A Novel Modified-Vista Technique With Connective Tissue Graft in the Treatment of Gingival Recession: A Case Report.

INTRODUCTION: The increasing esthetic demands from patients have required that clinicians sharpen their skills and adopt newer and more novel techniques to satisfy these demands. In periodontal therapy, periodontal plastic surgery poses a substantial challenge to the clinician, both because it is technique sensitive and also because it includes a wide array of procedures and their variations. Conventional plastic procedures have provided satisfactory results in the treatment of gingival recession but there is, presently, a greater need for more advanced procedures that cause less surgical morbidity as also provide improved results. Minimally invasive surgery has been harnessed in periodontics for this purpose and has been extensively used in multiple indications, including root coverage. Modified-Vestibular Incision Supra-periosteal Tunnel Access (M-VISTA) applies the principles of minimally invasive surgery to provide satisfactory results in root coverage. CASE PRESENTATION: A 28-year-old male patient presented with multiple Miller Class I/II buccal recession defects and associated high labial frenum on right maxillary anterior teeth. M-VISTA technique allowed coronal repositioning of gingival margin, which was then stabilized by orthodontics bracket assisted suturing technique. The V-shaped incision in the region of the frenal attachment allowed for conducting both the M-VISTA and frenectomy techniques simultaneously. Connective tissue graft was inserted in the supra-periosteal tunnel and vertical incision was sutured. Complete root coverage was achieved and maintained at 9 months with excellent esthetic outcomes. CONCLUSIONS: The use of connective tissue graft along with M-VISTA technique allows the clinician to successfully treat multiple recession defects.

Novel Surgical Approach for Root Coverage Using Coronally Advanced Flap in Conjunction With Transposition of Periosteal Pedicle Graft.

INTRODUCTION: Gingival recession is a complex phenomenon with multifactorial etiology. It is defined as the apical migration of the soft tissue margin beyond the cemento-enamel junction, thereby exposing the root surface. It results in the destruction of both soft and hard tissues. CASE PRESENTATION: Three patients with buccal gingival recession defects underwent surgical treatment consisting of transposition of a periosteal pedicle in conjunction with the coronally advanced flap (CAF) technique. As the cambium layer of the periosteum has greater osteoblastic potential than the fibrous layer, this study considered juxtaposing of the cambium layer directly onto the denuded root surface. A 9-month review demonstrated satisfactory: root coverage; gain in clinical attachment, reduction in probing depth; and increase in width of keratinized gingiva with a good color match and minimal scarring. CONCLUSION: Within the limits of the study, this CAF technique, in conjunction with the cambium layer of periosteum, showed a significant amount of root coverage.

A comparative evaluation of bovine-derived xenograft (Bio-Oss Collagen) and type I collagen membrane (Bio-Gide) with bovine-derived xenograft (Bio-Oss Collagen) and fibrin fibronectin sealing system (TISSEEL) in the treatment of intrabony defects: A clinico-radiographic study.

BACKGROUND AND OBJECTIVES: The purpose of this study was to compare the efficacy of bovine-derived xenograft (Bio-Oss Collagen) and Type I collagen membrane (Bio-Gide) with bovine-derived xenograft (Bio-Oss Collagen) and fibrin fibronectin sealing system (TISSEEL) in the treatment of periodontal infrabony defects. MATERIALS AND METHODS: Fourteen healthy patients in the age range of 20 to 60 years, showing bilateral or contralateral infrabony defects were selected. The defects were assigned randomly to Site A (bovine-derived xenograft [Bio-Oss Collagen] with bioresorbable Type I collagen membrane [Bio-Gide]) and Site B (fibrin fibronectin sealing system [TISSEEL] with bovine-derived xenograft [Bio-Oss Collagen]). The radiographic parameters were recorded at baseline, 6 months, and 9 months postoperatively. RESULTS: All fourteen patients returned for recall at regular intervals till the completion of the study. Both the experimental groups showed clinically and radiographically statistically significant reduction in probing pocket depth and gain in clinical attachment level. CONCLUSION: Both groups showed potential for enhancing the periodontal regeneration with no statistically significant between the two groups; however, on comparison the Bio-Oss Collagen and TISSEEL group were slightly better.

Evaluation of relative efficacy of ß-tricalcium phosphate with and without type I resorbable collagen membrane in periodontal infrabony defects: a clinical and radiographic study.

BACKGROUND AND OBJECTIVES: To compare clinically and radiographically, the regenerative potential of a ß-tricalcium phosphate bone graft, Cerasorb(®) with and without a bioresorbable type I collagen membrane, BioMend Extend™, in treating periodontal infrabony osseous defects. MATERIALS AND METHODS: A total of 20 sites from 10 patients showing bilateral infrabony defects were selected and selected sites were randomly divided into experimental site A (Cerasorb(®)) and experimental site B (Cerasorb(®) and BioMend Extend™) by using split mouth design. The clinical parameters like plaque index, gingival index, probing pocket depth, clinical attachment level and gingival recession were recorded at baseline, 6 weeks, 3, 6 and 9 months. Radiographic evaluation (Linear CADIA) at 6 and 9 months; and intrasurgical measurements at baseline and 9 months were carried out to evaluate the defect fill, change in alveolar crest height and defect resolution. RESULTS: Significant reduction in all clinical parameters was observed in both the groups. On comparison no statistical significance was observed between the two groups. Radiographically, in site A there was significant defect fill of 78.4 and 97.2% at 6 and 9 months respectively. Whereas in site B reduction was 78.4 and 97.2% at 6 and 9 months respectively. After surgical re-entry, there was significant defect fill of 89.2 and 74% in both groups. INTERPRETATION AND CONCLUSION: Individually both the graft and membrane have shown promising results in the management of periodontal intrabony defects. But the added benefit by combining Cerasorb(®) with BioMend Extend™ was not observed statistically in both clinical radiographic findings.