínicas e protocolo de resolução. Relato de caso: paciente com queixa principal de insatisfação estética na região dos dentes 11 e 21,em que se observou a presença de recessões gengivais rasas associadas à esses, sendo maior a do incisivo central superior esquerdo com a presença de coroas provisórias acrílicas com contornos fisiológicos inadequados e núcleos metálicos fundidos. O plano de tratamento indicado inicialmente foi deslize coronal do retalho com enxerto de tecido conjuntivo na região dos dentes 11 e 21, com objetivo de recobrimento radicular e confecção de novas coroas provisórias. Considerações finais: a técnica cirúrgica do envelope, associada ao enxerto de tecido conjuntivo, promoveu ganho clínico de inserção e recobrimento radicular, representando uma alternativa viável e altamente previsível para o tratamento das recessões gengivais, principalmente aquelas relacionadas aos defeitos classe I e II de Miller. O tratamento interdisciplinar associando cirurgia periodontal e tratamento protético contribuiu para o aumento de espessura da mucosa ceratinizada e a estabilidade da margem gengival respectivamente; coroas provisórias confeccionadas com contornos fisiológicos dão suporte à margem gengival e, consequentemente, favorecem a saúde periodontal.(AU)

Objective: The study presents a literature review with an interdisciplinary approach to the treatment of gingival recessions, by means of a case report, exemplifying their clinical characteristics and resolution protocol. Case report: Patient with the major complaint of aesthetic dissatisfaction in the region of teeth 11 and 21, which showed the presence of shallow gingival recession associated with said teeth. The greatest recession was in the upper left central incisor with the presence of temporary acrylic crowns, inadequate physiological contours, and molten metal nuclei. The initial treatment plan was the coronal slide of the flap with connective tissue graft in the region of teeth 11 and 21 to cover the root and the production of new temporary crowns. Final Considerations: The surgical technique of the envelope associated with the connective tissue graft promoted the clinical gain of insertion and root coverage, representing a viable and highly predictable alternative for the treatment of gingival recessions, especially those related to Miller class I and II defects. The interdisciplinary treatment associating periodontal surgery and prosthetic treatment contributed to increase the thickness of keratinized mucosa and to the stability of the gingival margin, respectively. Temporary crowns produced with physiological contours support the gingival margin and consequently favor periodontal health.(AU)

Treatment of multiple recessions with collagen matrix versus connective tissue: a randomized clinical trial

Abstract The objective of this study was to determine whether collagen matrix (CM) is an alternative to connective tissue graft technique (CTG) in the treatment of multiple gingival recessions (GR). The indication of CM for the treatment of multiple GR is not yet clear. More studies are needed to better understand this treatment modality, as an alternative to CTG. In this single-blind, split-mouth randomized clinical trial, fifteen patients with multiple Miller class I upper GR were selected and randomly assigned to control group (CTG) or test group (CM). Root coverage (RC) and patient-centered outcomes were evaluated at baseline and after 3, 6, and 12 months. A total of 82 GRs were treated. There was no significant difference regarding GR depth (GRD, primary outcome) between CTG (0.5 ± 0.9 mm) and CM groups (0.6 ± 1.0 mm) (p = 0.225). Percentage of RC was 82.14% in CTG and 77.7% in CM. Both groups demonstrated a gain in keratinized tissue width at 12 months (p < 0.05). Dentine hypersensitivity was effectively reduced in both groups. Postoperative pain was significantly higher in the CTG (p = 0.001). Esthetic satisfaction was high for both groups, with no significant difference (p > 0.05) between groups. After 12 months, both surgical treatments were able to promote RC, and GRD was similar in both CTG and CM groups.

Cirugía plástica periodontal: reporte de un caso clínico / Periodontal plastic surgery: report of a clinical case

El abordaje terapéutico de las recesiones gingivales requiere un plan de tratamiento que involucre terapia básica, la cual tendrá como objetivo la resolución de la/las etiologías de la/las mismas y una terapia de cirugía plástica periodontal adecuada al caso específico. Los procedimientos quirúrgicos con injertos de tejido conjuntivo tomados principalmente del paladar son el gold standard en el tratamiento de las recesiones gingivales. El objetivo de este trabajo es exponer paso a paso el tratamiento de una recesión gingival post-terapia de ortodoncia y su evaluación a largo plazo (AU)

The therapeutic approach to gingival recession requires a treatment plan involving basic therapy, which will focus on its etiologies, and the most suitable periodontal plastic surgery therapy in each specific case. Surgical procedures with connective-tissue grafts, taken mainly from the palate, are the gold standard in gingival recession treatment. The aim of this paper is to present the step-bystep post-orthodontic therapy treatment of a case of gingival recession and its long-term evaluation (AU)

The effect of enamel matrix derivatives on root coverage: a 12-month follow-up of a randomized clinical trial

Abstract Subepithelial connective tissue grafts (SCTGs) with a coronally advanced flap (CAF) are accepted as the gold standard for covering denuded root surfaces. In recent years, enamel matrix derivatives (EMDs) have been used for their regenerative potential in periodontics. The aim of this split-mouth and randomized controlled study was to assess the clinical and aesthetical impacts of EMD application in combination with SCTG+CAF in patients with Miller's Class I and II gingival recessions in contralateral canines of the maxilla. Participants who underwent SCTG+CAF+EMD application were identified as the test group (n = 19) and those who underwent SCTG+CAF as control group (n = 19). The outcome parameters were recession depth/width, root coverage percentage, and root coverage aesthetic score (RES). RES was evaluated by two calibrated blind periodontists one year after the treatment. Statistically significant root coverage percentage was observed at one year post-treatment for both groups (p < 0.05). However, significant differences between the groups were not observed in terms of total RES and complete root coverage rate (p > 0.05). The test group had significantly better results than the control according to the soft tissue texture and mucogingival junction alignment results (p < 0.05). These results indicate that EMDs contribute to the healing of soft tissue without scarring. As a result of better wound healing, the EMD-added group exhibited better results in terms of the harmony of the mucogingival junction between adjacent teeth. This paper is the first split-mouth study in which SCTG+CAF and SCTG+CAF+EMD were compared using RES in bilateral canines.

Comparison of two soft tissue substitutes for the treatment of gingival recession defects: an animal histological study

Abstract Objectives: This study aimed to compare two different soft tissue replacement grafts in their ability to treat gingival recession defects and successfully integrate with the surrounding tissues. Methodology: Nine beagle dogs were included and followed up to 10 weeks. Sites for intervention were allocated to one of the grafting materials investigated. Treatment consisted of coronally advanced flap combined with one of the two soft tissue substitutes on a previous surgically created defect. Materials employed were porcine-derived acellular dermal matrix (ADM) [Novomatrix™ (Test)] and collagen-based matrix (CBM) [Mucograft® (Control)]. Animals were sacrificed at 2, 6, and 10 weeks postoperatively and compared using descriptive histology and histomorphometric outcomes. Results: Macroscopic findings were similar between test and control groups at all intervals. After 10 weeks, both groups demonstrated successful incorporation of the grafting materials without signs of rejection and with comparable tissue integration. The histomorphometric data were similar between groups at 2 weeks; however, the test group provided greater root coverage and increase in tissue thickness than the control at 6- and 10-weeks post surgically. Conclusions: Both porcine-derived ADM and CBM revealed similar histological outcomes with successful integration and absence of adverse events. Test group provided superior outcomes regarding root coverage and increase in tissue thickness.

Movimento ortodôntico como auxiliar no tratamento periodontal cirúrgico: relato de caso / Orthodontic movement as an aid in surgical periodontal treatment: case report

Os pacientes adultos que procuram tratamento periodontal, geralmente trazem consigo outras situações bucais debilitantes, principalmente perdas e posicionamento inadequado dos dentes. Lançar mão dos mais variados recursos para resolver um determinado caso, torna-se uma necessidade. Através de um caso clínico, foi possível mostrar que o tratamento ortodôntico, ainda que para resolver problemas localizados, pode ser um recurso auxiliar importante na solução de sequelas no periodonto. Uma paciente de 43 anos, apresentava uma recessão severa na região do 31 e 41, ambos extruídos. Após controle periodontal, foi realizado o enxerto gengival livre. Dois meses depois foi dado início à mecânica ortodôntica, com aparelho fixo autoligado e forças leves. Como última etapa, buscou-se o recobrimento radicular, com a técnica de tunelização associada ao deslocamento coronário com tecido conjuntivo interposto. O procedimento demonstrou ser uma alternativa terapêutica razoável para a gravidade do caso (AU)

The adult patients who search for a periodontal treatment usually have others debilitating oral situations, especially losses and inadequate teeth positions. Taking advantages of the most varied resources to solve a particular case becomes a necessity. Through a clinical case, it was possible demonstrate that orthodontic treatment, even solving localized problems also can be an important auxiliary resource to solve sequels in the periodontium. A 43 years old woman with a severe recession in region of 31 and 41elements and both were extruded. After periodontal control, the FGG technique was performed. Two months later the orthodontic mechanicalwas performed, with self-ligating system and little forces. As last step was tried the root coverage, using the tunneling technique: coronary displacement with interposed connective tissue. The technique showed being a reasonable alternative facing the severity of the case.(AU)

Evaluation of the effect of dose-dependent platelet-rich fibrin membrane on treatment of gingival recession: a randomized, controlled clinical trial

Abstract Miller's class I gingival recessions (GR) have been treated using coronally advanced flap (CAF) with platelet-rich fibrin membrane (PRF membrane) or connective tissue graft (CTG). Objective: The aim of this study was to evaluate the effect of different multiple layers of PRF membranes for the treatment of GR compared with the CTG procedure. Material and Methods: Sixty-three Miller class I GR were treated in this study. Twenty-one GR selected randomly were treated with two layers of PRF membranes+CAF in 2PRF+CAF (test group-1), four layers of PRF membranes+CAF in 4PRF+CAF (test group-2), and CTG+CAF in the control group. The plaque index (PI), gingival index (GI), probing depth (PD), keratinized tissue thickness (KTT), clinical attachment level (CAL), recession depth (RD), recession width (RW), and keratinized tissue height (KTH) measurements were performed at baseline and 1, 3, and 6 months after surgery. The post-operative discomfort of patients, assessed with the visual analog scale (VAS) and healing index (HI), was recorded after surgery. Results: PI, GI, and PD scores were similar for all patients at all times. RD and RW scores were similar for each patient at 1 month, but these values were significantly increased in the subsequent periods in test group-1. The increase in KTT was significantly higher in the control group compared with the test groups. Similar root coverage scores were obtained in the test group-2 and control groups, and these scores were significantly higher compared with test group-1. Conclusions: The PRF membrane+CAF technique may be an alternative to the CTG+CAF technique for postoperative patient comfort. However, PRF membranes should use as many layers as possible.

Retalho posicionado coronalmente sem incisões relaxantes, associado a enxerto de tecido conjuntivo, para tratamento de retrações gengivais múltiplas / Coronally positioned flaps without relaxing incisions associated with a connective tissue graft to treat multiple gingival recessions

A retração gengival é caracterizada como o deslocamento apical da margem gengival em relação à junção cemento/esmalte (JCE), possuindo como consequência a exposição da superfície radicular. Diversas técnicas já foram descritas na literatura científi ca como tratamento para este problema gengival e, geralmente, a técnica cirúrgica de recobrimento radicular a ser escolhida relaciona-se com as características clínicas do caso, preferência do operador, habilidade manual, classifi cação da retração gengival, dentre outros. No entanto, a literatura indica que, dentre os procedimentos disponíveis, a técnica de retalho posicionado coronalmente com o uso de enxerto de tecido conjuntivo subepitelial parece ser a mais promissora. O objetivo deste trabalho foi apresentar um relato de caso de recobrimento radicular, utilizando a técnica de Zucchelli & De Sanctis associada a enxerto de tecido conjuntivo para recobrimento de retrações gengivais múltiplas. Paciente do sexo feminino, com 24 anos de idade, sem relato de alterações sistêmicas e/ou alergias, não etilista e não fumante, procurou tratamento odontológico queixando-se de hipersensibilidade dentinária e comprometimento estético bucal. Os resultados observados permitiram concluir que a técnica descrita por Zucchelli & De Sanctis, associada ao enxerto de tecido conjuntivo subepitelial, permitiu reduzir a altura das retrações gengivais, assim como aumentar e melhorar a qualidade do tecido gengival, com completa resolução da hipersensibilidade dentinária e alto nível de satisfação estética.

Gingival retraction is characterized as the apical displacement of the gingival margin in relation to the cementitious enamel junction (JCE), with consequent exposure to the root surface. Several techniques have already been described in the scientifi c literature as treatment for this gingival problem, and the surgical technique of root coverage to be chosen is generally related to the clinical characteristics of the case, operator preference, manual ability, classifi cation of gingival retraction, among others. However, the literature indicates that among the available procedures, the coronally positioned fl ap technique with the use of subepithelial connective tissue graft seems to be the most promising technique. The objective of this work is to present a case report of root coverage using the Zucchelli & De Sanctis technique associated with a connective tissue graft to cover multiple gingival retractions. Patient 24 years old, female, with no reports of systemic alterations and/or allergies, non-alcoholic and non-smoker, sought dental treatment complaining of dentine hypersensitivity and aesthetic impairment. The results showed that the technique described by de Zucchelli & De Sanctis associated with the subepithelial connective tissue graft reduced the height of gingival retractions, as well as increase and improve gingival tissue quality, with complete resolution of dentin hypersensitivity and high level of aesthetic satisfaction.

Enxerto de tecido conjuntivo subepitelial e retalho coronal em recessões gengivais múltiplas / Subepithelial connective tissue graft and coronal fl ap in multiple gingival recessions

Algumas das principais indicações para o recobrimento de superfícies radiculares expostas por recessão gengival compreendem a hipersensibilidade dentinária cervical e o tratamento de defeitos estéticos. Este trabalho descreveu o tratamento de recessão gengival múltipla classe III de Miller em um periodonto delgado, após 36 meses de uma intervenção cirúrgica com enxerto gengival livre. O tratamento cirúrgico periodontal proposto foi o recobrimento radicular por meio de enxerto de tecido conjuntivo subepitelial associado a retalho reposicionado coronalmente na região vestibular dos elementos 31, 41 e 42. Após 90 dias, foi possível observar o recobrimento parcial da recessão, aumento da espessura tecidual e o controle do biofi lme pelo paciente, promovendo maior proteção da região e redução do risco de recidiva das recessões. Diante da resolução do caso clínico apresentado, pôde-se concluir que a técnica do enxerto de tecido conjuntivo subepitelial associado ao retalho reposicionado coronalmente, quando bem indicada e realizada, pode ser empregada com sucesso em áreas de recessões múltiplas e periodonto com espessura reduzida.

Some of the main indications for the root coverage of gingival recessions include cervical dentin hypersensitivity and treatment of aesthetic defects. This manuscript describes the treatment of a Miller's Class III multiple gingival recession 36 months after a free gingival graft surgical procedure. The periodontal surgical treatment proposed was the subepithelial connective tissue graft associated with a coronally repositioned fl ap at vestibular region of elements 31, 41 and 42. After 90 postoperative days, it was possible to observe an increase on tissue thickness and biofi lm control by the patient, promoting a greater protection of the region and reducing the risk of recession recurrence. It can be concluded that the subepithelial connective tissue graft technique associated with the coronal repositioned fl ap, when well indicated and performed, can be successfully used in multiple recessions and periodontal regions with reduced thickness.