A Review of Gingival Recession and the Surgical Managements According to Their Classification and Etiologic Backgrounds: A Clinical Case Study.

Mucogingival deformities are a group of defects that occur around the cervical area of the teeth. Gingival recession is the most common type of these deformities. It might happen separately or with other related deformities like thin gingival biotypes, shallow vestibule, high frenal attachment, and cervical dental steps. Recent classification of mucogingival deformity matrix has collectively grouped gingival recession types with other mucogingival deformities and dental steps to establish the proper diagnosis and evaluate surgical/restorative management and prognosis of the treatment outcomes. The following case presentations have presented with a technical review, clinical evaluation, and surgical and/or restorative treatment according to the recent matrix.

The Effect of Hyaluronic Acid Gel on Periodontal Parameters, Pro-Inflammatory Cytokines and Biochemical Markers in Periodontitis Patients.

Hyaluronic acid in its various forms shows bacteriostatic, fungistatic, anti-inflammatory, anti-edematous, osteoinductive, and pro-angiogenetic properties. This study aimed to evaluate the effect of subgingival delivery of 0.8% hyaluronic acid (HA) gel on clinical periodontal parameters, pro-inflammatory cytokines (IL-1 beta and TNF-alpha) and biochemical markers of inflammation (C-reactive protein (CRP) and alkaline phosphatase (ALP) enzymes) in patients with periodontitis. Seventy-five patients with chronic periodontitis were divided randomly into three groups (25 in each group): group I received scaling and surface root debridement (SRD) + HA gel; group II received SRD + chlorhexidine gel; and group III received surface root debridement alone. Clinical periodontal parameter measurements and blood samples were collected to estimate pro-inflammatory and biochemical parameters at the baseline before therapy and after two months of therapy. The results show that HA gel has a significant effect on the reduction in clinical periodontal parameters (PI, GI, BOP, PPD, and CAL), IL-1 beta, TNF-alpha, CRP, and ALP after 2 months of therapy as compared to the baseline (p < 0.05) with nonsignificant differences from the CHX group (p > 0.05), except GI (p < 0.05), and significant differences from the SRD group (p < 0.05). Moreover, significant differences were found between the three groups regarding the mean improvements of GI, BOP, PPD, IL-1ß, CRP, and ALP. It can be concluded that HA gel has a positive effect on clinical periodontal parameters and improvements in inflammatory mediators similar to chlorhexidine. Therefore, HA gel can be used as an adjuvant to SRD in the treatment of periodontitis.

Determination of the Accuracy of Salivary Biomarkers for Periodontal Diagnosis.

BACKGROUND: We aimed to investigate the accuracy of salivary matrix metalloproteinases (MMP)-8 and -9, and tissue inhibitor of metalloproteinase (TIMP)-1 in diagnosing periodontitis and in distinguishing periodontitis stages (S)1 to S3. METHODS: This study was a case-control study that included patients with periodontitis S1 to S3 and subjects with healthy periodontia (controls). Saliva was collected, and then, clinical parameters were recorded, including plaque index, bleeding on probing, probing pocket depth, and clinical attachment level. Diagnosis was confirmed by assessing the alveolar bone level using radiography. Salivary biomarkers were assayed using an enzyme-linked immunosorbent assay. RESULTS: A total of 45 patients (15 for each stage) and 18 healthy subjects as controls were included. The levels of all salivary biomarkers and clinical parameters were significantly higher in periodontitis subjects than in the controls. The ROC curve showed that MMP-8, MMP-9, TIMP-1, MMP-8/TIMP-1, and MMP-9/TIMP-1 had statistically significant diagnostic accuracy, with areas under the curve (AUCs) of 0.892, 0.844, 0.920, 0.986, and 1.000, respectively, when distinguishing periodontitis from the controls. Similarly, these biomarkers showed significant diagnostic accuracy in the differentiation of S1 periodontitis from the controls (AUC range from 0.902 to 1.000). CONCLUSIONS: This study suggested that salivary biomarkers exhibited high diagnostic accuracy in distinguishing periodontal health from periodontitis in general as well as S1 periodontitis. Furthermore, TIMP-1 could differentiate S1 from S3.

Knowledge about Hepatitis B Virus and Relevant Safety Precautions among Dental Students in Kurdistan Region, Iraq.

Background: Hepatitis B virus (HBV) is still a major health problem worldwide, placing healthcare workers, medical and dental students, and professionals at higher occupational risk. The present study aimed to evaluate the level of knowledge about this virus and relevant safety precautions among dental students in the Kurdistan region of Iraq. Materials and methods. This cross-sectional study was conducted among the third, fourth, and fifth stage dental students of Hawler Medical, Sulaimani, and Duhok universities. Data on the students' demographic characteristics and their knowledge about HBV (16 close-ended questions) and safety precaution measures (10 close-ended questions) were collected by means of a questionnaire. Analysis of variance was used to compare the mean of knowledge and safety precaution scores. Results: In total, 372 students (mean age 21.77 ± 1.31 years) completed the questionnaires. The mean scores for knowledge and safety precautions were 13.17 ± 2.09 and 8.05 ± 1.61, respectively. Respondents from Hawler Medical University showed statistically significantly higher knowledge levels than their counterparts in Sulaimani and Duhok universities (p = 0.012). Conclusions: The majority of surveyed dental students are aware of HBV, its mode of transmission, infection, complications, vaccination, and safety precautions required to prevent the spreading of the virus. While the levels of knowledge about HBV and safety precautions among the dental students in the Kurdistan region of Iraq were generally acceptable, differences in knowledge level were identified between the universities, and these may be related to their educational and training programs.

First Molars-Incisors Rate and Pattern of Bone Loss: A Cross-Sectional Analysis of CBCT Images.

BACKGROUND: Periodontitis causes attachment and alveolar bone loss; hence, this study aimed to determine the prevalence, frequency, and pattern of bone loss at first molar-incisor areas using Cone Beam Computed Tomography (CBCT) images. METHODS: A retrospective, cross-sectional analysis was conducted of 250 randomly selected CBCT images of clearly defined full arches of patients aged from 18 to 70 years who were divided into six age groups and into male and female groups. Four sites around each tooth were scanned at several accesses for bone loss detection. Distance beyond 2 mm apical to the cementoenamel junction to the level of the remaining bone was considered to indicate bone loss. The Shapiro-Wilk test was used to test the normality of the data, and statistical tests were applied for data analysis at the 0.05 p-value level. RESULTS: The rate and amount of bone loss within the examined sample were relatively high. The examined images generally revealed a higher rate of bone loss on proximal than on labial/buccal and lingual/palatal surfaces of the first upper and lower molars. The highest amount of bone loss among all the teeth scanned in this study was seen on the mesial and distal bone of mandibular incisors, 4.36 mm and 4.31 mm, respectively, exceeding that in the labial and lingual bone, 3.23 mm and 1.89 mm, respectively, and it was highly horizontal rather than vertical in pattern. CONCLUSIONS: Based on 250 randomly selected CBCT images of clearly defined, full upper and lower arches scanned for this study, it was concluded that the rate and amount of horizontal bone loss were less than vertical bone loss and was focused mainly in the interproximal areas of the first molars. However, the highest recorded amount of bone loss was at the proximal and labial aspects of the mandibular incisors. Furthermore, younger age groups displayed significantly higher rates and amounts of bone loss than older groups, with a slight predilection for males.

Combined Surgical and Restorative Procedures to Treat Maxillary Canine with Gingival Recession and Cervical Wear.

Introduction: Gingival recession (GR) with cervical tooth wear is a major concern for patients on the prominent maxillary canines, from both esthetic and dentine hypersensitivity points of view. Hypersensitivity could be treated nonsurgically; however, esthetics remain the major patients' concern that mostly requires surgical intervention for covering the denuded root surface. Several surgical procedures are applied successfully for covering single and multiple gingival recession; however, these procedures are sensitive procedures and not always predictable. Semilunar coronally repositioned flap (SCRF) is a very simple procedure that found to be very predictable for covering a single recession in presence of sufficient keratinized gingiva apical to the recession. The procedure provides better clinical outcome by involving less adjacent papillary tissue that maintains greater blood supply and achieves maximum flap stability with mattress sutures with minimal postoperative complications. Therefore, this case report is aimed at explaining the simplicity of this surgical procedure in the presence of wide keratinized tissue around the recession and starting the restorative procedure after a sufficient soft tissue healing period. Case Presentation. 42-year-old systemically healthy female patient referred with a single wide gingival type 1 (RT1) and cervical wear around tooth #43. A semilunar coronally repositioned flap was released and advanced coronally to cover the denuded root totally; then, the flap stabilized by three mattress sutures, and complete root coverage was achieved. Six months later, the cervical lesion was restored with composite filling material. Sixteen-month and 32-month postoperative follow-up revealed full coverage of the denuded root surface with firm stable gingiva; later, the gingiva in the area looked stable and healthy. Conclusion: Using SCRF in treating RT1 recession in the presence of wide keratinized gingiva is very promising surgical intervention for receded root coverage that requires less technical skill.

Efficacy of MMP-8 Level in Gingival Crevicular Fluid to Predict the Outcome of Nonsurgical Periodontal Treatment: A Systematic Review.

Purpose: To explore whether baseline matrix metalloproteinase (MMP)-8 level in gingival crevicular fluid (GCF) (exposure) can predict the outcome (reduction in probing pocket depth (PPD) (outcome)) of nonsurgical periodontal therapy (NSPT) (manual or ultrasonic or both) in patients with periodontitis (population/problem) after 3 months. Methods: Six databases (PubMed, Cochrane library, ProQuest, Ovid, Scopus, EBSCO) were searched for relevant articles published until 30 July 2021. Retrieved articles were passed through a three-phase filtration process on the basis of the eligibility criteria. The primary outcome was the change in PPD after 3 months. Quality of the selected articles was assessed using Cochrane Risk of Bias tool (RoB2) and Risk of Bias In Non-Randomized Studies of Interventions (ROBINS-I) tools. Results: From 1306 articles, five were selected for analysis. The results showed high variations in the level of GCF MMP-8 level at baseline. The average amount of reduction in PPD was 1.20 and 2.30 mm for pockets with initial depth of 4−6 mm and >6 mm, respectively. Conclusion: On the basis of available evidence, it was not possible to reach a consensus on the ability of baseline GCF MMP-8 to forecast the outcome of NSPT. This could have been due to variation in clinical and laboratory techniques used. However, consistency in mean PPD reduction after 3 months was shown.

Transmission of 940 nm diode laser to the radicular area during its application as root canal disinfectant.

To measure the transmitted laser power in the coronal, middle and apical root thirds during vertical and horizontal irradiation of laser. 14 mm length whole roots and longitudinal root sections were irradiated using a 940 nm diode laser with 0.5 W in continuous mode for 5 s. A power detector was placed in front of the root apex for the vertical transmitted power measurement and placed laterally to root surface for the horizontal transmission experiment. The transmitted power from the root apex vertically was 53% of the irradiated power, while for the horizontal transmission experiment for the coronal, middle and apical root thirds were 25.6%, 40.4% and 41.3%, respectively. Irradiation of root canals with 940 nm laser power can be transmitted during vertical irradiation in more than 50% of the samples, whereas less transmission happens with horizontal irradiation at apical and middle root third than coronal.

Assessment of Creeping Attachment after Free Gingival Graft in Treatment of Isolated Gingival Recession.

BACKGROUND: This longitudinal clinical study aimed to determine the amount of creeping attachment and its relation to baseline recession depth after placement of free gingival grafts (FGG) apical to class I, II, and III Miller's recession defects. MATERIALS AND METHODS: Twenty subjects with Miller class I, II, and III gingival recession defects requiring FGG were recruited into this longitudinal clinical study. Site-specific clinical parameters (pocket depth, depth and width of gingival recession and width of keratinized gingiva apical to the recession) were recorded at baseline, 3 month and 6 month time points using a digital caliper. All subjects received motivation, oral hygiene instruction, full mouth scaling, and root surface debridement. FGG were placed using standard protocols for all subjects. Pearson correlation was used to determine the correlation between the amount of recession reduction at the six-month and baseline clinical parameters. RESULTS: Sixteen subjects completed the six-month follow-up. FGG resulted in significant improvements in all clinical parameters except pocket depth. Recession depth showed a significant reduction from 3.14±1.16mm at baseline to 1.87±0.92mm at the six-month time point (P= 0.001) and the amount of creeping attachment significantly correlated t the depth of recession at baseline (r= 0.66, P=0.01). CONCLUSIONS: FGG placed apical to recession areas resulted in a significant decrease of recession depth by creeping attachment. The amount of creeping attachment was associated with baseline recession depth.