Subepithelial connective tissue graft with purified rhPDGF-BB for the treatment of mandibular recession defects: a consecutive case series.

Anatomical characteristics, such as shallow vestibular depth, high frenum attachments, and thin labial bone tend to make treatment of mandibular gingival recession defects particularly challenging. Even though a number of recent systematic reviews have identified the connective tissue graft (CTG) in combination with coronally advanced flaps (CAF) as the most consistently effective treatment procedure for Miller Class I and II defects, they did not separate maxillary vs mandibular outcomes, reporting instead aggregate results. In this prospective consecutive case series, recombinant human platelet-derived growth factor-BB (rhPDGF-BB) was combined with CTGs for the treatment of Miller Class I or II mandibular gingival recession defects in 11 healthy patients. Changes for both mean recession depth and width from baseline to week 24 were statistically significant, with mean recession depth decreasing from 3.4 ± 0.5 mm to 0.8 ± 0.8 mm and mean recession width decreasing from 3.1 ± 0.7 mm to 1.7 ± 1.3 mm. As a result of the improvement in recession depth, the mean percent root coverage seen in this mandibular prospective consecutive case series at 6 months was 79.6%. Despite treatment results that were comparable to historical norms, the outcomes, especially percent root coverage at 24 weeks, were somewhat less favorable, emphasizing the anatomical challenges of mandibular recession defects.

Subepithelial connective tissue graft with growth factor for the treatment of maxillary gingival recession defects.

Gingival recession is a challenging defect for clinicians to treat effectively. A number of recent systematic reviews have identified the connective tissue graft (CTG) in combination with coronally advanced flaps (CAFs) as the most consistently effective treatment for Miller Class I and II defects across all outcome measures. Recent advances in recombinant growth factor technology may provide opportunities for improved outcomes in conjunction with CAF + CTG procedures. In this prospective consecutive case series, recombinant human platelet-derived growth factor BB (rhPDGF-BB) was combined with CTGs for the treatment of Miller Class I or II gingival recession defects. Improved outcomes were seen for keratinized tissue gains and percent root coverage at 6 months postsurgery when compared to historic norms. All other outcome parameters appeared equivalent between the two treatment approaches. The addition of rhPDGF-BB appeared to improve early wound healing as well.

The effect of ultrasound on bone dimensional changes following extraction: a pilot study.

BACKGROUND: Because of bone resorption following tooth extraction, preservation of adequate bony dimension is performed often for subsequent treatment with dental implants. This study evaluated a novel, non-invasive treatment using ultrasound to accelerate healing following extraction to minimize alveolar bone loss. The objective of this study was to evaluate the effect of ultrasound on the dimensional healing changes of alveolar bone following tooth extraction using cone-beam volumetric tomography (CBVT). METHODS: This randomized, split-mouth trial involved 12 subjects requiring extraction of two contralateral erupted permanent teeth. Baseline CBVT scans were captured 7 to 10 days following extraction, after which time ultrasound therapy commenced in test sites. Ultrasound therapy was delivered for 20 minutes using a piezoelectric transducer for 10 sessions over the subsequent 4 weeks. Follow-up radiographic scans were obtained at 4 weeks and 3 months postextraction. Analyses of variance and covariance were performed to assess dimensional changes over the 3-month healing period. RESULTS: Analysis of dimensional changes in all measures of vertical height and horizontal width demonstrated no statistically significant differences between the ultrasound and control groups from baseline to 3 months postextraction. Evaluation of correlations between dimensional changes demonstrated a moderately strong correlation (r = 0.67; P = 0.023) in the ultrasound group between the change in buccal vertical height and the baseline crestal ridge width. Analysis of the change in buccal vertical height relative to baseline crestal width demonstrated a statistically significant benefit to ultrasound compared to control (P = 0.016). This benefit was more pronounced in wider sockets compared to narrow sockets. CONCLUSIONS: In this pilot study, there was no significant benefit to ultrasound in absolute bony dimensional changes following tooth extraction. There was a significant interaction between the treatment rendered (ultrasound versus control) and the change in buccal ridge height relative to baseline ridge width at the crest and 3 mm apical to the crest. This benefit was apparent in wide sockets compared to narrow sockets; however, the clinical importance of these relative dimensional changes in the ultrasound group are difficult to determine given the inclusion of all tooth types in a pilot study with a small sample size.