Coronally advanced flap with connective tissue graft for the treatment of multiple recession defects: Case Report

Mucogingival deformities are a group of conditions that affect many patients, having an impact on function and esthetics; they can be congenital, developmental, or acquired. Gingival recession is defined by the American Academy of Periodontology as the location of the gingival margin apical to the amelocemental junction. They can be localized or generalized and include one or more sides of the tooth. Among the treatments, subepithelial connective tissue grafting and acellular dermal matrix can be considered, whose objectives are root coverage and keratinized tissue width. Case report: A 54-year-old female patient diagnosed with mucogingival deformities around the tooth, was treated with subepithelial connective tissue graft to obtain root coverage in recessions RT2 and RT3. Conclusion: The purpose of using a bilaminar technique where a flap is made, and a connective tissue graft is placed to cover gingival recessions is to obtain better esthetic results.

Food insecurity in Brazil by household arrangements and characteristics between 2004 and 2022 / Insegurança alimentar no Brasil baseado em arranjos e características domiciliares de 2004 a 2022 / Inseguridad alimentaria en Brasil según los arreglos domésticos y características de los hogares de 2004 a 2022

Abstract: Although food insecurity presents a decreasing trend worldwide, some regions recently observed an increase in hunger levels. Such was the case in Brazil between 2014 and 2018, during and after the great Brazilian recession, and between 2020 and 2021, during the COVID-19 pandemic. This paper describes the evolution of food insecurity in Brazil between 2004 and 2022 using Brazilian National Household Sample Survey (PNAD), Brazilian Household Budget Survey (POF) and Continuous PNAD. Households were classified in 20 types of arrangements, and the most vulnerable living arrangements between 2004 and 2018 were identified by multinomial logistic models. Overall, households headed by women (single blacks, whites or in couples) with or without children were the most prone to food insecurity. As for the evolution of food insecurity in Brazil between 2018 and 2022, logistic models were applied to estimate moderate and severe food insecurity levels among the 20 household types. Additionally, effects of the emergency aid and idiosyncrasies of the COVID-19 pandemic were estimated.

Resumo: A tendência geral de insegurança alimentar no mundo é decrescente. No entanto, algumas regiões observaram um recente aumento nos níveis de fome. Isso ocorreu no Brasil de 2014 a 2018, durante e após a grande recessão brasileira, e de 2020 a 2021, durante a pandemia da COVID-19. Este artigo descreve a evolução da insegurança alimentar no Brasil de 2004 a 2022 usando dados obtidos através das seguintes pesquisas: Pesquisa Nacional por Amostra de Domicílios (PNAD), Pesquisa de Orçamentos Familiares (POF) e PNAD Contínua. Os domicílios foram classificados em 20 tipos de arranjo domiciliar. Inicialmente, modelos logísticos multinomiais foram aplicados para identificar os arranjos domiciliares mais vulneráveis de 2004 a 2018. Em geral, os domicílios chefiados por mulheres (negras, brancas ou casais) com ou sem filhos foram os mais propensos à insegurança alimentar. Além disso, foi abordada a evolução da insegurança alimentar no Brasil entre os arranjos domiciliares de 2018 a 2022. Modelos logísticos foram aplicados para estimar os níveis de insegurança alimentar moderada e grave para os 20 tipos de arranjos domiciliar. Além disso, foram estimados os efeitos do auxílio emergencial e as peculiaridades da pandemia da COVID-19.

Resumen: La tendencia general de la inseguridad alimentaria está disminuyendo en el mundo. Sin embargo, algunas regiones han registrado un aumento reciente en los niveles de hambre. Esto había ocurrido en Brasil en el período de 2014 a 2018, durante y después de la gran recesión brasileña, y de 2020 a 2021, durante la pandemia del COVID-19. Este artículo describe la evolución de la inseguridad alimentaria en Brasil de 2004 a 2022 a partir de datos obtenidos de las siguientes encuestas: Encuesta Nacional por Muestra de Domicilios (PNAD), Encuesta de Presupuesto de Familiares (POF) y PNAD Continua. Se clasificaron los hogares en 20 tipos de arreglos domésticos. Inicialmente, se aplicaron modelos logísticos multinomiales para identificar los arreglos domésticos más vulnerables en el período de 2004 a 2018. En general, los hogares que tienen a mujeres (negras, blancas o en pareja) con o sin hijos como jefas del hogar fueron los más propensos a la inseguridad alimentaria. Además, se abordó la evolución de la inseguridad alimentaria en Brasil en los arreglos domésticos para el período de 2018 a 2022. Se aplicaron modelos logísticos para estimar los niveles de inseguridad alimentaria moderada y severa para los 20 tipos de arreglos domésticos. Además, se estimaron los efectos de la ayuda de emergencia y las peculiaridades de la pandemia del COVID-19.

Protocolo para el tratamiento de la recesión gingival con membrana de fibrina rica en plaquetas

Introducción: Es necesario la aplicación de protocolos de actuación como herramientas que permiten homogeneizar los procedimientos plásticos periodontales regenerativos y establecer las pautas de actuación del Periodontólogo para el abordaje de las recesiones gingivales con esta modalidad terapéutica de avanzada. Objetivo: Diseñar un protocolo para el tratamiento de la recesión gingival mediante la utilización de la membrana de fibrina rica en plaquetas, asociada al colgajo de avance coronal. Métodos: Se realizó una investigación con enfoque cualitativo en la Facultad de Estomatología de Villa Clara, de julio de 2020 a diciembre de 2021. Para el diseño del protocolo se empleó una fase de preparación y una de elaboración; dentro de esta última se estructuraron tres momentos: revisión sistemática de la literatura, aplicación de técnicas grupales (grupo focal y nominal) y conclusión del documento. Se realizó una valoración por criterios de especialistas externos antes de concluir la estructura definitiva del protocolo. Resultados: Se consultaron cinco guías para la confección de protocolos, cinco protocolos de atención médica y enfermería y 10 estomatológicos. La estructura del documento quedó conformada por: portada, introducción, objetivos, profesionales a quienes va dirigido, población diana, proceso de elaboración, procedimiento, algoritmo, fecha de implementación y revisión, proceso de implantación, indicadores de evaluación, glosario y referencias bibliográficas. Conclusiones: Se diseñó un protocolo de actuación que establece las pautas para la realización del proceder terapéutico regenerativo, desde la selección de los pacientes hasta la evolución de la terapéutica. El documento se valoró por especialistas externos como positivo.

Introduction: It is necessary to apply action protocols as tools to homogenize regenerative periodontal plastic procedures and to establish the guidelines for the periodontist to approach gingival recession with this advanced therapeutic modality. Objective: To design a protocol for the treatment of gingival recession using platelet-rich fibrin membrane associated with coronal advancement flap. Methods: A research with a qualitative approach was carried out in the School of Stomatology of Villa Clara, from July 2020 to December 2021. For the design of the protocol, a preparation phase and an elaboration phase were used; within the latter, three moments were structured: systematic review of the literature, application of group techniques (focal and nominal group) and conclusion of the document. An evaluation by external specialists was carried out before finalizing the definitive structure of the protocol. Results: Five guides for the preparation of protocols, five medical and nursing care protocols and 10 stomatological protocols were consulted. The structure of the document consisted of: cover page, introduction, objectives, target professionals, target population, elaboration process, procedure, algorithm, implementation and revision date, implementation process, evaluation indicators, glossary and bibliographic references. Conclusions: An action protocol was designed that establishes the guidelines for carrying out the regenerative therapeutic procedure, from the selection of patients to the evolution of the therapy. The document was positively evaluated by external specialists.

Application of modified mucogingival surgery in the treatment of gingival recession / 口腔疾病防治

@#With the increasing demand for beauty, the treatment of gingival recession has become a common request among patients. Clinically, gingival recession is mainly treated by surgery. The common surgical methods include free gingival grafting, pedicled flap technology and double flap technology (subepithelial connective tissue transplantation combined with coronally advanced flaps). If patients with indications are selected, satisfactory surgical results will be obtained. However, there are still some shortcomings in the above mentioned methods, such as the root coverage effect not being satisfactory. In recent years, researchers have put forward some improved schemes to minimize the shortcomings of the above methods to treat different degrees of gingival recession. A gingival unit graft containing gingival papilla and free gingiva can improve the blood supply of the recipient area and improve the effect of root coverage. It can obtain better root coverage for slight retraction, widening of the angular gingiva and deepening of the vestibular sulcus, but there may be issues with inconsistent color and shape of the gingiva after surgery, as well as poor aesthetic effects. Modified coronally advanced flaps, flaps prepared by the technique of half-thickness, full-thickness and half-thickness, and modified coronally advanced envelope flap technology are designed with the most serious retraction teeth as the center in the case of multiple gingival retractions, both of which can improve the effect of root covering. Tunnel technology and modified tunnel technology, without severing the gingival papilla and tunneling the gingival flap to accommodate the graft, can effectively reduce tissue damage and promote wound healing. This paper reviews the literature and summarizes the outcome of the modified surgery techniques in the treatment of gingival recession. These treatment options for gingival recession are proposed with the aim of improving clinical work, and some suggestions for the treatment of gingival recession to achieve a stable root coverage effect are put forward. In the future, the development direction of mucogingival surgery is to reduce trauma and have a stable curative effect.

Recubrimiento radicular de recesiones gingivales con matriz dérmica acelular / Root coverage of gingival recession with acellular dermal matrix

La recesión gingival es considerada como una deformidad o condición mucogingival, la Academia Americana de Periodontología, define a la recesión gingival como el desplazamiento del margen del tejido blando apical a la unión cemento-esmalte con la exposición de la superficie radicular. El tratamiento de las recesiones gingivales es un motivo de consulta común debido a razones estéticas, hipersensibilidad dentinaria, molestias durante el cepillado e incluso temor a la pérdida dentaria. Es una situación clínica común, 60% de la población humana tiene algún tipo de recesión gingival. Al realizar el examen clínico a paciente masculino de 55 años, se observó una recesión gingival tipo 1 (RT1) sin pérdida de inserción interproximal de la clasificación de Cairo. Se realizó el colgajo posicionado coronalmente (CPC) utilizando una matriz dérmica acelular (MDA) de origen humano OrACELL®. Se obtuvo resultado favorable en el recubrimiento de recesiones gingivales múltiples; considerándolos como una buena alternativa frente a los injertos gingivales autógenos. Concluyendo que, el uso de la matriz dérmica acelular para el tratamiento de la recesión gingival tipo 1 es una adecuada opción para el recubrimiento radicular. Se recomiendan más estudios a largo plazo para ver la estabilidad de los resultados obtenidos con la MDA (AU)

Gingival recession, considered a deformity or mucogingival condition, the American Academy of Periodontology, defines gingival recession as the exposure of the root surface resulting from migration of the gingival margin apical to the cementoenamel junction (CEJ). The treatment of gingival recessions is a common reason for consultation due to aesthetic reasons, dentin hypersensitivity, discomfort during brushing and even fear of tooth loss. It is a common clinical situation, 60% of the human population has some kind of gingival recession. Clinical examination of a 55-year-old male patient showed a type 1 gingival recession (RT1) without loss of interproximal insertion of the Cairo classification. Coronally advanced flap (CAF) was performed using an acellular dermal matrix (ADM) of human origin OrACELL®. Favorable results were obtained in the coating of multiple gingival recessions; considering them as a good alternative to autogenous gingival grafts. Concluding that, the use of the acellular dermal matrix for the treatment of gingival recession type 1, is a suitable option for root lining. Further long-term studies are recommended to see the elasticity of MDA outcomes (AU)

Recesión mandibular única tratada con colgajo desplazado lateral: Reporte de un caso

Introducción: Hoy en día, uno de los motivos de consulta de los pacientes es la inconformidad con su apariencia estética debido a la presencia de recesiones gingivales. Dentro de las diversas técnicas para tratar este tipo de defectos se encuentra el colgajo posicionado lateral, el cual, se utiliza para la cobertura radicular de recesiones gingivales únicas en dientes mandibulares y cuyos resultados han demostrado ganancia en altura de tejido queratinizado, ganancia en inserción clínica y una cobertura radicular completa. Reporte de Caso: Paciente femenino de 32 años, diagnosticado con defecto mucogingival único en torno a pieza dental 3.1 y que fue tratado con un colgajo posicionado lateral en combinación con proteínas derivadas de la matriz del esmalte, con el objetivo de cubrir la recesión gingival. Conclusión: La técnica de colgajo posicionado lateral es un tratamiento viable y eficaz para la cobertura radicular completa de defectos mucogingivales únicos en torno a diente, donde además se obtiene ganancia en altura de encía queratinizada, así como de nivel de inserción clínica.

Introduction: Nowadays, one of the reasons for consultation of patients is the dissatisfaction with their aesthetic appearance due to the presence of gingival recessions. Among the various techniques to treat this type of defects is the laterally positioned flap, which is used for root coverage of single gingival recessions in mandibular teeth and whose results have shown gain in height of keratinized tissue, clinical attachment gain and complete root coverage. Case Report: 32-year-old female patient, diagnosed with a single mucogingival defect around tooth 3.1 and treated with a laterally positioned flap in combination with enamel matrix derivatives, in order to cover the gingival recession. Conclusion: The laterally positioned flap technique is a viable and effective treatment for complete root coverage of single mucogingival defects around the tooth. In addition, there is a gain in keratinized gingiva and in clinical attachment.

Long-term outcomes of single monocular resection–recession in adult sensory strabismus and factors affecting the postoperative drift

Purpose: The purpose of our study was to analyze the clinical characteristics and outcome of horizontal strabismus surgery in patients having sensory strabismus and to analyze the factors that affect the postoperative drift in these patients over a follow?up of three years. Methods: This was a retrospective case series. Patients aged ?18 years, having low vision (visual acuity ?20/60) in one eye, and undergoing horizontal strabismus surgery (standard recess–resect procedures) in the same eye were recruited. All patients were advised patching of the good eye six weeks prior and continued for six weeks post strabismus surgery. We excluded patients who had paralytic disorders, motility defects, or those with chronic systemic conditions. Patients with a minimum follow?up of three years were recruited. Results: The study included 56 patients whose mean age was 22.9 ± 4.93 years. Exotropia (n = 38; 67.8%) was more common than esotropia (n = 18; 32.1%). Preoperative visual acuity was 1.1 ± 0.85 (range perception of light to 6/18p). The cause of low vision was amblyopia (n = 30; 53.5%) followed by trauma (n = 22; 39.2%). The mean preoperative distance deviation was 57.7 ± 15.5 PD in the primary position (range: 20–65 PD). The success rate of exotropia (78.9%) was more than esotropia (52.9%) at three years. Two patients with esotropia were overcorrected. All patients with exotropia showed an exotropic drift with time. Conclusion: The motor alignment after a single recession– resection procedure was satisfactory at the long?term in our cohort of sensory strabismus. The duration or extent of visual impairment had no relation to the postoperative outcome.

Suture Less Gingival Augmentation Using Gingival Unit Transfer – A Case Report

The use of root coverage procedures to treat gingival recession defects, a common periodontal condition, is an important aspect of periodontal regenerative therapy. The synergistic relationship between vascular configuration and involved tissues is the most important factor in soft tissue graft success. The present case reports the clinical effectiveness of Gingival Unit Graft (GUG) for the management of Miller's class III gingival recession.Clinical parameters like Probing depth, recession depth, keratinized tissue width and clinical attachment level were measured at baseline and postoperative 6 months. Percentage of defect coverage was evaluated at postoperative 6 months. Healing was uneventful and 3mm root coverage was observed with 1mm residual recession and increase in keratinized gingiva after 6 months follow up. Free soft tissue autografts such as gingival unit transfers can be used along with bio-adhesives such as cyanoacrylates for predictable results in the management of recession defects.

A modified tunnel technique to treat multiple gingival recessions: Case Series

Abstract This case series reports a modified tunnel technique with connective tissue graft for the root coverage of multiple Miller Class I, II, and III gingival recessions. The modified approach presents an innovative suture technique to improve the stability and position of the graft. Ten patients with multiple gingival recessions (n=85 teeth) received surgical root coverage treatment. The gingival recession height and width were measured and presented as median, minimum, and maximum values. The percentage of the root coverage after at least 12 months expressed the treatment effectiveness. The Shapiro-Wilk test evaluated the normality; pared Wilcoxon test determined the exact P-value for the differences in the height of the gingival recession before and after surgical treatment (α = 0.05). An average of 97.9% (± 5.6%, p < 0.0001) root coverage after treatment occurred, and 73 out of 85 recessions presented complete root coverage after 12 months. Treatment of Miller class I and II gingival recessions resulted in root coverage higher than 99 and class III higher than 95% (p < 0.0001). The presented case series report the efficacy of a modified surgical technique promoting more than 95% of root coverage after 12 months in multiple Miller Class I, II, and III gingival recessions. Well-designed blind randomized controlled trials are needed to validate the proposed technique.

Resumo Esta série de casos relata uma técnica de túnel modificada com enxerto de tecido conjuntivo para o recobrimento radicular de múltiplas recessões gengivais Classe I, II e III de Miller. A abordagem modificada apresenta uma técnica de sutura inovadora para melhorar a estabilidade e a posição do enxerto. Dez pacientes com múltiplas recessões gengivais (n=85 dentes) receberam tratamento cirúrgico de recobrimento radicular. A altura e a largura da recessão gengival foram mensuradas e apresentadas como valores medianos, mínimos e máximos. A eficácia do tratamento foi expressa como uma porcentagem da cobertura radicular após pelo menos 12 meses. O teste de Shapiro-Wilk avaliou a normalidade; o teste de Wilcoxon pared determinou o valor P exato para as diferenças entre a altura da recessão gengival antes e após o tratamento cirúrgico (α = 0,05). Uma média de 97,9% (± 5,6%, p < 0,0001) de cobertura radicular após o tratamento ocorreu, e 73 das 85 recessões apresentaram cobertura radicular completa após 12 meses. O tratamento das recessões gengivais classe I e II de Miller resultou em recobrimento radicular superior a 99 e classe III superior a 95% (p < 0,0001). A série de casos apresentada relata a eficácia de uma técnica cirúrgica modificada promovendo mais de 95% de cobertura radicular após 12 meses em múltiplas recessões gengivais Classe I, II e III de Miller. Ensaios controlados randomizados cegos bem desenhados são necessários para validar a técnica proposta.

The Effect of the Interproximal Creeping Attachment in Aesthetic Site After Root Coverage Surgery with VISTA Technique ? A Case Report

Gingival recession is a common manifestation in most populations. The mechanism by which gingival recession occurs is not well understood, but it seems to be complex and multifactorial. The main etiological factors are the accumulation of dental plaque biofilm with the resulting inflammatory periodontal diseases and mechanical trauma due to faulty oral hygiene techniques, especially in thin biotypes. This case report describes the treatment of a vestibular recession associated with interdental bone loss, with the VISTA technique associated with a connective tissue graft. The case was evaluated at 3, 9 months and 48 months after the surgery clinically complete root coverage and increased thickness of keratinized tissue were achieved, and the interdental papilla was augmented improving the soft tissue quality for future orthodontic treatment. VISTA technique associated with a connective tissue graft to reconstruct vertically papilla is a promising alternative for minimally invasive treatment and stable after 4 years.

Economic fluctuations and educational inequalities in premature ischemic heart disease mortality in Argentina / Variaciones económicas y desigualdades educativas en la mortalidad prematura por enfermedad isquémica en Argentina / Flutuações econômicas e desigualdades educacionais na mortalidade prematura por doença isquêmica na Argentina

Abstract: Although mortality from ischemic heart disease has declined over the past decades in Argentina, ischemic heart disease remains one of the most frequent causes of death. This study aimed to describe the role of individual and contextual factors on premature ischemic heart disease mortality and to analyze how educational differentials in premature ischemic heart disease mortality changed during economic fluctuations in two provinces of Argentina from 1990 to 2018. To test the relationship between individual (age, sex, and educational level) and contextual (urbanization, poverty, and macroeconomic variations) factors, a multilevel Poisson model was estimated. When controlling for the level of poverty at the departmental level, we observed inequalities in premature ischemic heart disease mortality according to the educational level of individuals, affecting population of low educational level. Moreover, economic expansion was related to an increase in ischemic heart disease mortality, however, expansion years were not associated with increasing educational inequalities in ischemic heart disease mortality. At the departmental level, we found no contextual association beween area-related socioeconomic level and the risk of ischemic heart disease mortality. Despite the continuing decline in ischemic heart disease mortality in Argentina, this study highlighted that social inequalities in mortality risk increased over time. Therefore, prevention policies should be more focused on populations of lower socioeconomic status in Argentina.

Resumen: Si bien la mortalidad por cardiopatía isquémica ha disminuido en las últimas décadas en Argentina, la cardiopatía isquémica sigue siendo una de las causas más frecuentes de muerte. Los objetivos de este estudio fueron describir el papel de los factores individuales y contextuales en la mortalidad prematura por cardiopatía isquémica y analizar cómo estos cambiaron las diferencias educativas en la mortalidad prematura por cardiopatía isquémica durante las variaciones económicas en dos provincias de Argentina durante el periodo 1990-2018. Para probar la relación entre los factores individuales (edad, género y nivel de educación) y contextuales (urbanización, pobreza y variaciones macroeconómicas), se estimó un modelo de Poisson multinivel. Controlando el nivel de pobreza en el ámbito departamental, se observaron desigualdades en la mortalidad prematura por cardiopatía isquémica según el nivel de educación de los individuos, lo que afecta a la población con bajo nivel de educación; la expansión económica se relacionó con el aumento de la mortalidad por cardiopatía isquémica; sin embargo, el periodo de expansión no estuvo asociado a aumentos de las desigualdades educativas en la mortalidad por cardiopatía isquémica. En el ámbito departamental no se detectó asociación entre el nivel socioeconómico de la área y el riesgo de mortalidad por cardiopatía isquémica. A pesar de la disminución continua de la mortalidad por cardiopatía isquémica en Argentina, este estudio destaca que las desigualdades sociales con relación al riesgo de mortalidad tuvieron un aumento con el tiempo. Por lo tanto, las políticas de prevención deberán dirigirse más a las poblaciones de menor nivel socioeconómico en Argentina.

Resumo: Embora a mortalidade por doença isquêmica do coração tenha diminuído nas últimas décadas na Argentina, a doença isquêmica do coração continua sendo uma das causas mais frequentes de morte. Os objetivos deste estudo foram descrever o papel de fatores individuais e contextuais na mortalidade prematura por doença isquêmica do coração e analisar como as diferenças educacionais na mortalidade prematura por doença isquêmica do coração mudaram durante as flutuações econômicas em duas províncias da Argentina durante o período 1990-2018. Para testar a relação entre fatores individuais (idade, sexo e escolaridade) e contextuais (urbanização, pobreza e variações macroeconômicas), estimou-se um modelo de Poisson multinível. Controlando o nível de pobreza no nível departamental, observaram-se desigualdades na mortalidade prematura por doença isquêmica do coração de acordo com o nível educacional dos indivíduos, afetando a população de baixa escolaridade; a expansão econômica esteve relacionada ao aumento da mortalidade por doença isquêmica do coração; no entanto, os anos de expansão não foram associados a aumentos nas desigualdades educacionais na mortalidade por doença isquêmica do coração. No nível departamental, não foi detectada uma associação contextual entre nível socioeconômico da área e risco de mortalidade por doença isquêmica do coração. Apesar do contínuo declínio da mortalidade por doença isquêmica do coração na Argentina, este estudo destaca que as desigualdades sociais em relação ao risco de mortalidade aumentaram ao longo do tempo. Portanto, as políticas de prevenção devem ser mais focadas nas populações de menor nível socioeconômico na Argentina.

Funcionalização de matriz colágena estável em volume utilizando Fibrina Rica em Plaquetas injetável (i-PRF) para o tratamento de Recessão Gengival unitária / Volume-stable collagen matrix (VCMX) biofunctionalized wit injectable platelet-rich fibrin (i-PRF) for the treatment of single gingival recession: randomized clinical trial

Substitutos de enxerto de tecido conjuntivo têm sido amplamente utilizados para superar as limitações dos enxertos autógenos no tratamento de defeitos dos tecidos moles periodontais e peri-implantares. No entanto, o desempenho clínico desses biomateriais ainda é inferior. A biofuncionalização de matrizes colágenas usando fibrina rica em plaquetas injetável (i-PRF) foi proposta como uma estratégia para aprimorar a bioatividade e, portanto, a eficácia clínica desses substitutos mucosos. Desta forma, o objetivo deste estudo foi avaliar a eficácia do uso da matriz colágena estável em volume (FG) biofuncionalizada com i-PRF no tratamento de recessões gengivais unitárias (RGs) do ponto de vista clínico, estético e de parâmetros centrados no paciente. Para tal, foram selecionados 66 pacientes portadores de RGs unitárias RT1, os quais foram alocados aleatoriamente em um dos seguintes grupos: grupo CAF (n=22), retalho posicionado coronariamente (CAF); grupo CAF+FG (n=22), CAF associado à FG; e grupo CAF+FG+i-PRF (n=22), CAF associado à FG biofuncionalizada com i-PRF. Após 6 meses, os três grupos apresentaram taxas de recobrimento radicular significativas [CAF: 69,1% (2,02 ± 1,06 mm); CAF+FG: 67,44% (1,7 ± 0,81 mm) e CAF+FG+i-PRF: 64,92% (1,64 ± 0,80 mm), sem diferença entre os grupos (p=0,33). Os grupos que receberam os biomateriais forneceram um maior ganho em espessura de tecido queratinizado (ETQ) (CAF: 0,12 ± 0,2 mm; CAF+FG: 0,43 ± 0,24 mm; CAF+FG+i-PRF: 0,48 ± 0,25 mm; p=0,000). Não foram observadas diferenças significativas em termos de altura de tecido queratinizado em nenhum dos grupos e tempos avaliados (p>0,05). Todos os grupos apresentaram redução significativa da hipersensibilidade dentinária e melhorias nas condições estéticas (p>0,05). Também não foram observadas diferenças em termos de dor e morbidade pósoperatórias (p>0,05). Dentro das limitações do presente estudo, conclui-se que as três abordagens forneceram resultados semelhantes e satisfatórios após 6 meses de acompanhamento. A adição da FG, biofuncionalizada ou não com i-PRF, proporcionou benefícios adicionais em termos de ganho de ETQ. (AU)

Soft tissue graft substitutes have been widely used to overcome the limitations of autogenous grafts in the treatment of periodontal and peri-implant soft tissue defects. However, the clinical performance of these biomaterials is still inferior. The biofunctionalization of collagen matrices using injectable platelet-rich fibrin (i-PRF) has been proposed as a strategy to enhance the bioactivity and, therefore, the clinical efficacy of these biomaterials. Thus, the aim of this study was to evaluate the effectiveness of using biofunctionalized volume-stable collagen matrix (VCMX) with i-PRF in the treatment of single gingival recessions (GRs) from clinical, esthetic, and patient-centered parameters. For this purpose, 66 patients with single RT GRs were selected and randomly allocated to one of the following groups: CAF group (n=22), coronally advanced flap (CAF); CAF+VCMX group (n=22), CAF combined with VCMX; and CAF+ VCMX +iPRF group (n=22), CAF combined with biofunctionalized VCMX with i-PRF. After 6 months, all three groups exhibited significant root coverage rates [CAF: 69.1% (2.02 ± 1.06 mm); CAF+FG: 67.44% (1.7 ± 0.81 mm); and CAF+FG+iPRF: 64.92% (1.64 ± 0.80 mm), with no difference between the groups (p=0.33). The groups that received the biomaterials showed a greater gain in keratinized tissue thickness (KTT) (CAF: 0.12 ± 0.2 mm; CAF+FG: 0.43 ± 0.24 mm; CAF+FG+i-PRF: 0.48 ± 0.25 mm; p=0.000). No significant differences were observed in terms of keratinized tissue height in any of the groups and assessed time points (p>0.05). All groups showed a significant reduction in dentin hypersensitivity and improvements in esthetic conditions (p>0.05). No differences were also observed in terms of post-operative pain and morbidity (p>0.05). Within the limitations of this study, it is concluded that all three approaches provided similar and satisfactory results after 6 months of follow-up. The addition of VCMX, whether biofunctionalized or not with i-PRF, provided additional benefits in terms of keratinized tissue thickness gain. (AU)

Conventional versus flap-protected free gingival graft: a multicenter randomized clinical trial

Abstract The purpose of this study was to compare the outcomes of a modified gingival graft technique, in which the released flap is positioned and sutured over the graft, with the conventional free gingival graft (FGG) procedure, when both are used for gingival augmentation. A 12-month, multicenter parallel randomized controlled trial was conducted. Subjects with buccal RT2 gingival recessions and keratinized tissue width (KTW) < 2 mm in at least one mandibular incisor were randomized to control group (n = 20; conventional FGG) or test group (n = 20; modified FGG; flap sutured over FGG using sling sutures). The primary outcome (KTW) was measured at baseline and after 3, 6 and 12 months, as was keratinized tissue thickness (KTT). Postoperative pain (POP) and analgesic intake were also recorded. Both techniques promoted a significant increase in KTW and KTT when compared to baseline (p < 0.05) with no significant differences between groups (KTW change of 6.1±1.5 mm and 5.4±1.6 mm, for control and test, respectively; p=0.16). However, test group patients reported less POP after 7 days and used less analgesic medication than control group patients (p < 0.05). We concluded that the modified FGG was comparable to conventional FGG in augmenting keratinized tissue width and thickness at mandibular incisors, but resulted in less patient morbidity.

Root coverage with platelet-rich fibrin or connective tissue graft: a split-mouth randomized trial

Abstract: This study aimed to compare the use of connective tissue grafts (CTG) and platelet-rich fibrin (PRF) associated with the tunnel technique (TT) for the treatment of multiple gingival recessions (GR). Fourteen patients with multiple bilateral GR [type 1 recession (RT 1)] in the maxillary incisors, canines, and/or premolars were included. The TT was performed on both sides (split-mouth model); CTG (36 GR) was used on one side, and on the other, PRF (36 GR) was used. Clinical parameters, including recession depth (RD), probing depth, clinical attachment level (CAL), and keratinized gingiva thickness/width (GT/KTW), were obtained at baseline and after 1, 3, 6, and 16 months. Lower RD (0.81 ± 0.68 vs. 1.23 ± 0.71 mm) and CAL (2.54 ± 0.63 vs. 2.73 ± 0.82 mm) were observed for CTG compared to PRF after 16 months. Higher GT was obtained for CTG compared to PRF after 3 (1.81 ± 0.56 vs 1.43 ± 0.47 mm) and 6 months (1.67 ± 0.61 vs. 1.38 ± 0.55 mm, p < 0.05). The recession coverage (RC) was higher for CTG (55.42% ± 37.14) in comparison to PRF (29.53% ± 34.08) after 16 months (p < 0.05). Similarly, CTG presented a more complete coverage of the recession (15; 41.66%) than PRF (9; 24.32%). There were no significant differences between the groups in terms of surgery time, postoperative pain, or healing patterns. Greater esthetic satisfaction was obtained with CTG. It was concluded that CTG combined with TT showed clinical and esthetic results superior to those of PRF in multiple GR treatments.

Intérêt de la greffe épithélioconjonctive au cours du traitement orthodontique multiattaches: rapport de 3 cas / Interest of free gingival grafting during multi-attachment orthodontic treatment: a 3-case report

Introduction. La récession gingivale (RG) entraine une exposition de la racine et une hypersensibilité. L'étiologie est multifactorielle. Une incidence plus élevée pourrait être observée au niveau des dents avec des phénotypes parodontaux fins ou si des forces orthodontiques ont été appliquées pour déplacer les dents en dehors de leurs processus alvéolaires. La greffe épithélioconjonctive (GEC) est indiquée pour prévenir ou corriger la RG et améliorer l'esthétique. L'objectif de ce rapport de cas est de montrer l'intérêt de la GEC dans la prise en charge des RG en cours de traitement orthodontique multiattaches. Observation clinique et prise en charge. Trois patientes en cours de traitement orthodontique multiattaches depuis 2 ans ont été référées dans la clinique de parodontie de l'Institut d'Odontologie et de Stomatologie de l'Université Cheikh Anta Diop de Dakar, avec des RG de type 2 (RT2) de Cairo sur la 31 et la 41. Un diagnostic parodontal de gingivite induite par le biofilm a été posé pour la première patiente. Les deux autres patientes présentaient une parodontite localisée de stade II et de grade B. La prise en charge a consisté en une thérapeutique initiale suivie d'une réévaluation à 2 mois. L'indication de la GEC a été posée avec comme objectifs de créer une bande de gencive kératinisée avec un approfondissement du vestibule en regard de la 31 et de la 41 et d'obtenir un recouvrement radiculaire. Des résultats satisfaisants ont pu être obtenus. Conclusion. Les rapports entre parodontie et orthodontie Impliquent un diagnostic initial précis et une planification thérapeutique coordonnée des intervenants.

Introduction. Gingival recession (GR) leads to root exposure and hypersensitivity. The etiology is multifactorial. A higher incidence may be observed in teeth with fine periodontal phenotypes, or if orthodontic forces have been applied to move teeth out of their alveolar processes. Free gingival grafting (FGG) is indicated to prevent or correct GR and improve aesthetics. The aim of this case report is to demonstrate the value of ECG in the management of GR during multiattachment orthodontic treatment. Case description and management. Three patients undergoing multiattachment orthodontic treatment for 2 years were referred to the periodontics clinic of the of the Institut d'Odontologie et de Stomatologie at Cheikh Anta Diop University in Dakar, with Cairo type 2 GR (RT2) on 31 and 41. A periodontal diagnosis of biofilm -induced gingivitis was made for the first patient. The other two patients presented with localized stage II, grade B periodontitis. Management consisted of initial therapy followed by reassessment at 2 months. The indication for FGG was to create a band of keratinized gingiva with deepening of the vestibule opposite 31 and 41, and to achieve root coverage. Satis factory results were obtained. Conclusion. The relationship between periodontics and orthodontics requires accurate initial diagnosis and coordinated treatment planning. .

Systematic review of clinical effects of enamel matrix derivative as adjunctive therapy for gingival recession / 口腔疾病防治

Objective @#To evaluate the clinical effect of enamel matrix derivative(EMD) assisted with connective tissue graft(CTG) in the treatment of gingival recession.@*Methods @#Search The Cochrane Library, PubMed, EMbase, Web of Science, Wanfang Public Database,VIP database and CNKI to search for randomized controlled trials of EMD in the treatment of gingival recession. The search period is from the establishment of the databases to October 3, 2022. The test group was treated with EMD+CTG, while the control group was treated with CTG alone. Meta-analyses were performed using Review Manager 5.4.1 and Stat12.0.@*Results@# Meta analysis results showed that only 12 months after treatment, there was a statistically significant difference in the PD and CAL outcome indicators between the EMD assisted treatment group and the control group [MDPD=-0.10, 95% CI (-0.19, -0.01), P = 0.03], [MDCAL=-0.38, 95% CI(-0.71, -0.04), P = 0.03]. There was no significant difference between the test group and the control group in other indicators.@*Conclusion @#EMD assisted CTG in the treatment of gingival recession may be beneficial to the reduction of PD and CAL.

Quantitative grading evaluation of the therapeutic efficacy of asymmetric bilateral lateral rectus recession in type Ⅲ Duane retraction syndrome / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To quantitatively evaluate the therapeutic efficacy of the asymmetric recession of bilateral lateral rectus in patients with unilateral type III Duane retraction syndrome.METHOD:Retrospective analysis of clinical data. The clinical data of 12 cases of type III Duane retraction syndrome with unilateral lateral rectus recession were analyzed. All subjects had restricted internal rotation, with narrowing of the palpebral fissure and vertical deviation, and restricted external rotation with widening of the palpebral fissure. All patients had abnormal head positions. The degree of strabismus was measured while maintaining the head in a neutral position. Asymmetric recession of bilateral lateral rectus was selected based on the degree of strabismus of affected eye or 1～3mm longer, with a smaller recession and Y-splitting in the affected eye and a larger recession in the healthy eye.RESULT:The difference in the degree of strabismus in the healthy eyes before and after surgery was statistically significant(Z=-4.158, P&#x003C;0.01), as was the difference in the degree of restricted internal rotation(Z=-2.640, P=0.008). The difference in the degree of restricted external rotation was not statistically significant(Z=-1.732, P=0.083). The difference in abnormal head position was statistically significant(Z=-4.181, P&#x003C;0.01), while the difference in eyeball recession was not statistically significant(Z=-1.414, P=0.157). The difference in vertical deviation was statistically significant(Z=-3.115, P=0.002). A total of 10 patients(83%)had stereoscopic vision before surgery, and 11 patients(92%)had recovered stereoscopic vision after surgery, with a further improvement in stereoacuity in 50% of patients.CONCLUSION:Asymmetric recession of bilateral lateral rectus combined with Y-splitting of the affected lateral rectus can effectively improve the degree of strabismus, abnormal head position, vertical deviation and stereoacuity without aggravating the degree of restriction of external rotation or eyeball recession.

Research progress on the tunnel technique for root coverage / 口腔疾病防治

@#Gingival recessions (GRs) result in root hypersensitivity, root surface caries, and esthetic problems. Various root coverage surgeries are being developed for periodontal plastic therapy. The tunnel technique (TUN) is one of the most widely applied surgeries due to its features of being minimally invasive, practical, excellent outcomes and long-term stability; however, there are still some limitations of this technique. The history and evolution from the envelope flap to TUN, including its efficiency when compared with coronally advanced flaps with a connective tissue graft (CTG), are reviewed in this paper. The limitations of TUN are discussed in consideration of our clinical experience; for example, there is high technique sensitivity when TUN is applied in GR>5 mm because of the great difficulty in covering the grafts. The advantages of surgical access, including vertical incisions in the vestibule, “W” type and pinhole access, are discussed for different situations. Mattress sutures and sling sutures in a single tooth or multiple teeth are applied in TUN. The different types of grafts, such as CTG, platelet-rich plasma, articular dermal matrix and xenogeneic collagen matrix, are described. Mechanical, chemical and biological conditioning of the root surface are recommended during surgery. Protecting the surgical area and taking antibiotics postoperatively are also very important. Finally, the modifications when TUN is applied with other kinds of techniques are discussed, including lateral closed TUN, laterally positioned flaps, double papilla flaps and frenuloplasty. Minimally invasive, esthetic, long-term stability and simplified techniques are the development trends of TUN in the future.

Comparison of the efficacy and long-term stability of tunnel technique and coronally advanced flap in the treatment of gingival recession: a Meta-analysis / 华西口腔医学杂志

OBJECTIVES@#This study aimed to evaluate the efficacy and long-term stability of tunnel technique (TUN) and coronally advanced flap (CAF) combined with connective tissue graft (CTG) in treating gingival recession.@*METHODS@#Databases including PubMed, Web of Science, Embase, and CNKI were electronically searched to collect randomized controlled trial (RCT) of CAF+CTG compared to TUN+CTG in the treatment of Miller class Ⅰ or Ⅱ gingival recession on September 1, 2022.@*RESULTS@#There were 8 RCTs with 305 patients (454 recession sites) participating. The results of the Meta-analysis revealed that, in terms of mean root coverage (MRC) of main indicators, no significant difference was found between the CAF group and the TUN group in both short- and long-term results, which were [MD: 1.45%, 95%CI (-2.93%, 5.82%), P=0.52] and [MD: -0.70%, 95%CI (-6.41%, 5.00%), P=0.81]. However, the CAF group outperformed the TUN group in the long term [MD: 5.69%, 95%CI (0.87%, 10.50%), P=0.02], and the results of complete root coverage (CRC) analysis were similar to those of MRC. In the short term, the TUN group grew keratinized gingiva significantly faster than the CAF group [MD: -0.38 mm, 95%CI (-0.67 mm, -0.10 mm), P=0.008]. Long-term findings revealed no significant difference between the two groups [MD: -0.26 mm, 95%CI (-0.94 mm, 0.43 mm), P=0.46]. The TUN group's secondary index root coverage esthetic score (RES) was statistically significantly higher than the CAF group's [MD: 0.62, 95%CI (0.28, 0.96), P=0.000 3]. Given that there were few results included in the literature and the heterogeneity was too great, no significant difference was observed in the postoperative VAS pain index score [MD: 0.53, 95%CI (-1.96, 3.03), P=0.68].@*CONCLUSIONS@#This study discovered that both CAF+CTG and TUN+CTG can achieve good root coverage in treating gingival recession, with CAF outperforming TUN and both groups achie-ving good long-term stability. After the operation, the TUN group had a higher RES than the CAF group. Given the limitations of this study, more high-quality studies are needed in the future to demonstrate the efficacy of TUN in gingival retraction surgery.

Evaluation of Dentine Hypersensitivity in Adult Population with Chronic Periodontitis Visiting Government Dental College & Hospital, Srinagar

Background: A working knowledge of the prevalence of hypersensitivity in chronic periodontitis patients, is imperative to adequate prognostication, treatment planning and outcome. The present study, is a primary report of the prevalence of dentinal hypersensitivity, in relation to various patient characteristics (demographic and clinical) in chronic periodontitis patients visiting Government Dental College and Hospital, Srinagar, J&K.Material & Methods:A cross-sectional study design was used to evaluate 100 male and 100 female patients diagnosed with chronic periodontitis both by questionnaire and clinical test for the presence of dentinal hypersensitivity, in relation to various features.Results:An overall prevalence of 34% was found for self-reported and 42 % for actual dentinal hypersensitivity in chronic periodontitis patients. It was highest in females, undergraduates, rural subjects and canine teeth. The most common provoking stimulus was cold, and duration of hypersensitivity was less than 6 months. Clinical attachment loss was found to be more often associated with hypersensitivity than clinical gingival recession.76% of the patients reporting hypersensitivity also reported the use of desensitizing toothpaste.The reported prevalence of hypersensitivity was in concordance with other reports from dental college clinics. The particular geo-social background of the study location could have contributed to the observed difference in precipitating factors, effect of diet, and treatment seeking behaviour. Conclusion: The prevalence of dentine hypersensitivity in chronic periodontitis patients was 34% according to questionnaire and 42% according to the results of clinical test. Periodontal attachment loss was found to be could be an earlier indicator or a possible risk factor of DH, indicating the need for clinical initiative in the management of hypersensitivity in chronic periodontitis patients.