Soft Tissue Substitutes in Periodontal and Peri-Implant Soft Tissue Augmentation: A Systematic Review.

BACKGROUND: Different extracellular matrix (ECM)-based technologies in periodontal and peri-implant soft tissue augmentation have been proposed in the market. The present review compared the efficacy of soft tissue substitutes (STSs) and autogenous free gingival grafts (FGGs) or connective tissue grafts (CTGs) in mucogingival procedures to increase keratinized tissue (KT) width around teeth and implants. METHODS: Two independent examiners performed an electronic search on MEDLINE and the Cochrane Library based on the following PICOS format: (P) adult patients; (I) soft tissue substitutes and FGGs/CTGs; (C) STSs vs. CTGs; STSs vs. FGGs; STSs vs control; (O) KT width gain; (S) systematic reviews, randomized controlled trials. Studies published before November 2023 were included. RESULTS: Around teeth, all biomaterials showed superior performance compared to a coronally advanced flap (CAF) alone for treating gingival recessions. However, when compared to CTGs, acellular dermal matrices (ADMs) yield the most similar outcomes to the gold standard (CTGs), even though in multiple recessions, CTGs continue to be considered the most favorable approach. The use of STSs (acellular matrix or tissue-engineered) in combination with apically positioned flaps (APF) resulted in significantly less gain in KT width compared to that achieved with FGGs and APFs. Around dental implants, free gingival grafts were deemed more effective than soft tissue substitutes in enhancing keratinized mucosa width. CONCLUSIONS: Based on the available evidence, questions remain about the alternative use of soft tissue substitutes for conventional grafting procedures using free gingival grafts or connective tissue grafts around teeth and implants.

A Novel Piezoelectric-Assisted Non-Surgical Periodontal Treatment: A Prospective Case Series.

The purpose of this study was to evaluate the clinical efficacy of a non-surgical periodontal treatment using a piezoelectric power-driven device with a novel insert. Plaque index (PlI), bleeding on probing (BoP), probing depth (PD), recession depth (Rec) and clinical attachment level (CAL) were assessed at 6 weeks, 3 months and 6 months. Furthermore, tooth mobility and furcation involvement were recorded and chewing discomfort and dental hypersensitivity were evaluated. Eighteen stage I to IV periodontitis patients providing 437 teeth and 2622 sites in total were analyzed. At six weeks, CAL gain (0.4; p < 0.0001), PD reduction (0.4; p < 0.0001) and Rec increase (0.1; p = 0.0029) were statistically significant. Similarly, the mean number of sites with PD > 4 mm and absence of BoP significantly decreased between baseline and 6 weeks (-12.7; p < 0.0001). At this time point, the patient's chewing discomfort was also significantly diminished (1.4; p = 0.0172). Conversely, no statistically significant changes were observed between 6 weeks and 3 months and between 3 months and 6 months for any of the clinical variables evaluated. In conclusion, within the limitation of this study, mechanical piezo-assisted non-surgical periodontal treatment in conjunction with an innovative tip resulted significantly efficacious to reduce pathological periodontal pockets, to gain clinical attachment and to reduce gingival inflammation.

Invasive dental treatment and acute vascular events: A systematic review and meta-analysis.

BACKGROUND: Acute infection/inflammation increases the risk of acute vascular events (AVEs). Invasive dental treatments (IDTs) trigger short-term acute inflammation. PURPOSE: The aim of this work is to critically appraise the evidence linking IDTs and AVEs. DATA SOURCES: Six bibliographical databases were searched up to 31 August 2021. A systematic review following PRISMA guidelines was performed. STUDY SELECTION: Intervention and observational studies reporting any AVEs following IDT were included. DATA EXTRACTION: Two reviewers independently extracted data and rated the quality of studies. Data were pooled using fixed-effect, inverse variance weights analysis. RISK OF BIAS: Risk of bias was assessed by the Newcastle-Ottawa Quality Assessment Scale for observational studies and the Cochrane Handbook-Rob 2.0 for randomized controlled trials. DATA SYNTHESIS: In 3 out of 16 clinical studies, a total of 533,175 participants, 124,344 myocardial infarctions, and 327,804 ischaemic strokes were reported. Meta-analysis confirmed that IDT did not increase incidence ratios (IR) for combined vascular events either at 1-4 weeks (IR of 1.02, 95% CIs: 0.92 to 1.13) and at 5-8 weeks (IR of 1.04, 95% CIs: 0.97 to1.10) after treatment. LIMITATIONS: A high level of heterogeneity (study designs and time point assessments) was found. CONCLUSION: Patients who received IDT exhibited no substantial increase in vascular risk over 8 weeks post treatment.

Factors influencing the aesthetics of smile: An observational study on clinical assessment and patient's perception.

AIM: To clinically assess the aesthetics of smile and the possible influencing factors. MATERIALS AND METHODS: In this explorative study, an initial questionnaire on demographic variables and perception of own quality of smile (Visual Analogue Scale) was administered by a first examiner. A second blinded assessor examined all patients and recorded clinical data. In addition, for each patient, the Smile Aesthetic Index (SEI) was calculated. Descriptive statistics and multilevel logistic models were performed. RESULTS: One hundred consecutive subjects were enrolled. The mean SEI was 8.4 ± 1.2, while the mean patient's perception of smile was 7.1 ± 2.0. However, they did not correlate (r = 0.16 from -0.04 to 0.34; p = .12). Gingival recessions were perceived by 21.9% of subjects, tooth alignment by 38.6%, tooth dyschromia by 34.3%, and missing papilla/diastema by 26.7%. In particular, gingival recessions were perceived when they were deeper (p = .0342), located in the upper jaw (p = .0223), and corresponding to incisors (p < .0001) and canines (p = .0159) with respect to molars. CONCLUSIONS: Clinical assessment and patient perception represent two important diagnostic phases. However, there is no correlation between them. Attention should be given to specific variables to provide the most comprehensive aesthetic analysis of smile.

There is still room for improvement in the completeness of abstract reporting according to the PRISMA-A checklist: a cross-sectional study on systematic reviews in periodontology.

BACKGROUND: To evaluate the completeness of reporting abstracts of systematic reviews (SRs) before and after the publication of the PRISMA-A checklist in 2013 and to assess if an association exists between abstract characteristics and the completeness of reporting. METHODS: A systematic search of the literature was conducted in the PubMed and Scopus databases in March 2020. The search focused on the SRs of evaluations of interventions published since 2002 in the field of periodontology. The abstracts of the selected SRs were divided into two groups before and after publication of the PRISMA-A checklist in 2013, and compliance with the 12 items reported in the checklist was evaluated by three calibrated evaluators. RESULTS: A set of 265 abstracts was included in the study. The total score before (mean score, 53.78%; 95% CI, 51.56-55.90%) and after (mean score, 56.88%; 95% CI, 55.39-58.44%) the publication of the PRISMA-A statement exhibited a statistically significant improvement (P = 0.012*). Nevertheless, only the checklist items included studies and synthesis of the results displayed a statistically significant change after guideline publication. The total PRISMA-A score was higher in the meta-analysis group and in articles authored by more than four authors. CONCLUSIONS: The impact of the PRISMA-A was statistically significant, but the majority of the items did not improve after its introduction. The editors and referees of periodontal journals should promote adherence to the checklist to improve the quality of the reports and provide readers with better insight into the characteristics of published studies.

Smile esthetic evaluation of mucogingival reconstructive surgery.

To assess the difference in smile esthetic impact of Coronally Advanced Flap (CAF) with or without the adjunct of a collagen matrix (CMX) used as root coverage procedures. Subjects with esthetic demands showing multiple upper gingival recessions of at least 2 mm, without interproximal attachment loss and cervical abrasion no more than 1 mm were recruited and randomized to CAF plus CMX or CAF alone. The Smile Esthetic Index (SEI) was adopted to quantify the quality of the smile recorded at baseline and 12 months after treatment for each treatment group. In addition, between group difference in the SEI was calculated. 24 Patients were treated and analysed. At baseline, mean gingival recession depths were 2.3 ± 0.7 mm for Test group and 2.6 ± 1.0 mm for Control group. After 1 year, the residual recession depth was 0.3 ± 0.4 mm in the CAF + CMX group and 0.6 ± 0.3 mm in the control group. The SEI at baseline was 8.1 ± 1.0 and 7.9 ± 0.7 for Test and Control group, respectively. The between groups difference at 12 months in SEI was 0.4 (95% C.I. - 0.0 to 0.8, P = 0.0697). Twelve months after treatment, CAF + CMX provided a similar SEI compared to CAF alone and the adjunct of a collagen matrix did not show a different impact on the smile esthetic appearance.

Adjunctive benefit of a xenogenic collagen matrix associated with coronally advanced flap for the treatment of multiple gingival recessions: A superiority, assessor-blind, randomized clinical trial.

AIM: To evaluate the superiority of coronally advanced flaps (CAFs) when used in combination with a xenogeneic collagen matrix (CMX) for root coverage of multiple adjacent gingival recessions. MATERIALS AND METHODS: Participants with at least 2 upper adjacent teeth exhibiting gingival recession depth ≥2 mm were recruited and randomized to CAF with (test) or without (control) CMX, respectively. Mean and complete root coverage, amount of keratinized tissue (KTw), gingival thickness (GThick) and patient-reported outcomes (PROMs) were recorded at baseline, 3, 6 and 12 months. RESULTS: Twenty-four patients providing 61 gingival recessions were analysed. After 1 year, gingival recession depth decreased from 2.3 ± 0.7 to 0.3 ± 0.4 mm in the CAF + CMX group (2.0 ± 0.8 mm meanRC) and from 2.6 ± 1.0 to 0.6 ± 0.3 mm in the control group (2.0 ± 1.1 mm meanRC). No difference was observed between the two groups (p = 0.2023). Nineteen (63%) of the test and 16 (52%) of control defects showed complete root coverage (p = 0.4919). GThick greatly increased in the test group (0.5 mm; 0.2-0.8 mm, 95% CI; p = 0.0057). No difference between the two groups was observed for KTw (p = 0.5668) and PROMs. CONCLUSION: At 1 year, CAF + CMX provided similar root coverage to CAF alone, but a significant increase in gingival thickness.

Root coverage procedures for treating single and multiple recession-type defects: An updated Cochrane systematic review.

BACKGROUND: This updated Cochrane systematic review (SR) evaluated the efficacy of different root coverage (RC) procedures in the treatment of single and multiple gingival recessions (GR). METHODS: We included randomized controlled trials (RCTs) only of at least 6 months' duration evaluating Miller's Class I or II GR (≥3 mm) treated by means of RC procedures. Five databases were searched up to January 16, 2018. Random effects meta-analyses were conducted thoroughly. RESULTS: We included 48 RCTs in the SR. The results indicated a greater GR reduction for subepithelial connective tissue grafts (SCTG) + coronally advanced flap (CAF) compared to guided tissue regeneration with resorbable membranes (GTR rm) + CAF (mean difference [MD]: -0.37 mm). There was insufficient evidence of a difference in GR reduction between acellular dermal matrix grafts (ADMG) + CAF and SCTG + CAF or between enamel matrix derivative (EMD) + CAF and SCTG + CAF. Greater gains in the keratinized tissue width (KTW) were found for SCTG + CAF when compared to EMD + CAF (MD: -1.06 mm), and SCTG + CAF when compared to GTR rm + CAF (MD: -1.77 mm). There was insufficient evidence of a difference in KTW gain between ADMG + CAF and SCTG + CAF. CONCLUSIONS: SCTG, CAF alone or associated with another biomaterial may be used for treating single or multiple GR. There is also some evidence suggesting that ADMG appear as the soft tissue substitute that may provide the most similar outcomes to those achieved by SCTG.

Root coverage procedures for treating localised and multiple recession-type defects.

BACKGROUND: Gingival recession is defined as the oral exposure of the root surface due to a displacement of the gingival margin apical to the cemento-enamel junction and it is regularly linked to the deterioration of dental aesthetics. Successful treatment of recession-type defects is based on the use of predictable root coverage periodontal plastic surgery (RCPPS) procedures. This review is an update of the original version that was published in 2009. OBJECTIVES: To evaluate the efficacy of different root coverage procedures in the treatment of single and multiple recession-type defects. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 15 January 2018), the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 12) in the Cochrane Library (searched 15 January 2018), MEDLINE Ovid (1946 to 15 January 2018), and Embase Ovid (1980 to 15 January 2018). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials (15 January 2018). No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: We included randomised controlled trials (RCTs) only of at least 6 months' duration evaluating recession areas (Miller's Class I or II ≥ 3 mm) and treated by means of RCPPS procedures. DATA COLLECTION AND ANALYSIS: Screening of eligible studies, data extraction and risk of bias assessment were conducted independently and in duplicate. Authors were contacted for any missing information. We expressed results as random-effects models using mean differences (MD) for continuous outcomes and odds ratios (OR) for dichotomous outcomes with 95% confidence intervals (CI). We used GRADE methods to assess the quality of the body of evidence of our main comparisons. MAIN RESULTS: We included 48 RCTs in the review. Of these, we assessed one as at low risk of bias, 12 as at high risk of bias and 35 as at unclear risk of bias. The results indicated a greater reduction in gingival recession for subepithelial connective tissue grafts (SCTG) + coronally advanced flap (CAF) compared to guided tissue regeneration with resorbable membranes (GTR rm) + CAF (MD -0.37 mm; 95% CI -0.60 to -0.13, P = 0.002; 3 studies; 98 participants; low-quality evidence). There was insufficient evidence of a difference in gingival recession reduction between acellular dermal matrix grafts (ADMG) + CAF and SCTG + CAF or between enamel matrix protein (EMP) + CAF and SCTG + CAF. Regarding clinical attachment level changes, GTR rm + CAF promoted additional gains compared to SCTG + CAF (MD 0.35; 95% CI 0.06 to 0.63, P = 0.02; 3 studies; 98 participants; low-quality evidence) but there was insufficient evidence of a difference between ADMG + CAF and SCTG + CAF or between EMP + CAF and SCTG + CAF. Greater gains in the keratinized tissue were found for SCTG + CAF when compared to EMP + CAF (MD -1.06 mm; 95% CI -1.36 to -0.76, P < 0.00001; 2 studies; 62 participants; low-quality evidence), and SCTG + CAF when compared to GTR rm + CAF (MD -1.77 mm; 95% CI -2.66 to -0.89, P < 0.0001; 3 studies; 98 participants; very low-quality evidence). There was insufficient evidence of a difference in keratinized tissue gain between ADMG + CAF and SCTG + CAF. Few data exist on aesthetic condition change related to patients' opinion and patients' preference for a specific procedure. AUTHORS' CONCLUSIONS: Subepithelial connective tissue grafts, coronally advanced flap alone or associated with other biomaterial and guided tissue regeneration may be used as root coverage procedures for treating localised or multiple recession-type defects. The available evidence base indicates that in cases where both root coverage and gain in the width of keratinized tissue are expected, the use of subepithelial connective tissue grafts shows a slight improvement in outcome. There is also some weak evidence suggesting that acellular dermal matrix grafts appear as the soft tissue substitute that may provide the most similar outcomes to those achieved by subepithelial connective tissue grafts. RCTs are necessary to identify possible factors associated with the prognosis of each RCPPS procedure. The potential impact of bias on these outcomes is unclear.

Scanning Electron Microscopy Evaluation of Root Surfaces After Instrumentation With Two Piezoelectric Devices.

Scanning electron microscopy evaluation of root surfaces after ultrasonic instrumentation was performed with 2 different metallic tips on piezoelectric devices. Fresh extracted teeth were collected for experimental observation and randomly divided into 2 groups: Test Group, where the root surfaces were treated using an iron, rough, double nano-structural coated (T-Black), corindone-treated tip, and Control Group where the root surfaces were treated with a conventional iron smooth tip. A scanning electronic microscope analysis was performed and the surface roughness and the amount of residual debris were evaluated. Descriptive and inferential statistics were performed. Twenty specimens were analyzed, 10 per group and a total of 21.4 × 10 µm has been observed. On treated area percentage of debris after ultrasonic scaling in Test Group was 1.9 ±â€Š1.8%, while in Control Group it was 5.7 ±â€Š4.3%. Within the limits of the study, it seems that the efficacy of the novel iron, rough, double nano-structural coated (T-Black), corindone-treated structure tip showed greater performance in terms of root surface debridement than the conventional iron smooth tip. The possibility to use a single tool (ultrasonic device with a specific tip) for the root planing procedure within the nonsurgical mechanical therapy may represent a significant advantage for the clinicians. The tested novel tip seems to be able to show the requested ideal characteristics. However, further clinical studies are needed to demonstrate the in vitro results.

Bone dehiscences and fenestrations of the anterior mandibular facial bone wall: a retrospective cone beam computed tomography study.

BACKGROUND: To calculate the prevalence of dehiscences and fenestrations and measure the buccal alveolar bone width overlying healthy mandibular incisors and canines. METHODS: Cone beam computerized tomographies (CBCTs) from patients aged 18 to 30 years were selected from a private database. The thickness of buccal bone in the sagittal scan was measured perpendicular to the long axis of 6 teeth at two locations: at the crest level and at the mid-root level. A single calibrated examiner performed all measurements. Descriptive and inferential statistics were performed. RESULTS: A total of 100 CBCTs (600 teeth) were selected for the analysis. The overall prevalence of dehiscences and fenestrations was 89.16% and 5.16%, respectively. Dehiscences and fenestrations were shown to have a mean length of 6.78±1.90 mm and 4.89±1.74 mm, respectively. This result was similar between young and old subjects as well as between men and women. Bone width at the crest level was significantly thinner in women (0.71±0.13 mm), whereas men were found to have a statistically significant thicker bone at the mid-root level of tooth #33. Comparisons of bone width at the mid-root level among the 6 analyzed teeth showed no statistical difference. CONCLUSIONS: A high prevalence of dehiscences and sites with thin buccal bone were identified in correspondence of the lower anterior teeth by means of CBCT analysis.

Nonsurgical Treatment of Peri-implantitis Using the Biofilm Decontamination Approach: A Case Report Study.

The aim of this preliminary study is to show the effect of the biofilm decontamination approach on peri-implantitis treatment. Clinical cases showing peri-implantitis were treated using an oral tissue decontaminant material that contains a concentrated aqueous mixture of hydroxybenzenesulfonic and hydroxymethoxybenzenesulfonic acids and sulfuric acid. The material was positioned in the pocket around the implant without anesthesia in nonsurgically treated cases. No instrumentation and no systemic or local antibiotics were used in any of the cases. A questionnaire was used for each patient to record the pain/discomfort felt when the material was administered. All of the treated cases healed well and rapidly. The infections were quickly resolved without complications. The momentary pain on introduction of the material was generally well tolerated and completely disappeared after a few seconds. The biofilm decontamination approach seems to be a very promising technique for the treatment of peri-implantitis. The local application of this material avoids the use of systemic or local antibiotics.

Treatment of Acute Periodontal Abscesses Using the Biofilm Decontamination Approach: A Case Report Study.

The aim of this preliminary study was to show the treatment effect of the biofilm decontamination approach on acute periodontal abscesses. Clinical cases showing acute periodontitis were treated using an oral tissue decontaminant material that contains a concentrated aqueous mixture of hydroxybenzenesulfonic and hydroxymethoxybenzene acids and sulfuric acid. The material was positioned into the pocket on the root surface and left in the site for 30 seconds. No instrumentation was performed before the treatment. No systemic or local antibiotics were used in any of the cases. A questionnaire was used for each patient to record the pain/discomfort felt when the material was administered. All of the treated cases healed well and very rapidly. The infections were quickly resolved without complications, and the pockets associated with marginal tissue recession were also reduced. The momentary pain upon introduction of the material was generally well tolerated in the nonsurgically treated cases, and it completely disappeared after a few seconds. The biofilm decontamination approach seems to be a very promising technique for the treatment of acute periodontal abscess. The local application of this material avoids the use of systemic or local antibiotics.

The Smile Esthetic Index (SEI): A method to measure the esthetics of the smile. An intra-rater and inter-rater agreement study.

PURPOSE: To propose a method to measure the esthetics of the smile and to report its validation by means of an intra-rater and inter-rater agreement analysis. MATERIALS AND METHODS: Ten variables were chosen as determinants for the esthetics of a smile: smile line and facial midline, tooth alignment, tooth deformity, tooth dischromy, gingival dischromy, gingival recession, gingival excess, gingival scars and diastema/missing papillae. One examiner consecutively selected seventy smile pictures, which were in the frontal view. Ten examiners, with different levels of clinical experience and specialties, applied the proposed assessment method twice on the selected pictures, independently and blindly. Intraclass correlation coefficient (ICC) and Fleiss' kappa) statistics were performed to analyse the intra-rater and inter-rater agreement. RESULTS: Considering the cumulative assessment of the Smile Esthetic Index (SEI), the ICC value for the inter-rater agreement of the 10 examiners was 0.62 (95% CI: 0.51 to 0.72), representing a substantial agreement. Intra-rater agreement ranged from 0.86 to 0.99. Inter-rater agreement (Fleiss' kappa statistics) calculated for each variable ranged from 0.17 to 0.75. CONCLUSION: The SEI was a reproducible method, to assess the esthetic component of the smile, useful for the diagnostic phase and for setting appropriate treatment plans.

Critical Evaluation of Complete Root Coverage as a Successful Endpoint of Treatment for Gingival Recessions.

Two differing evaluation criteria for complete root coverage (CRC) were used to compare incidence of CRC after root coverage procedures. Clinical records of 363 patients (386 single recessions) treated between 1984 and 2012 were screened. CRC was assessed 1 year after surgery using two separate evaluation criteria: CRC1, in which the gingival margin was at or above the cementoenamel junction (CEJ), measured using a periodontal probe directly on patients by a single examiner; and CRC2, in which the gingival margin was above the CEJ, rendering it completely invisible based on a visual assessment of high-magnification digitalized images by two calibrated examiners. Descriptive and inferential statistics were performed. The k statistic was also calculated to test the agreement between the two examiners. Four treatment groups were identified: free gingival graft (FGG; n = 116), coronally advanced flap (CAF; n = 107), CAF + connective tissue graft (CTG; n = 131) and guided tissue regeneration (GTR; n = 32). The overall difference between the proportion of CRC1 and CRC2 was statistically significant (P < .0001), as were the intragroup differences for FGG (P = .0002), CAF (P = .0009), and CTG (P = .0002). Treatment of gingival recessions should only be deemed completely successful when root coverage is associated with a gingival margin and a crevice probing depth that is coronal to the CEJ. When root coverage is regarded as complete with gingival margin located at the level of CEJ, it does not represent complete treatment success.

Long-term outcomes of soft tissue augmentation around dental implants on soft and hard tissue stability: a systematic review.

AIM: To investigate whether the height and volume of the soft tissues and peri-implant bone levels around dental implants are stable, when soft tissue augmentation has been performed. MATERIALS AND METHODS: Three operators conducted a search on electronic databases (MEDLINE, COCHRANE, EMBASE) and a hand searching on the main journals dealing with periodontology and implantology until 30 October 2014. Only articles that considered peri-implant soft tissue augmentation performed in a group of at least 10 patients and with a follow-up of at least 1 year were selected. The outcome variables were peri-implant attached/keratinized tissue width (KTW) changes, peri-implant marginal soft tissue level (PSL) changes, and peri-implant marginal bone level (PBL) changes. The review was performed according to the PRISMA statements. RESULTS: Ten articles were selected for the qualitative synthesis, but only one meta-analysis was accomplished, indicating that 1 year after implant recession coverage procedures, a mean gain of 1.65 ± 0.01 mm (90% CrI [1.44; 1.85]) was observed. CONCLUSIONS: There is no long-term evidence whether augmented soft tissues can be maintained over time and able to influence the peri-implant bone levels.

Long-term stability of peri-implant tissues after bone or soft tissue augmentation. Effect of zirconia or titanium abutments on peri-implant soft tissues. Summary and consensus statements. The 4th EAO Consensus Conference 2015.

INTRODUCTION: Several surgical techniques and prosthetic devices have been developed in the last decades, aiming to improve aesthetic, hygienic and functional outcomes that may affect the peri-implant tissues, such as procedures of bone and soft tissue augmentation and the use of custom-made abutments of titanium and zirconium. MATERIALS AND METHODS: Three systematic reviews, based on randomized clinical trials and prospective studies covering the above reported topics were analysed, and the detected evidence was exposed to interactive experts' discussion during the group's and general assembly's meetings of the 4th EAO Consensus Conference. The results are reported using the following abbreviations: S-T: short-term evidence, M-T: medium-term evidence; L-T: long-term evidence; LE: limited evidence. RESULTS: Soft tissue augmentation procedures may be indicated for the increase of soft tissue thickness and keratinized tissue, the reduction of interproximal peri-implant bone loss, and the coverage of shallow peri-implant soft tissue recessions (S-T, LE), L-T is lacking. Guided bone regeneration approaches (GBR) showed efficacy when used for ridge reconstruction after the complete healing of the soft tissues (S-T & L-T), and the stability of the augmented bone may play a role in the maintenance of the soft tissue position and dimensions (LE). No significant differences were observed between titanium and zirconia abutments when evaluating probing pocket depth, bleeding on probing, marginal bone levels and mucosal recessions. Zirconia abutments were associated with more biological complications but demonstrated superiority in terms of achieving natural soft tissue colour (S-T).

Influence of inter-dental tissues and root surface condition on complete root coverage following treatment of gingival recessions: a 1-year retrospective study.

AIM: To explore the influence of inter-dental tissues and root surface condition on complete root coverage following surgical treatment of gingival recessions. METHODS: Three hundred and eighty-six single recessions treated over 28 years were assessed. Patient-level and periodontal variables, presence/loss of inter-dental tissues, and presence/absence of non-carious cervical lesions (NCCLs) were recorded. Root coverage was assessed 1-year post-surgery. Multilevel analysis was performed to identify predictors of CRC. RESULTS: Based on type of root coverage procedure four patient groups were created: free gingival graft (FGG) (n = 116), coronally advanced flap (CAF) (n = 107), CAF+connective tissue graft (CTG) (n = 131), and guided tissue regeneration (GTR) (n = 32). Percentages of complete root coverage (CRC) were 18.1% for FGG, 35.5% for CAF, 35.1% for CAF+CTG, and 18.8% for GTR. There was an OR = 0.26 (p < 0.0001) of achieving CRC in cases with loss of inter-dental tissue compared with cases with no inter-dental tissue loss. Similarly, cases with presence of NCCL showed an OR = 0.28 (p < 0.0001) of achieving CRC compared with cases without a NCCL. FGG achieved less CRC then CAF+CTG (p = 0.0012; OR = 0.32). CONCLUSIONS: NCCLs, just like inter-dental tissue loss, are significant negative prognostic factors in achieving CRC following root coverage procedures.

Bone level variation after vertical ridge augmentation: resorbable barriers versus titanium-reinforced barriers. A 6-year double-blind randomized clinical trial.

PURPOSE: To compare the efficacy of two different techniques for vertical bone regeneration at implant placement with particulate autogenous bone at 6 years after loading by means of a double-blind, superiority, parallel-group randomized clinical trial. MATERIALS AND METHODS: The study was conducted in a private center in Italy between April 2004 and December 2011. Patients in whom vertical bone augmentation was indicated in combination with the placement of single or multiple implants were eligible for inclusion in this trial. Patients were randomized to receive either resorbable collagen barriers supported by an osteosynthesis plate (test group) or nonresorbable titanium-reinforced expanded polytetrafluoroethylene barriers (control group). The outcome variables-radiographic bone variation at implant sites, implant failures, and complications- were evaluated 6 years after loading. Randomization was done by computer, with allocation concealed by opaque sequentially numbered sealed envelopes. The patients and the radiographic examiner were blinded to group assignment. RESULTS: Twenty-two patients were randomized: 11 to the resorbable barrier group and 11 to the nonresorbable (control) group. One control group patient dropped out. The mean bone level 6 years after surgery was 1.33 mm for the resorbable group and 1.00 mm for the nonresorbable group. The adjusted difference in bone changes between groups was 0.15 mm (95% confidence interval, -0.39 to 0.69, P = .5713). No implant failures or complications occurred after loading. CONCLUSION: No differences were observed in this comparison of resorbable and nonresorbable barriers with simultaneous implant placement for vertical ridge augmentation.

Surgical treatment of single gingival recessions: clinical guidelines.

PURPOSE: The purpose of this clinical guidelines project was to determine the most appropriate surgical techniques, in terms of efficacy, complications, and patient opinions, for the treatment of buccal single gingival recessions without loss of interproximal soft and hard tissues. METHODS: Literature searches were performed (electronically and manually) for entries up to 28 February, 2013 concerning the surgical approaches for the treatment of gingival recessions. Systematic reviews (SRs) of randomised controlled trials (RCTs) and individual RCTs that reported at least 6 months of follow-up of surgical treatment of single gingival recessions were included. The full texts of the selected SRs and RCTs were analysed using checklists for qualitative evaluation according to the Scottish Intercollegiate Guidelines Network (SIGN) method. The following variables were evaluated: Complete Root Coverage (CRC); Recession Reduction (RecRed); complications; functional and aesthetic satisfaction of the patients; and costs of therapies. RESULTS: Out of 30 systematic reviews, 3 SRs and 16 out of 313 RCTs were judged to have a low risk for bias (SIGN code: 1+). At a short-term evaluation, the coronally advanced flap plus connective tissue graft method (CAF+CTG) resulted in the best treatment in terms of CRC and/or RecRed; in case of cervical abrasion and presence of root sensitivity CAF + CTG + Restoration caused less sensitivity than CAF+CTG. CAF produced less postoperative discomfort for patients. Limited information is available regarding postoperative dental hypersensitivity and aesthetic satisfaction of the patients. CONCLUSION: In presence of aesthetic demands or tooth hypersensitivity, the best way to surgically treat single gingival recessions without loss of interproximal tissues is achieved using the CAF procedure associated with CTG. Considering postoperative discomfort, the CAF procedure is the less painful surgical approach, while the level of aesthetic satisfaction resulted higher after CAF either alone or with CTG. It is unclear how much tooth hypersensitivity is reduced by surgically covering buccal recessions. It is important to note that the present recommendations are based on short-term data (less than 1 year). SOURCE OF FUNDING: The guidelines project was made possible through self-financing by the authors.