Clinical Comparison of Full and Partial Double Pedicle Flaps with Connective Tissue Grafts for Treatment of Gingival Recession.

STATEMENT OF THE PROBLEM: Gingival recession has been considered as the most challenging issue in the field of periodontal plastic surgery. PURPOSE: The purpose of this study was to evaluate the clinical efficacy of root coverage procedures by using partial thickness double pedicle graft and compare it with full thickness double pedicle graft. MATERIALS AND METHOD: Eight patients, aged 15 to 58 years including 6 females and 2 males with 20 paired (mirror image) defects with class I and II gingival recession were randomly assigned into two groups. Clinical parameters such as recession depth, recession width, clinical attachment level, probing depth, and width of keratinized tissue were measured at the baseline and 6 months post-surgery. A mucosal double papillary flap was elevated and the respective root was thoroughly planed. The connective tissue graft was harvested from the palate, and then adapted over the root. The pedicle flap was secured over the connective tissue graft and sutured. The surgical technique was similar in the control group except for the prepared double pedicle graft which was full thickness. RESULTS: The mean root coverage was 88.14% (2.83 mm) in the test group and 85.7% (2.75 mm) in the control group. No statistical differences were found in the mean reduction of vertical recession, width of recession, or probing depth between the test and control groups. In both procedures, the width of keratinized tissue increased after three months and the difference between the two groups was not statistically significant in this respect. CONCLUSION: Connective tissue with partial and full thickness double pedicle grafts can be successfully used for treatment of marginal gingival recession.

Bone-added periodontal plastic surgery: a new approach in esthetic dentistry.

This article proposes a combined technique including bone grafting, connective tissue graft, and coronally advanced flap to create some space for simultaneous bone regrowth and root coverage. A 23 year-old female was referred to our private clinic with a severe class II Miller recession and lack of attached gingiva. The suggested treatment plan comprised of root coverage combined with xenograft bone particles. The grafted area healed well and full coverage was achieved at 12-month follow-up visit. Bone-added periodontal plastic surgery can be considered as a practical procedure for management of deep gingival recession without buccal bone plate.

Interleukin 17 receptor gene polymorphism in periimplantitis and chronic periodontitis.

Gene polymorphism of cytokines influencing their function has been known as a contributing factor in the pathogenesis of inflammatory diseases of the tooth and implant supporting tissues. The aim of this study was to investigate the association of IL-17R gene polymorphism (rs879576) with chronic periodontitis and periimplantitis in an Iranian population. 73 patients with chronic periodontitis, 37 patients with periimplantitis and 83 periodontally healthy patients were enrolled in this study. 5cc blood was obtained from each subject's arm vein and transferred to tubes containing EDTA. Genomic DNA was extracted using Miller's Salting Out technique. The DNA was transferred into 96 division plates, transported to Kbioscience Institute in United Kingdom and analyzed using the Kbioscience Competitive Allele Specific PCR (KASP) technique. Chi-square and Kruskal Wallis tests were used to analyze differences in the expression of genotypes and frequency of alleles in disease and control groups (P-Value less than 0.05 was considered statistically significant). There were no significant differences between periodontitis, periimplantitis with AA, GG, GA genotype of IL-17R gene (P=0.8239). Also comparison of frequency of alleles in SNP rs879576 of IL-17R gene between the chronic periodontitis group and periimplantitis group did not revealed statistically significant differences (P=0.8239). The enigma of IL-17 and its polymorphism-role in periodontitis and periimplantitis is yet to be investigated more carefully throughout further research but this article demonstrates that polymorphism of IL-17R plays no significant role in incidence of chronic periodontitis and Periimplantitis.

IL-17 gene polymorphism is associated with chronic periodontitis and peri-implantitis in Iranian patients: a cross-sectional study.

Periodontal disease (PD) and peri-implantitis (PI) are characterized by an immune response leading to destructive inflammation. The prominent impact of genetic factors on periodontitis has been previously evaluated and IL-17 has found to play a critical role in this process. This cytokine has a controversial behavior. This study aimed at finding out whether the polymorphism of this cytokine plays a significant role in chronic periodontitis (CP) and PI or it is just a pro-inflammatory regulatory cytokine. Fresh human blood samples were obtained and three main genotypes were traced carefully. The samples were transferred into 96-well plates and sent to KBioscience Institute in the United Kingdom for genotyping the polymorphism using Competitive Allele Specific PCR (KASP) technique. SPSS version19 software and chi-square and Kruskal-Wallis tests were used for statistical differences considering p-value less than 0.05. A significant difference was detected between the three groups in terms of specific SNP studied in this experiment (P = 0.00). The CC genotype of IL17 polymorphism (rs10484879) may contribute to the pathogenesis of peri-implantitis and periodontitis. The association of IL-17 polymorphism with PI and CP is a promising finding that may help in future similar studies on other ethnicities and larger study populations.

Local concentration of systemic amoxicillin and metronidazole in healthy and inflamed gingiva: a comparative in vivo study.

BACKGROUND: One of the most recommended methods of systemic antibiotic administration in periodontics is the combination of amoxicillin and metronidazole, which has great inhibitory effect on periodontal pathogens. The aim of this study is to determine the local concentrations of these drugs in gingiva and compare its distribution in healthy and inflamed tissues. METHODS: The study population was selected from patients referred to our department. Fifteen subjects were referred for crown lengthening, and another 15 subjects required flap surgery because of severe periodontitis. All 30 patients received three doses of amoxicillin 500 mg plus metronidazole 250 mg before surgery. Tissue samples were gathered during surgery, and chemotherapy was continued for 7 days with 8-h intervals. After 7 days, during the second appointment, the next samples were collected. Samples were sent to the laboratory to determine the drug concentration with the use of high-performance liquid chromatography. RESULTS: Amoxicillin concentration in healthy gingival tissue was not detectable. The concentrations after 24 h and 7 days of administration were 25.9±4.1 and 124.8±18 µg/mL, respectively. The values for metronidazole were 28.86±1.7, 1.70±0.3, and 36.0±1.5 µg/mL. CONCLUSIONS: The combination of systemic amoxicillin and metronidazole for 7 days has sufficient gingival connective tissue concentration much more than the minimum inhibitory concentration in healthy and inflamed tissue.