Root surface modifiers and subepithelial connective tissue graft for treatment of gingival recessions: a systematic review.

BACKGROUND AND OBJECTIVE: Many techniques and flap designs have been used to treat gingival recession by root coverage, but subepithelial connective tissue graft (SCTG) seems to be the gold standard procedure. In an attempt to improve the healing process and increase the success rate of root coverage, some authors have used root modifiers, including different root conditioners, lasers, EMD, recombinant human growth factors and platelet-rich plasma (PRP). The aim of this systematic review was to evaluate the effects of root biomodification in clinical outcomes of gingival recessions treated with SCTG. MATERIAL AND METHODS: Studies reporting SCTG associated with any form of root surface biomodification for root coverage of gingival recessions (Miller Class I and Class II) were considered as eligible for inclusion. Studies needed to have data of clinical outcomes in a follow up of at least 6 months. Screening of the articles, data extraction and quality assessment were conducted independently and in duplicate. RESULTS: None of the products evaluated (citric acid, EDTA, PRP, lasers and EMD) showed evident benefits in clinical outcomes. Test and control groups presented similar outcomes related to root coverage and periodontal parameters, with no statistical differences between them. The exception was root biomodification with the neodymium-doped yttrium aluminium garnet (Nd:YAG) laser, which impaired root coverage and had a detrimental effect on clinical outcomes. CONCLUSION: Based on the present clinical data, the use of root surface modifiers to improve clinical outcomes in gingival recessions treated with SCTG is not justified. More in vivo studies, and randomized clinical trials with larger sample sizes and extended follow up, are necessary.

Relationship between periodontics and restorative procedures: surgical treatment of the restorative alveolar interface (rai)--case series.

Maintenance of a healthy periodontium is fundamental for the long term success of prosthetic restorations. Thus, prosthetic procedures with subgingival margins may affect the periodontal health if the distances between the junctional epithelium and supracrestal connective tissue attachment aren't respected, or if there is insufficient space to maintain the health of the interproximal tissues, leading to gingival inflammation, connective tissue attachment loss and bone resorption. The restorative alveolar interface (RAI) technique was described as the portion of the root surface extending from the alveolar crest apically to the restorative margin coronally. RAI consists of modifying the restorative margin position into a healthier environment, respecting the biological width and therefore allowing effective plaque control. This paper describes four clinical cases with indication for the RAI technique for maintenance of periodontal health. The cases were associated with prostheses. All cases were evaluated at 90 days and exhibited a healthy periodontal tissue. Successful outcomes were observed in the different indications for the RAI technique.

Análise do volume do tecido ósseo neoformado na superfície de implantes de titânio Cp em coelhos utilizando calceína e alizarina como marcadores em microscopia confocal de varredura à laser - Um estudo experimental / Analysis of the evolume of the bony fabric neoformated in the surface of you implant of titanium Cp in rabbits using calceína and alizarina as markers in confocal microscopie of sweeping to laser - an experimental study

O objetivo dessa pesquisa foi analisar através da microscopia confocal à laser o volume total de tecido ósseo que ocorre com a neoformação nas 4 primeiras roscas de implantes de Ti cp, no período de 3 meses. A visualização de tecido ósseo foi adquirida histologicamente por marcadores fluorescentes celulares, tetraciclina, alizarina e calceína, injetados intramuscularmente nos dias 0-7,14-21,28-35, respectivamente, repetindo a calceína semanalmente até 90 dias. Dez coelhos albinos machos receberam cada um 2 implantes de titânio na tíbia direita, 2mm abaixo da articulação (fíbula-tíbia). Vinte implantes foram inseridos, sendo 10 tratados com ácido hidrofluorídico 3 por cento e nítrico 30 por cento (grupo teste) e 10 sem tratamento superficial (grupo controle), sendo o modelo teste colocado primeiro, e aproximadamente 7 mm abaixo deste, o modelo do grupo controle. Os achados histológicos sugeriram que a interface implante/tecido ósseo era estável, não apresentando diferença estatisticamente significante entre os grupos estudados. Verificou uma forte tendência das superficies formarem mais óssos entre o 14 e o 28 dia, tempo no qual foi aplicada a alizarina resultando nos implantes teste P=0,004 e nos implantes teste p=0,002. Quando observadas as áreas das roscas iniciais, constatou-se uma maior proliferação óssea adjacente à porção medular do tecido (R2) com p<0,05, onde, nos implantes controle resultou em P=0,014 e em implantes teste P=0,010